Seniors' Health

Definition

Seniors' health refers to the physical and mental conditions of senior citizens, those who are in their 60s and older. The proportion of people age 65 years and older in the United States is on the rise and will continue to increase through 2030.

Purpose

For a senior, the aging process and a person's lifestyle will affect health. People who maintain a healthy weight, exercise regularly, eat nutritionally, and don't smoke reduce the risk for many health conditions. This wellness allows people to live longer and to remain independent for more years. Smoking, obesity (excess weight), and lack of exercise shorten life and increase the risk for many health conditions. According to a 2003 report, about 80% of people in the United States age 65 and older have at least one chronic (long-lasting) condition and 50% have two.

Diet and exercise

Proper diet and regular exercise form the foundation of senior health. A nutritional diet and physical activity can help prevent diseases such as cancer, stroke, heart disease, and diabetes. A healthy diet also can help manage diabetes, high blood pressure, and heart disease.

As people age, there is more of a need to exercise on a regular basis. According to the American Heart Association, the inactive person loses from 3-5% of muscle fiber each decade after age 30. That loss would total 30% of lost muscle fiber at age 60. Exercise helps to boost muscle strength. It can help improve balance and coordination, and therefore help to prevent falls.

Organizations including the heart association advise that regular physical activity helps prevent bone loss (osteoporosis ) and the risk of conditions such as heart disease, Type II diabetes, colon cancer, stress, and depression. In addition, exercise can help extend the lives of people with conditions such as diabetes, high blood pressure, and high cholesterol. Good health later in life helps to prevent serious illness or death from common infections as well. If a senior catches the flu, for instance, it can have more detrimental effects than in a healthier, younger person. When the SARS outbreak occurred in 2002 and 2003, clinicians expressed concern about the elderly Americans and again expressed the importance of diet and exercise. As people age, their immune system response weakens. Seniors need to be proactive in keeping their systems strong.

Osteoporosis

Osteoporosis is a condition in which bones become less dense (solid). Bones become brittle, thinner, and break easily. Although osteoporosis is associated with aging, it is only the risk of osteoporosis that increases as a person ages. It is linked to approximately 70% of bone fractures in people age 46 and older. According to the National Institutes of Health (NIH), one out of two women over age 50 will experience an osteoporosis-related fracture. So will one out of eight men over 50.

Osteoporosis is associated primarily with the changes that occur to women during menopause. During menopause, there is a decrease in the level of estrogen, the hormone that helps maintain bone mass. Other causes of osteoporosis include lack of exercise and a diet deficient in vitamin D.

Osteoporosis is largely preventable, however, research released in 2003said that evidence is increasing to suggest that the condition starts as far back as in the womb. If this is true, it still is preventable, but by the behavior of the mother carrying a child. More research needs to be done, but it is clear that childhood growth rates are linked to hip fractures that occur decades later.

Osteoarthritis

Osteoarthritis is a joint disease in which cartilage wears out and bones rub against each other. This condition can occur gradually over time as activities performed throughout the years cause wear on joints. In addition, bones thin as a person ages.

Excess weight and injuries can aggravate this condition. About 16 million Americans experience some form of osteoarthritis. It generally affects the neck, fingers, lower back, knees, and toes. Symptoms include pain, stiffness, swelling, and creaking. The pain may disrupt sleep, and joint stiffness may make it difficult for a person to dress.

Falls

More than two million Americans each year fall and experience serious injuries, according to the American Academy of Otolaryngology-Head and Neck Surgery. For seniors, fall-related injuries can reduce mobility and hinder independence.

As people age, their reflexes slow down so it may be more difficult to prevent a fall. Deteriorating vision and hearing can affect balance, which can cause an accidental fall. Furthermore, conditions such as arthritis, dizziness, and sleeping disorders can increase the likelihood of a fall. In addition, a person may fall at the start of a condition such as a stroke or heart attack.

Falls can result in broken bones or fractures because bones are weakened by osteoporosis. In addition, healing takes longer. Head injuries could affect sight and hearing. Injuries sustained during falls could reduce an active person's mobility and independence.

Vision

Eyesight changes as people age. Generally, people are in their 40s when they experience presbyopia, a form of farsightedness. This is a progressive condition involving a decrease in the eye's ability to focus on close objects (near vision). By age 65, little near focusing ability remains.

Glaucoma is a condition caused by pressure from the build-up of a large amount of fluid in the eye. This progressive condition is often seen in people in their 50s. It starts with the gradual loss of peripheral vision. If not treated, it can lead to some vision loss.

People in their 60s may experience the first signs of age-related macular degeneration (AMD). It is a progressive condition affecting the retina. The macula in the retina distinguishes detail. Degeneration in the macula could cause scarring and a gradual reduction in vision. The person experiences a circle of blindness, an area of sightlessness that grows as the condition progress.

More than half of people age 65 or older will be diagnosed with cataracts. Cataract refers to the loss of the transparency in the lens of the eye. As the loss progresses, the person is able to see less detail. This condition generally affects both eyes.

Hearing

Presbycusis, age-related hearing loss, is a progressive condition. It usually starts with a difficulty in hearing high-frequency sound such as people talking. A senior has less trouble with low-frequency tones. Background noise will make it even more difficult to hear. Presbycusis affects approximately 25% of people between the ages of 65 and 75 and half of those over 75. Many people diagnosed with this condition say they have lost hearing in both ears. They also report feelings of dizziness and that they experience a ringing in their ears.

Sleep disorders

Sleep patterns change when a person ages. Many people in their 60s and 70s experience less time in the stages of deep sleep known as delta sleep. Despite this change, many healthy older people don't experience sleep disorders. Overall health plays a role in whether a senior experiences trouble sleeping.

Obesity is linked to snoring and sleep apnea. Snoring can turn into apnea. A person with apnea stops breathing for up to one minute until the brain restarts the breathing process. This action could be repeated several hundred times each night.

Furthermore, a senior's sleep can be disrupted by conditions such as arthritis, osteoporosis, and Alzheimer's disease. Insomnia, or the inability to stay asleep, is a symptom of conditions including depression, anxiety, chronic pain, and restless leg syndrome (RLS).

RLS involves movement of legs when a person is at rest. The person moves legs in response to a tingling sensation in the upper leg, calf, or foot. In other cases, legs move involuntarily. Sensations that trigger movement can re-occur within seconds.

A person with RLS is likely to have PLMD (periodic limb movement disorder). A sleeping person with this condition will kick legs or move arms repeatedly. These involuntary movements can last from 20 seconds to an hour. Approximately 45% of the elderly have a mild form of PLMD, according to the National Sleep Foundation.

The cause of these disorders is not known. They are thought to be caused by a chemical reaction in the brain. In addition, the conditions may be hereditary.

Mental health

While age has little effect on the mind, social and emotional factors affect an older person's health. After a lifetime of work or raising a family, retirement brings several challenges. A person who has been identified for years by a profession may experience a sense of lost identity.

A senior may find that the thinking process has changed. Learning something new may take longer. However, older people have excellent recall of new information.

Memory loss may be a concern, particularly since this is a symptom of Alzheimer's disease.

Dementia

Alzheimer's disease is a form of dementia, a condition in which mental abilities decline. Symptoms of dementia include memory loss that goes beyond forgetting a word or where an item was placed. The person with dementia may never recognize family members or remember how to perform functions such as preparing a meal. Sometimes they experience a change in personality, with some uncharacteristic aggression or paranoia.

Alzheimer's disease is the most prevalent form of dementia. Although the cause of this condition is not known, the risk of Alzheimer's increases as a person ages. In 2000, the condition affected one in 15 people over the age of 65. The ratio rises to one in three people age 85 and older.

Alzheimer's is a progressive condition. In most cases, after five to eight years, a patient with this condition is unable to perform basic functions. There is no known cure for Alzheimer s. However, as of 2003, the U.S. Food and Drug Administration had approved four medications that could help delay the degenerative process.

Precautions

A health condition may result in a doctor recommending against some forms of exercise. However, even if a person can't jog, other forms of exercise include those designed for people in wheelchairs and those who are bedridden.

Treatments for menopause and osteoporosis include Raloxifene, a medication that may cause blood clots.

Description

The cost of treatment varies. Cost of medical treatment will be determined by the type of procedure and whether a person has medical insurance. Health plan and Medicare coverage and copayments impact an individual's cost for various preventions and treatments.

Nutrition

Nutrition plays an important role in senior health. Not only does a well-balanced diet keep a person from becoming obese, that same diet is a safeguard against health conditions that seniors face. Proper diet can help prevent a condition like diabetes or keep it from worsening.

The senior diet should consist of foods that are low in fat, particularly saturated fat and cholesterol. A person should choose foods that provide nutrients such as iron and calcium. Other healthy menu choices include:

• fish, skinless poultry, and lean meat.
• proteins such as dry beans (red beans, navy beans, and soybeans), lentils, chickpeas, and peanuts.
• low-fat dairy products
• vegetables, especially those that are dark green and leafy
• citrus fruits or juices, melons, and berries
• whole grains like wheat, rice, oats, corn, and barley
• whole grain breads and cereals

Exercise

Physical activity should be rhythmic, repetitive, and should challenge the circulatory system. It also should be enjoyable so that a senior gets in the habit of exercising regularly for 30 minutes each day. It may be necessary to check with a doctor to determine the type of exercise that can be done.

Walking is recommended for weight loss, stress release, and many other conditions. Brisk walking is said to produce the same benefits as jogging. Other forms of exercise can include gardening, bicycling, hiking, swimming, dancing, skating or ice-skating. If weather prohibits outdoor activities, a person can work out indoors with an exercise video.

Exercise also offers a chance to socialize. In some cities, groups of seniors meet for regular walks at shopping malls. Senior centers offer exercise classes ranging from line dancing to belly dancing.

Costs for exercise range from the price of walking shoes to the fees for joining a gym.

Osteoporosis

Prevention is the best method of treating osteoporosis. Methods of preventing osteoporosis include regular weight-bearing exercise such as walking, jogging, weight lifting, yoga, and stair climbing.

People should not smoke since smoking makes the body produce less estrogen. Care should be taken to avoid falling.

Diet should include from 1,000-1,300 mg. of calcium each day. Sources of calcium include:

• leafy, dark-green vegetables such as spinach, kale, mustard greens, and turnip greens
• low-fat dairy products such as milk, yogurt, and cheeses such as cheddar, Swiss, mozzarella, and parmesan; also helpful are foods made with milk such as pudding and soup
• canned fish such as salmon, sardine, and anchovies
• tortillas made from lime-processed corn
• tofu processed with calcium-sulfate
• calcium and vitamin D tablets

MEDICAL TREATMENT. An x ray will indicate bone loss when much of the density has decreased. A more effective way of detecting osteoporosis is the DEXA-scan (dual-energy x-ray absorbtiometry). This whole-body scan will indicate whether a person is at risk for fractures. It could be useful for people at risk for osteoporosis as well as women near the age of menopause or older. People should ask their doctors about whether this test is needed.

During menopause, a woman loses estrogen. A pill or skin patch containing estrogen and progesterone eases symptoms of menopause has been used to treat osteoporosis. This treatment is known as hormone replacement therapy (HRT). In 2002, the Women's Health Initiative found that HRT produced harmful effects in postmenopausal women, including increased incidence of breast cancer, heart disease and dementia. The effects were bad enough to stop the study. In 2003, researchers were looking for alternatives to HRT for women who had been using the hormones for osteoporosis. Until an alternative is identified, women and physicians have been advised to closely weigh the risks and benefits of hormone therapy. Several drugs are available to help reduce the risk of fractures in seniors with osteoporosis. In 2003, the FDA approved a new treatment option called Teriparatide. Some alternative treatments show promise in studies, including SAMe, (S-adenosylmethionine). However, long-term safety and effectiveness of SAMe have yet to be established.

Osteoarthritis

Treatments for osteoarthritis range from preventative measures such as walking to joint replacement surgery. Treatment costs vary from no cost for soaking a joint in cold water, the price of over-the-counter remedies to fees for surgery.

Preventive and maintenance remedies include low-impact exercise such as swimming and walking, along with maintaining proper posture. Nutritional aids include foods rich in vitamin C such as citrus fruits and broccoli. Also recommended is daily consumption of 400 international units of Vitamin E. Cutting back on fats, sugar, salt, cholesterol, and alcohol helps relieve the symptoms of osteoarthritis.

HOME REMEDIES AND PHYSICAL THERAPY. The Arthritis Foundation recommends several remedies for easing pain. To treat inflammation, a person should use a cold treatment. Methods include soaking the affected area in cold water or applying an ice pack. To soothe aches and stimulate circulation, a person applies heat to the affected area for 20 minutes. This should be done three times a day.

Over-the-counter (OTC) remedies such as aspirin and ibuprofen and salves containing capsaicin can be helpful. Furthermore, a doctor may recommend anti-inflammatory medications.

SURGICAL TREATMENT. If osteoarthritis is suspected, a doctor's diagnosis will include an assessment of whether joint pain is part of a patient's medical history. The doctor may take an x ray to determine the presence of cartilage loss and how much degeneration occurred.

Acupuncture may be helpful in treating mild osteoarthritis. Generally, a person should have one to two treatments a week for several weeks. Afterward, one treatment is recommended. An assessment of results should be made after 10 treatments.

In cases of severe osteoarthritis, joint replacement surgery or joint immobilization may be required. Joints are replaced with metal, plastic, or ceramic material.

Fall prevention

Fall prevention starts with regular exercise such as walking. This improves balance and muscles. The walk route should be on level ground. Other methods for preventing falls include:

• when rising from a chair or bed, a senior should move slowly to avoid dizziness
• people who smoke should quit
• shoes with low heels and rubber soles are recommended
• medications should be monitored because of side effects that increase the probability of a fall
• vision and hearing should be checked periodically
• fall-proofing the home, including the installation of lighting, especially on stairways, clearing clutter and electrical cords that can cause falls, and installing handrails and strips in bathtubs and rails on stairs.

MEDICAL TREATMENT FOR FALLS. After a fall, a senior may need first aid treatment for cuts or fractures. The doctor may evaluate whether medications cause balance problems. If indicated, the doctor may examine the patient's central nervous system function, balance, and muscle/joint function. A hearing or vision test may be ordered.

Corrective measures could include adjusting prescriptions, vision surgery or having the patient use a cane or walker.

Vision

A person diagnosed with presbyopia may need bifocals or reading glasses to read print that appears too small. These lenses may need to be changed as vision changes over the years. Eventually, a person relies on glasses to focus on items that are near. Other seniors who never needed corrective lenses may need to wear eyeglasses. Publishers aware of this condition produce books with large print.

A senior should schedule periodic vision exams because early treatment helps prevent or lessen a risk of cataracts or glaucoma. Diet also plays a role in vision care. Dark green vegetables like broccoli are said to help prevent cataracts from progressing. Physical exercise is thought to reduce the pressure associated with glaucoma.

Glaucoma can be treated with eyedrops. Surgery can remove cataracts. The affected lens is removed and replaced with a permanent synthetic lens called an intraocular lens. There was no successful treatment for age-related macular degeneration as of 2001.

Hearing

An audiologist can administer tests to determine the amount of hearing loss. Although there is no cure for presbycusis, hearing aids can help a senior affected by age-related hearing loss. If this treatment is not effective, the person might need to learn to read lips.

Sleep disorders

Losing weight can help with conditions such as snoring and sleep apnea. A doctor may advise the senior to quit smoking, reduce alcohol consumption, or to sleep on his or her side. In some cases, a doctor may refer the senior to a sleep disorder clinic. The senior may be prescribed a continuous positive airway pressure device. Known as a CPAP, the device is placed over the nose. It sends air into the nose.

PLMD and restless leg syndrome may be treated with the prescription drug Dopar. These disorders could be signs of kidney or circulation conditions. Treatment of those conditions should end these sleeping disorders.

Insomnia treatments include exercising and treating depression, stress, and other causes of sleeplessness.

Mental health

After retirement, a senior must find activities and interests to provide a sense of fulfillment. Otherwise, feelings of loneliness and isolation can lead to depression and susceptibility to poor health.

Activities that stimulate a person physically and intellectually contribute to good health. A senior can start an exercise program, take up hobbies, take classes, or volunteer. Senior centers offer numerous activities. Lunch programs provide nutritional meals and companionship. This is important because a senior living alone may not feel motivated to prepare healthy meals.

Dementia

Diagnosis of Alzheimer's disease starts with a thorough medical examination. The doctor should administer memory tests. Blood tests may be required, as well as a CT scan or MRI scan of the brain. If Alzheimer's is diagnosed, the doctor may prescribe medication to slow down progression of this form of dementia.

As of 2003, the FDA had approved four prescription medications for treatment of Alzheimer's. Tacrine, donepezil, riviastigmine, and galantamine are cholinesterase inhibitors that enhance memory. Modest improvement was reported in clinical trials on donepezil, riviastigmine, and galantamine. Tacrine's possible side effects include liver damage, so it is seldom prescribed.

Preparation

Before beginning a weight loss or exercise program, seniors should check with their doctors. The doctor will determine whether a patient is at a healthy weight, or needs to gain or lose weight. The medical professional should be informed about a health condition or a family history of a condition like heart disease. The doctor may order a physical exam or recommend a specific exercise program.

Exercise preparation

A senior should select a form of exercise enjoyable enough to become a regular routine. Suitable clothing or equipment such as walking shoes or a bicycle helmet should be purchased. If a person is active for more than a half-hour, the American Heart Association recommends drinking water every 15 minutes.

In addition to packing a water bottle, a person should pick an exercise buddy. Exercising with a friend or a group makes the activity more enjoyable. In addition, a person is more apt to stick with a routine if a buddy is involved.

Before exercising, a warmup with slow stretching exercises is recommended. This could take longer for a senior because muscular elasticity slows down as a person ages. The exercise session should end with a cool-down that includes slow stretches.

Aftercare

Some recovery time may be needed after surgery. However, a healthy person will heal more quickly. A senior needs to maintain a schedule of regular exercise in order to remain mobile. Otherwise, a minor illness could make them dependent on others for daily care, according to the American Heart Association.

If mobility becomes limited due to a condition such as osteoarthritis, equipment like a walker and devices that make it easier to open bottles and grip cutlery can be helpful.

Risks

Exercising too long or too strenuously can be physically harmful. The over-exertion could cause the person to lose interest in exercise and put off establishing a regular routine. Experts recommend starting out slowly and building up to more intense or longer sessions. This is particularly important for a sedentary person.

Osteoporosis

The long-term effects of hormone replacement therapy have ruled this treatment out for some women.

Normal results

Seniors who stay active and eat nutritionally will be at less risk for conditions such as diabetes. A senior also should seek mental stimulation and social interaction. These provide enjoyment, boost self-esteem, and help reduce feelings of isolation and depression. Although eyesight and hearing will weaken, glasses and hearing aids help seniors keep the senses of sight and hearing.

When surgery is required for osteoarthritis, hip replacement surgery is extremely successful. In about 98% of surgeries, flexibility returns and pain is eased. Knee replacement surgery also is effective.

If a person maintains a healthy lifestyle, the ability to avoid falls and recover from them is increased.

After a fall, seniors needs to build up physical strength and the confidence needed so they don't fear falling again. Care should be taken so that seniors don't feel isolated by their injuries. Isolation could lead to decreased mobility and loss of independence.

There is no cure for Alzheimer's disease. However, several medications have proved moderately effective in stopping memory loss. Since Alzheimer's is progressive, a person diagnosed with this condition should make arrangements for the future. Finances should be taken care of and plans should be made for future care. Family should be brought into the discussion.

After diagnosis, a person should stay active for as long as possible. Not only does this help with enjoying this stage of life, activities can help to fight depression. Alzheimer and other support groups can be helpful. In addition, modifications to environment can be effective.

Resources

BOOKS

Gillick, Muriel R. Lifelines: Living Longer, Growing Frail, Taking Heart. New York: W.W. Norton and Co., 2001.

Honn Qualls, Sara, and Norman Abeles, editors. Psychology and the Aging Revolution: How We Adapt to Longer Life. Washington, DC: American Psychological Association, 2000.

Powell, Douglas H. The Nine Myths of Aging: Maximizing the Quality of Later Life. Thorndike, ME: Thorndike Press, 1998.

Wei, Jeanne Y., and Sue Levkoff. Aging Well: The Complete Guide to Physical and Emotional Health. New York: Wiley, 2000.

PERIODICALS

"Aging Americans Face Growing Health Threats." Health & Medicine Week June 23, 2003: 3.

Evans, Jeff. "Aging U.S. Population Will Force Changes in Health Care Services." Family Practice News April 1, 2003: 54-61.

"Increasing Evidence That Osteoporosis Begins in the Womb." Womenós Health Weekly June 19, 2003: 30.

"Update on the Treatment of Osteoporosis Released." Drug Week June 27, 2003: 344.

Vernarec, Emil. "An Emerging Alternative to NSAIDs for Osteoarthritis?" RN May 2003: 24-31.

ORGANIZATIONS

Alzheimer's Association. 919 N. Michigan Ave., Suite 1100, Chicago, IL 60611-1676. (800) 272-3900. 〈http://www.alz.org〉.

American Academy of Otolaryngology-Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. 〈http://www.ent.org〉.

American Dietetic Association. 216 W. Jackson Blvd., Chicago, IL 60606-6995. (312) 899-0040. 〈http://www.eatright.org〉.

American Heart Association. 7272 Greenville Ave., Dallas, TX75231. (800) AHA-USA1. 〈http://www.americanheart.org〉.

National Institute on Aging. P.O. Box 8057, Gaithersburg, MD20898-8057. (800) 222-2225. 〈http://www.nih.gov〉.

National Osteoporosis Foundation. 1232 22nd St., NW, Washington, DC 20037. (800) 624-BONE. 〈http://www.osteo.org〉.

National Sleep Foundation. 1522 K St., NW, Suite 500Washington, DC 20005. Fax: (202) 347-3472. 〈http://www.sleepfoundation.org〉.