Healthy Aging – Adjustments for Living & Reality

For several years now my wife has been complaining that I do not hear her when she talks.  I have gone for regular ENT checkups with audiology testing and while there is clearly a drop in hearing certain frequencies, my word discrimination and comprehension put me in a position of delaying using hearing aids for another year.

I was aware I had trouble hearing my middle adult daughter’s voice frequency.  I was missing words on TV especially when foreign accents were present leading to the purchase of TV Ears which solved the problem.  Still I knew that without auditory stimulation your brain deteriorates at a faster rate.

Last year the ENT doctor sent me home with a pair of hearing aids to try.  “Your wife called and said that if you don’t try them she may find me and kill me in my sleep.”  I was so angry with my wife for interfering that I made a point of pretending not to hear her every time she addressed me and I had the hearing aides in.  Those hearing aids were returned within the 30-day trial period because I could not use my stethoscope with them in.

One year later I was back again and this time my hearing test showed some drop in my word discrimination. They suggested trying a blue tooth compatible pair of hearing aids and even took out a stethoscope to show me how my hearing was enhanced using the stethoscope thus eliminating my favorite argument.   I wore them home and frankly they are wonderful.

The next day I had an appointment for my six-month eye exam. My acuity was off and I suspected my visual field in one eye had diminished based on driving and athletic pursuits.  The test confirmed my suspicions with my ophthalmologist diagnosing “normal pressure glaucoma” in my right eye.  “We need to lower the pressure by 3% with the drops I am prescribing and if the pressure doesn’t decrease we will recommend a laser surgery procedure in three weeks.  You are not going blind, but we want to preserve your visual field.”

The look on my face advertised my disappointment.  “It’s not so bad, you have sent me hundreds of patients with this situation and we helped them all. Why are you so troubled over this?  Looking at your med sheet and problem list at least you aren’t complaining about ED.”    When I didn’t answer her there was a long pause and she said, “Oh, I am sorry if I brought up a difficult topic.”   The best I could mutter was that in geometry what was once an acute angle is now an obtuse one.”

I tried to sell the fact that my dermatologist had me on a short-term course of prednisone which was raising the ocular pressure, but she wasn’t buying that argument.  New glasses, nightly eye drops and hearing aides all in a 72-hour period.

Instead of being grateful and thankful that I had minor correctable issues, and I could afford to spend the $6000 plus dollars for hearing aides and new trifocal lenses, I was moaning and groaning about the trials and tribulations of healthy aging. It was like running into the ocean surf on a hot day preparing to dive in to the surf and cool off and an unexpected wave smacks you down and stuns you before you can dive below its crest and avoid the strong impact.  I was devastated.

It took about 72 hours to adjust.  At my regular Friday night dinner with friends my buddy said, “Steve you seem to be hearing much better tonight. We did not have to repeat anything. What are you doing?”   I told him I was wearing new hearing aids which he had not noticed.  I hear better through my stethoscope than I did before.  When I walk my dogs or take my daily walk I hear the birds chirping, the children playing, the sprinklers initiating their watering cycle. These are all sounds I had forgotten about.  At lectures and movies I am hearing clearer. The blue tooth connection to my cellphone makes calls easier to complete.  My new trifocals allow me to read up close far more easily and see distance much better.

As a physician and geriatrician, I stress eye exams, hearing tests and evaluations to determine our ability to stay independent and functional. I cannot explain why I was so resistant to applying the same principles to my own health.

My day-to-day life has improved markedly with the hearing enhancement and new glasses. I hope my patients and students will look at my stubbornness and reluctance to accept healthy age-related changes as an example of how hard we cling to our independence and how reluctant we are to give up pieces of it even when we know it is for the best.

Alzheimer’s Disease – More Insight

The August 1, 2019 issue of the journal Neurology carried a report of a team of researchers who have developed a blood test that can detect the presence of amyloid in the brain with 94% accuracy.  Amyloid is one of the chemical constituents found to be tangling up the neuron nerve communication pathways in humans with Alzheimer’s disease.

The article emphasizes this is currently a strict research tool. It is not a laboratory test that your physician or clinic can order or use to detect this form of dementia early. The results of the blood test correlate well with imaging studies currently in use. It is one small step in the investigation of the causes of this progressive, and fatal, heartbreaking disease and hopefully will allow us to evaluate Alzheimer’s at its earliest stages.

In a journal specifically dedicated to this disease entitled Alzheimer’s and Dementia, researchers at the University of California, San Francisco discussed the increased tendency of patients with Alzheimer’s disease to nap and sleep inappropriately and ineffectively. Previously it was felt that this inappropriate sleep pattern when observed was in fact a risk factor and marker for the development of the disease.

Lea Grinberg, MD and her co-authors feel it is a symptom of the disease instead. They believe that the disease process has already destroyed or inhibited those neurons (brain nerve cells) responsible for wakefulness and alertness. In the absence of this stimulation, patients nap and sleep ineffectively and inappropriately.

Imaging of these areas is difficult to obtain because of their location in the skull and brain but, on detailed studies, more tau protein deposition in these wakefulness areas is visualized.   This concept now allows researchers to zero in on other brain chemicals associated with wakefulness, alertness and sleep as a potential form of treatment of Alzheimer’s disease in addition to those chemicals in the cholinergic system that most medications attack.

More Anti-Oxidants Provide No Benefit for Aging Eyes

Eye Glasses, Older WomanTwo papers presented at the Association for Research in Vision (ARVO) conference in Seattle emphasized that in a population of patients with adequate nutrition the addition of more antioxidants, vitamins and supplements do not help your vision or prevent progression or development of eye disease. In fact, not only did they not help but there was a significant concern that the addition of lutein and beta carotene to the diet of smokers and former smokers actually increased the risk of those individuals developing carcinoma of the lung. The studies were published in JAMA Ophthalmology and the Journal of the American Medical Association.

The study, known as Age-Related Eye Disease Study 2 (AREDS2), concluded that adding lutein, zeaxanthin, and fish oil to daily multivitamin supplements does not boost prevention of age related macular degeneration or cataracts in high risk individuals.

The original AREDS study showed that adding high doses of Vitamin C and Vitamin E, beta carotene and zinc slowed and lowered progression of early and intermediate age related macular degeneration and associated vision loss. That original study suggested that the addition of more antioxidants might help. This was the basis for the follow-up study AREDS2.  The follow up study randomized patients to receive lutein plus zeaxanthin, or omega 3 fatty acids, plus DHA and EPA, both, or a placebo. No benefit of adding these antioxidants was noted except in patients with extreme nutritional deprivation situations.

Vitamin C is a water soluble vitamin.  You keep what you need and the rest is eliminated harmlessly through the kidneys. Vitamin E is a fat soluble vitamin and excess intake is stored in the cells of your body.  Toxicity can occur from ingesting too much of Vitamin E or Vitamin A.  Beta Carotene has been postulated to have an effect on lung cancer in other studies.   The bottom line, too much of anything is not good for you. 

Patients should be asking their ophthalmologists about the constituents of the supplements being recommended to them for eye health.  If they are a cigarette smoker or former smoker they should question the need for beta carotene and lutein because of the association with lung cancer. They should review their total Vitamin A, E, D and K intake from their ophthalmologic vitamins and supplements and their other vitamins and supplements to insure that their total daily intake does not exceed recommended levels.

Today’s Seniors Are Not as Healthy as Their Parents

Baby Boomer Couple, cropped

In the online version of the Journal of the American Medical Association an analysis of data compiled by the National Health and Nutrition Examination Survey ( NHANES) suggested that today’s baby boomers are not as healthy as their parent’s generation. The baby boomers, born between 1946 and 1964, may live longer but they do so with more complaints and more chronic illnesses.  The study compared the two generations at ages 46 and 64 on several health measures using the years 2007- 2010 for the baby boomers and comparing it to data they had from 1988- 1994 for the prior generation.

The demographics in the two groups indicated a larger number of Hispanics and non-Hispanic Blacks in the baby boomer generation than the previous generation.  The data in many cases was self-reported with only half as many baby boomers 13% reporting their health as “excellent” while their parents’ generation had 32% respond excellent to the same question.  The baby boomers reported that more were using walking assisted devices, more were limited in work and more had functional limitations than their parents’ generation. As a group, obesity is more common in the baby boomers (39% vs. 29%), as is high blood pressure, elevated cholesterol and diabetes.

The prior generation got more physical exercise than the baby boomers by a margin of 50% compared to 35% when asked if they were getting exercise at least 12 times per month. Smoking was more common in the prior generation.  The study authors concluded that we need to “expand efforts at prevention and healthy lifestyle promotion in the baby boomer generation.”

It is hard for me as a clinician to gain much insight from this data. Clearly the previous generation lived through a depression and fought two major wars. Their definition of “excellent” may be different than baby boomers whose expectations may be completely different from reality.

An epidemic of obesity has contributed to an increase in its associated diseases including diabetes, high blood pressure and lipid abnormalities. The goal of education and prevention is a wise one and needs to start in the preschools and elementary schools if we wish to be a healthier society

 

Aspirin Use for Prevention of Cardiovascular Disease

A study by the Veterans Administration in the 1970’s on veterans over age 45 showed that if they were given aspirin they had fewer heart attacks and strokes.  This study didn’t divide the participants into men and women or patients who never had a heart attack or stroke versus patients who had known cardiac, Cerebrovascular and or Vascular Disease already.  The exact dosage of aspirin to take was never quite clarified either. For years physicians prescribed “baby aspirin” to patients over 45 to prevent heart attacks and strokes. While no definitive evidence existed to show the benefit was present in women as well as men, we tended to recommend the low dose aspirin in that group as well unless they were a high risk for bleeding.

Recent studies have questioned whether daily aspirin use for primary prevention of vascular disease is beneficial.  The current opinion is that a daily aspirin may cause more harm than good in women.  There is a feeling that the risk of bleeding may outweigh any benefit. The data is not quite as clear in men.  To add to the confusion, an article published in the journal Ophthalmology asserts that in a European study aspirin use was associated with an increased risk of developing wet, age related macular degeneration (AMD). Of the 4691 participants in the study, 36.4 % developed early AMD and 17% of that group took aspirin on a daily basis.  This is not the first study to raise this question with equivocal findings on several previous studies concerning the relationship between aspirin intake and AMD.  It is clear that further research is needed in this area.

The study is one of many that raise conflicts in approaching AMD and eye disease versus systemic health. This is especially a problem since these older AMD patients are the same ones who are more likely to already have cardiac, Cerebrovascular or Peripheral Vascular Disease and this is the very group that we know and agree that aspirin is beneficial in.

Clearly more studies are needed. I will continue to take my daily 81 mg of enteric coated aspirins unless I develop aspirin related gastritis, ulcers or GI Bleeding. My male patients over 45 years old with low or few risks of GI bleeding will continue to be advised to consider aspirin. With no studies showing a clear cut advantage for women taking aspirin for primary prevention of heart disease and stroke, I will present the pros and cons of therapy and advise it less frequently if the patient has a low risk of vascular disease or a high risk of bleeding.