Common Diseases, Medications, and Treatments
Vision and hearing often begin to fail long before one is considered old. The need for reading glasses and hearing aids can begin in middle age, but by the time a person reaches seventy-five or eighty, other problems compound these issues. Osteoporosis and arthritis may have begun to show signs in middle age, especially if they are due to injuries, but now can have a profound affect on daily life for your loved ones.
Digestive disorders can produce a variety of issues. Muscles weaken and bowel and bladder incontinence becomes a real issue for many. The heart muscle may begin to show signs of weakening and failure. And the largest organ in the body, the skin, becomes thin and vulnerable to an assortment of imperfections and problems.
Vision Problems
Aside from presbyopia (which makes reading difficult because the eye has become more rigid, causing a degree of farsightedness), some of the more common eye disorders include cataracts, glaucoma, and macular degeneration. With the increasing instance of diabetes, diabetic retinopathy is also becoming more prevalent. Each of these is treatable, but the earlier they are diagnosed, the better the prognosis.
Surgery can correct cataracts and has a 95 percent success rate. The procedure has been perfected over the years and is now a simple, painless procedure that can be performed in an outpatient setting such as the doctor's office or a clinic. This is not the same surgery your grandparents may have had that required them to be flat on their back for days or weeks.
Cataracts affect about 95 percent of people over the age of sixty-five. The thin, transparent lens of the eye becomes cloudy. The world begins to look like they're wearing fogged-up glasses. This can be a gradual process and your parents may not even notice anything has changed, except that they have difficulty accomplishing small tasks or they bump into things more than usual with no other apparent cause. Sensitivity to glare or bright lights at night may make driving at night difficult. This can be due to cataract formation, and it may be one of the earliest symptoms. An annual eye exam can determine if cataracts are developing and when it's time to correct the problem.
The symptoms of glaucoma don't usually appear until at least some damage has been done. This is why it's important to have an annual checkup to have the pressure in the eye read by a professional. This is even more important if there is a family history of glaucoma. Glaucoma is more common in African Americans, those with a family history, and those with diabetes. Eye injury can also predispose a person to glaucoma.
Glaucoma is caused by a build up of fluid inside of the eye that presses on the optic nerve. As it does this, the peripheral vision is lost. With surgery, this fluid can be drained and the pressure reduced, but the vision is not usually restored.
Glaucoma can be treated with eye drops. It is critical that the treatment continues uninterrupted and that periodic checkups be made to evaluate the effectiveness. Partial to complete blindness can result if glaucoma is not properly treated.
Macular degeneration is characterized by the fine details in the center of the field of vision becoming curved or distorted. The macula, which is the part of the eye that distinguishes the fine details, is failing or degenerating.
A fuzzy or blind spot appears in the center of the field of vision, which usually affects both eyes at the same time. Over time, this blind spot enlarges until, while trying to read, your parent will be unable to see several words at one time. These symptoms should not be ignored. They will not go away and will only worsen with time.
When caught early, low-vision aids can help restore the ability to read and enjoy other activities that have been affected by the loss of this central field of vision. There are also several promising medications available and others under development and review that can help slow and possibly prevent macular degeneration.
For diabetics, one of the major side effects of poor blood-sugar control is blindness. Most often, this is caused by diabetic retinopathy. The retina is the light-sensitive area at the back of the eye. Diabetic retinopathy is primarily caused by the accumulation of new blood vessels on the retina, or leakage of the blood vessels that feed the retina, due to swelling. Blood fills the center of the eye, causing a blurring of vision. Left untreated, blindness can result.
Like other eye ailments, by the time there are symptoms from diabetic retinopathy, major damage has most likely been done. An annual eye exam with dilation of the pupils can detect retinopathy before symptoms and damage appears. This is an essential part of diabetic care and recommended for anyone with a family history of diabetes or retinopathy.
Diabetic retinopathy is treated with laser surgery called scatter laser treatments. The physician introduces 1–2,000 laser burns along the retinal arteries to cause them to shrink. Some peripheral or side vision may be lost due to these treatments. Most importantly, vision lost due to the bleeding associated with the retinopathy is not usually restored. This is why it is important to have an annual eye exam with dilation before any damage occurs.
Hearing Loss
Hearing loss is usually a gradual process that may begin in middle age. It is estimated that over 30 percent of the population over sixty has some form of hearing loss, but far fewer than that have addressed the situation. This may be because of the stigma associated with hearing loss, or it may be that the loss has been so gradual it has been ignored.
It is easier to turn up the volume on the TV or radio than to question whether there is a reason for not hearing so well. Asking someone to repeat what he said is simple enough, but when your father yells at you that he's not deaf when you repeat something louder, he may have a sensorineural loss of hearing rather than a volume issue. This involves losing the ability to clarify what is said rather than not actually hearing it and is one of the most common forms of hearing loss in the elderly.
Understand that hearing aids do not mimic the human ear. All sound will suddenly be created equal, and background noises will seem to become amplified because the hearing aid can't tune them out. This will require an adjustment and should be given three to six months before giving up on the hearing aid.
One of the prime reasons people tend to toss aside hearing aids is their hearing loss is the result of presbycusis, or sensorineural hearing loss. This is nerve deafness and involves the loss of the ability to distinguish certain sounds such as consonants. The sounds for “z,” “s,” and “f” can often be indistinguishable. Sounds at certain levels can be harder to understand, such as the more high-pitched tones. After a while, the brain forgets how to distinguish between these sounds, and hearing aids simply amplify the problem.
It is very frustrating to carry on a conversation with someone who cannot hear. The person with the hearing loss often gives up and withdraws. Any change in hearing should be evaluated by an otologist or otolaryn-goligist. These are doctors who specialize in ear disorders. If there is not a physical reason such as a buildup of wax or infection in the ear, she should refer your parent to an audiologist for evaluation. The audiologist can evaluate hearing loss and fit for hearing aids and train your parent in how to use them.
There are a number of other devices to help amplify for use with telephones, in theaters, or with the TV. Sometimes these provide a better hearing experience than the hearing aids do. Experimentation is important; support and encouragement are essential.
Osteoporosis
The bones and joints of the human skeleton are vital to the function of the body. They provide the framework and structure to support the other organs as well as the ability to move. If a bone or joint is broken or injured, that framework is compromised and can profoundly affect the rest of the body.
If your mother breaks her hip for example, she can find herself having to have major surgery to repair or even replace the hip joint. Surgery itself is a huge risk to older people. The aftermath can present even more problems such as infection, blood clots, circulatory problems, bedsores, and pneumonia.
Osteoporosis is a disease that diminishes the density or hardness of the bones. Over time, the bones can become very brittle and snap easily. The vertebrae can be especially susceptible to compression, due to this decrease in density causing painful compression fractures.
Osteoporosis can be prevented, but this has to begin at an early age. Exercise, a diet rich in calcium and vitamin D, and taking estrogen hormone replacements can help prevent osteoporosis. Hormone replacement therapy has become very controversial of late, due to the risks of cancer, heart attacks, and strokes, an issue to be discussed with your parent's primary care practitioner.
Arthritis
Arthritis is a group of more than 100 diseases that cause pain, stiffness, and swelling in the joints. Osteoarthritis is a degenerative disease that destroys the cartilage and joints as a result of injury or wear and tear. It usually affects only a few joints such as the knees, hips, hands, or spine. Rheumatoid arthritis (RA) is an autoimmune disease whereby the body attacks the cell lining (synovium) in its own joints. RA can affect many or all of the joints throughout the body at one time.
Arthritis is painful, and the most common reaction is to rest a joint and not use it. While rest during an acute phase can help, inactivity can be quite detrimental in the long run. It is important to reduce or alleviate the pain and swelling and increase mobility to prevent stiffness and eventual loss of movement.
Heat, ice, exercise, passive range of motion, massage, and other forms of nonmedical treatments can be quite effective in managing arthritis. Adaptive devices can be helpful with activities of daily living such as jar openers, reachers, long shoe horns, and devices to assist with buttons and zippers. Canes, walkers, splints, and other devices to assist with safe ambulation can help alleviate fears of falling.
Medications such as aspirin, acetaminophen, ibuprofen, and NSAIDS (nonsteroidal anti-inflammatory drugs) can be helpful in controlling pain and inflammation. Be aware that “arthritis strength” versions of these over-the-counter medications are simply a larger dose and don't have any special ingredients in them. All OTC medications should be discussed with your parent's health-care practitioner before taking them.
Stronger prescription medications such as corticosteroids may be needed for brief periods of time to relieve symptoms. These have many side effects and should not be taken for long periods of time, if possible. If these medications are needed, close medical supervision is necessary.
Surgery may also be needed to replace a severely damaged joint such as a hip or knee. This is a major surgery and should be considered carefully.
Digestive Disorders
These can include a variety of ailments from gas, heartburn, and indigestion to ulcers, hemorrhoids, diverticulitis, and difficulty swallowing. Constipation and diarrhea also commonly plague older people.
Taste buds change every few years, appetite and eating habits change with age, and even a change in water or environment can affect the function of the digestive system for anyone. As your parents age, many of these factors will influence the function of their digestive system.
Spicy, rich, and fried foods and chocolate are among some of the more common culprits of heartburn and indigestion. Smoking and alcohol consumption can exacerbate the situation. Overindulging at a holiday meal or eating too fast also contributes to the heartburn, bloating, nausea, and general discomfort. An antacid or a glass of ginger ale or 7Up can often help. Sitting upright or walking around can also help relieve symptoms. Changing diet and avoiding the trigger foods can help to prevent the problem. If it persists or worsens, consult the PCP.
Older people have less control over the sphincter muscle in the anus and therefore can't hold in gas as well as they used to. Although gas is uncomfortable, it's usually their ego that gets hurt from embarrassment. Gas is a part of life, and all you can really do is joke about it and not make a big issue about passing it.
Gas comes from swallowing air while eating and drinking or chewing gum. It also develops as food digests and bacteria are produced in the bowels. Older people often develop a lactose intolerance or sensitivity, and dairy products produce excessive gas. Other foods such as beans, broccoli, cauliflower, cabbage, bran, raisins, and fiber can also form gas. Avoiding these foods will help reduce the gas. Antigas antacids can help, but make sure they aren't contraindicated with other medications they may be taking. Some contain large amounts of sodium, which may also be contraindicated.
Ulcers are usually caused by bacteria in the stomach. Production of normal acids in the stomach is stimulated, and these acids eat away at the stomach lining producing raw, sensitive, openings. These sores are aggravated by spicy and acidic foods, alcohol, tobacco, and caffeine. Medications such as aspirin, NSAIDS, and many prescription drugs can also cause or irritate ulcers. Stress can influence ulcer formation as well.
Ulcers are treated with a bland diet of small, frequent meals, medications to reduce acid production, and antibiotics. Treatment regimen must also include eliminating foods, tobacco, alcohol, and other contributing culprits.
Hemorrhoids are caused by putting pressure on the veins of the anus. The veins protrude and become small, soft, nodule-like appendages about the size of grapes. This happens most commonly because of straining to move the bowels. It can be the result of sitting for long periods of time as well.
Hemorrhoids can itch or be painful. They can make sitting quite uncomfortable. There are a variety of creams and ointments that help shrink them and address the pain and itching.
Ice packs, sitz baths, and cold witch hazel can also help alleviate pain and itching from hemorrhoids. Fluids, fiber, and stool softeners can help alleviate constipation and straining; this will allow the hemorrhoids to shrink and disappear. Minor surgery may be necessary if these don't help.
Difficulty swallowing can be the result of other illnesses such as Parkinson's, cancer, stroke, dementia, or brain injury. These factors usually cause interference with the brain's ability to control the swallowing process. It can also be the result of dry mouth — with aging, the production of saliva is decreased. Some medications may also have the side effect of reducing saliva. This dry condition makes it difficult to swallow.
Diarrhea and constipation can be caused by many factors. Stress and change in environment can disrupt regularity. (See Chapter 6 for a more in-depth discussion of constipation.) The overuse of laxatives can also play havoc with normal bowel activity. Additionally, medications and a slowed mobility or activity level can affect bowel function. Diarrhea can be the result of overuse of laxatives or too much fruit or fiber. The water and sodium loss should be replaced. Gatorade is one example of a solution used to replace sodium and water. Diarrhea can also be the body's means of ridding toxins, so antidiarrhea medications should be used sparingly. These can cause constipation and create a vicious cycle. Consult your parents' or in-laws' PCP if diarrhea or constipation lasts more than five days, worsens, or at anytime is accompanied by pain, fever, confusion, or bleeding.
Swallowing difficulties should be evaluated, as they can lead to choking, malnutrition, and pneumonia by allowing fluids and food particles to go down the wrong pipe into the lungs instead of the stomach.
Incontinence
Weakened sphincter muscles decrease the body's ability to hold in urine and feces. Dementia, confusion, and illness also contribute to incontinence issues. There are solutions to the problem; however, they are not all without side effects or consequences. And not all of them will be long lasting or permanent.
Diapering and the use of incontinence pads, which are similar to sanitary napkins, can be used to catch accidents and prevent the soiling of clothing, furniture, and bed linens. Larger incontinence pads, also known as CHUX, help to protect bedding and furniture. They must be changed when they become wet or soiled and appropriate hygiene care given to avoid rashes, infection, and skin breakdown. This is essential if your loved one already has a bedsore that is trying to heal, as it will complicate or retard the healing process.
Another way to avoid incontinence is known as bladder or bowel training. The process is to visit the bathroom routinely every one to two hours. Encourage your parent to make a conscious effort to empty the bladder or bowel and avoid accidents from urgency.
A balanced diet is essential to general good health. Green leafy vegetables, whole-grain breads, pastas, and cereals, fresh fruit, plenty of water, and exercise are all elements needed to maintain normal bowel activity. Routines and daily rituals are important as well. And when the urge hits, don't hold it. Laxatives and enemas are habit forming and can become a necessary part of life if used more than occasionally.
The bowel pattern may be harder to establish, but most adults have established a pattern of elimination over their lifetime. Sometimes a cup of coffee or other hot liquid may stimulate the bowel, and then making a visit to the toilet a few minutes later will be successful.
Some medications can help with incontinence issues, especially if the incontinence is due to urgency issues, an enlarged prostate, or previous prostate surgery. These medications don't work for everyone and most shouldn't be used for long periods of time, but they can work well with bladder-training efforts.
A Foley catheter can be placed in the bladder and attached to a plastic bedside or leg bag. These can increase the chances of bladder (or urinary) infections and can be contraindicated in some. An external, or condom, catheter can be used for males and can also be attached to a bedside or leg bag. The infection rate is not as predominant, but these can be uncomfortable and not all fit well, so some leaking is likely.
Unfortunately, for bowel incontinence, unless bowel training works, diapers are the best choice. There are a few devices that plug the rectum like a cork, but they are not well suited for lay public use.
Sometimes incontinence is a symptom of infection or other underlying medical conditions. Sneezing or coughing can cause stress incontinence, where a small amount of urine or feces leaks with the cough or sneeze. These events should be evaluated by the PCP. Some medications are helpful in reducing stress incontinence. Sometimes a device such as a pessary is needed. This is a rubber ring inserted into the vagina to hold up a sagging or protruding uterus pressing on the bladder, causing the incontinence. In males, the prostate gland may be enlarged and causing bladder irritation and promoting incontinence.
Bowel incontinence, surprisingly, is usually the result of constipation. Liquid leaks around the blockages. A high-fiber diet can help control bowel incontinence by restoring regularity and allowing for routine toileting.
Heart Failure
Heart failure is a common ailment in the elderly. It can result from other heart disease or just from age. The heart muscle begins to wear out and is no longer as effective at pumping blood through the body. In basic terms, this causes a backlog of blood in one of the chambers of the heart and results in fluid retention (most notably evidenced by swelling of the feet and ankles), fatigue, and shortness of breath. The body actually tries to compensate for a reduced flow of blood by increasing the blood volume, which only serves to create more of a backlog and worsening congestive failure.
This is a progressive disorder, and when other factors such as kidney disease, diabetes, and/or hypertension are present, the condition can become even worse.
Medications such as lanoxin to control the heart rate, and diuretics to reduce the fluid volume, are used to control heart failure. Sometimes a pacemaker is needed. Oxygen is sometimes needed either periodically or full time. A low-sodium diet is usually prescribed as well.
Heart failure can't be cured, but it can be controlled. It is progressive, and periodic evaluation and adjustment of medications and other treatments is essential.
The Skin
The skin is the largest organ in the body. The body is made up of at least 55 percent water (varying by age and fat content); skin is essential to maintaining fluids necessary for other organ function. It also helps maintain body temperature.
Aging affects the elasticity and thickness of the skin. Older people have very thin skin that can bruise and tear easily. It is vulnerable to pressure, accidental contact with objects such as walls and furniture, and to friction such as moving about in bed against the linens.
These skin tears can become infected and be difficult to heal. The use of bandages may be necessary, but the very act of removing the bandage can cause another skin tear if special care is not taken.
The skin is a good source of information about the body. It is easily reddened or flushed with a fever, it becomes taught and stretched over areas of swelling, and it can become very dry, pale, and rigid in case of dehydration.
Pressure over bony prominences such as elbows, knees, ears, hips, and buttocks can reduce circulation and cause the skin to break as well. Underlying tissue can be damaged and infection or microscopic organisms can eat away at the tissue. This causes bedsores, or decubiti. If not treated quickly, these sores can rapidly worsen and can even be fatal.
Pressure should be avoided and alleviated by frequently changing position (every fifteen to twenty minutes), which can alleviate pressure sufficiently to avoid decubitus formation. In changing position, care should be taken not to pull too hard, bump against something, or cause friction by sliding or rubbing along material such as bed linens. Gently massaging the skin over bony prominences helps increase the circulation and reduce damage underneath the skin. Applying cream while massaging helps reduce any friction caused by rubbing.
