Physical changes

Aging is about change
Of course we have all been changing, and aging, from the moment we were born—physically, mentally, emotionally, spiritually. There are many myths about growing older. In these articles, we strive to debunk the misconceptions and speak candidly about the most common changes of our later years.

Age is fluid
Line up a group of people who are 65 and older and you will see remarkable variation. Have them stand in chronological order and you may be surprised that some individuals in the later years will appear to have more vigor than others in the younger years. This exercise is not about passing judgment. It’s simply to show that there is a distinction between “aging” (the chronological fact of living longer) and “decline.” While the functions of the physical body do decline over time, the rate of change is different for everyone.

It helps to begin with an understanding of the normal process of physical aging. And—especially for those who are not yet experiencing them—learning how those changes affect our lives on a daily basis and in the big picture.

Normal aging: the five senses

The normal changes of aging and the necessary daily lifestyle adjustments that go with them are easiest to see by looking at the five senses. Vision, hearing, touch, taste, and smell are how we experience our world. They greatly affect our understanding and often, our joy. Even normal changes to our senses create some risks and usually result in the need to do things differently in order to adapt.

Vision
More than one-quarter (28 percent) of persons over age seventy have experienced at least some vision loss. The normal changes of aging have potentially serious effects:

  • Difficulty seeing up close. (Glasses or contacts can usually remedy this problem.)
  • Need for more light, because we don’t have the receptors we used to.
  • Reduced ability to judge distance. This can have serious consequences for driving, because we have trouble judging the speed of oncoming cars, making a left-hand turn, or entering the freeway.
  • Problems with glare. Adjusting to light and dark takes the eyes much longer than we are used to. This makes driving at night difficult and dangerous. As a result, we tend to stay home in the evenings and are unable to go out easily to nighttime events.

More than three-quarters of legally blind individuals are people over age sixty-five who lost their sight because of age-related diseases. The most common diseases include glaucoma, cataracts, macular degeneration, and diabetic retinopathy.

Hearing
Nearly one-quarter of persons age sixty-five to seventy-four and half of those age seventy-five and older have a disabling hearing loss. It’s not only a matter of volume, but also being unable to hear words clearly. Loss of hearing has deep consequences.

  • Injury. Not hearing can lead to a greater chance of injury, particularly involving cars, when we may not hear one approaching. In addition, persons with even mild hearing loss are three times more likely to experience falls than are persons without. Scientists are unclear why. The fact that the inner ear plays such a large role in balance may be part of the reason.
  • Social isolation. Difficulty hearing tends to cause people to withdraw socially. We lose our relationships when we lose our hearing!

While technology aids are improving, they are expensive. Less-expensive versions tend to amplify all noises, which is not ideal. As a result, only 30 percent of older adults with hearing loss use hearing aids.

Other hearing impairments include tinnitus, an often-constant ringing, buzzing, or swishing noise in the ears.

Although the impact of hearing impairment is profound, it is frequently overlooked as a disability.

Touch
The sense of touch involves not only the skin, but also our nerves and brain. As we age, our sensitivity to touch, temperature, pressure, vibration, and the position of our body changes. Reduced sensitivity can have serious outcomes:

  • Burns. We may not feel that something is too hot. It’s important to set the temperature of the water heater to no higher than 120° to avoid burns.
  • Hypothermia or frostbite. We can’t rely on our bodies to judge the temperature outside. Check an outdoor thermometer when it’s cold, and dress accordingly.
  • Infection. By not feeling pain as acutely, we may be unaware that a sore or infection is developing. It’s important to check the skin regularly for injuries, especially the feet.

Taste
Eating is one of life’s pleasures. However, the taste buds lose their sensitivity with age, and the tongue has fewer of them. Following are some of the pitfalls:

  • Oversalting or oversweetening foods. As a result, older adults are often tempted to put more salt or sugar on their food than they did in their younger years. This can lead to problems for those on special diets.
  • Malnutrition. When food becomes less tasty, it can also become unappealing, leading to weight loss and poor nutrition.

Fortunately, taste is rarely lost completely, and texture—crunchy or chewy foods—can be emphasized for variety.

Smell
The ability to perceive odors declines with age, especially after age seventy. While outwardly this might seem to have some benefits, there are definite disadvantages:

  • Reduced pleasure in eating. For those who relate smells to the joy of food, it can reduce the pleasure of eating.
  • Potential to get sick from spoiled foods. A weak “sniffer” can cause problems because it’s more difficult to tell if food has gone bad.
  • Greater likelihood of injury. It’s harder to smell smoke in the case of a fire. Or a gas leak. It’s important to be sure that smoke and carbon monoxide detectors have fresh batteries and are tested regularly.
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The cellular process of aging

There is no one explanation of aging. More than 300 theories exist to explain physical decline. Some relate to environmental factors (exposure to air pollution, or things that we do, like drinking alcohol and smoking tobacco). About 25 percent of aging can be attributed to cellular changes that are more genetic in nature.

On the cellular level, the simplest explanation is that aging occurs as components in our cells wear out over time. This process begins in our twenties.

The cells in our body are constantly being replaced. Over the years, those cells don’t reproduce as accurately or as quickly as they did before. Our cellular repair systems don’t cull out dead or misfiring cells as effectively. Bodily processes become less efficient. Healing takes longer. Everything slows down.

Whether it’s a blood cell, a bone cell, a nerve cell, a digestive cell, a muscle cell, etc., all cells and systems are affected. Our immune system becomes weaker, and we are unable to fight disease as effectively. Our digestive system doesn’t extract nutrients as well as it used to. You get the picture.

And this doesn’t count the cellular impact of our lifestyle choices or environmental exposures.

Such changes are not noticeable in younger people. But as the years accumulate, so do those little changes. The inefficiencies become more obvious. And they have consequences.

The changes in the five senses—smell, sight, hearing, taste, and touch—for instance, are part of the normal process of aging. The cellular errors of aging, however, can also open doorways for mutations (cancer), infections, or other chronic conditions.

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When to see the doctor (women)

Women’s medical risks are different from men’s. Certainly for women and men both, any change that brings about pain, bleeding, fever, nausea, diarrhea or dizziness should signal the need to see a doctor. Also, an unintended loss in weight, or problems with general tasks of daily life that were easy before (driving, preparing meals, light housekeeping, paying bills, dressing, bathing, eating, toileting). These can indicate a medical problem worth investigating.

Early detection
Many conditions develop without any outward signs. High blood pressure or cholesterol, for instance, do not have physical symptoms, but they can cause big problems if they go undetected. Fortunately, a good number of the diseases that develop in older adults can be prevented, cured, or at least managed well, if they are caught early.

Screening Guidelines
Below are the guidelines set out by the U.S. Preventive Services Task Force for regular screening exams for women 65 or older.

 

Blood pressure

  • Have your blood pressure checked every year.

 

 Breast cancer

  • If you notice a change in your breasts, contact your doctor right away.
  • Once every 1-2 years up to age 70: Get a mammogram. Talk with your doctor if you are over 70 years old.

  

Cholesterol and heart disease

  • Every 5 years: Have your cholesterol level checked (a fasting blood test).
  • Have it checked more often if you have diabetes, heart disease, or kidney problems: ask your doctor.

 

Colon Cancer

You should be screened for colorectal cancer until age 75. There are several screening tests available. Some common tests include:

  • Every year: a fecal occult blood test.
  • Every 5 years: a flexible sigmoidoscopy.
  • Every 10 years: a colonoscopy, unless you have risk factors for colon cancer. Ask your doctor about recommended frequency.

 

Dental exams

  • Once or twice every year for an exam and cleaning.

 

Diabetes

  • Every 3 years: Screening for diabetes.
  • More often if you are overweight and have other risk factors for diabetes: ask your doctor.

 

Eye exams

  • Every 1-2 years: Have an eye exam.
  • At least every year if you have diabetes.

 

General physical exam

  • Yearly: Get a physical exam with your doctor. Medicare will pay for this.

 

Hearing tests

  • If you have symptoms of hearing loss, have your ears tested.

 

Immunizations

  • Once: Get a pneumococcal vaccine if you have never had one, or if you received one more than 5 years before you turned 65.
  • Every year: Get a flu shot.
  • Every 10 years: Get a tetanus-diphtheria booster.
  • Once after age 60: You may get a shingles or herpes zoster vaccination.

 

Lung Cancer

  • Once a year if you have a 30 pack-year smoking history AND you currently smoke or have quit within the past 15 years: Get a low-dose computed tomography (LDCT) until age 80.

 

Osteoporosis

  • Initial test at 65: All women over age 64 should have a bone density test(DEXA scan). Discuss with your doctor when you should have a follow-up scan.

 

Pelvic exam and pap smear

  • NO need for pap smear or pelvic exam if, by age 65, you have not been diagnosed with cervical cancer or precancer.
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When to see the doctor (men)

Men’s medical risks are different from women’s. Certainly for men and women both, any change that brings about pain, bleeding, fever, nausea, diarrhea or dizziness should signal the need to see a doctor. Also, an unintended loss in weight, or problems with general tasks of daily life that were easy before (driving, preparing meals, light housekeeping, paying bills, dressing, bathing, eating, toileting). These can indicate a medical problem worth investigating..

Early detection
Many conditions develop without any outward signs. High blood pressure or cholesterol, for instance, do not have physical symptoms, but they can cause big problems if they go undetected. Fortunately, a good number of the diseases that develop in older adults can be prevented, cured, or at least managed well, if they are caught early.

 

Below are the guidelines set out by the U.S. Preventive Services Task Force for regular screening exams for men 65 or older.

 

Abdominal Aortic Aneurysm

  • Initial screening if you have been a smoker and are between 65 – 75: Ultrasound.

 

Blood pressure

  • Have your blood pressure checked every year.

 

Cholesterol and heart disease

  • Every 5 years: Have your cholesterol level checked (a fasting blood test).
  • Have it checked more often if you have diabetes, heart disease, or kidney problems: ask your doctor.

 

Colon Cancer
You should be screened for colorectal cancer until age 75. There are several screening tests available. Some common tests include:

  • Every year: a fecal occult blood test.
  • Every 5 years: a flexible sigmoidoscopy.
  • Every 10 years: a colonoscopy, unless you have risk factors for colon cancer. Ask your doctor about recommended frequency.

 

Dental exams

  • Once or twice every year for an exam and cleaning.

  

Diabetes

  • Every 3 years: Screening for diabetes.
  • More often if you are overweight and have other risk factors for diabetes: ask your doctor.

 

Eye exams

  • Every 1-2 years: Have an eye exam.
  • At least every year if you have diabetes.

 

General physical exam

  • Yearly: Get a physical exam with your doctor. Medicare will pay for this.

 

Hearing tests

  • If you have symptoms of hearing loss, have your ears tested.

 

Immunizations

  • Once: Get a pneumococcal vaccine if you have never had one, or if you received one more than 5 years before you turned 65.
  • Every year: Get a flu shot.
  • Every 10 years: Get a tetanus-diphtheria booster.
  • Once after age 60: You may get a shingles or herpes zoster vaccination.

 

Lung Cancer

  • Once a year if you have a 30 pack-year smoking history AND you currently smoke or have quit within the past 15 years: Get a low-dose computed tomography (LDCT) until age 80.

 

Osteoporosis
Men also have problems of thinning and brittle bones as they age.

  • Once: Men age 70 and over should consider getting bone mineral density testing.
  • Talk with your doctor to find out if you have risk factors for osteoporosis.

 

Prostate cancer

  • Talk with your provider about prostate cancer This is such a slow growing cancer that unless you have symptoms, it has been determined that the consequences of screening have been less beneficial than waiting for symptoms to appear.
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Learning to age well

We are living longer!
Only one-hundred years ago, the average person lived to their mid-fifties. Now the average life expectancy is in the late seventies. According to the Social Security Administration, if you’ve made it to sixty-five already, there’s a 54% chance you will see your ninetieth birthday if you are a nonsmoking healthy female (43% chance for nonsmoking healthy males). For smokers, those numbers are 35% for females and 23% for males.

Are we living well?
Although we are living longer lives, many of those years are spent managing multiple chronic conditions. Diabetes. High blood pressure. Congestive heart failure. COPD. Alzheimer’s and other dementias. It is these chronic conditions that can profoundly affect our daily experience of life.

And it’s our daily lived experience that creates our quality of life. The joy in our days. In this sense, “living well” is not about our material belongings, although financial worries do diminish quality of life. “Living well” tends to be our satisfaction or pleasure in our ability to do what we want. It’s our relationships, our autonomy for making decisions, and our feeling of purpose or meaning in life. Ultimately, “quality” can be defined only by each of us personally.

Living well—and therefore aging well—is a balance between quantity and quality of life. This means having enough health to do what gives us joy, and the time to engage in those pleasant, meaningful activities.

Lessons from centenarians (people who live to be one hundred)

While our lifespan is of course affected by genetics, it turns out that is only 20%–30% of the picture. A pioneering international study looked at cultural and lifestyle habits of five communities around the world—in the United States, Greece, Italy, Costa Rica, and Japan. These communities were special because they had low rates of chronic disease and an extremely high proportion of people who live well into their nineties and even one hundreds. Dubbed “blue zones,” the communities shared nine qualities across four domains:

Movement

  • Move naturally. Ideally, physical activity would be just a natural part of living. Rather than going to the gym, people in blue zones walk a lot. They garden, and participate in other physical activities over the course of their daily chores and interactions. Other research suggests at least 75 minutes of vigorous activity or 150 minutes of moderate activity per week will add to health and longevity.

Diet

  • Eating food in moderation. Rather than eating until full or stuffed, people in blue zones tend to “leave room” by stopping when they feel 80% sated, not 100%. Along similar lines, their smallest meal is in the late afternoon or early evening. They refrain from eating at night, essentially fasting until breakfast. Other studies demonstrate that eating slowly and chewing longer can reduce hunger and increase feelings of fullness sooner.
  • “Plant slant.” Meat is eaten only five times a month or so. Instead, the vast majority of foods eaten in blue zone communities are from plant sources: Legumes (beans, peas, lentils), nuts, whole grains, and vegetables. These foods provide protein, fiber, vitamins, and minerals. They also provide unsaturated (good) fats. Together they promote heart health, a healthy gut, and reduced chance of metabolic syndrome (prediabetes).
  • Moderate wine consumption. With the exception of one community (which abstains completely), people in blue zones drink one, perhaps two glasses of wine per day. Other research suggests that red wine is associated with heart health and a longer life. This may be because of the antioxidants found in red grapes.

Social network

  • Strong social and intergenerational connections. Persons dedicated to a life partner benefit with three additional years of life expectancy. Having elders nearby who interact with children also seemed to be beneficial for all. We are social beings. The COVID-19 pandemic taught us that feeling connected—that we belong and have meaningful relationships—is important to well-being.
  • Belonging to a faith-based community. Meeting weekly with others who share a spiritual focus seems to add four to fourteen years of life expectancy. One theory is that the sense of awe or transcendence—meaning beyond the self—is a contributing factor. Other research seems to indicate that the social connection is helpful. Also, that people involved in faith communities typically have lower rates of depression.
  • Healthy friends. Good habits are contagious. Ideally, those in your social network support the type of healthy living you believe in.

Approach to life

  • Rest and relaxation. People in blue zone communities allow themselves to sleep until they feel rested. They have active strategies for setting aside worries during some part of the day (for example, prayer, naps, a social hour). This is confirmed by other research, which suggests seven hours of sleep at night and a short daytime nap (thirty minutes or less) are beneficial for both the heart and the brain.
  • Purpose. Having a sense of purpose, a reason to get up in the morning, provides seven added years to life expectancy.

With a focus on social, spiritual, and physical well-being, elders in these communities seem to have found a balance that allows them to live long and well. One doesn’t have to adopt all the habits to feel the benefit. Some will be easy or appeal more than others. Learning to age well is about making informed, conscious choices that feel right for you.

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Understanding end-of-life changes

It can be hard to accept, but at some point the physical challenges of aging will become unavoidable. Each of us will have the experience of losing our abilities. Eventually we will succumb.

It may be a crisis that lands us in the hospital. Or a terminal illness that allows us to die at home. It could be a heart attack. Or we could die because our organ systems gradually shut down and simply can’t function anymore.

The last few days
On the day we die, we will usually have been in and out of consciousness for a week or more. Unlike in the movies, very few people are awake, aware, or talking. The person may seem to be seeing or reacting to people the rest of us can’t see (hallucinations). Breathing will have become erratic and take on a gurgled sound, sometimes called the “death rattle.” Hands and skin will be cold to the touch. Eventually, the heart and lungs will find it too difficult to continue, and one breath will simply not be followed by another. The heart will stop.

The three pathways
Of course, everyone hopes for a quick and painless death. To die in our sleep, perhaps.

It used to be that most deaths were the result of injury or disease. They tended to be quick and often unexpected.

With modern medicine, things have changed. Now we tend to die with multiple chronic conditions that have been managed more and more aggressively over time. Eventually, one condition overpowers the body and becomes the actual cause of death.

Sometimes it helps to know what to expect.
Dying is actually a process that goes on for months (even years, depending on the condition). There are three general pathways or patterns of decline:

  • Episodes of crisis with adjustments in between. In our older years, most of us manage well enough. We adapt. Then something happens. There’s a fall. A sickness. A surgery. We bounce back, but not to the level of health and vitality we had before. We find a new normal, and cruise along. Then something else happens. We dip down, and we recover. Again, just not back to where we had been. As a rule, over time, these dips occur more frequently, and the bounce back is lower each time. This is a common pathway for people with CHF or COPD, for instance.
  • A short and rather steep decline. Some of us will get a disease, such as cancer. If it is not the kind that can be cured, it has a relatively steep (short) decline.
  • A gradual decline. Some of us reach advanced years with few chronic conditions and very few crises. This pathway is a bit different. One simply becomes more frail. We lose weight and become easily fatigued. We walk more slowly and become less active. That doesn’t mean we are unhappy. It’s just that the physical body sort of dwindles. Usually it is an infection, such as pneumonia, that finally tips the scale. As an example, this gradual decline is the general pathway for Alzheimer’s disease.
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