Episode Description
We are joined by Dr. Patrick Coll, geriatrician and professor of family medicine at the University of Connecticut and Medical Director for Senior Health across the UConn Health System. No matter what your age, this episode is a shower of practical insights to keep your physical, cognitive, and emotional health the best it can be. We discuss lifestyle behaviors that decrease our chances of dementia, the opportunity for systemic changes to incent continued engagement in the workforce, and the power of “use it or lose it”. Following this episode, Amy opted for a workout and Pat called a friend to play chess.
“The goal — for all of us — is to live a long, happy, healthy, secure life and NOT have a prolonged period of disability and dependency at the end of that life. And, most of that is in our own control.“
DR. PATRICK COLL
Resources Mentioned in this Episode
Dr. Coll’s book is available on Barnes & Noble
Healthy Aging: A Complete Guide to Clinical Management: https://www.barnesandnoble.com/w/healthy-aging-patrick-p-coll/1133096335
Transcript
PAT:
Hello, welcome to Going Older. I’m Pat Going.
AMY:
And I’m Amy Going Haworth.
PAT:
This is a podcast about aging from the perspectives of two generations. This podcast tackles what we’re talking about as it relates to living life well.
AMY:
And it seeks to bring the conversations we’re having as parent and child into the open so we can all learn together.
AMY:
So we are thrilled to have Dr. Patrick Coll with us today. Dr. Coll is a geriatrician and Professor of Family Medicine at University of Connecticut Health, where he served on the faculty for more than 30 years. He’s also the Medical Director for Senior Health at U. of Connecticut Health and responsible for efforts to improve care for all older adults within the U-Conn Health system. For more than 25 years, he was the Medical Director of a large continuing-care community in Bloomfield, Connecticut. He’s been named the Best Doctor in America every year, starting in 1991, and he’s made Connecticut Magazine’s list of best Geriatric mMdicine Specialists in Connecticut every year since 2004. He has a strong interest in promoting ‘healthy aging.’ That’s what we’re going be talking about today. He edited a book in 2019 on this topic, which is available on Barnes and Noble. It looks like an important read as I get a little bit older. I’m much more interested now in healthy aging. So in addition to all of this, Dr. Coll is also the father of my dear friend, Emma. So it’s really great to have you here today, Dr. Coll.
PATRICK P. COLL, MD:
Thank you, Amy. Nice to be here.
AMY:
Well, when we talk about even these words, ‘healthy aging,’ can you tell us a little bit more about what that means to you?
DR. COLL:
Yes, so maybe we can start with aging. So you can look at age as purely chronological age, which is easy to measure. We do it based on years, the number of times we go around the sun. And so it’s a pretty set number. And when we meet someone or if you’re filling out documents, you’re often asked to put down your age, and it’s simple enough to do it. You just put down a numerical number. But we also know that with chronological age, there are biological changes that occur. And they’re much more difficult to measure. And they’re much more variable than the simple number of what’s your age. And there’s still a lot about why we age biologically. We do know that as we get older, that can have a significant impact on our risk for certain medical conditions, certain diseases, and potentially disabilities associated with those diseases. I think we also know that at some point, and hopefully in extreme old age, we know that those diseases and or those disabilities lead to death. And so pretty much every, most every, not every single living thing on the planet, but most living things on the planet have a finite lifespan.
Although it’s interesting you mentioned my daughter Emma. I didn’t see her this weekend in Boston, but I was in Boston with my other daughter, Grace, and we went to the Arboretum in Boston, and there they have bonsai trees. that are more than 250 years old, which is fascinating. I mean, there’s not that many things on this planet that live that long. And certainly we as humans, at least at this point, don’t live that long. So there’s chronological age and then there’s biological age. And I’d be happy to talk more about these common conditions that occur with increasing age and what we can do to try and mitigate and change the impact of some of those illnesses.
AMY:
Yeah, that would be great. You know, I think this idea of chronological and biological age has been so interesting because as I’ve watched my parents age and seen sort of their demographic peers and just how different they are. I think I probably as a kid started to notice it around their chronological age 60. But looking across, you know, friends and parents of friends and even people in their professional world and started to see a real disparity of how active they were able to continue to be, what they found fun and interesting. There were forks – my parents were out climbing 14’ers when I went to college. Other people’s parents were slowing down. Maybe choosing to – to be patrons of the arts or things that just felt like a little different pace. So this is a really fascinating concept to me because as I’m almost 50, I’m thinking about what is the life I want to have in the decades to come. And so just what some of those influencing factors are. I would love to hear a bit more about that fork in the road and some of those leading behaviors that might help us chart our course for the future.
DR. COLL:
Yeah, absolutely. You mentioned my book – in the foreword for that book, it talks about this. Alot of this is in our control. There are what I call bad luck conditions, things that can happen to us almost at any age. But again, they’re a little bit more common with older age that are beyond your control. Something like ALS that we’ve heard of or pancreatic cancer that as best as we can tell, it’s really just kind of bad luck why someone gets a condition like that. But thankfully, those conditions are relatively rare. And the common conditions that we see with old age – whether it’s arthritis or cognitive impairment or heart disease or certain skin conditions, many of those are modifiable. And those modifications are based on mostly non-medical interventions – lifestyle things you mentioned, like activity levels. So we do know that as we get older, we lose muscle mass and we lose muscle strength. And I tell my patients, you’re not gonna notice that until you notice it. And when you notice it, you’ve lost a lot and it’s often hard to get it back. So you really need to think now about what you can do to preserve muscle function and muscle strength. And it’s remarkable what you can do while increasing in age. Now, I think it’s also fair to say that an 80 year old is never gonna win a gold medal for the 100 meter sprint at the Olympics. ‘Cause there will always be the 25 or 30 year olds who are gonna train and they’re gonna do better. But there are 80 year olds out there running 5Ks at under 30 minutes. Much, much faster than your average 20 to 30 year-olds. So there’s so much that can be done. So I would say muscle strength and resistance training is probably the single most important thing to preserve independence and health as you get old.
AMY:
What’s your reaction to that, Dad?
PAT:
This is just fascinating. Well, I don’t want to influence the good momentum you two have going here. But I’ll share that I’ve been fortunate over the years to maintain the habit of getting to the gym and doing those pull-ups and squats and bench presses. Those major muscle groups. So I’m so glad to hear that maybe I have been doing something right, even though I can’t figure out how to quit shrinking. You know, I hate being an inch shorter these days, but I guess that comes with it.
DR. COLL:
Yeah, that’s a good point.
PAT:
Amy and I put together some questions, but I think the direction you’re going here is just terrific. So I’ll just toss it back to you two.
DR. COLL:
I’m so happy to hear that you’re out there in the gym. I tell it again to my patients, you have to be careful. If you haven’t done this ever, or maybe for a long time, don’t jump in on the deep end. Start with lower weights. If you’re using equipment you’re not familiar with, get some instruction, gets some help in terms of how to use it, what to do. And in terms of the right amount of resistance. If you can lift a weight 50, 60 times, it’s too light. If you can only lift that weight two or three times, it’s too heavy. It seems like the sweet spot is what we call reps, right? Let’s say you’re doing a pull down on a weight. Once you get to the 10th, 11th, 12th rep, then you’re feeling that burn and you’re ready to stop. That’s about the right amount of resistance to build up muscle strength. You’re probably not gonna build muscle bulk, but you are gonna maintain muscle strength. If you work at this enough, you will get stronger and you will feel stronger and you will feel more secure in your walking.
We didn’t talk yet about balance and this is very important too in terms of maintaining independence. We have a lot of different mechanisms in our body that allow us to be on two feet. So as human beings, we’re bipedal, we’re on two feet, and there’s definitely advantages to being on two feet. Particularly, we get to use these feet. We get to use our hands. But being on two feet makes us a little bit more unstable, particularly as we get older. And so people can lose their balance. They can fall and they can sustain injuries. Or they may need some kind of assistive device to help with ambulation. And again, strength is important to avoid that, and maintaining good balance is important too. And so balance is like every other part of your body. If you challenge it, just like we’re talking about weight and strength, if you challenge it, you can get stronger. If you challenge your balance, you can become more secure and less likely to feel unsteady. There’s plenty of ways to do it. You can go on YouTube, you can look at videos. You have to be safe. You know, if you’re going to challenge your balance, you want to make sure you don’t fall while you’re doing it, but there’s lots of ways to do that.
PAT:
Very interesting. Carol and I have started walking backwards. But again, really being very cognizant of safety. We’re finding a running track that we know doesn’t have any obstacles is a good place. But walking backwards can be a challenge. I mean, walking backwards even 10 yards will catch your attention.
DR. COLL:
Yeah, that’s an excellent way to do it. You mentioned the running track – we spend most of our lives on really flat surfaces so we’re not really working on our balance very much. So challenging your balance like you’re doing or walking on an uneven surface, like hiking, is so beneficial. But again, if you haven’t done that for a while, or maybe you already have a little bit of issue with your balance, you’ve got to be careful. But challenging your balance is so good and definitely a good thing.
AMY:
How does all this play into cognitive side? I would imagine there’s a tight link between our physicality and our cognitive.
DR. COLL:
There is, Amy. So when we talk about cognitive decline, there are normal age-related changes that occur with our brain function. Short-term memory is the one thing that is impacted that’s normal and often referred to as a senior moment. Maybe not remembering the name of a book you read or having to write down appointments where you didn’t used to have to do that in the past. But then as we also know, there are conditions that are more prone in older adults later in life that can make a big impact on brain function. We call that dementia. And the most common form of dementia is Alzheimer’s disease.
Now, we feel that about 40% of the risk for developing dementia is modifiable. You can reduce your risk of developing dementia by about 40%. The way to do that is get a good education, interestingly. Being well-educated is an important protective risk factor for developing dementia. Making sure your hearing is good. There’s a relationship between risk for developing dementia and hearing impairment. And probably that most modifiable is there’s a big connection between cardiovascular health and brain health. So there is a big connection between heart health and brain health. Anything that’s good for your heart is good for your brain. Anything that’s bad for your heart is bad for your brain. So the same kind of things that put people at risk for having a stroke, having a heart attack, put patients at risk for developing dementia. So making sure your blood pressure’s under good control; eating a heart healthy diet; regular exercise. Just like we’ve been discussing – aerobic exercise, like walking. All of these can decrease your risk of developing dementia and preserve cognitive function. And the evidence is not as strong, but we also believe that by using your brain, makes sense, right? Like we’ve been talking about – using your muscles makes them stronger. Likewise use your brain, and it’ll be stronger too. Remain intellectually curious; be socially engaged; attend cultural events. We started seeing during the COVID pandemIC – this is well described in the medical literature – that many older adults developed issues with their brain function and cognitive impairment, at least in part, related to their social isolation. They were not getting out and interacting with others as much as they had previously.
PAT:
On a personal note, Dr. Coll, we create transcripts for these podcasts and selfishly, I can hardly wait to read the transcript because I love all of this wisdom that you’re sharing with us.
AMY:
So tell us a little bit more about the connection between the physical and the cognitive and what you’re seeing in cognitive health.
DR. COLL:
We do know that as we get older, there are some subtle changes that can occur with brain function. The most noticeable is an impact on short-term memory. So often referred to as a senior moment, where somebody may forget something minor. The name of a book they read, maybe an appointment or some such thing. However, we also know that with increasing age, there’s an increase in risk for cognitive disorders such as dementia or Alzheimer’s disease. We currently feel that about 40% of that risk for developing dementia is modifiable. You can reduce your risk by about 40%. And there’s a number of interventions that can help you achieve that.
First, get a good education. There’s a strong connection between educational level and risk for dementia. And obviously there’s a lot of social variables in determining how good an education someone gets. Some of those social variables are also risk factors for medical issues that can be a little difficult to tease out the actual impact of an education in that regard.
Exercise is a modifiable risk factor that can decrease your risk of developing dementia. There’s a big connection between heart health and brain health. Anything that’s bad for your heart is generally bad for your brain. Anything that’s good for your heart is generally good for your brain. So the same kind of things that put somebody at risk for a stroke or a heart attack, put people at risk for dementia. And so eating a heart healthy diet, getting regular physical exercise – although in this situation we’re talking primarily about aerobic type exercise, like walking. Make sure your blood pressure is under good control. If you have high cholesterol, have it be treated. These interventions can help decrease your risk of dementia. And hearing optimization is important too. There’s a connection between poor hearing and the onset of dementia. So I think these are lifestyle changes that are good for a multiple of reasons. Like we talked about – anything that’s good for your heart is good for your brain. But if you get a secondary benefit by preserving brain function, all the better.
AMY:
I am feeling more motivated than I felt in a long time to go exercise. But one of the things that you said – sometimes when you notice you’ve lost the muscle mass or the strength or when there is an onset of some of these conditions, it’s almost too late. And so I have this realization that maybe we don’t hear enough in our culture of prevention. Not early intervention, but prevention is just really standing out to me. Like opportunities we have that don’t cost a lot – like going out for a walk. Having a social connection. Following up with a friend. These cost us nothing, but we might not even know how much these activities will benefit us in the years to come. And, we certainly have the ability to enjoy those interactions in the moment.
PAT:
I have a question. I’ve been involved with disability issues for some 20 years, and I have heard that combining the physical and mental is so beneficial – one example is sign language. If somebody is learning sign language, it involves both the brain, and then the physical component with the hands. Also juggling since it involves both the physical and the mental. I fly a drone. I’m thinking that paying attention where the drone is and if it’s oriented towards me or the other direction and translating that into my fingers must be really healthy for me. It’s important that I pay attention so I don’t crash!
DR. COLL:
It’s very interesting. Anytime you activate your brain, any part of your brain, and maybe what you say is true, when you’re activating multiple parts of your brain at the same time, you get even more benefit. It’s a well used phrase, but it’s so applicable. ‘Use it or lose it.’
AMY:
I love that. I think that’s the new slogan for aging well, ‘use it or lose it.’ Do you have any advice for us? You’re talking today to an almost 50-year-old and an almost 80-year-old. As you think about any additional items that you would encourage us or anyone like us to be thinking about and spending time on in order to age well? Any final wisdom you’d give us?
DR.COLL:
There’s a combination of things. I think getting a regular examination. Seeing your doctor once a year which hopefully you have that opportunity. Or your nurse practitioner. Whoever it might be that’s providing your primary care. Have that opportunity to talk about your risk for certain medical conditions, like what immunizations should you receive? What kind of cancer screening should you receive? You had mentioned… Patrick earlier about losing height. So obviously bone health is important. And we probably don’t have time today to talk about bone health interventions, but you can lose height or you can also break bones easily as you get older.
So being conscious of those issues are so important. Being conscious of your skin. Many of us are very conscious about our appearance and how we look and obviously our skin does change with age. It’s not just age related. You can tell by looking at those parts of your body that are sun exposed. They look different, particularly, Patrick, me and you, like our face. You can kind of tell by looking at us that we’re older. And that’s sun related primarily. Some of it’s intrinsic, but a lot of it is sun exposure. So being careful about sun exposure for cosmetics, but also to reduce cancer risk, that’s important.
And then the other thing I would mention, and this is an issue. is ensuring good oral health. So as physicians, we don’t spend as much time on the oral health of our patients maybe as we should. But oral health is important both for cosmetics, how we look, but it’s also important for function, being able to eat certain foods or decreasing your risk of certain infections. So there’s a whole list of things, Amy, but again, if you’re conscious about these things, and you educate yourself with annual visits and such, you can know know how much risk you’re putting yourself at for certain conditions. There’s so much that you can do to age well. The goal for all of us is to live a long, healthy, happy, secure life and not have a prolonged period of disability and dependency at the end of that life. And most of that’s in our own control.
PAT:
Would you tell me the name of your book again?
DR. COLL:
So I have it right here. It’s a textbook, I will warn you. It’s not really a book for the public. It’s readable, but it was developed as a book for physicians and healthcare providers, healthy agents.
AMY:
I love it. As I was perusing the description on Barnes and Noble, I thought this looks like something that should be required reading once we all pass a certain threshold of life. After age 20? Or in the college class?
PAT:
I assume there’s no Cliff Notes?
DR. COLL:
As I thought about this book, obviously I’m a physician, so I’m very well-trained in kind of biomedical issues. But there are biomedical issues that are important with regards to how we age. We’ve talked about some of those, but psychosocial issues are very important too. The company we keep. For some people, spirituality is an important part of their lives. Another important part of healthy aging can be working. Retirement means different things to different people. And it depends, obviously, on the job you’re doing. If you’re doing a very physically demanding job, it might be very difficult to do that job into your late 60s or 70s. But for many people now who are working with their brains, I think continuing to work in some fashion or other can promote good health into old age. Again, you’re using your brain. You’re out interacting with others, and I just think it’s a very positive thing.
PAT:
This is great. We could talk for hours.
DR. COLL:
On a political note, I’m not gonna get too political on you, but with regards to this retirement issue, I personally believe that if you’re eligible for social security and you continue to work that your tax brackets should be cut.
AMY:
I’d love to promote that.
DR. COLL:
Yes, encourage adults to remain active and working in the community. Why not?
AMY:
Exactly. Even starting to think about harnessing the wisdom and keeping that wisdom as part of the economy. I think that’s something we need to start to shift how we think about age and relevancy. We need to really honor the wisdom rather than send it off somewhere else. I think there’s only benefit for everyone.
DR. COLL:
Agreed and encourage age-friendly communities. Towns and cities that not only promote healthy aging, but also accommodate the needs of patients or people who are older. People who might have some limitations and disabilities associated with their age. There are age-friendly communities and city organizations out there, but they limited. Some countries are much better at this than we are. The United States has a long way to go in terms of promoting what we’re talking about today which is healthy aging but also making our cities more age friendly.
AMY:
I agree and echo what my dad said. I feel like we could talk for a very long time. Maybe we can figure out a time to have you back. I think you’ve already identified six other topics that would be so fun to dive into.
PAT:
And we’d love to see you in Colorado.
DR. COLL:
That’s where you’re from? You’re in Colorado? Yeah, beautiful place.
AMY:
He’s in Colorado. I’m in Florida. But yes, anytime that we could all take a hike, I think that would be a wonderful way to continue the discussion.
AMY:
We love to end with some gratitude. And that’s really how we close every one of our episodes. And we’ll give you a little time to think, Dr. Coll. So I’ll start with you, Dad. What are you grateful for today?
PAT:
I’m grateful because what I heard today is really exciting to me. We are moving to a new brand new independent living complex, and it’s going to have an indoor pool. It’s going to have state of the art exercise equipment called HUR. All pneumatic for the resistance. And we’re going to have a very interesting group of people. We’re having social events before we actually can move in. I’m meeting some retired generals, attorneys, a couple of physicians. They are all very engaging. So hearing that we’re headed that direction by your comments makes me think we’ve made the right decision.
DR. COLL:
Awesome. Sounds very exciting.
AMY:
Dr. Coll, what about you? What are you grateful for today?
DR. COLL:
I’m grateful for my family. You mentioned, Emma. And I mean, family is important to all of us. But family is very important for our health too. And as a physician, it never ceases to amaze me the length of families will go to, to protect and to care for a loved one. And so I’m very grateful for my family. From a somewhat selfish perspective, they make me a better person. They make me a healthier person.
AMY:
That is fantastic. You do have an amazing family. I’m grateful that I have a real renewed motivation and purpose to ‘use it or lose it.’ I have allowed myself the month of May to sort of rest. But just in the last week I have been picking back up – really stepping into wanting to model for my son – the very healthy aging behaviors that were modeled to me. And so this conversation just really puts a whole new vigor into that commitment. And I’m also really grateful to finally get to meet you. So this has been a wonderful way to start the week and so thankful for your time.
DR. COLL:
Thank you, Amy, and to meet you both too.
PAT:
Thanks for letting me join you two.
DR. COLL:
Yeah, you’re welcome. Anytime.
AMY:
This is a podcast about aging. It’s actually a podcast about living. So get out there and live life well. We’ll talk to you next time.
Lots of great information!! I can still use a lot of the suggestions ,even if I am 84 years old.