Senior Health

Certain physiological changes take place in the human body as a natural part of aging.

• Physical changes of aging can potentially occur in every organ and can affect an older person's health and lifestyle.
• Many diseases and conditions become more common in the senior population.
• Psychological and social issues often play an important role in both physical and mental health of older adults.
• Diet and regular exercise can significantly improve seniors' health outcomes.
• A number of screening and preventive tests are recommended for seniors.
• Simple home safety measures can optimize the health of seniors.
• Because of complexity of medical care of the elderly, a medical specialty called geriatrics is dedicated to senior health.

A wide spectrum of changes occurs in the human body as we age. Although most of these changes are not a sign of disease, they can be distressing. Being aware of these potential bodily changes as an expected part of aging can reduce some of this distress and anxiety. Some of the common bodily changes of aging are listed below.

• Changes in skin: Skin can become less flexible, thinner, and more fragile. Skin can also bruise easily. Wrinkles, age spots, and skin tags may be more prominent. Decreased natural skin oil production can result in more dry and itchy skin.
• Changes in bone, joints, and muscles: Bones typically lose density and strength and may also shrink in size, thus, making them more prone to fractures (breaks). Muscle mass generally shrinks, and people become weaker. As a result of normal wear and tear, joints become inflamed, painful, and less flexible.
• Changes in mobility: Mobility and balance can be affected by aging. Bone, joint, and muscle changes along with changes in nervous system contribute to balance problems. Falls can result in further damage with bruises and fractures.
• Changes in body shape: As a result of bony changes of aging, body stature can shrink and back curvature can be lost. Muscle mass is reduced and fat metabolism is slowed leading to more difficult weight management. Fat is maintained in the abdominal and buttock areas.
• Changes in face: Facial wrinkles and age spots are common and the overall shape of the face can change. The face can sag and become droopy as result of volume loss related to shrinkage of bone and fat volume in the face.
• Changes in teeth and gum: Teeth can become weaker and more brittle. Gums can pull back from the teeth and less saliva is typically produced by oral glands. As a result dry mouth, tooth decay, tooth infections, bad breath, tooth loss, and gum disease may ensue.
• Changes in hair and nails: Hair can become thinner and weaker. Drier hair can cause more itching and discomfort. Nails can get dry and brittle and form vertical ridges. Toe nails can also become thick and lose their natural shape. Nail fungal infections are not uncommon.
• Changes in hormones and metabolism: Hormonal changes are commonly encountered in the elderly. Metabolism of sugar and carbohydrate cab be altered leading to diabetes. Metabolisms of fat, cholesterol, calcium and vitamin D are common altered. The thyroid gland can start to function poorly. Low levels of sexual hormones can lead to erectile dysfunction and vaginal dryness.
• Changes in memory: Memory problems are common in seniors. This entails simple forgetfulness about minor task and does not necessarily constitute dementia, which is a disease manifested by impaired executive functioning.
• Changes in immune system: The body's immune system may become weaker with age increasing the risk of infections.
• Changes in hearing: Changes in nerves of hearing and ear structures can impair hearing and lead to age-related hearing loss. Typically, higher frequencies become more difficult to hear.
• Changes in vision: The eye may get drier and the lens can lose its focus. Vision can become blurry and out of focus. Some of these problems can be modified by wearing glasses and contact lenses.
• Changes in smell and taste: Sense of smell and, less commonly, sense of taste may diminish leading to poor appetite and weight loss.
• Changes in bowel and bladder: Bowel and bladder incontinence (involuntary loss of feces or urine) are common. Constipation, urinary frequency, and difficulty initiating urine can be particularly distressing for seniors.
• Changes in sleep: Sleep can significantly change with age. Duration of sleep, quality of sleep, and frequent night time awakening are commonly seen in seniors.

Common diseases seen in the elderly population can involve many organs in the body.

• Common diseases of the musculoskeletal system in seniors are osteoarthritis (inflammation of joints due to wear and tear), gout, osteoporosis (bone loss), and bone fractures.
• Diabetes (impaired control of blood glucose), menopause, thyroid problems, high blood cholesterol, slow body metabolism signify hormonal dysfunction frequently encountered in the elderly.
• Dementia (Alzheimer's disease or other types), Parkinson's disease, strokes, poor vision, hearing impairment, and balance problem are neurologic problems routinely seen in seniors.
• Visual conditions as we age include macular degeneration, glaucoma, cataracts, diabetes and hypertension related eye disease.
• Cardiovascular diseases are common in the geriatric population and include 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 diseases seen frequently in seniors are chronic obstructive pulmonary disease (COPD), loss of lung volume, and pneumonias.
• Poor kidney function (kidney or renal disease) from long standing diabetes and hypertension are typical kidney diseases seen in seniors.
• Cancers are commonly diagnosed in seniors. Most common ones seen in this age group are cancers of prostate, colon, lung, breast, skin, bladder, ovary, brain, and pancreas.
• Bone marrow and immune system can start to become less functional and lose their ability to produce sufficient blood cells causing anemia, myelodysplasia (abnormal cell production), and decreased ability to fight infections.
• 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, and hemorrhoids are some of the age-related gastrointestinal conditions.
• Urinary problems in seniors include urinary incontinence, urinary urgency, difficulty urinating, prostate enlargement, and urinary infections.
• Common oral and dental conditions of the elderly are gum diseases, dry mouth, loss of teeth, poorly fitting dentures, and oral infections.
• Skin conditions such as rosacea, shingles, dry skin, easy bruising, skin cancers, and pre-cancerous skin diseases are frequently diagnosed in seniors.
• Psychiatric conditions of depression and anxiety are common in seniors, as are sleep disorders and insomnia.
• In addition, fatigue, general deconditioning, forgetfulness, medication side effects, diminished appetite, weight loss, and falls are typical causes of concern for senior health.

Social circumstances can have a significant impact on physical and mental health of seniors. Some of the important social and psychological problems for seniors may stem from:

• Loneliness due to losing a spouse and long term friends
• Taking care of an ill spouse
• Difficulty with independently managing regular activities of living
• Adjusting and accepting physical changes of aging
• Coping with ongoing medical problems
• Increasing number of daily medications
• Feeling isolated and less important as adult children are engaged in their own lives
• Sense of inadequacy from inability to work
• Lack of routine daily activities
• Financial constraints from having less income

These are some of the common factors impacting the overall health of older individuals. Addressing these issues makes comprehensive care of the elderly complex and multi-dimensional.

An array of screening and preventive tests is available and recommended for people over the age of 65 (many doctors may suggest some of these at younger adults). These are recommended guidelines by the U.S. Preventive Services Task Force (USPSTF) and the Centers for Disease Control (CDC) and are based on extensive clinical data.

Some of the important preventive and screening measures for seniors (and some adults) include:

• Influenza (flu) vaccination
• Pneumonia vaccination
• Vaccination against shingles (herpes zoster)
• Screening for colon cancer in adults between ages 50 and 75 ( or younger age in high risk groups such as African-Americans)
• Screening for breast cancer with yearly mammogram for females between 40 and 75 (or younger starting in high risk groups)
• Screening for prostate cancer with annual rectal exam and PSA (prostate sensitive antigen) in men above 50 (note , the PSA exam recommendation is undergoing revision in 2011, patients are advised to discuss this test with their physician before it is done)
• Screening for osteoporosis with bone density scan in women above age of 65
• Screening for lipid disorders and cholesterol yearly for men above 35 and women above 45
• Screening for diabetes 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
• Counseling for smoking cessation and alcohol reduction

Other screening tests for seniors often recommended by doctors are:

• Vision and hearing exams
• Skin cancer screening
• Cardiac stress tests
• Thyroid function tests
• Mental status exam
• Peripheral vascular disease screening

Many of these tests are recommended to be performed periodically. However, as people get older, the benefits of detecting certain conditions may diminish and further screening may be unnecessary. Sometimes potential risks of a certain test may outweigh its proposed benefits. Therefore, there are times when the right decision for an individual is to not have further testing for certain conditions. Each person's primary care physician or geriatrician can draft a personal health screening schedule. This is typically based on each individual's health history and shared decision making between the patient and the doctor.

Important home safety measures are recommended to elderly patients and their family members. Simple home safety recommendations for seniors include:

• Canes, walkers, wheelchairs, and scooters for safe mobility and independence
• Shower seats if unsteady on feet
• Carpeted floors instead of hard floor (and avoiding placing area rugs on slick surfaces) for injury reduction in case of falls
• Hearing aids, glasses, and good lighting to aid hearing and visual problems
• Pill boxes for medication management
• Help from care givers or family members if activities of daily living (ADLs) become difficult
• Routine sleep and wake times for improving sleep quality and day time efficiency
• Medical alert systems and readily available emergency phone numbers programmed into cell phones
• Regular social activities to optimize social interactions
• Careful driving and recognizing when it may be safer to no longer drive
• Properly executed advance health care directive, living will, and trust to outline decisions
• Properly documented financial and estate planning to avoid future confusion
• Adequate planning and preparation (know allergies, medical problems, surgeries, medicines and other information) in case of an emergency

Activities of daily living (ADLs) indicate basic ability to care for personal needs. There are 6 ADLs and include

1. ambulating (walking),
2. transferring (getting up or changing position),
3. dressing (putting on clothing),
4. eating,
5. toileting (using the bathroom), and
6. hygiene (washing, brushing teeth).

Most people are able to independently perform these functions. Some or all of these tasks may be difficult to perform for the elderly as they get older either as a part of their overall decline or because of an underlying illness. It is important to recognize when ADLs become burdensome and when to summon help from family members or care givers.

Seniors comprise the majority of hospitalized patients by the virtue their advanced age and multiple chronic (long standing) health problems. As hospital visits and admission to hospitals become more frequent for seniors, their overall health status can further decline with each episode. Hospitalization is often necessary for seniors, although, it is not always free of risks and complications.

Delirium is an important complication seen in the hospitalized seniors. It is recognized as episodes of waxing and waning confusion. Delirium is typically reversible, but it can potentially linger for a long time. It can also reset one's mental function at a lower baseline. Delirium can have many causes including:

• The impact of the medical illness on the body and mind
• Unfamiliar environment of the hospital
• Interacting with unknown people or strangers
• Lack of sleep due to noise and lighting at night
• Frequent night time awakening to draw blood or check vital signs
• The effect of pain medications and sedatives on thinking and mental judgment
• Presence of unnatural objects as in intravenous lines, urinary catheters, and other medical devices attached to the body

Other potential dangers and risks for hospitalized elderly are as follows:

• Hospital acquired infections
• Side effects and complications of medications and procedures
• Decline in function and deconditioning
• Falls and injuries

Hospitalists are usually board certified internal medicine doctors who oversee the care of a majority of patients in hospitals on behalf of their regular physicians. As seniors make up a significant portion of hospitalized patients, hospitalists play a crucial role in the medical care of the elderly. Upon release form the hospital, the patient's medical care is transferred back to the primary care doctor. The transfer of care between hospitalists and primary care doctors is typically done by communication to exchange necessary medical information.

Even though this system may seem disjointed and inefficient at first, it carries some valuable benefits as well. Hospitalists are well trained in the care of hospitalized seniors and proficient in reducing potential risks related to hospitalization. Moreover, because they are physically present in the hospitals, hospitalists are more readily available to address urgent issues and to discuss the plan of care with patients and their families.

Gerontologists usually are not hospitalists but physicians that specialize in the problems (usually the chronic and difficult to treat diseases like Alzheimer's) that occur in seniors. They have special training in those changes that accompany aging and specialize in how to care for senior patients. Many seniors may benefit from the insights that gerontologists may provide to improve the lifestyle of the elderly patient.