SENIORITIS: A Guide for Healthy Aging

A guide to what ails the aging.

 

                                                                  Case in point. 

 

     On her first visit to my office in months, I faced Mrs. Sanderson and her daughter, asking a pretty routine question that’s easy to pose but fraught with implications. 

Mrs. Sanderson was nearing 85 and had just been gotten home after two months at a skilled nursing home, following a several-week hospitalization for pneumonia and COPD exacerbation.

     Over the prior two years, she had suffered ongoing brittle diabetes, progressive kidney failure, and congestive heart failure. Plus she had hopefully been cured from a bout with breast cancer. Though the last time I had seen her she had not been the picture of health, by this visit she had  visibly deteriorated. She was down twenty-five pounds, her salt and pepper hair had thinned dramatically, her eyes were puffy and her bottom teeth were missing, at some point becoming lost in the transitions between institutions. But her mind was still sharp and she seemed upbeat in an almost manic way to finally be de-institutionalized. 

     Her daughter a high school English teacher in her early fifties, as per usual sat beside her mother, holding her hand. Though well made up and stylish, she clearly was also worn by the ordeals of the prior few months.

After speaking with Mrs. Sanderson for several minutes getting up to date with her recent problems and then examining her fragile body, I sat back on my stool, pushing the laptop away from me and asked, “So how do you think you’re overall health is doing?”

 

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      It’s a funny kind of process with patients—maybe a means of self-protection—but whenever I pose this question, it’s as if they’ve never before considered it. Perhaps because, so often their health issues are scatter shots in the daily flight of their lives, hitting at times but often not changing their day to day path. Maybe also because they’d rather not think about the “big picture.”

     But most often after mulling over the question for a few moments, especially if they are mentally with it, my patients will respond with, “not bad. I’m ok.”

Mrs. Sanderson, despite her life-threatening hospitalization heaped atop her chronic illnesses and the struggle to finally make it back home, gave me a similar response. This one came without any hesitation, “I’m pretty good doc. I think I’ll be ok now that I’m finally out of that old people’s prison .” And she smiled.

In my view, my job then is to engage in some reality testing. “And how do you see yourself doing over the next six months or so.” Her daughter raised her eyebrows at that one, but stayed silent.

     “Well hopefully do fine. Maybe start driving again and get to the store. Watch my stories in the afternoon. Once I get that pesky aide they keep sending over to supposedly help me, I’ll be good.”

     Now comes the hard part. “Well, Mrs. Sanderson, I have to say I’m kind of worried about you. Your lungs are not good at all from those years of smoking. Your circulation in your legs is a serious problem. Your heart although somewhat stable over the past month is just not pumping blood out to your organs and is backing up fluid into your lungs. And your kidneys have been going downhill for awhile now and they never really recover once they start this way.”

I waited a moment to let all that sink in. She sat quiet for a moment, looking pensive, then perked up. “Well at least I don’t have Cancer any more. That’s the real killer, you know.”

     “Well that is true and thank god for that. But maybe we should start some planning in case things do get worse. Do you think if you got sick again you’d want to go back into the hospital?”

     “No way. People are dying there all the time.”

     And so it goes. We talk some about resuscitation and advance care planning and even broach the topic of hospice.

At that she balks. “Hospice! That’s for people who are dying isn’t it?”

 

 

     That’s were it gets sticky. For we are all in the process of dying. Nowadays our bodies never seem to shut down in a cataclysm of illness as in the old days. Instead of the swift detonation of a heart attack ending our lives, we are the victim of a thousand cuts, as if a team of piranhas were eating away at our flesh.

 

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We, who are on the decline—which might include anyone past age five, since our internal organs begin to show signs of wear and tear from daily use even at that young age—are fixated on the inevitable loss of function that defines the aging process. Most of us fear death to one degree or another. But, more than death, we fear the loss of our independence, our control and our vitality—the core that makes us who we are.

Whenever a patient who tells me his age is catching up with him and the common complaint that he is “falling apart” and maybe he should be putting his affairs in order before it is too late, I remind him of three unwavering facts.

1. We are almost all living longer than our ancestors.

Patients often tell me they really don’t want to live to the ripe old ages so common now. But, unless you are willing to take the matter of your final exit directly into your own hands, even the approximate date of your death is well beyond your control.

Today, the average age of death in developed nations is 78, up from 67 just 50 years ago and climbing steadily. Especially in the later years, we are witnessing a boom, not just from the post-war baby boomers but in the nonagenarians and most publicly, the centenarians. The number of people over eighty is expected to rise from 110 million 6 years ago to 400 million by 2050. Improved control of the common cardiovascular killers—strokes and heart attacks—over the past few years, plus with advancements in cancer and dementia care will mean, in future years, even further delays of the inevitable.

If you are in reasonable health by age 70, there’s a mighty good chance you will hit 95. So get used to that idea and plan for it.

2. We, in the medical profession, cannot separate out those treatments that keep us healthy and vital from those that merely prolong our lives and sometimes our suffering.

Patients often tell me they do not want this or that medication or surgery or treatment because it will just stave off their death. When “their time has come,” they just want to go quietly and quickly.

First off, very few of us go quietly and, almost none, quickly these days. Our deaths are most often the result of series of stepwise deteriorations of functions in a variety of organ systems so gradual as to be undetectable until they begin to accumulate and snowball and eventually bury us in their avalanche.

So, when we replace your hip for advanced arthritis at age 86 so you may walk more comfortably, or ream out your carotid artery at 80 to prevent a stroke or place you on a $3000 a year pill to shore up your bone strength so you won’t fracture a hip, we are not necessarily trying to prevent your death. We are trying to maintain your lifestyle and keep you functioning as optimally as possible.

And, as physicians, we have no real way of telling which treatments we give will make you merely function better from those that will serve only to delay your death.

3. Medical science does not know at this point which conditions associated with aging are disease states that someday may be managed or cured and which ones are the inevitable, uncontrollable result of biological aging.

We all know that as we age, our hair turns grey then falls out, our joints stiffen, our thought processes slow, our memory declines, our skin wrinkles, our breasts sag, our ears and noses grow while our penises shrink, all the by-products of an inevitable, unstoppable deterioration.

But which of these is really inevitable? At this juncture, we realize that Alzheimer’s disease, once felt to be inevitable, is truly a disease and not just a result of aging. Alzheimer’s disease is caused by a specific biochemical abnormality that allows the build up of a certain protein in a certain area of the brain in a certain percentage of aging persons that causes their memories to lapse, their thoughts to confuse, their personalities to fade. In 10 to 15 years we may reverse this abnormality and this inevitable consequence of aging will no longer be inevitable. Similarly, in the future, we may find ways to maintain the lubrication in our joints, the elasticity of our skin, and the strength of our muscle fibers.

So, the hope and result would be that in some foreseeable future, we might all live vital, healthy rich lives, vital until age 116, when the true preprogrammed endpoint of each of our cells is reached. We will then suddenly collapse in preordained heap, then be carted off without fanfare or mourning because we lived such a full life to the very end.

The information to follow is designed for the lay person help him learn what he might expect, watch for, be leery of and prevent as he ages, much as the Dr. Spock of the fifties provided parents guidance for what problems they might encounter raising their babies. All seniors are clearly not the same, even more so than all babies are distinct.  In some vital super-seniors over 80, they are like the 60 year-olds of the last generation. While some 65 year-olds are so debilitated by illnesses, they may be worse off than the hundred-year old living in the next nursing home bed. These discrepancies-- which I will point out throughout this book-- are determined by an unpredictable interplay of genetics, environment, personal habits and the ever-indefinable element of luck.

The compilation is neither a complete nor comprehensive list of what may befall us, but rather includes those conditions and elements that in my experience of forty years as a Family Doctor have the most bearing your health during the so-called, declining years.

Many of the issues discussed here are my opinion based on a good deal of fact, but still open to debate. Many of the issues are in such flux, a year from now my comments may not still be accurate. I will frequently adjust the information when the need arises.

Most of the conditions itemized here will never impact your health individually. But all of us are susceptible to them and at least several are likely to affect each of us sooner or later. I am confident with exploding technology and dedicated researchers we will in the future have better answers than we have now for these timeless questions.   How do we live longer? How do we live healthier? How do we age more gracefully?