Hearing loss

A sure sign that you’re becoming hard of hearing, is that you start noticing that people mumble. And they do—it just wasn’t an issue before. When Ludwig Van Beethoven went deaf he was still able to create music and play music. However, although he could “hear” his music, he still could not hear the applause of his audience.

Hearing loss in older age has repercussions beyond individual sensory loss.  Those close to you start to get irritated with you. Some might stop talking to you altogether.  As frustrating as this may be for you, remember that it is also frustrating for friends and family members. Hearing plays a key part in how we communicate—talking on the phone, listening to the television or radio, and our daily face-to-face conversations. Loss of hearing creates difficulties in our primary means of communicating. Even so, the difficulty of accepting change—and especially change in our personal health—causes many people to blame anything and everything before admitting that their hearing isn’t what it used to be. But if these symptoms are familiar, you may need help.

Late-onset deafness—after age 65—usually results from diminished functionality in the middle ear. There are two primary causes. One is an erosion of microscopic blood vessels in the middle ear causes hearing loss but often does not affect the individual's ability to hear and understand speech.

The second degeneration is caused by loss of the ear's tiny 'hair' cells—known clinically as presbycusis. Presbycusis can have a more serious affect on the ability to understand speech. Vital components of speech sounds, usually the higher pitched consonants which define speech, become indistinguishable. For this reason many people first experience difficulty in understanding women and children—and since men are more likely than women to have hearing impairment, this can and does create psychological friction. Lower pitched male voices are often easier to hear and comprehend. As hearing deteriorates, the ability to understand speech becomes more severely affected.

While Whites and Latinos have a higher prevalence of hearing problems than Blacks, sensory impairments create a substantial problem for older Americans in general: One out of four has impaired hearing, and hearing impairments double from age 70 to age 80.  As U.S. life expectancy increases, the prevalence of hearing impairments among older adults will increase—impacting our ability to maintain independence, health, and quality of life.

Some people may have a genetic predisposition to hearing loss.  For others, diet and lifestyle may play a role. For example, exposure to noise or pressure, such as diving or flying, in one’s earlier years will hasten the onset of noticeable hearing loss. Other factors including osteoporosis and diuretic medications may also contribute directly to diminished hearing.

Vanity plays a major barrier to acknowledging that our hearing is not what it used to be and that we need hearing aids. Hearing aids have improved, but still noticeable and the quality remains a compromise. But successful aging means understanding our limitations, and overcoming them. Aging is a privilege, attesting to the fact that we have surmounted many of the inconvenient barriers that life has thrown at us.

Medicine and Religion at the end of life.

There are no guidebooks about getting old. Each of us experiences aging differently and we each deal with these changes in our own way. When we are younger, we have a very general sense—perhaps a distant idea—about aging.  But generally, our ideas don’t get more refined until we actually experience changes associated with aging.  These changes slowly make us aware about our eventual death.

Most of us have come across statistics about death, but these facts get blurred.  It is uncomfortable to think about death.  But while growing old may be a privilege, death is a certainty.

The British geriatrician Arthur Norman Exton-Smith—in a classic study—found that nearly half of his dying elderly patients were delirious at the time of death.  Despite the availability of hospice care both at home and hospital which often provides palliative care that deals with the pain rather than the disease—most people either do not utilize this service or use it too late. As a result, widespread distress about death remains common.

A study in 1997 by Joanne Lynn and her colleagues at George Washington University interviewed family members of older adults who died in hospitals. The authors reported that four in ten patients had severe pain most of the time. Overall, one in ten patients had a final resuscitation attempt. One fourth of patients were put under a ventilator, and a feeding tube was used in four tenths of patients. Under these circumstances death becomes a medical and technological failure.

With this overwhelming failure, some look to religion for answers. It is not by chance that all religions deal with death.  Most have fairly elaborate rituals that formalize how the dying person—and their loved ones—deal with life’s end-game.

Despite its historical role in filling this vacuum, some religions today seem to be diluting these important rituals. How prepared are faith leaders to deal with their constituents’ end-of-life issues? A number of Master theses within the Department of Gerontology and Religious Studies at SDSU have attempted to answer this question, resulting in some surprising answers.

The studies found that despite growing numbers of older constituents, most faith leaders are ill-equipped to deal with such issues. Religious leaders often receive little formal training in dealing with end-of-life issues; devote very little time to dying congregational members; and most surprisingly, are not comfortable talking about death.

Both religion and medicine are coming together to address the needs of people at the end-of-life. The evolving methods to deal with death is a central mission of hospice care—started in the 1950s by Dame Cicely Saunders, an Oxford graduate. Modern day hospice has evolved to include the spiritual as well as the palliative. In addition to providing spiritual and palliative care to the patient, one of the evolving roles is to provide spiritual counseling, respite and education for grieving loved ones. Sometimes continuing this support to the family even after the patient has died. Dealing with death requires help, support and some guidance to understanding its finality. 

Dreaming of Traveling

An AARP national telephone survey of 29,000 older adults recently asked people to describe their “top dream.”

Surprisingly, it was to travel. Two out of  five older adults said that vacation and travel was their top dream, ranked above hobbies and interests (15%); kids, grandkids, family and friends (13%); faith and spirituality (6%); good health (6%); and career, job and work (5%). So it comes as of little surprise that a 2007 survey of 30,000 consumers age 42+ by the New York-based Focalyst—found more than 81 million older adults who were planning to travel in the next year planned to spend a total of $126 billion. This economic potential does not go unnoticed by the travel industry.

More than 100 million Americans today are age 45 or older, their households accounting for 91% of the America’s net worth. This group represents the largest, fastest growing, richest consumer market on the planet, accounting for half of earth’s consumer spending.

However, do not think that Club Med might refer to Medication rather than Mediterranean, as these older traveling consumers enjoy both health and wealth. Research of older adults has resulted in the shattering of some stereotypes. Boomers are the wealthiest generation in history, and even though only 9 percent are truly affluent—defined as having pre-tax incomes of $150,000 or more if working, or $100,000 or more if retired—this 9 percent will transform travel as we know it.

It seems there is no limit to what American adventure travel will entail.  Travel brochures promote Everest treks, tours to Galapagos turtle breeding grounds, retreats at monasteries, and romps in exotic naughty places. Although France is the top tourist destination in the world with 75 million visitors in 2009, America makes the most money from tourism—more than $87 billion. In addition, Americans have become the top international tourists abroad. In around half of all international travelling, Americans end up in Western Europe and of these, one in five go to Britain, and equally to France and Germany (combined). Asia is the second destination for a quarter of all Americans’ international trips.

This resurgence of travel among older Americans may reflect not only affluence, but could be a backlash to years of work in careers that offered little opportunity for travel while working. On average, Americans have half as many holidays as workers in other developed countries. Workers in Italy—which surpasses all countries—have more than two-month annual holidays. American workers, at the bottom of the vacation list, average just over two weeks holiday a year. Retirement becomes an opportunity to make up for lost time.

In such a highly dynamic environment, airlines need to develop specific marketing strategies to cater to the needs of older travelers. In terms of representing the needs of boomers and the aging population, cruise ships are currently doing a better job than airlines. And there is no loyalty, more than half of all Boomers agree that in today’s marketplace, it doesn’t pay to be loyal to one brand or one method of travel. We are in for some radical changes.

Ageless Animals

Not all immortal beings come to us from Hollywood. In the same league as Peter Pan, Dracula and The Highlander, nature’s real-life examples of immortal beings include the turritopsis nutricula. This fairly small species of jellyfish—at 0.18inches—may be the only animal in the world to have truly discovered the fountain of youth. It can cycle from a mature adult to an immature polyp stage—its first stage of life—and back again. We do not know whether turritopsis nutricula retains any memory, or if it goes through an endless cycle of brainless regeneration—much like Hollywood's creations. It could be using its own body to provide the nutrients for a new being. The same mistake was made by French eugenist Alex Carrel, the Nobel prize winner in 1912, when he kept chicken heart cells alive “indefinitely” by feeding them stem cells.

The modern crusade to find immortality continues. However exciting turritopsis nutricula might be for biologists, it does not stir the hearts of modern Americans, who are accustomed to drawing their inspiration from fictional ideals. Besides, immortality has one simple problem to surmount, but it is a big one--physics.

One of the few all-encompassing laws in biology, which is determined in turn by physics, is Kleiber's Law. Max Klieber, a Swiss agricultural chemist, predicted that mass determines metabolism, and metabolism determines longevity. Larger animals live longer.

Kleiber’s Law, however, was complicated by Caleb Finch from the University of Southern California who, while researching aging among animals, found "negligible" aging among rougheye rockfish (who can live up to 205 years), sturgeon (150 years for females), giant tortoise (152 years), bivalves and possibly lobsters. These included no observable age-related increases in mortality rate or decreases in reproduction rate after maturity, and no observable age-related decline in physiological capacity or disease resistance. Finch coined the term "negligible senescence" to describe very slow or negligible aging. But these are just freaks of nature, exceptions to the rule. Or are they?

All this was changed dramatically by a little known experiment in the 1970's. Michael Rose began manipulating the life spans of fruit flies. He allowed fruit flies to reproduce only at late ages. This forced researchers to pay attention to the survival and reproductive vigor of the flies through their middle age. The flies evolved longer life spans and greater reproduction over the next dozen generations. This demonstrated that a “death clock” exists in each of us--which nature can re-set to give us a better chance of reproducing.

This is the kind of stuff that scientists can manipulate. And that is exactly the work done at UC San Francisco by Cynthia Kenyon--who by manipulating genes in the flatworm nearly doubled their life span. These long-lived worms still looked and acted younger than their control group brethren. This changed the way we think about aging on two counts. First, that a death clock exists that can be modified by manipulating genes, and second that longevity is associated with being healthy.

Ageless animals have thought us that there are two ways to live longer: increasing the lifespan and slowing down the aging process. Individually all we can do for now is to try to not accelerate aging by excessive behaviors.