How to Ace the Test of Time

Spring 2021 | By Nicole Dudenhoefer ’17

“When do we start aging?”

This is the question Nicole Dawson, UCF assistant professor of physical therapy, asks at the start of her Geriatric Physical Therapy course. She says students often struggle to respond to the question, but the answer is simpler than expected.

“We start aging from the moment we are conceived,” says Dawson, who has been working with elderly patients for more than 15 years.

While aging is often viewed societally as a condition that needs to be staved off and affects people close to their 60s, it’s a natural process of life that everyone goes through daily — whether 18 or 80.

“In our modern media everything related to aging is anti-aging, so I think the biggest misconception is that aging is a negative thing,” Dawson says. “But there are so many positive things to aging, and most of the literature shows aging successfully is really just a balance between our gains and losses.”

Dawson and other researchers at UCF have found striking the right balance boils down to three interconnected areas: cognitive health, physical health and social health. And the sooner you start to care for each of these areas, the better your chances of living a longer, healthier life.

Train Your Brain

One of the most common issues associated with aging is dementia, which is a range of conditions that affects thinking, reasoning and memory skills, impacting behavioral abilities.

The leading cause of dementia is Alzheimer’s disease, which is progressive and has no cure. However, research has shown that a combination of positive lifestyle choices, such as a healthy diet, not smoking, regular exercise and cognitive stimulation, can reduce the risk for the disease by up to 60% — and may even counteract genetic risk for it, according to a study released by the Alzheimer’s Association.

Attending college, taking a continuing education course, pursuing a career that requires creative thinking, and engaging in activities that challenge you to use multiple brain functions are some ways to keep your mind sharp throughout your lifetime.

But what happens once someone has already started to show symptoms of dementia?

“There are a lot of barriers that healthcare professionals — specifically physical, occupational and speech therapists — have in caring for patients with dementia,” says Dawson, co-director of UCF’s Innovative Mobility Initiative Lab. “We don’t get taught a lot about geriatrics in general, let alone dementia. So when someone is diagnosed with dementia, what often happens is they’re sat in a chair in a corner and told not to do anything anymore — and that’s the worst thing we can do for that patient population.”

In 2019, Dawson published a paper with Cleveland State University psychology Professor Kathy Judge and Ashleigh Trapuzzano ’15 ’19DPT, then a UCF physical therapy doctoral student, that outlines how healthcare professionals can help patients with dementia maintain a better quality of life. They called it the LEAD framework — Leveraging Existing Abilities in Dementia — which focuses on coping methods for the emotions associated with the disease, communication strategies and cognitive rehabilitation methods.

The methods include validating the feelings of the individual with dementia; using short, simple directions to help them complete tasks; and providing Montessori-based activities, such as puzzles and walking, that emphasize independence and natural development, among many other evidence-based methods.

“We’ve luckily been successful with helping therapists become more confident and learn how to practice these strategies to help patients with dementia,” Dawson says.

Step Up Your Strength.

As the Alzheimer’s Association has suggested, Dawson also notes that brain function can get a boost not just from mental exercises that keep you engaged but physical ones too.

“There’s a huge relationship between cognitive decline and physical decline,” Dawson says. “The two cognitive processes that seem most important are executive function, which is kind of our higher-level thinking, and processing speed. But what’s interesting is we know the relationship exists; we just don’t understand it.”

Which is why Dawson is studying this relationship in collaboration with Matt Stock, an associate professor of physical therapy and director of UCF’s Neuromuscular Plasticity Laboratory. Muscle weakness — particularly sarcopenia, which is the loss of muscle mass and strength that begins around 40 and accelerates after 70 — is a prominent issue related to physical health. Stock and other members of the scientific community are investigating the nervous system’s role in healthy muscle function.

“The brain and the spinal cord’s ability to control muscles really plays an equal role — and potentially even larger role — than the muscles themselves,” Stock says. “The cause of sarcopenia is not only related to muscles getting smaller. It’s also because oftentimes [due to] inactivity you lose the connectivity of the nervous system that controls the muscles.”

While the UCF duo doesn’t entirely know why this happens, Stock says mental imagery, such as envisioning oneself contracting muscles or watching someone else perform motor functions shows promise to combat connectivity issues. But above all, he suggests that strength training is the greatest preventative measure against all aging-related issues.

“Getting yourself on a strength-training program and maintaining it throughout your life is one of the most important things you can do for your health and well-being,” Stock says. “And you’re never too old to start. The principles of strength training for older adults are the same as younger adults. They just need to be tailored to each individual.”

Over eight years, a study of more than 80,000 participants from ages 30 to 81 found individuals who engaged in moderate-intensity strength training twice a week reduced their risk for dying from any health-related cause by 23% and from cancer by 31%, according to the American Journal of Epidemiology. The study also pointed to the potential for higher volumes of weekly weightlifting to reduce those risks even further, while emphasizing that these benefits aren’t as impactful with just aerobic exercise.

While total body conditioning is important, Stock says squatting and exercises that promote handgrip strength are especially beneficial since they support physical function across a range of activities. Many studies have shown that poor handgrip strength in particular is a strong indicator of mortality.

“The key component that oftentimes gets forgotten is progressive overload,” he says. “The finer details of the exercise program you do are less important than making sure you’re constantly making it more and more difficult over time. If you just keep doing the same thing, you’re not going to make any further progress. If you did 10 repetitions of an exercise last week, try 12 this week. Physiological stress drives adaptation. You have to push yourself to do a little bit more every time.”

And that push doesn’t just relate to physical function.

“Strength training changes older people’s ability to perform activities of daily living. They become less fearful, and it gives them a new sense of confidence and independence. They start trying new things that are totally unrelated,” Stock says.

“The brain and the spinal cord’s ability to control muscles really plays an equal role — and potentially even larger role — than the muscles themselves.”

Matt Stock, associate professor of physical therapy

Stay Socially Active.

Continuing to experience new things, and living without the fear of doing so, is vital to aging gracefully and supports the ability to continue living a fulfilling life.

“As we get older, a lot of the roles that we occupy disappear or change,” says Michael Loree, a UCF sociology instructor who researches aging.

“A lot of what the research shows on aging successfully is this idea of activity theory, or maintaining social interactions, which is supported by replacing the roles that are lost with new ones.”

For some people this can take the form of volunteering, becoming more involved with a religious group, traveling, hanging out with friends frequently or being an active member in a senior life care community — such as Legacy Pointe at UCF, which offers independent living, assisted living, skilled nursing and memory care residences and will open in Seminole County later this year.

But the impact of social ties starts from the time we’re teenagers and continues to make a difference through old age. The more diverse social relationships people have at an early age, the better their well-being is at the beginning and end of their lives, according to a 2016 study from the University of North Carolina at Chapel Hill. But during middle adulthood, the study found that it’s not so much how many friends you have, as much as the quality of your friendships.

“When it comes to retirement, just sitting on the couch in front of the television for the next 20 years of your life is not going to be very rewarding or healthy,” Loree says. “Those who embrace old age as a meaningful time in their life to do the things they want — those folks tend to do a little bit better.”

In about 1,100 seniors without dementia, the rate of cognitive decline was reduced by an average of 70% in those who were frequently socially active — with several outings each month — when compared to individuals who only went out once a year or less, according to a study conducted by the Rush Alzheimer’s Disease Center in Chicago. Another study found frequent levels of social activity also helped maintain lower disability levels in older people, allowing them to live independently longer.

“Those who embrace old age as a meaningful time in their life to do the things they want — those folks tend to do a little bit better.”

Michael Loree, instructor of sociology

Assistant Professor Ladda Thiamwong, who has 15 years of experience in gerontological nursing education, has developed a model for healthy aging that includes a theme focused on social health. Beyond remaining socially active and helping others, she also emphasizes that having dignity and being respected are major components to healthy aging.

“Respect is the foundation of healthy relationships — even the one with yourself — as it builds feelings of trust, security and happiness,” Thiamwong says. “We must treat older adults with respect because their time, experience and wisdom to navigate life can serve as valuable lessons for everyone.”

In American society, youthfulness is valued over aging, Loree says, and societal attitudes toward aging have an impact on the experience. To combat negative stereotypes, Dawson encourages everyone to embrace the journey that comes with age and to remember: “Aging is not a disease that needs to be cured. It is an opportunity that needs to be seized.”