Getting Old

A Positive and Practical Approach

Rowan Bayne, Carol Parkes

• Editorial: Routledge
• Año: 2021
• ISBN:
  9781351344395
• Edición: 1
• Categoría: Medicina
• Categoría: Infermieristica gerontologica

Getting Old offers concise advice and practical suggestions for all readers interested in or worried about ageing, either in themselves or in someone they care about. With a focus on a positive view of ageing, it discusses central physical and mental aspects of getting old, as well as the social and psychological aspects such as choosing where to live and becoming more oneself.

Rowan Bayne and Carol Parkes take a pragmatic approach to reviewing what is happening in many aspects of your life as you age. Essential topics covered include mobility; diet and digestion; understanding and improving sleep; memory problems and dementia; being an active participant in consultations about your own healthcare; attitudes to getting old; romantic relationships and loneliness; deciding where to live, moving house and choosing other types of living arrangements; and death and grief. They invite readers to focus on their own life and experience, to understand who they are and what they really want now. An important part of self-understanding is the application of personality theory to changes associated with getting old, and readers are encouraged to reflect on what might work for people with their personality characteristics, and how to improve their stress management, communication and decision making.

With suggestions for further reading and useful organisations that offer support, Getting Old offers valuable, affirming guidance for all those and their relatives going through this life stage, as well as health, social care and counselling students and professionals.

Section 1
Physical and mental aspects of getting old

Chapter 1
Mobility

Think of physical changes associated with getting old. For example, you may find that becoming less agile and more doddery are prominent and that negative changes like these come to mind most easily. Moreover, the fact that many of these changes can be slowed or reversed by physical exercise is not exactly welcome to many of us. Accordingly, we begin this chapter with some general principles which attempt to counter this dislike.

1. We define physical exercise very broadly, indeed to mean all physical movement, ranging from a gentle stretch at one extreme to an ultra-marathon at the other. Either of these and anything between can slow or reverse the undesirable physical changes associated with getting old.
2. Exercise should feel good and not be a strain.
3. If you choose to increase the amount or the intensity of an exercise, that too should feel good. If it doesn’t, we want you to stop. Generally, this means gradually increasing its level, speed, frequency or number.
4. We strongly recommend frequent recovery and rest days. Feeling very tired and aching muscles are useful warning signs, and we want you to listen to your body when deciding how much rest to take, although two recovery days a week may be a helpful general guide. Moreover, injury is more likely in old age, and recovery from injury tends to take longer, so it is much better to prevent it in the first place. It is a myth that lots of pain and effort are required for most of us to make useful improvements in physical fitness.
5. Maintaining or increasing mobility is central to coping with physical ageing for several reasons. First, it reduces the chances of many major illnesses such as heart disease and dementia. Second, it improves quality of life, for example making falls less likely and positive social contact more likely. Third, it can lead to feeling more alive.

In the rest of this section, we suggest some options for working on muscles, bones, feet, knees and hips, backs, necks, balance, sitting, walking and running.

Muscles, bones, feet etc.

Muscles

Muscles tend to weaken after 30 years old and especially after 70. Moving in any way helps counteract this deterioration, but there are also some exercises which are particularly effective. We outline these and hope you will try one or more of them.

The idea here, consistent with the general principles at the start of this chapter, is to start with an exercise and a level you can do comfortably. Check with your GP or another appropriately qualified health professional that you’re not being too enthusiastic in your choice. Ideally, a further safety precaution is for somebody else to be present who is trained in manual handling, and who is fit, alert and strong enough to break your fall if needed. Alternatively, have a sturdy table or worktop in easy grasping distance.

Press-ups: five levels of ease/difficulty

Next we describe several variations of the press-up, ranging from one for beginners to the excruciatingly hard for almost anyone. We don’t see the aim as being able to do the excruciatingly difficult variations! (Cf. general principles 2, 3 and 4).

Level 1 press-up

Stand facing a wall, raise your arms and press your palms against the wall and then move your chest towards the wall and back. Do as many press-ups as you can comfortably do and then stop.

Level 2 press-up

Stand next to a sturdy table or worktop, palms on the surface, and bend your knees, pressing down with your hands. Continue until your arm muscles are tired, counting the number of times you can bend and straighten.

Level 3 press-up

Kneeling on the floor, lower your chest towards the floor. Do this once and see how comfortable it feels. If it’s not comfortable, go back to level 2.

Level 4: the standard press-up

NB: This level is quite enough for most people.

Lie straight on the floor face down, supported only by your palms (which are placed beneath your shoulders) and by your toes.

Lower your body, breathing out and keeping your body straight and your buttocks squeezed together (imagine clenching a sheet of paper between them).

Lower your chest as close to the floor as is comfortable, breathing out as you do so.

Raise your body using your arms and knees, breathing in as you do it.

That’s one standard press-up. Aim to increase the number you do when and if you’re ready, bearing the general principles firmly in mind.

Advanced press-ups

There are lots of variations, e.g. holding one leg in the air, clapping hands between press ups, or resting both feet on a bench with your hands on the floor or ground.

Squats: two levels of ease/difficulty

Like press-ups, squats are a weight-bearing exercise, widely used and effective. They are more practical for some of us than press-ups.

Level 1: beginners’ squat

Sit on the edge of a firm chair, hands clasped in front of your chest, and stand. Keep your weight on your heels.

Sit on the edge of the chair and repeat when and if your body feels ready.

As before, count the number you feel comfortable with and aim to increase it and/or your speed.

Level 2: the standard squat

Start standing, with your hands in front, feet shoulder width apart and squat as if to sit on a chair.

Other exercises for the main muscles include walking and running (discussed later in this chapter), weight-lifting and going up steps or stairs.

Also, we suggest eating some protein and carbohydrates in the hour or so after exercise and remembering to rest and recover.

Bones

Bones tend to become less dense and therefore weaker in old age. The main causes of this are not enough calcium and vitamin D, so eating dairy foods and protein, and getting plenty of sunshine, can be helpful. Even standing helps maintain calcium levels a little. However, bone is living tissue and needs stimulating through feedback and, in particular, impacts of the kind produced by jumping, running and dancing – but not cycling and swimming, because although good for cardiovascular health, they are not weight-bearing.

Feet

The health of young feet is often taken for granted. In contrast, old feet are prone to several problems, for example dry skin forming corns, thickening toenails (to the extent that they can’t be cut in the usual way) and fungus infections (which if left untreated become very unsightly). Such changes can limit mobility, the first making movement painful, the other two through feeling embarrassed.

Having corns removed by a competent chiropodist is painless and the results are a pleasure. As a friend said after his first visit (in his mid-70s): ‘It’s like having two new feet’.

Thick toenails are easily trimmed by a chiropodist. Fungus infections take much longer because toenails grow slowly and the many remedies prominent in chemists are, in the experience of one of us and his chiropodist, not very effective (they may well recommend a liquid medicine). Treatment with a laser is potentially much quicker but much more expensive, and the evidence for its effectiveness is unclear so far. Washing socks at 60 degrees and spraying anti-fungal spray inside shoes are also part of the treatment.

There are some basic exercises for increasing foot core stability – they focus on a set of muscles that affect many other aspects and parts of our bodies including backs and posture, but tend to be neglected. You may like to try the following daily:

Sitting on a firm chair, place your bare feet flat on a towel. Wriggle your toes, then seize the towel with them and scrunch it towards you. Try for a minute or two twice a day.

Sitting on the floor or a chair, ‘write’ the alphabet with your toes one foot at a time.

Knees and hips

Pain in knees and hips can be caused in several ways and may be diagnosed wrongly as just ‘part of getting old’ or as needing surgery when they don’t. The causes include obesity and muscle imbalance and overuse, and the treatment options, apart from an operation, are medication, losing weight and structured exercises supervised by a physiotherapist. Generally, and obviously, it is best to try simpler procedures first.

If you do decide to have an operation to replace a joint, we suggest asking your GP which surgeons they and other GPs would go to for that operation themselves.

Ways of keeping joints healthy are regular exercise (with recovery and rest days), avoiding too much twisting, kneeling or lifting, and only occasional or no sugary food or drink (because they may cause inflammation).

Lower backs

For lower back pain, continue with normal activities as far as possible and vary the position of your body. It is a myth that the best treatment is bed rest or lying on the floor, although this was for many years the standard treatment, sometimes for several months, when the result of just a couple of days in bed is weaker muscles and bones and a slightly increased risk of dying from a blood clot.

The following exercises are worth considering for lower back pain:

• squats (see earlier in this chapter)
• brisk walking, arms swinging, head up (if it hurts, go more slowly for a while or stop)
• deep breathing in a relaxed way and using your diaphragm (rest your hands on your stomach and make it swell with your breath)
• mindfulness (deep breathing may be the active ingredient)
• whole body exercises, like running, dancing and swimming
• yoga, Pilates and the gym suit some people and not others – too much twisting and bending for them

Back pain is thus not inevitable with ageing, and we can do several things to help prevent it: being active (as discussed later in this chapter), maintaining a healthy weight (see the section on Diet in Chapter 2), eating and drinking well (both discussed in Chapter 2) and choosing a bed that suits you.

There is no such thing as an orthopaedic bed or mattress. Appealing as the idea may be, it is just a marketing term. A bed needs to be comfortable for you – e.g. you should not feel that the mattress is swallowing you, nor should it feel like a board – and it is probably worth changing a mattress after a few years. We also recommend the back stretcher developed by Neil Summers, especially after a warm bath, for a few minutes at a time.

Overall, drugs (including pain killers), surgery and injections are much more risky ways of treating back pain and are often useless. The simplest and (as it happens) the cheapest options are the most generally effective and safe, and most back pain heals itself. For the latest guidance, see nice.org.uk.

Necks

Neck pain is common and not usually a sign of serious illness, though it is of course painful and awkward. Possible exercises to try, very gently, are 1) stretch your neck, stopping if it hurts, by pointing your nose at the ceiling and moving it from side to side, 2) move your head from side to side, looking over each shoulder and using your hands to stretch a little further, and 3) put your chin on your chest. If these exercises don’t work, see a physiotherapist.

Falls and balance

Falls are both more likely and more dangerous for older people. Broken bones can mean months of pain and anxiety, and loss of mobility and independence.

The risk of falling increases at around 65 years old. This is because we have far fewer of the nerve cells which specialise in balance and coordination by then. Moreover, this loss is true for athletes as well as the general population: general fitness doesn’t prevent it, but particular exercises like those outlined next do.

Injuries from falls can be reduced and prevented by doing some of the following:

• press-ups (see earlier in this chapter) to strengthen wrists and arms, thus absorbing much of the impact of most falls and making your head less likely to hit the ground
• squats (see earlier in this chapter) to strengthen legs and prevent or reduce falling in the first place

Be especially careful with the following exercises: start them holding onto, or next to, something sturdy to steady yourself if you lose your balance – a wall or a table, but not a person.

• Stand on one leg when doing everyday things such as watching TV. How many seconds can you stand without wobbling? A much more difficult variation is to close your eyes before you lift one of your feet, and keep your eyes closed. As before, the aim is to do this comfortably and without wobbling.

Generally we think it better to compete with yourself, for example in how long you can stand on one leg, but you may prefer to compete with the average score of others or with a judgement on what i...