COMMENTARY: Don't assume symptom is a routine sign of aging

Charlotte Observer

31 Jan 2005

Nathan Rowman was in his late 80s when he was hospitalized for a
suspected heart problem. Seemingly overnight, Rowman, who had been
running his own business and going to work every day, became so
confused that his children considered putting him in a nursing home.

But before that, the family consulted a geriatric specialist who
suspected that the medication given to him in the hospital, and not
any organic brain deterioration, might be causing his confusion. When
the drug was discontinued, Rowman became his old self again, and
after being discharged from the hospital, he returned to work.

Many things occur as people age. As Dr. Elaine Amella noted in a
recent issue of The American Journal of Nursing, "Heart muscles
thicken, arteries stiffen, lung tissues diminish, brain and spinal
cord degenerate, kidneys shrink, and bladder muscles weaken."

But -- and this is a big "but" -- the changes occur at different
rates in different organs and in different people. One person's lungs
may function fully while the kidneys fail. One 85-year-old's brain
may fire on all cylinders while another person of the same age cannot
remember anyone or anything.

One consequence of these varying changes with age is difficulty in
determining whether an older person has an ailment that requires
diagnosis and treatment or is merely experiencing the gradual
physiological shutdowns associated with growing old. Too often, older
people and their relatives dismiss or ignore early symptoms of what
may very well be a correctable problem, because they wrongly assume
that the changes are to be expected as one grows old.

One of the most common correctable problems is drug toxicity. As
people age, body fat is gained at the expense of lean muscle,
resulting in less body fluids to dilute water-soluble drugs and more
fat tissue for storing fat-soluble ones. Loss of body fluids allows
certain drugs to reach toxic levels when given in doses appropriate
for younger adults.

At the same time, an older person's kidney and liver function
declines, so drugs are not cleared from the body as quickly. Yet
higher levels of body fat may mean that the usual dose of a drug is
inadequate to treat the problem.

Many possible explanations

In her report, Amella, an associate dean for research at the Medical
University of South Carolina College of Nursing, describes a host of
possible explanations for changes that commonly occur in older
adults. These are some possibilities:

** Change In mental status: This is "a common harbinger of disease,
drug toxicity or psychological trauma in older adults," she stated. A
deterioration in mental function that occurs over days or weeks is
often a result of a change in medication or the aftermath of

** Falls: A long list of ailments can cause an older person to fall,
among them heart problems, osteoporosis, vertigo, a slowly leaking
blood vessel in the brain, a loss of hearing or vision. A toxic
buildup of a drug is a common cause.

** Dizziness: This can be a symptom of a wide range of problems,
including anemia, abnormal heart rhythm, drug toxicity, depression,
infection, ear disease, eye problems, stroke, heart attack, a brain
tumor or simply impacted wax in the ears. It can also result from
drug toxicity.

** Diminished appetite: This may be a sign of worsening heart failure
or the beginnings of pneumonia, as well as depression or simply

** Delirium: In addition to drug toxicity, delirium can result from
dehydration, low levels of oxygen in the blood, untreated anemia,
nutritional deficiencies, infections and untreated thyroid disease.

** Incontinence: The onset of incontinence in older people should
always be investigated. It often has reversible causes, including
urinary tract infections, limited mobility and metabolic

** Pain: An increase in aches is common as people age, and it can
result in a loss of mobility and functioning. Although pain is often
treatable, many older people are reluctant to use pain medicine
because they harbor unjustified fears of addiction. (Misty- Is it

** Loss of functional ability: A decline in activity can be a
consequence of anemia, thyroid disease, infection, cardiac
insufficiency or a diminished lung capacity.

** Depression: Many conditions can lead to depression -- alcohol or
substance abuse and disorders like dementia, stroke, cancer,
arthritis, hip fracture, heart attack, chronic lung disease and
Parkinson's disease.Depression can also result from the loss of a
spouse, functional disability or the unrelenting demands of giving
care to someone.

The bottom line? Do not assume that a symptom is a normal sign of
aging. Get it checked out without delay.