Tuberculosis, Tobacco and Aging

Definition

TB) is a potentially serious infectious disease that primarily affects your lungs. Tuberculosis is spread from person to person through tiny droplets released into the air. Most people who become infected with the bacteria that cause tuberculosis don't develop symptoms of the disease.

Despite advances in treatment, TB remains a major cause of illness and death worldwide, especially in Africa and Asia. Every year tuberculosis kills almost 2 million people. Since the 1980s, rates of TB have increased, fueled by the HIV/AIDS epidemic and the emergence of drug-resistant strains of the TB bacteria.
Most cases of tuberculosis can be cured by taking a combination of medications for several months or longer. It's important to complete your whole course of therapy.

Symptoms

Although your body may harbor the bacteria that cause tuberculosis, your immune system often can prevent you from becoming sick. For this reason, doctors make a distinction between:

• Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't contagious.
• Active TB. This condition makes you sick and can spread to others.

Signs and symptoms of active TB include:

• Unexplained weight loss
• Fatigue
• Fever
• Night sweats
• Chills
• Loss of appetite

Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:

• Coughing that lasts three or more weeks
• Coughing up blood
• Chest pain, or pain with breathing or coughing

Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.
When to see a doctor
See your doctor if you have a fever, unexplained weight loss, night sweats and a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause. TB can be diagnosed by your primary care doctor or by a doctor who specializes in lung diseases (pulmonologist) or by an infectious disease specialist. If you don't have a doctor, your local public health department can help.

Causes

Lungs

Tuberculosis is caused by an organism called Mycobacterium tuberculosis. The bacteria spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings. Rarely, a pregnant woman with active TB may pass the bacteria to her unborn child.
Although tuberculosis is contagious, it's not especially easy to catch. You're much more likely to get tuberculosis from a family member or close co-worker than from a stranger. Most people with active TB who've had appropriate drug treatment for at least two weeks are no longer contagious.
TB infection vs. active TB
If you breathe TB bacteria into your lungs, one of four things might happen:

• You don't become infected with TB. Your immune system immediately destroys the germs and clears them from your body.
• You develop latent TB infection. The germs settle in your lungs and begin to multiply. Within several weeks, however, your immune system successfully "walls off" the bacteria in your lungs, much like a scab forming over a wound. The bacteria may remain within these walls for years — alive, but in a dormant state. In this case, you're considered to have TB infection and you'll test positive on a TB skin test. But you won't have symptoms and won't transmit the disease to others.

• You develop active TB. If your immune defenses fail, TB bacteria begin to exploit your immune system cells for their own survival. The bacteria move into the airways in your lungs, causing large air spaces (cavities) to form. Filled with oxygen — which the bacteria need to survive — the air spaces make an ideal breeding ground for the bacteria. The bacteria may then spread from the cavities to the rest of your lungs as well as to other parts of your body.

If you have active TB, you're likely to feel sick. Even if you don't feel sick, you can still infect others. Without treatment, many people with active TB die. Those who survive may develop long-term symptoms, such as chest pain and a cough with bloody sputum, or they may recover and go into remission.

• You develop active TB years after the initial infection. After you've had latent TB for years, the walled-off bacteria may suddenly begin multiplying again, causing active TB, also known as reactivation TB. It's not always clear what triggers this reactivation, but it most commonly happens after your immune system becomes weakened. Your resistance may be lower because of aging, drug or alcohol abuse, malnutrition, chemotherapy, prolonged use of prescription medications such as corticosteroids or TNF inhibitors, and diseases such as HIV/AIDS.

Only about one in 10 people who have TB infection goes on to develop active TB. The risk is greatest in the first two years after infection and is much higher if you have HIV infection.
HIV and TB
Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Tuberculosis and HIV have a deadly relationship — each drives the progress of the other.
Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren't HIV-positive.
TB is one of the leading causes of death among people with AIDS.   One of the first indications of HIV infection may be the sudden onset of TB, often in a site outside the lungs.
Drug-resistant TB
Another reason TB remains a major killer is the increase in drug-resistant strains of the bacterium. Ever since the first antibiotics were used to fight TB 60 years ago, the germ has developed the ability to survive attack, and that ability gets passed on to its descendants. Drug-resistant strains of TB emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well. Today, for each major TB medication, there's a TB strain that resists its treatment.
The major cause of TB drug resistance is inadequate treatment, either because the wrong drugs are prescribed or because people don't take their entire course of medication.
There are two types of drug-resistant TB:

• Multidrug-resistant TB (MDR TB). This form of TB can't be killed by the two most powerful antibiotics for TB, isoniazid and rifampin. Although MDR TB can be successfully treated, it's much harder to combat than is regular TB and requires long-term therapy — up to two years — with drugs that are very expensive and can cause serious side effects. People with untreated MDR TB can transmit this serious type of TB to others.
• Extensively drug-resistant TB (XDR TB). XDR TB is a less common form of MDR TB in which the bacteria resist isoniazid and rifampin as well as most of the alternative or second line drugs used to treat TB. XDR TB has shown up across the world.   Treatment for XDR TB is challenging and lengthy and leads to serious side effects and a higher rate of failure. Recently, the first cases of completely drug-resistant TB were reported — the bacteria could not be killed by any available TB drug.

Risk factors

Anyone can get tuberculosis, but certain factors increase your risk of the disease. These factors include:

• Lowered immunity. A healthy immune system can often successfully fight TB bacteria, but your body can't mount an effective defense if your resistance is low. A number of factors can weaken your immune system. Having a disease that suppresses immunity, such as HIV/AIDS, diabetes, end-stage kidney disease, certain cancers or the lung disease silicosis, can reduce your body's ability to protect itself. Your risk is also higher if you take corticosteroids, certain arthritis medications, chemotherapy drugs or other drugs that suppress the immune system.
• Close contact with someone with infectious TB. In general, you must spend an extended period of time with someone with untreated, active TB to become infected yourself. You're more likely to catch the disease from a family member, roommate, friend or close co-worker.
• Country of origin. People from regions with high rates of TB — especially sub-Saharan Africa, India, China, the islands of Southeast Asia and Micronesia, and parts of the former Soviet Union — are more likely to develop TB. In the United States, more than half the people with TB were born in a different country. Among these, the most common countries of origin were Mexico, the Philippines, India and Vietnam.
• Age. Older adults are at greater risk of TB because normal aging or illness may weaken their immune systems. They're also more likely to live in nursing homes, where outbreaks of TB can occur.
• Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to TB.
• Malnutrition. A poor diet or one too low in calories puts you at greater risk of TB.
• Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
• Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of TB. That's because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
• Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of TB infection.
• Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand washing greatly reduce your risk.
• International travel. As people migrate and travel widely, they may expose others or be exposed to TB bacteria.

Complications

Without treatment, tuberculosis can be fatal. Drug-resistant strains of the disease are more difficult to treat.
Untreated active disease typically affects your lungs, but it can spread to other parts of the body through your bloodstream. Complications vary according to the location of TB bacteria:

• Lung damage can occur ifTB in your lungs (pulmonary TB) isn't diagnosed and treated early.
• Severe pain, abscesses and joint destruction may result from TB that infects your bones.
• Meningitis can occur if TB infects your brain and central nervous system.
• Miliary TB is TB that has spread throughout your entire body, a serious complication.

Tests and diagnosis

If your doctor suspects TB, you will need a complete medical evaluation and tests for TB infection.
Skin test
The most commonly used diagnostic tool for TB is a simple skin test. Although there are two methods, the Mantoux test is preferred because it's more accurate.
For the Mantoux test, a small amount of a substance called PPD tuberculin is injected just below the skin of your inside forearm. You should feel only a slight needle prick. Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site, indicating a reaction to the injected material. A hard, raised red bump (induration) means you're likely to have TB infection. The size of the bump determines whether the test results are significant, based on your risk factors for TB.
The Mantoux test isn't perfect. A false-positive test suggests that you have TB when you really don't. This is most likely to occur if you're infected with a different type of mycobacterium other than the one that causes tuberculosis, or if you've recently been vaccinated with the bacillus Calmette-Guerin (BCG) vaccine. This TB vaccine is widely used in countries with high TB infection rates.
On the other hand, some people who are infected with TB — including children, older people and people with AIDS — may have a delayed or no response to the Mantoux test.
Blood tests
Blood tests may be used to confirm or rule out latent or active TB. These tests use sophisticated technology to measure the immune system's reaction to Mycobacterium tuberculosis. These tests are quicker and more accurate than is the traditional skin test. They may be useful if you're at high risk of TB infection but have a negative response to the Mantoux test, or if you received the BCG vaccine.
Further testing
If the results of a TB test are positive (referred to as "significant"), you may have further tests to help determine whether you have active TB disease and whether it is a drug-resistant strain.
These tests may include:

• Chest X-ray or CT scan. If you've had a positive skin test, your doctor is likely to order a chest X-ray. In some cases, this may show white spots in your lungs where your immune system has walled off TB bacteria. In others, it may reveal a nodule or cavities in your lungs caused by active TB. A computerized tomography (CT) scan, which uses cross-sectional X-ray images, may show more subtle signs of disease.

• Culture tests. If your chest X-ray shows signs of TB, your doctor may take a sample of your stomach secretions or sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria, and your doctor can have the results of special smears in a matter of hours.

Samples may also be sent to a laboratory where they're examined under a microscope as well as placed on a special medium that encourages the growth of bacteria (culture). The bacteria that appear are then tested to see if they respond to the medications commonly used to treat TB. Your doctor uses the results of the culture tests to prescribe the most effective medications for you. Because TB bacteria grow very slowly, traditional culture tests can take four to eight weeks.

• Other tests. Testing called nuclear acid amplification (NAA) can detect genes associated with drug resistance in Mycobacterium tuberculosis. This test is generally available only in developed countries.

A test used primarily in developing countries is called the microscopic-observation drug-susceptibility (MODS) assay. It can detect the presence of TB bacteria in sputum in as little as seven days. Additionally, the test can identify drug-resistant strains of the TB bacteria.
What if my test is negative?
Having little or no reaction to the Mantoux test usually means that you're not infected with TB bacteria. But in some cases it's possible to have TB infection in spite of a negative test. Reasons for a false-negative test include:

• Recent TB infection. It can take eight to 10 weeks after you've been infected for your body to react to a skin test. If your doctor suspects that you've been tested too soon, you may need to repeat the test in a few months.
• Severely weakened immune system. If your immune system is compromised by an illness, such as AIDS, or by corticosteroid or chemotherapy drugs, you may not respond to the Mantoux test, even though you're infected with TB. Diagnosing TB in HIV-positive people is further complicated because many symptoms of AIDS are similar to TB symptoms.
• Vaccination with a live virus. Vaccines that contain a live virus, such as the measles or smallpox vaccine, can interfere with a TB skin test.
• Overwhelming TB disease. If your body has been overwhelmed with TB bacteria, it may not be able to mount enough of a defense to respond to the skin test.
• Improper testing. Sometimes the PPD tuberculin may be injected too deeply below the surface of your skin. In that case, any reaction you have may not be visible. Be sure that you're tested by someone skilled in administering TB tests.

Diagnosing TB in children
It's harder to diagnose TB in children than in adults. Children may swallow sputum, rather than coughing it out, making it harder to take culture samples. And infants and young children may not react to the skin test. For these reasons, tests from an adult who is likely to have been the cause of the infection may be used to help diagnose TB in a child.

Treatments and drugs

Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. Normally, you take antibiotics for at least six to nine months to destroy the TB bacteria. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and its location in the body.
Several promising new TB drugs are in development, and some may become available within the next 10 years.
Treating TB infection (latent TB)
If tests show that you have TB infection but not active disease, your doctor may recommend preventive drug therapy to destroy bacteria that might become active in the future. You're likely to receive a daily or twice-a-week dose of the TB medication isoniazid. For treatment to be effective, you usually take isoniazid for nine months. Long-term use of isoniazid can cause side effects, including the life-threatening liver disease hepatitis. For this reason, your doctor will monitor you closely while you're taking isoniazid. During treatment, avoid using acetaminophen (Tylenol, others) and avoid or limit alcohol use. Both increase your risk of liver damage.
Treating active TB disease
If you're diagnosed with active TB, you're likely to begin taking four medications — isoniazid, rifampin (Rifadin), ethambutol (Myambutol) and pyrazinamide. This regimen may change if tests later show some of these drugs to be ineffective. Even so, you'll continue to take several medications. Depending on the severity of your disease and whether the bacteria are drug-resistant, one or two of the four drugs may be stopped after a few months. You may be hospitalized for the first two weeks of therapy or until tests show that you're no longer contagious.
Sometimes the drugs may be combined in a single tablet  which contains isoniazid, rifampin and pyrazinamide. This makes your treatment less complicated while ensuring that you get all the drugs needed to completely destroy TB bacteria. Another drug that may make treatment easier is rifapentine , which is taken just once a week during the last four months of therapy, in combination with other drugs.
Medication side effects
Side effects of TB drugs aren't common, but can be serious when they do occur. All TB medications can be highly toxic to your liver. Rifampin can also cause severe flu-like signs and symptoms — fever, chills, muscle pain, nausea and vomiting. When taking these medications, call your doctor immediately if you experience any of the following:

• Nausea or vomiting
• Loss of appetite
• A yellow color to your skin (jaundice)
• Dark urine
• A fever that lasts three or more days and has no obvious cause
• Tenderness or soreness in your abdomen
• Blurred vision or colorblindness

Treating drug-resistant TB
Multidrug-resistant TB (MDR TB) can't be cured by the two major TB drugs, isoniazid and rifampin. Extensive drug-resistant TB (XDR TB) is resistant to those drugs as well as three or more of the second line TB drugs. Treating these resistant forms of TB is far more costly than is treating nonresistant TB.
Treatment of drug-resistant TB requires taking a "cocktail" of at least four drugs, including first line medications that are still effective and several second line medications, for 18 months to two years or longer. Even with treatment, many people with these types of TB may not survive. If treatment is successful, you may need surgery to remove areas of persistent infection or repair lung damage.
Treating people who have HIV/AIDS
HIV-positive people are especially likely to develop active TB, and drug-resistant forms of the disease are especially dangerous for them. What's more, the most powerful AIDS drugs (antiretroviral therapy) interact with rifampicin and other drugs used to treat TB, reducing the effectiveness of both types of medications.
To avoid interactions, people living with both HIV and TB may stop taking antiretroviral therapy while they complete a short course of TB therapy that includes rifampicin. Or they may be treated with a TB regimen in which rifampicin is replaced with another drug that's less likely to interfere with AIDS medications. In such cases, doctors carefully monitor the response to therapy, and the duration and type of regimen may change over time.
Treating children and pregnant women
Treating TB in children is largely the same as treating adults, except that ethambutol is not used for young children because of the possible side effect of vision problems. Instead of ethambutol, children may take streptomycin.
For pregnant women with active TB, initial treatment often involves three drugs — isoniazid, rifampin and ethambutol. Pyrazinamide isn't recommended because its effect on the unborn baby isn't known. Some second line TB medications also aren't recommended.
Completing treatment is essential
After a few weeks, you won't be contagious and you may start to feel better. It might be tempting to stop taking your TB drugs. But it is crucial that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat. Drug-resistant strains of TB can quickly become fatal, especially if your immune system is impaired.
In an effort to help people stick with their treatment, a program called directly observed therapy (DOT) is recommended. In this approach, a nurse or other health care professional administers your medication so that you don't have to remember to take it on your own. Sometimes clinics provide incentives, such as food coupons or transportation, for people to show up for their appointments.

Prevention

In general, TB is preventable. From a public health standpoint, the best way to control TB is to diagnose and treat people with TB infection before they develop active disease and to take careful precautions with people hospitalized with TB. But there also are measures you can take on your own to help protect yourself and others:

• Keep your immune system healthy. Eat plenty of healthy foods including fruits and vegetables, get enough sleep, and exercise at least 30 minutes a day most days of the week to keep your immune system in top form.
• Get tested regularly. Experts advise people who have a high risk of TB to get a skin test once a year. This includes people with HIV or other conditions that weaken the immune system, people who live or work in a prison or nursing home, health care workers, people from countries with high rates of TB, and others in high-risk groups.
• Consider preventive therapy. If you test positive for latent TB infection, your doctor will likely advise you to take medications to reduce your risk of developing active TB. Vaccination with BCG isn't recommended for general use because it isn't very effective in adults and it causes a false-positive result on a Mantoux skin test. But the vaccine is often given to infants in countries where TB is more common. Vaccination can prevent severe TB in children. Researchers are working on developing a more effective TB vaccine.
• Finish your entire course of medication. This is the most important step you can take to protect yourself and others from TB. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

To help keep your family and friends from getting sick if you have active TB:

• Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active TB.
• Ensure adequate ventilation. Open the windows whenever possible to let in fresh air.
• Cover your mouth. It takes two to three weeks of treatment before you're no longer contagious. During that time, be sure to cover your mouth with a tissue anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. Also, wearing a mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission.

Coping and support

Undergoing treatment for TB is a complicated and lengthy process. But the only way to cure the disease is to stick with your treatment. You may find it helpful to have your medication given by a nurse or other health care professional so that you don't have to remember to take it on your own. In addition, try to maintain your normal activities and hobbies and stay connected with family and friends.
Keep in mind that your physical health can affect your mental health. Denial, anger and frustration are normal when you must deal with something difficult and unexpected. At times, you may need more tools to deal with these or other emotions. Professionals, such as therapists or behavioral psychologists, can help you develop positive coping strategies

Preparing for your appointment

If you suspect that you have tuberculosis, contact your family doctor, a general practitioner or your state health department. You may be referred to an infectious disease or lung specialist (Pulmonologist).
You can help your doctor by being prepared with as much information as possible. Here's some information to help you get ready for your appointment.
What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. In particular, ask if you should wear a face mask to your appointment.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including your HIV status (if known), country of origin, any recent travel outside the United States, contact with people who may have tuberculosis, any past infection with TB, and any medical conditions or diseases you have.
• Make a list of all medications, as well as any vitamins or supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For TB, some basic questions to ask your doctor include:

• What kinds of tests do I need?
• What is the best course of action?
• How long will my treatment last?
• What can I do to stay on track with my treatment?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow, especially with respect to preventing the spread of infection?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
• Will I work with a nurse or other health care provider to oversee my treatment?
• What are the side effects of my treatment?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have you been in contact with anyone who has TB?
• Were you born in another country, or have you traveled in another country?
• Have you ever had tuberculosis or a positive skin test in the past?
• What kind of work do you do?
• Do you use alcohol or recreational drugs?
• What is your typical diet?
• Do you have HIV infection or AIDS, cancer, diabetes or any other medical condition?

 

TOBACCO –ill effects

Definition

Nicotine dependence is an addiction to tobacco products caused by the drug nicotine. Smoke from cigarettes, cigars and pipes contains thousands of chemicals, including nicotine. Smokeless tobacco also contains nicotine. Nicotine dependence means you can't stop using the substance, even though it's causing you harm.
Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects spur your continued use of tobacco and lead to dependence. At the same time, quitting tobacco use causes withdrawal symptoms, including irritability and anxiety.
Nicotine dependence brings a host of health problems. While it's the nicotine in tobacco that keeps you hooked, the toxic effects come mainly from other substances in tobacco. Smokers have significantly higher rates of heart disease, stroke and cancer.

Symptoms

In some people, using any amount of tobacco can quickly lead to nicotine dependence. Symptoms that you may be addicted include:

• You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop.
• You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration or anger, increased hunger, insomnia, and constipation or diarrhea.
• You keep smoking despite health problems. Even though you've developed problems with your lungs or your heart, you haven't stopped or can't stop.
• You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these situations.

When to see a doctor
If you've tried to stop smoking but haven't succeeded, talk to your health care provider about medications to help you quit. Look for a stop-smoking counselor, who can help you create a treatment plan that works for you. Most people who try to stop on their own don't succeed. You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the psychological aspects of tobacco dependence.

Causes

Nicotine is the chemical in tobacco that keeps you smoking. It can be as addictive as cocaine. It increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior. One of these neurotransmitters is dopamine, which makes you feel good. Getting that dopamine boost is part of the addiction process.
Tobacco dependence involves psychological as well as physical factors. Behaviors and cues that you may associate with smoking include:

• Certain times of the day, such as with morning coffee or during breaks at work
• After a meal
• Drinking alcohol
• Certain places or friends
• Talking on the phone
• Stressful situations or when you're feeling down
• The smell of a cigarette
• Driving your car

To overcome your dependence on tobacco, you need to deal with the behaviors and routines that you associate with smoking.

Risk factors

Anyone who smokes is at risk of becoming dependent on tobacco and nicotine. Most people begin smoking during childhood or adolescence.
The younger you begin smoking, the greater the chance that you'll become a heavy smoker as an adult. Children with two parents who smoke are twice as likely to become smokers. Children with friends who smoke also are more likely to try cigarettes.
Other factors that influence nicotine dependence include:

• Genetics. The genes you inherit play a role in some aspects of nicotine dependence. For example, the likelihood that you will start smoking and keep smoking may be partly inherited. Some people experiment with smoking and don't experience pleasure, so they never become smokers. Other people develop dependence very quickly. Some "social smokers" can smoke just once in a while, and yet another group of smokers can stop smoking with no withdrawal symptoms. These differences can be explained by genetic factors that influence how receptors on the surface of your brain's nerve cells respond to nicotine.
• Depression, other mental illness and substance abuse. People who have depression, schizophrenia and other forms of mental illness are more likely to be smokers. Smoking may be a form of self-medication for these disorders. People who abuse alcohol and illicit drugs also are more likely to be smokers.

Complications

When you inhale tobacco smoke, you ingest numerous chemicals that reach most of your body's vital organs. Tobacco smoke contains more than 60 known cancer-causing chemicals and more than 4,800 other harmful substances.
Smoking harms almost every organ of your body. More than half the people who keep smoking will die because of it. The negative health effects include:

• Lung cancer and other lung diseases. Smoking causes nearly nine out 10 of lung cancer cases, as well as other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
• Heart and circulatory system problems. Smoking increases your risk of dying of cardiovascular disease, including heart attack and stroke. Smoking 15 cigarettes a day doubles your heart attack risk. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have cardiovascular illness or heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
• Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and also is related to cancer of the bladder, pancreas, kidney, cervix, stomach, and some leukemias.
• Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails.
• Infertility and impotence. Smoking increases the risk of infertility in women and the chance of impotence in men.
• Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, decreased birth weight and sudden infant death syndrome (SIDS) in their newborn. Low birth weight babies are more likely to die or have learning and physical problems.
• Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis, than are nonsmokers.
• Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications such as kidney disease.
• Impaired senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing as it once was.
• Risks to your family. Spouses and partners of smokers have a higher risk of lung cancer and heart disease, compared with people who don't live with a smoker. If you smoke, your children will be more prone to sudden infant death syndrome, asthma, ear infections and colds.

Tests and diagnosis

There are no physical tests to determine the exact degree to which you're dependent on nicotine. Your doctor may assess the degree of your nicotine dependence by asking you questions or having you complete a questionnaire. The more cigarettes you smoke each day and the sooner you smoke after awakening, the more dependent you are. Knowing your degree of dependence can also help determine the correct dose of a nicotine replacement medication.

Treatments and drugs

If you've tried and failed to stop smoking on your own, you're not alone. You're more likely to succeed if you follow treatment that's been shown to be successful in scientific studies. Medications and counseling both work. Combining these approaches is even more effective.
Although it may be tough to break your tobacco dependence, the benefits are well worth the effort. If you stop smoking before you're 50, you can cut in half your risk of dying in the next 15 years, compared with those who continue smoking.
No matter what your age, your health will benefit if you stop smoking. Just 20 minutes after your last cigarette, your heart rate goes down. Twelve hours later, levels of carbon monoxide, a toxic gas, in your blood return to normal. Your lung function improves and your circulation starts to get better within three months. After a year, your risk of having a heart attack drops by half. And after five to 15 years, your stroke risk will be the same as that of a nonsmoker.
Medications
Several medications, including nicotine replacement therapy and non-nicotine medications, are effective in treating nicotine dependence. Any of these medications, combined with behavioral changes, can double your chances of quitting.
Using more than one medication — such as a nicotine patch along with a nicotine gum, lozenge, nasal spray or inhaler — may help you achieve better results than if you use a single medication.
If you've tried a medication on your own but haven't been successful in quitting, talk to your health care provider. He or she can help you move in the right direction by adjusting the dose of your medication, recommending a different medication or using a combination of medications.
Most people who want to stop smoking can benefit from a medication. But if you're pregnant or breast-feeding, you smoke fewer than 10 cigarettes a day or you're under age 18, talk to your doctor before taking any over-the-counter nicotine replacement products.
Nicotine replacement therapy
Nicotine replacement therapy gives you nicotine without the other harmful chemicals in tobacco smoke. Many people mistakenly believe that nicotine causes cancer, but that's not the case. Nicotine replacement medications, including patches, gums, lozenges, nasal sprays and inhalers, can help relieve difficult withdrawal symptoms and cravings. The best time to start using nicotine replacement is on the day you set to stop smoking.
Most nicotine replacement products are available over-the-counter:

• Nicotine patch (NicoDerm CQ, Habitrol, others). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day. The treatment period usually lasts for eight weeks or longer. Don't be in a hurry to stop using the patch, especially if you've stopped smoking or dramatically reduced your smoking. If you haven't been able to stop smoking completely after the two weeks or so of treatment, ask your doctor for help in adjusting the dose of the patch or adding another medication.
• Nicotine gum (Nicorette, Rite Aid). This is a gum-like resin that delivers nicotine to your blood through the lining of your mouth. It's available in a 2-milligram (mg) dose for regular smokers and a 4-mg dose for heavy smokers. You can use up to 20 pieces a day as needed.  Nicotine gum is often recommended to curb cravings. To use the gum correctly, chew it a few times until you feel a mild tingling or peppery taste, then park the gum between your cheek and gumline for several minutes. This "chewing and parking" allows nicotine to be gradually absorbed in your bloodstream. Avoid drinking carbonated or acidic drinks, such as coffee or juice, before or while using nicotine gums or lozenges.
• Nicotine lozenge (Commit). This is a tablet that dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are available in 2- and 4-mg doses, for regular or heavier smokers. To use the lozenge, place it in your mouth between your gumline and cheek or under your tongue and allow it to dissolve. You'll start with one lozenge every one to two hours and gradually increase the time between treatments. The most common side effects are headache, diarrhea, hiccups, heartburn and nausea.

These nicotine replacement products are available by prescription:

• Nicotine nasal spray (NicotrolNS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into your blood vessels. The nasal spray delivers nicotine a bit quicker than gum, lozenges or the patch but not as rapidly as smoking a cigarette. It's usually prescribed for three-month periods for up to six months. Side effects may include nasal irritation.
• Nicotine inhaler (Nicotrol Inhaler). This device is shaped something like a cigarette holder. You puff on it, and it delivers nicotine vapor in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream. Common side effects are mouth or throat irritation and occasional coughing.

Non-nicotine medications
Medications that don't contain nicotine include:

• Antidepressants. The antidepressant drug bupropion (Zyban, Wellbutrin) increases levels of dopamine and norepinephrine, brain chemicals that are also boosted by nicotine. Bupropion may be prescribed along with a nicotine patch. Bupropion has the advantage of helping to minimize weight gain after you quit smoking. Side effects may include sleep disturbance and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, you shouldn't take this drug. Another antidepressant that has been shown to help people stop smoking is nortriptyline (Pamelor).
• Varenicline (Chantix). This medication acts on the brain's nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Potential side effects include nausea, headache, insomnia and strange dreams. Rarely, varenicline can cause serious psychiatric symptoms, such as depressed mood, agitation and suicidal thoughts.
• Clonidine (Catapres). This drug is approved for use in treating high blood pressure, but may be used as a second line medication for tobacco dependence if other medications haven't helped. Its usefulness is limited because of side effects such as drowsiness and sedation.
• Medications in development. Several nicotine vaccines are under investigation in clinical trials.  The vaccines cause the immune system to develop antibodies to nicotine. These antibodies then bind to nicotine as it enters the bloodstream and prevent the nicotine from reaching the brain, effectively blocking the effects of nicotine. The nicotine vaccine holds promise for preventing relapse among smokers who quit.

Counseling, support groups and smoking cessation programs
Research shows that combining medications with behavioral counseling provides the best chance for long-term success in abstaining from tobacco. Medications help you cope with withdrawal symptoms, while behavioral treatments help you develop the skills you need to stay away from tobacco over the long run. The more time you spend with a counselor, the better your treatment results will be.
Several types of counseling and support can help with stopping smoking:

• Telephone counseling. No matter where you live, you can take advantage of telephone counseling to help you give up tobacco. Two national help lines are the National Cancer Institute's 800-QUIT-NOW (800-784-8669) and the American Cancer Society's Quitline at 800-ACS-2345 (800-227-2345).
• Individual or group counseling program. Your doctor may recommend local support groups or a treatment program where counseling is provided by a tobacco treatment specialist. Counseling helps you learn techniques for quitting and provides support for the process. Many hospitals, health care plans, health care providers and employers offer treatment programs or have tobacco treatment specialists who are certified to provide treatment for tobacco dependence. Nicotine Anonymous groups provide support for people trying to quit.
• Internet-based programs. Several Web sites offer support and strategies for people who are trying to stop smoking. Text messaging services, including personalized reminders about a quit smoking plan, also may prove helpful.

Remember, it's common to "relapse." But your goal is no smoking at all — even light or occasional smoking is dangerous. You can learn from past quitting experiences, and you'll be stronger during your next attempt.

Lifestyle and home remedies

When you stop smoking, you'll likely experience some unpleasant or stressful symptoms of nicotine withdrawal. Medications will markedly reduce the difficulty of withdrawal. Even so, it's important to have a plan for managing withdrawal symptoms.
Withdrawal symptoms are usually the most intense during the first week after you stop smoking. They may continue for several weeks, with declining intensity. Although most nicotine withdrawal symptoms pass within a month, you may occasionally experience a strong urge to smoke months after stopping. Triggers or cues that were associated with your smoking can provoke these urges or cravings.
Here are some things you can do to manage withdrawal symptoms:

• Exercise regularly. Regular physical activity has been found to help people stop smoking.  Exercise also helps offset potential weight gain following smoking cessation.
• Wait out cravings. Cravings or urges usually last less than five minutes. Wash the dishes, go for a walk or have a healthy snack, such as carrots, an apple or sunflower seeds. Pursue a hobby that keeps your hands busy.
• Identify rationalizations. If you find yourself thinking, "I'll just smoke one to get through this tough time" or "Just one won't hurt," recognize it as a message that can derail your plan. Review your reasons for quitting, and replace that thought with something positive to support your stopping.
• Talk to a support person if you're feeling anxious or depressed or need encouragement to get through a difficult craving.
• Avoid high-risk situations. Know your triggers, and stay away from people, places and situations that tempt you to smoke.
• Be realistic about the energy and time it takes to stop smoking. Adjust your schedule to a lighter workload. Take time to do something fun or simply relax.
• Eat regular meals, including plenty of fruits and vegetables, and drink more water.

Coping and support

How can you stay motivated to maintain abstinence from smoking? Start by thinking about the mixed feelings you may have about smoking. Then make a list of your reasons for quitting.
Stopping smoking is a positive change for many reasons. Think of short-term benefits, such as breathing easier, saving money and having better smelling clothes. Long-term benefits include a lower risk of disease, increased chances for a longer life and a healthier environment for your family. Use these reasons to build your motivation. Look at your list often, especially when you feel your motivation is lagging.
To stay smoke-free over the long haul, consider these tips:

• Identify your major smoking triggers and challenges. This will help you solve problems and have a plan to deal with high-risk situations.
• Seek support. Seek the social support you need to stay quit. Ask your family, friends and co-workers for support and encouragement. Let them know what you find most helpful.
• Practice positive self-talk. Think of one or two phrases to use repeatedly for encouragement, such as "I am grateful to be smoke-free."
• Set smoke-free boundaries. If there's another smoker in your household, set boundaries by making your home and car smoke-free.
• Regularly review the benefits you're getting from quitting. Look at your list again. Add up how much money you've saved. Ask your family members for their observations.
• Avoid alcohol. Drinking is a high-risk situation. Avoid drinking situations until you are confident you can remain smoke-free.
• Reward yourself. Buy a magazine, go to a park, meet a friend for lunch, take a class.

Prevention

The best way to prevent tobacco dependence is to not smoke in the first place. The best way to prevent your children from smoking is to not smoke yourself. If you're a parent who smokes, the younger your children are when you quit, the less likely they are to become smokers themselves. Even if you don't smoke, here are some things you might try as a parent:

• Promote smoke-free environments. Support legislation to make all workplaces smoke-free. Encourage smoke-free public places, including restaurants or other places where your teen may work.
• Support legislation to increase taxes on tobacco products. Higher prices discourage teens from starting to smoke. Higher prices on tobacco products, coupled with smoke-free workplace laws, are the most effective public health policies to reduce smoking in adults and prevent young people from ever starting.
• Talk with your teenagers. Ask whether their friends smoke. Most teenagers smoke their first cigarette with a friend who already smokes.
• Learn what your children think about smoking. Ask them to read this article so that you can discuss it together.
• Help your children explore personal feelings. Use nonjudgmental questions and rehearse with them how they could handle tough situations regarding peer pressure and smoking.
• Note the social repercussions. Remind your teenager that smoking gives you bad breath and makes your hair and clothes smell.
• Work with your schools. Become active in community stop-smoking programs.

                                          AGING
                 Aging is a progressive generalized impairment of functions resulting  in loss of adaptive response to stress and increasing risk of age related diseases.  There are physiological and morphological changes. Its effect on chronology and behaviour leads to social impact.  So the individual becomes incapacitated, disabled and disease prone
   In India the elderly population + 65 years is about 8% of the Total population of 110 crores. It have its impact on Medical economical and social structure of our country spread over the urban and rural areas.
   The process of aging can be slowed down by certain modifiable factors like Calorie restriction, exercise , vitamins, mineral supplements (Chromium) ,avoidance fo stress like heat and light and abstinence from tobacco.   The health in the old age is suffering because of Physiological decline, the process of degeneration starts and the change in social status leads to diminished resources. Aging process is due to be a specific mechanism which are likely to be multifactorial environmentally influenced and species specific. Disease tend to manifest earlier and severely in elderly due to poor physiological reserve.

Getting the Nutrition You Need

As you get older, good nutrition plays an increasingly important role in how well you age. Eating a low-salt, low-fat diet with plenty of fruits, vegetables, and fiber can actually reduce your age-related risks of heart disease, diabetes, stroke, osteoporosis, and other chronic diseases. By eating a wide variety of foods, you can pretty easily get what your body needs, including:

• Protein, which is needed to maintain and rebuild muscles. You can get low-fat, quality protein from poultry, fish, eggs or egg substitutes, soy, and limited amounts of nuts and low-fat meat and dairy.
• Carbohydrate, which is the body's preferred source of energy. There are two main sources of dietary carbohydrates: simple sugars, such as sucrose (the refined white sugar added to sweets and desserts), fructose (the sugar contained in fruit), and lactose (milk sugar); and complex carbohydrates, which come from vegetables and grains. Unlike refined sugars, fruits contain vitamins and fiber, dairy products contain nutrients such as calcium and vitamin D, and complex carbohydrates contain vitamins, minerals, and fiber. Get most of your carbohydrate calories from vegetables, grains, and fruits. And try to replace fat calories with complex carbohydrates in your diet.
• Fat, which also provides energy. To help keep your blood cholesterol levels low, get most of your limited fat intake from the polyunsaturated fats (as in liquid corn oil or soybean oil) and monounsaturated fats (in olive oil, avocados, and nuts). Limit saturated fats (beef, pork, veal, butter, shortening, and cheese). You can do this by eating these foods less often, having smaller servings, choosing less fatty cuts of meat, and by using stronger tasting cheeses so you can use just a little and still get the cheese flavor. Try to avoid the trans fats (hydrogenated fats) found in stick margarine and in many processed foods such as crackers and cookies. Trans fats are now shown on the nutrition facts labels found on most packaged foods.
• Water, to replace water lost through activity. Because your kidneys gradually become less efficient at keeping your body hydrated, make a conscious effort to get six to eight 8fl oz glasses of water a day.

As you take a look at your daily diet, remember that as you age:

• Your body's daily energy needs slowly decrease. You therefore need fewer calories a day than when you were younger. Your doctor or a registered dietitian (RD) can help you calculate your ideal calorie intake.
• Natural hormone changes make your body prone to depositing more body fat (especially around your middle) and less muscle. Eating a healthy balanced diet and limiting your intake of saturated fat, along with increased activity and muscle strengthening (muscle cells are the major calorie burners in your body), can help you stay at a healthy weight.
• Your bones lose mineral content more rapidly than before, especially if you are a postmenopausal woman, because lower estrogen increases bone loss. As a result, you need to have calcium and Vitamin D in your diet, to help prevent osteoporosis, and your doctor may recommend you take a calcium and vitamin D supplement.

             Simply put, the best way to reach and stay at a healthy weight as you age is to take in fewer calories than you needed in your youth and to make sure that most of what you eat is nutritious and low in fat and processed sugar. Limit saturated fats and trans fats. These are harmful to your blood vessels and increase your risk for developing hardening of the arteries (atherosclerosis). And they can affect your cholesterol and increase your risk of heart disease. Saturated fats are found mostly in foods that come from animals, such as beef, pork, veal, butter, and cheese. Trans fats are found in the shortening in many cookies and crackers, in fried fast foods, and in stick margarine. Also consider how other food choices can improve your cholesterol levels or make them worse.
For more information on nutrition, see the topic Healthy Eating.

Help for managing underweight or poor nutrition

People who are underweight have low reserves for bouncing back after an illness or injury. In the later years, this can lead to permanent ill health or disability. If you have trouble keeping your weight up, it's critical that you take special measures to build your weight, energy, and resilience. Every day, follow your doctor's recommendations and:

• Eat three meals plus three snacks, and never miss a meal.
• Choose higher-calorie foods from each food group, such as whole milk instead of skim milk. But try to keep your overall saturated fat intake low-high cholesterol can affect anyone.
• Eat the highest-calorie foods in a meal first.
• Use liquid supplements, such as Ensure or Boost, between meals.

If you are having trouble getting the food you need because of transportation, financial, or health problems, ask your doctor about local meal programs. Most communities have Meals on Wheels programs that can deliver food to your door, as well as meals at churches and community centers that can nourish your needs for both food and social time.

The Anti-Aging Diet

WE are  all trying to find the "magic bullet" that delays the natural aging process. Put an antiaging label on most any product, and it flies off the shelves.
Yet if you're trying to look your best without going under the knife, a secret ingredient might be right under your nose. Some experts say one answer to aging gracefully can be found in the grocery store -- in fruits, vegetables, green tea, and a host of other healthful foods that are rich in antioxidants and other potentially age-deterring compounds.

What Is Aging?

Of course, the signs of aging include not only wrinkles, but also memory loss, decreased brain function, and an increasing risk for chronic diseases such as heart disease, osteoporosis, and cancer. Healthy aging is also defined as living a longer, healthier life. And many studies have documented the link between a healthy diet and prevention of age-related or chronic diseases.
Adopting a healthy lifestyle that includes regular physical activity, adequate rest, avoiding tobacco, and a diet full of healthy foods and beverages can be the best defense against aging.
"Dietary choices are critical to delay the onset of aging and age-related diseases, and the sooner you start, the greater the benefit,".

Antioxidants and Inflammation

Some foods and beverages contain powerful substances called phytonutrients that some believe are capable of unlocking the key to longevity. Phytonutrients, which are members of the antioxidant family, gobble up "free radicals" -- oxygen molecules that play a role in the onset of illnesses such as heart disease, cancer, osteoporosis, and Alzheimer's disease.
As we age, we become more susceptible to the long-term effects of oxidative stress (a condition where the body basically has too many free radicals) and inflammation on the cellular level. The theory is that antioxidants and other age-defying compounds help cells ward off damage from free radicals and minimize the impact of aging.
Beyond antioxidants, some other compounds in foods can affect aging. They can be classified according to their impact on inflammation at the cellular level, experts say.
"All foods fit into three categories: pro-inflammatory, neutral, or anti-inflammatory," .
You can help to slow aging at the cellular level by choosing foods that are anti-inflammatory and rich in antioxidants.
"Age-related changes may be reversed by consuming foods and beverages that are rich in a variety of compounds, including antioxidants, and are anti-inflammatory, such as cold-water fish and richly colored fruits and vegetables," .
On the other hand, foods classified as pro-inflammatory can accelerate aging..
If "we eat large amounts of saturated or trans fatty acids, sugars, and starches, insulin levels surge and trigger an anti-inflammatory response and accelerate the aging process,"..
While the benefits to eating healthy are many, that diet is certainly not the only factor that affects the aging process.
"Stress, hormones, ultraviolet light, and a weakened immune system also contribute to aging,"..
Still, making smart lifestyle choices are within your control, and are among the best things you can do to help prevent disease and retard aging.

 

Can what you eat help you age gracefully?

Food for Healthy Aging

For maximum benefits, experts say, you should load up on a variety of healthy foods.
"We know about antioxidants and anti-inflammatory activities of foods, but we suspect there could be so much more going on beyond attacking free radicals that promote health and ward off disease," These foods and beverages should  into your eating plan for good health and to reduce the signs of aging:

• Fish. Follow the guidelines of the American Heart Association and eat twice weekly, especially the fatty kind that is rich in omega-3 fatty acids. This is a powerful anti-inflammatory food that offers a multitude of health benefits.
• Fruits and vegetables are powerhouses of antioxidants. Aim for a variety of colorful produce. Enjoy at least 5 servings per day for the maximum benefits.
• Whole grains provide soluble fiber to help lower blood cholesterol levels, and also have phytonutrient content equal to any fruit or vegetable. Strive for at least 3 daily servings.
• Legumes are unsung heroes, packed with nutrients similar to fruits and vegetables and with very few calories. Add them to your diet 3 to 4 times a week.
• Yogurt has all the benefits of dairy foods, plus probiotics that help add healthy bacteria to the intestines. .
• Nuts are a great source of B vitamins that are good for your heart and your brain. The healthy fats in nuts benefit the elastin and collagen in skin, helping to maintaining skin's structure and keep it resilient. Small portions are advised, as nuts are high in calories.
• Water is essential for hydration of the skin, muscles, circulation, and all organs in the body. Enjoy 3-4 glasses of pure water in addition to other liquids and watery foods.

The following are  anti- inflammatory activity:

1. Allium vegetables: garlic, onions,
2. Barley
3. Green foods, such as wheatgrass
4. Beans and lentils
5. Hot peppers
6. Nuts and seeds
7. Sprouts
8. Yogurt

Micronutrients from food and beverages offer a wealth of health benefits. But when it comes to preserving the skin, some work better as topical applications such as creams.
"Drinking 6-10 small cups of green tea daily adds health-promoting catechins … but no matter how much green tea you drink, your blood level will never be high enough to retard or reverse skin changes,"  In  research researchers  found antiaging benefits when green tea polyphenols were applied directly to skin, and "protected the skin by absorbing ultraviolet light and eliminating free radicals."
A healthy diet and lifestyle may improve your health and keep you feeling young but don't expect wrinkles to disappear. The impact of diet on reversing signs of skin aging is overrated.
"Skin aging is related primarily to genetics and exposure to the sun," .. "If you want to age gracefully, stay out of the sun, use sunscreen, don't smoke, eat a healthy diet, and drink plenty of water."
To do your best to ward off aging, experts agree that a healthy lifestyle that includes regular exercise, wearing sunscreen, avoiding tobacco, regular sleep, and a nutritious diet is the answer.
"If you are already engaging in healthy habits, take it a step further and try to fine-tune your diet to achieve added health benefits by adding new foods to your diet," .

Getting Fit For Life

"I don't have time."
"I'm too old-I might hurt myself."
"I'd be too embarrassed at a gym with all those fit young people around."
Sound familiar? Maybe one of these is the reason you aren't physically active or exercising. But, in fact, scientists now know that it's usually more dangerous to not exercise, no matter how old you are. And you don't need to buy fancy clothes or belong to a gym to become more active.
Most older people don't get enough physical activity. Here are some reasons why they should:

• Lack of physical activity and not eating the right foods, taken together, are the second greatest underlying cause of death”. (Smoking is the #1 cause.)
• Exercise can help older people feel better and enjoy life more. No one is too old or too out of shape to be more active.
• Regular exercise can prevent or delay some diseases like cancer, heart disease, or diabetes. It can also perk up your mood and help depression, too.
• Being active can help older people to stay independent and able to keep doing things like getting around or dressing themselves.

So, make physical activity a part of your everyday life. Find things you enjoy. Go for brisk walks. Ride a bike. Dance. Work around the house and in the yard. Take care of your garden. Climb stairs. Rake leaves. Do a mix of things that keep you moving and active.

Four Types of Exercise

There are four types of exercises you need to do to have the right mixture of physical activities.
1.-Be sure to get at least 30 minutes of activity that makes you breathe harder on most or all days of the week. That's called "endurance activity," because it builds your energy or "staying power." You don't have to be active for 30 minutes all at once. Ten minutes of endurance activity at a time is fine. Just make sure those 10-minute sessions add up to a total of 30 minutes most days.
How hard do you need to push yourself? One doctor describes the right level of effort this way: If you can talk without any trouble at all, you're not working hard enough. If you can't talk at all, it's too hard.
2.-Keep using your muscles. When muscles aren't used, they waste away at any age.
How important is it to have "enough" muscle? Very! When you have enough muscle, you can get up from a chair by yourself. When you don't-you have to wait for someone to help you. When you have enough muscle, you can walk through the park with your grandchildren. When you don't-you have to stay home. That's true for younger adults as well as for people age 90 and older.
Keeping your muscles in shape can help prevent another serious problem in older people-falls that cause problems like broken hips. When the leg and hip muscles that support you are strong, you're less likely to fall. Even if you do fall, you will be more likely to be able to get up on your own. And using your muscles may make your bones stronger, too.
3.-Do things to help your balance. For example, stand on one foot, then the other. If you can, don't hold on to anything for support. Stand up from sitting in a chair without using your hands or arms. Every now and then walk heel-to-toe. When you walk this way, the toes of the foot in back should almost touch the heel of the foot in front.
4.-Stretch. Stretching can help keep you flexible. You will be able to move more freely. Stretch when your muscles are warmed up. Never stretch so far that it hurts.

Who Should Exercise?

Almost anyone, at any age, can improve his or her health by doing some type of activity. But, check with your doctor first if you plan to do strenuous activity (the kind that makes you breathe hard and sweat) and you are a man over 40 or a woman over 50. Your doctor might be able to give you a go-ahead over the phone, or he or she might ask you to come in for a visit.
You can still exercise even if you have a long-term condition like heart disease or diabetes. In fact, physical activity may help your illness, but only if it's done during times when your condition is under control. During flare-ups, exercise could be harmful. If you have any of the following problems, it's important to check with your doctor before starting an exercise program:

• a chronic disease, or a high risk of getting one-for example, if you smoke, if you are obese, or if you have a family history of a long-term disease
• any new symptom you haven't talked about with your doctor
• chest pain
• shortness of breath
• the feeling that your heart is skipping, racing, or fluttering
• blood clots
• infections or fever
• unplanned weight loss
• foot or ankle sores that won't heal
• joint swelling
• pain or trouble walking after you've fallen
• a bleeding or detached retina, eye surgery, or laser treatment
• a hernia
• hip surgery

Safety Tips

Here are some things you can do to make sure you are exercising safely:

• Start slowly. Little by little build up your activities and how hard you work at them. Doing too much, too soon, can hurt you, especially if you have not been active.
• Don't hold your breath while straining-when using your muscles, for example. That could cause changes in your blood pressure. It may seem strange at first, but the rule is to breathe out while your muscle is working, breathe in when it relaxes. For example, if you are lifting something, breathe out as you lift; breathe in when you stop.
• If you are taking any medicines or have any illnesses that change your natural heart rate, don't use your pulse rate as a way of judging how hard you should exercise. One example of this kind of medicine is a type of blood pressure drug known as a beta blocker.
• Use safety equipment to keep you from getting hurt. That means, for example, a helmet for bike riding or the right shoes for walking or jogging.
• Unless your doctor has asked you to limit fluids, be sure to drink plenty when you are doing activities that make you sweat. Many older people tend to be low on fluid much of the time, even when not exercising.
• Always bend forward from the hips, not the waist. If you keep your back straight, you're probably bending the right way. If your back "humps," that's probably wrong.
• Warm up your muscles before you stretch. For example, do a little easy biking, or walking and light arm pumping first.

Exercises should not hurt or make you feel really tired. You might feel some soreness, a little discomfort, or a bit weary, but you should not feel pain. In fact, in many ways, being physically active will probably make you feel better.

Fitness After 50: The Gym Goes Gray

"We could roll up the whole reasoning into just one phrase -- quality of life -- because the feedback we get is that people simply want to be active in their later years, and they now realize that being fit is one of the only ways to do that," . 
 "A lot of the problems we used to think of as being related to aging, we now know aren't related to aging at all. They are related to disuse of the body,.
Indeed, studies continue to show that we can. For example, research recently published in the Journal of the American Geriatric Society found that inactivity doubles the risk of mobility limitations as we age, while vigorous activity has the opposite effect. In another study, published in the journal Neurology, doctors found that exercise can slow cognitive declines -- meaning our minds can stay sharper longer.
"No matter what area you look to, be it heart disease, obesity, diabetes, high blood pressure, osteoporosis, research shows that being physically fit into your senior years will keep you healthier and active longer,"
"Unlike our grandparents, who simply hoped they could hang around long enough to collect Social Security, our generation has every expectation that at 60 we're going to be doing the same things we did at 45 -- and it's a very good possibility that we will," .

Redefining Fitness.

While the idea of midlife fitness may have been sneaking into our collective consciousness for some time, experts say the real difference came when health clubs themselves began to change.

50-and-Up Fitness: What You Must Know

While the spirit may be willing, experts say, by the time you're 50 or older, your body needs a little extra attention if you are to benefit in both the short and the long run.
Some experts worry that not every gym or health club is up to the challenge.
"The shift towards getting fit after 50 is definitely taking place, but unfortunately, the staff and instructors at many gyms and fitness clubs are not really set up for this paradigm change," ..
This is particularly important for those who have not exercised in the past or who have become sedentary in recent years .
"The longer it has been since you set foot inside a gym, the more you are going to have to rely on your instructors to guide you to the right kinds of activities, so it's important that they really know what they are doing.
If you're already saddled with health issues -- like achy joints, bad knees, or back pain -- as well as risk factors for heart disease such as high blood pressure, high cholesterol, or obesity, you need to be doubly sure you're getting the right advice.
"There's no question you can do it, and should do it, but there are certain things you have to pay attention to, and certain guidelines you have to follow, and they can't be the same ones you followed in your 20s or 30s or even 40s,"
7 Ways to Ensure Success
To help put you on the path to a fit and healthy future, the offer is the following guidelines to help ensure your midlife workout plan is a success.
1. Ask questions, particularly if you have health concerns: Can you accommodate my bad back, do you have instructors with a background in cardio exercise, is your pool heated and to what temperature? Anything that affects your condition should be addressed well before you sign on the dotted line. Also make certain that the instructors have experience coaching regular folks (not athletes) over 50.
2. Make sure your trainer, club manager, or fitness instructor takes a medical history as well as a family history before planning your workout program. This should include a Physical Activity Readiness Questionnaire or PAR-Q test to determine your physical age, which may not be the same as your chronological one. Workouts should be based on your physical age.
3. Tell your fitness instructors about any health conditions (for example, asthma or heart disease) or risk factors (if you smoke, if you get easily winded, if your have joint problems), and let them know about all medications you're taking. Some can cause fatigue, muscles aches, or other issues that could be confused with workout issues.
4. Be clear about your fitness goals and convey them to your instructor or health club manager. Do you want to lose weight, get more energy, relieve pain, and strengthen joints? Tell them -- and make sure gym has the ability to help you meet that goal.
5. Don't try to compete with younger members, or with the memory of your former self. Experts say the worst thing you can do is to focus on your years as a high school quarterback and try to match what you could do decades earlier. Set new, age-adjusted goals and compete with yourself only in the here and now.
6. Get a check-up before joining any gym or starting an exercise program, no matter how great you feel. Inform your doctor of your fitness plans and discuss any concerns or limitations together. Check in with your doctor anytime you experience significant discomfort while working out, including shortness of breath, chest pains, headaches, dizziness, or muscle aches that don't subside after a day or two of rest.
7. Listen to your body, not your trainer. While it's OK to push hard and long you're young, consistency is a better goal after 50. If your body is saying take it slower, then take it slower. Period.
                  We give ourselves an hour to get in a workout, and then end up wasting nearly half of it -- running an errand or two, getting dressed at the gym, chatting with acquaintances we bump into along the way. Even with the best intentions, you can sidetrack your progress if you don't make good use of your time. Think you might be frittering away precious fitness time? Check out what three fitness experts identified as the top 10 fitness time-wasters, and see where you can improve.
1. Spinning Your Wheels. When it comes to strength training, doing too many repetitions with lighter weights equals wasting time.
"When we're trying to build strength and build muscles, we want to attack as many muscle fibers as possible," explains sports conditioning coach Fiona Lockhart.
That means upping the weight and decreasing the reps: "Fifty biceps curls might build muscular endurance but you're not going to build the strength you're looking for," Lockhart says.
Of course, it also takes a lot more time to do 50 reps with light weights than 10 to 15 reps with more weight.
A good rule of thumb: If you're able to do more than 15 repetitions of an exercise, it's time to increase the weight, Lockhart says.
The same is true of cardiovascular exercise. It's easy to hop on the treadmill and type in the same speed, incline, and time every single time. But your body gets used to it.
"If you're trying to maximize time at the gym, work at a higher intensity for a shorter time. "If you can get and stay near 85% of your target heart rate, you'll accomplish more for your total fitness."
2. Failing to Plan. If you haven't been this person, you've seen her -- wandering from machine to machine with the 100-yard stare of someone whose mind is elsewhere.
It happens all the time. You get to the weight room and float around until you find an open machine. Then your time is over, and you've only gotten through three or four exercises.
"Think about what you're going to do in advance, then stick with it.. "If it's cardio, then get on the treadmill or bike and focus. Throw in some two-minute intervals."
For weight training, if you're not working with a trainer, become your own.
"Write a list of six or eight exercises (for different muscle groups) that you are going to accomplish in the given time,"  "When you have tasks, you get a better workout."
Have an alternate exercise machine in mind in case the one you want is being used,
"You keep your metabolism stoked by keeping your body moving," . "You shouldn't rest for more than 90 seconds or your body will go back to the pre-exercise state and you increase the risk of injury."
Avoid these time thieves and make the most of your trip to the gym.
3. Using Bad Form. Don't just do the exercise; do it right.
Improper exercise technique not only poses a greater risk of injury to muscles and joints, it also wastes your time.
You may be thinking you're strengthening one muscle when in fact you are straining another or stressing a joint. For example, doing bicep curls with your knees hyper-extended and your back muscles shortened could do more harm to your knees and back than good to your arms.
Fitness trainers or floor assistants are on hand at most gyms to assist you with proper form. Use them. Ask for someone to walk you through the equipment, showing you proper technique with machines and free weights.
4. Being Too Social. "Social support is great," . "Knowing that a familiar face will be there at the same time" can keep you going with your exercise regimen. "But you don't want to make it just a social hour."
When walking on treadmills with a companion, agreeing to chat during the warm-up and cool-down, but to stay quiet and commit to pushing yourself for the time in between.
"Work at an intensity that burns significant calories and is too high to carry on a full-blown conversation,”
When you work out with a friend or friends, set some rules first to be sure everyone stays on track with time.
 Try doing 8 to 10 exercises in 30 minutes, and resting no longer than a minute between exercises.
5. Getting Stuck in a Rut. Muscles have memory, . They adapt, they adjust -- and our bodies plateau.
"If you always use the same piece of equipment, your body will become adept at that type of exercise,".
Instead, mix it up.
"If you always use the treadmill, get on the bikes. "If you always work at the same pace, practice doing intervals -- shorter surges to build your upper-end capacity. It'll jog the body's systems -- make your body wake up and have to regroup."
To add intervals, increase incline or speed for short periods during cardio exercise. With your strength routine, change the order of the exercises or rotate from machines to free weights.
"With more versatility, your muscles won't be prepared and your body will not automatically know how to respond," . This will keep things fresh for your mind, too, "making workout routines less boring."
By  varying your exercise program every six to eight weeks if you're working out consistently. This is enough time for the body to benefit from the routine without getting complacent.
6. Watching TV or Reading.
"People tend to get on cardio equipment and think they're paying the piper, but they're so into their book they're wasting precious caloric time,”.
The bottom line is that when you're focused on other things, your workout suffers, .
You can walk at a 4 mph pace for 45 minutes and burn 300 to 400 calories, . But you could get the same calorie burn in 20 to 25 minutes doing intervals (running or walking as fast as you can for a minute or two) every 90 seconds.
"It's the total number of calories burned that counts,".
If you need a diversion to make it through your session on the elliptical machine, try music,. Invigorate your workout with a fresh mix on your pocket radio  instead of spending your time staring at the crawl on Fox News.
"Music can inspire you to pick up the tempo," .
7. Resting Too Long. The machine you want to use is occupied, so you grab a towel, get a drink of water, run to the bathroom -- and the next thing you know, 10 minutes have passed.
To avoid such time-wasting, rest only 30 to 90 seconds between strength exercises,.
To maximize time, alternate a set of exercises for your biceps with a set for triceps, he says. That allows you to shorten the rest interval in between -- while one muscle group is working, the opposing group is getting active recovery.
You can also save time during your warm-up by mimicking exercises you'll be doing in the workout. For example, , if you plan to work your legs by doing lunges and squats with weights, warm up with high knee steps, butt kicks, lunges with a twist, and sumo squats.
"Perform movements that are the same as you'll do in the exercise so that you can better prepare the body for the exercise," . "You're warming up the joints while tying into the neuromuscular system to create movement preparation."
8. Isolating Muscle Groups. How can you fit in separate exercises for your biceps, triceps, deltoids and lats when you only have 30 minutes to work out?
For body-builders, concentrating on two or three muscle groups per session might be fine, but this doesn't work for the average person. There's not enough time to get to all the muscle groups in three 30-minute sessions a week.
Instead,, choose exercises like squats and push-ups that target several muscle groups at once. You'll get a better workout in less time and you'll also be training more functionally (mimicking the way you use your body in daily life).
9. Changing Clothes at the Gym. Dressing at the gym can be a big time-waster. Change before leaving work or the house and you're less likely to change your mind about working out once you hop into the car.
You're also less likely to get into a conversation in the locker room that could shave 10 minutes off your workout.
"Some people even go to the extreme where they wear their workout clothes to bed so they can just get up and go,".
If you don't like the idea of sleeping in shorts and T-shirt, try laying out your workout clothes the night before to save time in the morning.
10. Waiting until Afternoon to Work Out. With determination, it's possible for late risers to fit in regular afternoon fitness sessions.
But there's no question that people who work out in the mornings are more likely to stick to their routines.
There's less time to make excuses, and fewer things to get in the way of a workout.
If you promise yourself a 4:30 p.m. walk, it's much more likely something will come up. Before you know it, it's 5:30, and you've missed your window.
Waiting until late in the day, "is setting you up for a downward spiral,".
Bottom line? If you are over 40 and athletic, chances are you're feeling some pain come Monday morning. Stiffened joints, aching muscles, and slow-moving limbs are the most common side effects weekend warriors often experience. And while these physical setbacks may tempt you to sit on the sidelines forever, most doctors recommend doing just the opposite. In other words: Get up, get out, and play more.

Sleep and Aging

More than half of men and women over the age of 65 years complain of at least one sleep problem. Many aging people experience insomnia and other sleep disorders on a regular basis.
As we get older, our sleep patterns change. In general, older people sleep less, experience more fragmented sleep, and spend less time in stages 3 & 4 and REM sleep (for example, deep sleep and dream sleep) than younger people. However, regardless of your age, good restorative sleep is essential to physical health and emotional well-being.

What Causes Sleep Problems in Older People?

Several factors may contribute to the inability to sleep well as we get older. Some common causes include:

• Poor sleep habits: Irregular sleep-wake patterns can affect an individual's circadian rhythm and make it hard to maintain a regular sleep schedule. Other sleep hygiene issues, such as consumption of alcohol before bedtime, increased wakeful time in bed, or daytime napping, can also affect a person's ability to sleep.
• Medications: Some medications may impair a person's ability to fall asleep or stay asleep and may even stimulate wakefulness at night.
• Psychological distress or psychiatric disorders: Aging is characterized by a lot of life events, some positive and some negative. Some elderly people experience psychological problems or psychiatric disorders that will affect the quality and quantity of sleep. For example, life changes such as the death of a loved one, moving from a family home, or physical limitations due to illness can cause significant stress and sleep problems.
• Sleep disorders: Sleep disorders such as sleep apnea, restless legs syndrome, periodic limb movement disorder, and REM behavior disorder, may be associated with aging in some cases.
• Retirement: Retirement often leads to a lot of downtime with less daytime activity; this can lead to an irregular sleep-wake schedule and chronic sleep problems.

 Are You Getting Enough Sleep?
Regardless of age, every person's sleep needs are different. If you are getting less sleep than when you were younger, but still feel rested and energetic during the day, it might just be that you now need less sleep. However, if you are noticing that your lack of sleep is affecting your daytime activities, you should talk to your doctor. There are steps you can take to improve your sleep quality.