Adding more years to life vs. more life to years

by Carolyn Thomas    ♥   @HeartSisters

I’ve noticed that a specific conversation topic keeps popping up when my girlfriends of a certain age get together – particularly when we start comparing what we used to be able to do with what we’re able to do now.          .

Here’s just one simple example:  I used to be able to sit down on the floor and then casually stand up again without any help. Now, with a wonky left knee encased in a big skookum brace, plus two painful wrists (one sporting its own brace), I know those days are gone.  (Thank you, osteoarthritis!)  Yes, I might still be able to painfully get myself down onto the floor, but there’d better be two strong adults around to pull me back up by both arms.    .  

Meanwhile, Brazil’s Dr. Claudio Gill Araújo and his team had been studying this simple motor function called the Sitting-Rising Test. Over 6,000+ heart patients who had gone through his  cardiac rehabilitation clinic (Programa de Exercício Supervisionado) in Rio de Janeiro were studied.(1)  Dr. Araújo told me that if you’re a  person aged 50-80 (the age range of his cardiac rehab patients) and you can carefully lower yourself onto the floor from a standing position and then back up again without using your hands, forearms, knees or the sides of your legs to help you – Congratulations!  It turns out that you’re not just mastering a show-off party trick, but you may actually be more likely to live longer compared to the rest of us who are still down there trying to struggle up off the floor.

♥  IMPORTANT NOTE:  You know your own body! Do not attempt the Sitting-Rising Test when you’re alone if you have reason to suspect you might keel over and bonk your head on something dangerous while doing it!

We know that life expectancy across the world has been rising since the mid-20th century, and the resulting increases in these older populations have been celebrated as major success stories. But as the Director-General of the World Health Organization once warned: “Adding more years to life can be a mixed blessing if it is not accompanied by adding more life to years.” 

In other words, I do not want to live longer simply for the sake of having more birthdays (although the promise of our traditional birthday mocha cake from the Dutch Bakery might just entice me to hang on). And to my astonishment, I’ve learned that my recent osteoarthritis diagnosis has impacted my day-to-day quality of life far more than heart disease now does. I did not see this coming. I’m relieved that, although there are motor functions I can no longer manage, long daily walks (with my brace) are not only still possible but surprisingly helpful in so many ways.

Published studies that have measured motor function in older adults (for example, walking speed, grip strength, and timed chair rises) have found that – like that ability to do the Sitting-Rising Test – these physical skills are associated with longer life.(2)  But as I’ve written in a number of Heart Sisters posts previously, avoiding death should never be the sole goal.

Approach goals, for example, (“I’m going for a long walk because I always feel good when I’m near the ocean”) are significantly more effective than avoidance goals (“I’m going for a long walk so I don’t die of another heart attack”)

It’s about balance and moderation, I think. Aging is not measured by timed chair rises or grip strength, but I know I’ll be happier one day if I can safely get up off my chair or open a pickle jar. I don’t need to sit down on the floor to play with my darling grandson Zachary, but I like to do my daily 30-Minute Full Body Pain Relief Workout  from Essentrix so I can balance my arthritis pain with our toddler play times (thank you Heart Sisters readers for introducing me to this free online program that adds life to my years!) Speaking of grandbabies, I highly recommend them!

This week, the British Medical Journal (BMJ) published an interesting essay written by Dr. Helen Salisbury. As well as seeing patients in her Family Practice office in Oxford, she leads the Communication Skills Course for medical students at the University of Oxford. And although her essay this week is about her experiences with patients living in England, her message feels truly universal.

She covers an issue that those girlfriends of a certain age and I have been increasingly wondering about lately:

“Is there something wrong with me, or am I just getting old?'”    

First, Dr. Salisbury describes her own family practice as serving a mixed community:

“They include sprightly octogenarian park runners, as well as people not yet 60 who have five longterm conditions and take multiple medications. When they do ask that question about age, it’s my job to take a careful history and look for treatable causes.

“What can they no longer do that they once could? Has there been a recent change?

“Only when I’ve satisfied myself and the patient that there’s nothing my medicine can fix, can we attribute the decline to age. And it’s never simply age, of course, but a combination of factors that include genetics, weight, alcohol use, smoking—as well as fortune, good or bad.”

Dr. Salisbury writes that she believes her job is to help her patients to age well, and also to notice any sudden or unexpected downturn:

“But as ever, continuity of care is the magic ingredient of general practice that enables us to work out when investigations and referrals are likely to be helpful—and when they’re not.”

She also believes that whether her patients seek her advice on aging at all will depend on their expectations:

“These expectations are driven by the experiences of their family, and of the people around them. And such experiences vary hugely across the wealth divide, so women living in the least deprived areas can expect nearly 20 years more of healthy life than those in the most deprived.(3)  She cites the much-quoted British poverty/social justice researcher David Gordon who quipped that the Number One tip for better health is: “Don’t be poor. If you are poor, try not to be poor for too long.” (4)

And Dr. Salisbury closes her essay with a scenario that will seem familiar to you if you’re one of those women of a certain age:

“I wish I could raise the expectations of some of my patients and persuade them that better health and fitness isn’t beyond their grasp even in late middle age, although the reality of their lives may make this hard to achieve.

“Interestingly, it’s also necessary to adjust the expectations of younger doctors, who often develop a skewed and pessimistic view of life at 80 as a result of their time spent on hospital wards.

“So I try to introduce these jaded trainees to others among my patients – the ones in their late 80s who are unhappy that they can no longer manage the two-mile walk into town and back without a rest – and who are disappointed that I don’t have a cure!”

Can we have both? Can we grow old having fun like those “sprightly octogenarian park runners” that Dr. Salisbury sees in her practice, and can we also grow old having fun even if our arthritis or other conditions make park running impossible anymore? The very best exercise, it is said, is the one you like doing so that you’ll keep doing it.

And no matter whether you’re immersed in Sitting-Rising Tests, or in baking peanut butter cookies with your grandkids, do so in the spirit of the immortal words of the late tennis great Arthur Ashe:

“Start where you are. Use what you have. Do what you can.”

 

♥

Image of lock:  Shon Ejai, Pixabay

1.  Araújo CGS et al. “Sitting–Rising Test: Sex- and age-reference scores derived from 6,141 adults.” European Journal of Preventive Cardiology. 2020;27(8):888-890.

2. Strand B H, Cooper R. “Monitoring changes in motor function in the years before death”, BMJ 2021; 374 n1882.

3.U.K. Office for National Statistics: “Health state life expectancies by national deprivation deciles, England: 2018 to 2020.”  April 25, 2022.

4. Townsend Centre for International Poverty Research. “Health Inequalities“, University of Bristol, England. 

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Q:  Have you noticed a declining ability or function you’ve chalked up to ‘just getting old’?

♥

NOTE FROM CAROLYN:   I wrote much more about changes in function among heart patients in my book, A Woman’s Guide to Living with Heart Disease. You can ask for it at your local bookshop (please support your favourite independent booksellers!) or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).