E28: 7 Domains of Our Aging Body

Well, you know the saying, "Getting old isn't for sissies, but it's better than the alternative." You've heard that one. Well, we're going to talk about the "7 Domains of Aging" and focus on the aging body today.

Now, what is aging? And what do we know about aging in humans compared to great apes? We share 98% of our genome with them, but we age very differently than they do.

So why do we live so long and why don't we live longer like tortoises? Well, there are some theories about the aging process. One is that we have only so many times that cells in our body can divide. And when we hit that limit, it's called a Hayflick limit, cells don't turn over anymore and renew themselves very quickly, if at all. So that's one theory, and that's associated with aging.

Another is that as we age, the ends of our chromosomes called the telomeres tend to get shorter as time goes by. And these telomeres are like the wrapped plastic at the end of your shoelaces that keeps the shoelaces from unraveling. Once the genes start to unravel, they make more mistakes when they replicate. And those errors lead to cancers and failure to clean out old cells and immunities fail. So that's another theory.

But there's another look at getting old that makes aging look like weathering. The more your face is in the sun, the more wrinkles you get. That isn't really about aging as it is exposure. And we know that diets high in sugar and some fats and low in vegetables and fruits are more oxidizing. They burn up the cell mechanisms more quickly.

And diets that are high in brightly colored vegetables, not ketchup, that doesn't count, or potatoes, real veggies that are green and yellow and orange and fruits seem to be anti-oxidizing. They help the cells stay younger. And vitamins don't really help here.

And we live longer than the great apes who die shortly after menopause at about 50, and they are pretty weak in their 40s, not like human women. New science has shown that we have genes that turn on when we exercise vigorously that keep our bones strong, our muscles strong, our metabolism balanced, our immune system strong, and our brains healthy. So we live longer so we can help raise the next generation of children, our grandchildren or our community's children.

Dr. Jones: To help us think about women and aging, we have with us in the virtual Scope studio, Dr. Karen Miller. Dr. Miller is an OB/GYN with special training in geriatrics and her focus and practice was on the gynecologic care of older women. So thanks for joining us, Karen.

Dr. Miller: Thank you for having me.

Dr. Jones: We're going to start this "Karen and Kirtly Show." It's going to focus on muscles and bones in the physical domain and then the lady parts.

So let's start with joints. Knees are bad ones and maybe your back joint or your feet. Part of this is aging because, seriously, as we get older, things do wear down. But part of it is because we used it a lot. People who've had a lot of accidents and illnesses in terms of their joints tend to have joints that need repair. So what is this about joints? Do you have any thoughts about joints and aging?

Dr. Miller: Well, cartilage, which, of course, your joint depends on the cartilage where the bone meets the bone, doesn't have a very high cell turnover, so it can't repair itself very well. It has very low blood supply. So as the cartilage wears down, our body has less ability to compensate for that.

And it is pretty remarkable how many people end up with knee replacements and hip replacements, but that's because they haven't figured out the magic bullet to repair cartilage.

But as far as physical aging, there is a magic bullet, and that is called exercise. Nobody really wants to hear that, but that is the magic bullet. So even though the joints do have wear and tear, you can compensate a lot by making sure you use them regularly and strengthen the muscles around them.

Dr. Jones: When women go through menopause, they often complain that they feel older and their joints hurt. And it's probably not necessarily at the mid-50s that it's their actually cartilage wearing down, but we do know that estrogen makes tendons and ligaments a little more relaxed.

So women who go through estrogen withdrawal may have tighter tendons and they have more sense of tightness when they wake up. But that's not usually a disrepair thing. And it's the kind of thing that also really responds well to exercise.

Now, we worry about women as they age, this wonderful word called sarcopenia, meaning loss of muscle mass. Are women destined to lose muscle mass, or . . .

Dr. Miller: Well, we all, women and men, lose muscle mass over time. And the thing I most recently read was 30% to 50% of your body muscle becomes nonfunctional or fat or something. That was a pretty ridiculous statistic I thought. But definitely, muscle changes to be more fibrotic, more replaced with fat cells, and less useful over time. Using the muscle will help combat that. And I have a couple of little suggestions.

Dr. Jones: Oh, go for it.

Dr. Miller: Well, in the physical domain, the important thing for aging is continuing four types of exercise: endurance, strength, balance, and flexibility. And one geriatric physical therapist said we keep our slow twitch muscles pretty well, but we lose a lot of the fast twitch muscles. So he has 85-year-olds skipping. He gets his patients to start skipping because you have that quick rise in the knee and you have to move your arms and legs around quickly. So that kind of activity is actually really helpful. That specifically combats the changes of aging.

Dr. Jones: You're going to see . . . the response of all my neighbors is I'm skipping up and down my street. I'm the oldest woman on the entire street and here I am skipping up and down maybe while I'm pushing my granddaughter's push cart or whatever.

Dr. Miller: Yeah, that'll do it.

Dr. Jones: Okay. So we're going to skip. What else?

Dr. Miller: Well, the other thing I think, particularly for my really old frail patients, you can really start small as far as just maintaining some muscle strength and balance such as in the grocery store, hold onto the cart and stand on one leg.

So you can choose to go in the checkout line that has a cashier there rather than do self-checkout, and then you stand in line and you stand on one leg and then you can stand on the other leg. Those little things do help improve your balance.

When you're sitting, don't sit for a long time. Make sure you take breaks and get up even every 15 minutes or more.

And if you want a real challenge, try going up your stairs backwards in your house. You will need a handrail to do that at first, but that will really strengthen your quads.

Dr. Jones: Wow. That's a good idea.

Getting back to some of the science here, we evolved to live long so we could be the hunter-gatherers to feed our grandchildren. Older women in hunter-gatherer societies gather more calories than they use and they share it with the kids. So we have the genetics to make our muscles work.

And this really amazing science is evolving that when we work our muscles hard as older people in our 70s, it affects our immune system positively, it affects our brain positively, and our metabolism positively, and it helps repair muscle and joints faster.

There are so many reasons for women who are older to get up and move. We think about the little old lady who can't get out of the chair. There's a test for frailty, which is that a get-up-and-go test, how quickly you can get out of a chair and walk . . . What is it? Ten feet or something?

Dr. Miller: Usually it's 10 feet, walk around some object or cone, and then go back and sit down.

Dr. Jones: So people who can't do that, it's a prediction for falls, for pneumonias, for poor immune system, for a whole lot of things.

Dr. Miller: Let me just say one more thing about the muscles. As you get really old, increasing your protein is important because geriatricians look at the tea-and-toast crowd that they just sit around and that's all they have is tea and toast. What they're missing is the protein. And so as you age, maybe not 60s, but maybe upper 70s, 80s, 90s, you could benefit from some extra protein.

Dr. Jones: Well, let's talk about bones, because we think about people who are frail, they break their bones. What about aging in our bones, Karen?

Dr. Miller: Well, we all lose bone mass after our 20s, maybe mid-20s, men and women. And women never reach as high a peak bone mass as men. So as we're all losing, women have their bones be too thin a little sooner than men usually do. But what really matters is are you going to fall and are you going to fracture?

Dr. Jones: We know that the astronauts when they're up in space and aren't moving around very much lose bone density just because they're immobile up there. And so staying active with weight bearing helps our bones stay stronger. But you don't know if your bones are thin, so maybe we need to make sure that women are actually getting their bone density measured as they get older.

Dr. Miller: Oh, yes, everyone should. At least by age 65, get your bone density measured.

Dr. Jones: You can do something about that, just as you can do something about your joints in terms of flexibility and you could do something about your muscles working them. There are things that can help your bones stay stronger or not lose so quickly. So it's worthwhile keeping all those things moving and finding out about them.

Well, as women age, and I think I put myself in that category, I'd say my least favorite aging organ is my bladder. Women have architecture different than men. Tell me about the aging woman's pelvic organs. Go for it, Karen. This is your specialty.

Dr. Miller: The big things are urinary incontinence and pelvic organ prolapse, AKA things falling out down there.

Dr. Jones: You had a story about somebody who came to you.

Dr. Miller: Oh, yeah. One of my favorite explanations to patients as to "Why is something falling out of the vagina?" I explained that the vagina can turn itself inside out like a sock with or without the uterus intact.

So I had a patient whose vagina had turned itself inside out like a sock and she needed the big repair. And she said, "Well, I told my friends I stripped my gears and dropped my gearbox and had to have a rear-end overhaul."

Dr. Jones: So the combination of time, usually some insults like having birthed children vaginally, low estrogens can be somewhat of a part of it, but time and gravity and some kids in there, and women have risk for prolapse. So what do we do about that? Is exercise going to help with that?

Dr. Miller: Probably not. So the vagina walls get more relaxed. We talk about a dropped bladder, but it's not a bladder problem. It's a problem of the vaginal walls that are weak that allow things to drop down. But if you examine women and then follow them over time, some actually get better. Some get worse, some get better, some stay the same.

There are surgeries that fix that. You can also wear a kind of donut in the vagina to hold everything in, which a lot of women do just to kind of give them some control while they're thinking about whether they do or don't want to have surgery. We don't have many treatments.

Keeping your pelvic floor muscles strong is probably helpful. It's much more helpful for urinary incontinence than it is for prolapse. And by that I mean Kegeling.

Dr. Jones: Right. More exercises. I can do them right now. I'm doing them on the radio. I'm doing them on the audio right now where no one can see my face.

Dr. Miller: A woman never has to waste time. She can always be Kegeling.

Dr. Jones: Yes, she can always be Kegeling.

Dr. Miller: When I'm talking to my husband and he's droning on and on about something, I think, "Oh, gosh, this is a little boring. Oh, I'll just start Kegeling and keep smiling." It's a good use of time.

Dr. Jones: You can do it and talk, so you don't have to just listen. You can do it while you're talking.

Well, as I think about our emotional response to aging and the things that happen around us, I want to introduce in the emotional domain what has been called the U-shape curve of happiness.

Studies all over the world in every country show that it seems like we have pretty good happiness when we're 18 or 20, and that's just because we don't even know what to be unhappy about yet. But we bottom out in terms of the rates of depression and our sense of unhappiness in our 40s. So around the time just before menopause and slightly after is when women have the highest rates of depression.

But by the time they get to 60 and 65, they're back on the upswing of happiness. So it turns out that emotionally older women often aren't as troubled by anxiety or depression as they might've been when they were younger. Although, certainly, there are women who really struggle, but it is a time when women are more likely to experience grief.

Do you have any thoughts about this, Karen?

Dr. Miller: It's just very difficult. Like you say, depression may be less of an issue, although it is still a pretty big issue in geriatrics, but grief seems to be for everyone.

And as you and I have talked about, by the time you live a long time, you have lost something significant in your life. You've lost a child or a spouse or an important job or a position in the community. I mean, everyone really experiences loss. And it's amazing to me how people come through that so well and deal with their grief and it doesn't seem to take over their lives. I just think that's pretty amazing.

Dr. Jones: The concept of wisdom, although there are certainly 20-year-olds who can be wise, but it helps to have lived a little to know what matters. And so what you do learn by the time you're in your mid to late 60s and early 60s is you know, hopefully, what matters and you try not to get so worked up about things that don't matter. I think that's helpful in terms of modulating one's emotional state. You just are better at figuring out things that you really can't control, I think.

Dr. Miller: Yeah.

Dr. Jones: Well, we're going to work on the social domain. Certainly, women who are getting into their late 60s and early 70s are likely to become grandparents, and that's helpful. And even if you're not a grandparent of your own grandchild, there is a role for many women in the community either as volunteers or volunteer physicians. I know, Karen, you work as a volunteer in a clinic for the underserved.

There are many things that women can do as they get older, and bringing our wisdom and our experience to the community is very important.

But I'm going to ask you to help me with a more delicate topic, and that's sex after 70. Can you help me with this one? Are you ready, Karen? Let's go for it.

Dr. Miller: The "New York Times" just had an interesting magazine article about sex in the upper ages. But of course, there are the physical changes after menopause and lack of estrogen and the changes that come with the potential for increased pain with intercourse and other problems. There happen to be a lot of things that now we can use to treat that.

There are only five species that undergo menopause: humans and four species of whales. Why is that? Nobody knows.

Dr. Jones: Oh, I have some thoughts about that, but keep going. That's a topic for another day.

Dr. Miller: For humans with the menopause and the lack of estrogen, that does affect the physical aspect of the vagina, the vulva, things that you use for sex, but not necessarily the cognitive aspect. The social impact of aging or long-term relationships, that's what's important as far as do you even want sex.

I had some interesting comments from my patients. One patient, as I was doing her pelvic exam, said, "Will it ever stop?" And I had another patient who came in for her annual and she said, "You think you won't miss it, but you do." So those are kind of the opposite ends of the spectrum of just interest in sexuality and sexual activity.

Dr. Jones: But there is quite a significant percent of 70-year-old couples, either long-standing couples who've been together a long time or couples who are finding themselves anew, a new relationship, who are sexually active into their 60s and 70s and 80s, even though that kind of sexual activity may change in some ways in terms of what the expectations are. But women can continue to have orgasms and can enjoy sex into their 80s if they have a partner.

In fact, the most common reason in a big survey for why women over 60 weren't sexually active is they didn't have a willing and able partner. But for those who do or have found a new one, it's not a topic that's often discussed with your physician, meaning how often does your physician, if you were a 70-year-old woman, say, "And tell me about your sexual relationship. Is that going well? Is it painful?" They just assume that you're not, and I think that's not the case. Nursing homes with mixed couples are having to kind of think about what that means.

Dr. Miller: There's also you satisfying yourself. And back to the pelvic organ prolapse, I've wondered, and I don't think anyone's ever looked at this, that if you have a lot of auto-erotic sexual activity, does that help your pelvic organs stay in better shape? It does increase the blood flow.

Dr. Jones: It does. Exactly. So there's evidence that vaginal thickness can improve with relatively regular sexual activity. So we know that the vagina gets thinner and potentially more uncomfortable as women move past menopause and aren't taking estrogen. But you can increase vaginal blood flow through sexual activity of any kind.

Dr. Miller: I had one patient come and was concerned because she had a vaginal discharge. Well, it turns out she had a new sexual partner and the only thing she and I could figure out is this partner actually stimulated her and she had more arousal than her late husband. So that was her vaginal discharge's good function.

Dr. Jones: Oh, good for her. So I think as those of us who may have this part of their life still be important if we're not comfortable or it's hurting, we should talk to our doctors about it. And for those who are clinicians, I don't think one should assume that their older female patient is not having some very satisfying or wants to be more satisfying sexual activity of some kind. So we should have it as part of our history, because we don't usually.

Dr. Miller: Yeah, they don't bring it up. You need to bring it up.

Dr. Jones: I'll bet you that geriatricians, people who do geriatric medicine, know that older couples are sexually active. Not all older couples, but many. So when I'm thinking about information, and this is in terms of the intellectual domain, how do you know where you should get your care? How do you know that there are people who know about aging, your aging body?

I think about doses of medications. I mean, there are things that change. Your metabolism of some medications changes, and how do you know if your doctor knows about this stuff?

Dr. Miller: There are not enough geriatricians. There are not enough geriatric-trained family doctors or internists, but most family doctors and internists and nurse practitioners have at least some knowledge of the aging person. And some of that information has filtered down to general practice about not overmedicating people.

It is nice if you can find a geriatrician or a geriatric nurse practitioner, but there are also two websites you can go to. Of course, this means you have to be computer literate, but you can go to these websites. One is put up by the American Geriatric Society, and it's HealthInAging.org. That's where they give lots of information about aging parts and things to know about.

And then the National Institute on Aging, NIA. If you go to nia.nih.gov, they have a lot of health information. And I was just looking there, they also have legal planning, like, "How do I need to plan for myself or my demented spouse?" They have lots of good information.

Dr. Jones: Well, I think there's also some really bad information out there. I'm particularly concerned about the rise of clinics that do anti-aging medicine, which includes injections of hormones or growth hormone or supplements that really have very little data on them.

I actually don't think that people are going to be severely harmed by any of these things, but I don't know that they're going to be helped all that much, although the placebo effect is very profound. If you feel like you're doing something and you're changing your diet and maybe exercising more, along with taking your supplements, maybe together people can feel a little more youthful and more energized. But I know that there are a lot of clinics and people attend them to have supplements or get injections or something to help them with their aging process.

Dr. Miller: I totally agree with you that those are a little sketchy. Mainly it's the ones that cost a lot of money and make promises that are not substantiated. So you can say, "Well, this estrogen can help you feel better," or, "This testosterone can help you feel better," and there is the placebo effect, but at least you know if you feel better or not. But if they say, "This will make you more youthful and make you live longer," you know those people don't know what they're talking about because they don't have the studies.

Dr. Jones: Right. As we go to the financial domain, I think about the cost of medical care and the cost of things that probably aren't working all that well, all the supplements that people might choose to take. But I'm more concerned that older women may not have this safety net or they may not know what safety nets they have.

They may not know what their partner, if they have a long-term partner, what financial resources they have as a couple. And they may not know that if they are widowed or divorced that they have resources. Some women worked inside the home all their lives and they don't have a pension plan and they don't have a retirement plan, and they may think that they don't have social security.

There are financial advisors out there. AARP, the Association for Retired Persons, has information and financial counselors that can help people find out what they've got, how they might be able to get a little bit more, and how to work through the social security system.

And I will say if you can finally get a social security person on the line, because you can wait a long time, they are phenomenally helpful. They are so helpful. So be patient. Please be patient. If you've got a question about your finances social security-wise, please, they have been terrific. I had someone trying to help me find extra money here, there, and everywhere and I said, "Gosh, I think I'm doing okay, but tell me more about that."

Dr. Miller: Yeah, they are so knowledgeable. Yes, that is so true.

And also, that National Institute on Aging, nia.nih.gov website, they had really interesting vignettes about, "Well, this person didn't prepare and her husband didn't give her this information and she struggled with these things."

They even go so far as to say, "What is an important document?" They actually give you a list of things that you should find out from your husband, like where the such and such is, and, "This is an important document and this is important to keep."

So that or AARP or it might be good to go to that website and say, "These are the things I need," and go to your husband with that.

Dr. Jones: Husband, partner, someone that you've been with a long time with whom you share your finances. I think financial abuse . . . People as they get older are more, unfortunately, vulnerable to not keeping on top of things or having people offer to manage their money. Maybe it's a family member or maybe it's a partner, and they find themselves in situations which are unfortunate.

Dr. Miller: Or children. Another big one is children abusing their parents financially, taking advantage of their parents financially. So financial abuse is huge for elders.

Dr. Jones: Yeah. Well, in the environmental domain, I'm going to put a quick plug-in for some new data on air pollution and cognitive decline in women. Big study looking at women across the nation, the Nurses' Health Study looked at women throughout the country and looked at their geo-code, their zip code where they live, and looked at air quality in that area. They found that women who lived in areas of high air pollution had more cognitive decline.

And I think for those of us who live in an area that we'd like to keep as clean as we can, it is keeping grandma's brain as healthy as we can. So it's not just important for young people, but older people as well.

Dr. Miller: I just read an article that showed that not only is air pollution associated with worse cognitive function, but that improving air quality, there was a slower decline in cognitive function.

Dr. Jones: Exactly. So where you live, keep an eye on the air quality and try to make sure if you're inside your home, that you have the best air quality to home by putting in a high-quality filter in your furnace if you've got that.

If you live in an area such as we live in, in Salt Lake City, where there's a lot of bad air in the summer from fires, you can filter your air inside to keep it healthier with a very simple home filter that's cheap. You can go online to learn about that or get someone to help you make one.

As we think about wrapping things up and talk about the spiritual domain, as you noted, Karen, by the time someone is over 60 to 70, everyone has suffered a loss. How, as a whole person, do you come to grips with that?

Dr. Miller: Well, I have a pretty funny example of a loss. A patient needed a vaginal repair and I did a hysterectomy, and she was ambivalent about that hysterectomy, but we decided, "Yeah, we'll go ahead and do it."

And then she said her 15-year-old daughter told her, "Mom, my first home is gone." She was already feeling bad about her hysterectomy. So that's kind of just an example of loss. Your kids always make things so much better for you, don't they?

Dr. Jones: They do. Right. Yeah, I guess that's well within the spiritual domain, is your first spiritual home as a person is your mother's womb and now it's gone.

Dr. Miller: People find their own meaning. And there is a Jackson Browne song that I just love some of the lyrics to "For a Dancer," and the lyrics are, "Perhaps a better world is drawing near, just as easily it could all disappear."

Song:Perhaps a better world is drawing near, just as easily it could all disappear. Along with whatever meaning you might have found, don't let the uncertainty turn you around. The world keeps turning around and around. Go on and make a joyful sound. Into a dancer . . .

Dr. Jones: Well, that's a perfect way to wrap that up for us. I think we want people to make a joyful sound as they embrace the fact that it is kind of a use-it-or-lose-it. And if you use your spiritual life and use your physical life and your emotional life in a way that works for you, if you can, you can make a joyful sound.

So I want to close and thank Karen. Thank you for joining us and adding your perspective and years of knowledge and your care for older women. Thank you.

Dr. Miller: Thank you for the chat about my favorite subject.

The aging process is inevitable, but senescence, meaning a decline in function in many domains because you just don't use them, is not inevitable. So here, I'm going to close with the 7 Domains of the Aging Body haiku:

It's not for sissies
Getting old with grace and style
Plan B is no option

So I'm going to put on my coat and mittens and head out to the 30-degree garage and put some time and music on the rowing machine as I think about not wanting to be senescent, but wanting to age with grace and style.

Thanks, everybody, for joining us, and we hope that we've given you a little boost and some hints and thoughts. Remember, you can listen to our podcasts on Spotify or Apple or wherever you get your podcasts, or you can find us at womens7.com. Stay well. Stay active. Talk soon.