Health issues in older people
As people get older, many will experience at least one chronic health problem. These may include arthritis, rheumatism, cancer, cataracts, dental problems, hearing and vision problems, diabetes, heart disease, orthopaedic injuries, hypertension and so on. Even the simple cough and cold can have serious repercussions for older people, as they have a reduced ability to fight decease. They also are more likely to fall, as they are at greater risk of losing their balance.
Osteoarthritis
It is most common in the knees, hips, feet and hands. Some people will develop it in their neck and back.
What is osteoarthritis?
Around a normal joint, there is smooth cartilage that takes the strain. But with osteoarthritis, the cartilage becomes brittle, rough and weak. To compensate for this, the bone becomes thicker and spreads out, causing the formation of knobbly outgrowths called osteophytes. The synovial membrane that surrounds the joint thickens and the fluid filled space within the membrane becomes smaller. There will often also be inflammation. As it gets worse, bits of cartilage can break away from the bone. This can mean that the bone ends rub together and ligaments become strained. This causes a lot of pain and changes the shape of the joint. It can be painful, and after a few years the joints will appear knobbly, but they become less painful as it settles down.
Causes
There is no known single cause, but a range of factors seem to affect the likelihood of getting the disease. These include:
- Age: osteoarthritis is uncommon before the age of 40, but it becomes increasingly more likely as the age of the person increases.
- Weight: being overweight leads to an increased risk of osteoarthritis, particularly in the knees.
- Injury: an operation, injury, repeated strain, or earlier disease can lead to osteoarthritis later in life.
- Sex: osteoarthritis is more common in women.
Rheumatoid Arthritis
In the UK, Rheumatoid arthritis affects 1`% of the population; and women are three times more affected than men.
Some people find that the condition gives them flu-like symptoms. They may also feel tired, irritable or depressed. There are several types of rheumatoid arthritis:
- Gout: Uric acids and crystals form in the joints, especially in the ankles, hands, wrists and big toe. It is very painful and easily controlled by medication and dietary changes.
- Ankylosing spondylitis: This involves inflammation of the spine and pelvis, causing the joints to stiffen and become immobile at times. The neck, knees, eyes, and shoulders can be affected. More men are affected than women.
- Systemic Lupus Erythematosus (SLE): This is uncommon, but is also known as lupus. It affects around nine times more women than men. It causes inflammation of the joints and skin, and sometimes other organs, such as the kidneys and lungs. It is potentially very serious, but can usually be controlled by medication.
- Polymyalgia rheumatica: This is an inflammatory condition that affects the soft tissue and muscles in the shoulder, upper arm, thighs and buttocks. It can lead to tiredness, weight loss and sometimes circulation problems.
- Reactive arthritis: This is a temporary inflammation of the joint(s) usually as a reaction to infection in another area of the body. This usually clears up by itself.
What is rheumatoid arthritis?
The joints become inflamed, especially the:
- Tendon sheaths
- Bursae: Fluid allowing the muscles and tendons to move smoothly over each other
- Synovial membrane.
Sometimes inflammation becomes far worse. This is known as a “flare-up.” The synovial membrane produces extra fluid, leading to swelling and stretching of ligaments. The joints become warm and red as blood flow increases to the area. This leads to a painful, swollen and stiff joint.
Causes
It is an autoimmune disease, so the body’s defence mechanisms operate even when there is no threat. In other words, the immune system attacks the joints and other parts of the body. It is not yet known why the immune system behaves in this way with some people.
Incontinence
Incontinence affects around one in five women in the older population. One factor is the decreasing levels of oestrogen after the menopause. Urinary incontinence is less common in men, but does still occur, particularly is they have suffered from a prostate disease or they are weak and frail. It is more common in people with reduced mobility and other medical problems, as they may be less able to get to the toilet quickly enough.
What is incontinence?
Incontinence is where a person is unable to control their bladder or bowels, so they may urinate or defecate unintentionally. This can range from minor leakage of urine to double incontinence, where both the bowel and bladder are involved.
Causes
Incontinence due to ageing is caused by a weakening and thinning of the pelvic muscles, ligaments and other tissues. There can be a variety of different reasons why a person becomes incontinent:
- Infections: Urinary tract or kidney infections can affect a person’s normal bladder control.
- Stress incontinence: One in five women over the age of 40 will experience this type of incontinence. It occurs when the bladder, sphincter, and pelvic floor muscles aren’t strong enough to keep the bladder closed when there is pressure inside the abdomen. It can occur when a person coughs, sneezes, laughs or exercises. It is commonly caused due to trauma in that area at childbirth and changes due to the menopause.
- Oversensitive bladder/Detrusor instability: This occurs when the bladder muscles go into an uncontrollable spasm and suddenly empty.
- Congenital defect: Some people are born with a defective bowel or sphincter, meaning that they may always suffer from incontinence or may be more likely to have a problem as they age.
- Nerve damage: Some conditions, such as Multiple Sclerosis or spinal column injuries can cause urinary and faecal incontinence or retention.
- Illness and Disease: Some illnesses can cause the person to become weak or confused, which can lead to incontinence. Also, other conditions such as tumours in the anus or rectum can cause faecal incontinence.
- Severe constipation: Sometimes faeces can block the bowel, but looser stools from higher up in the intestine can flow past the blockage, causing overflow diarrhoea.
