Healthy aging made simple: Tips from a geriatrician

(TNS) SAN JOSE, Calif. — When geriatrician Mehrdad Ayati first met Lee Katz in 2011, he encountered yet another patient — and her spouse — who were in despair over the conflicting and contradictory information they received in her care.

The Menlo Park woman was in a downward spiral of multiple chronic conditions that would lead to her death in April 2013 at age 84.

But the different specialists who rotated in and out of her case made things worse, with mix-ups and questionable interventions that took her in and out of the hospital and added to her suffering, husband Martin Katz says.

"They didn't know what one another was doing," says Katz, who is a retired a pharmaceutical researcher and executive. "Then Dr. Ayati appeared on the scene. He started looking at the entire patient, her personal and social history, all her medical problems."

Ayati coordinated Lee Katz's care and the information coming at them from different directions.

"He put it all together," Katz says.

What Ayati did for Lee Katz, he is now doing for everyone in his new book, "Paths to Healthy Aging." This "guidebook," as Ayati calls it, is designed as a concise overview of the basic ways people can improve their physical and mental health and enjoy life as they age.

Ayati is an assistant professor at the Stanford School of Medicine and treats geriatric patients at the Stanford Medical Center and the Veteran's Administration hospital in Palo Alto. He specializes in providing comprehensive care with a focus on prevention.

With his wife and co-author, Arezou Azarani, who has a Ph.D. in physiology, he synthesizes his experience and the latest research on nutrition, exercise and geriatric medicine into a book that emphasizes healthy lifestyle choices.

Ayati says those choices can be just as important as cutting edge medicine in fending off many common complaints, from high blood pressure to sleep disorders, from depression to frailty. These choices include eating a balanced diet, exercising regularly, being socially involved, and pursuing creative, stimulating activities. Ayati also is a fan of keeping things simple and affordable when it comes to eating better and exercising.

People don't need to join expensive gyms or start a strenuous program, he says.

"Physical health is achieved by persistent and enjoyable workouts," he says.

Ayati's book similarly tries to keep things simple with how it uses concise explanations and short chapters to acquaint people with key concepts.

"There is so much information out there, but it's hard to know which information is valid," Ayati says. "My goal is to simplify the journey."

Ayati loves working with older patients, in part because he was born and raised in Iran, where the culture reveres its elders.

"They are considered very sage, are highly respected and have a central position in the family and their community," Ayati says. "Gray hair is considered an asset, and the day you get your first gray hair, you don't dye it — you brag about it."

Unfortunately, he works in a specialty facing a shortage of experienced practitioners. About 80 percent of adults 65 and older require care for chronic conditions. To meet their needs, the United States would need about 17,000 more geriatricians, according to the American Geriatrics Society.

When students show an interest in geriatrics, Ayati gives them all the encouragement he can. One thing he especially likes about geriatrics is that doctors are encouraged to spend much more than just 10 minutes with patients, who typically have a complex set of medical issues.

For Ayati, some of that time is spent just talking to patients and learning their work and family history and how they live.

"I learn a lot from my geriatric patients," he says.

Ayati uses that same conversational approach in his book to correct misconceptions, including his view that people should stay away from nutritional and vitamin supplements unless a doctor has found a serious deficiency that needs to be addressed. Taking too much vitamin D, for example, can be toxic, he says. Generally, people can get all the nutrients they need by eating a balanced diet.

Ayati devotes a chapter to the problem of over medication, because he has seen too many patients suffering the ill effects of taking drugs they don't need.

Sometimes misdiagnosis can lead to the "drug cascade syndrome," where doctors pile on medications to treat the side effects of other medications.

He recalls one patient who ended up in a skilled nursing facility after falling at home and breaking his hip. This downward spiral started sometime earlier when the man went to see his primary care doctor for depression.

The doctor prescribed anti-depressants, but failed to get to the root cause of the depression. The man had restless leg syndrome, which caused him to lose sleep and go through his days exhausted, unable to concentrate or remember things.

The anti-depressants didn't alleviate his depression. They only made his leg cramps worse, so he lost more sleep. He became disoriented and fell, breaking his hip. By weaning him off the anti-depressants and treating the restless leg syndrome, Ayati was able to help the man fully recover from both his hip injury and his depression.

The last chapter of Ayati's book offers tips on how to find a geriatrician, which he knows can be a daunting task. He points out that most patients don't need to see a geriatrician too often, sometimes just once a year.

After his wife died, Martin Katz, 87, signed Ayati as his geriatrician. The two have also become friends; Katz endorsed Ayati's book and its tips for healthy aging.

Katz says he is in excellent health and admits he is "genetically blessed." Despite his background in pharmaceuticals, Katz shares Ayati's belief that less is better when it comes to drugs.

Katz may be one of Ayati's model patients, eating right, exercising regularly and staying active. Katz belongs to two senior centers that provide wonderful "social interaction, friends and activities."

Most importantly, he has "an avocation." He has taken up sculpting, and this artistic endeavor keeps him physically active, challenges him mentally and constantly introduces him to new people.

He began learning to sculpt in the early 1990s, even before he retired. He had never thought of himself as artistically inclined; he was just curious. Many workshops and classes later, he has launched a second career as a professional artist.

"I dreaded seeing those retired guys following their wives around at the supermarket," he says.

In late October, he unveiled his newest bronze work, "Kaddish," at Congregation Beth Am in Los Altos Hills.

Long before meeting Ayati, he put into practice one of Ayati's favorite tips: He signs up for classes.

"My mantra is, if you don't join a class, you're not going to do it," Katz says. "I tend to be a Type A, highly motivated, but with all that self-motivation, if I'm not signed up for a class, and unless it's on my calendar for 9 a.m. Thursday, I'm not going to do it."

Katz, who also travels extensively, probably is busier than he is, says Ayati, who also has a 1½-year-old son.

For his part, Katz wouldn't have it any other way and notes the health benefits of everything he does to take care of himself.

"The number of pills that I have reduced or dropped," he says, "is amazing."

Below are prescriptions for mental and physical health from Stanford geriatrician Mehrdad Ayati in his book "Paths to Healthy Aging."

Avoid trendy and drastic diets or exercise programs, especially rigorous programs you won't stick to.

Vitamins aren't necessary unless a doctor identifies a deficiency, and be wary of nutritional supplements. You can generally get all your nutrients through a balanced diet of mostly whole, organic foods; limit your intake of canned, frozen or instant foods, as well as alcohol and caffeine.

Find a hobby, or sign up for a class. Trying a new subject or activity can challenge you mentally and physically.

Don't just hang out with seniors; find ways to spend time with people of all ages.

Keep in touch with your network of friends.

Find a geriatrician. While there is a shortage of geriatricians, you won't necessarily have to see one often. This specialist will offer care that is comprehensive and focuses on prevention.

Mehrdad Ayati's "Paths to Healthy Aging" is available at www.pathstohealthyaging.com.

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