Old: What Happens As We Age?

c 2024 by Doreen C Parkhurst

All rights reserved.

ISBN: 979-8-89589-593-1

Disclaimer: This is not personal medical advice. Your situation, whatever it is, may be different than anyone else’s. You should obtain medical advice from your personal physician. The information in this book is for you to enjoy, think about and raise questions you may wish to ask when the time comes. The details have been changed for any patient’s story to protect confidentiality and respect HIPAA.

Dedication

This book is dedicated to my mother who had a full life for 100 years. After that it took her nearly two years to die.

It is dedicated to my daughter who knows exactly what I do not want at the end of my life.

It is dedicated to my husband whose wishes I fully understand.

Old

What Happens as We Age?

Table of Contents

Preface

Hurricanes, motorcycles, and ladders

What is your Longevity goal? Does the one who lives the longest win?

Aging

Changes of Aging

The Big D (Dementia)

Losing your loved one to dementia

Neurologic Changes in Aging

Everything you didn’t want to know about Sex and Aging and were afraid to ask

Everyday Annoyances

To Drive or to Uber?

A fib, V fib, Pacemakers, Defibrillators

Disease and Prevention

Contribution versus Consumption

Critical Decisions

Death

Intubation

Resuscitation: CPR, Ventilator Support

Dialysis

The Living Will

Hospice

Paradigm Shift: Living the rest of your life

Organ Transplant

MAID

Workbook

References

Recommended Reading

Appendices

Sample Living Will

Sample DNR

ADL’s and IADL’s

Experts on aging say:

If you’ve seen one 85-year-old, you’ve seen one 85-year-old. 

There is a wide variability in people as they age, and their chronological age should not be the only guideline in medical decision-making.

Preface

As I write this, the television news is nearly exclusively focused on the two presidential candidates. Both men are old. Interviewers and experts are discussing this, trying to sort out what effect and impact, if any, aging has on performance. Many spokespeople express concern. Some express alarm. People are worried about the consequences of an aging President and whether he will be able to handle global problems and catastrophes effectively and in a timely manner. There are two front runners: Joe Biden and Donald Trump.

President Biden is 81 years old, and Donald Trump is 78 years old. In their first debate, they both exhibited signs of aging. Not long ago, there was worry about Senator Diane Feinstein continuing to serve prior to her death. When Nikki Haley was running, she called for younger leadership in America, likening the US Senate to a privileged nursing home.

This is not a political book. I am not going to discuss the candidates. Consider this more of a primer on aging.

According to the National Council on Aging, in 2020 there were about 58 million people over the age of 65, 38% higher than in 2010. The number of people over 100 tripled in 2020 over the number in 1980.

The U.S. Census report commissioned by the National Institute on Aging predicted that Americans over 65 will double in size by 2030 reaching 72 million. The group 85 and older is the fastest growing group in American society.

So, let’s cut to the quick: what happens to a person as they age?

And, once we understand that, how do we use that knowledge to not only make choices about tasks like voting but, more importantly, how to make life choices for ourselves.

Because those people lucky enough to keep celebrating birthdays will age. Changes will occur. Everyone should come to reconcile that their futures may look different than their pasts.

Once you understand that aging has, and will continue to, change your needs, it will encourage you to strongly consider your future choices rather than repeat what was comfortable or practical in the past. And some inevitable decisions will have no precedents.

Because only one thing is certain: everyone will die. And whether one makes choices about the final phase of their life, eventualities occur.

Many years ago, I was asked to speak to the Association of American University Women in Boca Raton, Florida, about decisions for the end of life. After I spoke, an audience member approached me and said, "When I heard what you were going to talk about, I said, ‘Who would want to listen to that?’ She then thanked me for all that she learned and was grateful for the knowledge.

What I conveyed then and what I hope to accomplish here is to raise awareness about critical decision-making in complex medical situations so that when we make important choices for ourselves or people we love, we can feel comfortable and confident that our decisions informed, valid and beneficial.

This book is written for the following people:

Everyone who is old and all of those who hope to be.

Everyone who is lucky enough to have aging parents, partners or other loved ones.

Everyone who may be called upon to make complex medical choices for themselves or others.

Hurricanes, motorcycles, and ladders 

Hurricanes, motorcycles, and ladders. What do they have in common?

They are all capable of causing catastrophe. It’s not if it will happen but when.

That’s what I told my eighty-two-year-old husband this when I caught him on a ladder changing a lightbulb on the ceiling.

As an emergency physician I’ve seen it all. There are myriad threats in everyday life just lurking to cause heartbreak and pain. Accidents aren’t necessarily related to age, although the behaviors that lead to them may be. We worry about some accidents for certain age groups. For example, we worry about toddlers eating poison and about elderly people falling. This is not based on conjecture; it is supported by historical statistics.

I live in Florida, second only to Maine for the largest population of elderly people in a U.S. state. When I turned old, I noticed that when I check into a medical office I’m asked if I had a fall in the past year. Thirty to forty percent of people over the age of sixty-five fall each year. Fifty percent of those living in long term facilities fall each year. Why do elderly people fall so often? The answer is complex and multi-faceted.

Let’s start with arthritis. There are many types of arthritis, but let’s discuss common, every day, run-of-the-mill arthritis (osteoarthritis) that causes joint stiffness, swelling, and pain. At least forty percent of people over sixty-five have arthritis. It comes from wear and tear. It can affect any joint in the body and causes pain both when walking (or working) and when at rest (during sleep).

One day when I went to our community pool, my knee hurt. I put an elastic wrap on it. One of my friends asked, What happened to your knee? I responded, Nothing. It’s just very old.

When we have pain in one part of our body, our natural response is to try to protect it from further pain, so we compensate with other parts. When the pain is in the hip, knee, ankle or foot, the likely reaction is that we change our gait to favor the painful part. Thus, arthritis is one risk factor for falls.

Lower extremity weakness is another risk factor. Whether weakness is caused by an injury, a stroke, or just loss of muscle, it impacts gait and can lead to a fall.

Medications (especially