Cities nestled among breathtaking mountains with moderate year-round temperatures have begun to replace sunny beach towns as preferred retirement destinations. Last year, Colorado made the top three in a list of best retirement states.
But aging at altitude raises the stakes. For certain people, it can prolong life, but if it were really that simple, senior care centers would be fighting for real estate in Hinsdale and Lake counties. Spoiler alert: they aren't.
Altitude can protect against heart disease but can also damage the lungs and aggravate pre-existing conditions. And those who have not lived at high altitude long-term may want to think twice before retiring in mountain towns.
When studying age and altitude, there are a number of different factors and types of people to consider. Let's look at each of them.
The visitor
If you’ve recently moved to Colorado or visited for a couple of weeks, you may already be familiar with acute mountain sickness (AMS). Headache, nausea, shortness of breath and sleeplessness are some of the symptoms to which even the healthiest, most physically fit individuals can succumb.
But as people age, they are less prone to acute mountain sickness, according to Dr. Benjamin Honigman, professor of emergency medicine at the University of Colorado School of Medicine and director of the Altitude Medicine Clinic. There isn’t a wealth of research regarding this adaptation, though trail guides, doctors and researchers have noticed that, anecdotally, older people are more resistant to AMS, assuming they have no other health issues.
Next up: the long-stay visitor
Colorado Springs made Forbes’ list of top 25 cities for retirement in 2015 and 2016. The ranking was determined by a series of calculations, based on taxes, unemployment rate and property values -- it’s no wonder Denver did not make the list. Colorado’s beautiful weather, recreational activities and Gallup-healthways index rating earned it third place on a Bankrate list of best retirement states.
According to Honigman, however, moving to altitude to retire may not be the best choice for everyone. With aging come a series of natural processes: Muscles, including the heart, lose strength, arteries thicken and lungs stiffen, among others.
"Because of that aging process, even if you took a normal, older individual that doesn’t have underlying health problems and had them live at altitude of eight or nine thousand feet -- Summit County, for example -- some of them do a lot worse," Honigman said.
This is due to the conditions inherent with high-altitude living. There is a misconception out there that higher altitude air contains less oxygen. In reality, due to lower atmospheric pressure, there is less pressure driving oxygen into the lungs, effectively making less oxygen available, Honigman said. The lack of oxygen combined with natural aging can make the aging process more difficult to adjust to.
And a certain subset of people will develop pulmonary hypertension, even if they were completely healthy at a lower altitude. With pulmonary hypertension, the arteries that supply blood to the lungs grow tighter, reducing performance and raising blood pressure. This condition is usually reversible upon returning to lower altitude.
A Hypoxia Altitude Simulation Test can be administered to determine if an individual may be susceptible to pulmonary hypertension. The test requires that test subjects run or walk on a treadmill while breathing a low oxygen gas mixture, according to a 2008 study published in CHEST. If the subject exhibits symptoms during the test, it is likely they will develop pulmonary hypertension at altitude. Honigman emphasized that these tests are not 100 percent accurate.
And lastly, the native
A 2006 study published in PLoS named seven counties in Colorado among the places with the longest life expectancy in the country. What do Clear Creek, Eagle, Gilpin, Grand, Jackson, Park and Summit have in common? Altitude, for one.
Aging at high altitude can prolong life and provide a host of other benefits, but only for those accustomed to the conditions, such as long-time residents or natives.
According to the CDC, heart disease causes one in four deaths in the United States every year. It affects men and women indiscriminately. Long-time altitude living can reduce the odds.
First off: body mass. In 2015, Colorado had a 19.8 percent obesity rate, the second lowest in the country, according to Gallup-healthways. Colorado’s active, it’s true, but there are other factors at play here.
Populations living at low altitude were approximately five times as likely to be obese than their high altitude counterparts, a 2013 study published in Nature showed. Another study associated reduced oxygen intake with appetite suppression and increased metabolism -- for long-time altitude residents and newbies, alike. Healthy body mass comes, of course, with a number of benefits, including reduced risk of type 2 diabetes and, yes, of heart disease.
Low available oxygen at high altitude affects the heart by encouraging the growth of new blood vessels, said Dr. Peter Hackett of the Institute for Altitude Medicine. These additional vessels serve as back-up pathways for circulation thereby reducing the incidence of heart attacks.
Respiratory diseases, on the other hand, are more prevalent at high altitudes, according to a study published in Clinical Infectious Diseases. Low available oxygen combined with tendency toward dehydration don't make for the best lung health, and those with pre-existing lung disease are advised to avoid high altitude travel.
There aren't a whole lot of senior care centers at altitude.
Actually, almost none, Honigman said. Due in part to the complexities surrounding age and altitude, senior care facilities are not routinely located in high-altitude counties. That will change this fall. Sort of.
Augustana Care, an Evergreen-based nonprofit, will open Castle Peak Senior Life and Rehabilitation in Eagle County. The website boasts assisted living apartments, short-term rehab, long-term nursing and Alzheimer's and dementia care -- all at the breezy altitude of 6,483 feet.
Although Castle Peak's elevation falls below the 8,000-foot "high altitude" demarcation, Honigman says researchers don't really know enough to determine at what point altitude begins to impact health.
"People are concerned about how altitude might affect things like the tendency to Alzheimer's -- it just hasn’t been studied -- that’s a huge area of research," he said.
Castle Peak representatives did not respond to repeated requests for comment about resident health pre-screening procedures or altitude-specific care.
The facility will open in fall 2016 and offer boarding for 68 residents.
Multimedia business & healthcare reporter Chloe Aiello can be reached via email at [email protected] or twitter.com/chlobo_ilo.
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