The Best Years of Our Lives?

By Dennis Boone

It’s almost unfair, really: You spend decades working your way into a leadership position at a large corporation, or equal amounts of time building a business from start-up to a thriving, sustainable enterprise.

“In general, obesity rates are higher for those individuals aged 65 to 74 compared to all adults in America.” — Shadrach Smith, MD, Kansas City Internal Medicine

Then, just as you near the border of the Promised Land, it all catches up with you:
the long days, the late nights, the lousy diet, the stress, the missed sessions at the gym. And not too far over the horizon is what senior wellness author Chris Crowley has dubbed The Waterfall—the rapid decline that will soon usher you to the Big C-Suite in the Sky.
What’s happening in those critical years, from around age 50 to a retirement in the late 60s or early 70s, is part of a natural process that can be sped up by bad choices in life—or strung out by better behaviors that can keep you on your game during the most critical years of your career, as measured by earnings potential.

But in terms of the physiology of aging, “there’s a big difference between age 50 and 85,” says Peter Holt, a physician with Saint Luke’s Health System’s Plaza Primary Care and Geriatrics. “When we talk about geriatrics, we’re not talking about those who are 50 or 60 or even 65, we’re talking about those who are 70 to 85. So maybe the question is, what can that executive do at 50 to 55 to not become that geriatric patient at 75 or 80.”

As it turns out, there’s quite a lot that can be done, area medical experts say, to remain highly productive at work.
During the rush of day-to-day business, it’s easy to overlook what’s happening inside your body as the calendar flips. So it’s increasingly important to recognize that age brings on a huge variety of changes that are both physical and mental—from a steady loss of muscle mass after age 50 to impaired vision, from the softening of bones to the onset of arthritis in the joints, from cancer and cardiac issues (see Ingram’s April and October issues for more detailed reports on those two killers)—even issues with your teeth can speed the current leading you toward that waterfall.

More broadly, executives of all ages are staring at a wide array of workplace productivity issues linked to aging. After all, the advance of the Baby Boomers into retirement age—and the decisions by many to keep working well past 65—mean that millions of Americans in the rank and file will be produce a work force that’s grayer than ever. That trend will hold up through 2031, when the last of the Boomers hit the retirement age of 67.

We wrap up this year’s Executive Health Series with comments from some of the region’s top physicians in a number of those areas of specialization. If there’s a common denominator to what they have to offer by way of advice, it’s this: No matter what ails you—and no matter what bad health choices you might have made for many years—it’s never too late to make improvements in your overall health. And that’s a message you can, by force of example, impart on those who work for you, as well.

Let’s start with the, um, elephant in the health-care room. Obesity is well-known as a prime driver of numerous health issues: high blood pressure, heart attack, diabetes, bone and joint issues—the list is a long one. The concern for those approaching retirement, or who have deferred it, is that they’re battling a numbers game, says Shadrach Smith, a physician with Kansas City Internal Medicine.
“In general, obesity rates are higher for those individuals aged 65 to 74 compared to all adults in America,” he said. “For example about 35 percent of Americans are obese, compared to about 42 percent of men ages   65 to 74 and 40 percent of women.”

The trend, he said, is for peak rates of obesity to occur at age 55 and then to gradually decline. But there’s at least one good explanation for why the obesity rates fall to 27 percent for men and 29 percent of women older than 75—obesity has thinned the herd.
And the challenge for patients, Smith said, is that weight alone is not an indicator. Changes in body composition are important to know and track, as well as knowing the specific locations of body fat deposits.

“Excess fat in the abdominal area tends to be more associated with cardiovascular disease and Type-2 diabetes,” Smith said. “What we normally see with aging is a decrease in muscle mass, with an increase in total body fat before the age of 55 and a slight decrease following age of 55. Therefore, individuals greater than 55 are not as strong (less muscle) as younger individuals at the same weight.”
There really is a physical component to the Young Turk/Alpha Lion workplace dynamic. As Smith points out, “those in their late 50s or 60s will not be as strong, may have less stamina, or may be on multiple medications that have their own side effects such as low blood pressure or low blood sugar.  In addition, secondary to arthritis, their joints may be stiffer so they may not be as agile or move as quickly compared to the younger worker at the same weight.”

Addressing those issues, he said, can entail assessments to find medications that are more weight-friendly or don’t exacerbate other conditions brought on by obesity.

“We also find that many older individuals are very set in their ways in regards to both diet and exercise,” he said, so “we spend more time with them helping design an activity plan and eating plan that better fits into their normal eating and activity habits.”
Treating obesity also entails understanding different motivations for weight loss. “They may be more motivated to lose weight in order to be more active, decrease the number of medications they take, or be around longer to enjoy their grandchildren and other family members,” Smith said. “So in general, we find that the older individual tends to be more motivated to lose weight compared to the younger ones, but may have difficulty in changing unhealthy habits that were formed many years ago.”

Those habits can be broken with diets that focus not only on weight loss, but by incorporating macro-nutrient and micronutrient supplements such as calcium, B vitamins, and vitamin-D, Smith said. On the physical side, group exercise classes, yoga and Pilates, or water aerobics—even something as simple as walking can help address this killer condition.

“We are seeing more and more health programs started, helping senior citizens become fitter, with weight loss being a secondary goal,” Smith said.

There’s no getting around it: As people age, the body’s infrastructure changes. “Bones become softer, muscles begin to lose tone,
the cartilage that holds things together can start to decline, joint fluid can start to decrease,” says Holt. “It sounds terrible, but there is a general decline in the infrastructure as people get older.”

It all comes down, he said, to a single word: Degeneration. The good news here, Holt said is that “it’s never too late to start. The benefits accrue almost immediately in terms of fitness, in terms of your endurance, in terms of risk reduction for the things we talked about in terms of infrastructure.”

Use It Or Lose It, he said, is exactly the issue for maintaining one’s ability to perform at a high level—at work or at play. “And it can be any kind of exercise; it does not need to be running,” Holt said. “ You don’t need to do a marathon, just good, consistent, regular physical exercise. Stretching is as important as anything, but toning is also extremely helpful.”

That doesn’t mean you have to embrace the training regimen of a power lifter, he said, but something with at least a minimal level of resistance can tone the muscles, so no flopping down on the sofa after dinner. “Get up and get moving,” Holt said. “That will go a long way toward preventing the injuries and disabilities associated with infrastructure changes as people age.”

Smith, of KCIM, noted that a hidden change in that infrastructure comes with a natural thinning of the bones, which also results in a decrease in total body weight without a significant change in total body fat. So as people age, he said, “while their weight may decrease, their muscle mass and bones maybe the main source of the weight loss with less fat loss. This may be especially true for women as well.”

Arthritis and the Joints
How does one make a distinction between minor aches and pains—the kind of things that many simply write off because “I’m just getting older”—and conditions that warrant evaluation by a specialist?

For Herbert Lindsley, a rheumatologist at the University of Kansas Hospital, the line of demarcation is impaired function: If impaired movement in a joint or pain in your back is hindering your productivity, it’s time to see your family physician, if not a specialist.
“The most obvious sign of deterioration we see is cartilage loss,” Lindsley said, “but there is also development of joint deformity, the knees can begin to angulate, instead of remaining nice and straight.” There’s also joint deformity in the hands, with  rheumatoid arthritis as well as osteoarthritis, in which bony enlargements on both the proximal and distal interphalangeal joints.  

Much has changed in our understanding of the way arthritis develops, he said, but there’s a great deal that’s unknown about the triggers.

“We know that people who were athletes at a younger age who injured a joint probably  will have osteoarthritis develop at an earlier age,” Lindsley said, “But because that takes 10-20 years, it’s hard to identify specific causes.”

That’s not entirely the case with the knee, where mechanical stress contributes to the low-grade inflammatory process, he said, “and weight is one of those issues.” But on top of that, “we haven’t figured out a way to slow down the process of cartilage loss,” he said. “As cartilage disappears, you lose that resistance, that cushioning effect, and you begin to injure the bone below the cartilage.”

One concern he has is that with these conditions being consequences of aging, America is looking at a monstrous expense for osteopathic procedures. “The figure I carry in my mind is that we do more than 100,000 knee replacements a year” in the U.S., he said. “That’s a significant health-care expense.”

As did other physicians, Lindsley recommends exercise to get the weight off, relieving stress on the joints. “Certainly regular exercise benefits obesity and osteoporosis,” he said. That, plus use of over-the-counter and prescription drugs, can provide a comprehensive treatment program.

Like any other part of the body, the muscles and cells of the eye also change as we get older, says Nelson Sabates, an ophthalmologist who leads Leawood-based Sabates Eye Centers. “Are there things we do that can contribute to that? Absolutely. No. 1, not wearing sunglasses outside—the UV-added exposure to sunlight can affect the eyes, and that can produce cataracts more readily if you’ve been outside a lot and not taken care of your eyes.”

Age also brings higher incidence of age-related macular degeneration—“That’s always a big one,” Sabates says—and smoking also affects the eyes, just as it does the rest of the body.

“Usually, once we hit 40, that seems to be that magic number where people worry about their eyes a little more,” he said. “That’s usually the age when some start needing glasses for up-close reading, and we’re not able to do everything we were before with our eyes.”
From that point in life forward, Sabates recommends an annual eye exam to ensure that there’s no evidence of cataracts, glaucoma, macular degeneration—even non-ocular maladies. “The eyes are one part of the body that can pick up systemic diseases you didn’t know you had,” he said, including diabetes, high blood pressure and high cholesterol. “They are windows to the soul, and the only part of body where you can see an active artery, nerve and vein without cutting into the body.”

Too often, he said, it’s impossible to distinguish from garden-variety aging issues and serious medical conditions. “A lot of time, patients are saying ‘Oh, I’m just get-ting old, but the issue could be a cataract, a problem in the back of the eye, or a harbinger of other things.
Improvements in techniques and technology for eye surgery, plus advances in lens implants, have been huge changes over the past decade, often yielding immediate improvements that allow people to return to normal functions.

Dental Issues
For John Fasbinder, a Prairie Village dentist, it’s pretty simple: “What we find is—and there is literature to back up; it’s not a hunch—is that if you do not take care of your teeth, you usually have poorer health. We see diseases come from teeth that actually spread to other areas of the body.” Poor dental health won’t create heart disease, he said, but it can make that condition worse. “If you have a hip relaced, and don’t take care of your teeth, that can lead to an infection in the hip, or in a heart valve. There’s a highly significant, high correlation with disease.”

Which is why transplant physicians call dentists to request information on patient histories on candidates for cardiothoracic surgery. Poor dental health reduces a patient’s chances of selection.

Medications, as well, play a role, he said. “The meds we take that affect the overall health of the body, but they also affect the mouth. Lots of meds make your mouth dryer, which is common anyway as you get older, and if we don’t take care of the dryness, bacteria get more excited and can do more damage.”

To counter that, he recommends regular checkups, making sure that in between those sessions you’re brushing, flossing and using devices like a Waterpik to fight buildup.

“Going to the dentist is helpful,” Fasbinder says, “but it’s what you do on daily basis that makes the difference.”

Memory Loss
So . . . did you lose your keys—again—because it’s a habit dating to your youth, or because something more sinister is working on your mind after 50 or 60 years? It’s a question many of us simply don’t want to explore in depth.

But we should, says Stacy Younger of Johnson County Neurology and Menorah Medical Center.

“Everybody’s brain atrophies as they get older,” Younger says. “We’re losing neurons and losing neurotransmitters, chemicals that help the cells talk to each other. As far as anatomically slowing down, I don’t know that anything has been shown, other than that excess alcohol use will increase atrophy. Or if someone’s had a lot of little strokes, that will increase the aging process in the brain. So
we look at vascular risk factors like diabetes, hypertension and cholesterol levels.”

While many may consider matters of body and mind to be separate issues, they are not, physicians say. “As far as helping the brain function better, exercising the mind and the body naturally increases neurotransmitters,” Younger said. “Exercising the mind as well, meaning staying socially active, which would include working, is important. Talking to people and interacting with them if you’re not working, playing games, reading, computer activities—anything that involves using the brain.”

Excessive television, a passive activity, doesn’t count as “using” the brain, even if it’s processing the signals received. But those activities that do, Younger said, “even though they may not structurally slow down atrophy, they help the remaining brain work better.”

The big question most people will have is how to know whether normal memory loss has crossed over into something darker. “One thing is behavior,” Younger said. “If there’s a change in behavior, that would lead you to think it’s something more serious, like Alzheimer’s rather than a memory problem.”

If a patient says he’s having trouble with his memory, “that’s usually a good sign,” Younger said, “as opposed to if it’s a spouse, son or daughter saying that Mom is having trouble, and Mom says her memory is fine. That’s a very bad sign. If you’re able to recognize that you’re forgetting stuff, that means it’s a normal thing.”

In terms of work and career, most people will be retired before serious issues like Alzheimer’s interfere, she said. But even mild cases at early onset can be concerning, depending on what type of job a person has. “If it’s a job where people are relying on you (aircraft pilot, for example) and you make a mistake, or if you’re a physician, it could be bad to still be working at age 75 with dementia stetting in,” she said. “Other types of work, it may be OK, because you’re not harming anybody. But driving comes into play, too: When do you quit driving? A lot of times, you need formal neurocognitive testing to get more details on the extent of it and whether someone is still able to drive.”

Once again, though, exercise can make a big difference.

“There is fairly good evidence that physical exercise may be the single most important factor in maintaining cognitive function,” said Saint Luke’s Holt. “It’s a benefit for those concerned about muscle, bone and cartilage, but it also leads to a reduction of risk of cognitive decline. Unfortunately for most, it gets back to physical exercise, which is probably the hardest thing for most people who are working
because of the time commitment.”