A CONVERSATION WITH DR DOUG WILSON
There are many advantages to growing older. There’s the wisdom that comes with experience, for example … the joy of making your own career choices … the nerve to say what you really feel … and the freedom of being retired! (Not to mention the delight of having left those awkward adolescent years well behind you …)
Ageing is inevitable. It happens to most of us – that’s guaranteed. But there are no guarantees about ageing WELL. How can you ensure you have a longer ‘health-span’ – not just a longer lifespan?
Enter Dr Doug Wilson, medical teacher, researcher and expert on the ageing process. His most recent book – ‘AGEING WELL: HOW TO NAVIGATE LIFE’S JOURNEY IN YOUR LATER YEARS’ – is a handbook on how to benefit from extended health. And he urges readers to “focus on the goal: a longer, healthier life, one that you can enjoy and in which you can contribute to the happiness of others.”
That sounded like a worthy project. So we arranged to chat with Dr Doug and find out what prompted him to write on such a subject …
DR DOUG WILSON: Well, I’m ageing myself – I’m 84! I’ve been involved with academic medicine and the pharmaceutical industry for many years, and I’m particularly interested in the literature about what might disturb your opportunity to live longer and healthier.
In 1981, I was on a sabbatical year based in Oxford in the UK. I was writing a textbook, working out of the Bradford Science library – a very large library with many medical journals I’d never seen before. (They had hundreds; in Auckland, we only had dozens.) And I was struck with an observation I read: London bus conductors on double-decker buses lived longer than those on single-decker buses. All other factors were standard; the only difference was the stairs on the double-decker that bus conductors had to climb during their shift!
There were other similar eye-opening findings, too – all of which have kept my interest in ageing over the subsequent 40 years.
GV: So tell us: what’s our best chance at a longer, healthier life?
DOUG: There are some basic rules for healthy living that are especially important. Some major studies in the US have been running since the 1970s, following about 80,000 women (most of whom were professional nurses) and a similar group of men from the medical profession. From the beginning of the study they recorded weight, blood pressure, diet and exercise details, age, etc. Then they measured all these things again when the participants reached age 50.
They were looking for factors that contributed to longer, healthy living. And what it finally boiled down to was having these five good healthy habits. The study then compared those who had all five habits with those who had none. And according to their findings, even if these habits were adopted in the second half of life (from age 50 onwards), they were still linked with an increased lifespan of 12 years for men and 14 years for women.
GV: Wow – that’s significant! So what are they?
DOUG: The five healthy habits are: Diet, Exercise, Mental Stimulation, Sleep, and Strong Social Networks/Relationships. Besides getting rid of the major negative factors that reduce lifespan (the worst of which is smoking), these are the things we need to focus on.
Can I just add, it’s also important to seek and maintain medical support. Some of the negative things that affect us as we age are readily detected – things like high blood pressure (which contributes to several critical conditions such as heart attack, stroke, depression, and dementia), diabetes, and others.
So it’s a combination: adopting those five habits that contribute to longevity, and handling those diseases that contribute to a reduced lifespan.
GV: Okay, let’s talk about diet … besides all the fads that come and go promising miraculous weight loss, what’s the basic, medically-sound advice on diet?
DOUG: The one that’s constant in the literature is to follow a Mediterranean diet. It’s the diet that’s more common in countries like Spain, the south of France, Italy … There’s been a series of monumental studies following people’s eating patterns – and, compared with the standard ‘free-choice’ diet, people who practise the Mediterranean diet come out on top in just about everything.
Researchers have recently discovered that even the simple change of adding olive oil to your diet results in a huge reduction in things like strokes, heart attacks, and high blood pressure. All that from one dietary change alone!
Another diet – very similar to the Med diet – is the DASH diet (Google it!), widely recommended by medical practitioners for maintaining cardiovascular health. It’s pretty straightforward and easy to follow, but very effective – as is the Mediterranean diet.
Diet is key, because the epidemic of obesity is beginning to reduce life expectancy in certain countries, such as the United States. Since 1900, life expectancy has increased with every decade in most of the western world – but, for the first time ever, the life expectancy in these countries has begun to decrease.
It’s important to keep your waistline measurements stable (which is difficult as you go past middle age, but you’ve got to do it) and maintain your body weight as you age.
GV: If people have remained fairly sedentary up until their later years, are they wise to adopt a more active lifestyle now – or could that actually be risky?
DOUG:If someone has an underlying condition such as angina, or if the exercise they’re doing is very vigorous, it could pose some risk. But, generally speaking, there’s far greater risk in NOT embarking on some sort of gentle exercise programme. However, it never hurts to check first with your doctor. Most gyms and fitness centres insist upon doing so, anyway. Exercise is important at any age.
Your body is designed to be moving. We’ve always been a mobile species, and that’s what your heart, joints, brain, lungs, your entire system prefers. So keeping active is vital!
It doesn’t have to be a gym, although that can be helpful. But things like walking (ideally a couple of kms a day) are great. Walking outside is preferable because it helps to provide mental stimulation as well as physical exertion. If you walk fast enough to get your heart rate up, that’s good for your heart and lungs – and, at the same time, for your cognition. As you get older, you become more unstable – and walking helps strengthen and stabilise your muscles, which in turn helps prevent falls, and reduces the risk of osteoporosis.
Some studies were done in nursing homes in the early 1990s, where they took groups of frail old ladies and introduced some of them to weight-bearing, strength-training, and resistance exercises. They followed them first for six months, then every couple of years, and they found there was a big gap between those who didn’t exercise and those who did. For those who were exercising regularly, there was a significant reduction in falls and broken hips.
So, at any age, you can improve your outcomes – particularly if you haven’t been doing so before. Just get your body going!
It doesn’t have to be fancy. Don’t get sucked in by all those ads for exercise machines on TV! Just get walking!
GV: When people retire, they often discover that their non-work life doesn’t provide adequate mental stimulation – especially if they haven’t previously invested in hobbies or their own creative projects. What advice can you offer people to increase mental stimulation as they age? And what are the benefits of doing so?
DOUG: It’s essential to keep your mind active! Look, if you don’t do that intentionally, the brain tends to go into a sort of lockdown. You can’t think as clearly … you become more forgetful … and you just don’t function at your best. Passive entertainment – such as sitting on the couch and watching TV – doesn’t provide enough mental stimulation. In fact, it can even limit your life expectancy in measurable ways.
There’s a huge range of things people can do – and, of course, it varies widely according to your personality and interests! My wife does Sudoku and crossword puzzles every morning – she enjoys that, and those are great sources of mental stimulation. If she watches TV, she tends to watch educational programmes and documentaries, so she’s learning all the time.
Reading, too, engages the brain more than looking at a screen. Becoming involved as a volunteer can provide huge advantages in terms of both mental stimulation and social connection. Having hobbies helps keep your mind active … building models … knitting or sewing … doing your ancestry lineage and putting together a family tree … The list goes on!
Talking with teenagers can be hugely enriching! Teens these days are pretty remarkable human beings. Their understanding of the world today and current technologies is way beyond what we knew at that stage in our own lives – and even beyond what most of us in our 60s-and up understand today! So they’re an extraordinary community to connect with.
Really, anything that interests you is fine – but don’t be someone who has no interests, who gets up in the morning without a sense of purpose and curiosity. Instead, get out there – play a game of chess or do something to get your brain going. The mental gains from keeping your brain active and agile are similar to the physical gains of exercise.
GV: What are your tips for getting the best night’s sleep?
DOUG: Sleep is very important. Your body needs good sleep, and as many people age, they find their sleep patterns are disturbed. So it’s important to get to the bottom of what’s causing it and learn healthy sleep habits.
There’s a wealth of information available online, but generally speaking, the rules are:
- go to bed around the same time each day
- don’t have a TV in the bedroom (because that stimulates your mind and makes it harder to fall asleep)
- avoid having a ‘night cap’, because alcohol – while it can make you feel sleepy – doesn’t lead to a good, solid sleep
- keep your bedroom cooler, rather than warmer
- keep your bedroom dark – avoid having bright lights near your bed
- and if you do wake up, get up and walk around – move your body a bit – and then go back to bed.
These are small, incremental steps, but if you add them together you’re far more likely to get a good night’s sleep. If you’re really struggling, there are excellent sleep centres around the country where you can have your sleep analysed.
Sometimes people find they’re waking up not feeling rested, and it turns out that they have sleep apnoea. Many people who snore have this issue.
SOCIAL NETWORKING & RELATIONSHIPS:
GV: What’s the advantage of building and maintaining these close connections as we age?
DOUG: There’s a wonderful course that’s run through Yale University called ‘The Science of Wellbeing’. It goes beyond the healthy habits and more into what we call the ‘soft gains’ – things like the pursuit of gratitude, having a sense of purpose, and so forth. The course is run by Dr Laurie Santos, who set it up because she was finding her students at Yale were no longer really interacting with each other.
When she first started teaching at Yale 10 years prior, the students’ common room was a lively, noisy place, full of chatter and shouts of laughter and interaction. But 10 years on, it had become as silent as a tomb. Everyone was fixated on their devices and nobody engaged in conversation with those around them.
As a consequence, problems like anxiety, depression and stress had escalated enormously. The students had become less and less attuned to their fellow classmates, to thinking for themselves, to their socialisation. And so she introduced this course on how to improve your mental wellbeing. To her surprise, 10 times the number of people she expected showed up for her class! And it’s become the most popular course at Yale in 300 years!
It’s worth googling – and is now available online for free.
In terms of ageing well, The Harvard Study of Adult Development began in the 1930s, and is the longest-running longevity study in the world. It follows a group of Harvard students and a similar cohort of underprivileged kids in Boston (and their subsequent generations) … examining their health, finances, studies, careers and social lives from that time until today. And it produces a wealth of information on what factors truly influence the best outcomes for individuals.
What they’ve found is that the single most important factor influencing longevity is having a close personal relationship – a marriage or partnership, or even having a very close friend with whom you share life. The closer the relationship, the more likely you’ll handle life better, be resilient, and be physically healthy.
Harvard professor and psychiatrist Robert Waldinger’s TED talk on the study is well worth checking out – it’s very compelling (it’s already had upwards of 40 million views on YouTube), and it’s a good way to spend 12 minutes.
GV: As we age, we experience increased aches and pains. But many people don’t want to ‘make a fuss’ – especially when something might likely be ‘just a normal part of ageing’. Are there some general guidelines about when people should seek medical advice?
DOUG:It’s tricky because there’s often a gap between what the symptoms are and what the underlying cause turns out to be – and it becomes much more complicated in older people. An older person who’s displaying signs of confusion and struggling to get around might appear to be suffering from dementia – but, in actual fact, these symptoms can indicate a number of other issues.
Bladder infection (common in older people), for instance, can make a person feel woozy and confused. So it’s better to err on the side of caution – it’s better to go too often to see the doctor than to worry about making a fuss and go too seldom.
With diseases such as cancer, an early diagnosis can be critical for a good outcome – and the older you are, the more likely you are to get cancer. So – especially when you’re ageing – you need to work with your GP and persevere to get to the root cause of things.
Things have changed a lot since I obtained my medical degree 60 years ago.
In the decades since then, medicine has made some enormous gains. It wasn’t uncommon back in the late 1950s and early 1960s for men, in particular, to die of heart attacks in their fifties and sixties – whereas now the risk of fatal heart attacks has moved about 15 to 20 years further on in the lifespan.
There’s been a huge gain in life expectancy due to better advice for heart-health and recovery management.
Cancer treatment, too, has come along in heaps and bounds – from treatment that consisted almost entirely of radical excision of the tumour and tissues around it to the far more targeted approach offered through chemotherapy, radiation and other therapies. Similar gains have been made in the fight against diabetes. It’s been revolutionary, really.
The one area we’ve seen almost no gains, though, is dementia. For example, we haven’t had a new drug that modifies the progression of Alzheimer’s disease in 20 years.
GV: One of the great interruptions to ‘ageing well’ is mental decline. The stats tell us that about a quarter of individuals over the age of 80 suffer to some degree with dementia. What can we learn here?
DOUG: As people begin experiencing cognitive decline – whether actual dementia or not – the concern is that they can start making poor judgments. They can make mistakes when driving … they can begin to make lousy choices around legal matters (being easily conned, for instance) … they can make absolutely disastrous spending decisions …
So it’s a good idea for people as they age to consider these issues. Decide now who they’d like to have power of attorney and who they can trust to manage their finances if or when they become unable to do so for themselves.
It’s also important to recognise that Alzheimer’s is a particular disease. It has a natural pattern as it progresses, and it has an unfortunate inevitability about it. At this stage, there’s nothing we know of that can reduce the risk of getting it – nor reduce the pace of decline. But not all dementia is Alzheimer’s. There’s a proportion of people, for example, who have what’s called vascular dementia: a pre-existing condition that might otherwise trigger the onset of dementia as, bit by bit, the brain is damaged by mini-strokes.
And so the issue there is to control your blood pressure, your diet, your blood lipids … because by controlling your cardiovascular system, you can minimise your risk of heart attack, stroke and this particular type of dementia. So this is one area of cognitive decline that can actually be minimised or prevented.
GV: There’s a whole section in your book that examines financial security, accommodation changes, etc. What should people bear in mind as they make plans for their later years – when it comes to finance and housing?
DOUG: One of the biggest issues here – more than for previous generations – is that people are living so much longer. We’ve got a longer life after retirement, which is a positive statistic to think about! But how well you live depends a lot on your resources …
If you’re in a good space financially, then you’ve got lots of choices; but you may not have those choices – and particularly with our national superannuation here in New Zealand. It’s the absolute minimal support for living – and it assumes that people have their own accommodation, because the amount of money you receive from Government super doesn’t cover that. So, unless you have additional benefits, this becomes one of the toughest challenges.
About two-thirds of older New Zealanders have owned their own home – so they’re lucky because it’s both a place to live and a financial asset. But increasingly, for upcoming generations of elderly people, that’s not the case. They’re going to have to rely on support from their families, churches and community resources (such as the Salvation Army) … or renting at reduced rates from friends.
I don’t think we’ve adequately addressed this issue in our country, because the number of people in need is monumental.
We currently have about 750,000 people over the age of 65. By 2050, we’ll have about 1.5 million – one quarter of the population will be over 65!
So the question is: will there even be a national super for them? And what’s the pressure on health services going to look like? For most of us, the reality is that we won’t be able to rely on the state to provide us with an adequate income or housing. So as people are getting older these days, they need to consider that and prepare as best they can.
If you can continue to work, that’s ideal – but even those options are surprisingly limited. Many people find that they’re rejected from jobs – not given opportunities for work – once they’re past retirement age. In some cultures – such as the Pacific Island and Chinese – they’re very good about looking after the older folk in their communities. But there are many people in New Zealand society who are going to struggle in their old age.
So that’s a very pressing and important issue – and a very complicated one as well.
GV: As you said earlier, ageing is inevitable. And it’s not without its challenges. But the goal as we “navigate this journey” is AGEING WELL. And, at any point, there’s plenty we can do to improve our outcomes. Is there anything you’d like to add for our readers?
DOUG: When we’re considering the fact of ageing, and taking steps to manage it better, it’s important to remember that getting older is gifted time. If you’ve been fortunate enough to maintain your mental function, there are lots of wonderful things you can do and learn – and there are many things to enjoy as you make use of that time.
But you need to put in the preparatory work – otherwise you might wake up one day realising you’ve retired but have no plan. And that can be very difficult.
The best thing people can do is adopt a positive attitude about getting older. Find out what’s good for you and what’s bad … do more of the good and get rid of the bad … and you’ll live longer and happier!
And good on you – because this can truly be a wonderful time of life!
‘AGEING WELL: HOW TO NAVIGATE LIFE’S JOURNEY IN YOUR LATER YEARS’ BY DR DOUG WILSON IS AVAILABLE AT ALL GOOD BOOKSTORES.