Caring for older people was one of the most rewarding parts of my years as a clinical cardiologist. She appreciated his wisdom, his humor, and, very often, his respect and appreciation for doctors. It was always distressing to see them suffer a minor fall or a bout of atrial fibrillation and recognize that it could have major ramifications for their health.
Life expectancy has improved dramatically, but a longer life also means more chances for illness, pain, chronic illness, and dependence on others. Having helped older people live longer, the question is: how can we, as doctors, add more life to those years? How can we increase your “health expectancy”?
This is not just a matter of geriatric care. In the United States, there are fewer than two practicing geriatricians for every 10,000 seniors, so it is clear that geriatricians cannot assume this responsibility alone. Almost all primary care doctors and subspecialists must prepare to care for older people and help them age healthily.[1]
Dr. Susan Friedman, a board-certified specialist in geriatrics and lifestyle medicine at the University of Rochester School of Medicine and Dentistry, in Rochester, United States, reviewed the literature on the relationship between lifestyle and healthy aging and came up with to the conclusion that the integration of lifestyle medicine into medical care for older people is key to reducing morbidity. The pillars of lifestyle medicine—optimal nutrition, physical activity, stress management, restful sleep, positive social relationships, and avoidance of risky substances—both individually and collectively, are associated with fewer chronic diseases, greater commitment to life, better physical and cognitive function, less frailty and less sarcopenia. Framing conversations with patients around the six pillars of lifestyle medicine can be an effective strategy.[2]
Optimal nutrition
For a variety of reasons, older adults, especially those who live alone, often lose the desire to prepare a nutritious meal. Older adults need a different protein intake than younger patients to compensate for age-related sarcopenia, but it is essential to help them select healthy sources of protein. Both adequate protein consumption and dietary patterns rich in vegetables, legumes, fruit and nuts and low in saturated fats, red meat and processed meat can reduce the risk of frailty.[3]
Ask a patient to count what they ate over the past 24 hours and then seek nutritional counseling, a lifestyle medicine program or specialist, and insurance or community resources for food services. As medicine, it is a good first step.
Physical activity
Increasing physical activity in general can be a difficult task for many older people, and joint pain is one of the common reasons they are reluctant. Messages about specific exercises to mitigate falls, improve muscle strength, and reduce joint pain may be more appealing. Contemporary research shows that exercise, particularly open-skill exercise that requires quick decisions (such as table tennis) can be powerful. Maintaining cognition, improving mood, and independence can also be motivational messages.[4]
The first step is curiosity: What does your patient like to do? The patient can then be referred to a physical therapist or fitness specialist for step-by-step guidance and opportunities in the community.
Restful sleep
“I’m old. I don’t need that much sleep.” We’ve probably all heard this from older patients. But the National Sleep Foundation’s report on sleep health and aging indicates that the need for sleep does not decrease with age. However, the ability of sleeping may decrease. Evaluating and treating sleep disorders is another example of how each pillar of lifestyle medicine, such as nutrition and physical activity, is multidimensional and interacts to support the functional integrity of older patients. It’s hard to feel motivated to go for a walk if you don’t get enough sleep.[5]
Stress management
Exploring stress with patients can be very revealing. Do you experience stress that gives you energy and has a positive effect? What part of the day do they spend in a situation of negative anxiety? Chronic stress has been shown to affect immune function in older people. Start conversations with your older patients to normalize the importance of stress as a measure of health.[6]
Positive social connections
Loneliness increases the risk of heart disease, stroke and dementia, and even increases the risk of premature death by up to 60%. However, doctors and patients rarely talk about social relationships during medical consultations. There are tools such as the UCLA Loneliness Scale for health professionals to assess and identify patients at risk of loneliness, as well as resources to integrate social care into the provision of medical care.[7,8,9,10]
Avoid risky substances
Alcohol screenings aren’t just for younger patients. According to one study, 5.6 million adults aged 65 and older drank alcohol excessively during the previous month. Due to bodily changes, the negative effects of alcohol may be more harmful in older adults, including interactions between alcohol and commonly prescribed medications.[11]
Conducting a lifestyle assessment is an important way to engage with older patients and allows clinicians to identify opportunities to improve health behaviors, understand barriers, and support their patients to make changes in their lifestyle. Lifestyle. You can discover ways to eliminate some of the pill and treatment burdens that older adults often experience. The American College of Lifestyle Medicine (ACLM) offers clinical practice resources to support physicians, as well as “Lifestyle Medicine and Food as Medicine Essentials,” a free 5.5-hour CE/CME course on food and lifestyle medicine. that introduces physicians to the therapeutic use of lifestyle medicine. The American College of Lifestyle Medicine also offers its members interest groups focused on geriatrics, fitness, and mental health, which can be beneficial to physicians treating older people.
By engaging with older patients in their lifestyle habits, we can ensure that we are doing everything possible to help them live longer and better.
This content was originally published in the English edition of Medscape.
