Aging in the Hudson Valley, Part II: Staying Healthy
by Constance Young

"Demography Is Not Destiny," the title of a 1999 brochure put out by the National Academy on an Aging Society, alludes to a universal truism. Just because population statistics define a person as "old" does not mean he or she is crotchety or disabled. In fact, according to the same report, disability rates in the U.S. among men and women aged 65 and older have been declining—down 1.2 percent per year between 1982 and 1994—and still falling. The elderly of today "are healthier, wealthier, and better educated on average than the elderly of any previous generation," the report concludes.

We are living longer too. According to the National Center for Health Statistics (2005), between 1899 and 2002 life expectancy at birth for men increased from 48 to 75 years and for women from 51 years to 80 years. Moreover, centenarians are the fastest growing segment of our population, while people aged 85 and older are the second fastest growing segment (in July 1, 2004 they totaled 4.9 million people).

Secrets of the longest living people
In a CNN documentary aired December 30, 2005, host Anderson Cooper interviewed some of the world's longest living people. The documentary was based on a December 2005 cover article that appeared in National Geographic chronicling three communities inhabited by the most long-living people in the world. The Japanese island of Okinawa heads the list. Second and third are the Italian island of Sardinia and the city of Loma Linda, California.

Keeping active. CNN Correspondent Atika Shubert interviewed Zenei Nakamura, a 90-year-old Okinawan fisherman who sees no reason to give up fishing because of his age. Nakamura's work entails swimming in the open sea, diving about 12 feet under water to chase fish into wading nets, then repeatedly hauling the heavy catch aboard his tiny boat. In a nearby village, Ushi Okushima, age 103, shows up for work every day selling tropical fruits. "We worked for long hours in the fields... grew and ate our own vegetables [and] never spent our money on extra food," Ushi said. Okinawans in general are quite active, says Shubert. If they are not in their gardens, they're out walking, or socializing.

Sociability counts. Ushi also has a busy social life and even a new boyfriend who, at age 76, is 27 years her junior. The ability to find romance at any age could factor into her longevity. "The Okinawan Way," a 20-year study of the island's centenarians, shows that elders there often have higher levels of sex hormones, suggesting that romance can help you live longer.

Humor helps. Ushi's tongue-in-cheek advice for aging gracefully is to, "Get a young man, the younger the better." Saying that, she offered to "fix up" the CNN correspondent. As it turns out, her audacious humor is another common element in long life—a characteristic that seems to echo in the stories of many long-lived people worldwide.

Optimism key. Optimism is another common personality trait among people who live long lives. Okinawans generally have an optimistic, almost happy-go-lucky sense of joie de vivre. Moreover, unlike America's "youth culture," Okinawan society does not turn away its elders. "The older you get, the more respected you are," says writer Dan Buettner, author of the National Geographic article. He adds that Okinawans generally have low rates of heart disease, cancer, bone loss and memory loss. "If you want to live a long healthy life... you should emulate the lifestyle of Okinawans," says Buettner.

Genes only 30 percent responsible
Whereas some people believe that genes determine longevity, many studies show that lifestyle factors can play as great a role. In a New York Times article on February 28, 1996, Jane Brody writes that contrary to common belief, the way most people fare in old age may not be a matter of fate, or genes. She cites the prevailing statistic that only about 30 percent of the characteristics of aging are genetically based, and the remaining 70 percent are not. Brody's chief source is Dr. John W. Rowe, director of the MacArthur Foundation Consortium on Successful Aging, who claims that "People are largely responsible for their own old age."

Health experts agree that being active, both physically and mentally, as well as being socially connected to family and friends is crucial for maintaining health. Canadian Tom Spear, who died last year at age 103, still played 18 holes of golf three times a week, consistently shooting 15 strokes under his age while in his 100s. He also enjoyed fishing, gardening, dancing and other activities until over 100 years old. For more about how Tom did it, read his autobiography, Carry On: Reaching Beyond 100, written with Monte Stewart.

Closer to home
These and a few other healthful lifestyle factors also contribute to long life among some local people. Lifetime resident of Pine Plains, Christine Finkel, age 99, is also active. She takes walks most days and loves to be outdoors in the garden, she says, and she still does her own housework. Christine also claims that she is "careful" about what she eats. Her Pine Plains neighbor, Ruth Greene, age 98, survived a hip fracture about three years ago but says, "I gets along very well using a walker." Ruth adds, "I take each day as it comes; it doesn't do any good to worry," and claims, "I have it pretty good."

Both Christine and Ruth were very upbeat in their conversations with me, which in both cases were sprinkled with bits of wry humor. Note Christine's statement about what she eats: there is strong evidence that a healthful diet is a key ingredient of a long life.

In Okinawa and elsewhere, good diet appears to correlate with a long active life. Craig Willcox, author The Okinawan Way, says that Okinawans eat lots of green leafy vegetables, which are very high in antioxidants that help control the aging process. Author Dr. Andrew Weil, recommends eating "fewer foods of animal origin, more fruits and vegetables, and making sure you've got omega-3 fatty acids in your diet." Omega-3's are available in fish, fish oil supplements, flaxseed and flaxseed oil. Dr. Weil also recommends reducing the consumption of quick-digesting carbohydrate foods, such as those made from white (non-whole grain) flour, sugar and high-fructose corn syrup. In addition, he suggests taking supplements, drinking green tea, and taking dark chocolate and red wine in moderation (because they have antioxidant properties). In Loma Linda, California, another of the model communities, Marge Jetton, 101, who had been a nurse most of her life, still bikes eight miles a day, power-walks and lifts weights.

Marge cites several ingredients to healthy aging—exercise, good diet, a sense of humor —and faith. Marge is a Seventh Day Adventist; a National Institutes of Health study shows that Seventh Day Adventists in California live 5 to 8 years longer than other Californians. One hundred-six-year-old farmer Elijah Spencer from Oconto County, Wisconsin, would agree. "Laugh a lot, pray a lot, and trust in the Lord," he says. Spencer also attributes his longevity to hard work.

In addition to maintaining physical activity throughout life, which includes walking, all experts agree on the need to reduce stress as much as possible. Dr. Weil recommends using breathing techniques, called pranayama in yoga. Instructions can be found in any book on yoga, or go to a yoga class, or consult a website such as www.abc-of-yoga.com. Retired Connecticut cosmetic surgeon Dr. Marj Cramer says that her personal regimen includes yoga, meditation and exercise—and she eats "a completely vegan, partially soy-based diet, high in organic fruits and vegetables."

Those "senior moments"
Dr. Thomas Perls or Boston University Medical Center says that exercise is crucial for the brain as well as the body. "The most powerful [exercise], would be learning a musical instrument or learning a language," he says. Perls claims that brain exercise can actually delay the onset of Alzheimer's disease for those who are prone to it, and delay memory problems in general. Other experts say that mental puzzles, including games like chess or jigsaw puzzles, can improve our thought processes (cognitive functions), foster spatial orientation and stimulate inductive reasoning. Use it or lose it, as they say.

In their book, Mental Fitness for Life: Seven Steps to Healthy Aging, gerontology experts Dr.Sandra Cusack and Wendy Thompson claim that you don't have to surrender mental clarity with age. You should spend as much time enriching your mind, which they call a "brain account," as you do a bank account. Dr. Cusak and Thompson recommend setting goals that reflect your purpose and passions.

Let me add, however, that if you are still worried about memory problems even though you try lots of mental exercise, consult a physician. Some memory loss has a biological basis. A few prescription drugs can stabilize symptoms and slow the progression of Alzheimer's disease and some types of dementia, as well as improve the quality of life for both patient and caregivers.

Depression
Depression in its many forms affects more than 6.5 million older Americans. Unfortunately, older people rarely seek treatment of depression even though treatment is usually effective. Untreated depression can have fatal consequences; and suicide rates are high among depressed elderly people.

Depression often results from a complex interplay of psychological, biological, environmental and genetic factors in the elderly, and can be difficult to diagnose because it can be complicated by other factors. For example, the symptoms of depression—fatigue, loss of appetite, difficulty sleeping—are also often associated with the aging process or a medical condition. Other contributing factors include the loss of a spouse or friend, chronic pain and illness, difficulty with mobility, and frustration over memory loss.

Once diagnosed, medication, psychotherapy, electroconvulsive therapy (ECT) or any combination of the three can effectively treat 80 percent of clinically depressed people, including the elderly. Drugs are also effective in most people with depression.

Coping with what we cannot change
According to Dr. Weil, the key to longevity is "delaying the onset, and reducing the risk, of age-related disease." These include cardiovascular diseases (including strokes), cancer, Alzheimer's disease, Parkinson's disease and macular degeneration of the eye. Despite the increasingly good news about aging, not all old people do well. Genetic factors (the other 30 percent) may contribute to chronic diseases such as Alzheimer's and Parkinson's, arthritis, and heart disease. Resilience, the ability to bounce back from distressing events and chronic disease, is a major factor separating those who age successfully from those who experience sharp physical and mental declines, says Dr. Robert Kahn of the MacArthur project.

Above all, it is important to get the right advice from a trusted physician or other health care provider, and to consider all of your options, even including non-traditional holistic healing methods. For example, acupuncture and massage, are known to help ease pain, even perhaps turn around certain chronic conditions of aging. Stress reduction techniques can also prevent or control certain diseases such as high blood pressure—a known risk factor for heart attacks and stroke. However, when dealing with chronic diseases such as diabetes or high blood pressure, prescribed medications are often lifesaving.

Medicare Part D and other drug plans
The current Medicare Part D drug plans have just completed their first sign-up year, amidst much confusion and uncertainty. If you still have not signed up for a plan and are not sure what is right for you, contact the Dutchess County Department of Aging and they will arrange a consultation. They will plug your medical and drug history into the computer, while also taking into consideration your lifestyle and attitudes, and help you decide what plan, if any, is right for you. As of this writing, every year you do not sign up for a Medicare Part D Drug Plan means an added penalty should you decide to sign up in the future. (In my personal opinion, this is a bad as well as unpopular decision. Moreover, I think the plan generally is confused and confusing, as well as geared more toward the drug and insurance industries than seniors. I hope that a change in Congress after next year's election will result in significant changes in the plan.)

In New York State, there are 47 competing Medicare Part D drug plans. However, New Yorkers are fortunate. We are one of the very few states that have a state plan—the Elderly Pharmaceutical Insurance Coverage Program plan, called EPIC. Depending on your income and needs, you can sign up for one of two EPIC plans. The deductible plan has no annual fee, but there is a sliding annual deductible depending on your income, and a co-payment on each prescription. If you don't use it, you pay nothing. The other EPIC plan is a Fee Plan, for which you pay a low annual fee depending on your income. The advantage of joining EPIC is that it protects you for that year against any Medicare Part D penalties should you want to sign up in the future for any other Medicare Drug Plan. For information on EPIC call 1-800-332-3742.

In addition, you may wish to choose a Medigap, or Supplemental Medicare insurance plan, which covers the gaps in Medicare coverage for hospital and/or doctor's visits. Some more populated parts of our region also have so-called Medicare Advantage plans, which can be HMOs or other types of plans. Rural areas do not have such plans because there are not enough doctors or a large enough population base to make it worthwhile for insurers. There are also long term insurance plans offered by many insurers. For more information about these plans call Medicare or go to their website or, contact the Dutchess County Department of Aging.

Personally, even after having had a consultation with the Department of Aging, I am still very confused about what's available in my area. My best advice is first to get the basic information from a local, state, or federal government source, then call your friends and ask them what insurance they have, and/or spend time on the phone with each of the plans in your area.

It is probably unlikely that you'll live forever, so I wouldn't recommend 57-year old inventor and scientist Ray Kurzwell's plan. Kurzwell believes that humanity will ultimately achieve immortality in perhaps 20 years. He bases his predictions on what he calls "carefully constructed scientific models that have proven accurate," and he lays them out in his book Fantastic Voyage: Live Long Enough to Live Forever. To that end, Kurzwell takes 250 supplements a day, drinks eight to 10 glasses of alkaline water and 10 cups of antioxidant-packed green tea, and doesn't tailgate.

While we probably will never live Kurzwell's dream, "the gift of longevity is within our reach if we are focused, disciplined and practice healthy lifestyles; seek early detection of disease; and prevent accidents and injuries from smoke and fires," according to E. Veronica Pace, Executive Director of the District of Columbia Office on Aging. The D.C. Office of Aging also recommends prayer, and taking a baby aspirin a day.

Ten Keys to Healthful Long Life

1. Stay active.

2. Be sociable. Loneliness kills. People with weak or few relationships run a two to four times greater risk of death than those with strong social networks.

3. Exercise your brain to offset or reverse memory decline.

4. Be optimistic. "Worrying doesn't help," says 98-year old Pine Plains resident Ruth Greene, while recuperating from a hip fracture.

5. Humor helps.

6. Eat a healthy diet rich in fruits and vegetables.

7. Reduce stress

8. Faith, religion or spirituality are helpful

9. Prevent and treat chronic disease.

10. When applicable, explore alternative treatments

Resources

• Dutchess County Office for the Aging: 866-486-2555, or www.dutchessny.gov/countygov/departments/aging/agindex.htm

• The Nation's Voice on Mental Illness: www.nami.org

• Depression Help Center: www.womens-menopause-health.com/Depression/elderly_depression.htm

• Medicare 1-800-633-4227, www.Medicare.gov

• Alzheimer's drugs: www.cnn.com/HEALTH/library/AZ/00015.html

• New Centenarian Study: If you know someone who is near to, or over 100 years of age, ask them to apply at www.bumc.bu.edu

• Dr. Andrew Weil's website on healthy aging: www.drweil.com/u/Home/index.html