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June 29, 2024

Mediterranean diet

In cardiac rehab I learned that while exercise is key to improving heart health, it’s not the only tool. Diet is vital too, so vital that it was the topic of three of our sixteen sessions. There are lots of different diets and nutrition guidelines, but in terms of heart health, one stands out: the Mediterranean diet.

What is the Mediterranean diet? It’s not primarily a weight-loss diet; it’s really just an approach to healthy eating. If you want to learn about it in detail, there are many good sites, for example this one and this one, but here’s the short version: eat primarily plant foods, fruits, vegetables, nuts, seeds, legumes, fish, whole grains and low-fat dairy. Season with spices, onion and garlic, but not salt. Use extra virgin olive oil as your main source of fat. Limit your intake of sweets. In terms of proportions, imagine a dinner plate. One half is filled with vegetables, one quarter with whole grains, and one quarter with protein. You want to stay away from highly processed foods, so do your shopping around the outer edges of the grocery store, where the fresh whole foods are.

If you do decide to try the Mediterranean diet, what benefits can you expect? Plenty, as it happens. Of all the diets out there, the Mediterranean diet is the most thoroughly studied, and the results are impressive. The most striking evidence is for the primary and secondary prevention of cardiovascular disease. But the benefits extend to many other conditions as well, including cancer, cognitive decline, diabetes and obesity. Those are all conditions that particularly affect us seniors.

It’s hard to change the dietary habits of a lifetime; they’re all tied up with our culture and upbringing and personal tastes. But really, I find it to be no sacrifice. The food is tasty, digestible and easy to prepare. As we reach that time of life when health conditions and prescriptions start piling up, it’s nice to think that, at least to some extent, we can let food be our medicine.

May 29, 2024

Cardiac fitness

I’ve been working out regularly for years. Every morning before breakfast, I followed a twenty-to-thirty minute aerobics video for seniors, doing a different one every day. And in the afternoon, I would do a twenty-minute walk. I thought I was meeting the standard guidelines: 150 minutes of at least moderate activity per week, or 30 minutes five times a week. So I was a bit surprised when I got diagnosed with a heart condition not long ago. I was even more surprised when the cardiologist reviewed my stress test results and told me my cardiac fitness was weak. He whisked me off to cardiac rehab, where I soon learned that my exercise routine was all wrong. Really, I was just being an idiot, it’s all there if you look for detailed guidelines and read them carefully. But hardly any of the seniors I know are getting it right either, so I’m going to lay it all out for you.

What kind of exercise builds heart strength and endurance? It’s an activity that boosts your heart rate above resting level and keeps it there the whole time you’re exercising. You can’t stop, slow down, or change to a different exercise. Activities you could choose include brisk walking, cycling, swimming, or using an exercise bike or elliptical. To do this, you could go to a gym, invest in some home equipment, or, like me, just do the bargain-basement version: brisk walking in small circuits in the house: living room, dining room, hall, a thousand times over. How long do you do it? Ideally, you work your way up to twenty minutes at a time, plus five minutes to warm up and five to cool down, at least five times a week. How hard should you work? On a perceived exertion scale of 1 to 20, you want to feel you’ve reached 12 to 13, a bit hard to somewhat hard; you’re breathing deeply and starting to sweat. But if you’re like me and find it easy to lie to yourself about how hard you’re working, you need a more objective measure. Calculate your maximum heart rate: 220 minus your age. Your target heart rate should be 50% - 80% of your maximum heart rate for a moderate intensity workout, or 70% - 85% for a vigorous intensity workout. Ranges vary by age, so you might want to check this chart. Then get an inexpensive activity tracker that captures your heart rate and wear it on your wrist while you exercise. Of course, if you have a heart condition, don’t figure out your target heart rate on your own; consult your doctor. And to round out your exercise routine, add in some resistance training two or three times a week.

So what about fitness videos? Most of them aren’t ideal for building endurance. They keep changing movements, so it’s hard to keep your heart rate in the target zone. I still do them, but I see them as serving a different purpose now. They help me get going in the morning. They warm me up, loosen my muscles and bones, and get my heart going a bit. That’s all fine, but don’t depend on fitness videos to strengthen your heart. Follow those guidelines. Your heart will thank you.

April 30, 2024

Medical escorts

Has this ever happened to you? You get scheduled for surgery, and then they tell you that when it’s time to go home, someone has to come right into the medical facility to get you, escort you home, and then go into your home with you to make sure you’re settled. You have to tell the medical facility the person’s name and contact information. If you can’t provide this, your surgery will be cancelled. But you live alone and don’t have anyone to pick you up. What are you supposed to do?

This requirement rules out the transportation services most of us use. You can’t call a taxi or book WheelTrans or any of the Toronto Ride affiliates, because their drivers have to wait for you outside. What other options are there?

Some community service agencies offer a program called Home at Last, which provides precisely this service. But there aren’t many of them, and some operate only within a specific catchment area. Examples of agencies offering Home at Last include CANES Community Care, Lumacare, Transcare Community Support Services and West Neighbourhood House. Red Cross Transportation Services will try to find a driver / escort for you if you give them a lot of notice, and they cover rides anywhere within Toronto city limits. Some service organizations, for example Woodgreen, provide medical escorts, but you must arrange your own transportation. There are also some companies you can hire for this service. I found a couple through Google, but don’t know anything about them and can’t vouch for them. Examples include C-Care Health Services and The Care Company.

If this service is so important that our surgery can be cancelled without it, then we shouldn’t be left scrambling. This is a broken link in our healthcare system.

March 29, 2024

It's playtime

The daily news is dreadful, our memory is full of holes, our old bones ache, our friends are all sick. These days it’s sometimes hard to get out of bed. Wouldn’t it be great to escape real life for a while and get wrapped up in an activity that’s just plain fun? How about doing something not because it’s good for us, but for the pure joy of it?

Why not try video games? They’re not just for kids. You can go exploring, have adventures, build whole worlds. You can play on your own, or with strangers, friends, or even your grandchildren (won’t they be impressed!). I’ve tried to come up with a starter set of game titles. I picked games that had little or no violence, or at least let you decide how much there will be. If you want violent games you don’t need help from me, they’re easy to find. But the ones I chose focus on adventure, puzzles, problem-solving, simulation, strategy. They all can work on an ordinary desktop or laptop or cellphone. They’re free or inexpensive. Some of them have a bit of a learning curve, but that’s okay, you want a game with some depth. I researched these as best I could, but I haven’t played them, so do your own research too.

If you’re interested in any of these games and want to know if you can run them on your own computer or phone, just go here or here and type in the name of the game.

Abzu

  • You’re a diver, exploring the sea
  • Single player
  • Costs under $30 Canadian

Candy Crush Saga

  • Tile-matching puzzle game
  • Single player
  • Free

Forge of Empires

  • Build an empire, starting with Stone Age huts
  • Single player or multiplayer
  • Free

Freeciv

  • Each player becomes the leader of a civilization, taking your tribe from the Stone Age to the Space Age
  • Single player or multiplayer
  • Free

Gone Home

  • Solve a mystery as you walk through an abandoned house
  • Single player
  • Costs under $20 Canadian

Minecraft

  • You can do whatever you want: build things, explore the world, face daring challenges
  • Single player or multiplayer
  • Costs about $40 Canadian

Outer Wilds

  • Puzzles to solve as you explore space
  • Single player
  • Costs under $35 Canadian

Sims 4

  • A life simulation game. You create virtual people, place them in homes and build their lives
  • Single player
  • Free

Stardew Valley

  • You’ve inherited an old farm. Learn farming, make it thrive, join the neighbouring community
  • Single player or multiplayer
  • Costs under $20 Canadian

The Talos Principle

  • Puzzles with a philosophical flavour
  • Single player
  • Costs under $40 Canadian

February 29, 2024

Normal aging

It seems like every other day my body comes up with some new problem. And every time it happens, I wonder whether I should go to the doctor, or whether it’s just another symptom of normal aging. How am I supposed to know? I’ve never been old before. I wish I had a tricorder like the medical officers on Star Trek had. They’d just swipe it over the patient and get an instant diagnosis. Failing that, I thought I’d check out what the experts tell us to expect. I’ve pulled this together using reliable sources, like MedlinePlus, the Mayo Clinic and the Merck Manual. It’s a long list, but if you’re a senior, you probably won’t be surprised. This is not a formula; different changes happen to different people at different times. Many age-related changes creep up slowly. Whatever changes you’re going through, remember that there’s a lot you can do to mitigate many of them and go on enjoying your life.

Bones and joints

  • Bones become less dense, leading to osteopenia and osteoporosis, risk of fractures
  • Vertebrae become less dense, making the spine shorter
  • Cartilage thins, leading to osteoarthritis
  • Ligaments become weaker and more rigid, making us less flexible
  • Exercise; take vitamin D and dietary calcium

Brain and nervous system

  • Blood flow to the brain decreases
  • Reaction time slows
  • Vocabulary, short-term memory, the ability to multitask, learn new material, and recall words may be reduced
  • Balance is compromised by changes in the inner ear
  • Some red flags for dementia are the inability to learn and retain new information; the inability to complete tasks you are familiar with; disorientation in time or place
  • Don’t worry too much about forgetfulness if it is not interfering with your daily life
  • Stay mentally and socially active; challenge yourself

Digestive system

  • Digestive process slows, sometimes leading to constipation
  • Increased likelihood of developing lactose intolerance
  • Liver may be less able to remove drugs from the body; drug effects last longer
  • We may react differently to medications, may need lower doses
  • Eat a healthy high-fibre diet; exercise

Ears

  • Reduced perception of high-pitched sounds
  • Trouble hearing in groups or loud environments with background noise
  • Have your hearing checked periodically

Endocrine system

  • Insulin production diminishes and is less effective, increasing the risk of prediabetes and type 2 diabetes
  • Have regular blood tests

Eyes

  • Reduced near vision
  • Increased sensitivity to light
  • Need for brighter light
  • Changes in colour perception
  • Cataracts
  • Floaters
  • Dry eye
  • Schedule regular checkups; test for glaucoma and macular degeneration

Heart and blood vessels

  • Blood vessels stiffen, making the heart pump harder
  • Buildup of plaque in artery walls, obstructing blood flow
  • Blood pressure tends to increase
  • Eat a healthy low-sodium, cholesterol-lowering diet; manage stress; get enough sleep
  • Maintain regular aerobic activity, even just brisk walking

Immune system

  • Immune system acts more slowly
  • Cancer is more common among seniors
  • Vaccines are less protective
  • Infections like pneumonia and influenza are more common and more severe among seniors
  • Get all the regular vaccines

Kidneys and urinary tract

  • Bladder can hold less urine, resulting in more frequent urination
  • Urinary sphincter is less able to close tightly, sometimes leading to urgency or incontinence
  • In men, prostate gland may enlarge and obstruct the flow of urine
  • Do Kegel exercises

Lungs and the muscles of breathing

  • Breathing muscles weaken
  • Lungs become less elastic, deliver less oxygen
  • Exercising may be more difficult
  • Lungs become less able to fight infection
  • Try to build up endurance gradually through exercise

Mouth and nose

  • Reduced ability to taste and smell
  • Dry mouth
  • Receding gums
  • Nose lengthens and enlarges
  • Schedule regular dental checkups; brush and floss twice a day

Muscles and body fat

  • Muscle mass, strength, stamina and flexibility decrease
  • Percentage of body fat increases, fat distribution changes
  • Diet and exercise can minimize effects

Skin

  • Skin loses underlying fat, becomes thinner, drier, less elastic, more wrinkled
  • Reduced sensitivity to pain, pressure, temperature
  • Number of sweat glands and blood vessels decreases, making the body less able to cool itself
  • Increased risk of heat-related disorders
  • Skin bruises more easily, heals more slowly
  • Less protection against ultraviolet radiation; age spots
  • Use sunscreen, mild soap, moisturizers

Sleep

  • Sleep becomes fragmented
  • It may take longer to fall asleep, and seniors sleep more lightly, awakening more in the night
  • Don’t eat, drink or exercise within two to three hours before bedtime
  • Follow a regular bedtime routine

January 29, 2024

Prediabetes

Last summer, after a routine blood test, I learned that my blood sugar had gone up into the prediabetic range. I was surprised, because I thought that my diet was pretty healthy. But I sure didn’t want to add diabetes to my growing list of ailments. So I cut out white carbs, starchy vegetables like potatoes and corn, cheese, and anything with added sugar. I discovered chickpea pasta, farro and yu choy, stopped feeling hungry between meals and lost five pounds. Now my bad numbers are going back down.

When younger people get prediabetes, it’s a red flag. They have to make lifestyle changes, or they’re on their way to diabetes. But when seniors get prediabetes, it’s a different story. Guess what proportion of seniors have prediabetes: it’s 48.8%. That’s right: almost half of us. And it happens even to seniors who exercise regularly and eat healthy diets. That’s because many seniors produce less insulin and process it less efficiently than younger people. But we’re not at the same risk as younger people of going on to develop diabetes. A recent study of seniors with prediabetes showed that, over a 12-year period, most of the study subjects remained stable or reverted to normal. In fact, more people regressed back to normal than proceeded to diabetes. If you would rather read a layman’s version of the study, check out this New York Times article. But prediabetes still increases the risk of heart disease, and it may progress to diabetes in some seniors. So if we’re given a diagnosis of prediabetes, we probably shouldn’t blame ourselves for negligence, but we should keep exercising and maintaining a healthy diet.

It's simply a fact of life in old age: we have to keep pedalling faster just to stay in place.