YOUR HEALTH MATTERS:
Our Brains and Bodies, Growing Older
Thomas W. Shinder, M.D.
With the "Baby Boomer" generation beginning to enter mid-life, increasing interest is being devoted to attempts to alter the so-called "degenerative" processes involved with aging. In the past, it was taken for granted that we all slow down, become weaker and less adaptive, and wait for the ravages of time to take their toll.
But those now approaching the "golden years" seem less willing to accept that it must be that way. Perhaps this bias against the inevitable process of aging is based on the spirit of the times in which the "Boomers" first came to adult awareness. We rejected the values of our parents' culture and gave unparalleled commitment and energy to changing the rules.
With the passage of the last four decades came a moderation of some of the "new" beliefs. First we discovered that you CAN trust someone over thirty, and slowly came to realize that perhaps our former feelings about the value and function of older people in society were not quite accurate. Somehow, while we weren't watching, we became the older generation. To our surprise, we're finding that at 40 or 50, we're nowhere near ready to retire to our rocking chairs and pass the torch on to the youngsters. Mentally, emotionally and psychologically, many of us are at our peak. But how do we deal with the very real -- and sometimes frightening -- physical changes taking place?
Aging is not merely an extended process of "falling apart." There are numerous physiological changes which take place as a living organism progresses through its life cycle. Many of these are positive, but some of them are viewed by our modern societies with sorrow, fear, and even repulsion. This is especially true in the United States.
One problem is that the normal changes which take place with age are not well known. Limited resources had been devoted to this area of study in the past, because of extant biases against older people in many industrial societies. Four areas that beg for further research are related to changes which take place in:
Probably the greatest fear people have about getting older is the possibility of losing their mental capabilities. Some of us have been exposed to grandparents, great-grandparents, and other older people who seemed quite "senile" or "demented." In the last two decades, Alzheimer's disease has been one of the top three causes of death in the United States. This is a disease which was literally unheard of 50 years ago, except among a small cadre of neurological specialists throughout the world.
However, here's the good news: normal aging does not include that scenario. In a large number of studies involving not only the "old" (age 65-80), but the "very old" (80-100+), normal aging produces only moderate decreases in the speed of execution of intellectual tasks, and the ability to appreciate and analyze both simple and complex concepts does not suffer with advancing age.
Recent research indicates that continuing exposure to estrogen has a significant positive impact on preserving mental abilities. This finding comes on the heels of other research indicating that long-term exposure to estrogen after menopause may not be nearly as dangerous as previously believed, in terms of the risk of possible breast, uterine, and cervical cancers.
Without some other condition which could lead to dementia (such as stroke, Alzheimer's, certain prescription medications), there is no reason to believe that memory or higher intellectual functions should be impaired as we age -- despite occasional difficulties in recalling a name or phone number.
Much more significant than feared intellectual changes are the effects of the alteration of reproductive function in women in their forties and fifties. Menopause is the most common but least understood and addressed issue in the medical circles of industrialized nations. Perhaps this has to do with the traditional medical school philosophy of teaching male physiology as the "norm" and female physiology as a "deviation" from that norm.
Menopause represents a change in brain function; this is translated to the pituitary gland which subsequently informs the ovaries that they no longer will be performing their previous duties. The output of FSH (follicle stimulating hormone) and LH (luteining hormone) ceases and the ovaries stop producing estrogen and progesterone. With the withdrawal of both of these feminine hormones come a multiplicity of changes which affect other organs in the body.
The initial symptoms of menopause are easily recognized by those who have experienced it: hot flushes, irritability, weight gain or water retention, elevation or diminution of libido, and rapid mood swings. If this sounds a little like drug withdrawal, you're not that far off.
Continuing research into the actions of estrogen and progesterone have demonstrated that these hormones act as "neurotransmitters" in the brain.
The removal of the chemical messengers leads to a significant "chemical imbalance" until the brain has time to adjust to the new neurochemical environment. While the brain's ability to adapt and change continues to be remarkable throughout life, it does take some time, and that adaptation period can last from a few months to a few years. It's with good reason that menopause is known as "the change."
Other changes involve parts of the body known to be dependent primarily on estrogen for normal functioning. The glandular tissues involved with the moisturizing of the vagina decrease their output, hair follicles decrease in both number and vitality, the skin can become drier and coarser, and the elasticity of the skin diminishes, leading to an increasing rate of wrinkle formation.
The absence of estrogen appears to be the primary factor in these changes. Estrogen is proving to be a major influence in helping maintain blood flow through the very smallest of blood vessels, known as capillaries. There is good evidence that this reduction of blood flow through the capillaries leads to the decreased function of the organs and tissues noted above.
It has also been demonstrated that continued exposure to estrogen profoundly retards this aging process and that supplemental estrogens may be very beneficial in maintaining the body in its premenopausal state. This is one situation that we CAN do something about.
Visual deterioration is perhaps the trickiest of the changes that come with aging. Those who were previously near-sighted typically find that, beginning in their early forties, they no longer require glasses to see distances that formerly might have been impossible without some help. This is part of the normal change which takes place in the shape of the eyeballs and is known as presbyopia ("presby" meaning "old," and "opia" meaning "vision").
This process of presbyopia often continues to the extent that the person will require bifocals, or glasses which allow for both near and far vision.
Recent advances in lens technology have taken much of the stigma away from wearing bifocals, and today it is not easily apparent from looking at a person's glasses that she is wearing them. "Bifocal" contact lenses are available at reasonable prices as well. Advances in "RK" (radial keratotomy, a type of simple surgery) may make it possible to eliminate wearing corrective lenses completely.
Cataracts are the bane of the visual changes which commonly take place with advancing years. Vision appears to blur for both near and far objects, and often a person with early cataract formation will see a slight "halo" around objects (not unlike the halo seen around the moon in certain weather conditions; this phenomenon is also noted in some of Van Gogh's paintings, indicating that he suffered from cataract formation).
Surgical correction of cataracts is a simple procedure for experienced ophthalmologists. Surgery is a must to correct the condition, as it is progressive and there are currently no non-surgical approaches to reverse the changes which have already taken place.
Something that catches many of us by surprise is the subtle change which takes place in our hearing as we grow older. One type of change affects the acuity or sensitivity of one's hearing, and the other involves the process of interpreting the sounds which are actually heard.
Presbyacusis ("acusis" means hearing), also known as "sensorineural" hearing loss, involves changes that take place within the nerves responsible for delivering the signals received by the eardrum to the brain. Most commonly, individuals will notice a slight buzzing or ringing (known as "tinnitis"), vertigo (a sense of movement similar to being seasick), or chirping sounds similar to crickets.
The changes experienced with presbyacusis can remain static or become progressive. Both forms can lead to quite a bit of discomfort -- not because they are painful, but because they are unrelenting and irritating. A number of medications can be tried to alleviate the symptoms, but currently, no surgical or other definitive treatment is available.
"Conductive" hearing loss is at least as common as "sensorineural". This type of hearing change is related to how sounds are transmitted from the eardrum to the nerve which carries those sounds to the brain. Essentially, three very small bones separate the eardrum from the nerves which carry the signal. If the joints connecting these bones get "stiff", sounds must be louder in order to move as they did when the person was younger.
Unlike sensorineural hearing loss, conductive hearing loss can be helped by merely increasing the volume; this can be done with hearing aids, which are just amplified speakers that turn up the volume of normal conversation. These speakers can be embedded within normal glasses, or made to fit unobtrusively into the ear. Advances in Otorhinolaryngology (ears, nose, and throat) may make it possible in the future to "loosen" up these joints surgically, obviating the need for hearing aids.
Many of the changes associated with aging may be related to lifestyle and environmental issues. A common thread is microcirculation, or the blood flow within the capillaries, as mentioned above. There is an explosion of conventional and alternative medical research identifying substances (both synthetic and naturally occurring) which improve circulation. Use of these substances may make many of the symptoms described above obsolete and relegate them to the process of "abnormal" aging.
Lifestyle changes include minimizing the amount of fats ingested, avoidance of smoking and polluted atmosphere, and, most importantly, the belief that what you're doing to slow down the aging process is making a difference. There's an old saying that "you're only as old as you feel." In many instances, it's your attitude and mental outlook that determine how old -- or young -- you feel. We have no power to stop the clock, but we do have choices. We can cower in fear at the thought of growing older, and mourn the youth we've lost, or we can embrace the gift of our later years, and enjoy all that we've worked so hard to win.
THOMAS W. SHINDER, M.D. practiced neurology in Little Rock, AR, prior to moving to Texas in 1996 to begin a career in consulting and training.