Healthy Aging Protecting Mental Health

What is Healthy Ageing

Growing older is inevitable and according to the World Health Organization (WHO), the expected average life expectancy is getting longer.

In 2019 life expectancy was 73.4 years an increase from  66.8 years in 2000.

This increased longevity may be attributed to improved access to food, sanitation and healthcare.

However, while life expectancy may be improved, there is also an increase in chronic disease that impacts on quality of life.

This suggests that the ageing global population is the most important medical and social problem facing the world right now.

This is compounded by a decline in population growth which suggests that people aged over 65 outnumber children under 5 years old. 

In 2020, a Global Strategy and Action Plan for Ageing and Health was established by the WHO with the aim of supporting a healthy ageing population.

This highlighted the importance of supporting functional ability throughout ageing and prioritising the promotion of healthy ageing through person-centered integrated care.

This individualised approach has been linked to a greater sense of control as the individual is empowered to become the primary managers of their healthcare.

This is important as different countries face different challenges with regards to their populations.

For example in developing countries, the rise of chronic non-communicable diseases such as cancer is growing, suggesting changes in lifestyle and diet.

Defining what healthy ageing looks like is a broad concept but it is accepted that healthy ageing is “the process of developing and maintaining the functional ability that enables wellbeing in older age”.

Breaking down this definition further, functional ability is described as having all the capabilities (mental, physical and emotional) that facilitate individuals to have a life they feel is fulfilling.

This means that for older people (those aged over 65), work, social engagements and physical movement are still important aspects of their life.

According to the Australian Institute of Health and Welfare, in 2016, 1 in 8 older people were engaged in employment, education or training. While this may be positive for financial and social reasons, the statistics also revealed that 70% of the older population were overweight or obese.

Similarly, there is also a sharp increase of individuals suffering from dementia, especially Alzheimer’s disease.

This unforgiving condition results in most dementia patients eventually needing constant care and supervision.

Another condition that affects the elderly is sarcopenia which is a skeletal muscle disorder that progressively worsens and is characterised by a reduction in muscle mass, strength and function.

It is estimated that up to 6.4% of men and 9.3% of women over 65 years old live with sarcopenia.

This diseases increases their risk of falling my more than 3x.

It is becoming increasingly clear that a longer lifespan brings with it specific challenges as a result of individuals experiencing chronic disease, being on multiple medications and increased frailty.

The rapid rise in the ageing population has not allowed governments and organisations sufficient time to plan and implement support structures that align with the WHO goals leaving many unsupported, neglected or left in positions where they are vulnerable to elder abuse.

Therefore, it is prudent that individuals become better educated regarding health, especially for disease prevention to become their own health advocates. 

References:

Volume 139, 2020, Pages 6-11,

https://doi.org/10.1016/j.maturitas.2020.05.018.

(https://www.sciencedirect.com/science/article/pii/S0378512220302826

  • Avila, C., Grace, S., & Bradbury, J. (2020). How do patients integrate complementary medicine with mainstream healthcare? A survey of patients’ perspectives. Complementary therapies in medicine49, 102317. https://doi.org/10.1016/j.ctim.2020.102317
  • Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis.Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169

The Impact of Diet on Healthy Ageing

The link between diet and optimal health is already well known with much research establishing how nutritional deficiencies can negatively impact all areas of health.

With the rise of science in the food industry, food has become increasingly separated with specific diets being recommended for specific groups of people (diabetics, Coeliac’s, athletes etc.)

The focus of nutrition for the ageing population is of concern given the growing number of older persons. 

According to Heinrich and Prieto (2008), we are currently not making the best use of our food for health.

In particular, they identified areas where diet and health were at the forefront for an ageing population.

Among these areas were blood sugar levels, cardiovascular disease and fat intake.

The increase of these conditions may be attributed to a diet that has shifted away from local cuisines in favour of processed foods.

This is further compounded by the  effects of ageing on the digestive system which results in decreased enzyme production and the muscles of the digestive tract becoming stiff and weak.

The result is a digestive system that is not as efficient at breaking down food, nutrient absorption or waste elimination.

When a poor diet is combined with a decrease in digestive function, the risk of developing digestive system disorders markedly increases with older adults likely to develop diverticulosis, constipation, heartburn and reflux. 

By focusing on nutrient intake many health disorders may be prevented or better managed.

For example, increased intake of fresh vegetables and fruit will improve fibre consumption which is useful for constipation.

Where gastric secretions may be hampered, vegetables that are steamed or boiled until soft may help prevent hyperacidity. Improving the intake of foods high in resveratrol (red wine) has also been effective for controlling cholesterol levels.

This is also true for omega-3 fatty acids which are found in fish.

The multitude of health benefits for increased fish intake are many, being a potent anti-inflammatory increased fatty acids have been shown to improve cardiovascular health, improve insulin resistance, improve joint mobility and decrease joint pain.

Even more impressive, is the effect of omega 3 oils on cognition. 

With an increasing number of older people developing dementia and other cognitive disorders, mental health is incredibly important.

One study suggested that the global increase of obesity is effecting the incidence of chronic diseases including dementia as it increases markers of inflammation.

One study conducted in 2017 by Vauzour et al., suggested that neuronal activity may also be affected by flavonoids, in particular flavanols and anthocyanins (blueberries and green tea) which are able to dilate peripheral vascular blood vessels.

Flavonols at 495mg were shown to increase episodic memory and executive function. 

Other important nutrients for ageing include:

  1. B12  which provides methyl-group for energy production. Deficiencies have been linked to cardiovascular disease
  2. Folate which has reported to have a significant on memory
  3. Vitamin C which has been suggested to improve immune function responses and cognition
  4. Vitamin E which has been associated with a decreased risk of Alzheimer’s Disease and dementia 
  5. Vitamin D which is important for bone health, mood and immune support
  6. Calcium is required for proper nerve conduction and bone health
  7. Iron is needed for oxygenation of cortical tissues in the brain, a lack of iron can lead to decreased energy, focus and stamina
  8. Magnesium is needed for muscle health, nerve conduction and mental health
  9. Zinc, selenium and chromium have also been identified as being important for insulin sensitisation, antioxidant protection and brain protection. A low selenium status is associated with an increased risk of cognitive decline. 

References:

  • Denny, A. (2008). An overview of the role of diet during the ageing process.British journal of community nursing, 13(2), 58-67.
  • Heinrich, M., & Prieto, J. M. (2008). Diet and healthy ageing 2100: will we globalise local knowledge systems?.Ageing Research Reviews, 7(3), 249-274.
  • Yaqoob, P. (2017). Ageing alters the impact of nutrition on immune function.Proceedings of the Nutrition Society,76(3), 347-351. doi:10.1017/S0029665116000781
  • Vauzour, D., Camprubi-Robles, M., Miquel-Kergoat, S., Andres-Lacueva, C., Bánáti, D., Barberger-Gateau, P., … & Ramirez, M. (2017). Nutrition for the ageing brain: towards evidence for an optimal diet.Ageing research reviews, 35, 222-240.

The Link Between Exercise and Healthy Ageing

Research on ageing is usually concerned with health and disease prevention but there has been a shift towards functional capacity.

This is defined as a person’s ability to perform the activities necessary to ensure their own wellbeing and is broadly grouped into three areas:

  1. Biological
  2. Psychological
  3. Social

Assessing functional capacity can be done by evaluating an individual’s ability to carry out their normal daily activities.

This might include cooking, cleaning, shopping and self care activities such as showering and grooming.

To carry out all of these tasks, there needs to be a good level of physical fitness yet only one in 10 Australians over the age of 50 exercises enough to gain any cardiovascular benefit.

This is particularly concerning given that cardiovascular disease is the leading cause of burden for older Australians aged over 65.

Many older people no longer engage in physical activity as a result of chronic pain, a preference for sedentary life and a fear of injury.

Compounding this age-related physical decline which may result in:

  • Reduced muscle mass
  • Reduced strength
  • Reduced endurance
  • Reduced joint flexibility
  • Reduced cardiovascular and respiratory functino
  • Reduced bone strength
  • Increased body fat
  • Increased blood pressure

While it may take longer for older individuals to benefit from and recover from intense exercise, many health gains can still be made through regular moderate exercise.

By engaging in low-impact moderate intensity exercise, muscle mass and bone mass may increase while joint mobility and flexibility can be maintained and strengthened.

It goes without saying that where there is an increase in exercise there will also be a decrease in body fat levels which may attenuate systemic inflammation by encouraging healthy metabolism. 

Increasing exercise does not need to be daunting. Here are some tips to consider:

  1. Gentle daily walking 
    Begin by walking for 15 minutes at a slow pace before increasing the speed slightly. If you find this a challenge, perhaps keep it slow and simply walk for longer. Make sure to wear comfortable, supportive walking shoes and carry a phone just in case. 
    Walking in groups can also be a great way to improve social connections and improve mood.
  2. Consider exercise equipment at home such as a treadmill, exercise bike or cross trainer that is low impact and can be adjusted to suit your needs. If space is an issue consider free weights, yoga ball or yoga bands to provide resistance. 
  3. Swimming is fantastic for anyone with mobility issues as it takes the pressure of joints. Swimming enables individuals to move at their own pace – from gentle walking to swimming laps or doing aqua-aerobics in classes. If the water is heated, muscle recovery time is also enhanced. 
  4. Go online! The internet is full of useful videos with tips and tricks. Jump onto Youtube and have a look at the what’s available. There are classes designed with senior citizens in mind – ballet, yoga, pilates, weights, aerobics. Have fun! 
    Check out Pahla B Fitness for fun engaging workouts that have a strong focus on menopause

References:

Stress and Ageing

Under normal acute stressful situations, the brain co-ordinates with the adrenal glands to release adrenalin and cortisol to kick-start the fight-or-flight response.

This results in increased breathing (to allow more oxygen to the muscles), release of sugar and fat into the blood (to prepare for a fast burst of energy), increased heart rate and blood pressure and decreased sensitivity to pain.

Once the situation has passed, the brain senses an environment of safety and returns to normal functioning. 

As we age, our ability to respond to stress declines.

It is thought that this is a result of changes in physical, emotional and cognitive health and exacerbated by the presence of chronic disease.

In younger people stress results in the release of stress hormones in our brains allowing the front and midbrain to take over.

These areas of the brain are responsible for making decisions quickly, focusing attention and concentration allowing an increase in cognition.

After the stressful event has passed, sleep is used to remove these hormones. In older people, the presence of low grade inflammation inhibits the release of the stress hormones in the brain and the increased likelihood of sleep disorders further impairs their removal.

It is also anticipated that the elderly are more likely to have experienced severe life stressors such as moving homes, ending work, loss of loved ones and changes in financial status.

Combined with natural decreases in hormones, this leaves the elderly particularly vulnerable to experiencing exacerbated levels of stress. 

Another emerging factor is the role of predetermined genetic programming.

That is, how an individual is “wired” to cope with change as a result of their genetics.

It is becoming clear that individual stress responses are the result of both genetic and environment factors affecting how genes are expressed.

On a cellular level, ageing is the result of when a cell telomere reaches a critical shortened length, triggering cell senescence.

This is known as telomere-driven senescence and is different to stress-induced premature senescence.

Both are important yet ultimately lead to ageing symptoms and behaviours.

Stress induced ageing does not necessarily refer to stressful situations or emotional stress, there are many other kinds of stress including exposure to UV lights and oxidative damage which triggers cellular repair systems (thereby shortening telomere length). 

A large component of stress is the presence of inflammation.

Stress-related inflammation has been associated with insomnia, depression later in life, anxiety, cognitive decline and Alzheimer’s disease.

Chronic inflammatory markers are also associated with many conditions seen in later life such as cardiovascular disease, insulin resistance, diabetes and metabolic syndrome.

Differences in gender have also shown to impact responses to stress with women experiencing nearly twice the incidence rate of affective disorders than men with women appearing to be more sensitive to inflammatory markers. 

To manage stress levels consider:

  1. Mindfulness, meditation or prayer
    spirituality has been associated with decreases in stress, improved cognition and improved sleep making it an ideal practice for ageing individuals
  2. Increase activity 
    Keep your mind and body active. Consider learning a new language, art or skill. Keep your body active to ensure muscle and bone strength as well as cardiovascular health. Tai Chi has been shown to reduce levels of inflammation as well as improve stress levels making it a 2-for-1 deal.
  3. Increasing social connectivity
    Go out with friends, re-connect with friends and family. Consider using online social media to connect with new friends or interest groups. 
  4. Limit exposure to known stressors
    This includes limiting excessive alcohol, smoking, exposure to excessive UV light. 
  5. Be positive
    Consider keeping a gratitude journal, enjoying comics or funny movies. Go back to what brought you joy as a younger person! 

References:

  • Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis.Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169
  • Bejma, J., Ramires, P., & Ji, L. L. (2000). Free radical generation and oxidative stress with ageing and exercise: differential effects in the myocardium and liver. Acta Physiologica Scandinavica, 169(4), 343-351
  • Harvard Health Publishing (2016). How stress affects seniors, and how to manage it 
    https://www.health.harvard.edu/aging/how-stress-affects-seniors-and-how-to-manage-it 

Supplements and Ageing

There are a number of ways that healthy aging can be supported through the use of nutritional supplements.

Specifically, supplements may be used to target known drivers of ageing. These include:

  1. Inflammation
  2. Insulin resistance
  3. Stress
  4. Digestive dysfunction
  5. Loss of muscle and bone support 

Before commencing on any new supplement regime, ensure you tell your practitioner what medications you are on.

Most supplements are safe, however, caution is still required especially if there is concomitant use of medications.

When looking at commencing a supplement, ensure that it is able to target multiple drivers of ageing – at this stage, having multiple supplements is not conducive to liver support which is already going to be not as efficient.

Ideally, supplements should also be in liquid or powder form to facilitate easier absorption and uptake.

Nutrients that have been shown to be especially useful for healthy aging include:

  1. Turmeric 
    Possessing a bioactive compound known as curcumin, turmeric is a potent anti-oxidant and anti-inflammatory. This rhizome has also been shown to improve insulin resistance, reduce symptoms of osteoarthritic pain and is used to treat major depression, epilepsy and other neurodegenerative disorders through the modulation of serotonin and dopamine release. It has also been shown to enhance levels of brain derived neurotrophic factor. Even better, there are many studies demonstrating the safety of turmeric making it an ideal choice for healthy ageing.
  2. CoQ10
    Coenzyme Q10 (otherwise known as CoQ10) is a potent anti-oxidant that is naturally produced by the body and is located widely in cell membranes. Levels decrease with ageing (although this is not seen in all species). CoQ10 is chiefly used for energy production. Supplementation with CoQ10 has been shown to improve ageing through affecting cellular signalling, metabolism and gene expression. As a result of its impact on energy production it is a go-to supplement for anyone suffering from cardiovascular disease. As an anti-oxidant it also “recharges” vitamins C and E to help reduce free radicals and address chronic inflammation. 
  3. Glutathione and N-acetyl cysteine (NAC)
    Used in detoxification processes, both are potent antioxidants with helping to maintain glutathione levels and preventing the metabolic declines normally associated with aging. As nutraceuticals, both enjoy good evidence and are well tolerated within safe limits. NAC has also been shown to be particularly useful for insulin resistance and conditions where there is decreased lung function as well as mental health distress including anxiety, bipolar disorder and schizophrenia.  
  4. Green Tea and Resveratrol
    Among the most widely consumed beverages green tea and wine also provide a multitude of health benefits. In one study, green tea extract was shown to delay collagen aging suggesting it may be useful for the appearance of more youthful looking skin. It has also been associated with increased stress resistance and neuroprotection. Similarly resveratrol is also associated with a decrease in type 2 diabetes and cardiovascular disease as a result of it’s ability to affect enzymes known as sirtuins. 
  5. Fish oil
    The use of essential fatty acids for the treatment of inflammation is well known. More recently, it has been shown to help stimulate protein synthesis (muscle mass) as well as improving insulin resistance. It is worth noting that one study did not associate fish oil consumption with extended lifespan but did comment on its ability to affect quality of life. 

References:
Kulkarni, S. K., & Dhir, A. (2010). An overview of curcumin in neurological disorders. Indian journal of pharmaceutical sciences, 72(2), 149–154. https://doi.org/10.4103/0250-474X.65012

Barcelos, I. P., & Haas, R. H. (2019). CoQ10 and Aging.Biology, 8(2), 28. https://doi.org/10.3390/biology8020028

Oregon State University. “Boosting levels of known antioxidant may help resist age-related decline.” ScienceDaily. ScienceDaily, 24 October 2016. <www.sciencedaily.com/releases/2016/10/161024132851.htm>

Prasanth, M. I., Sivamaruthi, B. S., Chaiyasut, C., & Tencomnao, T. (2019). A Review of the Role of Green Tea (Camellia sinensis) in Antiphotoaging, Stress Resistance, Neuroprotection, and Autophagy. Nutrients, 11(2), 474. https://doi.org/10.3390/nu11020474

National Institutes of Health (2013) How Resveratrol May Fight Aging 
https://www.nih.gov/news-events/nih-research-matters/how-resveratrol-may-fight-aging 

Kamolrat, T., Gray, S.R. & Carole Thivierge, M. Fish oil positively regulates anabolic signalling alongside an increase in whole-body gluconeogenesis in ageing skeletal muscle.Eur J Nutr52, 647–657 (2013). https://doi.org/10.1007/s00394-012-0368-7

de Magalhães, J. P., Müller, M., Rainger, G. E., & Steegenga, W. (2016). Fish oil supplements, longevity and aging.Aging, 8(8), 1578–1582. https://doi.org/10.18632/aging.101021

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