Ages > 65 years

​

Diet:

A personalized diet plan is recommended. Among several, a whole foods mostly Plant based diet, Cardiometabolic diet or Mito diet provide the most benefits in terms of achieving optimal nutrition, maintaining cognitive function and preventing muscle and bone loss. Several tissues in the body go through degenerative changes and require supplements for optimal function. People see about 20-30% decline in appetite by age 65 along with decreased digestion and absorption. This further leads to nutritional deficiencies. Commonly needed supplements include vitamins, minerals, anti-oxidants, omega 3 fatty acids, probiotics, digestive enzymes and in some situations, collagen peptides. 

Exercise:

At this age, loss of balance becomes challenging. This occurs due to loss of core strength, neuropathy and bone weakness. Exercises to improve core strength and improve balance, bone mass and coordination are therefore beneficial. Specific exercises which help in this regard are,

• Pilates, yoga and stretching

• Strength training

• Balance ball 

• Tai Chi 

• Whole body vibration

Screening and Age Based Evaluation:

• Age appropriate cancer screening includes yearly mammogram until age 75. Prostate cancer screen when indicated in men and colon cancer screen in men and women starting at age 45 until age 75. In addition, bone density scan (DEXA) is indicated in women and high risk men.

• Age appropriate immunizations. 

• Metabolic, cardiac, hormone and additional evaluation based upon individual symptoms: When evaluating for the above, following must be considered, 

  • Most common female hormone imbalance at this age includes decline in estrogen, progesterone and testosterone with a parallel rise in cortisol levels. Over 80% men experience low testosterone levels in this age group. Hormone evaluation in the form of lab testing helps identify needs for hormone based treatment. 

  • Most common cardiac risk and disease in this age group includes atherosclerosis from years of accumulated high cholesterol and consumption of inflammatory diet. Cardiac function starts to decline and this leads to symptoms of heart failure such as fatigue, shortness of breath, leg swelling and chest heaviness. In addition V02max, which is a marker of cardiorespiratory fitness declines. Therefore, comprehensive cardiac and respiratory evaluation is often indicated. Some of these tests include

    • Vascular age determination​

    • Echocardiogram

    • Coronary artery calcium score

    • Carotid imaging

    • Spirometry

  • Additional cardiovascular complications with ensuing impact on quality of life include the following and must be avoided

    • Stroke - leads to neurological deficits and inability to care for oneself.

    • Peripheral vascular disease - leads to pain, delayed healing and loss of function.

    • Vascular dementia - leads to cognitive decline.

  • Common metabolic conditions include diabetes and related complications such as neuropathy, eye disease and decline in kidney function, gout and non-alcoholic fatty liver disease. Excessive alcohol intake in preceding years further exacerbates this condition. 

  • Kidney function starts to decline leading to decreased ability to clear toxins and medications from the system. This often results in high risk of developing medication related complications. Most people in this age group are on a few or several prescription medications and/or non-prescription supplements. It is therefore important to start low and go slow in this age group when it comes to medications and supplements.

  • Most common marker of inflammation are elevated CRP and elevated homocysteine. In addition, complications associated with chronic conditions such as autoimmune diseases, specific organ dysfunction etc. start to develop. Therefore, routine monitoring and management of these diseases is highly recommended.  

  • Immune system starts to lose its robustness and ability to fight infections. This leads to resurgence of chronic viral infections. Common viruses which tend to persist in body include herpes zoster or shingles, herpes simplex etc. In addition, several bacterial infections such as pneumonia, urinary tract infections and bacteremia become frequent. 

  • Digestive and absorptive capacity can start to decline in this age leading to a variety of nutritional deficiencies including vitamin D,B vitamins, and minerals such as magnesium etc. This leads to fatigue and inability to lose weight. In addition, loss of smooth muscle tone and mucosal damage from age related changes leads to a variety of common disorders such as GERD and functional bowel disorders such as SIBO, leaky gut and IBS. Gut evaluation, therefore can help identify some of these problems. 

  • Autonomic dysfunction in this age group increases susceptibility to falls and fractures. Monitoring and maintaining fluid balance and optimizing blood pressure is therefore recommended. 

  • Age related changes in vision, hearing and skin changes lead to a decline in function and quality of life in several areas; 

    • Vision loss as a result of cataract, glaucoma and macular degeneration ​leads to loss in function.

    • Hearing loss leads not only difficulties in communication but cognitive decline as well.

    • Skin related changes lead to a variety of uncomfortable conditions such as excessive dryness, loss of elasticity, slow healing, and risk for skin cancer.

    • Loss of healthy secretions lead to dry mouth, dry eyes and dryness in airway passages. All of these changes increase risk of infection in several areas in addition to causing discomfort. 

  • Cognitive decline starts to manifest in high risk individuals. Comprehensive cognitive assessment and treatment can help manage subtle and advanced cognitive decline. Risk factors include years of 

    • Cardiovascular disease

    • Metabolic disturbances,

    • Hormone imbalance,

    • Chronic infections,

    • Genetic factors.

Work evaluation: Usually by this age, people have look to prepare for retirement. Some people cut back on work hours but unfortunately, years of physical stress from high risk jobs accumulates and leads to medical conditions such as arthritis, mood disorder and overall deconditioning.

    Sleep:​

• Sleep tends to become an increasingly problematic issue by this age. People who already have insomnia or circadian rhythm disorder, see a worsening of their symptoms. This occurs due to

  • ​Loss of sleep center's ability to regulate orexin is quite common in this age group.

  • Fluctuations in melatonin levels.

  • Decrease in body's ability to metabolize caffeine and other products leads to further sleep disruption specially when these products are consumed to stay awake and functional. Thus a vicious cycle of non-restorative sleep, fatigue develops leading to a variety of metabolic derangements and cognitive decline. 

• Obstructive sleep apnea, if already preset, continues to cause problems in this age group. Therefore, when suspected, this condition must be evaluated and treated

Genetic testing

• Genetic testing is indicated based upon family history and/or specific clinical markers.