Physical changes

Normal aging: the five senses

The normal changes of aging, and the necessary daily lifestyle adjustments, are most readily seen when looking at the five senses. Vision, hearing, touch, taste and smell are how we perceive our environment. They greatly impact our understanding, and often, our joy in the world. These normal changes create some risks and result in the need to do things differently, to adapt.

Vision
As many as 30% of persons 75 or older have experienced at least some vision loss. This is due, in great part, to Presbyopia, literally “old sight.” Presbyopia begins in middle-age and is caused by the lens of the eye becoming less flexible. The normal changes of aging result in

• Difficulty seeing up close. Glasses or contacts can usually remedy this.
• Need for more light. We just don’t have the receptors we used to.
• Reduced ability to judge distance. This can have serious consequences for driving as we have trouble judging the speed of on-coming cars, creating challenges when making a left hand turn or entering the freeway.
• Problems with glare. Adjusting to light and dark takes much longer. This makes driving at night difficult, and dangerous. As a result, we tend to stay home in the evenings and are unable to go out easily to nighttime events.

Two-out-of-three legally blind individuals are people over 65 who lost their site due to age-related diseases. The most common diseases include glaucoma, cataracts, macular degeneration, and diabetic retinopathy.

Hearing
Nearly one quarter of persons 65 – 74 and half of those 75 and older have a disabling hearing loss. It’s not a matter only of volume, but also being unable to hear words clearly. Loss of hearing has deep consequences.

• Injury. Not hearing can lead to greater chance of injury, particularly with cars as we may not hear one approaching.
• Social isolation. Difficulty hearing tends to cause people to withdraw socially. We lose our relationships when we lose our hearing!

While technology aids are improving, they tend to amplify all noises, so are less than ideal. Only 25% of persons with hearing loss use hearing aids.

Other hearing impairments include tinnitus, a generally constant ringing, buzzing or swishing noise in the ears.

Although the impact of hearing impairment is profound, it is frequently overlooked as a disability.

Touch
The sense of touch involves not only the skin but also our nerves and brain. As we age, we become less aware of pain, temperature, pressure, vibration and the position of our body. Reduced sensitivity can lead to:

• Burns. We may not feel something as too hot. It’s important to set the temperature of the water heater to no higher than 120° to avoid burns.
• Hypothermia or frostbite. We can’t rely on our bodies to judge the temperature outside. Check an outdoor thermometer when it’s cold and dressed based on the numbers.
• Infection. By not feeling pain as acutely, we can have a sore or infection developing and not know it. It’s important to check the skin regularly for injuries, especially the feet.

Taste
Eating is one of life’s pleasures. However, the taste buds lose their sensitivity with age, and the tongue has fewer of them. Some of the pitfalls include:

• Over salting, or sweetening foods. As a result, older adults are often tempted to put more salt or sugar on their food than they did in their younger years. This can lead to problems for those on special diets.
• Malnutrition. When food becomes less tasty, it can also become unappealing, leading to weight loss and poor nutrition.

Fortunately, taste is rarely lost completely, and texture—crunchy or chewy foods—can be emphasized for variety.

Smell
The ability to perceive odors declines with age, especially after age 70. While outwardly, this might seem to have some benefits, there are definite disadvantages:

• Reduced pleasure in eating. for those who relate smells to the joy of food, it can reduce the pleasure of eating.
• Potential to get sick from spoiled foods. A weak “sniffer” can also cause problems in that it’s more difficult to tell if food has gone bad.
• Greater likelihood of injury. It’s harder to smell smoke in the case of a fire. Or a gas leak. It’s important to be sure that smoke and carbon monoxide detectors have fresh batteries and are tested regularly.

The cellular process of aging

There is no one explanation of aging. More than 300 theories exist to explain physical decline. Some relate to environmental factors (exposure to air pollution, or things that we do, like drinking alcohol and smoking tobacco). About 25 percent of aging can be attributed to cellular changes that are more genetic in nature.

On the cellular level, the simplest explanation is that aging occurs as components in our cells wear out over time. This process begins in our twenties.

The cells in our body are constantly being replaced. Over the years, those cells don’t reproduce as accurately or as quickly as they did before. Our cellular repair systems don’t cull out dead or misfiring cells as effectively. Bodily processes become less efficient. Healing takes longer. Everything slows down.

Whether it’s a blood cell, a bone cell, a nerve cell, a digestive cell, a muscle cell, etc., all cells and systems are affected. Our immune system becomes weaker, and we are unable to fight disease as effectively. Our digestive system doesn’t extract nutrients as well as it used to. You get the picture.

And this doesn’t count the cellular impact of our lifestyle choices or environmental exposures.

Such changes are not noticeable in younger people. But as the years accumulate, so do those little changes. The inefficiencies become more obvious. And they have consequences.

The changes in the five senses—smell, sight, hearing, taste, and touch—for instance, are part of the normal process of aging. The cellular errors of aging, however, can also open doorways for mutations (cancer), infections, or other chronic conditions.

When to see the doctor (women)

Women’s medical risks are different from men’s. Certainly for women and men both, any change that brings about pain, bleeding, fever, nausea, diarrhea or dizziness should signal the need to see a doctor. Also, an unintended loss in weight, or problems with general tasks of daily life that were easy before (driving, preparing meals, light housekeeping, paying bills, dressing, bathing, eating, toileting). These can indicate a medical problem worth investigating.

Early detection
Many conditions develop without any outward signs. High blood pressure or cholesterol, for instance, do not have physical symptoms, but they can cause big problems if they go undetected. Fortunately, a good number of the diseases that develop in older adults can be prevented, cured, or at least managed well, if they are caught early.

Screening Guidelines
Below are the guidelines set out by the U.S. Preventive Services Task Force for regular screening exams for women 65 or older.

Blood pressure

• Have your blood pressure checked every year.

 Breast cancer

• If you notice a change in your breasts, contact your doctor right away.
• Once every 1-2 years up to age 70: Get a mammogram. Talk with your doctor if you are over 70 years old.

Cholesterol and heart disease

• Every 5 years: Have your cholesterol level checked (a fasting blood test).
• Have it checked more often if you have diabetes, heart disease, or kidney problems: ask your doctor.

Colon Cancer

You should be screened for colorectal cancer until age 75. There are several screening tests available. Some common tests include:

• Every year: a fecal occult blood test.
• Every 5 years: a flexible sigmoidoscopy.
• Every 10 years: a colonoscopy, unless you have risk factors for colon cancer. Ask your doctor about recommended frequency.

Dental exams

• Once or twice every year for an exam and cleaning.

Diabetes

• Every 3 years: Screening for diabetes.
• More often if you are overweight and have other risk factors for diabetes: ask your doctor.

Eye exams

• Every 1-2 years: Have an eye exam.
• At least every year if you have diabetes.

General physical exam

• Yearly: Get a physical exam with your doctor. Medicare will pay for this.

Hearing tests

• If you have symptoms of hearing loss, have your ears tested.

Immunizations

• Once: Get a pneumococcal vaccine if you have never had one, or if you received one more than 5 years before you turned 65.
• Every year: Get a flu shot.
• Every 10 years: Get a tetanus-diphtheria booster.
• Once after age 60: You may get a shingles or herpes zoster vaccination.

Lung Cancer

• Once a year if you have a 30 pack-year smoking history AND you currently smoke or have quit within the past 15 years: Get a low-dose computed tomography (LDCT) until age 80.

Osteoporosis

• Initial test at 65: All women over age 64 should have a bone density test(DEXA scan). Discuss with your doctor when you should have a follow-up scan.

Pelvic exam and pap smear

• NO need for pap smear or pelvic exam if, by age 65, you have not been diagnosed with cervical cancer or precancer.

When to see the doctor (men)

Men’s medical risks are different from women’s. Certainly for men and women both, any change that brings about pain, bleeding, fever, nausea, diarrhea or dizziness should signal the need to see a doctor. Also, an unintended loss in weight, or problems with general tasks of daily life that were easy before (driving, preparing meals, light housekeeping, paying bills, dressing, bathing, eating, toileting). These can indicate a medical problem worth investigating..

Early detection
Many conditions develop without any outward signs. High blood pressure or cholesterol, for instance, do not have physical symptoms, but they can cause big problems if they go undetected. Fortunately, a good number of the diseases that develop in older adults can be prevented, cured, or at least managed well, if they are caught early.

Below are the guidelines set out by the U.S. Preventive Services Task Force for regular screening exams for men 65 or older.

Abdominal Aortic Aneurysm

• Initial screening if you have been a smoker and are between 65 – 75: Ultrasound.

Blood pressure

• Have your blood pressure checked every year.

Cholesterol and heart disease

• Every 5 years: Have your cholesterol level checked (a fasting blood test).
• Have it checked more often if you have diabetes, heart disease, or kidney problems: ask your doctor.

Colon Cancer
You should be screened for colorectal cancer until age 75. There are several screening tests available. Some common tests include:

• Every year: a fecal occult blood test.
• Every 5 years: a flexible sigmoidoscopy.
• Every 10 years: a colonoscopy, unless you have risk factors for colon cancer. Ask your doctor about recommended frequency.

Dental exams

• Once or twice every year for an exam and cleaning.

Diabetes

• Every 3 years: Screening for diabetes.
• More often if you are overweight and have other risk factors for diabetes: ask your doctor.

Eye exams

• Every 1-2 years: Have an eye exam.
• At least every year if you have diabetes.

General physical exam

• Yearly: Get a physical exam with your doctor. Medicare will pay for this.

Hearing tests

• If you have symptoms of hearing loss, have your ears tested.

Immunizations

• Once: Get a pneumococcal vaccine if you have never had one, or if you received one more than 5 years before you turned 65.
• Every year: Get a flu shot.
• Every 10 years: Get a tetanus-diphtheria booster.
• Once after age 60: You may get a shingles or herpes zoster vaccination.

Lung Cancer

• Once a year if you have a 30 pack-year smoking history AND you currently smoke or have quit within the past 15 years: Get a low-dose computed tomography (LDCT) until age 80.

Osteoporosis
Men also have problems of thinning and brittle bones as they age.

• Once: Men age 70 and over should consider getting bone mineral density testing.
• Talk with your doctor to find out if you have risk factors for osteoporosis.

Prostate cancer

• Talk with your provider about prostate cancer This is such a slow growing cancer that unless you have symptoms, it has been determined that the consequences of screening have been less beneficial than waiting for symptoms to appear.

Learning to age well

We are living longer!
Only 100 years ago, the average person lived to their mid-fifties. Now, the average life expectancy is in the late seventies. If you’ve made it to 70 already, there’s a 20-30% chance you will see your 90th birthday. As for children born today, 10% of little girls are likely to live to 100 or more.

Are we living well?
While we are living longer lives, many of those years spent managing multiple chronic conditions. Diabetes. High blood pressure. Congestive heart failure. Alzheimer’s and other dementia’s. COPD. It is these chronic conditions that can profoundly impact our daily experience of life.

What you can control
Know your numbers. Monitoring your health is the best way to identify a problem brewing and take immediate action. The American Heart Association suggests that every adult keep track of their

• Blood Pressure
• Cholesterol
• Blood Sugar
• Body Mass Index (Height-to-Weight calculation)

Talk with your doctor to find out where you stand and what you can do.

The importance of lifestyle changes to prevent or manage these chronic conditions cannot be over-emphasized. Ideally one makes those changes in mid-life (take note daughters and sons). But even in later years, eating well, stopping smoking and becoming more active can do a tremendous amount to help you feel better. And to stay independent and do the things you enjoy doing.

Improving quality of life

Quality of life is the ability to spend your days doing the things that give you joy or bring meaning to your life.

Of course, the goal is to live a long life. But as we age, the quantity of one’s days often becomes less important. The quality becomes a bigger priority. What most of us hope for is good health and then to die in our sleep. Not very common—or likely. Once you accept that, however, you can look candidly at ways to increase the quality of your days, no matter your state of health. In terms of your physical health, that revolves around four strategies:

• Maximizing energy
• Simplifying demands
• Reducing pain and discomfort
• Focusing on activities that bring joy and meaning

As experts in aging well, we can help you look realistically at your physical challenges. Together we can come up with strategies to give you maximum independence and the highest quality of life. Give us a call at [Your Phone].

The final leg of the journey

If we’re facing facts, we have to admit that at some point the physical challenges of aging will become unavoidable. Each of us will walk the path of losing abilities. Eventually we will succumb. This is not a battle we will ultimately win.

It may be a crisis that lands us in the hospital. Or, a terminal illness that allows us to die at home. It could be a heart attack. Or we could die because our organ systems gradually shut down and simply can’t function any more.

The last few days
On the day we die, we will usually have been in and out of consciousness for a week or more. Unlike the movies, very few people are awake, aware or talking. Breathing will have become erratic, as will the heartbeat. Eventually, the heart and lungs will find it too difficult to continue, and one breathe will simply not be followed by another. The heart will stop.

The three pathways
Everyone hopes for a quick and painless death. To die in our sleep.

It used to be that most deaths were the result of injury or disease. They did tend to be quick, and often unexpected.

With modern medicine, things have changed. We now tend to die with multiple chronic conditions that have been managed more and more aggressively over time. One condition eventually over powers the body and becomes the actual cause of death.

Sometimes it helps to know what to expect.
Researchers have identified three general pathways for the last few years:

• Episodes of crisis with adjustments in between. In our older years, most of us manage well enough. We adapt. Then something happens. There’s a fall. A sickness. A surgery. We bounce back, but not up to the level of general health and vitality we had before. We find a new normal, and cruise along. Then something else happens. We dip down, and we recover. Just not up to where we had been. As a rule, over time, these dips occur more frequently, and the bounce back is lower each time. This is a common pathway for people with CHF or COPD, for instance.
• A short and rather steep decline. Some of us will get a disease, like cancer. If it is not the kind that can be cured, it has a relatively steep (short) decline.
• A gradual decline. There are some of us who reach advanced years with few chronic conditions, and very few crises. This pathway is a bit different. One simply becomes more frail. We lose weight and become easily fatigued. We walk ever more slowly and become less active. That doesn’t mean unhappy. It’s just that the physical body sort of dwindles. Usually it is an infection, such as pneumonia that finally tips the scale. As an example, this gradual decline is the general pathway for Alzheimer’s Disease.