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Seniors
Topics:
Most immunizations are designed for children, but infections strike people of all ages, and immunizations are important for adults, too.
Aside from travelers and people with special needs and vulnerabilities, healthy adults have had only three vaccines to keep track of:
· a flu shot every fall for everyone over 50
· a pneumococcal pneumonia shot for everyone over 65
· a tetanus-diphtheria (Td) booster every 10 years.
Varicella-Zoster Vaccine The FDA licensed the varicella-zoster virus vaccine for shingles in 2006. (Shingles is caused by the chickenpox virus, which remains in the body after an initial bout of chickenpox and may emerge many years later to cause the painful condition known as shingles.) The Centers for Disease Control and Prevention (CDC) recommends the varicella-zoster virus vaccine for people over age 60 to prevent shingles and to reduce shingles-associated pain.
Hepatitis A Vaccine Children are routinely vaccinated for hepatitis A but many adults have not been vaccinated because the vaccine is relatively new. The Advisory Committee on Immunization Practices (ACIP) recommends it for all people and especially for those with chronic liver disease, people who receive clotting factor concentrates, individuals traveling to countries where hepatitis A is common, men who have sex with men, or people in occupations that might expose them to the virus. What about bird flu? The bird flu vaccines will not be available to the public except in case of a pandemic. Although the number of human deaths attributable to bird influenza strains has been low thus far, there remains the very real fear of a pandemic should the viral strains mutate sufficiently to pass easily from person to person. Other vaccines you may need. Even if you have received all your childhood vaccinations, ask your doctor whether you need any booster shots. If you have never had the chicken pox you should talk to your doctor about getting it Starting at about age 40, people typically lose about half an inch each decade, and the decline usually accelerates after the 70th birthday. The Baltimore Longitudinal Study of Aging is a well-known investigation that included roughly 2,000 people. The men in the study lost, on average, about two inches of height between ages 30 and 80, and the women, about three.
What causes it? Osteoporosis. As we get older, our bones become less dense, more brittle, and therefore more likely to fracture. This loss of bone tissue is called osteoporosis. Older women are particularly susceptible because of the drop-off in estrogen levels during menopause.
When a hip or wrist bone weakened by osteoporosis breaks, it’s usually the kind of crack we have in mind when we picture a broken bone. But fractures of osteoporotic vertebrae, those knobby bones that make up our spine, are different. The bone crumples like a cardboard box that has had too much weight put on it. Most of these vertebral fractures don’t cause any pain or other symptoms and are discovered incidentally in a chest or abdominal x-ray.
Bad posture. Some doctors and researchers believe that vertebral fractures have been overrated as a cause of height loss and kyphosis (pronounced kie-FOE-sis), the medical term for being hunched over. Dr. Harold Rosen, an osteoporosis expert at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston, points to studies that have shown that only about 30% of kyphosis can be explained by vertebral fractures. It’s hard to say what’s behind the other 70%, but a big share of it may simply be bad posture.
What are the consequences? For many people, losing a little bit of height is no big deal. Compared with the other challenges of getting older it can be pretty trivial. On the other hand, severe kyphosis can cause all sorts of problems. It may affect your breathing because the lungs don’t have enough room to expand. You may also be more likely to fall and break a hip or another bone because your center of gravity is shifted forward. And, no surprise, neck and back pain are often a problem.
What can you do about it? Improving your posture. You can do some simple exercises that will strengthen certain back muscles so you can stand up a little bit straighter. Sit-ups or crunches, a modified sit-up that involves contracting your stomach muscles, will strengthen your abdomen. For overall muscle control as well as posture and balance improvement, many people swear by yoga or tai chi, a form of Chinese martial arts that has been described as moving yoga.
You can do these preventive exercises on your own if you are healthy. But if you’re older, have osteoporosis, or both, it’s a good idea to talk to a doctor before you get started on an exercise program. The wrong exercises could do more harm than good.
Strengthening your bones. The other way to limit height loss is to counteract the effect of osteoporosis on bone — and on the vertebrae in particular. The single best way to do that is to stay as active as you can. Innumerable studies have shown that weight-bearing exercise stimulates the creation of bone tissue.
Getting enough calcium and vitamin D is also important. How much is enough? If you’re older than 50, the recommendation for daily calcium intake as of 2005 is 1,200 milligrams.
Doctors are changing their minds about vitamin D as the evidence of its benefits piles up. Those benefits seem to go well beyond just increased bone strength and may include improved balance. The recommended daily amount is 400 IU (International Units) for people ages 51 to 70, and 600 IU for those 71 and over. Some Harvard experts now believe that we may need at least 1,000 IU daily to protect ourselves against osteoporotic fractures.
A middle-of-the-road approach is to start taking a multivitamin. Most contain 400 IU of vitamin D. Milk, vitamin-fortified breakfast cereals, and coldwater fish (mackerel, salmon, sardines) can add another couple of hundred IU to your daily total. Your skin makes vitamin D when sunlight hits it, so stepping outside for a little bit on a sunny day is another way to get more of the vitamin into your system. When you do, feel good and stand tall
You probably have a pretty good idea of your health status. You may be able to reel off your blood pressure and cholesterol levels and maybe even your body mass index. But have you had your balance checked lately?
Try this. Put on a pair of comfortable shoes. Then stand with your arms relaxed at your sides. Lift one foot about six inches off the floor and hold that pose for 30 seconds.
If you felt a little wobbly, you’re not alone. Balance tends to erode with time. For weekend athletes, lost equilibrium can mean more spills on the slopes or wipeouts in the surf. For the sedentary, it can bring a surprise encounter with the sidewalk.
Even if a fall doesn’t injure much more than your pride, it sets the stage for subsequent stumbles. One fall increases the chance of the next, as does the mere fear of falling. Every year, more than a third of people over 65 — and half of those over 75 — take a tumble. Falls account for about 300,000 hip fractures annually. For older people, they’re the leading cause of death from injury and a major cause of disability.
Yet falls aren’t an inevitable consequence of growing older. It’s possible to regain equilibrium and compensate for permanent balance deficits.
Here are a few simple exercises that have improved strength and balance even in frail nursing-home patients. You can do them at home in a few minutes (as shown in the illustration below).
Few of us take advantage of the closest thing we have to a magic bullet — exercise — for preventing or controlling heart disease, diabetes, osteoporosis, and many of other physical woes.
If you can’t seem to find the time or motivation to fit in a formal exercise program, look for ways to add activity to your life. So walk the dog. Mop the floor. Take the stairs. Garden. Go dancing.
Activity lengthens life. In an effort to measure activity directly, a team funded by the National Institute on Aging followed 302 seventy-somethings for six years. Over the six year period, 25% of those in the low-energy group died, compared with just 12% of those in the high-energy group. The most active seniors didn’t exercise any more than the least active. Instead, they were more likely to take the stairs, work for pay, or do other daily activities.
Walk the dog. Nearly half of dog owners walk their pets for at least 30 minutes a day, exactly the amount the Surgeon General recommends for exercise. A big, energetic pooch can tug you along at a pace that more than qualifies as moderate exercise. Even if you have a smaller or less lively dog, two or three daily 10-minute walks are far better than sitting.
Move early. A long-term study from the Chianti region of Italy indicates that adults who are active during midlife are more likely to have better mobility and fewer physical limitations in their 70s.
“Make exercise part of your day.” It certainly sounds simple. But you know it’s easier said than done. There are plenty of obstacles, like arthritic joints, lack of time, difficulty finding a safe or convenient place to work out, or leg or chest pain when you move too fast. If you can’t get beyond the barriers to exercise, just try moving more throughout the day.
The health benefits of activity begin to kick in at around 100 calories a day. That’s the equivalent of walking a mile or square dancing for 15–30 minutes. The more energy you expend, the better. A long-term study of Harvard alumni showed the lowest death rates in those who burned about 300 calories a day in exercise or activity.
If you tend to be a sitter, adding “activity bits” during the day is a great way to start burning more calories, lower your risk of cardiovascular disease, and keep you mobile.
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