July 2015 issue of Healthy Years

1. Swimyourwaytowardsahealthierlife
A regular swim routine offers many physical and mental benefits for seniors.
Y
ou may have swum
only for fun in the
past, but this sum-
mertime sport offers
many year-round ben-
efits for older adults.
First off, swimming
is a low-impact activity,
which means it places
less stress on the joints
compared to endeavors
like running and tennis.
“The body feels like it
weighs less in water, so
there is less body weight
resistance for muscles
to work against,” says
Daniel Vigil, MD, of the
UCLA Division of Sports Medicine. “This
makes it an ideal activity for seniors who
have lost muscle mass and strength and want
to get their bodies back into exercise.”
It may not look aerobic, but swimming
can give you a heart-pumping workout. “It
uses large muscle groups like the quads
and abdominals, which requires your heart
and lungs to work hard to pump blood and
deliver oxygen,” says Dr. Vigil.
Swimming also is a good calorie burner.
An average 155-pound person can burn
between 300 and 400 calories in 30 minutes,
depending on effort. This is comparable to
running at a 11.5-minute-per-mile pace or
cycling at 14 to 16 miles per hour.
A regular routine can improve other
health issues specific to seniors. For
instance:
➥➥ Reduce your risk of falls: Australian
researchers recently looked at 1,700
men age 70 and older and compared
their choice of exercise to the likelihood
they experienced a fall over a four-year
period. They found that men who swam
were 33 percent less likely to fall com-
pared with those who did land-based
activities, such as golfing,
exercising on treadmills
and stationary bikes, and
calisthenics. (The research-
ers speculated that women
would benefit, too.)
The reason may be that
swimming develops strong
large and core muscles,
which are necessary for
good balance control and
are a major protective fac-
tor against falls.
In fact, the study also
noted that the swimmers
outperformed their coun-
terparts in a standing bal-
ance test, in which a person
stands as still as possible for 30 seconds
with minimal sway or change in posture.
➥➥ Lower blood pressure and stroke risk:
A 2012 study that examined how swim-
ming affects vascular health among
adults age 50 and older found that sys-
tolic blood pressure dropped from 131
mm/Hg to 122 after 12 weeks of swim-
ming. The swimmers also saw a 21 per-
cent increase in carotid artery compli-
ance, which is a measure of elasticity
of the blood vessels that carry blood to
the brain. “This is believed to lead to a
decrease in risk of stroke,” says Dr. Vigil.
➥➥ Promote social activity: While it may
look like a solitary activity as you swim
back and forth in a pool lane, the sport
can be quite social. “If you join a swim-
ming club or training team, there are
opportunities to talk and mingle, which
you often don’t get with other types of
exercises,” says Dr. Vigil. “And do not
neglect the mood-boosting fun and enjoy-
ment of being in the water, which can
help with stress reduction and fend off
depression.”
4
A New Look at
Improving Vision
Lens replacement
surgery can mean no
more glasses.
8 Ask Dr. Ferrell
■■ What is the difference
between soy, coconut,
and almond milk?
■■ What could be
causing my sudden
night blindness?
■■ What is the best
way to go off anti-
depressants?
2 News Briefs
■■ Two minutes of light
activity can help
offset long sitting.
■■ Drug to treat
pre-diabetes is
seldom used.
■■ Older Japanese-
Americans offer clues
for healthier living.
3 Know the Three Ds
Signs for delirium,
dementia, and depression
can be similar.
5
Be Optimistic About
Heart Health
Outlook on life is
linked to improved
cardiovascular health.
4 Picturing Stroke Risk
Routine imaging may
detect early warnings.
Continued on page 7
6
Feel the Power
of Pulses
These nutritional
powerhouses are
affordable and versatile.
July 2015
Volume 12 • Number 7
Swimmingiseasyonthejoints,soitcanbe
enjoyedthroughoutyourlifetime.
Thinkstock

2. EDITOR-IN-CHIEF
Bruce A. Ferrell, MD
UCLA Division of Geriatrics
EXECUTIVE EDITOR
Matthew Solan
GROUP DIRECTOR
Jay Roland
CONTRIBUTING EDITORS
Dawn Bialy
Kate Brophy
ADVISORY BOARD
Randall Espinoza, MD, MPH;
Arash Naeim, MD;
Michelle Eslami, MD;
John FitzGerald, MD;
Ellen Wilson, PT
Healthy Years
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2
N E W S B R I E F S
Two minutes of light activity each hour may offset risk from too much sitting
Studies have shown that sitting for extended periods of time each day leads
to an increased risk of heart disease, diabetes, and early death. However,
a new study from the University of Utah School of Medicine found that
breaking up hour-long sitting with two minutes of light intensity activity
lowered the risk of dying by 33 percent among 3,243 subjects. Surprisingly, the study
found no benefit of decreasing sitting by two minutes each hour, but only when sed-
entary time was interrupted with an activity like casual walking, light gardening, and
house cleaning. The recommendation for weekly exercise is 2.5 hours of moderate activ-
ity, which expels about 600 kilocalories (kcal) of energy. The researchers pointed out
that two minutes of light activity every hour during an average 16-hour awake period
equals 400 kcal each week. Light activity should not replace moderate exercise, the
study noted, as it strengthens the heart, muscles, and bones better than lighter intensity
exercise. Yet, adopting the two-minute per hour approach can help meet your weekly
goal of 2.5 hours of moderate exercise. “Even small changes in behavior can have a big
impact,” according to lead researcher Tom Greene, PhD.
Drug effective in treating pre-diabetes often not prescribed by doctors
Few doctors prescribe a low-cost drug called metformin that has been proven effective
in preventing the onset of diabetes, according to a new UCLA study. The research pub-
lished in the Annals of Internal Medicine found that only 3.7 percent of adults with pre-
diabetes were given the drug over a recent three-year period. (Metformin also goes by
the brand names Glucophage, Glumetza, Glucophage XR, and Fortamet.) The reasons
for its underuse are not clear, says lead researcher Tannaz Moin, MD, of the David Gef-
fen School of Medicine at UCLA. One opinion is reluctance by patients and doctors to
rely on medication to treat pre-diabetes. Metformin is used in conjunction with lifestyle
changes like weight loss to help treat pre-diabetes, says Dr. Moin. Metformin works to
restore your body’s healthy response to insulin. It also decreases the amount of sugar
your liver produces, which your stomach and intestines must absorb. It is not clear how
long someone would have to take metformin, as it depends on the individual. Accord-
ing to the Centers for Disease Control and Prevention, about one-half of adults age 65
and older have pre-diabetes, which is marked by higher-than-normal blood sugar levels.
On average, about 15 to 50 percent of this group will develop diabetes within five years.
Most people do not show the symptoms, which include unusual thirst, bouts of extreme
fatigue, and/or blurred vision. You are also at high risk if you have a family history of
diabetes, are overweight, or have high cholesterol. A blood test from your doctor can
confirm a diagnosis. “If you test positive for pre-diabetes, consult with your doctor about
all treatment options for diabetes prevention, lifestyle, and/or metformin, to determine
the best option,” says Dr. Moin.
Elderly Japanese-Americans could offer clues to longer, healthier lives
UCLA researchers believe older Japanese-Americans may hold the key to healthy aging.
Nearly one in four Japanese-Americans are age 65 or older—about twice the proportion
of seniors in the overall U.S. population. The facts that they are more likely to live
longer than other Americans and are healthier as they age could provide valuable
insight about how all Americans can age better, according to a recent study from the
UCLA Center for Health Policy Research. The research highlighted specific behavior
that may explain this group’s longevity and well-being. Using data from the California
Healthy Interview Survey from 2003 to 2012, the study found that elderly Japanese-
Americans have lower risks for nine of 15 health indicators compared with other racial
and ethnic groups, including obesity, psychological distress, and falls. More research is
needed, but these initial findings suggest that many older Japanese-American lifestyle
habits, such as diets high in fish and fresh produce, avoiding fast foods, eating meals
in moderation, and paying more attention to preventative care, like getting seasonal
flu shots, can be a model for all older Americans to follow, suggests lead researcher
Ying‑Ying Meng, PhD.
July 20152

3. Know the three Ds: delirium,
dementia, and depression
Recognize their early signs in order to get immediate treatment.
T
he three Ds are the most common
diagnoses in geriatric psychia-
try, but often the most difficult to
identify because they have overlap-
ping symptoms. “They can occur at
home as well as during certain situ-
ations, like during hospital stays or
returning home after a hospitaliza-
tion,” says Pauline Wu, DO, assistant
clinical professor of health sciences
at UCLA. “Knowing the difference
between them can help you get early
treatment or take steps to avoid the
conditions.”
DELIRIUMDelirium is an acute
disorder marked by inattention and
confusion. It is quite common among
older hospitalized patients, and the
condition is associated with prolonged
hospital stays.
People often describe those with
delirum as being “out of it” or “not
acting like themselves.” Episodes
have an onset within hours or days,
which sets the confusion apart from
dementia, which typically seeps in
over months or even years. “Delirium
is considered a major medical emer-
gency,” says Dr. Wu. “If not treated,
mortality rates can be from 10 to 20
percent.”
Delirium can be caused by infec-
tion, dehydration, electrolyte imbal-
ance, a fall or head injury, a reaction
to too much medication, substance
abuse, or any combination. “In many
elderly patients, and in individuals
with cognitive impairment, delirium
also can be the initial manifestation of
a new serious disease,” says Dr. Wu.
Treatment involves addressing
the underlying medical cause. “This
could vary from using antibiotics to
treat an infection, adjusting existing
medication, and/or ensuring the per-
son stays properly hydrated,” says Dr.
Wu. “Early diagnosis and treatment
leads to better outcome.” Delirium
symptoms can take time to resolve.
About 50 percent of patients have the
underlying cause treated within three
months of a diagnosis, yet symptoms
can linger for up to six months.
DEMENTIADementia is a progressive
syndrome best known for short-term
memory impairment, but also may
include a problem in at least one of
the following areas:
➥➥ Language: difficulty with expres-
sion or comprehension
➥➥ Motor memory: unable to perform
a learned skill like driving
➥➥ Sensory memory: failure to pro-
cess information stimulated by one
of the five senses
➥➥ Executive thinking: the inability to
create and execute plans
In addition to these cognitive symp-
toms, patients with dementia often
experience neuropsychiatric ones,
such as depression, agitation, apathy
(lack of interest and enthusiasm), and
psychosis (losing contact with reality).
“About one-half of people with demen-
tia will have these symptoms at some
point,” says Dr. Wu.
With advanced dementia, peo-
ple have problems completing daily
life tasks and become more isolated
as social interactions grow difficult.
There is no single test for demen-
tia—it is determined through clini-
cal examination, behavior analy-
sis, and cognitive assessments. Age,
family history, high blood pressure,
untreated depression, and uncon-
trolled diabetes increase your risk.
“While some of these factors you
can’t control, others you can by man-
aging your lifestyle,” says Dr. Wu.
DEPRESSIONDepression has many
forms, but telltale signs include low
mood, loss of interest in activities you
once enjoyed, difficulty with sleep
and appetite, low energy and con-
centration, and/or a growing sense of
worthlessness. You need to experience
symptoms for at least two weeks and
have them affect your social or work
life in order to be diagnosed with clin-
ical depression.
Seniors often will not admit or
recognize their declining emotional
state. Instead, early depression may
show itself in other ways, like com-
plaining more about physical condi-
tions that bother them.
“People think depression is nor-
mal when you get older, but that’s
completely false,” says Dr. Wu.
“Seniors often encounter life events
that can trigger sadness, includ-
ing loss and complex medical prob-
lems. However, reactive sadness
and clinical depression are not the
same. Depression is not normal and
in fact is treatable.” Treatment opti-
ions include recognizing symptoms,
providing support, limiting isolation,
and medication.
Seekhelpfromothers
If you live with someone, you can
each try to be more mindful of early
warnings signs. However, if you live
alone, this can be difficult, so you
should create a support group to mon-
itor any changes in your behavior.
“Ask close friends or family mem-
bers to be attentive to the symp-
toms,” says Dr. Wu. “The three Ds
become more relevant as you age.
But by increasing your education,
you may catch them early and seek
appropriate care and treatment before
they get worse.”
M I N D A N D M E M O R Y
ThethreeDssharemanysymptoms,whichcan
makediagnosisaconstantchallenge.
Thinkstock
3July 2015

4. V I S I O N
Thinkstock
Anewlookatimprovingvision
Lensreplacementsurgerycorrectseyesightsoyoudon’tneedglasses.
I
n the past, LASIK was the go-to
procedure to eliminate the need
for glasses. “While LASIK contin-
ues to be the procedure of choice for
younger people, lens replacement
surgery (LRS) using laser technology
may make the most sense for older
adults,” says Rex Hamilton, MD,
medical director of the UCLA Laser
Refractive Center.
As you age, your lens loses its
flexibility. This process, called pres-
byopia, leads to the need for reading
glasses or bifocal/progressive specta-
cles as you reach middle age.
Over the years, the lens also can
become progressively cloudy, a con-
dition known as cataracts, which
causes blurred vision to worsen and
cannot be corrected with just a stron-
ger eyeglass prescription.
“While LASIK treats the clear
window on the front of the eye
called the cornea, it does not address
the main problem in seniors,” says
Dr. Hamilton. “As one ages, it is the
lens inside the eye that causes vision
to decline. LRS directly treats this.
By replacing the lens of the eye with
a high-tech, multifocal intraocu-
lar lens (IOL) implant, patients can
see distance, intermediate, and near
without glasses.”
LRS can also protect you from
future cataracts, adds Dr. Hamilton,
since the natural lens is replaced
with a synthetic implant that will
remain stable for the rest of your life,
and never cloud up.
Laserprecision
LRS is an outpatient procedure that
takes only about 15 to 20 minutes
per eye. Eyes are often treated about
two weeks apart. Here is how the
surgery works:
➥➥ After numbing the eye, the sur-
geon uses a laser to make precise
incisions in the cornea. The laser
allows greater accuracy in terms
of depth and length of the inci-
sions compared with a traditional
blade. “Every eye has a cornea
that is unique in terms of thick-
ness and curvature,” says Dr.
Hamilton. “The laser uses real-
time image guidance, which cus-
tomizes the incisions to match
the unique dimensions of the
cornea.”
➥➥ In the second step, the surgeon
uses a laser to make a precise, cir-
cular opening in the capsule con-
taining the lens.
➥➥ Next the surgeon uses the laser to
soften the lens and break it into
segments for easier removal.
➥➥ Then an ultrasonic probe is
used to remove the lens mate-
rial through the small incision in
the cornea.
➥➥ The final step is the implantation
of the new replacement lens into
the capsule.
➥➥ The incisions are self-sealing.
Patients see out of the eye imme-
diately after the surgery, and the
eye feels essentially normal the
day after, says Dr. Hamilton.
Who is a candidate?
Lens replacement works best for
seniors with cataracts and those
without cataracts who are farsighted
and wish to function without glasses.
However, LRS may not be
appropriate for those who are only
nearsighted and/or have worn
glasses most of their adult lives.
“A nearsighted eye has a thinner
and more delicate retina, which can
more easily tear or become detached
during or after surgery,” says Dr.
Hamilton.
Replacing an aging lens with a multifocal
intraocular lens implant can help you see clearly.
Routineimagingoffers
cluesaboutstrokerisk
AnewapproachbyUCLAneurologistshasfoundthatmedical
imaging, like dental x-rays, MRIs, and CT scans, can detect
narrowing of arteries to the brain or vascular disease that may be an early warning sign of a stroke.
Theongoingresearch,ledbyDavidS.Liebeskind,MD,oftheUCLAStrokeCenter,canhelpbroadenthe
viewofpreventativemedicine.“Imagingcantellallkindsofinformationbeyondtheprocedure’soriginal
intent,”hesays.“Youjusthavetolookcloser.”Whileimagingcanpickupwarningsforotherneurological
conditions,itcanbeespeciallyhelpfulforstrokepreventionsincestrokesaresocommonamongolder
adults. Besides highlighting narrowing arteries, imaging can detect calcified plaque in blood vessels
outside the brain, which an American Heart Association report found increases the risk of stroke and
dementia.Dr.Liebeskinddoesnotadvocateundergoingextraimagingunlessotherwiseindicated,but
instead to share any past or future imaging with your primary doctor.“The information stays relevant
for years and can track a progression of your health,”he says.“In this way, it can offer novel insight to
help identify potential problems before they become life threatening.”
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July 20154

5. V I S I O N
Lens replacement surgery
is offered at a growing num-
ber of eye surgery centers. But
be mindful that LRS in an eye
without a cataract is consid-
ered cosmetic and rarely cov-
ered by insurance.
Costs can range from
$1,500 to more than $5,000 per
eye depending on the situation
and which technologies are
used. (Even if you have a cata-
ract there is often some out-
out-of-pocket expense. Check
with your insurance company
about your coverage.)
Still, for many seniors the
procedure may be worth the
price in order to increase qual-
ity of life.
“Patients should consider
that they are investing in a
treatment that will benefit them
every waking hour of every day
for the rest of their lives,” says
Dr. Hamilton. (For more infor-
mation on the procedure, visit
www.uclaser.com.)
WHAT YOU SHOULD KNOW
ThreetypesofIOLsareavailabletoreplaceyournaturallens,depend-
ingonyourvision.Yourdoctorwillmakearecommendation:
➢➢ Monofocal fixed-focus IOLs provide clear vision at
distance, intermediate, or near ranges—but not all three at
once.Toric IOLs to correct astigmatism also are classified as
monofocal IOLs.
➢➢ Multifocal IOLs provide clear vision at multiple distances.
➢➢ Accommodating IOLs enable focus at multiple distances
by shifting their position in the eye.
Be more optimistic about your cardiovascular health
Regular exercise and proper diet are the
standard formula for heart health, but there
is another way: Improve your outlook on life.
“The body and mind work together in a
continuouscycle,”saysGarySmall,MD,director
of the UCLA Longevity Center and co-author
of2WeekstoaYoungerBrain.“Ifyouarehappier,
your heart is healthier, and when your heart is
strong, your mindset will benefit.”
A 2015 study in Health Behavior and Policy
Review found a link between optimism and
heart health in more than 5,100 adults age 45
to84.Theircardiovascularhealthwasassessed
using seven metrics from the American Heart
Association to measure optimal heart health:
blood pressure, body mass index, fasting
plasma glucose levels, serum cholesterol
levels, dietary intake, physical activity, and
tobacco use.
Each subject was given zero, one, or two
points for each category representing poor, intermediate, and
ideal scores.Total health scores ranged from zero to 14. People
also completed surveys to assess their current mental health,
levels of optimism, and physical health.
The researchers found that total health scores increased
in tandem with perceived levels of optimism. People who
were the most optimistic were twice as likely to have ideal
cardiovascular health.
Even the smallest changes in outlook can have a significant
impact. Another study that used the same seven-metric
parameters found that just a one-point increase in total health
score lowered a person’s risk of stroke by eight percent.
How does a positive outlook affect heart health? For the
most part, optimists tend to take better care of themselves.The
study found they had better blood sugar and total cholesterol
levels than those with less optimism. They
also were more active, had lower body mass
indexes, and were less likely to smoke.
“Optimistic people also are more likely to
see their doctor regularly and follow his or her
advice,”says Dr. Small.
Of course, it is easier to say, “be more
optimistic” than to do it, especially for older
adults who confront more challenging issues
like illness, decreased mobility, and personal
losses than younger people. “Still, you can
learn to be more optimistic,” says Dr. Small.
Here are some tips:
■ Be flexible: If you experience physical
decline, focus on what you still can do.
“You can’t run anymore? Try walking
instead. You can’t walk as far as you once
did? Change your goal to just walking on
a regular basis,”says Dr. Small.
■ Begrateful:Keep a daily journal and list the things that make
you feel good or thankful, even if they seem minor, like a
compliment about something you did for someone.
■ Be aware of negative attitudes: It is not always easy, but each
time you find yourself thinking that something won’t work
out, take a breath, and ask how you can look at the situation
in a positive light.“Often you can find an upside if you try,”
says Dr. Small.
■ Be social: Isolation fuels negative thinking. If it is difficult to
drive, or you can no longer drive, rely on taxis or ask a friend
to transport you to social activities.
■ Seek out uplifting people: “Optimism is contagious,” says Dr.
Small. “Surround yourself with people who see the glass
half full and you will, too.”
H E A R T H E A L T H
Optimismcanbealearnedbehavior
thatcreatesstrongerhealthhabits.
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5July 2015

6. Feel the power of pulses
Driedbeansandpeas,chickpeas,andlentilsarelowinfat,highinprotein,
andcanprotectyoufrommanyhealthproblems.
P
ulses are some of the most inex-
pensive, versatile, and healthy
foods around, and seniors
should be eating more.
“They are nutrition powerhouses
full of nutrients, such as folate,
potassium, calcium, and fiber to help
seniors avoid heart disease, osteopo-
rosis, obesity, high blood pressure,
and diabetes,” says Elana M. Suss-
man, RD, with UCLA Health.
“Pulses also are a great option for
individuals who follow vegetarian,
gluten-free, or heart-healthy diets.”
Buying, cooking, and storing
Pulses are part of the legume fam-
ily and refer only to the dried seed.
Dried peas and beans, lentils, and
chickpeas are the most common.
Most pulses are bought in one of
two forms: canned or dried. Canned
pulses have already been soaked
and cooked, but make sure to choose
low- or no-sodium brands, or rinse
them to reduce the sodium content.
Dried pulses tend to be cheaper
than canned (average cost of 1 cup of
cooked dried beans is 25 cents com-
pared to 60 cents for canned). How-
ever, there is more labor involved, as
they must be soaked before cooking.
There are three methods of soak-
ing: quick, traditional, and hot. Soak-
ing time ranges from one to 24 hours
depending on the method (check the
package for suggestions).
The benefits of soaking are two-
fold: It decreases flatulence associ-
ated with eating beans and reduces
cooking time.
“Once beans are soaked, they can
take anywhere from 45 to 120 min-
utes to cook depending on the type
of bean,” says Sussman.
If you aren’t going to eat cooked
dried pulses immediately, then
quickly cool them, cover them, and
place them in the fridge or freezer.
“As with all cooked foods, don’t
leave cooked pulses at room
temperature for more than
one to two hours because this
allows bacteria to multiply,”
says Sussman. “If you keep
cooked pulses in the fridge,
eat them within two days.”
What is inside?
Pulses are a rich source of
protein, which seniors need
to strengthen their immune
system and help build and
maintain muscle mass.
Other high-protein foods
include meat and dairy prod-
ucts, but these also can be
high in cholesterol and satu-
rated fat. “In comparison,
pulses are a cholesterol-free
plant protein,” says Sussman.
A single cup can contain
between 14 and 18 grams (g)
of protein (see chart, left), which is
comparable to a 4-ounce serving of
fish (22 g) or lean beef (22 g), and
much higher than 1 cup of milk (8 g)
or a large egg (6 g).
Other benefits of pulses include:
➥ Better weight management: Because
pulses are high in fiber (1 cup has
about half the total daily amount
recommended for adults), they can
increase fullness and help with
weight control, says a 2014 study.
The research found that people felt
31 percent fuller after eating an aver-
age of 150 g, or ¾ cup, of pulses
compared with a control group.
Pulses are complex carbohydrates
and have a low glycemic index. This
means they break down slowly and
can make you feel fuller for a lon-
ger period compared to medium-
and high-glycemic-index foods
like bread, snack foods, white rice,
cereal, and orange juice.
“Controlling hunger can prevent
cravings and binge eating that leads
to weight gain,” says Sussman.
➥ Reduce cholesterol: A recent study
from the University of Toronto found
that eating one daily serving of
beans, peas, chickpeas, or lentils can
shrink levels of LDL (bad) choles-
terol by five percent and reduce your
N U T R I T I O N
WHAT YOU CAN DO
How to include more pulses in your daily diet:
➢➢ Substitute pinto, black or kidney beans
for meat in chili, stews, and soups.
➢➢ Toss chickpeas or lentils to salads.
➢➢ Create a pesto with navy beans, basil,
spinach, olive oil, and herbs, and pour
over your favorite pasta dish.
➢➢ Mash up beans to use as a dip for a
healthy midday snack with sliced carrots,
cucumbers, or celery.
➢➢ Place cooked peas in a blender with
some olive oil and seasonings of choice
to create an alternative spread to
mayonnaise or cream cheese.
➢➢ Add any variety of pulses to omelettes.
NUTRITIONAL PROFILE OF PULSES
(1 CUP SERVING, DRIED AND COOKED)
CALORIES FIBER
(g*)
PROTEIN
(g*)
IRON
(mg*)
Chickpeas 269 12.5g 14.5g 4.7mg
Beans 230-240 8-12g 14-16g 4mg
Lentils 230 15.6g 18g 6.6mg
Peas 231 16.3g 16.4g 2.5mg
*g = grams; mg = milligrams
Source: National Nutrient Database for Standard Reference
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July 20156

7. Testing the waters
There are many ways to dive into
swimming. Besides local pool centers
and YMCAs, most adult community
centers and fitness centers offer basic
swim classes, many of which are
designed for seniors.
“If you are new to swimming or
have been away from it for a while,
entry level classes can help you learn
basic stro ke techniques so you can
maximize your workouts and reduce
risk of injury,” says Dr. Vigil. “Once
you are familiar with different strokes
and workouts you can do them on
your own.” Another upside to swim-
ming is that it does not require much
time. Thirty minutes of pool time eas-
ily satisfies the American Heart Asso-
ciation’s guideline for 30 daily min-
utes of brisk exercise.
Mixitup
Swimming can put you at risk for
repetitive-use injuries like shoul-
der rotator cuff injury, which is why
you should always vary your rou-
tines during every workout.
“Devoting several minutes or
a certain number of laps to back-
stroke, freestyle, and breaststroke
can avoid excess stress on certain
parts of the body and ensure you
engage in an all-around workout,”
says Dr. Vigil.
Using paddle boards and fins—
which most pools offer, although you
may want to invest in your own—
can further balance your workouts.
Boards can help you focus more
on your lower body and give your
arms and shoulders a rest. Fins
enhance buoyancy and speed so you
can focus on your stroke technique.
Swimming does have its limita-
tions, adds Dr. Vigil. Since it is not a
weight-bearing workout, you should
complement it with resistance exer-
cises like weight training or walking
to keep bones strong.
“Swimming is one of those unique
exercises that has no limits,” adds Dr.
Vigil. “You can do some form of it for
almost your entire life.”
Swimming—cont. from page 1
N U T R I T I O N
risk of cardiovascular disease by five
to six percent.
➥ Fight deficiencies: Many older adults
are deficient in micronutrients, such as
zinc, iron, manganese, magnesium,
potassium, copper, and selenium. Iron
deficiency is the most common, fol-
lowed by zinc. In fact, 40 percent of
those age 65 and older do not consume
enough zinc, according to a 2015 study.
However, a 100-gram serving (3.5
ounces) of pulses can provide most
of the recommended daily allow-
ance of all these important micro­
nutrients, says Sussman.
WHAT YOU SHOULD KNOW
Swimming tips for beginners:
➢➢ Warm up with five to 10 minutes
of easy laps or range-of-motion
exercises that mimic swimming, like
shoulder rotations, body twists, and
neck rotations.
➢➢ Keep a water bottle within easy
grasp and drink regularly during your
workout to avoid dehydration.
➢➢ Wear goggles to protect your eyes
from chlorine and a swim cap to keep
water out of your ears.
➢➢ Enlist a friend if you feel anxious
about joining a class. It is always
easier to overcome fear if someone is
there for emotional support.
➢➢ Begin with water aerobic classes,
which are done in waist- to chest-
high water, if you are uncomfortable
in the water.
The most common swimming strokes are freestyle,
breaststroke, backstroke, and sidestroke.
Freestyle: The preferred stroke of swimmers. You kick
hard with a flutter kick, while you bring your arms over
your head and into the water one at a time. You usually
breathe to the side with each alternating stroke.
Breaststroke: Both arms execute half-circular arm
movements at the same time underwater in front of your
body. The arm recovery also occurs underwater. The legs
simultaneously execute a frog-style kick where you bend
your knees and kick your legs out beneath the water.
Backstroke: As its name suggests, backstroke is swum
onthebackandusesalternatingcirculararmmovements.
The legs execute a flutter kick like freestyle.
Sidestroke: You swim on one side using a scissor kick
while one arm does a reach and sweep movement
underwaterlikepickinganappleandplacingitinabasket.
DIFFERENT
STROKES
Thinkstock
7July 2015

8. QWhat are the differences between soy,
coconut, and almond milk? Is one better
for me than the others?
AEach dairy alternative has its own strengths
and weaknesses, so base your choice on
your specific nutritional needs and per-
sonal taste. For example, when seeking lactose-
and/or cholesterol-free alternatives to dairy milk,
most turn to soy, coconut, or almond milk. Soy
is a popular dairy substitute, providing protein,
iron, vitamin B-6, and magnesium, with little
fat. The concerns about soy milk come from
the estrogen-like properties of its isoflavones.
Consumed in large quantities, they may raise the
risk of certain cancers. However, in moderate
amounts, there is research that also suggests soy’s
isoflavones can lower the risks of cancers and
heart disease. The message here is that soy is fine
as long as you don’t eat/drink too much. Fortified
commercial coconut milk, while lower in calories
than soy and high in calcium and vitamins D and
B-12, offers no protein. Although some research
suggests there are heart-health and other benefits
provided by its medium-chain fatty acids, more
than one-half the calories in coconut milk come
from fat. Fortified, plain, commercial almond
milk is high in calcium and vitamins D and E,
but has only one gram of protein per 1-cup serv-
ing. Of the 30 calories in almond milk, 25 come
from fat. There are some questions about the
bioavailability of the calcium and other nutrients
in dairy milk alternatives. Some nutrients are
not as easily absorbed as those from dairy milk.
Research sources vary on the exact amount, so
remember that the container may contain 45
percent of the daily calcium you need, but your
body may not absorb that full 45 percent.
QMy night vision has become worse, even
though I have a current eyeglass pre-
scription. What causes this change?
AHas this change occurred suddenly, or
slowly, over a long period? One of the most
common causes of poor night vision, or
night blindness, is nearsightedness, but your
updated prescription likely rules that out as a
cause. Other sources include cataracts, which
cloud the lens and limit the light that reaches
the retina. Damage to the optic nerve from
glaucoma could be a source of your trouble,
too. Even some glaucoma medications have
night blindness as a side effect. Have you been
diagnosed with diabetes? Diabetic retinopathy,
caused by weakened retinal arteries, can cause
night blindness. Another possible reason is reti-
nitis pigmentosa, a condition that causes retinal
degeneration and vision loss. There are some
medications for heart conditions or blood serum
cholesterol control that can cause night blind-
ness and, though rare, a vitamin A deficiency
also may be the source. Don’t accept any chang-
es in your vision as just a natural part of aging.
See your doctor to identify the source of your
poor night vision so it can be treated as soon as
possible.
QI have been taking antidepressants for
many years, and would like to see how
well I might do without them now. Is there
a special way to go about this? Or can I just stop
taking them cold turkey?
ABy all means, do NOT suddenly stop tak-
ing your antidepressants. The withdrawal
symptoms for some medications can be
quite severe and unpleasant. Only under the
guidance of your physician should you try to
wean yourself off antidepressants. A slow, step-
down process is the only safe way to allow your
brain the time required to adjust to the chemical
changes, which could take anywhere from two
to six weeks or longer. How to proceed depends
on which medication you take. Also, never
break or cut your pills or tablets into halves or
quarters without consulting your doctor. Some
drugs have extended release formulas bound to
the drug’s casing. Cutting or breaking them can
inadvertently change the dosage, and ultimately,
how well they work for you. Having your doctor
guide you is the only safe way to proceed.
MILK ALTERNATIVES … NIGHT BLINDNESS … ANTIDEPRESSANTS
IN COMING
ISSUES
TREATMENT —
What vaccines
should you get?
GI HEALTH —
Food allergy or
sensitivity?
PREVENTION —
Stop low back
pain before it
worsens.
July 20158
Editor-in-Chief
Bruce A. Ferrell,
MD, Professor of
Medicine and
Geriatrics
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