As we get older, we get wiser, but, health-wise, we also get more complex. Over the years, life accentuates our differences. Look at 100 20-year-olds and most are similar in health. But 100 70-year-olds will have many differences. Your genes, the environment where you live, your economic situation, your education, your behavior—particularly exercise, nutrition, smoking, alcohol, and drugs—all of these factors affect your health and the likelihood of developing diseases in your 70s and beyond.
Here are some of the most common health problems people experience in their eighth decade of life—and some suggestions on how to avoid or reduce their effects.
Hypertension or high blood pressure is known as the “silent killer” because there are few or no symptoms. Having high blood pressure damages arterial walls and increases the risk of serious health problems such as heart attack, stroke, and peripheral artery disease. If you are a man or woman in your 70s, you have a 60% chance of having or developing high blood pressure.
The Remedy Rx: Ask your doctor for a blood pressure reading at least every two years. But, it’s important to know that what constitutes “good blood pressure” for people in their 70s remains a bit controversial. A recent study shows that, down to 120, lower is better, but other studies suggest a blood pressure in the 120s may raise risk for kidney problems, passing out, and falling. So, the take-home message is: we’re not quite sure what’s the best blood pressure for 70-year-olds, but have your doctor monitor yours to watch for changes over time.
Best bets for a healthy blood pressure: start by decreasing your salt intake, increasing physical activity, and eating a healthy diet, especially fruits and vegetables. Then if that doesn’t work, your doctor will likely recommend blood pressure medicines.
You may not know if you have hypercholesterolemia or hyperlipidemia—high levels of fat in the blood—until a blood test reveals it. It’s almost completely asymptomatic. Most often hyperlipidemia—the better term because it’s about more than just cholesterol—is the luck of the genetic draw. But cheeseburgers, milkshakes, and other foods that contain high levels of fats certainly don’t help and can make it worse. If untreated, high cholesterol can lead to heart attacks and strokes.
The Remedy Rx: High cholesterol (hyperlipidemia) can be managed through diet, exercise, and medication. Get more physically active doing the things you like to do—play tennis, walk, hike, or swim. Exercise at least 30 minutes a day—sweating a bit suggests you’re doing enough—four days a week. And follow a healthy diet, eating foods low in total fat and saturated fat. The good news is that some fats—mono- and polyunsaturated—found in avocados, dark chocolate, and nuts—are good for you. But limit fast food, junk food, and processed meats. These steps will help you maintain a healthy body weight, which is really important for your cholesterol and overall health.
It’s not life threatening, but arthritis can make you pretty miserable, affecting your quality of life, including how much pain you have and how much activity you can take part in. Arthritis grows more common with age. There are many different types of arthritis. Wear and tear, associated with aging, is the cause of osteoarthritis, the most common form, when cartilage inside your joints starts to break down, causing changes in the bone that worsen over time. Another type, rheumatoid arthritis, is linked with inflammation, when the immune system attacks the body’s joints.
The Remedy Rx: If you’re experiencing pain, swelling, stiffness and tenderness in your joints, the first thing you want to do is talk to your doctor. Depending on the type of arthritis you have, you may ache in the morning or throughout the day. Moving is one of the best treatments there is. In addition, strength exercises help because strong muscles protect the joints. There are a variety of pain medications, both in pill form and topical creams, that help joint pain. Ask your doctor what combination is right for you, they all have some adverse effects. If a clinician suggests that it’s time for joint replacement due to arthritis pain, it’s smart to get at least one second opinion. Total joint replacement is the most common elective surgery in the United States, and the number of these surgeries is on the rise. Some believe the operation is being performed too often these days. Joint replacements shouldn’t be done too soon or too late!
Over time, the clear lenses in your eyes can become cloudy and impair your vision. While several vision conditions affect older adults, including macular degeneration and glaucoma, the one that is most common is cataracts. Not only are cataracts unsightly, but they can get in the way of living your best life, making it hard to see clearly, especially at night.
The Remedy Rx: The good news is that cataracts are one of the most treatable vision problems for older people. Getting your cataracts extracted can be a game-changer; the surgery allows many to resume night driving because it decreases glare from headlights of oncoming cars. People who’ve had cataract surgery are also less likely to take a fall. While not everybody gets cataracts, the vast majority of older people do. They are more common in people who’re out in the sun a lot, have diabetes, or take steroids for any reason.. But, at some point in our lives, most of us will eventually need to have cataracts removed. One fringe benefit: If you’ve worn glasses most of your life, your distance vision may improve from having cataracts removed. I’m almost looking forward to it because I have been wearing glasses for distance since I was in kindergarten!
Uncontrolled Blood Sugar
A new worrisome trend is an increase in the number of people in their 70s getting diagnosed for the first time with diabetes. It’s not clear whether risk factors for diabetes in the 70s are the same as for those diagnosed at younger ages. Also, doctors are finding that tight control of your blood sugar (hemoglobin A1c) in older adults sometimes leads to excessively low blood glucose levels which is almost as bad as too high.
On the one hand, it’s important to keep your blood glucose, and what’s called your hemoglobin A1c, under control to decrease the likelihood of negative health effects to your vision, kidneys, or nerves (a condition known as neuropathy—when you can’t feel your feet or you get pain in your feet, and with uncontrolled diabetes, it can even lead to an amputation). But you also want to avoid the complications of too low blood sugar, which can cause fainting, breaking a bone, or brain damage.
The Remedy Rx: To reduce the odds of developing diabetes in your 70s, maintain a healthy diet and get plenty of physical activity, both of which help keep your weight in the healthy range. Obesity, after all, is associated with the development of diabetes. And, if you do get a diabetes diagnosis in your 70s, make sure your treatment is neither to little or too much—a bit like Goldilocks.
The frequency of hearing loss goes up among people in their 70s, and many underestimate how devastating this can be. Studies show that hearing impairment itself is a risk factor for dementia, depression, and other conditions. My guess is the generation that is growing up wearing earbuds in their ears all the time will experience an even bigger problem with hearing loss in the years ahead.
The key is to really recognize how important hearing is to quality of life. It is a major determinant of social isolation. I hear from my patients all the time: “Well, I really don’t want to go there because I can’t hear anything. I don’t want to go to the theater. I don’t want to go to this dinner party.”
The Remedy Rx: Number one, make sure you don’t have wax in your ears. The second thing is to get a hearing test. If hearing aids are recommended, recognize that the quality of hearing aids are markedly improving; these are not your grandmother’s hearing aid. I recommend getting the best quality hearing aid you can afford. Keep in mind that you have to get tested and may need repeat visits to get them adjusted to make sure they’re working correctly.
People who can’t afford hearing aids may find that listening devices can be helpful too, and they are far less expensive. Some, particularly helpful in situations like a one-on-one conversation in a relatively quiet place, can be purchased for around $50.
As we age, we lose bone density, and a condition called osteoporosis, weakening of the bones, can occur. It puts you (especially women) at risk for fractures. While post-menopause is one of the biggest risk factors for osteoporosis, bone loss can affect anyone. Whereas in your 20s you make new bone every few years, by the time you reach your 70s, you don’t make much new bone at all.
The Remedy Rx: To prevent fractures, moving is the best thing you can do. To benefit your bones, movement against resistance, like on a sidewalk is most helpful —so walking in the water or swimming won’t do it. In addition to activity, give your bones a good amount of calcium. If you don’t consume dairy, take calcium supplements and vitamin D supplements since vitamin D is also important to bone health. Although we can still absorb some from the sun as we age, it gets harder to absorb vitamin D from sun exposure.
Also, if you’re put on bisphosphonates, a class of drugs that people take to prevent bone loss, keep in mind that they should only be taken for five to seven years, after which you should take a holiday. If you take them too long, they can cause problems with bone. So ask your doctor: “How long have I been on this, and should I continue to take it?”
I see a lot of people worried they may be getting dementia, so it’s important to know that some symptoms occur in what we call “usual aging.” In usual aging it takes longer to learn new tasks, like computer skills. It also takes a little bit longer to retrieve information that you eventually remember. (This is the “tip of the tongue” phenomenon. For example, names are harder to recall. You know that person, and you know where you know him from, and you can probably remember what color of dress they wore five years ago, but you can’t remember their name. Or, you walk into a room and can’t remember what you came in to do.)
Those are all normal memory issues that come with aging and do not necessarily mean you’re any more likely to get dementia than anyone else. However, dementia may be the problem if memory loss starts interfering with your function: you don’t remember to pay bills, forget important appointments, or get lost when you drive to places where you’ve been many times.
The Remedy Rx: There are a lot of apps that promise to boost memory; we don’t know if they help. But the best recommendation I can give is to remain physically, socially and intellectually active, doing the things you like to do. Read if you like to read. If you like to do crosswords, do crosswords. It’s not clear that any one thing is better than another. Being socially involved—volunteering, going out with friends or whatever you like—helps. Sleep is important for cognition, so being mentally and physically active during the day will help tire you out.
As we get older, despite how much time you spend in bed, the amount of time that you are asleep—and stay asleep—goes down. What’s called sleep efficiency—the percentage of time that you’re in bed and sleeping—decreases with age. That’s a normal (albeit frustrating) part of aging. But changes in your normal sleep in your 70s really are not a problem unless you are fatigued during the day. That’s one clue that there may be a problem to see a sleep specialist about.
The Remedy Rx: Whatever you do, stay away from over-the-counter sleep medications. They all have bad effects and not many good ones. The only reason they’re available without a prescription is because they were on the market before the FDA started evaluating drugs. Except for melatonin, all of them contain a chemical that directly works against the major chemical in the brain for memory. Anything that says PM is in the same medication class as Benadryl, an antihistamine which is anticholinergic. The cholinergic nervous system is part of what maintains memory.
If you’re having trouble sleeping, my number one piece of advice is to have a regular sleep schedule. And if you are in bed and you’re not asleep within a half an hour, you should get up. Try again in a while when you are feeling drowsy.
Most cancers increase with age: prostate, colon, lung, and breast cancer all become more prevalent as we get older. However, there is evidence that the rates of cancer deaths overall is declining and has been for the 26th year in a row.
The Remedy Rx: While screening won’t prevent cancer, catching it early gives the best chance for successful treatment. Talk to your doctor about what screening tests are recommended for you, depending on your family history, medical history, age, gender, and other risk factors such as smoking history. Regular mammograms and colonoscopies are effective screening tools to detect cellular changes early before they become cancer or can spread. But, depending on the screening guidelines your healthcare system follows, it may be recommended to stop breast and colon screenings after age 75. This is because the benefits go down (the test won’t help you live longer) and harms (the adverse effects of the tests or subsequent treatments) go up.
Chronic Lung Disease
Chronic lung disease is increasing, and we’re seeing it more in women. According to the U.S. Office of Health & Human Services, the number of women diagnosed with lung disease in the U.S. is on the rise, as is the number of women dying from lung disease.
By far the major risk factor for chronic lung disease is smoking. And there’s pretty good evidence that no matter how old you are—and this is certainly true in your 70s, where you have another possible 20 years of life—it’s worth quitting.
The Remedy Rx: If you are having trouble with coughing or wheezing or shortness of breath with normal activities it’s important to ask your doctor about a screening test for lung disease. There are a number of treatments that can help you breathe easier. (Did I mention it’s almost never too late to stop smoking?)
About one out of three older people will fall doing normal activities. Falling can cause a considerable amount of stress, discomfort and even disability. Fall injuries, such as hip fractures or head injuries, are as common and devastating as strokes.
The Remedy Rx: The things that we know most contribute to preventable falls include muscle weakness and poor balance—both of which can be improved by being physically active and exercising, as well as with physical therapy. Medications are a major contributing factor to falls, particularly drugs that work on the brain or circulation. Blood pressure medicine, depression medicine, sleep medicine, and pain medication are among the biggest categories of medications to think about with fall prevention. You want to be on the lowest dose and take as few medications as necessary. Some studies suggest that Vitamin D may decrease the risk of falling and it definitely decreases the likelihood of a fracture if a fall does occur.
We shouldn’t think about depression any differently than we do cancer or heart disease or blood pressure. It’s a disease that’s caused by an imbalance of chemicals in your brain. We can adjust the balance among those chemicals with medication and talk therapy. If you’re feeling down and hopeless and aren’t enjoying activities you once did, talk to your doctor about screening tests that are easily done in office setting to detect depression.
Because depression can be both undertreated and overtreated, it’s important to make sure that there is a diagnosis of depression and a monitoring of response to the treatment and how long you should be on it. After a year or so, you and your doctor should evaluate whether to continue on the medication or come off of it.
The Remedy Rx: One of the best preventive therapies for depression is physical activity. If only you could bottle the benefits of movement—I don’t call it exercise, I call it physical activity because it’s incorporating it into your daily life as opposed to, “I’m going to sit on the couch for 20 hours a day and then I’m going to exercise for half an hour.” It’s really important to move as much as you can and get outdoors in the fresh air and sunshine. Those kinds of things can really help people’s mood.
Mary Tinetti, MD, is a Yale Medicine geriatrician and section chief of Geriatrics.
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