$Unique_ID{BRK01758} $Pretitle{} $Title{Aging--Learn to Enjoy the Inevitable, part I} $Subject{Aging old older ageism tired feeble confused silly indigestion constipation denture stains arthritis bladder incontinence vision eye eyes hearing knees joints PRESBYOPIA CATARACTS GLAUCOMA MACULAR DEGENERATION RETINAL DETACHMENT TINNITUS senility senile mental Alzheimer Alzheimer's disease multi-infarct dementia depression elderly Muscles ARTHRITIS Osteoporosis Digestion digestive Diverticulitis Diverticulosis diverticula Hemorrhoids MENOPAUSE BREAST CANCER PROSTATE cancers IMPOTENCE HEART ATTACK ARRHYTHMIAS ANGINA Medications medication age aged geriatric geriatrics collagen Uveitis} $Volume{Y-0} $Log{ Normal vs. Cataracted Eyes*0003101.scf Resource List*0174401.tid Contributing Factors to Osteoporosis*0005701.scf Osteoporosis*0005702.scf Cancer of the Prostate*0007601.scf Benign Hypertrophy of the Prostate*0007602.scf Diverticulosis*0010001.scf Diverticulitis*0010101.scf Pathology of Uveitis*0016201.scf} Copyright (c) 1991-92,1993 Health Update by Dr. Allan Bruckheim Aging--Learn to Enjoy the Inevitable, part I ------------------------------------------------------------------------------ Robert Browning wrote: "Grow old along with me! The best is yet to be, The last of life, for which the first was made." In just a few words, he summarized the idea that old age isn't the dim, dark, painful, fearful thing so many people think it will be. Growing older can be a fulfilling time, an age when you know what you want out of life but haven't stopped going out and getting it; an age when you have fond recollections and time to make more happy memories. Unfortunately, the subject is so full of myths that many people fear aging. We live in a society that practices "ageism," a prejudice against people based on their age. Advertisements make us believe that only young people enjoy themselves and have energy or sexual feelings. Old people, according to commercials, are tired, feeble, confused, silly and prone to indigestion, constipation, denture stains, arthritis and bladder incontinence. Admittedly, there is a small grain of truth in these myths. Although aging isn't a disease, getting older does mean more aches and pains and other changes in your body. YOUR vision may weaken; your hearing may be less acute; YOUR knees and other joints may start aching; you may slow down a bit. Very few people age without one or two physical problems, but the good news is that very few people get all of them. First, remember that you're not alone. The percentage of the American population over 65 is increasing as more people live longer. At the turn of the century, only 4 percent of Americans lived past age 65. Now, more than 12 percent of the population is older than that, and 40 years from now it will be more like 20 percent. It's important for you to understand the aging process, just as it was important for you to understand what was happening to your body when you went through puberty. Aging is inevitable. It's impossible to stop the flow of time and almost impossible to stop the effects of time's passage. But with a positive outlook, you can make Browning's words true for you: "The best is yet to be." It would be easy to define aging as the effects of a long life, but it isn't that simple. We all know of people like comedian George Burns, who is keeping a busy schedule of performances well into his 90's. Or producer George Abbott, who still works in the theater in his second century. Former congressman Hamilton Fish Sr. recently remarried, just a few months short of his 100th birthday. Yet, Rita Hayworth died of Alzheimer's disease at age 68. Why do some people get old so young, while others stay young so old? The answer is that we don't really know. Heredity is, to some extent, a factor. Someone once said that the best way to live a long healthy life is to pick parents who lived to healthy old ages. The trouble is, we don't get to pick our parents. While it's true that some of the infirmities of old age, such as impaired vision, hearing or arthritis, run in families, there is more to aging than your family tree. Different people age at different rates, but their problems will be similar. How well we take care of ourselves also can help us lead longer lives. People who smoke, are sedentary, eat and drink too much, generally don't live as long as people who keep their weight down, exercise regularly and don't smoke. Keeping active is the best advice on how to stay young. Activity helps both the mind and body. More people rust out than wear out. There is no simple explanation of aging, although there are several theories. These theories basically fall into two camps. One says that aging is related to how fast we live--that is, how fast our hearts beat, our lungs breathe and our metabolisms work--and that outside events, such as exposure to chemicals, accidents and plain wear and tear eventually wears us out. The other set of theories is based on the idea that aging and death are programmed into us and are an essential part of our lives, like growth and adolescence. These two groups of theories overlap a great deal, and both may be at least partly right. Both theories rest on the fact that throughout our lives our bodies reproduce and replace cells, the building blocks of human flesh. The genes, contained in a chemical called deoxyribonucleic acid, or DNA, in each cell's nucleus tell it how to create proteins and other chemicals and tell it when to split. Most cells in our bodies use the information in DNA to create replacements for themselves at regular intervals. Other cells, most notably nerve cells in the brain and nervous system, are meant to last a lifetime, and as they die off, they aren't replaced, although the remaining nerve cells do work harder. As we age, however, DNA is damaged through wear and tear, like a document copied too many times. Although the body can repair DNA--and does so regularly--it could be that the body slowly loses this ability and replacement cells aren't made as well as those created earlier in life. The chemicals, especially proteins, that receive faulty DNA instructions may be poorly made as well. A protein called collagen, which is an important component in skin and connective tissue, becomes less pliable with age and loses its ability to stretch and relax. Some researchers believe that unstable chemicals called free radicals, which are produced normally during metabolism, damage our bodies. This damage accumulates and eventually leads to the breakdown of individual cells and organs. On the other hand, other researchers believe that certain genes are switched off as we get older, in a predetermined pattern. They point out that different creatures have different life-spans that cannot be extended past a certain point. Mice live much shorter lives than people do, but parrots live longer. These researchers note that the maximum human life-span is probably in the range of 115-120 years. The oldest documented human life was 120 years, while longer life-spans for certain groups of people, notably those living in Soviet Georgia who are said to be in their 150's, are unsubstantiated. While either of these theories may be correct, the present fact is that more people are living to older ages than ever before. Research may not be able to extend our lives past a certain point, but it can help us improve the years we do have. The main goal of gerontology, the study of aging, is to let more of us age as well as we can with minimum disability. The problems that come with age follow certain patterns. As long as you're aging anyway--and we all will--it's best to understand as much about it as possible. The Senses One of the most frequently occurring disabilities of aging is sensory loss. Although people can lose portions of their vision, hearing, sense of taste or smell at any time during life, it commonly happens as we grow older. Partial loss of hearing and vision may occur with age due to lifelong activities--repeated exposure to loud noise can lead to hearing loss--or from certain disabilities.--diabetes can be a factor in certain types of vision problems. EYES Although many older people can read fine print and thread needles without glasses, others lose some vision as they age. Essentially, your eye is like a camera. Light comes in through the clear cornea in front, goes through the pupil and is focused by the lens, which is right behind the pupil. This focused picture is projected onto the retina that lines the back of the eye. The retina interprets the image into electrical messages sent to the brain by the optic nerve. If anything interferes with any of these steps, you can have impaired vision. You should have your eyes checked regularly by an ophthalmologist (a medical doctor who specializes in the eyes) or an optometrist (a nonmedical doctor who can examine eyes and fit you with glasses, but cannot treat medical diseases of the eye). If you have a family history of diabetes, have your eyes examined more frequently, since several eye conditions, notably cataracts, macular degeneration and retinal detachment, occur more frequently in diabetics. PRESBYOPIA: Probably the most common eye problem in older people, presbyopia is a problem of refraction, wherein it is difficult for the eye to focus on objects at nearer distances. A common symptom of presbyopia is holding a newspaper out at arms' length in an effort to focus on the print. In younger people, the lens of the eye is very flexible and can change shape slightly to bring objects at different distances into focus on the back of the eye, or retina. In presbyopia (which actually means aging eye), the lens loses some of its flexibility, and you may need glasses for close-up work such as reading or sewing. Presbyopia usually starts after age 40 and its treatment is simple: glasses. CATARACTS: A cataract is a clouding of the lens so that light doesn't pass though well. Instead of being like clear glass, a cataractous lens is like frosted glass. (The word cataract means "waterfall," because having a cataract on your lenses is comparable to seeing through a waterfall.) A cataract is neither a film over the eye, nor a growth within the eye. If the clouded area of your lens isn't in the center, but is off to one side, and isn't interfering with your vision, you can easily live with it. However, if a cataract keeps you from driving, reading or enjoying life the way you would like, consider having it removed. Surgery is the only way to treat cataracts and the whole lens is removed. No matter what you've heard, lasers cannot be used to treat cataracts, although they may be used during the surgical procedure or several months after surgery, if a complication sets in. For most people, cataract surgery is simple and is done on an outpatient basis. You go to the hospital, have the procedure done and go home the same day. There is little discomfort. Most people who have a cataract removed have a small plastic artificial lens (called an intraocular lens) implanted during the surgery. If an artificial lens isn't implanted, you will need special glasses or contact lenses after your surgery. Most people who develop a cataract that interferes with vision in one eye will develop one in the other eye. If you need cataract surgery in both eyes, the procedures will be scheduled a few weeks or months apart. GLAUCOMA: Two out of every 100 people over 35 years of age develop glaucoma, a serious eye condition. Glaucoma is a disease where the internal pressure of the eye increases, and if it isn't treated, can result in blindness. Part of the problem is that glaucoma has almost no symptoms. There is no pain and, frequently, the first symptom is a partial loss of vision. Normally, a fluid called aqueous humor flows from the back part of the eye, around the lens and into the front part of the eye and then back through a special drainage system around the edge of the iris. In glaucoma, this drainage system is partially or totally blocked, which means the pressure increases within the eye, leading eventually to damage to the optic nerve. The faults in the drainage system that cause the problem may be due to a congenital condition, to injury, to something clogging the system, or most commonly, to the narrowing of elements of the drainage system. Glaucoma is most commonly treated with prescription eye drops. These dilate the drainage system and allow the pressure to decrease. The eye drops do have some side effects, such as headaches or temporarily blurred vision. If your glaucoma progresses in spite of the medications, there are surgical procedures that your doctor may recommend, as well as laser treatments that may reopen the drainage system. Still, the first line of treatment is eye drops. MACULAR DEGENERATION AND RETINAL DETACHMENT: While problems such as presbyopia and cataracts are caused at the front of the eye, macular degeneration and retinal detachment are problems occurring with the back of the eye. The retina is a thin film lining at the back of the eve that receives images. The macula is the central area of the retina where the lens focuses the central part of an image. When you are looking at this page of print, the word you are reading now and a small area around it is being focused on your macula, while the rest of the page is hitting the rest of your retina. About 70 percent of cases of macular degeneration are caused by aging, with the rest caused by disease, infection or accident. In macular degeneration, when the macula breaks down, your central vision becomes blurry. If you are looking at a page of print, the edges of the page are clear, but the center is fuzzy, missing completely as if something were blocking your view, or distorted and wavy. If only one eye is affected, you may not even notice you have a problem, but if both maculas degenerate, you may have a great deal of difficulty in reading or doing close-up work. A good eye examination will detect macular degeneration early. However, for the type of macular degeneration that occurs with age, there is little that can be done. Ophthalmologists are using lasers to help stop the spread of macular degeneration that is caused by disease, but this treatment does not help the more common age-induced macular degeneration. Retinal detachment occurs when the entire retina, or parts of it, comes lose from the back of the eye. Retinal detachment can happen quite suddenly. Vision can be suddenly clouded or completely lost. If this happens, see your doctor or go to an emergency room immediately. There are ways to reattach a detached retina either with surgery or using a laser. These procedures can return some or most of your vision. Most people experience tiny black spots or specks that float through their vision. Commonly called floaters, these are usually harmless and most people learn to ignore them. If, however, you notice a sudden increase in their number, or if they are accompanied by flashes of light, an examination is in order, since this could be a sign of retinal detachment. LOW VISION AIDS: If you should experience some loss of vision, don't despair; there are several ways for you to cope and continue to live independently. Your ophthalmologist or optometrist can fit you with special glasses that will make the most of what vision you have. He or she will also refer you to therapists who can train you to use optical aids. These include special hand-held lenses, prisms or mirrors, and even televisions and computers that magnify the picture. Other helpful aids include large-print books and magazines, needle threaders, and even telephones and calculators with larger, easier to see characters on them. Many magazines are printed in large type, and local libraries often have a selection of large-print books. Many books are now widely available on audio tape for listening, which can be a great joy for someone who no longer can read easily. EARS Hearing loss is something many older people refuse to acknowledge, yet it is one of the most common results of aging. About 30 percent of all people between the ages of 65 and 74 have some degree of hearing loss and that percentage increases to 50 percent of all those over age 75. Refusal to admit that you have lost some hearing can limit your social life, frustrate your ability to communicate and be downright dangerous if you aren't able to hear something like a fire alarm. You may also become depressed and unresponsive. Unfortunately, hearing loss in the elderly can be misdiagnosed as mental confusion. Aging can affect hearing in several ways. Normally, your outer ear, collects sound and channels it into the ear canal to the ear drum. The ear drum vibrates when the sound hits it and three tiny bones in the middle ear conduct the sound into the cochlea, in the inner ear, where it vibrates tiny hairs that translate the sound into nerve impulses that go to the brain. Anything affecting how sound goes from the outer ear through to the tiny bones--a middle ear infection, wax buildup, a punctured eardrum--is called a conductive hearing loss. There are several medical or surgical ways to treat and reverse a conductive hearing loss. If the problem is in the cochlea, it is a sensorineural hearing loss, and this is where most problems caused by age occur. The bad news is that there aren't too many ways of treating this kind of hearing loss, which is also called nerve deafness. When nerve deafness is caused by aging, it is called presbycusis. Essentially, in nerve deafness, the tiny hairs of the cochlea have started to deteriorate and the body cannot regenerate them. These tiny cells are also damaged or destroyed by prolonged exposure to loud noise, such as years of working with a jackhammer or living near an airport. There are several warning signs to look for if you think you are losing your hearing. Do people around you seem to be mumbling? Do you have trouble understanding spoken words or a telephone conversation? Do you hear a ringing or hissing sound continually? Does your family tell you that you play the radio or television too loudly? Do you not hear common household sounds such as a faucet dripping or your doorbell? These are all symptoms of hearing loss and you should take them seriously. You can learn to cope with your loss of hearing first by acknowledging it. Let people know that you don't hear well and if you don't understand what they have said, ask them to repeat it. Many people who have lost some hearing get into the habit of nodding while listening, even if they haven't caught all of the conversation. This is a bad habit, because it gives the speaker the impression that you understood what they said. HEARING AIDS: Hearing aids can help many people who have suffered some hearing loss. They won't make you hear perfectly, but they can help. Don't be ashamed to get a hearing aid. No one is ashamed to get glasses, so think of them as glasses for your ears. Remember also that you may have to try out one or two hearing aids before you get one that suits you. There are basically five kinds of hearing aids, ranging from tiny ones that fit completely into the ear canal to large ones for severe hearing loss that are worn in a shirt pocket. All hearing aids consist of a microphone to pick up sounds, an amplifier to make the sound louder, a miniature receiver to deliver the louder sound into the ear, and batteries to power the whole thing. The size and type of hearing aid you get depends on how severe your hearing loss is, what kind of hearing loss you have and what type of hearing aid you can handle easily. In addition to assistive devices, consider buying a caption decoder for your television, which puts dialogue in print at the bottom of the screen. Many live and taped television shows are closed-captioned and this device can increase your viewing pleasure. TINNITUS: Tinnitus is a ringing in the ears, when your ears are hearing sounds that don't really exist. Ringing in the ear can be perceived as a constant hum, a buzz or a ringing sound that can be intermittent or constant. This can be one symptom of hearing loss, or it can occur in people who otherwise hear normally. If you suffer from tinnitus, have your ears and your hearing checked. In some cases, the apparent noise is caused by a wax plug in the ear canal, a buildup of fluid in the middle ear, high or low blood pressure, or a hole in the ear drum. These conditions can be taken care of and your tinnitus may be relieved. Tinnitus may also be a side effect of taking aspirin, but this usually occurs only when high doses are needed to treat arthritis pain. The most common cause of tinnitus is damage to the auditory nerve itself and this cannot be cured. Nerve damage that leads to tinnitus in the elderly is often due to aging, but it can be aggravated by constant exposure to loud noise. Even though your tinnitus may be untreatable, you can learn to cope with it. Because the hissing and ringing seem worse when you are in a quiet place, playing a radio softly in the background helps mask the noise. For some people, getting a hearing aid helps their tinnitus, although why this works is unknown. TASTE AND SMELL Many older people lose a portion of their ability to taste and smell. Although such a loss isn't as disabling as the loss of vision or hearing, it can interfere with eating and enjoyment of your surroundings. The loss of taste or smell, which often go hand in hand, may show up first as a lack of interest in food. Nothing may taste right; everything but highly seasoned food may taste bland. This could lead to a loss of appetite and eventual malnutrition. If you suspect you have lost part of your sense of taste or smell, see your physician for a complete physical. There are some reversible causes for these sensory losses, including medications to clear up sinus infections and head colds. The Nervous System Perhaps one of the greatest fears that people have about growing older is senility, the loss of one's mental capabilities with the passage of years. This fear is unfounded. Senility isn't an inevitable part of growing older. Indeed, people don't lose their power to think and remember without a physical reason, which is why senility is really a bad word. A better word is dementia ("deprived of mind"), which is a blanket term for any impairment of intellectual function. Meanwhile, we're learning more about Alzheimer's disease and multi-infarct dementia, two conditions that cause the loss of mental function and for which there are few treatments. Many people who are diagnosed as being senile are actually suffering from overmedication or poor medication combinations, depression, undetected hearing loss, hypothermia, drug or alcohol abuse, or any of several conditions that can be treated. Many cases of dementia can be reversed once their cause is properly diagnosed. ALZHEIMER'S DISEASE Perhaps there is no disease as merciless as Alzheimer's. A person in the final stages of Alzheimer's loses his or her memory and personality. The family must cope with the gradual fading away of their loved one while the body still lives. It is estimated that between 2.5 million and 3 million Americans have this disease, which means as many as one in 10 of all people over 65 years old. Alzheimer's causes a variety of physical, psychological and emotional changes. It can start as mild forgetfulness and episodes of confusion. Often, affected people will suddenly not know how to do something they have done all their lives, such as read music or find the way to a local store. If Alzheimer's, or any other dementia, is suspected, the patient should undergo a complete physical and psychological examination to rule out any other problems. Alzheimer's is a disease that causes changes within the brain. When bits of brain tissue from an Alzheimer's patient are examined under the microscope, researchers can see dead nerve cells and tangles of nerve fibers and plaques in greater amounts than in healthy older brain tissue. Unfortunately, no physician can be certain of the diagnosis of this disease until after the patient has died and this brain tissue can be examined. Generally, people with severe effects of the disease show more plaques and tangles in their brain tissue. The cause of Alzheimer's disease is still uncertain. It does tend to run in families, and there is evidence of a genetic link. Some evidence points to an infectious agent, such as a slow virus that takes many years to develop. There is no cure for Alzheimer's. Treatment consists of keeping the patient as comfortable as possible. Medications can be used to keep the patient from becoming agitated or anxious. The progress of Alzheimer's can be slowed by keeping the patient stimulated and active, so that the patient is using as much of the brain as possible. Overprotection actually may provoke babylike behavior. Until the disease is advanced and the patient is institutionalized, the burden of caring for an Alzheimer's patient can be a great emotional and physical strain on the family. There are self-help groups and home-nursing services that can help the family cope. Some social service agencies run programs where groups of Alzheimer's patients meet to exercise, undergo some training, and socialize--which gives them stimulation and their family members a needed "day off." MULTI-INFARCT DEMENTIA After Alzheimer's disease, the second leading cause of dementia in the elderly is due to problems with the circulation of blood to the brain. The brain needs a constant flow of oxygenated blood. Any interruption in that blood flow can cause parts of the brain to infarct or die from lack of oxygen. This interruption may be caused by a blood clot or a burst blood vessel, creating a stroke. If the affected blood vessel is a major one, the effects can be sudden and dramatic, even mortal. Small strokes, on the other hand, frequently occur and leave milder symptoms, such as slurring of words or numbness in a hand. If a series of small strokes occur, the chances are great that the person will lose some intellectual capability and decline physically. Multi-infarct dementia accounts for between 12 percent and 20 percent of all cases of dementia in the elderly. A combination of Alzheimer's and multi-farct dementia causes an estimated 20 percent of all cases of dementia in people over age 65. Patients with multi-infarct dementia usually have a history of cardiovascular disease, such as high blood pressure. Alzheimer's and multi-infarct dementia are different in the way they progress. Alzheimer's progresses gradually, but steadily. A patient with multi-infarct dementia loses mental function only with each new infarct, and so there is a loss of function followed by a period of stability, until suddenly another loss of function occurs. Frequently, the infarcts will occur in the same area of the brain, so a patient may eventually lose the ability to move one side of the body or communications skills. As with Alzheimer's disease, the patient should be kept as stimulated as possible. DEPRESSION You may be surprised to see depression listed as a mental condition of the elderly, but this problem can be devastating for older people. Depression is a term used to describe a broad category of mood disorders. It's more than just being down in the dumps or feeling blue. When a person is always sad and pleasurable activities such as friends, hobbies, and even food and sex, lose their attraction, a depression may be the cause. The sadness that comes with a loss, such as the death of a spouse, usually lessens with time. This is called reactive depression, for it is a reaction to a life event. The depression of the elderly is an endogenous depression (coming from within) that either comes on for no specific reason or lingers long after a loss, when reactive depression would have passed. Of course, depression can happen to anyone at any age, but often it goes undiagnosed in the elderly. As many as one in seven elderly people being treated for other conditions suffer from depression as well. Part of the problem with depression among the elderly is that older people don't seek psychiatric help as willingly as younger people do. This may be due to several reasons, such as a fear that seeking counseling will label them as mentally ill, or merely because they don't know how to seek help. Depression can be a side effect of another medical disorder, or of medications used to treat other diseases. People who have other medical conditions are also more likely to be depressed. If you are depressed in addition to being ill, speak to your doctor about it. There are several symptoms of depression, including irritability or sadness, loss of interest or pleasure in favorite activities, feelings of worthlessness or guilt, lack of concentration and inability to make decisions, recurrent thoughts of suicide and death, loss of sex drive, agitation, changes in sleeping patterns, fatigue and loss of energy, and changes in appetite. In the elderly, some of these symptoms may mimic those of dementia, which makes diagnosis difficult. Depression can be deadly. Although we hear more about teenage suicide, older people commit suicide also--and the main reason is depression. If you are depressed, don't ignore it. If someone around you is depressed, telling them to "snap out of it" won't help. Professional counseling and treatment is the best way to deal with depression. The good news is that depression is among the easiest to treat of all psychological conditions. There are several medications your physician can prescribe that can help relieve endogenous depression. (Reactive depression is generally not relieved by drugs.) Antidepressant medications may take some time, up to a few weeks to take effect, but they do help most people. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.