Exercise, Nutrition and the Older Woman: Wellness for Women Over Fifty PDF

Preface

"The greatest revolution of our time is the knowledge that human beings, by changing the inner attitudes of their minds, can transform the outer aspects of their lives."

Hopefully, as health care practitioners you have already embraced this concept of transformation in your work with older women in your care. Our goal in the assembly of these chapters has been to present a core of knowledge about the health of older women that will enable them to be more in control of the way they age and the speed with which they do it. But as William James suggests, it is the first step—the changing of the inner aspects of one's mind—that really matters. Once an individual has decided to exert some influence over the physical, mental, and emotional changes of aging, there is often a need for guidance from professionals with the right educational tools to effect such a transformation. The unifying goal of the authors of this book has been to facilitate the knowledge of how to change one's attitude toward aging as well as to impart specific lifestyle recommendations linked to health and well-being.

In most western countries, health promotion and disease prevention through lifestyle changes have not been the priority of individuals or the health care systems in general. Thus, it is not surprising that health care providers do not uniformly provide patients with the knowledge, access, or behavioral and financial incentives needed to effect substantial long-term changes in these areas.

There is plenty of accumulated scientific evidence that doing so would make a difference. Epidemiological studies indicate that exercise and physically active lifestyles are linked to longer life spans, less cardiovascular disease, stroke, diabetes, osteoporosis, cancer, high blood pressure, obesity, depression, and disability with age. Similarly, higher intakes of fruits, vegetables, and fiber, and lower intakes of fats and animal products are associated with lower rates of cancer, cardiovascular disease, diabetes, high blood pressure, high cholesterol, and obesity. These findings have led to numerous position papers and consensus statements over the past decade which give a central role to exercise and nutrition in health promotion at all ages.

In health promotion, as elsewhere, knowledge is power. The knowledge which has been advanced over the past century by scientific and medical research into health promotion and disease prevention is that much of what had been attributed to bad luck, bad genes, or mysterious forces of nature may instead be linked to poor lifestyle choices or environmental conditions. We clearly cannot control everything about how well people age and how long they survive; it will depend in part on their cultural and ethnic heritage, genetic endowment, environmental toxins, and socioeconomic status. Indeed, we may have limited influence over the very health care system in which we practice, and be frustrated by the lack of support for behavioral training and programs designed to optimize health rather than merely treat disease. However, it is certainly possible with the knowledge base of today to offer our older population a more optimistic and empowering alternative to years of biological degeneration and chronic disease.

As a professional working with older women, why should you concern yourself with the acquisition and dissemination of this empowering knowledge? Simple! Women now spend close to one-half of their lives in the years beyond child-bearing age. It is during these years in particular when attention to health and quality of life is critical to the maintenance of vigorous, active, and involved personal and societal roles for women. Since women currently outlive men by 6 to 8 years in most countries, women should have more and more influence over the priorities and needs driving health promotion, because they comprise an increasingly larger proportion of the population with each advancing decade. The vast majority of those over the age of 85 and those living in nursing homes are women. Thus, the specific health concerns of older women must be given greater attention in the research world, and the findings disseminated rapidly and responsibly to consumers and health care institutions by scientists and health care practitioners.

The health-related areas in which older women can often have the greatest influence over their own aging process are physical activity and nutrition. Most of the major chronic health conditions common in older women (heart disease, high blood pressure, diabetes, obesity, arthritis, osteoporosis, cancer, vascular disease, and others) can be prevented, delayed, modified, and/or treated in whole or in part by understanding the proper role of nutrition and exercise in their pathogenesis and prognosis. This is not to say that traditional medical care will not be needed in the future, but rather that the burden of disease and disability which accumulates with age may be substantially reduced by acting on this understanding. Hopefully, we are entering an era in which exercise and nutrition will be more fully integrated into the mainstream of health care practice, and the artificial distinction between traditional and non-traditional treatment can be eliminated, and replaced by complete rather than incomplete treatment options.

The benefits to the individual woman and society in general with this approach are enormous. If such diseases are prevented, or their disabling effects modified, there will be lower health care costs, regardless what system or policies are driving expenditures in the future. Individual quality of life will also benefit from achievement of optimal body weight and nutritional balance, as well as markedly improved fitness levels and physical capacities.

What might our health care system and policies look like if we really paid attention to the data available on the benefits of exercise and good nutrition? Insurance rates would be higher for those who are sedentary, just as they are for smokers. Employers would provide on-site wellness centers and wholesome food in their cafeterias, and health clubs would provide services for elderly and frail clients. Medical insurance would routinely cover long-term exercise training, nutritional counseling, exercise equipment, and transportation for those who don't drive to access these facilities. Health care providers would actually learn in detail about exercise, nutrition, and behavioral tools in medical, nursing, and other school curricula. Doctors' waiting rooms would be transformed into wellness rooms where videos, books, fitness equipment, cooking demonstrations, and stationary bikes replace the traditional line of chairs along the wall. Nursing homes would all have gymnasiums and exercise equipment in patient rooms, and staff would be trained to assist with these activities as part of their jobs.

Such scenes are currently happening in some areas, still far-fetched in others. Our purpose in this volume is to educate you, the provider of health care, to believe enough in the principles and practice of preventive health behaviors so as to start shaping the health care system of the future in your workplace today to include priorities of healthful, successful aging, enhanced by optimal fitness and good nutrition.

This book has been dedicated to the health of older women by a core of physicians and researchers who share these concerns by virtue of their own experiences as caregivers and educators. As a group, we have tried to identify in each topic area the essential tools needed by older women to change their lifestyles or expand their knowledge about the aging process in ways which will enhance their continued vitality and health throughout the years. We do not claim to have answers which our wise grandmothers did not—and in many cases you may recognize the admonitions and advice of your own matriarchs in these pages. We hope that we can simply convey the facts about how to enhance health, as well as dispel negative myths about aging or unfounded promises from the latest fountain of youth on the market.

Although knowledge is powerful, it is not sufficient. Physical activity and dietary intakes are behaviors, and behavior is shaped not only by knowledge, but also by habit, by experience, by fear, and by reward. We hope that after reading these pages you will be able to recognize and nurture in your patients and clients a readiness to change behaviors in a positive and healthful way. Even if only by one small step at a time, the habit of a physically active lifestyle and nutritious diet can be established. You may even experience subtle and not-so-subtle changes in your own attitudes, energy, mood, strength, function, optimism, and many other domains as you begin to apply this knowledge to those in your care. We hope that your fears of change, injury, or uncertainty are alleviated by the practical guidelines we have included along the way, and the reinforcing feedback you receive from women who benefit from this information.

The rewards of a newer, more robust physical, mental, and spiritual well-being may begin to be felt when one is 40 or 104. Women have much to offer the world at any age, and as health care practitioners we are in a unique position to facilitate their capacity to contribute throughout life. In the words of Goethe, "Whatever you can do, or dream you can, begin it. Boldness has genius, power and magic in it." There's never been a better time to begin than now.