Carol L. Monson, DO. MS. FACOFP, FAAFP
Family and Community Medicine
MSUCOM
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OBJECTIVES
Define the Philosophy of Optimal Aging
Compare philosophy of optimal aging with
the philosophy of Osteopathic Medicine and
Successful Aging
Describe the determinants of optimal aging
Discuss the components of optimal aging
Describe the effects of positive and negative
attitudes on health
Optimal Aging
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
Bates & Bates (1990)
Walsh (1993)
Kenneth Brummel-Smith MD (2007)
Principles of Osteopathic Medicine
“To find Health
should be the object of the doctor...
Anyone can find disease.”
Andrew Taylor Still, MD, DO (1899)
Principles of Osteopathic Medicine
Osteopathic medicine views the human
being as a unit of body, spirit and
mind in which structure and function
are interrelated or integrated
(Multiple authors interpreting A.T.
Still)
The human being has self-regulatory
mechanisms and is able to defend and heal
itself.
When the normal homeostasis of the human
being is altered, then this being becomes
susceptible to disease, and treatment must
occur.
Absence of disease and disability;
high cognitive and physical
functioning;
and active engagement with life
Rowe and Kahn (1997)
Determinants of Health
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Function
Disease
Social environment and support system
Physical environment
Genetic endowment
Individual responses – behavior & perspective
Healthcare system
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Components of Optimal Aging- Body
Biological - Exercise, nutrition, sleep,
avoidance of disease-causing agents,
practicing preventive medicine, early
treatment of diseases and medical
conditions, cognitive stimulation, avoidance
of iatrogenic complications
Functional- Strength, balance, flexibility,
conditioning
Components of Optimal Aging- Mind and Spirit
 Social- Support, activities, work,
volunteerism, sexuality, religion,
spirituality, “other-orientation”
 Psychological - Attitude, viewpoint, stress
management, resilience
 Societal- Health education, chronic disease
self management training, access to
information, community services,
environmental design, health policies and
insurance
Eleanor Hyndman,
Age 80
Started karate at
age 78.
Says it gives her
mental sharpness
Recently won a
gold medal.
Is a Purple belt.
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13% of the population is above age 65
Persons above age 85 are the fastest growing
segment of the population
More 85 year olds are alive today than Ever
Before
Florida is 1st in percentage of Older Persons
California is 1st in number of Older Persons
Michigan is 8th in the number of Older Persons
An increased percentage of Older Persons is
happening all over the world
Peak is expected in 2050
Helen Zechmeister, 81 y/o
Deadlift 245 lbs
She once competed in a
men’s 35-yrs and older bracket
because there were no other women.
She won.
Biological
 Impaired taste or smell
 Impaired vision
 Multiple medications
 Cognitive deficits
 Difficulty swallowing
 Stomach/intestine diseases
 End-stage disease
Functional
 Manual dexterity problems
 Mobility limitations
 Falls
 Incontinence
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Promotion of Optimal Nutrition
Replace saturated and trans-fats with
unsaturated fats
Substitute whole-grain carbohydrates for
refined-grain carbohydrates
Substitute nuts, beans, chicken, and fish for
red meat
Eat 9 servings per day of fruits and
vegetables
Use alcohol in moderation
Take a daily multivitamin.
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Poor nutrition and weight loss is
associated with excess mortality, frailty,
and a loss of quality of life.
Nutritional interventions play a major role
in disease management and have been
shown to limit the progression of disease.
◦ Dietary interventions may decrease the risk or
progression of macular degeneration, stroke,
heart attacks, and lipid abnormalities,
osteoarthritis , osteoporosis, and some cancers
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Exercise is the single most important healthpromoting activity a person can engage in
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Maintaining a healthy body weight has also
been shown to promote optimal aging
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Sleep appears to be important in optimal
aging
◦ Lack of sleep may be related to hyperactivity of the
hypothalamic-pituitary-adrenal (HPA) axis.
◦ result of this hyperactivity is excess glucocorticoid
production, and glucocorticoids are toxic to the
hippocampus
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Alcohol is often considered unhealthy
◦ but appears to have a positive effect on health, with
moderate consumption
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Tobacco is the single most important diseasecausing substance to avoid
◦ it appears that stopping smoking, even after age 70, is
associated with improved health.
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Recommendations regarding the use of prophylactic
aspirin are also controversial
◦ consider the risk and benefits in deciding whether to
take aspirin for cardiovascular prophylaxis.
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Avoiding or Reducing Stress
◦ reduction techniques such as regular exercise, breathing
exercises, tai chi, yoga, and meditation can all play a
role in the reduction of chronic stress if it cannot be
avoided.
Avoiding or Reducing Depression
◦ Depression is known as a risk factor for the development
of dementia and is associated with chronic elevations of
serum cortisol.
◦ Exercise can improve depression
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Exercising to Promote Optimal Aging
Do some form of exercise for 30 minutes a
day (some is better than none)
Never use an elevator or escalator when
stairs are available
Walk or bike on errands that would take
less than 10 minutes to drive
Don’t use remote control devices.
Use manual devices when possible (eg, lawn
mower, broom)Park a long distance from
the main door when shopping.
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Exercises to Improve Balance
Engage in exercise that requires balance (eg,
tai chi, dancing)
While standing in line or cooking, stand on
one leg (or with feet in tandem).
Try heel or toe walking for short distances
(10-20 ft)
Stand up and sit down on chairs using one
leg (with hand support if needed).
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Exercises to Improve Strength
Lift small weights (one can of peas) in a plastic
shopping bag,
◦ 10 repetitions on each side (vary the muscle groups).
◦ Bag handles with a can inside can be placed over feet to
exercise the leg muscles.
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Do sit-to-stand-to-sit exercises while watching
TV.
Join a health club that has both free weights and
weight machines, and do strength training 2-3
times per week.
Psychological/mental health
 Depression
 Dementia
 Bereavement
 Substance abuse
 Pre-death concerns
Social
 Isolation
 Recent moves
 Institutionalization
 Fear of crime
 Fear of falling
 Poverty
Societal
 Lack of resources in health education,
 Increasing chronic disease
 Poor self management training
 Poor access to information
 Lack of and limited access to community
services
 Environmental design geared to the ablebodied
 Confusion about health policies and
insurance
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Promotion of Optimal Cognitive Health
Take a multivitamin
Engage in mentally stimulating activities
Remain socially engaged
Exercise regularly (Body and Mind)
Develop methods to detect and reduce stress
(eg, relaxation, yoga, meditation)
Avoid or Reduce Depression
Get adequate sleep
“POSITIVE ATTITUDE” IMPROVES HEALTH
• Fewer risk factors
• Fewer negative events (e.g., heart attacks)
• Faster or more complete recovery from events
Feeling “Gratitude” or “Appreciation”
• is linked to positive well-being (Wood, 2010)
• Positive emotional functioning
• Positive social functioning
• Less anger & hostility
• Less depression
• Higher success in life activities
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The POWER of POSITIVE ATTITUDE
Increased longevity (Danner et al., 2001)
Reduced morbidity (Goldman et al, 1996;
Russek & Schwartz, 1997)
Increased cognitive flexibility (Ashby et al.,
1999)
Improved memory (Isen et al., 1978)
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The POWER of POSITIVE ATTITUDE
Improved decision making (Carnevale & Isen,
1986)
Increased creativity and innovative problem
solving (Isen et al., 1987)
Improved job performance & achievement
(Wright & Staw, 1994; Staw et al.,1994)
Improved clinical problem solving (Estrada et
al.,1997)
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Self-Esteem
Having something to offer to others
Personal goals for the future
Belief in something larger than self
Ability to adapt to new and changing
circumstances
Belief that you are important to others or the
world
Seeking happiness and joy for one’s self and
others
Desire to live one’s life to the fullest
Making peace with one’s life and death
Ada Thomas Age 72
Started jogging at
age 65
First marathon at
age 68.
“When I look in the
mirror…
I like what I see”
Brummel-Smith K, Optimal Aging, Part 1:
Demographics and Definitions, Annals of LongTerm Care, vol. 15,issue 11, November 2007
Brummel-Smith K, Optimal Aging, Part 2:
Evidence-Based Practical Steps to Achieve It,
Annals of Long-Term Care, vol. 15, issue 12,
December, 2007