80 is the new 60:Successful Aging in the 21st Century

Italian Embassy, October 12, 2010

Lewis A. Lipsitz, MDDirector, Institute for Aging Research, Hebrew SeniorLife

Chief of Gerontology, Beth Israel Deaconess Med CtrProfessor of Medicine, Harvard Medical School

The World is Rapidly Aging

Life Expectancy is Increasing

The Duration of Disability is Decreasing

Fries J. Ann Intern Med 2003;139:455-9.

Declining Stroke Rates

Increasing Recognition of the Role of Micro-Vascular Disease in the Aging Phenotype

• Slow Gait• Cognitive (Executive) Dysfunction• Depressive Symptoms• Co-occur in 17% of elderly populations

Watershed Areas of the Brain

Wong, HH et al, Stroke 2001; ooo = watershed

The Heart-Brain Connection-The same risk factors that affect the heart also affect the brain.

-High blood pressure, in particular can cause cognitive loss and functional decline.

-The treatment of hypertension may be preventative.

Relation between CV Risk and Executive Dysfunction

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56 (n=16)

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100 (n=1)

42(n=14)

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CV Risk Score

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Pugh, JAGS 2003; 51:1439

Relation Between SBP and Executive Impairment

Kuo, J Geront 2004; 59A: 1191

Poor Diabetes Control and Cognitive Dysfunction

Munshi, et al, Diabetes Care, 2006.

Treatment of Hypertension May Improve Cognition

• Syst-Eur Trial (Lancet, 1998, Arch Int Med 2002): In 2902 elderly people with Syst HTN, Rx w/ nitrendipine for 3.9 yrs reduced the incidence of dementia by 62%.

• PROGRESS Study (Arch Intern Med 2003): Among 6105 elderly people with CVD, Perindopril/Indapamide reduced cog decline assoc’d w/ recurrent stroke by 34%.

• Cochrane analysis of Sx w/o CVD in SCOPE, SHEP, & Syst-Eur showed no combined effect.

Treatment of Hypertension Reduces Functional Decline (1984-1993)

Current Challenges and Opportunities

• Major Challenges. Preventing– Loss of Memory (Dementia)– Loss of Mobility (Falls and Fractures)– Onset of Disease (Heart Disease and Cancer)– Mortality, disability and pain.

• Opportunity: – Many of these conditions are preventable.

Memory Loss

Ηallmarks of AD in the Brain

The Amyloid Plaque

Neurofibrillary Tangles

PET Scans in AD

Therapeutic Advances for AD• Restore Acetylcholine: Aricept, Exelon, Reminyl.• Prevent damage: Memantine• Reduce CV risk: Treat HTN, cholesterol, diabetes• Reduce oxidative stress: Vitamin E, ?Vitamin C• Prevent inflammation: ?NSAIDS• Reduce amyloid deposition:

beta-secretase inhibitors, vaccine• Mental and physical exercise.

“Use it or Lose it”

*Willis, S. L. et al. JAMA 2006;296:2805-2814.

ACTIVE Trial - Advanced Cognitive Training for Independent and Vital Elderly*

• RCT of 2802 normal adults > 65 years of age.• 10 sessions, 60-75 minutes, over 5-6 weeks, 60% had 75

min. booster sessions. • Training in Memory, Reasoning, and Speed of Processing

improved these cognitive abilities.• Immediate improvements in speed of processing (87%),

reasoning (74%), & memory (26%).• 5 years later, better performance persisted in trained areas. • Speed of processing and reasoning groups receiving

booster did best at 5 years.

Volunteer Teaching Increases Brain Activity

Carlson, Experience Corps, JG 2009

Mobility Problems

• 30% of community-dwelling elderly, 50% of NH residents fall/ year.

• High injury rate, mortality, & service use.• 300,000 hip fx/yr, 50% need assist, 25% die• Falls cost $20 B in 1995, est’d $32 B in

2020.

Muscle Loss and Aging

Age

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Resistance Training Improves Muscle Strength at Any Age

•113% increase in muscle strength •12% increase in gait velocity •28% increase in stair climbing power• 3% increase in thigh muscle area

100 frail nursing home residents aged 72-98 years (mean 87) randomized to 10 weeks of progressive quadriceps resistance training or placebo.

RESULTS:

Bischoff-Ferrari, H A et al.BMJ 2009;339:b3692

Vitamin D Prevents Falls

Is There a Medicine to Slow the Aging Process?

“The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.”

-- William Osler

Anti-Aging Pills?

• Estrogen• Growth Hormone• Resveratrol• Rapamycin• Polypill: BP, Cholest, Aspirin,. Vit D, etc,

etc.

“…a sense of humor and a good glass of red wine every

day.”“The keys to long life are olive oil and port wine.”

Antonio Todde (113)Jeanne Calment (122)

Longest Recorded Lifespans

Social Networks

• Social connectedness through marriage, family, religion, housing

• Improves health, reduces mortality, enhances recovery.

21st Century Approaches to Healthy Aging

• Physical activity• Mental activity• Social engagement• Reduce cardiovascular risk factors

– Hypertension, High Cholesterol, Smoking• Proper nutrition:

– Calcium, Vit D, low fat, modest alcohol

For her 92nd birthday, Jane Bockstruck, strapped onto her instructor, took her first skydive (P.J. Jackson/AP).

Never Too Old!