Age Related Health Changes and 12 Things We Can Do

Pronounced health changes are more obvious in advanced ages of 85 and older but there is also a great variability among all individuals depending on the impact of genetics, lifestyle factors, response to illness and even stress.  It is always a pleasure to see an active, vibrant, high functioning person in their 90's enjoying quality of life in their community; they serve as a positive role model for us all, giving us hope to join the growing number of healthy centurions in our current population.  Sadly, others in their 50's and even younger succumb to a lesser ability to function and must manage a poor quality of life often in a medical institution.  Normal aging brings causes the following normal changes:

Cardiovascular system: Arteries and heart valves become thicker and less pliable; diminished peripheral pulses and circulation. A decline in body temperature is noted as the baseline oral temperature in older adults is 97.4F versus 98.6F in younger adults.  There is a higher risk for fluctuations in Blood Pressure, arrhythmias, or syncope.

Pulmonary system: Respiratory muscle strength becomes weaker, mucus membranes drier and cough reflexes begin to diminish.  Our bodies are less tolerant for exercise, higher risk for aspiration, night time breathing issues and ability to fight upper respiratory infections.

Genitourinary system: Overall a decrease in creatinine clearance due to changes in kidney mass, blood flow and drug clearance.  Decreased bladder muscle tone, capacity and hormones cause higher urine residuals post voiding and increased night time urination.  There is a higher risk for adverse drug reactions, renal injury, dehydration, hypo/hypernatremia, hyperkalemia, volume overload causing heart failure, urinary urgency or incontinence, urinary tract infections and even potential for falls.  For men, a higher risk of enlarged prostate.

Integumentery system: Loss of collagen causes thinner, drier skin with less elasticity which is more prone to sunburn, cuts, tears and abrasion.  Overexposure to the sun earlier in life can cause skin melanoma later in life.

Musculoskeletal systems: Muscle mass and strength decline throughout the whole body.  Lean body mass is replaced with fat and redistributed.  Bone loss especially in women causes osteoporosis; tendons and ligaments become tighter, less flexible.  Intervertebral discs shrink and degenerate, cartilage erosion and changes in posture  may occur with a reduction in height or posture.  These changes not only limit our joint flexibility and range of motion but also increase our risk of falls, unsteady gait, bone fracture, joint inflammation and arthritis.

Oral-Gastrointestinal systems: Even the oral muscles of mastication become weaker along with dental changes cause difficulty chewing or receiving adequate nutrition.  Our perception of taste and thirst becomes impaired.  There is decreased motility throughout the gastrointestinal system causing slower stomach emptying, impaired defecation and malabsorption of nutrients.  The liver has a decreased ability to metabolize medications.  This places us at higher risk for adverse drug reactions, constipation, GERD, or NSAID-induced ulcers.

Nervous system and Cognition: Aging causes a decline in the number of neurons, support cells, synapses and neurotransmitter chemicals produced.  This contributes to overall muscle weakness, decline in reflexes, slowed motor skills and potentially impaired balance and coordination.
Temperature sensitivity is diminished and there may be a blunted or absent fever response.  Cognitive processing is slowed and some decline is common but not universal.  There is a lesser need for sleep time but a higher risk for sleep disorders, delirium and neurological diseases.

Immune system:  Dysfunction of the immune system will increase the susceptibility to infection while increasing the risk of chronic inflammatory diseases.  There may even be a reduced efficacy of vaccinations. 

WHAT CAN WE DO?

1. Get annual wellness dental and medical check-ups to monitor age related changes, obtain early intervention/prevention which will minimize risk factors that could be corrected. Obtain annual preventative testing for early detection of disease: i.e.. Mamography, lab tests.
2. Consider lifestyle changes that will promote healthy successful aging. ie stop smoking, minimize alcohol intake, reduce stress.
3. Keep immunizations current.
4. Emphasize weight bearing exercise, strength and overall fitness: walking, weight training are the best, while swimming, cycling and aerobics are good too.
5. Emphasize stretching all joints and maintaining an erect posture: Yoga is great!
6. Exercise your brain cells with memory and analytical games: Puzzles, Crosswords, Word finding, mathematics, reading and other intellectual stimulation.
7. Eat a well balanced, high fiber diet along with vitamin supplements.  Monitor and maintain a healthy weight.  Women should supplement their diet with 12-1500mg Calcium and 1000 Vitamin D daily.  Check with your doctor regarding recommended vitamin supplements specific to your needs.
8. Stay well hydrated with water.  Minimize soda, caffeine, alcohol consumption.
9. Remove household trip hazards such as area carpets, long cords and keep a safe pathway from bed to bathroom especially for night time toileting; consider night lights along this path.
10. Practice good sleep hygiene. 
11. Monitor skin for changes that may require medical attention, use daily body lotion.
12. Know and examine your body from head to toe; question if changes seem to be normal or abnormal.  Question if suggested medications are right for you.  Keep a record of your personal health history and current medications readily available for doctor visits or in case of any emergency.

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Honest Communication with Seriously ill Patients

It is not easy to tell patients they are going to die.  Despite the fact that chemotherapy delivered to cancer patients with a poor prognosis is intended only to provide palliation, not a cure, a majority of patients with metastatic cancer have false expectations regarding the curative potential of the treatment.

This raises the question of whether the needed patient-physician conversations about palliative and end-of-life care are even taking place.  Patients who do not know whether a treatment offers any possibility of cure may be compromised in their ability to make informed treatment decisions that are consonant with their preferences.  This misunderstanding could represent an obstacle to optimal end- of-life planning and care.

If patients have unrealistic expectations of a cure from a therapy that is administered with palliative intent, there is a serious miscommunication that needs to be addressed.  Studies have shown that two-thirds of doctors tell patients at the initial visit that they have an incurable disease, but only about a third actually state the prognosis.   It is not easy to tell patients that they are going to die and many physicians choose not to do this.  It might explain why two months before death, many patients with cancer have not heard any of their doctors use the word "Hospice."

Most patients want to know whether or not they can be cured, and physicians can provide them with the information they need in order to plan for their remaining life.  If patients are offered truthful information on what is going to happen to them, they can choose wisely and physicians can help them make these difficult decisions. 

Helping seriously ill patients and their families to become proactive in understanding and seeking the services of palliative medicine and Hospice care is the focus of a new educational campaign from The Joint Commission. "Speak Up: What You Need to Know about Your Serious Illness and Palliative Care," the program offers free downloadable brochures, videos and posters.  Topics addressed in the brochure include how and when to get palliative care, questions palliative care specialists may ask patients, questions for patients to ask their palliative care providers and where to get more information.  www.jointcommission.org/topics/speakup_brochures.aspx

The Villas in Antioch, Martinez and Alamo work together with families, residents, physicians and Hospice or Palliative care agencies to insure there is clear and honest communication with patients living with serious illnesses.  We are proud to assist guiding residents and their families through one of life's most challenging times with clinical expertise and compassion.  Please contact us if we can assist you with placement of a loved one, or just information regarding eldercare services.
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Ten Early Warning Signs of Alzheimer's:

1. Recent memory loss that affects job skills
It's normal to occasionally forget phone numbers and remember them later.  Those with dementia, such as Alzheimer's disease may forget things more often.

2. Difficulty performing familiar tasks
Those affected with Alzheimer's disease could prepare a meal and not only forget to serve it, but also forget they made it.

3. Problems with language
They may forget simple words or substitute inappropriate words, making their sentence incomprehensible.

4. Disorientation of time and place.
Those with Alzheimer's disease can become lost on their own street, not knowing where they are, how they got there or how to get back home.

5. Poor or decreased judgement
The disease can cause people to forget entirely the clild under their care; they may also dress inappropriately, wearing several shirts or blouses.

6. Problems with abstract thinking
Forgetting completely what number or words are and what needs to be done with them.

7. Misplacing things
Putting things in inappropriate places: an iron in the freezer, or a wristwatch in the sugar bowl.

8. changes in mood or behavior
Rapid mood swings from calm to tears to anger for no apparent reason.

9. Changes in personality
People's personalities ordinarily change somewhat with age, but a person with Alzheimer's disease can change drastically, becoming extremely confused, suspicious, or fearful.

10.  Loss of initiative
Becoming very passive and requires cues and/or prompting to become involved.

At Villa Care Homes, we can monitor behavior and provide a safe environment for your loved ones.  Stimulating a person mentally and physically to the best of their abilities to maintain independence is critical for quality of life.  Please visit the Villa Website at: VillaCareHomes.com