preventing falls.
Older people have an abnormal gait when walking, and this is evident in about one third of those over 65. The characteristics include slow speed, short step length and large variability, narrow stride width, and stepping frequency. Uneven pavements—in London one in five pavements is in a poor state of repair—can be hazardous. Elderly people could one day be relying on a bodysuit, rather than a Zimmer frame, for support. Scientists in Japan are developing the ‘Michelin gran’ Lycra suit which is covered in pairs of inflatable ‘muscles’ which assist the wearer’s real muscles. When they inflate, they help the wearer move their limbs with more strength and stability.
Type 2 diabetes is most often seen in older adults, with half of all cases diagnosed in people of 55 and over. It is by far the most common form of diabetes, and occurs when the body produces insulin but the cells no longer respond by allowing entry of glucose, especially in muscle, fat and liver cells. About 90 per cent of patients who develop type 2 diabetes are obese. Both being overweight and lack of mobility promote the disease.
There are many false ideas about the sexual activity of the elderly. It has been said that sex among the old is a well-kept secret because the young would not believe it if they were told. In fact there is little evidence for a significant age-related decline. The level of sexual interest and activity among people over the age of 65 is as diverse as the individuals who make up that population. A recent survey in the US of married men and women showed that nearly 90 per cent of married men and women in the 60–64 age range are sexually active. Those numbers drop with advancing years, and a bit less than one third of men and women over the age of 80 are still sexually active. A recent survey found that men enjoy five extra years of an active sex life—up until the age of 70— compared to women, who were less likely to make love after the age of 65, mainly because they had married older men and their partner had died. Those who are healthy in older age are twice as likely to enjoy a high libido and more likely to have regular sex, that is once or more a week. Even so the male sexual response tends to slow down with age.
There is, however, significant erectile dysfunction and impotence in those over 70—about one third suffer from this. Physical illness is a common reason for ending sexual activity, and medications such as antidepressants, statins and benzodiazepines can have similar effects. By the age of 65, about 15 to 25 per cent of men have this problem at least one out of every four times they are having sex. This may also happen in men with heart disease, high blood pressure or diabetes, either because of the disease or the medicines used to treat it. A man may also find it takes longer to get an erection and his erection may not be as firm or as large as it used to be. The amount of ejaculate may be smaller. The loss of erection after orgasm may happen more quickly, or it may take longer before an erection is again possible. Some men may find they need more foreplay.
It is well-documented that older women experience fewer sexual problems than men as they age. Most healthy women can expect unimpaired sexual activity to the end of their lives, if that was their pattern earlier. Normal changes in the older woman include a decrease in length, width and elasticity of the vagina. Recent studies, however, indicate that the older woman has no physical limitation in her capacity to achieve and enjoy orgasm. But there are some limitations. The decline in the female hormone, oestrogen, which occurs after menopause, can result in decreased vaginal lubrication. The loss of lubrication can often result in painful intercourse, but fortunately this condition can be easily treated with creams. Diana Athill, an award-winning writer over 90, wrote that she has given up sex and says she doesn’t miss it. ‘It’s like not being able to drink wine—at first I thought that was a terrible detriment, but once you can’t drink something, and it makes you ill if you do, you don’t mind giving it up… One reads from time to time absolutely obscene articles about senile sex—about how if you really go on trying hard enough, using all kinds of ointments, it can work, but for God’s sake! It’s supposed to be fun! If you need a cupboard full of Vaseline, you might just as well stop.’
Changes in our skin giving rise to wrinkles in the face are a major sign of ageing. A study of the basis of their formation using gene technology claims to have identified more than a thousand genes and their proteins that are involved. One pathway results in the loss of water, while another is the breakdown of collagen, a molecule that gives the skin strength, and a third is damage from sunlight. With ageing, the outer skin layer thins, even though the number of cell layers remains unchanged. The number of pigment-containing cells decreases, but the remaining ones may increase in size—age spots—in sun-exposed areas.
Ageing skin is thus thinner, pale, and more translucent. Changes in the connective tissue reduce the skin’s strength and elasticity, especially in sun-exposed areas. It produces the leathery, weather-beaten appearance common to those who spend a large amount of time outdoors. The blood vessels under the skin become more fragile, which in turn leads to easy bruising, but most bruises go away without treatment. The skin glands produce less oil with age and while men experience a minimal decrease, usually after the age of 80, women gradually produce less oil after menopause. This can make it harder to keep the skin moist, resulting in dryness and itchiness. The fat layer, which provides insulation and padding, thins, and this increases the risk of skin injury and reduces the ability to maintain body temperature in cold weather. The sweat glands produce less sweat and this makes it harder to keep cool in hot weather, and so increases the risk of becoming overheated. Growths such as warts and other blemishes are more common. Skin-healing can sometimes fail completely in later life, causing a wound to become chronic. Statistics suggest that at least one in twenty people over the age of 65 have a non-healing skin wound. At particular risk are older people with diabetes, and a distressed emotional state can impair healing even further.
Eye diseases like cataracts, glaucoma and macular degeneration cause loss of vision and are major problems in old age. Cataracts are areas that distort light as it passes through the lens of the eye. As we age, protein in the lens of our eyes can clump together and cloud the lens. Glaucoma is an eye condition in which the fluid pressure mounts inside the eye; this pressure can harm the optic nerve. It is often hereditary and worsens with age. Both cataracts and glaucoma can be treated. Macular degeneration is a disease that causes progressive damage to the central part of the retina that allows us to see fine details. In the USA 30 per cent of patients aged 75 to 85 will have macular degeneration There are genes which increase the risk, and diabetes and high blood pressure also increase the risk of eye problems. There is also presbyopia, the typical ‘long-sightedness’ of middle age, in which people find it more and more difficult to read small print. To begin with they cope by holding the reading material further and further away.
About one-third of Americans between the ages of 65 and 74 have hearing problems and about half the people who are 85 and older have hearing loss. In the UK there are more than 6 million deaf and hard-of-hearing people aged over 60. Tiny hairs inside your ear help you hear as they pick up sound waves and change them into the nerve signals that the brain interprets as sound. Hearing loss occurs when the tiny hairs inside the ear are damaged or die. The hair cells do not regrow, so most hearing loss is permanent. Another type of hearing loss results from damage to other parts of the inner ear. Tinnitus can occur with many forms of hearing loss, including those that sometimes come with ageing. People with tinnitus may hear a ringing or some other noise inside their ears. The good news is that hearing deterioration tends to halt at around the age of 70.
We visit the dentist more as we age. Teeth provide a good model of wear and tear as an ageing process. With age our teeth appear to get darken, due to changes in the dentine beneath the surface enamel. The enamel itself can become worn down from years of chewing, and this causes teeth to become more sensitive. The teeth themselves also become dryer and more brittle, which makes them more likely to break or crack during normal chewing, and old fillings may start to fracture. Gums can start to recede, especially if there is a periodontal disease or they have been subject to too-forceful brushing. Receding gums can increase the risk of tooth decay.
Approximately a quarter of men begin balding by the age of 30 and two-thirds begin balding by age 60. One hypothesis suggests baldness evolved in males as a signal of ageing and social maturity, showing that aggression and risk-taking decrease. This could enhance their ability to raise offspring to adulthood. Most of the hairs on a person’s head are in an active growth phase, which may last anywhere from two to seven years. At the end of this stage the cells causing growth, which are stem cells, die, and the hair falls out. The average scalp contains about 100,000 hairs and roughly 100 hairs are lost every day. Baldness is due to the failure to replace lost hairs and has a genetic basis, but stress can also cause hair loss.
The greying of hair can also occur at quite a young age but commonly begins in the mid-thirties. The blackness of hair is due to special dark-pigment-producing cells, melanocytes, entering the growing hair, and greying is due to their absence or failure to produce dark pigment. For unknown reasons, hair stem cells have a much greater longevity than the melanocyte stem cells, so greying can occur before baldness. Stress hormones may impact the survival and activity of melanocytes, but no clear link has been found between stress and grey hair. Genes can affect both baldness and greying, and twin studies showed that female greying is genetic.
