1. Physical Dimensions of Healthy Aging Ellen F. Binder, MD Division of Geriatrics and Nutritional Science ebinder@wustl.edu

2. Disclosures of Interest Research Support: National Institute of Mental Health National Institute on Aging Consulting Eli Lilly, USA I own no stocks or equity in any pharmaceutical company.

3. “Yet another national placing for Lavelle Kelly” Tillamook Headlight Herald April 11, 2006

4. What Defines Healthy Aging? Absence of major disease Absence of disability Defined as inability or great difficulty with ADLs or mobility

5. Significance of the Problem U.S. population > 65 yrs. expected to grow to 20% by 2030 and continue to increase until 2050. 40% of the older adult population has some disability or dependency. Such individuals are at high risk for recurrent hospitalization, injurious falls, NH placement, and death. The prevalence of chronic disability is higher in older women than among men. Although women have a longer total life expectancy they are likely to spend more years than men in a disabled state, even among those with severe disability.

7. Disabled Population & Rates NLTCS 1982-2004

8. Risk Factors for Disability in Older Adults Lifestyle and health habits Physiologic changes associated with aging Diseases/Conditions Social factors Economic factors

9. Physiologic Changes Associated with Aging Hormonal Body composition, energy intake, and lipids Cardiovascular and pulmonary Renal (kidney) Hepatic (liver) Sensory Cognitive/Neuro-motor

11. Changes in Aerobic Power with Age Women vs. Men From Holloszy & Kohrt in Handbook of Physiology-Aging, 1995

12. Diseases/Conditions Associated with Disability in the Elderly Vascular disease (heart, brain, arteries) Arthritis Lung Disease (Asthma, COPD) Depression Dementia Cancer Diabetes Malnutrition / Obesity Falls Incontinence Polypharmacy

13. Prevalence of Geriatric Impairments by Age Group from CHS Chaudhry et al. JAGS 58: 1686-92, 2010

14. Risk of Disability Onset over 7 Yrs. HR for Disability # of Geriatric Impairments (GI) or Chronic Diseases (CD) ADLMobility GICDGICD 1221.52 242.523 ≥38344 From Chaudhry et al. JAGS 58: 1686-92, 2010

15. Predictors of Healthy Aging in CHS Absence of Hypertension/Lower BP Lower Waist Circumference (non-obese) Higher HDL Cholesterol Absence of diabetes Regular exercise, especially higher intensity Moderate intake of wine Lower clotting factors No cigarette smoking No regular ASA use Stable financial status

16. Predicted Median Life Expectancy by Age and Gait Speed Studenski, S. et al. JAMA 2011;305:50-58

17. Exercise Can Reverse Disability Risk in Older Adults Muscle strength and power Body composition, lipids, weight Aerobic Power Gait speed Balance Flexibility Bone Density Mood and Psychological Well Being Falls

18. Components of “Best Practice” Physical Activity Programs Attention to health education & exercise “readiness” Accessibility Tailoring of the exercise program to physical ability and preferences Multi-component exercises flexibility, aerobic, strength training Multiple sessions per week (≥3) Ongoing social support Ongoing feedback

19. Components of Success for Community-Based Programs Collaboration with community agencies and organizations. Use of existing programs and infrastructure. Promotion as a social program. Planning for wide variability in functional ability. Use of an expert advisory board.

20. Successful Community-Based Health Promotion Interventions in Older Adults Multi-component falls prevention Vitamin D replacement Potential Areas (not disease-specific): Medication education and compliance Nutrition and weight management

21. Questions???

22. From Fried et al. J Gerontol Med Sci 561:M146-156, 2001