STORY BY
Deborah Mann Lake
We baby boomers are being dragged kicking and screaming into our sunset years. With binocular-strength reading glasses in hand and health care reform on our Sudoku-saturated minds, we mark time by each wrinkle, creak, sag and bag. By the year 2030, we titans of the 20th century will all be at least 65 and we’ll make up nearly a quarter of the country’s population.
As a voting block, we may have power. But when it comes to the doctor’s office, we’re facing competition from one another. If current elderly Americans are a precursor of what is to come, we will experience health challenges such as diabetes, dementia, depression and functional disability in record numbers.
But our sheer numbers may also open up specialized emergency rooms and critical care units, encourage more research into the mysteries of the aging body and place a focus on specialized geriatric and end-of-life care.
According to researchers and clinicians in the Division of Geriatric and Palliative Medicine at The University of Texas Medical School at Houston, here is a snapshot of 10 of the challenges that may be staring back at baby boomers:
- Functional decline: According to the U.S. Department of Agriculture, the body loses 1 percent of muscle mass a year beginning at age 45, which can result in sarcopenia as skeletal muscle is eventually replaced with fat and the body becomes weaker. Some research has linked protein deficiency with sarcopenia.
For every week spent in the hospital, it takes an aging body a month to recover muscle strength with daily rehabilitation, says geriatrician Liliana Andrade, MD, assistant professor of internal medicine at the UT Medical School at Houston. Exercise, including resistance and strength training, is absolutely essential for retaining muscle mass and strength. “For balance, tai chi is good,” she says. “We also encourage patients to rent ‘sit and be fit’ videos that use hand and leg weights.” A study published recently in Diabetes Care, a journal of the American Diabetes Association, found that older adults—especially women—with diagnosed or undiagnosed type 2 diabetes had a higher rate of skeletal muscle loss.
- Depression: Considered as prevalent as the common cold in the elderly, depression can be the result of major life changes: retirement, losing loved ones and loss of mobility and independence. It can show up differently in older people, says geriatrician Nasiya Ahmed, MD, assistant professor of internal medicine at the UT Medical School at Houston. “There’s not as much of a tendency toward tearfulness or feelings of hopelessness,” she says. “Instead they have vague somatic (body-based) complaints, increased pain, not sleeping or eating well or general apathy.”
- Disease: Chronic diseases associated with the aging process, including high blood pressure, stroke, cardiovascular disease, osteoporosis, chronic obstructive pulmonary disease, hypothyroidism, constipation, incontinence and arthritis, can take their toll. Preventive measures taken now such as quitting smoking, eating healthy food and exercising are all important steps toward a better quality of life, so just do it. “Even quitting smoking at age 60 is better than not quitting at all,” Andrade says.
- Polypharmacy: A term geriatricians are using for the number of prescription and over-the-counter medications that elderly people are taking in alarming numbers is polypharmacy. “People go to five different doctors and none of the others know what is going on,” Ahmed says. In some cases, seniors who wind up in the hospital may be prescribed a different medication for an existing condition such as high blood pressure because the hospital doesn’t stock the particular one they’ve been taking in the past. The patient returns home with a new prescription from the hospital physician and continues taking the other medication as well, which can be deadly. “I’ve had patients come in who are taking 20 different medications,” Andrade says. “A lot of them also take vitamins and herbal supplements that they don’t need and that can interfere with medications.”
Sometimes a prescription filled five years ago meant for a six-week course of treatment just keeps getting refilled. There may be no need for the patient to continue the medication, but the doctor keeps refilling it at the patient’s request, Ahmed says.
The solution, they say, is to have a written record of all prescriptions, supplements and vitamins that they can bring to their appointments and have a family practitioner or geriatrician who can be the lead physician in managing their care.
- Falls: Low blood pressure (hypotension), which can be a result of poorly managed high blood pressure (hypertension) or dehydration, can lead to dizziness. That dizziness, combined with a decreased ability of the vascular system to compensate for changes in position such as standing up, is the most prevalent cause of falls, they say. “So many patients have told me that they take blood pressure medication when they feel like it’s high instead of taking it as it is prescribed,” Ahmed says. “I ask them how they know it’s high and they give vague signs such as their nose tingles or their tremor worsening.”
Taking medications for sleep can also be dangerous. “Some take Benadryl to help them sleep and as people get older, that’s not such a good thing because it causes confusion and they can fall because they’re sleepy,” Andrade says.
- Abuse and neglect: These two problems, including self-neglect, will continue to afflict the elderly, says Carmel B. Dyer, MD, professor and director of the geriatric and palliative medicine division at the UT Medical School at Houston and co-author of the book, “Elder Abuse Detection and Intervention.” Education programs, such as the Houston Geriatric Education Center at The University of Texas Health Science Center at Houston, are needed now to train physicians to recognize the signs of abuse and neglect.
- Financial exploitation: Vulnerable elderly people can easily become victims of family members or caregivers. “We see cases where grown children have moved back in with them and are depending on them financially. They use their resources, borrow the car, rely on them to baby sit, and it upsets the senior’s ability to function,” Ahmed says. “I had one patient in her early 80s whose leg had just been amputated and she was still babysitting her 11- and 12-year-old grandchildren, who were taunting her.”
- Dementia: Alzheimer’s disease is the most common form of dementia, a gradual decline in a person’s mental functioning, and is the fifth leading cause of death for Americans over 65, according to the National Center for Health Statistics. The Alzheimer’s Association reports that Alzheimer’s disease and dementia triple healthcare costs for people over 65. But education about dementia and possible treatments including medications is lacking, Ahmed and Andrade say. “There are now more medications that are helpful. They can’t cure it, but they can help,” Andrade says. “Unfortunately, a lot of people are in denial. I had a 78-year-old patient who I knew was suffering from dementia because of the way he was managing his medications and health. But his son got upset when I started talking about it and they left the room.”
- Caregiver burnout: As baby boomers age, many will also be taking care of their own aging parents. That brings caregiver burden, which can lead to a higher risk for depression and other stress-related illnesses. Ahmed says caregivers should solicit health resources, such as daycares for seniors, to help them shoulder the stress. They should take advantage of support groups and ask social workers regularly about available community resources. Special units for acute care for the elderly (ACE units), such as the one at Memorial Hermann-Texas Medical Center where UT physicians see patients, can help make hospitalizations less stressful for the patient and family.
- Death and dying: Baby boomers will have to decide how they want to live out the end of their lives and how they want to die. Cultural and religious beliefs will impact these decisions and physicians will need to be sensitive to that, Ahmed says. As patients age, the physician begins to play a larger role in a patient’s life and strong physician-patient relationships will be important in determining a patient’s wishes. People should make those wishes known to family members and caregivers and put them in writing.
See you in the doctor’s office.
Last Updated: 10-09-2009
Dr. Liliana Andrade is an assistant professor of internal medicine at the UT Medical School.
Dr. Nasiya Ahmed is an assistant professor of internal medicine in the Division of Geriatric and Palliative Medicine at the UT Medical School.
Dr. Carmel Dyer is professor and director of the geriatric and palliative medicine division at the UT Medical School.
Health Tip:
Packing Bag Lunches Safely
If you pack lunches for your child to take to school, be careful that you do not accidentally expose them to foodborne illness.
Bagged lunches, especially those containing perishable foods, need to be packed and handled properly in order to keep the food safe. In general, perishable foods should not be left at room temperature for more than two hours. If left out too long, the temperature of the food can enter the danger zone where bacteria grow most rapidly, which is between 40 and 140 degrees Fahrenheit.
Below are some tips to help families pack bagged lunches safely:
- Pack foods that are nonperishable and won't require refrigeration.
- If you do pack perishable foods such as luncheon meats or prepackaged cheese and crackers, include a frozen gel pack or a frozen juice carton with the food in an insulated lunch bag or box.
- Pack only the amount of perishable food that your child can eat at lunch.
- Preparing lunches the night before and storing them in the refrigerator until you pack your child's lunchbox in the morning can help keep food cold longer the next day.
- Don't reuse packaging materials such as paper or plastic bags, aluminum foil, etc. as they can contaminate other foods and cause foodborne illness. Have your child discard all used food packaging and paper bags after lunch.
Before eating lunch or snacks at school, make sure your child washes his or her hands with soap and warm water for at least 20 seconds. If your child's school does not have a handwashing program in place, encourage them to adopt a such a program, as handwashing is one of the best ways kids and parents can protect health and stop the spread of germs.
