UPDATED: April 25, 2025
Welcome to the Healthy Living Is Good Medicine Newsletter, a totally free, health education publication covering a wide variety of topics with original articles intended to help people lead healthier and more fulfilling lives.
The results of a reader survey indicated that there’s a lot of interest in how to maintain good health as one ages. Preventing or delaying the onset of chronic illnesses such as obesity, diabetes, hypertension, cardiovascular disease, kidney failure, cancer, and dementia will obviously contribute to a better quality of life. However, most claims about life extension aren’t backed by good evidence, and should be considered bogus.
Currently, there are no clinically validated anti-aging interventions that will work for humans. Unless the biological processes involved in aging can be markedly slowed by a wonder drug or other miraculous discovery, human life extension is improbable. What we hope accomplish through preventive medical treatments and other interventions is to increase the number of years that people can spend in relatively good health, referred to by the nebulous term, “health-span.”
Medical interventions include immunizations and regular medical checkups. Routine screening exams and monitoring of at-risk patients can result in early diagnosis and treatment of incipient conditions. A strong social support network, including family, friends, and public social services, can be instrumental in promoting healthy aging.
The Power of Positive Relationships
Humans are social primates. Loners that thrive are rare. It is normal for people to belong to groups. Tribal affiliations dwindled as societies and nations formed, and people acquired other ways to identify their membership in groups. Extended families have become more difficult to maintain in the face of urbanization and suburban living.
With communities that are both more densely populated and more diverse, gangs, cults, religious congregations, identity politics, clubs, and other shared-interest affiliations have proliferated. If you want to have a mutually beneficial intimate relationship with a “special someone,” it is important that both of you aim for synergy:
A downside of longevity is that when our less resilient contemporaries die off, our social circle tends to shrink. A meta-analysis of previous studies showed that the influence of social relationships upon mortality risk is comparable to that of other well-established risk factors. A recent cohort study found that social isolation and loneliness are associated with an increased risk of adverse cardiovascular events in a dose-response response relationship; the greater the degree of social isolation, the greater the risk. Another study found that bereavement accelerates biological aging.
If we prioritize our health and would like to extend our health-span, it is important to instigate and cultivate new social connections, and nurture our existing positive relationships. It should go without saying that toxic and parasitic relationships are bad for our physical and emotional health, yet many people find themselves stuck in them. For those in that situation, especially when it involves family members, it may be necessary to seek professional help to deal with one's codependencies and self-defeating cognitive-behavioral patterns. It also helps to have a professional healthcare advocate to navigate the complexities of the system.
Social Isolation and Loneliness
A third of American adults experience long-term loneliness. The harmful impact of social isolation is comparable to that of smoking and obesity when it comes to cardiovascular disease and stroke. A statement from the American Heart Association details the adverse effects of loneliness on the heart and brain. It increases anxiety and depression, and adds to the risk of Alzheimer’s and Parkinson’s diseases. The increasing prevalence of social isolation makes loneliness a public health concern.
Some proven strategies for expanding your social network include joining groups or clubs related to your personal interests; joining a senior center; attending social gatherings, conferences, or workshops; volunteering for community organizations; taking classes; reaching out to people you haven't seen for a while; staying in contact with friends and family by phone, email, or video chat; joining local Meetup groups and participating in group activities; inviting co-workers to join you for lunch; spending quality time with new acquaintances; and appropriately leveraging social media, while not letting AI algorithms take control of your life.
It is important to identify your passions in order to find like-minded people. You also need to be clear about what you are seeking from new connections, such as professional networking, personal growth, or developing new friendships. You might need to work on your self-confidence and learn to set boundaries that prioritize your own well-being when you put yourself out there. All-in-all, developing new relationships and expanding your social network can be intellectually enriching, emotionally rewarding, and health-promoting, regardless of your age.
The National Institute on Aging, a branch of the NIH, has some excellent advice for the families of older adults. Staying in touch with them is first and foremost. Then comes encouraging them to be socially involved, stay physically active, eat a healthy diet, get regular medical check-ups, and properly manage their medications. It is also important to make sure that they have an advance medical directive or healthcare power of attorney, and have done adequate estate planning by creating at least a will, and possibly a living trust.
Blood Pressure Control and Healthy Aging
Nearly half of American adults have hypertension, recognized as a “silent killer.” It is an established risk factor for heart disease, kidney failure, and neurodegeneration leading to dementia. Decreasing blood pressure can reduce cardiovascular complications, but the effect of medication in protecting the brain is less clear.
The first thing that’s necessary is to clearly establish a diagnosis and then correctly monitor the response to treatment. There is a right way to take a blood pressure reading, and it’s something that patients need to insist upon when visiting their healthcare providers, and follow when taking their blood pressure at home. That involves selecting the correct cuff size, positioning it properly, and assuming the specified body positioning.
Single-pill combinations that include low doses of three or four drugs are currently being touted as a highly effective way to treat hypertension, with minimal side effects. Specific drug recommendations are for those that have benefits extending beyond blood pressure reduction, such as telmisartan (an angiotensin receptor blocker) and amlodipine (a calcium channel blocker). A diuretic such as indapamide might be indicated, and men with benign prostatic hypertrophy could consider doxazosin (an alpha blocker).
A post-hoc analysis of the SPRINT MIND trial found that participants 50 years of age and older who had intensive blood pressure management (goal < 120 mm Hg) versus standard management (goal < 140 mm Hg) had lower rates of mild cognitive impairment and dementia.
A meta-analysis of pooled participant data from five randomized, double-blind, placebo-controlled clinical trials found high-quality evidence to support the use of antihypertensive treatment in late-mid and later life to lower the risk of dementia.
Statins for the Primary Prevention of Cardiovascular Disease
The paradox of preventive medicine is that doctors will need to treat people who would have done well, even without their treatment, and some of them will experience unpleasant side-effects, and fewer still will have serious adverse reactions. That’s the problem with applying population-based statistical probabilities to unique individuals. Dr. Katz lays out the challenge when it comes to prescribing statins for primary prevention:
The question faced by many physicians caring for older people with no history of cardiovascular disease, such as angina, a heart attack, or a stroke, but who have a lipid panel that suggests an elevated risk, is whether treatment with statins would lower that risk enough to reduce the mortality rate for this demographic.
A recent study of people aged 75-84 years found that initiation of statin therapy led to a 1.2 percent risk reduction for major cardiovascular disease over a five-year period. For those aged 85 and older, there was a 4.4 percent risk reduction. No increase in the comparative risk for severe adverse effects were found in the older population. Another study reassessed the value of statin therapy and concluded that higher intensity statin therapies produced better health outcomes and was cost-effective for both men and women 70 years of age and older.
The other side of that coin is a new risk prediction calculator for people aged 30 to 79 years that could result in as many as 40 percent fewer Americans being candidates for cholesterol-lowering drugs to prevent cardiovascular disease, mostly affecting those in the 30-39 years age group. A new study found that while the new equations significantly reduced eligibility for statins, the majority of those adults who still qualified for statins based on the new equations are not taking them.
A downside of the new model is that a recent analysis predicts that using it will result in an increase in the number of heart attacks and strokes. The problem is that the new risk estimates need to be combined with updated treatment guidelines for the management of cholesterol and high blood pressure, and this has not yet been done.
For older adults, 70 to 75 years of age, the proportion who were deemed at-risk with the new equations was 10.2 percent, compared to 22.8 percent using the widely criticized 2013 equations. A significant problem associated with widespread statin treatment under the old equations is the increased risk of type 2 diabetes. That risk can no longer be justified for patients who are at a lower risk for cardiovascular disease under the new equations.
While controversy swirls around the new equations, physicians should still consider statin initiation for primary prevention with appropriate older patients. Risk thresholds apply only at the population level. At the individual level, any decision to treat needs to go beyond an impersonal risk calculation. That’s because no risk equation, no matter how accurate, can perfectly reflect every patient’s risk. Doctors must rely on population studies, but still have to adjust their recommendations to best suit the patient who is sitting right in front of them. An actual human being is not a statistic.
Statins provide additional health benefits beside lowering cholesterol and triglycerides. They have antioxidant properties, stabilize existing arterial plaques, and activate AMPK (AMP-activated protein kinase), considered to be a “master genetic survival switch” that’s controls the metabolic pathways necessary for energy homeostasis in every cell of the body. Consequently, statins have been shown to reduce the risk of heart attack and sudden death even in patients who don’t have high cholesterol.
A reasonable approach for physicians with elderly patients who are focused on their longevity, have few functional limitations, and experience a desirable quality of life, would be to assess other risk factors not taken into account by the calculator, such family history, lifestyle, and co-morbidities that can contribute to cardiovascular disease. If warranted, patients could be offered a low starting dose of a high-potency statin, such as rosuvastatin (generic Crestor), if they are at risk, and then monitor their serum lipids, metabolic panel, and hemoglobin A1c.
Strategies to Slow Brain Aging
The Value of Vitamin D Supplementation
Although vitamin D is one of the most common supplements taken by older adults, convincing evidence for its benefits has been mostly lacking. Using data obtained from randomized controlled trials and large longitudinal observational studies, current guidelines suggest that vitamin D supplements for healthy adults aged 18-74, excluding pregnant women, patients with high-risk diabetes, and those on a strict vegan diet are unnecessary. Be wary of claims about dietary supplements in general:
For older adults at least 75 years of age, vitamin D supplementation is recommended because of its possible risk reduction for all-cause mortality. In this population, it appears that the benefits of treatment probably outweigh any potential risks. The recommended daily dose for healthy adults over age 70 is 800 IU. Routine screening of vitamin D serum levels is not necessary unless there are signs of deficiency, or for those with conditions that warrant a vitamin D evaluation, such as osteopenia, osteoporosis, or cognitive impairment.
The Benefits of Vaccination
One of the most significant medical advances of all time is vaccination. It is widely regarded as the single intervention that has saved the most lives globally. One of the best ways to protect your health is to be up-to-date with your recommended vaccinations:
Shingles vaccination is now recommended for older adults because of the debilitating consequences that can occur when the latent chickenpox (herpes zoster) virus becomes active due to waning immunity. The Shingrex vaccine has been shown to be more effective than Zostavax in preventing shingles. Older people who have previously been vaccinated with Zostavax are advised to receive the two-dose Shingrex vaccine. As a possible added benefit, a new study found that Shingrex vaccination is associated with a significant delay in the onset of dementia.
Metformin
Studies examining outcomes when patients without diabetes take metformin suggest that it may have a beneficial effect in reducing mortality. Both clinical trials and observational studies that support this finding have been limited in the length of time over which they followed participants.
A longer-term study on the effects of metformin on longevity for people with type 2 diabetes found that for the first three years taking metformin showed a benefit over matched controls, but this could not be sustained after five years of treatment, presumably due to the natural progression of diabetes. More doctors are now prescribing metformin off-label for pre-diabetes that doesn’t respond to weight loss, exercise, and dietary modification.
According to a recent review, achieving the same blood sugar control using metformin lowers the risk of myocardial infarction by 39 percent more, in comparison to other standard diabetes medications, including insulin. Consequently, metformin is the drug of choice for type 2 diabetes, and has special value because of its action as an AMPK agonist:
Despite some tantalizing evidence, the use of metformin as an anti-aging drug in humans remains controversial. However, results from a recent randomized controlled trial suggest that metformin may reduce the risk of developing Long-COVID by as much as 40 percent, compared to a placebo. The trial did not look into metformin as a treatment for those who already have the syndrome.
Avoiding COVID-19 Reinfections
As we age, our immune system becomes less effective at fighting off pathogens, making seniors especially vulnerable to the severe complications of a SARS-CoV-2 infection. Pre-existing conditions such as heart disease, lung disease, diabetes, and obesity can increase the risk for severe disease and make a full recovery much more difficult. To put it bluntly, older people are far more likely to die from contracting COVID-19 than those who are younger and in better health.
Although seniors are more inclined to stay up-to-date with vaccinations than younger adults, there are still way too many older Americans who have not received the latest booster. Remember, it’s not vaccines that saves lives; it’s getting vaccinated. Some vaccines also do a great job of preventing infections. Unfortunately, the COVID-19 vaccines do not. Their role is to prevent the worst consequences of infection. To avoid COVID-19 infections, the best strategy is to wear an N95 mask or its equivalent in high risk environments such as indoor public spaces. These high efficiency masks also offer protection against wildfire smoke.
Updated vaccines, available since September, 2024, will better protect people against severe illness caused by recent variants. Seniors, people with underlying health issues, and those who are immunocompromised should continue taking extra precautions and seek early antiviral treatment if they become infected. Current risk assessments by state can be found in my weekly updates:
Studies have shown a much lower prevalence of Long-COVID among vaccinated people, compared to those who were unvaccinated prior to becoming ill with a SARS-CoV-2 infection. The more COVID-19 vaccinations a person has received, the less likely they are to develop Long-COVID after a breakthrough infection. However, among vaccinated individuals infected with the Omicron variants, there were still 3.5 percent who had residual symptoms suggestive of Long-COVID.
Repeated bouts of COVID-19 can result in persistent damage to the heart and brain, someting that seniors surely can't afford to risk. Watching President Biden's rather listless address to the nation following his recent coronavirus infection made me wonder if the virus had played a role in his decision to drop his bid for a second term. There's no doubt about the virus being able to knock the stuffing out of people, especially the elderly.
Lifestyle Interventions
See Part 2 of this series:
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