Aging Well: A Clinician’s Approach

Healthful aging isn’t just up to chance

By Deborah Jeanne Sergeant

It’s not just about growing older. It’s about aging better.

Jinjiao Wang, registered nurse, assistant professor of nursing at University of Rochester Medical Center and director of the post-op program at UR School of Nursing, has training in gerontological nursing and serves as a co-editor for JMIR Aging, an open access journal that focuses on aging. She offered 10 tips on how to age healthfully.

1. Eat right.

“From what I have observed, I think that trying to limit processed food is a good idea and increase the intake of vegetables. I feel like in the States, people eat too much meat products. I’m not sure everyone needs that much.”

Wang grew up in China, where meat typically is used more like a flavoring and most meals include plenty of vegetables. But it’s OK to enjoy treats as well.

“Not every day has to be perfect,” Wang said. “If you want to enjoy some ice cream, have some. I don’t believe in denying yourself all the joy of food. I like the philosophy of feeding your spirit. Be true to how you feel and what you need.”

She encourages shopping at farmers’ markets to buy fresh foods and to socialize.

2. Stay active.

“People who age well stay active in two ways: physically and cognitively-socially,” Wang said. “The key to consistently staying active is to make it interesting and a habit.”

No one can sustain unpleasant forays in the gym. But meeting a friend for walking or taking fun dancing lessons or biking along a beautiful trail with the neighbor sounds much more pleasant and more social.

Meeting others for physical activity also builds in an element of accountability.

“If you like to read, keep reading,” Wang said. “Talk with your book reading friends. There are games you can play online. A lot claim they can improve your memory and processing speed. Give them a try and see if you like them. Have a hobby.”

3. Stay useful.

Depression can follow in the wake of feeling pointless.

“Volunteering can help people become more active and gives a sense of being useful,” Wang said. “It’s so important. You think, ‘Grandma is old; let me help her with everything.’ The opposite is what you should do. We no longer look at people as an accumulation of deficits. We focus on the strengths that people still have and try to optimize those. Grandma can no longer walk very fast, but she can cook. Give her an opportunity to still feel useful to her family. When they help with small tasks, they feel very fulfilled. We often don’t do
enough of keeping that in mind.”

4. Get preventive screenings.

Although primary care physicians should recommend screenings, it’s really up to patients to follow through.

“Advocate for yourself,” Wang said. “Speak up for yourself because no one else will.”

If you think you need to be screened early, ask about it. Seek preventive tests and screenings on schedule. Screening includes hearing and vision tests.

“Untreated hearing loss is a risk for depression,” Wang said.

It also has been associated with higher risk for dementia, as less of the brain activates when hearing areas of the brain are not stimulated.

Stay on schedule for dental cleaning and seek needed dental work right away. Dental infection that goes unchecked is associated with higher risk of acute coronary syndrome.

5. Speak up.

“Before you go to the provider’s office, keep a note of the questions you have,” Wang said. “There’s a stereotype with the older generation that they want to be a good patient which is one with fewer questions. There’s no such thing as a ‘good patient.’ If you have a need, say it. If you have a question, ask it. If you want to challenge what you’re doing, challenge it.”

6. Talk about your pills.

“Make a note of all the medications or take them all in a bag, including herbals and sleeping aids,” Wang said. “Ask your provider to look at all of that. You should always report if you have any symptoms.”

Unnecessary polypharmacy — taking medication no longer needed — can cause health problems and can be very costly. Wang belongs to the U.S. Deprescribing Research Network, part of an international initiative toward taking only necessary medication.

“We believe older adults are taking more medications than they need,” Wang said. “That can lead to falls, confusion, UTIs, depression, even mortality. In the U.S. whenever there’s a question, they pop a pill, which contributes to it. There are so many resources that are equally effective.”

Do not stop taking medication without discussing it with the prescribing care provider, she said.

7. Monitor chronic conditions.

“As people age, they often accumulate chronic conditions like hypertension and diabetes,” Wang said. “Know what your medications do and take them on time.”

8. Plan to age in place.

If you’re among the majority of people who want to age in place — that is, in your home — you must plan for it. Wang said that in addition to financial planning, care planning and advanced directives, it’s important to modify your home so that you can age in place safely.

This should include:

• First-floor bathroom, bedroom and laundry facilities

• The ability to install grab bars near the toilet and shower (If you’re remodeling, at least get the studs in the right place behind the drywall so the bars can be anchored to the wall when you need them.)

• Low-entry shower

• Wider doors (32” clear width is the ADA standard for accessibility)

• Few steps to enter the home

• Reduced clutter inside and out (Can EMTs make it inside your home and navigate inside in order to carry you out?)

“Think about what you need and areas you need to start renovating,” Wang said.

It’s better to start early while you’re doing other home renovation projects, as once you’re on a retirement income, renovation will be harder to afford.

9. Identify caregiving resources.

Long before you need them, learn about community and social resources that can help you age. Wang said that Lifespan is an excellent resource for aging well, for example. Oftentimes, church groups and other social organizations can provide aging support such as transportation, social check-ins and meal delivery during a recovery from illness. Consider talking with your family about multi-generational living arrangements. Organizing this information early helps ease the challenge once a health emergency occurs.

10. Plan your finances.

Long-term care at home, in an assisted living facility or in a nursing home is very expensive. Talk with your financial adviser about your options to start planning financially as early as possible.

“Finances are a big barrier to care,” Wang said. “It’s mostly out-of-pocket unless you spend down and become Medicaid dependent. It’s an unfortunate reality we live in.”