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Tips for Healthy Aging from a Geriatrician

Healthy aging doesn't have one look or one definition. It involves optimizing various aspects of health—physical, cognitive, mental, and social. We uncovered tips for healthy aging through an interactive session with Dr. Loewenthal, a geriatrician and internist at Brigham and Women’s Hospital and Instructor in Medicine at Harvard Medical School.

Accessing Health Care

Accessing healthcare can be challenging due to shortages in primary care and geriatricians. Primary care is typically provided by professionals in family or internal medicine, but geriatricians can also serve this role. If you find a primary care provider (PCP), try to stick with them despite long waiting lists.

Primary care can also be provided by physician assistants (PAs) and nurse practitioners (NPs), who can often act independently. To make the most of your visits, write down questions beforehand and bring all your medications for review. If you feel unheard, bring a family member or friend to improve communication.

For more personalized care, concierge healthcare practices offer better access and higher touch care, often with an annual membership fee.

Medicare Annual Wellness Visits

Many people underutilize the Medicare Annual Wellness Visit, which is a comprehensive preventive health check introduced in 2011. This visit includes a long questionnaire and various screenings conducted by medical staff. Despite some skipping these visits, they cover a lot of important health aspects in one go.

The wellness visit includes a medical history review, medication review, blood pressure check, and screenings for psychosocial health, substance use, physical activity, and nutrition. It also checks for hearing and vision loss, functional and mobility issues, cognitive health, and focuses on preventive screenings and advanced care planning.

If you haven't had an annual wellness visit recently, consider scheduling one. It addresses many aspects of healthy aging and preventive care in a single appointment.

Colorectal Cancer Screening

Colorectal cancer screening is crucial as many colon cancers develop silently in mid to late life. Recent guideline changes have introduced more testing options. Early detection of polyps through screenings can prevent them from becoming cancerous.

There are two primary screening methods: at-home stool tests and colonoscopies. Stool tests, such as the FIT or Cologuard tests, are done annually and check for blood in the stool. If positive, a colonoscopy is required. Colonoscopies, done every ten years, allow direct visualization of the colon to identify polyps but carry risks like bleeding and bowel perforation, especially in older adults.

Screening typically stops at age 75, but this can vary based on individual health. Exceptionally healthy seniors might continue screenings, opting for stool tests over colonoscopies. Guidelines have recently lowered the recommended screening age to 45 due to rising colorectal cancer rates in younger people. Discussing these options with your doctor can help tailor the approach to your specific needs.

RSV Vaccine

The RSV vaccine is an important update in preventive care for adults aged 60 and older. RSV, a virus causing cold-like symptoms, can be severe for both young children and older adults. Three vaccines are approved: Arexvy by GSV, Abrysvo by Pfizer, and a new mRNA vaccine by Moderna.

Unlike other vaccines recommended universally, the RSV vaccine requires a shared decision-making discussion with your doctor. It can prevent pneumonia, particularly in older, frail individuals and those with chronic lung or heart conditions. If you are frequently around young children, especially infants, consider the vaccine. Discussing your specific health situation and risks with your doctor will help determine if the RSV vaccine is right for you.

Substance Use Screening

Substance use screening is a key part of the Medicare annual wellness visit. Recent years have seen increased alcohol use, particularly binge drinking among older adults.

Older adults are more sensitive to alcohol due to changes in liver metabolism and the presence of more medical conditions that can be exacerbated by drinking. Alcohol can interact with medications and medical conditions, such as diabetes, posing additional risks like low blood sugar.

While moderate alcohol use has been touted as heart-healthy, it increases the risk of cancer and dementia at any level. Guidelines recommend no more than one drink per day for women and two for men, with some suggesting one drink or less for all older adults. It's wise to reconsider long-standing drinking habits as you age and discuss any concerns with your doctor.

Hearing Loss and Dementia Prevention

Age-related hearing loss, or presbycusis, affects about two-thirds of people aged 70 and older and is linked to an increased risk of dementia. Reduced sensory input to the brain due to hearing loss can lead to brain shrinkage and memory issues, contributing to dementia. Additionally, some theories suggest that the dementia process itself may cause hearing loss.

Recent clinical trials have shown that using hearing aids can slow cognitive decline in those at higher risk for dementia. Managing hearing loss can also reduce depression, decrease social isolation, and improve communication with family and friends.

Hearing screenings are part of the Medicare annual wellness visit. If you or a family member are concerned about hearing loss, consider an audiology evaluation. While hearing aids can be expensive and often aren't covered by insurance, affordable over-the-counter options are available.

Cognitive Screening

Cognitive screening, performed during the Medicare annual wellness visit, often includes the clock draw test. While many dislike this test, it provides a useful snapshot of brain health. If the clock draw is abnormal or if there are memory concerns, further testing is recommended, which can be done by a primary care provider or a specialist such as a geriatrician or cognitive behavioral neurologist.

Even with a normal clock draw, it's essential to focus on brain health. Education in early life, hearing loss management, and blood pressure control in midlife are key factors. In late life, maintaining a healthy lifestyle can significantly reduce dementia risk. This includes quitting smoking, treating depression, staying physically active (with an emphasis on resistance training and aerobic exercise), and reducing social isolation.

Socializing is more cognitively stimulating than brain games like Sudoku or crosswords. Additionally, managing diabetes, reducing alcohol consumption, ensuring restorative sleep, and managing stress are all beneficial for brain health.

Medications That Can Slow Thinking

Certain medications can slow cognitive function, a key concern for geriatricians. Benzodiazepines like Ativan can slow brain activity similarly to alcohol and are linked to increased dementia risk. These medications should not be stopped abruptly and require a doctor's guidance for dose reduction or discontinuation.

  • Other medications to be cautious of include:

    • Zolpidem (Ambien)

    • Diphenhydramine (Benadryl) and over-the-counter medications with "PM" in their names

    • Nyquil

    • Meclizine

    • Cyclobenzaprine (Flexeril)

    • Opiates

These medications can impair thinking, increase fall risk, and cause constipation due to their anticholinergic effects. If you're taking any of these, discuss alternatives or management strategies with your doctor to minimize their impact on cognitive health.

Exercise and Balance

While many older adults walk for exercise, which is excellent for aerobic health, it's also important to include muscle-strengthening exercises at least twice a week and activities that improve balance. Exercises like tai chi or yoga can address multiple areas at once, enhancing strength and balance simultaneously.

As we age, our balance systems naturally decline, but targeted exercises can help slow this process. Even starting exercise later in life can yield significant benefits, improving exercise capacity and helping maintain muscle mass and balance. This not only supports independence but also benefits brain health, sleep, and mood. Prioritizing a well-rounded exercise routine is essential for overall well-being in older adults.

Promoting Longevity and Healthy Aging

Proactive healthcare is key to thriving in older age. Utilizing Medicare annual wellness visits, addressing health concerns and managing medications that impact cognitive function can greatly enhance quality of life. Embracing preventive measures such as incorporating a balanced exercise routine is vital for maintaining both physical and mental health. By adopting these strategies, you can improve well-being, and enjoy a vibrant, fulfilling retirement.

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