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Susan Friedman, MD, MPHKrupa Shah, MD, MPHUniversity of Rochester Division of Aging10th Annual Caring For Elders ProgramBurgundy Basin InnApril 27, 2016
The aging of America – opportunities andchallenges The Blue Zone approach Demographics; what does “extreme aging” look like?Changes in health / chronic diseasePresence / role of geriatriciansPrinciplesReplicationBehavioral changePractical ideas to “Blue Zone” your life
Na ta ekatostisis (may you live to be 100). (Greek) May you live to be 100 years, with one extra year torepent. (Irish) May you live to be 120. (Jewish) May you die in bed at 95, shot by a jealous spouse. (Irish) May you live to be 100 and may the last voice you hear bemine. (Frank Sinatra) Sto lat, sto lat, niech zyje zyje nam (Good luck, goodcheer, may you live a hundred years). (Polish)
6% married 17% live in poverty Dementia – 37% of those age 90 Functional status Over 80% with some activity of daily living impairment Independence 15% live alone 48% live in nursing homesCentenarians in the US. US Census Bureau, 1999Kincel B, The Centenarian Population 2007-2011, US CensusBureau, 2014.Neuroepidemiology. 2007 November; 29(1-2): 125–132
Lived 1875 - 1997Father lived to almost 100, mother86, brother 97Outlived her husband, daughter andgrandsonMet Vincent Van Gogh when she was13 Saw Eiffel Tower being built Took up fencing at 85 Lived on her own to 110 Oldest person ever in a movie (114) Ascribed longevity to olive oil, portwine and chocolate
Year180019002013 Lifeexpectancy2647.3 (US)78.8 (US)Of all the people whohave lived to be 65 orolder, half are currentlyalive.
02060US Census Bureau, 2014 NationalPopulation Projections
NEJM 1980; 303: 130-5.OR“The failure of success” - Ernest GruenbergMilbank Q. 2005 Dec; 83(4): 779–800.
Hippocrates460 BCE
Never smokerBMI 30Physical activity 3.5 hours per weekHigh intake fruits/veg/whole grain, low meatFord et al., Arch Intern Med 2009;169(15):1355-62
Physician’s healthstudy2,357 menAve age 725 risk factors: Smoking DM HTN Obesity Sedentary lifestyleArch Intern Med. 2008;168(3):284-290.
Released 20102020 Impact GoalControl risk /promote healthAim: cardiovascularhealth by 20% CVD and strokedeaths by 20% 4 health behaviors Non-smokingBMI 25Physical activity at goalDASH diet3 ideal health factors Total chol 200 Untreated BP 120/80 Untreated FPG 100“Primordialprevention”Lloyd-Jones et al. Circulation. 2010;121:586-613.
Obesity Trends Among U.S. AdultsBehavioral Risk Factor Surveillance System , 1990, 2000, 2010200019902010No Data 10%10%–14%15%–19%20%–24%25%–29%CDC, 2015 30%
60%50%40%1988-199430%2009-201020%10%0%WomenMenData from NHANES surveyLadabaum et al, Am J Med, 2014; 127(8):717-727.
Healthy people 2010 target75% consumingFruit 2 or more servings of fruit 50% consuming 3 or more servings ofvegetablesVegetables
Heart SCORE study1933 participantsMean age 59Community dwellingAllegheny Cty, PA66% women44% AfricanAmerican 1 person had all 7componentsAve of 2.35.3% with 5 or moreLess with Age Lower income African AmericanBambs et al. Circulation. 2011; 123(8): 850–857.
20%18%16%14%12%199810%20048%20086%4%2%0%No chronic disease4 chronic diseasesHung et al. BMC Geriatrics 2011;11:47-58.
hritisHung et al. BMC Geriatrics 2011;11:47-58.
Changes in mobility 9 60-69 70-79 80 Men19983050-59 60-69 70-79 80 WomenCrimmins et al. J Gerontology Soc Sci 2011; 66B: 75-86.
Over age 85Dependent in activities of daily livingComplex biomedical problems Multimorbidity Polypharmacy Complex psycho-medical situations Dementia Depression FrailGeriatric syndromesWarshaw et al. J Am Geriatr Soc 2008;56:1796-1801.
001000020042014
million beneficiaries)Active Certificates (per 1200198 201 201 204200186175150178162 132014Year* Aged 65 and over
Rapidly increasing older adult populationIncreasing prevalence of chronic diseaseEvidence of increases in disabilityLimited number of geriatricians and PCPs How do we address this?
Interest in health and physical fitnessActive in their own medical careInformation agePro-activeSelf-motivated
Areas of highestlongevityLive “better” as well aslongerNamed fordemographers’ mapsPersonal interviewsLooked forcommonalities
Icaria, Greece Highest % of 90 year olds on the planetAlmost 1 in 3 reach 9020% less cancer, 50% less heart disease, almost no dementia
Move naturally Hara hachi bu Plant slant Drink alcohol, especially red wine, in moderation Ikigai or plan de vida - purpose Reduce stress Belong to a spiritual community Keep family first Surround yourself with people who have similar blue zonevalues
The “3-legged stool”
IkariaRochester
Albert Lea, MN Town of 18,500 7 lakes History as meatpackingtown 60-65% overweight orobese AARP / United HealthFoundation
Town meetingsPersonal pledgeCommunity gardensWalking and bike pathsChanges in RestaurantsSchoolsGrocery storesWorkplace“Purpose” workshopsWalking moaisWalking school bus
Community participation 60% of the city’s restaurants 51% of employers 100% of its schools 27% of citizens 150 “ambassadors”Ave life expectancy increased 3.1 yearsAve wt loss of 2.8 lbs. each21% drop in absenteeism49% decrease in health care costs in city employeesBuettner, The Blue Zones Solution, 2015.
California Beach cities Manhattan Beach Hermosa Beach Redondo Beach 15 cities and towns in IowaNaples, FLHawaiiOregonTexas
Behavior change in older persons presentspecial challenges:multiple comorbiditiessensory impairmentsreduced mobilitypsychosocial factors (loneliness, depression, loss ofidentity) dependency
Health behaviors influenced by social network Smoking Obesity Happiness Influence extends to 3 degrees of separationChristakis and Fowler, N Engl J Med 2007;357:370-9.N Engl J Med 2008;358:2249-58.British Medical Journal 337 (337): a233842
Movement from South Asia to EuropeComplex changesPrimary trends Increase in energy and fat intakeReduction in carbohydratesSwitch from whole grains to more refined sourcesDecrease in fiberMore meat and dairyHigher incidence of DM2 Obesity CVDHolmboe-Ottesen et al, Food and Nutrition Research2012, 56:18891.
To get moving in your Blue Zone, try some ofthese tips. Inconvenience yourselfHave fun. Keep moving.WalkMake a datePlant a gardenEnroll in a yoga classErgonomic work stationActivity exercise
To follow 80 % rule in your Blue Zone, try thefollowing tips Serve and storeMake food look biggerUse small vesselsMake snacking a hassleGive yourself a daily reminderBuy smaller packages
To follow 80 % rule in your Blue Zone, try thefollowing tips Eat more slowlyFocus on foodHave a seatEat early
Try these tips to incorporate more plants inyour diet Eat four to six vegetable servings dailyLimit intake of meatShowcase fruits and vegetablesLead with beansEat nuts every dayStock up
Introduce a glass of wine into a daily routine Buy a case of high-quality red wine.Treat yourself to a “Happy Hour”Take it easy
To realize your purpose, try the following tips Craft a personal mission statementFind a partnerLearn something new
Use these tips to find a quiet space to slowdown in your Blue Zone Reduce the noiseBe earlyMeditateSleepDe-clutter
To strengthen the spiritual dimension of yourBlue Zone, try these tactics Spiritual does not have to mean religiousBe more involvedExplore a new traditionJust go
These tips can help you create your family’sBlue Zone. Get closerEstablish routines Meals Holidays Put family first
Try these tips to build up the inner circle ofyour Blue Zone Identify your inner circle.Don’t be a grump!Create time togetherCreate a moai
Timing – we are seeing changes in Demographics Health trends Healthcare reform Changes in lifestyle make a big difference!The Blue Zones focus on Activity Nutrition Connectedness
Na ta ekatostisis (may you live to be 100). (Greek) May you live to be 100 years, with one extra year to repent. (Irish) May you live to be 120. (Jewish) May you die in bed at 95, shot by a jealous spouse. (Irish) May you live to be 100 and may the last voice you hear be mine. (Frank Sinatra) Sto lat, sto lat, niech zyje zyje nam (Good luck, good
