Aging at Home with Chronic Illness

Posted By SHL Librarian

Presented by: Bryant Lin, MD
Clinical Assistant Professor of Medicine
February 9, 2017

Aging can be a challenge for anyone. Chronic disease can magnify the challenges as people pass the age of 60, 70, or 80.

But with grace and grit, people can avoid some pitfalls and minimize others. Bryant Lin, MD, had a pack of tips for people in his recent lecture at the Stanford Health Library. Many of them depend on some bedrock advice: keep moving and get a little help from your friends.

“Maintaining mobility through exercise is really one of the few things we can do in our lives that we have control over,” Dr. Lin said recently in his lecture at the Stanford Health Library. “You’ve got to do some weight-bearing exercise to maintain muscle mass.”

Preserving strength can help people cope with every aspect of aging, said Dr. Lin, who is a clinical assistant professor of medicine at Stanford. Strength can help prevent the number one risk of aging: falling. One out of 4 people over age 65 fall every year. Most of those falls are minor, but about 10% cause serious injury to the head, hip or spine.

“What has strength got to do with falling?” Dr. Lin asked. With strength, people can catch themselves from falling. “If you can’t compensate for imbalance, then you can fall. Even though you realize you’re falling you can’t react to it.”

Chronic conditions like cancer, osteoarthritis, diabetes, or heart failure can magnify the effects of aging, Dr. Lin said. But even normal aspects of aging can conspire against people trying to preserve mobility and balance. A person’s sense of balance can be impaired by declining vision as well as changes in the inner ear involved in balance.

Some prescription medicines, like blood-pressure drugs, can lower blood pressure so much it can impair balance. That can make people dizzy or faint. So can diabetes.

“Blood pressure medications are a well-known cause for people to have low blood pressure when they stand up, and that’s a very common cause of falls,” Dr. Lin said. “With diabetes, lower blood sugar can cause it. If you have blood sugar too high, you can get dehydrated and be more likely to fall.”

Sometimes it’s the combination of medicines—not any single drug—that increase dizziness or faintness. Dr. Lin advised people with these symptoms to make a list of all their medicines, and ask the doctor to review them. “Ask your doctor whether you can stop any medication,” he said.

Other villains that can impair mobility and balance include infections, including pneumonia, urinary tract or bloodstream sepsis. Any of these can slow down someone’s alertness and reaction time to events that end in a fall. “Falls can be associated with that because you’re just not feeling well,” Dr. Lin said.

Heart failure survivors can get short of breath and have swelling in their legs, which makes it harder to walk and keep their balance, Dr. Lin said. “If you could just try strapping 10-pound weights onto your leg maybe you’ll know how it feels,” Dr. Lin said. And osteoporosis can leave someone frail, so that even the smallest fall can cause serious injury.

For many of these conditions, “we don’t have any magic cures,” Dr. Lin said. In some cases, finding the right treatment with drugs can help tame the conditions enough so people can stay mobile. Once somebody has a fall that sends them to the emergency room, he added, “physical therapy is really the mainstay.”

A wide variety of devices is available to help people stay mobile even if they have chronic illness. Canes and walkers are the most common, used by about 6.5 million Americans, Dr. Lin said. Some people don’t like to use them because they think there’s a stigma. “You feel like it’s a sign that you’re getting older,” he said. But he advised people to get over it.

“It’s an important way to improve safety,” Dr. Lin said. Many devices have been upgraded to sleeker models. While some basic models are available at large drugstores, “to get the kind of fancy walker with bells and whistles, you’ve got to go to a medical equipment store.”

Medicare covers the cost of some walkers. Usually they are only available at Medicare-approved vendors that are harder to find. Medicare may also require a physical therapy evaluation before coverage is approved.

The Mayo Clinic has a great website with information for each person to pick the type of walker that meets their needs. “It’s important to make sure you get one that’s suitable for you, one that you like, one that fits your requirement, one that’s not too heavy,” Dr. Lin said.

Scooters and electric wheelchairs can also be handy for some people’s needs.

For people who are able to move independently, Dr. Lin recommended aerobic exercise. Walking, running, or cycling can help. Low-impact exercise is good for people with arthritis, but also keep in mind that weight-bearing exercise is important to make muscles strong.

Some people may need extra help from physical therapy to build their strength enough to get active again. To people who are skeptical that physical therapy will help, Dr. Lin had this advice: “It’s probably not going to hurt and it likely will help.”

People who are homebound and can’t leave their house without significant assistance may qualify for Medicare-paid home physical therapy, Dr. Lin said. For those who need help to do the small tasks of daily living around the house, occupational therapy can help. Stanford offers a free “Farewell to Falls” program through senior centers in Redwood City, East Palo Alto, Menlo Park, and Mountain View to low-income older adults.

In addition to maintaining mobility, there’s another big challenge that often comes with aging: memory loss. Some mild memory loss is normal and nothing to worry about, Dr. Lin said.

“There’s also this great fear, I think appropriate concern, of dementia,” he said. It’s easy to mix up normal memory loss–like forgetting where you left your keys–with the symptoms of the early stages of dementia, called mild cognitive impairment.

“There’s kind of this fuzzy line between what’s normal and what’s not normal,” Dr. Lin said. One way to describe the difference, he said, is to look at what someone remembers about going to a restaurant for dinner the night before. Normal memory loss is not remembering the name of the restaurant. Mild cognitive impairment is not remembering they ate at a restaurant last night. “With dementia, you don’t even remember you went out to eat,” Dr. Lin said.

Another tip-off of early dementia is behavior change. “People start to do odd things, strange things,” he said. Paranoia is one way this plays out. Not being able to handle checkbook finances and getting lost very easily are other signs.

Unfortunately there are no treatments yet that can reverse dementia once it starts, Dr. Lin said.
There are a few treatments like Aricept and Namenda that can delay the progression of dementia for a short time. There are also a lot of products advertised to treat dementia that don’t show any evidence they work.

“There’s no large-scale study that I know that really has been shown to reverse dementia as it occurs,” Dr. Lin said. “There are some things you can do to prevent it, and that’s primarily exercise.”

In addition to physical exercise, he suggested mental exercise. “I recommend learning new languages, learning new [musical] instruments, getting new experiences,” he said. “But do we have solid evidence that that reverses or delays dementia? We don’t, so I can’t say that.”

He added, “It’s different to prevent it, versus once you already have it.”

There are other challenges that magnify the effects of aging, such as declining vision and gradual loss of hearing. Dr. Lin listed several:

  • Hearing loss: 43 percent of the older population has some degree of hearing loss. Hearing aids can help some, but they’re generally not covered by Medicare and can be expensive. Some big box stores like Costco offer hearing aids at a better price, Dr. Lin said.
  • Declining vision: cataracts, glaucoma and macular degeneration can impair vision. Annual eye exams are important to detect and treat those conditions.
  • Nutrition: it’s important to get nourishing meals. Unplanned weight loss may be a sign of illness.
  • Constipation: up to 50 percent of older adults have this problem. It helps to eat plenty of fiber and drink lots of water—and get exercise.
  • Immunizations: getting vaccinated against pertussis, tetanus, and pneumococcus as well as shingles is important.

One other major challenge that can accelerate aging is depression. While depression can be a lifelong battle that starts early in life, aging at home alone can increase the risk of depression later in life, Dr. Lin said.

He described one patient who told him, “I’ve lost all my friends, they’ve passed away, this other friend’s moved away, and this other friend’s dying of cancer.”

Depression can be improved with drugs, Dr. Lin said. He also urged older people to stay in touch with old friends and family–as well as getting out to make new friends.

“There’s definitely clear evidence that social interaction can help with depression and prevent depression,” he said.

For more information:

Stanford Health Library can do the searching for you. Send us your medical questions.

About Dr. Lin

Farewell to Falls Program at Stanford