Sat, Jan-23-21, 03:34
How to stay fit and healthy after 70: the smart ageing guide
How to stay fit and healthy after 70: the smart ageing guide
Leading geriatrician Dr Lucy Pollock gives her expert advice on how to stay robust as we age.
There’s a lot about grace in growing old — the grace to be at peace with oneself and the world as it is, and to be satisfied with the life that you’ve had,” says Dr Lucy Pollock, the author of The Book about Getting Older (For People Who Don’t Want to Talk About It). However, according to Pollock, one of Britain’s leading geriatricians, grace is not all that can benefit older people. There is a lot you can do as you age to stave off frailty, maintain independence and improve mental wellbeing, she says, and even small changes can make a significant impact.
Pollock, 55, is a consultant in geriatric medicine at a large general hospital in Taunton, Somerset. Decades of experience inform her new book, which notes that growing old can, of course, be hard work, but that there’s a lot we can do to make it easier. “It’s about maintaining some independence, but also accepting when you need help,” she says. “Even modest activity makes a huge difference, as does maintaining social connections.”
And she points out that, with the UK Covid-19 vaccine programme well under way, older people, for whom the issue of shielding has dominated, can look forward to focusing on other aspects of life and good health again.
“This year has brought terrible fear, loneliness and loss, but we now stand at the threshold, literally, for many older people, of renewed freedoms,” she says. “There’s a real opportunity for restoring old connections and forging new friendships, for trying something different — an outfit, a role, an activity — that builds happiness, health, resilience or all three.”
Be risk-aware, not risk-averse
A little throwing caution to the wind is good for the soul, Pollock says. “We like exhilaration in youth, and some of the things that make us exhilarated are slightly dangerous. There’s a bit of me that doesn’t want to deny that joy to older people. I had one lovely old patient who fell off his bike and broke his arm — and was told he shouldn’t ride his bike any more. Hang on a minute — eight-year-olds fall off their bikes and break their arms all the time. Nobody says they’re not to ride a bike again. That’s just not fair.”
Yet there are situations, she says, in which it’s sensible to ask: “Am I making an unwise decision?” At which point, having a neutral observer assess the situation is helpful.
“Don’t be afraid to take external advice. If you are worried about your safety behind the wheel, charities such as Driving Mobility can organise a driving assessment once this pandemic is over.”
What to do to prevent physical frailty and falls
About a third of people over 75 fall each year, but, Pollock says, “a combination of strength and balance exercise reduces your risk of falling over”. Even gentle exertion improves fitness. “You might simply stand up during the adverts on the telly. If standing up is a struggle, do some chair-based exercises.”
Or try Joe Wicks’s exercises for seniors, she says. (See 10 Minute Chair-Based Workout for Seniors by the Body Coach on YouTube.) Watch before attempting to check that they suit you and start gently.
Lift weights, even if you are over 80
“Just by punching while holding a tin can into the air ten times with each hand you are improving your muscle, but you’re also improving your heart, brain, and immune system,” Pollock says. “Just do a little that makes you puffed out. And the next day a little bit more. You’ll sleep better as well.” And, she says, you may be in better shape than you imagine. “Lots of older people haven’t taken formal exercise, but are more fit than they realise, especially if they clean their own home. Housework is a very good exercise.”
Walking is the best exercise for your brain
For a lot of older people, walking is the best exercise, Pollock says, even during this lockdown. “It’s usually safe, it certainly brings pleasure, and in terms of mental wellbeing it’s huge. There’s this sense of purpose and achievement one can get.”
While the ability to walk fairly fast is a good measure of all-round health, don’t make speed your target. “Just enjoy the moment of walking, the process, being out there, the fact that you might be a bit tired and need to sit down and have a cup of tea when you get back,” she says.
The supplement to boost muscle strength
“I have a healthy disregard for a lot of medications,” Pollock says, “but getting some vitamin D is a good idea.” While we always think of vitamin D as improving bone strength and reducing the risk of fractures, Pollock says, “there seems to be a bit more evidence that vitamin D may improve muscle strength”.
It’s never too late to start a fitness regimen
The earlier in life you start to exercise, the less frail you’ll become, but, Pollock says, “it’s never too late. It is the people who do least, but then who move to doing a little who benefit most. If you’re doing a marathon in your eighties, fantastic, but you won’t gain much by doing two marathons. Whereas if you move from sitting all day to standing up once every hour or 20 minutes, that makes a huge difference. For some of my patients, simply being able to stand up on their own out of a chair or bed means they can stay at home.”
Eating what you fancy does you good
Pollock advocates a balanced diet with plenty of fruit, vegetables and fibre, and including some good-quality meat and protein. However, she says, “I think once you’re in your eighties or nineties, especially if you have medical or physical conditions that are making life quite complicated — hang it.”
Then, it’s far more important to enjoy what you’re eating than to fret about what you should be doing. “I’d much rather see someone tuck into a pasty, or enjoying a cream bun or fish and chips, than choke down a protein drink. It’s important to look forward to what you’re eating.’’
Stand on one leg every day to practise balance
Every day, as she brushes her teeth, Pollock does 20 squats, then stands on one leg with her eyes closed for 30 seconds (and then the other leg). When she started this she couldn’t stand on one leg with her eyes open. “Be sensible; don’t try to do this with your eyes closed immediately,” she says.
Even just standing still in one spot might be a challenge initially, but “the brain maintains a learning ability for ever, and that means we can learn pathways that improve our balance. So you can strengthen the brain’s ability to keep your body balanced by practising.” She adds: “That will translate into better ability to keep yourself upright.”
Men should do pelvic floor exercises too
“Men need to strengthen their pelvic floor as well as women,” Pollock says. “It can make a difference to continence in men, and to sexual performance. So many women are put on tablets for continence, but pelvic floor exercises really do make a huge difference.”
Pollock uses the NHS Squeezy app, which prompts her three times daily. However, an app isn’t essential — what matters is doing them, perhaps while waiting for the kettle to boil or lying in bed, Pollock says. She quotes the pelvic floor physiotherapist Elaine Miller’s advice: “You breathe out first, then imagine you’re trying to hold in a fart, using those muscles that sit around your bottom to shut everything off. Feel a squeeze and a lift. Keep breathing and hold for ten seconds. Let go, relax. Do that ten times.” If three times daily feels too much, start with what you can manage consistently.
Maximise social interaction even if you can’t see people
“Even in normal times people can become so desperately isolated and lonely,” Pollock says. If you’re on your own, “pick up the phone. Don’t feel bad about phoning a friend or a family member. They may not have ages to talk, but a short conversation is a good one.”
Connect by every means available to you. “A lot of older people have embraced technology and learnt to use Facetime.” If you are unfamiliar with technology, she says, “Don’t be afraid and don’t feel that you can’t do it. Go slowly. Be forgiving of yourself with new technologies. Allow a bit of time to learn how to work them.”
Make more fuss
“It’s not about being a serial complainer or putting excessive demands on the NHS — it’s about knowing what a good service looks like and asking for that,” Pollock says. This applies for vaccinations and all other health issues.
Falls, poor sleep, incontinence and discomfort aren’t inevitable as you age. They require a diagnosis, she says. “We can’t prevent all falls, but we can reduce the risk by about a third” — for example, having cataracts repaired reduces the risk. It matters because falls bring fear as well as injury, reducing quality of life and independence.
“If you’ve slipped on an icy puddle,” Pollock says, “OK, that’s a simple fall. But if you’ve tripped for no good reason, feel your balance is deteriorating or think you might have had a blackout [and] found yourself on the floor, seek help. Someone needs to listen and work out why you fell. Then we can do something about it.”
Get a medicine review
People often go on collecting their prescriptions, Pollock says. “They have a right to a really good medication review and an explanation of what’s going on.”
Often, if you have a range of conditions, you end up on a multitude of medications. “All of those medications have interactions and side-effects, and some may not be particularly effective. Someone needs to go through your medicines and make sure absolutely everything on that list is justified.”
Scans and interventions are not always advisable
A bowel cancer screening test is worth having, Pollock says, but private screening scans are often just as likely to turn up something that’s not likely to trouble you in the future, but will cause endless worry.
Gallstones that aren’t causing symptoms are a good example, she says. Others are tiny nodules in the lung or adrenal glands, or some degree of furred-up arteries in the neck in someone who has never had a stroke or mini stroke. Occasionally these will develop into something troublesome, but good studies have shown that in specific situations the benefit of any intervention is outweighed by the risks, Pollock says. “More isn’t always better.”
The real signs of dementia
How to distinguish between normal mild forgetfulness of old age or something pathological? “If your issue is forgetting why you’ve gone upstairs, or the awful moment you forget a friend’s name or where you parked the car — fine. I do that all the time and I’m not worried about it,” Pollock says. “If I forgot my way home, that wouldn’t be fine.”
For Pollock, a key issue is “the things that allow us to live independently. Having friends and a social life. Paying your bills. Looking after your house. Planning meals. These are the things people can start losing when their memory is beginning to fail.” (It’s fine to need to write a shopping list, but not fine to forget to go shopping.)
Dementia affects more than just memory. “People with frontotemporal dementia can run into problems with emotional control and can become very impulsive and rather rude.” It’s why sometimes a diagnosis can lift a weight from a family. “There’s an explanation for why somebody has angry outbursts or doesn’t seem particularly interested in their grandchildren. It can help families move from blame to understanding.”