There is an old Welsh saying that patients used to tell me when they came to see me in the surgery complaining of aches and pains, or failing eyesight and many other things – “old age doesn’t come by itself”, meaning all these ailments that just seem to appear from nowhere when we get older. The saying rings true more and more for me as I approach the age when they used to consult me. It is true that the aging process is impossible to avoid – sooner or later the problems come, unbidden and unwanted. Some can be put off for a while by looking after ourselves and avoided things like smoking and putting on too much weight which we know will cause problems; others need a touch of the magic of modern medicine to put us right so that we can keep going for longer. Now I am at that age, my friends often ask me for advice, so I thought I would bring back this blog, which seems to have strayed away from its roots a bit recently, by talking about the common things us oldies will get. I can remember very well those older people who used to come to see me when I was in my prime, grumbling so much about things which I hadn’t been taught about and often seemed very trivial. I don’t think I really gave a very good service then, concentrating, as I had been taught to do, on “real” serious illness, but now perhaps with the perspective that comes with age I can remedy that. The one thing this blog will not do is to try to sell you anything, as happens whenever you go on to the web for advice.

We all want to live longer and longer, and some of us spend a lot of time reading news articles of new advances to prevent illness, but there doesn’t seem much on how to cope with these things – joint problems, deafness, wrinkles and insomnia for example without the inevitable disclaimer – “consult your doctor”. So I thought I would compile a list and give my thoughts on how to deal with them. The whole point is to help oneself, and although you probably know most of it, I hope there will be a few nuggets that will be of interest.

The first thing that most of us notice as we get older is that our skin ages – all those wrinkles that start appearing in our late forties and go on deepening year on year. When I was in practice the only thing that would get rid of them was a face lift; and a few of my wealthier patients did that – privately of course. I remember several women coming in, really desperate for something that would stop them looking so old, but if they had no money nothing could be done – just like now of course. Cosmetic treatment has never, rightly, been available on the NHS. There were creams available to cover up the wrinkles – they worked, as they do now, by irritating the skin slightly so that the skin reacts by producing fluid under the skin. This fills up the wrinkles and makes them look less obvious. Such creams are not very effective though. These days ladies start having botox treatment in their thirties, and many in their fifties have no discernable wrinkles at all. It all looks rather false, and I wonder how these women’s skin will hold up in their seventies after decades of botox, fillers and the like. But for now they are benefiting from looking younger, in the workplace, in their marriages and in their self confidence, Those of us older ladies who have never done this will look a bit sad. But life is not just about looking young – you have to be healthy and active to enjoy old age.

Skin deteriorates in other ways too. In fair skinned people sun damage is a real problem, making the skin of the arms for instance look mottled, and increasing the risk of tumours of various sorts, some benign, some very dangerous indeed. Sun creams are essential if you have fair skin, and these should be started in childhood. The sunscreens available in my childhood were really pretty useless, (even if we thought to use them) but now a lot of unpleasant sun damage can be prevented. But the tissues underneath the skin degenerate with age even without sun damage so that the skin is no longer supported and sags. This sometimes irritates the nerves under the skin causing itching, with no rash to be seen. This is the commonest reason for itchy skin without a rash. The answer to this is to use a lot of emulsifying ointment. No need for expensive “serums” – just simple E45 or similar. If there is a rash it is generally due to drying of the skin and this causes eczema – not an allergic problem but just due to degeneration. Emulsifying ointment is the answer again.

Then there are all the lumps and bumps that appear with old age – most benign, such as solar keratosis – warty like lumps which sometimes go on their own. Most of these do need to be checked out by a doctor.

Bones are the next part of one’s anatomy to get old, all too soon . Back ache is common, and may be due to simple wear and tear. But osteoporosis is something that can quickly cause trouble in the over 70s, especially in those who are not very active. The fact is that bone strength is something that develops during our young adult years and depends upon enough weight-bearing exercise, walking, cycling or running while young, and for those who haven’t done any of this, their peak body mass is less than it would have been otherwise. Then, past the menopause for women and later for men, the process of losing bone strength starts to accelerate. Smoking makes it worse, as does lack of sunlight. There are effective treatments for osteoporosis, but it is far better to prevent it. Regular exercise and adequate sunlight are the best preventatives. Calcium and vitamin D are essential. Once bone mass deteriorates in the spine the vertebrae weaken and pressure of gravity reduces their height causing the familiar loss of height in older people. This is usually painless, but once a certain threshold is reached the vertebra collapse completely, and that is very painful indeed. Easy ways of prevention are to walk to the shops instead of taking the car, use every staircase as a “free gym”, get a dog, and walk or cycle at least once a week. In bones other than the spine, the result is easily fractured bones – the wrist and hip are the usual sites. Most people who have any sign of a problem will get a Dexa scan which will tell exactly how much at risk they are, and whether treatment is needed. But it is never too late to just take exercise, eat foods containing calcium (milk cheese and vegetables) and get sunshine when you can. If you can’t do these things then you can supplement with calcium and vitamin D, although the evidence on whether it is useful is mixed.

But other things that also come with old age can prevent people doing exercise. Feet for instance, have had an awful lot to put up with over the years, and corns, bunions, foot deformities, and collapsed arches are common. A good podiatrist can often prescribe orthoses (orthopaedic appliances) which re-align the feet so that walking is safer and more comfortable; and exercises which strengthen themuscles, and good foot wear is essential at all times. Foot problems should be treated and not used as an excuse not to walk as much as possible.

Joints have also taken a lot of wear over the years. Too much running and pounding hard pavements can cause excessive wear. It can be hereditary too. One of the main causes is excessive weight, which increases the risk of arthritis especially in the knees. So losing weight is definitely a good thing. Apart from that there is nothing that you can do to prevent arthritis, but I would of, course, support getting joint replacements when necessary. They can be life changing, and then you can continue to exercise and prevent osteoporosis!

Muscle weakness creeps up on you slowly, and is inexorable. However much you exercise and try to keep you muscles in trim, you will lose muscle mass year on year. It starts in your thirties it seems! It is called sarcopenia (“sarco” is Greek for muscle and “penia” means less of it). and this is the cause of difficulty in getting up from the floor and later from a sitting position. It is a real problem when people start getting frail, and can stop people living independently. A good physio can give you exercises which will slow the process though not stop it, although unfortunately it is not a priority for NHS physio services (it should be) so you may have to get it privately. Again excessive weight makes things worse. Diet is important – you need to make sure you increase the amount of protein in your food as you get older.

All these things, loss of bone, loss of muscle, wear and tear, deterioration of skin are inevitable. But as you can see an active lifestyle is essential – you have to use it or you will lose it!

Courtesy of my twin brother, I now share the following to illustrate the points above: –
How to start a fight –
“My wife was standing nude, looking in the bedroom mirror. She was not happy with what she saw and said to me, ‘I feel horrible; I look old, fat and ugly. I really need you to pay me a compliment.’
I replied, ‘Your eyesight’s damn near perfect.’
And then the fight started…”

My next blog is going to cover deafness, eyesight problems, swollen ankles and sleep problems. Then if I get that far, memory…….
Now what was I going to say??