Healthy Today, Frail TomorrowHealthy Today, Frail Tomorrow Jeremy D. Walston, M.D. Raymond and Anna...
Transcript of Healthy Today, Frail TomorrowHealthy Today, Frail Tomorrow Jeremy D. Walston, M.D. Raymond and Anna...
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Healthy Today, Frail Tomorrow
Jeremy D. Walston, M.D.Raymond and Anna Lublin Professor of Geriatric Medicine
Johns Hopkins University School of Medicine
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Fountain of Youth Search in 1513
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Was St. Augustine the Place?
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The Search Continued Near Naples…
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But ended in Havana 3 Weeks Later…
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Fountain of Youth Search Today
• Better Understanding of Aging
Biology Crucial for
– Fighting Chronic Disease
– Warding off Frailty
– Maintaining Resilience
– Facilitating a Long and Healthy Life
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• high energy levels
• good health
• clear thinking
• enjoyable social contacts
• meaningful activities
• to not trouble kids and
grandkids with their
problems
What Older Adults Want Now
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Biology of Healthy Aging Program (BoHA)
Approach not based on single disease state
• Focus on physiological systems that have broadest impact
• Requires interdisciplinary team science
– Basic Biological
– Clinical Physiology
– Medicine and Surgery
– Neurology, Psychiatry
– Bioengineering
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What We Know
• Very specific age-related changes take
place at cellular, physiological, and whole
person level
• Great variability exists between
individuals at older ages
• Disease states, as well as environmental
and genetic influences can accelerate or
slow biological aging processes
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Biologic Aging
Chronic Disease
- Depression
- Cognitive Decline
- Cancer
- Cardiovascular
- Diabetes/Obesity
Dependence
Disability
Chronic Disease
Early Mortality
Genes
Environment
Diet
Activity
Stress
Response
Systems
Energy
Metabolism
Weakness
Fatigue
Slowness
Weight loss
Acceleration Towards Frailty
Walston J, 2018
PhysiologyTriggers Symptoms Outcomes
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Lopez-Otin et al, Cell 2013
Progress: Biologic Aging
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Systems that Drive Frailty
• Energy Metabolism
– Mitochondrial Biology
– Endocrine Pathways
• Stress response systems
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Mitochondria
• Produce energy
(ATP) & free
radicals in almost
every cell in the
body
• Poor clearance
triggers free radical
production in cells
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Mitochondrial Aging
• Total mass decreases
• Power (ATP) generation wanes
• Excessive amounts of free radicals are
generated resulting in tissue damage
and chronic inflammation
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Stress Response Systems Are
Sometimes Activated with Aging
• Inflammation
• Sympathetic Nervous System (SNS)
• Hypothalamus Pituitary Adrenal (HPA)
Axis
• Renin-Angiotensin System (RAS)
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HPA Axis
Sympathetic
Nervous system
Aging Stress Response Systems
Renin angiotensin system
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Inflammation
HPA Axis
SNS
Aging Stress Response Systems
RAS
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Inflammation
SNS HPA
Axis
Chronic
Disease
DisabilityDepression
Altered Stress Response
Systems Have Consequences
Angiotensin
System
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If Not Fountain of Youth, Maybe
Fountain of Resilience?
• Complex etiologies are different for each
individual
• Diagnosis and treatment strategies will
need to be individualized accordingly
• Marked need for new diagnostic and
therapeutic approaches that target
underlying biology
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Biology of Healthy Aging Program (BoHA)
– biologic discovery related to the development of frailty and aging phenotypes
– diagnostics to find those at higher risk before conditions manifest themselves and to know which altered system to target
– treatments specifically designed to target and slow biological aging or aging-related disease processes
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Tips for Healthy Aging
Nutrition
Activity and Exercise
Prevention of Falls and Injuries
Prevention of Cognitive Decline
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‘Keep Trying New Things’Advice from runway model Wang Deshun, at age 80
• Learn a foreign language
• Study yoga
• Volunteer to tutor kids
• Write poetry
• Explore spirituality
• Volunteer for religious
organization
• Improve your computer
literacy
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Healthy Aging Tips on Twitter
@JeremyWalstonMD
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Acknowledgments
• National Institute of Aging (NIA)
– Older Americans Independence Center
– Physical Resiliency Study (SPRING study)
• BoHA Program Faculty & Staff
• Division of Geriatric Medicine and Gerontology
• Discovery Fund for a Long & Healthy Life
– Salisbury Family Foundation
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Optimizing Nutrition
• Eat fresh fruits and vegetables, beans and nuts (75% rule)– Provide potassium
– Cancel out acid production from meat and fats
– Anti-inflammatory
• Don’t add salt
• Don’t overcook
• Eat fresh berries
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Optimizing Nutrition
• Protein intake
– Protein helps older adults
maintain muscle
– Older adults may need more
– Seek high quality protein
– Eat ~30g in 2-3 hours after
exercise to maximally stimulate
muscle growth
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Supplements: Vitamin D
• Ensures muscle, brain, bone and immune
system health
• Sources: milk, oily fish, mushrooms, eggs,
meat
• Can be monitored with blood test
• Direct sunlight exposure helps activation
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All Types of Physical Activity Are Important
Aerobic
Activity
Balance & Gait
Exercise
Muscle
Training
Flexibility
Training
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Optimizing Physical Activity
• Protect vulnerable joints
• Women: don’t forget the
shoulders
• Deal with orthopedic
issues promptly to prevent
disabilities from developing
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Optimizing Physical Activity
• Stay active
• Don’t sit for long
periods of time
• Pick up activity later
in the day if you are
sedentary.
<60
60 – 67
68 – 74
> 75
Schrack et al, JGMS 2014
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Fall Prevention Strategies
• Be aware of risk factors
– Too much medication
– Balance and gait problems
– Lower extremity weakness
– Low lighting and cluttered living area
– Vision problems
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Fall Prevention Strategies
– Tai Chi and other balance focused exercises
– Lower extremity strengthening
– Medication review
– Housing assessment with friend or family
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Cognitive Risk Factors
• Poorly controlled diabetes
• High cholesterol
• High blood pressure
• Poor hearing
• Physical inactivity
• Depression
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Cognitive Protection
• Treat diseases and lipids
• Get hearing aids if needed
• Increase activity levels
• Get depression treated
• Read more
• Interact with others, make new friends, and
be engaged in meaningful activities