MONDAY, JUNE 23, 2008 FEATURES MAIN Healthy Returns – How to Live Longer By MARY PINKOWISH Special Report: Retirement -- Eight things to do to live longer and minimize the aches and pains of aging. MY AUNT AND GREAT-AUNT were both pushing 102 when they died. I figure I stand a decent chance of getting there, too -- and when I do, I'll try not to gloat. As Thomas Perls, director of the New England Centenarian Study, told me, living to 102 simply "won't be as great an accomplishment for you." That is, compared with my aunts I've lived a privileged life health-wise. In addition to my presumably good longevity genes, I'm enjoying the benefits of childhood vaccinations, anti-smoking campaigns throughout my school years, antibiotics and, of course, Lipitor. So are you.
The longer you live, the longer your life expectancy. At his birth in 1950, a white male had a life expectancy of 66. 3 years. When that man turns 65 in 2015, his life expectancy will have stretched to 77.8 (nearly the same as a baby born in the United States in 2006). And if he makes it to 85, his life expectancy will be 89.4 years. A white woman born in 1950 may do even better and can expect to live to age 80 if she reaches 65 and nearly 90 if she reaches 85.
Numbers like that have left baby boomers hoping to far outdistance their original life expectancies -- and to minimize the chronic diseases of aging. Living to 90 or 95 with an agile mind and only a brief illness before death -- that's the ticket. It can make for either a glorious retirement or a fulfilling professional life after 65, as many are planning
So, you've quit smoking and had a colonoscopy. What's next? Below, you'll find the latest thinking on everything from diagnostic tests to exercise to life-extending chemicals. The story "The Hidden Costs of the
Corbis Golden Years," meanwhile, shows how to handle the spiraling costs of
agile as they age. New tests, treatments
health care. Here's to a long and financially savvy life.
Get a Coronary Scan
"We can pick up coronary artery disease 20 years before you need bypass surgery or have a heart attack," says David A. Fein, medical director at the Princeton Longevity Center in Princeton, N.J. While cholesterol levels can be telling, a coronary CT scan to determine your calcium score, or how much calcium is in the plaque that lines blood vessels in your heart, is a better predictor of heart disease and stroke risk, says Fein. By a certain age most of us have some plaque, and calcium specks in plaque suggest that a person is at higher risk for a coronary "event" than someone whose plaque contains no calcium.
The predictive value of coronary calcium scoring was demonstrated in a study of more than 6,700 men and women published in the New England Journal of Medicine in March. Compared with people who had the lowest (best) calcium scores, those with the highest scores had 10 times the risk of angina, a heart attack, or death from coronary heart disease. A coronary-calcium scan, runs between $300 and $600; insurance coverage varies. You'll be exposed to X-ray radiation equivalent to the background radiation you'd normally get during the course of a year just walking around.
Exit the Road to Diabetes
Diabetes, which affects more than 20% of people over age 60, is the antithesis of healthy aging and reduces life expectancy by up to 15 years. Diabetes greatly increases the risk of heart disease, stroke, eye and kidney disease, and limb amputations. A study of more than 5,100 people published in an early, online edition of the July 1 Annals of Internal Medicine demonstrated a link between diabetes and hearing loss, with 21% of diabetics experiencing at least mild hearing loss, compared with just 9% of non-diabetics of the same age.
Your doctor can tell if you're at risk by determining whether you have metabolic syndrome -- a cluster of problems including excess abdominal fat, high cholesterol, high blood pressure, insulin resistance or glucose intolerance, a tendency to make blood clots, and high blood levels of C-reactive protein, or CRP. Early medication and lifestyle changes can delay the onset of diabetes, or prevent it.
Find Your Inner Fat
Body fat comes up frequently in health discussions, but not all body fat is created equal. There is subcutaneous fat, which lies just under the skin and is harmful mainly because of the extra pounds it represents, and there is visceral fat, which packs the spaces around abdominal organs and has been linked to increased risk of heart disease, diabetes and some cancers.
People with lots of visceral fat often have high levels of CRP, which is associated with heart disease. Visceral fat is very strongly associated with metabolic syndrome, according to results from the widely respected Framingham Heart Study that were published last year in the journal Circulation.
It's impossible to tell the difference between visceral fat and subcutaneous fat from looking at a person; even slim people can carry lots of visceral fat. So doctors are increasingly ordering scans. "A single CT
image through your abdomen is all I need to find out which type you have," says Fein, whose center is renowned for its comprehensive "executive physicals."
The remedy for visceral fat: a low-carbohydrate diet, an exercise program and possible dietary supplementation.
We hear a lot about how aging brains benefit from "brain training" -- learning a new language, or taking up a musical instrument, or playing certain types of video games. But does reality match the hype?
"I'm skeptical about these programs," says Harvard-based geriatric psychiatrist Deborah Blacker. She explains that the evidence that they specifically prevent or delay dementia is flimsy. "Keep active doing something that you like rather than something that someone has marketed to you," says Blacker. By all means learn Italian if you want to converse with the locals on your next trip to the Mediterranean, but don't take up the violin if you don't have a real desire to learn.
Cabaret artist Marilyn Maye is a case in point. She appeared on the Johnny Carson show 76 times, and at age 80 (looking 65), she still maintains a hectic performance schedule. She runs her own business -- from contracts and travel to rehearsals, choreography and lighting. And that may help keep her going. "I live in the details," she says.
Your internist has battered you with advice to help lower your risk of heart disease, but now Alzheimer's experts are singing the same song. "The measures we take to improve cardiovascular fitness, including the control of blood pressure, cholesterol, body weight, and increased aerobic exercise, also prevent dementia. This is a win-win," says Harvard's Blacker.
"At a minimum, the damage done to your brain by Alzheimer's is additive with the damage done by vascular disease," she explains. "These processes may even be synergistic, with vascular disease worsening the changes caused by Alzheimer's."
"The evidence that cardiovascular fitness reduces the risk of dementia is so strong that I advise people to really push themselves in this area," Blacker says. "Even if you don't like to exercise, the benefits to your brain make the effort well worthwhile."
Mind Your Bones
Since exercise is so vital to continued good health, you've got to ensure that you can continue. Hip and other fractures sideline older people and often mark the beginning of a permanent decline. That's why men -- not just women -- should consider getting tested for osteoporosis. "As many as 40% of our male patients aged 40 and older have low bone density that predisposes to fractures," says Fein. "One third of
these have low testosterone levels. We bring that up to a normal level, and we recommend calcium, vitamin D, weight-bearing exercise and weight training, just as we do in women."
Pay attention to your joints, too. "Do flexibility, range of motion and joint-strengthening exercises so you don't end up in a wheelchair or in need of multiple joint replacements," advises Houston-based podiatrist Jeffrey A. Ross. He recommends yoga and Pilates, along with swimming, walking and biking. Runners and walkers, he adds, should have a foot or sports-medicine specialist analyze their gait for biomechanical problems that could lead to hip, knee or ankle damage. Wearing prescription orthotics now could prevent pain and disability later.
Your Choice: Eat or Drink Your Polyphenols
Evidence has been building for 20 years that at least in some animals, extreme caloric deprivation triggers a process that curbs degenerative aging. Most people would find the amount of required caloric restriction (about 30%) too hard to maintain. But scientists have found that a chemical called resveratrol, famously present in red wine, may mimic the effects of caloric restriction.
Earlier this month, Richard Weindruch, a professor at the University of Wisconsin-Madison Institute on Aging, and colleagues published a study in the online journal PLoS One showing that resveratrol may delay aging in mice at lower doses than previously thought. "No other nutrients that I'm aware of have the ability to increase maximum life expectancy in mice. It's striking," says Weindruch. The findings, he adds, suggest that resveratrol and other polyphenol compounds "have the ability to oppose multiple aspects of aging." Some good sources of polyphenols: coffee, black tea, apples, wheat bran and cherries.
What can we learn from the very old? Thomas Perls of the New England Centenarian Study, a Boston University project billed as the largest-ever study of centenarians, says people who live to 100 and beyond know how to keep their cool. "They use a lot of humor in their daily lives and are gregarious," he says. "These characteristics help them develop important social networks, which do two things: They provide a social safety net and keep people mentally stimulated, which is incredibly important."
A study to be published in the July issue of the American Journal of Public Health supports this, showing that cognitive function is preserved when women have large social networks. "Men may not get quite the same lift, probably because women are better networkers," says lead author Valerie Crooks of Kaiser Permanente, the nonprofit health-care plan. Women make up 85% of centenarians.
Gentlemen, start your networks. And we're talking poker nights and bowling, not corporate computers.
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