Healthy Aging

Daniel Pendick

Straight talk needed to choose health care at the end of life

Birth, childhood, adulthood, and death span the book of life. Unfortunately, many people tend to avoid thinking or talking about how they want the final chapter to read. For the seriously ill or elderly—and even those who aren’t—not expressing wishes and desires about health care at the end of life can lead to getting care you wouldn’t have chosen for yourself. Families often bear the brunt of delaying or avoiding a discussion about a loved one’s end-of-life preferences. That often leaves family members making decisions without knowing what their loved one would have wanted. Doctors in Canada just published recommendations for starting the end-of-life conversation. The Conversation Project offers a “starter kit” to help people prepare to discuss their end-of-life wishes. Another resource is Five Wishes, a planning document distributed by the Aging with Dignity Foundation.

Anthony Komaroff, M.D.

Discovery reverses aging of mouse hearts—could it work in humans, too?

In the past decade, a remarkable series of experiments from laboratories all over the world has begun to show what causes aging—and how to slow it. In the latest example of such aging research, two of my Harvard Medical School colleagues, cardiologist Richard T. Lee (co-editor in chief of the Harvard Heart Letter) and stem cell biologist Amy Wagers and their teams have found a substance that rejuvenates aging hearts in mice. The researchers joined the circulation of an old mouse with a thick, stiffened heart to that of a young mouse. After four weeks, the heart muscle of the old mouse became dramatically thinner and more flexible. The team then identified a substance called growth differentiation factor 11 (GDF11) as the probable “anti-aging” substance. It’s too soon to tell if this discovery will ever help humans with heart failure. But it reveals that there are substances naturally present in all living things that cause aging and that retard it. By understanding them, we may someday be able to slow aging.

Mary Pickett, M.D.

Few plan for long-term care though most will need it

Two of every three Americans who reach age 65 will at some point need long-term care for up to three years. Yet the majority of those age 40 and older have done “little or no planning” for how they might pay for long-term care when they get older. That’s a key finding from a new survey of 1,019 Americans over age 40 on the topic of long-term care. The survey was done by the Associated Press and NORC at the University of Chicago. Most people underestimate the cost of nursing home care (it averages $6,700 a month) and overestimate what Medicare will cover. And few people are setting aside money for long-term care even as most worry about key issues of aging such as memory loss or being a burden to family members. Without a crystal ball, it’s tricky to plan for the future. It’s easy to convince yourself that you or a partner won’t need long-term care. But the statistics suggest you should start planning now, even if your plan isn’t perfect.

Daniel DeNoon

Benefit to improving diet and exercise at the same time

When you decide it’s time to live a healthier lifestyle, you’re likely to get better long-term results if you start improving your diet and increasing physical activity at the same time. It may seem better to improve just one thing at a time.  But while you don’t have to make drastic changes overnight, a new […]

Julie Silver, M.D.

Power training provides special benefits for muscles and function

Strength training is a popular term for exercises that build muscle by harnessing resistance against an opposing force. The resistance can come from your body, or from free weights, elasticized bands, or specialized machines. It makes muscles stronger. Another type of training, known as power training, is proving to be just as important as strength training in maintaining or restoring function. As the name suggests, power training is aimed at increasing power, which is the product of both strength and speed. Optimal power reflects how quickly you can exert force to produce the desired movement. Here’s an example: Faced with a four-lane intersection, you may have enough strength to walk across the street. But it’s power, not just strength, that can get you across all four lanes of traffic before the light changes. Likewise, power can prevent falls by helping you react swiftly if you start to trip or lose your balance. Some power moves are strength training exercises done at a faster speed. Others rely on the use of a weighted vest, which is worn while performing certain exercises that are typically aimed at improving functions such as bending, reaching, lifting, and rising from a seated position.

Heidi Godman

Which is better for keeping your mind fit: physical or mental activity?

Physical and mental activities are both important for protecting your thinking skills and warding off dementia. But does one trump the other? A study published yesterday in JAMA Internal Medicine tried to tease out if one was better than the other for brain health. Researchers recruited 126 older adults who felt that their memory or thinking skills had recently gotten worse, and divided them into four groups. All were asked to do an hour of mental activity three times a week and an hour of physical activity three times a week. What differed were the intensities of these activities. After 12 weeks, scores on thinking tests improved across the board. The big surprise was that there weren’t any real differences in improvement between the groups. The researchers concluded that the amount of activity is more important for stimulating the brain than the type of activity, because all of the participants both exercised and engaged in mental activities each week.

Patrick J. Skerrett

Studies explore global burden of disease and heart disease in the United States

If you like numbers and statistics, especially those about health, two reports released this week should keep you occupied for days: the massive Global Burden of Disease study was published in The Lancet, and the American Heart Association released its annual “Heart and stroke statistics” report. The Global Burden of Disease project found that average life expectancy continues to rise in most countries. It also found that infection and other communicable causes of disease no longer dominate deaths and disability. Today, so-called non-communicable causes like traffic accidents, violence and war, heart disease, cancer, and other chronic conditions account for two-thirds of world deaths and the majority of years lost to disability and death. According to the American Heart Association’s annual report, the percentage of deaths due to heart attack, stroke, and other cardiovascular diseases has fallen by nearly one-third since 1999, but don’t expect that to continue. Increases in high blood pressure, high cholesterol, diabetes, overweight, and inactivity threaten to reverse these gains.

Patrick J. Skerrett

Is retirement good for health or bad for it?

For many people, retirement is a key reward for decades of daily work—a time to relax, explore, and have fun unburdened by the daily grind. For others, though, retirement is a frustrating period marked by declining health and increasing limitations. For years, researchers have been trying to figure out whether the act of retiring is good for health, bad for it, or neutral. Researchers at the Harvard School of Public Health looked at rates of heart attack and stroke among men and women in the ongoing U.S. Health and Retirement Study. Those who had retired were 40% more likely to have had a heart attack or stroke than those who were still working. The increase was more pronounced during the first year after retirement, and leveled off after that. The results, reported in the journal Social Science & Medicine, are in line with earlier studies that have shown that retirement is associated with a decline in health. But others have shown that retirement is associated with improvements in health, while some have shown it has little effect on health.

Howard LeWine, M.D.

Doctor’s warning may prompt some to give up driving

In a car culture like ours, giving up the car keys can be a wrenching decision. Some see it as a loss of independence. For others, especially those who live in areas with poor public transportation, not driving makes it difficult to shop for groceries or see friends. But the fact is that some older people need to make that decision. Pleas from family members can sometimes do the trick. A special article in this week’s New England Journal of Medicine suggests that advice from a doctor can also help people who shouldn’t be behind the wheel any longer stop driving. There are no guidelines regarding who is fit to drive. Sadly, many people finally stop driving after they’ve crashed, or hurt someone. This is definitely a situation where “better safe than sorry” should rule.

Robert Shmerling, M.D.

Brain disease deaths high in pro football players

How’s this for a mind-bender: Lou Gehrig may not have had Lou Gehrig’s disease. Instead, the disease that ended his life may have been chronic traumatic encephalopathy (CTE). This brain disease is caused by repeated concussions—Gehrig sustained at least four during his baseball career—or other head injuries. It can cause symptoms very similar to those of amyotrophic lateral sclerosis (ALS), now commonly called Lou Gehrig’s disease. More evidence of a connection between CTE and ALS comes from a new study of almost 3,500 retired professional football players, all of whom had played for at least five years in the National Football League. Among the 334 who died during the course of the study, the risk of death from Alzheimer’s disease or ALS was nearly four times higher than expected. Players who manned a “speed” position (such as quarterbacks or receivers) had a risk of dying from Alzheimer’s disease or ALS that was more than three times higher than those playing “non-speed” positions (such as linemen).