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
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
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)
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 2007-2011, US Census Bureau, 2014. Neuroepidemiology. 2007 November; 29(1-2): 125 132
Lived 1875-1997 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
Year Life expectancy 1800 26 1900 47.3 (US) 2013 78.8 (US) Of all the people who have lived to be 65 or older, half are currently alive.
700 600 500 400 300 Thousands 200 100 0 2015 2020 2030 2040 2050 2060 US Census Bureau, 2014 National Population Projections
NEJM 1980; 303: 130-5. OR The failure of success - Ernest Gruenberg Milbank Q. 2005 Dec; 83(4): 779 800.
Hippocrates 460 BCE
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):1355-62
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):284-290.
Released 2010 2020 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;121:586-613.
Obesity Trends Among U.S. Adults Behavioral Risk Factor Surveillance System, 1990, 2000, 2010 1990 2000 2010 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% CDC, 2015
60% 50% 40% 30% 20% 1988-1994 2009-2010 10% 0% Women Men Data from NHANES survey Ladabaum et al, Am J Med, 2014; 127(8):717-727.
Healthy people 2010 target 75% consuming 2 or more servings of fruit 50% consuming 3 or more servings of vegetables Fruit Vegetables
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 2.3 5.3% with 5 or more Less with Age Lower income African American Bambs et al. Circulation. 2011; 123(8): 850 857.
20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% No chronic disease 4+ chronic diseases 1998 2004 2008 Hung et al. BMC Geriatrics 2011;11:47-58.
80% 60% 40% 20% 1998 2004 2008 0% HTN Diabetes Cancer COPD Arthritis Hung et al. BMC Geriatrics 2011;11:47-58.
Changes in mobility disability 60 60 50 50 40 40 30 20 1998 2006 30 20 1998 2006 10 10 0 50-59 60-69 70-79 80+ Men 0 50-59 60-69 70-79 80+ Women Crimmins et al. J Gerontology Soc Sci 2011; 66B: 75-86.
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;56:1796-1801.
8000 7000 6000 5000 4000 3000 2000 1000 0 Certificates 2004 2014 Certificates
Active Certificates (per 1 million beneficiaries) 200 150 100 198 201 201 204 200 186 175 178 162 154 135 50 0 20042005200620072008200920102011201220132014 Year * Aged 65 and over
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?
Interest in health and physical fitness Active in their own medical care Information age Pro-active Self-motivated
Areas of highest longevity Live better as well as longer Named for demographers maps Personal interviews Looked for commonalities
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
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
The 3-legged stool
Ikaria Rochester
Albert Lea, MN Town of 18,500 7 lakes History as meatpacking town 60-65% overweight or obese AARP / United Health Foundation
Town meetings Personal pledge Community gardens Walking and bike paths Changes in Restaurants Schools Grocery stores Workplace Purpose workshops Walking moais Walking school bus
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.
California Beach cities Manhattan Beach Hermosa Beach Redondo Beach 15 cities and towns in Iowa Naples, FL Hawaii Oregon Texas
Behavior change in older persons present special challenges: multiple comorbidities sensory impairments reduced mobility psychosocial factors (loneliness, depression, loss of identity) dependency
Health behaviors influenced by social network Smoking Obesity Happiness Influence extends to 3 degrees of separation Christakis and Fowler, N Engl J Med 2007;357:370-9. N Engl J Med 2008;358:2249-58. British Medical Journal 337 (337): a2338 42
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.
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
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
To follow 80 % rule in your Blue Zone, try the following tips Eat more slowly Focus on food Have a seat Eat early
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
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
To realize your purpose, try the following tips Craft a personal mission statement Find a partner Learn something new
Use these tips to find a quiet space to slow down in your Blue Zone Reduce the noise Be early Meditate Sleep De-clutter
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
These tips can help you create your family s Blue Zone. Get closer Establish routines Meals Holidays Put family first
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
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