Lifestyle Choice - The Key To Quality Of Life

Lifestyle choices have a major impact on how we age, according to Lora Wiggins, MD, geriatrician and Medical Director of Care Wisconsin. Dr. Wiggins, nationally respected for her work with the elderly, believes in the "use it or lose it" principle. She and her staff monitor the medical care management for over 650 participants in Partnership, a program for frail older adults with chronic conditions.

Physical activities are important at any age, according to Dr. Wiggins. Studies show that when frail nursing home patients did very simple, low exertion exercises, they were able to reduce their use of pain medications, were able to sleep better, and were less depressed. "Exercise, even if it's just walking a couple of times a week, can really improve quality of life as you age," Dr. Wiggins said.

"Just as you exercise to keep your body in shape, you want to keep your mind engaged to keep it functioning to the maximum," said Dr. Wiggins. "One of the normal changes in cognition as you age is slower recall."

"There is a natural tendency to step back from learning new things or taking on new situations as you get older because you are aware that it takes more time. But learning new things is actually a key component to keeping your mind sharp," she said.

Studies have also shown that a large social network provides better quality of life. "But as people age and get more frail, they tend to become more socially isolated," observed Dr. Wiggins. "The frail elderly who come into our Partnership Program and day centers are often depressed. We find that often, through interacting with staff and other elders at the day centers, participants can find help with this problem."

It is a myth that old age is equivalent to a second childhood. "People with memory loss and dementia tend to lose the ability to lay down new memory," Dr. Wiggins explained. "They may be quite disoriented or confused because they can't remember where they are or what they're supposed to do next. Yet their long-term memory is intact. Emotionally they can still be intact, too. They can often sense if they are being treated as children."

As people age, quality of life should be the top health priority rather than solely disease prevention. "A diagnostic procedure or a medication that you might eagerly undertake when you were 40 may not make sense when you're 85," Dr. Wiggins said.

In the Partnership Program, nurse practitioners, working closely with primary physicians, take quality of life into consideration when discussing appropriate medications. For example, there is a medication for people with heart failure that makes them urinate more often to get rid of fluids. If the individual is already having trouble getting to the bathroom in time and then takes that medicine, it may make him or her incontinent.

"What if the elder stops leaving home due to embarrassment? Or a family caregiver can't handle the incontinence and thinks their loved one should live in a nursing home?" queried Dr. Wiggins. "What makes perfect sense medically does not always make sense in a larger picture of keeping the person as independent as possible. It might be better to lower the medication dosage, tolerate a bit of fluid retention, and keep that person independent. This sort of decision is what we mean when we say that our Partnership program relates to the whole person."

Mobility issues can impinge on an older adult's ability to enjoy an active lifestyle. "Falls are a very significant problem for older adults and usually result from multiple factors," said Dr. Wiggins. "Some health-related causes - such as impaired vision and hearing, irregular gait and balance, side effects of medications and alcohol, and certain diseases - affect how an elder processes information and judges the situation when walking. Environmental risk factors - throw rugs, poor lighting, lack of grab rails - can also contribute to falls."

Dr. Wiggins said that even if an individual hasn't fallen but feels unstable, that older adult may, even unconsciously, limit activities. To address this "fear of falling", Partnership's rehabilitation staff assess participants for mobility patterns and risk for falls. The therapists then work out strategies to help, in conjunction with the Partnership Care Teams and Associate Medical Director, Jane Mahoney, MD, nationally recognized for her work in this area.

Dr. Wiggins believes it is important to start with quality of life as the goal rather than some smaller piece, such as controlling blood pressure. "You have to look at the whole person, not pieces or parts," she said. "And your choices can make a difference. Although genetics is a factor, representing about 30% of how long we live, the real key to longevity is healthy lifestyle choices."

By understanding the facts about aging, Dr. Wiggins hopes to empower us to make better decisions.