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.

My Personal Experiences of Aging

You can follow my personal experiences of aging on my blog:
iaging.blogspot.com

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Wiser Older Adults

Everyone has a different definition of wisdom, but we all agree that is it something that is desirable. Aristotle was one of the first to argue for the importance of practical over theoretical knowledge in determining what wisdom is. Historically—when survival to older age was less certain—it was assumed that survivors were wise. They had the practical know how to survive. However, practical knowledge is no easier concept to define.

In a 2007 study, Fredda Blanchard-Fields and Susanne Scheibe showed a disturbing video for two groups of adults, ages 20-30 and 60-75. They then they asked them to ignore what they have just watched and to play a memory game. People in the older age group performed better on the memory test. It seems that older adults are better at separating their feelings and looking at the practical task at hand. This ability allows older adults to remain positive in the light of accumulating negative experiences.

Despite multiple chronic illnesses that cause functional disability or cognitive decline, most older adults are able to tune out negative information into their late 70s and 80s. The recent 2010 AARP study that looked at wellbeing also showed that despite reporting a decrease in high overall quality of life since five years ago (48% from 50%), everyone expects their quality of life to increase in five years time. It could be that the ability to be positive—despite the reality—allows for practical and therefore wise decisions. But happiness is not solely the privilege of older adults.

A study published this year in the Proceedings of the National Academy of Science found a U-shaped relationship between happiness and age: Adults were happiest in youth and again in their 70s and early 80s, and least happy in middle age. A 2007 University of Chicago study similarly concluded that rates of happiness—the degree to which a person evaluates the overall quality of his present life positively—crept upward from age 65 to 85 and beyond, in both sexes.

This paradox that exist for older adults and not for younger adults—that older adults are happier despite the likelihood of multiple chronic illnesses, functional disability, cognitive decline, and accumulating negative experiences—can be the definition of wisdom.

The ability for most older adults to be able to tune out negative information and evaluate the situation on a practical foundation is unique. Raising a family, navigating a career and experiencing love, loss, success and failure educate adults. It is the ability to see all of this and still manage to search for compromise, admitting uncertainty, overcoming fear and finding flexibility that is the seat of wisdom.

This explains that it is not simply life that is a precondition for wisdom. Aristotle insisted that only individuals with good character could acquire excellence in practical wisdom. And it seems that we have known this all along as the English philosopher Bertrand Russell (1872-1970) said “To conquer fear is the beginning of wisdom.”


Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Poverty is (really) on the Increase among Older Adults

Having $100 in San Diego is not the same as having $100 in Wichita, Kansas. Anyone can tell you that. But the federal government has ignored this for the past four decades.

The Federal Poverty Level, originally developed in 1963-1964 by Mollie Orshansky of the Social Security Administration, took the dollar costs of the U.S. Department of Agriculture’s economy food plan for families of three or more persons and multiplied the costs by a factor of three. As such the federal poverty level does not take into account housing costs, differences in living expenses across the country, child care, health care costs, medications and transportation. For older adults, the cost of food is the smallest cost when compared to housing costs, medications and health care—therefore the Federal Poverty Level becomes meaningless.

The 2010 Current Population Survey reported 43.6 million people living in poverty—the largest number in the 51 years for which poverty estimates have been published.

Surprisingly, the same report shows that between 2008 and 2009, poverty increased for children under age 18 (from 19.0 to 20.7 percent) and people aged 18 to 64 (from 11.7 to 12.9 percent), but decreased for older adults (from 9.7 to 8.9 percent).

Such statistics contrast wildly with today’s reality. Hardship among older adults can be gauged by increases in homelessness, having to return to work, demand for subsidized housing and requests for economic assistance. In response to the imprecision of the Federal Poverty Level, the National Academy of Science developed a new formula it hopes will replace the current one. This January, the federal government officially acknowledged the need to improve the outdated federal poverty level by releasing a ‘Supplemental Poverty Measure.’
California could not wait, having already embraced an alternate formula called the Elder Index. This index, calculated by the UCLA Center for Health Policy Research on behalf of the Insight Center for Community Economic Development, and Wider Opportunities for Women shows that the cost of living for California seniors far outpaces the Federal Poverty Level. The inadequacy of the Federal Poverty Level is important to California’s older adults as it determines eligibility for many public programs, determines funding allocations for other programs, and is used as an evaluation measure in determining program effectiveness.

The Elder Index estimates that 18.6 percent of Americans over 65 live below the poverty line, which translates to 6.8 million older adults. This index is more accurate than either the antiquated Federal Poverty Level or the Supplemental Poverty Measure because it takes into account the costs of child care, health care and transportation.

The Elder Index could take on added significance at a time when the government is flaunting an overhaul of Medicare and Social Security as its best hope for reducing the ballooning federal debt. With the potential to add more older Americans to the ranks of the poor, the numbers may underscore a need for continued—if not expanded—old-age benefits.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Ethnic Diversity Among Older Adults: Older adults becoming more diverse

By 2050 out of 439 million Americans, minorities—those Americans who identify themselves as Hispanic, Black, Asian, American Indian/Alaskan Native, Native Hawaiian, Pacific Islander or mixed race—will account for 54 percent of the U.S. population (currently 34%). Among the nation’s children, the trend is even more pronounced—jumping to 62 percent by 2050 (compared to 44 percent today). It will no longer be accurate to refer to these ethnically diverse groups as minorities.

Immigration plays a leading role in both the growth and changing composition of the U.S. population. Immigration is the single reason why the United States has not aged as fast as most European countries.

The Pew Research Center finds that immigrants and their descendants will account for 82 percent of the projected population increase from 2005 to 2050. Nearly 20 percent of Americans will be foreign-born in 2050, compared with 12 percent in 2005, the Center projects. On the other side of the age continuum, by 2050 one in five people will be 65 and older and 59 percent will be White. That same year, when 19 million people will be age 85 and older, 67 percent will be White.

These changes signal that America is changing color while aging. Although older adults are becoming more diverse, for the next four decades, we will have a predominantly White older group, and a predominantly ethnically diverse younger group following. This seems to create social tension, especially when older adults express less tolerant views of an ethnically diverse population.

A popular view holds that older adults hold more narrow views than younger adults because they grew up in a less tolerant era. However, recent research shows that—even though they might have ethnic biases—older adults are less able to regulate associations. For older adults, implicit racial biases—which we all have—are likely to be acted upon.

Although older adults might be perceived as biased against ethnically diverse younger populations, they must, at the same time, rely on these same populations to generate the funds for their federal benefits. Especially, in light of the fact that both Social Security and Medicare rely exclusively on younger workers’ contributions.

In what we euphemistically term “pay-as-you-go,” today’s younger workers—including undocumented workers—contribute to the benefits of current retirees. In a now outdated but pertinent 1994 study, Donald Huddle estimated that total revenues from undocumented workers was $10 billion, including $7 billion in Social Security taxes.

Because of proposed changes under discussion for Social Security and Medicare, any changes to these federal benefit systems will have grave impact on younger workers who are currently supporting today’s older adults. And these workers will predominantly be ethnically diverse. The “pay-as-you-go” system might become a “pay-and-go” system. Older adults have an obligations to maintain current privileges to younger Americans.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Gambling and the Older Adult: Losing More than Just Your Money

Older adults are gambling in record numbers. For the first time, a large number of older adults have disposable income. With fewer economic obligations, some retired older adults have increasing opportunities to engage in recreation and leisure activities. Americans view retirement as a time to have fun after a lifetime of responsibility, work, bosses, children, family and mortgages—and gambling seems an exciting form of recreation.

A new report from Richard K. Miller and Associates revealed that gross gaming revenue in the U.S. totaled $80.5 billion in 2009. And, according to Debbie Rull of the Union of Pan Asian Communities, San Diego County has ten casinos with a combined annual gross revenue of $1.5 billion, employing 13,000 workers with an annual payroll of $270 million. Gambling in San Diego attracts 40,000 people daily. Gambling by older adults is big business. Many retirees begin gambling without appreciating the risks.

Data suggest that recreational gambling provides both beneficial and detrimental effects. Among older adults, recreational gambling—like many enjoyable leisure activities—may create opportunities for socialization, mental stimulation, and other benefits. The majority of adults in the United States who gamble recreationally, do so at levels not considered problematic or pathological.

On the positive side, Rani Desai in 2004 found that in comparison to younger adults, older adults expressed fewer negative measures of health and wellbeing. Specifically, increased rates of alcohol abuse, substance abuse, and incarceration—found among younger recreational gamblers—did not occur among older recreational gaming participants. In addition, older gamblers reported feeling happier and had positive subjective ratings of general health then their non-gambling peers.

However, research also suggests that older adults may be particularly vulnerable to some gambling-related problems. Approximately one in twenty adults who participate in gaming have a problem or tendencies toward pathological gambling. Many older adult gamblers with fixed incomes are more vulnerable to financial devastation than younger gamblers. Whereas younger gamblers are more resilient to losses because they can recover income losses, for many older adults gambling can result in permanent poverty.

Older adult problem gamblers are less willing to seek timely help for their addiction. Approximately two-thirds of the older adult population has gambled in the past year. Over the past several decades, gambling participation has grown the most among older adults.

Although gambling can represent a safe way to socialize and spend a few hours being entertained, a small proportion of older adults find that the attraction consumes their focus. If you suspect that you have a problem, resources exist to help you. Between 1999 & 2003, California gambling addiction hotlines reported that calls from older adults increased by 25%. If you or your loved one need help, call the California Council on Problem Gambling (888) 250-2282 or you can reach them on their website www.calproblemgambling.org.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Older Drivers

In many Americans’ minds, independence is firmly connected to being able to drive. Our cities—especially San Diego—rely heavily on personal transportation options. But for an aging population, our transportation system needs to be—in the near future—very different from todays.
Changes in our bodies partly ensure that driving will become more precarious. Apart from clinical issues that affect some older adults, other, normal changes—things like diminished physical capacities—affect our driving competence.
Visual acuity begins to diminish in normal older adults. Night vision and peripheral vision both decline with age. At the same time, older Americans take more prescription medicines than any other age group. Several types of medication can make driving harder because they affect perception and our senses. Drugs that might interfere with driving include sleep aids, medicine to treat depression, antihistamines for allergies and colds, strong painkillers, and diabetes medications. Changes in sleep patterns start to affect how well we can concentrate. These events combine in an overture driving difficulties that are likely to result in death.
Despite these changes, the percentage of older people who continue driving is growing. The concern is that there is very little debate on the implications of this transformation. We are not preparing for the inevitable.
Apart from the promotion of the trolley (train) service, and small pilot programs looking at volunteer drivers, there is no state or city-level discussion on how the aging of our drivers will radical effect our transportation system and what options we have.
Even if baby boomers drive at the same (modest) rates as the current older population, their sheer numbers means that total miles driven by those 65 and older will increase by 50 percent by 2020 and more than double by 2040.
Although older drivers drive far fewer miles than younger drivers they are more likely to be injured or die in a crash of the same severity—older adults are frailer and they tend to drive older and less safe cars. Older cars are less safe, but 26 percent of drivers over the age of 80 are driving pre-1988 vehicles, compared to 16 percent of drivers under 60.
For most older adults personal transportation is very much a necessity. We will be seeing more older drives, more older cars, frailer less responsive drivers, resulting in a higher susceptible to injury and therefore increase road fatalities.
An innovative program currently running in Lincoln City, CA shows some promise. They have developed Neighborhood Electric Vehicle friendly city, that allow older adults access to city services and to connect to train and bus services for long distance travel.
For now there are a number of things you can do to improve your driving and your chances of survival. Think about taking a driving refresher class. AARP sponsors “55 ALIVE/Mature Driving.” Call 1-888-227-7669 . While AAA has a number of classes including some by Posit Science called DriveSharp. Driving safely ensures that you continue to retain your license as well as your life.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Older Adults are programmed to remember happy thoughts: Happiness Helps You Live Longer

A 2008 Gallup telephone survey of more than 340,000 adults in the United States found that people become happier and experience less worry after they reach the age of 50. In fact, by the age of 85, people are happier with their life than they were when they were 18 years old. Is happiness part of growing older, or do happy people live longer?

In 2011 Donna Rose Addis from the University of Auckland (NZ), and her colleagues, tried to answer this question. They published a study that reveals that older adults' ability to remember positive events is linked to the way in which the brain processes emotions. In the older adult brain, there are strong connections between those regions that process emotions and those known to be important for retaining memories. They asked young adults (ages 19-31) and older adults (ages 61-80) to view a series of photographs with positive and negative themes, such as a victorious skier or a wounded soldier. While participants viewed these images, a functional magnetic resonance imaging (fMRI) scan recorded their brain activity. In older adult brains, two regions that are linked to the processing of emotional content were strongly connected to regions that are linked to memory formation. These findings suggest that older adults remember the good times well because the brain regions that process positive emotions also process memory. Living longer makes you remember positive emotions better. Older adults experience an increase in positive thoughts and feelings, along with a decrease in negative emotions like anger and frustration.

But it is not a one way street. Positive emotions not only make you feel good they also reduce blood pressure, promote better heart health, reduce frailty and promote exercise and a healthy lifestyle. Numerous studies continue to show that living longer relates to this ability to see things in a positive light. Research found that older individuals with more positive self-perceptions of aging—measured up to 23 years earlier—lived 7.5 years longer than those with less positive self-perceptions. This advantage remained after accounting for differences in age, gender, socioeconomic status, loneliness, and functional health.

Being happy also relates to being philanthropic, giving back to people. Anthropologists point out that early developed societies practiced helping others as a social norm. There appears to be a fundamental human drive toward helping others. Evolution suggests that human nature evolved emotionally and behaviorally by increasing longevity for those that helps others. We seem to prosper under the protective influence of positive emotions.

Being happy was always seen as important. Enshrined in the Declaration of Independent is the phrase “…endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness…” Jefferson himself equated happiness with living a virtuous and useful life. "It is neither wealth nor splendor, but tranquility and occupation (meaningful work)," he said, "which give happiness." How very true, and most older adults know that so well.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Fear of Alzheimer’s Disease

Far from abating Americans’ concerns about Alzheimer’s disease, public awareness of the disease has increased fears for many. According to a 2010 survey by the MetLife Foundation, people over 55 dread getting Alzheimer’s more than any other disease (after cancer). Although 93 percent were aware of the disease, almost three-quarters say they know very little or nothing about Alzheimer’s.

We do know that the disease is unprecedented, the repercussions pervasive, the impact profound and the effects enduring. We can only hope that increased knowledge about Alzheimer’s will alleviate some of the anxiety.

Of the more than 100 types of dementias, the four main types are irreversible. These include Alzheimer’s disease (60% of cases); Vascular dementia (30–40%); Lewy bodies (15%); and Fronto-temporal dementia (5%).

Other less common dementias result from head injury and trauma; tumors; pressure of fluid in the brain; bacterial and viral infections; toxic, endocrine and metabolic causes; chronic alcoholism; and lack of oxygen. Whatever the cause of the disease, the effect on the brain is the same. It begins with a gradual and progressive reduction in the number of living cells in the brain. The brain slowly begins to die.

Some potentially reversible causes of dementia—although a small proportion—include medication side effects, thyroid or excess vitamin B12 deficiency, abnormal calcium levels and abscesses in the brain.

The greatest risk factor in dementia is age, and as Americans live longer, the threat of Alzheimer's will continue to increase. The Alzheimer’s Association estimates that 4.5 million Americans now have dementia. It further affects more than a third of U.S. adults through a family member or friend who has Alzheimer’s. Three out of five people surveyed were concerned that they may someday have to be a caretaker for someone with Alzheimer’s. Although eight out of 10 people said they think it is important to plan ahead for the possibility of getting Alzheimer’s, they have taken no steps to prepare for the possibility of Alzheimer’s.

Apart from staying healthy, eating a balanced diet and generally staying mentally active, few options exist for stopping dementia. It is a degenerative disease that progressively weakens the capacity to function.

As a community, we still have not learned how to deal with this disease. The fear that cancer engendered is being replaced by “dementiaphobia.” The very word dementia inspires a degree of fear that “heart attack,” “stroke” or even “kidney failure” often do not. Any of these conditions can kill. Yet somehow, to many of us, the idea of dementia seems more horrifying. Perhaps we fear the idea of losing who we are—becoming a stranger in an unfamiliar body.

The unknown fuels fear. If you are one of the majority who has signs of dementiaphobia, start by finding family members or friends who have early stage dementia and talk with them. Converse. Keep the discussion simple, be patient and show compassion. You will be amazed how successful you will get at learning how to communicate differently. The fear will subside, maybe not completely diminish, but you will be able to see the disease without any emotional baggage.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Dying Older Adults

How would you like to die?  Gilbert Meilaender from Valparaiso University in Indiana suggested a one-word answer: Suddenly!  The idea is to live as long as we can at the peak of our powers, then fall off a cliff.  Doubtless he is right about contemporary attitudes toward death. If we have to go, let it be quickly and painlessly.

Last month a local woman, Sharlotte Hydorn, gained a measure of negative notoriety by offering to mail you, for only $60, a package containing a plastic bag, medical tubing, a canister of helium and instructions on how to commit suicide—by placing the bag on your head and filling it with helium which deprives the body of oxygen. The State of Oregon, one of the few states where physician assisted suicide is legal, was exploring the possibility of suing her.

These two perspectives point to the schizophrenic relationship many of us have with death. What we say we want is frequently quite different from how we deal with death. Since more than a quarter of us will likely die in an emergency room, our final departure might look more like a medical failure rather than a dignified release of life.

Despite the availability of hospice care—both at home and at hospitals, which often involves palliative care targeted to relieve pain—most older adults still experience widespread distress in the final stages of life. We have few guidelines how to deal with death or bereavement in older adults—even when death is not only inevitable but desired. The now classic Kubler-Ross’s process of bereavement—involving phases of denial, anger, rationalization and acceptance—was developed by her observation of children’s reactions to death.

Sherwin Nuland, an American surgeon, has made the point that death in older age is often a protracted affair, rather than a clear-cut process that allows patients and those bereaved to go through the classic end of life stages. He quotes an elderly patient as saying, “Death keeps taking little bits of me.”

Ever since it was eliminated as an official “cause of death” in 1951, we cannot die of old age. We have to die of a disease or trauma. In truth, there is only one real cause of death—oxygen starvation to the brain. The cause of death listed on death certificates is really the cause of the cause. As simple as this might seem, formalizing a definition of death was not easy, but we have been pioneers in California.

In 1973 hospitals threatened to cease organ transplants since criminal defense attorneys argued that harvesting a victim's organs while his heart was still beating caused the death. Dixon Arnett (R-Redwood City) introduced emergency legislation to recognize death when brain activity ceases.  This definition of death is now accepted across the world.  Despite such advancement, we still have difficulty preparing for death. Dying suddenly and painlessly might be our ideal, but we do very little as a society to give older adults that option.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Brain Fitness and Dementia and How We Can Re-Program Our Mind. The Story of Hormesis

Hormesis is the term used to explain the benefits of low exposures to toxins and other stressors as a kind of vaccination. Some of us take vaccinations every ear against the flu, so the concept of hormesis “what does not kill you makes you stronger” is not new. But can we apply the same concept to learning and developing our brain?

Psychologists think about learning in stages of development. Jean Piaget, a Swiss development psychologist, asserted that you can only teach infants what their development allows them to learn. Sigmund Freud also discussed stages of psychosexual development where each stage has its own set of learning requirements that determine our future emotional development. These stages have primed researchers to assume that changes to the brain stopped at adulthood. It is of little surprise, therefore, that anyone studying aging before 1960 looked at aging only as a period of loss and attrition.

David Snowdon’s research with Catholic sisters of Notre Dame living in Mankato, Minn., highlighted one of the paradoxes of aging—why some people who have the disease in the brain (neuropathology) continue to function normally; while others who do not have the disease seem to express demented behavior.  This study has made us re-evaluate how we think about dementia and learning in general because it shows us that we seem to have a reserve of brain cells. The question is how do we grow that reserve?

A developing body of knowledge shows that undertaking certain activities enhances and grows the brain in adults.  For example, studies show that London taxi drivers develop a larger part of their brain while learning different routes in London, than bus drivers who have a set route. Other studies that show that brain increases in size when medical students study for their exams, compared to brains of students who were not studying for exams.

Another popular and consistent finding relates to music and dancing. In a longitudinal study, growth in the hippocampus part of the brain was recorded among music students after two semesters of intensive musical training. A further study showed that participants over 75 years who frequently played a musical instrument and/or danced were less likely to have developed dementia over a five- year period.

These studies repeatedly show that the brain of older adults can develop a reserve of cells. The question is what works best in growing these extra cells?

In understanding what is happening scientists have come up with the Japanese term 苦労 (kurou), which stands for “hardship” and “labor.”  Learning happens when we are uneasy about what we know and make ourselves learn. Geoff Colvin In his book Talent is Overrated similarly argues that there is a learning zone which is above the comfort zone and below the panic zone—where all learning needs to take place. This mirrors Jean Piaget’s definition of intelligence —". . . what you use when you don't know what to do." We need to put ourselves in learning situations that make us uncertain. The uniqueness of the situation will trick our brain to develop ways to learn. What does not kill you makes you stronger.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Ageism-Modern Variants

Robert Butler, who died last year—was a physician, gerontologist, psychiatrist, Pulitzer Prize-winning author, and the first director of the National Institute on Aging—introduced the term “ageism” in 1969. By assigning a word to the practice of discriminating against older adults, researchers gained a focus. Words serve as bridges between action and understanding. By selecting specific words, we provide a strong indication about our beliefs—and probably actions—in relation to members of a group.
Ageist vocabulary—like other forms of prejudicial communication--is potentially harmful. Certain negative words refer to older adults’ physical appearance (decrepit, frumpy, wrinkled); behavior (crotchety, fussy, garrulous, grouchy, grumpy, miserly); physical ability (debilitated, feeble, infirm, rickety); sexuality (unattractive, impotent, sagging, droopy); and mental ability (doddering, eccentric, feebleminded, foolish, rambling, senile).
Despite the abundance of disparaging expressions for older adults, however, a few favorable terms, such as mature, mellow, sage, venerable, veteran, and wise, describe positive aspects of aging. “Old” has a negative connotation only when applied to people. Old implies positive meanings when applied to objects such as money, brandy, wine, cheese, lace, and wood.
Gerontologists still debate the appropriate designation for people older than 65.  A classic 1979 Harris Poll conducted for the National Council on the Aging indicated that the most-favored descriptive terms for older Americans were senior citizen, retired person, and mature American. While gerontologists Carole Barbato and Jerry Feezel, by sampling 162 people in 1987, also came up with those same three terms and added three more in order of preference—retired person, golden ager, and elderly. These terms seem antiquated today in reference to emerging baby boomers.
In contrast, the Thesaurus of Aging Terminology (8th edition 2005), an AARP publication, advises readers to use the expression “older adults.” In politically correct environments, older adults do not represent an end but a process (older vs. old.) The term is inclusive.
Because older adults (aged 65 years to theoretically 122) are extremely heterogeneous, it makes little sense to put a 65-year-old in the same category as a super centenarian (110 years old). “Old person” is a conceptual metaphor that considers old age as a terminal period. “Older adult” does not designate a terminal stage. It implies that you are still growing old, but with the emphasis on “growing.”
Another subtle expression of ageism occurs when referring to part of a person. Whether it is age, or another aspect of that person, the use of a part for the whole is termed a metonymy. Within health care and social service settings, metonymy is a common way to allude to older adults. The use of such expressions; the care recipient, the dementia, the broken hip, or the cancerous liver, are examples.
In some respects, these references underlie the intent of service providers to address specific issues rather than the individual. But words we use determine how we are treated. Part of the secret of long life is not to accept negative terms for us. How long we live is related to our perception of how long we expect to live, and what we allow others to dictate for us. 

Dancing away Dementia

As we age, we experience an increase in body fat, reduced muscle mass, strength and endurance, and diminished balance and aerobic capacity. Normally these deficits result in slowly diminished levels of our functional ability. The resulting loss of functional ability can result in susceptibility to falls, inactivity, and depression.  This in turn can exacerbate existing conditions or contribute to new, chronic diseases such as diabetes, stroke, cardiac infarction, or cancer.

The advice we hear usually involves “exercise and diet.”  But there might be more to this than meets the eye.

The benefits of dancing, for example, exceed mere physical exercise. One can easily see the primary benefits include improved balance and a reduced risk of falls. Dance has also been shown to have considerable physical benefits for older adults with arthritis, osteoporosis, and neurological conditions.

As early as 1989 Robert Katzman and Joe Verghese (2004) from the Albert Einstein College of Medicine were researching other benefits from dancing. In a 21-year study of older adults, 75 years and older, they examined the extent to which physical or mental recreational activities influenced brain health.  They studied mental activities such as reading books, writing for pleasure, doing crossword puzzles, playing cards and playing musical instruments.  And they studied physical activities like playing tennis or golf, swimming, bicycling, dancing, walking for exercise and doing housework. One of the surprises of the study was that almost none of the physical activities appeared to offer any protection against dementia with one important exception:  frequent dancing. Mental activities that offered similar protective benefits included playing an instrument and playing board games.

Music and dancing are becoming central features of healthy longevity.   Perhaps dancers and musicians are more resistant to dementia as a result of having greater cognitive reserve. They have more ways of thinking.  We have a word for this--neurogenesis--where our brain constantly rewires its neural pathways through dancing and playing music.

Gerontologists still argue why dancing shows benefits and playing tennis for example, does not.  Research using computer exercises show that engaging in unique events stimulates the brain to react and develop. Unstructured dancing, which requires instant reaction to your partner’s movements, stimulates the connectivity of your brain.  Unique and even frustrating classes have better results, as they create a greater need for new neural pathways. Dancing also makes your gait look better and you become more attractive.

In a study in 2005 William Brown and colleagues at Rutgers University found that people appear to be able to pick desireable partners based on the way they dance. The researchers analyzed 183 young dancers by attaching infrared markers and filmed the markers for one minute. Then they asked peers to evaluate how well the computer-generated figures danced. They found that skillful dancing is associated with desirability and attractiveness.

Dancing simultaneously involves movement, social engagement, musical appreciation, emotional expression and makes you more desirable. Repeating the poet Edwin Denby, “There is a bit of insanity in dancing that does everybody a great deal of good.“ 

HIV/AIDS among Older Adults

Hollywood sells the sexual revolution with ever changing but always young protagonists.  The reality looks much different, with older adults having more sex than we expect. A recent AARP study published in 2010 reports that for older adults aged 60 to 69, 42 percent of males and 32 percent for females had sexual intercourse in the past week or month. Although sexual activity declines with age, it does not go away. Even those 70 years and older, 22 percent of males and 11 percent of females report having sexual intercourse at least once a month.

Sexual activity comes with the risk of Sexually Transmitted Diseases (STDs). STDs refer to more than 25 infections transmitted primarily through sexual activity. Despite STDs being preventable, these diseases remain a significant issue, especially because some—especially HIV/AIDS—can kill.

STDs remain a hidden and quiet epidemic among older adults. But a perfect storm is brewing. Older adults who recently divorced or widowed started entering the dating scene again. Older women may be especially at risk because age-related vaginal thinning and dryness can cause tears that increase susceptibility to infection. Older men—although lacking experience and knowledge of STDs—seem to have an aversion to using condoms and other safe sex methods. With new easier access to partners through Internet dating, perceived lack of susceptibility and the use of Viagra, older adults are prime candidate for STDs, and statistics are now proving this susceptibility.

The Center for Disease Control and Prevention (CDC) reports that the number of persons aged 50 years and older living with HIV/AIDS continues to increase. In 2005—the latest data we have for older adults—one in four persons with HIV/AIDS was an older adult. This rate increased from one in six in 2001. Of all new cases of HIV/AIDS, one in seven is among older adults and a third of all deaths with AIDS are among older adults.

This increase is partly due to people living longer with the disease—especially due to the highly effective antiretroviral therapy (HAART)—and partly due to new infections.  However, it does not affect older adults equally.  HIV/AIDS rates among older adults are 12 times higher among Blacks and 5 times higher among Latinos compared with Whites.

The lack of testing, and subsequent identification of HIV/AIDS, prevents early detection and early treatment.  Health care professionals may underestimate older adults’ risk for HIV/AIDS. Also some symptoms mimic conditions wrongly associated with aging, for example, fatigue, weight loss, and mental confusion. Early diagnosis, which typically leads to the prescription of HAART and to other medical and social services, can improve a person’s chances of living a longer and healthier life.

Although the sexual revolution continues into older age, be wise and take care of your health by practicing safe sex. For HIV testing the county has a number of sites (including at all STD clinics). You can reach County Health Services Complex at 619-296-2120. The same number also connects you to an HIV Mobile testing unit that does home visits. In addition, people can reach the San Diego LGBT Community Center at 619-692-2077.

Plastic Surgery-Looking Younger in Older Years

Unsatisfied with living longer, some of us also want to look younger. In 2010 the American Society of Plastic Surgeons published national statistics on plastic surgeries. This report tells a story about vanity and the unyielding pursuit of youth.

Last year, Americans spent $10.1 billion on plastic surgery, more than the 2010 budget for the National Science Foundation (and close to the budget of the Environmental Protection Agency).

The surprise is that following the 40-54 year olds--who account for nearly half of all plastic surgery procedures--the main clients are seniors--those 55 years and older!  This older group had more surgeries, cosmetic procedures and minimally invasive procedures than 20-39 year olds.

While most popular procedures among young adults focus on their bodies, older adults are apparently more concerned about more visible features, such as their faces.

Americans aged 55 years and older had 3.3 million cosmetic procedures. Most involved having no surgery at all, opting instead for injections. The most popular procedure--performed 1.2 million times last year--was botox injection, followed by more than a half-million soft tissue fillers (injections of Hyaluronic/polyactic acid, fat, collagen, or calcium hydroxyapalite).

In comparison, for surgeries, nearly a third of these 349,000 procedures involved  eyelid surgery (100,000), followed by facelifts (74,000), dermabrasions (27,000), nose reshaping (24,000) and hair transplantation (23,000). Two out of three facelift surgeries in 2010 were performed on patients who were 55 years and older.

Even though plastic surgery might belong primarily to the wealthy, it is no longer the exclusive domain of Whites. Since 2009, all minorities have shown an increase in the use of plastic surgery--up by 6% for African Americans and 2% equally for Latinos and Asian Americans. The trend is one of convergence. While for African Americans the top procedures include liposuction, nose reshaping and breast reduction, for Asian-Americans it is breast enlargement, nose reshaping and eyelid surgery. Latinos’ top procedures include breast enlargement, liposuction and nose reshaping.

Apparently, Americans of all races share a fixation with physical appearance--one that seems to increase as we age. Do we think we can cheat death by looking younger? In a seven-year study led by Kaare Christensen of the University of Southern Denmark, researchers found that people who looked younger lived longer. Their report published in 2009, asked people to guess the age from photographs of faces of 387 pairs of twins in their 70s, 80s or 90s. They found that the older looking twin is more likely to die first. Surprisingly, the older looking twin also had shorter telomeres--telomere length indicates cell longevity, the longer the telomere the longer the cell will live.

Does plastic surgery, by making us look younger, also “teach” our telomeres to grow? Probably not.

People who have had a tougher life are more likely to have such stress etched in their faces, while at the same time the stress shortens their telomeres. We might modify how our faces look, but those telomeres are still getting shorter. 

Rich Man Poor Man

Three out of five of this year’s Forbes top 100 richest Americans were older adults 65 years and older. These affluent older Americans individually own enough capital to compare with most developing countries. But poverty is the side that we are more likely to hear when we discuss income of older adults. Income of older adults sits along a very very long continuum.  Therefore, talking about average income of older adults hides these extremes.

Most reports on income among older adults talk about poverty.  The reason is easy is to see. In a 2009 Congressional Report, Patrick Purcell reported the median income of individuals aged 65 and older as $18,208. The same report finds that one in four had incomes of less than $11,139.  It is not surprising that for 41% of elderly recipients, Social Security accounted for more than 90% of their total income. Even when older adults worked to supplement their income—the reality for 20% of individuals aged 65 and older in 2008—the median earnings of workers aged 65 to 69 were $25,000.  Clearly, Social Security on its own elevates some older adults out of poverty.

The rate of poverty among older Americans fell from 33% in 1960 to 9.7% in 2008—a rate lower than poverty rates among children under age 18 (19%) and adults aged 18 to 64 (11.7%). However, this low overall rate of poverty among older Americans is not shared by older women (unmarried and/or widowed), minorities, less educated, and adults over the age of 80.

Wealthy older adults comprise the opposite facet of this reality. The Social Security Administration Chartbook of 2008 (the most recent) reports that 23% of older adults aged 65 and older reported incomes of $50,000 or more; while 8% had incomes of more than $100,000.  There is a stark contrast between the very poor and very rich older adults.

A Pew Research study in 2009 asked a sample of adults to identify the most prevalent conflict in America. After conflicts of immigration—nearly half of respondents (47%) identified conflicts between the rich and poor as the most important social conflict. In this same survey, older adults are significantly less likely to see such conflict than those under the age of 50 (36% vs. 51%).

These contradictory worlds—extremely wealthy older Americans and their poor neighbors— highlight why some programs should address needs rather than age. Surprisingly, these two obvious extremes among older adults share a common behavior.

In the Anatomy of a Giver, Tim Stafford reports that in the United States both the poor (those making less than $20,000 per year) and the rich (those making more than $100,000 per year) give the highest percentages of their income to charity. Middle-class Americans—those making between $40,000 and $100,000 per year—donate at the lowest percentage.  Older adults are a disparate group. The older we get the more variance there is among our peers. One such measure of variance is income. We do however share at least one attribute. This attribute is our appreciation that our lasting legacy is to give back.

Sex, Romance and Relationships of Older Adults

The state of well-being among older adults does not seem to be improving. A recent AARP report compared sex and well-being in 1999, 2004, and 2009. Although overall, midlife and older adults currently have a positive outlook on life, this is less so than in 2004. Both the frequency of sexual intercourse and overall sexual satisfaction are down close to ten points since 2004.  Just over four out of ten say that they are satisfied with their sex lives, down from half in 2004. While the frequency of self-stimulation and sexual thoughts remain unchanged. Younger respondents, men, and Hispanics in general are more likely to report being satisfied.

Why should older adults report a decline in general well-being, particularly sexual experience? Several key factors influence sexual activity, including health, medications, stress, finances, and exercise. Health—as reflected by increased use of prescription medications--seems to mirror this decline in general sexual satisfaction and well-being. The most prevalent medications are for cholesterol, taken by 36 percent of all older adults—a number that has doubled since 1999. A similar increase appears in the use of blood pressure medications, which 43 percent of the older population takes--up from 36 percent in 1999. There was an increase in diagnosis of erectile dysfunction for 23 percent of men in 2009, compared to 17 percent in 2004.

Men continue to think about sex more often than women. They see it as more important to their quality of life, engage in sexual activities more often, are less satisfied without a partner, and are twice as likely as women (21 vs 11 percent) to admit to sexual activity outside of their relationship. Distinct male-female differences exist across age groups.

Men report less sexual intercourse, kissing or hugging, touching and caressing, self stimulation, oral and anal sex with increasing age (from45 to 70+).  Women—although the overall percentage is nearly half of that for men—tend to report a peak of activity at age 50-59, with hugging and kissing remaining stable over all ages.

The good news is that those who have sex at least once a week, 84 percent, are satisfied.  Those less satisfied report having sex less frequently. Half of all single and dating males report that they rarely or not at all, use protection during sex. This rate goes down to 29% for women. The statistic is still troubling, given that one in four persons with HIV/AIDS was an older adult in 2005. A fascinating paradox is the quality of life rating. Although both male and female—whether with a current or recent partner or not—show a decrease in reporting high overall quality of life since five years ago (48% from 50%), everyone expects their quality to increase in five years time, in some cases above the peak of five years ago (57%). By age 70, this optimism for the future diminishes, although one in three still report that the future appears more positive!

Sexual activity and well-being are intertwined. We should be aware of the impact that medication, stress, financial situation, and exercise have on our overall sexual health and well-being.

Falling for You

Falling is the leading cause of injury hospitalization and death among Americans aged 65 and older. Fall injuries, including hip fractures, deep bruises and head trauma, represent a growing public health problem that remains under-recognized and under-treated. Sadly, all falls are preventable.

Each year, falls occur for more than one in three (35% -40%) of older Americans who live at home. The older you are the more likely you are to fall.  In nursing homes and hospitals, rates triple (1.5 falls per bed annually). Women sustain about 80% of all hip fractures.  In 2000, the total costs of treating fall-related injuries among older Americans exceeded $19 billion. By 2020, these numbers are expected to climb to $59 billion as a consequence of the growing number of aging baby boomers.

Self-imposed activity limitations from the fear of falling affect more than half of all community-dwelling older adults, leading to increased risks for further falls, depression, social isolation, and a drastic decline in quality of life. In a study of 540 community-living adults aged 70 years and older, Jolanda van Haastregt and colleagues reported that more than half of all study participants said they fell at least once in the previous six months. More than one in four (28%) said they had severe fear of falling and severe avoidance of physical activity.

In 2009, one out of every 27 older adults aged 85 and older called 911 in San Diego County because of a fall. Falling was the fourth most common pre-hospital call, resulting in nearly one in ten of all calls (5,606 in 2009). Falls remain the leading cause of unintentional injury hospitalization for those over 55 years. In 2006 in San Diego County, two thirds of all falls occurred at home--nearly half from slipping (43%). Of these, “emergency room discharge with a fall injury” was highest for the east county cities of Lemon Grove, La Mesa and El Cajon. SANDAG projects that the older adult population for 2015 for San Diego county would be 435,805 it is expected that one in three (145,268) will fall that year. Of these, three out of four will fall a second time.

Aside from substantial medical cost, the individual cost involves more than money. Fall-related injuries are often single most common event that alter mobility and limit independent living.  Many fall injuries, such as hip fractures, increase the risk of premature death. For example, a recent survival analysis of men and women aged 50-plus years who had a hip fracture concluded that hip fractures increased all-cause mortality 5- to 8-fold during the first three months after the injury. Such negative outcomes persist over time. Life is not the same once you have had a significant fall.

Falling does not have to be a death sentence. Many of these risk factors are manageable and potentially correctable. Sensory problems and medications can be address with your health care provider. Since gait and balance problems are strong predictors of falls, yoga, exercise, and the use of assistive devices can reduce the likelihood of a fall. 

Sleep is the Best Medicine

Sleep is the best medicine. Although older adults need as many hours of sleep as younger adults—7-9 hours each night—we often hear the commonly-held but mistaken belief that you need less sleep as you age. Disruption of sleep can cause memory problems, depression, and a higher susceptibility to falls.

In the United States, insomnia is the third most common reason for a medical visit, behind only headaches and the common cold.  As sleeping patterns change for older adults—going to sleep earlier, getting up earlier and napping during the day—it becomes more difficult to fall asleep at night. Once asleep, older adults spend less time in deep sleep—rapid eye movement (REM) sleep—and are often therefore light sleepers. By themselves, even these normal changes can to disrupt sleeping patterns. More than half of older adults have a sleep disorder. The rate is higher among long-term care facility residents. Although researchers have described more than 70 sleep disorders, four disorders hold top billing.  These include insomnia, , sleep apnea, restless legs syndrome, and narcolepsy.

Among older people, women experience insomnia than men.  Insomnia—which is the most common sleep problem in adults age 60 and older—results in trouble falling and staying asleep. About 60 million Americans a year have insomnia, which tends to increase with age. It affects about 40 percent of women and 30 percent of men.

Sleep apnea is a disorder of interrupted breathing during sleep. It usually occurs in association with fat buildup or loss of muscle tone associated with aging. These changes allow the windpipe to collapse during breathing when muscles relax during sleep and is usually associated with loud snoring (though not everyone who snores has this disorder). An estimated 18 million Americans have sleep apnea.

Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD)--an unpleasant crawling, prickling, or tingling sensations in the legs and an urge to move them for relief--affects as many as 12 million Americans.  In one study, RLS and PLMD accounted for a third of the insomnia seen in patients older than age 60.

Older adults with narcolepsy have frequent "sleep attacks" at various times of the day, even if they have had normal amounts of night-time sleep. Narcolepsy affects an estimated 250,000 Americans who have attacks lasting from several seconds to more than 30 minutes. The disorder is usually hereditary, but is occasionally linked to brain damage from a head injury or neurological disease.

Disruption of sleep becomes more common  as we get older. Some clinical research now focuses on the role of melatonin in this cycle. Some serious conditions need consultation, while others just require a more disciplined approach to going to sleep.

Amanda Dew and her colleagues at the University of Pittsburgh, USA looked at one such reflection of peace of mind, sleep and how it can influence an early death. After controlling for things that can also influence death, such as age, gender, and how healthy they were, they then could predict death based on their sleep patterns. Individuals who take longer to sleep than 30 minutes were more than twice at risk of death. While those who sleep for less than 4/5th of the time while in bed were nearly twice as likely to die earlier. Even those who either dreamt too much or too little (Rapid Eye Movement sleep) were nearly twice as likely to die earlier. Sleeping just right is an important process that can promote longevity.

Follow a regular sleep schedule. Go to sleep and get up at the same time each day, even on weekends. Try to avoid napping and make an effort to get outside in the sunlight each day. Stay away from caffeine late in the day. Exercise and light meals also contribute to better sleep. You can sleep yourself to good health.


Refernces

Dew, M. A., Hoch, C. C., Buysse, D. J., Monk, T. H., Begley, A. E., Houck, P. R., ... & Reynolds III, C. F. (2003). Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosomatic Medicine, 65(1), 63-73.