Everybody should be able to age gracefully, and enjoy the aging process, as long as a good foundation began and pitfalls were avoided between ages 30 and 50, and healthy living habits are adopted and adhered to, according to gerontologist Dr. Agreta Eneas-Carey.
According to Eneas-Carey, growing older doesn’t have to mean being sick, bedridden and leading a solitary life. She says that in a person’s golden years once they’ve retired, they want to be fit, healthy and in a position to enjoy life and all it has to offer. And that there are things that a person can do while they are younger, and approaching old age as well, that they can start to do to give themselves a better chance of good quality of life. Exercise, diet, cognitive exercises, taking care of their health and a lot of other factors throughout their life cycle, she said, can have tremendous impact on the kind of life a person enjoys as a senior citizen.
“Our health is our wealth,” said the doctor who spoke at a recent Doctors Hospital Distinguished Lecture Series.
The gerontologist said healthy aging begins not at birth, but before – en utero; and the quality of life a person leads from birth to age 40 gives them the foundation so that their bodies can last until age 80 to 110 years of age.
Bad habits to avoid during the first 40 years of life, she said, include excessive alcohol, cigarette smoking, drug use and careless and unprotected intimate activity.
Research into quality of life, she said, conveys an overall sense of wellbeing, including aspects of happiness and satisfaction with life as a whole.
The current World Health Organization (WHO) definition of health, she says, states that health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease.
The WHO’s definition for quality of life says that an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns, is quality of life.
A recent study from Sweden, she said, showed that persons over 67 years of age felt that in rank order – social relations, health, activities, functional ability, wellbeing, living in one’s own home and personal finances were most important to give them a quality of life.
“Functional ability when we’re dealing with older people is one of the most important things I think, because people like to be able to do things for themselves,” said the gerontologist. “You don’t want to have someone having to lead you around, take you to the bathroom, so keeping an older person fit and functional is very important.”
She said related to quality of life is also the concept of aging well and it is felt that aging well contains three components – a lower risk of disease and disability so people who aren’t sickly, and who stay pretty healthy are aging well; high mental and physical function; and active engagement.
Four broad areas recognized by the WHO that are universally relevant to quality of life are: physical health, psychological wellbeing, social relationships and environment.
“Environment is important, and can be broadened to include finances, housing, security, schools, neighborhood, etc. A clean environment is important. You cannot have a good quality of life if you’re in an environment in which you are uncomfortable,” said the doctor.
Physical health is important, and broken down into six areas: diet, exercise, physical comfort, physical safety, pain relief and good hygiene.
Eneas-Carey said diet is the single most significant risk factor for disability and premature death, and this is something that Bahamians struggle with. She said approximately 50 to 70 percent of the people she sees says they don’t like vegetables and don’t eat vegetables.
“We don’t have the world’s best diet… too much carbohydrates, too much salt, too much grease. But diet is important, and vegetables, fruit, legumes or beans and whole grains should be emphasized. Many people have grown up on the potato salad, macaroni and cheese, and peas and rice, so it’s hard to switch to eat a lot of vegetables, etc. when you get to age 50 and 60, but you have to try, and minimize free sugars and red meat.”
Diets that she said are excellent in assisting with healthy lifestyles include the DASH (dietary approach to stop hypertension) diet, the Mediterranean diet and the vegetarian diet.
The DASH diet restricts saturated fat, cholesterol, refined grains and sugar. And helps with obesity, hypertension and diabetes; and recommends less than 2,400 milligrams (a little more than a teaspoon) of salt per day. According to Eneas-Carey, the average intake of salt is about 3,400 milligrams per day with a majority coming from processed foods which she says people should try to avoid, and eat fresh foods and vegetables.
The Mediterranean diet focuses on fish, vegetables and whole grain, and limits red meat, refined sugars and refined grains. She said a good steak is okay if you eat it once a month or once a quarter. This decreases the incidence of diabetes, obesity, cancer and cardiovascular disease.
“I think the best diet, and it’s not for everybody, is the vegetarian diet which avoids red meat, poultry, fish, eggs – avoids all animal products and some vegetarian diets even encourage you to avoid honey also.”
Exercise, the doctor said, is the number one contributor to long life, and one of the safest ways to improve health.
“Everybody should exercise. I don’t care whether you just walk around your yard, or go to the track or the beach or wherever, but it has proven benefits, even when we begin to exercise in later years. You just have to start, and do a little every day. People who exercise have a better prognosis during critical illness. A comprehensive exercise program should include aerobics – which means walking, biking, swimming – anything to get your heart rate up; strength training; flexibility; and balance training.”
Quality of life, she said, can also be broken down into intellectual, emotional and social.
“Intellectual quality of life focuses on keeping the mind stimulated, especially after retirement which can be very traumatic. You need to get involved in a new business, take a class, learn a new language, stimulate the mind with word/jigsaw puzzles. Keep busy and stay engaged.
“In emotional quality of life, people need affection, approval and relationships are really important to maintain. When you get older you need good relationships, you need support, you need family around. People need to maintain a certain amount of privacy also and dignity in life; and being able to be in control of one’s life is important to have a sense of autonomy.
“As far as social quality, again relationships are important. They reduce isolation and feelings of uselessness and depression. Depression is another major problem we have with older persons because people get depressed for many reasons – their spouse may have died, they retired and are bored with nothing do to, and if you don’t have great relationships, your children are away, your grandchildren don’t visit, so depression is very real, but it’s also something we can treat. But it’s very under-diagnosed and under-treated. So social quality of life is very important. Keep in touch with old friends, stay active in the community or at church.”
Prevention of disease
Usually when disease prevention is discussed, it’s in relation to children and babies, but Eneas-Carey said primary prevention is also important in older persons.
“You want to stop diseases before they start, so you have to keep up with your immunizations. Older people need immunizations too. Everybody over the age of 50 should get the flu vaccine yearly; the Pneumococcal vaccine should be given after age 65 – there are two pneumonia vaccines, the Prevnar 13 first and then the Pneumovax 23 a year later to prevent pneumonia. Tetanus shot should be gotten every 10 years. And the shingles vaccine – people who have had chicken pox have the herpes zoster in their body so if their immune system gets compromised, some people will get shingles, the shingles vaccine should be given twice after age 50 two to six months apart.”
She said secondary prevention aims to detect and treat a disease or its complications at an early stage, before symptoms or functional losses occur. “You have to continue getting your regular checkups every year, unless you have a disease or illness that requires you to see your doctor more frequently. Blood pressure should be monitored every chance you get to prevent a stroke. You want to get your blood sugar checked; if you have a family history of diabetes, that’s even more important to get your blood sugar checked. But more important we want to prevent pre-diabetes so they don’t get diabetes which is not a good disease to have.
“Weight is something we need to monitor. Prevent obesity. We use the body mass index, and not how much you weigh anymore; if you go to your doctor and you have a BMI of 25 or less you’re in good shape; a BMI of 25-30 you’re a little overweight; a BMI over 30, you are obese.”
Obesity, the doctor said, is linked to many illnesses – cancer, diabetes and hypertension.
She said height should be monitored for osteoporosis; hearing monitored for presbycusis (inability to hear high-pitched sounds) and vision monitored for glaucoma (pressure in the eye which causes people to go blind painlessly, but is treatable) and cataracts (clouding of your lenses).
Eneas-Carey said people should not smoke or chew tobacco between ages 30 and 50, maintain a desired body weight, decrease salt intake, exercise, limit caffeine intake and limit alcohol intake; she said a glass of red wine is supposed to be good.
Life expectancy tables reveal that at birth, men are expected to live for 76.3 years and women are expected to live for 81 years. Another one that starts at age 65, says if you’re a healthy 65-year-old man you should expect to live for another 18 years; a healthy 65-year-old woman should expect to live for another 20 years. At age 70 a man can expect to live another 14 years, and a woman another 16; at age 75, a man another 11.1 years, and a woman, another 12.9 years. At age 80 if you’re healthy a man can expect to live another 8.2 years, and a woman another 9.6 years.
The American Cancer Society recommends yearly mammograms from age 45 to 54 years of age, and women 55 years of age and older screened every two years.
“In our country we have a high incidence of breast cancer so I feel people should have a mammogram done every year. And screening should continue as long as overall health is good, and overall life expectancy is at least 10 years,” said Eneas-Carey.
Screening for cervical cancer should be stopped at age 65 in women who have had three consecutive negative pap smears within the past 10 years. Women who have had a hysterectomy do not need to continue to have pap smears, even if their hysterectomy was for cancer, she said.
With a lot of colon cancer in the Bahamian community, the gerontologist said people 50 to 75 years of age should be screened. Routine screening in those 76 to 85 should not be screened, but may be considered in certain individuals. And with life expectancy less than 10 years, screening is not recommended, but it depends on the individual person and it has to be discussed with their physician.
Prostate cancer, she said, is very up and down with recommendations. The American Urological Association (URA) says screening should not be performed in men who are 70 years or older or men who have a life expectancy of less than 10 to 15 years. For men 55 to 69 years of age, shared decision making is recommended between patient and physician.
“Healthy living also means a life of quality with good relationship with family, friends and joy. And you have to keep God in the mix. Church should be a vital part of our lives as we age, whatever your belief is,” said Eneas-Carey.