By Jeffrey VanWingen M.D. — One of many General blogs on SmartLivingNetwork.com
When my grandfather turned 90, I put our family tree together tracing the VanWingen lineage back to our ancestors who immigrated from The Netherlands in the late 1800's. In doing, the I encountered some conflicting reports as to just how many children Jacob and Lucy VanWingen, the first American VanWingens, had in their family. When I asked my grandfather about this he clarified the issue. They had 12 children total, but just 10 names. My grandfather explained - after two of their children died in the first couple years of life, their next same-sexed child assumed the name of their deceased sibling. We marveled together at how life seemed to have a different meaning back then.
In that time, the health of small children was much more precarious, but times, trends and risks change. As a doctor, it's important I stay on top of the most current health risks and trends.
So what are today's risks and trends exactly? The answer depends on your age.
For instance, while colon cancer would be a risk to look at in a 60 year old patient, I would not give this a thought in treating a 6 year old patient. Different times carry different concerns.
Modern medicine has dropped the infant mortality rate in America dramatically. Prior to 1900, infants died at rates of 200-300 per thousand depending on trends in weather, harvest and illness. Nowadays, the thought of losing 1 in 4 infants is disturbing. Recent data place the infant mortality rate at around 6 per 1000. Antibiotics, vaccines, good nutrition, sanitation and education have all worked to drop this rate dramatically over the years. Most deaths in infancy occur due to birth defects, low birth weight/prematurity and sudden infant death syndrome (SIDS).
In my patient population, I work with mothers to prevent birth defects. Some simple tactics include starting prenatal vitamins with folate before pregnancy to prevent spinal cord defects, avoiding alcohol in pregnancy to prevent fetal alcohol syndrome and not changing kitty litter during pregnancy to prevent an infection called toxoplasmosis. An understanding of genetic transmission of some birth defects can help parents understand their risks. Still many birth defects occur randomly and without any preventable cause.
Low birth weight pregnancy and prematurity can often be prevented through routine obstetrical care and close observation. If these situations arise, specialized neonatal units in the hospitals work to nurture the fragile infant toward better survival. Thanks to neonatal advancements, children can survive outside the womb if born after 24 weeks of gestation (normal term of pregnancy is 40 weeks). It is a tough and risky road for these infants, however.
SIDS (often known as crib death) is a tragic cause of death for a seemingly healthy infant that is put to bed and dies in the night. An improved understanding of SIDS has found that rates go down when children sleep on their back, free of restricting blankets and pillows. New parents are educated to put their babies down to sleep in this fashion.
Antibiotics and immunizations have made childhood a healthy time in present days. Ask anyone in their 80's about childhood peers who were crippled or killed by polio. Influenza, typhoid, diphtheria and meningitis also took the lives of children in years past. Now, these illnesses are readily preventable and while children still get infections, they are only rarely fatal. These days, around 25 per 100,000 children die and these deaths are mostly due to accidents. Other causes include certain rare childhood cancers and as a result of birth defects.
I tell parents at well child visits that the most important thing for me to do (more important than listening to the heart and checking the reflexes) is to make sure they wear a bike helmet, wear their seatbelts and practice safety around the water. While not all accidents can be prevented, helmets, restraints and education have been shown to help. And so that we do not revert to the days of fear over infections, routine immunization is important.
The vast majority of deaths in late childhood and early adulthood are accidental. Roughly half are due to unintentional injuries (mostly related to motor vehicles) followed by homicide (13%) and suicide (11%). In caring preventatively, I focus discussions with early adults on risky behaviors such as lack of seatbelt/helmet use, alcohol or drug use and peer interactions. Screening for depression is also vital as the root cause of suicide. I encourage parents to research drivers training programs to find one that is reputable and covers preventative strategies in driving. Behaviors are also important to discuss at this point in preparation for later adulthood-- smoking, exercising, minimizing sun exposure and eating right.
I tell my patients that this is the time in life where people either cash in on dividends from proper health care or start to pay the toll. This is the time in life when trends shift dramatically. Health issues tip the scales over accidental causes of death. Cancer can occur due to certain risk factors or randomly. Heart disease enters on to the scene and makes a big presence in mortality as the years progress. As a doctor, it is important to address health behaviors (although they are better addressed preventatively in earlier years). It is never too late to stop smoking or start an exercise routine.
Risk factors are stratified and summed up for heart disease and various cancers. For heart disease it is important to consider family history, cholesterol levels, body habits, aerobic fitness, blood pressure and smoking status. If risk warrants, cardiac stress testing should take place to catch heart disease before a heart attack.
For cancer, family history, smoking and some physical screening should be considered. While some cancers are not easily preventable, a physical exam can help to detect them at an early stage. Over the age of 50, colon cancer screening is important in preventing colon cancer. Mammograms in women over the age of 40 can detect breast cancer in the early stages. While prostate cancer screening is a bit controversial, I still recommend annual screening in men over age 50.
While heart disease and cancer still top the list of mortality in the elderly, other considerations come to play. Increases in life expectancy and preventative practices in middle adulthood have brought vitality into this age group. While it was unexpected to live into your late 70's and beyond decades ago, it is now commonplace. And while prevention is capable of knocking down a number of issues, dementia seems to elude definite means of prevention.
In the 80's, the risk of dementia was around 30%. The most promising remedy is found in a large study out of the Vetrans' Administration. Research there showed that vets taking a certain cholesterol medication simvastatin with an LDL cholesterol below 100 had a 50% reduction in dementia risk. Unlike its counterparts, Simvastatin is fat soluble - important because the brain is insulated in fat. I think the take home message from this is that lower LDL cholesterol (naturally or with simvastatin) can lower risk of dementia. Crossword puzzles and reading certainly can't hurt, but as methods for preventing dementia, they lack scientific proof.
The other health consideration in late adulthood is the issue of falls. Falls are the beginning of the end for many elderly people. A broken hip, spinal compression fracture, or head injury as a result of a fall can means infirmary and cessation of movement and this movement is important for control of other vital processes in the body. When an elderly person is confined to bed, other chronic health issues worsen and health can enter a downward spiral. For these reasons, it's very important to prevent falls. The home should be examined for risks such as loose rugs or lack of railings. Canes, walkers and other devices should be encouraged to prevent unsteadiness. Finally, bone health, especially in women, should be examined with periodic bone density testing. And if osteoporosis is identified, it should be treated aggressively.
A full life is a rich experience. It is like a book filled with different chapters that look very different from one another. Preservation of our health keeps this experience rich and full. With each chapter comes different risks and considerations. Being mindful of these risks can prevent a premature end to that life story.
Live...and live well!
Discuss this blog and find related content at: