7 Commonly Neglected Problems to Address for Healthier Aging:
The Healthy Aging Checklist Part 3

This is the third in a series of posts covering the Healthy Aging Checklist.

Again, the Healthy Aging Checklist summarizes the six fundamental activities I recommend when asked what to do to maintain the best possible health while aging. They are:

• Promote brain health and emotional well-being.
• Promote physical health.
• Check for and address common aging health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
• Learn to optimize the management of any chronic conditions.
• Get recommended preventive health services for older adults.
• Address medical, legal, and financial advance care planning.

In this post, I’ll cover the third item: addressing commonly neglected aging health problems that routinely sabotage healthy aging.

These issues are sometimes referred to as geriatric syndromes. They affect health and quality of life, and although they happen more in people who are older or frailer, they affect countless people in their 60s and 70s as well.

Virtually all of these issues affect a older adults’s ability to socialize, be physically active, and take good care of himself or herself.  So addressing these is key to enabling healthier aging.

Unfortunately, these issues routinely fall through the cracks of usual medical care. People often suffer from these problems for years without anyone taking effective action.

This may be because many people — doctors, older adults themselves, or family members — assume nothing can be done about these, and that they are just “part of getting old.”

Don’t believe that.  We have studied these problems in geriatrics and most of the time, correctly evaluating and then managing these problems helps older adults and their families feel better, live better, and sometimes even live longer.

Remember, healthy aging is not just about preventing problems. It’s also about spotting them and addressing them before they get worse, or drag down the rest of your health and independence.

So for healthier aging, be proactive in checking for these oft-neglected problems.

And then remember: sub-optimal treatment of these problems is all too common. So you’ll need to be proactive about getting them correctly managed — which might mean either seeing a geriatrician (here’s how to find a geriatrician) or making sure your usual doctor is thinking like one.

Here’s what to look for, and how to learn more:

7 Common Problems to Check for and Address for Healthier Aging

1. Falls

Why: Falls are very common in older adults. Many falls cause only minor injuries, but they are scary and can cause older adults to restrict their activities. In fact, fear of falling is common and has been linked to decreased involvement in activities; it’s also a risk factor for future falls.

More substantial falls can cause life-changing injuries such as broken hips and head injuries, which are a major reason for people leaving their homes.

Note: Most falls in older adults are due to a combination of underlying risk factors or health problems. Insufficient strength or balance is usually one of the problems — which can be addressed with the right exercises — but it’s good to check for other factors, such as medication side-effects or even a new illness.

For more information:

• CDC STEADI Materials for Older Adults (see here for PDF to check your risk factors)
• Why Older People Fall
• How to Prevent Falls: 4 Proven Approaches to Ask the Doctor About
• 8 Things to Have the Doctor Check After an Aging Person Falls
• Videos Illustrating Otago Exercises for Fall Prevention

2. Memory concerns

Why: Memory concerns often cause anxiety for older adults and families. They may — or may not — reflect substantial decreases in thinking abilities. Evaluation helps by providing a more objective measure of whether a person is cognitively impaired, and to what extent. Even more importantly, evaluation can uncover treatable causes of decreased brain function, such as medication side-effects, thyroid problems, and a variety of other problems which are common in older adults.

Note: People are often reluctant to have memory concerns evaluated because they are worried that it could be Alzheimer’s disease or another dementia. They also may believe that “nothing can be done.” It can help to tell people that we can often find ways to improve a person’s brain function, either by identifying and treating an underlying health problem or by encouraging the activities that promote brain health.

For more information:

• Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
• How We Diagnose Dementia: The Practical Basics to Know (this post explains exactly how I evaluate memory concerns and tells you how to prepare to see a doctor for this purpose.)

3. Depression

Why: Although healthy older adults have lower rates of depression than the general public, depression is still a common problem that is easily missed. It’s more common in those who are struggling with illness, involved in caregiving, or socially isolated. It’s important to spot and treat depression, as this is key to better quality of life and greater involvement in social activities. It can also enable older adults to better manage any health problems they have, such as chronic diseases or pain.

Note: One important sign of depression in older adults is “anhedonia,” which means one stops enjoying activities that used to bring pleasure. If you notice this in an older person — or yourself — it’s important to get help. Studies show that medication and psychotherapy are generally equally effective in mild-moderate depression, but non-drug treatment often isn’t offered unless you ask. Among medications, the selective serotonin reuptake inhibitors (SSRIs) sertraline and escitalopram tend to have fewer side-effects and drug interactions. Avoid paroxetine (Paxil) as it is anticholinergic, which means it dampens brain function.

For more information:

• Depression in Aging: Diagnosis & Treatment When the Golden Years are Blue
• Pharmacological Treatment of Depression in the Elderly (review article written for family physicians; walks the reader through a nice real-life example)

4. Urinary Incontinence

Why: Having chronic difficulties controlling one’s bladder is a common problem for older adults, and tends to get worse with aging. It affects both men and women, although it may have different underlying causes, such as prostate enlargement in men. It is often embarrassing, can cause aging adults to restrict their social or physical activities, and has been linked to depression.

Note: Incontinence comes in different “types,” each of which can have different causes. Correctly identifying the type and causes is key to effective treatment. Finding suitable pads to manage leaks can also make a big difference. (Ask a support group for advice; the average doctor knows little about specific incontinence supplies.)

Do remember that medications to treat overactive bladder are usually quite anticholinergic, hence they are risky for brain function.  To help a doctor evaluate incontinence, it’s helpful to log your symptoms in a voiding diary for 3 days prior to the appointment.

For more information:

• Urinary Incontinence in Aging: What to know when you can’t wait to go
• Bladder Control Problems (Urinary Incontinence)
• Bladder Issues in Men (Lower Urinary Tract Symptoms)

5. Pain

Why:  Surveys suggest that about 50% of all adults aged 65+ experience bothersome pain every month, often in multiple parts of the body. Persisting pain is linked with decreased social and physical activity, depression, and taking worse care of one’s own health.  Pain can also be the sign of a new health problem that needs attention or a chronic problem that’s being inadequately managed.

Note: Pain can and should be managed by non-drug approaches whenever possible. Studies have found that pain can often be lessened through certain types of psychotherapy, exercises or physical therapy, and many other approaches. Treatment with medication may still be necessary, especially for short-term purposes or in combination with other approaches. Bear in mind that many over-the-counter pain medications (such as Advil and Motrin) are non-steroidal anti-inflammatory drugs (NSAIDs), which are risky for older adults when used chronically or in high doses.

For more information:

• Pain Management in Older Adults: Tools & Tips
• How to Choose the Safest Over-the-Counter Painkiller for Older Adults

6. Isolation and loneliness

Why: Both isolation (not having a lot of social contact with others) and loneliness (the feeling of lacking social connection) have been linked to declines in physical health. A 2012 study found that 43% of older adults reported feeling lonely; over the next 6 years, they were more likely to lose physical abilities or die. Loneliness and isolation have also been linked to decreased immune function and greater risk of depression.

Note: Older adults who live alone or have been bereaved are at particular risk, especially if health problems are interfering with their ability to get out and about. But even people who are in proximity to others — such as family caregivers or older adults residing in a facility — may suffer from feeling lonely.

Studies have found that certain psychotherapies — including mindfulness — can help reduce feelings of loneliness and even inflammation in the body. However, another study found that isolation seems to be a stronger risk factor for premature death than loneliness, so it’s important to relieve social isolation as well. Arranging more social contact usually helps. Arranging for volunteering or some kind of purposeful activity can be even better.

It’s also vital to address any health concerns (including fear of falling, incontinence, or pain) that may be keeping an older person from getting out and about.

For older adults who are lonely or possibly even depressed, the Institute on Aging offers a Friendship Line designed for older adults.

For more information:

• Isolation V. Loneliness: The Difference And Why It Matters
• 14 Ways to Help Seniors Avoid Social Isolation

7. Polypharmacy (Taking Multiple Medications)

Why: Polypharmacy means taking multiple medications. It’s a problem mainly because as people get older, they become especially at risk for harm from medication side-effects or interactions. According to the CDC, every year 177,000 older adults visit the emergency room due to medication problems.

Polypharmacy also burdens older adults because purchasing all those drugs can be costly, plus it can be a real hassle to have to take medications at several times every day. Last but not least, when people have been prescribed many medications, it’s harder for them to take them correctly. This can lead to worsening of a chronic condition, or even misguided medical care as doctors may fail to realize that a patient hasn’t been able to take all medication as directed.

Note: The main thing you should know is that many older adults are taking medications they don’t really need. It’s basically much easier for doctors to prescribe medications than to “deprescribe.” Research has documented that inappropriate prescribing of medications is common. A careful medication review will often identify medications that are marginally useful or no longer necessary, but you may not get such a review unless you request it.

For more information:

• How to Review Medications for Safety & Appropriateness
• Deprescribing: How to Be on Less Medication for Healthier Aging
• MedStopper.com (Pharmacist-created online resource designed to help with deprescribing)

Have these problems been sabotaging your healthy aging?

If so, I hope the resources above will help you take action.

Now, I’ll admit that it can be very difficult to completely eliminate the problems above in some older adults.

But you have to try, especially if the problem is bothering a person or interfering with life activities. And you have to find professionals who will use the best-available knowledge to help you do so.

When we make a good effort, we can almost always improve an older person’s ability to be out in the world, doing the things they want to be doing, and doing things that are good for their health.

And that promotes healthy aging. So don’t let these problems fester and sabotage late-life health. Good luck!