Senior Health: Successful Aging

Regular exercise results in better health outcomes for seniors.

• As people get older, physiological changes occur in their bodies 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 the 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.

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 changes 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 the 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 the 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. Toenail 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 habits 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 nighttime 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.

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.

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

1. Musculoskeletal: osteoarthritis (inflammation of joints due to wear and tear), osteoporosis (bone loss), gout, loss of muscle mass, fractures.
2. Hormonal: Diabetes (impaired control of blood glucose), menopause, thyroid dysfunction, high blood cholesterol, slower overall metabolism.
3. Neurologic: dementia (Alzheimer's or other types), Parkinson's disease, strokes, poor vision, hearing impairment, balance problems.
4. Visual: macular degeneration, glaucoma, cataracts, diabetes, and hypertension-related eye disease.
5. 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).
6. Lungs: chronic obstructive pulmonary disease (COPD), loss of lung volume.
7. Kidneys: poor kidney function (kidney or renal disease) from long-standing diabetes and hypertension.
8. Skin and Hair: hair loss, dry skin, itching, infections.
9. Cancers: prostate, colon, lung, breast, skin, bladder, ovary, brain, pancreas, only to name a few.
10. Bone marrow and the immune system: inability to produce sufficient blood cells (anemia, myelodysplasia).
11. Gastrointestinal: stomach ulcers, diverticulosis (small pockets forming in the wall of the colon), colon inflammation or colitis from infection or ischemic (poor blood flow), swallowing difficulty (dysphagia), constipation, bowel incontinence, hemorrhoids.
12. Urinary: urinary incontinence, urinary urgency, difficulty urinating.
13. Oral and dental: gum disease, dry mouth, loss of teeth, poorly fitting dentures.
14. Infections: urinary tract infection, pneumonia, skin infection, shingles, colon infection (diverticulitis, colitis).
15. Psychiatric: depression, anxiety, sleep disturbance, insomnia.
16. General problems: fatigue, general deconditioning, forgetfulness, medication side effects, diminished appetite, weight loss, falls.

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

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

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

A balanced diet and participation in regular exercise are paramount in maintaining a healthy life for people of all ages. Routine exercise and a healthy diet in seniors can have an even more noticeable impact on 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 pressure, 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 lifestyle modifications to lead a healthier life in seniors include:

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

A good and healthy diet has numerous potential benefits for 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 that can be impacted by diet.
• Proteins, carbohydrates, fats, vitamins, minerals, and water are all essential nutrients that make up most cells and tissues in the human body. Thus, these essential components need to be provided in moderation through the diet for the 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 important components 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 is also important. These are foods that 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 a carbohydrate-controlled diet for people with diabetes are general examples of such guidelines.

The 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 of the common medical conditions in which routine physical activity and effective exercising may greatly benefit the patient.

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

1. Weight maintenance and burning excess calories
2. Improving the ratio of good cholesterol to bad cholesterol
3. Building up physical endurance
4. Optimizing the health of the heart, lung, and vascular system
5. Better delivery of oxygen and nutrients to tissues
6. Maintaining bone and muscle health
7. Reducing fall risks and arthritis
8. Mood enhancement
9. 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 that would increase the heart rate adequately to about 75% of the 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, fainting, or dizziness occur during or after exercising, it is important for the individual to stop the exercise and notify their physician promptly.

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.

• Influenza vaccination
• Pneumonia vaccination
• Vaccination against shingles (60 and older; some doctors recommend starting at age 50)
• Colon cancer screening for adults between ages 50 and 75 (younger starting age in high risk groups)
• Breast cancer screening with yearly mammogram for females between 40 and 75 (younger starting age for high risk groups)
• Prostate cancer screening with annual rectal exam and PSA (prostate sensitive antigen) in males above age 50
• Osteoporosis screening with bone density scan in women above age of 65
• Lipid disorder screening yearly for men above 35 and women above 45
• Diabetes screening in people with high blood pressure, high cholesterol, obesity, or previous high blood sugar levels with or without symptoms of diabetes
• Blood pressure screening at least once a year
• Smoking cessation counseling

Other screening tests may be recommended by doctors are:

• vision and hearing exams
• skin cancer screening
• cardiac stress tests
• thyroid function tests
• mental status exam
• peripheral vascular disease screening

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.

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:

• Use canes or walkers and shower seats for fall prevention if unsteady on your feet
• Utilizing assist devices such as walkers, wheelchairs, and scooters to promote safe mobility and independence if difficulty getting around
• Replacing hardwood floors with carpeting for injury reduction in case of a fall (avoid throwing rugs on hardwood floors or potentially slick surfaces)
• Using hearing aids, wearing glasses, and installing good lighting to diminish the effects of hearing and visual problems
• Managing medications by taking advantage of pillboxes when keeping track of medications becomes 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 daytime efficiency
• Subscribing to medical alert systems and programming emergency phone numbers 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 keeps 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 need medical care while "on vacation" or "traveling."

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) are 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 by 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 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
• The 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 in special training in the care of seniors to help manage their special medical problems and concerns.

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 from 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.