Transcript OPTIMAL AGING Subodh Agrawal MD Athens Heart Center Source: redandblack.com Source: Media.collegepublisher.com.

OPTIMAL AGING
Subodh Agrawal MD
Athens Heart Center
Source: redandblack.com
Source: Media.collegepublisher.com
Fred A. Birchmore jr.
• Athens most amazing versatile citizen is
98 years old.
• Took a world bicycle trip in 1934 – 1935.
• Won Southern conference bantam
weight boxing division (119 lbs) in 1930.
• Still works out at new Athens Y on
Hawthorne avenue.
Coach Dan Magill
Source:Athens Banner Herald, Saturday, November 29,3009
Besse Cooper
Source: ajc.com
Besse Cooper
• Besse Cooper lives in Monroe, Georgia
is 113 years old.
• Cooper is the world's 12th oldest and
Georgia's oldest person.
• She was born on Aug. 26, 1896 in
Sullivan County, Tenn.
• Rachel Tucker 106 years old is
President Barrack Obama’s oldest
attendee to Inaugration.
Source: http://sites.google.com/site/theoldestperson/
I can't die now - I'm booked.
George Burns
Source: http://www.unicyclist.com
Aging
Grow old along with me
The best is yet to be
The last of life
For which the first was made
Browning
(Smalley D, 1956)
Then what is OptimalAging ?
It is definitely
more than just the
absence of
disease!!
 It’s more than the
walking sick!
 It’s vitality!

Optimal Aging
• Doing and doing something meaningful
– Something worthwhile to do
– Balance between abilities and challenges
– Appropriate external resources
– Personal attitudinal characteristics
– Bryant et al
Why after some years cars go out of use?…
From One Cell to 100 Million Million
Oldest documented human: Jeanne Calment (Age
122 years)
Universality of aging
Human
Yeast
Mouse
Worm
Premature Aging (Progeria)
We now know it’s both...the
body and the disease
We know genes do not
dictate our
destiny.....it’s what we
do with those genes
that counts!
Disposable Soma Theory of aging
Kirkwood 1977, 1981; Kirkwood & Holliday 1979
 Organisms must allocate resources among
competing metabolic priorities: growth, reproduction,
maintenance and repair, storage.
 Under pressure of natural selection, organisms can
afford only limited investment in somatic maintenance
and repair.
 Ageing results from the lifelong accumulation of
unrepaired cellular and molecular damage.
A telomere is a region on
the very tip of
chromosomes.
They are composed of a
repeating series of six
nucleotides (TTAGGG).
A typical human telomere
may have more than 15000
such repeats in it.
Their relevance to the
ageing process is being
investigated.
(Source: Medina, 1997, p. 276,
with permission of the Editor)
Ageing and the conquests of modern medicine
According to the data by Olshansky1 if we consider the
two major causes of death – cancer and heart
disease – we shall notice how:
 could cancer be defeated overnight, then the average
age of the population would only increase by 2 years
 by eliminating all heart disease the same would
increase only by 3-4 years2
1
Olshansky S.J., Carnes B.A., 2001, Prospects for human longevity. Science 291: 1491-1492.
Olshansky S.J., 1998, On the Biodemography of Aging: A Review Essay. Population and Development
Review 24(2): 381-393.
2
AGING:
how do we manage
uncertainty?
Evidence-based anti-aging
The primary goal of
biomedical research
and efforts to slow
aging should not be
the mere extension of
live. It should be to
prolong the duration
of healthy life
60-year old women vitamins alone?
•
Dürer: Painting of his mother
1514
Sophia Loren
2002
Magnetic Resonance Proton Image: CrossSection at the Mid-Thigh
48 y.o. Man
70 y.o. Man
Courtesy B VELLAS 2002
AGEING of MUSCLES
Cell loss
Disuse
Cachexia
 Alpha motor neurons
 Muscle cell contractility
Modifications of humoral factors
( sexual hormones)
Inflammation
(  cytokines)
Isometric strength  1 to 2 % p.year
Explosive power
 3 to 4 % p.year
Adapted from A YOUNG EAMA IV3 January 2002
ATHEROSCLEROSIS RISK FACTORS
MODIFIABLE
NON-MODIFIABLE
Cigarette smoking
Sedentary lifestyle
Diet
Obesity
HYPERTENSION
HYPERGLYCEMIA
HYPERLIPIDEMIA
AGE
Male gender
Family history
Several of these RISK FACTORS are intensified by
THE AGING PROCESS ITSELF and
even more by
DIABETES
Atherosclerosis
ATHEROSCLEROSIS: possible target for treatments ?
Hip Fractures
• Outcomes
– Fracture related outcomes
• Healing
• Quality of reduction
– Functional outcomes
• Ambulatory ability
• Mortality (25% at one year)
• Return to pre-fracture activities of daily living
Hip Fractures
• Radiographic evaluation
– Occult hip fracture
• Technetium bone scanning is a sensitive
indicator, but may take 2-3 days to become
positive
• Magnetic resonance imaging has been shown
to be as sensitive as bone scanning and can be
reliably performed within 24 hours
The 1% Rule
• Old consensus view: after age 25, we lose 1% per
year in aerobic capacity, strength, speed and other
physical attributes.
• This is not necessarily the case, activity, exercise,
and diet have strong effects on function, the decline
in many physical parameters can be halted or
slowed.
Negative Tobacco Outcomes
• Smoking harms nearly every organ of the
body.
• Smoking low tar and nicotine cigarettes has
not been shown to be any less damaging.
• Smokeless tobacco also causes cancer.
• Smoking also causes gum disease, bone
loss, ulcers and many other diseases.
Environmental effects
Sun damage causes premature aging of
the skin:
Practically ….
Aging = reduced tissue/physiological
function
Aging = increased susceptibility to disease
(age-related diseases)
Aging = decreased resistance to stress
(physical and psychological)
EXERCISE
Yes, yes, yes ….. (but not too much)
Exercise ---> healthier muscles,
greater fitness
Greater protection from oxidative stress!
(not such a paradox, anti-oxidant defenses)
Think good thoughts!
Avoid undue stress
Physiological stress:
Stress hormones, a double edged sword
Physical stress:
Overwhelm cellular defense mechanisms
The peculiar phenomenon of hormesis
Diet
Benjamin Franklin use to
say….
“To lengthen thy life,
lessen thy meals.”
Diet for Optimal Aging
Moderate consumption of alcohol and mortality
490 000 subjects, mean age 56 years, 9 years of follow-up
Thun MJ N Engl J Med. 1997;337:1705-1714
Alcohol
• Heavy drinkers should be encouraged to
reduce their consumption
• Most light to moderate drinkers should
probably continue their consumption
• Nondrinkers should not generally be
encouraged to start drinking
Poor Lifestyle Choices
•
•
•
•
•
Sedentary lifestyle.
Poor food choices.
Use of alcohol.
Use of tobacco products.
Lack of understanding of
consequences.
• Lack of motivation to change.
Optimal Aging
T’ai Chi Inspired Exercise Program
KRESSIG RW and WOLF SL Neurology Report 2001; 25: 50-4
Effects of environment and lifestyle on
aging
Aging junk science
•Monkey glands
•Human growth hormone
•DHEA
•Supplements
•Oxygen chambers
•“Purification”
POSITIVE ENERGY
• As cardiologist, Dr. Paul Dudley
White explained, “Body, mind,
and
soul are inextricably woven
together,
and whatever helps or hurts
any one
of these three sides of the
whole man
helps or hurts the other two.”
Positive Energy : DONALD BOGGS
Positive Energy:
People are often unreasonable,
illogical, and self-centered;
Forgive them anyway.
If you are kind, people may
accuse you of selfish, ulterior
motives; Be kind anyway.
If you are successful you will win
some false friends and true
enemies; Succeed anyway.
If you are honest and frank,
people may cheat you; Be
honest and frank anyway.
What you spend years building,
someone could destroy
overnight; Build anyway.
If you find serenity and
happiness, they may be
jealous; Be happy anyway.
The good you do today, people
will often forget tomorrow; Do
good anyway.
Give the world the best you
have, and it may never be
enough; Give the world the
best you've got anyway
You see, in the final analysis, it
is between you and God; It
was never between you and
them anyway.