AF is caused by a disorder in the heart’s electrical system. Rapid, disorganized electrical signals in the heart’s two upper chambers, called the atria, cause them to rapidly and irregularly quiver instead of beating with regular contractions. “This electrical disturbance in the atria causes the ventricles [the heart’s two lower chambers] to beat irregularly as well,” says Daniel Brauner, M.D., a geriatrician and associate professor of medicine at the University of Chicago. “If one’s heart beats too rapidly, then it won’t pump blood very efficiently.”

Underlying causes of AF can vary. “Sometimes AF may be related to chronic heart disease, hyperthyroidism, or chronic lung disease. Sometimes we don’t know the cause—it may be related to aging changes in heart cells,” Taylor says.

AF: a dangerous condition

People who have AF may not have any symptoms and not even know they have the condition. Some people, however, have symptoms like palpitations, chest pain, shortness of breath, weakness, dizziness, fainting, fatigue, or confusion.

“The biggest risk of having AF is the potential for a stroke,” Taylor says. “Blood clots form because blood is pooling in the atria—these clots can lead to strokes,” Brauner explains.

Having AF also increases your risk of heart attack or heart failure.

People who have AF can live normal, active lives. For some people, treatment can cure AF and return their heartbeat to a normal rhythm. For people who have permanent AF, medicines or procedures to restore normal rhythm can successfully control symptoms and may prevent complications.

What to know about anticoagulation therapy

“The medicines prescribed for AF are typically anticoagulants [sometimes called “blood thinners”], meant to keep your blood from clotting too quickly,” Taylor says. “The most common is warfarin [Coumadin].”

“If you are taking warfarin, you need to have blood drawn regularly to ensure that your clotting factors are operating within a particular range,” Brauner says.

“Your medication dosage may change from month to month or even week to week, depending on your lab results,” Brauner says. “Always confirm your medication dosage with your doctor. Call to find out lab results if you don’t hear from your doctor within 24 hours of having your blood drawn.”

Tell your doctor about other medications, especially over-the-counter drugs or supplements. Some of these can affect your blood’s ability to clot. So can certain foods. “Many foods that contain vitamin K can interfere with your clotting status. You can eat them, but you need to keep up a steady intake—in other words, don’t eat a lot one day and then a little the next,” advises Brauner.

Vitamin K is found in many green vegetables like spinach, turnip greens, collard greens, broccoli, and Brussels sprouts. Some fruits like kiwi, blackberries, and blueberries also contain vitamin K.

“When you are taking anticoagulants, you need to be careful of injuries, even minor ones. It is common to see small areas of bleeding under the skin with even minor trauma in people taking warfarin,” Brauner says. “Seek medical help quickly if you have any bleeding that doesn’t stop in a short time—even a nosebleed. Minor bleeding could become an emergency,” he adds.

“Keep your appointments for your blood work and adhere exactly to your dose of medication,” Taylor adds. “Always tell all of your health care providers that you are taking anticoagulants.”

Be safe when taking anticoagulants

To prevent injury in your home:
Be very careful using knives and scissors.
Use an electric razor.
Use a soft toothbrush.
Use waxed dental floss.
Do not use toothpicks.
Wear shoes or non-skid slippers in the house.
Be careful when you trim your toenails.
Do not trim corns or calluses yourself.

To prevent injury outdoors:
Always wear shoes.
Wear gloves when using sharp tools.
Avoid activities and sports that can easily hurt you.
Wear gardening gloves when doing yard work.

Dr. Taylor received his bachelor’s degree from Haverford College in Haverford, Pa., and his medical degree from Temple University School of Medicine in Philadelphia. He completed his internship in internal medicine at Carney Hospital in Boston, Mass., and his residency in internal medicine at Temple University Hospital in Philadelphia.

Board certified in both internal medicine and geriatric medicine, Dr. Taylor joined Maris Grove in August 2006.

Q: I am 78 and in fairly good health, but once in a while I get dizzy and feel like I’m going to lose my balance. My doctor examined me but could find nothing wrong. What could be the cause?

A: Occasional periods of dizziness can occur in older adults for many reasons. As you age, your blood pressure might fluctuate because of your body’s decreased ability to compensate for sudden changes when you sit up or stand. Being even slightly dehydrated may cause you to feel dizzy, as can certain medications, ear or eye problems, or other health conditions.

No matter the cause, your biggest problem from having periods of dizziness is an increased risk of falls. Find ways to protect yourself against falls like improving the lighting in your home, removing loose rugs, and wearing comfortable shoes. If you are dizzy often, see your doctor for a more thorough evaluation.

Q: I eat a healthy diet, but I worry as I get older that I’m not getting enough vitamins or minerals. Should I take a multivitamin supplement?

A: A well-balanced diet may give you all of the vitamins and minerals you need, depending on your health. Sometimes, however, older adults need to take extra supplements to prevent or treat health conditions (calcium and vitamin D for osteoporosis, for instance). Extra doses of vitamins do not guarantee better health, so talk to your doctor before beginning any over-the-counter medication or supplement. There could also be health risks if you have other medical conditions, and some supplements might adversely react with other medications.

Send your questions by e-mail to expert@erickson.com.

In this column, I will use a common-sense approach to untangle this web of complexity. Topics will range from the best ways to be well and stay well to how health care legislation impacts Medicare.

We are living in the greatest time in human history. Just 100 years ago, life expectancy in the U.S. was 50 years. Remarkably enough, a baby born today will live to age 78 and 50% of women will live to 85. What a remarkable gift and opportunity! Thirty additional years to live and thrive added in just one century of human history! While we certainly know how to spend our first 50 years (focusing on school, work, and raising a family), we are much less certain about how to live the next 30.

How can you get the most out of your second 30 years? It’s not as complicated as you might think. No matter your age, feeling good and being well is achievable and has primarily to do with your physical and mental health. Although physical health is certainly important, it is truly remarkable what you can achieve with a positive attitude and social engagement with friends, family, or work. Even with significant physical limitations and disability, you can overcome obstacles to enjoy a high quality of life.

Despite our cultural bias toward youth, studies show 80-year-olds are in fact happier than 20-year-olds. Happiness levels improve about 5% each decade of life despite some degree of physical decline even among our most fit seniors.

In the coming months I will share perspective and insights into successful aging and dispel the myth that it can’t be done. Your second phase of life can be your very best.

Tai chi is like moving meditation—moving the body slowly and gently while breathing regularly.

“Tai chi is easy to learn,” says Karen Kansler, M.A., R.N., community outreach nurse and aging advocate at Good Samaritan Hospital in Baltimore, Md. “In its simplest form, tai chi is a moving meditation, which means moving your body slowly and gently while breathing regularly.”

Tai chi is not the same as yoga. “Instead of trying to hold your body in certain positions, you are doing slow movements,” she says.

Tai chi developed in ancient China. It started as a martial art and a means of self-defense. Over time, people began to use it for health purposes. Scientific studies have focused on its potential for preventing falls and improving cardiovascular fitness, osteoporosis, and osteoarthritis. “It’s also a great stress reliever,” Kansler says.

“It’s especially good for people with arthritis. It helps reduce pain, ease stiffness, and gives you more energy,” she adds. “You are no longer sitting in a chair doing nothing because your joints ache.”

“Having almost any chronic disease can increase your risk of falls,” says Philip Taylor, M.D., medical director at Maris Grove. “Tai chi can prevent falls by improving balance and muscle strength. It may also help decrease depression and anxiety.”

“The exercises in tai chi improve your breathing, which helps increase oxygen to your brain, muscles, and all of your organs,” Kansler says. “Many adults don’t breathe as deeply as they should because of various health conditions, but tai chi teaches breathing techniques that you’ll start doing naturally.

Tai chi can be modified for just about anyone with almost any health condition. “Everyone in my class has at least one chronic condition, and some are in their 80s. It can even be taught to people who need to stay in bed or who use wheelchairs,” Kansler says.

“If you join a tai chi class, you only have to do what you are able. If you need to sit down, that’s okay. You are still reaping benefits if you are doing exercises while sitting down.”

“Tai chi has so many potential benefits that no matter how healthy you think you are, there are advantages for almost anyone,” Taylor says.

“Tai chi is quite safe, but there are risks for some people,” says Taylor. “If you have a hernia, joint problems, back pain, fractures, or severe osteoporosis, your doctor may advise you to modify or avoid certain exercises.”

As with any exercise regimen, if you overdo it, you may have sore muscles or sprains. Tai chi instructors often recommend not practicing tai chi right after a meal, when you are very tired, or if you have an active infection.

Talk to your doctor before starting any new exercise regimen, including tai chi.

Additional considerations

• Do not use tai chi as a replacement for conventional care or to postpone seeing a doctor about a medical problem.

• Consult with your health care provider before starting tai chi if you have a medical condition or have not exercised in a while.

• Ask potential tai chi instructors about their training and experience.

• Learning tai chi from videos or books does not ensure that you are doing the movements correctly and safely.

Enter the epigenome, which sits atop DNA and can silence or activate a gene, directing it to behave a certain way.

‘The missing link’

At the fore of researching this phenomenon—which scientists have called “the missing link between genetics, disease, and the environment”—is the Johns Hopkins Center for Epigenetics. There, scientists have discovered that as people age, the variation in gene expression becomes more prevalent, with the epigenome dictating various messages to the DNA. For example, diet and lifestyle choices can impact whether or not certain genes (e.g., cancer) get turned on or are silenced.

Currently, Johns Hopkins researchers are investigating epigenetic markers to predict and treat various conditions that have, until now, challenged the medical community. For example, a team at Johns Hopkins has used epigenetics to predict colorectal cancer, which, according to the American Cancer Society, goes undetected approximately 60% of the time. There has been no treatment proven to increase odds of survival for late-stage colorectal cancer patients, who typically live between four to six months after diagnosis. At present, Johns Hopkins researchers are in the midst of a trial using a combination of epigenetic and other therapies to treat people whose cancer has advanced.

Another Johns Hopkins lab has discovered an epigenetic therapy for those who develop recurrent lung cancer after surgery. In addition, researchers at the Center for Epigenetics are working to predict and treat Alzheimer’s disease, frailty, and mental disorders, among other conditions.

“It’s heartening,” says Andrew Feinberg, M.D., M.P.H., professor of molecular medicine and director of the Center for Epigenetics. “We’re reinventing science as we go.”

There are many places throughout the body where vitamin D may have a life-sustaining effect. “Vitamin D can make your muscles stronger, which may prevent falls,” says Austin Welsh, M.D. , medical director at Tallgrass Creek. According to the Centers for Disease Control and Prevention, falls are the leading cause of injury deaths among older adults.

Vitamin D is also essential for promoting calcium absorption in your bones and, thus, may protect you from bone fractures. Research suggests that vitamin D may also have other health benefits. “Vitamin D helps boost your immune system,” Welsh says. “My patients who have adequate vitamin D levels report having fewer colds and flu.”

“Vitamin D has also been associated with healthy hearts, and it may have a protective effect against certain cancers,” Kazlauskaite adds.

In addition, emerging research is revealing that vitamin D might play a role in the prevention and treatment of diabetes, hypertension, multiple sclerosis, and other medical conditions.

Many seniors are D-deficient

According to the National Institutes of Health, vitamin D deficiency is quite common among seniors.

“There are a number of reasons why older people can’t maintain normal vitamin D levels,” Welsh says. As you age, your skin cannot synthesize vitamin D efficiently and your kidneys are less able to process it into its active form.

Salmon, milk, orange juice and fortified cereal are all great sources of Vitamin D. (File photos)

People are designed to make vitamin D when the skin is exposed to sunlight, but factors such as geographic latitude, ozone levels, time of year, time of day, and whether or not you’re wearing sunscreen all affect how much vitamin D you actually get from sun exposure.

“Most seniors don’t get enough sun exposure to have sufficient vitamin D levels. And those who do get a lot of sunlight may either be wearing sunscreen or have a tan,” Kazlauskaite says. “A tan prevents the sun’s rays from reaching the cells that make vitamin D.”

Your vitamin D levels may also be lower if you have certain medical conditions like liver disease or Crohn’s disease.

Extra weight can also contribute. “Fat tends to trap vitamin D and then it’s not available to the rest of your body,” Kazlauskaite says.

Despite the importance of the sun to vitamin D production, the American Academy of Dermatology advises that you take protective measures (including wearing sunscreen and protective clothing) when you are outdoors due to the risk of skin cancer.

Fortified foods: not what they seem

Vitamin D is measured in international units (IUs), a standard measurement for certain vitamins. The U.S. Food and Nutrition Board recommended intake is 400 IUs/day for adults 51-70 and 600 IUs for adults age 71 and over. Some experts, however, think even 1,000 IUs/day may be too little for some older adults.

Very few foods naturally contain vitamin D. Fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. See the sidebar for food sources of vitamin D.

Fortified foods provide most of the vitamin D in the American diet, but “people typically get less than 100 IUs per day of vitamin D from food,” Kazlauskaite says. “Studies show that amounts in fortified milk can vary from gallon to gallon. That’s because vitamin D, which is an oil, is added to large vats of milk and may not dissolve evenly.”

And many foods that you would expect to be fortified are not—like cheese, ice cream, and many yogurts marketed to adults.

Multivitamins and supplements

“Most multiple vitamins have a relatively low dose of vitamin D—about 400 IUs,” Kazlauskaite says. “Many of my patients have insufficient levels of vitamin D even though they take multivitamins,” Welsh says. “Vitamin D is absorbed better if it is taken with food and not with a bunch of other pills.”

Even if you are already taking osteoporosis medications or calcium/vitamin D supplements, you still may be vitamin D deficient. Symptoms that can indicate deficiency like bone pain and muscle weakness can be subtle and go undetected.

“Your primary care doctor or endocrinologist can do a simple blood test to check your vitamin D levels and recommend supplements if needed,” Kazlauskaite says.

Health risks

“On rare occasions, vitamin D can be toxic if taken in very high levels,” Welsh says. “Seniors should be under a doctor’s supervision when taking vitamin D to make sure levels aren’t too low or too high.” In addition, vitamin D supplements have the potential to interact with several types of medications like steroids, some cholesterol-lowering drugs, and some seizure medications.

Weight-bearing exercises, also known as resistance training, help preserve muscle mass. Start light and increase weight over time. (File photo)

“It’s not going to happen to everybody, and it’s not inevitable,” says Austin Welsh, M.D., medical director at Tallgrass Creek in Overland Park, Kans.

As people age, their body composition shifts; fat and muscle redistribute due to cellular changes. Body fat may increase by as much as 30%, and while fat increases, lean body mass—including muscle—decreases.

Although some muscle loss is normal, it shouldn’t be debilitating. For example, you shouldn’t have trouble walking or getting out of a chair. “Sarcopenia draws attention to those who have functional losses [things that interfere with daily living] associated with their muscle loss,” explains William Dale, M.D., Ph.D., chief of geriatrics at University of Chicago Medical Center. “It identifies dangerous amounts of muscle loss and strength.”

Dangers of losing muscle

“Sarcopenia is very similar to osteoporosis [loss of bone mass], but for muscles,” says Dale. The reason it doesn’t get as much attention, he believes, is because “people don’t break a muscle. Having thin bones translates into broken bones. With muscle mass, it’s a little less obvious.”

Sarcopenia is characterized by subtle symptoms, such as difficulty gripping objects, rising from chairs, walking, and maintaining balance. Overlooked as it may be, experts estimate that 45% of people over 60 have sarcopenia.

If you are concerned about muscle loss, Dale recommends talking with your doctor, who may suggest getting a body composition study. “Even the simple ones are a reasonable guide as to the amount of body fat or muscle mass you have,” he says.

However, there is no surefire way to determine how much is too much muscle loss. “The geriatrics research community is still trying to identify how to diagnose someone with sarcopenia,” says Chhanda Dutta, Ph.D., chief of geriatrics at the National Institute on Aging. “Whether the diagnosis is based on function—for example, the ability to get in and out of a chair—or lean body mass…is now being considered. There should be a diagnostic criteria for sarcopenia in the next couple of years.”

Flex your muscles to recover

The good news?

“Even though you tend to lose muscle as you get older, you can slow down that process or even prevent it if you exercise,” says Dutta. She likens sarcopenia to osteoporosis in that you lose muscle from a peak starting point and being physically active, including strength training, can help you to preserve your muscle mass as you age.

“It’s not only about muscle mass and strength,” continues Dutta. “Sarcopenia can also reflect changes in muscle quality. For example, as we get older, there’s more fat in muscles. Fatty meat may be desirable in a steak, but it’s not what you want in your own muscle. Physical activity can improve muscle strength and power; it can enable older people to do everyday as well as recreational activities, whether it’s going hiking or playing with their grandchildren.”

“Weight-bearing exercises are the best guard against sarcopenia,” adds Dale, pointing to resistance training, which includes lifting or pushing weights. Before beginning any new exercise plan, he advises checking with your physician or consulting a physical therapist. “How much and how often you do resistance training would depend on your level of fitness,” says fitness specialist Michael Hernandez, who designs customized wellness regimens for people living at Tallgrass Creek, the 65-plus community in Overland Park, Kans.

And the road to increased muscle mass doesn’t end at the gym.

“To maintain muscle mass, you also need protein,” says Hernandez. “Protein is the building block of muscle tissue.” People should try to incorporate a variety of protein sources (beans, poultry, seafood, meat, dairy products, nuts, and seeds) into their diet and increase their fruit and vegetable intake.

Hormones may be involved

Another element of muscle loss is hormonal. “We don’t understand all the reasons why people start to waste away as they get older, but we know there’s obviously some hormonal features involved,” says Welsh, who notes that a decline in hormone production goes with the territory of aging. “As we get older, men don’t make as much testosterone, for example, and testosterone is important for keeping muscle mass on.” To that end, Welsh checks his male patients’ testosterone levels routinely and gives men testosterone injections when warranted.

Dale cautions that there is no magic pill for combating sarcopenia: “Although people are working away at it, there’s not a specific medication, outside of testosterone or growth hormone for those who are deficient, that will help build up your muscle.”

In the meantime—whether you’re holding a set of weights or snacking on almonds—the key to preserving muscle mass is in your hands.

Dr. Welsh received his bachelor’s degree from Yale University in New Haven, Connecticut, and his medical degree from Wright State University School of Medicine in Dayton, Ohio. He completed his residency in family medicine at St. John’s Mercy Medical Center in St. Louis, Missouri. Welsh is board certified in family practice and geriatric medicine and has completed a fellowship in geriatrics. He joined Tallgrass Creek in October 2007.

Q: I’m taking medication for high cholesterol. If I eat a more healthful diet, can I stop the medication?

A: For some people, lifestyle changes such as diet, weight management, and physical activity can help lower “bad” (LDL) cholesterol levels and at the same time raise “good” (HDL) cholesterol. For others, a genetic predisposition for high cholesterol or the presence of other health conditions means they may also need medication to bring their cholesterol down to a safe level. Safe levels vary somewhat among individuals depending upon the risk of heart attacks, strokes, or other serious problems that can result from high cholesterol. Do not stop any medication without first talking to your doctor.

Q: Why am I tired so often? I had a physical a month ago (including blood tests) and everything checked out fine. I am 79 and have a few health problems like high blood pressure and arthritis.

A: If your doctor can’t find any particular reason for your fatigue, your sleeping habits might be to blame. Older adults need at least seven to eight hours of good quality sleep every night. Try developing a bedtime routine and keep your room cool, dark, and quiet. Don’t eat large meals, exercise, or drink caffeine within three hours of bedtime. Have your doctor review your medications—side effects may contribute to being tired. An adjustment or medication change might be needed. Finally, take a good look at your diet. Eating a lot of sugar or other carbohydrates may contribute to daytime fatigue.

Send your questions by e-mail to expert@erickson.com.

Move it! Regular exercise helps keep the mind, as well as the rest of you, flexible. (File photo)

Exercise

What’s good for your heart is good for your brain. Regular exercise may be one of the best ways to keep your brain sharp. You don’t have to necessarily exert yourself—moderate activity is best: One study found particular brain benefits for 60- to 80-year-olds who walked three times a week. Compared to their non-exercising counterparts, the walkers had more flexibility with their thinking skills.

Eat foods of many colors

Some research suggests that improved memory may be associated with a diet high in colorful vegetables, fruits, and fish—especially fish containing high amounts of omega-3 fatty acids. Omega-3 fatty acids are found primarily in coldwater fish or fatty fish like salmon and tuna. So put a rainbow of colorful foods on your plate every day.

Learn new things

If you get mired in the same routines, your brain becomes hardwired or less elastic. Research shows, however, that older adults’ brains retain some plasticity (the ability to rearrange connections among cells). Learning new things helps to preserve plasticity. If you like to play cards, learn a new card game. Learn a new language or even a musical instrument. If you like computer-based games, try new ones on a regular basis. Keep in mind, however, that there is little scientific evidence demonstrating that high-tech computer games are any better for your mental fitness than other activities.

Color me healthy! A diet high in colorful vegetables, fruit, and fish leads to improved memory. (File photo)

Be social

People who maintain social networks seem to have better mental fitness. And you don’t have to be a social butterfly to reap benefits. Simply interacting with key people on a regular basis, whether it’s sharing experiences, stories, or hobbies, can make a difference in keeping your brain sharp.

Dr. Kotwal received her medical degree from Jammu Medical College in India. She completed a residency in internal medicine at Prince George’s Hospital in Cheverly, Maryland. Board certified in both internal medicine and geriatrics, Kotwal joined Ashby Ponds in September 2008.

Q: I am 82 years old and in fairly good health, but I have never exercised regularly. Would it do me any good to start now?

A: No matter when you start, one of the most important things you can do for your health is to be active. Numerous studies have shown the benefits of exercise for people with heart disease, diabetes, arthritis, osteoporosis, and many other health conditions. It can improve your mood, help you sleep better, and may ward off dementia. A good guideline for exercising is to gradually build up to 30 minutes a day at least five days a week. It’s not necessary to do it all at once—divide your daily exercise periods into three 10-minute sessions, for instance. Your tolerance for physical activity may vary so always check with your doctor before beginning an exercise regimen.

Q: I’ve been taking blood pressure medicine for ten years. Since my blood pressure readings have been perfectly normal for the past two years, can I stop taking the medicine?

High blood pressure is an ongoing chronic condition. (File photo)

A: Never stop taking any medication without talking to your doctor first. High blood pressure is a chronic condition, which means it is ongoing and not likely to resolve on its own. Your normal blood pressure readings are likely due to your medication’s effectiveness. Abruptly stopping it could cause your blood pressure to rise dangerously and put you at risk of a stroke, heart failure, heart attack, or kidney failure.