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We are being flooded everyday with health advice. For instance, we are told food is no more just a culinary enjoyment, but a nutrition transportation system. We are aware of the importance of exercise, and the instructions we are getting has had an amazing impact on our body. Researchers claim the fastest growing age groups is the ‘old old’, particularly people aged 85 years and over, with more of those old-old years relatively free of illness.
The questions now are should the same health rules which helped us to reach a good old age continue to apply when we get there? In other words should a ‘healthy lifestyle’ really matter once we are in our 70s, 80s, and 90s? Do the treatments for specific illnesses like high blood pressure really help us, even when there are no symptoms, when we are ‘young old,’ (50-70) ‘old old,’ (80-100) or ‘something in between’? (60-80)? There’s been controversy on this issue, but for now are some facts on major health areas: nutrition, exercise, body weight, blood pressure, and cholesterol.
Over feeding is the weakness of many people. But in old age under feeding is a threat to good health. Old people suffer loss of appetite (anorexia) due to loss of taste and smell. Biologically with age, food stays longer in the part of the stomach that signals fullness before moving to the small intestine. Men are likely to be less attracted to food, due to the steady drop in testosterone with age. Also is the social aspect which contributes to the single life of older people, making it difficult to induce appetite that comes with eating with others.
As regards vitamin supplements, the needs for them don’t alter much as you get older. Possibilities are there for vitamin deficiencies since you eat less now than when you were younger. Depletion of vitamin D is another risk for older people because they spend much time indoors, and unable to get the necessary sunshine vitamin D required for calcium absorption and healthy bones. Short supply of B12 is also an issue since older people are unable to absorb it adequately from food. Contrarily older people are at risk of taking too much vitamin A.
Protein energy deficiency is prevalent and dangerous. People lose their appetite for protein, and the body uses the little that is available less efficiently, leading to a reduction of protein stores in the whole body. The result is weakness and weaker immune system. The problem auto corrects itself at times, but hard to resolve through eating. In the end, if serious and long term, the person may need to be tube- fed in the stomach.
On average, older people need fewer calories since they are not so active and with less muscle. People over 70 are more likely to eat a third less calories than younger people, overdoing healthful eating of super low fat diet, hence end up malnourished.
One predominant theory of aging is that it involves a loss of the reserve capacity built in your body’s organs and systems which allows you to battle an infection, injury, stress and be able to bounce back. With less reserve, older people are living dangerously. Take the issue of heart rate as an illustration. When resting your heart rate doesn’t change much as you get older, assuming you’re free from a heart disease.
During aerobic exercise, you breathe harder and your heart beats faster to allow more oxygen work the muscles. By increasing capacity reserve, aerobics seems to have a more general anti-ageing effect. For instance, a sedentary 70-year-old has little aerobic capacity above the bare minimum necessary to live, while an active person the same age can have the aerobic reserve of someone who is 10–20 years younger. Weight-bearing exercise has a similar effect on reserves. By developing muscle strength, it assists with balance and reduces the risk of falling. And when the bone density benefit is added it reduces the risk of osteoporosis.
It’s easier to overdo the exercise bit especially if older and hasn’t been exercising for a while. You should go slow and easy at first to avoid injury and, just as important, discouragement. For many older people, getting the heart going a modest 15–20 beats above the resting rate is a good goal. Brisk walking is ideal exercise for a beginner. The normal definition of brisk walk is 3 to 4 miles per hour. But experts are beginning to recognise that such a pace for a typical older person is much more than the ‘moderate intensity’ exercise generally recommended for disease prevention. The trend is now to measure exercise intensity relative to a person’s capacity rather than on a total, one-size-fits-all rule.
3. Body weight
The healthy survivor effect makes the late-life penalties of some risk factors hard to judge. The notion is that people who beat the odds and live into their late 80s, 90s, and even 100s are, through a combination of genes and life circumstances, able to stand health abuses that would cause trouble for the rest of us.
The healthy survivor effect has been used to explain some of the anomalous findings about weight and old age. Being heavy is a risk factor for hypertension, diabetes, and disability, all of which would put you at greater risk of dying. But several studies have shown that in old age, being heavy, like smoking, is not a particularly good predictor of mortality. Even one study concluded that ‘years of life lost’ from obesity increase in the decades up to age 70 and then decline for ages 70–79. This doesn’t mean that losing weight, if you are heavy, would not pay health dividends when you are older. It is just that the payoff may be less certain.
4. Blood pressure
It used to be doctors thinking that it was natural, even healthful, for systolic (top number) blood pressure to go up with age. The theory was that higher pressure gave the blood a little extra push through brain blood vessels. Later studies then revealed that blood pressure didn’t spontaneously go up with age, while big trials showed that using medications to lower blood pressure helped older people live longer. Lately many meta-analyses of multiple studies have revealed the benefits of blood pressure lowering drugs are especially great in 60 to 80 year olds.
As always, lifestyle changes if you can adhere to them are preferable to drugs. In fact, some research has shown that losing weight, if overweight, and eating less sodium may lower blood pressure more effectively among people ages 60 to 80 than in younger people. If you must take a blood pressure medication, studies and guidelines have re-introduced diuretics as the first choice, because they offer the added benefit of an anti-osteoporosis effect. But if you have an additional health condition, another kind of medication may be preferable. For instance, a beta blocker would be the first choice for a person with hypertension and angina. A diagnosis of heart failure might mean a different prescription. Talking to your doctor to discuss any concerns is the best option.
Higher cholesterol levels raise the risk of both heart disease and mortality in middle-aged people; however, starting at about age 70, the relationship becomes less clear. Therefore, just how often older people should get cholesterol test remains a little uncertain. Some experts say that every five years is often enough, because your cholesterol does not change much after age 65; and if you are in your 70s or 80s and do not have a history of heart disease or diabetes, some doctors see little reason to order a test at all. But it is a different story if you have a history of heart disease, clogged blood vessels, or diabetes. Studies have shown that, in people over 70 with heart or vascular disease, cholesterol-lowering statins are just as beneficial as they are in younger people, perhaps even more so. If you fall into this group, you should get your cholesterol levels monitored. Ideally, your doctor will work with you to improve your diet and get you to exercise more. Nonetheless, a lot of people will need a statins prescription.
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