Aging: What to expect as you get older

Do you expect to find a few more wrinkles and gray hairs each time you look in the mirror? These are just some of the changes you're likely to notice as you get older. You're not necessarily at the mercy of Mother Nature, however. Here's a list of common aging-related changes — and what you can do to promote good health at any age.

Your cardiovascular system

What's happening. Over time, your heart muscle becomes less efficient — working harder to pump the same amount of blood through your body. In addition, your blood vessels lose some of their elasticity and hardened fatty deposits may form on the inner walls of your arteries (atherosclerosis). These changes make your arteries stiffer, causing your heart to work even harder to pump blood through them. This can lead to high blood pressure (hypertension) and other cardiovascular problems.

What you can do about it. To promote heart health, include physical activity in your daily routine. Try walking, swimming or other physical activities. Eat a healthy diet, including plenty of fruits, vegetables and whole grains. If you smoke, ask your doctor to help you quit. Your risk of heart disease will begin to fall almost immediately.

Your bones, joints and muscles

What's happening. With age, bones tend to shrink in size and density — which weakens them and makes them more susceptible to fracture. You might even become a bit shorter. Muscles generally lose strength and flexibility, and you may become less coordinated or have trouble balancing.

What you can do about it. Include plenty of calcium and vitamin D in your diet. Build bone density with weight-bearing activities, such as walking. Consider strength training at least twice a week, too. By stressing your bones, strength training increases bone density and reduces the risk of osteoporosis. Building muscle also protects your joints from injury and helps you maintain flexibility and balance.

Your digestive system

What's happening. Constipation is more common in older adults. Many factors can contribute to constipation, including a low-fiber diet, not drinking enough fluids and lack of exercise. Various medications, including diuretics and iron supplements, may contribute to constipation. Certain medical conditions, including diabetes and irritable bowel syndrome, may increase the risk of constipation as well.

What you can do about it. To prevent constipation, drink water and other fluids and eat a healthy diet — including plenty of fruits, vegetables and whole grains. Include physical activity in your daily routine. Don't ignore the urge to have a bowel movement. If you're taking medications that may contribute to constipation, ask your doctor about alternatives.

Your bladder and urinary tract

What's happening. Loss of bladder control (urinary incontinence) is common with aging. Health problems such as obesity, frequent constipation and chronic cough may contribute to incontinence — as can menopause, for women, and an enlarged prostate, for men.

What you can do about it. Urinate more often. If you're overweight, lose excess pounds. If you smoke, ask your doctor to help you quit. Pelvic muscle exercises (Kegel exercises) might help, too. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Aim for at least three sets of 10 repetitions a day. If these suggestions don't help, ask your doctor about other treatment options.

Your memory

What's happening. Memory tends to becomes less efficient with age, as the number of cells (neurons) in the brain decreases. It may take longer to learn new things or remember familiar words or names.

What you can do about it. To keep your memory sharp, include physical activity in your daily routine and eat a healthy diet. It's also helpful to stay mentally and socially active. If you're concerned about memory loss, consult your doctor.

Your eyes and ears

What's happening. With age, the eyes are less able to produce tears, the retinas thin, and the lenses gradually become less clear. Focusing on objects that are close up may become more difficult. You may become more sensitive to glare and have trouble adapting to different levels of light. Your hearing may dim somewhat as well. You may have difficulty hearing high frequencies or following a conversation in a crowded room.

What you can do about it. Schedule regular vision and hearing exams — then follow your doctor's advice about glasses, contact lenses, hearing aids and other corrective devices. To prevent further damage, wear sunglasses when you're outdoors and use earplugs when you're around loud machinery or other loud noises.

Your teeth

What's happening. Your mouth may begin to feel drier and your gums may pull back (recede) from your teeth. With less saliva to wash away bacteria, your teeth and gums become slightly more vulnerable to decay and infection. Your teeth also may darken slightly and become more brittle and easier to break.

What you can do about it. Brush your teeth twice a day and clean between your teeth — using regular dental floss or an interdental cleaner — once a day. Visit your dentist or dental hygienist for regular dental checkups.

Your skin

What's happening. With age, your skin thins and becomes less elastic and more fragile. You may notice that you bruise more easily. Decreased production of natural oils may make your skin drier and more wrinkled. Age spots can occur, and small growths called skin tags are more common.

What you can do about it. Bathe in warm — not hot — water, and use mild soap and moisturizer. When you're outdoors, use sunscreen and wear protective clothing. If you smoke, ask your doctor to help you quit. Smoking contributes to skin damage, such as wrinkling.

Your weight

What's happening. Maintaining a healthy weight — or losing weight if you're overweight — is more difficult as you get older. Muscle mass tends to decrease with age, which leads to an increase in fat. Since fat tissue burns fewer calories than does muscle, you may need to reduce the number of calories in your diet or increase your physical activity simply to maintain your current weight.

What you can do about it. To prevent unwanted weight gain, include physical activity in your daily routine and eat a healthy diet. Also keep an eye on portion sizes. You might not need to eat as much as you used to.

Your sexuality

What's happening. With age, sexual needs, patterns and performance may change. Illness or medication may affect your ability to enjoy sex. For women, vaginal dryness can make sex uncomfortable. For men, impotence may become a concern. It may take longer to get an erection, and erections may not be as firm as they used to be.

What you can do about it. Share your needs and concerns with your partner. You might experiment with different positions or sexual activities. Be open with your doctor, too. He or she may offer specific treatment suggestions — such as estrogen cream for vaginal dryness or oral medication for erectile dysfunction.

Remember, it's never too late to adopt a healthy lifestyle. You can't stop the aging process, but you can minimize the impact by making healthy lifestyle choices.

Best eating habits for busy people

"I follow a super-busy lifestyle, have no time to cook, yet health is a priority for me and I want to learn a few healthy eating tricks."

If this is you and you tend to juggle work, family, cleaning, cooking, errands and what not, then maintaining a healthy lifestyle without having the luxury of time can be an uphill task. Fret not. To help you out, Dr. Simran Saini, Weight Loss Management Consultant at Fortis Hospital lists out the best eating habits for busy people. So let's get started!

The importance of cooking: A busy lifestyle is one of the most commonly heard health hurdles these days. But no matter how busy your daily schedule is, you always have those 5 minutes to cook something for yourself. It ensures that you know what you are eating, why and how much. It is also an essential tool to ensure quality food reaching your tummy and there are many for whom cooking works as a stress-buster in their hectic routines.

Setting reachable goals: Setting goals that are sensible and can be accommodated between the zillion things happening around you, is a wise thing to do. Food is comfort and it takes time to knock off old habits. So set a goal which is slow, but steady, something you will stick to for some time. This will give you your space and comfort and you will end up winning 80% of the healthy eating battles through an immediate goal-target basis.

Setting a diet journal: Setting a diet journal is like placing a mirror in front of yourself. Yes, it shows you when was the umpteenth time you repeated those cookies and added calories to your diet. It tells you that you are putting on weight, when you are eating too much, although you would like to say to yourself that you 'didn't really eat much food today.' You record details of daily food intake and this makes you think and organise yourself. Maintain a diet journal and stop that hand of yours from reaching out for extra cookies.

Making healthy eating a family effort: Things always work better when you do them together as a family. It always helps to overcome temptation and place yourself in a right perspective, when you see other people doing the right thing too. And it is depressing at times when people around you eat pizza and you are busy chomping on cabbage leaves. So, eat and enjoy healthy food as a family to ensure that no one falls off the healthy eating bandwagon.

Being calorie concious: A meal is a combination of different food groups. If we stick to the right proportions of ingredients used and limit the portion as we need it, it would solve most of our problems. Taking care of not using too much oil, restraining salt and excess sugar, adding more of the vegetables or fiber and keeping processed food to a minimum, makes sure your meal is calorie balanced. This calorie balanced meal is your daily tool for maintaining the right weight.

Avoid pre-packaged and processed meals: Chips, cookies and other fast foods that come from a box or bag count at pre-packaged foods that usually contain preservatives. At times even more of salt or sugar may be added to prolong the life of pre-packaged food, which may not be very healthy for everyone. The only way for you to stay away from pre-packaged food is to remind yourself about the calorie content of the food. Also, consider carefully if you can substitute the craving with a healthy alternative.

Top 5 on-the-go dishes for healthy eaters:
- A fruit yogurt such as strawberry yogurt or pomegranate yogurt
- A healthy sandwich (use hung curd or mustard sauce, instead of store-bought mayo)
- Fruit chaat
- Soy patties
- Dry fruit, vegetable and lean protein salad

Weight loss may help reduce sleep apnea

Obese people with sleep apnea may triple the chances of eliminating their sleep problems by losing weight, claims a new study.

More than just loud snoring, sleep apnea can lead to high blood pressure, stroke, cardiovascular disease and a poor quality of life.

"Existing research has been limited by a number of factors, so there are very few studies that show whether the recommended amount of weight loss - about 10 percent - is enough to sufficiently improve sleep apnea," said Gary Foster, director of the Center for Obesity Research and Education.

Foster and colleagues from six other universities recently completed the largest randomized study on the effects of weight loss on sleep apnea in patients with type 2 diabetes.

They found that among patients with severe sleep apnea, those who lost the recommended weight were three times more likely to nearly eliminate the number of sleep apnea episodes compared to those who did not lose weight.

The study has been published in the Sept. 28 issue of the Archives of Internal Medicine.
The new study, called Sleep AHEAD, looked at 264 obese patients with type 2 diabetes already enrolled in the Look AHEAD trial, an ongoing 16-site study investigating the long-term health impact of an intensive lifestyle intervention in 5,145 overweight or obese adults with type 2 diabetes. Participants were between 45 and 75 years old.

The 264 participants were broken into two randomized groups: the first received a group behavioral weight loss program developed especially for obese patients with type 2 diabetes, portion-controlled diets, and a prescribed exercise regimen of 175 minutes per week. The second attended three group informational sessions over a one-year period that focused on diabetes management through diet, physical activity and social support.

After one year, members of the first group lost an average of 24 pounds. More than three times as many participants in this group had complete remission of their sleep apnea (13.6 percent compared to 3.5 percent), and also had about half the instances of severe sleep apnea as the second group. Further, participants in the second group only lost about a pound, and saw significant worsening of their sleep apnea, which suggested to Foster and his team that without treatment, the disorder can progress rapidly.

"These results show that doctors as well as patients can expect a significant improvement in their sleep apnea with weight loss," said Foster, the study's lead author. "And a reduction in sleep apnea has a number of benefits for overall health and well-being," the expert added.

When injuries to the brain tear at hearts

At a crowded vigil on Sunday night in Tucson, Representative Gabrielle Giffords held her husband’s hand as she stepped up to the lectern to recite the Pledge of Allegiance.

It had been one year since a shooting at a Tucson supermarket killed six people, injured 12 others and left her with a severe brain injury. Ms. Giffords’s appearance was greeted by an enthusiastic crowd that applauded her remarkable progress toward recovery.

The man next to her, fighting tears, offered his own remarks. “For the past year, we’ve had new realities to live with,” said her husband, the astronaut Mark E. Kelly. “The reality and pain of letting go of the past.”

Captain Kelly was speaking of the survivors of the shooting. But his words echoed the sentiments of many brain injury survivors and their spouses as they grapple with interpersonal challenges that take much longer than a year to overcome.

Until recently, there had been little evidence-based research on how to rebuild marriages after such a tragedy. Indeed, doctors frequently warn uninjured spouses that the marriage may well be over, that the personality changes that can result from brain injury may do irreparable harm to the relationship.

Captain Kelly and Ms. Giffords largely have kept private their own experiences in this regard, and they declined to be interviewed for this article. Still, therapists are beginning to understand the obstacles that couples like them face, and what they are learning may lead to new counseling techniques to help restore the social links that give lives meaning.

Contrary to conventional wisdom, many relationships do survive after a spouse suffers a brain injury. Some studies find divorce rates well below the national average among these couples. A 2007 investigation found that the divorce rate was around 17 percent in couples followed for as long as 90 months after a spouse sustained a brain injury.

That is not to say these couples are always happy.

“Two or three years later, they want a whole lot more than simply to be alive,” said an author of the 2007 study, Jeffrey S. Kreutzer, a psychologist at Virginia Commonwealth University in Richmond. “While people may technically be married, the quality of their relationship has been seriously diminished.”

Dr. Kreutzer and other psychologists at V.C.U. are among the few therapists in the country trying to develop marriage counseling techniques tailored to couples dealing with brain injuries. Traditional marriage counselors often hope to restore people and their relationships to their original luster. For Dr. Kreutzer and his team, recovery often means teaching uninjured spouses to forge a relationship with a profoundly changed person — and helping injured spouses to accept that they are changed people.

The research is still in early stages, and in many ways the therapeutic toolbox is not much different from that of regular marriage counseling: Couples coping with a brain injury are taught to communicate better, to focus on positive developments and things they like about each other, and to set aside time to inject a little romance and fun into a life that can be consumed by doctors’ appointments and paperwork.

But other traditional techniques can backfire with these couples, the researchers have learned. For example, said Emilie Godwin, another V.C.U. psychologist, encouraging partners to remember what sparked their love in the first place can mean “highlighting the things that have probably been lost.”

“You’re asking people to just look forward, to not look back at all,” she said. “To try to recreate a relationship.”

The Stranger in the Living Room

About a month after surgery to remove a brain tumor in 2006, Terry Curtis turned to his wife, Vicky, and offered her a divorce.

“I told her she was free to leave,” he said. “I’m not the person you married.”

Mr. Curtis knew he had become cold, impulsive and incapable of focusing his attention. But it would be 18 months before doctors explained to the couple that complications from surgery had caused a brain injury.

Mrs. Curtis, 60, was once drawn to her husband’s “sparkle,” she said. After the injury, he “flat-lined” emotionally, and he suffers from depression, anxiety and a lack of motivation.

Her husband sometimes makes erratic decisions, she added, like the time he decided to take a do-it-yourself approach to the plumbing at their home in Coralville, Iowa. “Not a good picture when I got home,” Mrs. Curtis said. “And you can yell at him like a little kid, but he didn’t know any better.”

Once a software programming analyst, Mr. Curtis, 57, has “a lot fewer interests” than he did before the injury, and he estimates he has lost 90 percent of his friends.

“It’s a new you,” he said, “and they just can’t cope with that.”

Brain injury can be isolating, psychologists say, as the mental symptoms may last well beyond the obvious injuries. Strangers and friends often do not understand the root of a survivor’s socially inappropriate behavior.

Even relatives well versed in the changes wrought by brain injury constantly struggle not to take outbursts or remarks personally, therapists said.

“The word that describes it is just ‘lonely,’ ” said Mrs. Curtis of her role as caregiver. “My life is sitting in the living room quiet while my husband just sleeps.”

Guilt is the tie binding many people to a dependent stranger inhabiting their spouse’s body after a brain injury, Dr. Kreutzer said. But guilt is not unique to the caregiver who might fantasize about getting away. Studies show that few of the injured can work and that about half suffer from major depression; many feel inadequate because of their inability to provide financial and emotional support.

But Mrs. Curtis said she was staying with her husband not out of guilt or an obligation to take care of him — though she couldn’t say she had never contemplated leaving.

“If I was that unhappy, I would make the arrangements for him to be taken care of and get out,” she said.

Counseling has helped Mrs. Curtis, who works in administration at the University of Iowa, to manage her expectations, both for Mr. Curtis’s recovery and her own responses.

“We’ll have a whole day where he’s just fine, and it’s just like the old Terry,” she said last month. “And then he’ll say something out of whack, and I’ll say, ‘Oh, yeah, it’s 2011.’ ”

Psychologists say this type of halting progress adds to what they call “ambiguous loss.” Every day, reminders of the damage appear and disappear, and often couples struggle with grief that is never fully resolved and must constantly be reassessed.

Though the Curtises have not quite let go of the “old Terry,” their relationship is not identical to what they had before his injury. It has become a “combination,” Mrs. Curtis said.

Said Dr. Godwin: “People hold on to hope that just as when they survived the crash and they had this miraculous recovery, that they will overcome these challenges that other people may not in this miraculous way. That’s not going to happen.”

A Qualified Miracle

But some couples do manage to put their lives, and relationships, back together in the years after a traumatic brain injury. In 2002, while Hugh Rawlins was in an induced coma, half his skull removed to allow his brain to swell, doctors told his wife, Rosemary, that he might be angry, even abusive to their 14-year-old twin daughters — when and if he learned to talk again.

Mr. Rawlins had been struck by a car while riding his bike near his home in Glen Allen, Va. As he entered rehab, doctors warned that the couple might soon face bankruptcy and divorce.

But after years of halting rehabilitation and a devastating, failed attempt to return to his old job, Mr. Rawlins is a financial executive at a midsize engineering company. An avid surfer before the accident, he rides the waves off North Carolina’s Outer Banks, where the couple spends almost every weekend.

He never became the aggressive misanthrope doctors warned about. And he’s back on the bike.

But each positive step in Mr. Rawlins’s recovery has posed difficult challenges for his wife. Fearful, she hid the car keys as he learned to drive again. His determination to ride his bike sent her into therapy.

“All of a sudden I was in this position of always telling what you can do, what you can’t do — it’s horrible,” said Mrs. Rawlins, who documented her family’s ordeal in “Learning by Accident,” a self-published memoir.

Mr. Rawlins may have suffered a traumatic brain injury, but it was Mrs. Rawlins who, like many others caregivers, ultimately received a diagnosis of post-traumatic stress disorder.

Despite progress toward stable relationships, many couples stay trapped in a pattern in which the uninjured spouse does everything for the survivor, even when it’s no longer necessary, researchers have found. “No one likes to have their freedom stolen from them,” said Dr. Godwin.

Before they entered counseling, fights over Mr. Rawlins’s limits sometimes ended in a silent stalemate.

“There’s always a bit of the rebellion in me, and she’d pull me back just as a mother would or a father would to their teenager,” said Mr. Rawlins, now 55. “Sometimes she was right, and sometimes I could do it.”

The accident rocked the couple out of their “midlife doldrums,” Mrs. Rawlins said. As Dr. Kreutzer tells his patients, some post-injury changes can be positive. Mrs. Rawlins was thrilled to find her once wry and stoic husband is much less emotionally inhibited.

“The touchy-feely stuff, that shows more in me now,” he acknowledged.

More and more, Mrs. Rawlins believes that her husband is back to his “old self.”

She’s just no longer sure she remembers who that was.

10 Foods that make you feel full

More than how much you eat, what you eat determines the satisfaction level of a meal. Nutritionist Sneha Jain lists 10 foods that make you feel full, without making you fat.

Fatty Fish
Fatty fish such as salmon, tuna, mackerel, herring and sardines contain large amounts of omega-3 fatty acids which, besides lowering cholesterol, also hasten the metabolism rate. Omega-3 fatty acids alter the level of leptin - a hormone that directly influences metabolism and determines whether you burn calories or store them as fat. Fish also provides ample protein and the best way to eat it is grilled, with steamed vegetables on the side.

Citrus Fruits
Fruits such as grapefruit, lemon, sweet lime, papaya, guava and tomatoes are rich in Vitamin C and fibre. Vitamin C helps the body process fat faster and also stimulates the amino acid known as carnitine - carnitine speeds up the body's fat-burning capacity. Citrus fruits also have high water content and provide around 50 to 75 kcal, leaving us satiated for a longer period of time.

Green Vegetables
Spinach, asparagus and broccoli have a high thermic effect on the body and a low calorie density. This means that it's almost impossible for them to be stored as fat because most of their calories are burned off in the digestion process. Apart from that, the fibre in these foods provides roughage and contains antioxidants, vitamins and minerals that help you feel full.

Popcorn
Popcorn is rich in fibre and low on calories. Also, since eating it keeps our mouth busy for a longer time, the satiety levels are high. However stay away from the overly buttered, caramel and cheese cousins.

Oatmeal
Oatmeal is a complex carbohydrate which takes longer to digest - hence it releases energy slowly, keeping you feeling full for longer. It also keeps blood sugar and insulin levels stable, which helps prevent fat storage. Oatmeal is the most satisfying breakfast cereal, providing more protein per serving than any other grain. Mix it with yoghurt or skimmed milk and it'll keep you full all morning.

Almond and Walnuts
Raw, unsalted nuts, especially almonds and walnuts, provide essential roughage, protein, fat, minerals and micronutrients. Munching on handfuls of these nuts keeps you full and energetic for longer without adding to your waistline.

Low-Fat Dairy Products
Skimmed milk, low fat cheese and yoghurt are a good source of calcium, which helps break down fat cells. Some studies indicate that not getting enough calcium may trigger the release of calcitrol, a hormone that causes fat storage.

Beans
Beans are high in fibre and a good source of protein. They also take longer to digest, making you feel full for a longer time. Also, protein has the highest satiety index (which determines how long will you feel full) than any other element.

Whole grains
Jowar, bajra and ragi contain complex carbohydrates, which release glucose slowly when broken down during digestion. The glucose helps in maintaining your blood sugars levels and combats sugar craving. They are also a rich source of fibre and Vitamin B complex that play an important role in metabolic control.

Apples
High water content and ample fibre is the reason why you feel full after eating an apple. An apple's skin contains pectin soluble fibre that is a natural appetite suppressant. Seems like an apple a day keeps the weight away.