Heart Healthy Habits for Seniors

Introduction: I felt strongly compelled to write this blog on heart failure as it is such a pertinent issue in the aging population today. Before I go into details on this, Id like to address the definition of this disease process. Heart failure occurs when the heart doesnt pump well and fails to deliver adequate oxygen to the body. As a result, fluid builds up in the body and vital organs dont get the blood that they need. This can make it harder for individuals to perform everyday tasks and can lead to eventual overall decline. Problem:Heart failure is the number one reason for hospital admissions in older adults, and often leads to multiple readmissions (Agarwal et. al., 2021). As a cardiac nurse for many years, I can attest to the fact that heart failure is the biggest reason for multiple hospitalizations in seniors. Patients come in and out for problematic symptoms, sometimes coming into the hospital as often as every month. The three biggest symptoms I see that result in hospital admissions are shortness of breath (particularly when lying flat), weight gain, and swelling in the legs.One reason for such frequent admissions is the complexity of heart failure itself. It is a complicated clinical syndrome and is notoriously difficult to manage. A lot is put on patients to manage their heart failure at home, and this can be a challenge. In addition, individuals may have some level of cognitive impairment or multiple other comorbidities, making it even more challenging to perform the extensive monitoring needed to prevent heart failure from worsening. The importance of education:Education is also important in the treatment of heart failure. Unfortunately, this often does not get done. When I first started working in acute care back in 2004, every patient received extensive education in managing their heart failure prior to discharge. Nurses would provide lengthy verbal education on the importance of medication adherence, daily weights, low salt diet, and other factors, in addition to providing the patient with a heart failure educational pamphlet prior to discharge. Over the years, however, hospitals have increasingly faced staffing shortages and high nurse turnover. As a result, a lot of important patient education is not getting addressed. A lack of awareness and understanding in patients on how to manage their heart failure is definitely a key reason for worsening heart failure and repeated hospitalizations. Management:From a clinician standpoint, the goal in addressing heart failure is twofold: we want to reduce symptoms and prevent mortality. The best way to do this is through patient/family education and implementation of a treatment plan. A proper treatment plan will include such lifestyle modifications as a low salt diet, quitting smoking, and getting regular physical activity. A low salt diet can be incredibly helpful in preventing further fluid build up in the body. The American Heart Association recommends that all individuals consume no more than 2,300 mg of sodium per day (AHA, 2024). In todays era of processed and packaged food, a majority of the American population consumes much more than that, and it comes in the food itself rather than the saltshaker. Maintaining a low sodium diet has one other priceless benefit that I often do not see emphasized enough in heart failure: it can help reduce blood pressure. Almost half of all heart failure patients have uncontrolled hypertension (Heart Failure, 2022). It is a major risk factor in the development of heart failure and managing it can greatly reduce heart failure symptoms and decrease stress on the heart. Current guidelines recommend maintaining a systolic blood pressure of less than 130. Medication management is another important factor in the management of heart failure. This often includes the use of diuretics, beta blockers, and other medication classes that I will not go into detail on. I wanted to discuss diuretics and beta blockers because these are the two medications in heart failure that I see non-compliance with the most. I witness individuals often not taking one or the other for two main reasons:  they either dont understand the importance of them or they dont like the side effects. Seniors can often have difficulty getting up to go to the restroom. Diuretics cause frequent trips to the restroom because their purpose is to get excess fluid off the body. Many individuals do not comply with their prescribed diuretic because of the hassle of frequent bathroom trips. Unfortunately, ineffective diuresis causes heart failure to worsen and puts further stress on the heart. I often see non-adherence to beta blockers due to their side effects. The two biggest symptoms that get reported to me are fatigue and dizziness. As in the diuretic, a beta blocker can also help reduce the stress on the heart, and heart failure symptoms can worsen if the prescribed dose is not adhered to. Its important to maintain prescribed medication regime and if any negative symptoms are experienced to discuss them with the doctor. One final thing:I wanted to touch on one final monitoring recommendation for heart failure because it so often gets missed: daily weights. Weighing oneself daily is of tantamount importance in heart failure and can identify early on if heart failure is worsening. This can lead to early intervention, thus decreasing potential hospitalization. Adherence to this all too often does not occur. I see patients come into the hospital for large amounts of weight gain often 20 or more lbs. Many patients report that they never stepped on the scale to assess for weight gain and often do not get admitted to the hospital until symptoms are severe such as severe weakness and shortness of breath. In heart failure its recommended to contact the doctor if weight goes up by more than 2 pounds in a day or greater than 4 pounds in a week. The doctor can make modifications in the treatment regime and hence reduce potential hospitalizations and mortality. Conclusion:Heart failure is complex but manageable. Early action can prevent hospital admissions, reduce mortality, and optimize quality of life. Having ongoing guidance from an experienced clinician can be of great benefit if you or your loved one is having difficulty managing heart failure and other disease processes. Please do not hesitate to reach out to me if you have any further questions. I want to help and make the process of aging as stress free as possible while promoting positive health outcomes.  My name is Laura Carson and I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. Contact me for a 20 minute free consultation at 714-403-7040.  References:Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition Examination Survey 2001 to 2018 (April 28, 2022). Heart Failure. Almost half of heart failure patients have uncontrolled hypertension and diabetesAgarwal, M., Fonarow, G., & Ziaeian, B. (February 10, 2021). National Trends in Heart Failure Hospitalizations and Readmissions From 2010 to 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC7876620/Weber, C. (May, 2023). Heart Failure Pharmacology.  How much sodium should I eat per day? (2024). American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day  

By the time you read this, the reported deaths from COVID-19 and its variants in the U.S. will be close to 900,000. As staggering as that statistic is, its 400,000 short of the number of Americans killed by Heart Disease in the same time period. Heart disease is the leading cause of death for men and women of most racial and ethnic groups.Lets not allow the topic to overwhelm the fact theres a miracle inside your chest. Weighing about as much as a grapefruit, the heart is a powerful pump that drives five to six quarts of blood to every microscopic part of your body every second. And if it fails for even a second, the body is very unforgiving. Even though its the one piece of machinery driven by the brain, we tend to treat the heart like a kitchen appliance that we take for granted. Rarely serviced, rarely cleaned, and overworked until it burns out. Although heart bypass and transplant have become routine since the pioneering operations in the 1960s, its not like replacing the coffee maker you neglected too long. One Thing at a TimeThe better way to treat your heart with the respect it deserves is to start with changing just small habits. That way, youll avoid the relapse from trying to change everything at once and falling back to unhealthy heart habits inside of a month. The most obvious: if youre a smoker or heavy drinker, work on that first. Imagine a small team of remodelers arriving at your heart to do a makeover. The first thing theyre going to say is, Well, we cant do anything with the plumbing until we clear the smoke. Look for Help During Heart MonthQuitting smoking and reducing alcohol is never easy, but this is probably as good a time as any during the year to start a cessation program with help. February is American Heart Month, so youre likely to be reminded frequently of heart health and offered tips on modifying your routine to help your heart and prolong a happy life. If you only look to one place, trust the American Heart Association  www.heart.org. Prediabetes and Heart DiseaseWhats your blood sugar level? If you dont know, you should find out from your doctor if youre not already monitoring it yourself. You could be pre-diabetic without knowing it or showing any symptoms. Theres a good chance you could avoid becoming diabetic and reverse your pre-diabetic blood sugar to normal with relatively little change to your diet and a slight increase inyour activity. Diabetes has long been linked to heart disease, but recent studies suggest that reversing prediabetes is also linked to fewer heart attacks and strokes. [Reversing Prediabetes linked to fewer heart attacks, strokes, heart.org, Jan. 26, 2021.]While youre at it, get your cholesterol tested and routinely monitor your blood pressure.If youre worried you might be at risk for heart disease, ask your doctor to perform a simple cholesterol test to let you know if youre at risk and should adjust your diet. Home blood pressure monitors are not expensive, theyre digital, and theyre easy to use. Blood pressure stations are common in supermarkets now, and you can also check your weight and pulse. Womens Heart HealthWhy the emphasis on womens heart health? The American Heart Association tells us that cardiovascular disease is the No. 1 killer of women, causing 1 in 3 deaths each year about one woman every minute. They devote an entire website to womens heart health: Go Red for Women (www.goredforwomen.org). Here are just a few of the common misconceptions about womens heart health:Myth: Heart disease is for men, and cancer is the real threat for womenFact: Heart disease is a killer that strikes more women than men and is more deadly than all cancer forms combined. While one in 31 American women dies from breast cancer each year, heart disease is the cause of one out of every three deaths.Myth: Heart disease is for old peopleFact: Heart disease affects women of all ages. For younger women, the combination of birth control pills and smoking boosts heart disease risks by 20 percent. Heart defects are more common than you might think: 1.3 million Americans alive today have some form of congenital heart defect and at least nine of every 1,000 infants born each year have a heart defect. Even if you live a completely healthy lifestyle, being born with an underlying heart condition can be a risk factor.Myth: I run marathons no way I could be at risk.Fact: Factors like cholesterol, eating habits, and smoking can counterbalance your other healthy habits. You can be thin and have high cholesterol. The American Heart Association says to start getting your cholesterol checked at age 20. Earlier, if your family has a history of heart disease. Age and Heart HealthMany things, like wine and most people, grow better with age. The heart, however, takes more tending than a glass of fine wine. Avoid things that weaken your heart beyond the normal aging process. These are the usual suspects: smoking and tobacco use, lack of exercise, diet, alcohol, overeating, and stress. Some preexisting conditions you cant control: irregular heartbeat, congenital (inherited) heart defects, sleep apnea (although this may be a product of obesity or alcohol consumption).Viruses and MyocarditisMyocarditis is an inflammation of the heart muscle mostly caused by a virus, including COVID-19, and can lead to left-sided heart failure. The left ventricle of the heart is the part that pumps oxygen-rich blood back to the body. This valve tends to stiffen with age. Thats one of the many reasons why age combined with a preexisting condition puts you at greater risk of death from COVID-19. Even survivors of the novel coronavirus infection can sustain permanent heart damage. All people must protect themselves and others from COVID-19 by observing precautions, not just because of its immediate lethality but also because of its impact on the heart, known and unknown. How to Start with Your HeartThe factors involved in heart health and the onset of heart disease are many, varied, and complicated. But the common preventions (listed here, from the Mayo Clinic) are simple. You probably already know them by heart, so to speak:Not smokingControlling certain conditions, such as high blood pressure and diabetesStaying physically activeEating healthy foodsMaintaining a healthy weightReducing and managing stress Those may seem like six significant challenges, especially if you take on all six. But you should notice something else about them. Almost every one of them can affect the other five. So, if you pick one, youll find it easier to take on the next one. People who quit smoking usually discover that they have more energy within the first week, and exercise becomes easier. A little exercise and switching out one unhealthy food will help with weight, stress, blood pressure, and diabetes. Easy does it, especially if youre 65 and older. Youve spent a whole life learning one way. You can take your time. Learn to enjoy your healthier heart. But start today.First, Get a Checkup!Most of the questions this article has raised in your mind (Whats my blood sugar level? Whats my blood pressure? I used to smoke am I at risk?) can all be answered in a single doctors visit with simple lab work done a few days before. Schedule it now, before you start a program of exercise and diet. And schedule a regular exam per your doctors recommendation. Relieving the stress of not knowing will be a good start on your way to a healthier heart.

Since the start of the year, you may have noticed an uptick of fad diets. Maybe its your mom trying a pescatarian regime, or your neighbor raving about his new Mediterranean diet. With so many diet trends buzzing around, it can be hard to separate what works from what doesnt. This is especially true when it comes to heart healthy eating.The American Heart Association released a study comparing diets and their heart healthy potential and organized the results in four tiers. With the help of Kelly Elliot, RD at Intermountain Healths Denver Midtown Clinic - Weight Loss Center, we turned the studys results into easy-to-digest bites. It is important to always be mindful of your diet to reduce risk factors for heart disease, said Kelly. Creating a lifestyle that works for you as an individual that you can follow is what matters, because its what you will stick to!Whether youre a seasoned diet tryer, or just dipping your toes in heart-healthy waters, theres important information for everyone.Tier 4: Paleo Diets and VLDC/Ketogenic DietsStarting from the bottom of the barrel, we meet paleolithic and ketogenic diets. These diets, often hailed for their weight loss potential, may miss the mark when it comes to nourishing our hearts.The paleolithic diet, while rooted in our ancestral past, falls short in meeting heart-healthy guidelines. With its emphasis on meat and fat, and limited intake of fruits, grains, and legumes, it takes a detour off the heart health highway.Similarly, ketogenic diets focus on slashing carbs and loading up on fats. By cutting out essential food groups like fruits and grains, we risk missing key nutrients.These diets don't limit saturated fats, which can raise your LDL, which is the bad cholesterol, said Kelly. One way to modify these diets is to reduce saturated fat by consuming nuts and seeds instead of animal proteins, but this has to be balanced with caloric intake.Kelly also added that because these diets are low in carbohydrates, they could be beneficial for people with diabetes. However, because diabetics are at a higher heart disease risk, their saturated fats should be limited.Tier 3: Very Low-Fat Diets and Low-Carbohydrate DietsTier 3 diets include very low-fat and low-carb options, and present mixed heart health benefits.Both of these diets can potentially help with weight loss without omitting food groups and can help lower risk factors for heart disease, said Kelly.Very low-fat diets, while aiming to reduce overall fat intake, may inadvertently miss the mark on essential fatty acids. Likewise, low-carb diets, with their focus on slashing carbohydrates, could lead to a decrease in fiber-rich foods, which play a vital role in heart health.The drawback is that with low fat diets, they can lead to deficiencies in protein and essential fatty acids and B12, that the body requires for good health, said Kelly. On the other hand, a low carb diet can overemphasize animal-based protein and restrict fiber and increase saturated fat intake.Tier 2: Vegan Diets and Low-Fat DietsVegan and low-fat diets are the heart of Tier 2. These dietary paths offer a bounty of heart-healthy benefits with some caveats.The vegan diet, with its plant-based focus on fruits, vegetables, whole grains, and legumes, embraces the power of plants for heart wellness. However, tread carefully to ensure youre meeting your nutritional needs, particularly for vitamin B12.No animal protein is consumed in vegan diets, so they are very low in saturated fat intake, but the restrictive diet can lead to B12 deficiency, said Kelly. It is recommended to include a B12 supplement and choose plant-based milk alternatives.Meanwhile, the low-fat diet promises reduced cholesterol and a lighter load on our hearts. By emphasizing lean proteins, whole grains, and fruits and vegetables, it is a good heart healthy diet. But its important to avoid overconsumption of less healthy carbohydrates, such as added sugars.People with high cholesterol or high LDL cholesterol can benefit from replacing foods high in saturated fats with foods that have unsaturated fats, said Kelly.Tier 1: DASH-Style, Mediterranean, Pescatarian, and Ovo/Lacto-Vegetarian DietsStarted from the bottom, and now were here with Tier 1s DASH-Style, Mediterranean, pescatarian, and ovo/lacto-vegetarian diets. Its the pinnacle of heart-healthy eating, where the nutrients shine.Well start with the Dietary Approaches to Stop Hypertension, or DASH, diet. By the name alone, you might infer this diets ultra heart healthy nature. It emphasizes 8-10 servings of fruits and vegetables per day, whole grains, plant protein, and low-fat dairy, while limiting sodium.According to Kelly, the DASH diets sodium limitations help cut out highly processed foods, which can help control weight and high blood pressure. This diet provides adequate variety with adequate protein, moderate healthy fats and moderate healthy carbs intake, while minimizing sodium intake, she said.Moving onto the Mediterranean diet, with its emphasis on olive oil, fish, fruits, vegetables, and whole grains. These heart healthy foods make this a great choice for reducing heart disease risk. However, the Mediterranean diet also includes moderate alcohol consumption, which means two or less drinks for men a day, and one or less drinks for women per day.Kelly cautioned against misinterpreting what moderate alcohol consumption is. This does not mean, to have no alcohol for 3-5 days and then have all 3-5 drinks at one time, she said. These drinks should not include added sugar such as margarita mix, juices, and sugary sodas.A pescatarian diet is similar to a vegetarian diet, with the addition of fish, and sometimes includes dairy and eggs. Lacto-ovo vegetarians eat eggs and dairy, but not beef, poultry, fish, or pork. These diets may be lower in saturated fats, especially if whole milk products are not consumed. The biggest challenge with these diets boils down to protein.Kelly explained it simply as there being complete and incomplete proteins. While animal proteins contain all essential amino acids, plant-based proteins are incomplete, and must be combined for full nutritional benefits.The way to do this is to combine a nut or seed or bean with a grain, said Kelly. For example, red beans and brown rice, or nut butter on whole grain bread, will allow you to consume all of the essential amino acids.While these diets might seem daunting, remember youre not alone. A registered dietitian, like Kelly, can be an excellent starting source.Dietitians are full of ideas and strategies to help each individual overcome barriers to create effective behavior changes, said Kelly. Its important to remember that baby steps and small changes lead to big impacts on your health over time!Whether you're sticking to tried-and-true favorites like the DASH plan or exploring new diet horizons, the key is finding what works best for your heart. Remember, it's not about perfection it's about progress. So go ahead, savor those veggies, indulge in some heart-smart protein, and above all, listen to what your body needs.