It’s Time For Healthy Aging
Jonathan H. Maks, MD, FACP
Presence Medical Group
Senior Clinician Educator
University of Chicago Pritzker School of Medicine
April 5, 2017
NU Lunch & Learn Series
2016-2017
Jonathan H. Maks, MD, FACP
Presence Medical Group
Senior Clinician Educator
University of Chicago Pritzker School of Medicine
April 5, 2017
Today’s Outline for Healthy Aging
• Introduction
• Definitions and Theories of Aging
• Opportunities to improve aging
• Future Endeavors
• Q+A
WHO Study on global AGEing and adult health
(SAGE) – 2007-2010
Figure 3.
Healthy Life Expectancy (HALE) and Life
Expectancy (LE) at Age 60 by Sex: 2007
HALE (Healthy Life
Expectancy) is the # yrs
Free from disability*
Male HALE
Male LE
Female HALE
Female LE
China
Ghana
India
State of IL:
HALE**
MALE = 77.6 yrs
FEMALE = 79.3 yrs
USA HALE**:
MALE = 77.9yrs
FEMALE = 79.8 yrs
Mexico
Russia
South Africa
*NIA’s SAGE Report, issued May 2013
**MMWR July 19, 2013 / 62(28);561-566
0
5
10
15
20
25
Years
Note: Healthy Life Expectancy (HALE) is the number of healthy years,
free from disability, that a person can expect to live given the current
trends in deaths and diseases.
Sources: United Nations, 2009,
Revision
World Population Prospects: The 2008
; World Health Organization, 2008,
Disease: 2004 Update.
The Global Burden of
Let’s define aging…
We will ONLY discuss scientifically, research based concepts
We will NOT discuss “hearsay,” “celebrity-sponsored” methods
Avoid faulty logic and similar methods of salesmanship
– “It makes sense…”
– “I have a friend…”
– “Did you see the latest pictures from the Oscars? I wish I could use
the same active aging products as the movie stars!”
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Theories of Aging
Nature or Nurture
– Danish Twin Studies on Longevity 25% genetics, 50%
environmental influences, and genetics became more influential as
one entered very old age (90-100 yrs old)*
Physiologic Reserve or Resilience  “Homeostenosis”
*vB Helmborg J et al. Hum Genet 2006; 119(3):312.
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“Homeostenosis”
From maturity to senescence, diminishing physiologic reserves
are available to meet challenges to homeostasis.*
More vulnerability to disease that occurs with aging.
Inability to successfully handle stressors (e.g. due to diminished
physiologic reserves) will lead to frailty.
Frailty is the loss of reserve that occurs across multiple
physiologic systems and progresses across a lifetime.
*Cowdry EV. Problems of ageing: biological and medical aspects, 2nd ed,
Williams & Wilkins, Baltimore 1942
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“Homeostenosis”
*Cowdry EV. Problems of ageing: biological and medical aspects, 2nd ed,
Williams & Wilkins, Baltimore 1942
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We are obsessed with living forever!!!
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Opportunities for Successful Aging
Take care of yourself!!!
– Healthy Mind and Healthy Body
– Maintenance of functional status
– Use it or lose it
Exercise is good!
– Gait training
– Core strength
– Falls prevention
12
Retrieved 04/03/2017 from http://www.cancerresearchuk.org/aboutcancer/causes-of-cancer/bodyweight-and-cancer/how-beingoverweight-causes-cancer
13
Follow the MIND Diet
“Mediterranean-DASH Intervention for Neurodegenerative
Delay”
Morris MC et al published in Alzheimer’s & Dementia: The
Journal of the Alzheimer’s Association (March 2015)
Hybrid of DASH and Mediterranean diets, using past research
to develop a new formula
Rigorous compliance = 53% reduction in Alzheimers Disease
Moderately strong compliance = 35% reduction
Much easier than other research-based healthful diets
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MIND Diet – You eat things from these 10 groups
Green leafy vegetables (like spinach and salad greens): At least
six servings a week
Other vegetables: At least one a day
Nuts: Five servings a week
Berries: Two or more servings a week
Beans: At least three servings a week
Whole grains: Three or more servings a day
Fish: Once a week
Poultry (like chicken or turkey): Two times a week
Olive oil: Use it as your main cooking oil.
Wine: One glass a day
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MIND Diet – You avoid these things
Red meat: Less than four servings a week
Butter and margarine: Less than a tablespoon daily
Cheese: Less than one serving a week
Pastries and sweets: Less than five servings a week
Fried or fast food: Less than one serving a week
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When can “Less is MORE” ring true???
17
Polypharmacy -- coming to a clinic near you???
Over-use of medications (prescription and over-the-counter)
Why the Concern About Drugs and Older Persons? They
take more medications than any other group of patients, yet:
Unclear efficacy: many drugs not tested specifically in older
adults and those with complex comorbidities
Higher risk for adverse drug effects (ADEs) due to age‐related
physiological changes and comorbidity
Avoiding potentially inappropriate medications (PIMs) =
High value care
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High-risk medications in Medicare Population
Adapted from Dartmouth Atlas on Aging, 2016.
BEERS Criteria – international reference standard for
polypharmacy and living “Less is More”
Guidelines based upon research, expert opinion
Potentially Inappropriate Medications (PIMs)
PIMs due to Disease/Syndrome Interactions
PIMs due to drug‐drug interactions
Drugs to use with caution
Drugs to avoid in kidney disease
Drugs with strong anticholinergic properties (confusion, bladder
retention, constipation, dry eyes, dry mouth, memory loss, mood
changes)
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Example = use of PPIs for heartburn
Do I need a PPI?
PPIs have risks
PPIs can change the way other medications work
PPIs cost more
When should I consider a PPI?
When can I ease heartburn without drugs?
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Future ideas about healthy aging
Culture shift toward “patient-centered care”
Leverage technology
–
–
–
–
Fitbits
Apps
Enhanced communication
Transparency
Better-educated healthcare professionals
TMI (too much information)
Metformin???
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THANKS!
Jonathan H, Maks, MD
FACP
Presence Medical Group
847-251-1500
847-729-8833
Presencemedicalgroup.org
QUESTIONS?
Jonathan H, Maks, MD
FACP
Presence Medical Group
847-251-1500
847-729-8833
Presencemedicalgroup.org