Physical dimensions of healthy aging
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Physical Dimensions of Healthy Aging. Ellen F. Binder, MD Division of Geriatrics and Nutritional Science [email protected] Disclosures of Interest. Research Support: National Institute of Mental Health National Institute on Aging Consulting Eli Lilly, USA.

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Physical Dimensions of Healthy Aging

Ellen F. Binder, MD

Division of Geriatrics and Nutritional Science

[email protected]


Disclosures of Interest

Research Support:

  • National Institute of Mental Health

  • National Institute on Aging

    Consulting

  • Eli Lilly, USA

I own no stocks or equity in any pharmaceutical company.


“Yet another national placing for Lavelle Kelly”

Tillamook Headlight Herald April 11, 2006


What Defines Healthy Aging?

  • Absence of major disease

  • Absence of disability

    Defined as inability or great difficulty with ADLs or mobility


Significance of the Problem

  • U.S. population > 65 yrs. expected to grow to 20% by 2030 and continue to increase until 2050.

  • 40% of the older adult population has some disability or dependency. Such individuals are at high risk for recurrent hospitalization, injurious falls, NH placement, and death.

  • The prevalence of chronic disability is higher in older women than among men.

  • Although women have a longer total life expectancy they are likely to spend more years than men in a disabled state, even among those with severe disability.


Disabled Population & Rates

NLTCS 1982-2004


Risk Factors for Disability in Older Adults

  • Lifestyle and health habits

  • Physiologic changes associated with aging

  • Diseases/Conditions

  • Social factors

  • Economic factors


Physiologic Changes Associated with Aging

  • Hormonal

  • Body composition, energy intake, and lipids

  • Cardiovascular and pulmonary

  • Renal (kidney)

  • Hepatic (liver)

  • Sensory

  • Cognitive/Neuro-motor


Changes in Aerobic Power with AgeWomen vs. Men

From Holloszy & Kohrt in

Handbook of Physiology-Aging, 1995


Diseases/Conditions Associated with Disability in the Elderly

  • Vascular disease (heart, brain, arteries)

  • Arthritis

  • Lung Disease (Asthma, COPD)

  • Depression

  • Dementia

  • Cancer

  • Diabetes

  • Malnutrition / Obesity

  • Falls

  • Incontinence

  • Polypharmacy


Prevalence of Geriatric Impairments by Age Group from CHS

Chaudhry et al. JAGS 58: 1686-92, 2010


Risk of Disability Onset over 7 Yrs.

From Chaudhry et al. JAGS 58: 1686-92, 2010


Predictors of Healthy Aging in CHS

  • Absence of Hypertension/Lower BP

  • Lower Waist Circumference (non-obese)

  • Higher HDL Cholesterol

  • Absence of diabetes

  • Regular exercise, especially higher intensity

  • Moderate intake of wine

  • Lower clotting factors

  • No cigarette smoking

  • No regular ASA use

  • Stable financial status


Predicted Median Life Expectancy by Age and Gait Speed

Studenski, S. et al. JAMA 2011;305:50-58


Exercise Can Reverse Disability Risk in Older Adults

  • Muscle strength and power

  • Body composition, lipids, weight

  • Aerobic Power

  • Gait speed

  • Balance

  • Flexibility

  • Bone Density

  • Mood and Psychological Well Being

  • Falls


Components of “Best Practice” Physical Activity Programs

  • Attention to health education & exercise “readiness”

  • Accessibility

  • Tailoring of the exercise program to physical ability and preferences

  • Multi-component exercises

    flexibility, aerobic, strength training

  • Multiple sessions per week (≥3)

  • Ongoing social support

  • Ongoing feedback


Components of Success for Community-Based Programs

  • Collaboration with community agencies and organizations.

  • Use of existing programs and infrastructure.

  • Promotion as a social program.

  • Planning for wide variability in functional ability.

  • Use of an expert advisory board.


Successful Community-Based Health Promotion Interventionsin Older Adults

  • Multi-component falls prevention

  • Vitamin D replacement

    Potential Areas (not disease-specific):

  • Medication education and compliance

  • Nutrition and weight management


Questions???


From Fried et al. J Gerontol Med Sci 561:M146-156, 2001


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