Quality of Life Is Concern as Population Grows Older
Maintaining Your Health on Mackinac
By Yvan Silva, M.D.

Americans are now living longer than ever before. In fact, 34 million Americans are aged 65 years or older today - that is 1 in 8. Survival statistics continue to climb. Life expectancy is increasing, and over the next 20 to 30 years or so, the population over 65 is expected to double. As people survive into older age, besides the fear of death, there are concerns about disability and the need for institutionalization. Morbidity and disability have a tremendous impact on such individuals, as well as their families and health care delivery systems.

As the population grows older, there is increasing concern overall about maintaining a good quality of life. Recent research has shown that in tandem with increasing longevity, the quality of life of older folks has improved considerably. A recent study published in a leading medical journal compared the quality of life of people in two groups over 65 years of age in the year prior to their deaths, over a seven-year gap. The study reported that, especially among the oldest men and women at age 85, the use of hospital and nursing home services was much less. They also experienced fewer restrictions of activities of daily living, and had better mental function and overall improved quality of life.

Growing old gracefully is becoming a challenge to more and more people as we reap the benefits of progress. While the passage of time will mature most minds and even grow wisdom, aging has an opposite effect on the body and its many component systems. We know aging mostly from reflections of people we know as they grow older and become less able physically and mentally. Yet the fountain of youth remains elusive and science has yet to unlock the many secrets of senescence. Many men and women live well through the seventh, eighth, even into the ninth decades of their lives in relatively good health.

Many theories about aging abound, but it is clear that aging involves several processes that are interrelated. These processes progress at different rates within the same body and can vary widely among individuals. At the core of longevity is the genetic composition of the individual, yet this is not always the most important or predominant factor. Environmental factors and lifestyles do play significant roles. Family histories of longevity do not confer healthier, longer lives necessarily.

If there is a singular denominator of aging, it is cellular attrition. We live through the billions of cells in our bodies. Cells have finite lives. And cells have differentiated functions. In most cells, regular divisions take place to replace the dying or defunct precursors, but as aging continues, cell replication becomes slower and slower. Certain cells, such as those in the heart or the brain, do not replicate, so when they’re lost, they cannot be replaced. As cell populations decline, so does the work that cells are required to do. The strong elements that comprise the skin and the musculo-skeletal system show notable decline. The skin gets thinner and begins to lose elasticity, muscle mass loss is progressive, and the bones begin to thin. Production of hormones, which regulate growth and function diminish, and also enzymes that enhance biochemical reactions required for organ functions.

Tests used to determine the health of older individuals are standardized statistically for age groups and it is assumed that normal readings indicate good health. As aging sets in, blood pressure creeps upward, cholesterol levels rise, and the blood glucose begins to increase. The true sense of well-being is usually a reflection of mental attitude and physical activity and these progressively diminish. Large studies have shown that short-term memory begins to decline in one’s 50s; general intelligence declines in the 60s, and capacity for abstract thinking begins to wane in the 70s. Variations between individuals, however, can be great.

The cardiovascular system begins to show evidence of thickening of the heart muscle and hardening of the arteries. The peripheral blood pressure rises, posing a challenge to efficacy of the heart’s pumping abilities. The formation of plaque in the arteries that can cause heart attack or stroke is probably a combination of genetics and lifestyle and this varies widely between individuals. Maximal lung function is achieved during the early 20s. It begins to decline steadily, falling to about 70 percent of peak by 75. The elastic fibers that keep air sacs open begin to deteriorate and the exchange of oxygen into the blood diminishes. Here, aging does diminish capacity, but smoking or lack of exercise will further contribute to deterioration.

The digestive system is usually effective well into old age. Although some of the muscular tone of the intestinal tract diminishes, there is sufficient reserve in the functions to ensure proper digestion. Eating habits begin to change in response to aging.

Sensory organ changes are perhaps the hardest to deal with. Adult hearing loss is well known. Hair-like nerve cells that conduct sound signals to the brain begin to diminish, with a gradual decline in the ability to hear high-pitched sounds. Later, as more loss occurs, lower pitches become hard to hear. Reading glasses become a requirement as the lenses lose elasticity, lowering the capacity to change focus rapidly. Cataracts may develop.

Just what should you do to grow old gracefully? Growing older in good health is the key. Regular physical exercise is a very important element in the prevention of a wide range of health problems. Indeed, a recent US Surgeon General report emphasized improvement in the quality of life through lifelong moderate physical exercise. Regular physical activity can reduce the risk of developing or dying from heart disease, diabetes, high blood pressure, osteoporosis, stroke, and some forms of cancer. Maintenance and progressive improvement in muscle and bone strength, stability, flexibility, and balance help prevent falls and accidental injuries. Maintaining good heart and lung function is important for overall endurance. The report suggested that individuals should do at least 30 minutes of moderate physical activity on most, if not all days of the week. These activities can range from brisk walking, bicycling, swimming, or any such activity of choice. Yard work, gardening, household chores, and other activities that entail utilization of strength are also recommended. Group activities such as calisthenics, dancing, and other recreational activities can also be productive.

Nutrition is also an important subject in the quest for a good quality of life during the aging process. A diet high in fruits, vegetables, grains, and fiber is a high priority. The diet should be low in fat, especially saturated fat and cholesterol; sugar, salt, and sodium should be used in moderation and especially considered in certain relevant conditions including, among others, diabetes and high blood pressure. Six to eight glasses of water a day are recommended and alcohol is recommended in moderation for those who drink it. The need for vitamins and minerals does not decrease with age, but it is known that most people need 25 percent less calories as they grow older. Therefore, it is important that the total intake includes the nutrients needed for a healthy body.

The importance of regular medical checkups cannot be overstated. In addition to regular screening examinations to closely monitor for chronic diseases and conditions, it is also important for older people to be immunized against influenza, pneumonia, tetanus, and diphtheria. There are established programs for screening for alcohol, drug and tobacco abuse, breast cancer in women, decline in function and muscle strength, dental, visual, and hearing problems, diabetes, high blood pressure, malnutrition, risks of falls, thyroid disease, and other individual conditions known to occur through the lifetime.

In older people with known high risks, recommended screening at shorter intervals includes testing for prostate cancer in men, cervical cancer in women, colon cancer, oral cancer, and skin cancer, and cardiovascular and lung deterioration as often as indicated.

There is definitely a physical and mental edge to fitness as we grow older. The onset of depression is very real and is often accompanied by the diminution of daily physical activity. Medical science has advanced so far and so fast that testing and diagnostic innovations continue to help in controlling most conditions associated with the aging process. Longevity is increasing. A good quality of life is within the reach of most people who are in good health and can maintain good health with preventive measures. Exercise, good nutrition, regular medical checkups, and a healthy mental attitude can certainly help in the enjoyment of a good healthy and long life.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.