On Aging - A Discussion

TMCN: Recently I was told an interesting statistic. There's a high probability that 50 percent of the women who turn 50 this year will live to be 100. That's going to make for a very large elderly population.

Dr. Fay: That population of 65 years and older is the fastest growing segment, and in that group the 85-plus year-old segment is growing at the quickest rate. At this age [85], women outnumber men two and one-half to one. Most men grow old with a spouse, but the majority of women growing older are living alone. So there are some real implications here in terms of caring for elderly women. Many elderly women have children over 65, so we are seeing more and more grandchildren as caregivers.

Dr. Luchi: Yes, we've seen examples of great bonding between a grandmother and her grandchildren - and great-grandchildren.

In regards to living longer: in 1990 there were approximately 60,000 centenarians in the U.S. In the next decade we expect to see several million people in our country over 100. Of course living to 100 with a good quality of life is really what matters. But the women you mentioned who are turning 50 - and the men, too - can help ensure a better quality of life by simply taking care of their health, not in any dramatic ways but in the basics: regular exams, blood pressure monitoring, screening for cancers, and keeping active and eating the right diet which will certainly help with the bones and heart.

TMCN: We'll see more and more elderly return home to their children then?

Dr. Fay: Most elderly people live in their own homes or apartments, and they probably prefer it that way. Only about 5 percent of the elderly live in nursing homes and that's because of an illness. Most care-giving is informal. It's caring for your parents by calling them, stopping by to see if they need anything, spending time with them.

Dr. Luchi: We're doing an outstanding job. Every study indicates that Americans are heroic in taking care of older people, despite the fact that we're more mobile than ever and that families are not as tightly bound... I have seen enormous self-sacrifice.

TMCN: In regards to elder health care, are we expecting a shortage in geriatricians and geriatric nurse practitioners?

Dr. Luchi: There already is a shortage. All of the geriatric training programs in the U.S. combined turn out between 100-150 geriatricians a year. The total number of practicing geriatricians isn't increasing, and that's a problem. We need to look at the reasons physicians are not going into this area, or why the programs aren't larger. I do think there is already a lot of effort in the medical schools to educate young physicians who will be seeing a large number of older patients in their areas - internal medicine, primary care, gynecology - and those areas which traditionally focus on elders' special needs like ophthalmology and orthopedic surgery.

Dr. Fay: Houston has become one of the centers, I think, in this area of specialty. We have the Huffington Center at Baylor and the UT Center on Aging. Our geriatric nurse practitioner program is quite strong and one of the largest in the country. One hundred and fifteen geriatric nurse practitioners have completed our program in its 12 years. There are a lot of people outside of the medical fields who work with the elderly in a number of capacities. There has been - and it continues - a dramatic increase in assisted living facilities and in multi-level retirement communities. By and large, the people who manage these kind of residencies have little formal training in geriatric care or long term care. The Texas legislature may pass requirements or conduct testing. In the meantime, the [UT] School of Nursing has a program in long-term care administration, with 18 semester hours of course work and 12 semester hours in a preceptorship, and it's been very successful so I know there will be other programs like this.

Dr. Luchi: The Texas Medical Center is the finest center of medicine, so we need to be the premiere center on aging, for the treatment of diseases that affect elders and to study the aging process. There is already much collaboration between our schools [Baylor and UT] and with the University of Houston and Rice University.

TMCN: The aging process - and dreaded illnesses like Alzheimer's and dementia. As our senior population grows, we'll see a growing number of these illnesses.

Dr. Luchi: Remember that dementia is an umbrella category. Small strokes, Alzheimer's and rarer brain disease that rob us of our memory make up that larger dementia category. I'm very optimistic, and there's been some fascinating research that has come out recently and indicates that we're on a good path. In the research - done with mice - the over-production of a certain protein in the brain generated characteristics that greatly resembled Alzheimer's. A vaccine was made which prevented this process and also stopped the progression of the disease. That's very significant. Research like this gives us hope for a cure.

These are organic brain diseases, so we search for a cure. But growing older can sometimes cause people to relax using their brains, and that, I think, is a big mistake.

Dr. Fay: We talk a lot about staying active, and I can't emphasize the importance of that for healthy aging. My own father, who is 82, has a huge number of volunteer hours at Memorial Hermann Hospital. He stays active and socializes. My mother, who is 76, volunteers with the Look Good, Feel Better program of the American Cancer Society and teaches exercise classes at personal care homes for the frail elderly. The key is "involvement" I think. It means staying social, keeping mentally alert and realizing that you do not have to give up the things you like to do.

Staying active has to include exercise and a proper diet. It is never too late to start an exercise program. Some recent research shows that even very frail people who do some weight resistance training will be able to rise from a chair or from bed with more ease. So it pays off. Some older people are fitter and healthier than a 40-year-old couch potato. The elder years are not the time to count calories because older adults need protein and calories. But eating is a social activity, and many older people who live alone don't cook for themselves and are at real risk of malnourishment. Also, older adults have a decreased thirst response - they don't get thirsty - so there is a danger of dehydration.

TMCN: You both are very positive about aging - proactive might be a good word.

Dr. Luchi: Well, here are two stories, both personal. It came time that my mother needed to be cared for full-time. She was living in a small town back East and knew everyone. Bringing her to live with us was really going to uproot her and everything she was familiar with, but it had to happen. While she was with us, we recognized her need for independence, and we recognized her limits and boundaries. She came to know her grandchildren, and became closer to her family. There were many new experiences for her. One day she turned to me and said, "You know, we've had some good times together." So I think this period of time was a positive experience for her and her caregivers.

I'm 72, still in pretty good health and still very interested in making positive contributions. I've stepped back some from a couple academic appointments. I'm conscious that there are younger people that are doing exciting things and I need to step aside. But I'm always looking for new areas in which to learn and to contribute.

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©2006 Texas Medical Center

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