tag:theconversation.com,2011:/id/topics/geriatric-medicine-34951/articlesgeriatric medicine – The Conversation2017-01-25T19:53:59Ztag:theconversation.com,2011:article/691502017-01-25T19:53:59Z2017-01-25T19:53:59ZHeart disease: what happens when the ticker wears and tears<figure><img src="https://images.theconversation.com/files/148579/original/image-20161205-19407-b966rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our heart works hard for every second we are alive. Eventually its processes will wear out. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em> </p>
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<p>Nothing predicts the risk of heart disease more than age. Although seen at any age, rates of heart disease increase markedly in older people. It remains not only the <a href="http://aihw.gov.au/deaths/leading-causes-of-death/">leading cause of death in our community</a>, but also the key reason many older people cannot perform the physical activities they want and need for daily life. </p>
<p>Given our increasing lifespan, we need to better understand how and why the heart and blood vessels (cardiovascular system) age, and whether we can slow down the processes involved.</p>
<p>Heart disease can cause heart attack, angina, heart failure or eventually, sudden cardiac death. Heart disease includes stroke, aneurysm and other diseases of the arteries - the tubes that carry oxygenated blood from the heart to parts of the body.</p>
<p>Most of this list of serious conditions can be traced back to atherosclerosis in our arteries. This refers to build up of cholesterol and other factors such as modified cholesterol, cellular debris and cells associated with inflammation in the walls of arteries that obstructs blood flow. This leads to a blockage due to blood clots (thrombosis).</p>
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<span class="caption">A diagram of atherosclerosis and an image of an artery containing plaque.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
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<h2>What happens in the heart as we age?</h2>
<p>Does the heart wear out? Is there a timer ticking away somewhere in our body that eventually says “enough,” or do we cumulatively inflict damage over time?</p>
<p>The simple answer is: a little bit of the first two and quite a lot of the third. Continuous exposure to the risk factors for heart disease over decades plays a large part. Tobacco products, high blood pressure, abnormal blood fats and diabetes are all slow-burning toxins to the walls of arteries, and the longer the exposure, the more damage they do.</p>
<p>Ageing particularly affects the structure and function of arteries. Two important structural protein fibres hold the larger arteries together: collagen and elastin. </p>
<p>Collagen is inelastic but strong. It takes most of the burden of the pressure inside arteries brought about by the power of the heart pumping blood around the body.</p>
<p>As the name suggests, elastin is elastic, and has many of the characteristics of rubber. By stretching when the heart pumps blood, elastin helps cushion the fluctuations in pressure inside the artery. Like rubber, it is extremely tolerant of repetitive stretching and relaxation. But like rubber, it will eventually wear out. </p>
<p>After decades of repetitions (60 to 80 times a minute, 24 hours a day) more of the load is taken by the stiffer collagen and less by the softer, compliant elastin. As there is now less cushioning of each powerful beat of the heart, the systolic blood pressure (the peak pressure when the heart is actively pumping blood into the arteries) increases. </p>
<p>Blood moves more quickly through stiffer pipes so the diastolic blood pressure (the lowest pressure with each beat when the heart is relaxing and refilling) tends to fall. </p>
<p>Older people with stiff arteries have a bigger difference between their systolic and diastolic blood pressures. Regular physical activity, healthy nutrition and a good hormonal balance can delay this process.</p>
<h2>What are the effects of the ageing heart?</h2>
<p>High systolic pressure damages the walls of arteries. There are also other consequences downstream in the very small arteries that feed oxygen and nutrients to the organs of the body. They are subjected to a faster moving pulse of blood at a higher pressure, which rapidly falls away. </p>
<p>This means they’re pulled and stretched more vigorously with each beat, and that disturbs their function. Damage to small arteries in the brain can cause multiple tiny strokes, the <a href="https://www.fightdementia.org.au/about-dementia/types-of-dementia/vascular-dementia">cause of many cases of dementia</a>. </p>
<p>Damage to arteries in the kidney results in impaired function. As the kidney has an important role in regulating blood pressure in the rest of the body, a vicious cycle can be established where high blood pressure begets more high blood pressure, and more kidney damage leads to kidney failure.</p>
<p>The most vulnerable part of our arteries is the inner lining of their walls. This plays a vital function, acting as a barrier between the blood stream and the wall of the artery as well as controlling the function of the muscle layer of the wall. This widens or narrows the artery in accord with the oxygen needs of the organs of the body. </p>
<p>If they are damaged by tobacco smoke, a poor diet, diabetes or other risk factors, this barrier function can be lost, allowing the various ingredients of atherosclerosis to accumulate in the wall. </p>
<p>Atherosclerosis in the coronary arteries causes narrowing which can progress to blockage. Age is not necessarily the problem here but these build up over time and the longer the exposure to these damaging factors the more likely heart disease will emerge.</p>
<p>This is the underlying cause of most heart disease in the community. </p>
<p>As collagen is the major structural protein in the ageing heart, it is stiffer. Heart muscle cells are not replaced as quickly as they are lost. This less elastic heart does not fill as well, may not empty as well and therefore does not pump as well.</p>
<p>Heart failure is when the pumping ability has fallen to the extent the blood supply to the body is insufficient to meet the needs of daily living. Fortunately this only occurs after the vast reserve capacity of the healthy heart has been overcome. </p>
<p>Another consequence of these changes is that the electrical impulses the heart generates to activate each beat travel less efficiently across the heart. This is a cause of atrial fibrillation, a form of irregular heart beat that can lead to stroke, especially in older people. </p>
<p>Ageing of our cells is a lifelong race between production of new cells and loss of the old. As we get older the loss due to self-inflicted damage or acute disease challenges the replacement systems. </p>
<p>This is one of several natural processes that provide a ticking clock for our heart muscle. Staying physically and mentally active, being aware of the things that damage your arteries and having regular heart checks is the way to healthy ageing.</p>
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<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/69150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Garry Jennings receives funding from the National Health and Medical Research Council.
He is Senior Director of Baker IDI Heart & Diabetes Institute, Chief Medical Advisor of the Heart Foundation, a Board member of Ballarat Health Services, Nucleus Network and the Australian Cardiac Outcomes Registry.</span></em></p>Given our increasing lifespan, we need to better understand how and why the cardiovascular system ages and whether we can slow down the processes involved.Garry Jennings, Chief Medical Advisor at National Heart Foundation of Australia; Senior Director, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/676982017-01-25T19:53:56Z2017-01-25T19:53:56ZArthritis isn’t just a condition affecting older people, it likely starts much earlier<figure><img src="https://images.theconversation.com/files/149195/original/image-20161208-31405-1d8emw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No-one wakes up at 65 with arthritis. It's a condition that starts earlier in life and perhaps goes unnoticed until it worsens later in life. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
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<p>Arthritis is an umbrella term for over 100 conditions affecting the joints. All result in pain and often severely limit the activities a person can do. There are many different types of arthritis, each with a different cause.</p>
<p>Arthritis is a major cause of disability in Australia and world-wide. It also presents a significant cost to the community. In Australia, arthritis <a href="http://www.move.org.au/Research/PDFs/PLS/APWS-PLS.aspx">costs $55.8 billion per year</a>. </p>
<p>Most people think of arthritis as a disease of the elderly. While this is where it’s most commonly seen, it’s not where it starts. No-one wakes up with arthritis at 65. The different types of arthritis have different causes, but most of these start much earlier in life with mild symptoms that often go unnoticed. It’s usually only as the condition worsens over time that symptoms are noticed, and this is usually in older age.</p>
<p>Two of the most common types of arthritis are osteoarthritis and gout.</p>
<h2>Osteoarthritis</h2>
<p>Osteoarthritis is common as people age, and most frequently affects the hands, neck, back, knees and hips. Many people get osteoarthritis due to a familial tendency to develop it. Clearly we can’t change this.</p>
<p>We describe osteoarthritis as a disease of ageing, but it often begins many decades before a person has joint problems. In the past it was thought osteoarthritis was due to “wear and tear” of the joints and was thus inevitable. We now know this is not the case and there are a number of causes of osteoarthritis, with obesity being one of the most common contributing factors.</p>
<p>Osteoarthritis is more common in women than men, and is exacerbated by age. Over the age of 60 years, <a href="http://www.aihw.gov.au/osteoarthritis/who-gets-osteoarthritis/">more than 30% of people</a> have osteoarthritis.</p>
<p>It was previously thought that obesity affects joints because of the extra load the person carries, but this wouldn’t explain osteoarthritis in the hands. We now know obesity also causes inflammation in the joints as well as the extra loading. Obesity affects joints across all of the life span, so damage is already present in middle age, but becomes worse over time.</p>
<p>Hormones and injuries to joints also play a part in osteoarthritis. Many women develop hand osteoarthritis at menopause.</p>
<p>Maintaining a healthy weight, avoiding injuries to joints and regular exercise in order to strengthen muscles around the joints, are all important for the prevention of osteoarthritis. </p>
<p>Muscle strengthening exercises are very effective for reducing pain in osteoarthritis. Anti-inflammatory creams <a href="https://www.oarsi.org/sites/default/files/docs/2014/non_surgical_treatment_of_knee_oa_march_2014.pdf">have been shown to improve joint pain</a>. Medications such as paracetamol and anti-inflammatory tablets should only be used in the short term, and with advice from a doctor.</p>
<h2>Gout</h2>
<p>Gout is a very different type of arthritis. It results from a build-up of uric acid in the body. Uric acid is normally produced in the body, but some people don’t process uric acid effectively, so it builds up. Under some circumstances, such as changes in the diet, medications such as diuretics or excess intake of alcohol, this build-up can be <a href="http://www.move.org.au/Conditions-and-Symptoms/Gout">deposited in the joints</a>. This causes arthritis, experienced as a very painful, swollen joint.</p>
<p>Gout is more common in men than women, although women catch up after menopause. As with osteoarthritis, it tends to run in families. Gout becomes more common as we age because uric acid is able to accumulate with time. This is mainly because the kidneys cannot eliminate it as well as they used to, often as a result of other conditions such as diabetes or high blood pressure that over years may effect the kidneys. Some commonly used medications such as diuretics (or “water tablets”) can make this worse.</p>
<p>Diet is important for preventing gout. Alcohol needs to be taken in moderation, especially beer, both to prevent development of gout and to reduce the number of episodes. There are some types of food such as offal (liver, kidney) and shell fish that may result in an increased production of uric acid in the body and precipitate gout. One new risk factor for gout is a high intake of fructose, a sweetener commonly used in many soft drinks. Obesity can also make gout worse, so needs to be prevented as part of gout treatment.</p>
<p>Many people will also need medications to keep their gout in check. Gout can readily be treated with medications such as anti-inflammatories or colchicine. If gout occurs repeatedly, medication can also be prescribed to prevent this.</p>
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<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Flavia Cicuttini receives funding from NHMRC, MOVE Australia, Australian Arthritis Foundation, Monash University, The Alfred Foundation, Medibank Health Research Fund
Member of the RMA
</span></em></p>Most people think of arthritis as a disease of the elderly. While this is where it’s most commonly seen, it’s not where it starts.Flavia Cicuttini, Head, Musculoskeletal Unit DEPM, and Head Rheumatology Unit, Alfred Hospital, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/679302017-01-24T19:18:30Z2017-01-24T19:18:30ZWhy we lose our hearing and vision as we age<figure><img src="https://images.theconversation.com/files/152206/original/image-20170110-12672-15g6ms2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We experience lots of changes in our body as we age, and our eyes and ears are no exception. Unfortunately this toys with our senses. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
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<p>As the baby boomer generation begins to age, the prevalence of both eye and ear disease will rise exponentially, as there is a strong correlation between vision loss, hearing loss and ageing.</p>
<p>The <a href="http://www.who.int/mediacentre/factsheets/fs282/en/">World Health Organisation estimates</a> that 285 million people worldwide are visually impaired, with 82% of people with blindness aged 50 and above. Australia alone will have 800,000 people aged 40 or over with low vision or hearing loss by 2020.</p>
<p>As people age, they often experience a number of changes in their physical, mental and social health. Among these are eye and ear changes, and diseases that usually result in vision and hearing loss. Changes to our eyes and ears occur as a result of disease, genetic factors, “wear and tear” and environmental factors.</p>
<h2>What happens in our eyes as we age?</h2>
<p>There are a range of changes in our eyes that occur as a result of age. For example, over time the whites of the eyes, or “sclera”, undergo changes due to exposure to ultraviolet light. </p>
<p>These changes include a yellowing or browning of the white of the eye due to fatty or cholesterol deposits in the conjunctiva – the mucous membrane that covers the eye – also related to ageing and exposure to ultraviolet light. </p>
<p>Over time, changes also occur in the conjunctiva, such as a thinning of the membrane. This often results in dry eye, a condition caused mainly by reduced production of tears and reduced mucous from the conjunctiva.</p>
<p>As we age, we often experience a decrease in the strength of our muscles. This is no different in the eye, and the muscles in our eyelids can become weaker over time. Reduced tone in the muscle that gives shape to our lens, as well as stiffening of the natural lens with age, causes presbyopia (inability to see near objects), necessitating the use of reading glasses.</p>
<p>Eye disorders that commonly occur in older adults include:</p>
<ul>
<li><p><strong>macular degeneration</strong>. This terms describes <a href="https://theconversation.com/explainer-what-is-age-related-macular-degeneration-59889">damage to the pigmented oval</a> in the centre of the retina resulting in decreased central vision and seeing fine detail. This happens as we age because of deposits of fine grains that build up in the retina.</p></li>
<li><p><strong>Cataracts</strong>. This is a <a href="https://theconversation.com/explainer-what-are-cataracts-63699">clouding of the lens</a> that covers the eye. These are thought to be caused by breakdown and degradation of lens proteins, and are considered a part of the normal ageing of the lens. </p></li>
<li><p><strong>Diabetic retinopathy</strong>. This is damage to the retina resulting from diabetes. Type 2 diabetes is age related and the duration and control of blood glucose levels often determine whether or not diabetic retinopathy does or does not develop.</p></li>
<li><p><strong>Glaucoma</strong>. When <a href="https://theconversation.com/explainer-what-is-glaucoma-the-sneak-thief-of-sight-64807">glaucoma</a> occurs, the optic nerve is progressively damaged resulting in loss of the peripheral visual field.</p></li>
</ul>
<p>Among older Australians, cataract is the most common eye disease and cause of visual impairment (over <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/D1A5409787D800F2CA257C73007F12F3/%24File/eyehlth.pdf">70% of people in Australia</a> aged 80 years and over have cataracts), followed by age-related macular degeneration (occurring in <a href="http://www.aihw.gov.au/media-release-detail/?id=6442464587">3.1% of older people</a>).</p>
<h2>What happens in our ears as we age?</h2>
<p>As we get older, we experience changes all over our body, including the ears. Commonly, people’s ears (outer ears, that is) become bigger, earwax accumulates more easily and there is more cartilage in the external ear canal.</p>
<p>There is also often a stiffening of the eardrum and <a href="https://www.nursingtimes.net/roles/older-people-nurses/exploring-the-anatomy-and-physiology-of-ageing-part-6-the-eye-and-ear/1840889.article">changes to the neural</a> (nerve) system.</p>
<p>These changes contribute to older people suffering from hearing loss and central <a href="https://theconversation.com/is-your-child-having-trouble-learning-they-may-have-auditory-processing-disorder-62491">auditory processing disorders</a>, in which the ear cannot properly process sounds.</p>
<h2>How these changes affect daily life</h2>
<p>As a result of these numerous eye and ear changes and diseases, older people typically have vision and hearing problems that include sensitivity to light and difficulty visualising distant objects or reading print. </p>
<p>Hearing problems include difficulty with perceiving and discriminating sounds (including speech), understanding speech (particularly in poor listening situations such as when there is high background noise or echo), and processing auditory information.</p>
<p>These difficulties interfere with older adults’ everyday functioning and participation in activities. People with sensory loss may have difficulty performing independent activities of daily living such as bathing and shopping. This means they’re more at risk of problems with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448344/">mental health and social interaction</a>.</p>
<p>One of the most disabling effects of vision and hearing loss is decreased ability to communicate with others. People with severe vision loss (low vision or legal blindness) have difficulty lip reading or perceiving non-verbal cues (such as facial expression or gestures). </p>
<p>Those with hearing loss have communication difficulties including difficulty perceiving sounds or following a conversation. For people with loss of both senses, communication difficulties are much worse. They can’t adequately receive a verbal message and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030176/">frequently misunderstand conversation</a>.</p>
<h2>Management of sensory loss</h2>
<p>Management of sensory loss requires assessment by professionals (such as optometrists and audiologists) who will recommend the appropriate management plan that may include the use of a visual or hearing device.</p>
<p>Speech pathologists also play a role, with programs including speech perception training or communication programs for clients and carers. </p>
<p>Early identification and intervention can help those with vision and hearing loss so the effects of these sensory losses can be minimised, improving their quality of life.</p>
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<p><em>Acknowledgement: Dr Julian Sack (Ophthalmologist) for his input. Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67930/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chyrisse Heine does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Changes to our eyes and ears occur as a result of disease, genetic factors, “wear and tear” and environmental factors.Chyrisse Heine, Speech Pathologist/Audiologist Senior Lecturer, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/681452017-01-24T19:17:56Z2017-01-24T19:17:56ZWhy older people get osteoporosis and have falls<figure><img src="https://images.theconversation.com/files/148820/original/image-20161206-25721-hgzja7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older people are more likely to have falls as their balance and muscle strength usually isn't what it was. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>As the world’s population lives longer, the significance of osteoporosis and fractures increases.</p>
<p>In Australia, it is estimated that <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">4.74 million Australians aged over 50</a> have osteoporosis, osteopenia (less severe than osteoporosis) or poor bone health. By 2022, <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">it’s estimated this will increase</a> to 6.2 million, with one fracture occurring every 2.9 minutes.</p>
<p>In 2012, the <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">total cost of poor bone health</a> in adults aged over 50 was A$2.75 billion, and 64% of this cost was directly associated with treating and managing fractures.</p>
<h2>What is osteoporosis?</h2>
<p>Osteoporosis is a condition in which bones become fragile and brittle, leading to higher risk of breakage. This occurs when bones lose minerals such as calcium more quickly than the body can replace them.</p>
<p>In Australia, osteoporosis
affects <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">one in three women and one in five men</a> over the age of 50.</p>
<p>Referred to as a “silent” disease, osteoporosis generally has no symptoms and is rarely diagnosed until bones break or fracture. Osteoporosis is the disease and fractures are the outcome we are trying to prevent.</p>
<h2>Why do we get osteoporosis as we age?</h2>
<p>Our bones are living tissue and are in a continual state of renewal. As we age, more bone is broken down (resorbed) than is replaced by new bone. Thus our bones get thinner and more fragile as we age. This is particularly true during menopause for women and in men with lower levels of sex steroid hormones such as testosterone.</p>
<p>“Primary osteoporosis” is bone loss that can be attributed to ageing or the known hormonal consequences of ageing, such as the decline in oestrogen and testosterone. These hormones help regulate bone renewal that occurs naturally as we age. </p>
<p>As the level of these hormones decline from about the age of 50 in women and around 60 in men, the rate of bone breakdown is faster than the growth of new bone to replace it. Over time this leads to weaker, thinner bones. In women, the risk abruptly increases from the time of menopause, coinciding with a significant drop in circulating levels of oestrogen.</p>
<p>“Secondary osteoporosis” occurs as a consequence of another disease (such as coeliac disease with associated calcium malabsorption), or as an adverse consequence of therapy for another disease where medication might bring it on.</p>
<p>Thin bones of a poorer quality structure are more likely to break. The vast majority of fractures occur as a result of a fall from standing height. Vertebral or spinal fractures are the exception, frequently occurring without a fall or significant “trigger event”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We’re more likely to have a hip fracture if our parents did.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Why do we fall over when we get older?</h2>
<p>There are many reasons older adults are susceptible to falls. These include side effects of some medications, vision impairments and less ability to prevent tripping over as balance, muscle mass and strength decline with age.</p>
<p>The risk of fracture due to poor bones increases with age, and this is further enhanced by osteoporosis. </p>
<p>Genetics also plays a role in an individual’s risk of fracture. Those of us with parents who had a hip fracture have an increased risk of fracture. The most common sites of fracture in older adults are the hip, vertebrae or spine, wrist or the humerus (upper arm or shoulder).</p>
<p>About <a href="https://www.ncbi.nlm.nih.gov/pubmed/10083688">30% of older adults</a> fall at least once a year. The less often you fall, the less likely you are to break a bone.</p>
<p>People aged 70 and over <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">accounted for 70% of the total</a> acute hospital inpatient costs in 2012. Hip fractures <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">impose the highest burden</a> both in terms of cost and decline in health-related quality of life.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25792491">Results from a recent study</a> show most fracture patients have not fully recovered their previous level of quality of life by 18 months after the fracture.</p>
<h2>Preventing osteoporosis and falls</h2>
<p>Preventing falls in older people is an important way to prevent fractures. Adults who have good balance and muscle strength are often able to “save themselves” when they trip. Exercises that improve balance (such as Tai Chi) and help maintain muscle mass (weight-bearing and resistance exercises) are beneficial.</p>
<p>Preventing osteoporosis involves regular weight-bearing and resistance exercise, adequate calcium in the diet (at least three serves of dairy or equivalent per day) and an adequate level of vitamin D in the bloodstream.</p>
<p>Sunlight exposure on the skin is the primary source of vitamin D, but we need to practise safe sun exposure to reduce the risk of skin cancer. The recommendations vary by <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">skin type, latitude and season</a>. For people with moderately fair skin, six to seven minutes before 11am or after 3pm during summertime is considered sufficient. </p>
<p>During wintertime, the daily recommended sun exposure increases to between seven and 40 minutes <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">depending on where you live in Australia</a>.</p>
<p>While lifestyle factors such as nutrition and exercise can make an important difference to bone health over time, if an older adult has several risk factors for fracture their doctor may discuss the benefits of “bone active” medication. These medications slow the rate bone breaks down as we age. In general these medications halve the risk of fracture and are much more effective than lifestyle measures alone.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/68145/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kerrie Sanders has previously received an Honarorium from Sanofi Pty Ltd for presenting on the Burden of Osteoporosis. She has previously received several project grants from the National Health and Medical Council. One of these projects on the burden of disease study on osteoporosis received supplementary funding from Merck Pty Ltd. Prof Saanders is a member of the scientific advisory committees for both Osteoporosis Australia andfd the International Osteoporosis Foundation. </span></em></p>In 2012 the total cost of poor bone health in adults aged over 50 years was A$2.75 billion, and 64% of this cost was the direct cost associated with treating and managing fractures.Kerrie Sanders, Professor -Musculoskeletal Science, Nutrition and Health economics, IHA, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/677102017-01-23T19:17:07Z2017-01-23T19:17:07ZAussies are getting older, and the health workforce needs training to reflect it<p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>As our population ages and life expectancy increases, the need for comprehensive health and care services for older people becomes greater. Older people access health services across lots of different settings, but the ability for different services to share patient information is poor, and the opportunity to shift the costs from state and federal systems provides disincentives for them to coordinate services.</p>
<p>By 2031, <a href="https://www.adelaide.edu.au/apmrc/pubs/policy-briefs/APMRC_Policy_Brief_Vol_2_2.pdf">almost one in five people</a> will be aged 65 and over. If the system does not change by then, poorly equipped and uncoordinated services will fail our most vulnerable. Health carers need to be trained in dealing with the issues of the ageing population, and we need to be able to identify appropriate models of care that reflect the whole person’s needs.</p>
<h2>Training for GPs</h2>
<p>Older people use GPs more than younger people, so primary care is often their first point of contact. But there is little recognition of the care and training needed for GPs to tackle complex health and social concerns, including for people with dementia. <a href="https://www.fightdementia.org.au/files/Timely_Diagnosis_Can_we_do_better.pdf">Timely and accurate diagnosis</a> of dementia allows the person to make choices while they are still able. This requires the GP to differentiate the normal signs of ageing from dementia and recognise the importance of early diagnosis. </p>
<p>One financial incentive to encourage GPs to engage with patients is the “75+ health assessments”. First introduced in 1999, these assessments are designed to identify risk factors and plan interventions. However, uptake has been low, with <a href="http://ro.uow.edu.au/cgi/viewcontent.cgi?article=3149&context=smhpapers">only one in five eligible people</a> taking part. </p>
<p>Restructuring primary care from “Divisions of General Practice” in the 90s, to “Medicare Locals” in 2011 and now “Primary Health Networks” has meant aged care initiatives are in a mess. Aged care is one of the six priority areas for primary health networks but each network can still tackle the issue in their own way, resulting in no overall state or national approach.</p>
<h2>Hospital care</h2>
<p>Hospital admissions for those aged 85 and over have risen rapidly compared to overall admissions. <a href="http://www.aihw.gov.au/publication-detail/?id=60129543133">This group of older Australians</a>, while representing only 2% of the population, accounted for 7% of all hospital admissions and 13% of days spent in hospital. As the baby boomers age and this number <a href="http://www.aihw.gov.au/publication-detail/?id=60129543133">doubles by 2031</a>, hospitals will struggle.</p>
<p>More people die in hospitals than any other setting in Australia, so they need to acknowledge the role they have in providing acute and palliative care for older people. Often care for older people in hospital means fast-tracking them through the emergency department and if possible returning them home (including residential care) without admission.</p>
<p>Hospital staff need training in palliative care and dementia. Specialised medical, nursing and allied health positions (such as physiotherapists and occupational therapists) in geriatrics and dementia fall well short of what is required to keep pace with demand. For example, aggression from someone with dementia who is not able to talk may be due to pain, and clinicians need to know how to identify and treat the problem. </p>
<h2>Aged care services</h2>
<p><a href="http://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-volume1.pdf">Aged care services</a> are provided to over a million people in their homes. The <a href="https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/04_2016/strategic_roadmap_for_aged_care_web.pdf">Aged Care Reform agenda</a> is a ten-year program that sets out ways to improve services, recognise the role of carers and provide better information about services. </p>
<p>Unlike GPs and hospitals, increased numbers of aged care places subsidised by the government has helped aged care services to prepare for the increased demand posed by an ageing population. However, dementia projections remain a challenge. </p>
<p>Currently, care for most older people with advanced dementia occurs in residential aged care, settings in which care of the dying is becoming core business. </p>
<p>Recent government initiatives such as the <a href="http://www.careseaarch.com.au/PAToolkit">Palliative Approach Toolkit</a> and <a href="http://www.decisionassist.org.au">Decision Assist</a> have provided resources and education to meet the growing demands of palliative and end of life care for older people.</p>
<p>Another option to residential aged care, the <a href="https://agedcare.health.gov.au/programs/home-care-packages-programme">Home Care Packages Program</a>, enables the person to remain at home. Continued growth of this program under the aged care reform agenda with support for individuals with complex care needs will add pressure on GPs to identify and treat conditions that untreated would result in hospital admissions. </p>
<p>Like residential aged care, home care packages rely heavily on a workforce with limited formal qualification and no regulation. While in residential aged care, unregulated workers are more likely to be supervised, and home care workers may deliver care with limited direct supervision of a regulated worker. </p>
<p>With the demand for the <a href="https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/04_2016/strategic_roadmap_for_aged_care_web.pdf">aged care workforce nearly tripling</a>, the need for an appropriately skilled and regulated workforce is clear. We still don’t know how this can be done, or how to make sure workers are properly trained.</p>
<p>The baby boomers now needing more care expect a flexible and tailored approach to their needs. At present, the primary, acute and aged care workforce may not be adequately prepared to meet these expectations.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Parker is a Board Director of Carrington Care. She has received funding from the Department of Health and Ageing for the Palliative Approach Toolkit and Decision Assist and is currently Vice President of Palliative Care NSW, a member of the Palliative Care Nurses Australia and the Australian Association of Gerontology. </span></em></p>As our population ages and life expectancy increases so does the need for comprehensive health and care services for older people.Deborah Parker, Professor of Nursing Aged Care (Dementia), University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/696192017-01-22T19:10:59Z2017-01-22T19:10:59ZMedicine for older people is the same for anyone else: treat the person, not just the body<figure><img src="https://images.theconversation.com/files/153560/original/image-20170120-5227-1rz00z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Modern medicine too often posits doctors as mechanics and people as machines needing to be fixed. </span> <span class="attribution"><span class="source">Neil Kumar/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>In the 16th century, French philosopher Rene Descartes moved the body from the sacred to the profane by separating it from the mind. The body thus became a proper object of study by the emerging natural sciences. From anatomy flowed physiology and the birth of what we know as modern medicine. The model of the body as a machine which can be broken and therefore fixed has had great success, unimaginable only 100 years ago.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1289841/pdf/jrsocmed00206-0064.pdf">The problems with this model</a> seem well understood, and are best explained in a <a href="http://www.nejm.org/doi/pdf/10.1056/NEJM198203183061104">landmark paper on suffering</a> in medicine written 30 years ago. It points out bodies cannot suffer, only persons. A model with the body at the centre, focusing on the disease and how to get rid of it, fails to respond to the suffering of the person. Modern clinicians in this model do not see suffering as it is. We are merely the mechanics that fix the broken machine that is your body.</p>
<p>While this is admittedly a bleak, generalised view of modern medicine and some specialities such as general practice, geriatrics and palliative medicine do transcend this model, my experiences of hospital-based medicine give me reason to examine its effects.</p>
<p>I have always assumed older people were just like me, except older. As time goes on, fewer are older and more are younger. We all want the same things. Long productive lives, fulfilling relationships and to be able to do things. It is only as we age that we begin to understand the value of independence. It is invisible to the well and young.</p>
<p>Palliative medicine has shown me that people value their independence more than their lives. While discussions about death are often met with stoic indifference, rarely do people facing loss of independence remain unmoved.</p>
<p>Medical intervention in older people has the same aims as that in younger people. To cure, maintain or comfort. Being older just means you are more likely to have diseases already. Unfortunately, one of these diseases is frailty. Frailty is becoming <a href="http://jamanetwork.com/journals/jama/fullarticle/204046">increasingly recognised</a> as its own entity. Currently there is no cure for frailty and ageing, as its cause cannot be prevented.</p>
<p>To be frail means you are much more likely to need help to do things. You are more likely to have a chronic disease and you are less likely to survive a serious disease. It also means the part about cure “at any cost” can have quite a cost. The burden of the treatment can outweigh the benefit, the risks of death or disability loom. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The adage of ‘curing at any cost’ can have a significant cost in older patients.</span>
<span class="attribution"><span class="source">Screenshot, Youtube</span></span>
</figcaption>
</figure>
<p>An ethical approach to medicine requires we obtain consent for interventions we propose. Informed consent implies that accurate information about prognosis can be communicated to the patient. This has proved elusive <a href="https://theconversation.com/how-much-time-have-i-got-doc-the-problems-with-predicting-survival-at-end-of-life-52700">even for blunt measures</a>, such as whether or not someone will live. </p>
<p>When it comes to the likely effect on independence, estimating the risk of functional decline for an older individual facing a serious event becomes an inexact science.</p>
<p>The difficulties become more apparent when viewed within the idea of the body as machine and doctor as mechanic. Seeing only the body and not the person leaves me with inexact probabilities as guides. </p>
<p>Cure at any cost means I am unable within my own mind to comprehend the effect on the person. The frenetic pace of the hospital environment denies me the time. Lack of life experience for a younger doctor makes many considerations invisible. Death aversion within medical culture colours consultations.</p>
<p>My work in a busy emergency department has taught me older people are indeed like the rest of us. They want to be seen, recognised as people and treated as adults. It’s easy to find out something about the person. They don’t want superhuman medicos. They want us to be honest and to be able to express uncertainty. </p>
<p>A greater part of the satisfaction I find in my work comes from helping older people confront what is in front of them, and helping them make decisions in the context of them as a person, not just the failing lumber of the body.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/69619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Lukin has received funding from the Emergency Medicine Foundation. A Queensland Government funded organization promoting research in Emergency Medicine.</span></em></p>A model that has the body at the centre and a reductionist view of disease fails to respond to the suffering of the person.Bill Lukin, Consultant Emergency Physician and Palliative Medicine Trainee Physician, Clinical Associate Lecturer at the School of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.