W2B-026 Growing old-0.txt
GROWING OLD

The fact that most people can now look forward to a long and healthy life is one of the great achievements of modern man. During this century, there have been dramatic increases in the average life expectancy. Throughout history, of course, there has been a small group of 'biologically elite' who lived into old age, some even surviving into advanced old age. However, even in comparatively recent years, the change has been dramatic. The number of centenarians in the UK has increased from around 250 in 1950 to about 4000 today.
Two Irish women famed for their long lives were the sixteenth-century Countess of Desmond and the Honourable Katherine Plunket who died earlier this century. The Countess of Desmond, who lived in the castle of Inchiquin near Youghal in Co. Cork, is said to have lived to be 140. According to one of her contemporaries: She might have lived longer had she not mette with a kind of violent death, where she must need climb a nutt tree to gather nutts, soe falling down she hurt her thighe, which brought a fever, and that brought death.
The Honourable Katherine Plunket of Ballymascanlan House, Co. Louth, was born in 1820. She was an enthusiastic gardener, and in September 1931, when in her 111th year, she won a prize at the Dundalk show for her fruit and vegetable exhibit. She died a year later when she was almost 112 years old.

AVERAGE LIFE EXPECTANCY

Although there are now over 400,000 people aged over sixty-five in the Republic of Ireland, forming more than 11 per cent of the total population, Ireland still has the lowest life expectancy in the EC. The sixty-year-old European female can expect to live another 22.1 years on average, compared with only twenty years for the Irish female. The mean for the sixty-year-old European man is nearly eighteen years, while it is only sixteen years for the Irish male. From these figures, it is clear that, on average, women live four years longer than men, and that people in Ireland die, on average, two years earlier than the average European.

The main causes of death in Ireland are heart disease, cancer, lung disease and stroke. The fact that there is now more emphasis on a healthier lifestyle, as well as an increased awareness of good health care in later years, should improve the life expectancy of the average Irish person. A seventy-five-year-old woman can now expect to live for another ten years, a fact that emphasises the importance of good health care in old age. Ten years is a long time a person's life, so everything possible should be done to ensure that the years are of high quality. While this is desirable for humanitarian reasons, it also makes good economic sense in this increasingly mercenary age.

A UNIQUE POPULATION PROFILE

People are living longer now because of improved environmental factors. Better housing, clean water, improved sewerage systems, healthier diets Ð all of these have played a part. In the past, old age was the privilege of the few. Now, it is regarded as the birthright of all. We need a fundamental rethink on the whole subject of growing old. We must accept that most people expect to live long lives. It should therefore be our aim to make the quality of a person's last twenty years as good as the previous years.

SOME MISCONCEPTIONS

It is a common error to view the elderly as a single homogeneous group. Yet they are as different as any other age group in society. There are the usual distinctions associated with current or previous employment, social status and education. Although problems with health certainly are more common for those over seventy-five, even in advanced old age, the majority of people still live at home.

There is a general assumption that health and physical ability decline remorselessly with advancing years. This is simply not the case. One study carried out by Duke University in the US followed a group of elderly people over several years. They found that half of those who returned regularly for assessment suffered no decline in physical ability during periods ranging from three to thirteen years.

Sexuality in older years has been a taboo subject for many years, yet research has shown that many older people still enjoy enriching and fulfilling sexual relationships. Couples who share an active sexual relationship in their younger years usually continue this relationship as they grow older.

Ageing is part of the natural cycle that begins at conception and ends with death. It is therefore important to distinguish between chronological age and biological age. Two people aged seventy might have been born on the same day, but they may have aged at different rates, making one biologically much younger than the other. Even in the same person, organs can age at different rates. For example, the heart of one seventy-year-old person may compare favourably with that of a sixty-year-old, even though other parts of the body such as the skin may be more like that of the typical seventy-year-old.

Changes associated with ageing should not be confused with those caused by disease. Changes associated with ageing do not cause significant disability on their own. Complaints should never be dismissed with glib comments such as, 'What can you expect at your age?' If such a question is posed, the appropriate answer should be, 'Good health care!' People should be aware of the importance of distinguishing between the changes associated with normal ageing and those associated with illness. The treatment of illness in old age, as at any age, can bring about remarkable improvements in a person's quality of life.

OLD AGE AND MODERN MEDICINE

Despite the fact that older people can live healthy and active lives, there is still an unacceptably high level of illness associated with age. Conditions such as Parkinson's disease, Alzheimer's disease, arthritis and stroke all impair the quality of life for a small but significant percentage of older people. This fact presents modern medicine with one of its greatest challenges. At the beginning of this century, serious illness and disability were common in childhood and accepted as part of life. The concentrated efforts of pioneering paediatricians and medical scientists changed this situation so that serious illness in childhood is now unusual. The illnesses of old age are now being tackled by an increasing number of physicians and medical research institutes who specialise in the medical problems of the elderly. Consequently, many more people will be able to grow old without major disabilities.

Experts who make gloomy predictions about ageing often assume that, over the next twenty years, people will age in the same way that people did in the last twenty years. This is a fundamental error. People who are growing older today are far healthier than older people of a similar age twenty or thirty years ago.

AGEING SKIN

Contrary to popular opinion, ageing itself does not produce many changes in the skin. Thin skin, pigment changes and wrinkles are mainly caused by exposure to the sun. Ultra violet light is also responsible for the hard or keratotic patches seen on the faces of some older people. It also causes skin cancers, including malignant melanoma. Some older people can develop very thin skin, especially on the backs of the hands and the forearms. This is harmless and is the result of poor elasticity in the skin tissues. These changes can also lead to easy bruising which is slow to resolve. Itchiness can be due to excessively dry skin, although there can be other causes. If it persists, a doctor should be consulted.

VISION

Eyesight should be checked regularly as it can be affected by a variety of ageing and disease processes. A rapid build-up of fluid pressure within the eye can cause severe pain, blurred vision and vomiting. This condition needs urgent treatment.

More commonly, pressure can build up gradually and lead to an insidious loss of eyesight. People are often unaware that this condition, known as glaucoma, can have a silent and painless onset. A considerable amount of vision can be lost before it is detected.

There are several causes of sudden visual disturbance in older people. An acute change is always a medical emergency. It should be reported to a doctor immediately, as urgent action is often required if the vision is to be saved.

Most people have heard of cataract formation which is caused by an opacification of the lens. However, it is still surprising that many people allow their vision to go almost completely before they seek help. Modern technology has revolutionised the treatment of cataracts.

Some older men and women develop a condition known as macular degeneration which damages the retina and leads to marked visual problems. High magnification lenses can be helpful in dealing with this problem.

HEARING PROBLEMS

It has been estimated that over half of older people develop hearing problems. There is an age-related decline in the ability to hear higher frequencies, and this makes it particularly difficult to hear consonants. As consonants convey much of the sense of speech, high frequency loss can greatly impair in individual's ability to follow a conversation.

Age changes in hearing begin in middle age. They often become apparent when a person experiences an increasing difficulty in following conversations, especially when there is any background noise. Those who have significant high frequency hearing loss can be helped with a hearing aid. Modern aids are quite sophisticated in design and function. They amplify certain frequencies and have noise-suppression units that make it easier to follow speech in a noisy environment.

Impacted wax is a common and treatable cause of hearing loss. The amount of moisture within the ear canal declines with age so that wax secreted by the skin glands tends to become dry and hard. Removal of this wax can 'cure' the resulting deafness.

Whatever the cause of a hearing loss, it is important that it should be investigated and treated early. If deafness is ignored, the person who is affected can become socially isolated and depressed.

MUSCLE AND BONE

The density of bone tends to decline in both sexes from the fourth decade. Excessive thinning of the bone structure, known as osteoporosis, can lead to fractures of the limb bones or of the small vertebral bones of the spine. Loss of bone density can affect women, particularly after the menopause. This may be stopped by the use of hormone replacement therapy (HRT).

Among the other causes of osteoporosis are lack of exercise and an inadequate diet. An adequate intake of calcium and vitamin D is essential for healthy bones. Vitamin D is found in fish oils and margarine and, to a lesser extent, in eggs. Milk fortified with vitamin D is now available commercially. The body can also make its own vitamin D if the skin is exposed to sunlight. If vitamin D is lacking, normal strong bone is replaced by poor-quality soft bone, a condition known as osteomalacia. Apart from bone changes, osteomalacia can also lead to muscle weakness. The condition causes bone pain, weakness, difficulty in walking and recurrent fractures.

There are some age-related changes in the joints. However, the decline in joint function most commonly found in later life is due to osteoarthritis. In this condition, the cartilage is damaged and the joints become painful and swollen.
There are several methods of treating osteoarthritis, including physiotherapy and medication. Joint replacement can also revolutionise the quality of life for many with this severe disease. (There is further information in the chapter, 'Arthritis and Rheumatism'.)
BLOOD PRESSURE

Blood pressure tends to rise with age, and doctors accept higher levels as 'normal' for older people. The decision about whether to treat high blood pressure in old age is based on factors such as the level of the pressure, and evidence of damage to organs such as the heart and brain, and whether the person will be able to tolerate the treatment involved. Blood pressure should be checked periodically as part of a routine medical assessment, as significant and untreated high blood pressure can lead to conditions such as stroke.
