Ageing and active ageing

Ageing is a given. We do not choose to age. It happens to us whether we want it or not. Yet, everyone can choose how they wish to age and those who make the choice of active ageing early enough are likely to enjoy a greater degree of good health in their golden years. As J.K. Rowling wrote in her book, Harry Potter and the Chamber of Secrets, “It is our choices, Harry, that show what we truly are, far more than our abilities.” Unfortunately, healthy choices are often difficult choices for many people around the world and how people make choices and options in later life are influenced by education, upbringing and the attitudes and expectations of society.

Aging is a process that begins from infancy and continues to the very end. Some of these changes are genetically determined while others are affected by nutrition, lifestyle and environment.  Also, ageing is not a uniform process for everyone because some people show the effects of ageing to a greater degree than others of the same chronological age. 

Many changes in the body occur because of ageing. There is a decrease in muscle and fat and a redistribution of body fat with ageing. There is a tendency for fat to accumulate around the abdomen in an apple shaped distribution particularly in males. This increase in abdominal fat predisposes to diabetes and cardiovascular disease in older people. Body water decreases with age and increases susceptibility to dehydration. The tendency to develop dehydration is compounded by the decrease in thirst sensation seen in the elderly.  Ageing is most visible in the skin of the face and limbs because of changes in skin and hair caused by altered collagen in the dermis of the skin ,  thinning of the dermis and a reduced turnover of cells of the epidermis. The thickness of hair strands becomes less with age and there is also thinning of the hair leading sometimes to baldness. Greying of the hair occurs because of decreased pigment production. 

Progressive bone loss with ageing predisposes to the risk of fractures. Women are more at risk of age related bone loss because a fall in oestrogen production after menopause increases bone loss. Vitamin D is often low in the elderly. This may be partly because the skin of the elderly is less efficient in synthesising Vitamin D from sunlight and the kidneys of the elderly are less efficient in synthesising the active form of Vitamin D. The fact that many elderly people remain indoors for long periods of time and do not have sufficient exposure to the sun compounds this problem. 

Poor iron absorption in the elderly caused by reduced gastric acid secretion can lead to anemia.

Why does ageing occur? Some of the theories are: 1) The wear and tear theory which states that cells wear out with time and are inadequately replaced; 2) The auto immune theory which states that ageing is the result of defects in the immune system that become evident with time and 3) The cross linkage theory which states that changes in the molecular structure of collagen lead to the functional decline of tissues and organs and lead to the features of ageing. 

Active ageing refers to the concept of growing older with the expectation of remaining healthy and living a meaningful life. The word 'active' refers to the ability to continue participation in all relevant and meaningful activities at home and in the community. This implies that there will continue to be useful interactions between family, friends and neighbors and also between the generations while growing older (Reference). In dealing with the idea of growing old happily, there are two terms to consider: successful or active ageing and resilient ageing (Gattuso, 2003). The former deals with ensuring that the physical body remains in good condition and that the environment is appropriate. Resilient ageing is an acquired mental attribute where there is the ability to cope with the stresses and changes of life. Both are necessary, in varying measures, for making aging easier.

Active ageing is more likely to occur when strategies to preserve memory and cognition are followed. Such strategies include being intellectually and physically active, eating a brain healthy diet and learning to manage stresses so that glucocorticoids and adrenaline are not increased in the blood. 

Nutrition and exercise are important considerations for those who decide to be active participants in their ageing process because these are like fences that protect the elderly from many age-related diseases. While many people know that good nutrition and adequate exercise will contribute to their health in old age, they do not eat well or exercise adequately in spite of this knowledge. However, reduced food intake in the elderly can also be due to various factors beyond personal control. Changes in taste sensation and poor eating because of poor dentition are important. Those who have lost their own teeth tend to avoid foods that require chewing and biting. The elderly tend to have diminished salivation, diminished gastric acid production, diminished pancreatic secretions, impaired gall bladder contractility and atrophy of the gastric mucosa. Abdominal discomfort leads to diminished enjoyment from eating high calorie foods.Social isolation can also be a factor in poor eating habits. There is evidence that those who eat alone tend to eat less both in quantity and quality.

The elderly should be advised to have frequent small meals rather than a few large meals to ensure adequate nutrition. They must also be encouraged to drink enough water and not depend on thirst alone.  

Nutritional status can be identified by measuring the Body Mass Index (BMI) or Mid Upper Arm Circumference (MUAC) (Powell-Tuck, Hennessy, 2003). Lean body mass, which is composed mainly of skeletal muscles, decreases in size with ageing and this affects both strength and mobility. Those who are at greatest risk of falls due to poor muscle strength are those whose lean body mass is below 63 percent of total body weight (Phillips, 2003).  Sarcopenia is the term that refers to this decrease in muscle mass with ageing. Wasting refers to the loss of muscle mass associated with insufficient food intake while cachexia refers to muscle wasting as a result of an inflammatory disease process.

Fruits and vegetables with vivid colours contain substances called carotenoids. Beta carotene, found in carrots, is a well-known carotenoid.   Other carotenoids like lycophene (imparting pink or red colour) and lutein and zeaxanthin (imparting a deep yellow colour) are also important. Lycophene appears to have protective effects against prostate cancer and cardiovascular disease while lutein and zeaxanthin have similar beneficial effects against cataracts and age related macular degeneration. Tomatoes and tomato sauce are good sources of lycophene and have been shown in the Health Professionals Follow-up study to significantly reduce the risk of prostate cancer if 10 or more servings are used per week (Gioyannucci, et al. 1995).

 Current expert recommendations for healthy ageing stress on providing adequate amounts of the following micronutrients in diet because of strong evidence for their protective effect on health: folic acid, Vitamin B₁₂, Vitamin C, Vitamin D, Vitamin E, Selenium, Iron and Zinc (Bates, et al. 2002).

Exercise has a profound influence on ageing. Helen Hayes, an American actress, has been quoted as saying “resting is rusting”. Exercise blunts the age-related rate of loss of muscle bulk and strength. Those who do not exercise regularly show a greater decrease in the mass of their skeletal muscles as they become older when compared to those who do regular endurance exercises like walking. The Honolulu Heart Program study (Hakim et al. 1998) showed that those who walk more than 2.4km daily had half the relative risk of adverse cardiac events when compared to those who walk less than 0.8km per day. A randomised control trial called the Fitness for the Ageing Brain Study (FABS) from Australia showed that when elderly people walk for at least 150 minutes per week, there is a significant reduction in the risk of developing Alzheimer’s disease (Lautenschlager, et al. 2008).