A strategy to help you age well

Hands up if you like getting old? Unless you’re in your teens or younger, I imagine you kept your hand firmly below your waist.

No, it’s rubbish getting old, edging inexorably towards that meeting with your maker. For a large chunk of the population, getting older is accompanied by ailments and irritations. Joints start to ache; you get mysterious pains; you’re ill more often; you forget things, become more clumsy, go to the doctor more often, and you may go to hospital from time to time. And for too many, old age brings ill health, disability and a loss of independence.

But you don’t have to resign yourself to ill health once you pass retirement age. You can age well. A lot of research suggests the right lifestyle will help you enjoy old age and live a full and active life.

In this post, we outline the key findings of the research. And, to be clear, these aren’t guidelines to implement once you become elderly; they are recommendations for your whole life. Implement them now, and you’ll stand a much better chance of a long and healthy life. In contrast, the longer you continue to abuse your body or live an unhealthy lifestyle, the more you accumulate problems that will impact you earlier in life.

Keep reading to find out more about how to age well.

Compression of morbidity

Rationales for improving life expectancy

I’ve accepted my fate: I’m going to ‘pop me clogs’ one day. I can’t escape it. But what I do want to avoid is to spend the last fifth of my life sitting in a chair waiting to die. If I’m frail, diseased or have dementia, for example, then that’s pretty much how it will seem to be. I want to be lifting weights, visiting other countries, climbing mountains and generally living an active and enjoyable life. So, staying fit and well right into old age is a priority for me.

More generally, keeping the elderly well has to be good for the individuals, their relatives and the country. For a start, fit and healthy individuals can take an active role in family life, passing on knowledge and experience. But they are also a reduced burden to their family and the healthcare system. And, collectively, they incur a lower cost for the nation. Nobody wants to be a burden, do they?

Life expectancy and compression of morbidity

The good news is that life expectancy has gone up by one year for every three elapsed since 1970. That means you can expect to live 20 years longer than you might have done at the start of the 20^th Century. And, better, you’ll be healthier and more independent.

Longer life expectancy has much to do with improved healthcare, better housing and social support systems, economic improvements, and more recreational opportunities. And there’s also a heavy genetic component to life expectancy. But, as you’ll see, lifespan and health are also strongly influenced by lifestyle.

Later-life poor health used to be regarded as a normal part of getting old. But the accepted wisdom has changed. You can delay ill health until the last few months of life. We call that ‘compression of morbidity’. These days, people are less biologically old than their chronological age would suggest, sometimes by as much as ten years or more. And this difference between chronological and biological age has a lot to do with life-long nutrition and exercise.

Common problems associated with ageing

Before we reveal how to give yourself the best chance of being healthy right into old age, let’s look at some of the common health problems associated with ageing.

Body composition changes

Research shows that as people get older, they lose muscle and gain fat, with a tendency towards central fat storage. Testosterone and growth hormone are excellent hormones for muscle gain and fat loss. But they both decrease with age, making unfavourable body composition changes unavoidable. But another major contributor to muscle loss is poor nutrition and a sedentary lifestyle.

As muscle is lost, metabolism slows. That means you have to eat less to avoid weight gain. And when your calorie allowance is lower, you need to make sure all those calories count towards keeping you healthy. You have much less scope for ‘wasting’ calories on poor choices with low nutritional value.

It doesn’t help that, for various reasons, food intake tends to decline as you age. That means being underweight is a common issue among the elderly. Contrary to a widespread view that calorie restriction extends life, research tells us otherwise. In a number of studies, those with the lowest BMI have the highest mortality. So please don’t undereat and waste away as my father did. Carrying a little extra weight, especially if a lot of it is muscle, will improve your mortality risk.

You don’t have to accept detrimental body composition changes. Or, at least, you can slow them. What used to be considered a normal consequence of ageing is now thought to be down to lifestyle factors.

Frailty

Frailty isn’t simply about being weak. It’s is a clinical condition that covers multiple bodily functions. Someone who is frail is described as having low reserve capacity in muscles, organs and bodily systems. That means, if you’re frail, minor stresses can tip your body into illness, disability, organ failure or even death.

Falls, fractures, incontinence and confusion can all be attributed to frailty. Frailty can reduce your independence and could lead to institutionalisation.

But enduring years of frailty is not inevitable. Frailty is primarily the result of poor nutrition and a lack of exercise. A lack of protein and healthy nutrients can very quickly deplete your body of its reserves and leave you vulnerable to irreversible decline.

Low immunity

Immune function tends to decline with age. That doesn’t just mean you are more vulnerable to infection; lowered immunity is a symptom of a more general decline in health and nutrient reserves. That means you’ll have a reduced ability to cope with stressors and increased susceptibility to chronic diseases such as cardiovascular disease and cancer.

Chronic metabolic diseases

Diseases such as cardiovascular disease, stroke and diabetes become more likely as you get older. These are usually the result of a poor diet and a sedentary lifestyle and are generally accompanied by increased abdominal fat.

Exercise will allow you to have a higher energy and nutrient intake without gaining abdominal fat. That means you are more likely to meet your nutrient requirements. In studies, an active lifestyle with good nutrition was associated with a decreased cardiometabolic and cancer risk and increased life expectancy.

Cognitive decline

Depression, confusion and dementia are all more common as you get older. One factor is excess saturated fat, which has been associated with diseases such as Alzheimer’s. And a loss of appetite and motivation to cook can exacerbate nutrition-related cognitive decline. In contrast, omega 3 and 6 fatty acids have been associated with improved neural plasticity. And an adequate supply of healthy nutrients, especially from fruit and vegetables, improves brain function.

Gastrointestinal tract problems

As you get older, your gut transit times slow, giving rise to six times greater incidence of constipation in the older population. Inflammation of the stomach and less hydrochloric acid can mean more bacteria and impaired nutrient absorption, especially B12, calcium and iron. Atrophic gastritis in the elderly can also lower nutrient absorption.

Other nutrition-related problems

A reduction in your sense of taste and smell can take the enjoyment out of food. You may also find that you become full early on in a meal. These factors mean you can end up with low calorie and nutrient intake, which increases the risk of malnutrition. Furthermore, tooth loss and depression can influence food choices, and incontinence problems can lead to lowered liquid intake and dehydration.

Causes of accelerated ageing

Before we present a strategy to help you age well, let’s look at reasons why you might age quicker than you’d like.

Theories of ageing

The three main theories of ageing are

• Programmed ageing. Shortening DNA telomeres at each cell division may mean that you have a genetically determined fixed lifespan.
• Error theory. Increasing DNA damage and a reduction in DNA repair enzymes may contribute to common diseases such as cancer, heart disease, osteoporosis and diabetes.
• Free radical theory. Reactive molecules damage cells. An accumulation of damage may increase the risk of cancer and heart disease, for example. Antioxidants in food may reduce free radical damage.

As you can see, although genes have a strong influence on ageing, so too do lifestyle factors.

Poor eating habits, a sedentary lifestyle, smoking and alcohol abuse can all lead to deterioration in cardiovascular, lung and hormone function and accelerate ageing. But if you make the right choices, you can increase physiological and nutritional reserves, reduce your disease risk and increase your life expectancy.

Nutritional deficiency

Nutrient deficiency and undereating are much more of a concern amongst the elderly. This lack of nutrition will contribute to accelerated ageing and decline. Research shows that certain groups are particularly at risk of undereating or nutritional deficiency. These include people who are

• Institutionalised
• Older and living alone, especially men
• Of low socioeconomic status
• Socially isolated or lonely
• Depressed
• Physically handicapped
• Socially inactive
• Recently bereaved
• On multiple medications
• Suffering from disease
• Unable to chew properly due to poor dental health
• Followers of faddy or restrictive diets

Do any of these apply to you?

Protein deficiency

One common nutritional deficiency is protein energy malnutrition (PEM). An insufficient protein intake will lead to loss of muscle, impaired immunity, poor wound healing, osteoporosis, fracture and frailty. At its most severe, PEM can lead to kwashiorkor, a severe form of malnutrition associated with low protein intake.

Be aware that the recommended protein requirements for the elderly are slightly higher than those for the young, being 0.9 g per kg of body weight compared to 0.7-0.8 g per kg for younger adults.

Nutrients

As well as protein, older people are also at risk of low intakes of various other nutrients. This is due to less efficient processing of some nutrients, poor dental health and gastrointestinal tract inefficiencies. Folates, B6, B12, vitamin D, zinc, calcium, magnesium, water and, importantly, phytonutrients are all at risk. These nutrients help with bone health, wound healing and immune function. They will also help prevent vascular disease, anaemia, bruising, infections, neurological disorders, stroke and cancer.

Risky food patterns

Some eating patterns increase your risk of disease or ill health. These include

• Large, infrequent meals. This pattern may accelerate muscle loss and lead to high blood sugar caused by impaired glucose tolerance.
• Alcohol excess, especially bingeing, which has numerous health implications.
• Excessive use of salt, salty food, cured, smoked or preserved food, all of which increase cancer risk.
• Ultra-processed foods with no nutritional value which rob your calorie allowance, allowing less room for healthful nutrients.
• Excess saturated fat, which is associated with cognitive decline.
• Energy restriction, which will contribute to muscle and bone loss, nutrient deficiencies, and frailty.

Physical activity

Finally, as well as nutritional factors, a lack of exercise is heavily implicated in accelerated decline and a lower quality of life. Being less active means you

• May lose muscle, lowering your metabolism and requiring you to take in fewer calories.
• Will burn fewer calories, making it more challenging to avoid abdominal fat gain and less likely that you will take in all the nutrients you need.
• May develop metabolic diseases such as diabetes and cardiovascular disease.

All of the above are risk factors for frailty and lowered life expectancy.

A strategy to age well

Although the effects of poor eating habits and a sedentary lifestyle are cumulative, it’s never too late to change. Healthy eating habits and regular exercise will slow body composition changes and delay the onset of frailty. You’ll increase your chances of being able to compress morbidity into the last few months of life. The critical lifestyle choices are outlined below.

Food variety

Research shows that food variety is predictive of greater longevity and can reduce the risk of death by more than 50%. However, be aware that your energy requirement will reduce as you age. Typically, your calorie allowance will decrease from 2800 as a younger man to 2000 when you’re older. The same applies to women, reducing from 1900 to 1500. That means you have less scope for ‘wasting’ your calories on foods that provide few nutrients.

To ensure good food variety, you’ll need to pack your diet with healthy food, and you should aim to get 20-30 biologically distinct foods every week. This means you should consume a diet that is high in

• Vegetables, greater than 300g per day
• Legumes, greater than 50g per day
• Fruits, greater than 200g per day
• Cereals, greater than 250g per day
• Monounsaturated fatty acids and low in saturated fatty acids

and moderate in

• Dairy, 300g milk or equivalent
• Meat, 100g per day
• Alcohol, 10g per day

Your health will be better and you will age well if you achieve all of these things, not just some of them.

Physical activity

Regular exercise is associated with greater energy intake, a more nutritionally dense and diverse diet and a better quality of life.

Ideally, you’ll be able to expend 300-500 extra calories a day and offset this with increased food intake. Try to get the extra food from nutrient and phytochemical-rich foods. This pattern should decrease cardiovascular and total mortality risk and improve life expectancy. It will also protect against osteoporosis, fractures, diabetes, breast and colon cancer, and cognitive decline and reduce anxiety and enhance your sense of wellbeing.

Recent research suggests that a combination of cardiovascular exercise and strength training will help you age well. It will defer disease and mortality and compress morbidity into the very last period before death.

Cardiovascular training, which can be performed every day, improves heart and lung function and has psychological benefits. Strength training will improve your muscle size and strength and your walking and balance, reducing the risk of falls. It will also improve tendon and ligament strength, bone health and blood sugar levels.

Research has shown that weight training programmes can improve quality of life, even in nonagenarians.

Social activity

Research has shown that fewer social contacts outside the home and fewer social networks are linked with higher mortality. People tend to eat more when they are in the company of others. So, as well as improving your psychological wellbeing, social interaction will also improve your nutrition.

Studies have also shown that social and productive activities are just as effective as fitness activities in lowering the risk of death.

Substance abuse

Tobacco, excess alcohol, excess caffeine and unnecessary medications will all increase mortality risk. The same applies to ingredients in food that are detrimental to health, such as excess sugar, preservatives, cured and smoked products. Instead, keep your diet and lifestyle as clean as possible.

Focus on lifestyle

To maximise the benefits and reduce as much as possible morbidity and mortality risk, focus on all elements of your lifestyle, not just one component.

• Perform endurance and strength training exercise several times a week.
• Use the calories burned in exercise to eat more healthful nutritious food.
• Maintain a social network, meet and eat with friends and family regularly.
• Avoid products that are detrimental to your health

Help yourself to age well, and tick all these boxes, not just some of them.

The final say

We’ve outlined a strategy to help you age well. Although this is advice about being fit and healthy in old age, it applies to you right now, regardless of your age. You may not feel the ill effects of your unhealthy lifestyle at the moment, but you can be sure that you are storing up problems. Please don’t wait until you become diseased to do something about it. And don’t die young or endure an old age plagued by ill health.

Follow the advice now and keep following it for many more years to come.