Is This Just 'Getting Old'? ; "a Little Memory Loss Is Often Felt to Be a Normal Part of Aging. But It's Not Clearly Normal."

Buffalo News

09-21-06

The concept of "old age" doesn't have much use when you're trying to get well.

Almost all aches and ailments can be traced back to pathology -- something that has gone wrong with the body, a disease. Once we have identified a disease, we know where we stand, and frequently we can offer a treatment. So attributing a problem to "old age" doesn't help us solve it.

But when we try to understand certain situations, particularly where an aged person is very ill, the idea of "old age" starts to have some value. There is a feature of aging that we cannot attribute to a single pathology, and that feature is a buildup of multiple pathologies that won't get better, and which tend to worsen each other.

I don't think we have a word for this buildup. (Any suggestions would be appreciated.) Let's look some interlocking examples.

A little memory loss is often felt to be a normal part of aging. But it's not clearly normal. Many people get to advanced ages with sharp memories. For those who don't, there are many diseases that can erode memory to a greater or lesser extent: small or large strokes, the chronic inflammatory process that leads to Alzheimer's, small head injuries, and so on.

There are only a few causes of memory loss that are reversible: thyroid disease, vitamin B12 deficiency and hydrocephalus are the big ones. If none of these are present, we are mostly stuck with watching the deterioration.

A little memory loss might not be such a problem, except that even older people have to learn new things and keep track of numerous details. For example, you have to remember if you've taken your medications today. If you forget this, you might take a double dose.

A double dose might not be so bad for a 25-year-old person, but for an older person with some chronic kidney disease it is harder to clear the drug from the body. The kidneys may have had damage from chronic inflammation, recurrent infections, arterial disease or chronic hypertension. Mostly you can't reverse this; you can slow down the decline, but you can't get kidney function back.

Let's say you've taken a double dose of a beta blocker, a blood pressure medication that can slow down the heart rate. Your heart rate drops to 25, which is far too low. A younger person with a sharper nervous system and a more resilient cardiovascular system might be able to handle the ensuing dizziness, but for you, it's just enough to make your blood pressure plummet and you pass out.

So you pass out and land on the concrete floor of your basement. A younger person without the bone loss that accompanies aging wouldn't break a bone. However, your bone density, due to vitamin D deficiency, menopause and drinking too many soda pops in your youth, is low, and you break a hip.

After waking up, a young person without multiple chronic conditions might be able to drag himself or herself 30 feet across the floor to the basement phone, but you can't. Besides, because of the subtle brain disease you have (evidenced most obviously by the memory loss), you start to get confused and just lie there until you're found. Twelve hours later your daughter comes to visit and finds you.

If it was your daughter lying on a concrete floor for 12 hours, her skin would probably be OK, but because your skin is frail, you get some skin breakdown and an infection. So how did this happen? You could break this somewhat complicated situation down into individual pathologies, but you'd miss the big picture.

The pathologies worsen each other by reducing the ability of one organ system to compensate for deficiencies in another. Recovery from a worsening of one pathology becomes an exercise in managing them all.

There is no word for this type of knot of problems. But we can call it "old age" for now.