Americans can learn from more "traditional societies" around the world when it comes to the treatment of older people, says Mehrdad Ayati, a Stanford University geriatrician who grew up in Iran.
Arriving in the United States with a newcomer's eyes a decade ago, Ayati was struck by how, in contrast to his homeland, Americans appeared to view aging with fear and shame.
"This is a very youth-oriented, anti-aging society," he said. "That's why a lot of older people won't ask for help, won't walk with a walker or a cane or get a hearing aid.
"In traditional societies, this is not the case. Aging is always a sign of honor, and the oldest person in a family gets a lot of respect and is considered very sage their words carry a lot of substance. A young person would never get the message that 'When I get older I'm going to be useless.'"
Negative cultural attitudes toward aging could even explain the loneliness and isolation leading to cognitive impairment that he observes in some of his geriatric patients, Ayati suggests.
"In traditional society, the oldest person is still at the center of the family and society," he said. "The problem I see here is that when you retire in modern society, you retire to the solitude of your home and, if your partner passes away, you're just by yourself. And loneliness is one of the major causes of cognitive impairment."
The importance of social engagement for older people is a recurring theme in the book "Paths to Healthy Aging," which Ayati recently co-authored with his wife, physiologist and molecular biologist Arezou (Hope) Azarani.
"When people ask me what's the best climate for elderly people, I say, 'The best climate is to be surrounded by people who love you and support you,'" he said.
Ayati and Azarani created "Paths to Healthy Aging" in the form of a workbook, each chapter beginning with a list of "questions to ask yourself" and ending with a "take-home message" and an "action plan." Chapters cover nutrition, mental health, frailty and overmedication.
It's not unusual for an older person to be taking as many as five to eight medications a day for conditions like high blood pressure and high cholesterol as well as diseases like diabetes, arthritis or congestive heart failure, Ayati said. Many also take over-the-counter supplements. At the same time, older people are more prone to the side effects of adverse drug interactions.
He cites the example of a patient who suffered a fatal brain hemorrhage following a fall Ayati believes was caused by overmedication a prescription for a cholinesterase inhibitor to treat mild short-term memory loss combined with strong sleeping pills that were added after the patient complained that the cholinesterase inhibitor was causing him to have vivid dreams. When stronger sleeping pills were added, the vivid dreams became delusional-like thoughts, nighttime anxiety and nightmares.
Ayati advises patients to keep an up-to-date list of all illnesses and medications, including dosages, and share them with all physicians and pharmacists; and also to question physicians about any newly prescribed medication and its possible interaction with other drugs.
"Take only what (medications) you truly need," he said. "Any therapeutic benefit can be outweighed by the potential for drug cascade syndrome (when an undesirable side effect is misinterpreted as a medical condition and results in a new prescription) and other harmful interaction effects."
Ayati is skeptical of over-the-counter medications, supplements and herbal remedies.
"Supplements can't replace proper nutrition and should not be taken unless a blood test analysis ordered by your physician justifies prescribing them," he said.
Most people should be able to get adequate vitamins, including vitamin D and calcium, from food rather than supplements, he said.
Geriatricians are trained to understand the physiology of aging and the medical complexity of the aging process, he said.
"We're trained to be a good listener, and also to try to find the best way not to make a case more complicated," Ayati said.
He embarked on the book when he realized the 20-minute office visit was too short to cover everything he wanted to communicate to patients. "They leave my office and they get bombarded by contradictory claims, marketing campaigns and misinformation" about nutrition, vitamins, supplements and brain games, he said. "The way we wrote the book is very simple; we tried not to put any complexity in it so that any person with any level of education can get the message."
For exercise, he recommends "strenuous" strength training with weights and resistance bands, pushups, pullups and situps at least twice a week, as well as balance training, such a walking backward or sideways or Tai Chi at least three times a week.
On diet, he advises people to eat "nutritious foods in small portions more frequently and in good company."
But Ayati returns, repeatedly, to the value of social interaction for healthy aging.
"You can have the best cheese, the best wine, the best Mediterranean diet and the best olive oil, but if you're in the solitude of your apartment looking at the window it's not as beneficial as eating with others," he said.
He said he frequently sees depression and memory loss among his immigrant patients who have been brought here by their children and spend their days caring for grandchildren.
"Their quality of life is actually worse here because they left behind the social network of their home country," Ayati said. "You need to have interactions with people of your age and cultural background."
But "aging can actually be a time of growth and development" for people who keep up friendships and have a positive attitude, he said.
"One of the book reviewers got back to me and said that after reading the book she called her husband because she wanted to ask him, 'How many friends are we going to have when we retire?'"