PRACTICAL POINTERSONKEEPING WELL

HealthyAgeing

World Health OrganizationRegional Office for the Western Pacific

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World Health OrganizationRegional Office for the Western PacificUnited Nations Avenue, P.O. Box 2932

1000 Manila, Philippineswww.wpro.who.int

Healthy Ageing 1

PRACTICAL POINTERSONKEEPING WELL

HealthyAgeing

World Health OrganizationRegional Office for the Western Pacific

2 Healthy Ageing

WHO Library Cataloguing in Publication Data

Healthy ageing. practical pointers on keeping well.

1. Aged 2. Aging 3. Health services for theaged 4. Health promotion 5. Developing countries

ISBN 92 9061 061 1 (NLM Classification:WT 31)

© World Health Organization 2005

All rights reserved.

The designations employed and the presentation of the materialin this publication do not imply the expression of any opinionwhatsoever on the part of the World Health Organization con-cerning the legal status of any country, territory, city or area or ofits authorities, or concerning the delimitation of its frontiers orboundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’products does not imply that they are endorsed or recommendedby the World Health Organization in preference to others of asimilar nature that are not mentioned. Errors and omissionsexcepted, the names of proprietary products are distinguished byinitial capital letters.

The World Health Organization does not warrant that the infor-mation contained in this publication is complete and correct andshall not be liable for any damages incurred as a result of its use.

Publications of the World Health Organization can be obtainedfrom Marketing and Dissemination, World Health Organization,20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 7912476; fax: +41 22 791 4857; email: bookorders@who.int).Requests for permission to reproduce WHO publications, in partor in whole, or to translate them – whether for sale or fornoncommercial distribution – should be addressed to Publica-tions, at the above address (fax: +41 22 791 4806; email:permissions@who.int). For WHO Western Pacific RegionalPublications, request for permission to reproduce should beaddressed to Publications Office, World Health Organization,Regional Office for the Western Pacific, P.O. Box 2932, 1000,Manila, Philippines, Fax. No. (632) 521-1036, email:publications@wpro.who.int

Healthy Ageing 3

Contents

INTRODUCTION 5

AGEING AND HEALTH 8

ARE DISEASES A NATURAL PART OF AGEING? 8QUALITY AND QUANTITY OF LIFE 9WHEN TO MAKE LIFESTYLE CHANGES 9HEALTH: WHOSE RESPONSIBILITY? 10TYPES OF HEALTH 11PHYSICAL HEALTH 11MENTAL HEALTH 13WHO GETS THESE DISEASES? 13

LIFESTYLE CHANGES AND HEALTHYAGEING 16

DIET AND NUTRITION 16EXERCISE 18WEIGHT 20SMOKING 21ALCOHOL 22SOCIAL ACTIVITIES 23

AGE-RELATED DISEASES: PREVENTION,TREATMENTS AND TIPS 26

ALZHEIMER’S DISEASE 26BREAST CANCER 29CATARACT 30CONGESTIVE HEART FAILURE (CHF) 30

CORONARY HEART DISEASE 32DENTAL HEALTH 34DEPRESSION 35DIABETES 37EMPHYSEMA 39FALLS 40FOOT PROBLEMS 41GLAUCOMA 43HEARING DISORDERS 44HIGH BLOOD PRESSURE 45MACULAR DEGENERATION 47OSTEOARTHRITIS 48OSTEOPOROSIS 49PARKINSON’S DISEASE 51PROSTATE DISEASES 54RHEUMATOID ARTHRITIS 55STROKE 57URINARY INCONTINENCE 58VASCULAR DEMENTIA 59

CARERS 62

CARING FOR OTHERS 62CARING FOR THE CARER 64

4 Healthy Ageing

Healthy Ageing 5

Introduction

This booklet is designed for health workers inthe developing countries of the Western PacificRegion of the World Health Organization. Itspurpose is to assist them in their task of pro-moting better health among older people.

Health promotion involves a range of strat-egies. These strategies are discussed at lengthin the accompanying booklet Ageing andhealth: A health promotion approach for de-veloping countries. One important part of anyhealth promotion strategy involves buildinghealthier settings and making healthy choiceseasier for individuals. This approach to healthpromotion includes working for better healthsystems, advocating for legislation that sup-ports health, and building health-supportingenvironments and communities. The secondpart of an effective health promotion strategyinvolves empowering individuals to adopthealthy behaviours. Part of empowering indi-viduals is improving their health literacy sothat they can make healthier choices. The pur-pose of this publication, therefore, is to pro-vide health workers with materials they canuse to help improve the health literacy of olderpeople in developing nations.

Developed and developing countries alikeare facing a growing epidemic of noncommu-nicable diseases, the effects of which are espe-cially evident among the increasing populationof older people in all countries. Many of thenoncommunicable diseases that are commonamong older people have been called lifestylediseases. The risks of developing many of thesediseases are greatly increased by lifestylebehaviours such as smoking, poor diet, lack ofexercise, obesity and excessive use of alcoholand other substances. If men and women canbe encouraged to adopt healthier lifestyles, and

if the settings in which they live enable andsupport them in their efforts, better health willfollow.

However, older people (or any age groupfor that matter) cannot be expected to develophealthier lifestyles if they are unaware of theway in which lifestyle is linked with the dis-eases of later life. Furthermore, it is not enoughsimply to tell people to improve their diet, stopsmoking or exercise more without helpingthem to learn how to go about improving theirdiet, stop smoking or engage in age-appropri-ate exercise.

The purpose of this booklet, therefore, isto assist health workers in their tasks of:

helping older people understand moreabout the nature of the diseases of laterlife;helping older people learn how lifestylefactors contribute to their risk of develop-ing many of these diseases and disorders;providing practical tips to help olderpeople go about reducing their risk of de-veloping these diseases and disorders; andproviding practical tips for people whosuffer from these diseases, or for their car-ers, to help them manage better, maintainas much independence as possible, andmaximize their quality of life.An important part of the booklet is made

up of practical tips relating to common dis-eases and disorders of later life. These tips aremeant to serve as a template to be adapted tolocal circumstances, and the ideas provided willneed to be developed and modified accordingto the specific circumstances and cultures inwhich they are used. Most of the tips and sug-gestions are designed to enable older peoplethemselves to take control of some of the fac-

6 Healthy Ageing

tors that can improve their health. Little timeis spent in discussing expensive medical inter-ventions and medicines. In many countries theseare not available or affordable for many people.The emphasis in the booklet is on how to helpolder people themselves prevent diseases anddisorders and manage their health.

It is hoped that health workers will be ableto use the ideas in the booklet to help olderpeople, their families and carers to take chargeof their own health and to live a fuller and moreindependent life. However, it must be stressedthat better health cannot rely solely on betterhealth education and health literacy. Healtheducation must go hand-in-hand with ensuringthat the conditions in which people live, andtheir access to resources, enable them to adopthealthy behaviours.

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8 Healthy Ageing

Ageing and Health

Non-infectious, or noncommunicable diseases arenow becoming the main cause of death in manycountries and are affecting the quality of people’slives. Non-infectious diseases include:

heart diseases;cancers;strokes that attack the brain;dementias that affects memory and think-ing;injuries;loss of hearing and sight;diabetes;joint problems caused by arthritis;bone diseases that cause bones to breakeasily; andmental diseases, such as depression.These are diseases that affect older people

much more than younger people. As people livelonger, these types of diseases are becomingthe major causes of death and disability.

Are Diseases a NaturalPart of AgingThe older people are, the more likely they areto develop noncommunicable diseases. This hasmade many people think that they are, there-

fore, a natural and inevitable part of ageing –that there is nothing that can be done aboutthem. This belief is largely mistaken. Thereare two main reasons why these diseases aremainly found among older people.1. Growing older does contribute to some

diseases. Some parts of the body inevita-bly suffer wear and tear and there are somephysical and chemical changes in the bodythat occur naturally as people grow older.

2. Many of these diseases, however, are sub-stantially due to the way people live theirlives. They result from a lifetime of doingthings that gradually result in these dis-eases.The second point is particularly important.

If the way people live their lives is placing themat a higher risk of developing diseases such asheart disease, cancer and diabetes, then thereis a chance that these diseases can be preventedby people changing the way they live.

Scientists have found that five aspects ofmodern lifestyles are major causes of moderndiseases. They have found the following fac-tors to be particularly important:

poor diet;being overweight;

In the past, the most common health problems were diseases that peoplecaught - the infectious diseases that spread rapidly and killed large numbers ofpeople or caused widespread illness. Although great advances have beenmade in controlling these diseases with mass vaccination programmes and byimproving the quality of water supplies, providing better sanitation and drain-age, and by draining swamps, infectious diseases are still a problem, with dis-eases such as malaria, tuberculosis and HIV/AIDS still causing many deaths.However, in recent years new types of health problems have become far morecommon in the majority of countries throughout the world.

Healthy Ageing 9

getting insufficient exercise;smoking tobacco; anddrinking too much alcohol.These findings mean that there is a great

deal that can be done to improve health. Thegood news is that health can be improved with-out having to rely solely on doctors, hospitalsand medicines. If people change these aspectsof their behaviour, they can substantially re-duce their risk of contracting lifestyle diseases.By changing living habits, younger and olderpeople alike can live longer and healthier lives.

Quality and Quantity of LifeWhen considering health in later life, somepeople think mainly about how long they ex-pect to live. Scientists and health workers toohave sometimes focused solely on how to ex-tend life expectancy. However, when workingout how to help people live longer, it is alsoimportant to concentrate on helping them tolive better. If people are to live longer, it isimportant that their extra years of life are ofas high a quality as possible – that those extrayears are not just extra years of pain and de-pendence. As far as possible, the extra years oflife should be ones that older people can enjoyand live independently, and during which theyare treated with dignity.

This means that, as well as extending lifeexpectancy, efforts must be directed towards

extending the period for which people can livea healthy life. There is plenty of room to im-prove the quality of life for older people andthis can be done by changing the way in whichtheir earlier years are lived. If people adopthealthy lifestyles early in life, they are muchmore likely to avoid the diseases that can maketheir later years of life difficult, painful andmiserable.

When to Make LifestyleChangesIt is never too late for people to improve theirlifestyle. Stopping smoking, drinking less, get-ting to the right weight, eating better food andexercising more will all make people feel bet-ter at almost any point in their lives. Theselifestyle changes are frequently recommendedfor people who have already developed dis-eases, and they can slow or stop the progressof a disease, or at least make it easier to copewith health problems.

However, it is much better to make theselifestyle changes before diseases and disabili-ties develop. The really important point aboutthe main diseases of later life is that people donot catch them like they catch infectious dis-eases, such as malaria. Instead, people gradu-ally grow these diseases. They are the result ofa lifetime of unhealthy behaviour. The earlierpeople stop subjecting their bodies to poisons(tobacco, alcohol, high concentrations of fat,salt, etc.) and the more they use their body byexercising it, the healthier they will remain.

While it is never too late for people tochange the way they live, it is also never tooearly to develop a healthy lifestyle. The ear-lier, the better. In fact there are things thatparents should do even before their childrenare born, and when they are children and teen-agers, that can make a big difference to healthin later life. For example, a mother smokingor drinking alcohol during pregnancy has alifelong effect on her child. Overeating and poordiet in the teenage years can lead to obesityand diabetes. Lack of calcium in the growingyears can produce weak bones in old age.

The best way to remain healthy in laterlife is to adopt a healthy lifestyle throughoutlife. It is better by far if people do not leave thechanges that can prevent a disease until after

10 Healthy Ageing

they already have the disease. Changinglifestyles early in life will not only add years toa person’s life, but will add quality life to thoseextra years.

Health: WhoseResponsibility?Good health requires the efforts of many peopleat different levels of society. These include:1. Governments and society in gen-

eral: If older people are to remain healthy,the environment in which they live musthelp them keep healthy. While individualscan take certain steps themselves to keephealthy, there are things over which theyhave no control. If the air is polluted withpoisonous chemicals or food is poisonedwith insecticides, it is difficult for an olderperson to stay healthy. If the only food thatis available or affordable is unhealthy foodor the lack of food labelling makes it im-possible to know whether the food con-tains unhealthy ingredients, it is difficultto expect individuals to remain healthy. Ifthe environment is noisy or the workplaceunsafe, hearing as well as muscles andjoints will be damaged, regardless of thelifestyle changes that people make. If theneighbourhood is unsafe or is filled withtobacco smoke, or if tobacco promotionensures that young people smoke, we canhardly expect that older people will remainhealthy.

2. Communities: Communities and localgovernments have a wider responsibilityto help people to help themselves. Healthworkers must be available, and hospitalsand medication are required to assist withthe health care of older people. The healthof older people has to be given some pri-ority so that there is money available toassist them. Older people also need accessto housing that helps them to stay healthy.They need to be able to obtain healthy foodlocally and to be able to get out in thecommunity safely. Opportunities to mixwith other people locally are vital, sincebecoming isolated is known to lead topoorer health.

3. Health workers: Even where individualsdo all that they can to look after

themselves, they will still need to receivehelp from health professionals. Healthprofessionals can provide valuable healthadvice on how to prevent illness, diagnosedisease in its early stages and providesupport and treatment to either cure orcontrol the progress of the disease.

4. Older people: Good health for olderpeople requires that individuals actively tryto look after their own health. There arechanges that individuals can make andsteps they can take to help them enjoy ahealthier old age. Later in this publica-tion practical tips are provided to helpolder people in the task of helping them-selves.Healthy ageing requires the combined ef-

forts of individuals themselves, the work ofhealth professionals, the support of the com-munity and the actions of governments. Healthyageing is most likely when individuals develophealthy lifestyles early in life; where they have

Healthy Ageing 11

the support of health workers; and where theylive in an environment that supports, ratherthan undermines, the efforts they make to lookafter their own health.

Types of HealthHealth involves a healthy body and a healthymind. As well as working to keep bodies physi-cally fit and healthy, there is also a need toattend to psychological, or mental health.

Physical health affects psychological health andpsychological health affects physical well-be-ing. Efforts directed towards healthy ageingmust make sure that both aspects of health arelooked after.

Physical healthPhysical health includes freedom from diseasesand physical disabilities. Among older peoplethe most common physical health concerns are:(1)heart diseases; (2) brain diseases; (3) lungdiseases; (4) joint and muscle diseases; (5) dis-eases of the senses; (6) bone disease; and (7)cancer.

HEART DISEASESThere are many forms of heart disease com-mon among older people. The most commonform of heart disease is called coronary heartdisease. This form of heart disease is due tothe narrowing of the blood vessels leading tothe heart. These blood vessels become narroweddue to a build-up of fatty deposits (calledplaques) inside the blood vessels. This build-up in the blood vessels is caused by a high-fatdiet, smoking and high blood pressure. Thebuild-up stops enough blood getting to the heartmuscle and starves it of oxygen. This results ina pain in the heart called angina.

When the blood vessels supplying blood tothe heart become completely blocked, no bloodgets to parts of the heart muscle and that partof the heart is damaged, which can result indeath. This is called a heart attack.

The heart muscle pumps blood through thebody. If it is damaged through one means oranother, it pumps less efficiently and cannotempty its load of blood with every beat. Thiscan result in a build-up of fluids in the lowerlegs and in the lungs, which in turn makes itdifficult to breath. The failure of the heart topump properly is called congestive heart fail-ure. The loss of pumping efficiency can be dueto damage caused by narrowed or blockedblood vessels leading to the heart or to otherheart damage.

BRAIN DISEASESStroke: a stroke occurs when a blood vessel inthe brain either becomes blocked or bursts. Thiskills parts of the brain and affects behaviourcontrolled by the damaged part of the brain.

Dementia: There are many different formsof dementia, but they all involve damage tothe brain. The causes of the brain damage dif-fer between the different types of dementia. Theexact type of brain damage can also differ withthe different types of dementia. The two maintypes of dementia among older people areAlzheimer’s disease and vascular dementia (ormulti-infarct dementia –MID). Alzheimer’s dis-ease is a disease of the brain that leads tomemory loss, confusion, difficulty in commu-nicating and personality changes. Its exactcause is unknown. Vascular dementia is braindamage caused by a series of mini-strokes.These mini-strokes occur because of blockages

12 Healthy Ageing

in the smaller blood vessels in the brain. Theseblockages are due to the same factors that nar-row or block blood vessels leading to the heart.

Parkinson’s disease is a disease of the brainthat mainly affects the ability to control musclemovements. It can also lead to dementia prob-lems with memory and communication.

LUNG DISEASESTwo common lung diseases, emphysema andchronic obstructive pulmonary disease, bothprevent the lungs from filling properly withfresh air. As a result, the lungs cannot transfersufficient oxygen to the blood to feed the cellsand organs throughout the body. Breathing andany exertion is difficult because the body hasinsufficient oxygen to work efficiently. Themajor cause of these lung diseases is smokingand pollution in the environment or workplace.

JOINT AND MUSCLE DISEASESMany older people suffer diseases of the joints.Many of these joint diseases are a form of ar-thritis. The most common forms of arthritisamong older people are osteoarthritis and in-flammatory forms of arthritis. Osteoarthritisoccurs when the cartilage that cushions thebones in the joints becomes worn or damaged.This results in restricted and painful movementin the joints. Inflammatory arthritis occurswhen the soft tissue in the joints becomes in-flamed, which in turn causes restricted move-ment and pain. The most common forms ofinflammatory arthritis are rheumatoid arthri-tis and gout.

As people grow older their muscles losesome of their strength. This in turn can makeit more difficult to maintain balance and pre-vent falls. Falls among older people are a ma-jor cause of disability.

DISEASES OF THE SENSESCataracts are a disease in the lens of the eyethat prevents light penetrating into the eye prop-erly. Without light people cannot see. Sight canbe restored by simple surgery that replaces thediseased eye lens with a plastic lens.

Glaucoma is an eye disease that initiallycauses the loss of side vision but, if left untreated,causes complete and permanent blindness.

Age-related macular degeneration is an-other common eye disease that results in the

gradual but permanent loss of central vision.It does not lead to total blindness.

Hearing loss involves the gradual and pro-gressive loss of hearing. It may result in par-tial or total deafness.

Tinnitus is an ear disease that results inconstant or intermittent ringing (or othernoises) in the ears.

BONE DISEASEAs people age, their bones become less denseand this makes them weaker and more likelyto break easily. Where this loss of bone strengthand density is severe, a person suffers fromosteoporosis. This disease, which is much morecommon among women than men, is largelydue to a lack of calcium in the diet in a person’sgrowing years.

CANCERBreast cancer is the most common cancer inolder women. It involves the growth of tumoursin the breast.

Cervical cancer is another common canceramong women, Cervical cancer is the growthof a tumor on a woman’s cervix.

Prostate cancer is a very common form ofmale cancer that is usually slow growing.Many older men have prostate cancer whichdoes not cause them to die, but there are someforms of prostate cancer that can develop rap-idly and lead to early death.

OTHER DISEASESUrinary incontinence is the inability to controlurine flow. This inability can be due to a vari-ety of factors, but weakness in particularmuscles that stem the flow of urine is a com-mon cause.

Diabetes is a very widespread disease thatresults in high levels of sugar in the blood. Highblood sugar results from the malfunctioningof other organs that either produce or use sugar.The resulting high blood sugar affects manyother organs in the body and increases the riskof developing many other diseases.

High blood pressure is a condition whereblood is pumped through the body at a higher-than-normal pressure. The main cause of highblood pressure (also called hypertension) isunknown. High blood pressure makes the ef-fects of other diseases (e.g. heart diseases and

Healthy Ageing 13

strokes) more serious. Hypertension also in-creases the risk of heart disease and stroke.

Mental healthAs well as physical diseases, there are a num-ber of diseases in later life that affect mentalwell-being. The dementias described abovecould be called mental diseases since they af-fect the way the brain works.

Depression is probably more commonamong older people than is often thought. Infact, it is probably the most common mentalhealth problem found among older people.Depression frequently occurs at the same timeas some form of physical disease and is con-fused as part of that disease. Depression canprofoundly affect the quality of life for olderpeople and their ability to deal with or recoverfrom various physical ailments.

Who Gets These Diseases?While many diseases are age-related and aremuch more common among older people, thisdoes not mean that ageing is a stage of lifewhere everyone has one disease or another.Many older people enjoy good health and spendmost of their later lives healthy. While most

older people will have some signs of particu-lar diseases, not all are affected in the sameway. For example, most older people will havesome sign of narrowing of their arteries or havesome hearing loss. However, the extent towhich people suffer from these problems var-ies widely. While natural ageing will contrib-ute to some diseases, most of these diseasesare not a natural or inevitable part of growingolder. A variety of factors influence who getsthese diseases.

Social positionScientists have learned that the risk of contract-ing various types of lifestyle disease is linkedto a person’s social and economic position.People higher up the social and economic lad-der are less at risk for most of these diseasesthan those lower down. People who are betteroff financially get ill less than those who struggleor live in poverty. This is because people wholive in poverty:

are less able to afford healthy food;are less able to obtain good health care;live in less healthy environments;have jobs that damage their health;have poorer housing which makes it harderto remain healthy; and

Condition Prevalence is higher/ Age at onsetfor men or women? is earlier for

Diabetes mellitus Similar SimilarCongestive heart disease Much higher for men MenColon cancer Men MenCervical cancer Exclusive to womenProstate cancer Exclusive to menDementia Women MenParkinson’s disease Men in some places SimilarGlaucoma Much higher for women WomenCataract Women MenHeart attack Men MenAngina MenStroke Men MenChronic obstructive Men Menpulmonary diseaseRheumatoid arthritis Much higher for women WomenOsteoarthritis (hip) Much higher for men MenOsteoarthritis (knee) Much higher for women WomenSuicide Men Men

Source: Murray C.J.L., Lopez A.D. Global health statistics : a compendium of incidence, prevalence, andmortality estimates for over 200 conditions. Boston, WHO and Harvard University Press, 1990.

14 Healthy Ageing

feel less confident about their ability to dosomething about their health.This means that one way of helping older

people enjoy better health is to reduce the pov-erty in which many live.

Family historyMany diseases run in families. This means thatthe same disease occurs in each generation andamong relatives. This is because some peoplehave an inherited biological tendency towardscontracting the disease. Heart disease, glau-coma, diabetes, strokes, some cancers, os-teoporosis, hearing loss and high blood pressureare examples of diseases where the risk of con-tracting the disease is partly inherited. How-ever, although certain diseases run in families,there is nothing certain or inevitable aboutdeveloping or not developing them. People witha family history of a disease can remain freeof it, while other people with no family historyof the disease develop it. Family history is justone contributing factor that makes some peoplemore exposed to the risk of the disease. Lifestyleand other factors can intervene and neutralizethe effect of family history.

Race and ethnic backgroundIn a similar way as family history affects therisk of developing a disease, so can race andethnic background. For example, the chanceof developing diabetes, glaucoma, high bloodpressure and various cancers partly dependson race and ethnicity. It is not always clearwhether the different risks of developing thesediseases is because of biological differencesbetween races or because of their differentlifestyles, diet, etc.

GenderA person’s risk of contracting many of the dis-eases of later life depends partly on whetherthey are male or female. This is obvious fordiseases such as prostate cancer and breastcancer. However, there are also gender differ-ences for other diseases (see Figure 1). Womenare more likely than men to develop depres-sion, osteoporosis and osteoarthritis. Men, how-ever, are more at risk of heart diseases, goutand high blood pressure. Some of these differ-ences are due to hormonal differences between

men and women, but cultural and lifestyle fac-tors (e.g. men smoke and drink more thanwomen) may lead to other gender differencesin health risk.

LifestyleThere is not a great deal that individuals cando about social position, gender, family his-tory or race. However, they can do somethingabout the way they live their lives – their diet,their exercise habits, their weight, whether theysmoke and the amount of alcohol they drink.Some of the diseases of later life are not pre-ventable by changing lifestyle. For example,Alzheimer’s disease and Parkinson’s disease donot seem to be due to lifestyle factors and thereis little that can be done to prevent them. If aperson contracts these diseases, the best thatcan be done is to develop lifestyle methods ofmanaging them. However, other diseases leavesubstantial room for individuals to do some-thing about them. If they develop healthy hab-its early enough in life, they can reduce theirrisk of developing these diseases considerably.Even if these diseases are not prevented, healthylifestyles may still delay their onset and canhelp control their progress and their effect ona person’s life.

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16 Healthy Ageing

Lifestyle Changesand Healthy Ageing

Diet and NutritionA good diet makes people feel better aboutthemselves and gives them more energy, as wellas reducing their chances of developing thediseases of later life. As countries rapidly de-velop economically, diets and lifestyles changeconsiderably and overnutrition often adds to,and eventually replaces, undernutrition. Themajor dietary problems of many peoplethroughout the world now include:

Excessive fat intake. The fat in animalfoods, especially meat and dairy products,is mostly saturated fat, while the oil fromplants and fish is mostly unsaturated fat(palm and coconut oil are the exceptionsbecause they are high in saturated fat).Since saturated fats can increase the riskof cardiovascular disease, only a smallamount of foods containing saturated fatsshould be eaten. Fish and plant food canimprove health because of their unsatur-ated fats and a number of other nutritionalbenefits.

Saturated fats lead to an increase in onetype of cholesterol (called LDL cholesterol)in the body. This form of cholesterol islinked with increased risk of cardiovascu-

lar disease. The basic rule is to minimizethe amount of saturated fat in the diet.

Trans fatty acids have been linked toheart disease. These may be found in mar-garines and other spreadable oil products.The intake of trans fatty acids can be lim-ited by checking the labels of these prod-

People can do a great deal to influence their individual risk of developingmany of the diseases of later life by paying careful attention to five lifestylefactors: diet, exercise, weight, smoking and alcohol use. Throughout the West-ern Pacific Region, in recent years, many people have been adopting un-healthy diets, doing less exercise, becoming seriously overweight, smoking anddrinking too much alcohol. These behaviours have contributed to an increasein the diseases of later life. These five lifestyle factors affect a number of dis-eases. By adopting a healthier lifestyle, the risks of a whole range of diseasescan be reduced.

Healthy Ageing 17

PRACTICAL TIPSDIET AND NUTRITION

Eat a balanced diet. There are six food groups(see Figure 2):

– Group 1: Bread, cereal rice and pasta, preferablywholegrain [ limiting the amounts of potatoes andwhite rice ( especially if not parboiled as this isabsorbed in a similar way as sugars)];

– Group 2: Fruits;– Group 3: Vegetables;– Group 4: Meat, poultry, fish, dried beans, eggs

and nuts;– Group 5: Milk, yoghurt and cheese;– Group 6: Fats, oils and sugars.

The secret to a good diet is a balance that en-sures that the necessary vitamins and mineralsprovided by each food group are obtained.Extreme, crash and fad diets should be avoided.Reduce saturated fats and oils. As far as possible,animal fats should be reduced. This can beachieved partly by following some simple measures:

– Minimize butter, use lean meat, avoid chickenskin, change to low-fat milk, reduce takeawaysand limit cakes and biscuits.

– Avoid fried, fatty and sugary foods.– Check the labels when buying cooking ingredi-

ents or processed food to see whether they arehigh in animal fats (saturated fat) or trans fattyacids.

– Avoid fried food – grilling or baking is better asit allows fat to drain away.

– Cut fat off meat and remove skin from chickenbefore cooking.

– Eat fewer cakes, pies, biscuits and pastry sincethese usually contain high levels of animal fats,as well as sugar.

– Use vegetable oils rather than animal fats, butlimit the use of coconut oil and palm oil as theyare high in saturated fat.

– Use olive oil since it contains mostly unsaturatedfats and it lowers LDL cholesterol. Soybeans andcanola oil also lower LDL cholesterol.

– Use lower-fat dairy products (milk, cheese).– Eat at least 1-2 servings of fish per week since it

is low in saturated fat and high in unsaturatedfats that protect from heart disease.Eat fruits and vegetables.

– Purchase fresh fruits and vegetables.– Eat fruit rather than drinking fruit juice.– Eat at least two portions of fruit and three por-

tions of vegetables every day.Reduce salt intake. Bread is often the biggestsource of salt (in Western countries anyway) but

it may be difficult to tell which are the higherand lower salt breads without food labels. Thefollowing can help to reduce salt intake:

– Do not add salt when cooking or on mealswhen they are served.

– Check the salt content of processed foods onlabels and buy low-salt alternatives whereavailable.

– Avoid cooked takeaway foods that are highin salt.

– Limit the amount of canned foods eaten sincethese are often high in salt.

– Limit the amount of cured meats that areeaten as these contain high levels of salt.

– Limit the use of soy sauce.– Use herbs and spices rather than salt to add

flavour to food.Reduce the amount of sugar consumed.

– Minimize the amount of sweet food eaten.– Avoid (or limit the amount of) sugar in food

and drinks.– Limit consumption of soft drinks.

Include plenty of calcium in the diet through-out life. Ensuring that calcium-rich foods areeaten is a particularly important way for womento avoid bone diseases such as osteoporosis. Toimprove calcium levels:

– Use dairy products, since these are a goodsource of calcium. However, limit the con-sumption of animal fats. Low-fat dairy prod-ucts should be used - these still containcalcium.

– Use low-fat soy milk and other soy products.– Eat canned fish with soft bones, such as sar-

dines, anchovies and salmon.– Eat plenty of dark-green leafy vegetables.

Continued next page

18 Healthy Ageing

ucts and limiting the consumption of foodsthat contain them, such as biscuits, cakes,pastries and other desserts.too much sugar;too much salt;too little calcium;too little fibre;too little fruit and too few vegetables.Unfortunately some older people neglect

good nutrition. This happens for a variety ofreasons including:

Living alone: Often a person living alonecannot be bothered to prepare a meal justto eat on their own. They end up snackingand having a very unbalanced diet.Other health problems which lead to un-healthy diets: For example, difficulty chew-ing can cause a person to avoid a lot ofgood foods.A natural loss of the sense of smell andtaste that can make eating less enjoyable.Lack of money to obtain fresh and healthyfood.

ExerciseExercise helps maintain good health for a num-ber of reasons. Exercise:

helps control weight;improves emotional well-being and relievesstress;

improves blood circulation;increases energy levels;helps with sleeping;lowers blood pressure;increases flexibility;improves balance and thus reduces thedanger of falls;lowers blood-sugar levels and thus helpscontrol diabetes;improves bone density and strength andhelps prevent osteoporosis.As a result, exercise is a valuable part of

preventing coronary artery disease, high bloodpressure, osteoporosis, poor mental health anddiabetes.

Types of exercise:There are four main types of exercise: endur-ance exercises; strength exercises; balance ex-ercises; and flexibility exercises.

Endurance exercises: These exercisesimprove breathing and the heart rate and,therefore, improve the health of the heart, lungsand blood circulation. By improving endur-ance, people are more able to do everyday tasksthemselves and thus remain independent longer.Better endurance can also delay or prevent dis-eases such as diabetes, heart disease and stroke.

Strength exercises: These exercisesstrengthen muscles and can, therefore, helpolder people live independently longer. They

Eat high-fibre foods. Foods that are high in fibre aregenerally good and should be included in a healthydiet. Such foods are also a good way of filling upwithout putting on too much weight. Do the follow-ing to increase the amount of fibre in the diet:

– Eat whole grains, fruits, vegetables, beans, nuts andseeds. Processed grains, such as white rice or whitebread, do not contain much fibre.

– Leave the skin on vegetables and fruit where pos-sible.

– Eat fruit whole rather than as fruit juice.– Add beans to soups, stews and salads.

Further information on diet:http://www.who.int/hpr/global.strategy.shtmlhttp://www.pueblo.gsa.gov/cic_text/food/food-pyramid/main.htm

PRACTICAL TIPSDIET AND NUTRITION continued

Healthy Ageing 19

PRACTICAL TIPSEXCERCISE

Endurance exercises: Some general guidelines forendurance exercise are:

Take up exercises such as walking, cycling or swim-ming. These all strengthen the heart, lungs andblood circulation.When trying to build up endurance, it is impor-tant to build up gradually. A person who has beeninactive may begin with five minutes a day andgradually build up to about 30 minutes a day.The 30 minutes of exercise a day may be brokeninto smaller periods of, say, 10 minutes at a time.As the exercise becomes easier, the difficulty canbe increased a little at a time. Walking might bedone a little faster, a little longer or up gentlehills.It is important for older people to make sure thatthey drink plenty of water when exercising. Asthey get older, some people do not drink, evenwhen they need to.Endurance exercises should be undertaken whenthe weather is neither too hot nor too cold.Strength exercises: As they grow older, most

people lose up to 40% of their muscle tissue and thuslose strength. Moderate strength exercises can helpa great deal in overcoming some of the effects ofthis loss of muscle strength. Most strength exercisesinvolve lifting or pushing weights of some type. Someguidelines to build up muscle strength though liftingweights are:

Weights do not need to be heavy – starting witha weight of between one-half to one kilogram isa good beginning.Simple weights, such as a bottle filled with sandor water, or a small bag filled with beans, can besufficient.Pulling or stretching resistance bands (these arethick rubbery bands) is another way of doingstrength-building exercises.While the weights do not need to be heavy, theyshould be gradually increased as muscle strengthreturns. To build strength the muscle needs to bechallenged a little. However, heavy weights shouldbe avoided as they can cause injuries.Strengthening exercises should involve between8-15 repetitions in a row, a rest and then anotherset of 8-15 repetitions.

Each main muscle group should be exercised twicea week.Specific exercises for each muscle group are de-scribed at:http://www.nia.nih.gov/exercisebook/ http://

www.mayoclinic.com invoke.cfm?id=HA00032Stretching exercises: Stretching exercises can

help give greater freedom of movement, which canpromote greater independence. On their own,stretching exercises do not improve endurance orstrength. Some general guidelines regardingstretching are:

Stretching exercises should be done three times aday at the beginning in order to develop flexibil-ity. Once the flexibility has been regained one ortwo times each day should maintain flexibility.Each stretching exercise should be done between3 to 5 times at each session.Stretching is best done after other exercise whenmuscles are warm and easily stretched.Bouncing, jerking movements while stretchingshould be avoided. Stretches should be slow,gradual and even.Stretching to the point where the stretch is pain-ful should be avoided as this will cause damage.If the muscle or joint is painful during the stretchit is an indication that the stretch is too severe.Each stretch should be held for about 20 seconds.Details of particular stretching exercise are avail-able at:http://www.nia.nih.gov/exercisebook/

chapter4_stretching.htmBalance exercises: or particular exercises that

help with balance see:h t t p : / / w w w. n i a . n i h . g o v / e x e r c i s e b o o k /

chapter4_balance.htm

can also help keep weight and blood sugarunder control and thus reduce the risk of obe-sity and diabetes and all the health problemsthat follow from these conditions.

Balance exercises: Falls can be a seri-ous problem for some older people and can causeinjuries that can take away their independence.Balance exercises can reduce the risk of falls.

20 Healthy Ageing

Flexibility exercises: Flexibility exer-cises are stretching exercises designed to keepmuscles flexible. They can help prevent someinjuries and help injuries heal more quicklythan they would otherwise.

Many people do less exercise as they get olderand are concerned that exercise may make cer-tain conditions, such as sore joints, worse ormake heart problems dangerous. However, mostpeople can benefit from exercise, even if theyare suffering from one of the diseases or disor-ders that are more common in later life. How-ever, care must be taken regarding when and howmuch exercise is taken. Before beginning aprogramme of vigorous exercises, it is impor-tant to check these matters with a doctor.

Some people avoid beginning to exercisewhen they are older because they think it willbe too hard. However, even small amounts ofexercise can help. The secret with any exerciseis to:

begin slowly;increase the amount of exercise gradually;do it regularly;do not overdo the level of exercise. Stop ifany symptoms such as chest pain, exces-sive breathlessness or tiredness develop.Other people are reluctant to do exercises,

either because they do not like doing specificexercise programmes, or because they feel sillydoing so. An alternative is for people to re-main active – to build exercise into the nor-mal routines of their daily life. This might beachieved by everyday activities such as walk-ing, instead of driving or taking public trans-port, or walking part of the way, using the stairsand carrying items.

WeightOverweight and obesity have become majorproblems throughout the world and contributeto many of the diseases of later life. Overweightis not due just to eating too much food, but toeating food that is very energy-dense (high infat and sugar) and doing too little exercise.Obesity is an important factor in the followingdiseases of later life.

heart disease;stroke and the mini-strokes involved invascular dementia;diabetes;

PRACTICAL TIPSWEIGHT

As people get older they often become less active and,therefore, use up less energy. Unless they eat less tocompensate for their reduced activity, they will put onweight and possibly become obese. Controlling weight,therefore, requires: eating a balanced diet, with adequateenergy intake, which is rich in vitamins and minerals, andavoiding fad and extreme diets; and exercising sufficientlyand maintaining a physically active lifestyle. The guidelinesand tips above can help in this regard.

As with all the lifestyle factors discussed here, the earlierin life healthy types of behaviour are developed the better.Thus, an important part of guarding against obesity inlater life is ensuring that children and adolescents do notbecome overweight. In addition to the diet and exercisetips outlined above:

Avoid extreme (or “crash”) diets.Eat small meals regularly.Eat slowly and chew food slowly rather than gulpingfood.Eat foods that are filling but that are low in fat andcalories (e.g. high-fibre foods).Be realistic about weight-loss goals – aim for slow andmoderate weight loss.Leading experts recommend that most overweight

individuals should try to lose 5%-10% of body weight. Anoverweight person who loses 5%-10% of their body weightand keeps it off will experience improvements in theirphysical health, quality of life, energy level, physical mobility,general mood and self-confidence. Long-term weight lossis most likely to succeed where people change their generallifestyle, rather than go on sudden, unsustainable diets orexercise programmes.

Healthy Ageing 21

high blood pressure;arthritis – especially in the knees; andbreast cancer.Body weight is the result of the difference

between how much energy (measured as calo-ries or joules) is consumed and how much isused up by physical activity. If people consumemore energy than their bodies use, the excessenergy is converted to fat for possible use atsome future time. If energy intake is alwaysgreater than consumption, a person will keepputting on weight.

PRACTICAL TIPSSMOKING

Stopping smoking usually involves four stages:making the decision to quit; setting a date to quitand choosing a quit plan (e.g. stopping suddenly,reducing gradually); dealing with withdrawal; andmaintenance or staying smoke-free.· Setting a quit date and choosing a method of

quitting: Once a person has decided to quitsmoking, they should set a particular date whenthey will actually stop. Although there is no oneright way to quit, the most usual method is tostop suddenly. Reducing the number of cigarettesgradually is generally less effective than the firm,unambiguous act of stopping smoking. Once aQuit Day has been selected it is good to tell othersabout it so that they can support the decision.

The American Cancer Society advises that,on the Quit Day, the smoker should do the fol-lowing:

– Do not smoke at all.– Throw out all cigarettes, lighters, ashtrays, etc.– Keep active by walking or doing some other form

of exercise.– Drink lots of water and juices.– Use nicotine replacement (if that is the chosen

method of dealing with withdrawal symptoms).– Avoid high-risk situations where the urge to

smoke is strong.– Avoid or reduce alcohol intake.– Use the four “As” (avoid, alter, alternatives, ac-

tivities) to deal with tough situations (describedin more detail later).Dealing with withdrawal: Smoking is part of away of life for smokers and is linked, in thesmoker’s mind, with particular activities andsituations. Part of quitting is breaking the link

between these activities and smoking. Forexample, smoking and relaxing are closely linkedfor many smokers. Smoking is often associatedwith drinking coffee or alcohol. Alternativelymany smokers automatically light up when theyare stressed. Thus the automatic response is towant to smoke when relaxing, drinking alcoholor coffee, or when stressed. Part of quitting isto replace smoking with an alternative in thosesituations where the habit has been to smoke.The American Cancer Society suggests thefollowing approaches to this type of situation:

– While giving up smoking, avoid people andplaces where the temptation is to smoke.

– Alter habits that are associated with smoking.Instead of drinking coffee, switch to juice, oruse alternatives to cigarettes, such as gum andsweets, instead of lighting up.

– Keep active by exercising or do things that keepthe hands busy and help distract from the urgeto smoke.Remaining smoke-free: Once a person has quitsmoking, the urge to smoke can occur monthsor years later. In such situations, the ex-smokercan respond as follows to the urge to smoke:

– Review all the reasons they quit in the first place.– Avoid having just one cigarette.Persevere and the sudden urge will go away.

Further information can be obtained from:http://www.cancer.org/docroot/PED/content

PED_10_13X_Quitting_Smoking.asp#toquith t t p : / / w w w . l u n g u s a . o r g / t o b a c c o /

quitting_smoke.htmlhttp://www.nia.nih.gov/health/pubs/hearts-

arteries/index.htm#contenthttp://www.health.gov.au/pubhlth/quitnow/

quitbook/index2.htm

SmokingAll smoking is harmful. Smoking is linked toan increased risk of developing nearly all thediseases discussed in later sections of this book-let. Smoking is an especially important factorin heart disease; cancer of the lungs, mouthand throat; breathing problems; stroke; andosteoporosis.

Many older people think that it is not worthquitting – that after a lifetime of smoking thedamage has already been done. The good news

22 Healthy Ageing

is that, as soon as a person stops smoking, thebody begins to repair itself and the risk of smok-ing-related diseases begins to drop. While dam-age caused by smoking will not be completelyundone, there are still benefits to older peoplequitting. Within about 10 to 15 years of stop-ping smoking, the risk of contracting manysmoking-related diseases is not too muchhigher for the former smoker than for a life-long non-smoker.

While there are strong health reasons forstopping smoking, it is quite another thing forpeople to be able to quit. The fact is that thenicotine found in tobacco is a highly addictivedrug – as addictive as heroin or cocaine. Whensmokers inhale tobacco smoke, the nicotine isabsorbed throughout the body and creates plea-surable feelings that make the smoker want tosmoke more. The body adapts to nicotine inthe blood and develops a tolerance for the drug,which leads to the need to smoke more to getthe same pleasurable feelings.

Stopping smoking requires that:the person stops relying on smoking forpleasurable feelings; andthe body adapts to no longer having nico-tine present.Neither of these changes is easy. Even when

people want to give up smoking, they will nor-mally find it difficult to do so. Programmeshave been developed to assist people in thisdifficult task, but there is no single method that

works for everyone. Different ways of quittingare effective for different people.

When giving up smoking, a person willsuffer from withdrawal symptoms – from nothaving the nicotine drug in the body. Commonwithdrawal symptoms are:

depression;feelings of frustration and anger;irritability;sleeping difficulties;difficulty concentrating;restlessness;headache;tiredness; andincreased appetite.

AlcoholDrinking beyond a specified amountcontributes to a number of later life diseases.Men should not drink more than two drinksper day. Women should not drink more thanone drink per day. Drinking more than thisamount is linked to the following diseases andtheir management.

liver disease;stomach ulcers;gout;depression;osteoporosis;heart disease;breast cancer;diabetes; andhigh blood pressure.People who cannot control their drinking

should stop drinking altogether. People whodrink more than is good for their health shouldcut down to the amounts stated above.

Healthy Ageing 23

Social ActivitiesAs well as being affected by diet and exercise,health at all ages is influenced by social rela-tionships. People who become socially isolated– who rarely go out, do not join in the commu-nity, have few friends or do not see much oftheir family – are less healthy. Sometimes theysee less of other people because their healthmakes it harder to get out or they feel embar-rassed about their disabilities. But not mixingwith others also makes health worse.

Getting out and keeping involved withother people is an important way of keeping

PRACTICAL TIPSALCOHOL

Cutting down on alcohol can be difficult. However,there are ways of doing so. The Institute on AlcoholAbuse and Alcoholism recommends the followingtechniques for reducing alcohol consumption:

Write down the reasons for cutting down orstopping drinking.Keep a “diary” of how much alcohol is drunkand the situations in which it is consumed.Keep only a small amount or no alcohol at home.Drink slowly. This can be achieved by sipping adrink, having a break of an hour between drinksand alternating between alcoholic and non-alcoholic drinks.Avoid drinking on an empty stomach.Take a break from alcohol by not drinking anyalcohol at all on one or two days a week. Some-times not drinking at all for a week or so can be auseful check on whether dependence is develop-ing.Learn how to say ‘NO’ politely to offers of a drink.Stay away from people who give you a hard timeabout not drinking.Stay active. Replacing drinking with other enjoy-able activities can make drinking less of a reward-ing thing in itself.Get some exercise, which can reduce stress andtake away the urge to drink.Get support from family and friends, which canhelp make it easier to have the strength to cutdown drinking.Avoid temptations that lead to drinking. Certainpeople, places and times can lead to unplanned

and unwanted drinking. Planning ahead, ei-ther to avoid such situations or to be ready todeal with the temptation to drink too muchin those situations, can help cut down drink-ing to healthy levels.Avoid drinking when angry, upset or after abad day. These are habits that need to be bro-ken when tyring to cut down on drinking.Do not drink alone.

healthy in the first place. It creates a sense ofbelonging and being part of something big-ger. Mixing with other people of a similar age,at a similar stage of life or perhaps with simi-lar health concerns can help people realize thatthey are not alone. The support gained fromothers can be important in recovering fromillness. Simply knowing that others care helps.

Being part of family groups and the widercommunity provides the opportunity to feelvalued and to make a contribution. Being ableto help others, give a helping hand and feelneeded all improve the way people feel aboutthemselves. People who feel good about them-

24 Healthy Ageing

PRACTICAL TIPSSOCIAL ACTIVITIES

Social contacts and links can be improved bydoing the following:

Get out of the house and meet otherpeople.Join community groups.Invite people home.Arrange regular times for getting togetherwith friends and family members.Make the time with other people pleasantfor them so that they will want to keepup the contact.Find activities that involve doing things forother people.Go for walks in places where there is agood chance of meeting other people.Keep up regular contact with family mem-bers.Be friendly towards neighbours.

selves will look after themselves better. Whenpeople feel that they have something to livefor, they care for themselves better.

People who keep to themselves end up eat-ing less well, getting less exercise and drink-

ing more alcohol. Isolated older people getmore depressed and are much more likely tocommit suicide.

Healthy Ageing 25

26 Healthy Ageing

The purpose of these outlines is to providehealth workers with information to assist withimproving the capacity of older people to takecontrol of their health. They are designed toenable older people to make their own deci-sions and to take actions to promote their ownhealth in later life.

Alzheimer’s DiseaseWhat is Alzheimer’s disease?Alzheimer’s disease is a disease of the brainthat causes dementia – it affects the part of thebrain that controls thought and language. Thisleads to memory loss, difficulties in thinking,and problems in understanding other peopleand communicating.

Who gets Alzheimer’s disease?Alzheimer’s is not a natural part of ageing butdoes mainly occur among older people. Al-though it sometimes affects people in their thir-ties and forties, it is mainly found among peopleover the age of 60. About 3% of people aged65-75 suffer from Alzheimer’s, but 25% of thoseaged over 85 suffer from the disease. On aver-age, people with Alzheimer’s live for about eightyears after contracting the disease.

CausesScientists do not know what causes Alzheimer’sdisease, although there does seem to be sometendency for it to run in families.

Age-Related Diseases:Prevention, Treatmentand Practical Tips

SymptomsAlzheimer’s is a progressive disease. It startsoff with just a few symptoms, but these symp-toms get progressively more serious over thecourse of the disease.

People in the early stages of Alzheimer’swill find themselves becoming more forgetful– especially about very recent events. In thebeginning, this will happen only occasionally,but it will become more frequent and moresevere. Early on, an Alzheimer’s sufferer willfind that they cannot remember how to do somefamiliar tasks. As their memory gets lessreliable, they can become confused and unsureof where they are. This can result in themwandering off and getting lost.

Language abilities will decline asAlzheimer’s disease progresses. As the diseasedevelops, sufferers will find it increasingly dif-ficult to express themselves clearly and to un-derstand what others are trying to say, and willfind reading and writing increasingly difficult.Those in contact with a person suffering fromAlzheimer’s disease will begin to notice somepersonality changes, such as the sufferer be-coming more anxious, more aggressive or moresuspicious of other people.

The following symptoms may indicate thata person is developing Alzheimer’s disease. Ofcourse, any single symptom may be a sign ofsomething else, but an older person who expe-riences many of these symptoms should see adoctor.

The pages that follow provide brief descriptions of a range of diseases anddisorders that are more common among older people. The descriptions outlinethe main characteristics of the disease or disorder, the main known causes, thetypical symptoms and some of the things that can be done to either preventthe problem or make it more manageable.

Healthy Ageing 27

memory loss where the person frequentlyforgets things and becomes confused – evenat home;difficulty performing familiar tasks;forgetting simple words or frequently usingthe wrong words (The person developingAlzheimer’s disease will find it hard toexpress ideas simply or clearly, or to followfairly simple ideas or instructions.);becoming mixed-up and confused aboutwhere they are and what time of day it is– even when in familiar places;finding that abstract tasks such as simplearithmetic – adding or subtracting –become very difficult;constantly misplacing things;rapid mood swings for no obvious reason(The person developing Alzheimer’sdisease may be calm and happy onemoment and very anxious or depressed thenext, or suddenly become very angry orfearful.);things that were once enjoyed andinteresting become boring (The Alzheimer’sdisease sufferer may lose interest in things

and find that they can’t be bothered doingthings they once enjoyed.);loss of judgement about what to do andwhen to do it (A person developingAlzheimer’s disease may begin to dress in-appropriately for an occasion or say thewrong things in company.).

TreatmentThere is no known cure for Alzheimer’s disease.However, some actions can make things a littleeasier.

NON-MEDICAL TREATMENTS:Family education and counselling: It can helpto talk to people who know about Alzheimer’sand who can tell both the person developingAlzheimer’s disease and those close to themwhat to expect. Knowing what to expect andknowing that mood and other changes are dueto the disease can make things a bit easier. AsAlzheimer’s progresses, the sufferer will needhelp from others to do some things. Thosepeople will need to know about Alzheimer’sdisease and what to expect.

PRACTICAL TIPSALZHEIMER’S DISEASE

The effects of Alzheimer’s disease will steadily growas time passes. Things that were once easily achievedwill become more difficult. Making decisions,remembering, learning new things andcommunication will all get more difficult. Thesuggestions below are designed to help the persondeveloping Alzheimer’s disease to manage thesechanges a little better.

Memory tips for the person developingAlzheimer’s disease: Some of the problems causedby the loss of memory that is part of Alzheimer’sdisease can be reduced by the following actions:

Use a daily diary as a reminder for appointmentsand daily tasks.Keep a notebook in which to write down thingsto do.Keep a book with a list of people’s names, theirphone numbers and memory joggers about thepeople.Try to establish a routine that other people knowabout so they can help remind you or know whereto locate you.

Use an alarm clock as a reminder.Have a friend call to remind you about appoint-ments, mealtimes, etc.Label cupboards and drawers with words orpictures that describe their contents.Organize things in the home so that there is aset and obvious place for important things.Communicating: Alzheimer’s disease makes it

more difficult to express ideas and to beunderstood. Doing the following can help theperson with the disease:

Relax and speak slowly.Think through what you want to say.Ask other people to speak slowly or repeatthemselves.Find a quiet place for conversations.Structure the day: The following actions can

help the person developing Alzheimer’s disease:Write down the things you want to do in theday.Have an established routine for each day.Take time doing things.

Continued next page

28 Healthy Ageing

Try to relax to avoid getting frustrated whenfamiliar tasks seem difficult.Ask for help when you need it.Finding the way around: The person developing

Alzheimer’s disease may find that they get lost onoccasions – even in places with which they arefamiliar. Encouraging the person with Alzheimer’sto do the following can help to avoid this:

Write down in a book what you are going outfor.Write down where you intend to go.Ask for help if you become confused.Aways carry some identification with phone num-bers to contact in case you become confused orget lost.Coping with feelings: Alzheimer’s can cause

many feelings to surface. This is hardly surprisingand these feelings cannot be ignored. In additionto feelings of anxiety, sadness or anger, the personwith Alzheimer’s disease may feel very frustrated,guilty, embarrassed or very lonely.

Medication can help manage some of thesefeelings, but the person developing Alzheimer’sshould also try non-medical approaches such as thefollowing:

Join a support group to talk with others whohave Alzheimer’s.Do things you enjoy.

Spend time with family and friends.Tell others how you are feeling.Living alone: Since Alzheimer’s is more common

among older people, many people may be livingon their own when the symptoms begin. It isimportant, therefore, to take some steps in theearly stages of the disease to help manage betteras the symptoms progress. These steps include:

Make arrangements for help with meals andhousework. Although this help may not beneeded immediately, it is sensible to make surethat arrangements are in place for the time whenthe need arises.Leave house keys with a trusted neighbour, fam-ily member or someone nearby.Arrange for help with transport.Develop a daily routine.Arrange for people to drop by regularly or tokeep up regular contact.Ensure that any medications are monitored.Have a trusted person check things around thehouse.Arrange for someone to help with householdmanagement tasks (bills, etc.).Arrange for a trusted person to have the au-thority to deal with financial and legal matters.At a certain point, however, Alzheimer’s disease

will progress to the point where sufferers can nolonger live alone. Arrangements must, therefore,be made in the early stages of the disease toprepare for this time.

PRACTICAL TIPSALZHEIMER’S DISEASE continued

Modifying the environment: Loud or sud-den noises may begin to upset and confuse theperson developing Alzheimer’s disease. Somepeople with Alzheimer’s find that dim lightingmakes them uneasy and anxious. BeforeAlzheimer’s develops too far, it is wise to try todo something about those things that undulyupset the sufferer.

Planning activities: Keeping active can helpthe person with Alzheimer’s disease. It is good,in the early stages of the disease, if a routinecan be established, as this can help controlanxiety and depression. A routine can help (butnot solve) some forgetfulness and confusion.MEDICINES:Medication can play a role in managingAlzheimer’s disease.

Some medications can help halt theprogress of the disease for some time, but

Healthy Ageing 29

they cannot cure it.Medications can help control symptoms,such as agitation, anxiety, anger, depres-sion or feelings of suspicion about others.Other medications can help moderatememory loss, but they cannot overcomememory problems

Breast CancerWhat is breast cancer?Breast cancer is the most common form of can-cer among women. It occurs when cancerouscells in the breast form a tumour. These can-cerous cells might remain only in the breast ormay spread to other parts of the body and leadto cancerous growths in these parts. Left un-treated, breast cancer is fatal. Breast cancercannot be prevented, but early detection in-creases the chance of successful treatment.

Who gets breast cancer?The main risk factors in developing breast can-cer are:

Age: Although women can develop breastcancer at any age, it is rare among womenyounger than 30. Most breast cancers oc-cur in women over the age of 50.Family history: The risk of developingbreast cancer is higher if a woman’s motheror sisters have had breast cancer, as itseems to run in families.

Other factors that increase the risk of breastcancer are:Alcohol: Drinking two or more units ofalcohol each day;Weight: Being overweight increases therisk.Having the following characteristics alsoincreases the risk slightly:

– beginning to menstruate at age 11 oryounger;

– not having children or having a first childwhen 30 or older;

– not breast feeding.

CausesThe body is made up of millions of tiny cells.These cells regularly die and are replaced bynew cells in a controlled way. Sometimes thebody’s normal control over the production ofnew cells does not work properly and too many

cells are produced. When this happens, theseextra cells form a growth called a tumour. Thistumour can invade and destroy good, healthycells nearby and this can cause serious dam-age to the body and eventually death. The can-cerous cells that form a tumour can also betransported to other parts of the body and thesecells can invade parts of the body well awayfrom the place where the original problemstarted.

The reason why some cells lose their abil-ity to properly regulate the way they grow andreproduce is not always clear. The reasons seemto differ for cells in different parts of the body

SymptomsEarly breast cancer usually has no symptoms.As the cancer develops a woman might haveone of these symptoms:

an unusual lump in the breast;the skin near where the cancer is develop-ing turns coarse and wrinkled;a discharge from the nipple.

Prevention and treatmentThere is no sure way of preventing breast can-cer. Reducing risk factors will help, but willcertainly not eliminate the risk of developingbreast cancer.

The earlier breast cancer is detected, themore successfully it can be treated. Most breastcancers are detected by women who watch outfor the tell-tale signs or by a breast X-ray (calleda mammogram).

The best way of reducing the danger frombreast cancer is to regularly check the breastfor lumps;

The failure to remove a cancerous breasttumour will eventually result in death.

Surgery: The first step is to remove the

PRACTICAL TIPSBREAST CANCER

The earlier breast cancer is detectedthe more successfully it can betreated.Talk with other people who havebeen through the same experi-ences.Regularly check breasts for lumps.

30 Healthy Ageing

lump so that it can be tested to see what formof lump it is. Not all lumps are cancers thatinvade the body. Tests are used to check if thelump is cancerous and, if so, to see if it hasspread and how far developed the cancer is.

Once the nature and spread of the cancerare known, several different types of surgerymay follow:

removal of the cancerous lump and glandsin the armpit;removal of the lump and part of the breastsurrounding the lump and glands in thearmpit;complete removal of the breast and possi-bly the surrounding muscle tissue.

Additional treatments: In addition to sur-gery, the woman with breast cancer willoften need to have either:radiation therapy: This involves a se-ries of X-ray type treatments over a periodof five to six weeks; and/orchemotherapy, which involves taking avariety of medications.The purpose of both these therapies is to

make sure that any remaining cancerous cellsare killed.

CataractWhat are cataracts?Cataracts are a disease of the lens part of theeye which can lead to blindness. A cloudy areadevelops in the eye which stops the light get-ting into the eyeball. Without light the eye can-not see. There are different types of cataracts,but age-related cataracts are the most com-mon type

Who gets cataracts?People can develop age-related cataracts in theirforties or fifties, but these cataracts are nor-mally small and do not affect vision. Most cata-racts occur in people over the age of 60 and itis these that affect vision most.

CausesThe lens in the eye is made up mainly of twomaterials – water and protein. These are ar-ranged in the eye so that light can get through.As some people age, the protein can clumptogether and go cloudy. Scientists are not cer-tain what causes this change in the eye, but

they think that smoking and diabetes are in-volved. It could also be due to the long-termeffect of the sun on the eyes.

SymptomsAt first, lights appear very bright and glar-ing – especially at night.Colours appear faded and washed out.As the cataract develops, reading becomesmore difficult.People with well developed cataracts willfeel that they are trying to look through awaterfall – very clouded and blurred.

Prevention and treatmentThree protective actions are to:

protect the eyes from the sun;avoid smoking;prevent or control diabetes;If the cataract is not causing much trouble,

new glasses or brighter lights may be sufficienttreatment. Surgery is the only solution for cata-racts that have developed to the stage that theycause blindness. These operations have a goodsuccess rate at restoring sight.

Congestive Heart Failure(CHF)What is CHF?The heart is a muscle that pumps bloodthroughout the body. Congestive heart failureoccurs when the heart cannot perform this nor-mal function. There are many possible reasons,but the most common is damage to the heartresulting from narrowing or blockage of theblood vessels leading to it. When the heart can-not pump blood efficiently, fluids can build upin the lungs and lower legs.

CHF can be mild or very severe. A personwith mild or even moderate CHF should beable to manage the disease successfully withdiet, exercise, other lifestyle changes and some

PRACTICAL TIPSCATARACT

Wear a wide-brimmed hat to pro-tect the eyes when in the sun.Wear sunglasses that filter outultraviolet light.

Healthy Ageing 31

medication. A person who makes the neces-sary changes should be able to live a relativelynormal life. However, severe CHF may requiresurgery and can be more disabling.

Who gets CHF?CHF is mainly found among older people.It is common among people who have hada heart attack, have heart disease or havehigh blood pressure. These conditions dam-age parts of the heart so that it pumps lessefficiently. People who are liable to haveheart attacks, high blood pressure or nar-rowing of the arteries are all more likelyto develop CHF.CHF tends to run in families and is morelikely as people grow older if they are over-weight, smoke, have little exercise anddrink too much alcohol.People who have diabetes or kidney diseaseare more likely to develop CHF.

CausesCongestive heart failure is the end result ofmany different heart diseases. The most com-mon causes are:

damage to the heart from heart attack(s);andhigh blood pressure. When a person hashigh blood pressure the heart has to workharder to pump blood into the body againstpressure. This extra work damages theheart and results in the heart pumping

more weakly.SymptomsSymptoms include:

sudden weight gain due to fluid retentionin legs and feet;swollen legs, ankles and feet;swollen (distended) neck veins;shortness of breath doing what were pre-viously simple tasks;tiring very easily (because not enough oxy-gen is being supplied to the body);sleeping difficulties because the CHF suf-ferer cannot lie down for long without feel-ing that they will choke (This is due tofluid build up in the lungs.);persistent cough and mucus due to fluidbuild up in lungs; anddizziness.

Prevention and treatmentSince congestive heart failure is the end resultof other heart diseases, the only prevention isto prevent these other diseases. Later discus-sions of coronary heart disease and high bloodpressure provide information about how toprevent these conditions.

Surgery: The treatment for CHF dependson the cause of the problem. Where the prob-lem is a leaking heart valve, surgery can re-place the valve. To prevent further heart attacks

PRACTICAL TIPSCONGESTIVE HEART FAILURE

When going to bed, place pillowsbehind your back and sleep so thatthe chest is at about a 45° angle,rather than flat.Avoid extremes of heat and cold,which make the heart workharder.Exercise, but obtain medical advicebefore commencing. Walking, jog-ging, playing tennis or cycling, mayall be appropriate and possiblepending medical advice.Lose weight to reduce the strainon the heart (see coronary heartdisease for tips).Tobacco and alcohol:

– Stop smoking altogether.– Drink no more than one (women)

or two (men) drinks a day.

32 Healthy Ageing

or heart damage, surgery can be used to re-pair or bypass damaged blood vessels that carryblood to the heart. The most dramatic treat-ment for a damaged heart is to replace thewhole heart.

However, in most cases where congestiveheart failure symptoms have already developed,the only feasible treatment is to manage thesymptoms with medication and lifestylechanges.

Medication: Various medications can beused. These are designed to:

take the strain off the heart;strengthen the heartbeat or;help eliminate excess fluid from the body.Lifestyle: The risks of CHF can be re-

duced by:achieving the correct body weight;eating a diet that is low in fat;not smoking;having no more than one drink of alcoholper day;relaxing; andgetting plenty of sleep and rest to take thestrain of the heart.

Coronary Heart DiseaseWhat is coronary heart disease?The heart is a muscle. Like all muscles, it mustbe fed by oxygen and nutrients from the blood.A person whose heart cannot get enough oxy-gen from the blood will normally feel a painin the chest, left arm or shoulder. This pain iscalled angina.

The main reason that the heart cannot getenough oxygen is because the arteries bring-ing the blood to the heart have become cloggedand this limits the amount of blood they cancarry. Where the supply of blood from a par-ticular artery leading to the heart is cut offentirely, the person will have a heart attack.The part of the heart without its oxygen diesand the heart muscle is damaged. The heartwill, therefore, no longer work as well as itdid before (see congestive heart failure).

Normally a complete blockage to the heartis due to a blood clot getting stuck in arteriesleading to the heart. This is much more likelyto happen if the arteries are already cloggedor are hardened and cannot stretch. A block-age in the arteries is caused by a build up of

fatty substances inside the arteries.Who gets coronary heart disease?Fatty deposits from cholesterol (called plaques)begin to build up on artery walls from early inlife. The speed at which they build up dependson a person’s family history and on the amountof animal fats consumed. By the time peoplereach 45 or 50, there is a fair chance that theirarteries are blocked enough to put them at riskof coronary heart disease. However, people donot normally have heart attacks until they arein their mid to late sixties, and most peoplewho die of a heart attack are 65 or older.

Men are more at risk of coronary heartdisease but, as people grow older, the risk be-comes more similar for men and women. Onaverage, men develop coronary heart diseaseabout 10 years earlier than women.

People are certainly more likely to havecoronary heart disease the older they are. Thisis not because coronary heart disease is a natu-ral part of growing older, but because peopleconsume more animal fats over a lifetime andthe build-up from a lifetime of fat consump-tion means that the arteries become moreblocked as time goes on.

Heart disease is a common cause of deathamong older people. While it was once muchmore common in developed countries, it is nowa very common cause of death in developingcountries. This change is largely because ofchanging habits and diets and increased physi-

Healthy Ageing 33

cal inactivity.CausesFamily history makes a difference. A personwith a family history of coronary heart diseasehas a greater risk of developing it too. Thismay be partly because of common lifestylehabits within families, but is mainly becauseof genetic factors. There is nothing that can bedone about changing one’s family history, butthere are many things that can still be done toreduce the risk of heart disease. A person witha family history of heart disease should be es-pecially careful to take these preventive mea-sures.

The direct causes of coronary heart dis-ease are blocked arteries leading to the heartmuscle. There are a number of things that pro-duce blocked and hardened arteries.

too much animal fat in food (blocks arter-ies);high blood pressure (hardens and thick-ens artery walls);too little exercise;

smoking (hardens the arteries and encour-ages a build-up of fat in the arteries);being overweight (increases the chance ofdeveloping high blood cholesterol and highblood pressure); anddiabetes.

SymptomsAngina: Angina occurs if the heart needs moreoxygen than it can get. When people exercise,their hearts need more oxygen, so angina canoccur when exercising. Common symptoms ofangina are:

severe pain and tightness in the chest;the pain can spread to the left arm, neckand jaw;the pain often occurs with exercise, wheneating a meal or during the night;the pain that comes with exercise normallystops when resting;.the pain may feel like indigestion;heaviness or tightness in the arms or wrists– mainly on the left side;feeling especially tired and short of breath.Heart attack: Angina attacks are a sign

that not enough blood is getting through to theheart. Angina pain is not a heart attack, butdoes indicate the presence of the underlyingconditions that make a heart attack more likely.If angina attacks begin to occur more fre-quently or become more severe, it may indi-cate that a heart attack may occur in the nearfuture. The classic signs of a heart attack are:

feeling an uncomfortable pressure or asqueezing feeling in the middle of the chestthat lasts for more than a few minutes orgoes away and comes back;the pain may spread to the left shoulderand left arm or neck;as well as feeling uncomfortable in thechest, feeling light-headed, experiencingshortness of breath, sweating and feelingnauseous or faint.Any one of these could be a sign of a heart

attack. A person suffering from these symptomsshould get medical help immediately. Gettingto hospital quickly can prevent death and im-mediate treatment can prevent damage to theheart muscle.

Prevention and treatmentExercise and fitness: Keeping fit helps pre-

PRACTICAL TIPSCORONARY HEART DISEASE

Weight loss:Exercise more and eat less.Think before eating to ensure that eating is out of needrather than habit or as a form of comfort.Cut down on high-fat foods.Eat slowly (this results in feeling fuller with less food).Take small portions.Eat a few small meals each day instead of one main meal.Do not skip meals.Choose fruits, vegetables, cereals, pasta, dried peas andbeans, low-fat or non-fat dairy products, lean meat, fishand skinless poultry.Remove fat from meat and skin from poultry.Do not fry foods.Read food labels and avoid foods that are high in fat andcalories.Drink lots of water.Limit intake of alcohol and other high-calorie drinks.Eat a variety of healthy foods.Do not eat to relieve stress or boredom.

Tobacco and alcohol:Stop smoking altogether.Drink no more than one or two alcoholic drinks a day.

Exercise:Exercise for at least 30 minutes at least four times a week.Walk, jog, play tennis or cycle.

34 Healthy Ageing

vent hardening of the arteries and, therefore,cuts down the risk of heart disease. Exercisealso helps control weight – another importantfactor in preventing heart disease. Everyoneshould accumulate at least 30 minutes of mod-erate exercise daily.

Diet: Use diet control to:help control weight (and thus reduce bloodpressure);reduce the amount of cholesterol in theblood;reduce the amount of salt in the diet andthus help control high blood pressure;reduce fat in the diet, especially animalfat;eat plenty of fruits and vegetables.Smoking: Smoking is a major risk fac-

tor in heart disease. Stopping smoking reducesthe risk of heart disease.

Alcohol: Moderate consumption of alco-hol (one or two drinks a day) seems to lowerthe risk of heart disease. Scientists are not surewhy, but think that it may be due partly to theanti-clotting effects of alcohol. However, it isnot recommended that non-drinkers start drink-ing alcohol.

High alcohol consumption is bad for theheart. It raises the fat levels in the blood, causeshigh blood pressure and increases weight.

Medical:Tests are available in clinics to test blood

pressure and cholesterol.Medications are available to:prevent blood clotting (Blood-thinningmedications, which must be managed bya doctor, can reduce the chance of bloodforming clots in arteries. It is better to tryto keep the arteries clear. Aspirin is onesuch type of medication.);reduce blood pressure;help widen arteries;slow the heart and make it pump moreefficiently.Surgery is available to reduce the block-

ages in the arteries leading to the heart. Themain types of surgery are:

opening up the blocked artery by insertingan object in the blocked section of the ar-tery to stretch it open;by-pass surgery – inserting a new artery toby-pass the blocked or damaged sectionof the old artery.

Dental Health ProblemsWhat dental health problems doolder people have?Dental health problems are among the mostcommon health problems among older people.The ‘normal’ problems are:

tooth decay;gum disease;dry mouth (xerostomia).About 20% of older people have a dry

mouth as they are less able to produce saliva.A person with a constantly dry mouth will findit harder to chew, eat and swallow. A dry mouthalso increases the danger of tooth decay, sincesaliva is not washing away the harmful acidsin the mouth. Dry mouth can also result in asore throat and a dry and sore nose, and maymake it difficult to speak.

CausesTooth decay is largely affected by the foodpeople eat and the care they take of their teeth.Many foods create acids in the mouth and thisacid attacks the tooth coating and causes decay.The acids are produced by eating food with sugarand starches (from bread and cereals). Clean-ing teeth properly after eating can stop theseattacks, but snacking throughout the day with-out brushing the teeth will result in tooth decay.

PRACTICAL TIPSDENTAL HEALTH PROBLEMS

To avoid or reduce gum disease:Clean teeth regularly.Eat foods such as fruit, vegetables and dairy productsbetween meals. These foods do not create dangerousacids.

To reduce chewing difficulties:Cook foods with finely cut ingredients.Dice or mince meat before cooking.Use ripe fruit and well cooked vegetables so that theyare soft and moist.

To manage dry mouth:Sip water throughout the day.Chew gum or suck something hard to stimulate salivaproduction.Cook foods with moisteners added.Sip water (or something else) when eating. This helpswith chewing and swallowing.Cook moist foods (e.g. soups, stews, moist vegetables).

Healthy Ageing 35

Gum disease is caused by the sameacidic substances that cause tooth decay. Theacid causes the gums to pull away from theteeth and this allows germs to breed in the gapsand cause infection. This can cause tooth loss.

Dry mouth is frequently a side-effect ofother medical problems and medications.

SymptomsGum disease:

gums bleed when brushing teeth;red, swollen or tender gums;gums pulling away from the teeth;puss between the teeth and gums;bad breath that doesn’t go away;loose teeth;a change in the way the teeth fit togetherwhen biting.

Prevention and treatmentTooth decay is best prevented by regularcleaning, eating foods with less sugar andstarch (or cleaning immediately after eatingsweet or starchy food) and having regular den-tal checkups.

Gum disease: In the early stages gumsbecome sore, red and swollen. At this stagegum disease can be prevented by regular andcareful brushing with a soft tooth brush.

Dry mouth may be treated by checking onthe effect of other medications being taken. Oth-erwise the main treatment is to stimulate salivaproduction or to sip fluids regularly (see tips).

DepressionWhat is depression?Depression is a medical condition that affectsa person’s emotional well-being. A person suf-fering from depression feels extremely sad anddejected, has a deep sense of emptiness, andfeels a loss of self-worth. These feelings canlead to self-destructive behaviour, despair andhopelessness.

Depression comes in three mainforms:Depressed mood: This form of depressionis signalled by a mood that is dominated byfeelings of sadness, gloominess or emptiness,and possibly a lack of energy. This mood maybe temporary following a distressing event or

it may continue over the long term.Long-term, low-grade depression:

(dysthymia): Those suffering from this formof depression will have suffered from a de-pressed mood for at least two years, have alack of energy and a poor appetite, and havetrouble sleeping. Low self-esteem and hopeless-ness are part of this form of depression.

Major depression: The symptoms aremore severe than with low-grade depressionand will have persisted for at least two weeks.A person with major depression will have dis-turbed sleep and appetite, will lack energy, andhave the feelings associated with other typesof depression. As well as all the other feelings,the person will also have feelings of guilt anddespair. Major depression makes people feelvery distressed and when severe will lead tothoughts about or attempts to commit suicide.

Who gets depressed?Anyone can suffer from depression, althoughit is most commonly diagnosed among peoplein their twenties. Depression is also commonamong older people, but is almost certainlynot diagnosed as often as it should be, sincenot all doctors are experienced in detectingdepression in older people. Because depressionoften accompanies other health problems, somedoctors confuse elderly depression with theaccompanying disease. Women are diagnosedwith depression more often than men.

CausesLife events: Depression among older peopletends to accompany other life events such as:

loss of a spouse or close friend;chronic pain or illness;difficulty getting around;frustration due to memory loss;difficulty adapting to the dramatic changesthat can occur in later life, including mov-ing out of one’s home.Other diseases: Depression may be part

of another disorder. Depression can often ac-company diseases such as Alzheimer’s dis-ease, hypertension, heart disease, stroke,diabetes and cancer. This does not mean thatthe depression is not real depression. It is realand it requires treatment.

Medication: Taking medication for an-other condition can trigger depression. Depres-

36 Healthy Ageing

sion is linked to imbalances in brain chemis-try so medication can disturb this balance.Medication for Parkinson’s disease, arthritis,high blood pressure, heart problems and hor-mone disorders appear to be linked to the on-set of depression in some people. Too muchalcohol can also lead to depression.

Genes: Depression tends to run in fami-lies. People with relatives who have sufferedfrom depression have a greater risk of devel-oping it at some point in their lives.

SymptomsA depressed person will have a number of thefollowing symptoms. Some of these symptomscan indicate different problems, but a personexperiencing a number of these should getsome help.

irritability;temper and agitation;feelings of worthlessness or sadness;loss of interest or pleasure in daily ac-tivities;loss of appetite and/or unintentionalweight loss;sleeping difficulties such as:

– waking up through the night and findingit hard to get back to sleep;

– waking up early in the morning;– sleeping too much;

fatigue;difficulty concentrating;memory difficulties;abnormal thoughts,;excessive or inappropriate guilt;thoughts about death and suicide;plans to commit suicide or actual suicideattempts;excessive concern about bodily aches andpains.

TreatmentDepression can be treated successfully. Ratherthan simply putting up with depression andhoping that it will go away or thinking that itis just a normal part of ageing, help should besought. Depression will not just disappear onits own. It can be treated and the person seek-ing help will feel a great deal better for havingdone so. Feeling depressed does not mean thatthe person is crazy, or is ‘past it’. People of allages get depressed.

Medication and therapy: The mosteffective treatment for major depression is acombination of psychological therapy andmedication. One treatment without the otheris much less likely to have long-term effects.Most people respond well to this combinationof treatments. Although depression may recurafterwards, it can be treated again successfully.

Some new and effective medications(called SSRIs) can be very effective in helpingtreat depression, and generally have few side-effects. However, they can make people a littleless steady on their feet, so special care mustbe taken to avoid falls.

Where depression is linked to other medi-cations, or to non-prescription drugs or alco-hol, a doctor will need to sort out the wholeset of medications. Reducing alcohol consump-tion can help contain depression.

Exercise: Taking a regular walk canmake people feel better about themselves, helpcontrol anxiety and help with depression.

PRACTICAL TIPSDEPRESSION

Depression can be prevented or helped by doing thefollowing:

Seek help.Keep strictly to medication instructions if using medica-tion for depression.Exercise regularly.Eat well and do enjoyable things.Get out and mix with other people.Talk to a therapist to isolate the things that might beproducing the depression.Attend to other illnesses as these may be producing thedepression.Be persistent.

Healthy Ageing 37

Social support: Milder forms of depres-sion can be alleviated by dealing with some ofthe related problems. Where depression followsloss, depression can lift after grieving. Gettinginvolved with others and improving relation-ships with other people can help lift some ofthe sense of loneliness and lack of self-worthassociated with depression.

DiabetesWhat is diabetes?There are two main types of diabetes – Type 1and Type 2. Type 2 diabetes is the type nor-mally found among older people.

Diabetes Type 2 is a rapidly growing dis-ease throughout the world and is particularlyserious because it increases the risk of devel-oping a wide variety of other serious diseases.

CausesThe cells in the body must be fed with the cor-rect cell food. Sugar is an important cell food.Sugar is extracted from food by the body andis absorbed into the blood. The blood trans-ports this sugar to all parts of the body whereit is absorbed by the cells.

A substance called insulin enables the cellsto absorb the sugar from the blood. Most peoplenaturally produce the insulin they need. Dia-betes occurs when:

the body does not produce the insulin or;the cells cannot respond properly to theinsulin, in which case they cannot absorbthe sugar they require to remain healthy.The result is that the body is starved of its

fuel and the blood contains far too much sugar.High blood sugar can cause its own problems.

Type 2 diabetes is due mainly to the sec-ond cause – the inability of the cells to absorbthe sugar, rather than a shortage of insulin.For some reason, being overweight makes thistype of diabetes occur more frequently andearlier than would otherwise be the case.

Why does diabetes matter?Diabetes affects almost all parts of the body. Itleads to the starvation of cells throughout thebody. In addition, the blood that contains highlevels of sugar goes to all parts of the body, soany part of the body that is sensitive to highblood sugar is affected. High blood sugar can

result in damage to the large and small bloodvessels, nerve damage and increased risk ofinfections.

Damage to large blood vessels:Where diabetes damages the arteries:

it leads to the development of heart dis-ease;in the neck it can lead to a stroke;in the brain it can lead to mini-strokes andvascular dementia;in the legs it leads to poor circulation inthe feet and can lead to gangrene and legamputation.Damage to small blood vessels:in the eye it can result in bleeding andother damage that leads to blindness;in the kidneys it can prevent the kidneysfiltering out poisons from the blood. If thekidneys do not work properly, the personwill die unless their blood can be filteredartificially.Nerve damage can lead to:lack of feeling in the feet, which in turncan lead to sores and ulcers developingand becoming infected;sexual dysfunction;difficulty with bladder control (see urinaryincontinence).Infection: A person with diabetes is more

likely to develop infections such as:thrush;pneumonia; andskin infections.

Who gets diabetes?Diabetes Type 2 is the most common formof diabetes– about 90% to 95 % of peoplewith diabetes have Type 2.It usually develops in people who are overthe age of 40, but is most common amongthose aged 55 or more.Most people with diabetes Type 2 are over-weight. Changes in diet in the developingworld have led to a sharp increase in thenumber of overweight adults and children.Rates of diabetes vary between races andethnic groups.

SymptomsOne of the problems with Type 2 diabetes isthat many people show no symptoms. Thismeans that a great deal of damage can be done

38 Healthy Ageing

PRACTICAL TIPSDIABETES

To lose weight:Avoid crash diets (Instead, eat less of the foodsusually eaten.);Limit the amount of fat in food.Aim for a reasonable weight loss goal of between5-10% of body weight.Follow the diet tips below.Have small servings and eat slowly.Follow an exercise programme (see tips below).

Diet:Do not skip meals.Eat fruits and vegetables.Eat foods that include starch (e.g. noodles, rice,cereals, corn, potatoes).Eat wholegrain or natural cereals rather than re-fined products.Eat small amounts of protein (meat, fish, eggs,nuts).Use only low-fat dairy food.Minimize the amount of sugar.Minimize the amount of fat.Avoid fried food and food cooked in oil.Avoid food to which oil or butter has been added.Use food and drinks with artificial sweeteners.Steam vegetables, rice and other foods, ratherthan frying;.Stir fry or grill meat.Limit the amount of salt consumed (including soysauce, MSG).

Exercise:Accumulate 30 minutes of moderate exerciseevery day.Start slowly – especially after a period of inac-tivity. Check with a doctor about what kinds ofexercise are safe. Add 30 minutes of vigorousexercise two or three times a week after a while.Drink plenty of water.Build exercise into daily routines. Walk wherepossible.Exercise with a friend to help maintain motiva-tion.Pick an enjoyable exercise.Vary the exercise to avoid becoming bored.Start slowly and build up gradually.Do some exercises that exercise the heart andlungs (e.g. walking, jogging, cycling).Include some strength exercises.Check blood-sugar levels before and after ex-ercising.It is best to exercise 1-3 hours after a meal. Thiswill result in fewest problems with low bloodsugar due to exercise.Be prepared for low blood sugar. Exercise burnssugar and can result in too little blood sugar.Always have a snack on hand in case the blood-sugar level drops too low.

Other tips:Check feet daily to look for sores, cuts, etc. Anylack of feeling in the feet that goes unattendedcan become serious.Do not smoke. Smoking increases the risk ofmany of the diseases that are also caused bydiabetes.A person with diabetes who controls his bloodsugar can afford to drink some alcohol, but thisshould be kept to low levels. Alcohol should beavoided when blood sugar is not under con-trol.

More information :Exercise tipshttp://www.diabetes.org/main/health/exercise/

safety/steps_exercise.jspNutrition tipshttp://familydoctor.org/handouts/349.htmlhttp://www.niddk.nih.gov/health/diabetes/pubs/

nutritn/what/index.htm

Healthy Ageing 39

before they become aware of having diabetes.It makes sense, therefore, to be tested annuallyfor diabetes Type 2. If it is detected, a lot ofthings can be done to help control the damagethat it can cause.

The following symptoms are the most com-mon signs of diabetes.

increased thirst;frequent urination -especially at night;extreme tiredness;weight loss;blurred vision;genital itching or regular episodes ofthrush;frequent infections;slow healing of wounds or sores;losing feeling in the feet or having tinglingfeet.

Prevention and treatmentThe risk of developing diabetes can be reduced.The main ways of preventing Type 2 diabetesare:

exercising regularly;keeping to the correct weight;keeping to a diet that is not high in sugarand fat;monitoring blood-sugar levels.It is not possible to eliminate the risk of

diabetes altogether as there seem to be geneticfactors which affect the risk.

Once diabetes has developed it cannot becured. However, a lot of things can be done tocontrol it and thus reduce its dangers.

Early detection: Diabetes can be de-tected by testing for the amount of sugar in thebody. A first test can be to test for sugar in theurine, but a more certain test is to test theamount of sugar in the blood. Very simple, do-it-yourself tests are available. A reliable diag-nosis of diabetes should only be made by aphysician.

High blood sugar: Type 2 diabetes isthe result of cells being unable to absorb sugarfrom the blood. Scientists are not exactly sureof the reasons for this. The treatment for Type2 diabetes (and the method of preventing it) isto:

help the cells absorb sugar;control the amount of sugar in the blood.Exercise helps prevent and control dia-

betes because:

muscle use burns sugar (Exercise, there-fore, extracts sugar from the blood to usein the muscles and lowers sugar levels.);it helps cells absorb sugar;it makes insulin work more effectively;it improves the circulation of the blood andhelps reduce the effect of narrowed arter-ies;. andit reduces weight and, therefore, reducesinsulin resistance caused by being over-weight.Diet can reduce the sugar in the blood.

To do this it is important to limit foods thatcontain:

sugar (to control weight and blood-sugarlevels); andfat (to control weight).Medication: When exercise and diet do

not lower sugar levels enough, medication willbe needed to:

control the level at which sugar is releasedinto the blood;increase the ability of cells to absorb sugar.Reduce risk factors: Diabetes increases

the risk of many diseases. A person who devel-ops diabetes must also pay careful attention toother factors that may lead to those diseases.Since diabetes increases the risk of such dis-eases as heart disease or stroke, it is importantto reduce other risk factors that lead to thosediseases. For example, smoking is a known riskfactor in heart disease and stroke. To reducethe increased risk of these diseases caused bydiabetes, it is even more critical than usual toreduce the risk of heart disease and stroke bystopping smoking.

EmphysemaWhat is emphysema?Emphysema is a type of lung disease that re-stricts or obstructs breathing. Lungs act as anexchange station for the blood. They supplythe blood with the oxygen that is necessary forlife and extract unwanted carbon dioxide fromthe blood. These exchanges take place in thelung in tiny air sacs called alveoli.

People with emphysema have suffered ir-reversible lung damage because these air sacshave been damaged and cannot perform theirfunction. This means that people with this lungdamage cannot get enough oxygen into their

40 Healthy Ageing

blood or extract carbon dioxide from theirblood properly. This results in shortness ofbreath during exercise and eventually evenwhen resting.

Who gets emphysema?Smoking is the single most important cause ofemphysema. Smokers are about 10 times morelikely than non-smokers to develop the disease.People who are exposed to air pollution andirritating fumes and dusts in their workplaceor general environment are also more likelythan others to develop emphysema.

CausesInhaling materials into the lungs that destroythe tiny air sacs causes emphysema. Tobaccosmoke and fumes and dusts are the main ma-terials that destroy these air sacs.

Symptomsshortness of breath - the feeling of not be-ing able to get enough air;coughing and wheezing.

Prevention and treatmentPrevention is far more effective than treatment.To radically reduce the risk of emphysema aperson should:

avoid smoking; andavoid inhaling fumes and dusts.Treatments for emphysema are limited.

The damage to the lungs cannot be reversed.The main ways in which people with emphy-sema manage their disease is by:

using supplemental oxygen when the lungscannot absorb enough oxygen from the air.improving the efficiency of breathing withlung exercises;.using medications to help sooth the deli-cate lining on the air passages;undergoing surgery. Lung transplants canbe used to replace damaged lungs. How-ever, this option is not widely availableand carries a substantial risk.

FallsWhy are falls a problem?Falls are a major health concern for olderpeople as they can lead to disability, depen-dence and premature death. Falls are a par-ticular problem for many older people becauseold bones are:

more brittle and much more likely to break– even with a minor fall;less likely to mend.

What causes falls?There are a lot of things that can be done toprevent falls (see below) but it is useful to knowthe general sorts of things that lead to fallsamong older people. With these in mind, peoplecan think about the way their homes are orga-nized and the way they do things. Attention tothese matters can help reduce the risk of hav-ing a fall.

The main reasons why falls become morecommon as people grow older are:

The balance sensing mechanism in the earsbecomes less efficient so it becomes moredifficult to regain balance.Gradual deterioration in eyesight and eyedisease can lead to tripping over objects,and tripping on stairs and elsewhere. Asthe eyesight deteriorates and more light isneeded, or as side vision fails, small thingsare simply not seen.Arthritis leads to stiff and sore joints, whichcan add to the risk of falls.Since Parkinson’s disease interferes withcoordination and balance, a person withthat disease will need to take special careto avoid falls.Loss of muscle strength makes it more dif-ficult to recover once a person gets into anawkward situation.

PRACTICAL TIPSEMPHYSEMA

To reduce the risk of developingemphysema:

Avoid smoking.Avoid breathing in other people’ssmoke.Use a face mask when dealing withhazardous fumes or dusts to avoidbreathing fine particles into thelungs.Practise breathing exercises.

http://www.emphysemafoundation.org/pulhthex.htm

Healthy Ageing 41

Reaction time slows and this makes itharder to recover from tripping, etc.Alcohol, even small amounts, can inter-fere with balance, reaction time andsteadiness.Medication can cause people to lose theirbalance or become dizzy and light-headed.

Foot ProblemsWhat are the main foot problems?Foot problems are common and can have abig effect on the life of an older person. Footproblems can affect a person’s ability to walkand get around. This can mean that the older

person becomes less active, becomes more iso-lated and develops diseases associated withinsufficient exercise and social contact. Footcare is an important part of staying healthy inlater life.

Feet are a complicated part of the body.They contain 52 bones – about a quarter of allthe bones in the body. There are hundreds ofpossible foot problems and some of the mostcommon ones are linked to other diseases, suchas gout, arthritis, diabetes, narrowed bloodvessels and nerve diseases.

Common foot problems are corns, toenailproblems, bunions, collapsed foot arches, andtoe and joint problems.

Who has these foot problems?Foot pain is far more common among womenthan men – especially among women who wear

PRACTICAL TIPSFALLS

The risk of falls can be reduced by doing the following:Have regular eye and ear checks.Get up slowly. Standing up suddenly can lead to a sud-den drop in blood pressure and cause dizziness.Check carefully the effect of new medication on bal-ance.Do not skip meals as this can lead to dizziness.Use a cane or walker to help maintain balance on un-even ground or slippery surfaces.Wear strong, low-heeled shoes with non-slip soles.Exercise regularly to improve coordination and strength.Rearrange furniture so that there are clear pathwayswithin the home.Ensure that there are no loose mats or electrical cordsto trip over.Mark the top and bottom steps very clearly. Use brighttape on these stairs.Install handrails in difficult spots in the home (toilet,bathroom, bedroom).Light stairs well and use handrails.Install non-slip material on steps.Ensure that there are lights that can be turned onwhen entering a room.Place a light near the bed to avoid having to stumblearound in the dark.Leave lights on at night if necessary.Avoid using shelves that are difficult to reach.Never stand on a chair to reach things.Wipe up spills immediately.Take care with pets as they can get underfoot andcause falls.Keep a flashlight with good batteries where it can beeasily found.Raise the height of seats, toilets and the bed.

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high-heeled shoes. Some foot pain is more com-mon among older people. This is because ofthe wear and tear that accumulates over a life-time, but can also be linked with diseases thatdo not develop until later in life.

CausesIn general, foot problems are not inherited.Many of the problems are due to wear and tearover a lifetime and a lack of proper foot care.Common causes of foot pain include:

ill-fitting shoes or shoes with high heels orpointed toes;fractures in foot bones (This is a commonproblem of foot pain among people withosteoporosis as this disease results in veryweak bones that break easily.);arthritis;circulation problems related to diabetesand narrowed blood vessels;being overweight, as this puts much more

stress on the feet;nerve damage (e.g. from diabetes);gout;bunions;ingrown toenails; andfallen foot arches.

Prevention and treatmentThe best method of preventing foot pain is toavoid or treat the diseases that cause foot pain(e.g. arthritis, diabetes). In addition, some footproblems can be prevented by:

taking care to wear shoes that fit well;avoiding shoes with high heels or pointedtoes;clipping toenails correctly;avoiding cuts to the feet;exercising regularly;trying to keep the blood circulating as wellas possible so that it gets to the feet andhelps keep them healthy.

PRACTICAL TIPSFOOT PROBLEMS

As well as preventing foot problems there are anumber of things a person can do to minimize them.

Walking is a widely recommended form ofexercise for preventing many diseases of later life.Walking can be difficult for a person with footproblems but can be made easier by doing thefollowing:

Warm up and cool down. This involves gentlystretching the muscles before starting to walkand when finished. This helps prevent a build-up of substances in the muscles that make walk-ing painful.Use the correct shoes. Good shoes should fit well,with room for the toes but a snug fit aroundthe heels. Good cushioning can make walkingmuch more comfortable.Walk on soft surfaces where possible. This re-duces jarring and the wear and tear on the feetand back. This is particularly important for peoplewith osteoporosis and can help avoid stress frac-tures of the foot bones.Avoid walking in very cold weather when thefeet cannot feel anything. Feet can be damagedunintentionally in this way.Regularly check the feet for cuts and sores andattend to these without delay. A person withdiabetes may have limited feeling in the feet, and

cuts and sores may go undetected and developinto serious infections.Pay attention to foot pain. Continuing to walkwith foot pain without getting feet checked cancause more damage.

Other tips: The risk of developing foot problemscan also be controlled by doing the following:

Cut toenails straight across and leave them slightlylonger than the toe. This reduces the risk of de-veloping an ingrown toenail.Walk.Use shoe inserts for fallen arches and to preventrubbing that causes sores and bunions.Have feet measured before buying new shoes.Foot size can change as people grow older andshoe selection should reflect this.Avoid buying shoes that are too tight and ex-pecting them to stretch.Wear thick, soft socks that provide some protec-tion from tight spots in shoes.Try to keep blood circulating to the feet. To helpwith this a person should:

– avoid sitting with their legs crossed for long pe-riods;

– avoid smoking;– put their feet up when sitting;– massage their feet to get the blood circulating;

and– avoid tight-fitting shoes.

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GlaucomaWhat is glaucoma?Glaucoma is one of the main causes of blind-ness among older people. The eyes continuallyhave fluid flowing in and out. This fluid feedsthe eye and helps keep it alive. This fluid also‘fills out’ the eye with the right amount of pres-sure (like filling up a balloon with water). Ifthe fluid cannot drain out but new fluid stillenters the eyeball, the pressure in the eye willkeep building up. This pressure build-up dam-ages the main nerve in the eye and stops a per-son from seeing properly. In due course thiscauses blindness.

Who gets glaucoma?The risk of developing glaucoma increases aspeople get older. About 2% of people aged 40-50 have glaucoma, but about 8% of peopleover 70 have it.

A person is more likely to develop glau-coma if they have a family history of the dis-ease. Some races are also more likely todevelop glaucoma. For example, in America,African Americans are far more likely to de-velop glaucoma than white Americans.

Glaucoma is also more likely amongpeople who:

have had any eye injury;are very near-sighted (can only see thingsthat are very close).

CausesGlaucoma occurs when fluid cannot drain fromthe eye. Scientists do not know why this drain-age problem develops.

SymptomsIn its early stages the person with glau-coma will not notice any effects.As glaucoma develops there will be a lossof side vision. Looking ahead will be fine,but the sufferer will begin to bump intothings more when they are on the side.As glaucoma progresses the loss of sidevision will increase and increasingly thesufferer will feel like they are lookingthrough a tunnel. Eventually all vision willbe lost.

Prevention and treatmentOnce sight has been lost from glaucoma thereis nothing that can be done about it. Glau-coma damages the main nerve in the eye andthis nerve damage is permanent. Thus nervedamage must be prevented before it goes toofar.

There are three main ways to stop glau-coma progressing to blindness, but people mustknow that they have got the disease if it is tobe treated. The only way of knowing if a per-son has the early stages of glaucoma is for aneye doctor to perform an eye check.

Where the early signs of glaucoma aredetected, further damage can be prevented by:

Eye drops: These help the eye drain theextra fluid out, thus reducing the pressurein the eye.Medicine: This reduces the amount ofeye fluid the body produces and thus stopsthe pressure building up so much.Surgery: There are two types of surgery.

PRACTICAL TIPSGLAUCOMA

Older people in a risk group for glaucoma (e.g. over 40and have a family history) should have an eye doctor checkfor glaucoma each year.Older people not in a risk group should have their eyestested every two years.

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One type makes a new opening so that thefluid can drain. The other type uses lasersto help the fluid drain.

Hearing DisordersWhat are the main hearingdisorders?The two most common hearing disorders thatdevelop as people grow older are:

Hearing loss (presbycusis): This isthe most common type of hearing loss amongolder people. It is linked to changes in the in-ner ear and gets more serious as people getolder. It develops more quickly in some peoplethan in others.

Ringing in the ears (tinnitus): Thisis hearing a ringing or roaring in the ear, eventhough there is no actual noise. Sometimes,instead of hearing ringing, the person with tin-nitus might hear sizzling, buzzing, or hummingnoises. Tinnitus is linked to a range of hearingdisorders. A person with ringing in the earsmight have the ringing all the time, it mightcome and go, or it might stop altogether – itwill depend partly on the particular cause.

For some people, the constant noise canbe quite intrusive and affect their emotionalwell-being. It can affect concentration, makepeople very sensitive to noise, and can causethem to feel that no-one understands what theyhave to put up with. People who become verysensitive to sound and noise may start to avoidsituations where noise is likely to occur andbegin to withdraw from other people.

Who develops hearing disorders?Hearing loss generally begins between theages of 40-50. About one-third of people aged65 and 75 years, and around one-half of thoseaged over 75, have some hearing loss. Hear-ing loss tends to run in families.

Ringing in the ears: The risk of devel-oping tinnitus increases as people get older.This is because of age-related deterioration ofa number of parts of the ear and because ofthe effects of a lifetime of exposure to noise.

CausesHearing loss:

Being exposed to too much loud noise cancause damage in later life.

The loss of hearing is due to the hair cellsin the ear becoming old and brittle, ordestroyed. It seems that this is part of nor-mal ageing and that there is little that canbe done to prevent it.

Ringing in the ears:Although scientists are unsure why theparticular sounds of tinnitus develop, theyknow that tinnitus is often due to deterio-ration in the fine nerve endings in the ear.This is a common cause among olderpeople. A common cause of this damageis exposure to loud or constant noises.Tinnitus noises can also be linked to otherear problems such as wax in the ear, earor sinus infections, or other ear diseases.Sometimes the long-term use of some medi-cations (e.g. too much aspirin, quinine,antibiotics) can result in ringing soundsin the ear.

SymptomsHearing loss:

difficulty hearing in general, particularlyat higher frequencies;trouble hearing when there is backgroundnoise (e.g. when other people are talking);

Healthy Ageing 45

some hearing loss seems to be a normal partof ageing. The best way of preventing or de-laying hearing loss is to limit exposure to loudnoises throughout life. This can be assisted by:

turning down the volume of music, etc.;using ear muffs and ear plugs when in noisyenvironments.Hearing loss: Hearing aids can help

reduce the effects of hearing loss. Hearing aidshave a microphone that picks up sounds and asmall amplifier to make sounds louder for theperson wearing the hearing aid. However, hear-ing aids are expensive and need to be selectedto suit the particular hearing problem.

Ringing in the ears: If the cause of theringing can be found (e.g. ear wax, ear infec-tion), the ringing can be treated by dealingwith this cause. However, the cause cannotalways be found or repaired. Where the ring-ing is due to age-related damage to the earand the fine hairs and nerves in the ear, thereis nothing that can prevent the problem.

There are some things that can reduce therisk of developing tinnitus, but the risk cannotbe eliminated altogether. The following thingscan help reduce the risk of getting tinnitus andhelp to manage its effects:

avoiding loud sounds and noises;controlling blood pressure;avoiding nerve stimulants such as coffee,cola (caffeine) and tobacco;reducing anxiety;getting sufficient rest; andexercising.Apart from managing tinnitus in these

ways, the two main ways of dealing with ring-ing that will not go away are:

using medications that can help managethe stress that is associated with tinnitus(Stress seems to make the ringing soundsmore noticeable and more irritating.); andmasking the ringing with another sound(see below).

High Blood PressureWhat is High Blood Pressure?Another name for high blood pressure is hy-pertension. The heart pumps blood to all partsof the body through the arteries. When bloodis pumped through the arteries it will natu-rally meet some resistance. The amount of re-

PRACTICAL TIPSHEARING DISORDERS

Hearing loss: To reduce the effects of hearing problems:Regularly check to make sure that the hearing difficul-ties are not simply due to a build-up of ear wax.Only clean the ear with a finger and damp cloth. Theuse of any object that can go right into the deeper partsof the ear MUST be avoided.Do not hide the hearing problem from other people.Tell people of the hearing difficulty and ask them tospeak clearly.Ask people to repeat what they said a little louder.Move to the edge of a noisy crowd where there is lesscompeting noise.Sit closer to people.Avoid loud sounds and noises.Control blood pressure.Avoid nerve stimulants such as coffee, cola (caffeine)and tobacco.

Ringing in the ears:Avoid loud sounds and noises.Use competing noise. Tinnitus is more annoying wheneverything else is quiet. At such times it can help to usea competing noise such as a ticking clock or very quietmusic. This can make the sufferer less aware of the ring-ing in his ear.Avoid worrying about the tinnitus. The more peopleworry about the sounds associated with tinnitus, thelouder the sounds seem. Some of the medications usedfor tinnitus help people stop worrying.Avoid alcohol, tobacco and caffeine as these can makethe ringing appear worse.Relax. Relaxation techniques can be of great benefit.Do not dwell on the tinnitus.

difficulty understanding what others aresaying.Ringing in the ears: A person suffer-

ing from tinnitus hears sounds such as ring-ing, buzzing, humming, escaping air, runningwater, sizzling or the sound similar to thatwhich is heard when putting a seashell to theear. These sounds may be in one ear or bothears. They can be there all the time or comeand go.

Prevention and treatmentOne of the most important ways of preventinghearing loss in later life is to treat ear infec-tions in young children properly. Nevertheless,

46 Healthy Ageing

sistance can be calculated by measuring thepressure of the blood against the artery walls.If the blood meets too much resistance (e.g.arteries are blocked), the blood is forced harderagainst the walls of the arteries. It is like turn-ing on a tap to a blocked hose – the pressurebuilds up in the hose. When the blood is push-ing too hard against the artery walls, the per-son has high blood pressure.

What is the problem with high bloodpressure?Burst blood vessels: The high pressure onartery walls can weaken them. This can pro-duce a bulge in the weak spot (called an aneu-rysm). This can burst and lead to death. A burstblood vessel in the brain is a stroke. A burstblood vessel in the eye can cause blindness.

Blocked blood vessels: High bloodpressure can cause thickening of the muscleon the artery wall making it less flexible. Theresulting damage and blockage to arteries canlead to a number of serious health problems.High blood pressure can lead to damage inthe arteries:

leading to the heart - causing angina andheart attacks;leading to the neck – possibly causing astroke;in the brain – possibly causing stroke andvascular dementia;in the leg – causing poor circulation andpossibly cell death and;leading to and in the kidney – causing kid-ney disease and failure.

Who gets high blood pressure?The risk of high blood pressure is greateramong people whose parents suffered from highblood pressure.

Men develop high blood pressure at ayounger age than women. However, from theage of about 60 onwards more women thanmen develop high blood pressure.

CausesThe exact reasons for high blood pressure arenot clear. However, there are clear factors thatplace a person at more risk of developing highblood pressure. These are:

smoking;drinking too much alcohol;being overweight;eating salt regularly; andgetting too little exercise.

SymptomsHigh blood pressure develops slowly andwithout outward symptoms. For this rea-son it is sometimes called the ‘silent killer’.Some people with high blood pressure havea lot of headaches.

TestingThe only way to be sure about whether a per-son has high blood pressure is to test the pres-sure. This is simple, painless and quick. Regularchecking is worthwhile since there are no otherways to be certain whether the ‘silent killer’ isdeveloping.

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Prevention and treatmentSteps can be taken to reduce the risk of devel-oping high blood pressure, but even these pre-cautions do not get rid of the risk altogether.Once high blood pressure has developed, thereis usually no cure. However, its effects can becontrolled to stop it getting worse. These stepsinvolve people making changes for the rest oftheir lives. Medication can also be used.

Lifestyle changes that can help con-trol blood pressure include:

getting more exercise;reducing the salt in food; anddrinking only moderate amounts of alco-hol or coffee.Reducing risk factors: Since high

blood pressure increases the risk of a wide rangeof diseases (see above), the higher risk needsto be compensated for by reducing other causesof these same diseases. In general terms thiswill mean:

PRACTICAL TIPSHIGH BLOOD PRESSURE

To reduce salt intake:Do not add salt when cooking.Use spices rather than salt to add flavour.Avoid takeaway foods as these usually have a lot of salt.Check the amount of salt in processed foods.Avoid MSG.Avoid soy sauce;Avoid baking powder.

To reduce fat intake:Do not fry foods.Avoid deep-fried takeaway foods.Eat more fruits and vegetables.

Exercise more: The best exercises for people sufferingfrom high blood pressure are those that increase theheartbeat and blood circulation. These exercises includewalking, jogging, cycling and swimming. Muscle-buildingexercises should be undertaken with care, since they mayincrease blood pressure.

Medication: Medication is available that can:slow the heart down and thus reduce the load on theheart;relax the muscle walls of the arteries and thus let theblood get through more easily;stop the arteries from narrowing; andreduce the amount of fluid in the body, which in turncan reduce blood pressure.

eating less animal fat;stopping smoking;losing weight;eating less sugar; andexercising more.

Macular DegenerationWhat is macular degeneration?Macular degeneration is an eye disease thatdamages the part of the eye that enables peopleto see straight ahead and see fine detail. Themain form of this disease is called the ‘dryform’. It develops slowly and leads to the lossof central vision, but not to complete blind-ness. Sufferers can continue to live productiveand independent lives.

Who develops maculardegeneration?While macular degeneration can developamong people in their forties, it is more com-mon among those in their fifties or older. Therisk of developing the disease grows as peoplegrow older. By the age of 75 about 15% ofpeople have macular degeneration.

CausesScientists are not sure what causes maculardegeneration. However the risk seems to belinked to:

family history (Macular degenerationseems to run in families.);damage caused by the ultraviolet light fromthe sun;high blood pressure (People with highblood pressure are more prone to maculardegeneration.);smoking; andpoor diet.

SymptomsThe telltale signs of macular degeneration are:

vision gradually becomes fuzzy;straight lines appear wavy;some things that are straight ahead can-not be seen; andcolours seem to fade.

Prevention and treatmentLack of knowledge about what causes macu-lar degeneration has made it difficult to find

48 Healthy Ageing

out how to prevent it. However, there are pre-cautions that should be taken. These include:

having regular checkups with an eye doc-tor;protecting the eyes from ultraviolet sun-light;wearing a hat outside;reducing high blood pressure to healthylevels; andstopping smoking.

OsteoarthritisWhat is osteoarthritis?There are over a 100 types of arthritis. Onlythe most common form – osteoarthritis – isdiscussed here (see also rheumatoid arthritis).

Osteoarthritis is a disease that affects thebone joints. It develops over a long period oftime and generally keeps getting a little worse.Osteoarthritis can affect any joint in the body,but is more likely to develop in the hands andthose joints that carry weight – the knees, back,hips and feet. Joints that have been injuredearlier in life are also more likely to developosteoarthritis.

Who gets osteoarthritis?People can get osteoarthritis from about age45 onwards but it is much more common inpeople aged over 65. In some countries, abouthalf of all people aged over 65 have osteoar-thritis to some extent. Women are more likelythan men to develop the disease. Overweightpeople are more at risk of osteoarthritis – es-pecially in those joints that have to carry theextra weight.

CausesScientists are not sure what causes osteoarthri-tis. However, they no longer think that it is just anatural part of ageing caused by wear and tear.

Osteoarthritis is linked to the breakdownof cartilage in the joints. Cartilage is a flex-ible, tough cushion between the bones in thejoints that stop the bones grinding togetherwhen a person moves. Cartilage breaks downnaturally and regrows over time. In people withosteoarthritis the cartilage breaks down fasterthan it regrows, which eventually leaves littleor no cartilage to cushion the movement be-tween the bones. Scientists do not know whythis happens.

SymptomsOsteoarthritis will normally begin with painin just one joint, but may then develop in oth-ers. The pain can vary from mild to severe.Other signs of osteoarthritis are:

swelling and stiffness in a joint, particu-larly after using it;bony lumps in the fingers;joints becoming less flexible and painfulwhen used;sore joints when the weather changes; andredness or warmth in a joint.Fingers: Bony knobs develop on the top

part of the finger. Early on these are painful.After a couple of years the pain goes, but sodoes the flexibility in the fingers.

Back: The cartilage disks between thebones in the back deteriorate and pain and stiff-ness develop.

Weight-bearing joints: Knees, hipsand feet bear a person’s weight. In overweightpeople there is extra strain on these joints andthis adds to the stress on the cartilage. Thisresults in pain and swelling in these joints –especially the knees.

PRACTICAL TIPSMACULAR DEGENERATION

Some things can be done to decreasethe risk of macular degeneration:

Wear sunglasses that block out ul-traviolet light from the sun.Wear a wide-brimmed hat whenoutside to protect the eyes fromthe sun.Use brighter light and magnifyingaids to help see fine detail.Eat the following foods to in-crease zinc intake:

– high-protein foods;– beef, pork and lamb, which con-

tain more zinc than fish;– the dark meat of chicken, which

has more zinc than the light meat;– peanuts, peanut butter and le-

gumes;– green, leafy vegetables and yellow

vegetables such as carrots, sweetpotatoes and winter squash.

Healthy Ageing 49

Prevention and treatmentA number of steps can be taken to reduce thechance of developing osteoarthritis. These in-clude:

keeping to the correct weight;avoiding repetitive joint use;strengthening the muscles around the jointwith weight exercises;trying to avoid injuring the joint;exercising joints to keep them flexible.If osteoarthritis develops, exercise, medi-

cation and surgery can be used to try to man-

age the pain and the limits it creates.Exercise: Apart from making the osteoar-

thritis sufferer feel better overall, daily exer-cise that gets the joints moving and strengthensthe surrounding muscles can help reduce painand stiffness. However, such exercise must bebalanced with rest.

Hot and cold baths, or treating a sorejoint with a hot or cold pack, can reduce painand swelling.

Losing weight can take some of thestrain off the affected joints.

Medicines can be used to control thepain and reduce inflammation in the joints.

Surgery is sometimes the only solutionfor disabling joint pain.

OsteoporosisWhat is osteoporosis?Osteoporosis is a bone disease than makesbones very likely to break easily. The bones ofa person with osteoporosis become porus, thinand weak. Even very mild stress can cause thebones to snap. The bones that are most in dan-ger of breaking are those in the hip, back andwrist. For a person with osteoporosis, any fallcan be very damaging.Who is prone to osteoporosis?

Women are much more likely than men todevelop osteoporosis. About half of womenaged over 50 have a bone that breaks be-cause of osteoporosis, compared to about12% of men over 50.Caucasian and Asian women are twice aslikely to develop osteoporosis than Afri-can-American women.Osteoporosis runs in families, but whetheror not a family member develops os-teoporosis will depend partly on theirlifestyle and what steps they have taken tostop it developing (see below).People with small, slender bones are atgreater risk of developing osteoporosis.

CausesBone tissue is constantly breaking down andrebuilding itself. About every three months, oldbone tissue is replaced by new tissue. Up to theage of about 30, the body produces new bonetissue faster than the old tissue dies, so bonesbecome denser and stronger. Childhood and

PRACTICAL TIPSOSTEOARTHRITIS

Although osteoarthritis cannot be cured, there are waysof reducing its impact on daily life:

Focus on what can be done rather than on what cannotbe done.Maintain an ideal body weight.Include fitness in the daily routine.Warm up before exercise and begin exercise gently andslowly.Include daily exercises that help keep joints as flexible aspossible. These exercises involve moving the joint andgently stretching it.Do strength exercises each day. These exercises involvestrengthening the muscles around weak joints. This canhelp prevent joint bones rubbing on each other.Include endurance exercises such as walking, swimming,or cycling in an exercise programme. Doing these exer-cises for about 30 minutes three or four times each weekis sufficient.Try water exercises. These can take the weight and pres-sure off the joints and are a good way of increasing therange of joint movement. Exercise in warm water is best.Listen to the body. Pain should not be ignored. Exerciseshould help rather than result in more pain.Break down difficult tasks into a number of smaller,manageable tasks.Ask for help rather than overstressing the body andjoints.Stand up straight as this takes the strain of the joints inthe neck, back, hips and knees.Use the big joints when lifting or carrying. This helps avoidinjuring and straining the smaller joints.Alternate periods of heavy activity with rest. Continual stresson joints accelerates the wear and tear on cartilage.Change position regularly. Sitting in the same position forlong periods encourages muscle and joint stiffness.Begin new activities slowly and safely until it is clear howthe body will react to them.

50 Healthy Ageing

PRACTICAL TIPSOSTEOPOROSIS

These tips are designed to help avoid developingosteoporosis. The earlier in life these steps are takenthe better. However, it is never too late to start.

Diet: To improve bone mass:Eat foods that are high in calcium (e.g. low-fatdairy products, green leafy vegetables such asbroccoli).Drink milk and orange juice for calcium.Use soy products (milk, soy nuts, tofu) which seemto make up for the loss of oestrogen in womenafter menopause.Eat cereals, as these can provide calcium and vi-tamin D.Use calcium and vitamin D supplements.Take care not to eat large amounts of meat asthis reduces the body’s ability to absorb calciumfrom food.

Exercise: To improve bone strength and density:Engage in weight-bearing exercises such as walk-ing, running, dancing or playing tennis. As peoplegrow older, walking may be best, as it avoidsjarring on what may be weakened bones. How-ever, some people say that some jarring is bestfor building bone strength.Do back-strengthening exercises to improve backmuscles and improve posture. Poor posture canincrease the pressure on bones in the back andincrease the risk of greater damage.Use strengthening exercises to strengthen thebones and muscles in the arms and upper back.

Avoid exercises that include a risk of falling (e.g.cycling, skiing).Other: Other ways of reducing the risk of

developing osteoporosis include:Avoid too much alcohol (no more than twodrinks a day).Do not smoke, since smoking reduces oestro-gen production and the body’s ability to absorbcalcium.Get out in the direct sun for 10 to 15 minutesevery day. This helps the body manufactureenough vitamin D.

If osteoporosis has already developed:As well as the tips above, the following may

help osteoporosis sufferers manage the disease andmaintain their independence.

Maintain good posture:Keeping the head high, chin in, shoulders backand the lower spine arched reduces the stresson the spine.When sitting, a small cushion in the small of theback will help support the back and reduce pres-sure on the spine, as well as helping maintaingood posture.When reading, care should be taken to avoidhunching the back.When lifting, bending at the knees rather thanat the waist will help reduce strain on bones inthe back. Lifting is best achieved by straighten-ing the legs and keeping the upper back straight.

Prevent falls: Since falls can be very dangerousfor the osteoporosis sufferer it is important toprevent them. The risk of falling can be reducedby the following:

Wear low-heeled shoes with non-slip soles.Make sure the house is uncluttered and free ofsmall objects on which to trip.Remove slippery floor rugs.Use handrails in difficult places where there is adanger of falling.Go up and down steps carefully, one step at atime and using the handrails.Avoid carrying large loads and avoid having bothhands full when walking.Make sure that the house is well lit.

Healthy Ageing 51

the teenage years are particularly important timesfor building up bones. From the mid-thirties thisreverses – bone tissue dies a little more quicklythan new bone tissue develops. Among women,the rate of bone loss speeds up to about 3% to5% each year for a number of years after meno-pause, before slowing down to about 1% peryear . At around 60, this rate of loss slows butdoes not stop. Older women may lose 35%-50%of their bone mass, and men 20%-35%.

If people can grow a lot of bone before theage of 30, they have an advantage, becausethey will have more in store for later life. Ifthey can reduce the rate at which they lose bonedensity, they will reduce the risk of developingosteoporosis. Fortunately there are things thatcan be done to both grow bone more quicklywhen young and to slow the rate of bone tissueloss when older.

Exercise, calcium and vitamin D all playan important part in the growth of bones. Theless calcium, vitamin D and exercise a personhas, the less bone tissue will be grown and thefaster it will decline with ageing.

Hormones also play an important role inthe loss of bone strength. This is why womenhave a higher risk of developing osteoporosis.After menopause, women produce less of thehormone oestrogen, and this leads to an accel-eration of bone tissue loss.

Other factors can also contribute to os-teoporosis. These include:

smoking;drinking too much alcohol, which stopsthe body absorbing calcium;taking long-term asthma medications;taking medications used for thyroid dis-ease;rheumatoid arthritis; andkidney disease.

SymptomsOsteoporosis may go unnoticed until a bonebreaks very easily. However, the followingsymptoms may be evident:

back pain;neck pain;stooping;shrinking. Low bone density means thatbones will compress and the person willbecome shorter. A person who shrinks byone inch or more may have osteoporosis.

Prevention and treatmentOne way of reducing the chances of develop-ing osteoporosis is to build up as much bonetissue as possible before the age of 30, so thatthere is more bone tissue in reserve for later inlife. This can be done by getting plenty of ex-ercise that puts weight on the bones (e.g. walk-ing, running, dancing, tennis), having foodsand drinks that are rich in calcium, and get-ting plenty of vitamin D (sunlight).

The rate at which bone tissue is lost canbe slowed down after the mid-thirties by the samemeans – exercise, calcium and vitamin D.

For women, the decline in oestrogen aftermenopause accelerates the rate at which bonetissue declines. One way to reduce the rate ofbone tissue loss is to reduce the effect of oestro-gen loss at this point by using oestrogen re-placements or increasing the amount ofbone-building exercise and calcium. Othermedications are also produced to increase bonedensity.

Parkinson’s DiseaseWhat is Parkinson’s disease?Parkinson’s disease is a disease that affects thepart of the brain that controls movement. WhenParkinson’s disease develops, the brain cells failto produce enough of a chemical called dopam-ine. The lack of dopamine causes nerve cellsin part of the brain to ‘fire’ uncontrollably. Thisresults in loss of control over body movements.Parkinson’s disease lasts for a long time andgets progressively more severe as less and lessdopamine is produced by the brain. Althoughthere are treatments that can control some ofthe symptoms for a time, there is no cure.

Who suffers from Parkinson’sdisease?The disease has been around for thousands ofyears but was named in 1817 by an Englishdoctor called James Parkinson. Men contractParkinson’s disease a little more often thanwomen. About 90% of sufferers are 60 or older.The chances of contracting Parkinson’s diseaseincrease when people reach their seventies andeighties. Parkinson’s disease is found through-out the world in all social classes and ethnicgroups.

52 Healthy Ageing

CausesThe direct cause of the main symptom ofParkinson’s disease is a lack of dopamine pro-duction in the brain. There have been manytheories about why some people stop produc-ing dopamine. Until recently it was widelythought that environmental factors caused theloss of dopamine-producing brain cells. How-ever, the most recent research indicates thatgenetic factors are important in making somepeople more subject to Parkinson’s disease.

SymptomsThe symptoms and progress of Parkinson’s dis-ease can vary, but the following four symptomsare the most common.

Tremor: This is possibly the first sign thatthe person developing Parkinson’s disease willexperience. A tremor in the hand is most com-mon. This will probably first be experiencedwhen resting and will, at first, probably onlyaffect one side of the body.

Slow movements: Body movements un-predictably slow down (bradykinesia) or somelimbs will simply not move at all (akinesia).Parkinson’s disease sufferers can be doing some-thing one moment and then suddenly, and with-out warning, find that their bodies will not dowhat they want them to. When these attacksoccur, tasks that could normally be done in min-utes (e.g. washing, dressing) may take hours.

Rigidity: Whenever a person makes anymovement, two sets of muscles are involved.One muscle becomes active while an opposingmuscle relaxes. This combination of the twomuscles gives the ability to make smooth andcontrolled movements. When a person hasParkinson’s disease, the messages from the brainfail to coordinate the movements of both setsof muscles. Muscles that should relax remainrigid. If someone with the disease tries to move,say, his arm or leg, it will move in a jerky,ratchet-like fashion rather than smoothly.

Posture, balance and walking: Thelack of muscle control affects balance. This inturn may cause the Parkinson’s disease suffererto stoop or to lean backwards, which, in turn,can increase the chances of falling. Somepeople with Parkinson’s disease move withsmall, quick, shuffling steps as though they aretrying to avoid falling.

As well as these ‘normal’ symptoms other

things may happen.Depression: Depression accompanies

many diseases that last a long time and steadilyget worse. Depression may even develop be-fore the other symptoms of Parkinson’s disease.Some of the medications for Parkinson’s dis-ease may produce depression, but antidepres-sant medication can control these feelings.

Emotional and memory difficulties:People suffering from Parkinson’s disease maystop wanting to go out and meet other peopleor participate in social situations. This may bebecause they are worried about how they willmanage or because they feel embarrassedabout not being able to control their move-ments. As Parkinson’s disease develops, aperson’s memory may begin to fail and think-ing may slow. However, reasoning abilitiesshould remain intact.

Speech: There is a 50/50 chance ofParkinson’s disease sufferers developingchanges to their speech. It is common forpeople with Parkinson’s disease to speak verysoftly, making it difficult to hear. Speech canbecome slurred or very fast, or may becomevery flat or expressionless.

Urinary and bowel problems: Be-cause muscles do not always respond as theyshould, urinary difficulties can develop. Peopledeveloping Parkinson’s disease can find thatthey cannot control when they urinate (incon-tinence) or that they cannot urinate when theywant. Equally, Parkinson’s disease sufferers maybecome constipated as their intestinal muscleswork too slowly.

Chewing and swallowing: These twoactivities involve muscle control and may causeproblems – especially in the more advancedstages of Parkinson’s disease. Swallowing in-volves automatic muscle activity but, if themuscles do not behave as they are meant to,swallowing may become difficult or impossible

TreatmentParkinson’s disease cannot be cured and willprogressively become more severe. People withParkinson’s disease may only be mildly affectedfor the first few years and require no treatmentin this time. However, the disease is progres-sive and the symptoms will become more se-vere. Treatment or management will berequired eventually.

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PRACTICAL TIPSPARKINSON’S DISEASE

There are no magic solutions to Parkinson’s disease.The challenge for people with Parkinson’s diseaseis to manage their symptoms as well as they can.

Diet:There is no evidence that diet will do anythingto help with Parkinson’s disease. Nevertheless, ahealthy diet can help a person feel better in otherways and this can help in coping with some ofthe frustration and other feelings that are expe-rienced with Parkinson’s disease.Because swallowing can be slow and food movesslowly through the intestine, it is best to haveonly a small amount of food at a time.Drinking plenty of water can help. As people getolder their sense of thirst may not always be areliable guide as to when to drink. Furthermore,Parkinson’s disease drugs can dry a person out.Unless water is deliberately drunk frequently, theperson with Parkinson’s disease risks becomingdehydrated.Memory loss:See Alzheimer’s diseaseIncontinence:See Urinary incontinenceAvoiding falls (also see Falls): The following can

be done to reduce the risk of falls:Make sure that the house is uncluttered and thefloor is clear of small objects and loose rugs thatcould cause tripping.Install rails in parts of the house where falls aremore likely.Install rails to help get up and down and out ofbed and chairs or off toilets.Stand with the feet apart as this reduces the dan-ger of falling.Dressing: Dressing can be difficult because it

requires a lot of movement, and bending andstiffness can make this more difficult. Dressing canbe made more manageable by doing the following:

Wear loose fitting clothes or clothes with stretchymaterial.Avoid fasteners (buttons, zips, etc.). If fastenersare required, chunky zips, rings on zipper tabsand Velcro can help.Wear slip-on shoes and use a long-handled shoe-horn to get shoes on without bending.Place clothes in the order in which they are to beput on.Take plenty of time to dress.

Kitchen: Do the following to make kitchentasks more manageable:

Keep commonly used things within easy reach.Use flexible straws to help drink without spill-ing.Place non-slip materials under plates to stopslipping.Use spoons to help with eating.

Walking: Since walking becomes more difficultas Parkinson’s disease develops, it can be helpfulto do the following:

Use a cane to help avoid falling or tripping.Use other walking aids when walking with acane becomes too difficult.Install handrails on stairs or steps.Go up and down steps slowly, taking only onestep at a time.Avoid carrying things in both hands while walk-ing, as this makes it harder to remain balanced.Swing both arms freely but gently when walk-ing. This improves balance and the rhythm helpsreduce tiredness from walking.

Speech:Soft voice: To reduce the difficulties of the very

soft voice that often accompanies Parkinson’sdisease:

Take plenty of breaths when talking.Take a new breath for each word or phrase.“Push’ words out.Slurred speech: To reduce slurring of speech:Concentrate on each word and be very delib-erate with the formation of each word.Be conscious of the lips and tongue.Exaggerate speech movements of the tongueand lips.Use short sentences.Rapid speech: To reduce the tendency to rapid

speech:Be very deliberate about pronouncing eachword.Try to speak in a rhythm with a word or syl-lable for each beat.Swallowing: The changes in the muscles that

affect speech also affect eating and swallowing.Common eating and swallowing problems can begreatly reduced by changing what is eaten andhow it is eaten.

How food is eaten: To assist swallowing:Sit upright.

Continued next page

54 Healthy Ageing

Medicines: Since Parkinson’s diseasesymptoms are due to the failure of the brain toproduce dopamine, doctors prescribe a drugcalled levodopa. This helps with jerky move-ments and rigidity, but will not stop or slowthe progress of the disease. Levodopa worksby stimulating dopamine production in the re-maining healthy, dopamine-producing cellsbut, since the drug does not stop the remain-ing healthy dopamine-producing cells fromdying, its effect declines over time.

Exercise: Since muscle movements areaffected by Parkinson’s disease, exercises mayhelp to strengthen underused muscles. Exercisescan also improve balance and help with anawkward walking gait. Special exercises canhelp with any difficulties speaking and swal-lowing.

Prostate DiseasesWhat are the main prostatediseases?The prostate is a male organ about the size ofa walnut. It is located just below the bladderand surrounds the tube from the bladder to thepenis. The prostate produces fluid for semen.

Men develop two main prostate diseases:Prostate cancer: This is normally a slowgrowing cancer and it may be 20 yearsbetween the time when a cancerous cell ispresent and the symptoms of prostate can-

cer develop. Many men who develop pros-tate cancer do not die of the disease.Enlarged prostate: (called benign pro-static hyperplasia, or BPH). The prostategland begins to grow in all men fromabout the age of 40 onwards. It grows morequickly in some men than in others. Whereit grows relatively quickly it leads to thesymptoms of an enlarged prostate. It is avery common problem and is neither can-cerous nor fatal.

Who develops prostate diseases?Prostate cancer: The older a man is the morelikely he is to have some signs of prostate can-cer. By the age of 75 years, 50%–75% of menhave cancerous prostate cells. However, mostof these cancerous cells do not develop intoactive, growing cancers with symptoms. About15% of men develop prostate cancer, althoughthis varies between countries and races. Pros-tate cancer tends to run in families and is lesscommon in countries that have low-fat diets.

Enlarged prostate: Enlarged prostatesbecome more common after the age of 40.Approximately 50% of all males aged 50-60and 90% of those aged 80 or more have thisdisease to some extent.

SymptomsProstate cancer: There are no symptoms inthe early stages.

Tilt the head slightly forwards, not backwards,when swallowing.Take small bites of food, chew thoroughly andswallow before eating any more.Take small sips of liquid and hold the liquid inthe mouth for a short time to prepare for swal-lowing.Move the food backwards in the mouth withthe tongue.Take a sip of liquid between bites of food.Eat small amounts regularly rather than a fewlarge meals.

PRACTICAL TIPSPARKINSON’S DISEASE continued

What is eaten: To reduce swallowingdifficulties:

Select food that is moist and does not requirevigorous chewing.Cook meals with finely diced ingredients.Moisten dry recipes with moist ingredients.

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Enlarged prostate: The enlarged pros-tate presses on the bladder and the tube fromthe bladder to the penis. Only 30% of men suf-fer the symptoms of an enlarged prostate whichare:

pain in the groin or lower back;a weak urinary stream;difficulty starting urination;frequent urination;urgency (difficulty postponing urination);awakening frequently at night to urinate;interruption of the stream (stopping andstarting);pain or burning on urination.

Prevention and treatmentProstate cancer: Only about 50% of the menwho develop prostate cancer develop signifi-cant symptoms (about 8% of men) and onlyabout 3% die of the disease.

Since prostate cancer is much more com-mon among people with high-fat diets, it mayhelp to have a low-fat diet. However, there isno evidence that changing from a high-fat to alow-fat diet makes any difference.

Where the cancer is not developing noth-ing is done. Where the cancer is developing,the decision to treat the cancer with surgery,radiotherapy or chemotherapy will depend onhow quickly the cancer is growing and the ageof the person.

PRACTICAL TIPSPROSTATE DISEASES

Enlarged prostate: To help manage the symptoms of anenlarged prostate:

Avoid straining to empty the bladder since this can stretchthe bladder and make matters worse.Do not drink too much in the evening as this will increasethe number of visits to the toilet during the night.Limit the amount of alcohol and coffee consumed as thesetwo drinks are especially likely to create the need to uri-nate often and urgently.Do not leave long intervals between urinating.Check on the effects of medications taken for other ail-ments. For example, some cough medicines and someantidepressant medication can worsen the symptoms ofenlarged prostate.Plan ahead when travelling to ensure that toilets are likelyto be available when needed.

Enlarged prostate: There are three mainways of dealing with an enlarged prostate.

Wait: Frequently the best thing to do is sim-ply wait to see whether the symptoms getworse. Often they do not get worse andthe disease is managed by working outways of dealing with the symptoms.Medication: medications are available torelax the muscles in the bladder. This canhelp with urination. Medications are alsoavailable that can shrink the size of theenlarged prostate. A herbal remedy basedon saw palmetto berries has been shownto be reasonably effective.Surgery: Where an enlarged prostate causessignificant problems that cannot be man-aged by other means, a variety of surgicalmethods can be used to improve urine flow.

Rheumatoid ArthritisWhat is rheumatoid arthritis?Rheumatoid arthritis is one of many differenttypes of arthritis and is the second most com-mon type after osteoarthritis. It can affect anyjoint, with wrists, ankles, hands and feet beingthe most often affected. However, rheumatoidarthritis can also affect the elbows, shoulders,hips, knees, neck and jaw.

Affected joints ache and throb and make itvery difficult to perform even simple tasks. Thesigns of rheumatoid arthritis can come and goover time.

When suffering from rheumatoid arthritisthe soft tissue in the joints becomes inflamed.Over time this can damage cartilage, bone andmuscles at the joint, and may even destroy thejoint.

Who gets rheumatoid arthritis?Women are three times more likely than mento develop rheumatoid arthritis.

The disease seems to run in families. How-ever, a family history does not mean thatpeople will certainly develop rheumatoid ar-thritis – it just means that they are at greaterrisk than other people.

Rheumatoid arthritis usually develops inmiddle age before the age of 50. However, bothchildren and those older than 50 can developthe disease. Attacks become more frequent aspeople grow older.

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bag of ice wrapped in cloth) can help dull pain.Relaxation for pain management:

Relaxation methods can help control the painfrom rheumatoid arthritis. The limitations andpain caused by the disease can also result inemotional stress and depression. Relaxationand stress management methods can help tomanage these feelings better.

Joint care: Sometimes, immobilizing ajoint for a short while to stop any movement(especially hands and wrists) can help when arheumatoid arthritis attack is at its worst. Otherdevices, such as grab-bars to help sufferers getout of chairs or out of bed, can help put lessstrain on the joints.

CausesRheumatoid arthritis involves an inflammationin the bone joints. Scientists do not know whatcauses this inflammation, but some believe thatit may be started by a virus or bacteria.

SymptomsThe typical symptoms of rheumatoid arthritisare:

pain and swelling in the smaller joints ofthe hands and feet;aching or stiffness in the joints and muscles,especially after sleep or resting;restricted movement in the affected joints;loss of strength in muscles attached to theaffected joints;tiredness – especially when rheumatoidarthritis is most active; and

deformity of the joints as time goes on.

Prevention and treatmentThere is no cure for rheumatoid arthritis andno known way of preventing people from de-veloping it. The only thing sufferers can do isto manage the disease as well as they can.There are a number of ways of doing this.

Exercise: Exercise can help keep musclesstrong and maintain movement and flexibilityin the joints. It also helps control weight, helpswith sleep and can make the sufferer feel bet-ter overall. Gentle exercises, such as walkingor exercising in water, are useful. It is impor-tant to undertake exercises that involve a slow,steady rhythm, rather than jerking or bounc-ing. The rheumatoid arthritis sufferer shouldtake care not to exercise the joints when theyare especially tender or inflamed. When thejoints are at their worst, rest is best. (Also seeexercise tips for osteoarthritis.)

Weight control: Too much weightstresses the joints. This can add to the painand the damage to joints that are already un-der stress from rheumatoid arthritis.

Diet: While a healthy diet can make aperson with rheumatoid arthritis feel better andcan help control weight, there is no specialdiet that helps control joint inflammation.

Heat and cold: A hot shower or bathcan help ease the pain in joints and musclesand increase the blood flow to affected partsof the body. Heat packs on the affected parts ofthe body can do the same thing. Cold packs (a

PRACTICAL TIPSRHEUMATOID ARTHRITIS

The effects of rheumatoid arthritis can be reduced byfollowing these tips:

Keep a positive attitude. Keeping informed about rheu-matoid arthritis and trying to keep in control of it ratherthan just giving up can help.Take breaks when doing things to stretch and relax sorejoints.Rest when tired.Use devices to take the strain off joints. A wrist splint, aknee brace, or a cane to help walk can all take the strainoff joints.Avoid twisting joints or doing actions that require jointstrength. Such actions can put undue stress on weakand already damaged joints.Use several joints rather than one joint where possible(e.g. use both hands to lift things). This helps spreadthe load and reduces the stress on joints.Use the strongest muscles and larger joints. For example,when picking up something, bending the knees ratherthan the back, and lifting by straightening the knees,can take the strain off the weaker joints. Similarly, lean-ing on heavy doors to open them is easier on musclesand joints than pushing with one hand.Look after posture. Poor posture puts a great deal ofunnecessary strain on joints and muscles that were notdesigned to carry the stress. Walking is a good way ofimproving posture.Use slow, gentle movements to move affected joints eachday to help maintain their flexibility.Take notice of pain. If a joint is sore and tender it shouldbe rested. To ignore the pain risks damaging the jointeven more.Keep joints moving. For example, it is good to avoidsitting in the same position for long periods.

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Medication: A variety of medications areused to control arthritic pain and to controland reduce inflammation in the joints. How-ever, these medications do not cure rheuma-toid arthritis.

Surgery: Surgery may be used to replacebadly damaged and painful joints and to re-pair damaged muscles around affected joints.

StrokeWhat is a stroke?A stroke is a brain attack that results in the deathof part of the brain because the blood supply tothat part of the brain is interrupted. Lack of bloodmeans that the brain cells lack the oxygen andnutrients they require to stay alive.

There are two different types of stroke:Blockage of blood vessels caused bya blood clot in the brain. This is calledan ischemic stroke and is the type that oc-curs in about 80% of people who have astroke. The blockage can be due to thebuild up of fatty deposits in the blood ves-sels in the brain or to a clot forming else-where in the body and travelling to thebrain.Bursting of blood vessels so that theblood bleeds into the brain rather than get-ting to the parts it is meant to reach. Thisis called a haemorrhagic stroke.

Who has strokes?People of any age can have a stroke. However,the risk increases the older a person becomes.Every 10 years of life from age 55 onwardsdoubles the risk of a stroke, and about 65% ofpeople who have strokes are at least 65 yearsold.

Men at all ages are more likely thanwomen to experience a stroke, but women aremore likely to die from a stroke. The risk ofstroke differs in different racial groups. InAmerica, black men are more at risk than whitemen. Chinese, Korean and Japanese people aremore at risk than those from countries such asAustralia or America.

A person with high cholesterol, diabetes,high blood pressure or heart disease is muchmore likely to have a stroke. Those who smokeand drink too much alcohol increase their riskeven further.

CausesBlocked blood vessels: High blood pres-sure and fatty deposits in the blood vessel walls(caused by cholesterol) increase the risk ofblockages. Fatty deposits (plaques) build upon the lining of the blood vessels. These canbreak open inside the blood vessel and bloodcan clot around these areas. Once formed, thisblood clot can break off and travel up the ar-tery and lodge in the brain, where it blocks offany blood flow. The result is that either theblood will not get through or the blood vesselwill break. When this happens a brain attack(a stroke) results.

Burst blood vessels: Blood vessels willburst in the brain for one of two reasons:

the blood vessel wall is thin and weak; orthe vessel has lost its elasticity and becomehard and brittle and is, therefore, morelikely to break than stretch when placedunder pressure. High blood pressure is themost likely reason for blood vessels becom-ing hardened and brittle (see high bloodpressure).Family history: The chances of stroke

increase where there is a family history ofstroke.

SymptomsThe symptoms of a stroke appear suddenly andwill vary depending on the part of the brainthat is damaged. The stroke victim may diesuddenly or may experience other symptoms.Common symptoms include sudden:

paralysis, numbness or weakness of theface, arm or leg on one side of the body;trouble seeing in one or both eyes;confusion and mental damage;trouble speaking or understanding otherpeople;loss of balance or coordination and dizzi-ness;severe headache;depression and difficulty controlling emo-tions.

Prevention and treatmentWhile nothing can be done about family his-tory, there are many things that can reduce therisk of suffering a stroke.

Lifestyle changes: The risk of a strokecan be reduced considerably by several lifestyle

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changes. The earlier in life these changes aremade, the more the risk of a stroke is reduced.The four main lifestyle changes that reduce therisk of a stroke are:

not smoking;eating food with less fat and cholesterol;losing weight; andexercising more.Medication: Medication can reduce the

risk of a stroke by:reducing blood pressure;thinning the blood so that it is less likelyto clot.Therapy: Once a person has had a stroke,

the main task is to avoid further strokes. Thetips below can help avoid a second stroke.However, these lifestyle changes will not undothe damage done by the first stroke.

The three most common forms of therapyafter a stroke are:

Physiotherapy: This is designed to help thestroke victim relearn how to use parts ofthe body that were affected by the stroke.Occupational therapy: this helps the strokevictim learn new ways of doing everydayactivities, such as walking, dressing, cook-ing, swallowing and using the toilet, wherethe stroke has made these tasks difficult.Speech therapy: if the stroke has damagedspeech, this form of therapy can help thevictim to regain some speech.

Urinary IncontinenceWhat is urinary incontinence?Urinary incontinence is the inability to controlurination. This means that people suffering fromurinary incontinence may urinate in theirclothes, bed or in other awkward and embar-rassing situations.

There are four main types ofincontinence:

Stress incontinence: This is the most com-mon type and results in urine leaking whenexercising, lifting heavy objects, laughing,coughing or sneezing. It results from puttingpressure on the bladder and/or weakening ofthe muscles that close off the urinary tract.There is a very good chance of being able tocure stress incontinence.

PRACTICAL TIPSSTROKE

The most important things a personcan do to reduce their risk of a strokeare:

Stop smoking. Smoking increasesthe risk of suffering a stroke be-cause it is linked to the blockageof arteries leading to the brain andencourages blood clots by thicken-ing the blood and increasing bloodpressure.Reduce the cholesterol in the dietby minimizing the amount of foodeaten that contains animal fats(e.g. meat, eggs and dairy foods).Exercise by walking, swimming, cy-cling or something similar. Thishelps reduce cholesterol, weightand blood pressure.Lower blood pressure by using lesssalt and eating more fruit and veg-etables.Use medication to lower bloodpressure (only under medical direc-tion).Reduce the risk of blood clots bytaking a blood-thinning medication(e.g. aspirin) (only under medicaldirection).Ensure that any diabetes is wellunder control. If it is not, the dam-age from a stroke can be more se-vere. Controlling diabetes alsoreduces other stroke risk factors.

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weak bladder and pelvic floor muscles(can be damaged by childbirth);constipation;infections;inability to move quickly because of theeffects of stroke, Parkinson’s disease, ar-thritis, etc.;confusion from dementia;muscle weakness following surgery.

TreatmentCures:

Exercises can help strengthen the musclesaround the bladder to prevent leakage.Surgery can be used to clear problemscaused by blockages or to lift the bladder.Medication can be used to control bladdercontractions or to relax the bladder.

Management:Absorbent underclothes can help withmanaging leakage.Drainage bags can be fitted.Surgical devices can be fitted to preventurine escaping.

Vascular DimentiaWhat is vascular dementia?There are many forms of dementia. This par-ticular form is brought about by damage tothe small blood vessels in the brain. Where thesebecome blocked or burst they can starve partsof the brain of blood, which damages thoseparts and results in a small stroke. Vasculardementia, also known as multi-infarct demen-tia (MID), is the result of a series of these smallstrokes. Symptoms will vary depending on thepart of the brain that is affected.

Who gets vascular dementia?About 20% of people with dementia suffer fromvascular dementia. It normally occurs in peopleaged between 60 and 75, and among men alittle more often than women.

CausesPeople are more likely to experience vasculardementia if they have high blood pressure and/or hardening of the arteries. High blood pres-sure causes arteries to harden and lose theirelasticity, making them more liable to blockwhen small blood clots enter.

Urge incontinence: This occurs whena person cannot ‘hold on’ long enough to reachthe toilet. The urge to urinate occurs suddenlyand is very strong. This type of incontinence isoften linked to other diseases such asParkinson’s disease, stroke, diabetes and de-mentia. It may be a warning sign of bladdercancer and in men may be due to an enlargedprostate.

Overflow incontinence: This occurswhen small amounts of urine leak from a fullbladder.

Functional incontinence: This occursdue to difficulty reaching a toilet because ofdifficulties getting around (e.g. because of ar-thritis, Parkinson’s disease, etc.), rather thanbecause of poor bladder control.

Who gets urinary incontinence?Although incontinence can occur amongyounger people, it mainly occurs among olderpeople. About 10% of people over 65 havesome problems.

CausesIncontinence is not due to ageing. Incontinenceis normally a side-effect of other disorders. Itcan be due to:

a side-effect of medication;nerve damage that affects bladder control(from stroke or surgery);a blocked urinary passage (from prostatedisease);

PRACTICAL TIPSURINARY INCONTINENCE

To reduce some of the effects of urinary incontinence:Train yourself to urinate at specific times to get bettercontrol (e.g. each hour).Cut down the amount drunk before going to bed.Strengthen the muscles used for bladder control. Thiscan be achieved by tightening these muscles for 3-4 sec-onds then relaxing, and then repeating this 10-15 times,three times a day.Reduce the intake of drinks such as alcohol, tea, coffee,milk and fizzy drinks, all of which can irritate the bladder.Reduce the intake of foods that can cause bladder irrita-tion. These foods include chocolate, sugar, tomatoes, cit-rus fruits (e.g. oranges, lemons) honey and spicy food.Relax when emptying the bladder or bowel. Strainingcan simply make incontinence worse.

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Factors that cause high blood pressure andnarrowing and hardening of the arteries all in-crease the risk of vascular dementia. The bestway to avoid vascular dementia is, therefore, tosteer clear of the risk factors of these conditions.This means controlling weight, reducing salt inthe diet, getting sufficient exercise and stoppingsmoking. Damage to the blood vessels in thebrain can be caused by any of the general fac-tors that cause blood vessel damage in other partsof the body. These factors are:

high levels of LDL cholesterol in the blood;high blood pressure;diabetes;smoking;family history of heart and stroke prob-lems.

SymptomsA person who develops vascular dementia prob-ably will not notice much change at first, sinceeach mini-stroke has only a small effect. Thesymptoms may develop slowly as the effects of

PRACTICAL TIPSVASCULAR DIMENTIA

The following tips may help in dealing with someaspects of vascular dementia:

Legal: If vascular dementia appears to bedeveloping, it is important for the sufferer toensure that legal and financial matters are sortedout. It can save a great deal of difficulty later on ifarrangements have been made to enable a trustedperson to make legal, medical and financialdecisions on behalf of the person who has vasculardementia.

Confusion: A person suffering from vasculardementia may do the following to reduce thechance of getting suddenly confused:

Keep familiar things nearby.Leave a light on at night in case you wake upand become confused and disoriented.Write down the things to do for the day.Have an established routine for each day.Take time doing things.Trying to relax to avoid getting frustrated whenfamiliar tasks are difficult.Ask for help when it is needed.To reduce the problems of confusion when out

of the home, the person suffering from vasculardementia can:

Write down the purpose of the trip.Write down destinations and tasks.Ask for help in the event of becoming confused.Always carry some identification with phonenumbers to contact in case of confusion or be-coming lost.

Memory: In the earlier phases, peopledeveloping vascular dementia can do a number ofthings to help with the forgetfulness they areexperiencing.

Use a daily diary as a reminder for appointmentsand daily tasks.Keep a notebook all the time so that tasks canbe written down.Keep a book with a list of people’s names, theirphone numbers and memory joggers.Try to establish a routine that other people knowabout so they can help remind you or knowwhere to locate you.Use an alarm clock as a reminderHave a friend call to remind you of appointments,mealtimes, etc.Label cupboards and drawers with words or pic-tures that describe their contents.Organize things in the home so that there is aset and obvious place for important things.

each mini-stroke build up. Often vascular de-mentia progresses in steps. A person may re-main quite stable for a while and then suddenlydevelop new symptoms because of anothermini-stroke.

The symptoms will depend somewhat onwhere in the brain these mini-strokes occur.However, at least some of the following symp-toms are likely:

difficulty in remembering things – espe-cially recent events;appearing confused to other people andfinding that it is harder to follow what theyare saying (People with vascular demen-tia may find it difficult to make themselvesunderstood.);losing interest in doing anything much,including things that were once enjoyed;beginning to see or hear things that arenot real (hallucinations) or beginning tobelieve things very strongly although theyare not true (delusions);becoming depressed or having wild mood

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swings – laughing one moment and cry-ing the next for no obvious reason (Vascu-lar dementia sufferers may find themselvesbecoming very agitated.);having epileptic fits or finding that part ofthe body is paralysed.

Prevention and treatmentThe brain damage caused by vascular demen-tia cannot be undone. However, since vasculardementia is caused by blocked or hardenedarteries in the brain and by high blood pres-sure, the risk of further damage can be reducedby lowering blood pressure and stopping fur-ther artery damage.

Minimizing all risk factors: Sincevascular dementia is due to blood vessel dam-age that can result from a range of causes (highlevels of LDL in the blood, high blood pres-sure, high blood sugars etc), each of these fac-tors needs to be tackled to prevent the risk ofvascular dementia.

Permanent damage: The brain dam-age caused by vascular dementia cannot beundone. Once the symptoms of vascular de-mentia have developed, the future is generallynot promising. More often than not the condi-tion will continue to deteriorate and further

mini-strokes may follow. It is not uncommonto die from a major stroke, heart disease orpneumonia. The best treatment is prevention.

Medication:. Low doses of aspirin andother such medications may help prevent fur-ther small strokes. Medications can also begiven to:

manage some of the symptoms of vascu-lar dementia (These can control depres-sion, agitation, hallucinations anddelusions.);reduce blood pressure;control blood-sugar levels.Diet: Three basic dietary changes can re-

duce the risk of vascular dementia:reducing the amount of salt and MSG inthe diet to control blood pressure (see highblood pressure);reducing the sugar in the diet to controlthe risk of diabetes and the resulting dam-age to blood vessels;reducing the amount of animal fat in thediet to reduce the chances of blood vesselblockages.Smoking: Smoking is a major risk fac-

tor for any form of stroke.

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The tips listed here are general tips. Theycannot possibly cover the full range of circum-stances in which carers find themselves. How-ever, there are three principles to help guidethe way in which carers go about the task ofcaring. These are:

Encourage and expect those being caredfor to do things for themselves. People be-ing cared for should be encouraged to beas independent as their condition allows.Carers must take care of themselves as wellas caring for the other person. Unless car-ers look after themselves they will not beable to care for other people properly.Carers do not need to think that they haveto do everything by themselves. Carersshould try to spread the tasks and use re-sources provided by other family members,health workers and by other resources inthe community.

Caring for OthersAvoid the person being cared for becom-ing unnecessarily dependent. Carers shouldshow those they care for how to do thingsor set up ways so that they can do tasksthemselves. This may take longer in theshort term but in the longer term it willbenefit both the carer and the person incare.Try to learn about the illness to know what

to expect and understand the symptomsand changes better.Learn signs of potential problems.Safety: If the person being cared for has

problems getting around there are a numberof things that can help to prevent accidents:

Install equipment such as rails and rampsand make other home alterations to makethe home safer.Arrange furniture simply and consistentlyand keeping the environment uncluttered.Remove loose rugs and seal carpet edgesthat may be safety hazards.If the person in care needs to be lifted, thecarer needs to learn how to :

– move and lift a person without hurting him/herself;

– help people to climb up and go down stairs;– push a wheelchair over kerbs and stairs.

Depression: Since depression often oc-curs alongside other illnesses, carers should bealert for signs of depression in those for whomthey are providing care. If the person in careappears to be depressed it is important to:

Provide support to the depressed person.This can be difficult since the help may beresisted and the person may withdraw. Thecarer should try to be understanding with-out being judgmental in feelings orbehaviour.Keep a sharp eye out for any signs of sui-cidal intent. Suicide rates among older

Helping care for an older person can range from just helping out with a fewtasks to full-time care. The experience of caring can vary from being rewardingto being very demanding and distressing and will differ depending on the typeof illness the person has, the amount of care required and on how well thecarer and the person being cared for get on together.

Carers

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people are high and suicide attempts arefrequently successful.Avoid trying to push someone from theirdepression by telling them to ‘snap out ofit’ or by being cheerful. Depression is abiological condition.Dementia: The memory loss, confusion

and communication difficulties associated withdementia can make this a very demanding con-dition for the person suffering and for the carer.Some tips that can help are:

Make sure that there are familiar objectsand people around to help reduce confu-sion about where the demented person is.Keeping any schedule of activities simple.Help the person in care to keep up dailyroutines, physical activities and social con-tacts.Keep the person being cared for up-to-dateabout routine matters such as the time anddate, where he/she lives, who is doingwhat, and what is going on around him/her.Control behaviour that becomes too agi-tated or aggressive. This is necessary forthe safety of everyone. While this can bedifficult, it may be helpful to encourage

and reward appropriate or positive typesof behaviour and ignore others.Pay attention to the symptoms of depres-sion, hallucination or delusion. These canbe treated with medication and this treat-ment makes a big difference to daily liv-ing for everyone.Assist with plans and diaries and checkand remind about things that need to bedone.Ensure that the person in care always car-ries identification, including name and ad-dress and an emergency contact number.Undertake some modifications to the homeand equipment, such as installing auto-matic cut-offs for hot water jugs and otherappliances.Parkinson’s disease: When caring for

a person with Parkinson’s disease the follow-ing tips may help the carer:

Avoid rushing the person with Parkinson’sdisease. While it may be quicker in theshort term for the carer to do the simpletasks for the person with Parkinson’s dis-ease, this can simply create longer-termdependence.Be aware that abilities and speed may varyat different times of day, depending on theeffects of medication.Carers should learn about Parkinson’s dis-ease so that they know what to expect.This can help ease the way as the personin care deteriorates.Eyesight problems: When caring for a

person with eyesight problems it is helpful to:Leave all items as they were left. If some-thing has to be moved, tell the personwhere it has been moved to.Shut doors completely or leave them fullyopen. A half-open door is a hazard.Replace furniture exactly in the position itwas found to avoid accidents and aid mo-bility. Power points, blinds and lightsshould also be left in the same position asthey were found.Managing medication: If the person

in care takes medication, it is important thatthe carer fully understands what medication ismeant to be taken and what it is for and thatthere is a good system in place for managingmedicines. Carers should make sure that theyknow:

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the name and purpose of each medication;the possible side-effects and what shouldbe done if there are side-effects;how long the person in care should be tak-ing the medicine;what to do if a dose is missed;whether the medicine might interfere withother medication being taken;whether anything (e.g. alcohol) should beavoided while using the medication.Working with health workers: Health

workers are an important part of the supportsystem for people in care and their carers. Car-ers and health workers need to work togetherto ensure the best outcomes. Some tips thatcan assist the effective partnership of carersand health workers are:

Know who are the health workers dealingwith the person in care.Know how to contact the health worker(s)and make sure that they know how to con-tact the carer.Take notes when meeting with health work-ers. This can avoid forgetting or confus-ing the advice they offer.Keep a diary of the problems or symptomsof the person in care and a list of ques-tions to ask the health worker.Ask for any printed material that may beof help.

Caring for the CarerCaring can be both a rewarding and demand-ing task. As well as looking after the person intheir care, carers must look after their ownwell-being. The demands of caring can buildup over time and prevent the carer from pro-viding adequate care. Part of caring for othersis for carers to properly care for themselves.Different people will go about this in differentways but the following tips can help.

Carers should avoid trying to do all thecaring themselves. Use should be made offamily and friends and any respite servicesto help ensure that the carer has regularand frequent breaks.

Although people in care may be unable toleave their homes or find it difficult tomove around, carers should ensure thatthey continue with other activities andmaintain a social life.Although carers may feel guilty when theyleave the house, or enjoy an activity with-out the person in their care, they shouldnot let these feelings prevent such activi-ties.Carers should look after their own healthby:

– getting daily exercise (A brisk walk orexercise to help get rid of stress whilstkeeping flexible and fit.);

– spending time out-of-doors;– having a healthy diet and regular meals;– relaxing;– getting enough rest and sleep (Tiredness

can add considerably to the difficulty andstress of caring.).If carers find that caring responsibilitiesare getting them down it can be helpfulto confide in someone, rather than just let-ting the feelings build up.