1. HEALTHY AGING Dr. VINOD KUMAR Emeritus Prof., St Stephens Hospital, Delhi Formerly, Prof. of Medicine & Chief, Geriatric Services, AIIMS, New Delhi & WHO Advisory Panel on Aging and Health

2. HEALTHY AGING DEFINITION AND GOALS Healthy and active aging is a process to achieve physical, mental and social well being throughout one’s life particularly in the later years WHAT IS THE GOAL ? Disease & disability free life with high physical & cognitive function and active engagement with life in old age

3. HEALTHY AGING IS A REALITY AND NOT A DREAM Functional capacity like ventilator capacity, muscle strength & cardiovascular output increases in childhood & peaks in early adulthood, eventually followed by a decline resulting in disease & disability in old age. Rate of decline however gets accelerated by negative adult life style factors like smoking, alcohol, lack of exercise, improper diet as well as by environmental & external factors; Hence this decline can be slowed down or even reversed at any age through the individual himself or the policy makers.

4. DETERMINANTS OF ACTIVE AGING Behavioural: smoking, alcohol, exercise, diet, drugs Environmental: pollution, home safety, rural/urban Socioeconomic: family,community,income, literacy Personal: biology, genetics, coping mechanisms Services: primary care, health prom. disease preven

5. IS PRESENT MINDSET CHANGING ? Traditionally, elderly in India have come to accept failing health & dependency as a part of their old age, disengage from material life, practice spirituality and live in joint family. With increasing life span, greater social & household involvement of elderly is happening but it is a challenge for Indian geriatricians to change their mindset so that they begin adopting healthy lifestyles & environment to eliminate risk factors and remain fit and independent.

6. 6 HEALTHY AGING DETERMINANTS With Impact on Life Long Development and QOL NEGATIVE Poverty & Abuse Illiteracy Double Burden Insanitation Inaccessible Care POSITIVE Joint Family Joint Family Active Involvement Active Involvement Physical Activity Physical Activity Vegetarianism Vegetarianism Spirituality & Re lax Spirituality & Re lax

7. MODIFIABLE DISEASE RISK FACTORS Cardiovascular: sedentary, obesity, lipids, BP, salt, diet, smok, pollut Pulmonary: smoking, environmental pollution Neurological: BP, smoking, alcohol, diet, depress,mental inactivity Diabetes: diet,sedentary, obesity Musculoskeletal: sedentary, obesity, hormone deficiency Gastrointestinal: low fibre, alcohol, poor oral hygiene Urogenital: BP, hormone deficiency Infections: under nutrition, poor skin care and no vaccination Cancers: diet, smoking, chewing tobacco Spl senses: sunlight, noise, diabetes, water fluoride, drugs Accidents : unsafe homes K S Sunil. Primer on Geriatric Care. Pp 12-18, 2002

8. SUMMARY OF LIFE STYLE GOALS Physical activity Healthy diet Avoid smoking Judicious medication Good oral hygiene Health screening Social involvement Mental activity Immunizations Hormones – HRT Clean environment Home safety

9. PHYSICAL ACTIVITY Benefits: Physiological, psychological and social. if physical exercise could be dispensed as a pill, it could be the most valuable prescription to prevent diseases (Edward Staneley) Varieties: Aerobic, resistance and balance exercises. yogic, spiritual & exercise related to work, recreation, household and social interaction Duration: Brisk walk for 20-60 mts for 3-5 d/week morning walk better as he is fresh, walks with his whole body; in evening he walks only with his legs 1.WHO. The Heidelberg Guidelines. JAPA 5: 2-8, 1997; 2.Vinod Kumar. JAPA 6: 205-6, 1998

10. HEALTHY DIET Low fat, low salt, adequate liquids, proteins, vitamins, calcium, micronutrients and high fibre, fruits and vegetables Make them relish their food with good flavour, smell, colour, utencils and environment Frequent small meals, no overeating food left on the table does more good than what has been taken

11. SMOKING AND EXCESS ALCOHOL It is never too late to quit smoking Consuming alcohol in excess is different from taking in moderation Scientific methods are in place to give up these addictions and to deal with problems of withdrawl

12. JUDICIOUS MEDICATIONS Properly understand directions of their use Take with or after food unless told otherwise Get ingredients checked to avoid duplication Consult doctor to avoid unnecessary medicines Never hoard medicines you no longer require Do not share medicines with anyone

13. MISCELLANEOUS Personal cleanliness and oral hygiene Bowel movements and sound sleep Avoid dust and pollution Home and road safety Specific tasks e.g.Screening, HRT, immunization Engagement with life is a must: A perpetual holiday is a good working definition of hell-Bernard Shaw Have a positive attitude: To me old age is always 15 years older than I am