By Matt Stone
I’ve been thinking a lot about aging lately. My grandfather, age 87 and my last living grandparent, ain’t doin’ so hot. And yes, he’s old. He’s falling to pieces. He’s going to eventually die. I’m not fighting that, and tend to look at whether it happens now or several months or even years from now as pretty inconsequential in the grand scheme of things. Sure, he’ll miss a few golf tournaments and football games on tv, but from this point forward it doesn’t really matter when the big day arrives. The world will go on whether he is alive to watch The O’Reilly Factor or not (Yeah I know that’s kinda mean, but he’s at the bedridden diaper stage – the stage where most people promise themselves and their loved ones they’ll never reach).
So yes, I’m aware there’s nothing that is going to make him jump up and do cartwheels at this point. But I have to rant over the care that he has been given over the last several weeks. It’s ridiculous, and violates some of the most basic elements of proper elderly care.
While my tendency to encourage increased calorie consumption, including many naughties like sugar, salt, and saturated fat, as well as making an effort to maximize anabolic factors over the catabolic factors for health could be perceived as controversial for the general public, the older you get the less controversial and more obviously correct this advice becomes. When it comes to increasing health, immunity, longevity, and functionality for the elderly there’s no question that high calorie consumption and minimizing catabolism is highly effective.
When it comes to elderly care, and maintaining their functionality especially, a loss of which has landed my grandfather in a nursing home as of last Monday, there’s no question that the prevention of sarcopenia, or loss of muscle mass, is where success and failure resides.
When old people do their getting old thing, muscle mass decreases. This is due primarily to an increase of catabolic hormones like adrenaline and the glucocorticoids and others in proportion to youthful hormones like testosterone, DHEA, and growth hormone. One set favors muscle loss, the other set favors muscle gain.
While the effects of aging are inevitable and unavoidable in the long run, there are certainly measures, as discussed in the last post on metabolism changes with aging, that can delay and in some cases even temporarily reverse these declines. Some of the hallmarks of aging such as loss of appetite and a reduction in physical activity are clear contributors to loss of muscle mass.
But loss of muscle mass aside, what really matters most is that strength is maintained. Activities vital to doing basic things without requiring assistance, such as standing up and sitting down, rolling over in bed, walking, and moving around without reaching total exhaustion in the process, are mostly attributable to strength in proportion to bodyweight. For example, if you can leg press 400 pounds, and you weigh, 150, walking up a flight of stairs is effortless. If you leg press 150 pounds and weigh 250, sitting down on the toilet and getting back up again is damn near impossible. Walking up a flight of stairs is like a 20-year old walking up a flight of stairs carrying his bodyweight on his shoulders. It’s exhausting, and will cause you to suck wind like Arnold on Mars.
When it comes to maintaining strength and muscle mass, it is no different from the simple basics known about such things. Eat at least maintenance calories, preferably more, including plenty of carbohydrates and protein in particular. Do progressive resistance exercise – meaning continue to increase the weight you are able to lift as long as you can. Get plenty of sleep. If you can’t or won’t do resistance exercise, at least staying physically active and moving around will help.
So, ol’ grandpa, who my family has always referred to as “Granddaddy” (and since Puff Daddy made the switch to P-Diddy – G-Diddy), checked into the hospital for a mysterious infection a few weeks ago. Since then, from a lethal combination of laying around doing absolutely nothing, eating very little (mostly attributable to the hospital food being disgusting, not very calorie dense, and get this – low in salt because he had a couple of temporary high blood pressure readings), and in turn getting very little sleep – G-Diddy has lost 16 pounds in 3 weeks time.
And now lacks the strength to do anything and everything that he was capable of doing just a month ago. Because of this, he is no longer at home with his wife (who is NOT Starla, unfortunately) to help take care of him. He can’t help her enough, because of his lack of strength, to get in and out of his chair, in and out of bed, on and off the toilet, and so forth.
How in the world do they let this happen? Tube feed the guy if he’s losing weight like that. Or at least start by giving him ice cream instead of unsalted turkey and carrots for dinner, steamed broccoli, low fat scrambled eggs that an astronaut wouldn’t eat, and watery porridge with margarine… and feeding him a hell of a lot more often than three times per day. Get him out of bed and do some exercises to keep his strength up. Anything.
You never let an old-timer lose 16 pounds in less than 3 weeks. That should be rule #1 of elderly care.
It’s so dumb. The people down in “dietary” are giving him unsalted food. Meanwhile, the doctors are trying to perk him up by pumping saline into him. Know how much salt is in a liter of saline solution? 9 GRAMS! About the same as 3 double cheeseburgers and a half bag of sea salt potato chips. Where is the disconnect? These people work right down the frickin’ hall from one another. Why is one using salt to save lives while the other is mistakenly thinking they are saving lives by restricting salt? To borrow a phrase from the movie character Patches O’Houlihan, “it’s like a bunch of retards trying to hump a doorknob.”
Even more ironic is that G-Diddy’s problems turn out to be from a pill that went down the wrong hatch and ended up in his lung, triggering pneumonia-like symptoms, that the doctor went in to remove and accidently broke into several pieces making the problem worse. So basically he is almost killed by the “care” he was given while trying to fix a problem caused by a medication or vitamin pill that was supposed to keep him healthy.
Anyway, there’s no question that sarcopenia is one of the most, if not THE most, important issue with the elderly. Maintenance of muscle mass has repeatedly been found to be the physical attribute most tightly correlated with above-average longevity. Sleep, calorie dense and highly-palatable food with plenty of carbs and protein consumed frequently, and strength training in a few basic planes of motion, especially the legs, is the triad of strategies that prevent and reverse it. This triad also performs the same feat on osteoporosis and osteopenia, other primary elderly issues.
I suspect that in the distant future we’ll see resistance exercise machines like the CZT in every nursing home and assisted living facility, and perhaps even hospitals too. And hopefully better food. From what I can tell the food is still very much governed by the steamed broccoli paradigm of nutrition, when calorie-dense rocket fuel is needed by the elderly even more than the rest of us. I hope to write about this in much greater detail in the future, putting out an actual guide of some sort on this important and very basic and straightforward subject. All I really want to say right now is…
Friends don’t let their friends’ grandparents lose weight.