Senior Health

CONTENTS

1. Aging Well - how you feel about aging matters

2. Bad Memory? Worried about Dementia?

3.  Alzheimer's Disease - how to lower your risk

4.  Rucking for Health & Fitness

5.  Wisdom from a Physical Therapist on Rucking & Osteoporosis

6.   Easy Exercises for Better Bone Health

7.  Enlarged Prostate? Trouble Peeing? 

8.   Stay Safe: How to Fall Safely

9.   Hearing Loss - what you need to know

10.  Erectile Dysfunction (ED) - a warning 

11. Walking is important for health & longevity

12.  Older Brain More Vulnerable to Fraud

13. You can influence your genes for health & longevity

14. Long COVID can worsen health problems for seniors

15. Alzheimer's Disease & Diabetes

Aging Well – How You Feel About Aging Matters

Holly Burns reported for The NY Times, a decades-long study found people with positive beliefs about getting older lived 7-½ years longer than those who felt negatively. Other research showed a positive mind-set about aging is associated with lower blood pressure, longer, healthier life, lower risk of dementia.   “Research also shows that people with a more positive perception of aging are more likely to take preventive health measures, like exercising, which may help them live longer.” Another study found people in their 30s with negative stereotypes of aging were more likely to experience a cardiovascular event, like heart attack or stroke, later in life than people who felt positive about aging.

Bad Memory? Worried about Dementia?

“How to tackle memory lapses as you get older” (See: Honolulu Star-Advertiser, 10/10/23, A9; from The NY Times) Jancee Dunn, for The NY Times, reported approximately 5.8 million Americans have dementia. The biggest risk factor is aging. “But some age-related memory lapses aren't cause for concern.” They may be due to the ways memory shifts as we age. She consulted some experts for their advice.

Dr. Mario Mendez, director of neurology at David Geffen School of Medicine, University of California, Los Angeles, said, “memory changes and that does not translate necessarily into a problem.” Starting in your 50s, the area of the brain in charge of memory retrieval is less efficient. Dr. Mendez said, “being less efficient is different from impairment.” He said the memory is often there, it just takes longer to surface. For example, “five minutes later, you remember.”

Forgetting car keys or someone's name is not necessarily a sign of impending dementia. Dr. Ronald Davis, professor of neuroscience at Herbert Wertheim UF Scripps Institutes for Biomedical Innovation & Technology, said we are inundated with so much information, the brain has to manage memories. He said, “Forgetting is a normal part of one's brain function.”

Dr. Arman Fesharaki-Zadeh, assistant professor of neurology and psychiatry at Yale School of Medicine said memory changes may be normal but there are ways to improve memory. He advised limiting multi-tasking. He said it's not good for your brain health in general. As we get older, our ability to multi-task “typically diminishes.”

Two other things that are bad for memory are stress and not enough sleep. He said diet can affect memory. His advice is to eat fruits, vegetables, whole grains, lean proteins and healthy fats.

Dr. Fesharaki-Zadeh recommends a half-hour of daily cardiovascular exercise which can generate new neurons in the hippocampal area of the brain, which is critical for memory consolidation.

Alzheimer's Disease - how to lower your risk

Alzheimer's Disease is the most common type of dementia. Nearly 7 million people in the US are estimated to be living with Alzheimer's Disease. It's projected to reach 14 million by 2060. It's one of the 10 leading causes of death in the US and 5^th leading cause of death among adults 65 or older.

There is currently no known cure. Medical science does not fully understand what causes it. Age is the best known risk factor, but Alzheimer's Disease is not a normal part of aging.

Changes in the brain can begin years before symptoms first appear. Alzheimer's Disease is progressive, with observable symptoms starting with mild memory loss.

According to the National Institute on Aging, “Before the early 2000s, the only sure way to know whether a person had Alzheimer’s disease was through autopsy. Thanks to advances in research, lab and imaging tests are now available to help a doctor or researcher see biological signs of the disease, or biomarkers, in a living person. For example, it is now possible for many doctors, dependent on state-specific availability reflecting U.S. Food and Drug Administration guidelines, to order a blood test to measure levels of beta-amyloid, a protein that accumulates abnormally in the brains of people with Alzheimer’s.”

Definitive diagnosis is possible only by examining brain tissue after death for presence of two histopathologic features: neurofibrillary tangles and amyloid plaques.

Presence of neurofibrillary tangles, which are tau protein threads, twisted and tangled inside brain cells, are a hallmark of brain tissue associated with Alzheimer's disease. Another hallmark is amyloid plaques, dense clumps of beta-amyloid, in spaces between brain cells.

U.S. Center for Disease Control and Prevention (CDC) reports there is growing evidence healthy lifestyle habits, which have been found to help prevent cancer, diabetes, and heart diseases, may lower risk for dementia.

Good news: research is finding super-agers, whose brain function remains intact even up to 100 or older, when their brain is examined after death, presence of tau tangles and amyloid associated with Alzheimer's were clearly present in some of them. Brains of super-agers show signs typical of an old person's brain. But their cognitive function remains intact, except for slight memory loss. This is hope for us. Healthy lifestyle and staying physically and intellectually active can help even with age-related physical changes and even signs of Alzheimer's Disease in the brain.

Alzheimer's For Beginners

Click this LINK: https://www.youtube.com/watch?v=9RLJdAGFZQ8

RUCKING for Health & Fitness

Rucking is walking with weight on your back. Anyone who can walk can do it. According to GoRuck.com, it's “as simple as putting weight on your back and going for a walk.” It helps build muscle and strength while improving cardio and endurance. You can burn up to three times more calories than walking, depending on amount of weight you carry and how fast you walk.

Dr. Jennifer Earl-Boehm, associate professor of rehabilitation sciences at the University of Wisconsin-Milwaukee said any walking over a long period of time can build cardiovascular endurance, but rucking can also increase strength and bone density. Dr. Earl-Boehm recommends shoes with cushioning in the heel. Rucking gets you outdoors which helps improve cognitive function, brain activity, blood pressure, mental health, and sleep.

To get started, you only need three things. You need a backpack, also known as a rucksack. You need weight to put into the backpack. When you are serious about rucking, you can buy ruck plates. You can start with what you have, books, bottles of water, canned goods. One man said, “Instead of going to a gym, I walk to the grocery store and come home with everything I need for a week on my back.” Rob Shaul, founder of Mountain Tactical Institute, which develops training for mountain athletes and the military, said, “If you don't walk regularly, you can start with an empty backpack or only use light weights.” If you are accustomed to walking for exercise, “use a load that feels slightly challenging, around 10 to 20 pounds for most women, 15 to 40 pounds for men.” Then just walk.

Advice from GoRuck.com. Start at a comfortable pace, keep an upright posture and over time, increase weight, speed, and distance. If your backpack allows, keep the weight high and stable next to your back. 15 minutes a mile is a good goal in terms of pace. If you are going slower than 20 minutes a mile, try reducing the weight in your backpack.

Wisdom from a Physical Therapist on rucking & osteoporosis

This is about Rucking. Susan M. wrote, “Just a brief comment on the purpose for walking with a weighted backpack. As a retired physical therapist, I too made that recommendation as a more advanced stage in a program for osteoporosis. The downward/compressive forces aid in stimulation of the spinal and B LE osteoblasts to create new bone.” B LE is bilateral lower extremity, or both legs.

That's good news because medications like Fosamax, for osteoporosis, do not create new bone. They inhibit osteoclasts from breaking down old bone. So you retain old bone longer, which tend to be older, weaker, and maybe a little more brittle. As Susan wrote, osteoblasts create new bone.

Susan offered advice about using weights strapped to ankles while walking. She wrote, “While working as a PT, I did not recommend (and actually discouraged) this method, because one of the common ligaments that it could potentially strain over time is the ACL during the swing phase (open chain) of gait.” The ACL is the anterior cruciate ligament in the knee.

Final advice from Susan: “Please discuss this with your physician before starting or changing any type of exercise program.” I want to keep everyone safe and I would like to be respectful to the professionals who already created a program for that person.” Thank you to Susan.

Rucking can help promote and preserve bone health by increasing bone mineral density especially in parts of the body where fractures tend to happen in older people, including knees, ankles, and hips. Bone density declines with age. Preserving it is important for reducing age-related falls and fractures.

Easy Exercises for Better Bone Health

An AARP member, I receive AARP The Magazine. If you worry about bone density, see the December 2023/January 2024 issue's article, “Good to the Bone” by Pamela M Peeke, MD, Board of Trustees, American College of Sports Medicine.

Dr. Wendy Kohrt, distinguished professor of medicine, Division of Geriatric Medicine, University of Colorado, said, “Beginning in our 30s, we experience a gradual decline in bone mineral density, losing about 1% each year. But there's evidence that if you are physically active on a regular basis, you can optimize your bone health throughout your life.” Dr. Peeke said, “Any movement that causes you to fight against gravity by standing up and moving is good for your bones. But if you want to amp up the protection, these five exercises will help keep you, and your bones, strong for life.” For all five exercises see AARP The Magazine, December 2023/January 2024 issue.

Here are 3 of the easy exercises. Walk and Stomp. Dr. Peeke explained, bones are stimulated when they are jolted. Running and hiking will do that, but not your typical walk, so do the walk-and-stomp. While walking, stomp each foot 2 or 3 times every 10 steps or so, the way you crush a can by stomping on it. Dr. Peeke said, “Walking on real ground requires you to lift and push off with your legs in a way that's much more beneficial than using a treadmill.” 

Dr. Peeke advises, “Stair climbing increases bone density, particularly in postmenopausal women because it forces your body to resist gravity as you climb while strengthening the leg and hip muscles that support your pelvic bones. Use a handrail as needed, and consider adding an occasional stomp for more bone stimulation.”

Hip-Leg Lifts “This exercise strengthens the muscles around your hip bones, which are vulnerable to fracture, and can help to improve balance.” With your hand on a counter or a wall for balance, your feet hip-width apart, put your weight on your left foot. Straighten your right leg and lift it out in front of you until right foot is about 6 inches off the floor. Do about 8 to 12 lifts. Then shift your weight to your right foot and do 8 to 12 lifts with your left foot.

Enlarged Prostate? Trouble peeing?

In “How I solved My Great Big Prostate Problem” [AARP Bulletin, Oct 2023], John-Manuel Andriote said he was held hostage by his prostate; he couldn't travel anywhere unless he knew where the nearest restroom was. “Must-go-now emergencies came out of no-where.” He was getting up multiple times at night to pee. These are symptoms of enlarged prostate (benign prostatic hyperplasia, BPH). Urine flows out of the body through the urethra. In males the urethra passes through the prostate. As prostate enlarges, think of it as choking the urethra. This can cause urine flow to be partially or fully obstructed. When the bladder cannot empty completely it may keep trying, leaving a man feeling as though his bladder is always full. Other complaints include, weak urine stream, and difficulty stopping completely when done peeing, with urine dribbling out a little while longer.

Andriote reported, “There's a lot science doesn't understand about BPH---including what causes it and why it's more common in the West than Asian countries like China and Japan.” Answer to those questions are in Dr. Shintani's program. Men who participated in Dr. Shintani's program said their BPH symptoms improved even during the short time in the program. Urine flow improved and continued to resolve after the program ended if they continued to follow the program. 

Conventional medical treatment include pharmaceutical drugs. Discuss with your doctor. If those do not work, there are essentially 2 types of surgical treatments. One is TURP (transurethral resection of prostate.) I observed several being done. I saw computerized high-tech equipment, used for essentially a low-tech solution: make the opening bigger. A device is inserted into the external opening of the penis, passing through the urethra, to the prostate to cut away prostate tissue. It essentially cores the prostate to make a larger space for the urethra. Andriote reported it's effective at “relieving symptoms quickly,” but “it's impact on sex can be significant: It can result in retrograde ejaculation, and erectile dysfunction is a rare but potential result.” Retrograde ejaculation is also known as dry orgasm or ejaculation going in the opposite direction.

The other option is MIST (minimally invasive surgical therapy). There are different types of outpatient procedures including surgery, laser, or steam treatment. These are less likely to cause sexual dysfunction, but are not a permanent fix because the prostate continues to grow. Dr. Amy E. Krambeck, urologist at Northwestern Medicine in Chicago said, “We're definitely preserving ejaculatory function. But the re-treatment rates are exceptionally high.” She said deciding on a procedure essentially comes down to one question: “Do I want to risk having another surgery and preserve my ejaculation, or do I want to get rid of my ejaculation and not have to worry about another surgery?”

Andriote chose a MIST procedure that pinned back lobes of the prostate to open the urethra, though not as fully as the TURP does. A year later his urinary symptoms are improved and his sexual functions are intact.

Stay Safe: How to Fall Safely

You can find this information in June 2023 issue of AARP Bulletin. “How The Pros Fall Safely. Two Hollywood stuntmen share the tricks for avoiding injury when a sudden tumble occurs.” Thanks to AARP, writer Jenna Bergen Southerland, and photographer, Roger Kisby.

Every year, about 36 million falls are reported among people over 65 years-old. About 3 million need to go to the emergency room. 

In the movie, Indiana Jones and the Dial of Destiny, one of Harrison Ford's professional stuntmen is Stuart F. Wilson, 61 years-old. In the photo on this post, Wilson shows how to fall safely in a sideways fall, the number one cause of hip fractures. Mortality risk of patients over age 65 with hip fractures is three times higher than for the general US population.

In a sideways fall, bend your knees. Tuck your chin, keep your head lifted (to keep your head from hitting the ground). Keep your arms close to your chest. Allow yourself to go limp and collapse onto the outside of your bottom thigh. Then roll onto your torso and upper back.

Do not fall on the bony part of your hip. That is how hip fractures happen.

Do not plant your arm down when landing. That could break your shoulder, elbow or wrist. 

Backward Fall

Falling backward risks hitting your head on the ground which is especially dangerous for older people. 

Here's Wilson's advice for what to do in the backward fall. Tuck your chin to your chest. Do not look up or extend your neck which could cause your head to hit the ground first.

Stumble backward. Try to get your body (especially your butt) closer to the ground. Bend your knees into a deep squat, so you land on your butt, then round your spine and roll onto your back and shoulders.

Keep your arms by your sides. Do not try to stick your arms out behind you to catch yourself. That could cause a broken wrist.

Wilson says the first rule of falling down is relax. When people begin to fall they tend to tense up. That's how you can get hurt. Relax into the fall.

Harrison Ford's other stuntman, 52 year-old Thomas DuPont advises, “Don't try to stop the fall, especially when you're older. There is a much greater risk of your bones breaking . . .” Spread the impact of the fall over as much of your body as possible, using more cushioned areas like butt, thighs, and upper back to soften the fall.

Hearing Loss - what you need to know

Many people my age are experiencing hearing impairment. People tend to be resigned to it being due to old age and exposure when young to very loud sounds like deafening amplified music in rock concerts or taiko and shrill flute of bon dance music. The sound of that flute felt especially piercing to my ears, but I was the only one using ear plugs, to the amusement of others. But did you know there are some seemingly benign, common things that can contribute to hearing loss?

Medications can harm your hearing. AARP reported, "More than 600 drugs have been linked to hearing loss and tinnitus, including some over-the-counter pain relievers."

According AARP, because aspirin, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil and Motrin are widely available without prescription, many people take them regularly and assume they are harmless. 1 in 3 people in this country take over-the-counter pain meds every day. Dr. Sharon Curhan, epidemiologist at Brigham and Women's Hospital and Harvard Medical School and author of several research studies on this, warns that over-the-counter pain relievers can contribute to both hearing loss and tinnitus especially if used 2 or more days per week. Tinnitus can lead to further hearing loss.

The Epidemiology of Hearing Loss Study found that among adults who already have hearing loss, NSAID use was associated with 45% higher risk of progression of hearing loss.

Erectile Dysfunction (ED) - a warning

Erectile dysfunction (ED) in middle-aged men can be an early indicator of cardiovascular disease (CVD). CVD can cause ED. A study published in Annals of Family Medicine found middle-aged men with ED are at more than double the risk of having un-diagnosed diabetes compared to men who do not have erectile problems. One complication of diabetes is ED. Diabetes is a risk factor for heart disease. So diabetes, cardiovascular disease, and erectile dysfunction can be warning signs for each other.

Walking is important for health & longevity

I subscribe to National Geographic so I have access to Premium Content. One Premium Content by Vicky Hallett reported, “Experts agree that pretty much the worst thing a person can do is to stop moving.” According to the National Institute on Aging, lack of mobility is one of the top reasons older folks lose independence. It's also closely linked to cognitive decline, or risk for dementia.

Hallett reported, walking speed has emerged as the sixth vital sign because it can predict a huge range of health problems. Epidemiologist, Dr. Peggy Cawthon, science director of the California Pacific Medical Center Research Institute tells us, “the speed you walk is related to your risk of dying.” People who can keep up the pace are likely to stick around longer. And they are likely to live better.

If you have not walked or exercised in while, always consult with your doctor before starting. Walking is not as simple as it may seem. Especially if you are an older person, when starting, don't try to do it all at once. Start carefully and slowly. Over time, you can add to your time, distance, and walking speed. Check with your doctor.

Wear good walking or athletic shoes. It's recommended you get a new pair of athletic shoes every 6 months. Professional athletes and non-professional, serious athletes, depending on their sport, may need new shoes sooner. Folks who are not very active tend to use the same pair more than a year or several years, although that may not be recommended. I recommend you not go longer than 2 years with the same pair, even though they may still look good. Athletic shoes may look okay even after several years, but materials in them break down, even when the shoes are not used, and will not give you the same support and/or cushioning, putting you at risk for injury. If you think your old shoes look too good to throw away, give them to the homeless. Where I work homeless people search in the dumpsters. Some have no foot wear. When I leave my still-nice looking shoes out, the shoes disappear quickly. Someone is able to use them.

Older Brain More Vulnerable to Fraud

I subscribe to NY Times. Judith Graham reported, research published in Proceedings of the National Academy of Sciences showed old people's “vulnerability to fraud may be rooted in age-related neurological changes.” Researchers at University of California, Los Angles found the brain's anterior insula was muted when old people looked at photos of suspicious-looking people. Graham said this part of the brain activates gut-level feelings that help people interpret reliability of other people and assess potential risks associated with social interactions. Old people don't respond as readily to visual cues that suggest someone “might be untrustworthy, and their brains don't send out as many warning signals that ignite a danger ahead gut response.”

Younger adults (ages 23 to 46) and older adults (ages 55 to 80) were asked to evaluate trustworthiness of people in photographs while undergoing brain scans. 

When the younger adults saw a person as “not trustworthy” their anterior insula lighted up. This did not happen for the older adults. Dr. Shelley Taylor, professor of psychology at UCLA, the study's lead researcher, said, “The warning signals that convey a sense of potential danger to younger adults just don't seem to be there for older adults.” [If you cannot see the caption below the 2 photos, this is what it says:  "Would you buy a used car from this man? Spotting an untrustworthy face, like that of the legendary fraudster Charles Ponzi (right), may depend on activation in the brain's anterior insula (left)."]

You can influence your genes for health & longevity

I subscribe to National Geographic. That means I have access to “Premium Content” available to subscribers. One “Premium Content” by Dr. Michael F. Roizen, MD, chief wellness officer emeritus, Cleveland Clinic, and professor at Cleveland ClinicLerner College of Medicine at Case Western Reserve University reported in the US about 40% of premature deaths (before age 75) are related to lifestyle choices which are behaviors we can change.

Your lifestyle can influence your genes. Dr. Roizen wrote, “For example, after implementing changes to their physical activity, stress management and diet regimens, men were able to turn off genes associated with prostate cancer growth and turn on a gene that produced a protein that causes cancer cells to self-destruct. The same principle applies for colon and breast cancer: Lifestyle changes switched on genes that fought cancer and turned off genes that promoted it.”

Dr. Roizen said, "by the time you are about 60 years old, 75% of your health outcomes are determined by your choices. That's genetic self-engineering: Each healthy act switches on youth-promoting genes and switches off genes that cause you to age." He said you have the ability to change how healthy you are and how long you may live.

Long COVID can worsen health problems seniors already have

I'm a NY Times subscriber for more than a decade. Recently it published an article by Paula Span that people who follow my blog may want to know because many are seniors: “Long COVID poses special challenges for seniors.” Here is some information from it. Full article on The NY Times or Honolulu Star-Advertiser (09/26/2023; A8).

The World Health Organization defines long COVID as the continuation or development of new symptoms 3 months after the initial infection, lasting at least 2 months with no other explanation. It includes breathing difficulties, cardiovascular and metabolic diseases, kidney disease, gastrointestinal disorders, cognitive loss, fatigue, muscle pain and weakness, and mental health problems.

Dr. Ziyad Al-Aly, clinical public health researcher at Washington University School of Medicine warned, “There's almost no organ system long COVID doesn't touch.”

Long COVID is more likely in people who were severely ill with COVID and required hospitalization, but can happen after mild infection.

Long COVID can worsen health problems seniors already have. Dr. Monica Verduzco-Gutierrez is chair of rehabilitation medicine at University of Texas Health Science Center and co-author of American Academy of Physical Medicine and Rehabilitation guidance for treating long COVID. Dr. Verduzco-Gutierrez said she has seen, with long COVID, mild cognitive impairment progress to dementia. She said a mild heart condition can become more serious.

Dr. Al-Aly advised, “The best way in the world to prevent long COVID is to prevent COVID.”

Studies found vaccinations and boosters reduce risk of long COVID by 15% to 50%.

If you get sick, get tested right away to learn if it's COVID. If it is, call your doctor as soon as possible to see if you are eligible for Paxlovid which reduces risk of long COVID by about 20% for people in their 60s, and by about 34% for people over 70.

Alzheimer's Disease & Diabetes – Part 1

I subscribe to The Atlantic. Olga Khazan reported a longitudinal study, over 10 years, published in the journal Diabetologia found people with high blood sugar had faster rate of cognitive decline than those with normal blood sugar, whether or not their blood-sugar level technically made them diabetic. Higher the blood sugar, the faster the cognitive decline.

Dr. Melissa Schilling, professor at NY University conducted her own review of studies linking diabetes to Alzheimer's Disease. She said type 2 diabetics are about twice as likely to get Alzheimer's and diabetics who are treated with insulin are also more likely to get Alzheimer's. This suggests elevated insulin plays a role. Many other studies found elevated insulin (hyperinsulinemia) increases risk of Alzheimer's. Type 1 diabetics (do not make insulin at all) are also at higher risk of Alzheimer's. Dr. Schilling believes this is because of the insulin-degrading enzyme which is a product of insulin. This enzyme breaks down both insulin and amyloid protein in the brain.

People who don't have enough insulin, like diabetics whose bodies' ability to produce insulin has been tapped out by diabetes, are not going to make enough of this enzyme to break up amyloid plaques.

When people use pharmaceutical insulin to treat their diabetes and they end up with a surplus of insulin, most of the enzyme gets used up breaking that insulin down, leaving not enough enzyme to break down amyloid in their brain.

Part 2 – Dementia & High Blood Sugar

Dr. Rebecca Gottesman, a professor of neurology at Johns Hopkins said there are several other theories to explain the connection between high blood sugar and dementia. She said diabetes can weaken blood vessels, which increases likelihood of mini-strokes in the brain leading to various forms of dementia. High intake of simple sugars can make cells, including brain cells, insulin resistant, which could cause brain cells to die. Obesity often associated with type 2 diabetes means extra fat that release cytokins, or inflammatory proteins, that can contribute to cognitive deterioration. One study found obesity doubled a person's risk of elevated amyloid proteins in the brain later in life.

Even people who do not have any kind of diabetes need to watch their sugar intake. An association has been found between high blood sugar and cognitive decline. What we eat while we're young can affect our future cognitive health. Dr. Schilling said it takes time for amyloid clumps to form and cognition to begin to deteriorate. She said, “By the time you see the signs, it's way too late”