The Journal for Nurse Practitioners
Volume 8, Issue 1 , Pages 77-78, January 2012

Healthy Aging: Clinical and Lifestyle Considerations

  • Laurel Halloran, PhD

      Affiliations

    • Section Editor Laurel Halloran, PhD, APRN, is a professor of nursing at Western Connecticut State University and a family nurse practitioner.

Article Outline

 

“The best way to age is too die young as late as possible.”—Christian Barnard, MD

Ellen Hughes, MD, PhD, began her Hot Topics presentation with a discussion of the science of healthy aging and how it can teach us to live better. Aging is a nonpathological process that affects all organisms. The average life expectancy in the United States is 78 years old. We do better than the Angolans (average 38) but worse than the Macauans (average 84). One in 5 Americans will be older than 65 by 2030. Distressingly, US life expectancy is declining in some areas because of poor health habits.

The science of aging has taught us many things. The ethnographic book Blue Zones (2010) examined people living a century or more who remained mentally and physically vibrant as they aged. Centenarian studies have investigated what qualities or behaviors (both good and bad) lead to a long life. Up to this point we have thought that aging is like wear and tear that happens to a car, but we are now finding that many other things play into that equation. One of those things is caloric restriction. Animals that eat a third fewer calories live one third longer and have less insulin resistance, delayed onset of age-related disorders, and slower decline in functional status. Human studies are now ongoing in caloric restriction.

Longevity can run in families and allow some leeway in terms of lifestyle choices. Simple gene alterations can alter lifespan in several species. Clearly, there is more than just 1 “longevity pathway,” and the science of this is still evolving. So what does this mean for your patients? Individuals are in much greater control of their health than originally thought. Health is determined by a combination of factors, including genetics (30%), social habits (15%), environment (5%), access to health care (10%), and behavior (40%).

Most interesting is that individuals have a huge amount of influence about how the genetic hand of cards gets played out. It was originally believed that you were dealt the hand you had and that was that, but now it is known that adopting a healthy lifestyle can alter how DNA is marked, packaged, and expressed. Furthermore, that change can pass down to the next generation. There are 2 heritable alterations in gene expressions caused by mechanisms other than changes in DNA sequences (methahylation of DNA and histone acetation). Also, telomeres lengthen in response to a healthy lifestyle and stress management. Healthy lifestyles have powerful effects on epigenetics.

Unfortunately, many people are not leading healthy lifestyles. A telephone study with 153,000 US adults asked just 4 questions about their health habits: did they abstain from smoking, maintain a healthy weight, eat 5 fruits and veggies a day, and exercise regularly. Only 3% answered yes to all 4 questions!

How do you help patients begin to make healthier behavior choices? In order for a behavior to be successful, it needs to be easy, integrated into lifestyle, enjoyable, and sustainable. Dr. Hughes discussed the following 10 recommendations for healthy aging. (The first 2 recommendations are discussed in depth in her lecture “Clinical Considerations for Managing Obesity,” which will be detailed in a later Hot Topics department.)

•Maintain a healthy weight.

•Exercise.

•Stay mentally active. It is clear that we can develop new neurons as we grow older. The neurons we have can make new, more complex, and active connections. Challenge yourself mentally. Play videogames, learn a new language, and eat a meal with your nondominant hand. Give your brain a jolt.

•Reduce inflammation. Chronic inflammation plays a role in many diseases but can be reduced by following a diet high in nutrient-dense, plant-based whole foods and low in simple carbohydrates and saturated fat (Mediterranean diet). Periodontal disease has been shown to be an independent risk factor for cardiovascular disease, stroke, and diabetes. Flossing is an important preventive anti-inflammatory measure.

•Get adequate sleep. This may be one of the most underrecognized health risks. Lack of sleep has been associated with cognitive changes, obesity, insulin resistance, and driving accidents. People need 7 to 8 hours of good quality sleep each night.

•Manage stress. Stress can not be eliminated, but people can control how they respond to it. Identify triggers. Find a relaxation activity (yoga, meditation, biofeedback, breathing, exercise, music, reflective journaling). The latter has been very successful in improving happiness and health when writing about upsetting experiences and even more powerful when reflecting on positive experiences.

•Cultivate positive emotions. Choose to focus on what is wrong in a situation or what can be done to change it. Researchers in this field believe that happiness is 50% genetically determined, 10% environmentally determined, and 40% voluntary. A grateful disposition is associated with increased happiness, health, and optimism. Keeping a gratitude journal (twice a week writing 3 things you are grateful for) is associated with increased positive emotion, fewer physical symptoms, better sleep quality, and greater satisfaction with life. Forgiveness is an active, ongoing process that is not forgetting or surrendering; the primary beneficiary is the person doing the forgiving (not the perpetrator). Laughter promotes cooperation, reduces cardiovascular stress, enhan-ces immune function, increases pain tolerance, and lowers blood sugar in type 2 diabetes.

•Stay connected. Meaningful relationships are the most consistent predictor of quality of life—even more than health. The relationship can be platonic, romantic, or familial. Lone-liness, depression, and isolation increase mortality by 3-7 times (after controlling for other risk factors). Individuals need to connect and be part of a group.

•Engage in meaningful activities. Victor Frankl said in 1955, “He who has a why to live can bear with almost any how.” Volunteerism has been shown to extend the life of elderly veterans. People are happier when they give.

•Connect with something beyond you. Spirituality is associated with greater health and happiness. Individuals need to see themselves as part of a larger picture.

Dr. Hughes concluded her lecture with the advice to appreciate the benefits of aging. They include experience and wisdom, the gift of time, freedom from routines, and senior discounts!

 Ellen Hughes, MD, PhD, is clinical professor of medicine emeritus at the University of California in San Francisco.This department is brought to you by Hot Topics in Primary Care, a Contemporary Forums conference held every August in Jackson Hole, WY. For more information on this presentation, go to http://www.contemporaryforums.com/en/Live-CEConferences/. For more information about Contemporary Forums, go to http://www.contemporaryforums.com. For content and CE please go to www.onlinecelibrary.com. Providing Quality, Accredited Continuing Education to Thousands of Healthcare Professionals for More Than 25 Years

PII: S1555-4155(11)00514-9

doi:10.1016/j.nurpra.2011.10.002

The Journal for Nurse Practitioners
Volume 8, Issue 1 , Pages 77-78, January 2012

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