New Rx for older adults: Boost the dose on lifestyle change

Chronic disease management has come a long way in recent years, thanks in part to a host of new medications. But taking prescription medications can pose significant risks and side effects, especially for older adults.

that American College of Lifestyle MedicineA brochure produced entitled “6 Ways to Take Control of Your Health” summarizes the six pillars of lifestyle medicine, which can do more than just help manage chronic disease. When used extensively, these evidence-based lifestyle changes can prevent and even reverse chronic disease, eliminating the need for medications.

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“Whether we’re talking about cardiovascular disease, prediabetes, prediabetes or cognitive impairment, chronic diseases are all based on the same basic pathophysiology, which involves pathways associated with inflammation, an altered microbiome, or an altered microbiome,” said Kate Collings, MD, Ph.D. Or epigenetics, or poor neuroplasticity.” Cardiologist and former president of the American College of Lifestyle Medicine. “When we prescribe lifestyle medicine interventions, we may influence one or more of these pathways, altering the course of chronic disease.”

The six pillars of lifestyle medicine are:

  • Whole food, plant-based nutrition.
  • Physical activity.
  • Stress management.
  • Avoid hazardous materials.
  • Restorative sleep.
  • Social Media.

Some interventions may target only one pillar, while others may target up to all six pillars. In addition, interventions may be prescribed at more or less intense doses based on the patient’s needs and readiness. But regardless of dosage, follow-up and specificity are crucial.

Rather than advising the patient to adhere generally to a vegetarian or Mediterranean diet, the lifestyle medicine approach will be specific in prescribing “what to eat and what to avoid,” and include referrals to culinary medicine classes or shared medical appointments that can facilitate skill acquisition. The doctor may need to see the patient frequently to ensure accountability and monitor laboratory variables, Dr. Collings said.

“The lifestyle medicine approach relies heavily on the clinician balancing a coach approach with an expert approach, which translates into listening more than talking. This creates a better environment for behavior change,” she said.

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The chronic disease epidemic in the United States now affects adults of all ages. According to the Centers for Disease Control and Prevention, as of 2021, more than 40% of school-age children and teens had at least one chronic health condition.

However, older adults tend to have more chronic diseases, which puts them at an additional risk of polypharmacy.

“Ideally, their doctors have carefully examined all potential drug interactions, but we are learning more all the time, including after a drug is approved,” Dr. Collings said. “I’m not particularly concerned when an older patient takes two or three medications, but when they take, say, 10 or 12 medications, the drug interaction and the financial risks grow.”

As with pharmaceutical interventions, higher disease severity will require higher doses – so to speak – of lifestyle interventions. But unlike prescription drug use, therapeutic lifestyle changes across the six pillars interact positively. For example, better sleep often means more energy to exercise or cook at home. If patients are engaged and committed, lifestyle interventions can take effect quickly. This is good news, but changes in medication dosage may need to be made quickly as well, Dr. Collings noted.

“For example, if a patient is taking a diabetes medication that is associated with hypoglycemia, and they are about to make a major change in their diet, the doctor may need to reduce the dose of that medication to avoid causing low blood sugar,” she said. .

Patients may begin to see results once they adopt lifestyle changes.

“In many clinical cases, people see dramatic improvements from diet and exercise methods in as little as three to four weeks,” she said.

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