Aging Care: Who Benefits and Why?
By Dr. Ardeshir Hashmi
Geriatric. Senile. Aging.
History’s lexicon has been unkind to the phenomenon common to every single living being, every passing second getting older. Society and cinema alike lionize youth and reduce aging to a caricature, something to be feared, lamented and frowned upon. Recently, COVID-19 has underscored aging’s vulnerability.
What defines geriatric? Is it age 65, the age we are eligible for Medicare benefits? More importantly, who originally defined this? In 1883, Otto von Bismarck, the Prussian chancellor, arbitrarily appointed age 65 as the retirement age to aid the Prussian economy. Coming from someone who also said, “The great questions of time will be resolved not by…majority decision…but by iron and blood,” aging clearly needs new inspiration and redefinition.
Is aging something to be celebrated? Dan Buettner certainly thought so in his seminal work on the “Blue Zones” — global longevity “hot spots” with the longest living, healthiest populations. Spanning a culturally diverse spectrum, from Okinawa in Japan, to Greece, Sardinia, Costa Rica and Loma Linda, California, Buettner found Blue Zone principles shared by these disparate populations. Examples include:
- Seafood and plant-based diets
- Aerobic exercise integrated into daily routines
- Social connectivity
- Sense of purpose in life
- A slower pace of life
Aging is a marathon, not a sprint, won only by those who judiciously pace themselves.
The 5 Ms
While I never want to be geriatric, I do want to age successfully. Personalized successful aging care, infused with Blue Zone principles and a nuanced understanding of the 52 natural, physiological ways our bodies change between ages 50 and 80, can help us all achieve this.
It’s never too early to develop a keen awareness of how our thirst response gets blunted (losing our early warning system for dehydration causing “brain fog” and dizziness) and our muscle tissue turns to fat (engendering frailty). A partnering geriatric specialist with dual qualifications in both geriatrics and internal medicine can help navigate our voyage toward successful aging. Akin to pediatricians understanding the unique physiology of childhood, geriatricians are well versed in harnessing the silver lining of the other end of the aging continuum.
Successful Aging care by geriatricians is powered by 5 Ms:
- Mind (brain health — memory, mood, social isolation, anxiety
- Mobility (frailty, falls)
- Medications (de-prescribing harmful medications, reducing doses as kidney clearance decreases and predicting with genomics testing which medications are likely to be a friend or foe
- Matters most (goals, aspirations and care preferences)
Core principles of high-value aging focus on age-appropriate health screens, immunizations, self-care for caregivers for older dependents and financial counseling.
As new research highlights the role of underlying sleep disorders, hearing loss and macular degeneration on memory, it is imperative to adopt proactive successful aging care. All of this takes time, which traditional primary care visits do not allow for. It also requires a team, a village of geriatricians, geriatric pharmacists, social workers, nutritionists and audiologists, working together on a unified platform.
Finally, access to this next generation care must be quick, timely and simple. Precise, technology-powered and cost-effective care is the need of the hour. We have worked hard toward this all our lives. With apologies to Eleanor Roosevelt, we all aspire to be “works of art,” living both longer and better. And great art, like good wine, takes time to be fully appreciated.
Dr. Ardeshir Z. Hashmi MD, FACP is the Endowed Chair for Geriatric Innovation and Director of the Center for Geriatric Medicine at Cleveland Clinic.
