1. Heart-to-Heart: Gender
differences in cardiac care
Why men and women may need different tests and treatments
F
or quite some time it was assumed
that the male and female heart func-
tioned in essentially the same way.
But as science advances, it’s become
clearer that there are gender differences
in how hearts grow, and
how diseases develop
and manifest.
“While most risk fac-
tors for heart disease
affect both genders, some
more actively promote
disease in women,”
says Karol Watson,
MD and director of
the UCLA Women’s
Cardiovascular Center.
“Risk factors such as insu-
lin resistance, being over-
weight or obese and having
high triglycerides tend to be more harmful
in women.”
Analyzinggenderdifferencesinaginghearts
A federally funded study analyzed MRI
scans of aging hearts as part of an ongoing,
long-term project called the Multi-Ethnic
Study of Atherosclerosis (MESA), which
is following thousands of men and women
of different ethnic backgrounds across the
country. Several institutions, including
UCLA were involved in the MRI study.
Researchers studied scans of nearly 3,000
older adults, ages 54 to 94, without preexist-
ing heart disease. Participants were tracked
between 2002 and 2012. Each participant
underwent MRI testing at the beginning of
the study and once more after a decade.
The MRI scans revealed significant dif-
ferences in the way male and female hearts
change with age. The research was pub-
lished online in the October 2014 edition of
the journal Radiology. The results
don’t explain why there
are gender differ-
ences. It does, how-
ever, shed light on
the different forms
of heart failure
seen in men and
women. Those dif-
ferences indicate
that there may be a
need to develop gen-
der-specific treatments. The
standard practice has been
to develop both diagnos-
tics and treatments based on the male heart.
With this study and others that approach is
changing.
Heartfailure:similaritiesanddifferences
In both genders, the main heart chamber,
the left ventricle—which fills with and then
forces out blood—gets smaller with age. As
a result, less blood enters the heart and less
gets pumped out to the rest of the body. But
in men, the heart muscle that encircles the
chamber grows bigger and thicker with age,
while in women, it retains its size or gets
somewhat smaller.
According to the researchers, a thicker
heart muscle and smaller heart chamber
volume may increase the risk of age-related
heart failure. The gender variations suggest
that men and women may develop the dis-
ease for different reasons.
A condition that affects more than five
million Americans, heart failure is a gradual
weakening of the heart muscle and even-
tual loss of pumping ability. To lower the
risk, cardiologists often prescribe medica-
tions designed to reduce the thickness of the
Continued on page 7
February 2016
Volume 13 • Number 2
4
Don’t ignore joint
pain
Know when to self-treat
and when to call your
doctor.
8 Ask Dr. Ferrell
■■ Are natural sexual
enhancement
products safe?
■■ Is my spouse
a horder?
■■ What can I do about
yellowing toes nails?
2 News Briefs
■■ New breast cancer
screening guidelines.
■■ Seniors prescribed
more antipsychotics.
■■ Math equation can
detect dehydration.
3
Reduce stress with
mindfulness
Simple practices can
boost your wellbeing.
5
Stronger muscles for
longer life
Increased muscle mass
can reduce fall risk and
lengthen quality of life.
6
Build memory with
your life story
Create better social
bonds and improve
recall through memoir.
7 Eat more protein
Heart and other muscles
need protein. Most
seniors don’t get enough.
Someriskfactorsarethesameforbothgenders.
Buttherearealsosomeimportancedifferences.

2. EDITOR-IN-CHIEF
Bruce A. Ferrell, MD
UCLA Division of Geriatrics
EXECUTIVE EDITOR
JoAnn Milivojevic
GROUP DIRECTOR
Jay Roland
ADVISORY BOARD
Randall Espinoza, MD, MPH;
Arash Naeim, MD;
Michelle Eslami, MD;
John FitzGerald, MD;
Ellen Wilson, PT
Healthy Years
(ISSN # 1551 4617)
is published
monthly for $39
per year by Belvoir
Media Group, LLC,
535 Connecticut
Avenue, Norwalk, CT 06854-1713.
Robert Englander, Chairman and
CEO; Timothy H. Cole, Executive
Vice President, Editorial Director;
Philip L. Penny, Chief Operating
Officer; Greg King, Executive Vice
President, Marketing Director;
Ron Goldberg, Chief Financial
Officer; Tom Canfield, Vice
President, Circulation. © 2016
Belvoir Media Group, LLC.
Postmaster: Send address
corrections to Healthy Years,
PO Box 8535, Big Sandy, TX
75755-8535.
SUBSCRIPTIONS
$39 per year (U.S.)
$49 per year (Canada)
SUBSCRIPTION SERVICES
For customer service or
subscription information:
Healthy Years
PO Box 8535
Big Sandy, TX 75755-8535
Call toll free 866-343-1812
ONLINE SERVICES
Visit www.healthy-years.com/cs
to change your address, renew
your subscription, check your
account status, or contact a
customer service representative.
2
N E W S B R I E F S
Newbreastcancerscreeningguidelines
Late last year, the American Cancer Society (ACS) released their new breast
cancer screening guidelines. The changes include when women should start
having mammograms, at age 45 (previously 40) and then every other year
beginning at age 55. These ACS guidelines apply to women with average
risk, which are most women. Although breast cancer is more common in older women,
after menopause, breast cancer tends to grow more slowly. It is also easier to detect early
because the breasts are less dense. On average, the majority of women are post-meno-
pausal by age 55. According to researchers, there was no statistical advantage to annual
screening in post-menopausal women, hence the move to screening every two years. The
ACS has also removed the recommendation for physical breast exams by physicians bec-
uase there was no evidence that it reduced breast cancer. Women should, however, be
familiar with how their breasts normally look and feel, says ACS, and discuss any changes
with their health care providers. Women should report any lumps, nipple discharge, and
swelling around armpit or collarbones. As a preventative measure, diet can make a differ-
ence. A recent trial in Spain among women in their 60s found that those who followed a
Mediterranean Diet had a lower risk of breast cancer compared to the control group. You
can calculate your estimated risk by using the online Breast Cancer Risk Assessment Tool
at cancer.gov/bcrisktool.
Prescriptionsforantipsychoticsincreasewithage
Antipsychotics can be appropriate for some mental disorders such as schizophrenia and
bipolar disorder but researchers from the National Institute of Mental Health (NIMH)
recently found that more than three-quarters of seniors receiving an antipsychotic pre-
scription in 2010 had no documented clinical psychiatric diagnosis during the year.
Known side effects include metabolic problems and weight gain. For older adults the
potential side effects are more dangerous including risks of strokes, fractures and kid-
ney problems. Of special note is that the FDA has issued warnings of increased mortality
regarding antipsychotics in elderly patients with dementia, particularly for ‘atypical’ (or
2nd generation) antipsychotics according to Michael Schoenbaum, PhD, senior advisor for
mental health service, epidemiology and economics at NIMH and one of the co-authors
of the report. About 80 percent of antipsychotic prescriptions among adults 65 and older
were for atypical medications. The study also found that the percentage of people receiv-
ing an antipsychotic prescription increased significantly with age. The percentage with an
antipsychotic prescription was approximately twice as high among people 80 to 84 com-
pared to those aged 65 to 69. Psychiatrists, who are more familiar with the properties of
antipsychotics, did not write the majority of prescriptions.
Earlydehydrationcanbedetectedbyamathematicalequation
Seniors are particularly at risk of water-loss dehydration, which can lead to confusion,
falls and other disabilities. Older people drink less water for a variety of reasons. For
example they may want to avoid frequent trips to the toilet or they simply may not feel
thirsty. A serum osmolality test is widely recognized as the best test for diagnosing dehy-
dration but it’s expensive and not currently viable for wide-scale screening. New research
reported in the British Medical Journal showed how a mathematical equation applied to
routine blood tests could be used to screen for dehydration. A variety of mathematical
equations already exist to detect dehydration in blood, but none have been identified as
being especially useful for elderly patients according to the researchers. So, the team stud-
ied 595 people over age 65 including those who were healthy and lived independently,
frail people living in residential care, and those in hospitals. The group also included
those with poor kidney function and diabetes. Researchers assessed the diagnostic accu-
racy of 39 different equations, and found that one particular equation had the greatest uni-
versal accuracy across a spectrum of healthy and frail older men and women at all levels
of dehydration. The researchers suggest that clinical labs could apply the equation to rou-
tine blood tests, which could lead to more cost-effective and pragmatic screening for the
early identification of dehydration among seniors.
February 20162

3. H E A L T H Y A G I N G A N D P R E V E N T I O N
Shutterstock
Mindfulness Meditation
Practices for Stress Reduction
How doing nothing reduces stress and enriches life
M
ore than 30 years ago, Jon
Kabat-Zinn, a molecular biol-
ogist from MIT, introduced
mindfulness practices to Western
medicine in a program called
Mindfulness Based Stress Reduction
(MBSR). Today, mindfulness prac-
tices are taught in many programs
including UCLA’s Mindful Awareness
Practices classes (MAPs).
“The applicability of mindfulness
based practices are wide,” says Jus-
tin Laube, MD and internal medicine
provider at the UCLA Center for East-
West Medicine. “It’s helpful for psy-
chological traumas as well as various
medical conditions.”
Skepticalwarvets
experiencethebenefits
Left untreated, trauma can be a life-
long heavy burden leading to depres-
sion, violence, substance abuse and
suicide. It has been 40 years since the
Vietnam War ended, but it’s estimated
that about 271,000 veterans who
served in a war zone have Posttrau-
matic Stress Disorder (PTSD) accord-
ing to an article published in the Jour-
nal of the American Medical Associa-
tion Psychiatry.
A recent study by research-
ers at the Minneapolis Veterans
Affairs Health Care System ran-
domly assigned 116 veterans with
PTSD to receive nine sessions of
MBSR, which teaches participants to
be present in the moment in a non-
judgmental, accepting manner. The
others attended group therapy, pri-
marily focusing on current life prob-
lems. The veterans were monitored
before, during and after treatment.
Results found that among veterans
with PTSD, mindfulness-based stress
reduction therapy, compared to group
therapy, resulted in a greater decrease
in PTSD symptom severity.
Ahealthywaytoeasediseasesymptoms
A wide variety of studies have shown
that mindfulness practices can be
effective in reducing symptoms of
anxiety and depression, high blood
pressure, chronic pain, inflammatory
bowel disease and stress-related skin
conditions such as psoriasis. It does
so because it is effective in reduc-
ing stress, which can wreak havoc in
the body.
Mindfulness helps you become
more aware of how stress feels. It
could be a tense jaw, shallow breath-
ing or repetitive negative thoughts.
With practice and expert guidance,
mindfulness allows you to break
down problematic experiences into
smaller more manageable parts,
according to Natalie Bell, a certi-
fied mindfulness instructor for the
UCLA Mindful Awareness Research
Center (MARC).
“When you are mindful you are
seeing, listening and feeling with the
purposeful intention to notice your-
self and your surroundings with a
quality of curiosity and openness,”
says Bell. “You are developing a com-
passionate awareness that can be with
you no matter what is happening.”
The practice simply uses the
breath as a focal point. Consciously
breathing in and out helps you stay
present and aware of thoughts and
feelings. Knowing that thoughts
and emotions constantly shift and
change can help you be less judgmen-
tal and more accepting of yourself
and others.
Learningonlineandingroups
While there are online resources, it
is helpful to attend a live instructor-
led mindfulness course. The instruc-
tor can help you get started and com-
mitting to a weekly group class can
help you stick with the practice. In
groups, we also learn that there are
others who may be dealing with simi-
lar challenges. “Realizing that others
are also suffering can be therapeutic,”
says Dr. Laube.
Each time you meditate, it’s like
putting a deposit in your mindful
awareness bank account. Through
time you’ll find yourself becoming
more patient and less reactive to life’s
inevitable stresses. And when you
do find yourself overwhelmed, you’ll
have a reserve of resources to help
calm and support yourself.
WHAT YOU CAN DO
This short meditation can help you feel calmer
in just a few minutes.
1. Set a timer for three minutes
2. Sit upright and relaxed
3. Close your eyes
4. Focus on your inhale and exhale
5. When your mind wanders, notice and
refocus on your breath
Forfreeguidedmeditationsandmoreaboutthe
benefitsofmindfulness,gotomarc.ucla.edu.
Whetherseatedorlyingdown,mindfulbreathing
canhelprefreshandrelaxbodyandmind.
3February 2016

4. B O N E S A N D J O I N T S
Thinkstock
Ignoringjointpaincanmake
mattersworse
Know when to self-treat and when to see a doctor
J
oint pain increases with age for
many reasons including lack of
muscular strength, inflexibility,
genetics, and damage from overuse or
misuse. Joint pain is not something to
be endured as a normal part of aging.
It is a signal from the nervous system
that something is wrong and it should
not be ignored.
“Cartilage damage such as a torn
meniscus in the knee can get worse,”
warns Brad Thomas, MD, orthope-
dic surgeon and faculty member at
the UCLA department of orthopedics.
“The earlier you address the damage
the better because the outcomes of
repairing small tears are better than
trying to repair larger cartilage tears.”
Understanding pain from joint
injuries can help you seek relevant
treatment earlier. Health profession-
als often use a 10–point pain scale to
rank pain: one meaning no pain, and
10 meaning excruciatingly unbear-
able. If your pain is consistently more
than three on the pain scale, it’s likely
a problem that needs professional
assessment says Dr. Thomas.
Acuteversuschronicpain
How long pain has affected the qual-
ity of your life determines whether it
is categorized as acute or chronic. Has
it been a few days or several months?
What causes pain is also an important
factor to note and tell your doctor.
“If you are achy or sore after
exercise, that’s normal in your 60s,”
explains Dr. Thomas, “but if daily liv-
ing activities such as walking, going
up and down the stairs, or reaching
up causes pain or if you have reoc-
curring site specific joint pain such as
around the hip, knee or shoulder, see
your doctor.”
Acute pain is generally the result
of a sudden mishap such as when you
tweak your back lifting a heavy box.
Acute pain generally passes in a few
days. Or if the injury is severe, it may
take several weeks. The point is acute
pain goes away with treatment or
sometimes it passes on its own as the
body naturally heals. But when pain
persists for more than three months, it
is considered chronic and you’ll likely
need an ongoing treatment strategy
that might include physical therapy,
massage and medication.
Chronic pain may arise from an
small untreated injury such as a knee
sprain or torn rotator cuff. It can be
the result of osteo­arthritis.
Agingandarthritisare
commoncompanions
Arthritis is an umbrella term for more
than 100 rheumatic diseases and
conditions that affect joints, the tis-
sues that surround the joint and over-
all connective tissue throughout the
body. The pattern, severity, and loca-
tion of symptoms can vary depend-
ing on the type of disease. You may
feel pain and stiffness around one or
several joints. Symptoms can develop
gradually or suddenly.
The Centers of Disease Control
and Prevention estimates that 50 per-
cent of people over the age of 65 have
some kind of arthritis. Osteoarthri-
tis (OA) is the most common form of
arthritis. With OA comes pain, inflam-
mation and stiffness in the joints.
Areas most commonly affected are
knees, hips, shoulders and hands.
Whentocallthedoctor
Back pain can be quite excruciating.
Generally it’s not a medical emer-
gency but sometimes it is. If you
experience any of the following along
with your back pain, call your doc-
tor immediately:
•• Numbness in genital area
•• Loss of bowel or bladder control
•• Progressive weakness in arms or
legs
•• High fever that doesn’t respond to
fever reducers
Treatmentandpreventionstrategies
The standard protocol for acute and
increased flare-ups of chronic pain is
R.I.C.E (see above). NSAIDs (nonste-
roidal anti-inflammatory drugs) can
also help reduce swelling and pain.
You can reduce risk of further joint
injury through staying flexible and
strong says Dr. Thomas. “Flexibility
is key to youth. A regular stretching
routine such as with yoga and pos-
tural stability through methods such
as Pilates are both very important.”
WHAT YOU SHOULD DO
R.I.C.E is the standard protocol for treating
acute pain and is recommended within the first
24-hours of injury. It’s useful for flare ups of
chronic conditions, too.
➢➢ Rest.Take a break from the activity until
the pain subsides.
➢➢ Ice. Apply a cold pack to the area as soon
as possible.
➢➢ Compression. Lightly wrap the
area to provide stability and reduce
inflammation.
➢➢ Elevation. Elevate the injured part on a
pillow at or above heart level to minimize
swelling.
Toreducetheriskoffurtherdamage,it’sbestto
treatjointpainassoonaspossible.
February 20164

5. Thinkstock
Consider strength
training for
longer life
Increasing muscle mass can
reduce disease and fall risk
and lengthen your life
A
ccording to recent UCLA
research, maintaining muscle
mass can reduce risk of diabe-
tes, cardiovascular diseases and it
may help you live longer, too.
The study, published in the Amer-
ican Journal of Medicine, led by Pre-
ethi Srikanthan, MD, assistant clini-
cal professor in the endocrinology
division at the David Geffen School
of Medicine at UCLA, found that
building muscle mass is important in
decreasing metabolic risk.
“Greater muscle mass is associ-
ated with improved insulin resis-
tance, which is at the root of both
diabetes development and cardiovas-
cular disease risk,” says Dr. Srikan-
than. “We also found there was an
association between the level of mus-
cle mass and total mortality.”
Worry less about body weight,
focus on building muscle
Everyone starts to lose a little mus-
cle mass starting at about age 30.
The loss can accelerate when you
get older because people tend to
be less active and at 65 years and
older, muscle mass also declines at
a faster rate. Sarcopenia is the medi-
cal term for severe skeletal muscle
loss, which is typically associated
with older adults. Preventing muscle
loss is your best. But don’t worry if
you’ve been sedentary for a while.
You can increase your muscle mass
at any age.
Even small changes in muscle
strength can make a real difference
in daily life especially in people
who have lost muscle mass. A stron-
ger body can make it easier to get up
from a chair, climb stairs, carry gro-
ceries, open jars and play with your
grandchildren.
Analyzing data from seniors
reveals value of muscle mass
The researchers analyzed data col-
lected by the National Health and
Nutrition Examination Survey
(NHANES) III, conducted between
1988 and 1994. They focused on
a group of 3,659 individuals that
included men who were 55 or older
and women who were 65 or older at
the time of the survey. The authors
then determined how many of those
individuals had died from natural
causes based on a follow-up survey
done in 2004.
Muscle mass of study subjects
was measured using bioelectrical
impedance, which runs an electri-
cal current through the body. Muscle
allows the current to pass more eas-
ily than fat does, due to muscle’s
water content. This is how research-
ers could determine a muscle mass
index—the amount of muscle relative
to height—similar to a body mass
index. They looked at how muscle
mass index was related to longevity.
According to the researchers, the
study does have some limitations.
For instance, researchers point out
that you cannot definitively estab-
lish a cause-and-effect relation-
ship between muscle mass and sur-
vival using a cohort study such as
NHANES III. “But we can say that
muscle mass seems to be an impor-
tant predictor of risk of death,” Sri-
kanthan said.
To build muscle mass, you
must fail to succeed
Muscles love a good challenge. They
build by straining against a resis-
tance. That resistance can be a your
own body weight such as with push-
ups, using hand weights or a flex
band. What’s key is that you work
your muscle to a failure point, mean-
ing that you cannot lift it again. You
know you’re at the proper resis-
tance level if it’s difficult to lift the
weight when you reach about the
eighth repetition. If it’s easy to get to
10, then you need more resistance.
Generally you should perform three
sets of 8-10 repetitions with about a
minute’s resting time between each
set. By your last set, you should
not be able to complete 10. In other
words, you’ve failed to lift the weight
and therefore you have reached
the point where muscle will build
more efficiently.
Strengthening core muscles is
just as important as building up the
muscles of your arms and legs. Core
muscles include abdominal, hip and
shoulder muscles. They wrap your
torso like a corset. A stronger core
can improve balance and reduce risk
of falls and fractures.
It’s never too late to build more
muscle. An active 70 year old can be
biologically younger than an unfit,
sedentary 50 year old. Exercise vig-
orously at least three times per week
and you should see and feel some
results within a month. Experiencing
the energy of stronger muscles can
revitalize your body, mind and spirit.
That may be enough motivation to
maintain a healthy muscle building
habit for life.
E X E R C I S E
Usingdumbells requiresyoutobalanceand
controltheweightsaswellastoworkbotharms
equally.Avoidusingmomentum.Liftandlower
slowly..
5February 2016

6. Memory builder: How researching
your own story helps
Documenting life events benefits you and your loved ones
F
rom memoir to scrapbooks, doc-
umenting your life story is an
enriching creative process that
has many profound benefits for you
and for the people with whom you
share it. The process involves mem-
ory, creativity and organization–all
good for your brain. It also provides
valuable insights on what you have
accomplished in your life.
“Sometimes people think they
haven’t done much,” says Erica Cur-
tis, board certified art therapist and
instructor for the UCLA Arts and
Healing Social Emotional Arts (SEA)
certificate program. “But when they
start to tell their stories, it puts expe-
riences in perspective. It’s a very
affirming process to look back and
helps people find meaning and value
in their lives.”
Telling your stories can also cre-
ate closer relationships.The elderly
aren’t always given respect for hav-
ing lived a full life, says Curtis. This
can be especially true in assisted
living and long-term care facili-
ties where the relationship between
caregiver and resident can be rather
perfunctory and detached. Sharing
life stories can create warmth and
understanding.
Howtokick-startyour
creativeprocess
It can be rather intimidating to docu-
ment an entire life. Instead, think
about documenting particular times
and special moments of your life. A
good place to start is with questions
your children or grandchildren ask
you. These questions can also spark
a starting point:
➥➥ What was your childhood like?
Describe a favorite game, or your
neighborhood.
➥➥ What did you do as teenager?
Share school experiences such as
classes, sports you played.
➥➥ What kinds of pets did you have?
Describe names and adventures
with your pet.
➥➥ How did your spouse propose
marriage? Provide details on your
honeymoon.
Some people choose to docu-
ment their work life creating a flow
of interesting travels, projects and
experiences related to their jobs; oth-
ers may choose to tell about major
events such as emigrating to Amer-
ica. It really is up to you what and
how much to tell.
“Some older adults have lost some
control and choice in their lives,”
explains Curtis, “and this helps them
exercise choice in their world.”
Creatingyourstoryinwords,
picturesandotherartforms
Memoir is a classic method by which
to tell a life story. There are many
books and online resources that can
help you write your story. What it
comes down to is telling your truth
and providing details of what it was
like to live at a particular time. The
details matter and will add interest
as well as context to those who read
it. For example, the price of gas and
type of car you had growing up, com-
munications in the non-computer age
and living through major historical
events such as the Great Depression.
Collages are another way to
assemble a life story. Thumb through
magazines and tear out images that
inspire you. Once you have a pile,
you can assemble them onto a sheet
of paper, add your own photos, and
memorabilia as well as drawings,
doodles and captions. Make it fun
and use what inspires you be it glit-
ter glue, gold stars or ribbons.
Other ways to document the
events of your life can be through
quilts, paintings, audio or video
recordings. Search online for the year
you were born and look at the images.
Chances are many memories will
rush back into your mind. Our memo-
ries are very connected to images and
images help our brains remember.
Beawareandreadyforemotions
Documenting the events of your
life is an emotional process. The
reflections can bring up feelings of
joy, regret and sadness. It’s normal,
healthy and perfectly OK to have
these feelings. If difficult emotions
and unresolved matters linger, talk
with a family member, friend or a
health care professional.
“Pain in life is inevitable but suf-
fering is optional,” says Curtis. “Suf-
fering occurs when we judge the
emotion as bad or think we shouldn’t
feel a particular way.”
Assembling the narrative of your
life can also be a collaborative proj-
ect done with a friend or loved one.
Many community centers, includ-
ing the UCLA arts and healing, offer
memoir and collage classes. You
can also work directly with an art
therapist to help you put your story
together and to glean greater insights
on your life.
Thinkstock
B R A I N H E A L T H
Workingonyourlifestorywithotherscanbuild
deeper relationshipswithfamilymembers,friends
andcaregivers.
February 20166

7. heart muscle and boost cardiovascu-
lar performance. But because a wom-
an’s heart muscle tends to shrink or
remain the same size suggests that
women may not derive the same ben-
efit from such treatments.
Compared to men, women with
heart failure also tend to have more
symptoms such as shortness of breath
and more difficulty exercising. They
also have swelling around their
ankles more frequently than men.
Despite those differences, however,
women generally survive longer than
men with heart failure.
Heartattacksymptomsvary
Men and women can experience
heart attack very differently, accord-
ing to Dr. Watson.
“For men, it’s a like bomb going
off—you get a dramatic chest pain
that sends you to your knees.
But for women, the symptoms
can be more subtle.”
Women may experience
jaw or arm pain, feel nause-
ated or very tired. Because of
that, women’s heart attacks
often go unnoticed. If heart is
suspected, call 9-1-1 imme-
diately. Heart attacks occur
because the blood supply to
heart has been cut off, most
often due to blocked arter-
ies somewhere in the body.
About 70 percent of men and
women in the 60-79 year old
age group has cardiovascu-
lar disease Age is a factor,
but you can take preventative
steps to reduce heart disease
risk. A heart-healthy diet as
well as physical activity that includes
muscle building and cardiovascular
exercises will benefit your heart. The
American Heart Association also rec-
ommends an ankle-brachial index test
for everyone over the age of 60. It’s a
simple and quick in-office test. Using
the familiar blood pressure cuff, your
health care provider measures and
compares the systolic pressure in
your arms and legs. The test helps
diagnosis the presence of periph-
eral artery disease (PAD), which is a
lesser-known type of cardiovascular
disease where plaque builds up in
arteries of the legs.
Cardiac care—cont. from page 1
H E A R T & M I N D
N U T R I T I O N
WHAT YOU SHOULD KNOW
Men’s and women’s hearts age differently
➢➢ Heart attack symptoms in men are more
dramatic and more subtle in women
➢➢ Insulin resistance and high triglycerides
appear to more harmful to women’s hearts
➢➢ Women tend to develop heart failure at an
older age than men
➢➢ Aspirin may be beneficial in preventing
heart attack and stroke
➢➢ Regular exercise and a heart healthy diet is
beneficial to everyone
Protein for heart and other muscles
D
ecreased dietary intakes of pro-
tein, as well as other nutrients,
may contribute to sarcopenia
(age-related muscle loss). The current
average government protein guide-
lines state that women should eat at
least 46 grams a day and 56 grams for
men. Some researchers have found
that seniors may need more.
“As we age, our appetites tend
to decrease,” says Dana Hunnes,
PhD, MPH, RD at the UCLA Fielding
School of Public Health. “If we don’t
consume enough calories, our body
begins to break down muscle or pro-
tein and use that for energy.”
A typical senior’s daily intake of
food may consist of jam and bread for
breakfast, a salad for lunch and small
piece of chicken with dinner. That’s
simply not enough says Dr. Hunnes.
Calculatingproteinneeds
It’s recommended that seniors con-
sume at least 1 gram of protein for
each kilogram of body weight. To
convert pounds of
body weight to kilo-
grams, divide your
weight by 2.2. For
example, a 150-pound
adult weighs 68 kilo-
grams and should therefore eat 68
grams of protein per day.
Protein sources can be animal
or plant based. One ounce of tofu,
chicken, fish, or one egg all have
about 7 grams of protein. “Other good
sources of protein include grains,”
says Dr. Hunnes. “Whole-wheat bread
may have 5 grams of protein per
slice.”
Planning for protein can be easy. A
meal plan for 150-pound person could
be two eggs for breakfast, a whole-
wheat chicken sandwich
with 2 ounces of sliced
chicken for lunch and 4
ounces of tofu stir fried
with veggies for dinner.
GENDER COMPARISON
CARDIOVASCULAR RISK FACTORS
Common for
men and women
More likely to
affect women
• Obesity
• Smoking
• Highbloodpressure
• Metabolicsyndrome
coexistenceofhigh
bloodpressure,obesity,
andhighglucoseand
triglyceridelevels
• Increasinghighblood
pressureduringmenopause
• Autoimmunediseasessuchas
rheumatoidarthritis
• Stressanddepression
• Lackofrecognitionthatthe
abovehealthissuesarerisk
factorsforheartdisease
7February 2016

8. QI occasionally have erectile dysfunction and
I’ve seen nonprescription products in the
store that promise to improve sexual perfor-
mance, are these safe?
AIf ever there was a case to apply the cliché
“buyer beware” this is it. The Food and
Drug Administration (FDA) does not regulate
supplements. Therefore manufacturers can
make unsubstantiated claims. They also may
not disclose all the ingredients and that can be
dangerous. Reported side effects from popular
over-the-counter sexual enhancement supple-
ments include: high blood pressure, increased
heart rate, manic reactions, insomnia, anxiety,
irritability, shivering, sweating, nausea, flushing
and headaches. None of this is going to improve
your sex life. The FDA has issued a consumer
warning about several products including Cave
Diver, X Zen Platinum, and Reload which con-
tain the undeclared ingredient sildenafil, the
active ingredient in the FDA-approved prescrip-
tion drug Viagra. X Zen Platinum also contains
tadalafil the active ingredient in Cialis. If you
have diabetes, heart disease, high blood pres-
sure or high cholesterol, you may be taking
nitrate-containing prescription medications. The
undeclared ingredients may negatively interact
with nitrates. Weight, lifestyle, psychological
factors and diseases that may cause ED are often
treatable. Talk to your doctor to find the best
route back to a healthy sex life.
QMy spouse insists the growing piles of
useless items are collectables, I think it’s
a symptom of hoarding. How can I know for
sure?
AIt’s a good question because one person’s
trash maybe another person’s treasure.
There are however, some distinct differences
between a collector and someone with a hoard-
ing dysfunction. A collector will seek out spe-
cific items such as model trains, stamps and
figurines. These items are typically cataloged
and displayed with pride. Hoarding is quite
different. While the items may bring comfort
and security to the person, the items are strewn
all over, crowding countertops and filling
rooms. Stacks of magazines and newspapers for
example can be piled high and take up a lot of
space. This can make it difficult and dangerous
to walk through ever narrowing spaces. Triggers
to hoard can be death of the loved where the
survivor wants to hang on to everything from
that moment in time. Symptoms of hoard-
ing can include difficulty throwing anything
out regardless of value, distress at the idea of
throwing anything out, and the inability to use
rooms (e.g., kitchens, bathrooms, garages) for the
intended purposes. Hoarding is a psychological
problem. People who hoard need help to learn
better coping and decision-making skills. It may
be difficult to convince your spouse of the prob-
lem. Consider seeing a counselor together or on
your own to help facilitate communications.
QMy toenails are getting rather thick and
yellow. I’m embarrassed to wear open toe
shoes. What’s going on?
AWhat you are describing sounds like a nail
fungal infection. People over 60 are more
susceptible to nail fungus infection, as are
people with diabetes or a weakened immune
system. It won’t go away on it’s own but you
can try some over-the-counter (OTC) treatments
such as antifungal creams, lotions, or liquids
that you brush onto nails. It can take several
weeks to get rid of the infection. While nail fun-
gus may not ruin your nail bed, it could spread
to other nails if left untreated. If the skin around
nail becomes inflamed, red lines extend upward
from the area, or if you have a fever higher than
100-degrees without anything else causing the
fever, call your doctor immediately as it could
indicate a bacterial infection which requires
a different kind of treatment. If the fungus
spreads to other nails or doesn’t respond to OTC
treatments, make an appointment with your
doctor. A prescription medication is stronger
and may clear the fungus faster.
SEXUAL ENHANCEMENT PRODUCTS … HOARDING … NAIL FUNGUS
IN COMING
ISSUES
NUTRITION —
Food journaling
PREVENTION —
Health care law
and dementia
HEARING —
How hearing
loss can affect
balance
February 20168
Editor-in-Chief
Bruce A. Ferrell,
MD, Professor of
Medicine and
Geriatrics
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