LiveLongAgeWell

You may think that getting older means becoming less happy, but various studies, including this new one just released at the American Psychological Association (APA) meeting in Toronto, show just the opposite: most people actually become happier as they get older. Good news, especially as the fastest growing population segment—in the U.S. at least—is people over age 85.

This APA study from the University of California found two exceptions to the older=happier correlation. First are people dealing with dementia, and second are people stuck in a long-term stressful situation without escape, for example, a debilitating chronic disease.

Most of us, however, can look forward to greater happiness as we get older. The researchers felt that a main reason for that is that over time, we learn from experience what makes us stressed or unhappy, and we become better at avoiding or just ignoring those people or situations.

More from the APA Meeting

Two other interesting presentations at the APA …One a large Swedish study demonstrating that those adults who have a “strong social network” were 60% less likely to become demented over time.

The second one sounds obvious, yet is something frequently ignored—that many people who seem to be getting mentally slower are really not; it’s just that their hearing has slowly dropped, making them seem dim-witted. Be aware that many older folks are embarrassed to admit a hearing problem, so keep this in mind regarding your own family. If you notice someone losing sharpness over time, one of the first things to test is hearing.

“Sham” Vertebral Procedure and the Placebo Effect

The best possible research study is a “double-blind clinical trial”, and a typical trial like this involves splitting up a group of people into two equal groups, and giving one group an active drug, and the other group an inactive drug (placebo) and then comparing the outcome of the two groups over time. Unfortunately, since these studies are expensive and time-consuming, a majority of research studies are not true clinical trials, and surgical clinical trials involving placebo, or “sham” surgery, is exceedingly rare.

Sham surgery is complex in many ways; you can imagine trying to convince one half of a study group that they really had surgery, when in fact they had nothing more than an incision made, or an anesthetic shot given, rather than a full operation.

So I can’t recall the last time I read about a sham surgery clinical trial, but one was just completed by a team from Australia, Britain, and the U.S. The goal was to learn if vertebroplasty, a common back procedure (to decrease pain in vertebral fracture patients) was actually effective, or the improvement seen was just a placebo effect.

The researchers performed the full procedure on one half of the patients, involving an anesthetic shot and injecting bone cement into the fractured vertebra. The 50% of patients who had the sham procedure had the anesthetic shot but no cement was placed. To add realism to the sham group, the doctors had the cement in the room to give the same smell sensation as the real procedure.

The result was that the sham surgery group did just as well, with just as much improvement, as the ones who had the full procedure. For more details, look at this full summary in the New York Times. And if you have doubts about the efficacy of a procedure or operation your doctor suggests, you might ask “what clinical trials have been done, if any, to show this procedure is effective?” Your doc will be surprised, but should be able to answer.

Finally….it seems a number of research papers in the past decade have been “ghostwritten” by medical marketing companies rather than doctors. (This is probably no surprise to most doctors, but I suspect it might be for the general public.) In these cases the drug company hires a marketing company to write a paper with a positive spin on whatever they are selling or wanting to sell. Note that if the research did not turn out in their favor, they just wouldn’t publish it.

After the marketing writer finishes his favorable report, the doctor(s) may just look the paper over and make a few changes, but often the report is tailor-made to suit the drug company. Amazing how medicine has changed over the years, and how doctors can be bought off. Supposedly this practice, now exposed, will stop, but I doubt it.

Last week I presented some of the issues surrounding sunscreens and today I’ll give some practical hints. Unfortunately, there is still no sunscreen available that is even close to perfect; they all have potential issues regarding how well they block both UVA and UVB, how long they are effective, and how safe they are (particularly regarding absorption into the bloodstream). Still, protecting yourself from excessive sunlight is critical, not only to help protect from the number one cancer of all—skin cancer—but to avoid early aging. Consider this quote from the U.S. Environmental Protection Agency’s excellent pdf fact-sheet “The Burning Facts”:

Up to 90 percent of the visible skin changes commonly attributed
to aging are caused by sun exposure.

11 Hints…What You Can Do

1. If you are very concerned about the potential toxicity of sunscreens, consult this summary from the Environmental Working Group, a non-profit consumer “watchdog” organization that has issued a list of what they consider recommended and relatively safe products. One problem is that you probably won’t find many of their recommended ones at your local drugstore, but you can probably find most online.

2.If you are not so concerned about theoretical chemical risks, you can consult this short list of American Academy of Dermatology (AAD) “recognized” products (while not as cautious as the EWG list, the AAD is still quite a careful group). One brand from their list I particularly like is Aveeno, which you will be able to find locally. Aveeno makes high-quality products that are not terribly expensive.

3. The last several years has seen release of several products that have longer-lasting, stablilized UVA protection (as well as the more standard UVB protection), and Mexoxyl and Helioplex are two components to look for. Helioplex seems to be the superior product, and of those brands with Helioplex, I like the Neutrogena brand, particularly Neutrogena Ulta-Sheer SPF 70 with Helioplex. It’s what I use. Some researchers have claimed that since these chemicals are partially absorbed into the bloodstream, that they might have an estrogen, hormonal-type effect internally. Talk to your physician if you are concerned about possible hormonal effects,  and you may not want to use one that is absorbed, on children.

4. If you want a sunscreen that is not absorbed, find a zinc oxide or titanium dioxide product (and see EWG report above), though these often leave the skin with an unattractive white cast.

5. It is probably best to avoid spray and powder sunscreens that have (ultra-small) nano-particles which might be inhaled.

6. Besides using a broad-spectrum UVA/UVB product, buy at least a SPF 30, and use enough of it! Shockingly, you need to use a “shot-glass” amount, about 1 oz. (1/3 of a typical 3 oz. tube) for your entire body, if you want to get the advertised SPF factor. Bottom line: use more than you think you should.

7. Apply 30 minutes before going in the sun to allow it to absorb.

8. Sunscreens lose potency over time. Look at the expiration date when you buy or use, and throw away any product at 3 years.

9. Reapply after going in the water, after significant sweating, and about every 2 or 3 hours. Even “waterproof” sunscreens come off after 40 minutes in the water, so if you are a water person, look for “very waterproof” which should give double water protection.

10. Don’t forget to apply to areas commonly forgotten such as: the entire surface of the ear (I can’t count how many ear skin cancers I excised and re-constructed when I was in California), any bald spots, the tops of your feet….and use a lip-sunscreen too (lip cancer is common)!

11. Avoid the sun during peak times, 10 am to 3 pm, wear a hat and don’t forget quality sunglasses to protect your eyes from cataracts! (a subject for a future post…)

Next: self-tanning products.

First, the big picture: the most important measure you can take to keep a “youthful” appearance—as much as your particular genes will allow—is to minimize exposure to UVA and UVB irradiation from the sun. Of course staying out of the sun as much as possible is the most sure way, but also it’s inconvenient, impractical, and not healthy from many aspects, including the psychological ones, so most people use sunscreens. The problem is finding a good one.

Sunscreen use is critical both to minimize wrinkles and cut the risk of skin cancer, which ranks as the most common cancer of all. But the subject has become complex in the past few years, so today let’s go over some of the current science of sunscreens, and the next post I’ll give some specific ideas on what you can use.

A few years ago it was easy to know what to do. Most people, even dermatologists, felt that if you used a SPF 15 or, then…wow…a 30, you would be highly protected and would not have to worry much, because a 30 was thought to allow you to be in the sun 30 times as long as if you didn’t use any sunscreen. But in the last few years as more products have been released, with higher and higher SPFs, the sunscreen field has become much more murky and confusing.

Some doctors have even gone so far as to state that using sunscreens will increase the risk for the deadliest form of skin cancer, melanoma, because many products will stop the burn (mostly from UVB), but will not stop UVA. This UVA irradiation doesn’t cause as much redness, but penetrates more deeply into the skin causing worse aging damage and a higher melanoma risk. So since you don’t get red, you think you are fine, while the sneaky UVA rays are causing their deep damage.

One simple way to remember the basic difference between A and B is: UVA,  a longer wavelength, is the aging radiation, and UVB causes more burning…however, both, in excess, lead to wrinkles, skin cancer, and even a diminished immune system. And if you sit by a sunny window, know that UVA radiation penetrates glass.

Here is a summary of some recent issues. But don’t get discouraged as you read this, because there are some solutions, which we’ll discuss in the next post…

1. The “SPF” rating only concerns the level of UVB protection. There are no good FDA standards or labeling or SPF ratings for UVA, and many products don’t offer, or even claim, good protection from UVA.

2. Many of the chemicals that do provide UVA protection, perhaps ironically, break down quickly in the sun, which is one reason sunscreens should be re-applied every 2 to 3 hours.

3. Toxicity: some of the chemicals used in sunscreens are absorbed into our bloodstream and may be toxic. Particular concern has been raised about two popular components, oxybenzone and avobenzone, which theoretically could alter our internal hormonal balance, and some doctors advise: don’t use these on pregnant women or children. Then there are the super-small, nano-particles used in some expensive new products. Again, while some have claimed these tiny particles might be absorbed, the super-cautious Environmental Working Group has concluded they are not. But the EWG recommends staying away from spray or powder products that might cause lung damage from the inhaled nano-particles. Finally, some sunscreen chemicals have been shown to produce free radicals when mixed with sunlight, and free radicals (which we try to neutralize with antioxidants) lead to skin aging.

4. While many of those issues are controversial, most doctors agree: very few people use enough sunscreen to provide adequate protection. A large Australian study showed that even “diligent” sunscreen users were only applying about half of what they should to get the advertised SPF protection, and most people only get about a quarter of the protection they think they are.

5. “Waterproof” sunscreens only last for about 40 minutes in the water, and for typical beach use, even these should be re-applied regularly.

6. If you read this blog often, you know I am a big fan of vitamin D, which we naturally get from sun exposure on our skin, and many people are vitamin D deficient. For some, this D vitamin shortage is rooted in excessive paranoia about sun exposure and many of these people use too much sunscreen. Like most things in life, moderation is the best route.

Next: SPFs and good sunscreens.

When a new patient walked into my office I would occasionally test myself, and try to guess just by looking at her face if she was a smoker or not. Usually I was right, and I could tell by looking for vertical wrinkles around the mouth, typically much more pronounced in a smoker. Why is that? Why should smokers have more wrinkles?

For skin to look good and alive, it needs to be nourished by the blood vessels that feed it. These vessels are the pipes that send fresh blood, oxygen, and nutrients to the skin, and then carry away the bad stuff. But in a smoker, the small blood vessels that feed the skin get irritated and inflamed from the cigarette toxins, and when the vessel walls get irritated, cholesterol can more easily stick to the inflamed surface. So like a pipe filled with any sort of crud, the flow of oxygen and nutrients decreases, and the skin basically loses its elasticity and slowly dies.

The same thing is happening to the smoker’s blood vessels that feed the heart and the brain, and everywhere else in the body. We just don’t see the pipe build-up problem like we do in the skin. In the heart the smoker can experience angina (heart pain) or a heart attack. In the brain, the smoker loses brain cells faster, and are more prone to a stroke. In the penis, since a firm erection depends on good blood flow to your organ, even if you aren’t impotent, your erections won’t be as good.

Besides wrinkles, a few more reasons smokers tend to age much faster:

•    The smoke slowly kills your lung capacity, so if you DO manage to get to an old age as a smoker (note that smokers live an average of 13 to 14 years less than non-smokers), you won’t be able to handle athletic activities well; even climbing stairs might become a chore. Bad lungs severely limit your ability for fun, and there’s no cure at all. Carrying an oxygen tank is a big hassle.

•    Smoking ruins your breath, stains and loosens your teeth.

•    Smokers have a much higher rate of osteoporosis and bone fracture.

•    The risk of that much advertised affliction, ED, or erectile dysfunction, is about 50% greater in smokers.

•    Smokers are twice as likely to get macular degeneration, a common form of blindness, as well as cataracts.

•    Many plastic surgeons will refuse to operate on smokers, because they heal from surgery so much worse, and have a much higher complication rate.

•    Yes, smoking can keep your weight down somewhat, but there are better ways, and is being a little thinner worth all the negatives, and let us include: a higher risk of baldness for men and for women, increased breast cancer and a two times higher risk of cervical cancer?

About the time the Berlin Wall fell in 1989, several Berlin universities joined with several U.S. institutions and launched the Berlin Aging Study (BASE), with the goal of closely following, over many years, a group of more than 500 men and women aged 70 to over 100 years old. Over time this group has been put through extensive testing to asses their physical and mental health and their social and economic well-being. While the “subjects” in BASE were Berliners only, most likely the results generalize across cultures. The ultimate purpose of BASE is to find keys to aging better, and the study is ongoing.

Here are some of the results to date…which gives encouragement that when we hit middle age and beyond, our lives should continue to be happy and satisfying:

1. On average, the people in the study felt about 13 years younger than their actual age, and felt that they looked about 10 years younger than they actually were.

2. The men believed they looked younger than the women, by about 4 years. (I wonder if the men in this study might be well, slightly delusional, because in the U.S., it seems like the women take better care of themselves, and look younger. I’m really curious what the LLAW readers think about this. Please leave a comment with your opinion!)

3. Most in the group had a high level of satisfaction with their own aging; they weren’t depressed or discouraged about being older.

4. Some people, seemingly those in the best health, seemed to feel even younger as they got older.

5. Finally, referring back to “self-perceived age” discussed in Monday’s post: when BASE studied various groups of older people of the same age and physical health, the ones who just felt younger had better vitality, health, and longevity than those who felt their “real” age. Thinking and feeling younger seemed to give people more resilience to face the challenges of getting older.

I recently read two examples in the New York Times of older people doing amazing things (and from their pictures, they look pretty good too). First, a 73 year-old who 50 years ago played college basketball. He recently started community college in Tennessee, tried out for the college team again, and yes, he’s on the team and doing well as college basketball’s oldest player.

Second story was the 100th birthday celebration at Carnegie Hall for the composer Elliot Carter. Since turning 90, he’s published over 40 compositions; six in the past year alone. James Levine, the music director of the Boston Symphony Orchestra says about Elliot Carter “He’s still writing at the top of his form…every time he writes a piece he has new ideas he’s trying.”

This concept of “trying new ideas”—always being willing to experiment—not sticking to a rigid self, is one great secret to exceptional aging.

This quiz is to get you thinking about your different “ages”, as my Friday post will be about some encouraging results from the Berlin Aging Study. Like all quizzes here on the LLAW blog, there’s no pressure and no one checks the answers; it’s only to spark some thought.

When someone asks “how old are you?”, you probably think about your chronologic age (after perhaps first considering: should I even tell this person, and if so, should I lie?) But this quiz is about your five different ages:

1.    What’s your chronologic age? The easy one, your real age. The only age you can’t control, it just ticks upward, but the good news is that the rest of your ages you have lots of control over.

Regarding lying about your actual age, I think it’s generally not a good strategy. If you take care of yourself well, you hopefully won’t be shy about telling. If you don’t want to say, better to deflect the question than lie. Besides, forcing yourself to be honest is a great stimulus to take good care of yourself!

2.    What’s your physiologic age? How well is your body functioning? You might be 32 and have the physiology of a 45 year-old or 75 and have the inner works of a 59 year-old. So take a guess—where do you think you are at?

Your goal of course is to have a physiologic age no greater than your real age. Fortunately, this is more controlled by how you live your life than by your genes.

3.    Your apparent age? Assuming other people don’t know your real age, it’s how old someone thinks you are when they see how you look and act. It’s a complex issue involving not only how you look, but how you talk and walk and how you are dressed and much more…

You have lots of control over this age, but typically, it’s hard to know what people are thinking.  Most people won’t tell you, and if they do, they could be lying either up or down. (An embarrassing situation I have experienced is when a proud older person asked “how old do you think I am?”, and I guessed too high. Next time when someone asks this awful question, you might consider, as I have, well…adjusting what you say.)

4.    Your self-perceived age? In your own mind, and when you look in the mirror, the age you feel or think you are.

Often changes day to day of course, but in general, as we will see from the Berlin Aging Study, it’s healthy to think of yourself as younger than your chronologic age. So don’t worry if you don’t “feel your age”. It’s a good thing.

5.    Your desired or fantasy age? The age you’d like to be if you could choose. Nice if it’s approximately your real age, and again, if you do a really good job with yourself, it just might be.

Funny that when you’re very young, usually it’s more than your real age, then sometime in your twenties, when you feel the sting of responsibility, you want to be younger.

Now next time someone asks you your age, you might be a little snappy and say “which age are you referring to exactly?”. Or, if you really feel the need to fudge your actual chronologic age, try picking one of your other ages, like your fantasy age, and watch their reaction!