Chronic Health Conditions Not a Barrier to Successful Aging

Like highly engineered machines, our bodies generally remain healthier and in better working order when we take good care of them. But even with good care, humans and machines have a life cycle. The later years of that life cycle often find systems and parts are not working as well as they used to.

As the population ages, more of us do begin to develop some chronic illnesses - cardiovascular conditions such as high blood pressure and diabetes, or osteoporosis, osteoarthritis or dementia.

It's assumed that some of the wear and tear that comes with aging is inevitable and "normal," but that's not necessarily true in all cases, says Edith A. Burns, MD, Associate Professor of Medicine (Geriatrics and Gerontology) at the Medical College of Wisconsin. She is among a group of scientists who are researching the concept widely referred to in the profession as "successful aging." The term, which first appeared in 1961 in the premiere issue of The Gerontologist, has been used in many studies since. The term "successful ager" has been defined and redefined by scientists, and it can include factors like longevity, health, and happiness or satisfaction. It does not mean that you have to feel like you did when you were 30.

"You can be a 'successful ager' and still have chronic conditions like hypertension and osteoporosis that can be well tolerated with good management," Dr. Burns says.

"The likelihood of developing chronic conditions definitely increases with age," she says. "The arteries stiffen, which makes it more difficult for blood to circulate efficiently. So the incidence of hypertension and heart failure increases, simply because the cardiovascular system must work harder. Insulin sensitivity and production decreases, so diabetes becomes more prevalent. And bones become more brittle with aging, which is why we expect to see more osteoporosis, in both men as well as women, and osteoarthritis."

Osteoporosis
Typically, in discussions of osteoporosis and its diagnosis and treatment, much of the attention focuses on post-menopausal women, who lose bone density more rapidly as their estrogen hormone levels decrease. But men are affected, too, says Dr. Burns.

As one of the co-investigators of "Successful Aging," a study begun in 1993 through a National Institutes of Health grant, she and her colleagues followed 264 healthy men and women ranging in age from their mid-60s to early 70s. They were periodically tested for a variety of conditions including bone strength.

"We found the men in our study were actually losing bone density faster than women, and we're not sure why," she says. The finding was unexpected, she notes, because men's bones generally are stronger than women's, and a majority of the men under observation were taking adequate amounts of calcium, which ordinarily can slow down bone loss.

In October 2004, the US Surgeon General issued a first-ever report on bone health. It warned that by 2020, 50% of Americans age 50 and older will be at risk of fracturing a bone weakened by osteoporosis. It recommended that women over 65 and anyone who has had even a minor bone fracture over age 50 be tested for bone health.

Medicare covers part of the cost of bone density screening tests. These tests scan the heel, the wrists, the spine, or even the whole body to find weakened points or potential hairline fractures that might otherwise be undetectable. Men and women diagnosed with osteoporosis can prevent further bone loss and help prevent fractures through medications like Fosamax. They are strongly advised to engage in at least 30 minutes of physical activity a day and get the recommended daily amounts of calcium and vitamin D from food or supplements. Other recommendations for bone health: stop smoking and consider weight-bearing exercise.

Arthritis
Osteoarthritis is the most common type of arthritis, affecting more than 16 million Americans. This degenerative joint disease is common in people over 65. In addition to medications that reduce pain and inflammation, rheumatologists routinely advise a balance of physical activity and rest, according to FDA Consumer magazine. Exercise offers physical and psychological benefits that include improved overall fitness and well-being, increased mobility, and better sleep. Water exercises can often be well-tolerated by arthritis patients.

Diabetes
Dr. Burns currently is doing a series of studies involving self-management of chronic disease, predominantly diabetes.

"It does require good communication between patients and their physicians, and a willingness by the patient to do self-management," she says. "It's critically important for patients to know how and when to monitor their blood sugar and how to interpret their own symptoms. They need to understand the relationship between what they eat, their physical activity and their blood-sugar levels, and how and when to use their medications. If there's good self-management, they can enjoy active, engaged lives, despite their diabetes."

Sometimes, however, the communication between patient and health provider is inadequate. In her studies, Dr. Burns has observed that many patients check their blood sugar levels infrequently or, in some cases, not at all. In some cases, she fears, physicians assume patients fully understand the complex connection between food and medication and blood glucose levels, and they might not.

About 16 million people in the United States have diabetes, which is the main cause of kidney failure, limb amputations and new-onset blindness in adults, as well as a major cause of heart disease and stroke. Type 2 diabetes (formerly called adult-onset diabetes) accounts for up to 95% of all diabetes cases. With the rapid increase of obesity during the past decade, Type 2 diabetes has begun showing up in younger adults and even adolescents.

Hypertension
The National Heart, Lung and Blood Institute estimates that 29% of Americans - some 58 million of us - are living with high blood pressure, and require daily medications to control our disease. If left untreated, hypertension can lead to heart failure, stroke, kidney failure and other complications.

The Medical College, along with the University of South Carolina, did major work on trends in hypertension in America. Findings were published in 2003 in the Journal of the American Medical Association, recommending stricter guidelines for what's considered "normal" blood pressure.

The upper number in a blood pressure reading is called the systolic blood pressure, which measures the force of blood in the arteries as the heart beats. A systolic reading of between 120 and 139 is now regarded as pre-hypertensive, and a reading of 140 or more is considered high. The lower number measures diastolic pressure, or the force of blood in the arteries as the heart relaxes between beats. Diastolic pressure ranging from 80 to 89 is now classified as pre-hypertensive, and a reading above 90 is considered high. Both numbers are important, but for people who are 50 or older, systolic pressure is a stronger predictor of hypertension-related complications.

"Hypertension is definitely more prevalent and increases with age. Diastolic pressure tends to plateau after a certain age," says Dr. Burns.

Dementia
Even though dementia is not necessarily a normal part of aging, "there's no question age is the biggest risk factor for it," Dr. Burns says.

In addition to Alzheimer's disease - which is the most prevalent form of dementia, accounting for at least half of cases - dementia can also arise from vascular causes like uncontrolled hypertension and from alcohol abuse, or from a combination of these. Alzheimer's disease affects up to 4 million Americans - and untold millions of family members and others who care for them. Alzheimer's is a progressively worsening disease, but the rate of progression from mild to advanced can vary widely, from three years to 20 years. Once dementia is identified, its progress can sometimes be slowed through medication.

Good News About Aging
Growing old is not all deterioration and illness. In America and elsewhere, people are living healthy, productive lives through their 70s, 80s, 90s and beyond - and in numbers never before seen in recorded history. The longevity gap between men and women is closing.

Dr. Burns points to a series of landmark studies, the MacArthur Foundation's "Studies of Successful Aging," which suggest that loss of mental and physical function as we age can be delayed by developing a few good lifestyle habits.

"Keep active," she says. "Keep your mind and your body toned. Read, follow the news, do crossword puzzles, play cards. Walk more. People who walk three hours a week have lower rates of hospitalization, and lower rates of congestive heart failure. Physical exercise promotes vitality, mental sharpness, physical strength, balance, and overall wellness. Even if you've never exercised, it's not too late to start. You'll have more energy, be steadier on your feet and less likely to fall and, best of all - you will extend your useful life."

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.