Growing Old Pains

Article contributed by:

Raffles Medical Group

 

As we grow older, our body is no longer what it used to be.  We explore five common health problems that come with ageing.  Let our panel of experts shed light on the causes, prevention and treatment of these common ageing pains.

 

On this page: ► Eye - Cataract ► Ear - Age Related Hearing Loss ► Joints - Arthritis	► Brain - Stroke ► Blood - Hypertension

 
1. Eye

The most common eye condition affecting the elderly is cataract.  In a local study in 1997, 78.6% of 3000 elderly aged 60 and above suffers from cataract.  The other top three eye conditions include age related macular degeneration, diabetic retinopathy and glaucoma.  Explains Dr Lee Jong Jian, Ophthalmologist and Consultant at Raffles Eye Centre, “Cataract is the clouding of the natural lens in our eye, resulting in blurring of vision.
 
The lens works much like a camera lens, focusing light onto the retina at the back of the eye.  Some signs and symptoms include gradual blurring of vision, glare and sensitivity to light.”  Early cataract may be corrected with glasses.  If there is no improvement, surgery is the best option with a high success rate of more than 98%.
 
Over the years, the intraocular lens (IOL) used has become more advanced. The toric IOL can also simultaneously correct astigmatism and cataract. There are also accommodative and multifocal lens which can restore both distance and near vision.  Some eye care practitioners believe that a diet high in antioxidants such as beta-carotene (vitamin A), selenium and vitamins C and E, may slow down cataract development.  Sunglasses to prevent ultraviolet light rays exposure may also slow down cataract progression.

 

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2. Ear

As one ages, hearing problems become increasingly common. Presbycusis, or age related hearing loss, is most commonly caused by gradual changes in the inner ear.  As one grows older, structures of the ear can become less responsive to sound waves, contributing to hearing loss. The disorder occurs in about 25% of people aged 65 to 75 and in 70 - 80% of those over age 75.
 
Dr Stephen Lee, ENT Surgeon, Consultant at Raffles ENT Centre shared that the following factors may also cause hearing loss:

 

 

For a person with presbycusis, sounds seem deeper and less clear.  Other symptoms include:

 

 

Hearing problems can make it difficult for older people to hear doorbells, car horns, and alarms.  Its effect on communication can also reduce a person’s physical, functional, emotional, and social well-being.  It is often accompanied by isolation and depression.  All these can be frustrating, embarrassing, and even dangerous.
 
There are devices to help you hear and communicate more easily, including hearing aids and assistive listening and alerting devices, such as telephone amplifiers.  If you have trouble hearing, speak to your doctor to find out if you have a hearing loss; and if you are suffering from hearing loss, how to treat it.

 

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3. Joints

Older patients often come by to see Orthopaedic Surgeon, Dr Lim Lian Arn, a Consultant at Raffles Orthopaedic Centre, for their painful joints.  Arthritis, a problem faced by many elderly, is a condition that involves inflammation of a person’s joints.  Patients with arthritis suffer joint pain because the normal healthy lining of their joints is damaged by the arthritic process.
 
If you have any of the following symptoms, you should see your doctor or a specialist for evaluation and treatment:

 

 

In the early stages of arthritis, oral medications, injections, external braces and physiotherapy can control arthritis.  In the later stages, when there has been too much cartilage destruction, surgery gives options that can predictably reduce pain and correct deformities.
 
Surgery for arthritis includes keyhole arthroscopic surgery, cartilage replacement surgery, osteotomy to correct limb alignment and joint replacement surgery.  “Joint replacement surgery is usually done after all other methods fail to provide relief,” said Dr Lim, “It has a low complication rate; these include deep vein thrombosis and wound infection.”
 
Joint replacement surgery replaces the worn out surfaces of the joint with metal and plastic.  The metal and plastic parts reproduce the motions of a normal joint.  The pain, deformity and restricted motion of an arthritic joint can be eliminated and function can be reliably restored.
 
Prevention and early intervention measures:

 

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4. Brain

Cerebrovascular disease, or stroke, is a very common disease in Singapore.  It ranks as the fourth leading cause of death in Singapore. Almost 1,500 patients died from stroke in 2007 (Ministry Of Health Singapore).  However, thanks to the excellent healthcare infrastructure in Singapore, many of our stroke patients receive prompt emergency treatment.
 
Each year, approximately 10,000 patients are admitted with a diagnosis of stroke in Singapore.  While the vast majority survive, many have residual disabilities.
 
Stroke occurs when a portion of the brain dies because the blood vessel supplying that area:

1. Becomes blocked (‘ischaemic stroke’) or

2. Bursts and bleeds (‘haemorrhagic stroke’)
 
“In either case,” said Dr Alvin Seah, Neurologist, and Consultant at Raffles Internal Medicine Centre, “that area of the brain will be affected, and depending on the region affected, the patient will experience the sudden onset of severe symptoms such as numbness, weakness, difficulty in speaking, visual field loss, giddiness and so on.”
 
To treat an ischemic stroke, blood flow must be quickly restored to the brain.  Patients who are able to get medical help within three hours of the onset of a new ischaemic stroke can be treated with a ‘clot-buster’ drug (tissue plasminogen activator or TPA) which can dissolve the clot and re-open the blood vessel.  If this treatment is successful, the damaged area can recover faster.
 
Treatment for patients who pass the three hour window would focus on stabilising the patient medically, preventing complications and sending the patient for rehabilitation and physiotherapy.  Patients with ischaemic stroke will usually be treated with an antiplatelet agent to prevent further stroke.
 
Patients who are diagnosed to have a haemorrhagic stroke may need surgical intervention to remove the bleeding.  The decision whether to operate depends on many factors, including the physical condition of the patient, the size and location of the bleed and the underlying causes. Whatever the initial treatment, patients will benefit from a course of rehabilitation and physiotherapy.
 
In all patients who have suffered a stroke, and even for those patients who do not yet have a clinical stroke, treatment would focus on subsequent control of stroke risk factors and prevention of further strokes.  Stroke is a common and potentially fatal illness.  Controlling the risk factors is critical. In a suspected stroke, seeking treatment early may allow emergency drug therapy.  In all cases, rehabilitation and physiotherapy can help the patient to either regain the previous functional status or to cope with the resulting neurological impairment.
 
Main Risk Factors For Stroke:

 

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5. Blood

Hypertension or high blood pressure is often labeled “the silent killer” as it usually has no symptoms.  Yet, it can progress to develop several potentially fatal complications.  It may be present and remain unnoticed for many years if you do not undergo periodic blood pressure screening.
 
High blood pressure is when there is an increased pressure in your blood vessels and, therefore, less space for your blood to travel through.  It is dangerous as it leads to complications in many organs, ranging from heart to brain to kidney.  Hypertension affects 30% of those at age 50 and increases to 60-70% for those above 70 years old.
 
Thanks to the protective nature of female hormone estrogen, women tend to have lower blood pressure before menopause.  However, their blood pressure catches up with their male counterparts after menopause by the time they turn 70 years old.
 
High blood pressure is typically treated by making changes in your lifestyle, and with drug therapy.  Screening, diagnosing, treating and controlling hypertension early in its course can significantly reduce the risk of developing strokes, heart attacks or kidney failure “Effective blood pressure control is possible,” said Dr Antono Sutandar, Cardiologist, and Consultant at Raffles Heart Centre, “However, many hypertension patients may require two or more blood pressure medications.”
 
Prevention of hypertension only goes as far as the cause of it. While you can adjust lifestyle related causes, genetics, race, age and gender are outside the realm of change.  Modifiable factors include diet, weight, exercise levels and stress management.
 
If you have risk factors for ischemic heart disease (obstruction of blood vessels supplying the heart), blood pressure therapy would be more aggressive.  For example, patients with heart failure, kidney problems and diabetes will have a lower blood pressure target.  Elderly above 80 years old will have a blood pressure goal of below 150/90.
 
What Is “Normal” Blood Pressure?

There are several categories of blood pressure, including:

 

 

You should consult your doctor if your blood pressure is above your normal range. 

 

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Article contributed by:
Raffles Medical Group

Dated: June 2011

 

 

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