What We Mean By Healthy Aging

by Nina

Melitta teaches "Granny Yoga" to her mother,  aunt, and aunt's friend

For us, the life story of our friend Melitta’s mother Nancy is a perfect example of “healthy aging.” Born in San Francisco on December 12, 1921, Nancy died on August 27, 2015, age 93 (or 93 and a half as she liked to say). She was very active all her life. She played sports in school, and was her high school and college track and field champion in shot put and discus. She loved skiing, sailing, hiking, horseback riding—all things outdoors. She even worked as a wrangler at ranches around California. 

Even in her last years, she walked three miles every morning with her walking buddies Elaine and Ellen, power walking along the beach and greeting the other regular walkers. She did have some back problems with spinal stenosis, so Melitta gave her a yoga mat and some back care yoga poses to do. Nancy did them faithfully every morning, and was so pleased that they really improved her back.

Nancy also loved traveling, and during her lifetime, she traveled around the world, visiting every continent. In 2011, she returned to her favorite country, Turkey, and traveled around Eastern Turkey. In 2012, she did her last safari in Africa, and then gave up long haul travel, though she continued to travel within the US to spend time with family. She volunteered at her church until about age 91, and had an amazing network of friends and family. 

She lived independently in her apartment until her last few days. At age 90, she had made her own decision to stop driving. Although she didn’t have any hired help, her friend Elaine, a true force of nature, looked in on her regularly (and considered it an honor to do that). Elaine also helped her by taking shopping after she stopped driving and would send her husband Lloyd over to help her with tech stuff, such as her computer and printer. 

It was only in the last year of her mom’s life that Melitta noticed her mom was slowing down. She and Melitta did discuss her fear of decline, and Melitta’s fear of her decline. She had some gallbladder issues, and in July 2015 she had a bile duct blockage and had surgery. Then, in August 2015, she had emergency surgery for gallstones, but she also developed sepsis. She was in ICU for four days, and although doctors "threw all the antibiotics" they could at her, her organs were failing, so the family followed her directives and discontinued care. When Melitta first got to the hospital, Nancy was still conscious but unable to speak because she was intubated. In the joking way they had with each other, Melitta said, "it must be bad if I am here." Nancy laughed as best she could. She died two days later, with her children holding her as she moved on. 

In our post What is Healthy Aging, Anyway?, we defined what we mean by "healthy aging," describing its three basic components:

Compressed Morbidity. This is the time out of your life span that you spend in ill health. Nancy had a lifetime of excellent health, with some slowing down and her only serious problems limited to her last year of life. (This is generally the best-case scenario for people who live as long as she did.)

Independence. This means not just being able to live on your own, but being able to continue to do the activities that you love and that give your life meaning. And Nancy was not only able to stay in her home until the end of her life, she was able to keep up her active life almost until the end, including walking on the beach with her friends, traveling, volunteering at her church, and spending time with friends and family.  

Equanimity. This means being able to face difficulty and handle challenges with balance and grace. Although there’s much we don’t know about her life and how she faced earlier challenges, we think it’s worth considering how Nancy dealt with the challenges of being older. It sounds like she faced them head on! She realistically decided to stop overseas travel and driving when the time was right. And she was able to discuss her fears of decline and to confront her death. That allowed her to leave directives for her family and to die on her own terms. Finally, being able to laugh at her daughter’s joke at the very end sounds like she was she was able to stay engaged in life and family for all her days. How beautiful!

Thanks, Melitta, for sharing this story with us.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect 

Read More

A Declaration of Independence!

by Nina

Centennial of Independence by Henri Rousseau

In my old post What is Healthy Aging, Anyway?, I wrote that Baxter and I believed that “healthy aging” had three aspects to it: compressed morbidity, independence, and equanimity. Today I thought I’d focus on independence, on what it means and how yoga can help you maintain your independence as you age.

When medical professionals talk about maintaining independence, they usually focus on our ability to keep living in our own homes and take care of ourselves as long as possible. So they tend to focus on basic daily self-care activities, such as dressing, going to the toilet, getting up and down from a chair, doing light housework, and so on. But Baxter and I think there are two more important aspects to staying independent. 

The first is the ability to continue to do the activities we love (which I wrote about in my post Being Able to Do What You Love) for as long as possible. This can include activities that we think of as being primarily physical, such as cycling, hiking, doing construction projects, or gardening, but it also includes activities that get us out of the house and into the world, such as attending concerts and theatre, art exhibits, and poetry readings, or joining family and other social gatherings. Finally, being independent means being able to continue with doing the work that gives shape to your days and allow us to keep our intellects fully engaged, whether that means writing poetry and playing music, keeping up with a law or science career, or teaching in your area of expertise.

Beyond doing what we love, another quality of life that makes life worth living as we age is dedicating ourselves to a cause beyond ourselves. According to Josiah Royce, a Harvard philosopher from the early 20th century, the cause could be large, such as one’s family, country, or a principle, or small, such as the care of a pet. Atul Gawande says in his book Being Mortal, “The important thing was that, in ascribing value to the cause and seeing it as worth making sacrifices for, we give our lives meaning."

This concept fits well with karma yoga (see Altruism (Karma Yoga)), which can include community activities, such as, volunteering a food bank or an animal shelter, teaching low-cost or free yoga, or helping people learn to read and write. And Ram has written that caregivers, who give their time to family members, are true karma yogis (see Caregivers: The True Karma Yogis). 

Obviously, if basic self-care is all you are physically capable of, you’re going to be missing out on many of these activities. So for a truly independent life, you’ll need a combination of physical skills, including strength, flexibility, balance, and agility. A regular asana practice—even one that is modified over time—will help keep you able bodied, rather than sliding into the stiffness and weakness that results from a sedentary lifestyle. But rather than just doing any old yoga, such as Restorative Yoga all the time, we believe that focusing specifically on the four essential physical skills is the most effective way to maintain your independence. Although we’ve written about the four essential skills individually, we’ve never addressed them together (at least not so I can find them). So today I’m going to give a quick overview of each one along with a link to a post where you can find more information.

Strength. You need physical strength simply to get out of bed, stand well and move about your home, community, or work space in easy fashion and to carry what you need to take along with you. Even more strength is needed for more demanding physical practices, such as participating in athletic activities. You can use your asana practice to cultivate upper strength, lower body strength, core strength, and bone strength. Maintaining strength also helps you stay healthy, as maintaining muscle strength helps combat sarcopenia and promotes joint health, and maintaining bone strength helps combat osteopenia and osteoporosis. See Yoga for Strength: An Overview for information.

Flexibility. You need flexibility to maintain range of motion in your joints, allowing you to move your limbs and spine with ease so you can reach or twist as needed. Being flexible also helps you move smoothly and gracefully, rather than stiffly and awkwardly, allowing you to feel more confident in your body. Maintaining flexibility also helps you stay healthy, as flexibility preserves the range of motion in the joints, fostering joint health and improving arthritis symptoms. You can use your asana practice to cultivate flexibility in both your upper and lower body. See Yoga for Flexibility: An Overview for information.

Balance. The ability to balance is crucial for preventing falls, a serious concern for older people. It also allows you to move easily over uneven surfaces, whether that’s a cobblestone street or a mountain path, and to walk up stairs. You can use your asana practice to cultivate several different aspects of balance, from increasing proprioception (your awareness of where you body is in space) to improving your ability to focus. See Yoga for Balance: An Overview for information.

Agility. Maintaining agility increases your reaction time in the real world, preventing injuries and allowing you to participate in activities that require coordination and speed. Even something as simple as walking along a crowded city sidewalk (have you ever walked through the streets of New York on a weekday?) requires significant agility, not to mention dodging rude drivers. And, of course, skillful activities like dancing require even higher levels of agility. Moving in and out of your poses with your breath, linking poses together into simple or complex vinyasasa, and working on transitions into and out of static poses all help foster agility. See Yoga for Agility for information.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

"Transferring" and Yoga: Wisdom from Jane Fonda (Rerun)

by Baxter

Nina recently shared with me some fascinating information about Jane Fonda, who has lived many lives, from actor to fitness guru to political activist, just to name a few. Fonda reportedly used to practice a more strenuous yoga two hours a day. “But,” she says now, “those days are long gone. It got to be too hard.” All of that hard work has paid off even as Fonda approaches her golden years, though. She puts it this way:

“Every single time I go to get out of a car now, I say ‘Thank you, Lord, I have strong quads. Because if I didn’t have strong quads, I couldn’t be independent. You have to keep your back and legs strong so you can remain free and independent.”

Truer words could not be spoken! In my years as a Family MD, I cared for a lot of seniors, seeing them in my office if they were still living independently, or making trips to the nursing home if they needed special care. And one of the key skills that often allowed my aging patients to remain at home, which is were they all preferred to be, was the ability to “transfer” independently. By this I mean that they could go, typically, from a sitting or reclining position, such as their bed, to a standing position without any assistance. And they had to be able to do the reverse, that is, safely transfer from standing to sitting. Obviously, if they could do this from the floor to standing or vice versa, they would be way ahead of most of their peers! I have a 75-year-old student who does just that each week in class with me.

I found this expanded definition of “transfer” at the medical web site medicine.jrank.org:

“"Transferring" is the term used for moving from one condition to another, such as out of a bathtub, chair, or car, or getting into bed. The ability to transfer depends on many factors, including strength, balance, vision, and flexibility.”

Because of the physical benefits of a regular yoga practice, specifically maintaining flexibility, promoting muscular strength, improving balance and keeping the body agile, students who maintain a regular yoga practice are likely to remain independent much longer than their age-matched community, all other factors being equal. And even if they don’t have a vigorous practice like Jane did in her younger years, even a moderate or gentle yoga practice is likely to have the same four categorical benefits listed above.

Many of the standing poses would be likely to help with such daily activities such as getting in and out of the car.  Any standing pose that requires the knees to bend and straighten, such as entering, holding and exiting from Warrior 1 or 2, is simulating the action the knees, legs and hips perform for our car example (see Warrior 1 and Warrior 2 Mini Vinyasas). Even better would be Fierce pose (Utkatasana, also called Chair pose), especially if you added in a twist. One of the more challenging transfers for older people is using the toilet in a standard bathroom. It is usually lower than a typical chair, and so presents more potential challenge for most. Yet, if you continue to practice in an intelligent, age-adjusted yoga class, such situations may be non-issues for the aging yoga practitioner.

In classes designed for seniors with no previous yoga experience, it is quite common to utilize chairs to modify many yoga poses. So, just by virtue of getting in and out the chair in class a few times in class, with mindfulness and attention to detail, the student is again performing a similar movement to other important daily activities. The stress-reducing practices of yoga, as well as the mental sharpening skills of dharana, or concentration practice, are also likely to improve our chances of remaining independent well into our later years. So, let’s follow Jane’s example and keep our body and mind strong and agile via a regular yoga practice, so that we won’t even need an extra thought as we push away from the dinner table, stand and move onto the next activity of our full and satisfying day!

Subscribe to YOGA FOR HEALTHY AGING by Email ° Follow Yoga for Healthy Aging on Facebook

Read More

The Importance of Independence (and Interdependence)

by Baxter

Bee & Flower by Melina Meza

Yesterday Nina dove into three key aspects of Healthy Aging, and I wanted to pick up the ball on the middle concept, that of maintaining “independence.” As Nina mentioned in her post What is Healthy Aging, Anyway?, one goal of aging well is to “continue to live independently and care for ourselves as long as possible. And Nina outlined many of the independent skills we would ideally love to preserve as time goes on: “the basic daily self care activities, such as dressing, going to the toilet, getting up and down from a chair, doing light housework, and so on as well as the ability to continue to do the activities we love.” And indeed, a regular asana practice that is appropriate for our stage of life, as well as our unique health and physical challenges, will likely keep us on track in maintaining our independence. 

As I have mentioned in previous posts, loss of independence in my patients can be one of the most dramatic and potentially devastating changes that they will face in their lifetime. The more significant the loss of function, whether physical, mental or emotional, the more likely the individual will require intensive help from others to deal with the daily issues of life, possibly requiring in-home or nursing home care to stay safe and alive while recovering or adjusting to their new reality. Anything we can do to preserve independence is really crucial the older we get.  As we discussed a few months back (see From Independence to True Longevity), the simple ability to go from standing to sitting on the floor and back to standing is also a predictor of mortality, or the likelihood of death. The study done in Brazil noted that the worse you scored on the rating scale of what we call “transfer ability,” the more likely you were to die in the six years the study lasted.

So lately in my teaching, I have been emphasizing yoga postures that contribute to the ability to get up and down from the floor with greater strength, balance and ease. Variations of Powerful Pose (Utkatasana) seem to be popping up in just about every class I teach. In my Back Care class, we even practice transferring from standing to sitting in a chair and back to standing, keeping the feet symmetric, finding the safest alignment of the spine and pelvis, and maintaining as much control of the speed of descent and ascent when sitting and standing. And because of the high rates of osteoporosis in both women and men (50% of women over 65 and 25% of men over 65), that kind of control may translate into fewer falls for those with or without OP, and fewer fractures. If you don’t fracture your hip, you are much more likely to be around in two years than if you do! 

The other place were we want to be independent is on the mental level. Maintaining mental agility and learning new tasks as we age is going to also contribute to our independence. As an online educational text from the Cleveland Clinic noted:

“Decline in cognitive abilities contributes to decline in functional independence. With normal aging, processing speed of the brain declines and recall time increases.”

The researcher pointed out that western medicine deals with this not in preventative way, but by treating conditions like dementia after they arise in a patient. As they clearly note : “Current research has been focused on treating the consequences of dementia, but no treatment modality is currently available to reverse the process or halt its progression.”

Could yoga be that modality? Something as accepted and commonplace in our culture as using a computer or smart phone can be daunting to use or learn for some as they age, but utilizing the practices of yoga that cultivate mental and emotional calmness and lower our perceived stress levels can contribute to better and faster learning skills. And a recent study has showed that meditation practice may actually strengthen the brain (see Meditation and Brain Strength). Researchers found that long-term meditators have larger amounts of gyrification (“folding” of the cortex, which may allow the brain to process information faster) than people who do not meditate.

And the ability to maintain emotional equilibrium that Nina mentioned in relation to “Equanimity” yesterday, I believe, will also contribute to overall independence. It is also important to stress that when I talk about independence, I don’t necessarily mean living alone as we age.  Studies show that men live longer when married versus single, and women tend to live longer if they have a strong support community versus being in or feeling like they are in isolation. So we are talking about having a good degree of personal independence while acknowledging the importance of interdependence and community. In fact, a 2005 study done in Israel, looked at the factors that influenced genetics in contributing to longevity in adults from 70-82 years of age.  They found that “Increased physical and social activity is an important tool to lengthen the span of robust function.” So the group dynamics and sense of community of our modern yoga classes could actually be another way to feed that social factor that can also contribute to maintaining independence as we age.

Read More

What is Healthy Aging, Anyway?

by Nina

Dahlia by Melina Meza

It has only struck me recently that while we’ve written about what aging is and the many ways yoga can help foster healthy aging, we’ve never really addressed what “healthy aging” is. So I thought I’d take a moment to give an overview of the thoughts that Baxter and I currently have on this topic. At this point—we’re still just discussing these ideas—we consider healthy aging to have three important aspects:

• Compressed Morbidity
• Independence
• Equanimity

And the reason why we’re such proponents of yoga for healthy aging is that we believe yoga can help with all three of these aspects of healthy aging. For now, I’ll just give you a brief overview of how.

Compressed Morbidity. Last week I wrote a post Longevity vs. Morbidity comparing the difference between longevity and morbidity. The medical term “morbidity” refers to the period of time you spend in ill health before you die. Obviously we all would like—both for ourselves and for our loved ones—to keep this period of ill health as short (that is, compressed) as possible. A well-rounded yoga practice, especially one that includes stress management, can help by preventing some of the diseases, such as heart disease, high blood pressure, and diabetes that plague people during their older years.

Independence. Another goal I think we all share for ourselves and our loved ones is that we can continue to live independently and care for ourselves as long as possible. From our point of view living independently includes both the basic daily self care activities, such as dressing, going to the toilet, getting up and down from a chair, doing light housework, and so on as well as the ability to continue to do the activities we love (which I wrote about in my post Being Able to Do What You Love) for as long as possible. A regular asana practice—even one that is modified over time—will help keep us able bodied, rather than sliding into the stiffness and weakness that results from a sedentary lifestyle.

Equanimity. For me, maintaining emotional stability as we age is the most important aspect of healthy aging. For even if we can “compress” morbidity, we will certainly have to go through poor health at some point. And even if we can prolong our independence into old age, we may eventually have to face the loss of that, however briefly. In addition, even if we are ourselves blessed with long and healthy lives, we’ll all have to deal with losing people we love. So being able to handle the challenges ahead with balance and grace is crucial. But I also believe that this is where yoga has its greatest strength. Stress management practices help reduce stress, anxiety and depression. And meditation and yoga philosophy can help us keep grounded and strong. At least that is my fervent hope.

Baxter and I will be writing more on these topics in the weeks to come, but we’d also love to hear your thoughts, ideas and personal stories.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More