Nicole Didyk, MD, Author at Better Health While Aging

How Sex Changes With Aging (& What You Can Do About It)

(This article is a special guest post by geriatrician Dr. Nicole Didyk, founder of the blog and YouTube channel The Wrinkle. Like me, Dr. Didyk has a particular interest in informing and empowering older adults and families. So I’ve been very glad to have her contributing to the site, and I appreciate her covering some topics that I haven’t had the time to address. Enjoy! — L. Kernisan)

Quick! Think about older adults and sex. What comes to mind? George Burns cracking wise about sex after 90 being like trying to shoot pool with a rope? A sweet old couple holding hands in their rocking chairs? Nothing?

The truth is that what pops into people’s minds, when it comes to older adults and sexuality, is often negative. For instance, it’s common for older adults to be thought of as:

“Cute” in a chaste and childlike way,
Predatory and/or “lecherous”, as in the “cougar” or the “dirty old man”, or
Problematic (think sexual behavior when someone has dementia, or sex between nursing home residents).

This, of course, is largely due to pervasive ageism in society. Sexuality, sexual expression, and the urge for physical intimacy is actually an important part of every adult person’s life.

So it’s sad that it’s so common for it to be treated as “inappropriate” or otherwise discouraged in later life. But fortunately, we’re starting to see significant progress in combatting this aspect of ageism, too.

In my job as a consultant Geriatrician, I see older adults about a wide range of issues, including memory changes, falls, pain, depression, and medication adjustment. But what is often affected by all of those medical issues – yet rarely talked about — is sex.

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Depression in Aging:
Diagnosis & Treatment When the Golden Years are Blue

by Nicole Didyk, MD

Most of us can relate to feeling sad or blue, sometimes for days at a time. It may be in response to a major life event like losing a job, a break-up, or as part of grief. These sad feelings can lead us to feel less interested in enjoyable activities, make us lose our appetite or disrupt sleep.

Although research shows that people often become happier as they age, sad feelings are also very natural and can be associated with some of the typical transitions and changes of aging. But clinical depression, from a medical point of view, is something different, and should not be considered a normal part of getting older.

In this article, I’ll explain the most important things to know about late-life depression, including:

What’s different about depression in later life?
What are the symptoms of depression and how is clinical depression diagnosed (especially in an older person who may also have medical illnesses that can mimic depression symptoms)?
What does testing for depression look like?
What treatments are recommended for older adults with clinical depression?
What you can do if you’re worried that someone is depressed, and how to help someone with depression.

In an upcoming article, I’ll also cover the special considerations and challenges when it comes to diagnosing and treating depression in those living with dementia, which is a common scenario in my practice as a geriatrician.

Depression in Later Life

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Urinary Incontinence in Aging:
What to know when you can’t wait to go

by Nicole Didyk, MD

“I know where every bathroom is at the mall, and my wife rolls her eyes every time I have to visit one when we just arrived – even after I went before leaving the house! What can I expect? Most old guys are in the same boat!”

If you opened this article, you probably relate to the quote above, and you’re not unlike millions of other older adults.

Incontinence doesn’t always mean wetting yourself. It can involve urgent needs to use the toilet, frequent bathroom trips, or losing tiny amounts of urine with certain activities.

Incontinence is more than inconvenient; it can be life-altering, leading to early retirement or social withdrawal, depression, and loss of independent function. Important incontinence stats include:

1 in 3 older women and 1 in 12 older men have lower urinary tract symptoms that can include incontinence
Urinary incontinence cost the US economy $66 billion in 2012
6-10% of nursing home admissions are due to urinary incontinence
Only 22% of men with urinary incontinence seek help for the problem, as compared to 45% of women

For this reason, in geriatrics, we often ask our patients about incontinence.

A while back I had the opportunity to talk to Dr. Adrian Wagg, a Geriatrician-Internist and international expert in urinary incontinence. You can listen to this interview, and find out how to download a transcript of it here. In this article, I’ll share some of his insights about the management of incontinence in older adults, and why it remains undertreated too often.

In particular, I’ll cover:

How urinary function changes with age
Types and causes of urinary incontinence in both men and women
What to do if you’re experiencing urinary incontinence and want help
How to help manage urinary incontinence in an older person you’re caring for

What happens to the Urinary System with Aging?

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Leg Swelling in Aging: What to Know & What to Do

by Nicole Didyk, MD

Swelling in the lower legs – known as “lower extremity edema” in medical terms – is a problem that often affects older adults.

The good news is that most of the time, it’s annoying, but not terribly dangerous. However, in other cases, swelling in the feet, ankles, or lower legs can be the sign of a new health problem, or a worsening chronic condition.

And, even if it’s “benign” and not related to a dangerous health condition, edema can be a major risk factor for skin breakdown and reduced mobility in aging adults.

Since leg swelling becomes so common as people get older, in this article we’ll demystify leg edema and cover the most important things that older adults and families should know about this condition. In particular, we’ll cover:

How does edema happen?
Common causes of swollen ankles or legs in aging adults
Medications that can cause leg swelling as a side-effect
How leg swelling should be medically evaluated
How to prevent and treat leg swelling
What to know BEFORE going on a “water pill”

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Sex When Caregiving: Navigating Your Changing Relationship (Even if There’s Dementia)

by Nicole Didyk, MD

(This article is part 2 of a special guest series by geriatrician Dr. Nicole Didyk, founder of the blog and YouTube channel The Wrinkle. Like me, Dr. Didyk has a particular interest in informing and empowering older adults and families. So I’ve been very glad to have her contributing to the site these past few years — you may have noticed she’s been helping me answer comments — and I’m thrilled to say she’ll be covering some topics that I haven’t yet had the time to address. Enjoy! — L. Kernisan)

Let me begin by sharing a true story:

One of the most unforgettable couples I ever worked with was Grace and David. Grace developed Alzheimer’s at the age of 63, and within 2 years of diagnosis, her symptoms were such that she moved into a long-term care home and used a wheelchair to get around.

She and David had been married for 42 years, had 4 kids, a dairy farm, and a warm and affectionate marriage. David continued to visit Grace 3 times a week, until her death (after a bout of pneumonia) at the age of 69, and in the last two years, his girlfriend, Linda, accompanied him almost every time.

I remember being so touched by the way that David and his new partner lovingly advocated for Grace when she needed it, with both stepping in to provide hands-on care when staff at the home were overwhelmed. There were some who judged David for so boldly “having an affair”, but most saw his involvement in a new relationship as a much-needed respite for him, and a way to expand the circle of love for Grace.

Have you ever met a couple like Grace and David? Keep their story in mind, as I share more about Sex and Caregiving, and Sex and the Changing Brain.

How does sex and intimacy change when one partner becomes a caregiver?

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Depression in Later Life

What happens to the Urinary System with Aging?

How does sex and intimacy change when one partner becomes a caregiver?

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