While we wish that there was an easy, magic formula for staying healthy, it takes a concerted effort to eat well and exercise regularly. No one understands this more wholeheartedly than Dr. Vivien Brown, who in her new book A Women’s Guide to Healthy Aging sweeps aside the myths about aging well that inundate the Internet.
Q&A with Dr. Vivien Brown
Dr. Vivien Brown is a passionate advocate for women’s health and preventative healthcare. A past recipient of the prestigious Enid Johnson Macleod Award from the Federation of Medical Women of Canada, she now lectures around the world on women’s health and healthy aging.
On top of maintaining a successful private practice in Toronto, ON, Dr. Brown is a board member of the Women’s Brain Health Initiative, which creates education programs and funds research to combat brain-aging diseases that affect women. She’s also Vice President of Medical Affairs for Medisys Health Group, a network of clinics throughout Canada dedicated to preventative healthcare. Welcome, Dr. Brown.
Q: In A Women’s Guide to Healthy Aging you write about the seven key areas of health that women should focus on as they age. Can you recap them for us here?
A: In no particular order, they are: nutrition, exercise and sleep, immunization and disease prevention, cardiac health, osteoporosis, brain health and menopause.
Q: On the topic of immunizations and disease prevention, which vaccinations are the most important for women 50+? And why?
A: This is an area I’m passionate about because I’ve been in practice long enough to see people die of vaccine-preventable diseases. I’m adamant that people should get immunized against these diseases:
Influenza and Pneumonia
Influenza and pneumonia, for the most part, are preventable diseases. When you look at patients who are hospitalized for influenza, they’re generally over the age of 65. Of the number of people hospitalized for influenza, 10% will not survive and 16% will have catastrophic deterioration of their independence. They will lose the ability to either care for themselves or perform day-to-day activities.
Tetanus and Pertussis (also known as Whooping Cough)
Older adults should also get a tetanus shot, which includes pertussis. If you have grandchildren, vaccination against pertussis is crucial as it’s a killer disease in infants. It’s also responsible for more deaths than any other epidemic disease with the exception of influenza.
Shingles disease is so common — about 1 in 2 Canadians (if you live until you’re 80) [and 1 in 3 Americans in their lifetime] will get shingles. Women are more at risk than men. Caucasian women are more at risk than other women, and shingles can be a deadly disease both in terms of how sick you get, which is morbidity, as well as mortality. A severe episode of shingles can result in nerve pain that can last years, affecting your quality of life.
We do lose people to shingles, often not from the original disease, but from the treatment. People with painful shingles often get treated with narcotics which can make them dizzy and increase their chances of falling and suffering an injury. Shingles treatment should always take into account each individual’s needs, including their exercise and sleep routines.
Human Papilloma Virus (HPV)
The HPV vaccine is important for older women depending on their circumstance. We see deaths from cervical cancer in women aged 65-75. You absolutely should consider getting immunized against HPV if you’re sexually active with more than one partner or starting a relationship with a new partner.
Q: Concerning cardiac health, why is it that more women than men die of heart disease? What risk factors do older women need to pay attention to?
A: Smoking and stress are serious risk factors for heart disease. Women, particularly in their 40s and 50s, are very busy with family, and they may be in the “sandwich generation” where they’re taking care of younger and older people in their family. What we end up with is stressed, busy, hectic women who are probably not eating as well as they could or exercising regularly. Then, no surprise, they become more at risk for heart disease after menopause.
Women often present differently with heart disease, meaning they may not experience crushing chest pain the way a man does. For women, symptoms may involve fatigue, shortness of breath or sweatiness. Women are often diagnosed further along in the process than men. Plus, statistically we know that women are not treated as aggressively as men when they’re hospitalized for heart disease. For example, women are less likely to have bypass surgery. I think one of the issues is women somehow think they’re immune to heart disease. However, heart disease is still the number one killer in Canada and the U.S.
Q: What’s your message to women who are struggling with managing stress in their lives?
A: Women who are working very hard and juggling many responsibilities often tell me, I know I need to exercise. I know I’m too stressed. But I just don’t have the time. My interpretation is that your health is not your priority. I often use the analogy of being on a airplane, when, before takeoff, the flight attendant says: When the oxygen mask comes down, put yours on first so that you can breathe and be healthy enough to help the person beside you.
Taking care of yourself is not selfish. It’s actually being selfless. When you take care of yourself, you’re not a burden to anybody else. It’s important to make yourself a priority at least part of the time, and to do activities like meditation, yoga or pilates to de-stress.
Q: In your book, you talk about the anatomical and physiological difference in men and women’s brains. When it comes to early signs of cognitive decline women are at a disadvantage. Why?
A: Women tend to have better verbal skills than men, and can maintain those verbal skills in a testing situation. In an in-office test for brain health, women often score well on the tests even if they’ve lost some cognitive abilities because they’re able to compensate.
By the time the signs of decline are picked up, women are much further along in their decline. So then we’re also looking at subjective cognitive decline. This is where the patient notices that their mental capacity is changing and says, I just don’t feel right. Something’s wrong. I’m not remembering things. They may test out perfectly on a brain health test, and there may be nothing objective, but their subjective evaluation of how they feel has changed.
We know that 70% of new Alzheimer’s cases are in women, and we want to try and minimize that by looking for things that we can treat easily. For example, a B12 deficiency can sometimes cause changes in your cognition. Thyroid disease can also contribute to a slowing down. We want to look for things that may be reversed very quickly, and pay closer attention to women who talk about subjective cognitive decline.
Q: You’re an advocate of preventative healthcare. How can women keep their minds sharp?
A: Being socially connected is important and makes a huge difference on brain health. Volunteer, play cards with friends, learn a new language or sign up for an art course. When you’re socially connected, your brain has better neural plasticity and is able to cope better with change. Social connections also prevent isolation and loneliness, which are also detrimental to brain health.
Q: Osteoporosis. Can you talk about the risk of bone fractures for women 50+?
A: A fracture is the number one event for women over the age of 50. The bulk of fractures after age 40 are called ‘fragility fractures’. The number one predictor of experiencing another fracture is having had a fracture in the first place. Women have to pay attention to even minor fractures because they affect bone quality, even if their bone density is adequate.
Women often think that their bone density is good enough. But we should also be looking at fracture risk. Bone density testing only evaluates how dense your bones are, and not the quality of the bone. Currently, we’re only testing for bone density. Tests of bone quality are still at the research level, but if you’ve experienced a fracture it tells us that your bone is more brittle, that it’s not as dense or doesn’t have the same quality it did before. To reduce the risk of fracture and osteoporosis, talk to your doctor about how much vitamin D you’re getting, whether you’re getting enough calcium in your diet and if you’re exercising enough.
There are lots of areas that are modifiable, where good choices have an impact, so we can stay strong, healthy and independent as we age.