When Alfonso Cruz Jetoft talks about aging, he does so from a vitalistic and positive perspective, because aging does not have to be synonymous with limitation or, necessarily, illness. He is head of the geriatrics service at the Ramón y Cajal University Hospital in Madrid, of the Geriatrics Unit of the Ruber Clinic in the same city and also practices at the MIP Salud Comprehensive Medicine and Surgery Health Center. Currently, he combines his work activity with teaching, working as a professor of geriatrics at the European University of Madrid.

During his experience, he has developed his interest in pluripathology, polypharmacy, sarcopenia, Alzheimer’s disease and other dementias, in addition to becoming an international reference in geriatric pharmacology. For Cruz Jetoft, informative work is basic. He is director of the scientific journal European Geriatric Medicinehey author of books as didactic as Life begins at fifty (1996) and Positive old age: it is never too late to be happy (2006). Because we are all going to grow old, but how we do it is the difference.

We live longer than we did years ago, but do you think we live better in terms of habits?

We live longer and we live better in terms of quality of life and capabilities. A person who forty years ago was 70 or 75 years old looks very similar to a person who is 90 years old now. It seems that living longer is not increasing the time we live with a disability or in need of help, but rather that time is either the same as before, or even a little less.

And when we talk about healthy aging, what do we mean?

We usually refer, speaking in the broad concept of health of the WHO, that health is physical, mental, and also social and emotional well-being. Healthy aging is precisely that: reaching older ages with good physical health, good mental health, and good relational health.

What are the factors or problems that threaten healthy aging?

The first is bad habits. If you have bad habits, you age worse. The fundamentals are the way you eat and the amount of physical activity and exercise. The second barrier is diseases. There are some that we can detect and many people do not do the screening tests, and there are some that we can prevent and there are people who do not prevent them, for example, with vaccines, or who do not treat chronic diseases that have serious consequences. For example, many people with hypertension are not well controlled and are at greater risk of having strokes. There are people who smoke or drink and that puts them at greater risk, not only of dying earlier, but of having a worse old age, with more dependency.

You have talked about the influence of diet. What should nutrition be like in older people?

Healthy nutrition is equally good for all ages. Basically, it is following the Mediterranean diet, which is not just eating vegetables, it is eating legumes, bread and unrefined cereals, little red meat and much more white meat, eating more fish, more fruit… It is the diet most associated with healthy longevity. When you get older, there are two things you have to pay attention to: one is to increase the amount of protein in the diet (they are in legumes, dairy products and all meats and fish) because it prevents muscle problems that lead to disability. The other is to take enough calcium for your bones and not be too fat or too thin. Being a little stuffed is not so bad when you are older, but being too thin or too thick also leads to diseases.

What are the most repeated mistakes in the diet of senior people?

Eat a lot of sugar, a lot of animal fat and a lot of ultra-processed foods, and that is also increasing because new generations cook worse than older generations. Not drinking enough liquid is also a fairly common mistake, especially in a country as hot as ours. In summer, admissions due to dehydration among older people increase greatly because the sensation of thirst is lost a little, and they do not realize that they have to drink until they are dehydrated.

What exercise is recommended after 60 years of age?

Physical activity must be distinguished from exercise. Physical activity is everything we do throughout the day that involves moving and burning calories. It means walking a sufficient number of steps, but in general it means moving, not sitting in front of the TV without getting up, going for a walk… All that physical activity is important for aging well. And then, when you get older and to prevent diseases, you have to do two types of exercise: aerobic, which is sweating, that is, walking quickly, swimming, dancing… all those types of exercises. Furthermore, as you get older, you have to incorporate exercises at least two days a week to gain muscle strength and they can be done with tapes, with weights, with machines… One can say: “Now at 70 or 80 I’m going to start using machines”, but it is at the age in which it would be obligatory, because gaining muscle strength reduces falls and reduces the risk of needing to depend on others to move.

What role does the psychological factor play in healthy aging?

It is essential. There are two key aspects: one is cognitive, which is dementia. They are very common diseases that can be delayed with these habits, but they are not yet curable or preventable. The other most important aspect is the emotions: depression becomes very common when one gets older. Depression is a treatable disease and is one of those that can most affect quality of life. Therefore, in addition to leading a healthy life, one must have a life with relationships, with activities, with a meaning in life, knowing what I am doing, why I am here, what I want, what goals I have and, if one begins to have signs of depression, treat it with psychotherapy or medication.

What is sarcopenia? Why is so much importance given to aging?

Sarcopenia is a disease that we have defined in recent years. ‘Sarco’ means meat and ‘penia’ means lack of meat, lack of muscle. Until now it was thought that the muscle did not get sick and, in the last 15 years, we have seen that yes, the muscle does get sick in the sense that it becomes smaller and, above all, weaker. When the muscle begins to become weaker, it begins to be incapacitating for walking or living a normal life, and this disease is called sarcopenia. They are trying to develop drugs (there are already several in research), but the treatment is to intensify muscle strength exercise and treat the causes, which are very numerous: diseases, nutrition problems, immunity problems… This is what astronauts have, for example, when they return, since their muscles have atrophied and, therefore, they exercise even in space capsules, to prevent sarcopenia.

In other words, among the factors that cause it is a sedentary lifestyle…

Clearly a sedentary lifestyle, but also a diet with an inappropriate amount of protein or unbalanced diets. Then, several diseases favor it; For example, if you have a lot of osteoarthritis, your joints hurt and you don’t move, your muscles also atrophy.

You are the author of the book Life begins at 50Why did you choose that title?

It is very old now; Now maybe I had to title it Life begins at 60 or 70. I chose that title because in life one changes the way one faces old age. Normally, when you are under 50 or 60 years old, you don’t think about old age, nor do you think about disability. At those ages your parents begin to need help and you realize that this is your future, and you begin to reflect on it. At the time, Life begins at 50 I meant that you still have 20 or 30 years to live and that you have to start thinking that what you do at that age is going to determine how you are going to age.

Another of his books is Positive old age. How can you get the positive side of this stage?

First of all, giving it meaning. One has to think about what I am doing here and, in this society in which the elderly are increasingly despised, they are not given meaning. What are they doing here? They are spending pensions, they are bothering, they are using all health resources… Society has to decide what the value of older people is, give them their meaning – because they have it – and each individual must think about how they are going to complete their life. One must think: “I have been training as a child, then I have had children (or not), I have worked all my life and, now, I have a lot of years left to live” and decide what you are going to do with that. Because my value goes beyond working and I am a person. If you consider this and are clear about it, you will normally be happy and have a positive old age. There is an added thing that more and more research points to: spirituality. People who have some belief structure age with fewer illnesses and in a healthier way than people who no longer believe in anything. Regardless of the content, it can be a religious faith, it can be a humanistic belief, it can be anything, but it helps give meaning to life.

It is an international reference in geriatric pharmacology. What is being done wrong in this sense?

Many things are being done wrong. The first is that the research on the drugs that are coming out does not include the elderly people on whom they will be used. They are excluded from the research and then given when they are 80 years old, but the reaction to the drugs is very different than when they were younger. If we add drugs with interactions and adverse effects, it turns out that a very high percentage of people use inappropriate drugs, either because of the drug itself, because of the dose or because it has unaffordable risks. There are scales to look for inappropriate drugs; here we use the Stopp-Start, which is used throughout Europe. And the second is that you have to think in each case whether the medicine you take is in the necessary dose and, from time to time, you have to deprescribe, which means removing drugs that are no longer useful or are more dangerous.

You talk about the Stopp-Start criteria, but what exactly do they consist of?

They are an aid in detecting potentially inappropriate drugs. It involves a list of drugs that either have a better alternative or should not be used in certain settings. This way, the doctor can look at the treatment, check it against these criteria, and see if that potentially inappropriate drug is really appropriate for that patient or not. They are ways to help older people choose drugs wisely.

In your experience with patients, what are the most frequent problems in geriatric consultations associated with age?

The two most common are cognitive impairment, often mixed with depression, and the second, functional limitation, beginning to have difficulty taking care of yourself. Those are the two main reasons for consultation. And then, of course, many diseases. It is starting to not be unusual to see people who have many diseases and we have to think from the person instead of from the organ disease. Geriatricians focus on the person and see what weight each disease has in the development of that quality of life and we give importance to some over others to try to age a little better.