As a geriatrician who has spent 40 years treating older patients, Rosanne M. Leipzig, MD, PhD, hears the same question day in and day out—“Is [XYZ symptom] a normal part of aging?” Here’s what Dr. Leipzig tells them: Many changes in your physical, mental and emotional health can be chalked up to “normal” aging…and some physical and cognitive changes are inevitable. Needing assistive devices such as eyeglasses or hearing aids and occasionally losing your train of thought are to be expected as you age. But: That doesn’t mean a 75-year-old can’t be full of energy and free from symptoms of most chronic diseases.
Many of these changes, such as having the occasional “senior moment”…not being able to handle alcohol as well as decades earlier…and needing to use the bathroom several times a night may be manageable. Others, including poor vision or becoming off balance more easily, can be more concerning if they put you at risk for falls and other incidents. But only 20% of people age 65 and over…and 40% of those over 85…experience significant limitations in cognition, vision, hearing, mobility, communication or the ability to continue caring for themselves.
Still, Dr. Leipzig does not agree with the saying, “80 is the new 60”—even though the intentions behind it are good. Her take: Old age is a new stage of life, and it’s not the same as middle age. One of the keys to healthy aging is accepting the fact that humans change as the years march on—hair turns gray, weight shifts to the belly, eyesight gets weaker. You don’t need to enjoy these changes, but learning your options for navigating your new normal can enhance your well-being while helping you cultivate a positive mindset.
According to researchers at Yale University School of Public Health, older adults with negative perceptions of aging performed worse on memory and hearing tests than similar older adults with positive perceptions of aging. Positive perceptions of aging also were linked with longer life span…and those extra years (7.5 to be exact) were more likely to be independent.
Ready to make peace with aging? Dr. Leipzig explains what you can expect and how to manage these changes…
Change #1: Medications will affect you differently. What’s happening: The kidneys and liver play a role in processing medications. These organs change with age. Not only do they receive less blood flow, but the number of cells within the organs begin to dwindle. Both changes decrease the speed with which medications are eliminated from the body. This causes increased blood levels of medications, possibly leading to adverse drug events (ADEs) such as confusion (with common acid reducers like Tagamet and Pepcid) or hypoglycemia and fainting (with insulin.) This can happen with new drugs or with drugs you’ve been taking for decades.
Higher-than-usual drug levels also can be caused by drug-drug interactions. Older adults often take multiple medications, some of which may no longer be needed and others that are prescribed to treat side effects from a preexisting drug. This polypharmacy often leads to ADEs. The more drugs you take, the greater the chance for side effects.
Lastly, aging brains often grow more sensitive to common medications, including antihistamines like diphenhydramine (Benadryl)…sleeping pills such as zolpidem (Ambien)…and muscle relaxants like cyclobenzaprine (Flexeril). This can lead to greater sedation than usual, confusion and falls.
Alcohol hits harder, too. Body composition changes with age—muscle mass decreases, as does the amount of water stored in your body. Because alcohol is absorbed into the bloodstream—and blood is mostly water—this decrease in water results in an increased concentration of alcohol, so you feel every sip more than you used to. A 70-year-old liver also takes more time to metabolize wine, beer and liquor than a 30-year-old liver.
What to do: Practice Goldilocks’s motto, and take what’s just right for you. Tell each of your physicians and health-care providers that you’d like to be thoughtful with your prescription regimen, and confirm that you need every medication you’re prescribed and that you are taking the proper doses for your age and body composition. That includes medications that treat chronic conditions such as high blood pressure and diabetes—you may have taken them for years, but the dose you need may have changed with age. Or perhaps you’ve made a major lifestyle change such as losing weight or quitting smoking and no longer need a particular medication at all. Reminder: Part of ensuring the appropriate dose also involves checking for underdosing.
Important: Never stop taking a drug without talking to your provider first. That may cause uncomfortable—even life-threatening—withdrawal symptoms.
Change #2: You’ll need to urinate more frequently. What’s happening: With age, the urge to empty the bladder often grows stronger—even with smaller volumes of urine. This can be chalked up to spasms known as uninhibited bladder contractions that signal the brain to void the bladder. Nighttime urination, called nocturia, also becomes more frequent thanks to a natural decline in production of anti-diuretic hormone (ADH). Production of ADH is robust in younger adults and helps ensure that the majority of urination occurs during the daytime.
Your bladder also may not fully empty each time you urinate due to age-weakened bladder muscles…enlarged prostate in men, also called benign prostatic hyperplasia (BPH), which narrows the urethra…pelvic organ prolapse in women, in which age-weakened support structures allow the bladder or uterus to drop down into the vagina…or severe constipation, common in older years.
What to do: Use the bathroom regularly during the day. Avoid “holding it” for long periods—doing so can stretch and weaken the bladder over time. Ask your doctor for help resolving any problems with constipation. Starting around 4 pm each day, decrease your fluid intake, especially of alcohol and caffeinated and carbonated beverages, all of which are diuretics or bladder irritants. Caution: Don’t stop drinking altogether—that can lead to unintentional dehydration. Ask your doctor to evaluate you for pelvic organ prolapse or BPH—both conditions are treatable. If nocturia keeps you up at night, ask your doctor if any medications you are taking increase fluid retention. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil)…neurogenic pain medications including gabapentin (Neurontin) and pregabalin (Lyrica)…and calcium channel blockers such as amlodipine (Norvasc) and nifedipine (Procardia).
What is not normal: Consult your doctor if you experience…
Change #3: Your mood may shift…but in surprising, enjoyable ways. A patient once said to me, “It seems like old people have plenty of reasons to feel down. Their lives are filled with losses, physical illnesses, problems getting around and memory glitches. I’m only 50, but I dread getting older. How does anyone cope?” Reality: Older adults tend to be quite content. In fact, older people tend to be better emotionally adjusted than their younger counterparts because they remember positive images and statements more than negative ones and their successes more than their mistakes…they are less likely to have strong or negative responses to major stressors and emotional events…and they are less likely to develop major depressive disorder. This isn’t to say older people don’t get sad or mad—they do. But thanks to what’s known as the paradox of aging, it happens less frequently, is less intense and fizzles out relatively quickly.
Drastic or sudden changes in personality or self-esteem usually are due to illness (stroke, Parkinson’s disease, dementia)…or personal circumstances (intense grief, depression).
If you find yourself feeling sad or anxious, isolated or like you have nothing to look forward to: It is time to talk to a professional. Ditto if you feel like your sad, mad or hopeless feelings are interfering with daily life. One tip for boosting mood: Go outside! Force yourself to leave the house and feel the sunlight on your face. Bright light is wonderful for mood, as is exercise.
