CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0175/low.txt

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$Title{Aging--Learn to Enjoy the Inevitable, part I}
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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
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Cancer of the Prostate*0007601.scf
Benign Hypertrophy of the Prostate*0007602.scf
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Copyright (c) 1991-92,1993


Health Update

by Dr. Allan Bruckheim

Aging--Learn to Enjoy the Inevitable, part I


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     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 car 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 ton 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 cars and your hearing checked.  In
some cases, the apparent noise is caused by a wax plug in the car canal, a
buildup of fluid in the middle car, 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.

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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.