Senior Health Update
Being over the age of 65 comes with its fair share of emerging and changing health problems. Luckily, medicine is constantly evolving to treat the common concerns of aging as seniors are more active than ever. We asked local experts to share some advice on common senior health issues to keep the golden years golden.
Shingles causes nerve inflammation that can sometimes be debilitating, and according to SLUCare geriatrician Dr. John Morley, about 10 percent of patients have to deal with residual nerve pain called postherpetic neuralgia (PHN) even after the rash and sores clear up. The Centers for Disease Control and Prevention (CDC) recommends a new shingles vaccination, Shingrix, to protect against both shingles and PHN. It is suggested that healthy adults 50 years and older get two doses of the vaccine two to six months apart. Morley calls Shingrix a game changer. “The previous shingles immunization worked in about 50 percent of people, but the new one is effective for more than 90 percent,” he says. He suggests that even individuals who previously have been vaccinated against shingles get Shingrix.
The CDC recommends two vaccines for adults 65 and older to protect against pneumococcal disease, an infection from Streptococcus pneumoniae bacteria that can result in pneumonia, blood infection, middle-ear infection or bacterial meningitis. It is suggested that the immunizations, PCV13 and PPSV23, be administered one year apart. According to Washington University infectious disease specialist Dr. Caline Mattar, both vaccines are necessary. She explains that they protect against different strains of Streptococcus pneumoniae. “They offer complementary protection, so getting one doesn’t mean that you don’t need the other,” she says. “Getting both can prevent very serious infections.” She recommends that patients get the PCV13 vaccination first and follow it up with PPSV23.
An influenza vaccination is recommended annually for all adults. Morley and Mattar agree that it is critical for seniors to receive theirs. Morley explains that some people think the annual flu shot doesn’t work because colds and other viruses can produce flu-like symptoms, but the vaccine can help prevent serious or even fatal illness. Mattar adds that seniors should get the vaccination in September because it will ensure they are protected when the illness starts spreading.
when traveling …
Morley says there are special immunization recommendations for travelers based on the country they are visiting. She suggests consulting both your physician and a travel specialist a month before your trip to see if your destination requires any specific vaccines.
knees & hips
Conservative therapies are generally the first course of treatment, according to Zehnder. He says this can include:
» Activity modification
» Weight loss
» Physical therapy
» Steroid injections
» Viscosupplementation, or gel shots, for knees
“With fractures or other conditions that present in an emergency setting, there is less probability for less invasive treatment,” Zehnder says. “Nonsurgical care may not be the best option.” A hip or knee replacement may be necessary if conservative measures fail and patients find the pain debilitating. Replacement should be considered if the pain gets in the way of daily activities. He adds that 90 percent of hip replacements are designed to last 20 years, so it’s a long-term solution.
Sciortino says there have been great advancements with these surgeries. He performs a new type of SuperPath hip replacement. “It’s very minimally invasive and allows for a much more rapid recovery,” he says. “About 55 percent of patients are able to go home the next day, and they are generally walking without support in a month.” He adds that patients don’t have as many restrictions with SuperPath; they don’t have to use a special cushion afterward or worry about stretching or crossing their legs.
Other rapid recovery advancements include changes to the way doctors help patients manage pain. Sciortino says multimodal pain treatment is being used instead of just narcotics. This means local anesthetics and nerve blocks are used during surgery, and afterward, the patient is treated with Tylenol, anti-inflammatories, Lyrica and other drugs instead of being given a morphine drip. “Patients feel better and don’t lose a day feeling groggy because of medication,” he notes. “This will help seniors decrease their hospital stays and their dependence on narcotics.”
» too much screen time?
While spending too much time looking at a screen may have serious repercussions for children’s vision, the same is not true for adults. “A lot of times, reading small print on something that’s backlit actually makes it easier to see,” says Dr. Joseph Gira, an ophthalmologist with Ophthalmology Consultants. He says the biggest issues adults are likely to face are dry eyes and eye fatigue. “Anytime you look at something for a sustained period of time, you don’t blink as often, and when you’re not blinking, you get dry eyes,” he notes. There are several treatments available, including artificial tears, prescription eye drops or even just drinking more water.
» cataracts are inevitable.
“Pretty much everyone over 65 has some degree of cataracts,” says Dr. Sean Breit, an ophthalmologist with Eye Care Associates of St. Louis. Surgery, however, isn’t always necessary. He says if patients are satisfied with their vision and no longer drive, there is no reason for them to undergo surgery.
» readers aren’t unavoidable.
Contact lenses are always an option for anyone disinclined to put on a pair of specs, both Breit and Gira say, and there are also surgical options. “Corneal inlays are very thin lenses that are placed inside the front flap of the cornea, and they help correct problems with focusing,” Breit says. Gira suggests multifocal intraocular lens implants, which can be added during cataract surgery.
» play it safe.
While some eye issues like macular degeneration and glaucoma are due to age and family history, there is still a lot you can do to protect your eyes. “I always talk to patients about eye safety,” Breit says. “Trauma tends to cause major problems. Wear protective eyewear when working with power tools and sunglasses when you’re outdoors. You can prevent problems before they develop.”
» switch to annual eye exams.
Gira suggests that everyone start getting annual eye exams around age 40. He says that is when the incidence of glaucoma starts to rise. He adds that in your 50s, cataracts are a concern, and macular degeneration usually starts in your 60s or 70s.
» pay attention to how you see.
If you notice any changes in vision, schedule an appointment with your eye doctor. Breit says be aware of image distortion, rings and halos around lights, and headaches.
Dr. Robert Sciortino of STL Orthopedics and Dr. Scott Zehnder, an orthopedic surgeon with Signature Medical Group, say there are several common problems seniors face when it comes to their knees and hips. They both say osteoarthritis, or wear and tear of the joints, is the most common issue, with fractures coming in second. Lower back pain, inflammatory conditions and ligament tears also can cause pain in knees and hips. Sciortino and Zehnder note there are several things seniors can do to save their hips and knees a lot of pain, especially from falls.
“I’m a big believer in exercise,” Zehnder says. “It’s a great way to increase strength and range of motion in arthritic joints. It also can help with balance and coordination to reduce the likelihood of a fall.” Sciortino adds that while seniors need cardiovascular exercise, they should not do anything too intense that might increase the risk of injury.
Calcium and vitamin D are important for bone health. Sciortino says women especially need to take calcium supplements after menopause.
declutter your home.
Home safety is an important part of preventing falls. Consider getting rid of rugs, cords and other tripping hazards.
pay attention to your medication.
Zehnder says it’s important to be aware if your medication is making you drowsy or affecting your blood pressure because that means you’re more likely to fall.
Studies have shown that smoking is a risk factor for osteoporosis and bone fractures. Alcohol also can have a negative impact on bone health and increases the risk of falls.
check up on your bones.
Sciortino explains that everyone starts losing bone density after age 30. He recommends getting a bone density scan to check for osteoporosis. This is especially important for women because they tend to have less calcium to begin with, he notes.