Posts Tagged ‘Aging’


February 18th, 2011

In college I majored in psychology. Back then, B. F. Skinner ruled. I remember reading an essay he wrote about coping with aging. In his characteristic practical, methodical manner, Skinner dealt with memory lapses by writing himself a lot of notes and being very organized.

The first of the Baby Boomers have begun to turn 65. I’m a tad ahead of the Boomers, and many of the patients I see are in their 60s, 70s, and 80s. What advice can we give them—and ourselves—about steps to improve health and function and lower risks as the years take their toll?

Skinner used paper and pencil to augment his memory. We can do likewise, but we also have many electronic options from which to choose—and they can beep or chime at designated moments.

Modern technology can assist in many ways. For those who can afford them, new cars feature a growing number of active and passive safety features, helping to avoid and survive accidents. Trouble hearing? Technologic advances have made modern hearing aids vastly more effective than their predecessors—and easier to conceal.

There is nothing like a fall to make us feel old all of a sudden. Lowering the risk of falls as we age takes thought and planning. The greatest risk zone is one’s own home. Check it out. Look for and correct obvious hazards. Consider night lighting. Assess surfaces that are slippery when wet: e.g., bathroom and kitchen floors and entrance halls. When staying overnight in an unfamiliar setting, evaluate the path between bed and bathroom for hazards in low light. For our patients and ourselves, be mindful of postural hypotension and when dizziness may strike. Attention to sidewalks and proper footgear is important in winter.

Strength and aerobic training can lower the risk of falls. Balance exercises are particularly valuable as we age.

I love pets. Over the decades, I have bonded with and delighted in a number of horses, dogs, and cats. But for all they offer us, pets presents risks as we get older. The dangers from horses are obvious: you can fall off, get stomped on, kicked, etc. Smaller animals can trip their owners. Collars that jingle will warn of a running approach. It is good to routinely grip a handrail when descending stairs. Walking a dog on a leash idea demands constant awareness and precautions.

Doctors are always preaching the gospel of diet and exercise—and we should. Maintaining a healthy weight, body mass, flexibility, mobility, and cardiovascular tone help us age with grace, better function, and greater ease. Growing old may not be fun, but as the old cliché puts it, it beats the alternative.

– Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

The Age Variable

January 21st, 2011

Several articles I’ve been working on for my monthly newsletter, Biological Therapies in Psychiatry, made me think of aging as a key variable in therapeutics. Commonly prescribed psychotropic medications adversely affect bone health and may increase the risk of falls—a double whammy for fractures. Some psychiatric medicines increase the risk of bleeding, others the risk of venous thromboembolism. All of these hazards are even greater in the elderly—particularly in patients with medical illnesses and taking multiple medications.

The population is growing older. I am seeing more patients in their 60s, 70s, 80s, and 90s. And, miracle of miracles, I’m getting older! (Who knew?!) We can’t reverse the calendar. But we can factor a patient’s age, comorbid conditions, and other treatments into our therapeutic algorithms. Some of the approaches are decidedly low-tech.

Can my patient read the name and directions on a medicine bottle? (The print can be really teeny.) Does the bottle have a child-proof cap that’s hard for someone with frail hands or arthritis to open? Does the patient understand the nuances of how and when to take the tablets? Especially when there are multiple medications, advise about inexpensive pill containers, with the days of the week embossed in large characters on easy-to-open boxes. They come in many shapes and sizes and can be filled weekly by a patient or family member. Calendars and electronic devices also can provide mnemonic assistance.

Ask patients and family members about driving competence and safety. There are increasing numbers of electronic and mechanical devices in newer cars, which can enhance the safety of older drivers (and their passengers and others). And there comes a time to discuss relinquishing a driver’s license.

I think and ask about barriers, obstacles, and other tripping risks in the home—especially for paths likely to be trod after dark (like the route from bed to bathroom). What about risks for slipping in bathrooms?

Practitioners know to ask about other medicines a patient is taking. I cannot possibly be conversant with all current medications, but answers about their indications, adverse effects, mechanisms, and potential interactions are as near as my computer or smart phone. And I try to remember to ask about over-the-counter preparations, including dietary supplements—many of which can interact with prescribed medications.

We can’t turn back time. But we can remain aware of its effects and open practical conversations with patients and their friends and families.

- Alan J. Gelenberg, M.D.
Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Journal of Clinical Psychiatry