physical dimensions of healthy aging ellen f. binder, md division of geriatrics and nutritional...

Physical Dimensions of Healthy Aging

Ellen F. Binder, MDDivision of Geriatrics and Nutritional Science

ebinder@wustl.edu

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 & RatesNLTCS 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.

HR for Disability# of Geriatric Impairments (GI) or Chronic Diseases (CD) ADL Mobility

GI CD GI CD

1 2 2 1.5 2

2 4 2.5 2 3

≥3 8 3 4 4

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 Interventions

in 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