“You can’t help getting older, but you don’t have to get old,” according to comedian George Burns. That might explain why he performed into his late 90s and won an Academy Award at the age of 79. Of course, aging is an inevitable biological process, but experts agree that we have considerable control over what that process looks like.
[train the brain]
Who gets dementia?
“A small amount of brain decline is common, but I would caution not to think it is inevitable,” says Dr. Joseph H. Flaherty, professor of geriatric medicine at Saint Louis University School of Medicine. Just because average scores tend to go down with age does not mean your score has to go down, he explains.
And what, exactly, is dementia? “It is a general term that describes a group of symptoms—loss of memory, judgment, language, complex motor skills and other intellectual function—caused by the permanent damage or death of the brain’s nerve cells,” according to the Alzheimer’s Foundation of America. Several diseases, including Alzheimer’s, can cause dementia. “As we develop, the brain grows. When it gets up as high as it can on the curve of life, some people might be higher on the curve than others. Then some people decline quicker than others, and people start the decline at different times,” explains Flaherty. “We have people who make it to 100 who have not had a measurable decline.”
Brain exercise
While genetics play a role, the Alzheimer’s Foundation says we can maintain brain health through mental workouts. “What is good for the heart—exercise—is good for the brain,” says Darrah Strickland, coordinator of the Clare Bridge memory care program at Solana West County in Ballwin. Residents begin each day with a physical exercise session before moving on to a variety of mental and social activities. “Learning new things and challenging your brain are two consistent messages from the studies of brain health,” SLU’s Flaherty adds.
Lifestyle counts
It is thought that senior brain health improves with good lifestyle choices in early life: not being overweight, not smoking and not overdoing alcohol intake. “And once you become a senior, we think physical activity becomes even more important for the brain,” says Strickland. Furthermore, studies confirm that continued education is a ‘protective factor’ against later memory disease, Flaherty says. “We don’t know precisely why. It might be that higher education challenges the brain to make more neurons; it might be that people with higher education have better socioeconomic status and better lifestyle habits.”
But education is far from the only way to keep the brain fit. “Stimulate your brain and learn new things, be engaged and curious. Social interactions and meeting new people also are challenging,” Flaherty advises. “For people who are still challenging their brains after retirement, the downhill decline will not be as fast as if they retired and sat on the couch watching TV.”
Learning to play a new musical instrument is an excellent mental workout, adds Strickland, who is a certified music therapist. Called the universal language, music speaks to people of all capacities and stimulates them. “You can take piano or guitar lessons, or just sing while you’re walking,” she says. Continually taking the brain into new territory is the key, Flaherty says. “This is my opinion—not necessarily wellproven yet—but it has to be learning something new and challenging.”
[it’s the back, stupid!]
Did you know?
“Sometime during life, 92 percent of people will be affected by lower back pain,” says Dr. Heidi Prather, professor of orthopedic surgery at Washington University School of Medicine. And the prevalence of back pain is greater as we age, she adds.
Keep moving
While wear and tear are the usual suspects, so is a lack of activity, explains chiropractor Brenda Kingen of Kingen Chiropractic Wellness Center in Brentwood. “If you keep moving, you keep the muscles around the joints strong. Most people who start to feel back pain think they should stop what they are doing, but it is better to remain active,” she says.
Desk Danger
“There is 10 times the compression on the back when sitting than in any other position,” Kingen points out. That explains why people as young as the 30s are showing up in doctors’ offices with osteoarthritis of the back. “People working at computers sit and look down all the time, and repetitive motions cause wear and tear,” Kingen says. “When you sit and lean forward, you reverse the normal curvature of the spine.”
Why me?
Heredity plays a role in back pain, Prather explains, by determining the characteristics of your cartilage. “It’s the biology of how you are made,” she says. “Some people are stiff and others are really agile.” The lumbar spine, five vertebrae between the ribs and pelvis, carries a heavy load and permits much of the body core’s movement. These vertebrae are separated by discs of flexible cartilage that cushion shocks and allow movement between bones.
Hydration
As you age, time is not your spine’s friend. Into young adulthood, intervertebral discs consist of a jelly-water material. Over time, people dehydrate and the discs wear out, Prather says. “By the time we are in our late 50s or early 60s, less shock is absorbed by the discs, and more shock is transmitted into bone. That starts to wear out the joints and causes a cascade of other events.” Not the least among them: arthritis in the lumbar spine.
Managing the pain
A short-term regimen of anti-inflammatory medication such as ibuprofen or prescription drugs may be recommended, but, “You do not want to take these drugs long-term without the supervision of your physician,” Prather says.
Also important to consider are workplace ergonomics, exercise and physical therapy. “That can mean an appropriate chair and getting up and down regularly during the day. We know aerobic exercise helps,” Prather says. “For 75 to 90 percent of people, back pain will resolve in three months. The recurrence rate can be high, so once their pain comes down they need to train the muscles around the hips to support the back better.”
“A good diet and keeping the muscles strong will delay the progress of arthritis,” Kingen says. “I also suggest periodic chiropractic adjustments, since we mobilize the joints to restore flexibility, which slows the wear and tear.”
The goal is to educate people so they can manage their back on their own, Prather points out. “You may not eliminate all back pain, but you can reduce it to where it’s manageable and you can do all the things you want to do.”
[bionic seniors]
Lifestyle counts
When the Six Million Dollar Man battled the world’s villains with bionic limbs in the ’70s, little did we know most Americans over 60 would be walking around with hip/knee replacements, not to mention war vets and their mechanical appendages.
Knee injuries are, by far, the leading musculoskeletal condition reported in the U.S., according to the National Center for Health Statistics. Orthopedic surgeons replace more than 719,000 knees and 332,000 hips annually. “I have been involved in joint replacement since the 1960s,” says Dr. Leo A. Whiteside of Missouri Bone and Joint Center and Des Peres Hospital. “When I started, we told patients their implant would last seven years. Now, I don’t want to guarantee 20 years of performance, but 30 years is possible with modest activity.”
What’s the problem?
Heredity, injuries and years of use take a toll on the wear surfaces separating the bones of the knees and hips. “Arthritis is a fancy term for saying the cartilage is worn off the bone,” says Dr. Micah C. Hobbs of Orthopedic Associates. “Before hip and knee replacements came along, patients just lived with pain and had limited function.”
Cartilage in the weight-bearing joints of children is about 3/8 of an inch thick, Whiteside explains. “But it thins as you get older and reaches equilibrium at a little less than a quarter of an inch.” When cartilage becomes too thin to separate the bone surfaces, “That’s the beginning of the arthritic degeneration of the joint,” he says. “Once you wear a joint surface, it has a very limited ability to repair itself. The cartilage cannot heal very well.”
The devil’s in the details
Patients will know when pain management is no longer a sufficient treatment, Hobbs says. “We look at history, age and activity level to determine whether joint replacement is reasonable. It depends on how your symptoms affect your ability to do things you enjoy.”
The implants are typically made of cobalt chrome, sometimes titanium or zirconium. Their longevity has significantly increased due to improvements in the plastic wear surfaces and the methods that secure implants in the bone, Hobbs says. A hip implant has a cup that fits into the hip socket and a femoral stem that is inserted into the thigh bone. The stem is topped by a ball that replaces the worn bone at the top of the femur. Knee implants replicate the joint surfaces of the original bone with stems fitted into the femur and tibia, the large bones in the upper and lower leg.
Implant costs vary, but are typically covered by insurance. Most patients will spend two or three days in the hospital, Hobbs says, but therapy begins immediately. “Usually you will be up and walking the same day, and within three months you will have a good idea of how much range of motion to expect.”
No pain, no gain
Patients are told to resume most of the activities they pursued before joint pain. “You should be able to get back into things with a low risk of falling,” Hobbs says. “But I tell patients to avoid impact activities such as running and jumping.” Modest physical labor also can be possible, Whiteside adds. “But the wear rate can be faster and we have to keep a closer eye on joints exposed to that type of stress.” He expects continued improvements in the technology. “We’ve made many improvements, but the implants are not as good as they ought to be yet.”
By Rick Stoff