Can we fend off chronic disease? The evidence says yes

We have all heard that physical fitness is an important factor in health, but how important a factor?  And is it ever too late to get fit?

A study published earlier last month in the Archives of Internal Medicine suggests that becoming fit in middle age, even if you haven’t previously exercised, can stave off illness later in life.

In the study, researchers collected medical records for more than 18,000 healthy middle-aged men and women who’d visited the Cooper Institute in Dallas, Texas for a check-up since 1970. Each subject took a treadmill test to determine their aerobic fitness at their first check-up. Then the researchers checked their Medicare records from 1999 through 2009.

The study found that people who were least fit at the time of their initial check-up were the most likely to developed chronic conditions such as heart disease and cancer early in the aging process. Those who were most in middle-age developed the same conditions, but significantly later in life compared to the less fit.

The take-home message of this study actually parallels a lesson shared in Karl’s book 30 Lessons for Living, which shares advice from America’s elders. The lesson is: It’s not dying you should worry about – it’s chronic disease.

This study provides evidence that you can actually do something to help prevent chronic disease later in life – exercise!

The study is backed up by several systematic reviews. One published in the Journal of Science and Medicine in Sport found physical activity helps prevent heart disease, cancer and diabetes. Another published in Obesity Reviews found individual who are overweight but have good aerobic fitness are at lower risk of cardiovascular disease compared with individuals with normal weight and poor fitness.

The bottom line: Physical fitness can help you lead a healthier, happier life no matter what your age.

New evidence: Vitamin D helps prevent falls

Vitamin D is one of those supplements that makes it into the news media frequently. Here on EBL, we’ve written before about the U.S. Institute of Medicine’s recommendations on Vitamin D intake.

Now there is a new recommendation that taking Vitamin D supplements can help prevent falls in people over 65 years old with a higher risk of falling.

In a review of nine separate studies, the United States Preventative Services Task Force came to the conclusion a daily dose of 800 international units reduced the risk of falling by about 17 percent, compared with those who did not take the vitamin.

“The exact mechanism is not known, but it seems to help muscle strength and balance,” Dr. Al Siu, vice chairman of the task force and chairman of the geriatrics and palliative medicine department at Mount Sinai School of Medicine, told the New York Times.

The panel also made two other recommendations.  Doctors should do a comprehensive assessment of patients’ risk of falling – including asking about falling history and observing patients stand up and walk – to identify those at higher risk. And patients’ should exercise to improve strength and balance.

Falls are the leading cause of injury in adults 65 and older. While there’s no sure-fire way to prevent them, we have evidence that some interventions do work. That’s important information for all of us to know.

Evidence of a need: Mental health workers

As the U.S. population continues to age, our nation needs to give some serious thoughts to caring for an older population. In 2010, there were 40.3 million adults age 65 and older in the U.S.  Over the next 20 years, that number is expected to climb to more than 72 million.  With it will come a number of new challenges, many of them for our health care system.

The U.S. government released a new report last week that took an in-depth, systematic look at how the mental health care system is equipped to deal with an aging population. Their review found that there are   5.6 million to 8 million older adults in America today have one or more mental health and substance use conditions, and that number is expected to soar as the population ages.

The report calls for a number of major changes to the U.S. health care system including:

  • A redesign of Medicare and Medicaid payment rules to guarantee coverage of counseling, care management, and other types of services crucial for treating mental health conditions and substance use problems so that clinicians are willing to provide this care.
  • Health care accrediting organizations should make sure that health care providers who see older adults are trained to recognize signs and symptoms of geriatric mental health conditions, neglect and substance abuse.
  • The U.S. Department of Health and Human Services should make it a priority to promote building a work force trained in geriatric mental health and substance abuse care.

The report also details the consequences of inattention to older adults’ mental health conditions clearly leads to include higher costs and poorer health outcomes – an outcome that our senior citizens and our health care system can’t afford.

The link between happiness and health

A positive mood can certainly make for a brighter day, but now there’s new evidence that is also makes for a healthier heart.

A systematic review by researchers at Harvard University looked at more than 200 studies on cardiovascular risks and emotional state – the largest ever reviewed in one paper. They found that patients who reported a positive mental state were less likely to suffer from heart disease and stroke.

Feeling such as optimism, happiness and hope seemed to protect against cardiovascular disease independently of risk factors like smoking and obesity.

While the link provides an interesting insight, it is difficult to tell whether happiness produces health, or whether healthier people are, by nature, happier. In either case, it’s prudent to cultivate a positive mindset.

At Cornell, psychologist Anthony Ong’s research focuses on how people maintain a positive attitude, even when they experience stressful events like the loss of a loved one. His work has shown that social connectedness – having a supportive relationships with those around you – contributes these daily positive emotions, and leads people to be more resilient in the face of adversity.

The take home message: Get out in your community and cultivate some good feelings!

Building and maintaining relationships is one key to healthy aging

There are some clear risk factors that lead to an earlier death such as smoking, alcohol consumption and obesity. But are there other factors that influence health and wellness later in life – behaviors that researchers have yet to study?

Until recently, one of those unknown factors was social relationships. Anecdotal evidence suggested that people with strong social relationships reduced their risk of mortality, but there was little evidence to back up the suggestion. While many medical studies included a measure of social isolation, no one had looked at the issue on a broader scale.

That is, until researchers at Brigham Young University conducted a systematic review of the literature on how social relationships impact the risk of dying later in life.  They reviewed 148 studies that included more than 300,000 participants that included information about how people died, their initial health status and pre-existing health conditions, as well as type of assessment of social relationships.

Over all the data they reviewed, they found a 50 percent increased likelihood of survival for participants with stronger social relationships. The lack of social relationships had more influence on mortality rates that other risk factors like physical activity and obesity.

The researchers noted that more complex measurements of social relationships – instead of simple indications such as marital status –  were more predictive of death.

The take-home message is that your relationships later in life are just as important as what you eat and drink, how much exercise you get, and other important health behaviors. More research is needed to determine how relationships improve well-being, and specific characteristics that contribute to the trend. In the meantime, it’s important for medical professionals to consider social relationships in their treatment plans for older adults.

Are antipsychotic medications helpful for nursing home patients?

A systematic review published in the Journal of the American Geriatrics Society looked at medical records nearly 84,000 nursing home patients in 45 states to determine if taking antipsychotic medications increased the risk of other medical problems, specifically heart attack, stroke, serious bacterial infections and hip fracture.

The review found that within 180 days of starting antipsychotic medicines, nursing home patients were at higher risk for bacterial infections, heart attack and hip fracture, but not at higher risk for stroke. The study also identified which specific medications lead to increased problems, and which doses proved to be safer for residents.

On the whole, this is exactly the kind of information that medical providers need to make the best decisions for patients with complex medical issues.  The scope of this study – encompassing thousands of patients across the nation – and detail of data about specific medicines and doses provides a roadmap to help residents stay healthy.

Can you boost your IQ? The evidence says yes

It’s an age-old question studied by researchers for more than a century:  Is there anyone to make your-self smarter?

In the early days of this inquiry, researchers were certain the answer was no.  But studies over the past two decade have proven otherwise.  Yes, you can raise your intelligence quotient, or IQ.   In fact, the very question was covered in a recent Wall Street Journal article.

While I didn’t manage to track down a systematic review of the topic, I did find a body of literature pointing to methods for improving your IQ.  One study that followed 250 adults over the course of six years found that people in jobs involving complex relationships, elaborate systems or difficult problems tend to perform better over time on cognitive tests.

Likewise, the work of Cornell Professor Steve Ceci has found that schooling raises IQ by several points a year, mainly because students are exposed to information and problem-solving often included in cognitive tests.

In another recent study, British students were given IQ tests and brain scans at ages 12 to 16 and again four years later. The students with significant improvements in IQ – 15 points or more – showed changes in gray matter in areas corresponding with their improvements.

Alas, the issue is complicated.  Another recent study tested adults using at Wii video game, reading and reference ability. While the participants showed improvements in what they practiced, their new-found skills didn’t transfer well to other areas, suggesting that learning for adults may be more narrow than for young adults and children.

Clearly, more research is needed. But it seems that we can say definitely that if you practice something – whether physical or mental – you will see improvements in that specific area.

Video feature: Q&A on decision-making

Most of us have seen it before.  Maybe it was a neighborhood boy riding his bike down the middle of the road, or a group of girls performing stunts on the diving board at the local pool. Whatever the circumstance, it’s fairly common knowledge that young people don’t always make the best decisions. In fact, it’s a topic we’ve written about here on EBL.  But given the stakes, it’s one worth revisiting.

Earlier this month, Cornell professor Valerie Reyna — an expert in decision-making  — was featured in a new video on the topic.  In it, Reyna explains the science behind decision-making in adolescents, as well as how the neuroscience of decision-making plays a role in other areas of our lives including health care and memory.

It’s certainly worth a watch!

Proof positive: T’ai chi helps improve health

Even if you’ve never practiced t’ai chi before, you’ve probably seen other people making the graceful, flowing movements that define this martial art.

T’ai chi is a Chinese exercise system that uses slow, smooth body movements and deep breathing to achieve a state of relaxation of body and mind. The practice is based on the Confucian and Buddhist belief that health is controlled by two opposing life forces, yin and yang.   

For at least 700 years, and likely much longer, people have been practicing t’ai chi as a way to improve health and achieve balance in their lives. While the practice has stood the test of time, is there any evidence that it really works?

The answer is yes.

A new paper published in the British Journal of Sports Medicine evaluates of 35 individual systematic reviews of t’ai chi to determine if the practice contributes to improvement of any disease or clinical symptoms.  The paper looked at a wide range of medical conditions – cancer, Parkinson’s disease, osteoarthritis and cardiovascular disease, to name a few.

Several of the systematic reviews reviewed in the publication reached conflicting conclusions. But there are two areas where health benefits of t’ai chi are clearly present – preventing falls in older adults and improving psychological well-being and overall health in people of all ages.

If you’re looking for a gentle way to improve your health, why not give t’ai chi a try?

How older adults make decisions

As the U.S. population continues to grow older and technology moves ahead at break-neck speeds, older adults are being asked – in many cases required – to make more complex decisions than ever before.

 Should they stay in their homes or invest in a senior living community where care will be available when they need it?  Which prescription drug plan is best?  What course of treatment is best for serious illness?

But are we giving older adults the information they need to make quality decisions? The evidence suggests that the way older adults make decisions differs substantially from the way younger adults do. Research conducted by psychologist Joseph Mikels and economist Kosali Simon, both Human Ecology faculty members, offers practical insights for improving older adults’ decision-making. Their findings are summarized in a paper created by Human Ecology’s Department of Human Development.

For starters, research has shown that emotional functioning and regulation improve with age. Older people report more frequent positive emotions and fewer negative emotions, and they are more likely to focus on, and remember, positive information. When helping older adults make complex decisions, it may be best to encourage them to focus on their feelings as opposed to the specific details. They may not only make better decisions, but also feel more satisfied with their choices.

Studies also show that older adults do not desire or value choice to the same extent that younger adults do. In a series of large-scale surveys, hundreds of adults over 65 and undergraduate students reported how many options they wished to choose from in a variety of domains, from prescription drug plans to ice cream flavors. Older adults desired on average less than half as many options as younger adults did.  When older adults face a decision, it’s better to present them with a reasonable number of options.

“For example, instead of listing all of the available home health care agencies in the area, first present the five or so most popular ones,” the paper suggests. “If the person you are assisting isn’t satisfied with any of them, present an additional few options. By restricting the flow of information in this manner, you will increase the odds of making a high-quality, satisfying decision.”

More evidence on living the good life

Last week, you read about an evidence-based center focused on social and emotional well-being.

Cornell psychologist Anthony Ong has dedicated his career on a related topic: how can some cope with life’s stressful events and still remain positive, while others spiral into negative emotions?

Ong’s work focuses on the complex interplay of social, emotional, cognitive, and cultural resources that people draw upon to adapt to stressful life circumstances as they age, and the ways these factors have an effect on health and well-being.

His research has shown that people who have positive emotions on a daily basis recover more easily from stressful events, both in daily life and major stressful events like the loss of a loved one. This work has raised the possibility that positive emotions are important factors in undoing the autonomic arousal generated by negative emotions.

Ong has found that this daily access to positive emotions actually creates a psychological antidote for people in times of crisis. The ability to experience a positive emotion despite a major stressor – such as a serious illness or the loss of a love one – provides a momentary respite from the ongoing stress.

A steady stream of positive emotions also leads to greater emotional and physical well-being. By undoing negative emotions and fueling psychological resilience, positive emotions trigger an upward spiral of contentment. This, in turn, creates a measureable difference in cardiovascular functioning.

 “When our positive emotions are in short supply — when we feel hemmed in by such negative emotions as fear and sadness — we become stuck in a rut and painfully predictable,” he said. “But when our positive emotions are in ample supply, we become generative, resilient versions of ourselves.”

Ong’s work has also shown that social connectedness – having a supportive relationships with those around you – contributes these daily positive emotions, and also leads people to be more resilient in the face of adversity. 

Based on findings from dozens of studies, Ong offers some practical advice for fostering positive emotions in everyday living:

  • Find meaning in everyday life through reframing adverse events in a positive light, infusing ordinary events with positive value, and pursuing and attaining realistic goals.
  • Explore relaxation techniques that create conditions conducive to experiencing contentment and inner calmness.
  • Make connections by reaching out to others.
  • Engage in activities that you enjoy and find intrinsically motivating.
  • Take care of yourself by eating right, getting enough sleep and engaging in regular physical activity.

Everything you wanted to know about the aging population

You would have to be living in total isolation not to know that American society is rapidly aging. But how rapidly? What’s happening to life expectancy, economics, health and related issues as our society “greys?”

The good news: Today’s older Americans enjoy longer lives and better health than did previous generations. These and other trends are reported in Older Americans 2010: Key Indicators of Well-Being, a unique, comprehensive look at aging in the United States from the Federal Interagency Forum on Aging-Related Statistics. This easy-to-understand report  provides an updated, accessible compendium of indicators, drawn from the most reliable official statistics about the well-being of Americans primarily age 65 and older. The indicators are categorized into five broad areas—population, economics, health status, health risks and behaviors, and health care. In addition, the site provides very nice Powerpoint slides of all charts.

No matter how old you are now, you are aging, so this information should be of interest to all of us.

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