Harvard Health Letter

A Q&A with our new board member

Editor's Note: Dr. Suzanne Salamon is joining the Health Letter's editorial board. Dr. Salamon is associate chief for geriatric clinical programs at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston. We interviewed her in her office.

When should someone see a geriatrician?

The vast majority of older patients are doing just fine with their own internal medicine doctor. We tend to see patients who have many medical problems, are seeing multiple specialists, and are taking many medications. This can get complicated and difficult to coordinate, so some doctors will tell their patients that they would benefit from seeing a geriatrician.

You see many people in the "old old" category, ages 85 and older, right?

Yes. As a matter of fact, the definition of geriatrics, which is care of patients over age 65, is probably going to change to care of older, frailer people. The average age of our patients is 82.

How old is your oldest patient?

I have a 100-year-old lady whose birthday party I went to last summer with my mother, who is 88. We had a wonderful time. There was a lot of singing and dancing.

Do you have a philosophy about how to stay healthy as you age?

The philosophy of everybody in this department is that the more you keep active, the better. Whether you exercise on your own, dance to music or videos, go to the senior center and join an exercise class, or walk — it doesn't matter, as long as you are moving.

I think it's also helpful if people stay socially engaged, although some people are more social than others. Typically, that doesn't change in old age.

Don't many older people have problems like arthritis that make exercise difficult?

Yes, it can be hard getting started. At the same time, most people can do more than they think they can. We used to think that people with arthritis who got backaches or leg aches shouldn't move too much. Now we believe for many people that the more they exercise, the less pain they will have.

What about preventing falls? Is it true you should get rid of throw rugs, for example?

There was a study that showed that really might not be true. Although it makes sense, the research shows that the only things that prevent falls are exercise and physical therapy, and vitamin D.

People also need to keep their bones strong. So how do you do that? We know that vitamin D, 1,000 international units a day, can strengthen bones. We've always believed that calcium, about 1,000 milligrams a day, strengthens bones. There's a bit of controversy now about calcium affecting the heart, but for the time being, that seems to be just from calcium pills. So the best way to get calcium is from calcium-rich food or by drinking milk.

I think most everyone worries about cognitive decline in old age. What can people do to prevent that?

In this country, 50% to 60% of serious cognitive decline is caused by Alzheimer's disease. We don't know yet what causes it — or how to prevent it. There are some drugs, called cholinesterase inhibitors, that can be used in the early stages, but they only slow down progression.

But vascular disease causes about 25% of the cognitive decline in older Americans — and in many cases, we can prevent that, or at least keep it from getting worse. By vascular disease, I mean disease that inflames and clogs up the blood vessels that supply the brain.

The main thing older people can do about vascular disease is to get their blood pressure under good control, which means the systolic pressure — the top number — should be below 140. Cholesterol has to be controlled, either with diet or pills. And for many people, a baby aspirin a day can help.

What about exercising the brain with, say, crossword puzzles or Sudoku — do you think that helps?

I don't. But I do believe that the brain should be kept active. I think you'll find that people who are naturally energetic, active, interested in life, who like to get together with other people, who like to have conversation — I think all of that does help keep the brain functional. Being social is also associated with less depression, and depression can make cognitive decline worse.

But old age — it just seems so depressing.

I think that is how many people view aging. You see people who have trouble walking, so they have their canes or their walkers. It all looks like such hard work. But surveys have found that there's actually less depression among older people than commonly believed.

What advice do you have for families?

Older people should establish a health care proxy, someone who can make medical decisions for them, in case they become cognitively impaired. That's helpful legally and also with family dynamics.

I know people are busy, have jobs, and often kids of their own. But if a parent is already cognitively impaired, it is very helpful if someone comes to the appointments with them. With cognitive impairment, people often don't know what medications they are taking. And in my experience, they'll often say that everything is fine, when it's not.