Susan Friedman, MD, MPH Krupa Shah, MD, MPH University of Rochester Division of Aging 10 th Annual Caring For Elders Program Burgundy Basin Inn April

Transcription

1 Susan Friedman, MD, MPH Krupa Shah, MD, MPH University of Rochester Division of Aging 10 th Annual Caring For Elders Program Burgundy Basin Inn April 27, 2016

2 The aging of America opportunities and challenges Demographics; what does extreme aging look like? Changes in health / chronic disease Presence / role of geriatricians The Blue Zone approach Principles Replication Behavioral change Practical ideas to Blue Zone your life

3 Na ta ekatostisis (may you live to be 100). (Greek) May you live to be 100 years, with one extra year to repent. (Irish) May you live to be 120. (Jewish) May you die in bed at 95, shot by a jealous spouse. (Irish) May you live to be 100 and may the last voice you hear be mine. (Frank Sinatra) Sto lat, sto lat, niech zyje zyje nam (Good luck, good cheer, may you live a hundred years). (Polish)

4 6% married 17% live in poverty Dementia 37% of those age 90+ Functional status Over 80% with some activity of daily living impairment Independence 15% live alone 48% live in nursing homes Centenarians in the US. US Census Bureau, 1999 Kincel B, The Centenarian Population , US Census Bureau, Neuroepidemiology November; 29(1-2):

5 Lived Father lived to almost 100, mother 86, brother 97 Outlived her husband, daughter and grandson Met Vincent Van Gogh when she was 13 Saw Eiffel Tower being built Took up fencing at 85 Lived on her own to 110 Oldest person ever in a movie (114) Ascribed longevity to olive oil, port wine and chocolate

6 Year Life expectancy (US) (US) Of all the people who have lived to be 65 or older, half are currently alive.

7 Thousands US Census Bureau, 2014 National Population Projections

8 NEJM 1980; 303: OR The failure of success - Ernest Gruenberg Milbank Q Dec; 83(4):

9 Hippocrates 460 BCE

10 Never smoker BMI < 30 Physical activity 3.5 hours per week High intake fruits/veg/whole grain, low meat Ford et al., Arch Intern Med 2009;169(15):

11 Physician s health study 2,357 men Ave age 72 5 risk factors: Smoking DM HTN Obesity Sedentary lifestyle Arch Intern Med. 2008;168(3):

12 Released Impact Goal Control risk / promote health Aim: cardiovascular health by 20% CVD and stroke deaths by 20% Primordial prevention 4 health behaviors Non-smoking BMI < 25 Physical activity at goal DASH diet 3 ideal health factors Total chol < 200 Untreated BP < 120/80 Untreated FPG < 100 Lloyd-Jones et al. Circulation. 2010;121:

13 Obesity Trends Among U.S. Adults Behavioral Risk Factor Surveillance System, 1990, 2000, No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% CDC, 2015

14 60% 50% 40% 30% 20% % 0% Women Men Data from NHANES survey Ladabaum et al, Am J Med, 2014; 127(8):

15 Healthy people 2010 target 75% consuming 2 or more servings of fruit 50% consuming 3 or more servings of vegetables Fruit Vegetables

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17 Heart SCORE study 1933 participants Mean age 59 Community dwelling Allegheny Cty, PA 66% women 44% African American 1 person had all 7 components Ave of % with 5 or more Less with Age Lower income African American Bambs et al. Circulation. 2011; 123(8):

18 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% No chronic disease 4+ chronic diseases Hung et al. BMC Geriatrics 2011;11:47-58.

19 80% 60% 40% 20% % HTN Diabetes Cancer COPD Arthritis Hung et al. BMC Geriatrics 2011;11:47-58.

20 Changes in mobility disability Men Women Crimmins et al. J Gerontology Soc Sci 2011; 66B:

21 Over age 85 Dependent in activities of daily living Complex biomedical problems Multimorbidity Polypharmacy Complex psycho-medical situations Dementia Depression Frail Geriatric syndromes Warshaw et al. J Am Geriatr Soc 2008;56:

22 Certificates Certificates

23 Active Certificates (per 1 million beneficiaries) Year * Aged 65 and over

24 Rapidly increasing older adult population Increasing prevalence of chronic disease Evidence of increases in disability Limited number of geriatricians and PCPs How do we address this?

25 Interest in health and physical fitness Active in their own medical care Information age Pro-active Self-motivated

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27 Areas of highest longevity Live better as well as longer Named for demographers maps Personal interviews Looked for commonalities

28 Icaria, Greece Highest % of 90 year olds on the planet Almost 1 in 3 reach 90 20% less cancer, 50% less heart disease, almost no dementia

29 Move naturally Hara hachi bu Plant slant Drink alcohol, especially red wine, in moderation Ikigai or plan de vida - purpose Reduce stress Belong to a spiritual community Keep family first Surround yourself with people who have similar blue zone values

30 The 3-legged stool

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33 Ikaria Rochester

34 Albert Lea, MN Town of 18,500 7 lakes History as meatpacking town 60-65% overweight or obese AARP / United Health Foundation

35 Town meetings Personal pledge Community gardens Walking and bike paths Changes in Restaurants Schools Grocery stores Workplace Purpose workshops Walking moais Walking school bus

36 Community participation 60% of the city s restaurants 51% of employers 100% of its schools 27% of citizens 150 ambassadors Ave life expectancy increased 3.1 years Ave wt loss of 2.8 lbs. each 21% drop in absenteeism 49% decrease in health care costs in city employees Buettner, The Blue Zones Solution, 2015.

37 California Beach cities Manhattan Beach Hermosa Beach Redondo Beach 15 cities and towns in Iowa Naples, FL Hawaii Oregon Texas

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40 Behavior change in older persons present special challenges: multiple comorbidities sensory impairments reduced mobility psychosocial factors (loneliness, depression, loss of identity) dependency

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42 Health behaviors influenced by social network Smoking Obesity Happiness Influence extends to 3 degrees of separation Christakis and Fowler, N Engl J Med 2007;357: N Engl J Med 2008;358: British Medical Journal 337 (337): a

43 Movement from South Asia to Europe Complex changes Primary trends Increase in energy and fat intake Reduction in carbohydrates Switch from whole grains to more refined sources Decrease in fiber More meat and dairy Higher incidence of DM2 Obesity CVD Holmboe-Ottesen et al, Food and Nutrition Research 2012, 56:18891.

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45 To get moving in your Blue Zone, try some of these tips. Inconvenience yourself Have fun. Keep moving. Walk Make a date Plant a garden Enroll in a yoga class Ergonomic work station Activity exercise

46 To follow 80 % rule in your Blue Zone, try the following tips Serve and store Make food look bigger Use small vessels Make snacking a hassle Give yourself a daily reminder Buy smaller packages

47 To follow 80 % rule in your Blue Zone, try the following tips Eat more slowly Focus on food Have a seat Eat early

48 Try these tips to incorporate more plants in your diet Eat four to six vegetable servings daily Limit intake of meat Showcase fruits and vegetables Lead with beans Eat nuts every day Stock up

49 Introduce a glass of wine into a daily routine Buy a case of high-quality red wine. Treat yourself to a Happy Hour Take it easy

50 To realize your purpose, try the following tips Craft a personal mission statement Find a partner Learn something new

51 Use these tips to find a quiet space to slow down in your Blue Zone Reduce the noise Be early Meditate Sleep De-clutter

52 To strengthen the spiritual dimension of your Blue Zone, try these tactics Spiritual does not have to mean religious Be more involved Explore a new tradition Just go

53 These tips can help you create your family s Blue Zone. Get closer Establish routines Meals Holidays Put family first

54 Try these tips to build up the inner circle of your Blue Zone Identify your inner circle. Don t be a grump! Create time together Create a moai

55 Timing we are seeing changes in Demographics Health trends Healthcare reform Changes in lifestyle make a big difference! The Blue Zones focus on Activity Nutrition Connectedness

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