Enjoyment of Life Leads to Longer Survival Among Seniors

Early morning - a bird relaxing. (Dr. Noorali Bharwani)
Early morning - a bird relaxing. (Dr. Noorali Bharwani)

“Old age ain’t no place for sissies,” said Bette Davis, an American actress. Keeping that in mind there is a continuous effort to improve the quality of life of seniors. Pills and more pills is not always the best way to make life of seniors healthy and functional.

A research article in the Canadian Medical Association Journal (CMAJ March 4, 2014) titled Enjoyment of life and declining physical function at older ages says, “Positive affective well-being (i.e. feelings of happiness and enjoyment) has been associated with longer survival and reduced incidence of serious illness.”

The authors of the article go on to say that their objective was to discover whether enjoyment of life also predicted a reduced risk of functional impairment over an 8-year period in a large population sample.

This was a prospective study involving 3199 men and women aged 60-years or older from the English Longitudinal Study of Ageing. The results provided evidence that reduced enjoyment of life may be related to the future disability and mobility of older people. Researchers obtained similar results when they limited analyses to participants younger than 70-years at baseline.

Studies have also shown that when seniors are having a good time their life is associated with longer survival and reduced incidence of coronary heart disease and stroke. That means if a senior is not happy then there is a decline in physical function. This predicts early death. That is not good.

The authors looked into several lifestyle parameters including whether the participants enjoy the things that they do, enjoy being in the company of others, whether they look back on life with a sense of happiness and feel full of energy on a regular basis.

After eight-year-study, the authors found greater enjoyment of life was associated with reduced risk of developing impaired activities of daily living and with a slower decline in walking speed.

Slow walking speed was considered an early marker of disability and frailty, as well as a predictor of dementia, admission to a long-term health facility and death. That does not sound good either.

After analysing their research results, the authors came to the conclusion, “Our results provide further evidence that enjoyment of life is relevant to the future disability and mobility of older people. Efforts to enhance well-being at older ages may have benefits to society and health care systems.” A CMAJ Editor’s comment on the article says the degree of enjoyment of life remains an important predictor of future functionality, indicating the power of a positive outlook on life.

The message is quite simple and clear. Growing older gracefully and in good health requires attention and work. As Bernard Baruch, an American financier said, “Old age is always 15 years older than I am.” He also said that one of the secrets of a long and fruitful life is to forgive everybody, everything, every night before you go to bed. Can we do that? Go have fun now.

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Saying Hello and Goodbye to Friends

One candle - multiple lights. (Dr. Noorali Bharwani)
One candle - multiple lights. (Dr. Noorali Bharwani)

“I once heard two ladies going on and on about the pains of childbirth and how men don’t seem to know what real pain is. I asked if either of them ever got themselves caught in a zipper,” says Emo Phillips, an American entertainer and comedian.

This is just a joke so don’t get upset about it. But it also makes a point. Almost everything in life is relative. We can moan and groan about our problems but if you talk to your friend or relative they probably have a worse story which they don’t even want to talk about.

After my recent illness, my first real outing was to attend a friend’s funeral. I had known him and his wife ever since I came to Medicine Hat – about 29 years ago. They were the nicest couple I had the privilege to know. I have known his wife from her work and I knew him as a genuine dedicated golfer. Now he is gone but he has left behind wonderful memories of charm, dedication, honesty and so much love and affection for everybody.

My second story is about another friend. Last week, I was in Lethbridge for a checkup. My wife and I were rushing to find the clinic. We passed by a couple and I didn’t even look at their faces. Then I heard a voice, “Noorali, is that you?” said the man. I recognized the voice right away. It was my good friend James (not his real name). I have known him for as many years as I have been in Medicine Hat. He worked as a family doctor in a small place until he moved to Lethbridge.

We stayed in touch with our yearly golf trips to the mountains. Last year he could not make it because he was too busy. This year he could not make it because he is not well. And I could not go this year for the same reason. And how ironic that our paths should cross in a Lethbridge hospital corridor?

As a surgeon, I have seen lots of sick people. But life is different when it affects you. I ask the same questions to my doctors as my patients used to ask me. Lots of those question have no good answers. My doctors look at me and smile. There is so much in life we know and there is so much we don’t.

I gave you three examples (including mine) of people with different backgrounds, facing the same kinds of problems in life. Is there a message in there somewhere?

Talk to you again soon. Stay healthy, happy and smiling.

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Broken-Heart Syndrome is also known as Takotsubo (Stress) Cardiomyopathy

Nurse helping a senior patient. (Wavebreak Media)
Nurse helping a senior patient. (Wavebreak Media)

Takotsubo cardiomyopathy is a transient acute illness typically precipitated by acute emotional stress. It is also known as “stress cardiomyopathy” or “broken-heart syndrome.” In 2011, there was an article on this subject in a medical journal, Circulation, by Dr. Scott W. Sharkey and his colleagues from the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN explaining the signs, symptoms and treatment of this illness.

In Japanese, “tako-tsubo” means “fishing pot for trapping octopus,” and the left ventricle (pumping chamber of the heart) of a patient diagnosed with this condition resembles that shape.

This is a fairly new condition recognized initially in Japan in 1990, with the first report emerging from the United States in 1998. Takotsubo cardiomyopathy starts suddenly, with symptoms of chest pain and, often, shortness of breath. The condition affects women older than 50 years of age (only 10 per cent in men). Most patients go to the emergency department thinking they have a heart attack.

Sharkey gives examples of emotional stressors which include grief (death of a loved one), fear (armed robbery, public speaking), anger (argument with spouse), relationship conflicts (dissolution of marriage), and financial problems (gambling loss, job loss). Physical stressors include acute asthma, surgery, chemotherapy, and stroke.

“Although patients with takotsubo do not have significantly narrowed coronary arteries, in the early hours takotsubo and heart attacks share many similarities in presentation, including chest pain and breathlessness, as well as abnormalities in both the electrocardiogram and blood biochemical tests,” says the article. But coronary angiogram will show normal coronary arteries but unusual shape of the left ventricle that has given takotsubo its unique name.

Once the diagnosis is made (via several invasive investigations) patients are in the intensive care unit for at least 24 hours, during which time vital signs are monitored and blood is tested for troponin (a protein released by injured heart muscle). Medications are used to promote recovery of heart muscle and blood thinners are used to avoid a stroke caused by a blood clot traveling from the heart to the brain.

Major life-threatening complications are infrequent. Low blood pressure (hypotension), fluid buildup in the lungs (congestive heart failure) and a chaotic heart rhythm will require appropriate medications.

“Fortunately, with timely recognition and supportive therapy, takotsubo events are reversible, and recovery is usually rapid and complete. Heart function (contraction) gradually improves over several days and is usually normal by hospital discharge (3–7 days). The term stunned heart muscle is commonly used to indicate that injury in takotsubo, although initially profound, is only temporary. Drugs are discontinued once heart contraction has returned to normal,” says Sharkey.

Why would acute stress cause heart failure? This is an unresolved question. It may have something to do with the autonomic nervous system. It has been suggested that when powerful hormones such as adrenaline are released in excess, the heart muscle can be damaged in patients with takotsubo. Fortunately, the long term prognosis is good. Nearly all patients survive an acute takotsubo episode. In approximately five per cent of patients, a second (or third) stress-induced event may occur. Best thing is to avoid stressful situations. Relax, do deep breathing exercises and keep smiling.

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Happiness and Good Health

Almost everybody I know wants to be happy and healthy. As somebody has said, happiness is man’s greatest aim in life. In 2005, a British study showed that happiness and health may overlap. That means we should continue to strive to be happy if we want to be healthy.

How do you define happiness? Happiness can mean different things to different people. And what exactly makes men and women happy? Is it the materialist extreme searching for happiness in external conditions or is it the spiritual extreme claiming that happiness is the result of a mental state? It seems research supports both the materialist and the mentalist positions, later has the stronger findings.

Although human sciences recognize that happiness is the fundamental goal of life, there is a very limited understanding of what happiness itself consists of. With the tremendous technological advance in the western countries people believed that materialism, longevity, healthy life, acquisition of wealth and ownership of consumer goods would lead to happiness. But wealthy people are not necessarily happy or healthy people.

You may wonder why I thought of this subject at this time of the year. During the Christmas holidays I was in Disneyland, California with my family. This was my sixth visit to the Mickey land and third one with my family. And we have been once to Disneyworld in Orlando as well. Call me nuts if you like but I am a big Mickey and Pluto fan and I am very happy when I am in Disneyland with my family. It is the most carefree happy holiday I can have. Plus it is a healthy one as we walk a lot. Three days in Disneyland, one day at Universal Studios and one day in Los Angeles and Hollywood makes it a worthwhile happy trip.

Disneyland is promoted as the happiest place in the world. For me it is. Last time we were there in 1992 and 1993 when my children were six and four years old. Their memory is pretty foggy of what they did in 1993. So they wanted to go there again and have fun and be happy and healthy. My wife and I were ready to oblige. And that is what we did. That is my kind of happiness. Of course there are many other things which make me happy. I can produce a long list of things which make me happy each day.

Amazing thing about Disneyland is that they take their responsibility of making people happy very seriously. We stayed at one of their hotels and we did not have one complain. The service was excellent. In the park itself, there are hundreds or thousands of helpers to guide you and make your day a happy one. The long lines keep moving and you don’t even realize you have been in the line for an hour. The new system of Fastpass works quite well. I am really impressed the way they manage to keep every body smiling and happy all the time. It is amazing. Can we do the same for our family and friends and strangers we meet each day?

While I was having fun and being happy in Disneyland, I am sure there were people all over the world doing other things that made them happy. And that begs the question: What makes happy people happy? You must have noticed that happy people have a different attitude, they interpret the world in a different way and they are not complainers or whiners. Their glass is always half full not half empty. They are not materialistic in nature.

Why is happiness important? Studies have shown that happier people are generally healthier people – not only mentally, but also physically. Happiest people have lower levels of the stress hormone cortisol. Their hearts keep a mellower pace than those of less happy people, and they don’t flip out as much during a mental stress test.

So, the message is simple: If you want to be healthy then be happy, don’t worry and hug Mickey once day!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!