Do everything you can to avoid going “gentle into that good night.”
Happiness, fulfillment, adventure, purpose and joy—all the things that make our lives wonderful and worth living—hinge on sound health. When I was a younger woman and brimming with the bounce-back factor, I took my health for granted. Staying up late and eating too much sugar hardly bothered me. But since crossing the threshold of my sixties, I’ve noticed that my body requires much more TLC than it once did. As I have endured my own health problems and watched friends deal with serious diagnoses such as Type 2 diabetes, heart disease and breast cancer, the foundational triad of excellent health—restorative sleep, nourishing nutrition and exercise—has taken on new significance. I am in good health now, but what can I do to prolong it?
“After age 60, the burden of chronic disease sets in,” says Dr. Jennifer Pearlman, the willowy, gravitas-filled physician and founder of Ageless Vitality, a Toronto-based practice devoted to helping women age well. While Dr. Pearlman treats women of all ages, it’s the post-60 crowd who come to her with a “basket of symptoms and conditions”—ranging from turkey neck and sleeplessness to heart disease, diabetes and osteoporosis. When I look at my friends who are ten or fifteen years ahead of me, I see many who get around with walking aids, live with some sort of chronic disease and take multiple medications.
The health problems we experience as we age restrict the scope of our lives. Getting around is harder when we have a cane or walker, so we are tempted to stay at home. To be spared the occasional embarrassment of urinary incontinence, we might avoid socializing because we really might laugh so hard we pee our pants. (Less entertaining in practice than in theory, it turns out.)
If the body really is a vessel for the soul, than the health fears (or expectations?) our society has traditionally held about aging—that most of us will eventually become old, sick and infirm—necessarily equate to smaller, more subdued and restricted lives. And this is precisely the opposite of what I—indeed, most of us—want.
But if the fulfillment and vibrancy of the last third of our lives depend so much on health, and physical decline is a part of aging, what can we do to make a difference? The answer, according to health experts, is everything. We must do everything we can to not go gently into that good night.
In my case, it’s been time to “age proactively” for a good fifteen years. Montreal-based physician and geriatrician Dr. Cara Tannenbaum, who specializes in older women’s health, says the window of opportunity to begin shaping a healthy old age truly opens by around age 50. By the mid-sixties, if you haven’t taken a good, hard look at your lifestyle, well, you should. Or, as Dr. Pearlman puts it, “Leave the aging gracefully to your grandmothers. It’s time to age proactively.” Of course, you couldn’t be blamed for buying into the “aging gracefully” mantra. In this, as in so many aspects of our lives, we cannot truly look to our mothers for guidance. Had I asked my own mother, at age 60, what she was doing to “age proactively,” she would have laughed out loud.
It’s not that our mothers and grandmothers weren’t as bothered by achy knees and chronic disease as we are. But the last decade has seen huge advances in the understanding and treatment of aging-related illness and decline. Thanks to advances in the field of epigenetics, we now understand our DNA is no longer necessarily our destiny. Yes, knowing our family history is crucial in predicting the risk of diseases such as breast and ovarian cancer. But regardless of our genes, there is in fact a tremendous amount we can do to stave off physical decline and preserve our health for as long as possible. And that’s the key, really—preserving health for as long as possible.
If, like me, you’ve reached 65, chances are decent that you are in for a long life—if you’re a woman. According to Statistics Canada, 50 percent of women who live to be 65 are likely to live past the age of 85. (At which point there will be 2.5 women for every man, which may be a good or bad thing, depending on one’s view.) But as geriatricians warn, it’s one thing to have a twenty-year life expectancy; it’s quite another to have a healthy life expectancy. I don’t want to spend the next twenty years merely living. I want to be travelling, seeking adventure, basking in the sunshine, taking walks, going to plays, chasing my grandchildren and generally enjoying myself. I expect you do too.
To realize this dream, we’ll have to ensure we have the physical health to underwrite it. And that means dropping the laissez-faire attitude toward health that we held in our younger years, and cultivating a health-oriented mindset.
The Bad News
I prefer to ignore or bury bad news for as long as possible. However, in the spirit of change, renewal and general self-improvement, I’ll deal with the unpleasantness first. As we age, we face a host of threats to our health. This isn’t earth-shattering, of course. I don’t know of a single woman my age who doesn’t have some sort of health complaint. Except, perhaps, for my friend Dotty, who teaches bootcamp, has a formidable ability to resist sugar and still has the body of a 35-year-old. Dotty notwithstanding, the rest of us have some sort of health complaint we didn’t have five years ago.
The body has a stunning capacity to develop a myriad of weird, not-wonderful diseases, injuries and complications, but some are too common to ignore. They are the Geriatric Giants, which I list here, in random order: chronic disease, urinary incontinence, falls and polypharmacy. (Another common health concern in aging is cognitive impairment. We’ll discuss that topic at length in Chapter 7.) In the section that follows, we’ll look at these challenges—along with some others that you may not yet have considered. Brace yourself. The next section is a little like back labour; it will get worse before it gets better.
CHRONIC DISEASE
Chronic diseases such as cancer, heart disease, stroke and diabetes are estimated by the World Health Organization to kill 36 million people worldwide each year. Treating these chronic diseases soaks up roughly three-quarters of health care spending in the United States. And these scary numbers promise to get worse as our population ages. One in nine women will be diagnosed with breast cancer (the most common cancer for women) over the course of her life, and more than half of all those cases affect women ages 50 to 69, says Katarina Gagne of the Breast Cancer Society of Canada. And while screening and early detection have helped to reduce death rates from breast cancer to record lows—the five-year survival rate is now 88 percent—the numbers are still grim. Sixty-five Canadian women are diagnosed with breast cancer each day, and fourteen die from the disease each day.
I have watched many friends battle cancer, and have experienced the sense of powerlessness we all feel when we, or someone we love, is struck with the disease. It is true that some of the risk factors for breast cancer are outside our locus of control. For instance, simply being a woman over age 50 increases your risk. Being born with “dense breast tissue”—or heavy breasts—can increase your risk factor as well because lumps are often harder to detect in dense breasts. And finally, there is a genetic component. But even here, the reminder that our DNA is not our destiny is worth heeding. In 2013, the actress Angelina Jolie made headlines with her decision to undergo a double mastectomy after discovering she had the BRCA1 gene. Jolie’s mother died of breast cancer at age 56, and in an op-ed for The New York Times, Jolie stated her own doctors had told her she had an 87 percent risk for developing breast cancer and a 50 percent risk of developing ovarian cancer. Jolie assessed her odds and opted for surgery—a proactive approach that would have been unheard of a few decades ago. Her decision is an excellent example of how research can revolutionize the battle against chronic illnesses such as breast cancer. Much more is needed.
There are many other risk factors for breast cancer that fall well within our locus of control. Breakthrough research from the American Cancer Society that followed 73,000 post-menopausal women over seventeen years found in 2013 that an hour of vigorous walking per day reduces a woman’s risk of developing breast cancer by 25 percent. Controlling body weight and eating a balanced diet also help. (Indeed, diet and exercise are crucial in preventing all sorts of ills, as we explore later in this chapter.)
But as scary as the C word is for us, it may not be the most deadly of all the chronic diseases. According to 2008 data from Statistics Canada, that distinct honour goes to cardiovascular disease (i.e., heart disease and stroke), which is the number-one killer of women. When I heard this, I was surprised. Like many people, I’ve long associated heart disease with men—round-bellied, red-faced men with high blood pressure. But in fact, across much of the developed world, more women die of cardiovascular disease each year than men. Dr. Beth Abramson, a cardiologist and spokesperson for the Heart and Stroke Foundation, points out that while death rates from cardiovascular illness have decreased in men since the 1970s, more women are dying from heart disease than ever before. In part, this is because the population is aging.
Women enjoy some protection from heart disease before menopause. Estrogen is believed to regulate cholesterol in the body and dilate the arteries. But as estrogen levels drop after menopause, a woman’s risk for heart disease increases significantly. The trouble is, women are often the last to know. A survey from the Heart and Stroke Foundation found that only one in eight women surveyed understood that cardiovascular disease was her most serious health concern, and only one in three knew it was the leading cause of death.
Physicians suggest that women often under-report heart attack symptoms such as pressure in the chest, pain in the left arm, neck, jaw, shoulder or upper back, or abdominal discomfort; shortness of breath; right arm pain; nausea or vomiting; sweating; light-headedness or dizziness; and unusual fatigue. Because of this tendency, by the time women do show up in emergency rooms, heart damage may already have occurred.
In her book Heart Health for Canadians: The Definitive Guide, Dr. Abramson tells two patient stories that demonstrate just how lethal second-guessing symptoms can be. In one case, a 44-year-old woman with a family history of heart disease woke up in the middle of the night with heaviness in her chest. Her husband called 911, and when they arrived at the hospital, doctors discovered she’d had a heart attack. She was immediately treated and because she had acted without hesitation, she did not sustain any irreparable muscle damage to her heart.
Compare this experience to that of a busy 64-year-old woman who began feeling ill with nausea and severe indigestion in the lead-up to a major fundraiser she was planning. Halfway through the event she became so ill she had to go home to bed. Over the next three days she and her husband debated whether or not she should go to the hospital. When she did finally arrive at the ER, she had already suffered moderate damage to her heart, and she will never make a full recovery. Dr. Abramson suggests this “second guess” mindset could be partially to blame for the fact that women are more likely to die following a heart attack or stroke than a man. If you are experiencing symptoms of a heart attack, override your self-doubt and get thee to an emergency room, and prepare to kick up a fuss if you are told to go home and take a baby Aspirin. Not only do women under-report their symptoms, but also they are often under-treated within the health care system.
As Dr. Abramson reports in her book, women are not as likely as men to be treated by a cardiologist, and if they are treated at a smaller hospital, they are less likely to be transferred to a facility with a specialty cardiac care unit. Though these care gaps are diminishing, Dr. Abramson urges women to advocate on their own behalf. If you are presenting with symptoms of a heart attack, ask these questions: Could it be my heart? Do I need an angiogram or other test? Should I see a specialist? They may spur health workers to give you the care you need.
By the time you do have symptoms of heart disease, of course, the proverbial ship has sailed. Yes, many women do recover and change their lifestyles for the better. But wouldn’t it be best to avoid it in the first place? This is where understanding your risk factors can help.
Diabetes, smoking and a lack of physical activity can all increase your chances of cardiovascular disease. Metabolic syndrome—a worrying cocktail of belly fat, high blood pressure and blood sugar, and bad cholesterol—puts you at risk as well. Mental stress and depression—both of which are more common in women than in men—put increased stress on the heart, as do lower levels of estrogen. But while natural estrogen protects against heart disease, Dr. Abramson warns that hormone replacement therapy (HRT) is not the magic bullet. In fact, she points to studies that have linked HRT with increased risk of breast cancer, heart attack and stroke. It’s worth pointing out, however, that physicians are divided on its risks.
If you, like me, have any of the risk factors or symptoms I’ve just mentioned, talk to your doctor and ask the questions Dr. Abramson suggests. We explore later in this chapter steps you can take to eradicate the risk factors before they become a problem.
URINARY INCONTINENCE
The gifts of pregnancy, childbirth and menopause combine to make us twice as likely as men to experience urinary incontinence. Menopause and the resulting drop in estrogen and testosterone (yes, women have testosterone as well) reduce muscle mass significantly and shorten the urethral sphincter, causing it to stop closing properly. This, combined with weight gain, which puts pressure on the bladder, can cause urinary incontinence. The condition affects millions of women, as evidenced by the plethora of pads available in any drugstore. For some women, the problem is little more than an inconvenience. For others, it can be debilitating and prevent them from going out in public for fear of humiliation. Kegel exercises are a huge help. You know, those exercises we were instructed to do to prepare for labour but invariably neglected or forgot until a few days before our babies’ due dates? Yes, those Kegels. Strengthening the pelvic muscles is the best remedy for urinary incontinence. Surgery is another option for more serious cases.
Dr. Tannenbaum says she has seen women suffer for years before seeking treatment because they believe incontinence is an inevitable part of aging. “It absolutely is not,” she says. In fact, she warns against automatically accepting anything as a normal part of aging.
FALLS
When my grandchildren come to my condo for the weekend, I watch them fall dozens of times a day. Occasionally, one of them will have a cry-worthy tumble, but for the most part, they barely notice when they trip. Ah, the good old days. The older we get, the harder we fall.
According to the U.S. Centers for Disease Control, falls in older adults (both men and women) are the leading cause of fatal and non-fatal injuries, including traumatic brain injuries. Rates of fall-related fractures are twice as high for women as for men. This is partly explained by our relative lack of bone mineral density.
And when we are talking about a reduction in bone density and related bone fractures, we have to talk about osteoporosis. According to Osteoporosis Canada, fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined. At least one in three women will suffer an osteoporotic fracture during her lifetime, and as many as 90 percent of all hip fractures are caused by osteoporosis. The problem is that older adults who fall are four to five times as likely to be admitted to a long-term facility for a year or longer. But even if you don’t have to go and live in a treatment facility, the injuries you sustain from a fall are likely to curb your lifestyle considerably.
Diagnosis and prevention are important. Osteoporosis Canada estimates that without bone mass density (BMD) testing, 80 percent of patients with a history of fractures are not given proper therapies. Because of this, thousands of Canadians needlessly fracture their bones each year because their osteoporosis is undiagnosed and untreated. In this, as in most health concerns, it’s important not only to talk to your doctor, but also to ask for a BMD test. Osteoporosis is called “the silent thief” because the reduction in bone density is usually not detected until after a fracture has already occurred. Vitamin D is also helpful in staving off the disease.
What can you do to prevent falls? Exercise—especially exercise that cultivates balance, such as tai chi—is an obvious first step. Less obvious are getting your eyes checked regularly and reducing fall hazards like rugs, little side tables and possibly even (in my case) little furry cats named Aurora who adore hanging out just outside the bedroom door. In truth, while I am committed to enhancing my balance, I have yet to get rid of my rugs. I’m working on it, though (see Chapter 9, A Home of One’s Own). But Aurora is here to stay.
Closely related to falls is the general decrease in mobility we experience as we age. There are all sorts of reasons for decreased mobility—injury or illness, for instance. But one worryingly common cause is osteoarthritis. Joanne Simons, chief mission officer of the Arthritis Society, says there are currently 3 million Canadians living with osteoarthritis. “The burden is increasing,” she says.
Unlike the more than ninety other forms of arthritis, many of which affect young people as well as old, osteoarthritis tends to strike older adults. The disease generally rears its head with pain or burning in the joints. And though major advances have been made in the treatment of other forms of arthritis, such as inflammatory arthritis, there’s no cure for osteoarthritis—this degenerative condition gets worse each year.
The main course of treatment, says Simons, is to manage the pain and to feed the affected joints with lots of oxygen, which means movement. “It’s critical to keep moving,” says Simons. Unfortunately, because osteoarthritis is so painful, it’s common for the afflicted to avoid moving their joints to prevent pain—which not only worsens the disease, but leads to other problems. When people stop moving and doing their normal life activities, they become more prone to depression, and Simons says there is a link between osteoarthritis and depression for this reason. Safe sports such as walking, swimming or riding a bike can all slow down osteoarthritis. To reduce your risk of developing arthritis, maintain a healthy body weight. Obesity is the leading risk factor for osteoarthritis. Losing ten pounds can remove as much as four times the force on your knees, and slow down the advance of osteoarthritis. This is key, because roughly eighty thousand people per year receive joint replacements in Canada, and across the country wait times for these surgeries are long. The joint condition often has to be especially severe in order to make it eligible for surgery. Interventions such as exercise and diet have helped people come off the surgical list altogether, says Simons.
Despite lots of research and the growing prevalence of osteoarthritis, the condition is still misunderstood, says Simon. “We constantly hear, ‘My doctor said to live with it.’” She urges people to take that advice with a grain of salt. “Self-management is critical.” The Arthritis Society offers a range of workshops in managing chronic pain, weight and lifestyle to help people maintain a full life as they live with the condition.
Finally, we can’t very well discuss bones without discussing teeth. Oral care becomes more critical as we age. Over the last year, I’ve spent more time in the dentist’s chair than I care to admit. And far more money than I want to think about. Root canals, implants, you name it. I have paid and suffered in the dentist’s chair for it (I adore my dentist, but I really do suffer in that chair). Getting my mouth fixed is possibly the most grown-up thing I have ever done. There were far more exciting things I wanted to spend my money on. Not to mention that seeing a dentist ranks as one of the most traumatic experiences possible for me.
When I was 17, my family dentist sent me across the road to a dental surgeon for a root canal. He gave me laughing gas and then proceeded to touch me underneath my shirt. I was shaken to the core, too terrified to shout for help. When I emerged from the room, I told my mother not to pay the bill, but felt too sick to explain why. She paid the bill and we left, but I never mentioned the experience to anyone.
Years later I went to a dentist for an implant, which he performed without sedation. I remember lying in the chair, feeling the grinding of the drill in my toes. When he was finished I could barely move or speak. I didn’t return to the dentist for some time. But then my teeth started cracking. A few years ago I was walking in the park with a girlfriend. I bit down on an apple and lost part of my tooth. I just knew I had to do something before they all fell out. I had horrors of a set of teeth in a glass of water by my bed. So coached myself through the process of finding a dentist I could trust.
My rationale was that it’s better to have any dental work I need done now than later. In fact, Dr. Barry Dolman, a dentist and president of Ordre des dentistes du Québec, warns of the dire consequences of putting off tooth problems for a rainy day. He relates a story about a woman who complained of a problem tooth but elected to avoid treating it because it wasn’t posing a huge problem at the time. A few years passed. She then had a serious heart attack and was hospitalized and put on blood thinners. Around that time, her tooth began causing her extreme discomfort and interfered with her eating. But because she could not risk going off blood thinners and was in such poor overall health, her doctors and dentist told her she could not have her problem tooth fixed. “People sometimes wonder why I’m suggesting they get a crown at age 75,” says Dr. Dolman. “The reality is, they may need that tooth for another fifteen or twenty years.”
As we age, we face a number of threats to our teeth. The first is a condition known as dry mouth, when saliva production is suppressed. Saliva is crucial for balancing the pH levels in the mouth and protecting teeth from decay. Combine dry mouth with the tendency for gums to recede with age and expose roots, and you have an increased risk for cavities. The solution, says Dr. Dolman, is to be aware of the types of prescribed and over-the-counter medications that cause dry mouth, including antihistamines, antidepressants, antihypertensives, sedatives and diuretics. If you are taking these medications and experiencing dry mouth, Dr. Dolman recommends speaking to both your dentist and doctor about the condition. Chewing sugar-free gum can help stimulate saliva production.
Another challenge we face as we age is that decreasing mobility or agility can actually impede our dental hygiene. Using fluoride rinses is an excellent way to give your teeth the protection they need, says Dr. Dolman. Another concern of particular relevance to older women is a condition called osteonecrosis of the jaw. This is a condition where the jawbone becomes starved of blood, weakens and begins to die. In dental patients, the condition might not present until a patient has a routine dental surgery and discovers the jawbone isn’t healing properly. Dr. Dolman says that for some patients, there is a link between osteonecrosis and biophosphonates, drugs sometimes given to people suffering from osteoporosis. While osteonecrosis of the jaw is rare, Dr. Dolman says it’s a serious condition. Make sure you tell your dentist about all the medications you may be taking.
POLYPHARMACY
More and more, I notice an increasing reluctance in people to take pharmaceutical drugs in favour of alternative approaches to health. While I support any choices a woman makes to be healthier, I firmly believe that pharmaceutical drugs play a major role in keeping us healthy. That said, I know that, especially for those over age 60, a confluence of health complications means that many of us have enough pharmaceuticals in our drug cabinets to restore the health of a small army. And this is precisely why polypharmacy—the use of multiple drug medications—is such a cause for concern for older adults. Certified geriatric pharmacist Carla Beaton says that a person’s risks for adverse health effects increase as prescriptions are added. “The more drugs you take, the more interactions you are at risk of seeing.”
According to the Agency of Healthcare Research and Quality (a division of the U.S. Department of Health and Human Services), adverse drug events result in more than 770,000 injuries and deaths each year.
Polypharmacy reflects an overarching theme within the health care system of adding drugs but not necessarily taking others away. Beaton explains the cycle: “You experience a health problem, so you may add one drug. This causes a side effect, so you add another drug to address the side effect, which causes something else.”
It’s not uncommon for polypharmacy to happen gradually, as in the scenario Beaton explains above. But there’s another source of potential polypharmacy—a hospital visit to address a specific health issue. For instance, perhaps you have fallen and broken your hip. The hospital is concerned with fixing your hip and treating your pain—which is why the doctors might miss the fact that you’re on thyroid medication. While you’re in hospital, they stop giving you thyroid medication (it simply slips off the radar in the wake of the crisis of breaking your hip), and put you on powerful painkillers. You get out of the hospital, return home and take both your thyroid medication and the painkillers—and within a week or two you suffer an adverse drug reaction.
The best way to protect yourself from the ills of polypharmacy, Beaton says, is to meet with your pharmacist at least once per year to review all your medications. And if at any point you are prescribed another medication, meet with your pharmacist again for another review. “You want to develop a relationship with your pharmacist and see them as part of your health care team,” she says.
AGE AND GENDER BIAS
Another threat we face with respect to our health is one we don’t talk about nearly enough, in my opinion: bias. As much as I respect the medical system and owe a deep debt to Canadian physicians, there are ways in which the health care system is failing older women. As I pointed out in the section focused on heart disease, research has shown that women cardiac patients are less likely than men to be referred to a specialist, or to be transferred to a larger centre with a specialty cardiac unit. There are other examples of bias in the health care system, some of which I have experienced first-hand.
Earlier I mentioned the little skiing accident I had while sliding down the bunny hill with my grandson. Sacha took me to the local ER, and after three hours of nauseating pain, my shoulder was put back in its socket. I returned to Montreal and went to an orthopedic surgeon to have it checked out. He was a relatively young, self-satisfied man, who diagnosed me with an unstable shoulder. In other cases, he would recommend surgery to repair the damage, he said, but at my “advanced age,” he didn’t think surgery was worth it—the recovery would be slow and painful. I would simply have to live with the injury.
I went home feeling both dejected and enraged. I felt as though I had been insulted in a foreign language and lacked the ability to properly respond. Was 64 really too old for surgery? I was healthy, strong and had lots of energy. I didn’t really believe it would take me months to recover from the surgery. But he was a doctor, and I heeded his advice. Over the next eighteen months, I dislocated the shoulder five more times. For some months after my fall, I was barely able to lift my arm. To this day, the joint can cause me aching pain. I have since spoken to other doctors who have told me that as a strong, healthy woman, I’d be an excellent candidate for shoulder surgery, despite my “advanced age.”
I’m considering it, just as am I considering walking back to the hospital to find the doctor and lecture him on age and gender bias in health care, as well as the difference between chronological age and biological age. Many of the health experts interviewed for this book underlined the importance of focusing on your biological age. Some 64-year-olds may well be “too old” for shoulder surgery. I wasn’t one of them, though I also know it can take two years to heal completely.
Dr. Paula Rochon, vice-president of research at Women’s College Hospital in Toronto, suggests that one way to establish total equity in the health care system is to ensure women play a larger role in shaping research. “Women have not been as well represented in research,” she points out. “We need to make it easier to include more gender-based studies,” she says, which will build our understanding of women’s unique needs and physiology.
The Good News
It’s tempting to dwell on all the things that could go wrong with our health. But the resounding evidence is that we are in a position to be able to have a dramatic and positive influence on our overall health. And taking care of ourselves is actually quite simple. The three essential elements of health and longevity are restorative sleep, proper exercise and good nutrition.
SLEEP
Last year, after participating in a fundraiser for mental health sponsored by Shoppers Drug Mart and athletic wear retailer The Running Room, I debated with the company’s founder, John Stanton, on what was the most important element of maintaining health—sleep, exercise or nutrition. He argued for exercise, and I argued for sleep. I won the debate—in my estimation, at least. Sleep is vastly important for longevity and overall health, and plays a critical role in immune function, metabolism, memory and learning. Nevertheless, the intricacies of sleep—why we need it, and what specifically happens while we are resting—remain a mystery, says sleep specialist Dr. Raymond Gottschalk, medical director of the Hamilton, Ontario–based Sleep Disorders Clinic. For instance, Dr. Gottschalk points out that the body can recuperate very well with simple rest—lying down and doing nothing. Meanwhile, sleep is a “phenomenon of reversible unconsciousness for the brain, by the brain.”
The current popular “restorative sleep theory” suggests that it is the primary way our bodies restore and repair themselves. For instance, advocates maintain that a number of restorative processes, including muscle repair, tissue growth and protein synthesis, occur only when we are sleeping. Getting a good night’s rest is critical for cognitive function. During our waking hours, the brain’s neurons produce a by-product called adenosine. The buildup of adenosine is thought to contribute to making us feel tired. Only when we sleep does the brain have the chance to clean adenosine from our system, which is why we wake up feeling so refreshed.
Unfortunately, as essential as sleep is to our health, few women seem to be getting enough. Sleep quality frequently deteriorates after menopause, says Dr. Gottschalk. One of the reasons for this is a fragmenting of our natural sleep cycles. Every five or six minutes during sleep, the average person will “breach the surface of unconsciousness,” Dr. Gottschalk says—essentially becoming more sensitive to sounds, movement or light that might wake us up. This is thought to be an evolutionary tool to protect us from predators. While teenagers require a significant sound to rouse them—more than twenty decibels in some cases—older women become much more sensitive. In addition, because estrogen is a temperature stabilizer in the body, decreases can produce hot flashes that prevent us from sleeping well.
And while older adults appear to tolerate sleep deprivation better than younger adults, research suggests that many of us are looking for solutions to frequent night-waking. Dr. Cara Tannenbaum quoted research suggesting that 30 percent of older women in Quebec, the Canadian province where I live, take sleeping pills on a regular basis. And while sleeping pills may serve as a stopgap measure for sleeplessness, they do not allow for the restorative qualities of natural sleep. What’s more, because women cannot clear the medication from our systems as quickly as men, taking a sleeping pill at night can affect our ability the next day to complete activities that require one to be totally alert, like driving. Some physicians prescribe melatonin to help with sleep, but I have always preferred the old-fashioned way—sticking to a routine.
Almost every night, I follow the same pattern of activities to help my body anticipate sleep. I have a little snack. I start turning off the lights. I don’t watch the news, which is too much of a downer before bed. If I watch TV it is comedy. Doing the same thing night after night helps me to anticipate sleep. I try to get exercise each day because that always helps me sleep better. And I avoid alcohol and sugar at night, both of which interrupt my sleep. Nutrition plays a tremendous role in ensuring a sound sleep, and we explore sleep-enhancing diet in the next section.
Another important consideration is the amount of sleep you need. While studies suggest that most people need seven to eight hours of sleep, physicians who work with older women say not to fret if you find yourself waking up after only six hours. It’s common for older adults to require less sleep—especially if you are less stimulated and more sedentary than you once were. Rather than taking a sleeping pill to ensure you are getting your eight hours each night, you might consider exercising more or simply accepting that six hours of sleep is your new normal.
There are other things you can do to promote better sleep. One is to avoid screens before bed. Blue light makes us more alert and can delay melatonin production—which makes it harder for us to stay asleep. Working or doing any stimulating activity close to bedtime is also a no-no. “Sleep is a state of consciousness that is very easily influenced,” says Dr. Gottschalk. Finally, because rates of sleep apnea spike in women after menopause, often because of post-menopause weight gain, controlling your weight is another important piece of the equation.
EXERCISE
I can’t remember a time when I wasn’t being advised to get lots of exercise. However, the call to get one’s body moving becomes un-ignorable later in life. The benefits of exercise go far beyond feeling fit and strong. The British Women’s Health and Heart Study, which has followed 2,500 women since 1999, has found that regular exercise is a key factor in reducing a woman’s risk of major late-life disabilities such as frailty, heart disease and arthritis. According to the research, women who never exercise are twice as likely to develop arthritis and problems walking later in life. Exercise is crucial for maintaining a healthy body weight and maintaining the strength and stamina we need to live a full life deep into older age. But a major benefit of exercise is that it helps to reduce stress, making it an effective anti-aging tool.
And while exercise is crucial, it’s not a matter of any old exercise, says Dr. Cara Tannenbaum. “A lot of people tell me, ‘Oh, I’m getting enough exercise, I walk every day.’ The problem is, that doesn’t do anything for the muscles in your arm, or for your pelvic floor.”
A well-rounded exercise regime for an older woman includes three distinct focus areas: cardiovascular activity with agility work, strength training and balance exercises. This cardio/strength/balance trio works together to create a strong, balanced and healthy body that is more energetic, more resistant to illness and chronic joint problems such as osteoarthritis, knee and hip pain, and back problems, and less prone to falls and injury. The sooner you incorporate a well-balanced exercise program into your regime, the better.
Vancouver-based personal trainer Kate Maliha of Love Your Age Fitness specializes in exercise plans for older women. She compares two clients she works with, both of whom are in their midnineties. One woman—we’ll call her Maria—sought out Maliha recently, after she began experiencing serious difficulties walking, which had largely kept her homebound and, because of this, diminished her socializing considerably. Given what we know about the strong link between health and community, this social isolation in turn likely suppressed her overall health even more. Contrast Maria with another client I’ll call Alice. At age 95, Alice has been working with Maliha for more than fifteen years. She walks every day, and during her weekly training sessions goes through an intense combination of strength, agility and balance exercises. While Maria is housebound, Alice is continuing to work, has the stamina of a much younger woman and flies around the world delivering lectures and brushing off concerned offers for help with the stairs to the stage.
When it comes to aging and exercise, Maliha warns against allowing your chronological age to dictate what you can and can’t do. For instance, one pervasive myth about older women and exercise is that we can’t exercise hard. The truth is that, especially with the guidance of a professional who can help ensure you are doing exercises properly, women of all ages can work up a good sweat. The older you are, however, the more recovery time you’ll need between workouts.
For this reason, women over age 50 who have some degree of urinary incontinence may have trouble with high-impact cardiovascular exercises like running or bootcamps. In these cases, swimming, aqua-aerobics, biking or walking are all excellent alternatives. But in addition to these standard exercises, exercise specialists for older women suggest we begin integrating agility exercises into our workouts. These include ladders—the exercise popularized by football players that involves alternating high-knee steps moving forward and backward. One agility exercise Maliha uses with the 95-year-old globe-trotting Alice is a timed session in which Alice scoots around an exercise area picking up coloured balls and putting them on top of like-coloured pylons. This workout combines agility—stooping to pick things up, and avoiding stepping on the pylons—with cognitive function—matching the right balls to the right cones—all of which work together to create a longevity-enhancing workout.
Weight-bearing exercises too are critical for women over 50. Not only are we losing muscle mass, but we’re losing our fast-twitch muscles more quickly than our slow-twitch muscles. Slow-twitch muscles, which are more effective in burning oxygen to produce fuel, contribute to endurance—these are what you’d use should you decide to go on a spiritual quest and hike the Camino de Santiago trail through France and Spain, for instance. Fast-twitch fibres generate lots of power quickly—these are the fibres you might use should you have to run out of a burning building. The relatively speedy die-off of fast-twitch muscles after 50 is one of the biggest contributors to the lack of “pep” that older women might experience. And what might start as a sense of general slowing down—taking our time to get in and out of the car, for instance—can transform, over time, into the shuffling walk of the aged—and a lack of both the reaction time and explosive strength you need to catch yourself after you’ve lost your balance. For women closer to 50, weight-bearing squats or lunges can help cultivate fast-twitch muscles. Exercises that use higher weight but lower repetitions (eight lunges with ten pounds in each hand versus fifteen lunges with five pounds per hand) can also build explosive strength.
If you haven’t been on a regular weight regime in the past, Maliha recommends you seek out a trainer who specializes in working with older women before lifting heavier weights. But one simple exercise to build your power and explosiveness is simply to walk quickly up a ramp several times.
Balance work is largely preventive in your fifties and sixties, but it’s common by your seventies to have fallen, had a close call that scared you or be experiencing balance problems such as difficulty standing on one leg to put your trousers on. Balance issues are often worse for women who’ve spent a lifetime in heels—which cause the toes to permanently curl, the calves and Achilles tendons to shorten and the foot itself to narrow. Yet it must be said there are times when a good pair of high heels is essential to a woman’s well-being. I feel very sexy when I put on heels. In any case, wearing heels can significantly reduce balance and compromise ankle mobility, which increases your likelihood of tripping or injuring your ankles in older age. How do you prevent this? Aside from cutting down on heel time as much as possible, Maliha recommends balance exercises such as tai chi, gentle yoga and aqua-aerobics. Simple balance exercises you can do at home include standing in a wide stance with your legs apart and your feet directly in line with one another, so that your toes line up with the heel of your opposite foot. Once that becomes easy, try moving your gaze around, rotating your torso and even closing your eyes.
Even if we do manage weekly workouts targeting each of the cardio, strength and balance areas, we cannot rest on these periods of intense physical activity alone. As we get older, retire from work and cocoon in our homes, we are much more likely to lead sedentary lives. And there is a high price to pay for sitting still. Research headed by Dorothy Dunlop of Northwestern University, published in 2014, revealed that if you are 60 or over, each additional hour you spend sitting still each day doubles your risk of becoming disabled—no matter how much you exercise. The researchers defined disability as not being able to perform an important self-care task, such as getting dressed. So for instance, if you were to compare two 65-year-old women, one who spent twelve hours a day sitting and another who spent thirteen hours a day sitting, the thirteen-hour-a-day woman would be twice as likely to develop a disability. The study’s authors came up with a number of suggestions to avoid sedentary behaviour over the course of the day: standing up when talking on the phone, parking in the farthest spot from the door when shopping to encourage walking, taking short hourly walks around the house, and using the stairs rather than the elevator, when possible.
The problem, of course, is that it can sometimes be difficult to remember just how long you have spent being sedentary. If you are up for it, there’s lots of technology to help. The Fitbit—a plastic bracelet with embedded computer chips and sensors—tracks your sleep, the number of steps you take in a day, how much water you drink and how many calories you consume in a day. While something in me rebels against the idea of keeping such close tabs on myself, friends who have them swear by the rule that what is measured is usually accomplished.
NUTRITION
As a society we’re more conscious of diet than ever before. Though, I think we can take dietary constraints a little too far—almost everyone seems to be allergic to something. I recently saw a funny little sign that said it all: She’s either bipolar or lactose intolerant, I can’t tell which. I had a good laugh over that. But as skeptical as I can be about the rise of self-ordained sensitivity, I am a huge proponent of the notion that food is medicine. As we age we need a good balanced diet, high in vegetables, whole grains, fruits, proteins and dairy—as much as we ever did. But there are two types of food that older women need more than ever—and that we rarely get enough of, says Dr. Jennifer Pearlman.
The first is protein. Some researchers have suggested that many dietary guidelines underestimate just how much protein older women need in order to stay in optimal health. For instance, in the United States, the recommended daily protein intake for older women is 0.36 grams for each pound of body weight. But new research suggests we need much more than that. Dr. Pearlman advises her clients to eat 90 grams of protein a day—most women are getting less than half that. It doesn’t help that as we age, we usually eat less, even as our need for protein increases. Protein helps maintain muscle mass and fight off osteoarthritis-related decline as well as osteoporosis. Bottom line: eat more protein, whether you get it through lean meats, eggs, nuts, seeds or beans. Protein shakes are a simple way to boost your protein intake.
Another element our diets should include is DHA, the dietary fat found primarily in fish. DHA has an array of health benefits—it helps to nurture and preserve brain function, heart health, supple joints, a strong immune system and good eyesight. DHA protects against certain cancers and is an anti-inflammatory. And because DHA actually helps slow down cellular aging, it’s a longevity booster too. This miracle oil can be found in flax, chia and hemp seeds, as well as walnuts. I love to cook fatty fish such as salmon, but doctors say it doesn’t hurt to consume omega-rich oils by the tablespoonful as well. (For those of you still traumatized by a childhood that involved daily doses of cod liver oil, rest assured that the ensuing decades have seen the flavour of fish oils improve dramatically.)
The foundation of great nutrition, says personal nutritionist Theresa Albert, is controlling your blood sugar levels, and this process starts with a nutritious breakfast that contains at least 10 grams of protein and 10 grams of fibre. (I remember hearing this advice before, from cardiologist and TV host Dr. Mehmet Oz, who advised eating 10 grams of protein within thirty minutes of waking. The problem is that I mistakenly thought he said 30 grams of protein within ten minutes of waking. The next morning I woke up and ran to the kitchen, where I grabbed a small container of yogourt. It contained 3 grams of protein. I thought I’d have to eat ten of them each morning just to make my protein count. I went online and double checked his advice, and soon realized my mistake.) Albert recommends a “magic muesli” containing Greek yogourt and a mix of hemp seeds, chia seeds, fruits and nuts.
Fibre is often relatively deficient in our diets. In his fascinating talk “Sugar: The Bitter Truth,” Dr. Robert Lustig points out that fifty thousand years ago, our ancestors consumed between 100 and 300 grams of fibre each day. Today we consume on average 12 grams. Nutritionists used to think that the primary function of fibre was to fill the gut and turn off ghrelin, also known as the “hunger hormone.” But Albert says researchers now understand that as fibre is digested, it passes into the bloodstream and then triggers in the brain the production of leptin, the “satiety hormone,” which signals that the body is full.
Controlling blood sugar comes down to eating protein- and fibre-rich meals, and eating on a regular basis. “Most people wait far too long to eat,” says Albert. When they do, they experience a hunger crash, or a drop in blood sugar levels. The result is often a last-minute grab for a nutrient-low and calorie- and sugar-rich snack, like a pastry or a sugary granola bar. This causes blood sugar levels to spike, which then triggers a release of cortisol, the stress hormone. Cortisol not only suppresses the immune system, but also shortens the telomeres—little caps on the edge of our chromosomes that serve a range of functions, including promoting longevity. By controlling blood sugar levels and also eating lots of DHA, we can maintain the health of our telomeres, a crucial step in healthy aging.
It goes without saying that one of the best ways to control blood sugar is to reduce overall sugar intake. As much as I adore sugar, I know that when it comes to our health, it really is the devil. According to Dr. Lustig, a pediatric endochrinologist at the University of California, San Francisco, who specializes in treating obese children, the average American woman consumes 335 more calories per day than in 2004, mostly from sugary drinks. These sugary drinks, in turn, derive their sweetness from highfructose corn syrup. This particular type of sugar raises small LDL fat counts—which can lead to heart disease—but also suppresses leptin production, which essentially turns off the feeling of fullness. The more sugar we eat, the less able we are to feel full. And high sugar consumption can also lead to increased risk for Type 2 diabetes.
In 2014, this range of risks associated with high sugar intake prompted the World Health Organization to urge people to lower their sugar intake to less than 5 percent of daily calories. In fact, Dr. Francesco Branco, the head of nutrition for the World Health Organization, called sugar “the new tobacco.” For some of us, lowering sugar consumption to less than 5 percent of total caloric intake could mean major lifestyle changes that go beyond avoiding chocolate bars. Many of our staples, such as breads and cereals, contain sugar, as does wine. Theresa Albert points out that drinking two glasses of red wine could put you at the upper limits of sugar consumption for the entire day. One easy way to cut out sugar is to avoid sugary drinks altogether. (I’ll get to alcohol in a moment.)
Theresa Albert also recommends that older women take a daily magnesium supplement. She says that nutrient-depleted soils caused by commercial farming practices now mean that up to two-thirds of Canadians are magnesium deficient. Magnesium contributes to improvement in a number of body functions, including nerve-impulse conduction, muscle contraction and heart rhythm. I have used magnesium supplements for years to prevent leg cramps.
¶ A Note on Alcohol
I recently stopped at a liquor outlet to pick up a bottle of wine for a potluck and was astounded by the number of alcoholic drinks that were specifically marketed to women: SkinnyGirl Vodka, Cupcake wine and so on. As Ann Dowsett Johnston writes in Drink: The Intimate Relationship between Women and Alcohol, alcohol consumption by women is on the rise, and when it comes to problem drinking, “women are closing the gender gap.” The U.S. Centers for Disease Control estimates that alcohol is the leading cause of preventable death after tobacco and the combination of poor diet and inactivity.
Alcohol has increasingly deleterious effects on a woman’s body as she ages. Muscle mass is what helps us to metabolize alcohol, and as we age, we gradually lose muscle mass, thus diminishing our body’s ability to properly filter alcohol. Alcohol intake is also a risk factor for certain illnesses such as breast cancer. The Centers for Disease Control estimates that 23,000 women die each year from alcohol-related harms, half of which are related to binge drinking.
So how much is too much? Canada’s current safe drinking guidelines suggest that women should not consume more than ten drinks per week, with no more than two drinks in a sitting. Experts say the guidelines for older women should be lower than this, due to our decreased capacity to metabolize alcohol.
Alcohol consumption can lead to all sorts of health problems—for one, there are the adverse reactions with drugs, especially as we enter an age where we will likely be prescribed more medications. Alcohol consumption also compromises our balance, which can lead to falls and disabilities. And it can damage the stomach lining, liver and heart, increase the chance of some cancers and lead to poor sleep.
I still have a small glass of Scotch on occasion; after all, a Scottish heart surgeon told me on my television show that he “would not underestimate the medicinal value of a wee dram of Scotch”! Nevertheless, I firmly believe that at a certain age, women should be mindful of their alcohol consumption.
I could probably write an entire chapter about the health benefits of cannabis. Suffice it to say that cannabis offers myriad health benefits, especially when it comes to reducing pain. When I was suffering from acute pain related to my shoulder injury, I was prescribed cannabis in a pill form, nabilone. This offered the pain relief, minus the high. I took two before I went to bed, and for the first time in months was able to get a proper sleep.
I still enjoy the occasional joint. Pot is to me as the occasional glass of wine is to many others. I like the way I suddenly notice the colours of my flowers, the way I see the moon with fresh eyes. My imagination becomes more vivid and active, and I feel happy. I remember a few years ago talking to some leading psychiatrists after a talk I did. One of them said, in all seriousness, that the minute he entered a nursing home, he would make a plan with his kids to bring a bong to his window every evening at seven. He understood the pain-relieving and relaxational benefits of a little puff. While Aspirin is still, in my mind, the miracle drug (old school, but it works for me, to ease both headaches and joint pain), cannabis is a close second.
Lobby for Change
Taking charge of one’s health is simple: exercise, eat a protein- and DHA-rich diet, get proper sleep, and avoid alcohol and other harmful substances such as tobacco. But experts in older women’s health like Dr. Tannenbaum say that baby boomer women can have the biggest impact by working collectively to lobby for changes to the health care system that would benefit their cohort.
For instance, because women often outlive their husbands and thus end up spending years of their older life alone, services that assist them to access fitness classes would contribute to their overall health. The government pays for sleeping pills and medication, but what about cognitive or group therapies to give women the tools to deal with the emotional challenges of aging (which almost always manifest themselves in the body)? “Empowered baby boom women have the capacity to change the way health service are delivered and how money is allocated to preserve health,” says Dr. Tannenbaum. The time to lobby for a health system that truly supports older women isn’t when we are ill or disabled. The time is now.