Welcome. You’re doing the right thing by informing yourself about conditions and diseases common among adults 65 and older. These illnesses affect elderly people differently from younger folks. That’s why you’ll find a basic description for each one, followed by facts on how it affects seniors in unique ways.

You’ll also find an overview of diagnostic tests your doctor is likely to suggest, and you’ll learn about the most common treatments. Of course, your geriatrician will discuss everything with you in much more detail.

For additional resources on conditions common to seniors you can visit Health in Aging website as well as the National Institute on Aging.

Shortcuts to condition infromation:

Anxiety

What is anxiety?
It's normal and sometimes even helpful to feel a little anxious occasionally. Feeling a bit worried can help you focus on a task and get it done. But too much anxiety, all the time, is not normal— and not helpful. It can make it harder to focus and accomplish tasks. And anxiety can interfere with managing daily activities or enjoying life.

Anxiety

How is anxiety different in older people?
As many as 14 percent of older adults have anxiety problems. These disorders are more common among older women than older men. In later life, people can develop anxiety during stressful events, such as a serious illness, the loss of a spouse or other close relative or friend, or when financial problems arise.

What tests can I expect?
Your doctor will probably start by simply asking you questions about what’s happening in your life, probing for a reason for your anxiety. The doctor will also look for signs that your anxiety is connected to a medical condition. He or she will review your medical records, do a physical examination, and possibly order blood or urine tests.

How is anxiety treated?
Most anxiety can be treated through psychotherapy (“talk therapy”) and/or medication. Psychotherapy involves talking with either a psychiatrist, psychologist or trained social worker, in order to understand what’s causing your anxiety and how to reduce it. Medication may be considered as well.

For evaluation and other mental health services go to the Division of Geriatric Psychiatry of Mount Sinai Beth Israel.

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Atherosclerosis

What is atherosclerosis?
Some changes in the heart and blood vessels are normal as you grow older. But over time, disease can damage your blood vessels and heart. This is the case with atherosclerosis, which is the buildup of fatty deposits (plaque) along the walls of arteries. The buildup narrows the arteries, reducing the blood flow to all parts of the body, including the heart. This can lead to heart disease.

Atherosclerosis

How is atherosclerosis different in older people?
This is a common problem in older people. One reason is that over time, cholesterol—which is a fat in the body—can keep adding to the plaque building up in your arteries, causing these vessels to narrow. The narrowing of the arteries can lead to a number of health issues including stroke, blood clots, poor circulation and many more.

What tests can I expect?
Your doctor may find signs of narrowed arteries during a physical exam. If so, he or she may suggest one or more tests, including: blood tests, a Doppler ultrasound (to measure blood pressure at various points along your arm or leg, which helps reveal the degree of any blockages), an ankle-brachial index (shows narrowing in the arteries of your legs and feet), an electrocardiogram (ECG), or a stress test.

How is atherosclerosis treated?
Lifestyle changes, such as eating healthily and exercising, are often the best treatment. Other treatment involves various drugs that slow—sometimes even reverse—the condition. If you have severe symptoms or a blockage that’s endangering the health of muscle or tissue, you may be a candidate for various surgical procedures. If surgery is required, your geriatrics physician will work closely with the surgeon to prepare you for the surgery and help during your recovery.

For more information, see the American Heart Association website, at: www.heart.org

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Atrial Fibrillation

What is atrial fibrillation?
Normally, the four chambers of the heart (the two upper atria and the two lower ventricles) contract in a coordinated way. But a heart rhythm disorder can disrupt the normal pattern of contractions. The result is an irregular and unusually fast pulse.

Atrial Fibrillation

How is atrial fibrillation different in older people?
The condition becomes more common with increasing age. Among the causes are: coronary artery disease, heart surgery, high blood pressure, medications, and an overactive thyroid gland.

What tests can I expect?
Your doctor may hear a fast heartbeat while listening to your heart with a stethoscope. Your pulse may feel rapid, irregular, or both. An ECG can reveal this condition. You may need to have your heart monitored over a 24-hour period using a Holter monitor, since the irregular beats often occur at some times and not others. Your doctor may suggest other tests to find underlying heart disease.

How is atrial fibrillation treated?
Medication can usually slow the heart down. Sometimes, however, emergency treatment is needed to get the heart back into a normal rhythm. This treatment can involve electrical cardioversion or intravenous drugs. Sometimes blood thinners are prescribed to prevent blood clots and strokes.

For more information, see the American Heart Association website, at: www.heart.org

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Constipation

Fiber

What is constipation?
This ailment involves having trouble making a bowel movement, or being unable to. The condition usually involves straining to defecate, and a feeling of never having defecated enough, even if something comes out.

How is constipation different in older people?
Constipation is common among older adults. Although it is not a result of normal aging, the fact that many seniors move less, have other medical conditions, and take more medications, makes them more vulnerable to constipation.

What tests can I expect?
Your doctor will ask you questions and conduct a physical exam to help pinpoint the causes of your constipation. After examining your abdomen, anus and other parts of the body, your doctor may suggest lab tests, an X-ray or a sigmoidoscopy or colonoscopy to examine the rectum or colon in more detail.

How is constipation treated?
After evaluating for other problems, your doctor may suggest one or more of the following treatments: Change your diet to include foods (such as high-fiber crackers and vegetables) that help the body form and eliminate stool, drink more fluids, add bulk-forming supplements to your diet, and move more—increased activity gets things “moving.”

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Delirium

What is delirium?
Most of us have noticed problems with memory and understanding as we get older. We forget names or take more time figuring out directions. This can be a normal part of aging. But delirium, which involves sudden and extreme problems with memory, understanding or thinking, is not an automatic result of aging. Examples are getting lost walking to the bathroom, becoming confused by simple tasks, forgetting the names of loved ones, and having trouble speaking logically.

Many of delirium’s symptoms are the same as those for dementia. In fact, people with dementia are at high risk for developing delirium, and the conditions often occur together. However, here’s the difference: When the behavior or thinking of a person with dementia suddenly gets much worse, it might be delirium.

How is delirium different in older people?
Delirium is especially common in older people. Records show that one-third of older adults arriving at emergency rooms are delirious. For older adults in a hospital, delirium is one of the most common complications of illness or recovery from surgery.

What tests can I expect?
Your doctor’s diagnosis will be based on careful observation, and if necessary, testing. To evaluate thinking, doctors use a set of simple in-office or bedsides tests and questions. They will look for other causes of the worsening confusion, such as infection, pain, medication, anemia or a change in environment. Your doctor may also ask for other tests, for example, a neurological exam (to test feeling, thinking and motor function), X-rays or blood tests.

How is delirium treated?
Once an older patient develops delirium, it’s very important to manage the environment so he or she feel oriented. The feeling of being in a safe, stable environment helps greatly. This means not moving from one room to another unnecessarily, and keeping to a regular schedule for meals, exercise and other daily activities. Everyone involved needs to do everything possible to reduce the fear and anxiety a delirious person often feels. In addition, the physician will probably stop or reduce drugs that might play a role. Sometimes medication is used if there is sever agitation. Delirium may take weeks or even months to subside.

For more information, go to the Geriatric Mental Health Foundation.

For evaluation and other mental health services go to the Division of Geriatric Psychiatry of Mount Sinai Beth Israel.

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Depression

What is depression?
We all feel sad from time to time. But depression is different. It can take the form of long-term deep sadness, anger, frustration, and emptiness. It can drain your energy and interfere with your ability to work and have healthy relationships. It can even lead to thoughts of suicide.

Depression

How is depression different for older people?
Major or "clinical" depression is the most severe and persistent type, and it is fairly common in later life. There are several reasons why: First, some symptoms of major depression resemble symptoms of dementia, and can accompany dementia. Also, if you are suffering from a chronic disease like diabetes, cancer or heart disease, as many elderly are, your risk of depression is higher. Last, seniors take more medications, and sometimes their side effects can contribute to depression.

What tests can I expect?
Your physician will ask you questions about yourself, focusing on your feelings and your mood. The doctor may also use screening tests and questionnaires that reveal depression. He or she will also determine if your symptoms might be due to a physical condition, such as a nutritional deficiency (for example, low Vitamin B12 levels).

How is depression treated?
Depression in older adults is treated in various ways, and sometimes techniques are used in combination. The most common approaches are psychotherapy (“talk therapy”) and antidepressant medications. About half of adults with major depression respond well to drug treatment within six weeks. Another 15-25% of adults just begin to respond during the first six weeks, then continue to improve on the medication for another four to six weeks.

For more information, go to the Geriatric Mental Health Foundation.

For evaluation and other mental health services go to the Division of Geriatric Psychiatry of Mount Sinai Beth Israel.

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Diabetes –Type 1 and Type 2

What is diabetes?
Diabetes develops when the amount of sugar in your blood becomes too high. This can be because your body doesn't make enough insulin (Type 1 diabetes), or because your body doesn't produce enough insulin or your cells can't use insulin properly (Type 2 diabetes).

Diabetes

Here's why insulin is so important: When your body digests food, it converts much of it to a sugar called glucose, which acts as fuel for your body. The hormone insulin helps your body use glucose, and also helps maintain a healthy level of glucose in your blood.

When your body produces too little insulin, or can't respond to it, glucose tends to remain in your bloodstream, instead of going into your cells. This can lead to many major health problems, some life-threatening. Persistently high levels of sugar in your blood can damage your blood vessels, which in turn, can lead to stroke, heart attack, kidney disease, vision loss, and more.

How is diabetes different in older people?
Type 2 diabetes is more common in older adults. Being overweight also increases your chance of developing Type 2 diabetes. The good news is that most people— including older adults—can prevent or control Type 2 diabetes by eating a healthy diet and being physically active. According to a study of people at high risk for diabetes, people ages 60 and older who lost weight and exercised reduced the development of diabetes by 71%, compared to people who didn't make those changes.

What tests can I expect?
The test for a diagnosis of diabetes is simple. Your doctor uses a blood test to check the level of glucose (sugar) in your blood.

NOTE: It’s important to know that medications can sometimes raise your blood sugar. So before your blood test, you need to give your doctor a complete list of everything you’re taking – prescriptions, over-the-counter medications, vitamins, even herbal or other supplements.

How is diabetes treated?
The good news is, you can take steps right away to treat and manage diabetes—and prevent complications. Even a weight loss of 10 to 15 pounds can dramatically lower your blood glucose level. Exercise (doesn’t have to be strenuous) helps you lose weight and helps bring down the level of sugar in your blood. Even a small increase in physical activity goes a long way. Other treatments include oral medications to lower glucose and, if diet, exercise and medications don’t bring your blood sugar level to a healthy level, your doctor may suggest taking insulin. If your blood sugar levels are very high, your doctor may recommend insulin first.

For more information, see the American Diabetes Association website, at: www.diabetes.org

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Emphysema

What is emphysema?
This chronic condition damages the lungs' ability to work properly, and decreases the amount of oxygen your body is using. It starts when chronic infections and irritation within the lung— most often caused by smoking— harm the air sacs where oxygen and carbon dioxide (with its toxins) are exchanged. Oxygen gets into the sacs, but the carbon dioxide has trouble getting out. This means the body is not completely expelling the waste products in the carbon dioxide. In addition, because some carbon dioxide remains in the air sacs, there is less room for oxygen. You are simply running on less oxygen. As the body slowly begins to build up a tolerance for less oxygen and more carbon dioxide with its toxins, all body cells are hurt by this imbalance.

Emphysema

How is emphysema different in older people?
After age 50, the symptoms progress more rapidly. For older people who may also have osteoporosis—thinner and more fragile bones—coughing from emphysema can be severe enough to fracture the ribs. Medications use to treat emphysema may affect other medical conditions.

What tests can I expect?
Your physician will start by studying your complete medical history and giving you a physical examination. He or she may suggest one or more of these tests: laboratory tests of blood, urine and possibly saliva; blood from your arteries to determine how much oxygen you’re taking in; lung function studies (breathing studies); and X-rays of your lungs.

How is emphysema treated?
Treatment focuses on relieving your symptoms. Possible medications include: antibiotics, bronchodilators and steroid therapy. Drinking more fluids helps because it keeps secretions in the lungs thin. Breathing exercises combined with fitness training can also help, as this increases the amount of oxygen you’re taking in. You may ultimately need additional oxygen.

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Failure to Thrive

Failure to Thrive

What is failure to thrive?
This term refers to a general decline that occurs specifically in older people, and includes frailty, disability and psychiatric problems. More precisely, it typically involves all of the following:

  • Weight loss
  • Decreased appetite and poor nutrition
  • Dehydration
  • Inactivity
  • Depression
  • Impaired immune function

What tests can I expect?
Your doctor can conduct some diagnostic tests right in the office. He/she will evaluate cognitive ability, look for depression, medication problems or other medical issues. Lab tests include a complete blood count, chemistries, thyroid tests, hormone tests and urinalysis. Side effects of drugs or drug interactions need to be ruled out, as does the impact of chronic diseases.

How is failure to thrive treated?
Physical therapy and exercise can help counteract muscular weakness. Improving diet and dietary supplements can help with weight loss. On the other hand, geriatrics caregivers understand that this condition may represent a turning-point for an elderly patient, even a conscious choice on their part. In this case, it is appropriate to discuss end-of-life care issues.

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High Blood Pressure

What is high blood pressure?
If you have this condition, your heart is pushing blood with abnormally high pressure through your arteries. Over time, if the force of the blood flow remains high, the tissue that makes up the walls of your arteries gets stretched beyond its healthy limit. This creates many problems.

Also known as hypertension, high blood pressure is sometimes called "the silent killer" because it produces few or no symptoms. So it's easy to not even realize you've got high blood pressure. But left untreated, this condition can lead to heart attacks, strokes, kidney disease, eye diseases and other serious problems.

Bloodpressure © 2012 Jeffrey M. Levine

How is high blood pressure different in older people?
90 percent of people with normal blood pressure at age 55 are at risk for developing high blood pressure as they age. In fact, over half of people age 60 and older have some degree of high blood pressure. African Americans have the highest rate of high blood pressure of any race/ethnic group in the U.S.

What tests can I expect?
Your doctor will take your blood pressure in the office. If it’s high, the doctor will check for any illnesses that might be causing it—or that it is causing. These can include heart problems, kidney disease, diabetes or eye problems. This will involve a routine history and physical examination, along with blood and urine tests. To make sure the reading is accurate, your doctor may measure your blood pressure while you're lying down, and again when you’re standing, and may do this during more than one visit.

How is high blood pressure treated?
The goal of treatment is to lower your blood pressure and as a result, to lower your risk of heart disease and stroke. Your doctor will probably first recommend changes in diet (for example, cutting back on salt) and lifestyle (for example, reducing stress and exercising).

If lifestyle changes don't help, or if you have extremely high blood pressure, your doctor will recommend medications. The first might be a diuretic (a water pill) if this approach doesn't work, your physician will recommend one of a variety of medications.

For more information, visit the American Heart Association website, at: www.heart.org

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High Cholesterol

What is high cholesterol?
Cholesterol is a type of fat in some foods. Eating fatty foods can raise the cholesterol in your blood. When a person has high cholesterol levels, this substance often starts to build up in the arteries, contributing to a waxy material called plaque. As a result the arteries become narrowed and less blood reaches all parts of the body. This can cause many serious problems, including heart disease.

High Cholesterol

How is high cholesterol different in older people?
Having high cholesterol is never a good thing. But as we get older, it becomes more dangerous. Here’s why: Our risk of developing diabetes and heart disease increases with age. High cholesterol is a major contributor to heart disease, stroke and diabetes. That’s why it becomes especially dangerous in elderly people. The good news is that by reducing our cholesterol, we lower our risk of developing these serious diseases. Often, we can bring it down to a healthy level just by making changes to our diet and becoming more active.

What tests can I expect?
Your doctor can check your cholesterol level with a blood test. This reveals your total cholesterol level as well as the LDLs (“bad” cholesterol), HDLs (“healthy” cholesterol), and triglycerides (another type of fat in the flood that puts you at risk for heart problems). It is better to test these after fasting overnight.

How is high cholesterol treated?
Eating a healthy diet (your doctor will explain which foods are good cholesterol-busters), exercising and losing weight are often very effective in bringing cholesterol down to healthy levels. Medications are another commonly used approach.

For more information, visit the American Heart Association website, at: www.heart.org

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Lower Back Pain

What is lower back pain?
When we are young, lower back pain can be caused by distortion of the gel-like discs sandwiched between—and cushioning—the vertebrae of the lower back. Low back pain can also be caused by muscle spasm, strain or changes in the spine, including those produced by arthritis.

Lower Back Pain

How is low back pain different in older people?
As we age, these disks lose much of their water content and are less likely to become distorted. However, the drying-out and flattening of the disks allows disks that are next to each other to touch, and this increases the wear and tear on their cartilage. As cartilage degenerates, bony outgrowths (commonly called "bone spurs") may compress nerve roots, causing pain. This pain can become chronic, reducing mobility.

What tests can I expect?
Your doctor will take a history of your lower back problems, and perform a physical examination. Further tests can include blood and urine tests, X-rays, CAT scan, MRI scan and tests of the nerves and muscles.

How is lower back pain treated?
Lower back pain has so many different causes, it’s nearly impossible to discuss the full range of possible treatments. Once your doctor determines the precise cause of your lower back pain, he or she will suggest an appropriate course of treatment. Low back pain can be acute (you’ve had it less than three months) or chronic (you’d had it more than three months). The acute type usually responds to heat or ice, pain medication, and not too much rest. For the chronic variety, your doctor may prescribe physical therapy, stronger pain medication or a muscle relaxant.

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Memory concerns: Dementia and Alzheimer's Disease

What is dementia?
Dementia is a decline in memory and other mental abilities that makes daily living difficult. Alzheimer’s Disease is the most common type of dementia. Symptoms include problems with memory, language, and decision-making abilities. People can also suffer changes in mood, becoming irritable, depressed, anxious and sometimes agitated.

How are dementia and Alzheimer’s disease different in older people?
About seven percent of adults ages 60 and over suffer from dementia. Alzheimer's disease—damage to the brain due to abnormal changes in certain areas—is the most common cause of dementia among older people. Usually, the first symptoms of Alzheimer's appear after age 60. This slowly progressing disease has three stages: an early stage with minor symptoms; a middle stage of mild-to-moderate memory impairment; and a final stage of Alzheimer's dementia in which memory and thinking skills are severely affected, along with the ability to carry out the simplest tasks of daily living.

The second most common (NON-Alzheimer’s) type of dementia is called vascular dementia. This is caused by a series of strokes or changes in the blood supply to the brain.

What tests can I expect?
NOTE: It is important to be evaluated for memory issues to make sure they are not caused by something that is reversible— for example, a medication, metabolic problem, or infection.

Testing can start in our office, with a lab analysis of blood (which can reveal a vitamin deficiency or thyroid problem), and a brief memory evaluation. Referrals might include an MRI or CT scan of your head (to reveal brain tumors or evidence of stroke), or more extensive memory tests performed by a neurologist. If there are behavioral or mood concerns, we can refer to a psychiatrist. Depression, for example, can cause temporary confusion and memory problems.

How are dementia and Alzheimer’s disease treated?
There is no cure for either Alzheimer’s disease or vascular dementia. However, there are medications and strategies that can slow decline, and help you make the most of the abilities you have, at each stage, in order to enjoy the best possible quality of life.

For more information, visit the Alzheimer’s Association website, at: www.alz.org

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Osteoarthritis

What is osteoarthritis?
Osteoarthritis is the most common form of arthritis. It is a disease of the joints. Cartilage is a slippery tissue covering the ends of the bones in a joint, which lets your bones glide over each other as you move. When you have osteoarthritis, the top layer of cartilage has broken down and worn away. This lets the bones below rub against one another. That’s why you feel pain, swelling and loss of motion in that joint. The condition usually affects the joints of the hands, knees, hips and spine.

Joint Pain

How is osteoarthritis different in older people?
Osteoarthritis occurs in older people because it's usually the result of many years of wear and tear on your body, most likely from normal physical activity or possibly from past injuries. Eventually, all that movement takes its toll, especially on your joints, the places where two or more bones meet. About half of Americans over 65 have arthritis, with women slightly more prone to it. If you are either overweight or obese, your chance of developing arthritis increases.

What tests can I expect?
Diagnosis of osteoarthritis will include one or several of the following: a physical examination by your doctor; X-rays to show bone damage, loss of cartilage, bone spurs, debris in the affected joint and other damage; MRI to show the soft tissues of your joints; joint aspiration (fluid drawn from within your joint is examined for bacteria); and possibly blood tests.

How is osteoarthritis treated?
The condition is treated with various approaches, often in combination. These include: medications to control pain and joint swelling; exercise; rest and joint care; and surgery for severe damage that’s having an extreme negative effect on your daily life.

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Osteoporosis

What is osteoporosis?
This condition involves the thinning of the bones, loss of bone density, and increasingly fragile bones that break or fracture easily. It is a result of a process that develops gradually over many years as we age. Our bodies are constantly renewing and repairing bone tissue, breaking down old damaged bone and producing new healthy bone in its place. But this process changes as we age.

Osteoporosis

How is osteoporosis different in older people?
As we age, the healthy process in which old bone breaks down and new bone takes its place, becomes unbalanced. Now, more bone is lost than new bone is formed. Bone loss is especially noticeable in women after menopause, because they no longer produce the hormone estrogen. Older women can lose up to seven percent of their bone every year. Older men also lose bone, since they produce less of the hormone testosterone, but their bone loss is more gradual.

The first sign that bones are thin or fragile may be a fracture after a minor strain, fall, bend— even a cough. A fracture usually means your osteoporosis is serious. About one in five American women over 50 already has osteoporosis.

What tests can I expect?
Your doctor will check your bone health by first asking you questions about your risk factors for osteoporosis, in other words, whether you are prone to the condition. You will also have a test called a DEXA or DXA scan (dual-energy x-ray absorptiometry scan). This safe and painless test uses low-level X-rays to determine how much calcium is in your bones. That figure is called your bone mineral density or bone mass density. You’ll probably be measured at the hip and spine.

How is osteoporosis treated?
Treatment can slow down bone loss—and even improve your bone density. In other words, you can often reverse the condition. This, in turn, lowers the risk of fractures and falls. Non-drug approaches can be extremely effective, especially regular exercise. Research shows that moderate to vigorous exercise at least three times a week makes bones stronger, increases bone mass and reduces fractures. Weight-bearing exercise, like walking—which puts a healthy stress on your bones – is particularly effective. Muscle-strengthening or “resistance” exercises— in which you push against weights or weight machines—are also effective. You may be surprised to learn that Yoga and Pilates are resistance techniques. In addition, eating foods high in calcium – the main building block of your bones—is essential on a daily basis. It is also important to take in adequate Vitamin D. Your health care provider might consider medication called bisphosphonates to help strengthen your bones.

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Pressure Sores (Bedsores)

What are pressure sores?
Pressure sores are wounds to the skin and the tissue below the skin. They result mainly from lack of movement. When a person can't easily change position while seated or in bed, this puts prolonged pressure on the same patch of skin covering bony areas of the body—heels, ankles, hips or buttocks. This continual pressure against the skin (because the person isn't shifting their position) prevents enough blood from reaching the skin and the underlying tissues. This lack of blood, which carries oxygen and nutrients, causes sores. Bedsores can develop quickly and they can be very hard to treat especially in individuals with limited mobility.

How are pressure sores different in older people?
Older people are more susceptible to bedsores for many reasons. Seniors are more likely to be immobile or to not move very much, due to poor health or weakness, injury, illness that requires bed rest or a wheelchair, or recovery after surgery. Also, the skin of older adults is generally more fragile, thinner, less elastic and drier. What's more, we generate new skin cells more slowly as we age. All these changes in the skin make it more vulnerable to damage and harder to heal once the damage is done.

What tests can I expect?
Your doctor will examine the sore, looking for particular features, such as its size and depth; bleeding, fluids or debris in the wound indicating infection; odors indicating infection or dead tissue; and signs of spreading tissue damage around the sore. Your doctor will question you or your caregiver about your care, particularly about how you are being helped to change position and your doctor may also order blood tests and tissue cultures.

How are pressure sores (bedsores) treated?
They are treated in various ways. Wound care can include topical (surface) cleaning, special dressings to remove dead or infected tissue, pain management and a healthy diet. It is also very important to keep pressure off the wound. You may be advised to change positions or to use a special mattress. Sometimes a surgeon has to remove dead or infected tissues.

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Stroke

What is a stroke?
A stroke happens when normal blood flow is interrupted to some area of your brain. Your brain cells need a constant supply of fresh blood carrying oxygen and nutrients in order to survive. If blood doesn't get to brain cells—even for a very short time—the cells start to die very quickly. Because of this, you can suffer brain damage in the affected area.

Depending on the location of the stroke, you may end up with a disability because the affected part of the brain can no longer send signals to your body.

Stroke

How is stroke different in older people?
The most common type of stroke is ischemic stroke. It occurs when a blood vessel gets blocked by a blood clot or by fat deposits (plaque). Adding to the problem, the blood vessel may be already damaged from high blood pressure—and this is one factor that puts elderly people at greater risk for stroke, since they are much more likely to have high blood pressure. A stroke can also be caused by a hemorrhage or bleeding into the brain.

What tests can I expect?
Among the tests you may receive are the following: CT scan for the head or a brain MRI, angiogram, CT angiogram, echocardiogram, ultrasound and Doppler studies (to check the carotid arteries in your neck), electrocardiogram or heart rhythm monitoring tests.

In addition, your blood pressure will be checked, and your blood tested for high cholesterol, heart disease, diabetes and blood clotting time.

How is stroke treated?
Immediate treatment can include oxygen, an IV line to prevent or treat dehydration; and medications to control underlying problems such as high blood pressure. Depending on the cause of your stroke, you may receive a blood thinner (to prevent blood clots) or clot “busting” medication. You may also be evaluated for surgery to treat narrowed blood vessels. If you have disabilities from the stroke, you may need to spend time in a rehabilitation facility.

For more information, visit the American Heart Association website, at: www.heart.org

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Tinnitus and Hearing Loss

Hearing Loss

What is tinnitus?
Tinnitus is a chronic ringing, buzzing, tinkling, humming or other noise in the ears that only the affected person can hear. Treatable causes of tinnitus include high blood pressure, wax in the ear canal, or some medications (for example, aspirin, antibiotics and antidepressants). Tinnitus may also be a symptom of an ear infection, allergy or thyroid problems.

How is tinnitus different in older people?
You may be surprised to learn that nearly 36 million Americans have tinnitus. It is more common among older adults because they have a lifetime of exposure to loud noise.

What tests can I expect?
Your doctor will examine your ears, head and neck looking for possible causes of your tinnitus. Typical tests include: a hearing (audiological) exam; you’ll be asked to make certain movements to see if your tinnitus changes or worsens, which helps identify an underlying disorder; imaging tests, such as CT or MRI scans. The specific nature of the sounds you hear can also help your doctor identify an underlying cause.

How is tinnitus treated?
Your tinnitus may be caused by a treatable underlying condition. Treatment might include: earwax removal; addressing a blood vessel condition; or changing a medication that’s triggering the sounds. In other cases, your doctor may suggest using an electronic device to cover the sound, for example, a “white noise” machine. Another remedy might be wearing a hearing aid.

What is hearing loss?
It can be anything from deafness to the loss of certain kinds of hearing, like being unable to hear higher frequency sounds or to pick out words against a noisy background.

How is it different in older people?
Hearing loss is very common with aging—and is one of the most correctable yet unrecognized problems. It can be dangerous, when you don't hear the sound of your smoke detector alerting you to a fire. Sadly, it often causes social isolation. Missing out on talks with friends and family can leave you feeling anxious, upset and left out. People often withdraw when they can't follow what’s being said. Meanwhile, friends and family may think you're confused, uncaring or difficult….when it’s just that you can’t hear.

About 25 percent of people between 65 and 74 years, and 50 percent of people 75 or older report difficulty hearing. After age 60, we lose a certain amount of hearing sensitivity with each decade. Older men are more likely to have hearing loss than older women.

What tests can I expect?
Your doctor will first examine your ear canal for wax, foreign material, inflammation or other possible causes of hearing loss. If your hearing doesn’t improve, your doctor may refer you to an otolaryngologist (ear, nose and throat doctor), or to an audiologist (hearing and balance specialist) for a hearing test.

How is hearing loss treated?
Most hearing loss in older adults is treated with strategies to amplify sound. Various types of devices could be right for you, such as microphones and a transmitter; personal pocket amplifiers; or telephone ringers that make the ring louder. Or, you may be a candidate for a hearing aid—the most common amplification device. The comfort of the newer “open-fit” hearing aids, which don’t go in the ear, are appreciated by many seniors with mild to moderate hearing loss.

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