How do you want to spend the rest of your life - going slowly downhill until death or being the person, you want to be despite life’s challenges and stressors? Maintaining a healthy lifestyle plays a vital role.
If your answer to that question is to be the person I want to be despite life’s challenges and those challenges include being a care-giver, your goal is more difficult. Let’s look at how the physical, intellectual, social, emotional, spiritual, and functional dimensions of wellness play a role. They are key!
As the old Spanish proverb says “A man too busy to take care of his health is like a mechanic too busy to take care of his tools.” As the mechanic of your health and a caregiver, you must maintain your mind and body, as well as that of the person you care for.
My husband and I are 81 years old. We met when we were 12 and have been married 62 years. Born and raised in Ohio, we moved to California, lived in Washington State for several years, and then moved back to California to be near our family and more sunshine. While we are basically healthy, we have the typical age-related aches and pains. I recently had cataract surgery and he experienced memory loss after having abdominal surgery three years ago. Whether the memory loss was caused by the trauma of the hospital stay, the effect of the medication and anesthesia, or something else, I will never know, but the change was dramatic and lasting.
While the surgery may have been necessary, our lives changed markedly. Yet despite those changes, we remain committed to aging well and the dimensions of wellness play a major role - although they mean different things to me and to him. So, let’s briefly review how we manage.
The first dimension, physical wellness, typically covers exercise and nutritious eating. In a recent study, researchers analyzed the exercise, functional limitations, excess weight and obesity, self-perceived health status and chronic health problems within the over 65 population and found they are increasingly less physically active. However, even if one’s lifestyle has been inactive; it is never too late to change.
Of course, an older adult’s workout will be different than the workout of a younger adult or teen. Cartwheels and handstands may no longer be wise. Consider consulting a fitness trainer who specializes in working with older clients or your doctor as you get started and develop an exercise plan that includes strength, balance, and core training. This plan keeps you on track and maintains focus on your goals.
Although, aches and pains may occur, being active and more than a “couch potato” is a primary factor in the pursuit of physical wellness. Older adults who exercise tend to have improved immune systems and digestive functioning, better blood pressure and bone density, a lower risk of dementia, diabetes, heart disease, osteoporosis, and certain types of cancer. People too busy to take care of their health are like the mechanic who is too busy to take care of his tools.
Our exercise plan includes daily walks and stair climbing, playing a little tennis or pickleball, and using the exercising room.
Just like exercising, eating nutritiously is an important part of maintaining physical wellness. Eating nutritiously helps manage weight, energizes the body, and provides necessary nutrients. Eating nutritiously also lowers the risk of developing chronic health conditions such as heart disease and diabetes.
For older people, being underweight may be related to lack of food, not eating nutritiously, or having an illness. Being overweight may increase the risk of heart disease, high blood pressure, diabetes, and bone issues. Did you know that during the past 30 years, the proportion of obese older adults has doubled?
Guidelines suggest that a 60-year-old, woman who exercises very little should consume about 1,600 calories a day and a man who exercises very little should consume about 2,000 calories a day. Maintaining one’s healthy weight is crucial and healthy weight varies depending on height and body frame. The Harvard School of Health suggests the following guidelines for healthy eating:
While the Healthy Eating Place offers guidelines for healthy eating, let’s look at three less healthy foods: saturated fat, sugar, and salt.
In the book, Salt Sugar Fat: How the Food Giants Hooked Us, Pulitzer Prize-winning journalist Michael Moss goes inside the world of processed and packaged foods. Moss found that by “Employing scientists to dissect elements of the palate and tweak ratios of salt, sugar and fat to optimize taste, the processed food industry has hooked consumers on their products the same way the cigarette industry hooked smokers on nicotine.” How scary is that!!! So, let’s look at those substances a bit closer.
For years, people were told to banish all fat from their diets. However, thinking has changed because even though people switched to low-fat foods, they were no healthier. Perhaps, because they cut back on healthy and harmful fats.
Now experts realize the body needs some fat from food; it is a major source of energy. Fat also helps a person absorb certain vitamins and minerals and is needed to build and maintain cell membranes.
Unsaturated fat is a healthier choice than saturated or trans-fat. Sources of unsaturated fat include avocados, nuts, whole grains, olive oil, and fish. Unsaturated fat helps reduce the risk of high cholesterol levels and provides other health benefits.
Sources of saturated fat are palm and coconut oils, cheese, and red meat. Saturated fats increase blood cholesterol, which increases the risk of heart disease, and causes other health problems. As a rule of thumb, liquid fats are better for a person than solid fats.
Eating too much sugar has negative health effects, as well. An excess of sugar can lead to weight gain, blood sugar problems, teeth decay, and an increased risk of heart disease, among other conditions.
The American Heart Association says the maximum amount of sugar a man can consume daily is 150 calories or 9 teaspoons. The maximum amount of sugar a woman can consume is 100 calories per day or 6 teaspoons.
Consider this, there are about 10 teaspoons of sugar in a 12 oz. can of coke. So, one can of coke is over the daily requirement.
Salt causes the body to retain water. When someone eats too much salt, extra water stored in the body raises the blood pressure. Higher blood pressure causes greater strain on the heart, arteries, kidneys and brain.
Americans typically eat about 3,400 mg of sodium per day. The Dietary Guidelines for Americans recommends limiting sodium intake to less than 2,300 mg per day—that's equal to about a teaspoon of salt!
We follow the Mediterranean diet. We also limit salt and eat fresh food rather than canned food. Our downfall is sugar and we really do need to do a better job of decreasing our intake.
There are other culprits, as well. While smoking, drinking, and prescription drugs, impact physical wellness; their negative impact is often overlooked and downplayed.
The Bureau of Labor Statistics found the average American spends approximately one percent of an annual gross income on alcohol purchases, which is about $565 per year. Similarly, iSpot.tv notes that 187 commercials about 70 prescription medications collectively are aired almost half a million times on TV and drug companies spent $2.8 billion during a 9-month period of time in 2018.
Cigarette smoking is the leading cause of preventable disease and death in the United States. Smoking accounts for approximately one in five deaths yearly. In 2016, an estimated 37.8 million adults in the United States smoked cigarettes and more than 16 million Americans live with a smoking-related disease such as asthma or emphysema.
The results of smoking occur disproportionately among older people because there is typically a long period of accumulated damage. Lung cancer is the largest cause of excess smoking-related mortality over the age of 60.
No matter the age, to quit smoking improves health and adds years to one’s life. My Dad smoked for 50 years, had progressively debilitating emphysema, and died at age 71. I never smoked and have already outlived him by 10 years. His smoking may not be the only reason he died so young, but it was a factor.
Similarly, a research study suggested that the greatest increase in marijuana use was observed among people 65 years and older. More adults use marijuana medicinally than recreationally. However, that may change as recreational use of marijuana becomes legal in more states. While the effects of marijuana smoking by older adults must be explored more thoroughly, almost everyone agrees the public health consequences of opioids are far worse.
As people age, physiological changes occur and they metabolize alcohol at a slower rate. Therefore, an older person may experience the effects more intensely and for a longer period of time than a younger person; even experiencing effects without increasing the amount of alcohol they drink. It is also true that older women are more sensitive than older men to the effects of alcohol.
Drinking too much alcohol over a long period of time may lead to the masking or worsening of health problems and more susceptibility to accidents or falls. While a glass of wine with dinner isn’t a cause for concern, the cumulative effects of drinking alcoholic drinks can take a toll. That toll may include inflammation, skin problems, high blood pressure, brain damage, and dependency. We drink very little.
Finally, a third concern in discussing physical wellness is prescription drugs. While there is a time and need for medication, medications are often over prescribed and abused. Think about this:
“The statistics on medication usage among elderly patients in the US are eye-opening: more than one-third of prescriptions drugs used in the US are taken by elders. The average elderly patient has more than five prescriptions; the average nursing home patient has more than seven.”
Pain is more prevalent in older people, as is the use of medication for pain management. Older people experience various life changes and an increased likelihood of having pain and physical illness – a very popular solution is prescription drugs.
A doctor described patients who “doctor shop” until they found a doctor who would write the prescriptions they wanted to have.
My husband’s experience may be an example of what can happen with the overuse of medications. As an older adult, he had a tendency toward memory loss. However, he took no prescription drugs prior to surgery.
During the surgery, he was given a large amount of anesthesia and during his nine-day hospital stay was given numerous medications. After the hospital stay, his memory never recovered.
While he exercises regularly, eats nutritiously, manages his weight well, and does not smoke or drink, his physical wellness has been compromised. Presently, we take no prescription drugs.
The physical dimension of wellness includes exercising, eating nutritiously, and other factors. So, whether you are a care-giver or a person needing care, physical wellness is a priority. You are the mechanic in charge, it is up to you to keep your mind and body healthy as best you can.
Exercising the brain is as important as exercising the body. The old saying “if you don’t use it, you lose it,” applies. So, the second dimension of wellness, intellectual, refers to active participation in scholastic, cultural, and community activities. It is valuing many experiences, getting excited with new ideas, and sharing. It is responding to challenges and opportunities, making plans, developing strategies, and solving problems. It is the ability to engage in clear thinking and recall, and to think independently, creatively, and critically.
Maintaining intellectual wellness expands a person’s knowledge and skills needed to live a stimulating, successful life. To improve intellectual wellness, one should value creativity, curiosity, and lifelong learning.
A major concern is that as people age, they can lose their mental faculties and perhaps their independence. Ways to maintain sound intellectual health in addition to being active and eating well include drinking sensibly, keeping in touch with others, asking for help, and doing something you are good at.
Another aspect of intellectual wellness is keeping the brain sharp. The brain, like the rest of the body, changes as you grow older. Many people notice gradually but increasing forgetfulness as they age; it may take longer to think of a word or to recall a person's name.
A recent meta-analysis reported that the global prevalence of dementia is somewhere between 5 and 7 percent within people aged 60 or over. By the age of 85 years and older, between 25 and 50 percent of people display symptoms of dementia, which is all encompassing because the brain’s functioning affects everything you do from remembering to brush the teeth to taking medications.
Maintaining a high level of intellectual wellness can occur when you learn a foreign language, subscribe to a journal, read a book, attend exhibits, plays, and musicals, explore different intellectually stimulating pass times such as crossword puzzles or board games such as Scrabble and Chess.
So, you can see what an important role intellectual wellness plays in maintaining a healthy lifestyle. Without intellectual wellness, a person won’t be able to make healthy lifestyle choices.
We eat well, drink minimal alcohol, keep in touch with others, and have a close family.
While my husband is not interested any of the pass times mentioned above, he does take Prevagen, we make jigsaw puzzles, he plays pool, watches television, and we exercise regularly.
The third dimension of wellness is social. Social wellness is having positive interactions with and enjoying being with others. It is feeling at ease during work and leisure times, as well as expressing one’s feelings and needs to others. It involves developing and building close friendships and intimacy, practicing empathy and effective listening, caring for others and the common good, and allowing others to care for you. It is recognizing the need and taking the time for leisure and recreation.
Social wellness occurs when a person lives in harmony with the environment and the community. Volunteering is one way to engage in social wellness because it can give a sense of satisfaction and purpose; however, it is not the only way. There are a variety of opportunities available for older adults to increase their social circle and add value to living. Those activities include doing fun things, pursuing a hobby, finding exercise and companionship by participating in a sport, or joining a group and making new friends.
Approximately 20 percent of Americans feel lonely and isolated during their free time which is another valid reason for maintaining social wellness. Socially isolated people are more susceptible to illness and have a death rate two to three times higher than those who are socially connected.
People who maintain their social network and support systems do better under stress. Similarly, a strong social network can create a good mood and enhance self-esteem. Touching, stroking, and hugging have been found to improve health; just as laughter is good medicine. Cholesterol levels rise when human companionship is lacking and close friendships cause higher levels of immunoglobulin.
The current health crisis and call for social distancing only heightens the problem. Many cities and states are initiating outreach programs to seniors. An added concern is created for people with loved ones in nursing homes, assisted living facilities, and memory care who can no longer visit and maintain physical contact with their loved ones.
Being socially active is a key to wellness. Particularly with the restrictions created by the corona virus, loneliness is a major issue and must be considered. I connect with friends and loved ones via email, Skype, and phone. My husband is not interested in volunteering or joining groups; so, we get together with family members because they know and understand the situation.
The fourth-dimension is emotional wellness. The term emotional intelligence (EQ) comes to mind. For many people, emotional intelligence is more important for attaining success in life. than intelligence (IQ).
Howard Gardner, developmental psychologist and Harvard Professor, named skills that must be developed for high emotional wellness. The four skills are:
1. Self-awareness - Listen to your true feelings, recognize the effects of your emotions and have confidence in your capability to manage them.
2. Self-regulation – Have a say in how long an emotion lasts. Use various strategies such as re-framing a situation in a more positive light, taking long walks, or meditating to mitigate negative emotions such as anger, anxiety, or depression.
3. Self- motivation - Inspire yourself with clear goals and a positive attitude. Even if you currently have a negative attitude, you can learn to think positively with effort and practice.
4. Empathy - Recognize how other people feel. The more skillful you are at understanding the feelings behind the signals someone gives, the better you can control the signals you send.
Another aspect of emotional wellness is resilience. Those who master emotional resilience tend to be prepared for emotional emergencies and adept at accepting what comes at them with flexibility rather than rigidity. Emotionally resilient people know and maintain their boundaries, practice acceptance, don’t pretend to have all the answers, make a list of self-care habits, and enlist a support team.
Imagine the important role emotional wellness and resilience play in maintaining a healthy lifestyle especially when providing care for another person. Finding ways to adapt and accept the changes that are occurring is key.
Emotional wellness is an issue both of us must work on. We get discouraged. Sometimes, he is angry at himself and sometimes he is sad, but the moods pass quickly. I must learn to acknowledge my feelings and be compassionate with both of us. This is so very difficult in so many ways.
Spiritual wellness is the fifth dimension of maintaining a healthy lifestyle. It is being connected to something greater than yourself and having a set of values, principles, morals and beliefs that provide a sense of purpose and meaning for life, then using those principles to guide your actions.
Spiritual wellness means having a sense of purpose and living a life that reflects one’s beliefs and values. The path to spiritual wellness can involve meditation, yoga, prayer, affirmations, or specific spiritual practices that support a connection to a higher power or belief system.
Compassion, the capacity to love and forgive, altruism, joy, and fulfillment help a person enjoy spiritual health.
Spiritual wellness can be assessed by answering four questions. A "no" to any one of them may indicate an area to improve the state of spiritual wellness. The questions are:
1. Do I make time for relaxation in my day?
2. Do I make time for meditation and/or prayer?
3. Do my values guide my decisions and actions?
4. Am I accepting of the views of others?
Spiritual wellness is key to maintaining a healthy life style. People who are care-givers experience many ups and downs and a spiritual connection is so beneficial.
I practice mindfulness and see myself as being spiritual. While my husband was never a “spiritual” person, he definitely has a set of beliefs and values that guide his life still and he has a strong purpose - to keep living.
Functional wellness is the sixth dimension and I define it as managing oneself in life. Age-related functional decline can be subtle. My eyes are an example. I needed reading glasses many years ago and the prescription needed to be stronger and stronger over time. My eyesight worsened so that I was unable to drive or accomplish certain daily tasks. I was fortunate; cataract surgery solved the problem.
One in every eight senior citizens, though, need help with one or more basic daily tasks. One study found that the most important factor associated with functional decline is the number of days the person took off from regular activities, the number of hot meals he or she consumed per day, and his or her cognitive status. Also, interestingly, people who believed their health was worse than it was previously were significantly less likely to improve their function.
What can someone do to prevent functional decline? The answer will likely sound familiar: eat a healthy diet, exercise regularly, manage chronic diseases that you might experience, and stay active. Since having cataract surgery, I am functionally healthy. My husband not so much, I am basically living his life for him.
We have talked about the six dimensions of wellness in this article – what they involve and how we apply them. Remember that Spanish proverb “A man too busy to take care of his health is like a mechanic too busy to take care of his tools?” Well, you are the mechanic and of your body and wellness plays a major role in keeping you healthy enough to take care of someone else.