Never before have so many humans approached the century mark in birthdays. And this bunch is not going to let aches and pains, failing eyesight or tired feet hold them back. They’re more likely to be proactive about their ailments—so they can keep on keeping on.
[backs]
Anyone who’s closed in on age 60 ought to know: As the spine gets older, arthritis sets in. And this sad situation is happening to more and more Americans as the population over 65 grows exponentially.
graying group
“People develop a lot of arthritis in their joints and back,” confirms Dr. Paul Santiago, associate professor of neurological surgery at Washington University School of Medicine. “The disks wear, and the shape of the spine changes. We didn’t use to frequently encounter what we called ‘an elderly patient’. Now, at a lot of our clinics, half the patients are elderly.”
Dr. Howard Place, professor of spinal deformity and reconstructive spine surgery at Saint Louis University School of Medicine reports the same, admitting there is a challenge in providing all these older people and their spines with the activity levels they desire. “As people age, their backs tend to settle,” he explains. “Some people settle straight, and they get some disk bulges and narrowing of the space for their nerves. That’s called spinal stenosis. When the back settles crookedly, they can develop degenerative scoliosis. Besides putting pressure on the nerves, scoliosis also can cause lots of pain because the spine is slipping and sliding in directions it isn’t supposed to.
uphill battle
Physiological changes and wear and tear stress the senior back. The disk pads between the vertebrae also change. “People tend to have fewer problems with ruptured or herniated disks because the disks dehydrate and the coverings of the disks become hard,” Santiago says. “They develop more stenosis, and the space in the center of the spine becomes smaller.” The most common issue with spinal stenosis is pain in the legs, usually while standing or walking, notes Place.
Yet even with all these issues and the pain they cause, surgery on the back is not commonplace. “Just having symptoms isn’t enough to mean surgery,” Place says. “Many people are able to adjust their activities, take some medications and do some physical therapy. Pool therapy and epidural steroid injections can be beneficial.”
Physical therapy can be a way for patients to help themselves. “Some people tend to pooh-pooh physical therapy, but it is not just a bunch of exercises, Santiago says. “It’s having an expert in body movement show you how to exercise, “and hold your body.”
Epidural steroid injections, he adds, put steroids “around the spinal sac and the nerve roots to decrease inflammation of the nerves. As people get older, they may be more responsive to what we call facet rhizotomy injections.” These disable sensory nerves that pass through the facet joints of the spine.
Some back discomfort is inevitable with age, Santiago says. “A certain number of people have to expect to live with some back aches and pains and stiffness, just like they do with aches and pain and stiffness in their knees and hips.
what if?
What if the non-surgical options do not relieve significant pain? “The most significant indication for surgery is when the symptoms limit your activities,” SLU’s Dr. Howard Place says. “If you can’t go out to dinner or take care of your health because you can’t walk any distance, then you may need surgery.”
When spinal bones have settled onto the nerves, surgeons may perform a procedure known as a decompression or laminectomy, in which bone and ligament are removed. “It creates more room for the spinal sac and nerves in the lumbar spine,” Santiago says.
New minimally invasive procedures, often involving small tubes through which instruments are guided, have reduced incision sizes and recovery times for many back operations, but may not be suitable for elderly patients, Santiago says. “As people get older, their problems occur over more segments, so they are not the greatest candidates for many minimally invasive procedures.
[feet]
“When you step on the brakes, your life is in the hands of your feet,” observed the late comedian George Carlin. And even though he was joking, he wasn’t wrong. It’s sobering just how much your quality of life depends on those feet, because when your feet ache, nothing feels right.
it’s inevitable
You know how ‘old people’ always wear sensible shoes? There’s a reason for that. A 2008 population study published by the Journal of Foot and Ankle Research found that more than a quarter of those over age 65 report foot pain. Nearly a third of adults say their ability to walk is restricted by foot pain, according to a 2014 American Podiatric Medical Association survey.
And people tend to ignore their feet—until there are problems. “For taking care of the feet, the biggest thing is daily maintenance,” says podiatrist Dr. Steven Frank.
After all, our feet serve us every day of our lives. “One of the biggest things we see is the skin aging,,” he says. “You lose some of the padding under the bottom of the foot, so you are more prone to calluses and nerve pain.”
Padding in shoes is helpful, as are skin moisturizers, he says. “With skin care, we include the toenails. Older people have trouble reaching their toenails to trim them. And the toenails become thicker and can develop fungal infections. Older feet need daily checkups,” Frank says. “The skin is vulnerable to skin cancers and the circulation starts to go. Also, the nerves don’t work as well so you may not feel sores.
age before beauty
You know how old pants, blouses and shoes no longer fit? Well, it’s not the garment that has changed. Same with feet. “The arch of the foot is maintained by muscles and ligaments, and as the arch is loaded over time, it gives out a bit,” says Dr. Michael H. Horwitz of the Feet for Life Centers. “As the arch drops, the foot gets longer and wider, which can change your shoe size.”
Women are more likely to experience changes in foot size. “During the child-bearing years it is a combination of the weight and the hormones that open ligaments in the pelvis to enable the child to be born,” Frank says. “Those hormones also can affect the ligaments in the feet.”
Additionally, foot problems are inherited, adds Horwitz. “Congenital predispositions to bunions or hammertoes will be exacerbated by age. Some symptoms are exacerbated by footwear, but the more years you are on your feet the more you are likely to become your parents when it comes to foot issues.”
if the shoe fits
Have your feet measured when buying new shoes, the doctors suggest, to ensure a fit that will not pinch and rub. Many foot issues and much pain can be prevented through exercise and proper shoes, Horwitz says. Also, “there is a diagnosis I call ‘generalized foot weakness.’ It’s intrinsic muscle weakness and lack of proprioception that comes from wearing footwear that is overly supportive or wearing custom orthotics when you don’t need orthotics.”
Highly supportive shoes may keep the feet from getting exercise, he says. “The orthotic may provide a false exoskeletal support system and weaken the foot because it was not adapting to its environment. Adaptation starts with keeping the range of motion and understanding that your Achilles tendon is absolutely vital in supporting your body.”
Horwitz recommends ‘minimalist’ shoes for moving about the house or making trips to the store. “These come in many styles now, with many variations in padding. They passively stretch the Achilles tendon.” Exercise is highly recommended, Horwitz adds, but heavier workouts warrant more supportive shoes. “As long as you can walk, you should keep doing it,” Frank adds. “The more you move, the more your feet will stay in shape. And walking every day will keep the blood flowing through those legs and help prevent some of the arterial problems we see later in life.
[cataracts]
For most of us, cataracts join taxes as a universal inevitability—but in a much sneakier manner. Thankfully, the problem is so widespread that the solution has become routine, too.
a matter of time
“The onset is gradual, so the symptoms are a bit undersold. It usually takes five to 10 years, sometimes longer,” says Dr. Sean M. Breit of Eye Care Associates. “The average age for cataract surgery is 70 to 75. But we sometimes see cataracts in people in their 50s and earlier, due to various health conditions.”
“Cataracts are an age-related change of the natural lens,” explains Dr. Mujtaba Qazi, director of clinical studies at Pepose Vision Institute. “The lens starts to become cloudy, and when it becomes cloudy enough, it blocks light from entering the eye so things become blurry.” Cataracts form in the lens at the front of the eye, which is crystal clear through most of our lifetime. This area of the eye consists mostly of water and protein, and with age it slowly changes in composition. “As new layers of cells grow, old cells are pushed to the center, causing the center to become so dense that light can’t penetrate,” Qazi says.
solutions
Routine surgery restores the eye’s lost focus and sometimes improves acuity. “People say that things are brighter and colors are more vibrant and focused almost immediately,” reports Qazi. Breit has experienced the same response. “Usually on the first day after surgery, people are full of stories about things they discover,” he says. “They see details like the leaves on the trees that they thought were blobs. Occasionally people complain that they have more gray hair and wrinkles than they remembered!”
About 3 million cataract surgeries are done in the U.S. annually, the American Academy of Ophthalmology estimates. But in many parts of the world, cataracts are the leading cause of blindness because they are not treated. Several risk factors can increase the likelihood of cataracts. The American Optometric Association lists these as diabetes mellitus, certain medications, exposure to ultraviolet radiation and sunlight, smoking, alcohol and some nutritional deficiencies.
Catract surgery involves only oral sedation and anesthetic drops, Qazi says. “We make an incision about the size of a pin point and break the natural lens into little fragments. We replace the cloudy natural lens with a clear artificial lens, and we build a prescription into that lens so people can see even better without glasses.”
“The interesting thing about cataract surgery is how much it has evolved,” Breit adds. “It sometimes took an hour or two and involved a relatively large incision. Now we do it in 15 minute or less through a 2 millimeter incision.” After a few days of recovery, the patient may have better vision than before the cataracts developed. “We are taking advantage of the fact that the eye has aged and we have the technology to rejuvenate vision as well as improve it,” says Qazi. Cataract surgery has been documented to result in a 16 percent decrease in hip fracture and a 13 percent decrease in car crashes, according to the American Academy of Ophthalmology.
timing
Despite their gradual onset, cataracts make themselves known when people realize they no longer can drive at night or follow the ball while watching baseball on television. “They realize they are losing detail. They can’t read signs that are far away. They can’t read small print,” Breit says. “We check to see if a cataract is the main cause. If new glasses won’t help, we know they are ready for surgery.”
Surgery is likely to be recommended at younger ages than in recent decades, Qazi adds. “There used to be a concept of letting the cataract ripen—letting it get so dense that people were significantly affected. Now everyone wants to be more productive. Older patients are driving and doing computer work, so we want to make sure they are as productive as possible.”
