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  • Resilient AgingGregg Warshaw, MDUniversity of Cincinnati

    OAGE ConferenceDayton, OhioMarch 28, 2014

    M1 GD 2008

  • M1 GD 2008

  • Myth #1

    To Be Old is to Be Sick

    M1 GD 2008

  • Self-rated Health

    M1 GD 2008

    Sheet:

    Poor or Fair

    Good

    Age < 65

    Age > 65

  • ADL/ IADL LimitationsNational Health Interview Survey, 1999 data. CDC. NCHS.Percentage

    M1 GD 2008

  • Myth # 2

    You Cant Teach an Old Dog New Tricks

    M1 GD 2008

  • Myth # 3

    The Horse is Out of the Barn

    M1 GD 2008

  • Myth # 4

    The Secret to Successful Aging is to Choose Your Parents Wisely

    M1 GD 2008

  • Myth # 5

    The Lights May Be On but the Voltage is Low

    M1 GD 2008

  • Myth # 6

    The Elderly Dont Pull Their Own Weight

    M1 GD 2008

  • What is Aging?

    M1 GD 2008

  • AgingIs not a diseaseOccurs at different ratesamong individualswithin individualsDoes not generally cause decline in function or significant symptoms

    M1 GD 2008

  • Usual Aging

    Functioning wellAT RISK for disease and disabilityMOST older adults

    M1 GD 2008

  • Usual Aging: RISKS

    Decline in reserves in organ systemsDecline in immune/recuperative power

    M1 GD 2008

  • Successful Aging. . .If we can figure out how to get the Baby Boomers to arrive at old age in better shape:Societys health care costs will be reducedLife-long personal resources will be savedFamilies will be less burdened

    M1 GD 2008

  • Rowe & Kahn (1987)s definition:

    Few or no age-related declinesImplies that it is possible to reach advanced age relatively free of age-associated disease and functionally intactParadigm shift, but number of persons experiencing this type of successful aging is minority

    M1 GD 2008

  • Successful Aging vs. Resilient AgingAlternate definitionsMinimal interruption of usual functionDoing the best with what one has

    Shifts the focus from minority to majorityMajor differentiator: extent to which a person can have a chronic disease or functional disability and still be considered to be aging successfully

    Schmidt (1994); Baltes & Carstensen (1996).

    M1 GD 2008

  • Resilient AgingAvoid or manage chronic illness and disabilityEngage independently or with support in most normal activities of daily livingMaintain cognitive functionAble to cope with physical, social, and emotional changesSense of control of life

    M1 GD 2008

  • M1 GD 2008

  • M1 GD 2008

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  • Determinants of Successful Aging Biologic AgingDiseaseHealth BehaviorsSocial Supports

    M1 GD 2008

  • Normal Physiologic Effects of Aging Copyright 2010 Pearson Education, Inc.

    M1 GD 2008

  • Determinants of Successful Aging Biologic AgingDiseaseHealth BehaviorsSocial Supports

    M1 GD 2008

  • M1 GD 2008

  • Determinants of Successful Aging Biologic AgingDiseaseHealth BehaviorsSocial Supports

    M1 GD 2008

  • Lifestyle ChoicesDietExerciseSmokingDrinking

    M1 GD 2008

  • Rather than seeking permission to exercise, you should have to get permission to be sedentary.

    Maria Fiatarone, M.D.

    M1 GD 2008

  • M1 GD 2008

  • M1 GD 2008

  • M1 GD 2008

  • M1 GD 2008

  • Benefits of ExerciseWeight lossDecrease central adiposityIncrease lean body massBlood pressure declineAerobic capacity increaseInsulin sensitivity increaseIncrease bone massIncrease muscle strengthIncrease perceived well being

    M1 GD 2008

  • Determinants of Successful Aging Biologic AgingDiseaseHealth BehaviorsSocial Supports

    M1 GD 2008

  • Social FactorsMarriageFamilyFriendsReligiosity WorkVolunteering

    M1 GD 2008

  • Resiliency Independently functioningIn good health at least to the age of ninety. Few centenarians are obese Substantial smoking history is rare Source: Perls T., Silver M., Lauerman J, 1998Centenarian Characteristics

    M1 GD 2008

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  • Regular exerciseHealthy dietAvoid tobaccoAlcohol in moderationCorrect use of medicationsScreen for disease and treat earlyEducation about caring for illnessesStrengthen social networkHealth Promotion Needs to be a Major Focusfor Geriatrics/Gerontology Professionals

    M1 GD 2008

  • Prevention of premature death Delay of the onset of chronic diseases Postponement of disability related to chronic diseases Higher quality of life Greater participation in the life of the family and community Reduction in medical care costs, especially hospitalization and nursing home costsReasons for Geriatrics/Gerontology Professionals to Focus on Health Promotion/Disease Prevention

    M1 GD 2008

  • Longevity is a splendid trend in the United StatesSuccessful, resilient aging is complexExercise, Exercise, ExerciseAchievements of centenarians demonstrate that physiologic aging can allow for late life independence, productivity, and pleasure

    To Summarize

    M1 GD 2008

  • Age is not a particularly interesting subject. Anyone can get old. All you have to do is live long enough. Groucho Marx (1890-1977)

    M1 GD 2008

    Those who have aged successfully managed to avoid serious, debilitating diseases and disability.

    They function well physically, live independently, and engage in most normal activities of daily living.

    They have maintained cognitive function and are actively engaged in mentally challenging and stimulating activities and in social and productive pursuits.

    They are resilient and able to cope reasonably well with physical, social, and emotional changes.

    They have a sense of control over circumstances in their lives.

    ***we will see a dramatic increase in the number of centenarians; e.g., in the United States there may be as many as 2.5 million 100+ year old people in the year 2060 vs. the estimated 76,000 now.

    Centenarian research is difficult and complex, because individuals who achieve extreme old age belong to a rare and unique age group with continued strength in some areas and possible limitations in others.The New England Centenarian Study began in 1994 as a population-based study of 46 centenarians in 8 towns in the Boston area and has grown to enroll centenarians from throughout the United States and other countries and has grown to be the largest comprehensive study of centenarians in the world. There are currently 1,500 subjects to-date, including centenarians, their siblings and children (in their 70s and 80s) and younger controls. Not all centenarians are alike. They vary widely in years of education (no years to post-graduate), socioeconomic status (very poor to very rich), religion, ethnicity and patterns of diet (strictly vegetarian to extremely rich in saturated fats) better able to handle stress

    Centenarians markedly delay or even escape age-associated diseases (e.g. heart attack, stroke, cancer, diabetes, Alzheimer's disease), we noted that 90% of them were functionally independent the vast majority of their lives up until the average age of 92 years and 75% were the same at an average age of 95 years. Geriatric Professionals have a Crucial Role in the Care of Older Adults**Point 3- By 2030, 22% of the population will be age 65 and over--Feared to put huge burden on medical and social systems and exceed supply of health professionals trained in good geriatric care

    We all should be grateful to be amidst their wisdom and we should thank them for sharing their memories, their humor, their poetry, parental pride, and patriotism.*The Dichotomy We want a long life but fear old age/Increased awareness of the blessings of life/Fear of infirmity, dependence, death

    Successful aging is defined not only by longevity, but also by the ability to sustain a capacity for functioning effectively in changing environments. The determinant of such resilience is complex and includes the integration of genetics as well as physical, psychological and social dimensions of health. Components of such dimensions include reaction to challenges, disease incidence, availability and effectiveness of health care and personal prosperity. In the face of such complexity, scientific approaches to the phenomena associated with successful aging should be holistic; one cannot fully detach the individual from their environment nor can the environment be completely alienated from the individual. It is at the intersection between biology and environment that the degree of success in aging is examined. Taken as a whole, this biopsychosocial perspective of successful aging provides a more comprehensive view of the interactions of biological and environmental factors that affect health status of older adults (Inui, 2003).SOC