Director, Emergency Services, Bikur Cholim Hospital
In this installment, we will go through the process of aging,
and why elderly people develop the conditions that they
do.
In people, there are special cells called melanocytes that
create color. They cause tanning, freckles, skin color
(obviously black people have a higher concentration of these
cells), eye color and hair color. As one ages, these cells
begin to atrophy, and the result is hair that gradually turns
white.
Many men lose their hair. Hair thinning is related to the
hormones that males have. Usually it spares the side of the
head. They say it is genetic. I am not sure how it works as
my father was bald and my mother's father had receding
temples — yet I have not lost any hair.
Women who lose hair need to be investigated; although, as
women age, hair thinning can happen. Women have the female
hormone called estrogen. This protects them from facial hair,
but as the levels fall in aging, hair can grow on the chin
and under the nose.
Skin is moister in youth. As age comes on, the skin becomes
less fixed to the subcutaneous tissues, again, due to
atrophy. As a result there are wrinkles, and a tendency to
suffer from onion skin tears of the skin which are too
superficial to sew back together.
Atrophy affects the muscles as well. They begin to sag and
our builds become less tight. Men develop "bellies" due to
inactivity and looser muscles. Drooping muscles cause jowls
on the side of the face. Muscles do not hold up the uterus
well and the muscles that hold the stomach weaken as well. As
a result the uterus could fall and impede urination causing
frequent urinary tract infections. The wall — called
the diaphragm — holding the stomach in the abdomen can
tear, and a "hiatal hernia" results, causing sever acid pain
in the chest.
The sphincter which keeps food in the stomach also weakens.
It too is a muscle and the result is food coming back up or
acid reflux. The sphincter of the urinary tract weakens, so
incontinence can happen. Incontinence of stool does happen,
although it is less than urinary incontinence. It isn't
because that sphincter doesn't weaken, but rather that the
transit time of stool slows down. This is also a muscle
function. As it slows down, there is more fluid taken out of
stool and constipation results.
With hormone levels going down, especially in women, bones
become softer and more prone to breaks. Hips break easier.
The fluid in joints that lubricates them dries up and pain
and arthritis occurs.
Arteries become less elastic and fill with cholesterol. This
makes for less blood to all parts of the body. The result is
that sometimes there can be leg cramps due to arteries being
clogged and narrowed or even lack of blood supply. Heart
arteries are affected, making more heart attacks and chest
pains. Clogged brain arteries may lead to strokes and
dementia.
This explains a lot, but there are some surprises. In the
elderly , the prostate enlarges, and doesn't shrink like all
the other organs we mentioned. This can lead to obstruction
of urination. Long term memory is preserved. While dementia
may affect short term memory, long term memory is preserved
for a lot longer. What this means is that Zaide may remember
learning in Europe but forget what day it is today.
Depression is not a disease of the young. It affects lots of
seniors and suicides are not uncommon. Another problem is the
medications that help in a lot of these problems may have
side effects that may make other problems worse.
This is just an explanation. Sometimes little can be done to
stem the aging process, but here are some ideas on how to
help your elder. First and foremost — dignity. Many
very bright and useful elders have catheters and need
diapers. They are often treated poorly by hospital and
nursing home staff. These people were once young and active
and need to be respected for what they have accomplished. If
they shake or need help walking or getting in a car —
help, but do not make them feel helpless. Never, never, ever
belittle a person fighting dementia. They need love. It is
hard to deal with the smells of nursing homes and sick
people, but they need affection as well. They need to be in a
familiar environment which is protected from falls. Often
they have walkers or canes, and a fall can be devastating.
They need to be kept active. My 16 year old son learned with
my 81 year old father. This activity keeps a person sharp.
Exercise is important. If they need physiotherapy, perhaps
you could participate. Pills can be confusing and a younger
person can help organize this. If they have special medical
devices like a feeding tube, learn how they work and how to
do minimal maintenance.
In conclusion, I am not asking you to go out and volunteer to
work with aged, but perhaps, if you can, hold a hand of one
whose experiences in life have made them an extra special
person. And believe me, every elderly person is just that
— special. I love you Mom (age 79) and Dad (age 81).
