Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

12 Sivan 5766 - June 8, 2006 | Mordecai Plaut, director Published Weekly










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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

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).


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