As we age our bodies change. Things take longer to heal, our bodies experience more daily aches and pains, it is harder to lose weight (my least favorite), and most people need reading glasses. The list of things to know about our own bodies and how they change each decade is long.

What about older adults with whom we may spend time, especially those over the age of 80 years old, sometimes even younger?  It turns out that there are some things that dramatically change as you reach that age. The signs and symptoms that we observe as we spend time with older adults as family members, friends or caregivers may be significant indicators of problems.

It is important to be aware of some important facts that may surprise you because incorrect assumptions may cause us to make choices regarding an older adult that may be detrimental to their health. Here are just a few things to be aware of that are related to both the physiological and mental health of older adults:

1. Loneliness is a factor in decline in health, even death: Loneliness and social isolation among older adults have been found to be associated with declines in their health along several factors. Loneliness in particular was found in several studies as being associated with declines in the ability to perform Activities of Daily Living (ADL) such as grocery shopping, dressing, etc., and reduced mobility. It was also associated with increased risk of heart disease and stroke as well as increased likelihood of dying earlier. But it is interesting to note that loneliness for older adults is quite different than it would be, for example, for a millenial, for which we can thank the onset of the digital age. A number of studies recently point to the loneliness of millenials even when in the midst of a large number of people (see future blog posts) or if they only have one or two good friends. This has been attributed in large part to the changes in the nature of their communication with their peers due to the advent of social media. For an older adult these days, social isolation and loneliness can be dramatically reduced by having meaningful relationships with one or two others.
   
   
2. Sudden onset of dementia? It could be a UTI: Sudden symptoms of dementia in an older adult, with or without a fever, could possibly be caused by a Urinary Tract Infection (UTI). This can be confusing because 1) with an older adult people often erroneously assume dementia must be Alzheimer's and 2) younger people do not usually experience dementia with a UTI. Fortunately, this is a reversible form of dementia once the underlying UTI is successfully treated. It is very important to take the older adult immediately to a physician, urgent care or the Emergency Room to be evaluated. Older adults with UTIs may or may not experience the burning and discomfort commonly felt by younger people. There are other symptoms of UTIs that may present and go unnoticed, but dementia is the one that is most often misconstrued. UTIs are especially risky in older adults because, left untreated, they can spread to other organs and become more difficult to treat. Ideally it is always best to treat something in older adults before it requires hospitalization. Once hospitalized, the older adults are exposed to even more potential risks from others. Recovery from anything is also just harder as you age.
   
   
3. Loss of muscle mass tied to emotional and physical well being: Sarcopenia is a condition that afflicts many adults beginning as early as age 40 (about 13% of adults) and causes them to lose as much as half of their skeletal muscle mass by age 70. According to a recent article in the New York Times  many physicians neglect to discuss this common disease with their patients nor do they discuss that its progress can be reversed through physical activity no matter how old or out of shape you are. Sarcopenia is present in almost half of the population by the time they are in their 80s and is one of the major contributors to both emotional and physical decline among older adults. Encourage the older adult in your life to get evaluated for sarcopenia if you notice a change in strength or physical mobility and this has not yet occurred. Either way, physical activity is proven to be good for both the mind and the body. Watching the movie RBG, the documentary about Ruth Bader Ginsburg, inspired me. If she can do the workout we see her do in that film at the age of 85, the rest of us have something to aspire to.
   
4. Depression is worse among older adults:  A recent study published by Dutch researchers in Lancet Psychiatry, indicates that the depth of depression and how long it lasts tends to be much greater in older adults. It is also less likely to recede or remit.  Although loneliness and co-occurring diseases etc played a role “old age by itself remained a significant risk factor.” This points to a significant need for more psychiatrists and therapists with expertise in geriatric behavioral health, geriatric psychiatry, masters and PhDs in geriatric mental health. While there are training programs in these subspecialties, there are not enough available providers. There are mental health providers who focus on or have expertise in working with older adults. These should always be the first choice. Some social workers will even come to the patient’s residence. In particular, when it comes to prescribing psychiatric medications, it is critical that the provider has expertise in those medications and understand the sensitivity of older adults. Primary care practitioners who have been in practice for a long time, while they are wonderful, frequently do not understand the risk that medications like benzodiazepines pose when inappropriately prescribed to this population.
5. Alcoholism and substance abuse are huge problems in older adults and getting worse: Substance abuse among older adults is a growing problem in particular alcohol, painkillers and anxiety medications such as benzodiazepines. According to the National Center for Alcoholism and Drug Dependence, nearly 50% of nursing home residents have alcohol related problems. Widowers (men who have lost spouses) over the age of 75 have the highest rate of alcoholism in the U.S and older adults are hospitalized as often for alcohol-related problems as for heart attacks. And the list goes on. Benzodiazepines such as Xanax and Atavan, which are highly addictive especially to an older adult, are frequently inappropriately prescribed and abused prescriptions. They are even more risky when mixed with alcohol. Activities at older adult communities that emphasize drinking such as hosting happy hours and gambling, which can be a substitute addiction, exacerbate the problem. Older adults are more sensitive to alcohol and medications than they were when they were younger which also complicates the situation because they may not realize it. Family members are often unaware that an older parent’s memory loss and confusion, even hostility and depression, may in fact be caused by alcohol abuse and/or medications interacting with alcohol or substances. As family members age, reducing alcohol is almost always advisable given changes in the body’s ability to metabolize it and the increase in medications. Watch for changes in behavior, personal hygiene, etc. Sometimes this is just inadvertent caused by mixing medications or mixing medications with alcohol. Sometimes there is an abuse problem that needs to be addressed through treatment. There are programs specifically geared to older adults, both outpatient and residential.
   
   
6. If you are responsible for someone with dementia…:  If you are presented with the challenge of managing the care of someone who is struggling with true dementia, whether it be Alzheimer’s or any other form, there are several critical factors to help improve the outcome of your efforts. Probably the most important is to make sure that you or whoever has caregiver/oversight responsibility takes care of yourself. If that does not occur not only will you suffer but so will the patient. There are many excellent programs available now that offer multifaceted resources to help including neurologists, psychologists, social workers, and sometimes day care services and programs. One program created at the University of Michigan explicitly states that managing dementia well begins by starting with working with the caregivers rather than the patients. The results have been impressive.
   
   

This has been a short list of things to be aware of that you may or may not have known about. Particularly as the Baby Boomer portion of our population (born between 1946 and 1964) ages into the Older Adult segment, more and more focus is on this area. As a result, new information emerges on a regular basis. Being age 75 now is not the same as it was 10 years ago!  Many 75 year olds are still active in the workforce as well as running track, hiking and the tennis court.

All of these factors impact the aging process. There are resources being devoted on how to make this easier.

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Stay healthy and take care of yourself!

Lee

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¹ Where is your tribe? Who are your people? Social Isolation and Loneliness in the 21st Century. (2018). CSA Journal, 1, 7."

² Where is your tribe? Who are your people? Social Isolation and Loneliness in the 21st Century. (2018). CSA Journal, 1, 7."

³ Brody, J. E. (2018, September 3). Preventing Muscle Loss as We Age. New York Times.‍

⁴ Bakalar, N. (2018, June 7). Depression in Older People Tends to Be More Severe. New York Times.

⁵ Bakalar, N. (2018, June 7). Depression in Older People Tends to Be More Severe. New York Times.

⁶ Alcohol, Drug Dependence and Seniors. (2015, June 26). Retrieved from http://www.ncadd.org

⁷ Gravitz, L. (2018, September 15). To Manage Dementia Well, Start With The Caregivers. National Public Radio.