WELL BEING RETIREMENT. Dr S. Rao, Medical Services UNOG 11 October 2016
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2 WELL BEING & RETIREMENT Dr S. Rao, Medical Services UNOG 11 October
3 The Quest for the fountain of Herodotus Youth Ponce de Leon Endocrine therapies: Dehydroepiandrosterone (DHEA) Human growth hormone Estrogens Androgens 3
4 Process of aging is complex Unavoidable programmed death of cells Measures we can take Effective medical help 4
5 Learning from my patients Great differences in the aging process Youthful Age prematurely More than genetics: zest for life What is their secret? What have I learned from them 5
6 Four common denominators 1. HUMOR 2. DIET 3. EXERCISE 4. STAYING CONNECTED 6
7 METABOLIC CONCERNS Menopause Estrogen Replacement Therapy (ERT) breast + uterine cancer & existing heart disease ERT : unpopular Advice: Non hormonal therapies (exercise, mood elevators, soy products) Gynecologist yearly, mammogram Breast palpation 7
8 8
9 METABOLIC CONCERNS Andropause 1% testosterone / year Mid 70 s, 75% men will have low testosterone levels Testosterone therapy Drawbacks: HDL, sleep apnea, stimulating malignant prostate cells! Advice: Urologist regularly PSA, prostate cancer screening, eventual libido issues 9
10 METABOLIC CONCERNS = Vitamin D deficiency coronary artery disease prostate cancer, colon cancer, bone loss Advice: 800 units of D3 /day Better: walk daily 10
11 METABOLIC CONCERNS Hypothyroidism Metabolic syndrome Truncal obesity Low HDL, high triglycerides, elevated glucose, hypertension, atherosclerosis & diabetes 11
12 GAIT DISTURBANCES Reasons for instability and falls Neurologic (brain & nerves) Non neurologic (muscles & bones) 2/3 body weight is centered in upper body Muscle loss (quadriceps, gluteus muscles) Advice: Simple activities (walking, climbing stairs, biking) Best treatment for a broken hip is prevention 12
13 DEMENTIA SYNDROMES Alzheimer s disease = specific form Definition of dementia: impairment in memory + APHASIA = disturbance in language / APRAXIA = inability to execute motor skills / AGNOSIA = disturbance of visual processing / ABSTRACT REASONING 13
14 Major dementia syndromes o REVERSIBLE FORMS o IRREVERSIBLE FORMS 1. ALZHEIMER DISEASE (AD) : 60% 2. FRONTAL-TEMPORAL DEMENTIA :20% 3. VASCULAR DEMENTIA: 10% 4. PARKINSON DISEASE : 10% 14
15 ALZEIMER S DISEASE (AD) Kepe V et al. PNAS 2006;103:
16 Help ourselves avoid AD! Weight control Regular exercise 30 daily Statins Folic acid? New therapies: act directly on the Amyloid deposit - cure? 16
17 Dementias: etiology & treatment? Neuropathogen (virus) New therapies? Antivirals? vaccine? 17
18 Adult vaccines: PEARLS 1 / 7 Tetanus, diphteria and pertussis < age 65 & repeated every 10 years Flu vaccine annually > 65 / chronic disease (heart, lung or diabetes) Pneumonia vaccine > 65 repeated every 5 years Shingles? > age 60 18
19 PEARLS 2 / 7 Age Related Macular Degeneration (ARMD) smoking, alcoholism, family history, coronary artery disease, cholesterol diet Advice: Zinc containing foods Antioxydant vitamins C, E and beta Carotene 19
20 PEARLS / 7 Good oral hygiene is fundamental Scale & Floss your teeth: Inflammation major role in stroke and heart attack Fish Oil 20
21 1% cholesterol PEARLS 5 / 7 2% reduction in incidence CAD Statin therapy modern day miracle : They are to heart what antibiotics were to infection 60 years ago! 21
22 Stress reduction Heart attacks Strokes Susceptibility to infections PEARLS 6 / 7? cancer by interfering with our immune system 22
23 PEARLS 7 / 7 Cancer screening reflex colonoscopy (gastroenterologist) colon cancer 23
24 PEARLS 7 / 7 Cancer screening reflex (continued) skin inspection (dermatologist) melanoma 24
25 Twelve Foods for life 1. Tomato: Lycopene (powerful antioxydant) 2. Spinach: Iron, Folic acid & Lutein. 3. Wine: HDL levels, antioxydants 25
26 Twelve Foods for life 4. Almonds, nuts: HDL levels, LDL, apoptosis, vitamin E. Caveat : diverticulosis 5. Broccoli: vitamin E & C 6. Oats: fibers, cholesterol 26
27 Twelve Foods for life 7. Fish: Omega 3 fatty acids, LDL cholesterol 8. Garlic: triglycerides, HDL, antibacterial, antifungal; antimalarial? 9. Green tea: polyphenols 27
28 Twelve Foods for life 10. Blueberries: Best antioxydant 11. Nori 12. Olive, colza oil 1.5 L / day + fresh 28
29 Summary 4 common denominators to age with grace Humor, diet, exercise & staying connected Metabolic concerns Gait disturbances Dementia syndromes 7 Pearls 12 Foods for life 29
30 To live in good health after 60 is also up to you! 30
31 Happy active retirement! 31
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