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 Table of Contents  
PUBLIC HEALTH FORUM
Year : 2021  |  Volume : 17  |  Issue : 1  |  Page : 43-48

How to live well in old age?


Former Professor, Department of Medicine, All India Institute of Medical Sciences; Lifetime Achievement Awardee in Ageing, Government of India; President Emeritus, Alzheimer's and Related Disorders Society of India, New Delhi, India; Former Expert Advisory Panel Member on Ageing & Health, WHO, Geneva

Date of Submission31-Mar-2021
Date of Decision22-Apr-2021
Date of Acceptance22-Apr-2021
Date of Web Publication17-Aug-2021

Correspondence Address:
Dr. Vinod Kumar
J-100, GF, South Extension, Part 1, New Delhi - 110 049

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_8_21

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How to cite this article:
Kumar V. How to live well in old age?. J Indian Acad Geriatr 2021;17:43-8

How to cite this URL:
Kumar V. How to live well in old age?. J Indian Acad Geriatr [serial online] 2021 [cited 2021 Oct 24];17:43-8. Available from: http://www.jiag.com/text.asp?2021/17/1/43/323944



“Age is an issue of mind over matter. If you don't mind, it doesn't matter.”

– Mark Twain, American Writer


  Preamble Top


A long life full of well-being and good health is any one's dream. While we have no control on our genetics, race, and gender which to some extent determine our longevity and health, there are several ways to enhance our health, wellness, and longevity. As we grow older and older, there is an overall decline of our body and mind and maintaining health and wellness becomes increasingly important. There are some positive factors also which facilitate us in caring for our health. First, decline of body and mind is often gradual and permits us to undertake good health practices and accordingly adjust our life to our advantage. Second, with composure, flexibility, experience, and availability of time, elderly people are in a better situation to figure out their relationships and social support which are important factors for well-being. Strengthening of spiritual beliefs in old age such as praying, worshipping, empathizing, and forgiving also helps navigate challenges of life including those of death and dying. This paper emphasizes the fact that there are numerous barriers to health and wellness in old age; however, with right attitudes, an elderly person can achieve satisfactory health and well-being. The topic of this paper “how to live well and healthy in old age” is both a question and also an intent to answer this question in a holistic manner.


  Problems of Old Age Top


These are both visible and invisible. Decline of body seems to be faster than that of mind, and since medical problems of the body can cause physical discomfort and threaten the very existence of life, these are quite visible in the form of diseases, disabilities, and a variety of medical complaints due to old age itself even without any disease.[1],[2],[3] [Table 1] shows some common life-threatening diseases and nonlife-threatening medical symptoms of old age in an alphabetic order.
Table 1: Common medical problems in old age

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Coming to problems of mind, on the other hand, these remain often invisible and are generally not complained about. These can also be diverse and the common ones can be represented alphabetically as follows:

  • 2As: Anxiety and aloofness
  • 2Bs: Boredom and bereavement challenges
  • 2Cs: Coping difficulty and cynicism
  • 2Ds: Despair and diffidence
  • 2Es: Emotional disorders and enthusiasm deficit
  • 2Fs: Falling income and fears from unknown sources
  • 2Gs: Generational disconnect and grappling with thoughts of death and dying
  • 2Hs: Hopelessness and harmful tendency toward self
  • 2Is: Insecurity and investment worries
  • 2Js: Jitteriness and joblessness.


Above list is by no means complete; however, coupled with agism and discrimination against elderly persons, these problems have a serious negative influence on wellness and health. However, they can be tackled by several nonmedical measures such as bringing about attitudinal changes in emotional, intellectual, social, spiritual, and financial aspects of life.


  Managing Problems of Old Age Top


There are five paths to practice for achieving the state of well-being. These are related to physical, mental, social, spiritual, and financial health. Practicing these paths is a work of a lifetime, and there is no short cut to health and longevity. It is however never too late to start. Earlier it is begun, better it is. Following steps are briefly highlighted to practice these paths.


  Physical Health Top


This includes personal hygiene, healthy lifestyles, and certain miscellaneous steps.[4]

Personal hygiene

Personal cleanliness such as brushing of teeth, taking bath, daily changing of clothes, frequent hand washing, combing hairs, and caring of feet and nails. All these measures not only protect from infections but also give a sense of dignity and self-esteem.

Bowel movements are facilitated by observing fixed regular timings, consuming roughage and fiber diet, drinking adequate amount of water, and engaging in some daily physical activity. They all help prevent constipation. One should report to the doctor if there is sudden change in the bowel habit.

Sleep hygiene is important for a sound sleep and includes going to bed at least 1–2 h after dinner, avoiding day time naps, keeping the room free from noise and bright light, and avoiding TV, coffee, tea, alcohol, and drinking excess water before sleep. In case of difficulty in getting to sleep, deep breathing and concentrating on a point to prevent unnecessary thoughts crossing the mind will help. A sound sleep is good for preventing and controlling many diseases such as high blood pressure, heart disease, diabetes, stroke, depression, and dementia.

Healthy lifestyles

Proper diet and nutrition is based on vegetarianism with adequate amounts of fruits and vegetables including dark leafy vegetables, proteins, vitamins, calcium, and liquids. Prolonged fasting, overeating, excess sugar, salt, fat, and junk foods should be avoided. As they say, food that we leave on the table does more good to us than the food we have consumed. Vegetable fats and oils are better than animal fats and oils.[5],[6]

Physical exercise is very important. Those who do not find time to exercise soon find time for illness. Prolonged sitting or lying is highly detrimental to health and shortens life. Exercise can be walking for 30 min daily or other aerobic exercises such as cycling, swimming, and outdoor sports.[7] Strengthening or resistance exercises such as weight lifting, climbing stairs, or carrying laundry and grocery are also useful. Balancing exercises, chair sit ups, and pushups help in fall prevention in older people. Stretching exercises are also useful for senior citizens. Yogic asanas also improve balance, muscle tone, flexibility, mental calmness, and self-confidence. Forceful clapping is also useful. Even the household chores and work-related physical activities need to be encouraged.[8] All exercises however should be tailored under medical advice. Normally, common exercise such as walking should not raise the heart rate beyond 95–120/min for those aged 50–60 years, 85–110/min for those aged 60–70 years, and 80–105/min for those aged more than 70 years.

Deep breathing exercises with or without humming help improving stress, sleep, composure, energy, and even digestion. It also lowers anxiety, blood pressure, and pain. It is therefore a good idea to learn and practice deep breathing techniques during the day's routine. Loudly laughing also involves breathing and is useful.[7] Playing flute or saxophone and blowing Shankha and trumpet also involve deep breathing.

Smoking including use of smokeless tobacco contributes to numerous disorders, such as heart disease, cancers, stroke, and dementia. Smoking is just not cigarette or bidi smoking or vaping but also includes use of smokeless tobacco such as pan, gutka, zarda, and pan masala. Chewing areca nut, i.e., supari, stimulates saliva formation and repeated spitting which apart from being socially unacceptable is injurious to the health of others. Alcohol consumption is also bad for liver, heart, brain, and nerves. Those who habitually indulge in heavy alcoholism should go in for deaddiction or come down to at least moderate drinking, instead of stopping suddenly to avoid alcohol withdrawal symptoms.

Miscellaneous steps

Periodic health checkup is a thorough medical examination including necessary laboratory tests and also to detect any hidden disorder. Doctor would also check and monitor all medications you may be regularly using. He/she would also assess you for your teeth, nutrition, urinary problem, and depression and for physical and mental disabilities such as impaired vision, mobility, hearing, and memory during your health checkup and take corrective actions if needed.[9] You should also enquire from him/her about the need of any vaccination, especially the pneumococcal and flu vaccination and the one against corona when available.[10] It may be emphasized that any abnormal feature such as unintentional weight loss, lump in the breast, recent change in the bowel habit, persistent cough, or unusual bleeding can be an indication of malignancy and should prompt you to visit your doctor immediately.

What one needs to avoid

Self-medication, pollution, smoke, dust and extremes of weather are to be avoided.[11] House should be well ventilated, and inside the house, there should not be any poor lighting, slippery and wet floors, loose fitting carpets, wrongly placed furniture, any stairs without railings, or toilets without support grips because all these make the elderly vulnerable to falls, injuries, and fractures. One should avoid driving with poor vision, hearing, and slow reflexes or during night or if on a drug which dulls the mental faculties.[4]


  Mental Health Top


Both the brain and mind are precious gifts to human, brain because of its cognitive qualities such as power of memory, comprehension, reasoning, judgment, and attention and mind because of its control on thoughts, emotions, desires, and feelings. Since old age is accompanied by changes in the brain resulting in mental slowness and forgetfulness, on the one hand, and by changes in mind resulting in anxiety, mood and sleep changes, on the other hand, following steps are important to keep ourselves mentally healthy.

Health of the brain

Proverb about the brain that “Use it or lose it” cannot be more than true. Some of the brain challenging activities are reading new material, learning new language, attending lectures, solving puzzles, working with nondominant hand, and working on computer and internet. Playing chess, video games, and even cards can enhance cognition. Engaging the brain in activities such as gardening including planning a garden, playing with grandchildren, and playing indoor games are also useful. Learning musical instruments is useful brain exercise. Knitting activities by older women are supposed to stimulate both sides of brain.

Working on computer and exploring the internet are like treading in unchartered waters and can be useful for cognitive and memory stimulation. However, its usefulness on the one hand and its addictive attraction have to be balanced because its excessive use makes one sedentary and also leads to the opposite effect of reduced memory due to overdependence on computer's memory. Internet addiction also causes e-mentia, a term comprising stress, anxiety, depression, sleeplessness, body aches, and premature aging.[12] Moreover, continuous engagement of other family members of the household with the internet has a negative influence on interpersonal relationships because many seniors citizens traditionally engaged in tending to younger members of their families may find themselves in an environment of indifference, neglect, and devoid of frequent eye-to-eye contact with their dear and near ones.[12]

Health of the mind

Physical and spiritual exercises have multiple benefits including reduced stress, improved mood and sleep, and an overall mental well-being. Spiritual practices such as yogic asanas, ethical living, pranayama, meditation, and praying are all stress busters, mood elevators, and sleep promoters and are described later. Living in clean and natural environment and observing personal hygiene also add to a sense of self-esteem and dignity.

Music, apart from enhancing cognition, intelligence, and memory of brain and immunity, in general, gives multiple health benefits for our mind also. Listening to music is supposed to stimulate both sides of brain. Music is useful for stress, anxiety, and depression by its influence on attention, mood, and emotions. Music does it by reducing the stress hormone, i.e., cortisol. Music can be useful for sleeplessness by increasing the hormone, melatonin. Music has been credited with its usefulness even in pain management, fatigue, dementia, stroke, and Parkinsonism. In the western world, there are qualified music therapists for hospitals, out patients departments, day-care centers, psychiatric hospitals, deaddiction, rehabilitation and respite care centers, palliative care centers, and correctional facilities.[13]


  Social Health Top


Feeling connected to other people and having strong relationships and social support offer a robust protection against morbidity and mortality in the elderly persons that is comparable to the benefit we get from avoiding smoking and obesity.[14] Unfortunately, social isolation is on the rise among elderly (living alone or with spouse was 9% in 1992 but 18.7% in 2006).[15] Social inclusion is therefore paramount for wellness in old age. This also helps combating agism and discrimination against elderly. Following steps are important for enriching social health.

  1. Socializing can be done by networking, gossiping, humoring, story-telling, participation in social and religious functions, going to pilgrimages, pursuing a hobby, volunteering, or working for a cause. Any work done meticulously with prudence, persistence, perfection, and passion gives greater satisfaction and wellness. If your passion and zest are strong enough, you and others would not know whether you are working or playing and thereby deriving happiness. Zest keeps the elderly continuing to be amazed for life long and repeated feelings of amazement are a source of joy and happiness
  2. Internet-supported interventions, especially for those elderly who cannot move out of their residences for any reason, are being increasingly employed for social connectedness. These may be person-to-person or group activities or interaction with a segment of society. These may take the form of participation in social functions, service delivery, online shopping, computer training, medical support, education and counseling, and a host of other activities. In the case of disabled elderly, connectedness may be through their caregivers. However, there is some debate if such e-interventions can effectively replace face-to-face interaction when employed on a long-term basis.[16] Moreover, such interventions are beyond the reach of poor, illiterate, and cognitively impaired elderly people. Indeed, a very old quote “I fear the day that technology will surpass human interaction, the world will have generation of idiots” was said by someone but was falsely attributed to Albert Einstein.



  Spiritual Health Top


Many elderly persons find it difficult to cope with stress, bereavements, and other challenges of life and take recourse to spiritual path to find hope, peace, contentment, and positive thoughts. Following steps are important to fulfill these needs.

Ethical living

Since scientists say successful aging is 80% attitudes and 20% everything else,[17] the principles of ethical living which are all about attitudes contained in Yama and Niyama of Yoga way of life become important.[18],[19] Some of these attitudes and beliefs are forgiveness,[20] optimism,[21] repentance,[22] kindness or gratitude,[23] introspection,[24] veneration,[25] empathy,[26],[27] and personal meaning of life which is service to others by giving, helping, caring, and teaching. These attitudes should be enhanced through religious and spiritual practices such as praying, worshiping, listening to divine discourses, meditation, yogasanas, vegetarianism, fasting and watching Mother Nature as these attitudes have several undermentioned physical and mental health benefits.

  1. Improve health, quality of life, sleep, self-esteem, and longevity
  2. Reduce despair of old age decline and stabilize our thoughts toward death and dying even if physical health is failing
  3. Inculcate healthy lifestyles such as proper diet, exercise, deaddiction, and access to medical care
  4. Give benefit in emotional disorders, body pains, high blood pressure, heart disease, diabetes, cancer, cognitive impairment, emphysema, cirrhosis, and pneumonia
  5. Mechanism of these benefits is through lowering of stress hormone cortisol, cellular inflammatory markers such as C-reactive protein and interleukin-6 and by improving cardiovascular, nervous, immune, and kidney functions.


Pranayama and meditation

Both come under spiritual practices. Pranayama is an act of breathing while meditation is an act of mind. Pranayama can be done by different techniques such as Ujjayi, Kapalbhati, Anuloma Viloma, or Sitali Pranayama, while meditation can be done through transcendental meditation, vipassana, mantra, chakra, zen, tai chi, and qigong meditation.[13],[28],[29] Before starting meditation, senses have to be brought somewhat under control by any procedure such as Pranayama. Pranayama is therefore a stage before and preparatory to meditation. Meditation is not just about focusing on a thought or object but also on devotion and work.

Benefits of these spiritual practices are on stress, anxiety, sleep, deaddiction, blood pressure, pain, digestion, and immunity. Meditation also enhances self-awareness, promotes emotional health, lengthens attention span, generates kindness, and reduces age-related memory loss.


  Financial Health Top


Loss of job and income with consequent financial insecurity in old age are common sources of anxiety among most elderly persons who come from lower socioeconomic status. Seeking dependence on the family and assistance from the welfare schemes may be the only way forward. It seems to work for many older persons in India at least to some extent.

However, financially well to do older individuals have different kind of anxiety altogether. They may have thoughts about the fate of their moveable and immoveable assets. Even small- and medium-value assets accumulated or rather hoarded by them in large numbers in their lifetime may become a matter of worry. Contrary to mindset of senior citizens, some legal heirs are not even interested in every kind of asset they are going to get. Then, why worry for every small things.

Decision to allocate assets to the right beneficiaries may be tough, and it is tougher if there are no immediate legal heirs.[30] Moreover, such decisions become urgent once body and mind have started a fast decline. All decisions are private and according to individual choices but should leave the older person free from anxiety as far as possible. Any desire for charity by older persons should be respected. Following two points may be worth considering.

i. Writing a registered will is not merely an expression of desire but an effort to avoid any confrontation among those who are left behind. There are abundant examples where wills have been challenged. Hence, there should be no lack of financial and legal help for older persons on this aspect

ii. For those who have no immediate legal heirs, benchmark decisions are needed at right points. For example, all moveable assets subject to market risks may be shifted from private agencies to more stable government securities at 70–75, dispose all collectibles and artifacts at 80, sell off the house and move to assisted living at 85, reduce personal belongings to the minimum at 90, and so on. If some of these individuals may still like to leave something for people they like, decision needs to be respected.


  Self-Care During the Pandemic Top


It is common knowledge that older persons especially those with comorbidities such as heart disease, diabetes, and lung and kidney diseases have to be extra careful during COVID-19 pandemic. Their ability to access care for routine medical assessment, management of preexisting as well as new ailments, and medical emergencies is no longer simple due to social distancing during the pandemic. Tele and video medical consultations are not within easy reach of elderly population. Full potential of face-to-face socializing, brain storming, volunteering or working for a cause, and outdoor spiritual activities such as going to places of worship or going for pilgrimages has taken a big hit during the pandemic. It is not clear if internet-supported interventions for social connectedness have the same value as the face-to-face interaction. Simplifying personal finances has to take a back seat for the time being. There is also the additional burden of more stress, anxiety, social isolation, and even panic during COVID-19. All this implies greater responsibility on the part of older person himself/herself and his/her family to adopt preventive measures to sustain his/her physical, mental, social, and spiritual health. These self-care measures during the pandemic need modifications and have to be more effective to protect against COVID-19. They also have to boost our immunity more strongly.

First, mouth and nose being the gateway of all sorts of germs, greater attention on oral hygiene is required through more frequent tooth brushing, flossing, and gargling. Drinking warm water has been recommended. Balanced diet that is protein rich but low in carbohydrate and having adequate antioxidant containing fruits and vegetables and essential vitamins such as B, C, and D together with trace elements such as zinc is good for immunity. Turmeric (haldi), cumin (jeera), coriander (dhania), garlic (lahsun), and herbal tea have all been intensely advocated. Adequate hydration and a good 6–8 h sleep are also immune boosters.

If there is not enough space for walking in the house, indoor exercises such as strengthening, balancing, or stretching exercises can be done depending on the fitness level of the person. Having extra oxygen in the system needs emphasis and useful indoor activities such as pranayama, meditation, and yogic asanas should be encouraged. They also help destressing the individual. Deep breathing should become a part of day's routine. Use of tobacco and excess alcohol is particularly dangerous during such period.

Physical distancing is a must to protect from COVID-19, but social distancing is not and is a misnomer. In the absence of an alternative, many kinds of social connectedness are still possible through technology although it has its own limitations. Scientists say successful aging is 80% attitude and 20% everything else. Period of COVID-19 era, though difficult, provides an extra opportunity to adopt spiritually positive attitude and reap the benefit of successful aging. Meditation reinforces these attitudes and along with pranayama can be easily done inside the homes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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