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I N T E R N A T I O N A L L O N G E V I T Y C E N T E R - U S A 国际长寿中心 - 美国

I N T E R N A T I O N A L L O N G E V I T Y C E N T E R - U S A 国际长寿中心 - 美国. Healthy Aging Malta -MAGG 健康老龄化 马耳他 -MAGG Harrison G. Bloom, M.D. 医学博士 Director, International Geriatrics Clinical Education and Consultation Service, International Longevity Center-USA 主任，国际老人病学临床教育及咨询处

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I N T E R N A T I O N A L L O N G E V I T Y C E N T E R - U S A 国际长寿中心 - 美国

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  1. I N T E R N A T I O N A L L O N G E V I T Y C E N T E R - U S A国际长寿中心-美国 Healthy Aging Malta-MAGG 健康老龄化 马耳他-MAGG Harrison G. Bloom, M.D.医学博士 Director, International Geriatrics Clinical Education and Consultation Service, International Longevity Center-USA 主任，国际老人病学临床教育及咨询处 国际长寿中心-美国 翻译:陈浩然

  2. Healthy Aging健康的老龄化 • Work 8 hours工作8小时 • Play 8 hours 玩8小时 • Sleep 8 hours睡8小时 (Not the same 8 hours)不同样的8小时

  3. Healthy Aging健康的老化 Listen to your mother! 听母亲的 • Eat your fruits and vegetables • 吃水果和蔬菜 • Share with others 与他人共享 • Be a nice person • 做一个好人

  4. Healthy Aging健康的老化 • Have good genes ( about 30%) • 好的基因（大约30%） • Practice reasonable preventive health (e.g. vaccinations) • 实施合理的预防性保健（如接种疫苗） • Be lucky (e.g. don’t get hit by a car) • 运气好（如:不被车撞） • Keep active – physically and cognitively • 保持活动-躯体的和认知的 • Be a women • 做个妇女

  5. Healthy Aging健康的老化 “Never go to a doctor whose office plants have died.” 不要找一个办公室植物已经死亡的医生看病（不要找一个不关爱生命的医生看病） -Erma Bombeck

  6. Healthy Aging健康的老化 Aging: Not a Single Process 老龄化: 不是一个单一的过程 • Accumulation of mutations and changes in genes and chromosomes. • 基因和染色体转变和改变的积聚 • Damage to DNA, proteins, membranes, and mitochondria by reactive oxygen species (ROS) produced during metabolism (free radicals). • 代谢时，产生的活性氧粒子（自由基）对DNA、蛋白、膜及线粒体的损害. • Chemical changes in amino acids of proteins, including oxidation, glycation, deamidation, abnormal phosphorylation, methylation. Accumulation of altered proteins as aggregates, such as AGEs, advanced glycation end products. • 蛋白氨基酸的化学变化，包括氧化、甘油、脱酰胺、不正常的磷酸化、甲基化。聚集时，蛋白积聚改变，例如晚期终末化产物、老的糖化终产品。

  7. Healthy Aging健康地老龄化 Aging – Not a Single Process 老龄化: 不是一个单一的过程 • Break down in mechanisms to ensure the accuracy of DNA, RNA, and protein synthesis 确保DNA、RNA、蛋白精确合成的机制的破坏 • Breakdown in recognition of self vs. nonself antigens, leading to increased autoimmunity • 认知自身及非自身抗原的破坏，导致自身免疫增加 Holliday R. Journal of Gerontology, Biological Sciences. 2004: Vol. 59A, No. 6, 568-572.

  8. Healthy Aging健康地老龄化 Maintenance Defenses 维护防御措施 • DNA repair. (Est.) 10,000 apurinic gaps in the genome of each cell/day; most are repaired. • DNA修复.(欧洲毒物学会) 每天每个细胞整组遗传基因10，000无嘌呤缺口 • Enzymes that destroy or antioxidants that absorb ROS (free radicals) • 破坏的酶和吸收了活性氧粒子（自由基）的抗氧化物 • Proteases that recognize abnormal proteins and degrade them (Continual protein turnover in cells with active metabolism) • 认知异常蛋白和降解它们的蛋白酶（有着活跃代谢的细胞中的连续的蛋白质转换） • Immune system recognizes foreign pathogens • 识别外来病原体的免疫系统

  9. Healthy Aging健康地老龄化 Maintenance Defenses 2 维护防御措施 • Liver detoxification, based on p450 cytochromes, of plant and animal food toxins • 基于p450的、对动植物毒素的肝解毒作用 • Wound repair, blood clotting, broken bone repair • 创伤的修复、血液凝固、骨折修复 • Cell suicide mechanism, apoptosis • 细胞自杀机制、编程性细胞死亡 • Homeostatic mechanisms, e.g. temperature control • 稳态机制，如体温控制 • Fat storage to survive periods of inadequate food 为食物不足生存期的脂肪储存 Holliday R. Journal of Gerontology, Biological Sciences. 2004; Vol. 59A, No. 6, 568-572.

  10. Healthy Aging: Theoretical Pathways to Increase in Longevity and Delay in Dysfunction健康地老龄化：增加长寿和延缓机能不良的理论的通路 • Preventing disease • 预防疾病 • Control of free radical damage • 控制自由基的损伤 • Delay of immunosenescence • 延缓免疫衰老 • Caloric restriction • 控制热量 • Stem cells and cell replacement • 干细胞和细胞移植 • Gene regulation • 基因调节

  11. Healthy Aging健康地老龄化 What should we be telling our patients? 我们应该告诉病人什么？ Is There An “Anti-Aging” Medicine? 存在抗衰老药吗？

  12. Healthy Aging 健康地老龄化 • Luigi Cornaro, 1550: extreme longevity possible by maintaining reserves of vital energy through moderation in all things • Luigi Cornaro，1550：可能通过减少所有事物的重要能量维持储存物达到极端长寿 • Late 18th, early 19th centuries: hormone transplants • 18世纪后期、19世纪早期：激素移植物 • Brown-Sequard 1889: injections of animal sex glands • Brown-Sequard 1889: 注射动物性腺 • Lydston and Stanley, early 1900s: testis transplants • Lydston及Stanley，1900早期：睾丸移植 • 1990: American Academy of Anti-Age Medicine (A4M): end of aging promised by combination of hormone treatments, plastic surgery, supplements • 1990：美国抗衰老学会（A4M）：期望通过激素治疗、整形外科手术及补充物中止衰老

  13. Healthy Aging健康地老龄化 “Within the next 50 years or so, assuming an individual can avoid becoming the victim of major trauma or homicide, it is entirely possible that he or she will be able to live virtually forever.” “在大约未来的50年里，如果一个人可以避免成为大的创伤或杀人犯的受害者，她或他是完全可能永远生存。” Klatz RM, Advances in Anti-Aging Medicine, Liebert, 1996.

  14. Healthy Aging健康地老龄化 Position Statement on Human Aging “Advocates of what has become known as anti-aging medicine claim that it is now possible to slow, stop, or reverse aging through existing medical and scientific interventions. “ 认为有抗衰老药的拥护者主张通过现存的药物和科学干预可能延缓、中止或逆转衰老。 Claims of this kind have been made for thousands of years, and they are as false today as they were in the past.” 这种主张已有数千年，今天仍然和过去一样是错误的。” Olshansky, Hayflick, Carnes, J Gerontology, 2002, Vol 57A, No. 8, B292-297

  15. Healthy Aging健康地老龄化

  16. Anti-oxidants抗氧化剂 DHEA脱氢表雄酮 Human growth hormone人生长激素 Testosterone睾丸素 Melatonin褪黑激素 Healthy Aging健康地老龄化 Anti-Aging Boon (doggle )s抗衰老的好处

  17. Healthy Aging健康地老龄化 Human Growth Hormone 人生长激素 • Rudman et al, Effects of Human Growth Hormone in Men over 60 Years Old, NEJM 323(1990) ; 1-6. • Rudman 等，人生长激素对大于60岁男士的作用，NEJM 323（1990）；1-6。 Human growth hormone administered to men deficient in growth hormone increased lean body mass, decreased fat, and increased bone mass.人生长激素给予人生长激素缺乏的男士的去脂肪体重、减少脂肪及增加骨密度。 • Subsequent studies have investigated potential benefits of rhGH in malnourished, frail, and critically ill older persons. • 后来的研究调查了rh 生长激素对营养不良、虚弱及重病的老年病人的潜在好处。 • Recent animal studies: overproduction of GH shortens longevity; underproduction, or decreased activity of GH/insulin signaling pathway, increases longevity. 近来的动物研究：生长激素过度产生缩短长寿；生产不足或减弱人生长激素或胰岛素信号通路的活性，增加长寿。

  18. Healthy Aging健康地老龄化 Human Growth Hormone人生长激素 • Problems: • 问题 • IM therapy • 免疫抑制治疗 • Adverse effects: edema, carpal tunnel syndrome, joint pain, diabetes mellitus, hypertension, CHF, gynecomastia, possibly increased CA • 副作用：水肿、腕管综合症、关节痛、糖尿病、高血压、慢性心力衰竭、男子女性型乳房及可能增加的癌症 • Cost: $15,000/year • 费用：$15.000/年 • Clinically significant functional benefits, prolongation of youth, increased longevity not demonstrated 未显示临床明显的功能利益、青春期延长及增加长寿

  19. Healthy Aging健康地老龄化 A Model of a Successful Aging. From Rowe and Kahn, Successful Aging, The Gerontologist, Vol. 37, No. 4, 1997.

  20. Healthy Aging健康地老龄化 “From birth to age 18, a girl needs good parents; “从出生到18岁，女孩子需要好的父母； from 18-35 she needs good looks; 从18-35她需要好的容貌； from 35-55 she needs a good personality; 从35-55她需要好的人格； and from 55 on she needs cash.” 从55开始她需要现金。” -Sophie Tucker

  21. Healthy Aging:健康地老龄化：Promotion of Optimal Nutrition最佳营养的改善 • Replace saturated and trans fats with unsaturated fats. • 用不饱和脂肪代替饱和脂肪和反式脂肪。 • Substitute whole-grain carbohydrates for refined-grain carbohydrates. 用完整谷类碳水化合物代替精细谷类化合物。 • Substitute nuts, beans, chicken, and fish for red meats. • 用坚果、豆类、鸡肉及鱼代替红肉。 • Eat plenty of fruits and vegetables. • 吃大量的水果和蔬菜。 • Use alcohol in moderation. • 少量饮酒。 • Take a daily multivitamin. • 摄取日常多种维生素。 K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to Achieve it. Annals of Long-term Care. 15(12).: 32-39.

  22. Healthy Aging:健康地老龄化Promotion of Optimal Cognitive Health最佳认知健康的改善 • Take a multivitamin. • 摄取多种维生素。 • Engage in mentally stimulating activities. • 参与用脑筋的刺激性活动。 • Remain socially engaged. • 在社会中保持参与。 • Exercise regularly. • 有规则地锻炼。 • Develop methods to detect and reduce stress (e.g., relaxation, yoga, meditation). • 制定办法检出和减少压力（如：放松、瑜伽及沉思）。 • Get adequate sleep. • 获得充足的睡眠。 K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to Achieve it. Annals of Long-term Care. 15(12).: 32-39.

  23. Healthy Aging:健康地老龄化Exercises to Promote Optimal Aging锻炼以促进最佳的老化 • Do some form of exercise/physical activity for 30 minutes a day. • 每天做30分钟某种形式的运动或体力活动 。 • Never use an elevator or escalator when stairs are available. • 如有楼梯时，从来不用电梯或自动扶梯。 • Walk or bike on errands that would take less than 10 minutes to drive. • 步行获骑车完成小于10分钟车程的任务。 • Don’t use remote control devices. • 不要使用遥控装置。 • Use manual devices when possible (eg, lawn mower, broom). • 可能时使用手动装置（如，割草机、扫帚）。 • Park a long distance from the main door when shopping. • 购物时把车停在离大门远的距离。

  24. Healthy Aging:健康地老龄化Exercise to Improve Balance锻炼以改善平衡 • Engage in exercise that requires balance (e.g., tai chi, dancing). • 参与需要平衡的锻炼（如：太极、跳舞）。 • While standing in line or cooking, stand on one leg (or with feet in tandem). • 当站队和烹饪时，用一条腿站立（或两脚前后站立）。 • Try heel or toe walking for short distances (10-20 ft). • 试着用脚跟或脚趾短距离行走（10-20英尺）。 • Stand up and sit down on chairs using one leg (with hand support if needed). • 用一条腿站立或坐在椅子上（如果需要用手支持） K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to Achieve it. Annals of Long-term Care. 15(12).: 32-39.

  25. Healthy Aging:健康地老龄化Exercise to Improve Strength • Lift small weights (one can of peas) in a plastic shopping bag, 10 repetitions on each side (vary the muscle groups) • 拎在熟料购物袋中的小的重物（一罐豌豆），每边重复10次（变化肌肉群） • Bag handles with a can inside can be placed over feet to exercise the leg muscles. • 内中有罐的袋子提手可以放在脚上以锻炼腿的肌肉群。 • Do sit-to-stand-to-sit exercises while watching TV. • 观看电视时做坐-站-坐的锻炼。 • Use both free weights and weight machines, and do strength training 2-3 times per week. • 即用自由重物也用重物机器，并且每周2-3次重物训练。 K. Brummel-Smith, M.D. 2007. Optimal Aging, Part II: Evidence-Based Practical Steps to Achieve it. Annals of Long-term Care. 15(12).: 32-39.

  26. Healthy Aging:健康地老龄化Optimal最佳的 The capacity to function across many domains- physical, functional, cognitive, emotional, social, and spiritual – to one’s satisfaction and in spite of one’s medical conditions. 跨越许多领域的能力-身体的、功能的、认知的、情绪的、社会的及精神的-令人满意并且虽然他在就医中。 K. Brummel-Smith, M.D. 2007. Optimal Aging, Part I: Demographics and Definitions. Annals of Long-term Care. 15(11).: 26-28

  27. Healthy Aging:健康地老龄化Successful成功的 Absence of disease and disability; high cognitive and physical functioning; and active engagement with life. 没有疾病和残疾;高的认知和身体机能；及积极地参与生活。 K. Brummel-Smith, M.D. 2007. Optimal Aging, Part I: Demographics and Definitions. Annals of Long-term Care. 15(11).: 26-28

  28. Healthy Aging健康地老龄化 New England Centenarian StudyThomas T. Perls, MD MPH, Margery Silver EdD 新英格兰研究百岁老人研究 • 169 centenarians in 8 communities near Boston • 居住在靠波士顿的18个社区的169个百岁老人 • 85% female • 85%是女性 • 15% living independently, 35% with family, 50% in nursing homes • 15%独立生活、35%与家庭、50%在护理院 • 25% free of cognitive disorders • 25%无认知障碍 • 4/5 male centenarians have extremely good mental and physical health • 4/5男性百岁老人拥有极好的精神和身体健康 • Female centenarians: wide spectrum of mental and physical health 女性百岁老人：宽广的精神和身体健康谱

  29. Healthy Aging健康地老龄化 Characteristics of Centenarians : NECS 百岁老人的特点： • 95% physically healthy, cognitively independent into 90s • 95%身体健康、认知独立进入90岁 • Significantly lower scores for “neuroticism” and “negative emotionality”; only 4/74 with severe depression on GDS • “神经过敏”和“消极情绪”的分数明显低，仅4/74在剂量递增表上有严重的抑郁 • Almost all ahad suffered severe bereavement, but demonstrated ability to cope with stress and loss • 几乎所有的ahad经历了痛苦的死别，但显示了处理压力和损失的能力 • High degree of continued intellectual stimulation: musical instrument, painting, sculpture, new language • 高度的持续的智力刺激：乐器、绘画、雕塑及学习新语言 • No pattern in diets • 没有典型的饮食 • Wide range of education • 广泛的教育

  30. Healthy Aging健康地老龄化 Characteristics of Centenarians : NECS 百岁老人的特点： • 99% non-obese • 99%不肥胖 • Alcohol consumption minimal • 最小限度地消费酒精 • Smoking non-existent • 不 吸烟 • Prominent use of humor as coping mechanism • 卓越的使用幽默作为应付机制 • Nearly all have many meaningful relationships and ability to attract people • 几乎所有人拥有许多有意义的关系和能力吸引人们 • 82% report religious beliefs important influence in life • 82%报告宗教对生活有重要的影响

  31. Healthy Aging健康地老龄化 Exercise : The Real Fountain of Youth 锻炼：年轻的真正源泉 Reduction in: 减少： CAD and stroke (effect on BP, HDL, DM)冠心病和中风（对血压、高密度脂蛋白、糖尿病） colon cancer 结肠癌 osteoporosis骨质疏松症 diabetes mellitus糖尿病 obesity肥胖症 depression抑郁 Improvement in: muscle mass, balance, strength, Sleep 改善：肌肉质量、平衡、力量、睡眠。

  32. Healthy Aging健康地老龄化 Numerous Studies Demonstrate Benefits of Exercise in Reduction of All-Cause Mortality 大量的研究显示锻炼在减少全因死亡率的益处 • Kaplan, 1987, Alameda County Study : increased risk of death in persons > 70 who reported low levels of activity • Kaplan, 1987, Alameda 县研究： • 低水平活动量增加死亡的风险 • Blair, 1989, JAMA : 10,224 men, 3,120 women. All-cause mortality decreased across quintiles of treadmill-determined physical fitness. • Blair, 1989, JAMA : 10,224 男士, 3,120 女士.通过1/5的平板决定的身体适合度的全因死亡率下降。 • Kujala, 1998, Finnish Twin Cohort, JAMA: leisure-time physical activity associated with reduced mortality, even after genetic and familial factors accounted for • Kujala, 1998, Finnish Twin Cohort, JAMA: 业余时间的体力活动伴随下降的死亡率，甚至在可以解释的基因和家族因素后

  33. Healthy Aging健康地老龄化 Myers, 2002, NEJM: After adjustment for age, treadmill peak exercise capacity was the strongest predictor of mortality in normal subjects and those with cardiovascular disease. 在年龄调节后，平板高峰运动能力是正常个体和有心脏病者的最强的死亡预测因素。 Each 1 MET increase in exercise capacity conferred 12% increase in survival. 运动能力每增加1级赋予生存率12%的增加

  34. Healthy Aging健康地老龄化 Helen Zechmeister, 91, weight lifter (200 lbs.)举重者

  35. Healthy Aging健康地老龄化 Woody Brown, 83, surfer 冲浪运动员

  36. Healthy Aging健康地老龄化 Ida Kline, 100, aerobics instructor有氧健身操教练

  37. Healthy Aging:健康地老龄化Psychosocial Factors in Longevity Studies suggest that 研究提示 • social support systems –社会支持体系 • ability to cope with stress-处理压力的能力 • lifelong learning, meaningful activity -终生学习，有意义的活动 • Laughter -笑 may contribute as much if not more to longevity than healthy behaviors 也许对长寿贡献许多即使不超过对健康行为的贡献

  38. Healthy Aging健康地老龄化 Psychological Well-Being: The Value of Social Support 心理健康：社会支持的价值 • Berkman, 1979, Alameda County Study: 7000 men and women, followed for 9 years, were 2-3x more likely to die if they lacked social and community ties, regardless of age, gender, health practices, or physical health status • Berkman, 1979, Alameda 县研究: 7000男人和女人，随访9年，假如缺少社会和社区联系，不论年龄、性别、健康情况或身体健康状况，2-3倍地易于死亡， • Orth-Gomer, 1987. 17,000 Swedish persons over 6 years. Socially isolated 4x more likely to die prematurely, even if age, health behavior, and health status controlled • Orth-Gomer, 1987. 17,000 超过60岁的瑞典人. 即使控制年龄、健康行为及健康状态，与社会隔离，4倍易于过早地死亡。

  39. We don’t not stop working because we are old; we grow old because we stop working. 因为我们老，我们不停止工作； 因为我们停止工作，我们变老。

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