The Forgotten Generations and Ageism
Disengagement in Old Age

A Workbook for Healthy Aging

When I was a kid, old people regularly annoyed me with a mantra they used as a catchall comment to discussions of even the mildest difficulties: “As long as you've got your health.” they repeated. “As long as you've got your health.”

Now that I'm old, I understand. A simple cold feels more like a flu these days and lasts longer too. We all know, or know of, someone whose broken hip sent them permanently to a care home or worse, who died without recovering (20 percent of elder fall victims, within a year).

Our sleep goes out of whack, foods we've enjoyed all our lives now give us gas, stairs become problematic, our stamina is gone with the wind we used to have.

And that's just for the healthiest among us. Eighty percent of people older than 65 have at least one chronic disease and many have more than one.

What else most of us have in common, however, is a determination to do what we personally can to maintain our health, to take responsibility for it ourselves.

The difficulty emerges from the plethora of advice and information available nowadays via the internet. There is way too much that is too often contradictory and it takes too long to sort out what is useful and what is not, what is true and what is false.

Now, however, along comes a guidebook for healthy living just for old people written by a husband and wife team. Mehrdad Ayati is a physician board certified in family medicine and geriatrics. He's also an assistant professor of medicine at Stanford University School of Medicine and has a slew of other impressive credentials.

His wife, Arezou Azarani holds a degree in physiology along with fellowships in molecular biology and genetics.

PathstohealthyagingcoverPaths to Healthy Aging is a deceptively short “workbook,” as Dr. Ayati calls it, with just five chapters: Nutrition, Mental Health, Frailty, Overmedication, How to Find a Geriatrician. It is packed with useful, common sense information with easy-to-understand explanations about how we age and how that affects our health.

What is most neglected in treating the medical needs of elders, says Dr. Ayati, is someone who will actually listen and pay attention to their concerns. (I don't know about you, but my primary care physician spends more time looking at a laptop screen when I'm with him than at me.)

”The next thing that is of most interest to patients,” writes Ayati in his introduction, “is valid, up-to-date information on how to prevent, treat or live with diseases. They want to grasp complex medical issues in a comprehensible format...

“My goal here is to...simplify the journey. Based on my experience of what has worked best for my patients to achieve meaning, joyful and healthy lives...”

And that is exactly what he does throughout deceptively simple little book.

Each of the chapters begins with a set of questions to ask yourself that can be used then as a reference and comparison as you read through the information.

In nutrition, for example, he discusses loss of taste buds in old age, the need to keep up dental care, the importance of companionship (perhaps at lunch together each day) and why fad diets that rely on emphasizing or de-emphasizing certain nutrients lead to unwanted results and poorer health.

Since most people I know have a problem keeping their weight down, I was surprised at how much time Dr. Ayoti spends discussing weight loss in old age but as he explains,

”Data indicate that even the loss of a small percent of weight over a three-year period is associated with multiple negative health outcomes such as frailty, fatigue, a higher risk of infection, delirium (confusion) and an increased death rate in the elderly.”

He follows with an impressive section on many ways of overcoming loss of appetite or interest in food and eating.

The chapter on mental health is equally wide-ranging, easy to understand and, as you would expect, covers physical activity, stress reduction and staying engaged by choosing a variety of activities that, he notes, aren't very useful unless we enjoy them.

I know from my own reading that Dr. Ayati is up-to-date on the latest findings. I appreciated the pithy section on blood pressure that explains why systolic pressure of 135-140 over diastolic of 70-90, which might be considered high for young people, is normal for elders.

The frailty chapter includes a good selection of easy exercises anyone can do at home without special equipment to help maintain strong bones and muscles, balance and independence.

Each chapter ends with a “take home message” list summarizing the most important parts of the information along with an “action plan” you can fill in to track what you want to change and a long list of studies he has consulted in writing each chapter.

Although I won't attempt to summarize, the chapter on overmedication is important with extremely useful explanations of the reasons it can be a problem and how you can help control it with your physicians. And I like this funny cartoon he includes on the topic:


Throughout the book, Dr. Ayati reminds readers that it is not intended as a substitute for medical advice from your own doctors. Generally, at this blog, I ignore medical advice books as most of them have a particular axe to grind, usually on the order of “drink six cups of green tea a day while standing on your head and you'll live to be 147 without a single wrinkle.”

Oh, all right, I made that up but you know what I mean. Paths to Healthy Aging, however, is the opposite - filled with common-sense information you can trust, written by a friendly geriatrician whom I wish could be my own. He genuinely likes and understands the health needs of old people.

By the way, the one place where I part company with Dr. Ayati is his chapter on finding a geriatrician. He acknowledges that there are too few, but that it is good to see a trained expert in aging health once a year.

I don't disagree but I spent nearly two months calling and emailing local geriatricians when I moved here trying to find one who would see me.

It wasn't that I would need to wait several months as Ayati acknowledges can happen with the geriatrician shortage in the U.S. It was that they all gave me, politely, some version of we're not taking on new patients at this time.

That doesn't mean it is futile to try, but it's really hard.

You can read more about Paths to Healthy Aging at the website and it is available online at several of the most popular booksellers.


I guess I am "lucky" in that when I changed doctors my primary physician is now a geriatrician. She is not as concerned with my health as I would wish because I am sure she sees me as much younger and healthier than 90% of her patients, but perhaps we will grow on each other.

Sounds like an interesting book except for the chapter on unintended weight loss. Like you, everyone I know fights gaining weight and wants to lose.

I am interested in what he has to say about overmedication. There are people here at the ALF taking 12 to 14 pills two or three times a day.

It's true these days. Most doctors spend most of your visit looking at their laptops while talking to you. The last straw came when the doctor asked if I had any questions and I stated yes, and he then stated, quickly! Needless to say we no longer have this doctor.

Thank you for this introduction to the book, Paths to Healthy Aging. It sounds like a primer for the boomer children who have aging parents as well as a guidebook for the aging.

I agree with you that finding a geriatrician is impossible for most of us. I tried to find one, just one that I could attempt to make an appt. with—if any exist in my city, theirs is a well-kept secret.

I lucked out with a geriatrician. There weren't any here but my pulmonologist told me they were getting one here and set me up as a patient. I love her, and a couple of my family are seeing her as well. Sometimes good fortune just drops on a person.

I too am very interested in this book and what he has to say about over-medication. Thanks for the head's up.

I use an HMO and the doctor is the same age as our only child, he is not versed in the care of anyone really over 65 years of age, so went to the new billion dollar med clinic and hospital got a geriatrician and feel better already, however it is far from our home, but prefer someone who treats a human being like they know what they are doing, he is wonderful and so does my hubs who is older than me by about 7 months will be 68 soon this year..The former gov. of Oregon made a big ass out of himself over a woman 20 years his senior lost his governorship and they might still go to federal prison for their shenanigans, he is the same age my hubs will be near Halloween of this year, like I always heard when I was young there is no fool like an old fool and this fellow is an old fool and a crook, too bad his family did not intervene and let him know of his crookinessness if that is a word, enjoy your blog, it is informative and nice!

This sounds like a worthwhile book. Of particular interest to me will be the re-evaluation of test results. For some time I've felt many tests are geared for the "average" and need to be adjusted for age, which often eliminates a need for medications. You see, I fear that medications will lead to other medical problems that need more medications and pretty soon it's hard to tell what is causing what.

The exercising section is another interest, especially for upper body strength. I prefer 'alone' exercising, so it sounds promising.

I noted their association with the VA hospital, which for decades has been the resource for geriatricians in this area, so might check out their doc list if you live near one.

Thanks for telling us about this I got the Kindle version.

Where can I get some of that "loss of appetite or interest in food and eating"? That would really come in handy.

Haven't seen hide nor hair of a geriatrician around here. Have been given to believe you don't need one until you have several conditions whose treatments conflict and therefore pose complex management issues. I like my doctor, but would feel somewhat more confident if most of her time weren't spent with children and young mothers.

Overmedication may become a problem for some, but you don't want a doctor like I ran into in a new, small town.. "You're overmedicated," he said on my first visit. "Which half of these do you want to drop? You choose." Each of those meds had been prescribed by a doctor for a specific problem after careful diagnosis and discussion. Who was I to decide which half of them could and should to be abruptly discontinued? He didn't even ask why each had been prescribed. What a quack.

Over-medication is an interesting matter. Dr. Alan Rubin, an authority on thyroid disease and diabetes, suggested in one of his books that when doctors has a new patient, they need to carefully go through the entire list of medications the patient is taking.

Then the doctor needs to determine whether the patient still has the condition for which the med was prescribed. Or in fact whether the patient ever had it.

The suggestion was that meds are prescribed rightly or wrongly and tend not to "unprescribed."

My doc sees me about as often as the Pope wears a sombrero. I go only when there is an issue.

The first thing doc wants to know is if I am on any medication. The answer is no. Then she gives me a look like "how can that be?"

Seventy something and no meds?

She looks me over like I'm a one eyed cat- there has to be something she can fix.

"Take your shoes off."

"Hey, look at that, an ingrown toenail."

"Nope. It's just sock fluff."

Good health.

Money can't buy it. So far, I'm good. Maybe it's luck or perhaps it's my mom's genes.

Whatever it is, I appreciate it.

But I don't take anything for granted. I could pop off poking in my garden, like The Godfather.

I do my best to keep balanced like a see saw.

Thanks for sharing this. I may just get the book. My best resource on knowing what and what not to do is my mother. I watch and learn from her. She will be 99 next month and still lives independently.

Articles like this are so helpful. My husband is 7 years older and over 70, and I am trying to educate myself on what to expect for us both. I would love to ask my parents but too late.

My father is one who fell and broke his hip. Never walked again and survived almost two years of true pain and suffering in expensive skilled nursing facility. He and my mother (who tripped over the dog) in one room, day in day out. Do not fall.

The weight loss issue is very real. Husband has been going through that and it can be serious as you pointed out.

Love this blog and thank you so much Ronni.

I have an outstanding doctor, one of the best in our city. I only go see her when I am truly sick, and she knows that. She has a note on my computer screen--schedule immediately when she calls.

One time I just needed to renew a prescription for an ointment and had to convince the receptionist I didn't need an immediate appt. I always say, leave the important appts for the really sick patients.

The weight loss section needs to be clarified and perhaps it is in the book. For instance, did the people who lost weight over those three year do so because of health issue to begin with?

My neighbor, who is probably in her early 80s has lost a lot of weight recently. Her clothes just hang on her. But she's been through the decline and death of her husband over the last 2-3 years. I can safely say, as a non-medical person, that her weight loss is probably harmful for her. But if people like her and people who are failing in other ways are included in the study/ies the author refers to, then we need to consider the weight issue presented in the book differently.

I talked to my primary care doctor recently about losing weight. I'm 30 pounds over the days when I was a size 8-10 and long to be back to that size clothes. However, when I suggested that I needed to lose that 30 pounds, she said, well, maybe 10 pounds would be better.

She probably knew that 5 pounds would be a problem.

Moderation in all things - my old age motto.

Because the State Dept. Of Health (The governing body for most health related facilities in most states) likes to see monthly figures showing healthy weight gains amongst the senior population, the menus at those facilities tend to emphasize the carbs, pasta, rice, and potatoes which are served in abundance at all meals while the protein portions are relatively small. You want to gain weight, move in here.

Whaaat? Bruce, that's... Just mind-boggling. Crazy.

One menu does not fit all! A diet designed for the tiny minority of seniors (only 1.2% of the U.S. population over 60, according to this source!) who are chronically underweight is a SERIOUS THREAT to the health of those who aren't.

Okay, so at 71 I am still amongst the young-old, and still do (mostly) have my health. Perhaps I don't yet appreciate the problems that come with a loss of appetite. But I am holding diabetes at bay right now by being very, very careful to maintain the major weight loss I recently achieved (no fads, I did it the sensible way with diet and exercise over a period of two years). It's a daily struggle. A high-carb diet such as you describe would balloon me right back up and kill my pancreas entirely.

I'm going to buy two. One for me and one for Mom, who will be 90 in June. Thanks for this, Ronni! Esp. looking forward to the chapter on meds. PS my mom is such a social person she has that part whipped.

Thanks, Ronni. I, like so many others, love this blog.

And I echo Priscilla's comment: do not fall! Just today I was lost in thought while crossing the street, my foot went into a small pothole just before I stepped up onto the curb, I twisted my ankle and went down like a ton of bricks. Fortunately, I was able to break my fall somewhat with my hands and came down hard on my side, but not my hip. Some good samaritans hoisted me up, but I was well shaken. I was near a grocery store, so went inside and walked around using a cart as a walker for awhile until I felt steady enough to walk the few blocks home. No more daydreaming for me... I am lucky I wasn't seriously hurt. My takeaway -- healthy aging requires active vigilance!

Ronni, it is very true that there is a shortage in the number of geriatricians in the US as well as in the world. And that is a very sad reality. The reasons for this are partly political, partly economical and mostly lack of knowledge on how beneficial and critical are geriatricians. That is why it is crucial to raise awareness about their role, shortage and reasons why the ones out there can only take a few patients on. Dr. Ayati explained this in details to me. We are going to do an article on it and posted on website. Let us hope that moving forward, together, we can change this tragic reality.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Your comment could not be posted. Error type:
Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.


Post a comment

Your Information

(Name and email address are required. Email address will not be displayed with the comment.)