Population Care

New Rx for older adults: Boost the dose on lifestyle change

Timothy M. Smith , Contributing News Writer

Chronic disease management has come a long way in recent years, thanks in part to a host of new medications. But taking prescription drugs can pose substantial risks and side effects, especially for older adults.

An American College of Lifestyle Medicine-produced booklet, “6 Ways to Take Control of Your Health,” summarizes the six pillars of lifestyle medicine, which, it notes, can do more than just help manage chronic diseases. When used intensively, these evidence-based lifestyle changes can prevent and even reverse chronic illness—obviating the need for pharmaceuticals. 

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In honor of Older Americans Month, May is marked each year as AMA Senior Physicians Recognition Month. Learn about the AMA Senior Physicians Section, which gives voice to and advocates on issues that affect senior physicians, who may be working full time or part time or be retired.

“Whether we're talking about cardiovascular disease, prediabetes or diabetes or cognitive impairment, chronic diseases are all based on the same underlying pathophysiology, which involves pathways related to inflammation, altered microbiome, epigenetics or impaired neuroplasticity,” said Cate Collings, MD, a cardiologist and past president of the American College of Lifestyle Medicine. “When we prescribe lifestyle medicine interventions, we may impact one or more of these pathways, altering the trajectory of chronic disease.”

Lifestyle medicine’s six pillars are:

  • Whole-food, plant-based nutrition.
  • Physical activity.
  • Stress management.
  • Avoidance of risky substances.
  • Restorative sleep.
  • Social connection.

Some interventions may target just one pillar, while others may target as many as all six. In addition, interventions can be prescribed at more or less intense doses based on patient needs and readiness. But no matter the dosing, follow up and specificity are crucial.

Instead of advising a patient to generically adhere to a plant-based or Mediterranean diet, a lifestyle medicine approach will be specific in prescribing “what to eat and what to avoid,” and include referrals to culinary medicine classes or shared medical appointments that can facilitate skills acquisition. Dr. Collings said the physician may need to see the patient more frequently to ensure accountability and monitor laboratory variables.

“The lifestyle medicine approach heavily relies on the physician balancing a coach approach with an expert approach, which can be translated to listening more than speaking. This creates a better environment for behavior change,” she said.

Learn more about the AMA’s innovative efforts to help physicians prevent type 2 diabetes and achieve rapid, sustainable improvements in hypertension control.

The epidemic of chronic disease in the U.S. now affects adults of every age. And according to the Centers for Disease Control and Prevention, as of 2021 more than 40% of school-aged children and adolescents had at least one chronic health condition.

Older adults tend to have more chronic illnesses, however, putting them at the added risk of polypharmacy.

“Ideally, their physicians have carefully examined all the potential drug interactions, but we are learning more all the time, including after a drug is approved,” Dr. Collings said. “I’m not particularly concerned when an older patient is taking two or three medications, but when they are taking, say, 10 or 12, drug interaction and financial risk grow.”

As with pharmaceutical interventions, higher disease severity will require higher dosing—so to speak—of lifestyle interventions. But unlike with the use of prescription drugs, therapeutic lifestyle changes across the six pillars positively interact. For example, better sleep often means more energy for exercise or cooking at home. If patients are engaged and adherent, lifestyle interventions can take effect quickly. This is good news, Dr. Collings noted, but changes in medication dosing may need to happen quickly as well.

“For example, if a patient is on a diabetic medication that is associated with hypoglycemia, and they are going to make a substantial dietary change, the physician may need to reduce the dose of that drug to avoid precipitating low blood sugar,” she said.

Patients may start seeing results almost as soon as they adopt lifestyle changes.

“In many clinical cases, people see dramatic improvements from dietary and exercise modalities in as little as three to four weeks,” she said.