Healthy Aging Archive

About a third of people over age 65 fall each year, and foot problems are one of the major causes. A foot-health program combining orthoses (shoe inserts), footwear advice, and foot and ankle exercises can help prevent such falls, according to an Australian study published online June 16, 2011, in BMJ. Many guidelines for fall prevention suggest that older people who've experienced falls or have difficulty walking should have their feet and footwear examined by a podiatrist (foot specialist), but they don't indicate what, specifically, should be assessed or what people can do to prevent falls. The Australian study helps fill the gap.

The study. The participants in this yearlong randomized trial were 305 women and men ages 65 to 93 with disabling foot pain. Half of the participants received only routine podiatric care, and the other half were enrolled in the foot-health program as well. Patients assigned to the program received premade foot orthoses (molded to conform to the patient's foot), an educational booklet on fall prevention, and advice on choosing proper footwear. They also performed a 30-minute foot and ankle exercise regimen at home, three times a week, for six months. All participants recorded their falls and underwent clinical foot assessments at the start of the study and again six months later.

It isn’t easy to get rid of a harmful habit like drinking too much, or to make healthy changes like losing weight and exercising more. Media stories often sugar-coat changes like these, making them seem easier than they really are. In a moving essay in the American Journal of Health Promotion, Michael P. O’Donnell (the journal’s editor) describes his dad’s efforts to become healthier for his sake and the sake of his family. There was no monumental struggle, no epiphany—just a regular guy doing his best each day to become healthier for his sake and for his family. It’s a truly inspiring story.

With age come changes in the structure and quality of our sleep. After about age 60, we have less deep (slow-wave) sleep and more rapid sleep cycles, we awaken more often, and we sleep an average of two hours less at night than we did as young adults. It was once thought that older people didn’t need as much sleep as younger ones, but experts now agree that’s not the case. Regardless of age, we typically need seven-and-a-half to eight hours of sleep to function at our best. So if you’re not getting enough sleep at night, what about daytime naps? Or does napping disrupt the sleep cycle, ultimately yielding less sleep and more daytime drowsiness?

These questions were addressed in a study by researchers at the Weill Cornell Medical College in White Plains, N.Y., and published in the Journal of the American Geriatrics Society (February 2011). The authors concluded that napping not only increases older individuals’ total sleep time — without producing daytime drowsiness — but also provides measurable cognitive benefits.

It's never too late to benefit from talk therapy.

By midlife, you've probably spent years thinking of yourself as a certain kind of person — outgoing or introverted, high-strung or easygoing, optimistic or pessimistic. You may have become accustomed to certain roles and styles of communication in your relationships and certain ways of coping with stress. Even if you're dissatisfied with those roles and your patterns of coping aren't working so well anymore, you may think it's too late or too bothersome to question your perceptions or seek changes in important relationships.

Q. I had a heart attack three years ago at age 78. My doctor started me on lisinopril, carvedilol, and aspirin. My total cholesterol is 190, and my LDL is 128. Should I be taking a statin?

A. Almost everyone who has had a heart attack should be on a statin for life. There are some exceptions, of course, such as individuals whose heart attacks stemmed from unusual causes, like an infection, and those who have had an exceptionally severe problem from taking a statin, like severe skeletal muscle breakdown (called rhabdomyolysis). I recommend that you ask your doctor why you aren't taking a statin; if he or she doesn't know, then you should see a cardiologist.

A large international trial of exemestane (Aromasin), a drug that reduces the risk of breast cancer recurrence, has found that it can also help prevent breast cancer from developing in the first place. That makes exemestane a third option for preventing breast cancer in postmenopausal women who are at elevated risk for the disease. Two other drugs, tamoxifen (Nolvadex, generic) and raloxifene (Evista), are already approved for prevention, but few women take them for that purpose because they can have serious (although rare) side effects such as stroke and blood clots. Exemestane appears to have less frightening side effects — for example, hot flashes, joint pain, and loss of bone density.

All three of these drugs target estrogen, which fuels the growth of most breast cancers, but exemestane works by a different mechanism than the other two. Tamoxifen and raloxifene are selective estrogen-receptor modulators, which bind to estrogen receptors in the breast and block their interaction with estrogen. Exemestane belongs to a different class of drugs, called aromatase inhibitors, which work by blocking the body's production of estrogen. Previous studies have shown that aromatase inhibitors are more effective than tamoxifen in preventing breast cancer from recurring. The study, funded by the drug's maker, Pfizer, and conducted under the auspices of the National Cancer Institute's clinical trials unit, looked at whether exemestane could reduce the likelihood of a first occurrence of breast cancer. Results were presented at the American Society of Clinical Oncology meeting in Chicago on June 4, 2011, and simultaneously published online in The New England Journal of Medicine.

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.

The same vision changes that make you eager to toss your glasses or contacts can complicate your decision about surgery.

Even if you've worn glasses or contacts for decades, you may be wondering about having your vision surgically corrected. Your contacts may feel less comfortable; perhaps you hate wearing reading glasses; or maybe you finally have the money to seek an instantly clear view of the world as you wake in the morning or pop your head out of the swimming pool. But how advisable is laser vision correction in your 50s, 60s, or beyond?

Q. My doctor told me I have bradycardia. I live at an altitude of 5,765 feet — would moving to a lower altitude help my heart rate? Recent cardiac tests, including a nuclear stress test, were normal. My cardiologist said I did not need a pacemaker, and to keep on doing what I've been doing. I used to jog five miles a day and now, at age 85, walk three miles a day.

A. I wholeheartedly agree with your cardiologist that you should keep doing what you are doing. Walking is wonderful medicine.

Q. I am a 72-year-old with diabetes, and I need to have a hip replaced. Does my diabetes make this surgery too dangerous for my heart?

A. While people with diabetes have a generally higher risk of cardiac problems than those without this condition, the increase in risk for cardiac complications with major surgery is quite low — and there may be no increase at all with good care. People with diabetes have higher rates of atherosclerosis, of course, and if you've already had a heart attack or kidney problems, those risk factors do increase your risk of heart problems with surgery. But after taking those factors into account, diabetes is not clearly linked to short-term complications with surgery.