On Old Age and Death VII

The following descriptors of aging are included here—taken from Mayo Clinic, Cleveland Clinic, and AARP information sources and guidelines:

Knowing what to expect as you grow older can help you develop a more positive perspective. After all, you are not just a passive participant in your own aging process. By under-standing the physiological and psychological changes of aging, you can play a more active role in protecting your well-being. The list is divided into organs and areas of the body:

1. Skin changes with age in everyone—the seven signs of aging are fine wrinkles, dull skin, uneven skin tone, dry skin, age spots, rough skin texture, and visible pores. You earned many of your wrinkles over a lifetime of smiling, laughing, and frowning. One should try to see them as reminders that you have lived a life of feeling rather than something to be hidden by heavy makeup as demanded by our youth-obsessed culture and the multibillion-dollar skincare industry which constantly markets the idea of hiding the effects of aging on skin.
•Elastin and collagen fibers help keep younger skin firm and smooth. But sun exposure and other environmental factors can lead to the breakdown of those fibers. As a result, fine wrinkles form, particularly on the forehead, around the mouth, and at the outer corners of the eyes. Limiting sun exposure is important to avoid wrinkles. Outside, wear sunscreen and a sun hat. There is a higher risk of wrinkles from smoking. Do not start or if you are a smoker, quit. It can be done.
•Dullness—skin constantly sheds old cells and replaces them with newer, brighter, skin cells. But as you age, this process slows down. The result is a duller texture to your skin. To combat that dullness of age: exfoliate gently to get rid of the old cells. Increase skin blood flow to encourage new cells to grow. Staying adequately hydrated, exercising, getting adequate sleep, and eating a healthy diet all help.
•Uneven skin tone–some seniors experience an overproduction of melanin, leading to pools of it that are called melasma—blotchy skin, with dark patches and spots. Diligent use of sunscreen can help prevent melasma, and there are in-office procedures and topical treatments which can help lessen the effects of melasma.
•Dry skin–as we age, our bodies lose water; so, an elderly body is only about 50 percent water compared to 75% in early childhood. Moisturizers can help some to keep skin soft and hydrated. A diet high in antioxidants and rich in fatty acids can act as a preventative and a treatment.
•Age spots/ “liver spots”–are small, flat marks occur from repeated sun exposure. They are usually harmless, but changes in their appearance should be brought to the attention of your doctor. Laser therapy and cryotherapy can remove them, or they can be lightened with skin-bleaching products for cosmetic purposes.
•Rough skin texture–babies have soft, smooth skin. Dry skin and dead skin cells associated with old age create an uneven surface. Good skincare centered around moisturizing and exfoliating can help, and it does not need to be expensive.
•Visible pores–As skin loses elasticity, normal pores become more visible as they clog with oil or dead skin cells. Gravity appears to “stretch” pores over time. Laser treatments, exfoliation, and pore-minimizing products can reduce their size.
•Facial shape–Many of the signs of aging are due to skin damage. But facial shape itself can also change because of loss of fat. Lacking elastin, moisture, and fat, gravity pulls the fat that we do have downwards. Face changes as you age through the development of more jowls around the jawline and more hollows around the eyes, and “bags” under the eyes.

2. Hearing loss is a very common result of the aging process. According to the National Institute on Deafness and Other Communication Disorders, about ⅓ of seniors between the ages of 65 and 74 experience some hearing loss, and almost half of those over 75 do. The onset of age-related hearing loss, or presbycusis, can be subtle. Seniors usually do not experience a sudden drop in hearing ability. Instead, they may gradually find that they turn up the TV or radio volume more often, or more frequently asking people to repeat what they just said.
•As people age, the small hair cells of the inner ear can start to break down. Those hair cells “translate” sound into electrical signals for the brain to interpret. With fewer hair cells, this process is less effective.
•Several conditions that frequently affect seniors can impact their hearing, including: hypertension, heart disease, diabetes, or strokes. A history of being subjected to loud noises may permanently damage the fragile hair cells,
•Many people take hearing loss for granted as a normal part of aging. But some of the long-term effects can be serious. In fact, several studies have found a possible link between hearing loss and dementia. Poor hearing can impact long-term health and safety, since you may not hear a doctor’s instructions clearly or notice an alarm going off. Age-related hearing loss cannot be reversed or “cured” but, hearing aids and other treatments can help. To protect hearing with age: limit exposure to noise or wear earplugs or earmuffs. A buildup of ear wax can muffle hearing. Talk to your doctor about the best way to clean it out. Never put anything in your ear smaller than your elbow—do not use cotton swabs, since they may damage your ear drums.

3. Teeth and gum disease–with proper dental care, your teeth can last your lifetime. But seniors are more vulnerable to dental problems, including: gum disease, which can lead to tooth loss, dry mouth–which increases the risk of tooth decay and other problems–tooth sensitivity, which can make it difficult to eat some foods or hot or cold foods, and tooth decay, which can be painful and also lead to tooth loss
•Factors involved in tooth and gum problems arise from simple wear and tear; a lifetime of chewing can break down tooth enamel. Because our bodies lose water with age, our mouths regularly become drier, creating an environment that can lead to tooth decay. Gums recede, leading to the softer, more vulnerable root of a tooth being exposed.
•Aging increases the odds of losing teeth. ~ 20 percent of Americans over the age of 65 have no teeth at all. Missing teeth can lead to other health problems since it becomes more difficult to chew food.
•Also, recent research suggests a link between gum disease and serious health problems such as diabetes, dementia, and heart disease. Since seniors already face a higher risk for many of these problems, it is increasingly important to be aware of oral health as one ages.
•To protect your teeth and gums: Make diligent brushing and flossing a habit. For dry mouth, try sucking on sugarless candies or chewing sugarless gum. Stay hydrated. Avoid alcohol and cigarettes. Artificial saliva, moisturizing sprays, and similar products can also provide relief; investigate low-cost dental care options. Many seniors lose access to affordable dental insurance after they retire.
By quitting alcohol and tobacco, you may save enough money to afford crucial professional dental care. Because of rising dental costs, and seeing other issues as priorities, some seniors often stop seeing a dentist. For older adults, dental checkups are more important now than they have ever been.

4. Digesting food is a complex process that requires the coordination of several different organs. So perhaps it is not surprising that seniors can face a few changes to their digestive systems. Some possible problems include:
•Difficulty swallowing–As with other organs, movement in the esophagus tends to slow down with age making swallowing difficult. Some medical and dental conditions common among seniors can also lead to swallowing issues: gastroesophageal reflux disease [GERD]—characterized by a characteristic burning sensation occurs when the acidic contents of the stomach regurgitate into the esophagus. Many medications commonly taken by seniors GERD as a possible side effect: Antibiotics, such as tetracycline and clindamycin; bisphosphonates taken orally, such as alendronate [Fosamax], ibandronate [Boniva] and risedronate [Actonel, Atelvia], iron supplements, and quinidine.
GERD is more than an annoyance; serious complications, such as bleeding and scarring in the esophagus, can result. The elderly are more likely to experience complications from GERD than younger people.
•Constipation: Bowel movements change with age because the movement of the lower intestine weakens and slows down; so, many older adults struggle with constipation. Other possible causes of constipation include: having less physical activity, dehydration—which is more likely in seniors, is a factor in constipation; many drugs can contribute to constipation, such as: narcotic pain medications, e.g codeine, iron supplements; antacids that contain calcium, e.g. Maalox or aluminum, e.g. Mylanta; overuse of OTC laxatives, e.g. Metamucil, diuretics, and some anti-depressants, e.g. Zoloft. Certain medical conditions–such as diabetes–contribute to constipation.
•Diverticulosis and diverticulitis: These two related conditions are more common for seniors. In fact, ~⅔ of Americans over the age of 85 have diverticulosis, which develops when small pockets or pouches form in the colon. Diverticulitis occurs when those pockets become inflamed. Serious complications can arise from diverticulitis.
To achieve better digestive system function:
•Eat a healthy diet. In particular, make sure your diet contains enough fiber ~about 21 grams a day for women and 30 grams a day for men. Fresh fruit and vegetables, beans, whole grains, including whole grain coarse bread, are all excellent sources of fiber.
•Strive to have a bowel movement daily. Exercise will stimulate blood flow to your digestive system.
•Drink enough water. Staying hydrated reduces the risk of constipation.
•Watch your stress levels. When you experience stress, the amount of gastric acid in your gut can rise, which can increase the risk of heartburn. Treat heartburn and excess gastric acid appropriately.
•Treat any sleep problems. Research in Sleep suggests a link between insomnia and gastrointestinal problems. Plus, being well rested makes it easier to exercise, eat well, and stay relaxed.
Consult with a gastroenterologist if you have persistent constipation, diarrhea, bloody stools, or abdominal pain with any of the other symptoms.

5. Urination–is another process that many of us take for granted through most of our lives; but–like digestion–the process of urinating requires the orchestration of several body parts. When any one of those parts experiences difficulties, the results can include: difficulty emptying the bladder completely, incontinence, increased risk of a urinary tract infection, and the potential for urethral obstruction requiring prompt or emergency surgery. Older males are more likely to be hospitalized for UTI complications than older women.

6. Urinary problems are more common in older people. That is partly because the muscular bladder wall tissue becomes weaker and less elastic. These changes make it more difficult for the bladder to contract, which is necessary in order to pass urine. The prostate gland is often the source of the problem, either from benign prostatic hypertrophy or cancer. Because of the prostate’s location, as it grows, it can block the passage of urine through the urethra. That can lead to frequent urination, difficulty completely emptying the bladder, even frank obstruction of bladder flow. Surgery is usually required, and men should not wait until symptoms are severe.
In older females, aging-related body changes include the muscles supporting the bladder become weaker which can lead to bladder prolapse where the bladder drops into the vagina. And when estrogen levels start to decline, the walls of the urethra become thinner and lose strength. As a result, the urinary sphincter does not close as tightly as it needs to. That results in an increased risk of incontinence, UTI, and possible need for reconstructive surgery.
Incontinence and other bladder issues do not have to be accepted as a normal part of aging. Many treatments are available for urinary issues. To exercise pelvic floor muscles do Kegel exercises frequently every day–squeeze the muscles you would you use to stop passing gas. Work up to doing the exercise 10 to 15 times in a row, 3 seconds at a time, at least three times a day every day.
Avoid bladder irritants–Caffeine, acidic foods, alcohol and carbonated beverages.
Avoid constipation. Eat more fiber and take other steps to avoid constipation, which can worsen incontinence. Gentle osmotic laxatives such as polyethylene glycol 3350 [Miralax] which triggers peristalsis without interacting with bacteria or causing nerve stimulation-which can lead to harsh side effects–are recommended for the elderly patients with constipation.
Seek treatment if: you feel that you must urinate immediately, and that happens frequently; if you have an increasing number of instances of being unable to hold your urine and have episodes on incontinence, even minor ones; if you have unusual urinary frequency; difficulty emptying your bladder, especially if it is persistent; fever associated with urinary tract symptoms; or bloody urine—which may be only a reddish tint in the urine.


7. According to The National Kidney Foundation more than half of seniors over the age of 75 may have kidney disease. Kidney disease is responsible for more deaths annually than breast and prostate cancer. The short explanation is that kidneys become smaller and less efficient with age. This decline in efficiency is partly because the arteries supplying blood to the kidneys shrink over time. These changes do not occur with all adults.
The symptoms of kidney disease are often deceptively mild and subtle. They often are not recognized until the disease is quite advanced. Simple blood tests can help measure your kidney function. Be observant of potentially important symptoms: puffy eyes, especially in the morning; unexplained itchy skin; unusual fatigue and difficulty focusing; muscle cramps at night; unusual reduced appetite; or unexplained foot and ankle swelling.


8. Lung function begins to decline around the age of 35; and by age 65, people lose ~liter of lung capacity. Because lungs typically have a peak capacity of about six liters, that is significant. That decline is not just due to the aging process in your lungs themselves, but also changes to other parts of your body that support the respiratory system.
Some of the changes that can affect breathing are: Osteoporosis thins bones and can lead to postural changes leading to a smaller ribcage and stiffness that make it more difficult for the chest to expand; the diaphragm muscle weakens, making it more difficult to take a deep breath; the immune system becomes less effective, rendering the elderly more vulnerable to respiratory infections; the alveoli stretch out and become less efficient; airways, blood vessels, and muscles stiffen.
Lung protection comes from: breathing clean air and avoid indoor and outdoor pollution, including secondhand smoke. The single best thing for lung health is never to start, and if a smoker now, to quit smoking. COPD, emphysema, and lung cancer, are almost entirely the result of smoking cigarettes; Exercise–Not only can cardiovascular exercise improve lung function, but upper-body strength exercises can improve your posture and make breathing easier. Make sure vaccinations are up to date. Pneumonia vaccination can prevent premature—and potentially lethal pneumococcal pneumonia—and an annual flu shot helps prevent damage from respiratory infections.
Be sure to do both formal exercises but also make a commitment to yourself to keep moving as much as possible every day. Sitting about or lying in bed for long periods causes mucus to accumulate in bronchi and lungs leading to airway stiffening and bronchial and lung infections. in your lungs. Finally, research in the European Respiratory Journal shows a relationship between a diet with plenty of fresh fruit and other antioxidant-rich foods and healthy lung function.


9. Almost half of all adults in America have at least one problem with their heart or blood vessels today. Some age-related cardiovascular changes are: heart wall thickening resulting in an enlarged heart which obtains less blood to it. That results in the heart being a less efficient pump, thereby increasing the risk of heart failure. Walls of large arteries thicken and become harder—arteriosclerosis—which leads to hypertension. High blood pressure can lead to strokes, heart attacks; and vision, kidney, and other health issues. Plaque can build up on the inside walls of arteries leading to reduced blood flow to the heart. The electrical system controlling heartbeat can become less reliable causing in an erratic heartbeat or arrhythmias which are potentially fatal without treatment. The valves that control the movement of blood in and out of the heart tend to stiffen with age causing the heart has to work harder than in the healthy state.
Many cardiovascular maladies take time to realize the effects of growing older on your heart. Indications for seeking medical advice include: irregular or fluttering heartbeat; swollen ankles, feet, belly, or neck; chest pain with activity; dizziness or lightheadedness; unusual fatigue; unexplained nausea or vomiting; feeling short of breath during activities, while at rest, or while lying down [a progressive and worsening sequence]; difficulty keeping up with regular activities or keeping up with your peers.
Some cardiovascular problems typically do not cause any symptoms but can still wreak havoc. All seniors should maintain a schedule of regular checkups with their doctors or other medical providers monitoring your blood pressure, cholesterol levels, and blood sugar.
Cardiovascular events leading to a heart attack [myocardial infarction] do have classical signs such as substernal chest pain, left arm pain, and fainting. However, many—especially in women—are different but no less serious. Warning signs to watch for include: pain that seems worse than heartburn or different than is usually experienced; chest pressure, tightness, and heaviness; extreme or persistent fatigue; unexplained fainting, lightheadedness, or nausea; pain in shoulders, neck, jaw, or arms; shortness of breath with or without chest pain; or sweating for no apparent reason.
Prevention of cardiovascular problems is much the same as that for lung function. It is also very important to relieve stress and to have a thorough workup for sleep apnea, snoring, insomnia, and requiring afternoon naps.
If you are suspicious that you may be on the way to have a heart attack, take one common aspirin [I recommend 325 mg.], call the nearest emergency room and hasten to get there safely.


10. A healthy sex life can extend well into the old-age years, but it is important to recognize, accept, and adapt to the considerable change occurs during those years. Age-related hormonal changes especially require adaption.
Men usually experience lower libido as they get older due to declining testosterone levels, and many have difficulty with full or partial erectile dysfunction [ED]. But these issues are not always caused by age-related physiological changes. Recognize that other factors may be in play, such as stress, relationship difficulties, or medication side effects. So, bring up any sexual difficulties with your doctor. Men need to remember that their ability to reproduce does not decline dramatically with age. Many older men are able to father children; so, males with female partners who have not yet completed menopause should ensure that they use a reliable form of birth control if they want to prevent pregnancies.
For women, hormonal changes lead to menopause, sexual changes, such as thinning of the vaginal walls and painful intercourse, vaginal dryness, and diminished libido.
Seniors can still contract sexually transmitted infections. In fact, because their immune systems are often weaker, seniors who engage in risky behavior may be more vulnerable to STIs than younger people. Infection rates are rising for seniors, and caution is necessary.


11. Bodily changes occur seemingly almost from nowhere and with amazing rapidity. Seniors may notice that even if their weight remains constant, their body shape changes with age. They feel less firm; more body fat migrates to their bellies despite the bodily transformations taking place even without changes to their diet and exercise routines.
The effects of aging on muscles can start as young as 30 and accelerate with age. As a result, we lose about 30 to 50 percent of our muscle strength between the ages of 30 and 80. Because muscle burns more calories than fat, losing this muscle can lead to a slower metabolism; and slower metabolism can lead to fat accumulation.
However, you are never too old to start building strength; it is just slower and more difficult. Another change to body composition is the loss of bone mass with age. Due to the effects of aging on their bones, seniors are at a higher risk for fractures. A seemingly simple fall can have serious health consequences for an older person. No one should climb ladders beyond age fifty.
Many seniors discover that they are a bit shorter than they used to be. On average, men lose about five centimeters by the age of 80, and women lose about eight. As well, when we lose muscle mass in the torso, we can develop a more stooped posture that makes us appear shorter. Several studies tie height loss to increased health risks. For example, a study in the Journal of Bone and Mineral Research found that seniors who experience a rapid reduction in height are more likely to fracture a hip.
There are reasonable preventative steps: exercise regularly, even walking, dancing, and swimming; get enough vitamin D and calcium–foods rich in calcium include leafy greens, yogurt, and tofu. Good sources of vitamin D include mushrooms, eggs, fatty fish, fortified drinks, and cereals. The process of making vitamin D naturally from the sun becomes less efficient with age; avoid exposure to harmful substances, especially cigarette smoke, alcohol, illicit drugs, and possibly wild mushrooms which negatively impact your bone density; work in cooperation with your health provider regarding prescriptions and even OTC medications—some cause bone loss, and others increase bone density.


12. Joints and Connective Tissues
When it comes to painful joints, scientists now think that inactivity may be a bigger factor than chronological age. Many seniors notice a change in their ease of movement as they get older. We also get stiff as we age because our connective tissues [ligaments and tendons] tighten, partly because our bodies lose water. That leads to a decrease in the range of motion in our joints.
Paradoxically, the best way to avoid stiff, painful, movement is to keep moving. Activity will prevent cartilage from stiffening and keep synovial fluid circulating. Our natural tendency is to stop moving when we experience pain, to rest the area. And, it is important to rest. But seniors can enter into a cycle in which the resulting inactivity leads to even more stiffness and pain and less inactivity.
Get adequate amounts of calcium. The National Academy of Science, Engineering, and Medicine recommends at least 1,000 milligrams of calcium daily for adults. The recommendation increases to 1,200 mg daily for women age 51 and older and men age 71 and older. Dietary sources of calcium include dairy products, broccoli, kale, salmon, and tofu. If you find it difficult to get enough calcium from your diet, ask your doctor about calcium supplements.
Get adequate amounts of vitamin D. The recommended daily intake of vitamin D is 600 international units for adults up to age 70 and 800 IU for adults over 70. Many people get adequate amounts of vitamin D from sunlight, but sunlight is a two-edged sword. Excessive sunlight promotes skin cancer. Other sources include tuna, salmon, eggs, vitamin D-fortified milk and vitamin D supplements.
However, if you experience pain, stiffness, redness, and tenderness, at any of your joints, or in your lower back, it is important to see a doctor right away. Focus on the fact that joint pain is not necessarily a part of the aging process.

13. Immunosenescence is the process of weaking and slowing of the immune system.
The immune system fights germs and other threats to well-being with T cells. With age, the immune system has fewer T cells, and the rate at which antibodies are produced slows down. That process results in: more colds and flus than usual; takes longer to recover; and increased vulnerability to autoimmune disorders including rheumatoid arthritis or multiple sclerosis.
Immunosenescence can be improved by: up-to-date vaccinations; well-rounded diet; avoiding or stopping smoking; getting moderate exercise and adequate rest; and avoiding stress.

14. Sleep
~50 percent of elderly adults have problems with sleep, and studies confirm that many older adults do not get enough. Seniors tend to have more fragmented sleeping patterns with difficulty getting to sleep, staying asleep, and problems falling back to sleep after waking. It is absolutely not true that either seniors or teenagers need less sleep. Sleep is as important as eating well or exercise. Lack of sleep has been proved to activate the cellular processes linked to aging. Studies show that regularly sleeping less than six hours a night can lead to brain changes linked to dementia.
Seniors experience many conditions that disturb their sleep: the pain of arthritis; many medications have sleep disturbance as a side effect; some older adults find that the new routines of retirement can affect their sleep schedules.
The following can help seniors have more sleep:
•If you share a bed with a partner, coordinate your sleep schedules and resolve conflicts before bed.
•Do not drink [anything] before going to bed; especially avoid alcohol and caffeine. Fluid intake leads to increased need to urinate, restlessness, and disturbed sleep.
•Adjust environment to quiet, dark, and cool. Consider using a white noise machine to mask sounds.
•Seniors should take appropriate fall prevention steps in the bedroom, since seniors too often experience falls when they get up at night.
•Create a sleep-friendly lifestyle. Regular exercise can help you fall asleep but avoid exercise within three hours before bedtime. A regular sleep schedule is best so that you go to sleep and wake up at about the same time every day, even on weekends.

15. Brain and Nervous System

The effects of aging on the brain do not necessarily lead to a fast mental decline; the reality is far more nuanced and reflects the plasticity of the nervous system. There is a remarkable variation from person to person. Many seniors remain bright and engaged well into their 90s, while others experience a decline in cognitive function much earlier. Many find it more difficult to multitask.
Minor and brief memory lapses are usually not a cause for concern despite being frustrating—such as going into a room and forgetting why. By itself, aging does not cause dementia, but it is one of many risk factors. Dementia is not a normal part of aging.
Memory and our ability to learn new things tend to slow down because aging affects the brain in several ways:
•The hippocampus shrinks which may affect the way memories are formed and retrieved.
•The hormones that lead to the growth of neurons and the repair of brain cells start to decline.
•Blood flow to the brain slows down and diminishes, which can lead to memory and cognition problems.
So, the cognitive changes that are seen in the normal aging process include some declining memory functions. But in normal aging, they do not decline enough to affect daily life beyond being inconvenient and possibly embarrassing. Bear in mind that forgetting where you left your keys is normal. However, not remembering that you need car keys in order to drive, is not normal. In general, the main difference between dementia and normal aging is that dementia-related memory loss affects your day-to-day functioning in a fundamental and negative way.
The effects of aging are not all negative:
Seniors are more likely to focus on the good in a situation.
•Seniors tend to be more optimistic than younger people. Older people can draw from a lifetime of experiences that may have taught them to take a long-term perspective. And because the senior years are often marked by inescapable loss as older adults experience the death of friends and loved ones, their tendency is to protect an optimistic view of life as a way to cope.
•Seniors get better at “big picture” thinking. As we grow older, neuronal dendrites [branches] of neurons) start to make more connections between different areas of the brain making it easier to see relationships between diverse issues.
•~25% of older adults experience a mental health problem such as depression, anxiety, schizophrenia, or dementia. The suicide rate for men over 85 is higher than that of any other age group.
•Contrary to earlier presumptions, human brains can continue to grow neurons throughout life. However, there is an important caveat: “use it or lose it”, i.e. work the brain to learn and use new things constantly; the continuing ability to grow new neurons relies on our brains remaining active.
Some of the other age-related changes to the nervous system involve the spine. As the discs between the vertebrae compress, the function of the nerves along the spinal cord can be damaged. That can lead to balance and coordination problems.
Steps to help protect the functions of your brain and nervous system:
There are steps that can help maintain and increase brain health: A good diet for the brain should include omega-3 and omega-6 fatty acids have been linked to healthy brain aging. Good sources of omega-3 include: chia seeds, egg yolks, fatty fish, ground flax seeds, and walnuts. Good sources of omega—6 fatty acids include: pumpkin and sunflower seeds, sunflower, soybean, and safflower oils.
Stay mentally active and continue to challenge yourself. Complex new activities that encourage problem-solving are good for the development of new neurons. Seniors enrolled in arts classes seem to age more slowly than peers who do not participate in creative activities.
Protect your head. Even fairly minor head injuries can affect cognitive function. Again, avoid falls if at all possible. Do not climb ladders.
Nurturing social relationships to protect brain health is backed by growing evidence. Regular social activities and interactions with family and close friends can help protect brain health.

16. Vision

For many adults, the first sign of old age is when they become unable to read a restaurant menu. Vision problems increase with age; but with proper care, most age-related vision problems can be managed; so, vision issues do not have to affect quality of life to any significant degree. Early detection is important in preventing vision problems. Schedule regular eye exams; after the age of 50, have a dilated eye exam. That can help eye doctors identify potential problems before other and more serious symptoms and conditions appear.
Some vision issues that are more common as you grow older include:
•Presbyopia/farsightedness. This is demonstrated by having to hold things further away in order to see them clearly. It is a normal part of the aging process and happens because the lens inside your eye hardens and thickens with age.
•Age-related macular degeneration. The macula is the part of the eye that helps you see straight ahead and for fine focus vision. When the macula starts to decay, blurry spots in the center of the field of vision appear. As AMD progresses, blank spots appear near the center of vision; and the brightness of objects declines. AMD is a disease that weakens vision and is not a regularly expected consequence of age. ~10% of Americans aged 50 and older have the early form of AMD, and approximately 1% of Americans aged 50 and older have the vision threatening late form of AMD. Treatment is complicated and varies in success. Contact an ophthalmologist promptly if symptoms occur.
•Cataracts: The lens of an eye is composed of water and protein. With age, the protein can start to form clumps on the lens. The result is cloudy vision and difficulty distinguishing colors. Although cataracts may develop in middle age, they are more common in seniors. Surgery is safe and effective to restore vision.
•Glaucoma is an umbrella term for many diseases that affect the optic nerve. Often, one of the first signs is difficulty with side vision. Although it cannot be entirely cured, early treatment can markedly reduce the impact on vision. Regular eye exams–including measurement of eye pressure–can help reduce the effects of glaucoma. That is important, because glaucoma is the second-leading cause of blindness.
There are lifestyle choices that can help reduce the impact of age-related vision changes, including wearing sunglasses when outdoors; resting your eyes when looking at a computer screen for a long time; and eating foods that are known to help with eye health, such as leafy greens, fatty fish, and fresh fruits. Carrots contain beta-carotene, a substance that the body converts to vitamin A, an important nutrient for eye health. An extreme lack of vitamin A can cause blindness. Vitamin A can prevent the formation of cataracts and macular degeneration, the world’s leading cause of blindness.

I chose to use a pseudonym for personal reasons. I’m a retired neurosurgeon living in a rural paradise and am at rest from the turbulent life of my profession. I lived in an era when resident trainees worked 120 hours a week–a form of bondage no longer permitted by law. I served as a Navy Seabee general surgeon during the unpleasantness in Viet Nam, and spent the remainder of my ten-year service as a neurosurgeon in a major naval regional medical center. I’ve lived in every section of the country, saw all the inhumanity of man to man, practiced in private settings large and small, the military, academia, and as a medical humanitarian in the Third World.