Senior Health

Senior Health Overview

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.

Body Changes That Occur As We Age

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 and Conditions of Seniors

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

Side Effects of Taking Medications As We Age

Older Bodies Handle Drugs Differently

While everyone needs to be careful when taking a medicine, older adults frequently take more than one medication at a time, and anyone taking several medications at the same time should be extra careful. Also, as the body ages, its ability to absorb foods and drugs changes.

As people age, the body's ability to break down substances can decrease, so that older people may not be able to metabolize drugs as well as they once did. Thus, older people sometimes need smaller doses of medicine per pound of body weight than young or middle-aged adults do.

Risks and Benefits

All medicines have risks as well as benefits. The benefits of medicines are the helpful effects you get when you take them, such as curing infection or relieving pain. The risks are the chances that something unwanted or unexpected will happen when you use medicines. Unwanted or unexpected symptoms or feelings that occur when you take medicine are called side effects.

Side effects can be relatively minor, such as a headache or a dry mouth. They can also be life-threatening, such as severe bleeding or irreversible damage to the liver or kidneys.

Tips to Avoid Side Effects

Stomach upset, including diarrhea or constipation, is a side effect common to many medications. Often, this side effect can be lessened by taking the drug with meals. Always check with your doctor, nurse, or pharmacist to see if you should take a particular medication with food.

Here are some more tips to help you avoid side effects:

  • Always inform your doctor or pharmacist about all medicines you are already taking, including herbal products and over-the-counter medications.
  • Tell your doctor, nurse, or pharmacist about past problems you have had with medicines, such as rashes, indigestion, dizziness, or not feeling hungry.
  • Ask whether the drug may interact with any foods or other over-the-counter drugs or supplements you are taking.
  • Read the prescription label on the container carefully and follow directions. Make sure you understand when to take the medicine and how much to take each time.
  • If you experience side effects, write them down so you can report them to your doctor accurately.
  • Call your doctor right away if you have any problems with your medicines or if you are worried that the medicine might be doing more harm than good. He or she may be able to change your medicine to another one that will work just as well.
  • Don't mix alcohol and medicine unless your doctor or pharmacist says it's okay. Some medicines may not work well or may make you sick if taken with alcohol.

SOURCE:
National Institutes of Senior Health. Taking Medications. Side Effects.

Social Issues and Seniors

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.

Common Medical Treatments and Tests for Seniors

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:

Other screening tests for seniors often recommended by doctors are:

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.

Safety Measures for Seniors

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 and Hospitalization

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 and Gerontologists

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.

Reviewed on 11/20/2017
Sources: References

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