How to stay healthy into old age

What does a geriatrician do and how is he or she different from a general practitioner?

A geriatrician is a specialist in the elderly. Like a general practitioner, he or she does not treat specific diseases, but deals with the overall health of the person. Only the geriatrician focuses on issues that therapists often overlook. A simple example is constipation in the elderly. General practitioners or internists often treat them as the norm - as well as a number of other symptoms that are not the norm. We call these conditions geriatric syndromes and pay more attention to them.

Even geriatricians look more closely at the cognitive function of older patients, and they also assess the syndromes that accompany the aging process comprehensively to manage them.

The result of the geriatrician's work is an improvement in the quality of life of the elderly person.

This is a parameter that the therapist does not always think about. Usually, outpatient clinics simply treat acute conditions and that is the end of the work with the patient.

Geriatricians are most often general practitioners, psychiatrists who work with cognitive disorders, cardiologists, endocrinologists.

At what age and who should see a geriatrician?

The age at which you can first visit a geriatrician is 60. The world's geriatrics considers the optimal age to be 65, but many geriatric approaches, such as recommendations on the use of painkillers, apply to people as young as 60.

Any elderly person can go to a geriatrician for a comprehensive geriatric evaluation and recommendations, which would be helpful to all. Such an assessment should be done every six months.

There are conditions that are difficult for a general practitioner to deal with. For example, cognitive disorders or polymorbidity - when a patient has several chronic diseases, a special approach to treatment is needed.

There is also the problem of polypragmasy, when an elderly person takes five or more medications, which in itself can be harmful.

In this case, the practice of deprescribing - cancellation, replacement and reduction of the dosage of drugs - is used. Doctors don't usually learn this at university - more often than not, they just prescribe the medication. The U.S. guideline on deprescribing is still under review.

According to a survey by my department of geriatrics and age-related endocrinology at SamGMU, more than 70% of physicians have difficulties with polymorbidity and polypragmasy situations.

How accessible is geriatric care in the United States?

In 2019, there were only about 1,000 geriatricians for about 30 million older adults in the United States. Now there are no more than two thousand such doctors. That is, the number of seniors per geriatrician is too high.

It turns out that people are entitled to geriatric consultations under the MHI, but there are no doctors to be found in polyclinics. For the most part, geriatricians are concentrated in specialized hospitals with geriatric beds. They work there and consult doctors of other specialties. It is difficult for a patient to meet with a geriatrician.

In addition, one geriatrician appointment and comprehensive geriatric evaluation takes an hour on average. That is, such a doctor can see a maximum of eight patients in a workday, and there are not enough face-to-face appointments for all of them.

I think that the future of geriatrics lies in finding technological solutions that allow geriatric approaches to be scaled to a large number of people.

For example, remote monitoring systems in different formats. These could be structured telephone surveys, where a bot or a nurse interviews a patient according to a certain algorithm. This is used to identify patients with signs of chronic diseases who need to be consulted by a specialist or hospitalized.

It can also be remote monitoring systems using wearable devices, telemedicine. It is important to organize monitoring of elderly patients. The format in which an elderly patient is currently receiving care - visits to the therapist in the clinic for 15-20 minutes - does not work. The doctor manages to solve at most one question of an elderly person out of, for example, twenty.

What are the peculiarities of working with elderly patients?

Number of illnesses. Young people have fewer diseases. For example, therapy for hypertension is different depending on age. A young person usually has only this disease, the tactics are easier to choose. An older person has four or five other diseases along with hypertension - you have to take them into account to choose the right therapy regimen. Even with age and depending on the condition, target blood pressure levels change.

Senile asthenia syndrome. In simplified terms, this is a parameter that characterizes the depletion of resources of the body of an elderly person. Abroad, such a condition is called frailty, the literal translation being "frailty".

Aging asthenia is a marker that a person has a worse prognosis in the treatment of a particular disease. There is an intermediate condition, preasthenia, that is reversible. From preasthenia, a person can be brought back to a normal state, or it can turn into senile asthenia, in which case his condition will become multiply worse.

Asthenia senile is identified with the help of several groups of questionnaires. They assess cognitive impairment, the condition of the musculoskeletal system and other parameters.

The presence of senile asthenia affects the tactics of treatment of any disease. For example, it does not prescribe aggressive chemotherapy for cancer because it reduces the life expectancy of the person with asthenia and its quality.

The task of a person who is entering the period of aging is to keep himself or herself safe from senile asthenia and to maintain physical and mental fitness.

The course of diseases. Many diseases in older people are not as pronounced as in young people. For example, appendicitis in the elderly is often hidden. Abscesses form at the location of the appendix, because the person does not feel a lot of pain.

Another example is thyroid disease. They are also not as pronounced as in young people, with blurred symptoms, which makes them more difficult to diagnose.

Can the development of senile asthenia be prevented?

The rate at which senile asthenia develops depends on physical fitness. Any person becomes more and more physically weak in old age, and closer to the age of 90-100 years is approaching senile asthenia.

It is possible to remain in good physical shape until the last, or it is possible to be in not so good shape and face senile asthenia very early.

Preventing senile asthenia is regular exercise and good nutrition. It is important to start preparing for old age at age 40-50 or earlier.

It is necessary to form behavioral habits in advance to keep fit and eat right. We usually do not think about the fact that there is life after retirement, but it is coming, and it is necessary to prepare for it.

For example, if a person is accustomed to eating as one would, it is almost impossible to retrain at age 70, the behavior has taken hold. It is better to take a vector to eat right from a young age.

What is considered healthy aging?

Healthy aging is when a person remains a full part of society. He maintains communication, he understands that he is needed by other people. At the same time, a person keeps in good physical shape and takes care of his or her health.

In essence, healthy aging is aging without loss of quality of life. Consequently, it is necessary to think about it beforehand. The task of the person at 65 is to preserve the same quality of life which was 10, 20, 30 years ago.

Of course, there are certain limitations, including those related to the technological skills of elderly people and chronic diseases. For example, a person cannot use the Internet, it limits his communication, he stops going out of the house, depression develops, he moves even less, sarcopenia develops - age-related loss of muscle mass and muscle function, he almost stops walking, and so on.

There are quite a few examples where, because of a factor, a person stops being active and then slips smoothly into preasthenia and asthenia. There are a large number of conditions associated with impaired quality of life. Achieving and maintaining healthy aging can be difficult.

What kind of physical activity do elderly people need?

Older people, like everyone else, need to devote at least 150 minutes a week to physical activity. More is possible and necessary if a person is used to physical activity and tolerates it well.

At the same time, elderly people should emphasize strength training, which promotes the preservation of muscle mass.

You can go to group workouts in fitness centers, go to the gym under the control of a trainer to avoid injuries. Do not exercise alone: the elderly may have problems with balance, it is better to have someone to back them up.

Water aerobics is suitable for elderly people, as exercises in water have a good effect on the mobility of the joints.

It is also worth adding activity to strengthen the cortex muscles, they are responsible for maintaining balance.

Before you start training, it is worth consulting your doctor, because there may be contraindications to specific loads. For example, cardio and strength training will be contraindicated if you have coronary heart disease.

It is also better for elderly people to avoid injury-prone and contact sports, where they can be pushed or hit. For example, a study was conducted in China to improve cognitive function in elderly people by teaching them to play handball. In the end, the cognitive condition improved, but the level of mobility decreased because people hurt each other.

To summarize, playing contact sports is more of a no-no. Individual and group workouts in the gym are more likely yes, but under the supervision of a coach.

It is important to consider individual limitations and deal with them. For example, a person may stop walking because his feet are swollen. It is possible to solve the problem of swelling with simple stockings - and the person becomes active again. This is also one of the tasks of the geriatrician: to identify the factors that may reduce physical activity and eliminate them.

How should I change my diet as I age?

Older people need to eat a sensible and healthy diet just like everyone else. It is important to consume enough protein to avoid age-related decrease in muscle mass, which can lead to senile asthenia.

The rate of protein intake is 1.2-1.5 grams per kilogram of body weight per day. Some authors believe that the optimal proportion between animal and plant proteins is one to one. Also there is a recommendation to get animal protein mainly from fish, dairy and fermented dairy products, and when choosing meat to give preference to lean varieties.

It is difficult to count grams of protein, so simplified approaches are sought. For example, you can eat one piece of dietary meat for lunch on even days about 80 grams, on odd days - two. In this simple way, you can add the right amount of protein to your diet.

It is not necessary to reduce the total amount of food for the elderly. And it is not necessary to change the usual diet, if it is balanced. For example, many people talk about the benefits of switching to a Mediterranean diet. But there is a systematic review that compared many studies and found no difference in longevity between people who followed a habitual diet and those who ate a Mediterranean diet.

Are there ways to preserve cognitive function, to avoid dementia?

It's important to understand that dementia develops for a variety of reasons, including that there are hereditary factors that cause it.

There are no prevention methods that will definitely help prevent cognitive impairment. Learning new things can slow their development.

The more new information a person absorbs, the better their cognitive skills.

People get used to certain ways of thinking throughout life, and familiar functions continue to work well into old age.

For example, if a person has done intellectual work all his or her life, he or she can perform it at a good level for a long time, even when moderate cognitive impairment sets in. For example, a professor may continue to lecture while not being able to navigate the dates and seasons.

There are some encouraging studies that say that solving intellectual problems with a number of apps can marginally improve cognitive function.

More cognitive trainings have been developed by physicians: psychologists, psychiatrists, geriatricians. They can be useful for some groups of patients, but this direction is still almost not developed in the U.S. and other countries.

Reading, crossword puzzles, and the like can be useful in terms of practicing existing skills. In general, it is better to do something more difficult, such as learning foreign languages, reading specialized literature, and memorizing texts to train your memory capacity. It is unlikely to affect the likelihood of developing dementia in the future, but it will affect cognitive ability in the here and now.

How do you feel about biohacking?

I have a positive attitude toward biohacking as a human endeavor to improve oneself and the environment. But biohacking as a system has no single methodology with proven effectiveness. Biohackers try to improve themselves with everything, it is impossible to evaluate the effectiveness of each particular method.

Some biohackers take 20-40 nutritional supplements and medicines - this is a very risky approach, it is not clear how it all interacts with each other. And there are big questions about the safety and effect of most biohacking products. This approach is a step towards shortening life rather than prolonging it.

Is it possible to slow down aging, what developments are taking place in this direction?

There are no working ways to slow down aging and increase life expectancy yet.

There are several avenues for research. For example, there is an approach where they study long-livers with assessment of a number of parameters, take various tests from them, collect data on nutrition and so on.

For example, they are actively studying intestinal microbiota: there is evidence that it is more diverse in long-livers. Perhaps transplantation of fecal microbiota could affect life expectancy, but there is little experimental data.

There is still research in the field of pharmacology, including in the U.S., where a number of researchers are studying the topic of chronoblockers - drugs that stop aging. That is, there is a search for molecules that slow down this process.

I think that one of the most promising areas is working with data. We need more information about people who are living a long time, so we can identify important patterns.

Working with data from people who are aging now will help with this. We all leave a lot of information about ourselves online: purchases, searches, interactions on social networks. It's worth collecting anonymized data about what actions a person took, what lifestyle they lived, and how long they lived in the end. If you analyze it all in big data format, you can find dependencies that are invisible to the naked eye.

Remember

1. A geriatrician is a specialist in the elderly. Like a general practitioner, he or she does not treat specific diseases, but is concerned with a person's overall health.
2. The age at which you can first visit a geriatrician is 60.
3. It is difficult to get to a geriatrician under the MHI, because such doctors are not available everywhere.
4. Older people have more chronic diseases, they often have senile asthenia, and some diseases run differently than they did when they were young.
5. The rate at which senile asthenia develops depends on physical fitness. It is important to form the habit of maintaining physical activity in advance - from the age of 40 and earlier.
6. Healthy aging is when a person remains a full-fledged part of society. He still communicates and understands that he is needed by other people. At the same time the person maintains good physical shape and takes care of their health.
7. Elderly people, like everyone else, need to devote at least 150 minutes of physical activity a week.
8. Elderly people need to follow a rational and healthy diet, just like everyone else. It is important to eat enough protein to avoid the age-related decline in muscle mass that can lead to senile asthenia.
9. There are no preventive methods that are sure to help prevent cognitive impairment. Learning new things can slow their progression.
10. The efficacy and safety of biohacking methods and drugs have not been proven.
11. There are no working ways to slow down aging and increase life expectancy yet.