Nobody wants to grow old, but what is the alternative? If one has to age, the best alternative is to do so when you are as healthy as possible. That is what sent nearly 500 graying Jerusalemites to Jerusalem’s Shaare Zedek Medical Center’s 360-seat Hedi Steinberg auditorium about two weeks ago. Doctors and other professionals from the geriatric department presented free lectures on “Till 120: Medicine and Disease Prevention in the Third Age” as part of the hospital’s Shishibari (Healthy Friday) lecture series hosted by Dr. Hagit Miskin.
Not only were extra chairs brought in, but many in the audience sat on the steps on the two aisles. It was the eighth and most successful in the free lecture series. The event will soon be placed on the medical center’s You- Tube link for all to see and hear (in Hebrew).
SZMC director-general Prof. Jonathan Halevy noted that when he first came to run the hospital at the age of 39, he didn’t feel much in common with elderly patients.
But today, more than 28 years later, “I definitely do identify with them more,” he said with a smile. “Every hospital has its own niche. We develop services according to the needs of the population we serve.”
Dr. Reuven Friedman, an internal medicine specialist and head of the hospital’s geriatrics department, added that the department was created out of need. In 1960, only five percent of Israel’s population was over the age of 65, but today, it has more than doubled as life expectancy rises. In the coming years, the rate will increase even more. The average Israeli lives 82 years, 72 of them in good health.
But in the gap between the two, many suffer from diseases of a variety of physical, cognitive and emotional complaints, including depression.
Their physical limitations affect their daily routines, and they need help from their family members and others, Friedmann said. Most patients in the department arrive from the emergency rooms, while the minority are referred by their family physicians.
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“The average age of our patients is 84 years, and after admission, each one undergoes assessment for medical, nursing, functional and social needs from suitable professionals.
The department has 35 regular beds for treating patients with acute conditions, five more for monitoring patients who need intensive supervision and nine for rehabilitation after suffering functional problems, usually after having a hip fracture, stroke or serious and long-term disease.”
The department’s multidisciplinary staff includes not only doctors and nurses but also social workers, physiotherapists, occupational therapists, hearing and speech specialists and clinical dietitians. In addition to outpatient clinics, there is also a memory clinic where the elderly undergo assessment after they or their relatives complain of reduced memory and get recommendations for follow-up and treatment, he added.
PROF. MOSHE Sonnenblick, head of the department’s clinical geriatric unit, noted the incredible growth in life expectancy over the millennia. At the time of the Second Temple, most people lived to 35; by 1900, it was only to 49, but in 2015, it had reached 82.
“Every few years, another year is added to the average lifespan. Israeli men are in third place in the world’s list of life expectancies,” he said, and although Israeli women average a couple of years more, they are lower on the list.
At this rate, it seems that almost every baby born in a developed country in the 21st century can expect to see his or her 100th birthday.
“Among the reasons for long lives are economics, accessibility of medical care, family ties and even religion (being observant adds years to life, it seems) and diet.
In a list of 45 countries, Israel’s medical system was ranked fourth. Deaths from heart attacks and stroke have been reduced by two-thirds since 1965 due to better prevention (less smoking and better diet) and improved medical treatment.
There were no breakthroughs in cutting deaths from cancer until 2000, but since then there have been some dramatic discoveries that have lowered fatalities, said Sonnenblick. Dementias from vascular problems (not enough blood to the brain) – but not Alzheimer’s disease – have declined in the last quarter century.
When looking at the 12 leading diseases, he said, women live four years longer than men do, but the gap has been declining a bit in recent years. The explanation he gave is that women “have a better immune system and deal better with free radicals.
The telomeres [caps of their chromosomes] are longer than men’s and shorten more slowly as the years pass). They also have an extra X chromosome compared to men’s XY combination that helps them deal with defects. There are 600 people in the world over the age of 110, 90% of them women.
Currently the oldest man in the world is an Israeli aged 113.”
Consuming fewer calories is also considered by many to be a way to live longer, said Sonnenblick, who mentioned Alvise (Luigi) Cornaro, a nobleman in Venice born in the 15th century who – after having a hedonistic lifestyle at the age of 40 and suffering exhaustion and poor health – decided to live on a severely restricted diet of 1,000 calories daily. He reputedly lived to be a vigorous centenarian.
Lab experiments on rats and monkeys who were fed fewer calories than they were used to showed they lived longer and looked better.
Residents of the Japanese island of Okinawa, who eat a lot of vegetables and little meat or dairy products and who drink tea and the spice turmeric – consuming 33 percent fewer calories than in the rest of Japan – reportedly live long lives, with many residents over the age of 100, the SZMC doctor said.
“If there is a cure for dementia, people will live three more years on average. If you wipe out cancer, they will live 2.5 years longer and stroke and heart attacks by 11 years.
If you don’t smoke, are not overweight and eat right, you can extend life by an average of eight years. If modern medicine managed to cure the 15 main diseases, we would live some 15 years more altogether,” said Sonnenblick. “The environment is responsible for 70% and genetics for 30% of longevity.”
DR. HELENA Feldman, a senior physician in the geriatrics department, said that 60% of those over 65 enjoy good health, while 20% to 35% suffer from chronic illnesses that affect their lifestyles and the rest are frail. She recommended that at their 65th birthday, people go to their health fund clinic and get (with a doctor’s referral) a free pneumococcus vaccination that prevents the most common cause of the lung infection with a success rate of 70%.
Influenza complications are the sixth most common cause of death in the elderly; 200 Israelis die of them in an average year, and they are responsibility for half of hospitalizations in the flu system. Thus she strongly urged the elderly (and everyone else over the age of six months) to get an annual flu shot. The vaccine, said Feldman, can even “reduce the risk of dementia by 35% if one gets it at least three years in a row.
Other ways of improving and extending your life is physical exercise; it helps the heart, reduces the risk of diabetes and osteoporosis and improves your joints, sleep and memory, she said.
People of this age should also have their blood pressure checked at least once a year, have a mammography every two years from age 50 to 69 (unless a family history makes a woman high risk) and once every three years until the age of 75, the SZMC doctor advised. Check feces for things like color, consistency and signs of blood.
If a woman’s Pap smear (to detect cervical cancer) is normal three years in a row, she can stop undergoing the test at 69. One should test for occult blood in the feces once a year after 50, and undergo a colonoscopy as recommended by your doctor. Check hearing and vision on a regular basis. A prostate-specific antigen (PSA) test is not recommended if a man has no complaints.
Chest x-rays are also not done without a doctor’s recommendation, she said.
ON AVERAGE, people over 65 fall at least once a year; 5% of them have a brain concussion, while others suffer a hip or arm fracture. Of those who break a hip, a fifth will die from complications within a year, said SZMC physiotherapist Eitan Cohen.
The tendency to fall is exacerbated by chronic illness and physical functioning, reduced hearing and vision, taking lots of medications (polypharmacy), having rugs and wires on the floor and too little light at home and drinking alcohol, he added.
Physical conditions at home should be adjusted to reduce the risk of falls.
“When we have a patient who fell, we check to learn how and where it happened and if he lost consciousness. If it takes longer than 12 seconds for a person to walk three meters from a chair to a line, his risk of falling is much higher.” If someone falls, he is fearful of getting around, and this fear keeps him in bed more than he should be.
Bathrooms should be adapted so that the elderly don’t fall in the shower.
He recommends that older people exercise at least 30 minutes a day five times a week.
“Doing tai chi is very helpful, but if not, walking, biking, swimming and aerobics are very good for flexibility, muscle tone and balance,” said Cohen. “Get out of the house, join a club for the elderly, don’t skip meals, take vitamin D and drink eight to 10 glasses of water daily. Don’t be embarrassed about using hearing aids and walkers if you need them.”
DR. DEBBIE Shapira of the internal medicine department and the memory clinic discussed what many elderly fear – dementia.
“Most people lose some of their memory as they age; a few fortunate people retain their long- and short-term memory from their youth through old age,” she said.
“In the memory clinic, we teach patients to know where they are and how to return home. It’s harder to remember names; they may remain on the tip of the tongue. Multitasking is reduced in older people. It takes longer for them to learn something new.
Immediate memory, vocabulary and the ability to express yourself do not usually decline.”
Of those with only mild cognitive impairment, about 15% move on to dementia, which is irreversible damage to cognition.
Alzheimer’s disease, she said, causes 60% to 80% of dementia and Parkinson’s results in an additional 5%. Some cases can result from clogged blood vessels to the brain or a vitamin B12 deficiency. Most Alzheimer’s cases are not caused by genes. Having little education raises the risk, and higher education or “exercising” and challenging the brain with puzzles, reading and other cognitive activities can delay onset, said Shapira.
THERE IS a lot one can do to reduce the risk of dementia, said Dr. Shelley Sternberg, who runs the memory clinic and heads the urgent geriatrics department at the hospital. Maintain normal weight; if you have diabetes, keep sugar levels steady; follow a Mediterranean diet including fresh produce, olive oil, nuts, fish and some lowfat dairy products; don’t be sedentary; use your mental ability or lose it. But there is still no magic bullet or pill that prevents dementia. In a decade or so, we will know more.”
She endorsed Melabev day centers for people suffering from dementia and for advice to caregivers, who, she said, very often suffer from psychological burnout and physical problems.
“Dementia patients often suffer from aggression, apathy, mania or depression.
Caregivers should not be ashamed to seek help.”
Familiar music, photos of grandchildren, speaking in a warm, encouraging way all help deal with Alzheimer’s patients, Sternberg said, adding that when she went to medical school, she was taught that “there was no plasticity in the brain. But they were wrong. One can build new connections between nerves and learn even in old age. There is reason to be optimistic.”
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