One of my favorite patients likes to point out, “aging ain’t for sissies, but it sure beats the alternative.” The average life expectancy in the United States is now 77.5 years of age and rising. This is due to high tech advances (like open heart surgery), and to low tech advances (like speed bumps reducing neighborhood traffic fatalities). Women, on average, will live over five years longer than men. If you are already 65, you can expect to live (on average) until you are 83.4! If you are already 75, you can expect to live (on average) until you are 87!
So what are the factors that help determine how old you will become? Other than how old you already are (the biggest factor) there are several factors that you would ordinarily think of as “clean living.” Included in this category are: drinking alcohol (less is better), lifetime cigarette use (none is better, as few as 100 cigarettes in your life is bad), remaining in the “normal” weight range for your height, eating a healthy diet (see box 1), and getting regular exercise (see box 2). Some factors that are out of your control include your family history and your gender. Factors that you may be surprised about include your level of education (college educated people live longer), your driving record (more accidents equates to a shorter life) and your personality type!
What is your personality type? If you describe yourself as laid-back, easygoing and even-tempered, you will probably live longer than someone who is similar to you but who angers easily. The high stress type-A personality is more prone to die of heart attacks and other conditions than you are, all else being equal. In their book, Anger Kills: Seventeen Strategies for Controlling the Hostility That Can Harm Your Health, Redford and Virginia Williams talk about how the mind and body interact, help you identify your hostility level and provide strategies to deal with your hostility. (See box 3).
How long will you live? You can figure this out by playing “The Longevity Game.” This game is provided by the Northwestern Mutual Financial Network (www.nmfn.com/tn/learnctr--lifevents--longevity) and is based on life insurance industry research. I was curious so I played. Starting with my age (42) and gender (male) I can expect to live until I am 76. Next, I factor in my BMI (box 4) which adds a year to my life expectancy. Based on my family history of heart disease (thanks, grandpa), I lose that added year and I’m back to square one. I have ideal blood pressure (less than 120/80) and this adds three years. I eat an average diet, am somewhat stressed, and exercise moderately, so I’m keeping the status quo at this point. I always buckle up and haven’t been in an automobile accident for over 20 years — this adds two more years to my life! I don’t drink much (add one more year), and I’ve never smoked, so now I’m going to live two more years. Finally, add one more year for never using recreational drugs and I’ll live until I’m 85!
Playing with The Longevity Game I realize I could live until I’m 92 if I made three simple changes in my life: incorporate daily physical exercise (which would add another three years), reduce my stress level (another year), and eat five servings each of fruits and vegetables a day (adding the final three years). My dad, who is in his 70s, tells me that daily physical exercise doesn’t really add three years to your life, it only feels that way. Actually, he’s wrong. Exercise has been shown to both add years to your life and to improve your mood and outlook on life! It has even been shown to reduce joint pain in people suffering from arthritis. It also keeps us mobile as we age, a major quality of life indicator.
That answers how we can age well; what about healthily? This is where together you and your physician can have a big impact. Everyone would like to be as independent and functional as long as we are living, so protecting mobility, vision, and hearing are high priorities. Exercise and eating right prevents diabetes, the number one preventable cause of vision loss. Exercise is also important for keeping us mobile as we age.
People suffer from different diseases at different ages. Younger people are more at risk from infectious diseases (which is why we immunize) while older adults are more at risk from heart disease, cancer, and other chronic conditions. The U.S. Preventive Services Task Force (USPSTF) is an independent panel of experts that makes evidence-based recommendations about health screening and disease prevention. I think of them as the “Consumer Reports” of prevention.
What recommendations does the USPSTF make to help us healthy? Children and adults should be immunized against a variety of diseases. We should be screened for breast cancer, cervical cancer, and colon cancer. All adults should be screened for tobacco use. As a physician, the most important advice I can give to anyone is to remain tobacco free. Starting at age 18 everyone should be screened for high blood pressure. Two things that people don’t usually think of as “medical” which should be screened for are alcohol overuse (box 5) and depression. Treating these greatly improves quality of life.
Pete Townshend, age 61, is nearly deaf. This has a huge impact on his quality of life. To avoid hearing loss, listen to music at reasonable volumes. Protect your hearing by decreasing the frequency and intensity with which you are exposed to loud noises. Use ear plugs if you can.
People try to put us down (talking ‘bout my generation) just because we get around. As Pete Townshend said, “It’s my generation, baby.” If we take care of ourselves we’ll follow the advice of Lieutenant Commander Spock of the USS Enterprise: “live long and prosper.” I hope I die after I get old. n
Dr. Lenny Salzberg is a family physician who works and teaches at SR-AHEC.
What is the best diet plan for healthy living?
My parents’ generation recommended eating beef every night, drinking whole milk, and frying our eggs in butter. Since then there have been low-fat crazes and low-carb diets popularized by Dr. Atkins. What should we eat? The National Heart, Lung, and Blood Institute (NHLBI) says: “Get with the plan that is clinically proven to significantly reduce blood pressure. It’s not enough to tell hypertensive and pre-hypertensive patients to,
“Watch your diet.” Give them a week’s worth of sample menus, recipes, heart healthy dishes, and an easy-to-read summary of the findings from the “Dietary Approaches to Stop Hypertension” clinical study that showed how elevated blood pressure levels can be reduced with an eating plan low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and low-fat dairy products. It even has a form to track food habits before starting the plan and a chart to help with meal planning and food shopping.” The DASH diet is available at http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
Since this diet is recommended for all hypertensive patients and all “prehypertensive” patients, it applies to all of us! The basics of the diet: eat foods that are rich in calcium, such as low-fat milk and low-fat cheeses. Eat four to five servings per day each of fruits and vegetables. Make meat a part of your diet, but not the focus of your diet. Limit your salt intake. Limit the fats in your diet to 27 percent of your daily calories. Only eat a limited amount of low-fat sweets. If you follow this diet, it will lower your blood pressure and extend your life. It is also a good diet if you have high cholesterol or diabetes, other common chronic medical conditions.
How much is enough exercise, and what type of exercise should I do?
This is a question that needs an individualized answer. Some exercise is better than no exercise. Walking three times per week is better than walking once per week. In order to increase fitness, ideally you should walk for 30 minutes four or more times per week. The pace at which you walk is based on your fitness level and your age. If you are beginning a new exercise program, and you have any health concerns, check with your doctor first. Always start slowly and work your way up to your goal. A quick rule of thumb: warm up for five minutes with gentle stretching. Increase the intensity of your walking (or running/ biking/ rowing, etc.) until you reach 60 to 80 percent of your predicted maximum heart rate. Your target heart rate is 60 to 70 percent of your max for fat burning, 70 to 80 percent for increasing your aerobic capacity. To calculate your predicted maximum heart rate, subtract your age from 220. Exercise at your target rate for at least 20 minutes, and then cool down for at least three. Aerobic exercise builds lean muscle mass, which burns calories while you sleep! Older adults should do weight lifting in addition to aerobic exercise. Use light weights and do more repetitions. This will help maintain your mobility.
Seventeen ways to deal
with your anger
(from “Anger Kills” ):
reason with yourself; stop hostile thoughts, feelings and urges; distract yourself; meditate; avoid overstimulation; assert yourself; care for a pet; listen; practice trusting others; take on community service; increase your empathy; be tolerant; forgive; have a confidant; laugh at yourself; become more religious; pretend today is your last day.
BMI stands for Body Mass Index. It is a calculated number based on your height and weight. (Weight in kg divided by height in meters squared). Normal BMI is 18.5 to 24.9. Overweight is 25 to 29.9. Obese is 30 or over. “Normal” BMI’s tend to be higher than “Ideal Body Weight” measures which you may be familiar with. Ideal Body Weight is based on actuarial tables. It isn’t at all what we consider normal weight. In fact, so many Americans now have BMIs over 25 that overweight appears normal to us. For more information on BMI, check out http://nhlbisupport.com/bmi/
Screening for alcohol overuse. There are long questionnaires to screen for alcohol abuse (e.g. the Michigan Alcohol Screening Test (MAST)) but these aren’t easy to administer in a brief clinical encounter. The most useful easy test to use is called the CAGE questions. If someone answers yes to two of these four simple questions, it is a strong indication that they have a problem with alcohol and should seek help. The questions are: C – Have you ever felt you should cut down on your intake of alcohol? A – Have people annoyed you by criticizing your drinking? G – Have you ever felt bad or guilty about your drinking? E – Have you ever had an eye-opener to steady your nerves in the morning?
