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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Medical Myths Medical Myths
 

Old Age: It's Tough, But It Won't Kill You


February 27, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center


Last reviewed and revised February 27, 2013

When I ask patients about family history, I often hear this: "I'm not sure about my grandmother; I think she just died of old age."

Perhaps it's just a figure of speech, but I've encountered plenty of people who believe that a person can reach an age that is simply "too old to go on," that the state of being aged can actually cause death.

While no one lives forever, reaching a sufficiently advanced age is not itself fatal. It's a myth that may be important to dispel because it promotes the notion that certain conditions are inevitable with aging or that simply reaching an advanced age is incompatible with life.

In fact, older people are more prone to certain diseases (and more prone to dying of these conditions), but few of these are universal or inevitable. Without these conditions, people can live much longer than you might expect. In fact, some experts predict that advances in the treatment of heart disease and other conditions that commonly cause death may lead to much longer life than we see today. On the other hand, other experts believe we are quickly approaching the limit of the human lifespan. Only time will tell which is true.

Am I Just Getting Old?

In my arthritis practice, many patients tell me they have aches and pains but are ready and willing to accept them. They'll ask, "What else can I expect at my age?" But it's likely there are specific reasons for those symptoms. Joint disease, tendon inflammation (tendonitis) and degeneration of discs in the spine are examples of exceedingly common conditions in the elderly that may contribute to aches and pains. These conditions — not aging — cause the symptoms.

It's also important to recognize that just because a condition commonly accompanies aging, it still may respond well to treatment. That means symptoms bad enough to cause an older person significant worry, reduced function or reduced quality of life should be evaluated and not just attributed to age.

Another example is forgetfulness. We all forget things, and memory problems tend to increase with age, but severe or suddenly increasing memory loss should be evaluated. A reversible condition could be to blame. A wide variety of conditions, including depression, an underactive thyroid or a side effect of medications, may contribute to difficulties with mental functioning and respond dramatically to treatment. Assuming symptoms are due to "just getting old" could delay diagnosis and treatment.

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Dying of Old Age

When people say someone died of old age or "natural causes," they probably refer to complications of common conditions such as heart attack or stroke. Other frequent causes of death in an elderly person include infection (such as pneumonia or a bloodstream infection), cancer, Alzheimer's disease and falls.

These conditions may not be fatal on their own, but complications of them may be. For example, an older person who falls and breaks a hip is at risk for complications related to surgery such as pneumonia or pulmonary embolus (a blood clot blocking arteries in the lungs). Death caused by these types of conditions occurs more commonly in older people because their ability to withstand organ damage, to fight off infection or to tolerate treatment is usually less than for a younger person.

In addition, older adults are more likely to be taking multiple medications. While they may take these medicines for good reasons, drugs may interact with each other or with a new medical complication to cause irreversible organ damage. For example, an elderly person taking a diuretic (a "water pill" that increases urination) for high blood pressure may also have an age-related reduction in kidney function. If that person develops food poisoning, the combination of fluid loss from diarrhea, age-related loss of kidney function and the diuretic may lead to severe kidney failure.

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How Age Changes Your Body

In healthy adults, different parts of the body age in different ways. For example:

    • Over time, the heart's blood vessels tend to accumulate calcium and plaque, the cholesterol-containing material that narrows vessels and causes a heart attack. The heart's valves keep blood flowing in the proper direction and maximize the mechanical force of each beat, but they tend to build up calcium deposits and thicken with aging. This process may lead to abnormally leaky or narrowed valves. Still, in a healthy older adult, the valves and pumping action of the heart should work well, even into advanced age.
    • The kidneys' ability to filter the blood diminishes with time; however, there is generally plenty of "backup." In fact, that's why people are able to do well with just one kidney.
    • Joint flexibility and range of motion tend to diminish because of age-related injury ("wear-and-tear") and degeneration, some of which may be genetic. So, while the average 80-year-old is less limber (and often more achy) than the average 20-year-old, symptoms are often mild and relatively unimportant.

 

    • As we age, the brain often atrophies (shrinks). This effect is particularly prominent in the cortex, the part of the brain handling language, speech, memory and other complex functions. In addition, blood vessels may become narrowed, decreasing the supply of oxygen and other nutrients to brain cells. Even so, brain function is often preserved in older adults, and brain disease, such as stroke or dementia, is by no means an inevitable part of the aging process.

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Preventing Age-Related Diseases

No one can escape the effects of aging (despite what you may see in infomercials and glamour magazines!). But there are ways to maximize your chances of aging successfully. And they are probably measures that have been recommended to you before: getting more exercise, eating a better diet, and keeping your brain active.

A study published by researchers at the National Heart, Lung and Blood Institute in July 2005 found that aerobic capacity — the ability to use oxygen during exercise — falls dramatically with age. That was true even for people who exercised. However, as might be expected, those who exercised the most had smaller declines with age and had higher aerobic capacity than those who were inactive. So, regular exercise should help to offset the age-related decline in aerobic capacity. As we age, we may need even more exercise than currently recommended to prevent a decline in aerobic capacity. Walking, biking and swimming are excellent exercises to build or maintain exercise capacity.

Diet matters as well. Many adults don't get enough calcium or vitamin D. This can contribute to osteoporosis, which in turn can lead to age-associated complications (such as hip fracture and reduced mobility).

Obesity can reduce lung function and increase the risk of diabetes, heart disease and arthritis, all of which are more common in older adults, so it's important to avoid excess weight. Taking dietary measures to lower cholesterol, blood sugar and blood pressure (such as the DASH eating plan ) and not smoking may reduce your chances of having a heart attack or other cardiovascular disease.

The risk of the most common types of cancer increases with advancing age. Getting screening tests such as mammograms and colonoscopies can help detect these cancers when they are at a curable stage.

Finally, there is suggestive (though not definitive) evidence that keeping your brain "exercised" intellectually and emotionally may help to keep it working well. Reading, working crossword puzzles, joining discussion groups and maintaining social relationships with family and friends are all examples of behavioral changes that may slow the rate of cognitive decline with advancing age.

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Conclusions

The expression "dying of old age" may only be a figure of speech, but it's worth noting that while everyone dies of something, the passage of time is not one of them. It may be difficult or even impossible to figure out the cause of death — even when an autopsy is performed — but, as far as we know, the heart does not "run out" of beats, the brain doesn't just shut down, and the body does not simply quit working like a battery running out of energy.

Keep that in mind the next time you hear that an elderly friend or relative is failing. It's entirely possible that a reversible cause can be found and that he or she will bounce back much more quickly and completely than expected, especially if recent health has been good.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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