What is “successful ageing”? For some, living beyond the age a parent died might seem an achievement in itself, while others aspire to be sea swimming daily at 90.
Life expectancy having increased to well into the 80s in this part of the world gives us the luxury of focusing on how to put more life into our later years, rather than just years into our lives. Consultant physician in geriatric medicine Prof Rose Anne Kenny, a pioneer in the study of older people in this country, defines ageing well as “being happy with your state”. This, she suggests, can pervade all levels of physical incapacity that will come to us at some stage – if we live long enough.
We can’t hold back the years, but we can influence the pace of our biological ageing and focus on the positives. Here are 26 ways, suggested by Kenny and other experts, to increase your chances of ageing well.
Start early
The earlier you adopt consistent, healthier habits, the better. “You’re putting ‘money’ into the bank so you can tap into it later on,” says Kenny, founding principal investigator of the Irish Longitudinal Study on Ageing (Tilda) at Trinity College Dublin and director of the Mercer’s Institute for Successful Ageing at St James’s Hospital.
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There is no doubt, however, that there are benefits even if you make healthier choices at age 90. She cites a recent study of nursing home residents that showed daily activities “made a huge difference to their cognitive function, quality of life and their muscle strength”.
Spread your bets
It’s far better to address to some degree the whole menu of different aspects of behaviour that affect the ageing process rather than to go overboard with one or two, which will not be sufficient on their own. It also means you don’t have to be demoralised if you can’t persist with something, says Kenny, author of Age Proof – The New Science of Living a Longer and Healthier Life.
Move it
Exercise is an undisputed priority. Naturally the best form of exercise is the kind you do, as opposed to the sort you only think you should do.
Walking briskly for up to half an hour a day, or at least for 150 minutes over a week, is probably the most accessible bedrock of aerobic exercise to help maintain, if not improve, your health. Substitute or add whatever else appeals, such as swimming, cycling, dancing, jogging, tennis or its new cousin on the block, padel. Being outdoors and doing it with others bring added benefits.
Muscle in
Strength and balance are vital components of any exercise programme. Muscle mass and strength tend to decline progressively from early adulthood, a process that is worsened by inactivity, especially prolonged sitting or bed rest, says Dr Noel McCaffrey, founder and director of ExWell Medical, a community-based rehabilitation exercise programme. Eventually muscle wasting will make it difficult even to stand up or lift and carry everyday objects. Failing strength is a major contributor to social isolation and loneliness, which compound your problems.
“Adding regular strength work to your routine (meaning three 20-minute sessions a week or five to 10 minutes every day) will make an enormous difference,” he promises. “Strength work can be carried out using dumbbells, resistance bands or just body weight exercises such as sit-to-stands, press-ups, heel raises, planking and sit-ups. With a little planning, strength work can be carried out sitting in a chair.”
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Mimic a stork
Working to improve balance involves challenging the control systems we all use, thereby improving their efficiency, explains McCaffrey. The three key systems are our eyesight, our inner ear mechanism and feedback from our limbs (carried in sensory nerves).
“We cannot change our inner ear mechanisms, but we can easily challenge the other two by, for example, standing on one leg (thereby narrowing our base and reducing the flow of information from one leg) and/or closing our eyes.” Make sure there is something within reach to hold on to for support. By working on balance and strength, the risk of falling is greatly reduced.
Kenny echoes that point: “If I, as a clinician, see somebody who is having falls, the most frequent treatment I recommend is muscle balance and strengthening exercise programmes – but far better to do it in advance of falls. Forty-five per cent of people who fall and fracture a hip never get back to their [previous] level of independence.”
To roll two good habits into one, try standing on one leg while you brush your teeth.
Eat more protein
Starting in middle age, a protein-rich diet along with physical activity is needed to prevent sarcopenia, the age-related, progressive loss of skeletal muscle mass and strength, says Susan Byrne, a senior dietitian with a frailty intervention team.
While consuming 0.83g of protein per kilo of body weight a day is recommended for healthy adults of all ages, it is now being recognised that older adults need a higher guideline. The Food Safety Authority of Ireland suggests daily consumption of 1-1.2g of protein per kilo is best practice for older people. High quality, protein-rich foods include: meat, poultry, fish, dairy products and eggs, and, to a lesser extent, says Byrne, beans, peas, lentils and nuts. Examples of foods containing 10g protein are: 2 eggs, 1½ matchbox size of cheese, 1 bowl (200g) rice pudding, 1 pot (125g yoghurt), 33g (4 slices) chicken breast), 3 slices of ham, 2 handfuls of nuts. Consider adding items such as full-fat milk, skimmed milk powder, cheese, nut butters and hummus to meals.
Recent but ongoing research suggests that spreading protein intake more evenly throughout the day, instead of eating most of it at dinner, could have a more beneficial impact on muscle protein synthesis.
Get a quit plan
More than 4,500 people die in Ireland every year due to smoking. It causes cancer, heart disease, stroke, lung diseases, diabetes and chronic obstructive pulmonary disease. Knowing is one thing, stopping is another. Sign up now for a free, personalised Quit plan with a choice of supports on quit.hse.ie.
Assess your drinking
We might have toasted the research that suggested moderate drinking could have potential benefits for the cardiovascular system, but there is no evidence these gains outweigh the concurrent increased risk of cancer. No level of alcohol consumption is safe for our health, says the World Health Organisation.
If it’s a case of happily choosing your poison when it comes to alcohol, be aware of the weekly “low risk” guidelines of 11 standard drinks for women and 17 for men. Listen to your ageing body, as it may start to react differently to alcohol. It takes its toll on various organs, including the brain; increases the risk of falls; can exacerbate other health issues; and may cause dangerous interactions with medications.
Watch out in ‘sniper alley’
After the age of 50, it is recommended you visit your GP at least once a year, even if you have no specific symptoms. You’re entering so-called “sniper alley”, a decade or more when you can be ambushed by an acute health crisis or the onset of chronic disease.
“From that age on, checks to detect age-related conditions can be very beneficial,” says Dr Suzanne Kelly, a Cork GP and assistant medical director of the Irish College of General Practitioners. Annual blood pressure checks and cholesterol and blood glucose readings are recommended, as well as availing of all free public health screenings and relevant vaccinations. But your GP has your personal and family history so can specifically order tests that might be important to you.
High blood pressure and high cholesterol are silent risk factors for stroke and heart disease. “We know that if we manage three patients with high blood pressure well, we prevent one of those three having a stroke,” says Kelly.
“People love the idea that one secret supplement or just one diet will help you live longer, but in fact it’s low-tech fundamentals that really count. Don’t underestimate the persuasive power of face-to-face, tailored advice about lifestyle changes.
“Studies have shown that patients who attend a named GP live longer and are less likely to need acute admission to hospital.”
Feed your lifespan
Norwegian researchers investigating the impact of food choices on life expectancy have concluded that optimising your diet could increase your lifespan by up to a decade. You can log your age, gender and location into their Food4HealthyLife calculator to get a prediction of what extra time you might gain by adjusting your daily consumption of 14 main foodstuffs, from typical to feasible or to optimal. It might be motivation to make dietary changes, in the hope you can nudge that sobering “expected years left” upwards.
Find your fitness age
Another potentially motivating online calculator, also produced by Norwegian academics, can be used to calculate your “fitness age” vs your chronological age. Maintained by the Norwegian University of Science and Technology, this tool at hvemereldst.no/en/ estimates your fitness age based on honest answers about age, weight, exercise habits and resting pulse.
Take the plunge
Hardy souls who swear by how good all-year-round sea swimming is for them have science on their side. Cold water is a physiological stressor that forces the body to work to restore core temperature, resulting in an indirect benefit to many systems and organs, says Kenny, a keen sea swimmer herself. Switching the shower dial to cold can have a similar effect.
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Treat your gut
Eating fibre-rich food not only provides intestinal microbes with the complex carbohydrates they like to feast on, but can also reduce your calorie intake.
When fibre is not available, certain gut bacteria like to “munch on mucus”, including the protective mucus layer that lines the gut and thins out as we age, according to Seattle microbiome specialist Sean Gibbons. He told the New York Times he had started eating a lot more fibre since starting to study microbiome. Fermented foods, such as yoghurt, sauerkraut and some pickles, can create a healthier mix of gut microbes.
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Sleep well
More important than trying to ensure you get enough sleep is not worrying about it, says Kenny. There is no ideal sleep pattern.
She refers to the work of Oxford professor Russell Foster, an expert on circadian rhythms, who warns against any obsession with eight hours. What is sufficient sleep and optimum bed and rising times vary from individual to individual. Find what works for you, although expect that to change over time. By our late 50s and early 60s, we are likely to be getting up and going to bed about the same time as when we were 10, according to Foster.
Make your bedroom “like a cave”, adds Kenny. “Your bed warm but your room dark and cool.”
Think positive
Believing ageing is all about diminishing abilities, increasing ill health and sadness can be something of a self-fulfilling prophecy. A pessimistic attitude to getting older has been shown to have impacts on real-life issues such as heart health and memory.
“We need to challenge negative perceptions of ageing in ourselves and our society if we want to age well,” says Trudy Meehan, a psychologist who lectures at the RCSI Centre for Positive Health Sciences. Don’t succumb to ageism. Envisage what sort of older person you would like to be, and then consider what practical steps you might be able to take now to make that happen.
Consider uprooting
“You are not a tree,” says Meehan. Just because you have put down roots somewhere does not mean you are stuck there. Bear in mind that successful ageing is not just down to your personal resources and characteristics. Our physical environment and the people around us also play a huge part in our ability to thrive. Ask yourself: do you need to travel somewhere or move so that you have more opportunities that would suit your life right now? Maybe the weather is bad for your arthritis, or your house and garden too big to maintain. Or perhaps try to change the “soil” you’re growing in by campaigning for action in your locality that would create a more supportive environment for older people.
Have a purpose in life
As we get older, very obvious purposes we had for many decades, such as a career and/or supporting a growing family, may no longer be there.
“We have to recreate purpose and one can do that,” says Kenny. “Purpose can be very simple, provided you are focused on making something purposeful.” It could be voluntary work, keeping in regular contact with friends (see below), or having a timetable for each day, even if it’s as mundane as shopping on one day, laundry another.
“If you focus on it and document it, you are making it a purpose and that’s really good for us.”
Engage with other people
There is mounting scientific evidence on how toxic loneliness can be to both brain and physical health. “I think that pertains to all age groups and it is something we have to work hard on,” says Kenny. It can be easier to stay at home and avoid other people “but when you actively engage, the benefits are huge”. Try to cultivate leisure pursuits where you meet people other than colleagues and family, with a view to continuing them past retirement. Join your local Active Retirement Ireland (activeirl.ie) when the time comes.
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Check your hearing
“Test your ears at 50 years,” is a mantra that Enda Dooley, a hearing aid audiologist with Hidden Hearing, wishes everybody would take to heart.
Inexplicable stigma makes people reluctant to have their hearing checked. The average time between individuals noticing their hearing declining and doing something about it is five to seven years. Yet even mild hearing impairment doubles your risk of dementia, according to Johns Hopkins medical research in the US; people with severe hearing loss are five times more likely to develop dementia.
Availing of a free hearing test at 50 will establish a baseline to measure yourself against in future years. If/when you need them, today’s high-tech hearing aids, which amplify weakened sound signals for your brain, bear no comparison to the whistling ones your grandparent might have used.
There is nothing negative about making sure you can hear properly, says Dooley. “It’s good for your brain; it’s good for your memory; it’s good for your marriage.”
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Be creative
“More and more we are understanding the value of engaging in culture and creativity,” says Kenny. “It helps engage our parasympathetic nervous system, which is our relaxation, and to subdue the sympathetic system, which is the fight or flight system.” It can be as effective as medication or breathing programmes.
Whether looking at artistic endeavours or engaging in them yourself, it is often done in the company of others, thereby providing multidimensional stimulation. Pursuing variety in our lives, whether that’s what we read, places we go and what we do, is also good for our brains. Even just reversing the direction of a habitual walking route gives a new outlook.
Supplement wisely
Robust research shows that if you have a good diet (think broadly Mediterranean) there is no need for vitamin supplements apart from vitamin D, according to Kenny. Deficiency in this is common at any age, and the Department of Health recommends all children and adults take vitamin D supplements during the winter. She encourages older adults to take 800-1000 IU (international units) a day all year round.
Be present for better memories
The biggest issue with ageing and memory is that we have difficulty managing our attention, says Prof Charan Ranganath, a neuroscientist at the University of California and author of How We Remember, to be published here in March. “We become more distractible, which leads us to forget the things that are important lsuch as names, or where we put our phone or keys), miss appointments, and even lose track of where we were in conversations or have trouble keeping up with movies and TV shows,” he says. “We can minimise distractions by turning off unimportant alerts on our devices like phones and watches, avoiding multitasking, reduce demands on our time, eliminate environmental distracters like loud TV shows.”
Accept that most of our life experiences will be forgotten; our brains prioritise quality over quantity. “But you can do better at remembering anything by focusing on what is distinctive during the moment (like an unusual detail about someone’s face, or odd landmarks in a new city that you are trying to navigate) and repeatedly retrieving that information – like recalling a person’s name a minute or two after they introduce themselves.”
Avoid the graveyard of regret
Do not mull over mistakes and wrong choices you’ve made in life. Dwelling on losses and “if onlys” is toxic. People who age successfully are better about letting go of past failures, according to a long-running Harvard study on longevity and happiness.
“Realising that life is short and paying more attention to what makes you happy right now instead of looking back with regret is an evidence-informed path to happiness as you age,” says Meehan.
Protect your skin
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Consultant dermatologist Dr Bryan Murphy believes helping skin to age well is best achieved by taking steps to combat the effects of external toxins, chemicals and potentially damaging agents that will alter skin texture, turgor (elasticity) and pigmentation.
The number one priority for all ages should be to use high factor, broad spectrum sunscreen daily, ideally all year round. Even though cloudy skies weaken the damaging ultraviolet (UV) rays, they still penetrate our skin, causing “burning and colour change, alteration of collagen and elastin skin fibres, whilst also increasing the risk of precancerous and cancerous skin lesions”.
Regular use of moisturiser will not only nourish and soften the skin, it can also act as a barrier against potentially harmful toxins in the air, says Murphy, who works in the Cathedral Dermatology Clinic and Kingsbridge Private Hospital, both in Belfast. To protect against dry, flaking skin, which increases as we get older, he advises “keeping yourself well hydrated by drinking plenty of water every day, in addition to applying a moisturiser after the shower and before bed”.
Remain intimate
Sex is good for us, and don’t presume that what seem like age-related problems mean it’s the end of the road for intimacy.
“You can be sexually active well into your 90s,” says Kenny. Just being physically close with another human being boosts our “cuddle hormone”, making us feel happy and safe. Although there are physical changes that can make sex more difficult as we age, there are solutions, she stresses, that can be discussed with a GP.
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Contemplate care wishes
Talking with loved ones about your preferences relating to possible incapacity and certain death doesn’t tempt fate, as some may believe.
“It can even be enjoyable for the right person,” says Valerie Smith of the Irish Hospice Foundation, which offers a Think Ahead planning pack, covering medical and personal care and afterlife arrangements. “You can really think about what matters to you. It all comes down to the values you hold.” Having advance care documents prepared is likely to reduce stress and anxiety as you move towards end of life. She recommends beginning “when you’re youngish, in your 40s”, and then updating. Or at least making it part of your retirement process. See thinkahead.ie.
