Americans who reach age 65 can expect to live an additional 19.4 years. Rebecca Rosen, MD, says that adopting a few simple lifestyle practices can help reduce risk for several life-limiting conditions and help people make the most of those later years.
Rebecca Rosen, MD, geriatric medicine specialist at Summit Medical Group in Morristown.
Dr. Rosen, a geriatric medicine specialist who practices with Summit Medical Group in Morristown, offers the following five-step prescription for enhancing health and quality of life into a person’s 70s and beyond.
- Keep – or start – moving: The goal is 150 minutes of moderate exercise, such as walking at a regular pace, or 75 minutes of more vigorous aerobic exercise each week, Rosen said, adding that people should shape an exercise plan in consultation with their physician. That plan should incorporate balance-enhancing exercises or work with weights three times a week, the geriatrician said. She emphasized that people should talk with their physician or another health care professional, such as a physical therapist, about appropriate weightlifting approaches. “Tai chi or similar programs can be excellent means of enhancing balance and also can have a social benefit in terms of participating in regular classes. Studies have shown that older adults who participate in group exercise are less likely to have falls,” Rosen said.
- Go to the Mediterranean (diet): Adopting an eating plan that is high in vegetables, fruits, whole grains, beans, nuts, olive oil and healthy fats — and that includes moderate amounts of fish and poultry while limiting red meat — has been shown to be heart healthy and likely offers several other benefits, Rosen said. “It also is important that older adults focus on obtaining adequate amounts of Vitamin D, which has been shown to help with fall prevention, and calcium, which supports bone health and can help both prevent falls and reduce the risk of a fracture should a fall occur,” the geriatrician said. She added that it is preferable for people to obtain their recommended daily calcium intake through the foods they eat, rather than through supplements, and that this should be readily accomplished by following a healthy diet. Obtaining adequate Vitamin D through diet alone is more difficult, she noted, adding that a high-quality, reliable supplement may be needed.
- Stay engaged with others: Avoiding isolation is key as one grows older, said Rosen, noting that factors including retirement and the loss of a spouse can leave people spending more time alone. The Department of Health and Human Services reports that 28% of older adults who are not in assisted living facilities or similar settings live alone. That figure represents 9.3 million women and 4.5 million men.
“Whether you volunteer, work part time, get together with friends for lunch or dinner once a week, take a class or join an organization, it’s good to have something in place to ensure regular contact with others, in addition to your spontaneous interactions with people,” the geriatrician noted. “While there is no scientific evidence that proves a greater degree of social activity guards against Alzheimer’s disease or other forms of dementia, interacting with other people clearly yields benefits in terms of an enhanced sense of overall well-being and staying engaged mentally.”
“Whether you volunteer, work part time, get together with friends for lunch or dinner once a week, take a class or join an organization, it’s good to have something in place to ensure regular contact with others, in addition to your spontaneous interactions with people,” the geriatrician noted. “While there is no scientific evidence that proves a greater degree of social activity guards against Alzheimer’s disease or other forms of dementia, interacting with other people clearly yields benefits in terms of an enhanced sense of overall well-being and staying engaged mentally.”Dr. Rosen added that one of the most important steps people can take to reduce their risk for cognitive problems is to control their blood pressure. “Hypertension is a major risk factor for stroke, which can be devastating in its own right, and significantly increases the risks for dementia,” she said.
- Get vaccinated: Vaccinations are as important in the later decades of life as they are in the earliest years of life, Rosen explained. “Vaccination is a very effective means of preventing shingles – which can be a miserable experience and can cause ongoing complications. Vaccination also can greatly reduce the risk of pneumococcal pneumonia. Tetanus boosters are important, as is the seasonal influenza vaccine,” she said, noting that influenza takes a particularly heavy toll on older people. Indeed, the CDC reports that people aged 65 years and older accounted for 86% of the estimated 79,416 deaths attributed to seasonal influenza in the US in 2017-18. That proportion translates into an estimated 68,448 deaths among older people.
- Take your medicine, but take stock of what you’re taking, as well: It’s not uncommon for an older person to take a half-dozen or more pills each day. Those medications are essential for preserving health, relieving pain and enhancing quality of life, but as the number of medications taken rises, so does the potential for harmful drug interactions, Rosen said.
“I routinely do a ‘brown bag check’ with my patients,” she said, explaining that she asks patients to bring a brown bag with all of their medications, over-the-counter supplements, and any herbal or homeopathic preparations to an appointment so that she can evaluate whether all the agents are still needed and whether any may interact in problematic ways. “In many cases, patients are seeing a primary care provider plus three or four other types of physicians, such as a cardiologist, endocrinologist or pulmonologist. While doctors and pharmacists are diligent about asking what drugs a patient is taking, and while the advent of electronic medical records has helped greatly in terms of seeing the full picture of a patient’s health and care, there still can be occasional problems, particularly when you factor in herbal preparations that people may not think to mention to a physician,” Rosen said.
The physician noted that insulin, digoxin and anticoagulants, in particular, can be associated with drug interactions, as can herbal supplements. “Acting in consultation with the patient and his or her other physicians, we can craft a strategy that keeps people receiving the benefits of needed treatments while reducing the likelihood of side effects caused by the way one drug affects the way another is metabolized,” she said.
When to see a geriatrician
Geriatricians such as Rosen provide care to older people living independently in the community and those in assisted living and skilled nursing facilities. “Sometimes, there’s a tendency to think that geriatricians practice primarily or even exclusively in hospitals, rehabilitation centers, nursing homes or similar facilities, but we also work in the outpatient setting, with a focus on maximizing health and preserving and prolonging independent living,” Rosen said. The physician, board-certified in both internal medicine and geriatrics, divides her time between seeing patients in the hospital and at Summit Medical Group offices on Madison Avenue in Morristown.
Rosen said that her typical patient is about 75 years old, although the age range extends from the mid-60s into the 90s. “I think it’s worthwhile for anyone age 65 and older to have a comprehensive geriatric assessment so that doctor and patient can formulate an individualized plan for promoting health and maximizing quality of life,” she said. She also stressed the importance of talking with patients about an advance care plan so that they can consider and make known their preferences for which types of care they do and do not wish to receive. Engaging patients in these important but sometimes difficult and oft-avoided conversations is an area of expertise for geriatricians, added Rosen, who explained that such discussions can occur when seniors are healthy, not just once when they begin to experience cognitive or functional decline.
In many cases, Rosen noted, the impetus to see a geriatrician is not reaching a certain age but rather the development of multiple medical conditions that warrant coordinated care by a physician with specialized training on how both diseases and their treatment affect older people. “As we age, we experience changes in metabolism, in kidney function, in muscle mass and in many other key physiologic characteristics that have important implications for susceptibility to various conditions, for the severity and course of those conditions, and for how we process medications. A geriatrician has expertise in understanding and addressing these age-related considerations,” Rosen said, noting that she both co-manages patients with their primary care physician and, in other cases, assumes responsibility for patients’ ongoing care.
“Thanks to lifestyle improvements, medical advances and other factors, we’re seeing more and more people live into their 80s, 90s and – increasingly – to 100 or more. This is a wonderful development, but we want to match that increased longevity with good health and a good quality of life. People are never too young – or too old – to take steps today that will promote better health for the rest of their lives,” Rosen said.
Rebecca Rosen, MD, is a member of Summit Medical Group’s Geriatric Services team. She specializes in treating geriatric patients with both acute and chronic health needs while paying attention to supporting both patients and their families. Dr. Rosen earned her bachelor’s degree and medical degree from the State University of New York in Brooklyn. She completed her residency in internal medicine and primary care at George Washington University Medical Center in Washington, D.C., and her fellowship in geriatric medicine at The Mount Sinai Medical Center in New York. She is board-certified in geriatrics and internal medicine. Dr. Rosen’s office is located at 95 Madison Ave., Morristown. She can be contacted at (973) 267-1010.
Summit Medical Group is the premier multispecialty medical practice in New Jersey, with 80-plus locations throughout northern and central New Jersey. Summit Medical Group’s 900-plus providers cover more than 80 medical specialties and services, with a focus on delivering patient-centered and coordinated care. The Summit Medical Group health care model provides patients with more convenient and affordable care for every stage of life – from birth and pediatrics to geriatrics – with all ancillary services under one roof, including wellness, cancer care, disease management, surgical services, behavioral health and chronic conditions. For more information visit summitmedicalgroup.com.
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