CD-ROM Today 1996 January

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$Unique_ID{BRK01744} $Pretitle{} $Title{Aging--Learn to Enjoy the Inevitable} $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 Eye*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 ------------------------------------------------------------------------------ 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 focussed 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 sensoneural 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. Tbe 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 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.