Old age isn’t a battle, old age is a massacre.
–Philip Roth
By Judith Graham
How many of us have wanted a reliable, evidence-based guide to aging that explains how our bodies and minds change as we grow older and how to adapt to those differences?
Creating a work of this kind is challenging. For one thing, aging gradually alters people over decades, a long period shaped by individuals’ economic and social circumstances, their behaviors, their neighborhoods, and other factors. Also, while people experience common physiological issues in later life, they don’t follow a well-charted, developmentally predetermined path.
“Predictable changes occur, but not necessarily at the same time or in the same sequence,” said Rosanne Leipzig, vice chair for education at the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York. “There’s no more heterogeneous a group than older people.”
I called Leipzig, 72, who works full time teaching medical residents and fellows and seeing patients, after reading her new 400-plus-page, information-packed book, “Honest Aging: An Insider’s Guide to the Second Half of Life.” It’s the most comprehensive examination of what to expect in later life I’ve come across in a dozen years covering aging.
Leipzig told me she had two goals in writing this guide: “to overcome all the negatives that are out there about growing older” and “to help people understand that there are lots of things that you can do to adapt to your new normal as you age and have an enjoyable, engaged, meaningful life.”
Why call it “Honest Aging”? “Because so much of what’s out there is dishonest, claiming to teach people how to age backwards,” Leipzig said. “I think it’s time we say, ‘This is it; this is who we are,’ and admit how lucky we are to have all these years of extra time.”
The doctor was referring to extraordinary gains in life expectancy achieved in the modern era. Because of medical advances, people over age 60 live far longer than people at the dawn of the 20th century. Still, most of us lack a good understanding of what happens to our bodies during this extended period after middle age.
Several months ago, a medical student asked Leipzig whether references to age should be left out of a patient’s written medical history, as references to race have been eliminated. “I told her no; with medicine, age is always relevant,” Leipzig said. “It gives you a sense of where people are in their life, what they’ve lived through, and the disorders they might have, which are different than those in younger people.”
What questions do older adults tend to ask most often? Leipzig rattled off a list: What can I do about this potbelly? How can I improve my sleep? I’m having trouble remembering names; is this dementia? Do I really need that colonoscopy or mammogram? What should I do to get back into shape? Do I really need to stop driving?
Underlying these is a poor understanding of what’s normal in later life and the physical and mental alterations aging brings.
Can the stages of aging be broken down, roughly, by decade? No, said Leipzig, noting that people in their 60s and 70s vary significantly in health and functioning. Typically, predictable changes associated with aging “start to happen much more between the ages of 75 and 85,” she told me. Here are a few of the age-related issues she highlights in her book:
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- Older adults often present with different symptoms when they become ill. For instance, a senior having a heart attack may be short of breath or confused, rather than report chest pain. Similarly, an older person with pneumonia may fall or have little appetite instead of having a fever and cough.
- Older adults react differently to medications. Because of changes in body composition and liver, kidney, and gut function, older adults are more sensitive to medications than younger people and often need lower doses. This includes medications that someone may have taken for years. It also applies to alcohol.
- Older adults have reduced energy reserves. With advancing age, hearts become less efficient, lungs transfer less oxygen to the blood, more protein is needed for muscle synthesis, and muscle mass and strength decrease. The result: Older people generate less energy even as they need more energy to perform everyday tasks.
- Hunger and thirst decline. People’s senses of taste and smell diminish, lessening food’s appeal. Loss of appetite becomes more common, and seniors tend to feel full after eating less food. The risk of dehydration increases.
- Cognition slows. Older adults process information more slowly and work harder to learn new information. Multitasking becomes more difficult, and reaction times grow slower. Problems finding words, especially nouns, are typical. Cognitive changes related to medications and illness are more frequent.
- The musculoskeletal system is less flexible. Spines shorten as the discs that separate the vertebrae become harder and more compressed; older adults typically lose 1 to 3 inches in height as this happens. Balance is compromised because of changes in the inner ear, the brain, and the vestibular system (a complex system that regulates balance and a person’s sense of orientation in space). Muscles weaken in the legs, hips, and buttocks, and range of motion in joints contracts. Tendons and ligaments aren’t as strong, and falls and fractures are more frequent as bones become more brittle.
- Eyesight and hearing change. Older adults need much more light to read than younger people. It’s harder for them to see the outlines of objects or distinguish between similar colors as color and contrast perception diminishes. With changes to the cornea, lens, and fluid within the eye, it takes longer to adjust to sunlight as well as darkness.
- Because of accumulated damage to hair cells in the inner ear, it’s harder to hear, especially at high frequencies. It’s also harder to understand speech that’s rapid and loaded with information or that occurs in noisy environments.
- Sleep becomes fragmented. It takes longer for older adults to fall asleep, and they sleep more lightly, awakening more in the night.
This is by no means a complete list of physiological changes that occur as we grow older. And it leaves out the many ways people can adapt to their new normal, something Leipzig spends a great deal of time discussing.
A partial list of what she suggests, organized roughly by the topics above: Don’t ignore sudden changes in functioning; seek medical attention. At every doctor’s visit, ask why you’re taking medications, whether doses are appropriate, and whether medications can be stopped. Be physically active. Make sure you eat enough protein. Drink liquids even when you aren’t thirsty. Cut down on multitasking and work at your own pace. Do balance and resistance exercises. Have your eyes checked every year. Get hearing aids. Don’t exercise, drink alcohol, or eat a heavy meal within two to three hours of bedtime.
“Never say never,” Leipzig said. “There is almost always something that can be done to improve your situation as you grow older, if you’re willing to do it.”
Brian says
Yes old age sucks. My body is worn out, I have pain 24/7. Can’t do a lot of things I did even 4 years ago. Balance… LMAO not in this body. The mind does not function at all either and that hurts the most. This article could have been written about me for me. Personally death does not scare me anymore. I almost welcome it.
Pogo says
@A most needed, and useful, report.
Thank you FlaglerLive.
Related reading
https://www.google.com/search?q=Judith+Graham
JimboXYZ says
Any stage of life has it’s challenges.
Laurel says
Yes, except you see Aiden Turner walk out of the ocean with water running down his chest, then realize you could be his mom. That’s a shocker.
Greg says
So much of what’s listed in this article, strikes home! In almost 73. Three years ago, next week, I fell off a roof, spent 6 weeks in Halifax. Was sent home on hospice! I’m still kicking, but at a much slower pace. My whole body hurts, but still manage to do a few things and we go someplace everyday. I can’t walk too far, so I bought a mobility scooter. Life is precious, especially when you on borrowed time. Growing old sucks, but better than the alternative. Enjoy old age and fight through the pains. Enjoy life in what ever way you can.
Laurel says
Greg: Heal, and feel, better. Hopefully, without the scooter.
Jane Gentile-Youd says
Thank you for publishing this. I was not aware that I should eat more protein and not eat heavy dinner less than 3 hours before bedtime. We often eat at 8 – even 8:30 and go to bed at 10 – that is going to stop.
None of my doctors ever told me these things.
Wow! And when I had pneumonia recently I was told how dehydrated I was too…
Thanks again
Ray W. says
I hope you have fully recovered from pneumonia.
Dehydration is a hidden curse, which I experienced without warning. Many people just do not consume enough water to maintain a healthy balance in life.
As I wrote about months ago, Dr. Bulic, before he suddenly died, had described to me under oath during a deposition the mechanism of sudden stroke/sudden heart attack. When we allow ourselves to reach a certain level of dehydration, our red blood cells become “sticky.” When sufficiently sticky, they suddenly begin to adhere to plaque deposits on our arterial walls, but not to healthy arterial wall. A 100% blockage can form in minutes anywhere in our body where plaque exists on an arterial wall, no matter how minor the plaque deposit. I had what the doctor described as a “widowmaker” heart attack early one hot afternoon upon experiencing a sudden 100% blockage of the blood vessels that fed oxygen to my heart muscle. According to the surgeon, I did not have a significant amount of plaque buildup in my arteries. I was, however, extremely dehydrated after working outdoors under an extremely hot sun with a neighbor for roughly five hours putting up fence panels after a hurricane, without my drinking any liquids. I felt fine until I didn’t feel fine. Dehydration simply built up until I reach a tipping point.
As a slightly humorous aside, I am fond a saying that there is only one good thing about getting older: The older I get, the better all vegetables taste. Simple fact of life, but I really enjoy my vegetables now.
Laurel says
Ray: You are so correct about water. I have a Yeti, with a straw sticking out of the top, that stays filled with ice water, that I drink all day. It goes with me everywhere.
I know, so weird about veggies and different tastes! The taste buds become less finicky. I discovered cilantro at 50 something, and wondered where it had been all my life. Later, I became a cabbage fan! Just roast cabbage steaks with nothing but olive oil, salt and pepper! Yummo! Raw, shaved brussel sprouts on my salads. Who knew?
marlee says
I’m not giving up my wine!
Flapharmtech says
Birds of a feather…
Joyce Cotto says
Great article, & every word is true.
marlee says
Here ya go…Author unknown:
The Elderly
They call us ”The Elderly”
We were born in the 40-50-60’s.
We grew up in the 50-60-70’s.
We studied in the 60-70-80’s.
We were dating in the 70-80-90’s.
We got married and discovered the world in the 70-80-90’s.
We venture into the 80-90’s.
We stabilize in the 2000’s.
We got wiser in the 2010’s.
And we are going firmly through and beyond 2020.
Turns out we’ve lived through EIGHT different decades…
TWO different centuries…
TWO different millennia…
We have gone from the telephone with an operator for long-distance calls to video calls to anywhere in the world.
We have gone from slides to YouTube, from vinyl records to online music, from handwritten letters to email and Whats App.
From live matches on the radio, to black and white TV, colour TV and then to 3D HD TV.
We went to the Video store and now we watch Netflix.
We got to know the first computers, punch cards, floppy disks and now we have gigabytes and megabytes on our smartphones.
We wore shorts throughout our childhood and then long trousers, Oxfords, flares, shell suits & blue jeans.
We dodged infantile paralysis, meningitis, polio, tuberculosis, swine flu and now COVID-19.
We rode skates, tricycles, bicycles, mopeds, petrol or diesel cars and now we drive hybrids or electric.
Yes, we’ve been through a lot but what a great life we’ve had!
They could describe us as “exennials”; people who were born in that world of the fifties, who had an analog childhood and a digital adulthood.
We’ve kind of “Seen-It-All”!
Our generation has literally lived through and witnessed more than any other in every dimension of life.
It is our generation that has literally adapted to “CHANGE”.
A big round of applause to all the members of a very special generation, which will be UNIQUE.
-Author unknown
Keep on keeping on!
Laurel says
Marlee: Loved it, and thank you!
Still have my vinyl, because, we had the best music ever! I saw the best bands ever, from the Cream to Donovan, to Jimi Hendrix, to Moody Blues, to Jefferson Airplane, to Mothers of Invention, to Dan Fogleberg, and many, many more. We were so damned lucky! AND saw them in small venues for little money. Did I mention the Doors? My favorite? Well, Jim was drunk…
Flower power! :)
oldtimer says
Duh, does anyone think this won’t happen to them?
endless dark money says
Enjoy the free healthcare.
More than 13% of American adults — or about 34 million people — report knowing of at least one friend or family member in the past five years who died after not receiving needed medical treatment because they were unable to pay for it.
Sad so many have to die for greed but we have to protect the shareholders.
Remember when the r-con’s sabatoged obamacare and took out the public option and guaranteed insurance company profits. Then complained that the costs went up(gov option was price control). Just imagine a country where little timmy gets his medicine and doesnt have to die young cause his parents werent wealthy.
Did you hear the one where the older couple got divorced not cause they didnt love each other but because one got sick and so to avoid going bankrupt for medical bills they divorced so the other could keep the house. This is everyday in merica. wake up!
Laurel says
Endless: No, I don’t want to wake up to your constant Debbie Downer. Yes, we know all about this stuff, but holy beans, man, for your own health, lighten up!
Buddah smiles and cries at the same time. The reason being, that is the world.
Dana says
The gaslighting from the for-profit medical industry isn’t just around aging, but around each particular disorder that becomes more common with aging.
We’ve all seen those commercials for arthritis drugs.
As a person with metastatic cancer, it’s impossible not only for me, but even my medical team, to find information about how my disease may progress. Even support groups are focused around navigating “treatments” for a disease that’s considered incurable at this stage. Everything but big smiley faces and improbable results is carefully erased from the literature.
Laurel says
Dana: I send you wishes of health. Have you tried Mayo Clinic (not for profit)? They are truly amazing. Insurance companies will tell you they won’t cover Mayo until it’s your last hope. Crazy. Mayo doesn’t take Advantage plans, but they do take regular Medicare. We purposely stay away from Advantage plans because of that.
Give them a call. We feel blessed we are close enough to go there, and won’t move away because of that.