Women's Health Matters

Text Size
Jump to body content

Aging Wisely

In July 2009, our guest experts were members of the multidisciplinary Wellness for Independent Seniors (WISE) program team at Women’s College Hospital.

Kinga Balogh, RD is a registered dietitian who has been working at Women's College Hospital since graduating three years ago. Kinga provides nutrition counselling in the WISE program. She also counsels patients with multiple health concerns, including endocrine, digestive and metabolic conditions, and works at the Henrietta Banting Breast Centre raising awareness about dietary strategies for breast cancer prevention.

Jenna Egan, BSc. Hons OT, OT Reg. (Ont.) is an occupational therapist who immigrated to Canada after graduating from Trinity College Dublin, Ireland. Her clinical work has focused in the areas of working with clients who have both physical and cognitive functional limitations. Jenna has also been actively involved in formal and informal patient and family education sessions in both rheumatology and the prevention of falls.

Lina Jobanputra, MSW, RSW has worked as a social worker at Women’s College Hospital for the past six years. She provides support and counselling to patients and caregivers in the Henrietta Banting Breast Centre, Women’s Cardiovascular Health Initiative, Urgent Care Centre and 23-Hour Medical Day Unit.

Tania Obljubek is a physiotherapist with the WISE team. She graduated with a BSc from Lakehead University and a physical therapist degree (BScPT) from the University of Western Ontario. She also holds a clinical lecturer position at the University of Toronto, Faculty of Medicine. She has been working in the area of geriatrics for 10 years.

Here are their answers on Aging Wisely.

Q: Are there any studies on the benefits of post-menopausal women using testosterone cream to help improve libido and energy?

A: After menopause many women report loss of libido, decreased sexual activity, diminished feelings of physical well-being and fatigue.

Although a direct link between sexual dysfunction and testosterone levels has not been clearly established, some studies suggest that testosterone therapy may increase libido and sexual activity.

A study published in the Climacteric Journal in 2008 suggests that testosterone treatment may be helpful in women who have no biological or psychosocial causes related to decreased testosterone levels for their sexual disorder. The authors of the study warn that women receiving testosterone should be monitored for clinical improvement and for adverse reactions. The researchers also state that testosterone therapy is usually administered with estrogen therapy due to a lack of adequate safety and efficacy data on testosterone alone.


Q: When I was a child I had a pediatrician. What do you think of using a gerontologist instead of a general practitioner as one grows older? Where would I find one for my parents? At what age or at the onset of what physical symptoms should one start to use a gerontologist?

A: A gerontologist is a physician who specializes in working with older persons. The typical age range that a gerontologist works with is 65 and older. There are a limited number of physicians who work as gerontologists; therefore, finding one to see on an ongoing basis can be challenging. People may consider seeing a gerontologist if they are trying to manage multiple co-morbidities and need the support of a specialist who can help them through these aging issues. You may need a referral from a general practitioner.

In Ontario, you can search for a geriatric specialist on the College of Physicians and Surgeons of Ontario website: www.cpso.on.ca/docsearch


Q: As a 23-year-old who really values her health, I have a goal of living to 100 (seriously!) What are your best anti-aging tips that I can employ in my life? I believe in being proactive and investing in my health for today and for the future.

A: There are many different ways to invest in your body so you can live a long and healthy life. These include exercise and diet, and social, emotional and spiritual well-being.

Did you know that researchers have found that people who exercise have younger DNA by up to nine years? So exercise not only helps prevent illness but makes you younger too. It is important to do different types of exercise – including aerobic activities, strengthening, stretching and posture exercises.

Aerobic activities use your large muscle groups and increase your heart rate. Examples include walking briskly, swimming, tennis, fitness classes and dancing. You should do aerobic activity four to seven times per week for 30 to 60 minutes depending on your fitness level. Regular aerobic activity will reduce functional declines associated with aging, help you lose or maintain weight, lower your risk for many diseases, keep your joints moving to reduce arthritis pain and give you more energy.

Strengthening requires your muscles to use force against a resistance. This might include lifting weights or your body weight. Strengthening will keep your muscles and bones strong as you age. You should do resistance exercise two to three times per week.

Stretching every day helps increase the length of your muscles, reduce injuries and prevent stiffness as you age. Examples are yoga, pilates and stretching exercises.

The last type of exercise is maintaining your posture. Take a look at yourself in the mirror and notice if you are slouching. Try to stand tall. You will look and feel better.

Part of the answer to aging gracefully can be found in the grocery store – in fruits, vegetables, and a host of other healthful foods that are rich in antioxidants and other potentially age-deterring compounds.

According to Susan Moores, dietitian and spokesperson for the American Dietetic Association, ‘Dietary choices are critical to delay the onset of aging and age-related diseases, and the sooner you start, the greater the benefit.’

Some foods and beverages contain powerful substances called phytonutrients that some believe are capable of unlocking the key to longevity. Phytonutrients (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 and inflammation at the cellular level. Antioxidants and other age-defying compounds may help cells ward off damage from free radicals and minimize the impact of aging.

Add these foods and beverages into your eating plan for good health and to reduce the signs of aging:

  • Fish, especially fatty fish, is rich in omega-3 fatty acids. An anti-inflammatory food, fish offers a multitude of health benefits. Substitute an omega-3 supplement of ground flax-seed if you dislike fish. Eat fish twice weekly.
  • Fruits and vegetables are powerhouses of antioxidants. Eat at least five servings per day of a variety of colourful produce.
  • Whole grains provide soluble fibre to help lower blood cholesterol levels, and also have phytonutrient content equal to fruits and vegetables. Aim for five to seven daily servings.
  • Legumes such as beans, chickpeas and lentils are packed with nutrients and are low in calories. Add them to your diet two to three times a week.
  • Yoghurt has all the benefits of dairy foods, plus probiotics that help add healthy bacteria to the intestines. Consume yogurt with active cultures as one of your three dairy servings each day.
  • Nuts and seeds 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 maintain its structure and keep it resilient. Eat small portions, as nuts are high in calories.
  • Water is essential for skin hydration, muscles, circulation and all organs in the body. Drink three to four glasses of pure water in addition to other liquids and watery foods.

Memory and the brain
From an occupational therapy perspective on promoting good health and longevity, treating your body well can enhance your ability to process and recall information. Healthy habits that can improve your memory include:

  • Exercising regularly. Exercise increases oxygen to your brain, reduces the risk for disorders that may lead to memory loss (such as diabetes and cardiovascular disease) and may enhance the effects of helpful brain chemicals and protect brain cells.
  • Managing stress. Cortisol, the stress hormone, can damage the hippocampus if the stress is unrelieved. Stress makes it difficult to concentrate.
  • Developing good sleep habits. Adequate sleep is necessary for memory consolidation. Sleep disorders like insomnia and sleep apnea leave you tired and unable to concentrate during the day.
  • Stopping smoking. Smoking can heighten the risk of vascular disorders that can cause stroke and constrict arteries that deliver oxygen to the brain.
  • Maintaining social interaction. Research shows that people who are regularly engaged in social interaction maintain their brain vitality. A combination of physical and mental activity with social engagement and a brain-healthy diet is more effective than any of these factors alone.


Q: My motto has always been: everything in moderation. I don’t smoke or overeat, and drink no more than one alcoholic drink at a time two to three times a week. I also exercise moderately (stretching and weight-bearing exercises three to four days a week for half an hour, and daily 20-minute walks with my dog). Is there anything else that I should be doing to make sure that I age wisely? I am in my late-50s.

A: From a proactive planning perspective, the best advice is to take control of your emotional well-being and health care, and to plan for the future. When looking at emotional well-being, general areas to focus on are grief and loss, depression and the importance of social support.

Grief and loss
Everyone’s reaction to grief and loss is different. As we age we are coping with both the loss of loved ones and the grief associated with loss of independence and physical abilities. Be aware of your personal coping style and seek out support when needed.

About one in five women and one in ten men will suffer from depression at some point during their lifetime. Less than one-third of these people seek medical help.

Depression is one of the most common undiagnosed conditions in seniors. Depression can be caused by stress, transition, health concerns, social isolation and loneliness. We all experience highs and lows, but someone who feels troubled both mentally and physically for an extended period of time (the general rule is two weeks or more) should seek help.

Social support
As we age, there will be times when we need the support of others. Don’t be afraid to ask for or accept help. Social networks are integral to physical, emotional and spiritual well-being.

Power of Attorney for personal care and finances
You are never too young to consider a Power of Attorney appointment. It is important to appoint someone you trust to be your health advocate and to make health-care decisions on your behalf when you are not able to speak for yourself. The province of Ontario has published an excellent publication called A Guide to Advance Care Planning that offers a comprehensive look at health care decision-making.

Preparing for your future care
Find out about programs and resources in your community that you can access as your needs change.

If you are in Ontario, become familiar with your local Community Care Access Centre (CCAC).

Educate yourself about long-term care facilities and retirement homes. Go out and take a tour of some of these facilities so that you can make more informed decisions about what would be the right fit for you as your needs change. The CCAC has a list of long-term care facilities that you can access via their website.

It sounds like you are on the right track with your exercise program. Ensure that you are also adding resistance (along with your weight-bearing exercises), posture and balance activities to round out your routine. Resistance exercise requires your muscles to work against a force. This will help prevent falls and ensure that you can continue to lift your groceries and get up from a chair in your very senior years. Studies are also now finding that resistance training helps prevent cognitive decline. So not only does it strengthen your muscles but your brain too. Balance activities, which typically involve the muscles of the abdomen, lower back, hips and legs, help you control your body and move through space to avoid falls and prevent injuries. Examples of exercises include standing on one foot, walking heel-to-toe in a straight line, tai chi, yoga and Pilates.

Treating your body well can enhance your ability to process and recall information. Healthy habits that can improve your memory are described in detail in the previous question.

Personal safety
Being careful is important at any age. Personal safety, such as falls prevention, is something to consider at any stage in your life. You should have your vision checked regularly, use medications correctly, fall-proof your environment where possible and wear proper footwear. Here are some pamphlets with more information on preventing falls and maintaining your independence:


Q: My elderly mother continues to drive, against the wishes of everyone in the family. I have spoken to her about giving up her driver’s licence but she refuses to do so. Do you have any suggestions for dealing with this very sensitive issue?

A: It may be best to discuss with your mother the possibility of her agreeing to partake in a driving assessment. That way the results of the assessment can prove to both your family and your mother whether she can drive safely or not. Keep in mind your mother may consider her ability to drive a huge contributing factor to her independence.

You did not mention why you believe your mother should no longer drive. Below are some warning signs of unsafe driving and normal age-related changes that may affect driving ability.

Warning signs of unsafe driving

  • driving too quickly or too slowly 
  • needing help or instructions from passengers 
  • ignoring signs and signals
  • neglecting to use turn signals to indicate turns 
  • making slow or poor decisions (e.g. poor judgment of distances, too close to other cars)
  • becoming easily frustrated or confused 
  • getting lost, even in familiar areas 
  • having accidents or near-misses 
  • drifting across lane markings into other lanes 
  • being in a poor road position or making wide turns 
  • seeing things late and braking hard as a result 
  • missing important things like pedestrians in walkways 
  • having difficulty interpreting traffic situations and predicting changes and potential hazards 
  • failing to yield 

Normal age-related changes that may affect driving ability
Many seniors start to notice changes and adjust their driving habits accordingly. Mature judgment, experience and good habits can help compensate for many age-related changes. We can change the way we drive, consider adaptations to our car or take refresher courses, all of which can extend the length of time we can drive safely. Some normal age-related changes are:

  • decreased movement in joints, which may affect steering and ability to turn the head to check blind spots 
  • increased difficulty to quickly see, decide and act 
  • decreased ability to see at night 
  • decreased ability to quickly scan the environment and interpret what is seen 
  • increased chances of age-related eye conditions  
  • decreased ability to change focus between near and far objects 
  • increased need for medications, which can slow down or reduce the capacity to make decisions and process information rapidly 

Age alone does not stop a person from driving. When family members, family doctors or even individuals themselves are unsure of driving ability, they are often referred for an evaluation.

As difficult as it is, if you believe that your mother could be dangerous behind the wheel, it's important to deal with the issue sooner rather than later.


Q: I’ve always been a little anxious, but find my anxiety increasing as I age (I’m 68). I heard of something called age-related anxiety. What is that, how can I tell if I have it and what can I do about it? (Note: I am on four medications for high blood pressure.)

A: The term ‘age-related anxiety’ is not something that we have much information on. Our best guess is that this is a term associated with the concerns and fears that some may experience with aging.

We consulted a nurse practitioner with a cardiac specialty about you being on four medications for high blood pressure. She believes that excessive anxiety may affect blood pressure. This is something that you may like to get assessed further. We encourage you to speak with your family doctor about seeing a trained mental health therapist (social worker, psychologist or psychiatrist) for your anxiety and to work with your general practitioner to see if you should see a cardiologist to review your blood pressure medications.

If you are in Ontario, you may want to consider MedsCheck. This is a new program for those taking three or more medications. It allows you to schedule an annual discussion with a pharmacist to do a comprehensive review of your medications. This may help ease some of the anxieties you have about aging and having to take multiple medications. At the appointment you can discuss how your prescription, over-the-counter and alternative medications may be affecting each other. Contact your local pharmacy to find out if they offer the MedsCheck program.


Q: I'm 67 and I exercise for about one hour a day. I do weights, aerobics classes, walking, some tai chi and some stretching. My friends all tell me I exercise too much. It's true I get more injuries than the average couch potato, but isn't that par for the course for athletes, especially aging ones?

A: With aging there are some physical changes that are unavoidable and that make one more prone to injury. These include changes to the heart, lungs, muscles and nervous system. Exercise has more benefits than risks if done properly. Injuries can be avoided if you take steps to prevent them. These strategies include warm-up routines, coaching on proper technique, conditioning programs and injury rehabilitation to prevent re-injury.

If you are injured, ensure that you take care of the injury by seeing a health-care provider to aid in your recovery. If you allow an injury to persist it will only worsen with time. Include a warm-up of 15 minutes before any activity to prepare your body for more intense exercise.

This could include a slow walk for five minutes and some light stretching.

If you are getting injured during your aerobics or weights classes, ask the instructor to look at your form and correct any problems. Often people have been doing an activity for so long that they do not realize their technique is wrong until they are injured. Also ensure that you have added core stability exercises including lower abdominal exercises.


Q: My father is still relatively young (just turning 60) but sometimes I see hints of how he will be when he is very old. Are there any websites or resources you can recommend that give advice on the best way to care for aging parents?

A: Be knowledgeable about the following issues (and perhaps consider creating a binder with this information):

  • Find out about current and past specific health issues (including medical history of your family).
  • Be aware of any medications that he may be taking (prescription and non-prescription).
  • Know who his family doctor is.
  • Have an open and honest discussion with him to understand his wishes for short- and long-term plans regarding housing (i.e. does he want to move into a retirement home or long-term care facility?) Consider touring some facilities to become more informed about what is available in the community.
  • Discuss a Power of Attorney appointment (POA) with your father and help him to create one.
  • Discuss his financial situation. Is there money for alternative living (i.e. retirement home vs. staying at home with private care vs. long-term care)?

With this knowledge, it may be easier to manage your father. Here are some resources that may be helpful. Note that some of these are region-specific.

You can also find many resources on aging and caring for older people in the Health A-Z section of womenshealthmatters.ca.


Q: My grandmother had Alzheimer’s disease and I’m nervous about my mother developing it when she is older. Sometimes I notice that she is forgetful or distracted but she is only in her mid-50s. What signs should I be aware of? How can I tell what is normal in the aging process or whether I should worry? Is patience the best tactic when I notice signs of forgetfulness or should I point it out to her? Also, is there anything I can do for myself to help prevent getting the disease?

A: Alzheimer's disease (AD) is an age-related, non-reversible brain disorder that develops over a period of years. Initially, people experience memory loss and confusion, which may be mistaken for the kinds of memory changes that are sometimes associated with normal aging. However, the symptoms of AD gradually lead to behaviour and personality changes, a decline in cognitive abilities such as decision-making and language skills, and problems recognizing family and friends. Scientists do not yet fully understand what causes AD, but it appears that AD develops as a result of a complex series of pathological events that take place over time inside the brain.

It may be hard to figure out on your own if your mother has a serious problem. It is important for her to see a doctor if you notice any symptoms, as they may be due to other conditions such as depression or an infection.

As for what signs to be aware of, it is important to know that AD is a progressive disease; the symptoms grow worse over time. Symptoms progress at different rates and in different patterns. The appearance and progression of symptoms will vary from one person to the next. The classic sign of early AD is gradual loss of short-term memory. 

Some signs that may indicate the disease are:

  • memory loss that affects day-to-day function
  • difficulty performing familiar tasks (trouble with tasks that have been routine or familiar such as preparing a meal)
  • problems with abstract thinking (e.g. balancing a cheque book or not recognizing what the numbers in the cheque book mean)
  • changes in personality (becoming confused, suspicious or withdrawn)
  • problems with language (forgetting simple words or substituting words, making sentences difficult to understand)

The aging process may affect memory by changing the way you store information. It may also affect memory by making it harder to recall information the brain has already stored. Your short-term and remote memories aren’t usually affected by aging, but your recent memory may be. You may forget names of people you’ve met recently. These are normal changes.

A memory problem is serious when it affects your daily living. You may have a more serious problem if you have trouble remembering how to do things you’ve done many times before, getting from a place you’ve been to often to another place, or doing things that require steps, like following a recipe.

Certain situations can affect your memory and make you become more forgetful than you normally are – including age, poor concentration, depression and a physical illness. 

To answer your question about the best tactics: yes, patience is the best approach. It may help to discuss your concerns with your mother. Stress and depression can cause similar signs and symptoms and cannot be truly assessed without finding out how your mother is feeling. Cognitive difficulties are best addressed when there's a focus on insight. Addressing your concerns with your mother may encourage her to be less likely to develop a pattern of covering things up, which can be dangerous if her cognition deteriorates.

Consider that your mother might be also having similar concerns because her own mother suffered from the disease, and no doubt she is becoming frustrated with herself at her recent forgetfulness. But the most positive thing that can be done is to get a doctor’s assessment that involves an interview, cognitive and functional assessments, and blood work. While AD is degenerative and therefore cannot be cured, there are still important reasons to seek medical advice. 

Formal supports can be put in place to ease caregiver burden and improve the person’s quality of life. Tasks can be adapted so that the person can remain independent for longer. The home can be assessed to ensure safety.

In the earlier stages of the disease, people with AD will still have enough cognitive ability to have a say in their future treatment, care and other issues that may need to resolved such as wills, finances and property.

Unfortunately, we do not know how to prevent AD. However, there is growing evidence that lifestyle habits may help prevent or delay the onset of the disease. Treating your body well can enhance your ability to process and recall information. Healthy habits that can improve your memory include regular exercise, stress management, good sleep habits and not smoking.

Research has found that keeping the brain active seems to increase its vitality and may build its reserves of brain cells and connections. Mental decline as you age appears to be largely due to altered connections among brain cells. Mental activities can include attending courses in an adult education centre, community college or other community group, attending plays or even gardening.

Research also shows that people who are regularly engaged in social interaction maintain their brain vitality. The combination of physical and mental activity with social engagement and a brain-healthy diet is more effective than any of these factors alone. 

You can also help your mother create a memory book.

For some ideas on memory strategies and making the most of your memory, see the Canadian Association of Occupational Therapists website.

Please see the answers to previous questions on how to keep a healthy and active mind.

For more information, visit the Alzheimer Society of Canada website.


Q: I find it harder to manage my health as I age. My doctor just doesn't seem to want to bother with me even though he agreed to see me once a month. He just doesn't understand the stresses of aging. Yet I understand gerontologists are few and far between. What to do? I never knew aging would be this hard.

A: I am sorry to hear that you feel that your doctor is not meeting your needs. I know it can be challenging finding another GP, but this may be something you may want to consider. In addition, here are some tips that we can offer for maximizing your visits to your doctor.

While doctors and other health-care professionals are very knowledgeable, you are the only person looking after your own care 24 hours a day, seven days a week. Having open, honest, direct, and assertive communication with your doctor is important. Other members of your health-care team, such as nurses, social workers, dietitians and pharmacists, can also be good sources of information. 

Here are a few tips:

  • Go with a list of questions and prioritize your questions from most important to least important (if there is not enough time, you want to ensure that the questions that are most important to you get addressed).
  • If you don't understand your doctor's responses, ask questions.
  • Take notes during appointments. Ask your doctor to write down his or her instructions for you.
  • Take a support person (if no support person is available, consider getting permission from your doctor to tape record the appointment so that you can play it back to review the information).
  • Ask your doctor for printed material about your condition.
  • If you continue to have difficulty understanding your doctor's answers, ask where you can go for more information.

Questions you may ask to elicit more information include:

  • What is my diagnosis? What may have caused my condition?
  • Can my condition be treated? What is the treatment of choice for my condition?
  • Should I watch for any particular symptoms or new developments?
  • Should I make any lifestyle changes?
  • What are the benefits and risks of this treatment?
  • What is this medication or prescription for? How will it affect my condition? What are possible side-effects?


Jump to top page

Connect with us

Subscribe to our E-Bulletin

  • A publication of:
  • Women's College Hospital