Take Care Now For Later

Here is the latest Get Fit email from Dr. Jacobs.

What to do now to stay independent in your later years
(Harvard Medical School [healthbeat@mail.health.harvard.edu]

We all hope to stay active and independent for the rest of our lives. And most of us want to stay in the familiar surroundings of our own homes and neighborhoods, rather than move to an assisted living or continuing care community, or—worse—a nursing home, a prospect so devastating that, according to a study published in the medical journal BMJ, many older women who suffer hip fractures say they would rather die than face it.

Fortunately, there are ways to help ensure that you never have to make such a dire choice. Addressing a handful of health risks at midlife can profoundly affect your ability to continue living independently. Meanwhile, new concepts and technologies are helping to make staying in our own homes and communities an attainable goal for increasing numbers of us. Below are some steps you can take—and recommend to friends and aging parents.

Safeguarding your health
• Smoking. Smoking increased the likelihood of a nursing home admission by 56% in the younger group and by 32% in the older group.

• Inactivity. Among those ages 45 to 64, physical inactivity boosted the risk of entering a nursing home by 40% (although it had no significant impact at older ages).

• Obesity. In the 65-to-74 age group, obesity increased the risk by 31% (although it had no significant impact at a younger age).

• Diabetes. Among those ages 45 to 64, diabetes more than doubled the risk of eventually entering a nursing home.

• High blood pressure. High blood pressure also increased the risk, by 35% in the 45 to 64 group and by 29% in the older group.

These problems contribute to many chronic illnesses that can cause disability and death as we age, including heart disease, stroke, osteoporosis, and certain cancers.

The effect was even greater when risk categories were combined. For example, diabetic smokers in the younger group were five times more likely to enter a nursing home than people the same age with no risk factors.

What to do
Taking steps to address these five factors could reduce not only the risk of a future nursing home admission but also the chance of premature death. Fortunately, most are within our control.

Here are several things you can do to preserve your independence throughout life. Keep in mind that these changes interact and reinforce one another; the more you adopt, the greater the potential payoff:

1. If you smoke, talk to your doctor about options for quitting. We all know that smoking is bad for health, but here's a quick reminder of how bad: it's harmful from before birth to the end of life, raising the risk of cardiovascular disease, cancer, respiratory disease, osteoporosis, macular degeneration, and cataracts.

2. Become more active. Just 30 minutes of brisk walking five days per week reduces the risk of heart attack, stroke, and diabetes; lowers blood sugar levels; decreases depression; and helps activate genes that clear fat and sugar from the bloodstream. Upping your physical activity level to 60 to 90 minutes most days of the week can help you lose weight—and keep it off.

3. Improve your diet through some simple changes. Add more servings of dark green, red, orange, or yellow vegetables or fruits to your daily intake, with a goal of reaching nine servings per day. And switch to healthier fats: skip trans fats, choose fewer saturated fats, and get more healthy fats (monounsaturated and polyunsaturated oils and omega-3 fatty acids). Plant oils, nuts, and fish are all good sources.

4. Get your blood pressure under control. Exercise regularly, don't smoke, and consider adopting the classic DASH eating plan (www.nhlbi.nih.gov/health/public/heart/hbp/dash ), a diet high in fruits, vegetables, and low-fat dairy products and low in red meats (and other sources of saturated fats), sweets, and sodium (salt). The OmniHeart trial, published in 2005, showed that you can lower blood pressure even more by eating fewer carbohydrates and more healthy fats and protein. If improved diet and increased exercise alone don't bring your blood pressure under control, prescription antihypertensive medications may help, as long as you take them consistently.

5. Talk to your doctor about bone mineral density (BMD) testing. All women ages 65 and over should have their BMD tested. If you're at high risk for osteoporosis, your clinician may recommend screening at an earlier age. Be sure to get adequate calcium (1,000 to 1,200 mg per day) and vitamin D (800 to 1,000 IU per day).

Depression is another risk factor for nursing home admission. A 2007 European study that analyzed information from 11 countries on adults ages 65 and over receiving home care services found that the more severely depressed a person was, the more likely she or he was to be admitted to a nursing home. There are several possible explanations.

Depression can chip away at immune function, heart health, self-care, and the ability to stay active and connected with others. If you think you might be depressed, talk to your clinician about antidepressants and psychotherapy.