There is no doubt that the effects of getting older can be very troublesome. With the insouciance of youth in the surgery I would often joke about it, and sometimes say “well, the alternative is worse”, meaning that at least the elderly person in front of me is alive and able to grumble. I was very aware as a GP of how many of my patients sadly had not lived to get to the point of grumbling. And most of my patients took this in good part, although they didn’t like to remember that some of their contemporaries were now six foot under.

Poor sight, deafness, loss of taste and teeth, are very common, and can now be alleviated by spectacles, hearing aids, dental implants and so on. One wonders what on earth people in the Middle Ages did without spectacles, as the lens in the eye which has to be flexible to allow vision at short distance starts to stiffen in your forties. I suppose only a few people needed to read in those days as many were illiterate, but scribes doing these wonderful manuscripts, craftspeople and needle-workers must have had such a short working span before they had to give it up. Seeing clearly before spectacles must have been a bit of a lottery, because if you were short sighted you would not need spectacles for reading for a very long time, perhaps into your sixties or older, at the expense of not recognizing your old friend in the street for most of your life! Shortsightedness improves with age, whereas if you are long sighted you will need glasses for reading much earlier.

A big problem causing deterioration of vision, not due to disease, is the fact that the vitreous gel (the clear stuff within the eyeball) tends to get more opaque as it is unable to clear the detritus of old cells, particulate matter and so on which collects as you age. This is the cause of “floaters” which everyone gets at one time or another. As we age this degeneration can also lead to detachment of the retina, and this is more likely in short sighted people. It is said that in over 60’s, much less of the light from outside gets to the back of the eye, so that people in their 60s need three times more ambient light for comfortable reading than those in their 20s. This is why the first thing you need to do, before spectacles even, if you want to see clearly to read, is to ensure a very good light behind you. Nowadays though, a lot of reading and writing is done online with a backlit screen!   Cataracts are caused by opacities within the lens, and these are extremely common. In most parts of the world cataracts can now be cured very cheaply by removing the lens and substituting an artificial one, and in the developed world minor refractive errors are corrected this way. Some of my friends who have had cataracts removed have arranged to have lenses inserted so that they can see well to read with one eye and see at a distance with the other. My own experience has been somewhat different as in my youth I had one quite shortsighted eye and one normal sighted eye. I used the shortsighted eye for reading and the other eye for distance. It is amazing how the brain accommodates to the two different images. However in my case this eventually did cause double vision.

Other common problems are dry eyes, because tear production is reduced, and blepharitis, due to inflammation of the eyelids. People often don’t realize their eyes are dry, and are aware only that that their eyes are irritable and sore. “Artificial tears” – eye lubricant gels and drops, help both. Aging also reduces our field of vision by up to 30 degrees, and this can be very important when driving. It is worth knowing about it and taking extra care especially at night.
There are so many diseases that can cause loss of vision, as we get older, so it is really important to get a yearly check from an optometrist.

Deafness is very common, often hereditary, and very annoying for both the person with the problem and the listener. The usual form of age related deafness should not be called “deafness” at all, because unlike childhood deafness and other sorts of damage, its most obvious symptom is that hearing sounds very distorted, rather than not hearing at all. This is because the reduction of hearing is not spread evenly across the acoustic range, but skewed completely towards the higher range of tones that we use for speaking. So people think they hear but in fact are only hearing the lower register which distorts the sounds that they do hear. Hence the old jokes such as: Three retirees, each with a hearing loss, were playing golf one fine March day. One remarked to the other, “Windy, isn’t it?” “No,” the second man replied, “it’s Thursday.” And the third man chimed in, “So am I. Let’s have a beer.”

When I was a GP and used to visit people in their homes I was often exasperated by the fact that the patient would almost never be wearing their hearing aids, and when I raised my voice to try to get them to understand what I was saying they would say irritably “don’t shout, I’m not deaf”! They had to be prompted to put them on, which took ages because they really often had no interest in wearing them. I now realize that this was because the analogue hearing aids of the time just magnified everything, so that the deeper sounds were even louder and they still often couldn’t hear the upper registers.   I think those aids really helped only a minority of my patients, and were often a complete waste of NHS money. Now modern NHS digital ones are so much better (you would have to spend an awful lot of money on private aids to get ones as good) and can really improve the quality of life,

Other senses such as sense of smell and taste deteriorate too, although not usually to the extent that people find it a problem. One man I saw regularly did complain a lot about the lack of taste, and indeed he lost a lot of weight. He said everything tasted of cardboard. He was seen by specialists, but nothing could be done. He in fact got very depressed, and I am not sure really whether the lack of taste caused the depression or the other way around.

We all know the problems our teeth can cause as we get older. My generation has been very lucky; my parents both wore dentures from their fifties because of poor dental care, and they told me of people who had all their teeth taken out as a 21^st birthday present as it was thought that dentures were so much better looking!   They did not know about bone loss in those days. Bone loss is inevitable if multiple teeth are removed, as bone constantly regenerates itself as a result of the pressure and stimulus of chewing. When teeth are lost the bone in the jaw “resorbs” (reabsorbs) into the body – in the first year after tooth extraction 25% of bone is lost, and this continues year on year. . Regular visits to a dentist are essential, but even with the best dental care, teeth sometimes have to be removed, so nowadays many people have dental implants rather than dentures or bridges. They are expensive and not entirely without problems so they are not for everyone.

Sleep problems loom large for many older folk. When I was working such people took up a lot of time. As each wave of sleeping tablets came on stream, from barbiturates, then benzodiazepines, then the Z drugs, and now melatonin, we GPs were told by the drug reps that each new group had none of the problems associated with the older ones – dependence or addiction, sleepiness the next day, dizziness and falls. In fact none of them were risk free, and I found patients often wanted to increase the dose as the “tablets aren’t working”. We were told not to prescribe them by the NHS watchdogs, but patients were often very persistent in their demands. I had some sympathy with them as I had to do night calls once a week, and was often up seeing to urgent problems, and sometimes couldn’t get back to sleep especially if the case had been difficult or upsetting. And f course I had to work the next day. But now I am retired I have a lot less sympathy. If you don’t sleep you can occupy the time listening to radio 4 or podcasts, and often they are uninteresting enough to send you to sleep! Reading does the same thing although the light tends to keep you awake. Language tapes can be useful too. although I don’t think you actually learn very much when half asleep! It all helps to switch off your thoughts, which are going round in your mind and keeping you alert. You can prevent problems with waking your partner by using earphones. And if you don’t sleep you can have a nap the next day. But people in their eighties used to come to me desperate to get some sleep and used to put pressure on me to prescribe stronger tablets. I realized that some of these people were lonely and bored, and some used to go to bed at 8 o’clock, and then wonder why they woke at 2 am. Lifestyle changes are much better, though some people will always want sleeping tablets.

As you have probably gathered I am not trying to give a detailed account of the problems of old age here. These are just musings in the hope that some people will be find it interesting and maybe learn something. This isn’t the place for detailed discussion on how to keep healthy in old age, still less to say anything about the many diseases we can get. There are many books, websites and community groups which do that, and of course if you have medical problems or questions you should consult a doctor.

Next time I will write about such varied problems as swollen ankles, feeling the cold, weight gain and weight loss, before finally tacking the most difficult of all – memory problems, other mental problems, and the frailty of old age. If there is anything else you want covered, reply to this post.