$Unique_ID{BRK01759} $Pretitle{} $Title{Aging--Learn to Enjoy the Inevitable, part II} $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 II ------------------------------------------------------------------------------ The Joints and Muscles How much your body is affected by old age depends on you. It depends on how you spent your youth, or misspent it, and whether you have kept active. Although conditions such as osteoporosis and osteoarthritis increase in incidence as we grow older, they are less severe in people who keep active and exercise regularly. The joints and muscles of our bodies can be compared with door hinges. A door that is opened infrequently creaks and complains and may even have rusted shut. A door used every day opens easily. Remember that the phrase "use it or lose it" applies when it comes to your muscles and joints. Exercise in moderation, but if a choice is to be made, it's probably better for you to do more than to do too little. ARTHRITIS The pain in joints that comes with age is usually a sign of osteoarthritis, the "wear and tear" arthritis that is partially the effect of years of use. Osteoarthritis usually hits matching sets of joints, both your knees, your hips, your fingers, in a symmetrical fashion, rather than one hand alone, and there is no swelling or feeling of heat in the affected joints. If you have a lot of pain, or if there is swelling, it is likely that another process is involved, and that a new diagnosis is needed. Osteoarthritis is a chronic disease. While over-the-counter pain preparations may be sufficient to control the pain and discomfort, managing all these medications may become quite involved, so professional guidance and advice is a must. Even though osteoarthritis is due to wear and tear, you should exercise, to maintain the flexibility and action of the involved joints. Moderate exercise will improve your muscle tone so that some of the strain is taken off your joints. If you're overweight, you're straining your joints more than necessary. Losing a few pounds may be the best thing you can do, and increasing your level of exercise is one way to do it. Arthritis sufferers are always on the lookout for some new or magic cure to relieve their pain and discomfort. There are many unscrupulous individuals who prey on the uninformed. Your only defense is to rely on well-known sources of information, including the counsel of your family doctor, to make the appropriate decisions. OSTEOPOROSIS Osteoporosis is the thinning and weakening of bones due to calcium loss caused by the reduced levels of estrogen and activity. Although we think of it as a problem that generally affects women, it also occurs in men, although to a lesser degree over a longer period of time. Women are affected by osteoporosis more because they have less bone mass, and when the bones thin, they become much more fragile. Thin, petite, fair-skinned women who smoke and don't exercise are more at risk than other women, since their bones are small to start with. One out of four white women over age 65 develops osteoporosis. Severe osteoporosis can result in hips so fragile that they break if you turn rapidly, or vertebrae that start to collapse into themselves, reducing height and even causing breathing problems as the rib cage slowly caves in on itself. Prevention is the best approach to osteoporosis. Regular exercise and a diet rich in calcium help build strong muscles and bones. Bone mass is at its greatest around age 35, so preventing osteoporosis should start early. Some physicians recommend estrogen replacement therapy to prevent osteoporosis in women who are at greater risk of developing it. This may mean taking estrogen, either orally or by wearing a skin patch, for the rest of your life. Digestion Have you ever noticed how most of the people in advertisements for laxatives and antacids are older? While poor digestion can happen to anyone, it is true that digestive problems may increase with age. The digestive system may start working less efficiently as the years pass. In addition, changes in lifestyle, such as reduced activity and changed eating habits, can have major effects on digestion. Poor digestion can be helped simply by eating a better diet; adding vegetables and grains to meals and reducing fat content. Some people may need to eliminate certain foods from their diet, particularly those that provoke discomfort. Exercise can help a great deal in keeping the digestive system working well. INDIGESTION Digestion is one of those activities that you don't notice as long as everything is working fine. Indigestion is pretty much any digestion that you notice; it can include heartburn, nausea, vomiting, stomach pain, cramps, diarrhea, excessive flatulence, bloating or early fullness. Simple indigestion isn't usually a serious problem; we all have some of these symptoms occasionally, especially after too much pepperoni pizza. But the same symptoms may indicate an intestinal virus, emotional distress, or blockages of the intestine; if the problem persists beyond a few days, you should consult a doctor to rule out a more serious condition. Some cases of indigestion are caused by disturbances in the rhythm of the intestinal system. The thin muscular walls of the stomach, small and large intestines contract and relax to more food through the system as it is being digested. These movements are controlled both by the nervous system and by hormones. Anything that interferes with either of these controls can interfere with digestion. Some older people are plagued by digestive gas problems, and frequently belch or pass gas, or suffer gas pains. Although gas is a by-product of digestion, the most common source of gas in the intestines is swallowed air. People swallow air inadvertently by eating too rapidly or because of poorly fitting dentures. Drinking a lot of carbonated beverages is also a factor. Certain foods, such as beans, cabbage, bran and broccoli, are also leading offenders in gas production. Eating slowly and chewing food well can help reduce gas problems. CONSTIPATION Constipation is a digestive problem, but you may be surprised at what it is and what it isn't. Constipation is the infrequent and difficult passage of stool. Some people normally have a bowel movement not daily, but every second or third day; this is normal for them, and not a sign of constipation, unless there is also difficulty in the passage. There are several causes for constipation: poor diet, insufficient intake of fluids and lack of exercise are the leading causes, and the ones most easy to remedy. Regular moderate exercise appears to help constipation by stimulating intestinal activity. Drinking fluids does this also, as it adds water to the intestinal contents. The most important "cure" for constipation is also its prevention: a diet rich in roughage or fiber. Fiber-rich foods include vegetables, whole grains and fruits. Easy ways to add fiber to the diet include switching to whole-wheat bread, brown rice and eating fruit instead of drinking fruit juice. DIVERTICULOSIS AND DIVERTICULITIS Another digestive condition that occurs more frequently with age is diverticulosis. In some people, parts of the walls of the large intestine weaken slightly and pouches (or diverticula) form. Diverticulosis is the presence of these pouches. If the diverticula become inflamed or infected, that is diverticulitis. The symptoms of diverticulosis include pain in the abdomen (usually on the left side), bloating, alternating diarrhea and constipation, and vomiting. Diverticulitis has the same symptoms, plus a fever. Diverticulosis appears to occur because of increased pressure in the intestines. This pressure increase can be due to constipation or use of stimulant laxatives. Diverticulitis occurs when bacteria in the intestinal system enter small perforations in the diverticula, creating abscesses. The abscesses may heal by themselves, but sometimes the infection can spread throughout the abdominal cavity. In severe cases, surgery may become necessary to remove the inflamed portion of bowel. Diverticulosis is managed with a diet high in fiber. This reduces pressure within the intestines as it speeds food through and makes passage of stool easier. Constipation should be avoided, so drinking plenty of fluids and exercise are advisable. Gas-producing foods, such as cabbage, cauliflower and carbonated drinks should be avoided, because excess gas in the intestines increases pressure. HEMORRHOIDS Hemorrhoids, while inconvenient and uncomfortable, fortunately aren't very serious. They are actually an inflammation of the veins found just inside and outside the anus. Internal hemorrhoids can prolapse, or protrude through the anus, while external hemorrhoids can become painfully clotted. Either kind may bleed. The most common cause of hemorrhoids is straining during bowel movements. Increased abdominal pressure, due to pregnancy or obesity, can also cause hemorrhoids. Another factor may be spending too much time sitting on the toilet, which allows the veins to fill with blood. The most common treatment for external hemorrhoids is conservative: a warm sitz bath and stool softeners to ease bowel movements. Your physician may remove a clotted external hemorrhoid if it is caught early. Internal hemorrhoids are removed surgically if they prolapse. This is a simple office procedure, in most cases. Prevention is the best treatment for hemorrhoids. Exercise regularly, eat a balanced diet and drink plenty of fluids to avoid constipation and difficult bowel movements. Women and Aging It has been said that women get the small piece of the pie when it comes to getting older. In our society men are considered mature and distinguished in their middle and later years; women, it is said, just get old. This is hogwash. MENOPAUSE Women age a bit differently from men. Rather than a gradual change here and there, a woman's body goes through menopause, the changes associated with the shutdown of her ovaries. The ovaries have been working since puberty, emitting an egg once a month and making the female hormones estrogen and progesterone. These two hormones made the uterus build up a special lining of blood and tissue once a month to accept a fertilized egg. If fertilization does not occur, this lining is released from the uterus as menstruation. Menopause is essentially the cessation of menstruation. At one time, a woman's life expectancy was such that few survived more than a few years beyond menopause. Today, the average life-span for women is in the mid-70's, while average age at menopause is in the mid-50's. A woman can live a quarter to a third of her life after menopause. The ovaries stop producing eggs during menopause, but it's not a sudden halt. Although menstruation may have become irregular, the ovaries may still produce a few eggs and may continue to do so for months after menstruation has stopped. It isn't completely unusual for a woman to have a "change of life" baby. For this reason, contraception should be continued for at least a year after your last period. Hot flashes and night sweats--which are actually the same thing--occur because the decreased estrogen allows capillaries in the skin to open up suddenly. You may feel very hot, sweat and blush for a few minutes a few times a month. Similarly, before your body is acclimated to the new levels of estrogen, your heart may flutter for a few minutes every now and then. If these episodes are bothersome, a physician should be consulted. The wide-ranging effects of menopause may include weight gain, aches and stiffness, wrinkling, and vaginal dryness and atrophy. You may gain weight because your body needs less food after menopause, and you may retain water more easily. Stiffness and wrinkles are caused by a loss of elasticity in the body tissues that results from the estrogen decrease. Estrogen also keeps the walls of the vagina thick and moist, which means that after menopause you may have some discomfort during intercourse and be more prone to vaginal infections. If hot flashes or vaginal atrophy are causing you problems, your physician may prescribe either estrogen supplements or vaginal creams that contain estrogen. Taking estrogen supplements won't reverse menopause and they could increase your risk for endometrial cancer. Your doctor will discuss the pros and cons of estrogen supplement with you before you decide whether to take it. BREAST CANCER Being over age 50 means that you are at greater risk for developing breast cancer. One in 11 women will develop breast cancer at some point in her life. If your mother, sister or aunt has had the disease, this increases your risk. We still don't know what causes breast cancer, but we do know that the earlier it's caught, the easier it is to treat. A professional examination is recommended each year, but you should examine your own breasts once a month. Your physician will show you how. After age 50, the National Cancer Institute recommends having a mammography done every year. Men and Aging With men, aging does not cause the relatively sudden changes that women experience with menopause. The effects of aging may be gradual but they are pretty much inevitable. THE PROSTATE One of the most common effects of aging in men is enlargement of the prostate gland. The prostate gland is about the size and shape of a chestnut and is located at the bottom of the bladder. The urethra, the tube from the bladder to the outside passes through it. In about half of all men past age 50, the prostate enlarges. The enlargement itself isn't a problem, but it can cause more frequent urination or difficulty in urination. If the enlargement begins to block the urethra, surgery may be necessary. This operation removes all or part of the prostate using a tube that is passed down the penis. The procedure may impair the ability to ejaculate and can cause impotence in a certain number of cases, but most men have no problem with their sexual functioning. Sometimes the prostate may become infected or inflamed. As with other infections, you may have a fever, chills and pain. Prostatitis is usually treated with antibiotics and is generally not serious unless it recurs frequently. Prostate cancer, however, is very serious. After lung cancer, it is the second most common cancer among men. It is usually detected during a rectal exam, which is why such exams, although unpleasant, are necessary. The earlier prostate cancer is caught, the easier it is to treat and beat. The normal treatment for prostate cancer is removal of the prostate, which sometimes results in impotence. Prostate cancer that has spread to other organs grows faster in the presence of the male hormone testosterone. Some patients must undergo removal of the testicles or estrogen therapy in order to treat advanced cases of prostate cancer. IMPOTENCE One of the greatest fears about aging that men have is that they'll become impotent and their sex lives will be over. One in every 10 American men suffers from continuing or chronic impotence. The causes for impotence can be divided into two categories, psychological and physical. At one time, it was thought that most cases of impotence were caused by psychological stress: worry, anger, frustration and performance anxiety. Now, with better diagnostic methods, researchers have discovered that more than half of all impotence is due to physical problems. To determine whether the impotence is caused by physical or psychological reasons, a complete physical examination and several other medical tests are necessary. One test involves monitoring for nocturnal erections that normally occur in healthy men while they sleep. If erections occur, then it is probable that the cause of impotence is psychological. If the erections don't occur, physical problems probably exist. An erection depends on several factors. The penis enlarges and becomes firm when blood fills two chambers that run its length. The blood must flow in and stay there, and then flows out after the sexual urge passes. All of the elements in this complex system must work for proper function. There are several physical causes for impotence. The arteries that supply the penis with blood are about the same size as the coronary arteries. It should come as no surprise that if the coronary arteries are blocked or thickened, the same condition may be affecting the penile arteries, which could cause impotence. Diabetes, chronic kidney disease and other conditions can also impair these arteries. In addition, drug abuse, alcoholism and certain medications (notably high blood pressure and antidepressant drugs) can adversely affect the nervous system and/or the hormones governing erection. For some of these physical causes, the cure is relatively easy: stop abusing drugs or alcohol, or talk to your doctor about changing medications. Some hormonal causes for impotence can be treated with medications. For physical impotence that cannot be so treated, a penile implant may be considered--a device surgically implanted into the penis that allows a man to have an erection. Psychological impotence often can be treated with professional counseling, which also can be important in treating physical impotence. Remember: A strong, loving relationship depends far more on how your emotions and mind function, than on how a body part functions. Sexuality Sex is an important part of life that age may gradually change. Our youth-oriented society tends to view sexual relationships as the territory of the young and ignores or derides the sexual functioning of older people. Many women once saw menopause as the end of their sexual functioning and some men assumed that after a certain age their genitals would cease to function. Both of these ideas are silly myths. Most older people have satisfying sexual relationships until the end of their lives. This does not mean that an older man has the sexual stamina he had when he was 18, nor does it mean that a woman's sexual response is exactly the same. Men may take longer to achieve an erection. Women generally have less flexibility and lubrication in their vagina. Some disabilities may interfere with a fulfilling sexual life, but that doesn't mean these problems cannot be overcome. If arthritis makes certain sexual positions uncomfortable, try others. A heart attack may mean that sex should be curtailed during the recovery period, but it can usually be safely resumed after several weeks, depending on your doctor's advice. Heart attacks rarely occur during sexual activity, so put this worry from your mind. Essentially, you should think of sex as a healthy, normal part of your life, whatever your age. Your Heart Heart disease is the No. 1 killer in the United States, with all forms of cancer coming in second. Older people are at greater risk for heart attacks, strokes and high blood pressure. In general, it isn't so much the added years that increase the risk, as the way those years have been spent. We are a nation of who smoke, eat too much fat and salt, and get too little exercise. The years of mistreating your heart add up. This may sound like a broken record, but eating a low-fat, high-fiber diet, exercising regularly and not smoking are the keys to a healthy heart. There is no getting around it. HEART ATTACK About two out of three deaths from heart disease are due to heart attacks. A heart attack occurs when the blood vessels (the coronary arteries) that supply blood to the heart muscles become blocked with cholesterol deposits or stiffen up. These arteries can be up to 75 percent blocked before symptoms such as chest pain occur, which means that the first sign of coronary artery disease can be sudden death. Most heart attack victims are men because the female hormone estrogen apparently has a protective effect. But after menopause, the decrease in estrogen means that older women run the same risk of heart attack as men. The symptoms of a heart attack include chest pain, weight or pressure on the chest, pain in the upper arms, weakness and shortness of breath. If you think you might be having a heart attack, don't think twice. Go to the hospital immediately. Some people who have blocked coronary arteries are good candidates for coronary bypass operations. In this procedure, a surgeon uses pieces of vein from the legs or artificial grafts to bypass the blocked coronary arteries and bring blood to the muscles of the heart. ARRHYTHMIAS For some people, the problem may not be blockage of the arteries but disturbances in the rhythm of the heart's pumping action. The heart synchronizes its pumping through a tiny system of electrical pulses. If the system goes awry, the heart may beat too fast, too slowly, or without a rhythm, any of which is called arrhythmia. Disturbances in rhythm may occur after a heart attack if parts of the heart involved in that electrical system are damaged. To overcome a poorly functioning electrical system, cardiologists can insert a pacemaker, a tiny, battery-powered device that artificially causes the heart to beat in the correct rhythm. The pacemaker is placed in a pouch of the skin over the chest and is connected to one or two wires that are threaded through a blood vessel into the heart. ANGINA The chest pain that accompanies certain heart conditions is called angina. It is caused by a partial blockage or narrowing of the coronary arteries that results in too little blood reaching the muscles of the heart, reducing the amount of oxygen necessary for their proper contraction. This narrowing can be due to clogging by cholesterol deposits or by spasms of the artery walls. Angina may come and go for years without getting worse or it can presage a heart attack. Some people's angina is worse when they exert themselves or are in a stressful situation, while others have pain for no reason. In general, being overweight, having high blood pressure, smoking and not getting enough exercise are all risk factors for angina. Your physician may prescribe medications for your angina. Some are pills that are taken at regular intervals or patches that must be worn, while others are preparations that are used when you have the chest pain. HIGH BLOOD PRESSURE High blood pressure is a risk factor in heart disease and stroke. Like an overfilled balloon, too much pressure placed on the blood vessels could cause them to burst. Burst blood vessels can destroy vision, result in brain damage or even cause death, depending on whether they occur in the eye, the skull or the heart. High blood pressure, or hypertension, is a risk factor for many diseases, but has few symptoms by itself. The only way you may find out you have it is by regularly having your blood pressure monitored. If you have high blood pressure, cutting down on the amount of salt in foods you eat, losing weight and getting regular exercise may help. If your physician prescribes medication for your high blood pressure, take it regularly, no matter how you feel. If you are bothered by side effects, talk to your doctor before stopping your medication. Your Medications Older people take more medicine than any other sector of our society. Medicines are a great boon, but they can be misused and abused. No drug works absolutely the same for everyone every single time. Sometimes drugs have side effects and cause adverse reactions. When we speak of drugs, or of life in general, there is no such thing as complete safety. Because older people receive more prescriptions, and because their eyesight and hearing may be diminished, they are more apt to become confused about what drugs they are taking and when they should be taken. In addition, they may be receiving prescriptions from several health professionals, who may not know what the others are prescribing. These medications could interact with each other, or even with foods, producing effects that could be dangerous or deadly. You can avoid many of these problems. Know what drugs you are taking. Never take any medication without asking questions. Ask your physician what the name of the drug is, what it is supposed to do and why you need it. Ask how long it will be before the drug takes effect. Ask how often you must take the medicine and what side effects will occur. Make sure your doctor knows what other medications you are taking. If possible, always go to the same pharmacist to fill a prescription, so that a record of all your prescriptions exists. Make sure you understand when you have to take a medication and for how long. If an antibiotic should be taken for 10 days, do it. This ensures that the infection is truly gone. If your medication is to be taken every six hours, ask whether it is necessary to get up in the middle of the night. And never, under any circumstances, share your medications with other people or take someone else's prescription. All medications have a generic name, while some have a generic and a brand name. For example, ibuprofen is the generic name and Motrin is a brand of prescription ibuprofen. If you are on a tight budget, it may be possible for your physician to substitute a generic medication in some situations. A frank discussion could save you dollars without risking your health. A generic version may vary in size, shape or color of the tablets or capsules, so if you're ever confused or have questions, ask your pharmacist. Always ask questions about your medications and your health care. Never feel that your physician will be bothered by your questions or that they are silly. To make sure you don't forget to ask an important question, bring a written list with you to office visits. Make sure your doctor answers your questions in language you can understand. If your doctor isn't willing to answer your questions, switch to another doctor. You are paying your doctor for health care, and part of health care is information. At the same time, listen to what your physician tells you. You and your physician must work together for you to receive the best health care. It's been said that growing old isn't for sissies. Actually, growing old doesn't take courage as much as it takes patience, knowledge and a healthy sense of humor. No matter how old you get, with a little luck, you'll get older, so preparing for it is the best defense. Aging isn't so bad when you consider the alternative. The best is yet to be. ------------------------------------------------------------------------------ Research for this Issue of Health Update by Valerie DeBenedette; Consulting Editor Robert DeMarco, M.D. SUGGESTED BOOKS Care Giving: Helping an Aged Loved One, by Joe Home. Scott Foresman & Co., 1865 Miner St., Des Plaines, Ill. 60016. An all-in-one reference for care givers for $15.70. (Note: AARP members can get this book for $11.70.) Successful Aging, by Anne Averyt. Contains national hot-line numbers, home safety checklist, sample of living will and much more. Ballantine Books ($9.95). The Age Care Sourcebook, by Jean Crichton. A book covering the financial, medical and emotional issues of aging. Simon & Schuster ($9 .95). Who Cares? An 80-page compilation of helpful hints for caregivers from Andrus Volunteers, Andrus Gerontology Center, USC University Park MC0191, Los Angeles, Calif. 90089. The Consumer Health Information Source Book, 2nd Edition, Rees & James R.R. Bowker Co., New York & London, P.O. Box 1807, Ann Arbor, Mich. 48106. Complete Guide to Prescription & Nonprescription Drugs, by H. Winter Griffith, M.D. A book on side effects, warnings and vital information for the safe use of drugs. Available in most bookstores for $12 .95. A Healthy Old Age. A source book for health promotion among older adults. A gold mine of information and list of resources for improving the health of the elderly. Requests for copies can be sent to the Superintendent of Documents, United States Government Printing Office, Washington, D.C. 20402. ---------------- 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.