Staying on Top of the Hill

Magazine cover 2011

Aging Well…Tips from Faculty

By Kukla Vera

Everyone who lives long enough no doubt wishes at least once for a fountain of youth. Of course there isn’t, but that doesn’t mean the journey of aging has to be totally downhill.

The School of Pharmacy includes a cadre of experts whose work focuses in large part on maintaining health and vigor throughout our lifetimes. Following are tips from nine of the School’s many faculty conducting relevant work in this field.

First Off, Aging is a Fact of Life

“Aging is an intrinsic process,” says Raj Sohal, PhD, Timothy M. Chan Professor in Complementary Therapeutics. “There’s no escaping it and there are no elixirs that can extend the biological limits of life span.”

Still, human life expectancy has increased over the decades due to improvements in hygiene, the advent of antibiotics and vaccines, as well as cures and treatments for some age-associated diseases, including cardiovascular disease, diabetes and some cancers. Today, the average life expectancy is about 85 years for women and 80 for men. According to Sohal, the potential human lifespan is 100 years – maybe 122 tops. The final years are often dominated by struggles with various frailties and diseases.

While he adds that curing heart disease, cancer, neurodegeneration or diabetes, for example, may increase life expectancy by 10 to 15 years, to dramatically increase life span beyond the age of 100, we would have to find a way to change our biological/genetic nature in an as yet unknown way. Such a breakthrough is not on the horizon, partly because the causes of the aging process at the molecular level are not well understood.

If we accept Sohal’s premise, what can we do in the meantime to increase our own life expectancy and quality of life as we age? His tips include maintaining a normal body weight and a good lifestyle – marked by a diet heavy on fruits and vegetables – and avoiding stress by “ banishing petty anxieties and shunning avoidable confrontations”.

He also suggests the desirability of a comfortable and enjoyable life by effective management of monetary resources, making the very best of daily life and accepting your limitations – because you can’t change your genes..

“Remember there isn’t another individual like you – not now, not before or after you. Each of us is unique. This is the genetic basis of life and it is truly precious.”

Living the Good Life

At 78, Mel Baron, PharmD, associate professor in clinical pharmacy, has some experience on living the good life. Topping his advice? Have a happy and rewarding marriage. Baron and his wife, Lorraine, recently celebrated their 57th anniversary, and he believes that having this special relationship plays a big role in aging well.

“Oh, continuous exercise is an invaluable ingredient to health and healthy aging,” he adds. “But I greatly credit my happy marriage with keeping me on top of the hill.”

Baron is also quick to add the importance of pursuing work that you’re passionate about. He still approaches each new day at the School with excitement and pursues innovative projects that meet community needs. For instance, he recently developed an ambitious series of educational materials, including printed fotonovelas and videos, targeting the low-literacy Latino population with invaluable information on combating childhood obesity, preventing and managing diabetes, and recognizing early symptoms of Alzheimer’s disease.

“It makes life sweet and easy when you enjoy what you’re doing,” says Baron. “This is a victory lap for me, allowing me to reach out and help others in the community.”

Glen Stimmel, PharmD, professor of clinical pharmacy, seconds Baron’s emphasis on relationships, citing the importance of staying connected to family and friends as a necessity throughout life, even more so as we get older.

“Nurture your existing network of family and friends and establish new relationships through outside activities,” he advises.

Stimmel tells of a man he knows who lives alone and whose retired life revolves around a weekly French class he takes at a community college. The class provides a new network of friends and a common interest that excites him. Stimmel believes this kind of connection is pivotal to enhancing life at any age, but especially after 60.

Also high on the Stimmel list is staying healthy and maintaining whatever health you have by keeping appointments for medical care, adhering to your medication regimen and avoiding unnecessary medication.

“All too often, older people take more medicine than they need because different physicians prescribe for them and don’t know what they are already taking. It’s very important to have all your medicines regularly reviewed by a pharmacist or a physician,” he says.

Stimmel finds that regular medication review is the best way to ensure that benefits of prescriptions are not outweighed by adverse side effects. Patients often continue taking medications that were intended to be temporary.

A simplified drug regimen also can help increase compliance among older people. If a patient can take a pill once a day instead of three times a day – or one pill that delivers the therapeutic effects of two – those changes should be incorporated into the regimen. “Simplicity encourages adherence,” he says.

“As you age, you have to focus on what you can do, not on what you can’t do,” adds Stimmel. “You have to shift your focus and adjust. How well you do that will have a big effect on how well you age.”

Looking at the Numbers

Geoffrey Joyce, PhD, associate professor, looks at aging through the lens of a health economist.

“Cost is a huge concern for Medicare,” he says. “The more we move toward a cost effectiveness approach, the elderly don’t fare so well.”

Unlike other fronts where technology saves the day, in health care, technology often increases costs as it extends life. For instance, if you don’t have diabetes at age 65, you’ll live approximately three years longer than your counterpart with diabetes. While your annual medical costs go down, your cumulative costs to Medicare increase.

Another major concern, end-of-life care, hasn’t changed substantially in 25 years. Some 27-29% of average lifetime health costs are for care in the final year of life. Prevention and education also play a role but must start early in life to have a profound effect.

“Social policy change is a slow process,” says Joyce.

He offers three tips for graceful aging from the perspective of the health economist. Start young with good health habits and prevention. Get ready to accept higher taxes to cover the escalating costs of Medicare and Medicaid. Be willing to have a frank discussion about end-of-life care that is incredibly expensive for individuals and society and often does not improve quality of life.

Also cognizant of the enormous cost that aging, and specifically Alzheimer’s disease, poses to society is Liqin Zhao, PhD, a neuroscientist whose research seeks to discover therapeutic strategies that will prevent or delay Alzheimer’s. She notes that some 5.3 million Americans currently suffer from the disease and this number is expected to triple to 16 million by 2050.

While scientists don’t clearly understand the cause of the disease, nor have they developed a drug that can stop Alzheimer’s, Zhao believes raising awareness is key.

“Research has identified a number of risk factors that may accelerate brain aging, including lack of physical, social and mental activities, malnutrition, stress and certain medical conditions, such as high blood pressure, high cholesterol and diabetes,” she says.

Additionally, Zhao points to nutritional research that indicates a link between a diet rich in phytoestrogens, found in soy-based foods, and lower rates of Alzheimer’s disease, menopausal symptoms, and breast and prostate cancers. These epidemiological studies were based on comparisons of populations in Asia, with a high intake of these foods, to those in North America and Europe where such intake is low. Zhao cautions that these studies were based on food intake rather than supplements.

“In our lab, we developed a phytoestrogenic formulation that is currently being tested in clinical trials for effectiveness against hot flashes and cognitive decline,” she says.

Additionally, Zhao notes that studies suggest having diabetes in middle and later life increases the risk for ultimately developing Alzheimer’s disease two-fold. While research is still underway, she says, “Diabetes is something you don’t want to get – and exercise and a healthy diet are a good defense.”

Being Smart as You Age

Remember when you were 16, and you could undertake just about any physical challenge and wake up the next morning ready to do it all over again? As the years pass, you still might meet those big challenges, but the aftermath is often marked by sore muscles. Or you may be confronted with arthritis, have become more susceptible to injury or face other conditions that cause pain.

Melissa Durham, PharmD, who is a clinical pharmacist at the USC Pain Center, notes that many over-the-counter, herbal and nutritional remedies for pain pose significant and potentially harmful drug-to-drug interactions. While acetaminophen – brand name Tylenol – tends to have the least side effects of all the OTC analgesics, it is also present in many non-prescription and prescription medications.

“Be sure to read the packaging to make certain that you’re not taking an additional amount,” she cautions. “And, when in doubt, ask your pharmacist.”

Prescription pain medications have significant side effects, including constipation -which is a common ailment of older people. Durham recommends staying adequately hydrated and eating a diet high in fiber. These medicines also can cause drowsiness and dizziness, posing a risk for falls and other injuries. As a precaution, do not drive while taking these medications and clear your home of obstacles that you might trip over, remove any slippery rugs and always use a non-slip rug in the bathtub.

Finally, Durham suggests: “Exercise to strengthen your muscles and maintain muscle tone, which can help with stiffness and creaky joints. But know your limits and check with a health provider when in doubt.”

Echoing the universal call for exercise is Enrique Cadenas,MD, PhD, the Charles Krown/Alumni Professor in Pharmaceutical Sciences, whose research of over three decades focuses on the molecular mechanisms that underlie many age-related diseases, including neurodegenerative disease like Alzheimer’s.

Cadenas considers exercise and diet as good ways to delay or prevent the diseases of aging, such as diabetes, heart disease and neurodegenerative diseases.

“You can’t delay them forever,” says Cadenas. “But you can die healthy.”

Colleague Roberta Diaz Brinton, PhD, the R. Pete Vanderveen Chair in Therapeutic Discovery and Devleopment, adds that the body is a movement organism – so “move it.” In addition to its other benefits, exercise is the pump of the lymph system, much like the heart is the pump for the circulatory system, notes Diaz Brinton.

“There is no internal pump for the lymph system that removes waste materials from cells,” says Diaz Brinton. “So if you don’t move, this waste stays in the lymph fluid instead of exiting through the body’s waste system.”

She also notes that the brain is the most highly vascularized organ in the body, so playing havoc with the vascular system plays havoc with the brain. And she, too, stresses the importance of diet as one ages. “Less sugar is a very good goal,” she adds.

She also is a great believer in sleep. “Sleep is the time for the body to regenerate. So get enough of it.”

How much is enough? Diaz Brinton believes your body tells you how much you need – so listen to it. Her last tip is let gratitude be a part of your life. “Every minute of gratitude is a moment of happiness,” she says.

Taking Action Today For a Healthier Tomorrow

Brad Williams, PharmD, a geriatric pharmacist, emphasizes a comprehensive strategy.
“I ask my patients, where do you want to be in 15 to 20 years?,” he says. “Their answers help us together plan a strategy for the whole person.”

Like his colleagues, he ranks diet and exercise at the top of the list of essential strategies for aging well. But he cautions that it’s important to design activities that meet your specific needs.

“If your heart isn’t doing what it’s supposed to do, work with your physician to design an exercise program with your heart goals in mind,” he says. “Likewise, if you have osteoarthritis, strengthen muscles to improve function.”

Williams believes that helping patients realize what they must do today to achieve the health status and abilities they hope to have in 20 years will help motivate them to make changes now. He recounts the story of a patient in his 60s who was still smoking despite repeated efforts to quit. After his physician referred him to Williams, the man told him, “If I have a heart attack or stroke today and die, I’m OK with that.”

“I reminded him that most victims of heart attack or stroke survive but need help, which typically places a burden on the family. That clicked for him and he became committed and successfully quit smoking,” says Williams.

Williams believes his generation, the Baby Boomers – who are used to getting what they want when they want it – may find it difficult to adjust to life after 60.

“As we age, we have to adjust to realistic goals,” he says. “You’re not going to be able to do what you did at 40.”

Williams suggests looking at the whole you and designing a lifestyle to maximize your older years – including diet, exercise, social connections, therapeutic adherence, outlook – that will help you live longer without disability.

“We’re not going to avoid the inevitable, but we need to plan and work toward dealing with it in the best way possible,” he says. “This is a good approach to keep from falling ‘over the hill.’”