In the beginning

Everything has a beginning: thoughts, beliefs, ideas, human beings, relationships - I could go on but I’m pretty sure we’re on the same page here. As far as living beings go, we may not know the exact moment our children and loved ones began but, hopefully for as long as we live, we will remember the moment we found out they existed and our world changed.

There is also the beginning of the end. By definition, it’s the point where something begins to get gradually worse until it ends or fails completely. It’s the thing that sometimes you see coming and can prepare for or it’s the thing that happens, on a random day in a random month, that changes the course of the rest of your life.

I’m far from being an expert but, from what I’ve been reading and from what I’ve seen, it seems that for most relatively healthy, older adults the beginning of the end (in this case, meaning the end of living independently and the end of control over one’s life and well-being) starts with a fall. A fall that results in perhaps a concussion, or a broken bone, or a new diagnosis; that’s what seems to be the catalyst that can take us from being active, autonomous members of society to relying on a healthcare system that is already struggling to keep up. Our healthcare system, and others around the world, are ill-prepared for the numbers of geriatric patients who will need care far beyond an antibiotic prescription or a yearly screening and checkup. Here’s a little something to consider from the Forbes website:

“Elder and long term care is rapidly becoming one of the most daunting healthcare challenges of our day. Between 2015 and 2030, the number of people in the world aged 60 years or over is expected to grow by 56%, from just over 900 million to nearly 1.5 billion. By 2050, the global population of people older than 60 is expected to jump to two billion. In the United States, the number of Americans over the age of 65 is expected to double from roughly 50 million today to nearly 100 million by 2060.”


“Neither low, nor middle, nor high income countries are immune to the implications of this change. As people age, they suffer from more and more illnesses. These chronic illnesses are placing an increasing burden on health systems. Governments need to recognize the effects of demographic change, not merely on public services, but on the social climate of each nation. Countries will have to reconsider all aspects of their communities, from healthcare systems and methods of delivering care to how whole cities are structured. An aging population can also create an unsustainable burden at the household level. The physical and emotional burden of providing care to an aging loved one is compounded by the fiscal burden as well.”

Well, now. That puts us in quite the pickle, doesn’t it?

As far as dementia and Alzheimer’s is concerned, I’ll never know when it began in Mom. But I do know when the diagnosis happened - in the hospital, after a fall - and her whole life changed.  Sure, we remember odd behaviors and times when something seemed “off” but was it just because of the natural progression of getting older or was it a symptom? I do know when it became undeniable that something was wrong, and there are no words to describe that feeling. If it were me, would I want to know the exact moment the genetic flaw in my DNA fired up and started me down a course that scares the hell out of me? Maybe. And even if I could throw myself into being proactive about my healthcare, find the right specialists, and sign up for every single drug trial I could find, would I want my life, and the lives of the people who love me, to be overshadowed  by a battle I’ll most likely lose? I don’t know the answer to that.

Time out for a fun fact I didn’t know but thanks to Google and Wikipedia I know now: A gerontologist is a healthcare professional (with at the least an associate’s degree) that specializes in the physical, mental, and social aspects of aging. A geriatrician is a physician that focuses on healthcare for the elderly with a focus on promoting health by preventing and treating diseases and disabilities. I didn’t know the two specialties were different, I honestly haven’t given it much thought. However, I do know how to use affect and effect correctly so there’s that. Go me.

So, what can we do to delay the beginning of the end for as long as we can? We can eat right, exercise, and keep our minds engaged but really, that goes for just living life. Finding a good geriatrician could be helpful since a doctor with a background in geriatrics could take into account our age, medical history, lifestyle, and the medications we’re taking. In turn, we could potentially lessen the chance of negative medication interactions and perhaps find a way to take less of the medications that cause the most severe side-effects. For instance, blood pressure medication can cause dehydration which can cause dizziness which can lead to a fall. A reminder to drink more water could be extremely helpful (doing it would help even more). Overheating, low blood sugar, and low iron levels can also lead to dizziness which could result in a fall.

However, finding a geriatrician may be a problem. In a given year, fewer than three hundred doctors will complete geriatrics training in the United States. Given that the number of people who are sixty-five years or older is on its way to doubling in the next forty years, to around 100 million, we’re looking at a whopper of a deficit.

Of course, regular physicians can treat geriatric patients but some things may end up getting overlooked. For example, when was the last time your general practitioner took a look at your feet? For now it probably isn’t an issue; however, it can be tough for an elderly person to trim their toenails or take care of their feet in general. Why do I mention feet? Because overlooking them can cause some serious problems. The following is from an article written by Dr. Paul Dearden and Dr. Andrew Wines:

Foot pain, progressive deformity, and loss of function...are seen as a natural consequence of getting older. However, age-related loss of natural soft tissue fat cushioning, loss of skin elasticity, bony deformity, and difficulty with basic foot care can lead to significant problems that may compromise an older person’s ability to maintain their independence. In many cases these foot issues contribute to...problems that can increase falls [sic] risk, with its well documented associated morbidity and mortality.

The article is from a peer reviewed journal so the content is rather dry. But the findings, or the message, is incredibly important. Something so small as foot pain or change in gait can be the beginning of the end of an independent life or life itself. If it were in your power to delay the beginning of the end, just by tweaking your daily routine or practicing more mindful self-care, would you do it? If you’re still on the fence, take a side trip to a skilled nursing or assisted living facility and get back to me. If that doesn’t change you, nothing will.