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By Dr. Anthony Ellis, WCI Columnist
In my first year of practice as a psychiatrist in 1995, I saw a 69-year-old patient who was a successful real estate investor. She had accumulated several dozen properties, and she was renting them for income. She said she had built an empire and had become a millionaire. I asked her what she would be doing with all her money in retirement, and she said, “Well, my health is not so good, so I won’t be able to enjoy the money. I can’t walk very far due to my arthritis.” She went on to say that she had COPD from smoking, and she bad osteoarthritis in her knees and hips from being overweight for many years. She simply could not do many of the things she had planned for herself. Smoking, obesity, arthritis, and lack of mobility made her success bittersweet and supplied a cautionary tale that physicians have seen thousands of times.
My father was afflicted with Alzheimer’s Disease at about age 70, and it robbed him of the bulk of his “golden years” after his full retirement from nursing at age 65. He had become a nurse after serving six years in the British Army during World War II. The illness slowly destroyed his executive function, his memory, and his ability to care for himself. His quality of life was eroded further as he stopped driving, handed over his money management, and needed more care every year until he died at 79.
His intact retirement had lasted only five years.
He was a smoker for more than 40 years, and the artery-clogging effects had likely accelerated the onset and progression of dementia despite his other healthy habits and his daily outside walks. In his intact years, he was a nursing professor, a charge nurse, or a supervisor, and he had a singular intellect and amazing wit. The disease took everything away from him, and it was one of the worst times in my life as I was helpless to stop it. My father once told me, “Don’t end up like me.” He was referring to retiring on Social Security alone.
I followed this advice for financial reasons and for health reasons, and now that I've semi-retired at 58 and moved to the mountains of North Carolina from my Michigan McMansion, it's something I think about quite often.
Staying Physically and Mentally Healthy in Retirement
Seeing older patients who were financially well off but physically doing poorly and then watching my father’s short functional retirement spurred my move to Geriatric Psychiatry. I needed to learn things one might do to “not end up like that.” Seeing these types of outcomes focused my interest in living to an old age with our bodies, brains, and abilities intact. My wife and I became runners, and we ran road races for the next 20 years to stay in the best shape we could to improve our overall health and stamina. (In a prior post, I mentioned that I authored a book about running in 2005.)
I also took a position as the medical director of a geriatric psychiatry unit from 2001-2011. Having seen the effects of aging and dementia up close and personally, I wanted to be on the front in the battle against dementia. I learned as much as I could about the effects of aging on the body, brain, and functional longevity. I bore witness to the many ways that the brain “went bad” in the 60- to 95-year-old patients.
I helped them as much as I could with “too little, too late” dementia pharmaceuticals, antidepressants, exercise plans, and cognition-enhancing activities. I developed a hypothesis that brain amyloid management and removal were partly dependent on adequate vascular perfusion and oxygen delivery. A common denominator seemed to be the known vascular risk factors: smoking, HTN, diabetes, elevated cholesterol, obesity, inflammation, and a sedentary lifestyle. The more of these you had, the more “periventricular white matter hyperintensities” one would likely find on the brain MRI scans. You want your scan report to note “few or none” of these white spots and certainly not have it say “severe and confluent with associated cortical atrophy.”
Many patients with these risk factors tended to also have heart disease and strokes that markedly affected their quality of life and functional longevity in their later years. Their “decade of decline” was moved back from their 80s to their 70s or even their 60s. If they developed dementia, it was earlier and more aggressive.
I noticed that many of my older patients did not have enviable longevity. They were not hiking, biking, walking, swimming, traveling, and enjoying their hard-earned retirement income and Social Security. They tended to be saddled with about a dozen medications, notable arthritis, mobility issues, joint surgeries, obesity, and markedly decreased flexibility. The effect of all of this was a diminished or restricted ability to simply move and enjoy a modicum of quality. They were doing less of all the things I enjoyed. I took note of the relative absence of people over 70 on hiking trails and while traveling abroad. There seemed to be fewer people over age 65 in many of my favorite physical activities.
I started to lecture at the local medical graduate programs to psychiatry residents, social work students, and doctors and staff at the local community mental health centers on delaying the onset of dementia.
All doctors have seen “the list” that many patients over age 60 bring with them: two HTN meds, Synthroid, inhalers, diabetes meds, statins, arthritis medications, a “water pill,” and pain medication. This has become the identifying data for many patient histories. “This pleasant obese 60- to 85-year-old female (or male) with HTN, CHF, hypothyroidism, elevated lipids, GERD, type 2 diabetes, neuropathy, and chronic pain is seen for complaints of knee pain, back pain, decreased mobility, poor sleep, forgetfulness, and related depression.”
Below are the top 10 Medicare prescriptions administered by claim count (2014 data):
- Lisinopril (38.2 million claims)
- Levothyroxine Sodium (37.7 million claims)
- Amlodipine Besylate (36.3 million claims)
- Simvastatin (34.1 million claims)
- Hydrocodone-Acetaminophen (33.4 million claims)
- Omeprazole (33 million claims)
- Atorvastatin Calcium (32.6 million claims)
- Furosemide (27.1 million claims)
- Metformin HCL (23.5 million claims)
- Gabapentin (22.1 million claims)
How can you avoid having to make this list (and having to spend hundreds of thousands of dollars in healthcare) once you reach retirement age? Here's how I think about it and how I put these plans into action.
Steps for How to Thrive in Retirement
Here's what to do to stay healthy.
The high points:
- Do not smoke or, if you do, quit. Patches and gums improve the dismal 5% success rate to 50%.
- Maintain a healthy body weight to avoid diabetes, hypertension, and elevated lipids.
- Eat a healthy diet with plenty of vegetables, minimize red meat, and drink lots of water.
- Participate in aerobic exercise for an hour several times a week.
- Use body weight and functional exercises to maintain muscle mass.
- Stretch and do functional movement exercises or yoga to maintain flexibility.
- Develop an anti-stress regimen such as meditation or “forest bathing.”
- Maintain social connections.
- Optimize cognition through lifelong reading and learning.
- Get adequate sleep and practice good oral hygiene.
It is close to what many of us tell patients about wellness and reaping what they sow. So, if you know this and practice these points daily, you may stop reading here and send me a comment about another five wellness practices or how well you are doing so the rest of us can benefit. After all, we are lifelong readers and learners, and there are dozens of other things we tell our patients to do to avoid us.
Again, what is the use of seven-figure retirement savings if that money is mostly used for insurance copays, joint surgeries, long-term care, and the like? It’s nice to have the ability to pay for needed care, but it may be better to need far less care. All of us will lose muscle mass, gain weight, and become slower and less flexible, and these changes are clearly unavoidable. But why not mitigate or delay those with proven strategies?
Let’s look at the list in more detail.
Smoking is self-explanatory, and everyone knows it contributes to coronary heart disease, heart attacks, cancer, strokes, and premature aging. If you are smoking, you probably cannot do more for your health than to quit. When I see a wellness-oriented person smoking, it is frankly hard to take them seriously.
A healthy body weight has so many direct health correlates that one could surmise that we may have given up on ourselves as a species in some countries (especially wealthy countries like the US) based on the percentage of obese people. It must be very easy to gain weight and very hard to lose it. Food restriction is one of the few proven ways to expand longevity. The reduced risk of HTN; diabetes and its myriad effects; elevated lipids; dementia; increased cancer risk; higher risk of stroke and heart attack; negative effects on joint health and mobility; and the effects on mood, sleep, and sexual function are not enough for many of us. If one incorporates several of the other things on the list, it would likely influence weight.
By exercising several times per week, maintaining muscle mass with low-impact strength training, eating a healthy vegetable-laden diet, reducing stress, drinking lots of water, and getting adequate sleep, we would have a better chance at weight loss and maintaining a healthy weight.
Instead of training isolated muscle groups like biceps, triceps, calves, pectorals, back, or abdominals for aesthetics, utilizing compound body weight movements can help build a better body for daily activities, sports, or work. I don’t need 20-inch biceps in retirement. I need to be able to get on and off the ground, perhaps tend a garden, and bring in the groceries with fewer trips. I don’t need six-pack abs, but I do want to walk, drive, hike, swim, bike, get dressed without pulling a muscle, and travel without worrying about basic mobility and walking distances. These exercises typically use the whole body and multiple muscle groups and emphasize core strength and stability.
Functional weight training can be done without any equipment, and there is an entire industry built on body-weight exercises with six broad movement types: push, pull, bend, twist, squat, and lunge. Many of the exercises can also be done anywhere, including at home. Basic everyday activities like maintaining balance while putting shoes on or squatting to pick something up are crucial movements. Some of us reading this are old enough to know the odd feeling of barely being able to get a pair of shoes or shorts on without holding on to the wall for support. I can’t teach you these exercises here, but I invite you to peruse the internet for resources to start at the level that fits your ability and current fitness level.
Here are some other benefits of functional strength training:
- Reduced risk of injury due to better strength and balance.
- Improved form during everyday movements lowers the risk of injuries and falls.
- A stronger “you” can do things with more control and confidence.
- Improve your longevity and feel better in your body as you age.
Stretching and doing functional movement exercises or yoga also maintains flexibility.
Total body exercise activities like yoga are widely available at the beginner and more advanced levels at the YMCA, studios, online, and via home video or streaming services. Yoga improves muscle strength, balance, flexibility, and mobility. My wife and I practice yoga together because we noted decreased flexibility and balance as we age. She had to push me on this as I am frequently one of only three men in the classes. Yoga has been helpful in maintaining mobility and flexibility as well as core muscle strength as we have gotten older. We need this strength and balance for many of the activities we have planned in retirement. Yoga is also a low-impact activity that is easy on the joints, which is important in any exercise regimen for retirees.
You probably know or treat many people who have had knee, shoulder, hip surgery, or overuse injuries. I know people who have had joint surgeries due to running on pavement and other high-impact sports. These are fun when you are young. We ran for 20 years, but our days of running long distances on pavement are over, replaced with hiking, yoga, swimming, and walking in the woods.
Swimming is underutilized as a total body, low-impact exercise that can be maintained for one’s whole life after learning the basic skill. I have been a member of a gym with a pool or the local YMCA since 2007 to swim because I enjoy it. For me, it ticks all the boxes: low impact, aerobic, expands vital capacity, builds muscle, does not worsen flexibility, and feels like a meditation exercise. My own PCP recommended I try it, and I never looked back. I saw him last year, and he was still swimming laps at the local college pool at age 80, having completed his career in Internal Medicine.
After noticing the benefits of swimming, I trained for five months one summer in 2009 to complete the Bermuda “Round the Sound Swim.” At the end of my training, my resting heart rate was 49. This event had distances from 1,000 meters to 10,000 meters, and I completed the 4,000-meter event. It was spectacular. When I finished, I was feeling rather good about myself, and then a 10-year-old from India spoke with me about her finish in the 10,000-meter event.
In Michigan, there is a 5,000-meter event called “Swim to the Moon and Back” across five lakes near the town of Hell. I completed it at age 50 and again at 55. When my functional longevity fails, I can’t wait to tell the nursing home staff I swam through Hell . . . twice. Why? To stay functional.
What Is Forest Bathing?
It’s not sitting in an outdoor hot tub with a glass of wine, although I recommend that too if you have easy access and you might enjoy it. In 1982, the Japanese Ministry of Agriculture, Forestry, and Fisheries coined the term “shinrin-yoku” or “forest bathing.” I didn’t even know I was doing it until I read an article about the benefits. Most of us who have access to the outdoors or who can take a trip to get to a wilderness area or a calming outdoor vista that produces awe have tried it or specifically sought it out, not knowing the term. There is something very beneficial about being in the woods and walking trails or seeing these types of natural sights. In fact, people set up trips just to do this. We are going to visit five national parks in February to get even more of it. Not everyone will choose to move to a mountain and live in a forest to get a full-time dose, but if you can work this in, it may well be worth it.
Here's how Psychology Today writes about it:
“The idea is to immerse yourself in a natural environment and soak up the many health benefits of being in the green woods . . . Across the continents, you will find forest bathing clubs and guides and tutorials. Forest bathing, also referred to as forest or nature therapy, has become popular in all corners of the developed world. The restorative nature of sitting in nature has been called soft fascination, whereby we are enraptured and uplifted by our surroundings. Forest bathing is an antidote to pinging distractions, impending deadlines, and never-ending obligations. Also, in one study that included images of natural environments, people felt more positive about their body image, which is the opposite of the self-disdain we may feel when scrolling through social media.”
The rest of the above list is self-explanatory, and many of us try to get ourselves and our patients to develop and maintain social connections, optimize cognition through lifelong reading and learning, get adequate sleep, and practice good oral hygiene. Getting people to floss every day is about as hard as staying at their ideal body weight.
In summary, functional longevity is connected to brain health, which is connected to vascular health. Strength, balance, flexibility, and mobility can affect emotional well-being. You can manage and mitigate the known vascular risk factors. The inevitable loss of muscle mass and mobility with age can be counteracted to a degree with functional exercise and yoga. Look around on the trails when you are traveling for the active older folks. Ask them how they have done it. I’ll bet a lot of them are following a wellness plan, taking a yoga or fitness class, walking, eating well, not smoking, and having fewer copays and regrets.
Remember: what use is retirement if you can’t move? What use is a couple of million dollars, a pension, Roth money, and Social Security if you can’t take the trips you planned? You don’t want to be on 10 medications and have four different types of doctor’s appointments. While some decline and slowing down are inevitable, why not leverage a positive outcome?
If you're retired or close to it, how do you plan to maintain your functional longevity? Is that something you've thought about? Would any of these tips help? Would you give forest bathing a try? Comment below!
One of the best articles I’ve read on WCI in the last 11 years. Thank you for the work on this! I just read ‘Die with Zero’ and feel it would be a good book review for the site (should I submit one Dr D??). Having money saved is one thing – being able to spend/enjoy it is another – and spending/enjoying it at the RIGHT time is yet another entire discussion….great post!
-Jon
Thank you for the positive feedback. I’m glad you enjoyed it.
Being well and staying functional in retirement is as important as investing and planning.
Always welcome to submit a guest post Jon:
https://www.whitecoatinvestor.com/contact/guest-post-policy/
another phenomenal article. Really makes you stop and think. I’ve been trying to translate financial discipline into nutrition and fitness discipline. It’s not the easiest transition in the world for some of us, but incredibly important.
Thanks!
If you think about all the things you want to do in retirement, you can focus on optimizing health and staying physically fit.
Since you can do the hard work in finance and budgeting, you can do this too. It pays quality dividends.
Great article and something people occasionally talk about, but is often overlooked and not given the attention it deserves. If we are going to be disciplined financially and plan for a retirement, we ought to give at least as much attention to our physical health, and certainly not neglect it for the sake of a bigger nest egg. Take the stairs at work and pack a healthy lunch, avoid the cafeteria. Exercise at least 3 times per week, you will feel better and have less fatigue. It may even become the favorite part of your day. I would personally rather retire with 2M and great health than 8M and poor health!
“our days of running long distances on pavement are over,”
the hardest lifestyle change for me.
We had to switch to trail running, hiking, and nature walks.
Yesterday, we climbed down a rope assisted descent to a river narrows from a beautiful trail. It was difficult, but awesome.
If we were not in shape, this would be impossible.
Our hikes frequently go for 4-5 miles, have 1000 feet of elevation change, and are mostly in the mountains.
It is incorrect to say running causes arthritis or joint damage. There are now numerous studies confirming this, but we can’t stop saying it for some reason.
https://pubmed.ncbi.nlm.nih.gov/27333572/
I’m sure it is dose dependent. Ultras cannot possibly be good for your joints or anything else.
Probably truth in that – the studies I know about looked at 5K type runners. I do know there are studies saying ultras are bad for your heart.
I don’t think there is evidence that ultras are bad for the heart. There was a recent study showing increased coronary artery calcification, but that is a physiological variable, not an outcome – the suggestion was that vulnerable plaques may be being converted into stable calcified plaques. Everyone is different, but there certainly are ultramarathon runners doing very well in their mid-70s. You are of course absolutely right about running and arthritis – everyone acts as if arthritis was “wear and tear” while every rheumatologist knows it isn’t!
While I”m sure it’s a far better habit than sitting on the couch, and while I don’t have any hard evidence, I have a hard time believing that frequent ultra running is not much harder on the body than running more moderate distances.
This article says diastolic dysfunction, large artery wall stiffening (not sure what that really means) and increased a fib as well. Definitely agree with you though, this is not conclusive evidence by any means but it does seem to be a case of too much of a good thing.
https://www.mayoclinicproceedings.org/article/S0025-6196(12)00473-9/fulltext
Great article! I really enjoyed this one, and it’s so true. I’m doing most of those, need to work on a couple of them.
I would add though, limiting alcohol use. We all know the health consequences of too much alcohol.
I agree that alcohol use should be moderated.
I go to a local store that has beer from all over the world, and buy a mixed six pack of lagers, pilsners, ambers, Helles, Kolsch, and Blondes, and have a “pint of the day” on the deck while watching the sunset.
The view of the valley and surrounding mountains is incredible.
All makes excellent sense. Now how to overcome my main problem of all the risk factors, illustrated by my satirical retort to dietary advice: “Eating less chocolate (wine, red meat, etc) may help me live longer. But if I must eat less of that, is it truly worth living longer?”
Luckily ? I am already old enough to have an immediate pay off from (gentle) exercising: less aches and pains.
Thank you Jenn.
I think you can keep those and make up for them with the rest…
I eat red meat occasionally, and I have not given up chocolate either and there are two “top ten new vineyards” in the country within ten minutes of me…
As a board certified lifestyle medicine physician researcher and Fellow of the American College of Lifestyle Medicine, I can say that you are spot on after interviewing thousands of patients over your tenure as a geriatric psychiatrist.
We talk about the six pillars of Lifestyle medicine:
1. A whole food plant predominant eating pattern
2. At least 150 minutes of moderate intensity or 75 minutes of vigorous intensity physical activity per week
3. At least 7 hours of sleep per night
4. Stress Management
5. Positive social interactions and social engagement
6. The avoidance of risky substances such as tobacco, alcohol, and recreational drugs.
If this topic interests others, please visit http://www.lifestylemedicine.org for more evidence-based information to further help your patients.
There is currently a training available for everyone and gives you 5.5 free CME put out in collaboration with the White House Conference on Hunger Nutrition and Health called Lifestyle Medicine and Food as Medicine Essentials.
http://www.lifestylemedicine.org/WHConference
Everyone loves free CME, especially when it actually helps your patients!
Cheers!
Scott
Thank you for your reply.
I’m going to use both of those links after I finish my work today.
I’ll try the free CME.
Best function and success to you!
I also wanted to mention just how much I enjoy your posts. You really deliver thought-provoking messages through each of them. Great work!
Thanks,
Scott
I appreciate it.
What an interesting specialty you have.
I had not heard of it until now.
Great article and service to the readers!
I particularly like how the article was penned in plain English so non-medical trained readers (like myself) can easily understand it.
The consequences of prolonged illness and early death are enormous in several cultures inside and outside the North America and Europe.
Another way to promote good health and longevity here is to promote peace and good health everywhere on earth.
Just like optimum health can not be achieved by doing only one or two of the aspects cleverly articulated in the article, we need to promote peace and prosperity and security and environmental justice everywhere in the world to enjoy them ourselves here.
The world is ever so connected and we need to live a symbiotic life, if we want to live and age gracefully!
“We are the world “!!
Well, I contribute to the United Way, a charity for the homeless in the USA, and the Salvation Army.
Unfortunately, there’s a strong genetic component to all this. Some people are just born with poor genes, and no matter what they do they start falling apart as they get older. Certainly doesn’t mean they shouldn’t try everything possible to maintain good health, but sometimes the decline is inevitable.
The optimal solution for someone with a strong family history of health issues in older age is to retire earlier and enjoy the best remaining years of life.
As you say, one can mitigate genetics to some degree.
I planned for the earliest move to half time that I could make happen partly due to my family history.
No looking back now. I’m having a blast.
Great article! I wholeheartedly agree with your advice. I am in my mid-50’s and have practiced all of these my entire life. I like that you included good oral hygiene. As a teen, I recall asking elderly people for their advice, and “take care of your teeth” was mentioned by the majority. Many others said “don’t get bored.”
Thanks much.
I think your healthy habits and good oral hygiene will pay off.
I can’t imagine being bored.
Best of luck to you!
A friend quoted his dentist: “You don’t need to floss all your teeth, just the ones you want to keep.”
Great article and very important message. The one thing that I add when I talk about this aspect of retirement planning is that this investing in our human capital is analogous to how we invest financially. The returns compound over time. So, an early start to build habits, relationships, and interests outside of medicine is key. You can’t just grind away and expect it to all be there for you at the “finish line”.
-LD
I agree.
I love hiking, swimming, yoga, and travel and my family and friends.
You don’t seem “loonie”…
Best wishes for a great retirement.
A loonie is a Canadian one dollar coin, not an implication of his current psychiatric state!
Oops…I feel kind of looney after that one.
I saw it was spelled differently but never thought “Canadian dude”.
You didn’t spend years playing hockey with Canadians. Maybe next week you get to find out about ginch and gaunch.
https://www.nytimes.com/2021/05/21/world/canada/canadian-dictionary.html
Thank you for such a learned, informed and quite a superb article.
I’ll be deploying the items I’m not presently doing…
I look forward to reading more about these topics!
Thank you for sharing your expertise!
S
😉
Thanks for the feedback.
Our health is our most important asset.
All quality of life flows from there.
Can you give an example of a sample workout you do for functional exercises other than just referring us to research on our own? I know there are plenty of workouts online, but what would be an example of a longevity workout? Most videos online are young people doing crazy plyo exercises and lifting 300lbs, looking like they are about to blow an artery.
That can’t be the best way to exercise. Are we supposed to exercise to failure? Should we do 6-8 reps or 15-20 reps? Should we lift until we can’t lift anymore or just do it to a comfortable level where we could do another few reps but choose not to in order to not exert ourselves? I personally grew up reading bodybuilding magazines and modeled by workouts after them because I figured they knew the best way to do it, but doesn’t seem like those are the best for longevity.
So can you please provide a sample longevity workout including what functional exercises, how many reps, sets, going to failure, etc?
Thanks so much!
Jamal,
You can just do something which encourages bodily motion and gets your heart rate up. Obviously, the more vigorous the workout, the more health promoting benefits you will receive (up to a point, but we don’t all need to go running for 10 hours per day).
The best exercise is the one that you will do, make it something you enjoy, like a walk somewhere fun, or a game of basketball, or skiing, etc. The American College of Lifestyle medicine has a plethora of resources for you.
In Health,
Scott
Yes, I can.
I use body weight exercises and I don’t do anything “to failure.” I want to be strong, but I don’t care if I have abs. I’m 59 in April.
Air squats of several types : regular, wider stance, feet close together. Build up to 100 per day. I do 5 sets of twenty.
Yoga, any type that makes you sweat a bit. An hour or two a week. In general it helps with flexibility, strength and balance. We take the free classes at the YMCA.
For upper body strength, I prefer push ups. There are many variations. An initial goal would be to build up to 50 (5 sets of ten of five different types). After a back injury in 2011, I had to start back with pushups on my knees.
I also liked “farmer walks” with kettlebells, but I mostly backpack now. I need to be able to hike five or more miles with a packed lunch and water.
I don’t do pull-ups anymore but did from age 35 to 50. I also stopped doing dips. These two became tough on my shoulders.
I like “Turkish get ups” but I have gone to just plain get ups now…I like to be able to get on and off the floor with ease.
The exercises one chooses depend partly on age, abilities, and goals. As I say, I’m approaching sixty and I don’t want to get hurt.
Hiking twice a week with a small backpack, swimming a half mile twice a week (in 16 minutes), yoga once or twice a week, 100 air squats, 50 pushups, and get ups are working for me. Does that help?
It does, I appreciate it! How about your dietary routine? Has that changed over the years? What’s a typical day for you in terms of eating?
Since I have dropped to two days a week this past six months:
I cook a LOT more.
I use more spices, less salt.
I eat more unprocessed whole food
I eat almost no fast food.
We eat more veggies 🥗
Very little red meat 🥩
Breakfast is typically a three egg omelette with a lot of veggies, a bit of meat, some cheese, and I split it with my wife and have a serving of avocado or berries on the side.
Lunch is soup that I have made, or a chicken sandwich, or a salad with salmon or chicken on it.
Dinner is seared salmon with sides, ground turkey shepherds pie, or pasta with homemade marinara sauce and meatballs, or chicken Parmesan. I roast Brussel sprouts, or sauté broccoli with garlic, or roast mushrooms with garlic and thyme. I make my own salad dressings.
I get most of my cooking ideas from TiKTok where I am @DocMushroom. I mostly post hiking, mushroom growing, and cooking videos.
I lost seven pounds in January eating very good food. 😊
Lots of great advice. Two points
1. I do not see what what any of this has to do with retirement. It is at least as important to stay healthy while working as it is to be healthy in retirement.
2. Rather than “limit” drinking, it is clear that the data show the healthiest level of alcohol consumption to be zero.
You are right. They changed that one up on me.
I was taught “two drinks a day for men and one drink a day for women”.
This newer data was AFTER I moved near Asheville, a city with the most breweries per capita in the country…and now Hendersonville also has about a dozen local brew pubs…and two fairly new “top ten new vineyards” in the country.
I think I’ll stick with the old guideline 😊. I’m not likely to be a total non-drinker.
As to the other point, I disagree, hence the post. I think wellness and fitness during your working years and into retirement are crucial for quality of life. That’s why it started with two cautionary tales.
I agree that wellness is important throughout life. But there is no reason it is more important to be healthy and retired at 70 than to be healthy and working at 70.
Good health in old age is important, whether or not one is working.
“Good health in old age is important, whether or not one is working.”
Well, that is certainly true.
Most of us would like to stop working at some point. When you get there, it’s nice to still be functional.
Some I know worked so hard and so long, their health suffered. They arrive, and are finally free, but are not healthy.
It is certainly possible to neglect one’s health by getting too little sleep, eating junk from vending machines instead of proper food, etc. But one can live a healthy life while working. In fact, one of the themes of this discussion is that being healthy in old age requires a lifetime of healthy living.
Staying mentally active is crucial to staying cognitively intact. Working in a high cognitive load occupation contributes to that.
A slow short walk around the block once a week is no substitute for daily vigorous exercise. Occasionally doing crossword puzzles is no substitute for 8-10 hours a day practicing medicine.
I do not the obsession with retirement or the notion that one is only “free” when unemployed.
One can be working in old age and still be free.
I have a feeling you and I will have to agree to disagree.
“Obsession” is pejorative…as in an obsession with work. You don”t see the moniker “retiraholic.”
One man’s bondage is another man’s freedom and vice versa.
For me, freedom includes the choice to work or not. If one chooses to work, great. Then you are free. If I choose what to do with my days, I am free. If others do, I am not. I was always an employee, so our experience may have differed.
“Unemployment” is not the same thing as retirement. It is seeking to trade time for money but not being able to find an employer or suitable work. Retirement is a planned choice to withdraw from a likely successful career and pursue avocation.
After four decades of total work, I’ll be even more happy to be fully “unemployed.” You may have missed my other article in which I explained that I had worked a “career and a half” due to the the hours I worked.
Practicing medicine is cognitively similar to many other activities. Planning a complicated vacation, reading extensively, developing new hobbies, learning and shopping for, then executing new complex recipes, learning new hiking venues, exploring how to optimize income outside of medicine, woodworking, cultivating mushrooms, etc.
You say one can live a healthy life while working…yet half of physicians describe themselves as burned out. None of the doctors I worked with seemed to have anything like a balanced life. None.
“Healthy and working at seventy”…no thanks. But then, everyone is different. To each, their own, as my father used to say.
Afan is going to keep working on the entire online personal finance community until the rest of us agree to work until the day we die and never spend anything. 🙂 He’s definitely pretty far out on the saver side of the saver-spender spectrum.
As you know, there is scant support for finishing your career “early.” I wrote a post about it.
As I said in that post, each person is different. Clearly, given that I equate lack of having to work at this point with freedom, I feel strongly about this choice.
So far, it’s definitely good for me to not have to work full time.
Some people simply love their job more than leisure. My GI doctor did. He and others I have known worked until they died or simply couldn’t work anymore.
I’d like two decades of leisure, but one has to live that long, intact.
I interpret “healthy while working” to also be important for the first step of most of the financial advice here- which is to maintain your medical (or other professional) skill and ability so you can earn money to invest for retirement. Mental health/ burn out might be the biggest risk factor disabling medics at a younger age but fatigue and lack of sleep contribute to that as well as increasing your risk of accidents and of not getting enough exercise and sleep or decent nutrition.
As I’m 63, I hope readers here realize that we’re coming very close to controlling and REVERSING aging. Thus, it would be highly recommended that you all try to take best care for that eventual outcome likely within a decade or two. If interested read about Audrey De Gray ( very famous in the longevity field), plus author ” Reason” daily blog ” Fight Aging ” which I’ve been reading over 20 years. Reason provides daily articles in his blog on latest medical news in this field. Huge amount of money been pouring into longevity research especially in last 5 years.
Forgive my skepticism. I hope you’re right though.
Hello Robert,
I’ve read a few articles on the ongoing and recent advances in “reversing aging”.
I’m going to use what I can now and am happy to see how that pans out in terms of safe applications.
At present, I haven’t been inspired by the quality of life for most folks in their nineties, so I’m doing what I can. No male in my lineage
on either side has made it to ninety, going back about six generations.
A bigger coup that is already here is the ongoing alteration of lifeending/ disabling diseases (HIV, HepC for a few) to controlled diseases (once we have an easy cure for DJD and obesity, we’ll really need to raise the retirement age). I myself now have two diseases (I’m 60 but they started 20 and 7 years ago) which only 20 years ago often required colectomy and liver transplant. Now an immune modulator and bear bile salt and I’m healthier than most of Steveark’s church group. (But my hikes are only over 2 miles when we get lost.)
Of course I think our better control of BP and cholesterol and CAD is why we have so many more aged slowly, at a later age, developing heart failure than suddenly dropping dead.
This article struck home. My wife and I are in a church group of similarly aged people ( we are 67 and 68). Of the twenty or so people in this group three of us are very fit, my wife and me and one other guy. The rest are mostly obese, and if not, they lead relatively sedentary lives. None of them would be comfortable attempting the eight mile loop my wife and I are hiking next week in a wilderness area. And they would not even consider the four mile rough terrain bushwhacking we’ll do later that same day. I’m sure some of their issues are genetic and some may simply be unable to pursue an active lifestyle due to things beyond their control. But my guess is most of them just eat too much and move too little. I love playing on a 55 year age group tennis team at age 67, and I am one of their better players. My wife plays on 40 year age teams at the age of 68. And we were never natural athletes, but we keep moving and don’t eat much. Seems to be working for us so far.
Great for you guys. I assume you’ll be fighting an uphill battle as you ( we get older), but stick to being active. I encourage everyone within listening distance to be active. I had my own gym ( some ab machines, cardio, and full universal gym till I moved from California. I’m hoping to build larger gym as we live in mountains and it’s 2 hours to my new public gym
But, hey, we’re next to national forest so I guess that counts for something.
But, yes, staying active is very important. My dad was active ( machinist in railroad), but died at 77 of emphysema due to smoking.
Congratulations on being active, though, happy for you two:
My wife’s friend asked her if she knew any other women in their 70s that could play on a soccer team she’s putting together.
You are seeing what I’ve been seeing. The top 15-20% are less restricted. Being able to do what you want is the best reward.
My wife and I are in our late 50s and we have friends 10 years younger to 10 years older who can not do many of the things that we do.
In fact, sometimes, when some of our friends come to visit, we simply can’t go hiking with them. We frequently have to park close to our end destination to make sure that they can get in a place.
Most of my functional friends have been runners, walkers and hikers for decades. Many also swim and do yoga. Sadly, some of my sedentary overweight friends take medications, suffer more aches and pains, and their activities are restricted.
“A man’s health can be judged by which he takes two at a time: pills or stairs.”
— Joan Walsh Anglund
True.
I am paraphrasing this next statement from memory and I don’t remember where I read it some time ago, but it really made me think at the time (purportedly from a European): “I have never understood why Americans work themselves to death to get wealthy and then have to use their wealth to regain their health”.
It’s true. Some employers push too hard. I think a lot of people work too many hours.
My wife and I have been active since age 35. Both of us were not very active from 25-35. We got by on our “youth dividend.”
It’s became a way of life for most of the last 25 years. I always feel better when I’m the most active. We trained for many events together. My best half marathon was during a Detroit Free Press marathon relay with my wife. She ran several ultra (> 26 mile) distances and completed several trail marathons.
Even when I worked twelve to twenty side gig weekends a year, I was usually done by 2pm and could walk in the evenings. I also have had bosses that let me swim at lunchtime since 2007.
I feel like I got behind on fitness during the second year of the pandemic. I gained weight and lost some fitness when I didn’t swim for a year. I’m reversing that trend now.
I think diet diet trumps everything. I went on a whole foods, plant-based, no oil diet 10 years ago at age 66. I always had what I thought was a good diet and worked on having a better diet since the age of 21. I just wish I had found plant-based earlier. Heck, I wish my mother was on plant-based when she was pregnant with me. What you eat is so powerful to keeping you in good shape and good health. Diet also controls genes a lot. Everyone in my immediate family had hyperthyroid: my parents had I-131, my sister had surgery, and my brother died of a sudden heart attack at age 62 because he would not go to the doctor and get his hyperthyroid fixed. I am 76 and I have never had thyroid problems although my mother’s endocrinologist told her that I had a 100% chance of getting it. I do check my thyroid every few years. Best source IMO is nutritionfacts.org
Are you saying it the most important and the others don’t matter, or just that it’s the most important? I have heard “food is medicine”.
Why “no oils?”
You said you are 76. Just curious if you are happy with your level of function? Are you able to do all the things you want to do?
Excellent article and advice! A few comments: don’t wait till retirement to do things like travel! Prepare for the future but don’t neglect the present. Emphasize weight training and yoga. You will gain and maintain strength while improving balance thus reducing risk of falls which are the beginning of the end for many. I should know, I repair hip fractures almost daily. Workout with your spouse, that keeps you accountable. Lastly, red meat is not evil, is quite nutritious and please ignore the government food pyramid.
I agree. We have been active since age 35.
We took so many vacations and traveled so much…I listed it as a financial mistake in another article …but then took it back because we enjoyed the vacations so much. 😊
Those trips are the things you’ll cherish! We travel a great deal as a couple but also put together a family trip with the kids & spouses once or twice a year. As the family gets bigger, it gets more expensive but our rule is you get there and the rest is on us . Money well spent in our opinion.
Stupendous Doctor!
‘Google evolutionary biology and obesity. Drive around any town in America with its abundant fast food restaurants. Or lookup environmental mismatch and obesity. Collectively we have no chance. On top of that, most believe the diet fix is what caused the problem to occur in the first place.
The highest cause of death is damage to the most important organ in the human body, the endothelium.
Thank you.
I will try that Google search.
Fast food, processed foods, cheap oils, and sugar…bad news.
https://journals.biologists.com/dmm/article/5/5/595/3258/The-evolution-of-human-adiposity-and-obesity-where
Interesting.
You should consider hiking in Nepal. The penultimate of hiking in my humble opinion. You tube it!
I will look on YouTube.
Our next adventure is going to be hiking from Northern Portugal 🇵🇹 to the top of Spain 🇪🇸
We plan to do the last 100km of the Camino de Portugues for our 30th Anniversary in May.
Definitely on my list.
If Nepal is the penultimate of hiking… what then is the ultimate? I’d love to do Nepal as well some day (excited to do Grand Canyon rim-to-rim for my birthday this year)
dude awesome post man!!! Love how you swam over 5 lakes/4000m!!! I was a high school swimmer and just doing the 500 yd free was a killer for me!
As a neurologist you are absolutely right about exercise- seems to have the best evidence of preventing and being disease modifying and slowing down the progression of Alzheimer’s. I am hugely disappointed in the new amyloid targeting antibody treatments that have come out, but hopefully these will be refined where they will have less side effects, and possibly identify pre-symptomatic Alzheimer’s patients for early treatment before clinical symptoms manifest.
Have you thought about getting an annuity like a SPIA or deferred annuity to hedge your possible cognitive decline in the unfortunate circumstance you get Alzheimer’s?
Thanks Rikki!
I’ve been disappointed with the Amyloid antibody treatments too. I thought they would be more clearly helpful.
As far as a SPIA, I’ve thought about it as bonds have done so poorly, but how does help me if I get Alzheimer’s? To reduce the amount of our money tapped to pay for care?
My prior financial advisor tried to get me to buy an annuity that had a floor of 6% simple interest but it was so complicated I didn’t buy it.
The longer you live, the better the deal an annuity may be! That insurance company is hoping you die early but the data shows annuity holders actually live longer!
Did you just make a pro-annuity comment? Just kidding. I know you have talked about “SPIA’s”.
I’m getting about 5.5-6% at YieldStreet on a third of my “big house equity”. I just rolled a supply chain finance chunk into another 9 month short term note.
My Fundrise portfolio hasn’t done as well recently, erasing all 2019-2021 gains this quarter. While I haven’t lost any money (due to dividends paid), I haven’t made any either on that 2.5% of my portfolio.
Excellent article. I am a 75 year old male with decent health retired for 19 years. I don’t follow established exercise routines, but do maintain my 2400 sq ft house and my 1/3 acre property. My health issue is heart disease. One oblation and one heart attack. Probably genetic. One thing you didn’t mention was alcohol. I am a serious drinker for 60 years, presently 4-5 drinks every other day. I thought my alcohol consumption would end my life early, but it hasn’t. I am interested in your thoughts.
Better 4 than 20. I met a patient 30 years younger than you this week whose skin was the color of Homer Simpson’s. He probably won’t make it to a transplant as he had only been one month sober and already had a MELD score of 28.
That’s about 20 drinks a week. Seems high with the recent data on cancer and health risks.
I’d drop it in half and make sure you have been looked over for the top five cancers in men:
Lung, colorectal, prostate, bladder, melanoma.
I had a stage 1A melanoma on my back taken off with 1cm margins in 4/2021. It’s been two years. I’m still almost uninsurable “for five years”. My health insurance premium is $6500 a year for myself only and it’s a high deductible, limited benefit piece of junk.
Ask your PCP: colonoscopy, PSA, yearly labs, CXR and “skin survey”. I’m sure the vigilance work up could have changed a bit.
Excellent article. Am certain that you’re familiar with the book “Younger Next Year” by Crowley and Lodge. Basic premise: if you want to hike / bike / ski / etc into your 70’s, 80’s and beyond, you have to increasingly pick up your conditioning as the years go by. The amount / intensity of exercise that you did when younger will not have the same positive effect as you age. So – have to almost workout more and more, almost like a pro athlete. Have been running stadium steps (pure torture but incredibly effective: lost 30+ lbs in four months), lifting, aerobic exercises, etc etc. My kids tell me I’m not going to be a good old person, going gracefully into the sunset. Nope I’m not – am going kicking and screaming. Google up Klaus Obermeyer, speaks for itself. And if I hear one more guy say ‘I’m now an old guy’……. Becomes a self-fulfilling statement. All the best to you ‘experienced’ athletes out there – keep it going!
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.
Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.
Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.
Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
Love your article! Love the comments! driving the Blue Ridge Parkway in May!
Great comments.
As an ER doctor, I only have a short time-frame to advise my patients on risk-factor reduction, so I made a Youtube video to help inspire/motivate (described in this short article with the Youtube link at the end).
Feel free to share my video with your patients —or maybe record your own advice.
https://journals.lww.com/em-news/Fulltext/2021/08000/Letter_to_the_Editor__ED_Patients_and_Teachable.27.aspx