Describing Caroline’s book, the Editor’s Choice review in Caregiver Solutions magazine of Canada said it best:

"A 78-year-old fitness professional, Caroline Anaya, wrote and self-published this quirky and optimistic outlook on aging to encourage seniors to get fit both physically and mentally. The Curious Upside of Growing Older reveals seven ‘keys’ to ‘embrace’ life: thinking, eating and sleeping well, knowing yourself, staying active, being social and stimulating the brain. The relaxed, personal style and large print make this book straightforward and accessible."

The editors here at Experience! couldn’t agree more. In addition, we’d like to suggest to our readers that The Curious Upside of Growing Older would make a fine, inspirational gift for your "special someones" during the upcoming holiday season. For ordering information, click on www.great-senior-fitness.com.

While most senior health-fitness professionals

Structured exercise and physical activity programs should be covered by insurance as a way to promote health and reduce health care costs, especially among high health-risk populations such as those who have diabetes.

So says Marco Pahor, M.D., director of the University of Florida Institute on Aging, in an editorial Wednesday, May 4, in the Journal of the American Medical Association. Pahor’s paper accompanies an analysis of multiple clinical trials that examined the effect of exercise and physical activity on the control of blood glucose levels.

“Cumulative work over the past few decades provides solid evidence for public policymakers to consider structured physical activity and exercise programs as worthy of insurance reimbursement,” Pahor said.

A host of studies have linked exercise programs with improved health measures related to blood pressure, lipid levels — including cholesterol and triglycerides — cardiovascular events, cognition, physical performance, premature death and quality of life. People who take part in programs that contain both aerobic and resistance training are likely to get the greatest benefit, compared with people who do only resistance exercises.

The study that Pahor’s editorial accompanied, conducted by Daniel Umpierre, M.Sc., of the Hospital de Clinicas de Porto Alegre, Brazil, and colleagues, compared the association between physical activity advice and structured exercise programs, respectively, and markers of diabetes.

Analyses of interventions to promote physical exercise in adults have found that compared with no intervention, exercise programs are cost-effective and have the potential to improve survival rates and health-related quality of life.

Some insurance providers already include a fitness benefit for members, such as monthly membership at certain fitness centers or access to personal trainers or exercise classes at reduced cost. Use of such health plan-sponsored club benefits by older adults has been linked to slower increases in total health care costs.

In one study, older adults who visited a health club two or more times a week over two years incurred $1,252 less in health care costs in the second year than those who visited a health club less than once a week. Programs among people with lower incomes can also pay off, because people in that group are otherwise more likely to forego health-promoting physical activity because of economic constraints or safety concerns.

“People are willing to invest in improved health, but if you have a fixed amount of resources then you want to choose where you get the most health for the dollar,” said Erik Groessl, an assistant professor of family and preventive medicine at the University of California, San Diego, and director of the UCSD Health Services Research Center. Groessl was not involved in the current analysis.

Group training or walking programs, for example, can be cost-effective, sustainable forms of physical activity that don’t require expensive health care professionals or equipment. But more costly interventions that yield dramatic results might also be worth the expense.

With respect to type 2 diabetes, Medicare reimburses for approved self-management education and medical nutrition therapy programs. But no specific reimbursement is given for any physical activity or exercise program, despite evidence that such programs can help improve health and cut costs.

Questions remain as to what format reimbursable exercise and physical activity programs should take, what population group should be targeted, and at what stage of life or health status would a lifestyle intervention be most cost-effective to implement.

Various studies, including the UF Institute on Aging Lifestyle Interventions and Independence for Elders, or LIFE study, are aimed at answering those questions through randomized controlled trials that can provide data about the efficacy and cost-effectiveness of structured activity programs with respect to a range of health outcomes. Funded by the National Institute on Aging, the LIFE study is the largest of its kind to examine physical activity and health education as a way to prevent mobility disability among older adults, and accounts for the largest federal award to the University of Florida.

The institute will break ground on May 26 for a 40,000-square-foot complex within UF’s new $45 million, 120,000-square-foot Clinical and Translational Research Building, which will serve as headquarters for this research and others aimed at speeding scientific discoveries to patients.

“There is a lot of evidence that physical activity works, and I think it’s time to start putting it into practice more widely,” Groessl said.

When a movie character says, “It’s too quiet,” that’s usually a sign something bad may happen.

Now, University of Florida researchers have discovered that when variations of a certain protein in our cells are too quiet, it may add to the risk that someone will develop lung cancer. When scientists restored the protein to its normal, active self, its cancer-inhibiting properties reappeared.

These discoveries, published in two reports in the online version of Oncogene, provide evidence that drugs can potentially suppress tumor growth by restoring cellular processes rather than inhibiting cancer-causing genes known as oncogenes.

“It’s a well-accepted fact that you can inhibit things, particularly oncogenes,
that drive cancer. Oncogenes are the cancer’s gas pedal,” said principal investigator David Reisman, M.D., Ph.D., a UF associate professor of medicine and a member of the UF Shands Cancer Center. “What we’ve done is demonstrate the feasibility of reconstituting the cancer brake.”

The protein, known as Brahma, or BRM, is involved in the regulation of cellular functions like gene expression, DNA repair, cell adhesion and telling cells whether to divide and grow or stop dividing and die. Other studies have found
“silenced” BRM is present in 10 to 20 percent of all solid tumors. Reisman knew from his own research in mouse models that silencing the BRM gene alone did not cause tumor growth, but when carcinogens were introduced, 10 times as many tumors appeared compared with mice with normal BRM expression.

“The gene was not a tumor suppressor in the classical definition but a tumor susceptibility gene, and when the expression is lost, it primes you to other events that potentiate the development of tumors, such as tobacco carcinogens,” Reisman said.

More people die of lung cancer every year than of cancers of the breast, colon, prostate or lymphoma combined, according to the National Cancer Institute. However, only 10 percent of smokers develop lung cancer and as many as 15 percent of those diagnosed with lung cancer have never smoked.

Reisman’s work suggests the presence of two variations within the BRM gene — known as polymorphisms — could potentially be biomarkers for lung cancer and assist doctors in identifying individuals at higher risk, which could lead to more cost-effective screening practices and lifesaving early detection.

Study investigators sequenced the genes of 160 people and learned that roughly 20 percent carry the gene variants. With collaborator Geoffrey Liu, M.D., a research scientist at the Ontario Cancer Institute at the University of Toronto,
the team then verified the presence of the silenced BRM variants in human lung tumors.

Reisman and Lui also conducted case control studies on 1,199 people who were
matched for age, gender and smoking history but in whom 484 individuals had lung cancer and 715 were healthy and cancer free.

“We found these polymorphic sites were greatly enriched in the population that had developed lung cancer,” Reisman said. “The chance that you would develop lung cancer if you had both polymorphic sites was 220 percent higher. Our analysis demonstrated those odds to be independent of smoking history, sex, race and cancer type.”

Reisman’s team also studied whether it would be possible to restore the normal expression of the BRM protein. Certain compounds, called histone deacetylase — or HDAC — inhibitors, had been demonstrated by other researchers to reactivate the BRM gene, but did not restore the normal, cancer-suppressing function of the BRM protein.

By introducing the healthy protein alongside the reactivated gene, the researchers were able to stop the growth of cancer cells. That makes the process a potential target for drug therapies to use in suppressing many tumor types.

“We know there are a lot of genes that are silenced in cancer, and it’s believed that gene silencing is necessary in order for the cancer to grow and thrive. This research demonstrates — and is really the first example of — an approach that’s led to the reactivation of a specific tumor-suppressing gene,” said Aubrey Thompson, Ph.D., a professor of cancer biology at Mayo Clinic Comprehensive Cancer Center in Jacksonville, Fla., who was not involved in the research.

“That’s a really big deal,” he said. “It’s an approach that is widely applicable to a lot of genes and a lot of different types of cancer. I think it’s going to be met with a great deal of enthusiasm and interest from researchers in human cancer therapy.”

The primary purpose of palliative care is to alleviate suffering and enhance the quality of life. The concept of medical palliation in its inception conjured up images of dying patients with a similar set of physical symptoms that required relief. As older people began living longer with incurable chronic disease, the concept of palliative care took on a broader meaning. Palliative care now includes providing care that addresses the physical, emotional, cultural, and spiritual issues that affect a patient and their family during the final phase of life. This stage may last days to weeks when associated with an acute event, or may last months to years as in chronic illness with progressive debility.

Providing quality palliative care requires a multifaceted approach that achieves best results when a team of nurses, social workers, physical therapists, religious counselors, and other therapists supply care under the supervision of a physician team leader. The expertise and involvement by all these individuals is important to identify and address the "whole person." Members of the palliative care team conduct their own evaluations over a period of time talking to the patient, family, and care providers to obtain the complete picture. The evaluation will elucidate team members as to social needs such as financial concerns, need for closeness, care-giving needs, and access to care; spiritual needs such as the degree of distress, role of spirituality, and the extent to which one has settled relationships; medical needs such as the role of further diagnostic evaluation and treatment of physical and mental symptoms; and finally therapeutic issues that illuminate the goals of care.

The evaluation is a constant process. Goals of care and treatment priorities shift with increasing disease burden, but treating physical symptoms is always paramount. Symptom management includes nondrug interventions such as physical therapy modalities and acupuncture, and pharmacological management with both traditional and alternative choices. Typically treatment is a combination that minimizes potential adverse reactions. After therapy is initiated, regular patient follow-up is important to assess relief of symptoms, effect of treatment on abilities to maintain usual activities, and measure whether the identified goals are being met.

The concept of a "good death" is central to the modern palliative care movement, but watching the diminishing physical capabilities and the death of someone close is never easy. The truth is: no one can escape the experience. We all feel the fragility of life and worry about our own future end-of-life experience. Embracing palliative care allows better management of symptoms and prevents unnecessary suffering for the patient, bolsters the family and care-givers with skills to adapt to the transitions and face the losses, and, in creating a more positive outlook on end-of-life care, can help so many groups of people.

DEAR JIM: I have managed to outlive most of my friends and three wives to make it to age 92, and I feel pretty good for my age. I don’t drink or smoke, and I try to stay physically active. Still, I can’t help thinking about dying. I have seen so many of my friends expire after lingering for months with cancer, heart problems, Alzheimer’s disease, and other conditions, and I have to admit that it scares me to think that it could happen to me too — and the likelihood becomes greater with every passing year. Am I just being paranoid?

SCARED IN SCARSDALE

DEAR SCARED: No, you’re not being paranoid. The thought of dying becomes more commonplace as we get older and have a greater sense of our own mortality. And, as many of our friends and loved ones pass on, we think about it more often. However, you seem to be living a healthy lifestyle which has probably contributed to your longevity and could sustain you for years to come.

To put your mind more at ease, you might be surprised to know that most people in their eighties, nineties, and above are often healthier than those 20 years younger. Many medical afflictions usually happen to people in their sixties and seventies. Those who have reached their eighties and nineties — like you — are "survivors" who often carry on for years in comparative health.

With all of the current concern about Medicare, most people are not aware that the average Medicare bill for someone who dies by age 70 is three times greater than for someone who lives to be 90. In fact, the medical cost during the last two years of life — which are usually the most expensive — is typically just $8,300 for someone who dies at age 90 compared to $22,600 at age 70. It won’t be the centenarians who stretch the limits of Medicare but, rather, it will be the baby boomers turning 65!

It is not easy to put the thought of death on the back burner when so many of your peers are already deceased, but dwelling on it will not add years to your life either. You have been given a great gift to live so long, so continue to take good care of yourself and enjoy each and every day. Your healthy lifestyle has seen you through the years and should continue to serve you in good stead. Remember, it is not how long you live that counts but the quality of those years. With more and more people living longer, you are in good company.

"The one red leaf, the last of its clan,

That dances as often as dance it can,

Hanging so light, and hanging so high,

On the topmost twig that looks up at the sky."

– Samuel Taylor Coleridge

Americans Less Healthy Than English, but Live as Long or Longer, Study Finds
www.sciencedaily.com

This special issue of Experience! delves into the perplexing matter of defining old age. All of the books listed in the discussion below are published by Human Kinetics. The sources named are experts and their works are recommended by the American Senior Fitness Association (SFA)

Also called primary aging, biological aging concerns a number of processes in the human body that, over time, result in reduced adaptability, disease, physical and functional declines, disability, and ultimately death. Numerous theories of biological aging — for example: genetic theories which emphasize heredity; damage theories which stress the long-term build-up of cell damage; and other theories — are presently under scientific investigation and debate.

Functional age refers to an individual’s functional fitness level, compared to others of his or her same chronological age and sex (for example: how much and what types of physical activity can one successfully perform? what is the status of one’s cardiovascular system? one’s musculoskeletal system? what are an individual’s capacities and/or limitations in terms of carrying out activities of daily living?). As a good example of gauging functional fitness, Jones and Rose cite influential researcher Waneen W. Spirduso’s well-known Hierarchy of Physical Function. Her publication Physical Dimensions of Aging (1995) separates physical function into five categories in descending order: physically elite; physically fit; physically independent; physically frail; and physically dependent. A second edition of Physical Dimensions of Aging was published in 2005.

Psychological age refers to a person’s mental or cognitive functioning and includes factors such as memory, learning, and self-esteem. Ongoing research suggests that while some older individuals exhibit the psychological adjustments characteristic of their chronological age, others act psychologically younger or older than their peers.

Social age has to do with the concept that society imposes a strong influence on what is perceived to be appropriate or inappropriate behaviors for persons within specific chronological age groups. As an example, Chodzko-Zajko notes that some older adults view public physical activity as undignified, while others embrace it. Contemporary researchers want to know whether society’s expectations might be conditioning people to become less active with age and, therefore, less healthy. The World Health Organization supports a more dynamic approach to aging in which older adults are encouraged to demonstrate higher levels of activity.

Howley, Franks, and Shephard deeply respect the complications involved in attempting to define or identify specific stages of the aging process. The Fitness Professional’s Handbook emphasizes that health-fitness personnel must be alert to the differences among their older adult physical activity participants.

However, like all of the other authors, researchers, and organizations named above, their major focus is not on age numbers. Taylor and Johnson make an important distinction between eugeric aging (changes that will inevitably happen to everyone) and pathogeric aging (pathological changes that are not predestined aspects of aging). They point out that disuse and a progressive decrease in physical activity level over time can significantly contribute to pathogeric aging.

"These kinds of complexities illustrate to a large degree why SFA has always stressed the importance of individualization in older adult fitness programming," says Janie Clark. "This includes obtaining medical clearance for exercise and seeking relevant input from the client’s health care professional. The client’s lifestyle, physical activity history, and personal interests must be taken into account. On another practical front, easy-to-administer functional fitness testing methods can be implemented in the workplace to help determine functional status, plan appropriate programming, and track the progress of senior physical fitness participants."

SFA member Rudy Rich is spreading the word about enjoyable, productive aging. "It’s not just about long life or longevity; it’s about a long, fit life, or fitgevity," he explains in his bookFitgevity Lifestyle. An experienced personal trainer in Newport Beach, California, Rudy also holds advanced degrees in English. His illustrated 246-page soft-cover book neatly combines those areas of expertise. It provides interesting historical context regarding the aging process and discusses timely health and fitness issues in a reader-friendly way. Rudy also relates the inspiring personal stories of several individuals who exemplify the fitgevity lifestyle. Highly motivational, Fitgevity Lifestyle would be a fine gift for loved ones who recently made fitness-related New Year’s resolutions — as well as for already-avid physical fitness fans. For more information, click on www.fitgevitylifestyle.com.