By: Jean Johnson for Heart1
“If undetected heart disease is implicated in older folks who are doddering about, then I guess I could try and be more compassionate,” said LeAnn Barber of Portland, Oregon. “But really, the other night I took a friend of the family, Grandma as we call her, out for a chorale performance at one of our private colleges. It was at intermission that we discovered that the nearest bathrooms were in an adjacent building, up a little hill and across the way under the pines,” Barber said with a sigh. “The long and short of it was that Grandma was so incredibly slow, just a huffin’ and a puffin’ with these tiny little steps that we didn’t get back in time. We had to stand outside in the lobby until the first selection was finished. Also, she was fretting every turn of the way. ‘Is that it up there?’ she said in this eensy worried voice over and over, even though I assured her that I had not been there before either.
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The National Institute of Aging offers a four-fold approach to physical activity:
Endurance exercises like walking rapidly (while still being able to talk to a partner).
Strength exercises to build muscles in the legs and arms.
Balance exercises that can help prevent falls.
Flexibility exercises to help keep the whole body limber. “Stretching the long muscles in the legs, arms, and across the upper back can improve range-of-motion and the ability to reach things on the top shelf.”
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“I don’t know,” said Barber, laughing. “I hate to sound like someone who doesn’t respect her elders, but to me it seemed like Grandma’s attitude has as much to do with her slow-poke ways as anything.
“They’re not all that way, thank heavens. We have some friends down at the coast who are well into their 80s and still playing golf, going out on the beach for clam digging, driving up here to see their kids, and generally conducting themselves like they always did,” said Barber, who has just entered her 60s. “To tell you the truth, they are more with it now than Grandma was when she was young. So, to me at least, while the heart thing may be true, the state-of-mind part of it really makes sense too.”
Frailty: A Function of Undetected Heart Disease?
In an effort to understand why some elders get frail and others remain active and vital, Anne B. Newman, PhD, a geriatrician and professor of epidemiology at the University of Pittsburgh, and her colleagues looked at cardiovascular function. “With frailty, which is the slowing of gait, the loss of muscle strength,” she told the New York Times, “we had chalked it up to being totally nonpreventable.”
Newman is in a good position to evaluate connections between heart health and aging. She developed the protocols to assess functional outcomes (disability, gait disorders, cognitive impairment) and important geriatric syndromes (sleep disorders, weight loss) in Pittsburgh’s Cardiovascular Health Study. The longitudinal study, now in its 19th year, is funded by the National Heart, Lung, and Blood Institute and is focused on the “risk factors and natural history of cardiovascular disease in older adults.”
Newman and her colleagues compared elders who had various forms of detected cardiovascular disease like heart attacks, strokes, or congestive heart failure with those that did not. The team found that while those with known heart problems were likely to be frail, those who had heart problems (identified in the study by scans and tests) but who had not had symptoms that had prompted treatment, were three times as likely to age and become frail than healthy individuals. More, Newman said that those with undetected cardiovascular problems grew so frail that they lost their independence about five years earlier that their healthy peers.
Newman underscores that undetected cardiovascular disease is most likely only one factor that contributes to the degree to which people succumb to frailty as they age. She notes that conditions like arthritis and osteoporosis slow elders down as well.
That said, in those who are otherwise healthy, the data she and her team analyzed suggest that non-symptomatic, and therefore undiagnosed, cardiovascular disease seems to be implicated. “With a lot of people, slow walking is due to poor blood flow to the legs,” Newman said. “Then their muscles atrophy.”
The promising news for baby boomers like Barber is that those who take advantage of the blood pressure and cholesterol drugs currently available, and also stay active and watch their weight and nutrition like she does, have better chances of keeping their cardiovascular health in first rate shape.
Indeed, Newman thinks the current generation is well poised to age gracefully. “I think there will be less frailty, and I think it will be delayed,” she said.
“That’s excellent news,” Barber said. “And I respect the heart-frailty connection. But to be honest, I always did think my generation would age well. Just look at the difference between our attitudes. So many of our parents could hardly wait to retire and get old, it seemed. In my view they watched way too much TV and got all kinds of crazy ideas from that. The Geritol crowd, you know. My crowd, we’re busy hiking or biking or reading or cooking real food that hasn’t been processed. We think young at heart. We have since the 60s when we first started figuring out how decadent and boring middle class America really was.”
Aging and the Mind
Barber’s point is well taken, according to Richard M. Suzman, PhD, the director of the office of behavioral and social research problems at the National Institute on Aging. Responding to the idea that studies are increasingly suggesting that aging really is a matter of mind over body, he told the New York Times: “I am changing my initially skeptical view. There is growing evidence that these subjective experiences might be more important than we thought.”
In the area of memory, for example, the work of Becca Levy, PhD, a psychologist at Yale University, sounds an confirming bell. She tested the memories and walking ability of 90 healthy elders by flashing two batches of word cards before them. The first batch had positive words about aging like wise, alert, sage, and learned. The second had pejorative ones like dementia, confused, senile and so on. The group scored higher on memory and walking ability with the first group of cards.
After this provocative finding, Levy went looking. She found the Ohio Longitudinal Study of Aging and Retirement, a two decade-long projects of 1,157 people 50 and older. Results of the study showed that those who had more positive associations about aging tended to be healthier in their latter years – including less hearing loss – and also lived an average of 7.6 years longer than their peers.
Aging Well
Fitness is a key area that people interested in the topic of aging well focus on. Judith Salerno, MD, MS, and deputy director of the National Institute on Aging, for example, addressed the United States Senate in 2003. Her message was that “National Institutes of Health research continues to demonstrate the phenomenal benefits of exercise across the lifespan.”
Salerno lives of what she speaks. In 2002 she started running and did a “half-marathon to honor the memory of my father, who died of a stroke due to high blood pressure. I also ran the race to celebrate my 50th birthday. I had the good fortune to find a coach, running partner, and role model, Dixon Hemphil, who at age 77 is fit and active.”
Salerno’s report to the Senate included a recap of research related to fitness and nutrition, a combination that she termed “the healthy prescription for aging.”
She noted that “compared to their sedentary counterparts, older exercisers are not only more likely to live to an advanced old age, but are more likely than non-exercisers to remain independent right up to the end of their lives.” She went on to list studies that have shown how exercise decreases falls in older people, that walking and strength-building reduces pain associated with knee osteoarthritis, and that generally, “inactivity can lead to frailty, poor health and dependence,” situations that Salerno notes are “universally feared by older people.”
