To Age is Human

To Age is Human
Sinai and Northwest Hospitals in Baltimore, MD
Promote Understanding and
Healthy Aging for Older Americans

©Richard Pelletier

As demographic shifts go, this one qualifies as tectonic: In little more than a generation, the United States added three decades to the average American’s life span. As we barrel along the nation’s roadways behind 85 year old drivers, and jog alongside our 67 year old neighbor, (with the two new knees) it’s hard to fathom that in 1900 the average American lived only to the ripe age of forty-seven. Today – due largely to improved sanitation measures, better medical care and disease prevention — that same person lives for roughly 77 years and the trend (with some caveats) continues upward.

Health care providers have an increasingly complex mission to provide far-reaching services as we live longer and better. “We’ve tried,” says Sinai’s Physician in Chief, Dr. Steven Gambert, “to provide a full spectrum of services recognizing that aging occurs along a continuum. There are preventive services we provide for the young adult and the middle aged person that hopefully will help them to have a more successful aging process so that when they are in their 80’s and 90’s they are more functional and doing well.”

Both Sinai and Northwest Hospitals have made clear their commitment to treating older Americans. Dr. Gambert specializes in geriatric medicine. He is the editor of the three volume publication Contemporary Geriatric Medicine. He is the editor in chief of Geriatric Times a publication that educates medical professionals about geriatric medicine, is a medical educator and writes widely on the topic of medicine as it relates to older Americans. Dr. Michael Gloth of Northwest Hospital sits on the White House Council of Aging, Directs Northwest Hospital’s Geriatric Evaluation and Management unit, is the founder and president of Victory Springs Senior Health Associates a geriatric practice and jogs three miles once or twice a week with his 80 year old father. Dr. Gloth speaks and writes widely on the topic of ageism.

Levindale is a comprehensive geriatric center and hospital with 292 beds. The facility has a 20 bed geropsychiatric unit, 26 bed dementia care unit and a 20 bed rehabilitation unit. Levindale operates two adult day care centers. Levindale’s 172 nursing home facility is Maryland’s first nursing home to employ the Eden Alternative, a groundbreaking approach to nursing home care pioneered six years ago by Harvard trained family physician Dr. William Thomas. The Eden Alternative is designed to mitigate loneliness and bring a fuller, richer experience to nursing home environments. Levindale residents plant flowers, interact with children and pets, grow vegetables and create small family units called “kibbutzim” that helps people negotiate their everyday lives with more grace.

By the year 2030, the last of the much discussed baby boomer generation will have reached 65 years old, at which point 71 million people, approximately 20% of the population will be classified as “older Americans.” What are the chances that Boomer’s will have a successful old age? What constitutes “successful” aging? Will full time work at 80 become routine? (If the stories about boomer savings habits are true, it will.) Will the Ipod come with large type instruction manuals? Will podcasts cover such topics as “How to Get More Fiber in Your Diet?

More important, will our youth obsessed, culture of self reliance learn to love and accept the old, the hard of hearing, the infirm and the frail?

The Problem of Ageism
Ironically, with ever larger numbers of older Americans to live with and care for, we stand bewildered and distinctly uncomfortable before this growing sea of older people. It’s as if one day you cross an invisible line; your gait slows, your hair might be grayer or whiter, maybe you don’t hear so well, and you’ve crossed over; you’re different, you’re one of them. Ageism emerged as a term in the popular culture in the 1960’s by Dr. Robert N. Butler who wrote about the problem in Growing Old in America, and later founded the National Institute on Aging. Dr. Butler defined ageism as a “deep and profound prejudice against the elderly, which is found to some degree in all of us…ageism allows the younger generation to see older people as different from themselves; thus they subtly cease to identify with their elders as human beings.”

Dr. Michael Gloth, who sits on the White House Council on Aging and directs the Geriatric Evaluation and Management unit at Northwest Hospital, speaks and writes widely on the problem of ageism. We disdain older people at our peril, he says. The accumulated knowledge and wisdom of our elders constitutes a vast national resource that if not totally squandered, is not fully understood or properly deployed.

From the perspective of life experience alone, older Americans have much to share if only we are not too smug and self satisfied to receive it, says Dr. Gloth. In the arena of community volunteerism, older Americans have achieved near heroic status, quietly strengthening the national fabric in a thousand places and in thousands of untold ways.

This cultural disdain for the aged has many consequences, but it turns ominous when it affects medical care. In a 2003 report, How Health Care Fails the Elderly, the Alliance for Aging Research based in Washington, D.C., paints a grim reality of elder care. Well meaning, but insufficiently trained medical professionals are treating many older Americans. Preventive measures such as screening for specific diseases are sorely lacking and nine out of ten adults over 65 do not receive appropriate medical screening leading to unnecessary illness and exorbitant cost. Lack of participation in clinical trials by older Americans is striking given that 63% of all cancer patients are age 65 and older. “It refutes logic,” the reports states, “that the largest group of prescription drug users should be one of the groups most discriminated against in medical studies.”
Too few medical schools require course work in geriatrics, reimbursement rates for geriatric specialists lag well behind other branches of medicine and some pharmacists lack the specialized training they need to properly administer medications to an elderly population. Medical options are sometimes taken off the table because the patient is considered “too old.” Age becomes a sole determining factor for treatment rather than function or quality of life.

As frustrating as our current situation is, it wasn’t that long ago when the picture was much worse. Dr. Graham Mooney of the Institute of the History of Medicine at Johns Hopkins University, says that geriatric medicine finally took hold in the 1930’s and 1940’s after emerging as a discipline in the early years of the twentieth century.
“The care of the elderly and infirm has changed a lot over the last hundred years or so. The aged sick were mostly tended to in their own homes, neglected by the medical establishment as incurable and untreatable. When they were institutionalized, it was in almshouses and old aged homes rather than in general hospitals.”

Individually, too many Americans – young and old – remain unaware that actions taken at any age can have enormously positive consequences. If you’re overweight and in poor health at 65, it is not too late to course correct and we can confidently report that being sick and overweight at seventy-five or eighty-five is a far greater ordeal. Conversely, taking care of yourself by eating well and exercising, means, in the words of Dr. Gambert, “maximizing your genetic potential.”

If you understand the aging process, both physically and spiritually, if you take steps now to care for and educate yourself and others then you have a good chance to age well and gracefully, to admire the resilience and wisdom of your elders and to leave this place a little better than you found it.

Effects of Aging
“Each of us ages differently,” says Dr. Gloth. “However, as people age, there are going to be changes in renal (kidney) function and nerve function. People will experience changes in their vision. A host of physiologic changes can occur. Where a person lands at 75 or 80 years old depends on many factors only some of which are modifiable.” Those modifiable factors will sound pretty familiar to most people: reduced exposure to sunlight, quitting smoking, taking care of one’s bones, regular exercise and a balanced diet. The payoff is increased longevity, greater mobility, less frailty. Toss in a healthy dose of crossword puzzles and you significantly improve your mental functioning.

Although behavior plays a central role in a person’s health and longevity, genetics plays an even bigger role says, Dr. Gambert. “We know from the human genome project that we have long lived families and short lived families. A study of centenarians revealed that the children of centenarians are generally healthier than their equal age counterparts. The 50, 60 or 70 year old child of a centenarian is more like a 30, 40 or 50 year old.” While we have no control over our family of origin, we do have significant control over managing our own health.

All things being equal, Dr. Gambert believes a person should see a geriatrician for a geriatric assessment at or around age 80. The geriatrician he says, is uniquely qualified to evaluate the multiplicity of conditions that often prevail in older patients. “The geriatric assessment will not only detect abnormalities, but hopefully will identify warning signs of things that are at risk with a given individual.”

How Your Aging Body Changes
Over time, your heart becomes less efficient, working harder to perform the same function – pumping blood through your body – than it has for decades. Blood vessels are not as pliable as they were when you were younger. In addition, diets that are high in saturated fats can clog your arteries making your heart work even harder leading to hypertension – high blood pressure.

Over time our bones actually become smaller and less dense. Osteoporosis is the loss of bone density and it means greater fragility and a higher likelihood of fracture. Falls in the elderly are especially worrisome, because hip fractures, according the Centers for Disease Control, cause the greatest number of deaths and lead to the most severe health problems and reduced quality of life.  White men, followed by white women are at the greatest risk. The CDC notes that modifying the risk of falling can be achieved by increasing lower body strength, doing Tai Chi to help balance and to have your physician perform a comprehensive review of all medications.

As you age, your vision deteriorates. One of the earliest signs of aging is that the newspaper is suddenly at arms length because you can’t read it otherwise. You may have difficulty adjusting to changing light. Older drivers often stop driving at night because the headlights from oncoming cars are too difficult to adjust to.

Eye disease, such as glaucoma and cataracts are not natural outcomes of aging. Any change in your vision should prompt a visit to your doctor for the simple reason that your vision is an indicator of overall health. In fact, emphasizes Dr. Gambert, — any change whatever – should prompt a visit to the doctor.

Older people are prone to changes in their ability to digest and eliminate food, and in kidney and bladder function.

Some age prevalent conditions are more serious than others. Among the most serious is diabetes. Type II diabetes is a looming health crisis in the United States. In Type II diabetes, the glucose that is supposed to provide energy to your body’s cells remains in the bloodstream, leading to high blood sugar. Diabetes is a deadly serious disease with a horrific catalogue of outcomes to its name – blindness, amputation, nerve damage, heart failure and death. Adding to the difficulty is that diabetes remains undiagnosed in millions of people who show little or no symptoms. Anyone with a family history of diabetes should alert their doctor, maintain a healthy diet and exercise frequently.

Depression is present in 40% of the elderly population. However, it’s important to recognize that depression is not an inevitable by-product of aging. People in chronic pain are vulnerable to depression, as are people who have lost loved ones or their independence. Depression is often associated with higher rates of cardio vascular disease and heart attacks. Older people who suffer from depression also have higher rates of hip fracture. Sherry Myers, Director of Geropsychiatric Services at Levindale, says that too often primary care physicians don’t screen patients for depression. Screening is crucial because people over 65 have the highest rate of suicide and 50% of those people had visited their primary care physician in the previous six months. Misdiagnosis is a concern. A patient appearing depressed may be diagnosed with depression but in fact may have a urinary tract infection that if left untreated is extremely serious. Levindale is conducting an outreach program to alert physicians who treat the elderly to screen for depression.

Dementia
Alzheimer’s disease is the most commonly known and widespread form of dementia. It’s impact on individuals, families, caregivers and communities in terms of emotional, physical and financial stress is deeply felt. A 2004-2005 Progress Report on Alzheimer’s disease compiled by the National Institute on Aging and the National Institute’s for Health states that 4.5 million people currently suffer from the disease and it is estimated that 50% of people over 85 have some form of dementia. Dementia is an irreversible brain disorder that should never be interpreted as a normal aging process.

One of the unintended consequences of the extended life span we now enjoy is the increase we see in such age related diseases such as Alzheimer’s. By 2050 the report states, 13.2 million Americans will be afflicted if population trends remain the same and no preventative treatment emerges. The report is available online at www.alzheimers.org.

The great majority of Alzheimer’s cases, over 90% the report states, occur in people over 65. It still remains unclear what causes “late onset” AD to develop, but a mix of genetic, environmental and lifestyle issues are thought to play a role. Federally supported research is underway to examine risk/cause factors, diagnosis and treatment/caregiving.

The major risk factors for AD are age and genetics, which might lead you to believe there isn’t much you can do. However, by reducing cholesterol, exercising regularly, managing diabetes and engaging in intellectually stimulating activities you manage risk factors that may in fact play a role in AD.

Aging Successfully
Disease and disability are not the default outcomes of aging. The patterns of aging that characterized our grandparents path into their later years need not be the path we ourselves take. Dr. Gambert has patients in their 60’s and 70’s who he considers to be middle age largely because their lifestyle, good health and functional abilities resemble middle age more than they do old age.

Successful aging results from a set of conscious decisions to live well that ultimately springs from people who take an active role in managing their own health and well being. Those best situated for a successful aging experience are those people who develop good habits early in life. It’s a familiar litany: Exercise, quitting smoking, reducing exposure to the sun, a healthy diet, a strong social network, taking care of your bones, maintaining good psychological health. Moderate amounts of red wine are seen as beneficial.

Adjusting to the changes that come with aging are part and parcel of life. We achieve a measure of dignity for ourselves and for our families if we can accept those changes with the wisdom that a good long life proffers. To age after all, is human. To age well? Divine.

Resources on Aging

AARP
www.aarp.org

National Institute of Aging
www.nia.nih.gov

Alliance for Aging Research
www.agingresearch.org

National Institutes of Health
www.nih.gov

National Library of Medicine
www.nim.nih.gov