The Rolling Stones, well before they became seniors themselves, may have said it best: “What a drag it is getting old.” Time undeniably takes a toll on the organs, brain, and muscles. Fortunately, though, there are ways to get an edge on age. Research into what scientists call “optimizing function” in old age is an especially hot topic now as the first of nearly 80 million baby boomers begin their march this year into 65-plus seniordom. Learning tactics for aging well is particularly critical for people with diabetes, who are at a high risk of becoming disabled. Here is what science has to say about staying able-bodied for the long haul.
The goal for many people as they age is maintaining their independence—in other words, avoiding disability. Being able to cook, shop, clean, and do all of life’s other little chores is essential for people who want to stay at home and on their own. The basic body functions that are necessary to accomplish these tasks include reaching, grasping, stooping, lifting, and, probably most important, walking. Functional disability means having trouble performing these activities of daily living and is a common side effect of aging in all living creatures.
“Declining function of aging is a phenomenon that is consistent across species,” says Marco Pahor, MD, professor and chair of the Department of Aging and Geriatric Research at the University of Florida. “Worms, as they age, move slower. Rats move slower. It’s likely due to a very basic biological mechanism related to energy metabolism.” These age-related biological changes lead to the loss and shrinkage of muscle that makes basic tasks more difficult.
Another reality of getting older is that it makes people more likely to develop diabetes, itself a leading cause of functional disability. A 2004 study in Diabetes Care found that people with diabetes are 2.4 times as likely to become functionally disabled as those without the disease, probably because of the effects of diabetes complications.
“You may develop diabetic neuropathy [nerve damage], so you don’t walk so well,” says Eric Rackow, MD, professor of medicine at the New York University School of Medicine. People with diabetes “can develop eye problems, retinopathy, so they don’t see so well,” he adds. “If you don’t walk so well and you don’t see so well, those are functional limitations.” Another factor in disability is depression, which also is more common among people with diabetes. The 2004 study found that people with both diabetes and depression are 7.2 times as likely to develop functional disability as people without either diabetes or depression.
A Two-Way Street
Yet a common misconception about aging is that life is just a plodding march down a one-way path of deterioration. Just because someone becomes disabled in old age doesn’t mean he or she will stay that way. “About 70 to 80 percent of older persons will regain independence after an illness or hospitalization,” says Thomas Gill, MD, director of the Yale Program on Aging. “These same folks will likely have subsequent disability episodes. Older persons are moving in and out of disability.” So rehabilitation is a possible outcome, even a likely one.
The truth is that for most people who become disabled, there’s typically a trigger. “A lot of the work in the field is focused on risk factors that make a person vulnerable for developing bad functional outcomes,” says Gill. “It’s not those risk factors themselves that cause disability; bad things happen. It’s usually an illness or an injury, or something along those lines.”
About 7 in 10 cases of disability among older people can be attributed to a particular event, says Gill, usually something that requires hospitalization. Heart attacks and strokes commonly lead to being hospitalized and subsequently disabled. This is one more reason that people with diabetes, who are prone to cardiovascular disease, are at such high risk. Gill adds that falls, while less common, are the event most likely to precipitate disability.
How to avoid these unpleasant events and outcomes? The first step is to accept the real possibility that they can happen. “It’s a common phenomenon in health that people tend not to recognize their problems,” says Rackow. “Number 1, people really need to understand their status . . . either by self-assessment or by going to a doctor.”
One way to measure functionality is the “get up and go” test. The person being assessed sits in a chair, crosses his or her arms so they can’t be used for support, and then tries to stand up. Someone who can’t stand has “substantial weakness in the lower extremities,” says Gill. After standing up, the person is told to walk. How far, fast, and steadily the person is able to walk can be used to predict disability risk.
After evaluation, it’s time to make a plan for preventing disability. For people with diabetes, keeping blood glucose under control can help keep the nerves and eyes healthy, which in turn reduces the risk of taking a nasty spill. Blood fats and blood pressure should also be kept within target ranges to lower risk for the heart attacks and strokes that typically end in hospitalization.
Avoiding falls is a key to aging well. A big contributor to falls is a condition called postural hypotension. This basically means getting dizzy upon standing or sitting up because of a drop in blood pressure. Medications can cause postural hypotension, and since older people with diabetes often take several medications, they can be at risk for the condition. To reduce their risk of falling, Gill recommends that his patients flex their ankles 10 times before standing, and then hold still for a count of 10 before taking a step.
Creating a safe home environment can also prevent injuries that lead to disability. “Don’t have a throw rug in the hallway,” says Rackow, who is also president and CEO of SeniorBridge, a company that manages the care of older people in their own homes. “Have a grab bar in the bathroom and a toilet seat that is high, so people can have an easier time getting up.” Reducing clutter, having a good stepping stool, and keeping walking areas free of cords or other obstacles can also increase safety, as can using a cane or walker.
The best way to stay strong and independent, most experts agree, is to exercise. “Exercise slows the consequences of aging. In terms of physical function, disability, and mobility, physical activity is the most promising intervention,” says Pahor. No medication being tested to slow the effects of aging, he says, has been “as astonishing as physical activity.” And Gill says that people who exercise regularly before becoming disabled are the ones more likely to eventually regain their independence.
A major National Institute on Aging clinical trial, the Life (Lifestyle Interventions and Independence for Elders) study, is under way to test the hypothesis that exercise is king. The target population is seniors at high risk for becoming disabled; a quarter of those recruited so far have diabetes. Participants will either simply receive education on successful aging or undergo an exercise program that includes 30 minutes of walking five days a week, plus resistance training with ankle weights. After about four years, the researchers will count how many people have become disabled to see if the exercise helped. “This is designed to be the definitive study,” Gill says.
Whether your idea of exercise for health is walking around your neighborhood or practicing yoga or tai chi, any foray into physical activity by older people should be initiated gradually, says Pahor, who is heading up the Life study. Participants in the study are encouraged to walk at a rate they feel is challenging but not too strenuous. “For younger people, you can look for a target heart rate” to set a walking pace, Pahor says. “In older people, there is no objective measure; heart rate regulation is compromised for many reasons, so it is not a reliable indicator of exertion.”
Exercise may one day be joined by medication as a means of staving off disability. Trials are currently testing whether testosterone (in men) or aspirin can keep seniors functional by preventing muscle loss or easing blood flow, respectively. Other drugs are in the pipeline, too, but all are in an early stage of development. Gill says researchers want to know whether medications alone can be effective or need to be paired with exercise to work.
Aging is inevitable, of course, but people can still exercise, so to speak, some control over their future. Good old physical activity remains science’s best formula for preventing, slowing, and reversing disability in old age. Staying strong may prove the Rolling Stones wrong after all.