[Paleopsych] NYT: Aging and Infirmity Are Twinned No Longer

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Personal Health: Aging and Infirmity Are Twinned No Longer
NYT January 25, 2005
By JANE E. BRODY

Nathan Rowman was in his late 80's when he was hospitalized
for a suspected heart problem. Seemingly overnight, Mr.
Rowman, who had been running his own business and going to
work every day, became so confused that his children
considered putting him in a nursing home.

But before that happened, the family consulted a geriatric
specialist who suspected that the medication given to him
in the hospital, and not any organic brain deterioration,
might be causing his confusion. When the drug was
discontinued, Mr. Rowman became his old self again, and
after being discharged from the hospital, he returned to
work.

Is Something Really Wrong?

Many things occur as people age. As Dr. Elaine J. Amella
noted in a recent issue of The American Journal of Nursing,
"Heart muscles thicken, arteries stiffen, lung tissues
diminish, brain and spinal cord degenerate, kidneys shrink,
and bladder muscles weaken."

But - and this is a big "but" -the changes occur at
different rates in different organs and in different
people. One person's lungs may function fully while the
kidneys fail. One 85-year-old's brain may fire on all
cylinders while another person of the same age cannot
remember anyone or anything.

As the Baltimore Longitudinal Study on Aging has shown by
tracking over 1,000 people since 1958 from age 20 to past
90, "No single chronological timetable of human aging
exists."

One consequence of these varying changes with age is
difficulty in determining whether an older person has an
ailment that requires diagnosis and treatment or is merely
experiencing the gradual physiological shutdowns associated
with growing old. Too often, older people and their
relatives dismiss or ignore early symptoms of what may very
well be a correctable problem, because they wrongly assume
that the changes are to be expected as one grows old.

The symptoms I'm referring to include a diminished
appetite, a change in mental functioning, incontinence,
falls, dizziness, pain and a loss of functional abilities
like dressing oneself or negotiating stairs.

"These problems aren't inherent to aging," Dr. Amella
pointed out, adding that failing to check into their causes
can result in a missed opportunity to treat a health
problem while it is still possible to correct it.

One of the most common correctable problems is drug
toxicity. As people age, body fat is gained at the expense
of lean muscle, resulting in less body fluids to dilute
water-soluble drugs and more fat tissue for storing
fat-soluble ones. Loss of body fluids allows certain drugs
to reach toxic levels when given in doses appropriate for
younger adults.

At the same time, an older person's kidney and liver
function declines, so that drugs are not cleared from the
body as quickly. Yet higher levels of body fat may mean
that the usual dose of a drug is inadequate to treat the
problem.

Complicating matters further is the fact that symptoms of
an illness in older adults can differ from those in younger
people. For example, a young adult may run a high fever
with a serious infection, but the naturally lower body
temperature of an older person, along with a diminished
ability to mount an immunological attack against an
invading organism, may result in no noticeable rise in body
temperature.

Rather than experiencing fever and chills, an older person
with an infection may become confused or lose functional
abilities. For example, an 80-year-old with pneumonia may
experience a more rapid breathing rate with decreased
appetite and functioning, and someone with a urinary tract
infection may become incontinent and confused and suffer
falls. When such symptoms are ignored, an infection can
rage undetected until it reaches a very serious, even
life-threatening, stage.

The Meanings of Symptoms

In her report, Dr. Amella, an associate dean for research
at the Medical University of South Carolina College of
Nursing, describes a host of possible explanations for
changes that commonly occur in older adults. These are some
possibilities:

CHANGE IN MENTAL STATUS This is "a common harbinger of
disease, drug toxicity or psychological trauma in older
adults," she stated. A deterioration in mental function
that occurs over days or weeks is often a result of a
change in medication or the aftermath of anesthesia.

FALLS A long list of ailments can cause an older person to
fall, among them heart problems, osteoporosis, vertigo, a
slowly leaking blood vessel in the brain, a loss of hearing
or vision, incontinence prompting a rush to the bathroom
and even a fear of falling. A toxic buildup of a drug is a
common cause. Particular attention should be paid to
psychoactive drugs like sedatives, drugs that lower blood
pressure and those that may cause low blood sugar. "Those
who fall will fall again until the cause is found and
corrected," Dr. Amella wrote.

DIZZINESS This can be a symptom of a wide range of
problems, including anemia, abnormal heart rhythm, drug
toxicity, depression, infection, ear disease, eye problems,
stroke, heart attack, a brain tumor or simply impacted wax
in the ears. It can also result from drug toxicity.

DIMINISHED APPETITE This may be a sign of worsening heart
failure or the beginnings of pneumonia, as well as
depression or simply loneliness.

DELIRIUM In addition to drug toxicity, delirium can result
from dehydration, low levels of oxygen in the blood,
untreated anemia, nutritional deficiencies, infections and
untreated thyroid disease. Other factors include vision or
hearing loss, which can usually be corrected simply with
eyeglasses or hearing aids.

INCONTINENCE Dr. Amella says the onset of incontinence in
older people should always be investigated: it often has
reversible causes, including urinary tract infections,
limited mobility and metabolic abnormalities, as well as
the use of medications like diuretics and sedatives.

PAIN An increase in aches is common as people age, and it
can result in a loss of mobility and functioning. Although
pain is often treatable, many older people are reluctant to
use pain medicine because they harbor unjustified fears of
addiction. They may not realize that there are often ways
other than drugs to relieve pain.

LOSS OF FUNCTIONAL ABILITY A decline in activity can be a
consequence of anemia, thyroid disease, infection, cardiac
insufficiency or a diminished lung capacity. In addition to
correcting underlying conditions, rehabilitation programs
can often restore an older person's vitality.

Finally, a word about depression, the most common mental
health problem in older people. Many lay people and health
professionals alike expect the elderly to feel tired, sad
and show little interest in life. But, in fact, most older
people enjoy life, and failing to recognize and treat
depression can deprive the elderly of continued joy and
satisfaction.

Dr. Amella lists many conditions that can lead to
depression - alcohol or substance abuse and disorders like
dementia, stroke, cancer, arthritis, hip fracture, heart
attack, chronic lung disease and Parkinson's disease.
Depression can also result from the loss of a spouse,
functional disability or the unrelenting demands of giving
care to someone.

The bottom line? Do not assume that a symptom is a normal
sign of aging. Get it checked out without delay.

http://www.nytimes.com/2005/01/25/health/25brod.html