Living Longer and Ageing Gracefully

130 years ago, our average life expectancy was around 47 years for men and 51 for women. Thankfully, we’re living longer, healthier lives than our ancestors! These days, our current life expectancy is 80 years for men and 85 years for women. In centuries past, acute infections were our leading cause of death, but this is no longer the case. This change is due, in large part, to the advent of antibiotics and vaccinations, but we’ve also had to educate ourselves about hygiene and implement appropriate changes, personally, socially and on a government policy level. 

The current leading cause of death for most Australians over the age of 65 in Australia is coronary heart disease (CHD). In second place, we have cerebrovascular disease (which includes stroke). Third is dementia and Alzheimer disease, followed by lung cancer and chronic obstructive pulmonary disease (COPD). The fifth leading cause of death is bowel cancer, also known as colon or colorectal cancer). And while we have modern medicine coming to our rescue once again with surgery and medication, much of the power to prevent, and sometimes even treat these diseases, lays in our own hands.  

	AGE 65-74	AGE 75 – 84	AGE 85 and over
1ST LEADING CAUSE OF DEATH	LUNG CANCER	CORONARY HEART DISEASE	CORONARY HEART DISEASE
2ND LEADING CAUSE OF DEATH	CORONARY HEART DISEASE	DEMENTIA AND ALZHEIMERS DISEASE	DEMENTIA AND ALZHEIMERS DISEASE
3RD LEADING CAUSE OF DEATH	CHRONIC OBSTRUCTIVE PULMONORY DISEASE	CEREBROVASCULAR DISEASE	CEREBROVASCULAR DISEASE
4TH LEADING CAUSE OF DEATH	CEREBROVASCULAR DISEASE	LUNG CANCER	CHRONIC OBSTRUCTIVE PULMONORY DISEASE
5TH LEADING CAUSE OF DEATH	BOWEL CANCER	CHRONIC OBSTRUCTIVE PULMONORY DISEASE	HEART FAILURE

Coronary heart disease 

Our number 1 leading cause of death in Australia is Coronary Heart Disease. CHD occurs  when the blood vessels inside our heart become narrower and less flexible due to fatty material building up inside them. This fatty material, called ‘plaque’, builds up slowly, often starting when we are young and becoming well advanced by middle age. This disease process is called ‘atherosclerosis’ or more commonly, ‘hardening of the arteries’. 

Our blood transports oxygen and nutrients to cells throughout our body, so when coronary arteries narrow due to atherosclerosis and less blood is flowing through them, our heart cells are starved of oxygen and nutrients. This is what causes the chest pain and discomfort of angina. When our blood vessels become stiff due to atherosclerosis, this brittleness makes them vulnerable to damage, especially if the plaque becomes ‘unstable’. Unstable plaque contains more fat and has a thinner surface that becomes inflamed and can split open. When blood cells try to seal this crack with a blood clot, the clot can be large enough to completely block blood supply to the heart. This can cause a heart attack, which can be fatal

The most common symptoms of a heart attack include:

• pressure or tightness in the chest
• pain in the chest, back, jaw, and other areas of the upper body that lasts more than a few minutes or that goes away and comes back
• shortness of breath
• sweating
• nausea
• vomiting

Cerebrovascular Disease 

Another part of the body atherosclerosis can affect is the brain. Cerebrovascular disease is defined as any disease that affects the health of the blood vessels that supply the brain, with brain cells dying due to a loss of oxygen and nutrients. Stroke, transient ischemic attack, aneurysms, and vascular malformations are all types of cerebrovascular disease.

Urgent medical attention is needed if anyone has symptoms of a cerebrovascular attack, because losing blood supply to the brain can have long-term effects, such as cognitive impairment and dementia. A stroke is the most common cause of death from cerebrovascular disease, with I in 3 people dying within a year of having a stroke. 

The acronym F.A.S.T. is a helpful, quick way to recognise the warning signs of stroke:

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call 000

Other symptoms can include problems with vision, dizziness, loss of balance, or a sudden, severe headache. It’s predicted that Australians will suffer more than half a million strokes in the next ten years.

Dementia and Alzheimer’s Disease 

Dementia is not a single specific disease, it’s a broad umbrella term that includes over 100 different diseases that impair brain function, such as Alzheimer disease and vascular dementia.  The early signs of dementia are subtle and hard to spot, but some common symptoms may include progressive and frequent memory loss, confusion, personality changes, apathy and withdrawal, and losing your ability to perform everyday tasks. 

Research studies have consistently shown that people with dementia have an increased risk of death. In 2016 in Australia, there were approximately 354,000 people with dementia, almost all of whom were aged 65 and over (93%). This number is predicted to more than double by the year 2046 to around 833,000. A history of heart attacks, strokes, or head injury can increase your risk of dementia, while staying mentally active helps reduce your risk. 

Lung Cancer and COPD 

In Australia, lung cancer is the leading cause of cancer death, responsible for almost one in five cancer deaths in Australia. The five-year survival rate for lung cancer is 17%. Symptoms of lung cancer can include shortness of breath and wheezing, hoarseness, chest pain, coughing or spitting up blood, a new cough that does not go away, recurring bronchitis or pneumonia, loss of appetite, unexplained weight loss and fatigue.

COPD stands for “Chronic Obstructive Lung Disease”. Usually diagnosed in middle-age or elderly people, COPD can also affect younger people. As with lung cancer, the longer our lungs are exposed to cigarette smoke or other inhaled irritants such as air pollution and chemical fumes, the higher our risk for developing this disease. Sufferers have difficulty with breathing, usually as a result of emphysema combined with chronic bronchitis. The difficulty with breathing slowly gets worse over time and is often eventually fatal. 

Bowel Cancer 

Bowel cancer, also known as colorectal cancer, is the most commonly diagnosed cancer in Australia for people aged 65 and over. We have one of the highest rates of bowel cancer in the world! It’s estimated that the risk of an individual being diagnosed with colorectal cancer by their 85th birthday will be 1 in 13 (1 in 11 males and 1 in 15 females). The colon is the first 1.8 metres of the large bowel, while the rectum is the last 15cm, which ends at the opening on the anus. 

Bowel cancer is usually a slow-growing cancer, and there often aren’t any symptoms in the early stages of the disease. The main modifiable risk factors are smoking, eating red meat (especially when charred), eating processed meats (smoked, cured, salted or preserved), drinking alcohol, physical inactivity, and being overweight or obese. 

Risk Factors

So what are the risk factors for these leading causes of death? As with all diseases, there are some risk factors we can’t do much about, such as having a family history, but let’s take a look at the most common risk factors we do have some control over:

	CORONARY HEART DISEASE	CEREBRAVASCULAR DISEASE	DEMENTIA & ALZHEIMER’S DISEASE	LUNG CANCER & CHRONIC OBSTRUCTIVE PULMONARY DISEASE	BOWEL CANCER
Cigarette Smoking	✅	✅	✅	✅	✅
Lack of Regular Exercise	✅	✅	✅		✅
Being Overweight	✅	✅	✅		✅
Unhealthy Diet	✅	✅	✅		✅
Heavy Drinking	✅	✅	✅		✅
High Blood Pressure	✅	✅	✅
High Blood Cholesterol	✅	✅	✅
Diabetes	✅	✅	✅
High Homocysteine Levels	✅	✅	✅
Depression, Social Isolation, Lacking Social Support	✅	✅	✅

Become a Non-Smoker 

Tobacco smoking is one of the main preventable causes of death and disease in Australia. Smokers have an increased risk of a wide range of health conditions, including heart disease, diabetes, stroke, cancer, renal disease, eye disease and respiratory conditions such as asthma, emphysema and bronchitis. Never forget that second-hand smoking (breathing in someone else’s smoke) can be damaging for your health, even if you aren’t a smoker yourself!

Part of the problem with smoking is that it contributes to atherosclerosis by damaging blood vessels walls. As if this wasn’t bad enough, carbon monoxide in tobacco smoke reduces the amount of oxygen in your blood. This alone would force the heart to work harder, but to top it all off, nicotine makes the heart beat faster and raises blood pressure. As a result, a smoker’s risk of heart attack is twice that of a non-smoker, and they are 3x more likely to die from sudden cardiac death. A smoker’s stroke risk is 3x higher than average and they are 20x more likely to suffer from angina (heart pain). 

When the blood vessels being damaged by atherosclerosis are those supplying the arms and legs, this results in a condition known as Peripheral Vascular Disease (PVD). While some people can have PVD without the usual symptoms of pain, the most PVD symptom is intermittent severe pain, usually in the leg, hip or foot while walking or climbing stairs. In the later stages of PVD, open sores in the legs and feet that won’t heal can progress to gangrene. In severe cases, amputation may be necessary. Smokers are 5x more likely to suffer from PAD. 

If you are a smoker and are ready to quit, thinking about quitting, or want to help someone else to quit, talk to your doctor or health practitioner about giving up smoking, or call the Quitline on 13 7848 or visit the Quit website. As the National Health Foundation says on their website, don’t give up! “Many people slip up after they quit and start smoking again. 

Don’t see this as a failure. Instead, think about what made you smoke again. How can you deal with this situation next time? What worked and what didn’t work? Learn from this and try quitting again. You become better at quitting each time you try.”

Twenty minutes after quitting, your heart rate and blood pressure will drop. After a few weeks, your blood circulation and lung function will improve. After a few months, the “sweeper cells” in your lungs that clean the lungs, remove mucous and reduce the risk of infection start to regrow. One year after quitting, your risk of heart attack or stroke is reduced by half. And in 5 to 15 years, your risk of stroke and coronary heart disease will return to that of someone who has never smoked. 

Be Physically Active

A lifelong habit of not participating in enough sport and physical activity can lower life expectancy and quality of life. Are you doing at least 30 minutes of physical activity most days of the week? If you aren’t, you are being physically inactive. In Australia, physical inactivity is ranked second only to tobacco smoking, in terms of the negative effect it has on disease and poor health. 

Being physically inactive increases your risk of breast and bowel cancer, depression and anxiety, and doubles your risk of cardiovascular disease, type-2 diabetes and obesity. On the flip side of the coin, getting your body moving can help improve your mental and musculoskeletal health, and reduce your blood pressure and cholesterol levels. Just 10 minutes of activity three times a day can make all the difference! This is one of the very best forms of medicine for treating stress, low energy, poor concentration and insomnia. 

Any activity is better than none. You can begin with something as simple as sitting less. From here, start walking more. What would be fun for you? Do you like gardening, dancing, or team sports? Make sure you talk to your doctor before starting an activity program, especially if you have heart problems, you smoke, you’re overweight, have high blood pressure or cholesterol levels, or you’re pregnant. In the long run, aim for 150 minutes of moderate intensity or vigorous activity each week, and do muscle-strengthening activities at least two days of the week. 

Maintain a Healthy Weight

Based on data from the 2014–15 NHS, 72% of people aged 65 and over were overweight or obese. The proportion of people who are overweight or obese in Australia seems to increase with age, peaking at ages 55–64 for men and at ages 65–74 for women. 

Being overweight puts you at greater risk of dying younger and having a lower quality of life in the meantime. Obesity works hand in hand with physical inactivity and an unhealthy diet, functioning as a major cause behind many of the risk factors leading to an earlier death, such as high blood pressure, diabetes and high blood cholesterol. 

You can quickly check whether your weight is in a healthy range by calculating your Body Mass Index (BMI), a measuring system that can be used for both men and women, aged 18 or older. Your BMI is your body weight in kilograms, divided by the square of your height in meters. For example, if you weigh 75kg and you are 175cm tall (1.75m), your BMI = 75 / (1.75 x 1.75) = 24.5.

Your BMI will fall into one of four categories:

BMI (kg/m2)	Classification
Less than 18.5	Underweight
18.5 to less than 25	Normal weight range
25 to less than 30	Overweight
30 or more	Obese

Another way to assess your risk of developing obesity-related chronic diseases is to measure your waist circumference. A higher waist measurement is linked with an increased risk of chronic disease. The risk levels presented below are for Caucasian men; and both Caucasian and Asian women.

	Increased risk	Substantially increased risk
Men	94 cm	102 cm
Women	80 cm	88 cm

Improve your Diet

It’s remarkable how quickly cardiac patients improve when placed on a plant-based diet! Whole plant foods such as fruit, vegetables, wholegrains, and legumes contain valuable fibre and nutrients that help us maintain a healthy weight while also protecting us from a wide range of diseases such as heart disease, atherosclerosis, high blood pressure, high cholesterol, type 2 diabetes and depression. Did you know that citrus fruits, for example, can help strengthen and repair your arterial walls and improves your blood circulation? Or that walnuts are beneficial for diabetics with poor circulation, and can help lower high blood pressure levels?

Some of the foods that can be most damaging for our health include red and processed meats, saturated fats and sodium (salt) from animal products, and trans fats and sodium in processed foods. Processed meat, for example, appears to increase the risk of COPD, which has researchers wondering if the nitrate preservatives in meat mimic the lung-damaging properties of the nitrate by-products from cigarette smoke. 

The World Health Organisation estimates that insufficient intake of fruit and vegetables causes around 14% of gastrointestinal cancer deaths, 11% of ischaemic heart disease deaths and 9% of stroke deaths. The National Health and Medical Research Council (NHMRC) recommends that adults have 2 servings of fruit and 5 servings of vegetables every day, but based on data from the 2014–15 NHS, most Australians (95%) reported not eating enough fruit and vegetables to meet these recommended guidelines. Those over the age of 65 are doing a little better, with 8% of them meeting the guidelines compared with only 5% of those in younger groups. 

It’s never too late to go vegan by the way! Adopting a healthy whole-foods plant-based diet in older age can help protect you from all of the leading causes of death and disability. Many of us don’t realise that whole plant foods are full of powerful, naturally occurring plant chemicals, many of which are antioxidant, anti-inflammatory, and anti-cancerous. Take broccoli for example: one study showed that broccoli-eating cigarette smokers suffered 41% fewer DNA mutations in their bloodstream over a 10-day period, thus decreasing their risk of lung cancer. Another showed that just one extra serving of fruit per day could translate to a 24% lower risk of dying from COPD.

Putting a bit of work into making sure your plant-based diet is healthy and well-balanced can put a sparkle in your eyes and a spring in your step that makes you feel 10 years younger! As Dr Bernard from the Physicians Committee of Responsible Medicine says, “Plant-based diets are the nutritional equivalent of quitting smoking.” 

Cut down on your Drinking

Every time you drink an alcoholic drink, your heart beats faster and your blood pressure goes up. Over the long term, too much alcohol can contribute to high triglycerides, unhealthy cholesterol levels, high blood pressure, a weakened heart muscle and irregular heartbeat, all of which increases your risk of heart attack and stroke. 

While healthy men and women are advised to drink no more than two standard alcoholic drinks a day, anyone who is obese or suffering from high blood pressure, heart failure, cardiovascular disease, coronary heart disease, liver disease or diabetes, should consider drinking less or becoming a non-drinker. Talk to your doctor to find out what is right for you.

A standard drink is a unit of measurement, and in Australia, this is measured as any drink containing 10 grams of alcohol. One standard drink always contains the same amount of alcohol, regardless of container size or alcohol type (beer, wine, or spirit). Different alcoholic drinks have different strengths, so it’s important to check product labels for more information.

To reduce your alcohol intake, alternate each drink with tap or mineral water and consider diluting your drinks with tap or mineral water. Use only half-measures of spirits, and choose low-alcohol wines and light beers. When you are thirsty, drink cold water instead of alcohol. Don’t forget that alcohol contains calories that can contribute to weight gain while also making you feel full and disinterested in eating healthy foods. 

Lower your Blood Pressure 

High blood pressure – also known as hypertension – is a major risk factor for stroke, coronary heart disease, heart failure, and peripheral vascular disease. Blood pressure is measured by comparing the level of systolic pressure (pressure in the arteries when the heart beats, pumping blood into the arteries) with diastolic pressure (pressure in the arteries when the heart is relaxed between beats), expressed as millimetres of mercury (mmHg). The World Health Organization (WHO) defines blood pressure of 140/90 mmHg or more as high.

Based on data from the ABS 2014–15 NHS, 1 in 2 people aged 75 and over had high blood pressure (42% for men and 51% for women) compared with 42% among people aged 65–74. Why is high blood pressure such a big problem? Probably because there are so many lifestyle factors conspiring to push it up, such as smoking, obesity, physical inactivity, excess alcohol consumption, too much sodium in our diet, and stress. There are, of course, other factors at play that we have less control over, but it helps to know there are steps we can take to lower our blood pressure side from relying solely on medication. 

Take sodium, for example, which is often referred to as “salt”. The 2011–12 AHS showed that most of the population exceeded the UL for sodium. You can reduce excess sodium in your diet by avoiding milk, cream, eggs, meat, and processed foods. Sodium occurs naturally in whole plant foods, but it doesn’t cause a problem for us due to the small quantity and the accompanying synergistic nutrients that keep the sodium in balance and help the body process it. The fibre in unprocessed plant-based foods has the added benefit of containing fibre, nitrates and… which helps to lower blood pressure. Some particularly helpful foods for high blood pressure include beetroot, legumes, wholegrains and leafy greens such as basil, lettuce, coriander and silverbeet.  

Maintain Healthy Blood Lipid Levels

Blood lipids are fats in the blood, such as cholesterol and triglycerides. When our blood lipids are in an unhealthy range, this is called dyslipidaemia. In the ABS 2011–12 Australian Health Survey (AHS) it was found that the prevalence of dyslipidaemia was generally increasing with age, peaking in the 65–74 age group, where 1 in 3 had high cholesterol while 1 in 7 had high levels of triglycerides. 

Did you know that high cholesterol levels in mid-life and late-life can increase the risk of Alzheimer’s disease? There are two types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL cholesterol contributes to atherosclerosis by forming part of the plaque that’s laid down inside arteries, while HDL cholesterol helps the body remove cholesterol and makes it harder for plaque to form in the arteries.

Saturated and trans fats in the diet tend to increase LDL cholesterol in the blood. Saturated fat in our diet primarily comes from animal products (butter, meat fat, beef, lamb, chicken skin and full cream dairy foods), and processed foods like pastries and biscuits. Trans fatty acids are manufactured fats used by the food industry for use in products such as cakes and biscuits. Most monounsaturated and polyunsaturated table margarines sold in Australia have very low levels of trans fatty acids, making them a better choice than butter, which is a very rich source of saturated fat. As a dairy product, butter also contains naturally-occurring trans fatty acids. These trans fats tend to increase the LDL cholesterol.

The best cholesterol-balancing foods are whole plant foods rich in fibre. If you want healthy cholesterol levels, switch out the animal products and processed junk foods for plant foods such as beans, oats, nuts, berries, kale, garlic, onions, brown rice and whole wheat. Plant-based diets have been shown to lower cholesterol as effectively as statin drugs, but without the risks. 

Prevent and/or Manage Diabetes 

Diabetes is a chronic condition characterised by high levels of glucose in the blood, caused either by the body’s inability to produce insulin (a hormone produced by the pancreas to control blood glucose levels), or by the body not being able to use insulin effectively. Diabetes can result in a number of acute and chronic health conditions, including heart attack and stroke, and recent study found that having diabetes increases the risk of developing Alzheimer’s disease by 65%. 

There are 3 main types of diabetes: gestational diabetes in pregnancy, Type 1 diabetes which is an autoimmune disease that can occur at any age (usually during childhood and adolescence), and type 2 diabetes which is largely associated with modifiable lifestyle risk factors. Each type can be managed with a combination of medication and lifestyle changes. You are at greater risk of type 2 diabetes if you have a high body mass index (BMI) and high blood pressure, and this risk increases with age. Up to 90% of those with diabetes are overweight, so physical activity and diet have a big role to play when it comes to prevention and cure!

Those eating plant-based diets appear to be better at producing and using insulin. They have better insulin sensitivity, better blood sugar levels, and better insulin levels. In fact, people have been known to completely reverse type 2 diabetes using a plant-based diet, and in randomised controlled clinical trials, vegan diets are proving more effective than conventional treatment diets for type 2 diabetes. What do these successful dietary treatment programs have in common? They are consistently rich in fibre, phytochemicals, and antioxidants from whole foods while being low in saturated fats and free from trans-fatty acids and cholesterol. 

Reduce High homocysteine levels 

Homocysteine is a natural by-product of many metabolic reactions occurring in our body, but when we have too much of it, it can damage our blood vessel walls, triggering blood clots, oxidative stress and inflammation. High homocysteine levels have been shown to be highly predictive of cardiovascular disease and coronary events such as heart attacks, and some studies have found that high homocysteine levels are associated with an increased risk of Alzheimer’s disease and other dementias. 

Poor folate, vitamin B6 and B12 levels are associated with elevated homeocysteine. Vegans tend to have excellent folate and B6 status because of their plant-rich diets, but they must be supplementing with vitamin B12 to avoid a deficiency. If testing shows your serum B12 levels have dropped below 400pg/ml, you should ask to have your homeocysteine and serum methylmalonic acid (MMA) levels checked. There appears to be a link between elevated homocysteine and poor omega 3 fatty acid status, especially in those who have high blood levels of adrenic acid, a long chain omega-6 fatty acid, and low blood levels of docsahexaenoic acid (DHA), a long-chain omega-3 fatty acid. 

Include plenty of leafy greens in your diet, along with small amounts of nuts, seeds, sea vegetables, olives, avocados, and soy. Some of the most useful omega sources include chia seeds, hempseeds, flaxseeds and walnuts, but don’t overdo it! If you are vegan, avoiding trans-fatty acids; smoking; excessive use of refined oils, caffeine, and alcohol; a high fat diet; and chronic diseases such as diabetes, hypertension and dyslipidaemia will help your omega status. 

Address loneliness, social isolation, depression and stress

Adults with few social contacts and those who feel lonely, have an increased risk of dying younger. It might be tempting to downplay this risk factor, but the science is clear: the influence of social relationships on mortality is comparable with other well-established risk factors, including physical activity and obesity. The only thing is, we’re just not entirely sure why, but researchers do have some theories. 

When people feel lonely or they are socially isolated, they are less likely to look after themselves well. Loneliness has been linked to lower self-esteem and limited use of healthy coping methods, with statistics showing that lonely people are more likely to smoke and be physically inactive, for example. Poor social relationships are associated with a 29% increase in the risk of coronary heart disease, and a 32% increase in the risk of stroke. Feeling lonely or being socially isolated is also associated with defective immune functioning and higher blood pressure. 

Chronic stress can potentially lead to anxiety and depression, as well as to physical health issues such as high blood pressure. For the elderly, most of the chronic stress they are grappling with arises from serious illness and the death of a loved one. To lower stress levels, it can help to implement stress management strategies, such as relaxation, physical activity, time management and social connection. By the way, it does not seem to matter if you enjoy being alone and never feel lonely in your own company: social isolation can be as bad for you as smoking and obesity when it comes to damaging your health! So make sure you step our of your comfort zones by nurturing your relationships and your social skills. A wonderful way to do this might be to find other people to exercise with, or share a meal with.