Aging Related Conditions

Health Conditions Associated With Aging

Many physical and mental health changes occur with aging. These age-related diseases and conditions are not necessarily inevitable but certainly become more common as one ages.

Hearing Loss

Age-related hearing loss, also called presbycusis, is very common. Hearing loss occurs gradually, which means you may not realize that your hearing is getting worse.

Presbycusis occurs in around one-third of people aged 65 to 74 and almost half of people aged over 75.

There are multiple reasons why hearing may get worse with age.

• Medical conditions, such as hypertension and diabetes, can cause hearing loss.
• Many medications can also affect your hearing and cause hearing loss.
• Long-term exposure to loud noises can damage the nerves that connect your ears to your brain, resulting in hearing loss.

Many forms of age-related hearing loss that cannot be prevented, but you can protect yourself from loud noises by using headphones or earbuds and avoiding loud noises when possible. You can also protect your hearing by talking with your healthcare provider about managing your other chronic medical conditions and whether any medications you may be taking could impact your hearing.

Eye Problems

Several different eye conditions can occur as you get older. Regularly seeing an eye doctor is important because many eye conditions don’t have symptoms early on. The American Optometric Association recommends getting an eye exam yearly after age 60.

Age-related Macular Degeneration

Age-related macular degeneration affects the center of your retina, an area called the macula. The macula helps with seeing fine detail and color. Age-related macular degeneration has two primary forms: a dry form and a wet form. These are defined by whether additional blood vessels form in the choroidal neovascular membranes.

Age-related macular degeneration causes central vision loss, which affects reading, driving, watching TV, and recognizing faces. It is the leading cause of irreversible vision loss in people over age 60, but it can be treated, especially if caught early.

Cataracts

Cataracts form when the proteins in the lens break down and become opaque, forming cloudy areas in the eye’s lens. Cataracts frequently occur in both eyes, but one is usually worse.

Cataracts cause blurry vision, difficulty seeing contrast, and sensitivity to glare, making it hard to drive at night.

Cataracts can be treated by replacing the lens in the eye with an artificial one.

Glaucoma

Glaucoma occurs when fluid builds up in the front of the eye. This causes damage to the optic nerve, causing peripheral vision loss. Your eye is full of fluid called aqueous humor. This fluid flows through the eye and drains out an area called the drainage angle. With glaucoma, the drainage angle doesn’t work correctly, which results in fluid building up.

In open-angle glaucoma, the drainage angle is still open but doesn’t drain as well as normal. Pressure builds up slowly and damages the optic nerve. Vision changes associated with open-angle glaucoma are more gradual and painless.

Closed-angle glaucoma occurs when the iris, the colored part of your eye, is close to the drainage angle and breaks it. The drainage angle gets blocked quickly, and the eye pressure rises very quickly. Closed-angle glaucoma frequently causes sudden blurring of vision, severe eye pain, headaches, nausea, and vomiting, or halos around lights. This is an ophthalmologic emergency and can result in blindness if not treated.

An ophthalmologist or optometrist can screen for glaucoma by checking the pressure in your eye and evaluating your optic nerve.

Age-Related Presbyopia

The lens of your eye is flexible and changes shape to allow you to focus on things that are both close and far away. As you age, the lens loses some flexibility, making it more difficult to see things up close. This can result in presbyopia or farsightedness.

Presbyopia can be treated with corrective lenses, medications, or, in some cases, surgery.

Musculoskeletal Conditions

Wear and tear can increase your risk for musculoskeletal conditions as you age. Arthritis, tendon problems, and muscle loss are all more likely to occur in people over 65.

Osteoarthritis

Osteoarthritis is one of many forms of arthritis. It is generally caused by wear and tear on the joints and is more likely to affect the hands, hips, knees, and spine.

Osteoarthritis causes symptoms in approximately 10% of men and 20% of women over 60, according to the World Health Organization Global Burden of Disease study.

Osteoarthritis occurs more commonly in:

• Women
• People who are overweight or obese
• People who have other chronic health conditions
• People who have a family history of arthritis
• People who have a previous joint injury
• People who have repeated stress on joints

Osteoarthritis causes pain, stiffness, swelling, decreased range of motion, and a feeling of joint instability. The joints may also become deformed and “bumpy.” Osteoarthritis is caused by chemical changes in the joints that lead to inflammation and a gradual breakdown of the cartilage. This may cause the bones to form osteophytes, which are bony protrusions that further narrow the joint spaces.

Sarcopenia

Muscle loss, or sarcopenia, is another common condition related to aging. Sarcopenia may start as early as age 30 but becomes more common with age It decreases mobility and increases the risk of falls, hospitalization, and loss of independence. People with chronic health conditions, especially those who may be immobilized for periods of time, are at an increased risk of sarcopenia.

You can combat sarcopenia by staying physically active to increase your muscle mass and maintaining a healthy diet, including protein, to support the building and rebuilding of muscle mass.

Bladder Concerns

Another common health concern that occurs as people get older is urinary incontinence or loss of bladder function. Incontinence can occur from overactive bladder muscles or weak pelvic floor muscles. Incontinence can also be more common due to nerve damage from other medical conditions or arthritis-related mobility problems that make it difficult to get to the bathroom in time.

Urinary tract infections become more common in women after menopause due to the decrease in estrogen. Without estrogen, the pelvic region’s mucosa can lose some moisture and be less protective against bacteria.

Cognitive and Mental Health

The relationship between aging and the brain is a complex one. As you age, there are often changes in cognition and brain health. Cognitive changes are frequently related to decreased brain volume and less efficiency in how your neuronal networks operate. Cognitive changes may start declining as early as your 20s. Processing speeds generally become slower, and you may experience being more easily distracted or a decreased ability to multi-task. Some components of memory may decline, but getting older doesn’t always mean that you’ll develop dementia or Alzheimer’s disease. There are ways that you can navigate the age-related memory problems you experience. Some of these include:

• Learning new skills
• Following regular routines
• Using memory tools such as notes, calendars, and lists
• Volunteering and staying active in your community
• Spending time with friends and family
• Working with your healthcare team to control your chronic medical conditions
• Getting regular exercise
• Maintaining a healthy diet
• Getting enough sleep (usually 7-8 hours per night)
• Avoiding or limiting your alcohol intake
• Seeking medical attention if you feel depressed or if something else changes

Depression is a common condition at any age, but it becomes increasingly common in older adults. By the age of 85, the prevalence is estimated to be around 27%. Nearly 50% of people who live in senior communities or nursing homes suffer from depression.

Depression can affect many parts of your life and is a risk factor and a predictor of poorer outcomes for other health conditions. Depression in people over 65 can be more difficult to treat as depression is less likely to respond to medications, which may have more side effects as you get older. Treating age-related depression is important because it can mimic other conditions that also increase with age, such as cognitive decline and dementia. Screening for depression is important when evaluating other medical conditions for this reason.

Normal Aging vs Dementia

As previously mentioned, some memory loss is not uncommon with aging. Determining what is normal and when to be concerned about more serious memory issues is important. The best way to determine whether your memory problems are normal or related to a more serious condition is to talk to your healthcare provider about your concerns. In addition to taking a history and examining you, your healthcare provider may offer labs to rule out other medical conditions such as diabetes, high cholesterol, urinary tract infections, etc. Your healthcare provider may also want to screen for depression as it can mimic other conditions.

There are screening tools that healthcare providers frequently use to evaluate memory when determining whether memory problems are normal aging or something more serious. Tools such as the Mini-Mental Status Exam (MMSE) or the Montreal Cognitive Assessment (MoCA) have been standardized and validated to determine the degree of cognitive impairment. These tests take the individual through a series of questions and exercises that evaluate memory, thinking, and problem-solving abilities. In some cases, the healthcare provider may determine that additional testing, such as brain imaging, is necessary.

Abnormal Aging: Mild Cognitive Impairment vs Dementia

Dementia and other memory problems occur on a continuum. Mild memory problems, which may be demonstrated by a mildly low score on the MMSE or MoCA, are frequently classified as mild cognitive impairment. Symptoms of mild cognitive impairment may include:

• Losing things
• Forgetting things such as events or appointments
• Difficulty with word finding
• Movement difficulties
• Decreased sense of smell

Mild cognitive impairment may progress over time to conditions such as dementia, which is a more severe form of memory loss.

Lower scores on cognitive screening tests may indicate dementia. Dementia is not a normal part of aging; rather, it is an age-related illness. Symptoms of dementia are generally more severe than those of normal age-related memory loss and even mild cognitive impairment:

• Getting lost in a familiar area
• Using unusual words to refer to familiar objects
• Forgetting the names of close family or friends
• Forgetting old memories
• Loss of ability to complete tasks without help

There are many forms of dementia, and all have different characteristics.

Alzheimer’s Dementia

Alzheimer’s dementia is the most common type of dementia. This type of dementia can be genetic, with more than 80 associated gene regions. There are some tests to help guide the diagnosis of Alzheimer’s disease, including blood tests to measure beta-amyloid levels, which may indicate Alzheimer’s as a source of dementia but doesn’t make the diagnosis by itself. There is no way to prevent Alzheimer’s disease, but there are some things you can do to reduce your risk. Maintaining a healthy lifestyle and controlling chronic health conditions may be beneficial. Several medications are used to treat Alzheimer’s, but they are targeted at slowing the progression of the disease and not as a cure.

Vascular Dementia

Vascular dementia is caused by decreased blood flow to the brain that disrupts the oxygen supply. It is more common in people who have had strokes or who have other medical conditions such as heart disease or diabetes. The best way to prevent vascular dementia is to control the conditions that increase your vascular risk, such as controlling hypertension or diabetes. Treatments for vascular dementia are also targeted at controlling the underlying health conditions.

Lewy Body Dementia

Lewy body dementia is caused by the abnormal deposit of the alpha-synuclein protein in the brain. These deposits are called Lewy bodies and cause chemical changes in the brain, which leads to memory, behavior, and movement problems.

There is no known way to prevent Lewy body dementia, but like other forms of dementia, maintaining a healthy lifestyle and controlling chronic conditions may decrease your risk of developing the condition. The medications used to treat the symptoms of Lewy body dementia are similar to those of Alzheimer’s disease, focusing on slowing the progression of the disease as opposed to curing it.

Frontotemporal Dementia

Frontotemporal dementia results from damage to the neurons in the frontal and temporal parts of the brain. This type of dementia is rare and usually occurs in younger people (60% of people are 45-64).

Frontotemporal dementia causes emotional problems, unusual behaviors, trouble communicating, and difficulty walking and working. There is no known prevention or cure for frontotemporal dementia. Moderate exercise may help decrease the risk of developing this condition. Unfortunately, there is currently no way to slow down this form of dementia, but working with a multidisciplinary healthcare team may help control some of the symptoms.

Mixed Dementia

Mixed dementia is made up of one or more of the other types of dementia, such as Alzheimer’s and vascular dementia. This may cause faster progression or an overlap of symptoms. Mixed dementia may be more difficult to diagnose.

Risk Factors for Cognitive Decline

Many conditions can affect cognitive decline. Some of these risk factors are controllable, while others are not.

Some of the modifiable risk factors associated with cognitive decline and dementia include:

• Hypertension
• Obesity
• Hearing loss
• Depression
• Diabetes
• Inactivity
• Smoking
• Social isolation
• Alcohol consumption
• Traumatic brain injuries
• Air pollution
• Low educational level
• High cholesterol
• Medication
• Sleep apnea

There are also risk factors for cognitive decline and dementia over which you have no control. This includes:

• Age
• Family history of dementia
• Stroke
• Chronic kidney disease
• Atrial fibrillation
• Hearing loss

Your healthcare provider can help you understand and evaluate your personal risk factors for cognitive decline.

Symptoms To Watch For

It may be easy to dismiss memory problems because some memory problems are normal with aging, but the earlier that dementia can be diagnosed and treated, the better chance that medication can slow the progression of the disease. Some of the early symptoms of dementia include:

• Memory loss
• Trouble concentrating
• Difficulty carrying out daily tasks
• Difficulty following a conversation or having word-finding problems
• Confusion about time and place
• Changes in mood
• Forgetting names and recent events
• Repeating questions
• Increased difficulty with task planning and organization
• Increased anxiety or withdrawal
• Movement problems
• Repeated falls
• Hallucinations
• Fluctuating levels of confusion or alertness
• Sleep disturbances
• Personality changes

If these symptoms are present, it is important to seek care from a healthcare provider as soon as possible to get evaluated.

Factors Influencing Healthy Aging

Many factors can influence healthy aging. Like the risk factors for most conditions, some are within your control, and some are not.

There are numerous benefits to exercise, and partaking in physical activity is one of the most important things you can do for your health. Exercise can modulate many of the risk factors associated with age-related illness. It improves bone health, strengthens your muscles, improves your immune system, helps prevent obesity, and helps control other diseases such as heart disease and diabetes. Multiple studies show that exercise is beneficial for healthy aging.

Healthy eating is also beneficial for mental health and healthy aging. Like exercise, a healthy diet can offer multiple benefits to your overall body and health. A healthy diet focuses on fresh fruits and vegetables, whole grains, healthy fats, and lean proteins.

Social isolation is a risk factor for multiple health problems, including depression and dementia. A social support network can help with your overall health. Quality sleep is another factor that can help with healthy aging. Studies have shown that less than six hours of sleep each night can increase your risk of developing dementia, possibly due to a buildup of beta-amyloid, one of the proteins associated with Alzheimer’s disease.

Maintaining Your Brain

The Centers for Disease Control recommends seven steps to help maintain your brain health:

• Stop smoking. Smoking increases your risk for multiple conditions, including heart disease, cancer, lung disease, stroke, and other smoking-related illnesses.
• Control your blood pressure. High blood pressure increases your risk of several conditions that negatively affect your brain. If you have high blood pressure, talk to your healthcare provider about ways to control your blood pressure.
• Stay physically active. Exercise can improve your cognition, decrease the risk of depression and anxiety, improve your sleep, and help control other health conditions.
• Maintain a healthy weight. Like exercise, maintaining a healthy weight improves multiple aspects of your health.
• Get good sleep. Treating conditions like sleep apnea and getting the recommended amount of sleep are important for overall brain health.
• Maintain a good social support. Stay engaged in your community and maintain a support network with your family and friends.
• Manage your blood sugars, especially if you have conditions such as diabetes.

Many of the same factors that help you protect your overall health at any age can protect your brain and help you age gracefully.

Challenges in Responding to Population Aging

There are many challenges on a community and national level when it comes to responding to the aging population. As the baby boomer generation ages, the retirement age population grows. The U.S. Census Bureau estimates that by 2030, 20% of the population will be of retirement age.

There are many concerns regarding caring for the aging population. One of the concerns is that there is a growing shortage of healthcare providers nationwide. An aging population means increased strain on the already taxed healthcare system. The aging population is also increasingly complex in terms of their healthcare needs.

Another concern about the aging population is the increased economic burden, which is related to a decline in the percentage of the population that is working-age as well as the increased healthcare costs related to caring for an aging population.

Healthy Aging

While many age-related conditions can impact your quality of life as you age, there are steps you can take to try to decrease the impact. Taking control of modifiable risk factors and engaging with your family, friends, and community can help you remain happy and healthy as you age.