Alan Frischer, MD, MPH
Life expectancy in this country has increased dramatically. A boy born in 1900 lived, on average, into his mid to late 40’s. Current average male life expectancy is now about 76. Although much of this gain can be attributed to a significant decrease in childhood mortality, life expectancy at every age beyond 40 has also noticeably increased. A 65-year-old man can now expect to live to about 83, and a 65-year-old woman to about 86. Interestingly, for those over 100 years old, longevity records have not varied much.
We each age at different rates. The reasoning behind 65 being a traditional retirement age is based in history and politics, not biology. Germany was the first to establish a retirement program, and set it at age 65. In 1965, that was the age chosen to be eligible for Medicare in the United States. However, age can be defined in several ways:
Chronologic age is based solely on the passage of time. It is simply one’s age in years, and has limited significance in terms of health.
Biologic age refers to changes in the body that commonly occur as we age. We all know some people who are biologically old by 65, while others are not until much later. Those disparities are related to differences in lifestyle (including access to quality health care), habits, genetics, environmental exposures, and the effects of chronic disease.
Psychologic age is based on how we act and feel. An 80-year-old who works, plans, and participates in many activities is considered psychologically younger.
What changes naturally accompany aging?
Hair loses its pigment. Dark hair becomes grey, and blonder hair turns white.
The cardiovascular system is impacted. Blood vessels stiffen, causing our heart to work harder, and the heart muscles must adjust to the increased workload. The resting heart rate stays about the same, but doesn’t increase during activities as much. All of this increases our risk of high blood pressure (which affects more than half of those over 60) as well as other heart issues.
The bones, joints and muscles are affected. Bones tend to shrink in size and density, becoming weaker and more susceptible to fracture. Most of us become shorter. We lose muscle tissue and the muscles become more rigid and less toned, losing strength, endurance and flexibility. These changes affect stability and balance, making falls more likely.
The digestive system changes. Structural changes in the large intestine may result in constipation, and this is made worse by lack of exercise, not drinking enough fluids, and a low fiber diet. Many medications (including diuretics, calcium and iron supplements) and certain medical conditions (such as diabetes) can also make constipation worse.
The bladder and urinary tract are affected. The bladder becomes less elastic, so we need to urinate more frequently. The weakening of bladder muscles and pelvic floor muscles may make it difficult to empty the bladder completely, or may lead to loss of control and incontinence. For men, this is exacerbated if there is an enlarged prostate. Other factors that contribute to incontinence include being overweight, nerve damage from diabetes or spinal issues, certain medications (like diuretics), and caffeine and alcohol consumption.
Memory and thinking skills diminish. The brain changes and we may forget familiar names or words, or have difficulty accomplishing tasks. Generally, information processing slows, and it becomes more difficult to multitask. Alzheimer’s dementia is not merely age-related forgetfulness. It is mental decline, with difficulty thinking and understanding, confusion in the evening hours, delusion, disorientation, and forgetfulness. About one in eight of those between 65-74 suffer from Alzheimer’s, as do 43% of those over 85.
The eyes and ears are affected. By around age 40, almost everyone tends to reach for reading glasses. This condition, presbyopia, occurs when the lens becomes stiff and doesn’t properly refocus from distance to near vision. Cataracts, or clouding of the lens, may occur after about 60. Long-term exposure to sunlight increases the risk. Cataracts can usually be corrected through surgery. Hearing will likely diminish. About a third of those over 60 have some hearing loss. This is often due to the loss of sensory receptors in the inner ear, which causes some sounds to seem muffled, and higher-pitched voices to be harder to understand. Men tend to experience greater hearing loss.
The teeth and gums change. The gums might pull back. Certain medications (such as some for allergy and asthma, high blood pressure and high cholesterol, and dry mouth) can contribute. The teeth become more susceptible to decay and infection.
The skin thins, becomes less elastic, and more fragile. The layer of fatty tissue just underneath decreases. We may notice more bruising and easier skin tears, as well as wrinkles, age spots, and small growths (skin tags). The production of natural oils decreases, which makes the skin drier.
And, weight? Our metabolism, which controls how the body burns calories, slows down. If activities decrease, but we continue to eat the same diet, we will gain weight. To maintain a healthy weight, stay active, eat good foods, and watch those calories.
What happens to sexuality? Desire and performance might change. Illness or medication can certainly have an impact. For women, vaginal dryness can make sex uncomfortable. For men, changes in erections and even impotence might become an issue.
We can't stop the aging process, but we can make choices that improve our ability to maintain an active life, to do the things we enjoy, and to spend time with loved ones. I see this every day in my practice: How we choose to live our lives truly makes a difference. It is never too late to incorporate more of these practices:
Include physical activity in your daily routine.
Eat a healthful diet.
Maintain a healthful weight.
If you smoke, please quit. Avoid other recreational drugs, and limit alcohol consumption.
Find an avenue to manage stress.
Get sufficient sleep.
For bone health, get adequate calcium and vitamin D.
Remain mentally active.
Have regular physical exams, and treat active diseases.
Practice simple prevention: Wear sunscreen, sunglasses, and a hat. Brush and floss regularly. Use ear plugs when exposed to loud noises.
Finally, consider this: Build a community. Fill it with family, friends, hobbies, service, etc. As we age, others will be there to share the good times, and will support us in difficult times, as well.