80 is the new 60 - esteri · 80 is the new 60: successful aging in the 21st century italian...
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80 is the new 60:Successful Aging in the 21st Century
Italian Embassy, October 12, 2010
Lewis A. Lipsitz, MDDirector, Institute for Aging Research, Hebrew SeniorLife
Chief of Gerontology, Beth Israel Deaconess Med CtrProfessor of Medicine, Harvard Medical School
Increasing Recognition of the Role of Micro-Vascular Disease in the Aging Phenotype
• Slow Gait• Cognitive (Executive) Dysfunction• Depressive Symptoms• Co-occur in 17% of elderly populations
The Heart-Brain Connection-The same risk factors that affect the heart also affect the brain.
-High blood pressure, in particular can cause cognitive loss and functional decline.
-The treatment of hypertension may be preventative.
Relation between CV Risk and Executive Dysfunction
71(n=7)
56 (n=16)
0 (n=5)
100 (n=1)
42(n=14)
0
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0 1 2 3 4
CV Risk Score
% Im
paire
d
Pugh, JAGS 2003; 51:1439
Treatment of Hypertension May Improve Cognition
• Syst-Eur Trial (Lancet, 1998, Arch Int Med 2002): In 2902 elderly people with Syst HTN, Rx w/ nitrendipine for 3.9 yrs reduced the incidence of dementia by 62%.
• PROGRESS Study (Arch Intern Med 2003): Among 6105 elderly people with CVD, Perindopril/Indapamide reduced cog decline assoc’d w/ recurrent stroke by 34%.
• Cochrane analysis of Sx w/o CVD in SCOPE, SHEP, & Syst-Eur showed no combined effect.
Current Challenges and Opportunities
• Major Challenges. Preventing– Loss of Memory (Dementia)– Loss of Mobility (Falls and Fractures)– Onset of Disease (Heart Disease and Cancer)– Mortality, disability and pain.
• Opportunity: – Many of these conditions are preventable.
Therapeutic Advances for AD• Restore Acetylcholine: Aricept, Exelon, Reminyl.• Prevent damage: Memantine• Reduce CV risk: Treat HTN, cholesterol, diabetes• Reduce oxidative stress: Vitamin E, ?Vitamin C• Prevent inflammation: ?NSAIDS• Reduce amyloid deposition:
beta-secretase inhibitors, vaccine• Mental and physical exercise.
*Willis, S. L. et al. JAMA 2006;296:2805-2814.
ACTIVE Trial - Advanced Cognitive Training for Independent and Vital Elderly*
• RCT of 2802 normal adults > 65 years of age.• 10 sessions, 60-75 minutes, over 5-6 weeks, 60% had 75
min. booster sessions. • Training in Memory, Reasoning, and Speed of Processing
improved these cognitive abilities.• Immediate improvements in speed of processing (87%),
reasoning (74%), & memory (26%).• 5 years later, better performance persisted in trained areas. • Speed of processing and reasoning groups receiving
booster did best at 5 years.
Mobility Problems
• 30% of community-dwelling elderly, 50% of NH residents fall/ year.
• High injury rate, mortality, & service use.• 300,000 hip fx/yr, 50% need assist, 25% die• Falls cost $20 B in 1995, est’d $32 B in
2020.
Resistance Training Improves Muscle Strength at Any Age
•113% increase in muscle strength •12% increase in gait velocity •28% increase in stair climbing power• 3% increase in thigh muscle area
100 frail nursing home residents aged 72-98 years (mean 87) randomized to 10 weeks of progressive quadriceps resistance training or placebo.
RESULTS:
Is There a Medicine to Slow the Aging Process?
“The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.”
-- William Osler
Anti-Aging Pills?
• Estrogen• Growth Hormone• Resveratrol• Rapamycin• Polypill: BP, Cholest, Aspirin,. Vit D, etc,
etc.
“…a sense of humor and a good glass of red wine every
day.”“The keys to long life are olive oil and port wine.”
Antonio Todde (113)Jeanne Calment (122)
Longest Recorded Lifespans
Social Networks
• Social connectedness through marriage, family, religion, housing
• Improves health, reduces mortality, enhances recovery.
21st Century Approaches to Healthy Aging
• Physical activity• Mental activity• Social engagement• Reduce cardiovascular risk factors
– Hypertension, High Cholesterol, Smoking• Proper nutrition:
– Calcium, Vit D, low fat, modest alcohol