Baby Boomers Face Down Aging: 10 Most Common Medical Challenges

In the year 2030, the youngest members of the baby boomer generation will hit 65, making up nearly a quarter of the country's population, according to the U.S. Census Bureau. If current elderly Americans are a precursor of what is to come, they will experience health challenges such as diabetes, dementia, depression and functional disability in record numbers.

16 aug 2009--But their huge presence may also open up specialized emergency rooms and critical care units, encourage more research into the mysteries of the aging body and place a focus on specialized geriatric and end-of-life care.

According to researchers and clinicians in the Division of Geriatric and Palliative Medicine at The University of Texas Medical School at Houston, here is a snapshot of 10 of the challenges that may be staring back at baby boomers:

1. Functional decline: According to the U.S. Department of Agriculture, the body loses 1 percent of muscle mass a year beginning at age 45, which can result in sarcopenia as skeletal muscle is eventually replaced with fat and the body becomes weaker. Some research has linked protein deficiency with sarcopenia. For every week spent in the hospital, it takes an aging body a month to recover muscle strength with daily rehabilitation, says geriatrician Liliana Andrade, M.D., assistant professor of internal medicine at the UT Medical School at Houston. Exercise, including resistance and strength training, is absolutely essential for retaining muscle mass and strength. "For balance, tai chi is good," she says. "We also encourage patients to rent 'sit and be fit' videos that use hand and leg weights." A study published recently in Diabetes Care, a journal of the American Diabetes Association, found that older adults especially women with diagnosed or undiagnosed type 2 diabetes had a higher rate of skeletal muscle loss.

2. Depression: Considered as prevalent as the common cold in the elderly, depression can be the result of major life changes, including retirement, losing loved ones and loss of mobility and independence. It can show up differently in older people, says geriatrician Nasiya Ahmed, M.D., assistant professor of internal medicine at the UT Medical School at Houston. "There's not as much of a tendency toward tearfulness or feelings of hopelessness," she says. "Instead they have vague somatic complaints, increased pain, not sleeping or eating well or general apathy."

3. Disease: Chronic diseases associated with the aging process, including high blood pressure, stroke, cardiovascular disease, osteoporosis, chronic obstructive pulmonary disease, hypothyroidism, constipation, incontinence and arthritis, can take their toll. Preventive measures taken now such as quitting smoking, eating healthy food and exercising are all important steps toward a better quality of life. "Even quitting smoking at age 60 is better than not quitting at all," Andrade says.

4. Polypharmacy: A term geriatricians are using for the number of prescription and over-the-counter medications that elderly people are taking in alarming numbers is polypharmacy. "People go to five different doctors and none of the others know what is going on," Ahmed says. In some cases, seniors who wind up in the hospital may be prescribed a different medication for an existing condition such as high blood pressure because the hospital doesn't stock the particular one they've been taking in the past. The patient returns home with a new prescription from the hospital physician and continues taking the other medication as well, which can be deadly. "I've had patients come in who are taking 20 different medications," Andrade says. "A lot of them also take vitamins and herbal supplements that they don't need and that can interfere with medications." The solution, they say, is to have a written record of all prescriptions, supplements and vitamins that they can bring to their appointments and have a family practitioner or geriatrician who can be the lead physician in managing their care.

5. Falls: Low blood pressure, which can be a result of poorly managed hypertension or dehydration, can lead to dizziness. That dizziness, combined with a decreased ability of the vascular system to compensate for changes in position such as standing up, is the largest cause of falls, they say. "So many patients have told me that they take blood pressure medication when they feel like it's high instead of taking it as it is prescribed," Ahmed says. "I ask them how they know it's high and they give vague signs such as their nose tingles or their tremor worsening." Taking medications for sleep can also be dangerous. "Some take Benadryl to help them sleep and as people get older, that's not such a good thing because it causes confusion and they can fall because they're sleepy," Andrade says.

6. Abuse and neglect: These two problems, including self-neglect, will continue to afflict the elderly, says Carmel B. Dyer, M.D., professor and director of the geriatric and palliative medicine division at the UT Medical School at Houston and co-author of the book, "Elder Abuse Detection and Intervention." Education programs, such as the Houston Geriatric Education Center at The University of Texas Health Science Center at Houston, are needed now to train physicians to recognize the signs of abuse and neglect.

7. Financial exploitation: Vulnerable elderly people can easily become victims of family members or caregivers. "We see cases where grown children have moved back in with them and are depending on them financially. They use their resources, borrow the car, rely on them to baby sit, and it upsets the senior's ability to function," Ahmed says. "I had one patient in her early 80s whose leg had just been amputated and she was still babysitting her 11- and 12-year-old grandchildren, who were taunting her."

8. Dementia: Alzheimer's disease is the most common form of dementia, a gradual decline in a person's mental functioning, and is the fifth leading cause of death for Americans over age 65, according to the National Center for Health Statistics. The Alzheimer's Association reports that Alzheimer's disease and dementia triple healthcare costs for people over 65. But education about dementia and possible treatments including medications is lacking, Ahmed and Andrade say. "There are now more medications that are helpful. They can't cure it, but they can help," Andrade says. "Unfortunately, a lot of people are in denial. I had a 78-year-old patient who I knew was suffering from dementia because of the way he was managing his medications and health. But his son got upset when I started talking about it and they left the room."

9. Caregiver burnout: As baby boomers age, many will also be taking care of their own aging parents. That brings caregiver burden, which can lead to a higher risk for depression and other stress-related illnesses. Ahmed says caregivers should solicit health resources, such as daycares for seniors, to help them shoulder the stress. They should take advantage of support groups and ask social workers regularly about available community resources. Special units for acute care for the elderly (ACE units), such as the one at Memorial Hermann-Texas Medical Center where UT physicians see patients, can help make hospitalizations less stressful for the patient and family.

10. Death and dying: Baby boomers will have to decide how they want to live out the end of their lives and how they want to die. Cultural and religious beliefs will impact these decisions and physicians will need to be sensitive to that, Ahmed says. As patients age, the physician begins to play a larger role in a patient's life and strong physician-patient relationships will be important in determining a patient's wishes. People should make those wishes known to family members and caregivers and put them in writing.

Source: University of Texas Health Science Center at Houston