Healthy Aging: Lessons from the Baltimore Longitudinal Study of Aging
What Does All This Mean for You?
Putting Research into Action
Over the years, BLSA scientists and other researchers from a broad range of disciplines have identified factors that influence healthy aging. From their research have come action steps we can take to maintain our health and function as we get older. From diet and physical activity to health screening and managing disease risk factors, these actions may influence different areas of our health.
The following review of selected findings from the BLSA and other studies describes in practical terms some of the evidence for actions that may lead to healthy aging. Not all the information will necessarily relate to your needs or fit with your lifestyle. But these findings will provide a context and general ideas for you to consider — and act on — as you think about your own aging. Before trying anything new, talk with your doctor about some of the approaches presented here to determine which might best apply to you.
Get Moving: Consider Exercise and Other Physical Activities
Some people love it, some people hate it, but regardless of your personal feelings, exercise and physical activity are good for you — period. In fact, exercise and physical activity are considered a cornerstone to almost every healthy aging program. Emerging scientific evidence suggests that people who exercise regularly not only live longer, they live better. And, being physically active — doing everyday activities that keep your body moving such as gardening, walking the dog, and taking the stairs instead of the elevator — can help you to continue to do the things you enjoy and stay independent as you age.
Specifically, regular exercise and physical activity can reduce your risk of developing some diseases and disabilities that often occur with age. For instance, balance exercises help prevent falls, a major cause of disability in older adults. Strength exercises build muscles and reduce the risk of osteoporosis. Flexibility or stretching exercises help keep your body limber and give you the freedom of movement you need to do your everyday activities.
Exercise may even be an effective treatment for certain chronic conditions. People with arthritis, high blood pressure, or diabetes can benefit from regular exercise. Heart disease, a problem for many older adults, may also be alleviated by exercise. Scientists have long known that regular exercise causes certain changes in the hearts of younger people. These changes, which include lowering resting heart rate and increasing heart mass and stroke volume (the amount of blood pumped with each heart beat), make the heart a better pump. Evidence now suggests that people who begin exercise training in later life, for instance in their sixties and seventies, can also experience improved heart function. In one study, BLSA researchers observed a decrease in the risk of a coronary event, like a heart attack, in older male BLSA participants who took part in high intensity, leisure time physical activity like lap swimming or running.
In addition to benefits for the heart, studies also show that exercise helps breathlessness and fatigue in older people. Endurance exercises — activities that increase your breathing and heart rate — such as dancing, walking, swimming, or bicycling, increase your stamina and improve the health of your lungs and circulatory system as well as your heart.
There are many ways to be active. You can be active in short spurts throughout the day or you can set aside specific times of the day or specific days of the week to exercise. Many physical activities, such as brisk walking or raking leaves, are free or low-cost and do not require special equipment.
For more information about how to get started and stick with an exercise and physical activity program, get a free copy of Exercise and Physical Activity: Your Everyday Guide from the National Institute on Aging. If you have a chronic health condition, you may want to talk to your doctor about your interest in physical activity and exercise. He or she may have some safety tips to accommodate any health problems you might have.
Pay Attention to Weight and Shape
Weight is a very complex issue. For older people, the health problems associated with obesity may take a back seat to problems associated with body composition (fat to muscle ratio) and location of fat (hip or waist) on the body.
Most of us know that many health problems are connected to being overweight or obese. People who are overweight (defined by a BMI of 25 to 29.9) or obese (a BMI greater than or equal to 30) are at greater risk for type 2 diabetes, high blood pressure, heart disease, stroke, some types of cancer, sleep apnea (when breathing stops for short periods during sleep), and osteoarthritis (the wearing away of joints). But data show that for older adults, thinner is not always healthier, either. In one study, researchers found older adults who are thin (a BMI less than 19) have a higher mortality rate compared to those who are obese or of normal weight. In another study, women with a low BMI had an increased risk of mortality. Being, or becoming, thin as an older adult can be a symptom of disease or an indication of developing frailty. Those are possible reasons why some scientists think maintaining a higher BMI may not necessarily be bad as we age.
For some older adults, problems associated with body composition can be more dangerous than obesity alone. For instance, one study compared older adults with sarcopenic obesity — a deficiency in skeletal muscle mass and strength as well as a high percentage of body fat — with obese older adults without sarcopenia and with lean older adults with skeletal muscle deficiencies. Scientists found older adults with sarcopenic obesity to have an increased risk of disability for doing instrumental activities of daily living (IADLs). Sarcopenic obesity interfered with the ability to perform such tasks as using the telephone, accessing transportation, getting groceries, making meals, doing housework, and managing money.
Body fat distribution, specifically waist circumference and waist-to-hip ratio, can also be a serious problem for older adults. We know that the "pear" shape, with body fat in peripheral areas such as the hips and thighs, is generally healthier than the "apple" shape, with fat around the waist. Being apple shaped can increase risk of heart disease and possibly breast cancer. According to BLSA research, with age, the pattern for body fat can shift from safer peripheral areas to the abdominal area of the body. BLSA researchers examined 547 men and women over a 5-year period to observe body measurement changes. They found that men predominantly shifted in waist size while women showed nearly equal changes in waist and hip measurements. The men developed a more dangerous body fat distribution, even though women carried more total body fat. This may help explain why men generally have a higher incidence of certain diseases and a shorter lifespan.
So is there a "normal" weight range or pattern for healthy aging? For older adults, one size does not fit all.
On one hand, when deciding whether or not to lose weight, there are a variety of risk factors to consider: high blood pressure (hypertension); high LDL cholesterol ("bad" cholesterol); low HDL cholesterol ("good" cholesterol); high triglycerides; high blood glucose (sugar); family history of premature heart disease; physical inactivity; and cigarette smoking. The National Heart, Lung, and Blood Institute guidelines recommend weight loss for people who are considered obese or overweight and have two or more of these risk factors. Even a small weight loss (just 10 percent of your current weight, for example 16 pounds if you weigh 160 pounds) can help to lower the risk of developing diseases associated with obesity.
On the other hand, it is normal for people to gain some weight with age. While extra weight — especially around the waist or accompanied by loss of skeletal muscle mass — can cause health risks, losing weight may not be a good idea for some older adults. For example, it may be more important for people who are pear shaped and have less than two of the risk factors described above to prevent weight gain rather than try to lose weight. One group of researchers found that involuntary and even voluntary weight loss, regardless of BMI, can actually increase an older adult's risk of mortality. In another study, scientists had similar findings, reporting that weight change (loss or gain) is associated with mortality risk.
While we have learned a lot about patterns of weight and aging, watching your weight as you age is very much an individual matter. Talk to your doctor about any weight concerns, including decisions to lose weight or if you notice unexplained weight changes.
In Their Own Words: Reflections from the BLSA Staff
I have been working with the Baltimore Longitudinal Study of Aging in the cardiovascular labs since August 23, 1982. From the time I started with the study to the present, I have seen the BLSA change the way society reacts and responds to research. The BLSA has truly spread into a large realm of health care areas concerning the aging process, helping to amend views of aging. The research is important to everyone, but especially to the growing numbers of participants ranging from 60 years and older.
Our BLSA participants are viewed and treated as family members, not study groups. In turn, they often leave one visit looking forward to the next. Many have stated that they would never get this type of testing and concern from their primary care providers. To me, this speaks volumes about the staff of the BLSA.
Over the past 26 years, I personally have valued the relationships I've developed with participants. It is the BLSA participants who keep us looking ahead and growing each and every day. Their unselfish participation and willingness to stay with the study year after year allow us to continue our research and hopefully make a difference in the community of health care. Thank you to the participants.
Healthy Food for Thought: Think About What You Eat
You may have heard of the French saying "tell me what you eat and I will tell you what you are" or the shortened American version "you are what you eat." The insight in both of these sayings speaks to an interplay between food and health. What you eat can either support healthy aging or cause health problems. NIA scientists along with other investigators have found certain components of food, like saturated fats, cholesterol, and trans fats, may increase the risk of age-related disease, whereas foods like vegetables, fruits, fish, and nuts may have health benefits.
This booklet has already discussed how weight and body composition may play a role in how people age. Food has been shown to be an important part of that equation. In one BLSA study, scientists investigated how dietary patterns influenced changes in BMI and waist circumference, risk factors, again, for many diseases. Scientists grouped participants into clusters based on what foods contributed to the greatest proportion of the calories they consumed. BLSA participants who had a pattern of eating "meat and potatoes" had a greater annual increase in BMI, and participants in the "white-bread" pattern had a greater increase in waist circumference compared to those in the "healthy" cluster. "Healthy" eaters had the highest intake of foods like high-fiber cereal, reduced-fat dairy, fruit, nonwhite bread, whole grains, beans and legumes, and vegetables, and low intake of red and processed meat, fast food, and soda. This same group had the smallest gains in BMI and waist circumference.
Scientists think there are likely many factors that contribute to the relationship between diet and changes in BMI and waist circumference. One factor may involve the glycemic index value (sometimes called glycemic load) of food. Foods with a low glycemic index value (such as most vegetables and fruits and high-fiber, grainy breads) decrease hunger but have little effect on blood sugar and therefore are healthier. Foods like white bread have a high glycemic index value and tend to cause the highest rise in blood sugar.
Scientists have also used BLSA data to look at how the diet of male participants influenced risk of mortality from coronary heart disease (CHD) — the leading cause of death for people age 65 and over. Researchers studied the protective effects of eating fruits and vegetables along with the harmful effects of eating saturated fat. As expected, they observed that people who ate fruits and vegetables, particularly vegetables, had proportionately (based on amount of fruits and vegetables consumed) less coronary heart disease mortality. Participants with diets high in saturated fat had proportionately greater risk of CHD death and, conversely, participants on a low saturated fat diet had a lower risk of CHD death. A diet rich in fruits and vegetables and low in saturated fat was even more effective in decreasing risk. These BLSA findings are supported by data from many similar studies.
In addition to the BLSA, other NIA-supported researchers have studied the connection between food and health. For example, the relationship between physical problems and micronutrient or vitamin deficiency is one area of focus. Low concentrations of micronutrients or vitamins in the blood are often due to poor nutrition. A low carotenoid concentration, which can result from not eating enough fruits and vegetables, is associated with a heightened risk for a decline in skeletal muscle among older adults. Low concentration of vitamin E in older adults, especially women, is correlated with a decline in physical function. When compared to other older adults, those with low vitamin D levels had poorer results on two physical performance tests. Women with a low vitamin D concentration were more likely to experience back pain. These studies provide support for the takeaway message: the nutrients you get from eating well can help keep muscles, bones, organs, and other parts of the body strong throughout life.
So, eating well is not just about your weight, it can also help protect you from certain health problems that occur more frequently among older adults. And, eating unhealthy foods can increase your risk for some diseases. If you are concerned about what you eat, talk with your doctor about ways you can make better food choices. You may also want to visit www.choosemyplate.gov, a website developed by the U.S. Department of Agriculture (USDA), offering personalized eating plans, tools to help you plan and assess your food choices, and other advice to help you make healthy food choices.
In Their Own Words: Reflections from the BLSA Staff
I have been with the BLSA since April of 2001. I am a Clinical Research Nurse and work closely with the endocrine group. We have been studying the hormone response to the "tasty" orange-flavored drink used for the Oral Glucose Tolerance Test and how hormones are related to diabetes.
I believe that what we know about aging from the BLSA will help lead to future discoveries that will help all generations live healthier and improve and maintain their quality of life. The testing we do is precise and uses state-of-the-art equipment geared toward studying the aging process. Furthermore, the physicians involved in reviewing data and examining the participants are of the highest caliber, extremely knowledgeable, and very respected in their fields.
People are always talking about age 50 as the new 40, and 70 as the new 60. I see that every day here with the BLSA participants. They share with us their new and exciting endeavors, including classes they are taking, world travel, and other life experiences. It is amazing to see how some of our oldest participants have adapted to technology by using computers and e-mail. I am inspired by 80- and 90-year-olds who are routinely doing more exercise than me. I especially admire women of that age group who attended college, raised families, and have contributed so much to our society.
It is a pleasure working with the BLSA participants. You encourage me in so many ways. Happy 50th, and thank you for the contribution of your time and patience!
Participate in Activities You Enjoy
Sure, engaging in your favorite activities can be fun or relaxing, but did you know that doing what you like to do may actually be good for your health? It's true. According to BLSA data, people who are sociable, generous, and goal-oriented report higher levels of happiness and lower levels of depression than other people. Research from other studies supports this observation.
People who are involved in hobbies and social and leisure activities may be at lower risk for some health problems. For example, one study followed participants for up to 21 years and linked leisure activities, like reading, playing board games, playing musical instruments, and dancing, with a lower risk for dementia. In another study, older adults who participated in social activities (i.e., played games, belonged to social groups, attended local events, travelled) or productive activities (i.e., had paid or unpaid jobs, cooked, gardened) lived longer than people who did not report taking part in these types of activities.
Participate in your health care
Another component of participation is taking an active role in your health care. This means continually learning about how you can stay healthy. Websites like www.nia.nih.gov, www.nih.gov, www.medlineplus.gov, and www.nihseniorhealth.gov provide up-to-date, trustworthy health information. NIHSeniorHealth.gov is an example of a senior-friendly website with special features that make it easy to use. You can have the text read out loud or make the type larger.
Other studies have found that older adults who participate in what they see as meaningful activities, like volunteering in their community, reported feeling healthier and happier. Programs like the Experience Corps® are testing this idea, with promising preliminary outcomes. The Experience Corps® is a community-based program that places older adult volunteers living in an urban setting in public elementary schools for approximately 15 hours a week. Results suggest that the first group of Experience Corps® volunteers (living in Baltimore, Maryland) had an increase in physical, social, and cognitive activity levels, which might decrease their risk for disability, dependency, and dementia in later life. In addition to physical health benefits, volunteers reported feeling personal satisfaction from their experience.
Staying Healthy at 50+
Adapted from information provided by the Agency for Healthcare Research and Quality; based on research findings from the U.S. Department of Health & Human Services and the U.S. Preventive Services Task Force.
DAILY STEPS TO GOOD HEALTH
SCREENING TESTS AND PREVENTIVE MEDICINE
Heart and Vascular Diseases
* Being at risk means that you may be more likely to develop a specific disease or condition. Whether you are at risk depends on your family history, things you do or don't do (such as exercising regularly or using tobacco), and other health conditions you might have (such as diabetes). If you think you might be at risk for a specific disease, talk with your doctor.
Publication Date: July 2010
Page Last Updated: March 21, 2014