Meghana Gulawani
Interview
*Some answers may be shortened
1. What are some actions that lead to degenerative diseases in the elderly? Are these actions preventable?
It is important to mention that severe brain damage cannot be reversed. However, certain factors such as education, exercise, and good health not only improve some mild losses but may prevent worse ones. According to the World Health Organization approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential [Lisko et al., 2021]. Of these, activity may be most important. Because brain plasticity is lifelong, exercise that improves blood circulation not only prevents cognitive loss but also builds capacity and repairs damage. In fact, even more than nutrition and mental exercise, physical movement prevents, postpones, and slows cognitive loss of all kinds.
Companions are particularly important during old age. As socio-emotional theory predicts, the size of the social circle shrinks, but close relationships are crucial. Bonds formed over the years allow people to share triumphs and tragedies with others who understand and appreciate them. Siblings, old friends, and spouses are usually the common companions. The specifics may differ with each person; with some elders relying more on partners, some on adult children, some on friends. In every case, however, active social connections (visiting, chatting, eating together) are important. Lonely elders have higher rates of mental and physical problems, including clinical depression, heart disease, fibromyalgia, dementia, insomnia, stroke. Some unhealthy habits such as excessive alcohol, smoking and drug use play a role in the increase of cognitive decline as well.
2. How does one cope with feelings of isolation and loss of self in later years? Do you have any tips as to how they can regain a sense of control?
In addition to nutrition and the factors mentioned above, attitude plays a major role as well. What matters is who the elderly think they are. Usually, self-maintenance correlates with a sense of control. A positive attitude and a sense of control are very important for mental health and longevity.
What matters is the perception of the isolation. Some older adults prefer to be alone, especially after retirement. If financial responsibilities do not place a burden, then this lifestyle offers a chance to make their own choices, live by their own rules and pursue activities or hobbies they didn’t necessarily have an opportunity to pursue during their working lives. In that sense, if this isolation is perceived as independence, the sense of control remains. On the other hand, if it is forced or as a result of lack of social support or perhaps as a result of death or separation, it may lead to additional stress, increasing the impact of potential impairment. Usually, companionship is a very important factor related to mental and physical health in the older population.
A survey in one Japanese city (Ikoma) assessed everyone over age 74 living in the community, not certified as needing long-term care. Over 12,000 people were asked to fill out a standardized frailty measure, specifically a checklist of 25 questions that measured ADLs (Activities of Daily Living), IADLs (Instrumental Activities of Daily Living), social interactions, and mood. What correlated with the improvement? Prior work had considered biological measures — diet, better health care — that had nudged people toward better health. This study focused instead on social factors. Three of them, “trust in community, interaction with neighbors, and social participation,” were even more significant than biological factors. In practical terms, this means that older people need to play games with friends, take walks with relatives, join campaigns for political office, attend worship services, work for clean water, or whatever. Yes, senescence (the process of deterioration with age) is inevitable. No, frailty is not. Finally, having pets also has shown benefits for some elderly in ameliorating the sense of loneliness.
3. Do you think the effects of degenerative diseases can be assuaged by practices like exercise or mental stimulation through puzzles or other activities (in addition to necessary medication)?
Aging and cognitive decline are two of the main causes that lead to the onset of neurodegenerative disease and are identified through a progressive evolution of brain and motor symptoms. Physical activity and exercise can improve mobility, autonomy, and functional skills. Moreover, cognitive functions have positive effects on the quality of life and well-being. Physical activity improves health. In addition, exercise can be effective in improving cognition, independent functioning, and psychological health in adults over 65 and sedentary adults with the diseases typical of this age group. A recent review by Kramer et al (2006) highlighted the beneficial effects of exercise on cognition and brain health in the elderly, suggesting a possible correlation between the improvement of cardiorespiratory activity and cognitive functions. According to the United States Centers for Disease Control and Prevention (Haskell et al, 2007), 150 min/week of moderate-intensity aerobic exercise are enough to reduce the probability of acquiring the vascular risk factors.
Research has also linked mental stimulation with the decrease of cognitive deterioration. Older adults who learn technology or spend time online either on social media or learning new technology skills, tend to benefit in two ways. First, as a result of the continued stimulation that these activities provide and second, this offers an online community which assuages the concerns of loneliness.
4. In your opinion, what are some practices for physical and mental health that can prevent (not cure) worse conditions?
Even for the oldest-old, some movement is better than none. A remarkable study in Australia found that an exercise program improved health for people with major neurocognitive disorders, living in long-term care facilities (Traynor et al., 2018).
A theory called the ‘Activation theory’ has been proposed by professionals. According to this theory, older people want to and need to remain active in social spheres such as with friends, relatives and community groups. They become withdrawn only unwillingly, as a result of ageism. And they suffer as a result of it as well. This disengagement correlates with illness. Another issue that gets less consideration or discussion is the concept of ageism, which is discrimination on the basis of age. For example, as people age, their well-meaning adult children may restrict their physical and mental activity. How common is it to hear things such as, “Do you really have to spend all that time gardening?”, “Why don’t you hire someone else to cook for you?”, “Do you know you can save your grocery trips by ordering things to be delivered to your doorstep?” This is the age group where organ reserve is naturally depleting. "Organ reserve" refers to the ability of an organ to successfully return to its original physiological state following repeated episodes of stress.
For majority of physically healthy individuals, it is the physical activity, engagement and independence in their daily chores that keep them healthy and active. However, by taking that independence away and limiting the activity, places them in the risk of further decline, which could have been preventable. Instead, to prevent frailty, everyone needs to encourage older people to move.
6. Finally, do you have any further advice for our audience?
Prevention is best but not always sufficient. Some problems, such as major neurocognitive disorder or severe heart failure, can be postponed or slowed but not eliminated. However, when prevention is a possibility, older adults need to keep busy. Engaging in social activities such as inviting people home, visiting others, attending social events, taking classes they enjoy and joining community events or clubs, etc. are examples of activities that promote activity theory.
Ageism was mentioned earlier. In my experience with caretakers, including health professionals, when communicating with the elderly (healthy as well as those dealing with NCD), many of the caretakers make certain assumptions that may not be true. For example, speaking is a high volume, speaking very slowly, emphasizing each word, bending down or sitting down when talking to the older adults, repeating the same sentence over and over again, etc. These practices would make sense if a person suffered from hearing impairments or certain cognitive impairments or language difficulties, etc. However, majority of the population in this age group does not suffer from these difficulties. In that case, it may feel insulting or condescending to many of them. Therefore, these generalized assumptions that every older person is hard of hearing or lacks the capacity to understand normal speech, need to be corrected and most of us need to empathize with people by treating each person as a unique individual. Over time, ageism becomes a self-fulfilling prophecy, a prediction that comes true because people believe it.
Treat older people as if they are frail and confused, that treatment itself makes the elderly become more dependent.