Month: February 2021

Facts you should know about health in seniors

Regular exercise results in better health outcomes for seniors.

• As people get older, physiological changes occur in their body as a natural part of aging.
• Physical changes due to aging can occur in almost every organ and can affect seniors’ health and lifestyle.
• Some diseases and conditions become more prominent in the elderly.
• Psychosocial issues can also play a role in physical and mental health of older adults.
• A balanced diet and regular exercise are strongly linked to better health outcomes in seniors.
• A series of routine screening tests and preventive measures are recommended for the elderly.
• Important preventive measures at home can improve the safety and health of seniors.
• Geriatrics is a medical subspecialty dedicated to the care of the elderly. Physicians who have specialized training in this field are known as geriatricians.

What changes occur in the body as we age?

A wide range of changes can happen in the body to different degrees as we age. These changes are not necessarily indicative of an underlying disease but they can be distressing to the individual. Even though the aging process cannot be stopped, being aware of these changes and adopting a healthy lifestyle can reduce their impact on overall health.

Expected bodily changes of aging include change in:

• Skin: With aging, skin becomes less flexible, thinner, and more fragile. Easy bruising is noticeable, and wrinkles, age spots, and skin tags may become more apparent. Skin can also become more dry and itchy as a result of less natural skin oil production.
• Bones, joints, and muscles: Bones typically lose density and shrink in size making them more susceptible to fractures (breaks). Muscles shrink in mass and become weaker. Joints can suffer from normal wear and tear; joints become inflamed, painful, and less flexible.
• Mobility and balance: A person’s mobility and balance can be affected by various age related changes. Bone, joint, and muscle problems listed above in conjunction with changes in nervous system are the major contributors to balance problems. Falls may occur resulting in further damage with bruises and fractures.
• Body shape: As a result of bony changes of aging, body stature can become shorter and curvature of the back vertebrae may be altered. Increased muscle loss and reduced fat metabolism can also occur. Fat can redistribute to the abdominal area and buttock areas. Maintaining an ideal body weight becomes more difficult.
• Face: Aging changes also take place in the face. Other than wrinkles and age spots, the overall facial contour can change. Overall loss of volume from facial bone and fat can result in less tightness of the facial skin and sagging. The face becomes droopier and bottom heavy.
• Teeth and gums: Teeth can become more weak, brittle, and dry. Salivary glands produce less saliva. Gums can also recede (pull back) from the teeth. These changes may result in dry mouth, tooth decay, infections, bad breath, tooth loss, and gum disease.
• Hair and nail: Hair can become thinner and weaker as a person ages. Dry hair may lead to itching and discomfort. Nails may become brittle and unshapely. Nails can also get dry and form vertical ridges. Toe nail thickening (ram’s horn shape) is common. Nail fungal infections may occur frequently.
• Hormones and endocrine glands: Hormonal changes are seen commonly in the elderly. Most common is the hormonal control of blood sugar and carbohydrate metabolism leading to diabetes. Thyroid dysfunction and problems with fat and cholesterol metabolism are also commonly encountered. Calcium and vitamin D metabolism may also become altered. Sexual hormones reach a low level and can lead to erectile dysfunction and vaginal dryness.
• Memory: Problems with memory are common in seniors. However, it is important to realize that minor memory problems do not constitute dementia or Alzheimer’s disease. Simple lapses of memory such as not remembering where you left a key or whether you locked the door are a normal part of aging.
• Immunity: The body’s immune system can get weaker with age. Blood cells that fight infections (white blood cells) become less effective leading to more frequent infections.
• Hearing: changes in nerves of hearing and ear structures can dim hearing and cause age-related hearing loss. Higher frequencies become harder to hear.
• Vision: Eyes can become drier and the lens can lose its accuracy as we age. Vision can be affected by these changes and can become blurry and out of focus. Glasses or contact lenses can help correct these problems.
• Taste and smell: Sense of smell and, less commonly, sense of taste may fade leading to poor appetite and weight loss.
• Bowel and bladder: Bowel and bladder control can cause problems with incontinence (involuntary loss of feces or urine). Additionally, bowel and bladder habit can change. Constipation is common in older adults, as are urinary frequency and difficulty initiating urine.
• Sleep: Sleep patterns can significantly change with age. Duration of sleep, quality of sleep, and frequent night time awakening are commonly seen in seniors.

These changes are different in every individual. Some people may experience more changes in a particular area compared to others.

What are the most common diseases and conditions seniors face as they age?

Medical problems in the elderly can involve any organ system in the body. Most conditions result from decreased function or degeneration of the involved organ.

Most commonly encountered medical conditions in seniors based on organ system are listed below:

• Musculoskeletal: osteoarthritis (inflammation of joints due to wear and tear), osteoporosis (bone loss), gout, loss of muscle mass, fractures.
• Hormonal: Diabetes (impaired control of blood glucose), menopause, thyroid dysfunction, high blood cholesterol, slower overall metabolism.
• Neurologic: dementia (Alzheimer’s or other types), Parkinson’s disease, strokes, poor vision, hearing impairment, balance problem.
• Visual: macular degeneration, glaucoma, cataracts, diabetes and hypertension related eye disease.
• Cardiovascular disease: heart attacks, congestive heart failure, irregular heart rhythm (atrial fibrillation), high blood pressure (hypertension), atherosclerosis (hardening and narrowing of blood vessels) and peripheral vascular disease or peripheral artery disease (poor blood flow as a result of narrow blood vessels).
• Lungs: chronic obstructive pulmonary disease (COPD), loss of lung volume.
• Kidneys: poor kidney function (kidney or renal disease) from long standing diabetes and hypertension.
• Skin and Hair: hair loss, dry skin, itching, infections.
• Cancers: prostate, colon, lung, breast, skin, bladder, ovary, brain, pancreas, only to name a few.
• Bone marrow and immune system: inability to produce sufficient blood cells (anemia, myelodysplasia).
• Gastrointestinal: stomach ulcers, diverticulosis (small pockets forming in the wall of colon), colon inflammation or colitis from infection or ischemic (poor blood flow), swallowing difficulty (dysphagia), constipation, bowel incontinence, hemorrhoids.
• Urinary: urinary incontinence, urinary urgency, difficulty urinating.
• Oral and dental: gum disease, dry mouth, loss of teeth, poorly fitting dentures.
• Infections: urinary tract infection, pneumonia, skin infection, shingles, colon infection (diverticulitis, colitis).
• Psychiatric: depression, anxiety, sleep disturbance, insomnia.
• General problems: fatigue, general deconditioning, forgetfulness, medication side effects, diminished appetite, weight loss, falls.

How can social issues affect the life and health of seniors?

Social issues can have a significant impact on life and both physical and mental health of seniors. Some of the major contributors to social and psychological problems for seniors are as follows:

• Loneliness from losing a spouse and friends
• Inability to independently manage regular activities of living
• Difficulty coping and accepting physical changes of aging
• Frustration with ongoing medical problems and increasing number of medications
• Social isolation as adult children are engaged in their own lives
• Feeling inadequate from inability to continue to work
• Boredom from retirement and lack of routine activities
• Financial stresses from the loss of regular income

These factors can have a negative impact on overall health of an older individual. Addressing these psychosocial problems is an integral component of seniors’ complex medical care.

What are lifestyle changes seniors can make to lead a healthy life as they age?

A balanced diet and participation in regular exercise are paramount in maintaining a healthy life for people of all ages. Routine exercise and healthy diet in seniors can have an even more noticeable impact in their general well-being.

Many diseases in seniors may be prevented or at least slowed down as a result of a healthy lifestyle. Osteoporosis, arthritis, heart disease, high blood pressures, diabetes, high cholesterol, dementia, depression, and certain cancers are some of the common conditions that can be positively modified in seniors through diet, exercise, and other simple lifestyle changes.

In addition to diet and exercise, other important life style modifications to lead a healthier life in seniors include:

• Limiting alcohol intake to one drink daily
• Smoking cessation
• Using skin moisturizers and sun protection
• Brushing and flossing teeth once or twice a day
• Staying proactive in own healthcare and participating in decision making
• Going to the primary care doctor routinely
• Reviewing list of medications with their doctor(s) often
• Following recommended instructions for health screening, preventive tests, and vaccinations
• Visiting a dentist annually or biannually
• Following up with eye doctor and foot doctor, especially for people with diabetes
• Being aware of potential medication side effects and drug interactions including over-the-counter drugs, herbals, and alternative medicine
• Adhering to routine sleep schedule and using good sleep hygiene
• Engaging in routine and scheduled social activities
• Taking vacations

What role does diet play in senior health?

A good and healthy diet has numerous potential benefits in the health of seniors.

Heart disease, vascular disease, diabetes, high blood pressure, high cholesterol, strokes, memory problems, osteoporosis, certain cancers, skin, hair and nail diseases, and visual problems are examples of conditions which can be impacted by diet.

Proteins, carbohydrates, fats, vitamins, minerals, and water are all essential nutrients that make up most cells and tissues in human body. Thus, these essential components need to be provided in moderation through the diet for maintenance of good health.

A balanced diet consisting of fruits and vegetables, whole grains, and fiber is generally recommended to provide these necessary nutrients. Avoidance of saturated fats (animal fat), supplementation with minerals and vitamins, and consumption of plenty of fluids are considered an important component of a healthy diet.

Although the quality of food is important, its quantity should not be overlooked. A large portion of a very healthy diet can still lead to a high caloric intake. Moderate portion sizes to achieve daily caloric goals of 1500 to 2000 are generally advised. Avoiding empty calories are also important. These are foods which lack good nutritional value but are high in calories. Examples include sodas, chips, cookies, donuts, and alcohol.

Special dietary restrictions for certain conditions are also important to follow. Restricted salt and fluid intake for people with heart failure or kidney disease, or carbohydrate controlled diet for people with diabetes are general examples of such guidelines.

Is exercise important in health of the elderly?

Benefits of exercise in disease prevention and progression cannot be overemphasized.

Regular physical activity and exercise can help manage or even prevent a variety of health problems in the elderly.

Heart disease, high cholesterol, diabetes, osteoporosis, muscle weakness, certain cancers, depression, and stroke are some the common medical conditions which routine physical activity and effective exercising may greatly benefit the patient.

Some of the numerous health benefits of exercise for seniors include:

• Weight maintenance and burning excess calories
• Improving the ratio of good cholesterol to bad cholesterol
• Building up physical endurance
• Optimizing health of the heart, lung, and vascular system
• Better delivery of oxygen and nutrients to tissues
• Maintaining bone and muscle health
• Reducing fall risks and arthritis
• Mood enhancement
• Better sleep quality and duration

Regular exercise 3-5 times a week for at least 30 minutes is strongly advised for seniors. An effective exercise is one which would increase the heart rate adequately to about 75% of maximum heart rate. A person’s maximum heart rate is roughly calculated by subtracting age from the number 220.

Walking, swimming, and exercise machines are generally safe and can help achieve these goals. Balance exercises, flexibility exercises, and resistance exercises (weight lifting) can also be beneficial.

As a general precaution, if symptoms such as chest pain or tightness, shortness of breath, or fainting or dizziness occur during or after exercising, it is important for the individual to stop the exercise and notify their physician promptly.

What are some of the routine medical tests for seniors?

A wide range of screening and preventive measures are available and recommended for people over the age of 65. These guidelines follow the recommendations by the U.S. Preventive Services Task Force (USPSTF) and the Centers for Disease Control (CDC) and are based on extensive clinical data.

The following lists some of the important preventive and screening measures for seniors.

Other screening tests may be recommended by doctors are:

It is worth noting that even though these are general health maintenance guidelines, primary care doctors may draft an individualized plan for each person based on their personal history.

Many of these tests are recommended to be performed periodically. As people get older, the benefits of detecting certain diseases may diminish, obviating the need for further screening. Accordingly, the patient’s primary physician may help guide patients with their decisions regarding recommended health screening tests.

Sometimes the possible risks associated with certain tests may outweigh the potential benefits. Therefore, there are times when the right decision for an individual is to not have further testing for certain conditions.

What are important safety measures for the elderly?

General safety measures both at home, and away from home, are encouraged and recommended to elderly patients and their family members. Falls and injuries, confusion, adherence to medical instructions, and future health and financial planning are among the concerns pertinent to elderly care.

Simple home safety recommendations for seniors include:

• Using canes or walkers and shower seats for fall prevention if unsteady on feet
• Utilizing assist devices such as walkers, wheelchairs, scooters to promote safe mobility and independence if difficulty getting around
• Replacing hard wood floors with carpeting for injury reduction in case of a fall (avoid throw rugs on hard wood floors or potentially slick surfaces)
• Using hearing aids, wearing glasses, and installing good lighting to diminish effects of hearing and visual problems
• Managing medications by taking advantage of pill boxes when keeping track of medications become burdensome
• Hiring caregivers or accepting assistance from family members if activities of daily living become difficult
• Scheduling routine sleep and wake times to improve sleep quality and day time efficiency
• Subscribing to medical alert systems and programming emergency phone number into cell phones for easy access in cases of emergency
• Planning regular social activities to improve social interactions
• Driving with care and recognizing when it may be safer to stop driving
• Preparing a properly executed advance healthcare directive, living will, and trust to outline decisions and preferences in preparation for the time a person may become incapable of making sound decisions

Another noteworthy concern for the elderly is the subject of medications. With the rise in availability of various medications, naturally a growing list of drugs is offered to the elderly due to their high prevalence of medical conditions. As a consequence, interactions between these drugs and their individual side effects become increasingly more likely. The best approach to address these concerns is a discussion and periodic medication review with the treating physicians or the primary care doctor. If the elderly patient or their caregiver keep up-to-date records of allergies, medications, diseases, medical and surgical history, and advance directives readily available; the patient will have a better experience if they need emergent care or hospitalization. This is especially true if they arrive at a hospital where the patient’s doctors do not practice, or if they have need of medical care while “on vacation” or “traveling.”

What are some concerns regarding hospitalization of the elderly?

With increasing medical issues in seniors, their medical care becomes more complex and difficult to manage. Subsequently, seniors become ill more severely and frequently compared to younger people. As hospital visits and admissions become more frequent, the overall health status can decline as a result. Although hospitalization is often necessary for seniors, it is not always free of risk.

Episodes of waxing and waning confusion (delirium) is a common feature in hospitalized elderly. Even though delirium is typically reversible, it can sometimes linger for a long time and possibly reset one’s mental function at a lower baseline. Delirium can be caused from several reasons:

• Effects of the medical illness itself
• Being in an unfamiliar environment
• Interacting with unfamiliar people
• Noisy and brightly lit hallways and hospital rooms during the night
• Frequent awakening at night time for blood draws and vital signs
• Medications for pain and sedation which can alter thoughts and mental judgment
• Intravenous lines, urinary catheters, and other medical devices attached to the body

Other potential dangers of hospitalization of seniors are as follows:

• Hospital related infections
• Medication and procedure side effects and complications
• Interaction between home medications and new hospital drugs
• General decline in function and deconditioning
• Falls and injuries

Although there are many problems that seniors may encounter, both in and out of the hospital, understanding the problems and then forming a plan to address them is a first large step in making the senior years still productive and enjoyable. Seniors should consider finding a geriatrician who is as special training in the care of seniors to help manage their special medical problems and concerns.

What is a hospitalist, and where is my regular doctor?

Hospitalists are board certified internal medicine physicians who see a majority of hospitalized patients on behalf of their regular doctors.

In modern day medicine, hospitalists play a key role in the medical care of patients in hospitals. As seniors make up a significant portion of patients in hospitals, hospitalists are also critical to the medical care of the elderly. Upon release form the hospital, the medical care is transferred back to the primary care doctor on an outpatient basis. This transfer of care is usually done by communication between hospitalists and primary care doctors.

Although this system may seem disjointed at first, there are some obvious benefits to it. Hospitalists are often well trained in the care of hospitalized seniors and generally are very proficient in reducing potential risks associated with hospitalization of the elderly. Moreover, because they are physically in hospitals most of the time, hospitalists are more readily available to address urgent situations and to spend time discussing care plans with patients and families.

What are bones made of?

The best ways to prevent osteoporosis are to get enough calcium, vitamin D and exercise.

Bones are uniquely constructed to carry the weight of our bodies and to perform other functions, such as growing blood cells.  They are living structures that are continually being built and broken down. For about the first 20 or 30 years of your life, your body creates more bone than it loses. After that, the ratio is reversed, and you lose more bone than you grow. 

Minerals, especially calcium, are important to build bones and keep them strong. The more minerals your bones contain, the denser they are and the lower your risk of fractures. They are more likely to break if you have osteoporosis. 

What is osteoporosis?

Osteoporosis means “porous bones.” Bones have a hard, solid exterior, but the interior is a sponge-like structure with many holes. If you have osteoporosis, the holes are larger. The outer shell of your bones may also be thinner. The combination of these two changes means that your bones are more likely to break. 

Most people who have osteoporosis have no symptoms. In the United States, about half of women over 50 will break a bone because of osteoporosis. Men can have osteoporosis, too, but they start out with heavier bones and lose bone density more slowly than women.  

Besides being female, some risk factors for osteoporosis are out of our control, including:

• Being over 60, with risk increasing with advancing age
• Having a family history of osteoporosis or bone fractures
• Having suffered a broken bone in the past
• Having gone through menopause early or had a hysterectomy before menopause
• Having taken certain medications, including thyroid hormones, steroids, some antidepressants, and others
• Having another condition that puts you at risk, including rheumatoid arthritis, cancer, and others

Risk factors that you can control include:

• Smoking
• Having more than two alcoholic beverages a day
• Being underweight, with a body mass index of less than 19
• Poor nutrition
• Low intake of Vitamin D and calcium
• Inactive lifestyle

How to prevent osteoporosis

Get enough calcium

Calcium intake is important in osteoporosis prevention. Many foods contain calcium, and it is possible to get enough without taking a supplement. Most people know that dairy products contain calcium. Other good sources include leafy greens, winter squash, almonds, tofu, edamame, and canned salmon and sardines. Plant milk and orange juice are often fortified with calcium.

The Recommended Daily Allowance (RDA) for calcium is 1000-1200 mg daily. Nutritional labels are based on 1000 mg a day, so keeping up with your consumption is fairly easy. A food containing 100 mg would provide 10% of your need. Some of the calcium found in plants is not bioavailable, meaning the body can’t absorb it. For that reason, you might want to take a calcium supplement. 

Doctors do not recommend taking big doses of calcium, since too much calcium can cause other health problems. If you routinely get calcium from your diet, look for small supplements to take when your dietary sources fall short.

Get more vitamin D

Without sufficient vitamin D, your body may not absorb the calcium you take in. Our bodies manufacture vitamin D when exposed to sunlight, but we don’t always get enough exposure to meet our needs. Fortified milk and dairy products contain vitamin D, as do fish, eggs, and shellfish, but dietary sources rarely provide enough D. 

The best solution may be to take a supplement. You will find vitamin D available as D2 or D3. Both are effective. The RDA is 400 IUs for ages 51-70 and 600 IUs for those over 70, but it may be easier to find supplements of 1000 to 2000 IUs. Don’t go over that amount, since you can get too much vitamin D.

Get some exercise 

Another important step in osteoporosis prevention is exercise. Putting stress on the bones through exercise increases bone growth. The most effective exercises are high-impact and weight-bearing, such as running and jumping, but these activities aren’t appropriate for everyone. 

Other weight-bearing activities, such as walking or stair climbing, can be substituted. Strength training, also known as resistance training, builds bone in a different way, through the action of muscles pulling on the bones. 

Exercises only affect the part of the body that is being used. For example, walking strengthens the bones of the lower body but not the ribs or wrists. In addition, if you stop exercising, you will lose the benefits you gained. 

Check with your doctor

How to know if you have osteoporosis

A bone density scan can tell you whether you have osteoporosis. The test is quick and non-invasive and uses only a small dose of radiation. The bones in the spine and hip are checked most often, as that is where the most serious fractures tend to occur. 

Women over 65 and most men over 70 should have a test, and the test should be repeated periodically, depending on your results. If you are younger but at high risk of osteoporosis, you may need a scan. 

When you get your bone density results, your doctor will help you understand them. You may be told that you have normal bone density, low bone density (osteopenia), or osteoporosis. If your bone density is below normal, your doctor may suggest a medication for osteoporosis.  

Treating osteoporosis with medications

Medications for osteoporosis can reduce the risk of hip fracture by up to 40% and also lower the likelihood of other fractures. Medications come in two varieties: ones that prevent bone loss and ones that promote bone growth. Like almost all medicines, these drugs have side effects. They can also be expensive. Your doctor can work with you to find a cost-effective medication that fits your needs.

Even if you take medication for osteoporosis, you should keep up your levels of vitamin D and calcium and participate in exercise that is appropriate for you.