Features February 2014 Issue

Personalized Preventive Heart Care Essential for Older Adults, Too

These four healthy behaviors and preventive treatments are important at any age.

Strategies to prevent a heart attack, stroke or other cardiovascular problem should be individualized for older adults, according to a recent statement by the American Heart Association (AHA). Because older adults may have more than one health complication, take multiple medications and face challenges in exercising, it’s especially important for doctors and patients to work closely together to plan and stick to a regimen that will maintain a good quality of life for as long as possible.

Preventive care for the heart is just as important for older adults as is it is for younger people.

Steven Nissen, MD, Chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic, says it’s vital that older adults not dismiss preventive care and a healthy lifestyle simply because they are advancing in years. “This is about taking into consideration all the factors an individual is dealing with and making the best decisions,” he says. “Prevention is still important when you reach your 70s, 80s, 90s. Nothing will undermine your quality of life more than developing heart disease.”

In recognition of February as American Heart Month, consider the following five preventive strategies to keep your heart healthy:

Remember that getting older doesn’t mean giving up on healthy behaviors.
“You are never too old or too sick to start living healthily,” says Leslie Cho, MD, co-section head of Preventive Cardiology and Rehabilitation at Cleveland Clinic. “There are good data that if you eat badly after a heart attack you are more likely to be re-admitted to the hospital or have another adverse event. Same with exercise.”

Dr. Nissen adds that the same benefits a person derives from exercising every day at age 50, for example, can be obtained at age 75. But with advancing age comes the need to consider extenuating circumstances that can affect healthy behaviors. A daily walk may be difficult for someone with arthritic knees, but a daily swim may be easier on the joints while still providing a good cardiovascular workout.

You have to take charge of your health care.
The AHA says its incumbent on older adults to research their conditions and become knowledgeable health care consumers.

“The best patients are those who are actively involved in their health care,” Dr. Nissen says. “You should question everything. And if your doctor doesn’t like you asking questions, then get a new doctor.”

He also notes that many older adults tend to accept what their doctors tell them without question. And on top of that, many older patients are reluctant to express concerns or doubts about a particular treatment plan.

“We have to help this generation become more knowledgeable and more willing to speak up,” Dr. Nissen says.

Carefully weigh the risks and benefits of any treatment or procedure.
The AHA statement stresses the importance of respecting a patient’s preference when it comes to health care. The doctors who wrote the statement note that “some older patients may prefer to live with an increased risk of a cardiovascular event rather than make lifestyle changes or undergo procedures late in life.”

That’s why it’s important that you understand everything you can about recovering from surgery or the potential side effects of a new medication.

For example, a basically healthy 80-year-old man with a life expectancy of another 10 years may be a good candidate for statin therapy. But Dr. Nissen says he may be less likely to prescribe statins to a different 80-year-old man who is already taking many medications to deal with several serious health problems, and who has a life expectancy of one year.

Be honest with your healthcare providers about your lifestyle, medications and other important factors.
Your doctor relies on your word to provide the best care possible. But if you aren’t honest about your medications, for instance, it will be difficult to provide safe and effective care. Say you go into your next appointment and your blood pressure isn’t under control. If you tell your doctor you’ve taken your anti-hypertensive medications as prescribed, but you really haven’t been taking them, your doctor may assume that what he has prescribed isn’t effective. As a result you may be prescribed an additional medication or a higher dose when that may not be necessary.

Dr. Cho acknowledges the challenges of changing your eating habits or exercising regularly when you haven’t in the past. But she adds that if patients buy in to their treatment plans and make a sincere commitment to preventing future problems, good outcomes are likely.

“Lifetime habits are hard to break, but you can do it,” Dr. Cho says. “There are data that show if you do something for 21 days it can become a lifelong habit. It takes time and effort, but it can be done. That is why cardiac rehab is so important, because it teaches good diet and exercise to patients after an event.”

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