Successful Aging: Social tips, home safety advice, balance exercises for seniors, and more to help you live independently

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By UHN Staff • December 10, 2015

Successful Aging:
Social tips, home safety advice, balance exercises for seniors, and more to help you live independently

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INTRODUCTION: SENIOR WHOLE HEALTH

Understanding how the aging process affects our minds and bodies is an important part of preparing for our older years. The U.S. Census Bureau reports that in 2015 there are 6.3 million Americans over the age of 85. Experts anticipate that by 2050, that number will grow to 18.7 million.

With age comes a variety of health problems, some of which can be avoided or minimized by certain lifestyle changes, and others which, though unavoidable, can be better managed by certain treatments or approaches. In either case, educating yourself about factors that affect your health is your best bet towards healthy and successful aging and maintaining as much independence as possible.

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I. MAINTAINING YOUR HEALTH

As we age, our bodies undergo many undesirable changes. We tend to lose muscle mass, our organs tend to function less efficiently, and our risk of disease increases. The good news is that there are things we can do—lifestyle choices and changes we can make—to mitigate some of these problems.

Exercise: Stay Active

Exercise or physical activity is perhaps one of the most important steps you can take towards improving your health.

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Multiple studies have shown that people who are physically active are more likely to live longer and remain independent compared with those who are inactive. And yet, a 2015 report from the United Health Foundation states that 33.3 percent of seniors are not engaging in physical activity compared with 28.7 percent in 2014. This is a trend that needs to change, because exercise has the potential to make a positive impact on the aging process.

Benefits of Exercise
Research proves that exercise benefits every aspect of our lives, from mental to emotional to physical aspects.

• Longevity: Researchers have shown that exercise increases your likelihood of living longer. While it is important to consult with your doctor if you have never been physically active and want to begin an exercise regimen, evidence suggests that it is never too late to reap the benefits. One study found a significant survival benefit in people between the ages of 70 and 85 who started a physical activity regimen compared with those who remained inactive.
• Independent living: Studies have shown that people who are physically active are more likely to be able to live independently as they age. One study evaluated the physical activity level of people at the age of 78 and found that those who were most active were more likely to be living independently at the age of 85.
• Brain age: Exercise has a positive impact on our brains. Increased physical activity is associated with improved cognitive function, including better executive functioning skills like planning, organizing, and strategizing. While exercising can help you avoid or delay developing mild cognitive impairment, it has also been shown to improve cognitive functioning in those already experiencing some degree of impairment.
• Weight control: Exercise can help you maintain a healthy weight and avoid obesity, which in turn will help reduce your risk of many diseases. Excess weight is also a burden on the body’s musculoskeletal system and can impair your mobility.
• Decreased risk of disease: Regular exercise has been shown to both reduce the risk of and improve symptoms of many diseases including high blood pressure (hypertension), heart disease, type 2 diabetes, and some cancers. It can also help prevent bone density loss in people with osteoporosis and can improve lung function in people with chronic obstructive pulmonary disease (COPD). Exercise, when part of a doctor-approved program, can help speed recovery from certain illnesses as well.
• Reduced anxiety and depression: Exercise has been shown to improve both anxiety and depression. Exercise releases chemicals like endorphins that can ease depression. One study of an elderly population showed that people who exercised regularly had a 20 percent reduction in anxiety compared with those who did not exercise.
• Reduced risk of falls and hospitalization: Exercise, particularly exercise that increases muscle mass and strength, is associated with a decreased risk of falls and a decreased risk of being hospitalized.
• Financial savings: By being physically fit and minimizing your risk of disease and other age-related disorders, your need for prescription medication can decrease, translating into what can be a substantial cost savings over the years.

Creating an Exercise Plan
It is particularly important as you age to consult your healthcare provider so you can avoid injury before beginning a new exercise regimen. The most effective way to embark on a successful exercise program is to find one that you enjoy and that is convenient. There are several steps you can take to improve the odds that you will create a plan you can stick with:

• Make it fun: Exercise does not need to be boring. Find an activity you enjoy, whether it is walking, swimming, taking a dance or yoga class, or hiking. There are many different ways to get exercise.
• Make it convenient: Find a place that is easy to get to for your exercise so that getting there does not become burdensome.
• Keep a schedule: Find a time of day and pick certain days of the week when exercising will best fit into your routine.
• Make it social: Finding a partner to exercise with, or joining a class at a gym or community center can not only keep you motivated, but can make the process more enjoyable.
• Be smart: Consult with your doctor on a plan that is healthy for you. Leave yourself time to warm up your muscles before taxing them with more rigorous exercise. If it causes pain, you need to reevaluate your regimen. Be willing to readjust your routine if you have an illness or injury that prevents you from doing the exercise you are used to doing.

What Types of Exercise Should I Do?
There are four main categories of exercise. Which type(s) you decide to incorporate into your regimen should depend on your health and medical problems. Your doctor can help guide you in creating a safe regimen.

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• Aerobic: Engaging in an exercise that safely raises your heart rate or makes you breathe a little harder can help build up your stamina and energy level. Swimming, tennis, aerobics, or simply walking briskly are examples of activities that raise your heart rate. Most experts recommend 30 minutes a day of this kind of exercise, at least several days a week. If 30 consecutive minutes is too much for you, you can break it into 10-minute segments throughout the day. A study of people between the ages of 60 and 83 showed that this type of exercise was the most beneficial in terms of reducing abdominal fat and C-reactive protein levels (a marker of inflammation), both of which are linked to heart disease and diabetes.
• Strength training: This type of exercise, which includes such activities as squats or push-ups, helps you maintain muscle mass. Muscles are important for many reasons. Since muscles are what support your joints, stronger muscles can help reduce arthritis symptoms and avoid joint injuries.
• Balance: Balance exercises such as heel-to-toe walking can help you reduce the risk of suffering a fall. Single leg stands and balance walks also will help improve your overall strength (see our “Maintaining Your Balance” section in Chapter 2).
• Flexibility: Stretching exercises for seniors keep your muscles limber and can help keep you flexible. Increased flexibility not only helps keep you mobile, but also helps prevent strains and sprains or other types of muscular injury. Working out in water is an ideal way to get stronger and more flexible without putting more stress on your joints. Exercises you can do both in and out of the water include leg abductions and side raises.
  • Leg abductions strengthen your outer thighs, the muscles around the hip, and the core. Stand tall, holding on to the side of the pool or a wall for support. Lift your left leg out to the side, keeping your foot pointing forward; then bring your leg back to the start position. Do 10 to 12 repetitions, then switch to the right leg. Do three sets (left and right) on non-consecutive days.
  • Side raises strengthen the muscles around the shoulders and tones the arms. Stand tall with your feet hip-width apart, arms at your sides. Close your hands, with thumbs pointing upward. Slowly raise your arms up, keeping them slightly in front of your body, not straight out to the side. Keep shoulders down as you raise your arms no higher than shoulder level. Slowly lower to the start position. Do three sets of 10 to 12 repetitions on non-consecutive days.

Diet: The Importance of Healthy Eating

The food we eat is the fuel for our bodies. It also has a significant impact on our risk of disease development and disease management. Most experts agree that a diet rich in whole grains, fruits, vegetables, lean proteins, and nuts and low in processed foods and refined carbohydrates is what we should aim to consume.

The amount of food we eat is also important. Watching our total caloric intake and keeping an eye on portion control can help avoid weight gain.

What to Include

• Whole grains: Whole grains such as brown rice, quinoa, and whole oats, are rich in fiber. A diet containing whole grains can help prevent and manage diabetes. It can also help promote regularity.
• Fruits and vegetables: Fruits and vegetables, in addition to having fiber, are often rich in vitamins and minerals that have important health benefits. For example, dark leafy greens such as kale and spinach contain calcium needed for bone mass and the beta-carotenes and vitamin C found in peppers and cantaloupe can help fight certain eye diseases like macular degeneration. Certain fruits and vegetables also contain antioxidants, substances that help fight damaging free radicals in our bodies, which can help prevent a variety of problems from certain cancers to aging skin. Examples of antioxidants are the anthocyanins found in blackberries and blueberries and the lycopene found in tomatoes.
• Lean proteins: Protein is essential for maintaining muscle mass. Examples of lean proteins are fish and legumes. Fatty fish such as salmon or tuna have the added benefit of containing omega-3 fatty acids, which have a protective effect against heart disease, stroke, and Alzheimer’s disease. Legumes such as beans and lentils are a fiber-rich, low-fat and an inexpensive source of lean protein.
• Low-fat dairy/calcium-fortified dairy substitutes: Low-fat dairy products such as skim milk or low-fat yogurt contain calcium and vitamin D, which is important in preventing bone loss or osteoporosis. If you cannot eat dairy, look for alternatives such as calcium-fortified almond or soy milk.
• Nuts: While nuts have a relatively high fat content, the fats they contain—monounsaturated and polyunsaturated fats—are the healthy kinds of fats. Nuts are also high in protein, omega-3 fatty acids, and fiber among other nutrients and have been linked with a decreased risk of heart disease and stroke. It is important to bear in mind that nuts are high in calories and some nuts come prepared with added sugar and salt, all of which can counteract the positive health benefits.

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What to Avoid

• High sugar/processed foods: Foods high in sugar can raise your blood glucose levels, leading to an increased risk of diabetes and weight gain.
• High fat foods: Foods high in saturated and trans fats increase your risk of heart disease and stroke by contributing to the build-up of plaques in the arteries of the heart and brain in addition to other places like our legs (resulting in peripheral artery disease).
• High salt foods: High salt consumption has been linked with an increased risk of developing high blood pressure and kidney disease. In addition to watching the salt that you cook with or season your food with, it is important to check food labels for sodium content.

Mental Wellbeing

The changes that our bodies undergo as we age can sometimes affect our emotional health. It can be frustrating and discouraging to experience new physical limitations or new medical conditions. There are a number of steps we can take, however, to help maintain a positive outlook on life.

• Get moving: Exercise leads to a release of chemicals in our brains called endorphins that are associated with a “feel good” effect. Multiple studies have linked exercise with a reduction in anxiety and depression.
• Be social: Research has consistently demonstrated that regular interaction with other people is associated with a reduction in cognitive decline; in other words, it is good for our brains to socialize. There are many ways to increase our interaction with others:

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• Exercise together: Take a walk with a friend or neighbor, join a class at a gym or community center
• Brain games: Brain-building games like Sudoku, crossword puzzles, or bridge, when played with others, can have a very positive impact on our cognitive function and our mental well-being.
• Meals: Plan a regular weekly meal with a friend or group of friends.
• Volunteer: There are many organizations, from hospitals to museums, in need of volunteers. It can be an excellent way to interact with others and to feel like you are making an impact on your community.
• Special interest groups: Join a book group at your public library, a class at your place of worship, or a support group. Check with your public library or community center for a list of groups that meet on a regular basis.
• Be self-compassionate: Research has shown that when we are compassionate towards ourselves—treat ourselves kindly and non judgmentally—we tend to have better adaptive functioning skills, improved quality of life, and a greater sense of well-being in our older years.
• Practice mindfulness: Mindfulness is the ability to focus on the present moment, awaken to experience, and acknowledge and accept out thoughts and feelings. Research has found that practicing mindfulness can slow the aging process at the neurological and chromosomal level. In fact, our brains normally shrink 5 percent every 10 years after the age of 40; however, studies have shown that people who regularly practice mindfulness have less age-related loss of brain volume. Meditation is a common mindfulness practice, but there are many other small ways to start practicing mindfulness, including:
• One-minute breathing: This is something you can do anywhere and at anytime. Take a minute and breathe in slowly and deeply, focusing on your breath. Hold your breath for several seconds and then slowly exhale. If your mind wanders, acknowledge your thoughts but don’t judge them.
• Observation: Sit still for a moment and pick a natural object around you such as a tree branch or a butterfly. Try to feel as though you are noticing it for the first time and observe the way the wind blows the leaves or the butterfly’s wings flutter. Appreciate the nuances of the movements.
• Mindful action: Take a moment to perform an activity you do on a regular basis, but slow down and allow yourself to notice everything about it. For example, as you fill the coffee pot with water, watch your hands, observe the flow of the water, consider how your brain is directing your hands to hold the pot and turn on the faucet.
• Get help when you need it: Depression is not a normal part of aging, but the elderly are at increased risk of experiencing depression. Depression is also more common in people with chronic medical problems and data shows that over 80% of older people have at least one chronic medical condition. If you are experiencing symptoms of depression such as loss of interest in activities you once enjoyed, irritability, feelings of hopelessness, insomnia or excessive sleeping, you should seek medical help. There are many options for treating depression and anxiety, including medications and cognitive behavioral therapy, and your healthcare provider can help guide you towards the right treatment option.

Annual Preventative Care

Seeing your primary care provider on at least an annual basis allows him or her to help keep tabs on your overall physical health. If you have chronic medical problems, however, the visits with your provider can sometimes be dominated by focusing on the management of those problems. It is important to remember that as we age, there are a number of yearly preventative measures we should take:

• Immunizations: As we age, our immune systems stop functioning as well as they used to, putting us at increased risk of acquiring infections. As a result, it is critical that the elderly stay up-to-date on immunizations. In particular, it is important to get:
• Shingles vaccine: The Centers for Disease Control (CDC) recommends that all people over the age of 60 receive the shingles vaccine, a one-time shot designed to prevent the painful skin rash and nerve pain caused by the shingles virus.
• Tdap: The CDC recommends that people get the tetanus, diphtheria, and pertussis (whooping cough) booster every 10 years.
• Pneumococcal vaccine: All adults over the age of 65 should receive a pneumococcal vaccine to prevent infection (pneumonia, meningitis, sepsis) caused by the pneumococcal bacteria. There are two types of the vaccine, and you should discuss with your healthcare provider which one(s) you need.
• Annual flu shot: People over the age of 65 are at increased risk of serious complications from influenza infection, therefore it is critical that they get the flu shot every year before flu season starts (early fall).


Don’t forget your annual flu shot!

• Annual eye exams: There are many different eye conditions such as macular degeneration and cataracts that can affect vision in the elderly. Often when people’s vision starts to deteriorate, they will go to their local drug store and buy an inexpensive pair of reading glasses in the hopes of solving their problem. It is important, however, to see your eye doctor so that he or she can evaluate you for more serious eye conditions. Early treatment can help delay and prevent progression in many of these conditions.
• Oral health: More than 70 percent of Americans over the age of 65 have some degree of gum disease. Gum disease is the leading cause of tooth loss and studies have shown that tooth loss is associated with both physical and mental decline. Additionally, gum disease has been strongly linked with heart disease. Good daily oral healthcare and yearly visits to your dentist are an important part of maintaining your overall physical health.

Managing Those Day-to-Day Issues

Many of the day-to-day tasks we took for granted when we were younger become more onerous in our older years. It is important to ask for help when these tasks become difficult and to take advantage of resources in the community to help meet some of our needs.

• Meals: Grocery shopping and meal preparation can become difficult tasks in later years, particularly if you are no longer able to drive or suffer from conditions that prevent prolonged standing or lifting. Many community centers have meal programs for senior citizens and/or information on Meals on Wheels programs. Try calling your local community center, local library, or chamber of commerce for a list of such programs. Asking friends or family for assistance with grocery shopping or hiring someone to do it for you are other options.
• Transportation: Driving in later years can be challenging as our reflexes slow and our vision deteriorates. Many communities have transportation programs for the elderly. You can visit www.eldercare.gov or call 1-800-677-1116 to find out what options exist in your community.
• Hygiene: Maintaining good personal hygiene is important. This can be complicated if you suffer from incontinence. If this is a problem for you, you should discuss it with your healthcare provider so that they can help determine the cause of your incontinence and possible treatment and daily management options. Additionally, good oral hygiene is also important to prevent gum disease and even heart disease. Our skin is often thinner and more prone to infection as we age, so keeping it clean is critical. However, simply taking a shower or bath can become very difficult tasks for the elderly. Often, having a walk-in-tub or a shower seat and shower handle bar are absolute necessities for maintaining the ability to bathe independently. Even with this equipment, it can be sometimes be necessary to have someone assist you in the bathing process. If family is not an option, you might need to have a home health provider come on a regular basis. Your healthcare provider can help direct you towards local care resources or you can visit www.eldercare.gov or call 1-800-677-1116 for local options.
• Getting around: Walking around your home can become a dangerous activity as we age, particularly if you suffer from balance problems or arthritis. Taking certain precautions can make it safer:
• Footwear: Make a point to find comfortable shoes that give you the type of support (for example arch support) you need. Your healthcare provider, podiatrist, or physical therapist can help you determine the right type of shoe for you. Research suggests that it is not safe to walk in stocking feet without shoes as your risk for falls might be increased.
• Assistance devices: If you suffer from balance problems or have limited mobility you might be in need of an assistance device such as:
  • Canes: Canes can relieve pressure on joints, provide stability, and help prevent falls. Canes can be found at medical supply stores and regular pharmacies. It is important to find a cane that is the appropriate height, handle, and design for your needs. If you are not certain what those requirements are for you, consult with your doctor, physical therapist, or medical supply store staff.
  • Walkers: Some people need the wider base of support that walkers provide. Walkers can be purchased at medical supply stores or ordered online.
  • Scooters/wheelchairs: When walking is no longer an option, it may be necessary to obtain a scooter or wheelchair. If your doctor agrees that this is necessary, Medicare and many insurance companies will help cover some or all of this expense. You should consult with your healthcare provider, insurance company, and Medicare (1-800-MEDICARE) to determine where you should obtain your device.

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II. MAINTAINING YOUR MOBILITY

Maintaining our mobility is one of the most important factors in remaining independent as we age. Many factors can influence our mobility, particularly our joints and muscles and our balance.

One helpful step in staying mobile is to understand how your joints work. Our skeletal system is the scaffolding of our body, providing structure and support. Joints are the parts of the bodies where different bones come together, allowing our skeletons to move. Healthy joints contain cartilage, synovial membranes, and synovial fluid that provide cushioning.

As we age, joints can be affected in a number of ways. Our bones lose mass and become more brittle and prone to fracture. The fluid content diminishes and the cartilage can wear away. Mineral deposits or calcifications can develop around the joints, restricting movement and causing pain. The symptoms experienced by these changes and the problems that occur with age are different for each joint.

Your Knees

The knee is the strongest and largest joint in our body and bears the burden of the majority of our body weight. The end of the femur (or thighbone), thetibia (or shinbone), and the patella (or kneecap) meet in the knee joint. Articular cartilage cushions the bones as the knee bends and straightens.

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Two other pieces of cartilage, called the meniscus, provide cushioning between the ends of the femur and tibia. The entire joint is surrounded by a synovial membrane that secretes a fluid that lubricates the joint.

The most common knee problem in the elderly is osteoarthritis of the knee. In osteoarthritis, the cushioning cartilage wears away to varying degrees, allowing the bone to rub against bone.

Symptoms

• Pain: This can range from a mild ache to debilitating pain. Some people report feeling more pain with changes in the weather.
• Swelling and stiffness: Some people experience this most after sitting or resting.
• Crepitus: A click or creak of the joint can sometimes be heard from loose pieces of cartilage in the joint.

Treatment

• Muscle-strengthening exercises: Your doctor or physical therapist can help you determine what exercises (such as quad sets that strengthen the quadriceps or thigh muscles) you can do to help strengthen the muscles that support your knee joint.
• Modify your workout: Switching from high impact exercise like jogging to low impact exercise like swimming or cycling reduces the stress on your knee.
• Weight loss: Lowering the burden of weight that your knees must bear can have a significant impact on pain reduction and increased mobility of the joint.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are often used to treat the pain and inflammation of arthritis, but they can have serious risks including gastrointestinal bleeding, so you should consult your doctor before taking them.
• Knee replacement: Knee replacement is the treatment of choice when all other treatment options have failed.

Your Hips

Much like the knee, the most common hip affliction in the elderly is caused by osteoarthritis, or “wear and tear” arthritis. Hip fractures, however, can also occur in older people and the risk of having a hip fracture increases with age as well as with other medical conditions like osteoporosis, cancer, and a history of long-term steroid use.

Hip fractures can have serious consequences in the elderly and require immediate medical attention and often surgery. The hip is another of the body’s largest joints, but unlike the knee, it is a ball-and-socket joint. The “ball” is the head of the femur (thighbone) and the socket is the surface of the pelvic bone called the acetabulum.

As with the knee, the bony surfaces of the joint are covered by a cushioning articular cartilage and the entire joint is surrounded by a lining that secretes a lubricating fluid. When this cushioning cartilage begins to degenerate, the symptoms of hip osteoarthritis begin to appear.

Symptoms

• Pain: Pain around the hip joint, but also occasionally pain in the groin or thigh that radiates to the buttocks or knee, can occur with arthritis of the hip. Vigorous activity and changes in weather can aggravate the pain.
• Stiffness and swelling: People with arthritis of the hip may have stiffness and swelling that can interfere with range of motion and walking and often cause a limp.
• Crepitus: As with arthritis of the knee, you may experience a locking of the joint or a grinding noise caused by loose tissue in the joint.

Treatment

• Muscle-strengthening exercises: Exercises designed to strengthen the muscles that support your hip joint or the muscles of your leg can be a good way to ease the work of the joint. Your doctor or physical therapist can help you create a regimen of strengthening and stretching exercises best suited for you.
• Modify your workout: Switching from high-impact exercises like tennis to low impact exercises like swimming can reduce the wear and tear on the remaining cartilage in your hip.
• Assistive devices: Depending on the degree of your arthritis, using a cane or walker may help increase your mobility and independence by providing more support and stability.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are often used for pain management with arthritis. The carry significant risks such as gastrointestinal bleeding, so be sure you discuss them with your healthcare provider, particularly if you require them often. Sometimes corticosteroid injections into the joint space are used to control pain and inflammation as well.
• Hip replacement: For hip pain that cannot be managed with non-surgical means, replacement surgery may be the next step.

Your Feet

Our feet are at risk for a number of problems as we age. The foot arch starts to weaken, often resulting in a small loss of height.

Additionally, circulation to the feet can be compromised, particularly in people with peripheral artery disease (in which plaques build up in the arteries of the leg) or diabetes (in which the blood vessels to the leg become damaged by high blood sugar levels).

As with the rest of the body, our skin also thins and is more prone to injury, which—along with diminished circulation—can lead to an increased risk of infection, particularly in people with diabetes. There are several things you can do to avoid complications with your feet:

• Exercise: Exercise can strengthen the muscles and arches of your feet and promote better blood circulation. If you are already experiencing foot problems, consult with your physical therapist or podiatrist to discuss a suitable exercise regimen.
• Hygiene: Keeping your toenails clipped is an important step towards avoiding pressure sores and ingrown toenails which can lead to infection.
• Footwear: Wearing footwear that provides the right support and is the right size can ease foot pain. Keeping your feet covered can also keep them warm and increase circulation, although it is important to not wear socks or shoes that are so tight they restrict circulation.
• Check your feet: Given the increased risk of developing sores or infection in your feet, it is important to inspect them regularly so that early signs of infection can be detected.

Your Back and Spine

Our spine is composed of multiple bones called vertebrae, between which are gel-like cushioning bodies called discs. The spinal cord travels from our brain down the length of the back through the center of each vertebra, sending nerves out to various parts of our body along the way.

Every older person has some degree of degeneration of their spine, although many are fortunate enough to remain asymptomatic. The most common conditions of the spine related to aging are:

• Spinal stenosis (the narrowing of some portion of the canal through which the spinal cord travels)
• Degenerative spondylolisthesis (the joints between the vertebrae degenerate such that the one vertebrae slips forward on top of another)
• Degenerative disc disease (when the cushioning bodies between the vertebrae become thinner and lose their fluid)
• Compression fractures (fractures in the vertebrae, most commonly due to osteoporosis, that cause the height of the vertebrae to shrink)
• Adult scoliosis or hyperkyphosis (a curvature of the spine to the side, or a front-to-back curvature, respectively)

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Spinal conditions are complicated because they are generally not isolated conditions but are interrelated. If the spinal cord or nerves are compressed, as they can be in spinal stenosis or spondylolisthesis, numbness, tingling, and weakness can occur in whatever body parts the affected nerves supply. Loss of cushioning between vertebrae in degenerative disc disease can cause loss of motion and stiffness. Back “spasms” can occur when the muscles that support the spine contract in an attempt to stabilize the spine.

Treatment for spinal problems involves treating any underlying diseases (such as osteoporosis) that can lead to compression fractures, physical therapy to strengthen the supporting muscles in the back, and pain management with acetaminophen or NSAIDs. Pain is sometimes managed with corticosteroid injections into the vertebral space. Surgical options exist for problems that cannot be medically managed. Because symptoms can be the same for multiple spinal conditions, it is important to consult your healthcare provider with any back pain so that they help determine the right diagnosis and treatment.

Understanding Balance

Balance problems are one of the most common reasons people over the age of 65 consult their healthcare provider; in fact, some data suggests that 40 percent of seniors are affected by balance problems.

Balance is defined as the ability to maintain the body’s center of mass over its base of support. This is achieved by a complex interplay of input to the brain from our eyes, our muscles and joints, and the vestibular organs in our inner ear.

Our vision allows us to take stock of where our body is in relation to other objects. Our muscles and joints, with input from nerves, allow us to sense where our body parts are and need to be. Our vestibular system helps our brain track the position of our head with respect to gravity.

How Aging Affects Balance
Even in the absence of other medical conditions, our risk of developing balance problems increases with age for a variety of reasons:

• Cells in the vestibular system begin to die off
• Our vision diminishes
• Hearing deteriorates
• Muscle mass and strength deteriorate
• Reflexes slow

Health Conditions that Can Affect Balance
Many different health conditions can impact our balance:

• Eye disorders: As vision is an important part of the sensory input that helps us maintain balance, conditions that affect our eyes can impact balance. Eye muscle imbalance, cataracts, macular degeneration, diabetic retinopathy are examples of such conditions.
• Arthritis: The pain and the limitations on range of motion that arthritis can cause in our joints can impact our ability to maintain our center of gravity over a stable base of support. Arthritis can cause changes in posture that impact balance as well.
• Nerve problems: The nerves in our feet and legs tell our brain where these body parts are and provide them with the signal from our brain to move. Many diseases can affect these nerves, and thus our balance, including multiple sclerosis, Parkinson’s disease, stroke, and diabetes.
• Diabetes: In addition to affecting the nerves in our feet and legs, diabetic neuropathy can affect the nerves in our autonomic nervous system that help us stay steady as we go from lying down to standing. Diabetes can also affect our vision and increase the risk of stroke. Low blood sugar levels can also undermine our balance, causing lightheadedness or weakness.
• Ear disorders: The inner ear is a critical part of maintaining balance. Localized ear infections, upper respiratory infections or vertigo can all affect the vestibular system of the inner ear and, thus, our balance.
• Dehydration: Dehydration can affect our ability to tolerate changes in posture.
• Side effects from medications: Many different medications can impact our balance. Examples include blood pressure lowering drugs (diuretics, ace inhibitors, etc), some antibiotics, chemotherapeutic drugs, antihistamines, and sleep aids, among others. Additionally, the interaction of different medications can affect balance.

Diagnosing and Treating Balance Problems
If you’re experiencing problems with your balance, you should consult your healthcare provider. If your balance problem is related to an underlying medical condition, identification and treatment of that condition may improve your balance. If you have not already been diagnosed with an underlying condition, physical examination can often determine whether the problem is musculoskeletal, neurologic, or vestibular.

Your primary healthcare provider may refer you to an ears, nose, and throat (ENT) doctor if they suspect the cause is related to your vestibular system. There are several different problems that can affect the vestibular organs in the inner ear. In the elderly, the most common of these is benign paroxysmal positional vertigo in which calcium particles build up in the canals of the inner ear. Treatment usually involves physical maneuvers that make use of gravity to get the particles dislodged from the canals.

Improving Your Balance
The ability to maintain balance is key to preventing falls that lead to fractures and head injuries. There are steps you can take to improve your balance.

• Balance exercises for seniors: In addition to regular aerobic and muscle strengthening exercises, there are specific balance exercises you can practice. If you have underlying medical conditions, you should consult your healthcare provider before beginning balance exercises. He or she may refer you to a physical therapist who can create a regimen best suited to your needs. If you are otherwise healthy, there are several exercises you can do at home; however, you should begin slowly to ensure your ability to safely perform them:
• Heel-to-toe walking: Walking in a straight line, place the heel of one foot in front of the toes of the other foot. Walk across a room in this pattern, attempting to stay on a straight course.
• Single leg stand: Holding on to the back of a chair, lift one leg and balance your weight on the other leg for 20 seconds. As your steadiness improves, you can perform this without holding onto the chair.
• Balance walk: Raise your arms on both sides to shoulder height and walk in a straight line, one foot in front of the other. As you walk, lift the back leg and hold it up for one second. Keep your arms raised at all times.
• Assistance devices: If you suffer from a medical condition that affects your balance such as arthritis or Parkinson’s disease, or if you have suffered a stroke, you may need to use a cane or walker to help you maintain your balance. Medical supply stores carry these and can help you find one that fits your body and your needs.

Senior Citizen Help: Why a Senior Medical Alert Is a Good Idea
In the event you do experience a fall, it’s important to have some method to call for help. Falling accidents do happen, so be prepared with a device—one of many medical alarms for seniors—that can ensure quick help. The cost of a medical alert product can be a few hundred dollars per year, but in the event of the elderly falling down, it’s well worth it.

A number of companies produce senior alert devices; they typically involve a medical alarm button that can be worn as a neck pendant or wristband and, optionally, wall-mounted near the floor in multiple rooms. The button’s speaker and voice capabilities allow an elderly person to contact a “care specialist,” as one manufacturer, LifeStation, calls its operators, who are on duty to respond to calls and alert emergency services.

Among the other companies cited, along with LifeStation, by Consumer Reports as makers of recommended senior alert systems are Life Alert, Medical Alert, MobileHelp, Phillips Lifeline, and Rescue Alert.

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III. KNOW THE BASICS OF THE MAJOR DISEASES

There are many different diseases that can affect the human body, but certain disease rank among the most common causes of major illness in older adults. Your healthcare provider will screen you for obvious signs and symptoms of these diseases at your annual check-up; however, if you ever suspect you are suffering from one of these diseases, you should see your healthcare provider immediately. Some of these diseases affect both men and women and others are gender-specific.

Men and Women

• Cardiovascular disease: Cardiovascular disease is a term that is primarily used to refer to the effects of atherosclerosis, the build-up of plaques in our arteries. As the plaques build up they begin to block the flow of blood through the arteries. These plaques can build up in the arteries of the heart, creating coronary artery disease (the cause of heart attacks), in the arteries of the brain, which can cause stroke by blocking blood flow (called ischemic stroke), and in the arteries of the feet and legs, causing peripheral arterial disease.

Risk factors for atherosclerotic cardiovascular disease include family history, obesity, abnormal cholesterol levels, smoking, diet high in saturated fats, and lack of exercise. Sometimes, people use the term cardiovascular disease to refer to other conditions affecting the heart such as heart failure (when the heart cannot pump blood to the body efficiently), arrhythmias (abnormal heart rhythms), and heart valve problems (when the valves of the heart don’t work properly to keep the blood flowing in the right direction).

Lifestyle changes such as exercise, better diet, and smoking cessation are part of the treatment regimen for most types of cardiovascular disease.

Depending on the type of cardiovascular disease you have, your healthcare provider may prescribe medications to prevent blood clots, lower cholesterol levels, improve your heart’s pumping ability, or control your heart rate.

• Stroke: Ischemic stroke, the most common form of stroke, occurs when the flood of blood in a vessel in the brain is blocked by an atherosclerotic plaque or blood clot. Risk factors for ischemic stroke include family history, heart disease, high blood pressure, smoking, diabetes, obesity, sedentary lifestyle, poor diet, and abnormal cholesterol levels. Hemorrhagic stroke occurs when the wall of a blood vessel in the brain weakens and bursts causing bleeding into the brain. This is usually the result of a long history of high blood pressure. If you have had a stroke, treatment includes treating the underlying condition that led to it (e.g. high blood pressure or blood clot formation) as well as physical and occupational therapy of the affected parts of your body.

• Lung cancer: Lung cancer is the leading cause of cancer deaths for men and women. The biggest risk factors for developing lung cancer are a history of smoking or long-term exposure to secondhand smoke; however, some lung cancers occur in people who have never smoked. Exposure to certain carcinogens (cancer-causing chemicals) such as asbestos is also a risk factor for some lung cancers. Lung cancer treatment can include chemotherapy, radiation, and sometimes surgery.

• Chronic obstructive pulmonary disease (COPD): COPD is a disease in which chronic inflammation in the lungs obstructs airflow, resulting in progressive breathlessness. There are a number of different types of COPD including emphysema, chronic bronchitis, and non-reversible asthma. Risk factors for COPD include smoking or history of exposure to second-hand smoke, exposure to fumes or small particles, and family history/genetics. Treatment for COPD can include drugs that help dilate the airways in your lungs (bronchodilators) and decrease the inflammation in the airways (steroids, phosphodiesterase-4 inhibitors) as well as other drugs like theophylline. Oxygen therapy and monitored exercise regimens can also be prescribed.

• Alzheimer’s disease: Alzheimer’s disease (AD) is the most common cause of dementia. It is a progressive, degenerative disease in which, for mostly unexplained reasons, the build-up of beta-amyloid plaques and the tangling of tau proteins in the brain leads to brain cell death. It is thought that interplay of genetics, environment, and lifestyle is behind the cause of AD. Among the identified risk factors are family history, history of head trauma, older age, diabetes, and lifestyle factors such as lack of exercise, poor diet, and smoking. Treatment includes medications such as cholinesterase inhibitors and memantine as well as taking measures to provide the necessary daily care required for those experiencing cognitive impairment.

• Diabetes: Diabetes is a disease characterized by elevated blood sugar (glucose) levels. In type 1 diabetes, the body does not produce enough of the hormone insulin that allows our cells to take glucose up from the blood stream. This form of diabetes is more commonly diagnosed in younger people.

Type 2 diabetes is characterized by the cells of the body being resistant to the effect of insulin. The body will initially try to compensate by producing more insulin, but will ultimately not be able to do so. This type of diabetes is more commonly diagnosed in adults. Diabetes can have dire consequences on the body, causing damage to the small blood vessels of virtually every organ. This can result in disorders of the eye (such as glaucoma and retinopathy), ears (hearing loss), kidney (kidney failure), cardiovascular system (such as heart disease), and nervous system (nerve damage or neuropathy), among others. Treatment is centered around keeping blood glucose levels within a normal range either by using insulin (in type 1 diabetes), oral glucose-lowering medications (in type 2 diabetes), or both (in type 2 diabetes).

• Colorectal cancer: Cancer of the colon or rectum is the second leading cause of cancer death affecting men and women in the United States. This cancer begins in the form of polyps that grow in the large intestine and become cancerous over time. Screening with colonoscopy can help prevent these cancers by allowing for the biopsy and removal of these polyps. Treatment depends on the stage of colorectal cancer but can include chemotherapy, radiation, and/or surgery.

• Influenza and pneumonia: Infection of the lungs caused by influenza or bacteria is a major cause of death among people over the age of 65. This is in part because as we age, we are sometimes not able to clear the secretions from our lungs as well, allowing for bacterial growth and decreased oxygen exchange. Our immune systems tend to be weaker as we age and the odds of having a co-morbid condition that impairs our ability to fight infection (such as diabetes) increase. Being sure that you receive your pneumococcal vaccine once you turn 65 and your annual flu shot can help prevent you from getting pneumonia. If you are diagnosed with pneumonia, treatment may include antibiotics or antiviral medications. Hospitalization and oxygen therapy may be necessary for more severe cases.

• Chronic kidney disease: Chronic kidney disease is the gradual loss of kidney function. This can ultimately result in the kidneys losing the ability to filter waste from the blood into urine, leading to dangerous build-up of fluids, electrolytes, and protein in the blood. Risk factors for the development of kidney disease include diabetes, high blood pressure, obesity, advanced age, abnormal cholesterol levels, smoking, and family history among others.

Treatment includes managing any underlying condition that is contributing to the kidney disease (such as diabetes or high blood pressure), dietary changes to limit the salt and protein content of your blood, and drugs to minimize swelling from excess fluid retention. If the disease progresses, you may need dialysis (filtering of the blood by a machine) or even a kidney transplant.

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IV. BE AWARE OF AGE-RELATED DISORDERS

Certain conditions or disorders can develop as we age that impact our quality of life and ability to live independently.

• Osteoarthritis: This is sometimes called the “wear and tear” arthritis. It is characterized by a loss of the cushioning cartilage found between the bones of our joints and can cause pain, stiffness, swelling, and decreased mobility.

Lifestyle changes such as reducing excess body weight, regularly performing exercises that strengthen the muscles that support our joints, and changing from high impact activities such as jogging to low impact activities such as swimming can be helpful in managing symptoms. Additionally, pain can be controlled with acetaminophen or NSAIDs.

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• Osteoporosis: The bones in our body are undergoing a constant process of change: old bone is being broken down and new bone is being created. We reach our peak bone mass in our mid-twenties and by middle age the rate of bone loss tends to increase. This is particularly true of post-menopausal women. In osteoporosis, you either make too little new bone, lose too much old bone, or both. The end result is that the bones become weak and brittle and are prone to fracture.

Men and women who have lower bone density by the time the bone loss increases are at increased risk of osteoporosis.Other risk factors include a diet low in calcium and vitamin D, a diet high in sodium and caffeine, excess alcohol consumption, history of smoking, sedentary lifestyle, family history of osteoporosis, low body weight/small frame, female gender, history of taking medications known to cause bone loss (such as steroids or aluminum-containing antacids), and being post-menopausal.Treatment can include medications such as bisphosphonates which slow the breakdown of bone, increasing your calcium and vitamin D consumption, strengthening and weight-bearing exercise, and taking measures to reduce your fall (and, thus, fracture) risk.

• Age-related macular degeneration (AMD): AMD is the leading cause of vision loss in people over the age of 50. It is a degenerative disease of the macula, a part of the eye needed for sharp central vision. While it does not lead to complete blindness, it often results in a blurring of the center of our vision, which can affect daily activities such as reading and driving. Risk factors include a family history of AMD and Caucasian race. Treatment of AMD must be supervised by your doctor and can include a combination of vitamin and mineral supplements (vitamins C and E, zinc, copper, and beta-carotene have proven effective at certain doses) and, in severe cases, injections, photodynamic therapy, or laser surgery.

• Hearing impairment: Hearing occurs because of a complex process of events that occur between our outer, middle, inner ear and the auditory nerve that travels to our brain. As we age, changes often occur in the middle and inner ear that diminish our hearing. Additionally, a long history of exposure to loud noises can irreparably damage the hair cells in our inner ear that are critical to the hearing process. Treatment for age-related hearing loss can include hearing aids, telephone amplifiers, or cochlear implants.

• Age-related urinary incontinence: There are four main categories of urinary incontinence that can affect the elderly. They are typically a combination of the effect aging has on our muscles combined with the anatomic or physiologic effects of another condition:
  • Urge incontinence: This is the most common cause of incontinence in the elderly and is characterized by early, forceful contractions of a muscle in the bladder wall resulting in frequent small to moderate losses of urine even when the bladder is not full. Risk factors for urge incontinence are a history of stroke, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, pelvic organ prolapsed, or benign prostatic hyperplasia (BPH). Treatment includes pelvic floor muscle exercises and anti-spasmodic medications.
  • Stress incontinence: This is more common in early menopausal women or younger elderly women who have had multiple vaginal childbirths. It is characterized by leakage of urine with increases in intra-abdominal pressure such as coughing, sneezing, laughing, or exercise. Pelvic floor muscle exercises, hormone therapy, and surgery are among the options for treatment.
  • Overflow incontinence: This is characterized by a diminished urinary stream and the sensation of incomplete voiding and can result because of outlet obstruction (as in BPH or severe pelvic organ prolapse) or a dysfunction in bladder contractility (as in diabetic neuropathy or spinal cord nerve compression syndromes). Treatment depends on the underlying cause but can include surgery or medications.
  • Functional incontinence: This is associated with cognitive impairment or loss of mobility that impairs an individual from accessing a restroom. Use of disposable protective undergarments and planned, assisted bathroom visits can be helpful management options.

• Age-related skin conditions: A number of changes occur in the skin with age including thinning of the skin, loss of ability to retain water in the skin and a loss of moisturizing glands in the skin resulting in dryness, loss of immune cells in the skin resulting in decreased wound healing, and a loss of elasticity. Some of these effects can be managed by regular moisturizing and inspection of the skin for sores; prompt treatment can be initiated to avoid infection. Other skin disorders that can occur are:
• Skin cancers: These are commonly the result of sun exposure. It is important to see your dermatologist regularly so that he or she can check for skin cancers.
• Age spots: These are flat tan or brown spots that usually develop in areas that have been exposed to sun. If they are true age spots they are harmless, but any irregular spot should be inspected by your healthcare provider.
• Bed sores/pressure ulcers: These are lesions that typically develop because of increased pressure on certain areas of the body from remaining in the same position for prolonged periods of time. They usually develop in people with decreased mobility or in people with diabetes who have impaired circulation and immunity. Management involves frequent position changes to alleviate the pressure on the sores and good skin hygiene.

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V. NAVIGATING THE MEDICAL SYSTEM

Your relationship with your healthcare provider becomes even more important as you age and begin to face a host of new medical conditions or changes. Having a good rapport with him or her and knowing that you can get answers to the questions you have or appointments when you want to be seen are all important factors in that relationship.

If you find yourself in the position of searching for a new primary care provider, one of the first decisions you want to make is what kind of primary care provider you would like to see:

• Family practitioner: A family practitioner is a primary care provider for both children and adults.
• Internist: An internist is a primary care provider for adults only. All specialists, such as cardiologists or pulmonologists, are trained as internists before they go on to complete their specialty training.
• Geriatrician: A geriatric doctor is a primary care provider specializing in the care of older adults. He or she has completed a family practice or internal medicine training program and then gone on to train specifically in caring for the elderly.

Asking friends or family for personal recommendations or other physicians (if you see a specialist, for example) for a professional recommendation can be good ways to get a list of possible options. Furthermore, asking about the location of the practice (to determine its convenience for you), asking whether it is a group practice, asking who sees you when the doctor is out of town, and asking whether the doctor is board-certified (meaning they have passed a rigorous set of qualifying tests in their specialty) can also be helpful in deciding if the practitioner is a good fit for you.

One of the most important questions to ask is whether or not the physician is a participating provider for your insurance plan or for your Medicare plan. The best way to determine this is by calling your insurance company or contacting Medicare (www.medicare.gov or 1-800-MEDICARE).

Medicare 101
Medicare is a federally funded program designed to help provide seniors with healthcare coverage. If you are 65 or older, have collected or qualify to collect Social Security, are a current U.S. resident and citizen, or a permanent U.S. resident having lived in the U.S. for 5 continuous years before applying, you are eligible to apply for Medicare coverage.

Medicare can be used alone or in combination with another insurance plan. It is important to note that Medicare does not provide coverage for all healthcare costs; for example, routine dental and vision care is not always covered. To learn more about Medicare or to get help with applying and understanding your benefits, there are many places you can turn, including:

• Medicare: www.medicare.gov or 1-800-MEDICARE
• Social Security: You can contact your local office or call 1-800-772-1213.
• State Health Insurance Assistance Program (SHIP): Every state has a SHIP that provides free counseling and assistance with navigating Medicare. You can find your state’s SHIP at www.shiptacenter.org.
• Medicare Rights Center: This is a non-profit that provides help in obtaining access to affordable healthcare for the elderly and disabled (1-800-333-4114).

Medicaid 101
Medicaid is a federally funded program designed to provide assistance to those who cannot afford medical care. There are a number of factors that determine whether or not you qualify for Medicaid coverage including income, assets, and disabilities. For senior citizens, it may be worth applying if your income is low, you are legally blind, have a disability, or need nursing home care. There are a number of places to contact if you are interested in applying including:

• Medicaid: www.medicaid.gov
• Health Department: You can apply for Medicaid at your local health department. If you do not know where your local health department is you can ask your local hospital or visit www.naccho.org.
• Social Security Office: You can apply for Medicaid at your local social security office or call 1-800-772-1213 for more information.

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VI. PLANNING FOR THE FUTURE

An important part of preparing for the future in older age is making decisions and preparations for end of life issues. These measures can help ensure that you receive the care you wish to receive and can make it easier for your loved ones by knowing what your wishes are. Many experts advise that the best time to begin making these decisions is when you are healthy.

Advance Directives
Advance directives are written statements of an individual’s wishes regarding medical care made to ensure that those wishes are carried out should the individual not be able to communicate them to their doctor. There are two types of advance directives that most physicians recommend you have:

• Living wills: A living will is a form that states your wishes regarding receiving different forms of end of life care. You can state whether or not you would like to receive resuscitation (with CPR or an automated defibrillator) to restart your heart if it were to stop beating, tube feedings (through a tube passed into your stomach from your nose or through the abdominal wall) if you are no longer able to eat, dialysis if your kidneys stop working, mechanical ventilation if you are no longer able to breathe on your own, or antibiotics/antiviral medications for infections. You can also specify your wishes about what kind of palliative or comfort care (pain medications, etc.) you would like to receive if you do not wish to have more invasive measures taken. Living wills are also opportunities to state whether or not you would like to donate your organs or tissues for organ transplantation or your body for medical research. Living wills cannot be used for medical decision making until 2 physicians have certified that you are unable to make medical decisions and that you are in a medical condition specified by your state’s living will law.
• Medical power of attorney/healthcare proxy: When you make someone your healthcare proxy you are appointing them as your surrogate decision maker and authorizing them to make medical decisions on your behalf in the event that you are unable to make them. When you select your healthcare proxy, it is wise to select someone you know well and who understands your wishes, who will not be afraid to advocate for you with your doctor, who communicates well with your family, and who is calm in a crisis.

There are several important things to know about advance directives.

• Paramedics cannot honor either your living will or medical power of attorney. If they are called to attend to an emergency, they must provide emergent care until they have taken you to a hospital where a physician can then be made aware of your advance directives.

• Laws regarding advance directives differ from state to state and some states will not honor an advance directive from another state. If you spend a good deal of time in more than one state, it is wise to have an advance directive for each state. You do not need an attorney to create an advance directive, although many people do have an attorney help them create one. Your physician or local hospital can direct you to organizations that provide state-specific advance directive forms, or you can visit www.caringinfo.org to obtain free advance directive forms. You will have to have witnesses for all advance directive forms and it is important to be sure that your witnesses comply with your state’s requirements.

• Where you keep your advance directives is also critically important. It is wise to make copies and give them to your family members, your healthcare proxy, your physician, and your family attorney. Since advance directives contain information regarding matters of life or death, it is important to review your advance directives periodically to be certain they still reflect your wishes.