INTERNATIONAL LONGEVITY CENTER-USA
国际长寿中心-美国
Healthy Aging
Malta-MAGG
健康老龄化
马耳他-MAGG
Harrison G. Bloom, M.D.医学博士
Director, International Geriatrics Clinical Education and Consultation Service,
International Longevity Center-USA
主任，国际老人病学临床教育及咨询处
国际长寿中心-美国
翻译:陈浩然
Healthy Aging健康的老龄化
• Work 8 hours工作8小时
• Play 8 hours 玩8小时
• Sleep 8 hours睡8小时
(Not the same 8 hours)不同样的8小时
Healthy Aging健康的老化
Listen to your mother!
听母亲的
• Eat your fruits and vegetables
• 吃水果和蔬菜
• Share with others
与他人共享
• Be a nice person
• 做一个好人
Healthy Aging健康的老化
• Have good genes ( about 30%)
• 好的基因（大约30%）
• Practice reasonable preventive health
(e.g. vaccinations)
• 实施合理的预防性保健（如接种疫苗）
• Be lucky (e.g. don’t get hit by a car)
• 运气好（如:不被车撞）
• Keep active – physically and cognitively
• 保持活动-躯体的和认知的
• Be a women
• 做个妇女
Healthy Aging健康的老化
“Never go to a doctor whose office plants have
died.”
不要找一个办公室植物已经死亡的医生看病（不要
找一个不关爱生命的医生看病）
-Erma Bombeck
Healthy Aging健康的老化
Aging: Not a Single Process
老龄化: 不是一个单一的过程
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Accumulation of mutations and changes in genes and chromosomes.
基因和染色体转变和改变的积聚
Damage to DNA, proteins, membranes, and mitochondria by reactive oxygen species (ROS)
produced during metabolism (free radicals).
代谢时，产生的活性氧粒子（自由基）对DNA、蛋白、膜及线粒体的损害.
Chemical changes in amino acids of proteins, including oxidation, glycation, deamidation,
abnormal phosphorylation, methylation. Accumulation of altered proteins as aggregates, such
as AGEs, advanced glycation end products.
蛋白氨基酸的化学变化，包括氧化、甘油、脱酰胺、不正常的磷酸化、甲基化。聚集时，蛋白积
聚改变，例如晚期终末化产物、老的糖化终产品。
Healthy Aging健康地老龄化
Aging – Not a Single Process
老龄化: 不是一个单一的过程
• Break down in mechanisms to ensure the accuracy of DNA,
RNA, and protein synthesis
确保DNA、RNA、蛋白精确合成的机制的破坏
• Breakdown in recognition of self vs. nonself antigens, leading to
increased autoimmunity
• 认知自身及非自身抗原的破坏，导致自身免疫增加
Holliday R. Journal of Gerontology, Biological Sciences. 2004:
Vol. 59A, No. 6, 568-572.
Healthy Aging健康地老龄化
Maintenance Defenses
维护防御措施
• DNA repair. (Est.) 10,000 apurinic gaps in the genome of each cell/day; most
are repaired.
• DNA修复.(欧洲毒物学会) 每天每个细胞整组遗传基因10，000无嘌呤缺口
• Enzymes that destroy or antioxidants that absorb ROS (free radicals)
• 破坏的酶和吸收了活性氧粒子（自由基）的抗氧化物
• Proteases that recognize abnormal proteins and degrade them (Continual
protein turnover in cells with active metabolism)
• 认知异常蛋白和降解它们的蛋白酶（有着活跃代谢的细胞中的连续的蛋白质
转换）
• Immune system recognizes foreign pathogens
• 识别外来病原体的免疫系统
Healthy Aging健康地老龄化
Maintenance Defenses 2
维护防御措施
• Liver detoxification, based on p450 cytochromes, of plant and animal food
toxins
• 基于p450的、对动植物毒素的肝解毒作用
• Wound repair, blood clotting, broken bone repair
• 创伤的修复、血液凝固、骨折修复
• Cell suicide mechanism, apoptosis
• 细胞自杀机制、编程性细胞死亡
• Homeostatic mechanisms, e.g. temperature control
• 稳态机制，如体温控制
• Fat storage to survive periods of inadequate food
为食物不足生存期的脂肪储存
Holliday R. Journal of Gerontology, Biological Sciences. 2004;
Vol. 59A, No. 6, 568-572.
Healthy Aging: Theoretical Pathways to Increase in Longevity and
Delay in Dysfunction健康地老龄化：增加长寿和延缓机能不良的理
论的通路
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Preventing disease
预防疾病
Control of free radical damage
控制自由基的损伤
Delay of immunosenescence
延缓免疫衰老
Caloric restriction
控制热量
Stem cells and cell replacement
干细胞和细胞移植
Gene regulation
基因调节
Healthy Aging健康地老龄化
What should we be telling our patients?
我们应该告诉病人什么？
Is There An “Anti-Aging” Medicine?
存在抗衰老药吗？
Healthy Aging 健康地老龄化
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Luigi Cornaro, 1550: extreme longevity possible by maintaining reserves of vital
energy through moderation in all things
Luigi Cornaro，1550：可能通过减少所有事物的重要能量维持储存物达到极端长寿
Late 18th, early 19th centuries: hormone transplants
18世纪后期、19世纪早期：激素移植物
– Brown-Sequard 1889: injections of animal sex glands
– Brown-Sequard 1889: 注射动物性腺
– Lydston and Stanley, early 1900s: testis transplants
– Lydston及Stanley，1900早期：睾丸移植
1990: American Academy of Anti-Age Medicine (A4M): end of aging promised by
combination of hormone treatments, plastic surgery, supplements
1990：美国抗衰老学会（A4M）：期望通过激素治疗、整形外科手术及补充物中止衰
老
Healthy Aging健康地老龄化
“Within the next 50 years or so, assuming an
individual can avoid becoming the victim of major
trauma or homicide, it is entirely possible that he or
she will be able to live virtually forever.”
“在大约未来的50年里，如果一个人可以避免成为大
的创伤或杀人犯的受害者，她或他是完全可能永远
生存。”
Klatz RM, Advances in Anti-Aging Medicine, Liebert, 1996.
Healthy Aging健康地老龄化
Position Statement on Human Aging
“Advocates of what has become known as anti-aging medicine claim that it is now
possible to slow, stop, or reverse aging through existing medical and scientific
interventions.
“ 认为有抗衰老药的拥护者主张通过现存的药物和科学干预可能延缓、中止或逆转衰
老。
Claims of this kind have been made for thousands of years, and they are as false
today as they were in the past.”
这种主张已有数千年，今天仍然和过去一样是错误的。”
Olshansky, Hayflick, Carnes, J Gerontology, 2002, Vol 57A, No.
8, B292-297
Healthy Aging健康地老龄化
Healthy Aging健康地老龄化
Anti-Aging Boon (doggle )s抗衰老的好处
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Anti-oxidants抗氧化剂
DHEA脱氢表雄酮
Human growth hormone人生长激素
Testosterone睾丸素
Melatonin褪黑激素
Healthy Aging健康地老龄化
Human Growth Hormone 人生长激素
• Rudman et al, Effects of Human Growth Hormone in Men over 60 Years Old,
NEJM 323(1990) ; 1-6.
• Rudman 等，人生长激素对大于60岁男士的作用，NEJM 323（1990）；1-6。
Human growth hormone administered to men deficient in growth hormone
increased lean body mass, decreased fat, and increased bone mass.人生长
激素给予人生长激素缺乏的男士的去脂肪体重、减少脂肪及增加骨密度。
• Subsequent studies have investigated potential benefits of rhGH in
malnourished, frail, and critically ill older persons.
• 后来的研究调查了rh 生长激素对营养不良、虚弱及重病的老年病人的潜在好
处。
• Recent animal studies: overproduction of GH shortens longevity;
underproduction, or decreased activity of GH/insulin signaling pathway,
increases longevity.
近来的动物研究：生长激素过度产生缩短长寿；生产不足或减弱人生长激素或
胰岛素信号通路的活性，增加长寿。
Healthy Aging健康地老龄化
Human Growth Hormone人生长激素
• Problems:
• 问题
– IM therapy
– 免疫抑制治疗
– Adverse effects: edema, carpal tunnel syndrome, joint pain, diabetes
mellitus, hypertension, CHF, gynecomastia, possibly increased CA
– 副作用：水肿、腕管综合症、关节痛、糖尿病、高血压、慢性心力衰竭、
男子女性型乳房及可能增加的癌症
– Cost: $15,000/year
– 费用：$15.000/年
– Clinically significant functional benefits, prolongation of youth, increased
longevity not demonstrated
未显示临床明显的功能利益、青春期延长及增加长寿
Healthy Aging健康地老龄化
A Model of a Successful Aging. From Rowe and Kahn,
Successful Aging, The Gerontologist, Vol. 37, No. 4, 1997.
Healthy Aging健康地老龄化
“From birth to age 18, a girl needs good parents;
“从出生到18岁，女孩子需要好的父母；
from 18-35 she needs good looks;
从18-35她需要好的容貌；
from 35-55 she needs a good personality;
从35-55她需要好的人格；
and from 55 on she needs cash.”
从55开始她需要现金。”
-Sophie Tucker
Healthy Aging:健康地老龄化：Promotion of
Optimal Nutrition最佳营养的改善
• Replace saturated and trans fats with unsaturated fats.
• 用不饱和脂肪代替饱和脂肪和反式脂肪。
• Substitute whole-grain carbohydrates for
refined-grain carbohydrates.
用完整谷类碳水化合物代替精细谷类化合物。
• Substitute nuts, beans, chicken, and fish for red meats.
• 用坚果、豆类、鸡肉及鱼代替红肉。
• Eat plenty of fruits and vegetables.
• 吃大量的水果和蔬菜。
• Use alcohol in moderation.
• 少量饮酒。
• Take a daily multivitamin.
• 摄取日常多种维生素。
K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to
Achieve it. Annals of Long-term Care. 15(12).: 32-39.
Healthy Aging:健康地老龄化Promotion of Optimal
Cognitive Health最佳认知健康的改善
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Take a multivitamin.
摄取多种维生素。
Engage in mentally stimulating activities.
参与用脑筋的刺激性活动。
Remain socially engaged.
在社会中保持参与。
Exercise regularly.
有规则地锻炼。
Develop methods to detect and reduce stress (e.g., relaxation,
yoga, meditation).
• 制定办法检出和减少压力（如：放松、瑜伽及沉思）。
• Get adequate sleep.
• 获得充足的睡眠。
K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to
Achieve it. Annals of Long-term Care. 15(12).: 32-39.
Healthy Aging:健康地老龄化Exercises to Promote
Optimal Aging锻炼以促进最佳的老化
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Do some form of exercise/physical activity for 30 minutes a day.
每天做30分钟某种形式的运动或体力活动 。
Never use an elevator or escalator when stairs are available.
如有楼梯时，从来不用电梯或自动扶梯。
Walk or bike on errands that would take less than 10 minutes to drive.
步行获骑车完成小于10分钟车程的任务。
Don’t use remote control devices.
不要使用遥控装置。
Use manual devices when possible (eg, lawn mower, broom).
可能时使用手动装置（如，割草机、扫帚）。
Park a long distance from the main door when shopping.
购物时把车停在离大门远的距离。
Healthy Aging:健康地老龄化Exercise to Improve
Balance 锻炼以改善平衡
• Engage in exercise that requires balance (e.g., tai chi, dancing).
• 参与需要平衡的锻炼（如：太极、跳舞）。
• While standing in line or cooking, stand on one leg (or with feet
in tandem).
• 当站队和烹饪时，用一条腿站立（或两脚前后站立）。
• Try heel or toe walking for short distances (10-20 ft).
• 试着用脚跟或脚趾短距离行走（10-20英尺）。
• Stand up and sit down on chairs using one leg (with hand
support if needed).
• 用一条腿站立或坐在椅子上（如果需要用手支持）
K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to
Achieve it. Annals of Long-term Care. 15(12).: 32-39.
Healthy Aging:健康地老龄化Exercise to Improve
Strength
• Lift small weights (one can of peas) in a plastic shopping bag,
10 repetitions on each side (vary the muscle groups)
• 拎在熟料购物袋中的小的重物（一罐豌豆），每边重复10次（变
化肌肉群）
• Bag handles with a can inside can be placed over feet to
exercise the leg muscles.
• 内中有罐的袋子提手可以放在脚上以锻炼腿的肌肉群。
• Do sit-to-stand-to-sit exercises while watching TV.
• 观看电视时做坐-站-坐的锻炼。
• Use both free weights and weight machines, and do strength
training 2-3 times per week.
• 即用自由重物也用重物机器，并且每周2-3次重物训练。
K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to
Achieve it. Annals of Long-term Care. 15(12).: 32-39.
Healthy Aging:健康地老龄化Optimal最佳
的
The capacity to function across many
domains- physical, functional, cognitive,
emotional, social, and spiritual – to one’s
satisfaction and in spite of one’s medical
conditions.
跨越许多领域的能力-身体的、功能的、认知的、情绪的、
社会的及精神的-令人满意并且虽然他在就医中。
K. Brummel-Smith, M.D. 2007. Optimal Aging, Part I: Demographics and Definitions. Annals of
Long-term Care. 15(11).: 26-28
Healthy Aging:健康地老龄化Successful成
功的
Absence of disease and disability; high
cognitive and physical functioning; and
active engagement with life.
没有疾病和残疾;高的认知和身体机能；及积
极地参与生活。
K. Brummel-Smith, M.D. 2007. Optimal Aging, Part I: Demographics and Definitions. Annals of
Long-term Care. 15(11).: 26-28
Healthy Aging健康地老龄化
New England Centenarian Study
Thomas T. Perls, MD MPH, Margery Silver EdD
新英格兰研究百岁老人研究
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169 centenarians in 8 communities near Boston
居住在靠波士顿的18个社区的169个百岁老人
85% female
85%是女性
15% living independently, 35% with family, 50% in nursing homes
15%独立生活、35%与家庭、50%在护理院
25% free of cognitive disorders
25%无认知障碍
4/5 male centenarians have extremely good mental and physical health
4/5男性百岁老人拥有极好的精神和身体健康
Female centenarians: wide spectrum of mental and physical health
女性百岁老人：宽广的精神和身体健康谱
Healthy Aging健康地老龄化
Characteristics of Centenarians : NECS
百岁老人的特点：
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95% physically healthy, cognitively independent into 90s
95%身体健康、认知独立进入90岁
Significantly lower scores for “neuroticism” and “negative emotionality”; only 4/74 with severe
depression on GDS
“神经过敏”和“消极情绪”的分数明显低，仅4/74在剂量递增表上有严重的抑郁
Almost all ahad suffered severe bereavement, but demonstrated ability to cope with stress and
loss
几乎所有的ahad经历了痛苦的死别，但显示了处理压力和损失的能力
High degree of continued intellectual stimulation: musical instrument, painting, sculpture, new
language
高度的持续的智力刺激：乐器、绘画、雕塑及学习新语言
No pattern in diets
没有典型的饮食
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Wide range of education
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广泛的教育
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Healthy Aging健康地老龄化
Characteristics of Centenarians : NECS
百岁老人的特点：
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99% non-obese
99%不肥胖
Alcohol consumption minimal
最小限度地消费酒精
Smoking non-existent
不 吸烟
Prominent use of humor as coping mechanism
卓越的使用幽默作为应付机制
Nearly all have many meaningful relationships and ability to attract people
几乎所有人拥有许多有意义的关系和能力吸引人们
82% report religious beliefs important influence in life
82%报告宗教对生活有重要的影响
Healthy Aging健康地老龄化
Exercise : The Real Fountain of Youth
锻炼：年轻的真正源泉
Reduction in: 减少：
CAD and stroke (effect on BP, HDL, DM)冠心病和中风（对
血压、高密度脂蛋白、糖尿病）
colon cancer 结肠癌
osteoporosis骨质疏松症
diabetes mellitus糖尿病
obesity肥胖症
depression抑郁
Improvement in: muscle mass, balance, strength,
Sleep 改善：肌肉质量、平衡、力量、睡眠。
Healthy Aging健康地老龄化
Numerous Studies Demonstrate Benefits of Exercise in Reduction of All-Cause Mortality
大量的研究显示锻炼在减少全因死亡率的益处
• Kaplan, 1987, Alameda County Study : increased risk of death in persons > 70 who
reported low levels of activity
• Kaplan, 1987, Alameda 县研究：
• 低水平活动量增加死亡的风险
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Blair, 1989, JAMA : 10,224 men, 3,120 women. All-cause mortality decreased across
quintiles of treadmill-determined physical fitness.
Blair, 1989, JAMA : 10,224 男士, 3,120 女士.通过1/5的平板决定的身体适合度的全因
死亡率下降。
Kujala, 1998, Finnish Twin Cohort, JAMA: leisure-time physical activity associated
with reduced mortality, even after genetic and familial factors accounted for
Kujala, 1998, Finnish Twin Cohort, JAMA: 业余时间的体力活动伴随下降的死亡率，
甚至在可以解释的基因和家族因素后
Healthy Aging健康地老龄化
Myers, 2002, NEJM:
After adjustment for age, treadmill peak exercise capacity was the strongest
predictor of mortality in normal subjects and those with cardiovascular
disease.
在年龄调节后，平板高峰运动能力是正常个体和有心脏病者的最强的死亡预测
因素。
Each 1 MET increase in exercise capacity conferred 12% increase in survival.
运动能力每增加1级赋予生存率12%的增加
Healthy Aging健康地老龄化
Helen Zechmeister, 91,
weight lifter (200 lbs.)
举重者
Healthy Aging健康地老龄化
Woody Brown, 83, surfer 冲浪运动员
Healthy Aging健康地老龄化
Ida Kline, 100, aerobics instructor有氧健身
操教练
Healthy Aging:健康地老龄化Psychosocial Factors in
Longevity
Studies suggest that 研究提示
– social support systems –社会支持体系
– ability to cope with stress-处理压力的能力
– lifelong learning, meaningful activity -终生学习，
有意义的活动
– Laughter -笑
may contribute as much if not more to longevity
than healthy behaviors
也许对长寿贡献许多即使不超过对健康行为的贡献
Healthy Aging健康地老龄化
Psychological Well-Being: The Value of Social Support
心理健康：社会支持的价值
• Berkman, 1979, Alameda County Study: 7000 men and women, followed for
9 years, were 2-3x more likely to die if they lacked social and community
ties, regardless of age, gender, health practices, or physical health status
• Berkman, 1979, Alameda 县研究: 7000男人和女人，随访9年，假如缺少社会
和社区联系，不论年龄、性别、健康情况或身体健康状况，2-3倍地易于死
亡，
• Orth-Gomer, 1987. 17,000 Swedish persons over 6 years. Socially isolated
4x more likely to die prematurely, even if age, health behavior, and health
status controlled
• Orth-Gomer, 1987. 17,000 超过60岁的瑞典人. 即使控制年龄、健康行为及健
康状态，与社会隔离，4倍易于过早地死亡。
We don’t not stop working
because we are old; we grow
old because we stop working.
因为我们老，我们不停止工作；
因为我们停止工作，我们变老。