“Aging in the world’s population is a major contributor to the diabetes epidemic and older adults represent one of the fastest growing segments of the diabetes population.” Treating older adults with diabetes is generally more complicated since it tends to occur with multiple co-existing medical conditions. The good news is that there are things to do to gently slow aging and taking care of your diabetes is only one major aspect of healthy aging.
What is the Definition of Aging?
“The definition of aging is the process of becoming older.” There is evidence that healthy aging is increasing in the US. Aging takes place over time and it is a gradual and natural process. Age related changes occur in all tissues of the body and affect the functioning of our system. There is not one specific age considered, “being elderly”, but traditionally 65 has been designated as the beginning of old age. As time goes on, the tradition of aging is changing. Your chronological age marches on but your biological age or changes in your body and affects everyone differently.
Psychological age is more about how you “act and feel”. Age differences are rarely attributed to the actual number you are, but more dependent on lifestyle, habits, attitudes, and your own personal involvement to be healthy. Disease takes a very different toll on your body compared to normal aging. A diagnosis of diabetes added to normal aging can put you at risk for a variety of other health issues such as heart attacks, strokes, hypertension, kidney, eye and nerve problems as well as experiencing more falls and chronic pain. The positive side of aging is that it adds wisdom, knowledge, confidence and patience, which are all very beneficial qualities. Some parts of aging are normal with or without diabetes. Aging gracefully can happen when you are in charge and continue to stay in charge.
Although we all age differently, there are certain universal changes that occur with everyone with or without diabetes. As cells in our organs age, they start to function less efficiently. Liver and kidney cells die as we grow older, and they are not replaced. This decreases their ability to function at 100%. This is just considered part of “normal aging.” Normal aging is different than developing a true medical problem or disease. Let’s examine normal aging.
Presbyopia and other eye conditions
Aging causes your eye lens to thicken, stiffen and become less able to focus on close objects or reading material, called presbyopia. The lens yellows, changing the way you see colors, they may seem neutral and dull. The lens becomes dense making it difficult for you to see in dim light, especially in the nighttime. Your vision becomes cloudy due to cataracts or a film covering your eye. Your eyes produce less tears making them feel dry, look red and irritated. The whites of your eye (sclera) turn yellow due to years of exposure to the sun, wind and dust.
Older adults may see floaters, which are black specks drifting across your field of vision. Floaters are usually not dangerous unless they are accompanied by flashing lights. Always report this immediately to your eye physician. Diabetic retinopathy is an eye condition specific to diabetes which can be serious and eventually cause blindness if not treated.
Eye Health: What can help?
- Getting yearly eye exams and filling prescriptions for proper reading glasses. Using the wrong strength prescription for eyeglasses may cause headaches and eye strain. Your eyeglass prescription may change frequently as you grow older.
- Determining if you have a dry eye condition or just need OTC lubricating eye drops to keep them moist and less irritated. There are prescription drops to alleviate severe dryness.
- Consider talking to your ophthalmologist about eye vitamins. Vitamins for eye health generally include Vitamin A, Vitamin C, Vitamin E, Vitamin B6, B9, B12, riboflavin, niacin, lutein, zeaxanthin and omega 3 fatty acids. There are formulations which include all these vitamins in one easy vitamin. Ocuvite is one of the top five complete eye vitamins recommended by ophthalmologists. Getting vitamins directly from your food choices is also essential.
- Control blood sugars to prevent diabetic retinopathy. “Finding and treating diabetic retinopathy early can reduce the risk of blindness by 95%.”
- Diabetes also increases your risk of cataracts and glaucoma. Get routine testing for these conditions.
- Provide proper light while reading or doing crafts.
- Take breaks from all screens including TV, phone and computer several times a day.
- Use a magnifier if you still have problems reading.
- Wear protective eyewear if you are doing anything which could lead to an eye injury.
- Wear sunglasses and a hat to protect your eyes form direct sunlight.
Changes in your hearing can be related to aging as well as from years of loud noise exposure. There are different reasons for hearing loss, but it comes on gradually, and in both ears, specifically when due to aging. Words are more difficult to understand, and everything starts to sound garbled and mumbled. High pitch sounds become difficult to interpret. It’s not just speaking loudly which can seem to help, since all consonants are high pitched. Women and children tend to have high pitched voices so older people struggle to hear and understand what they are saying.
Background noise is hard to filter out as you become older. One in three people age 65-74 have difficulty hearing and over 50% of people over 75 have definite hearing loss. Tinnitus or ringing in the ears is also very common in aging. Tinnitus is a symptom, not a specific disease. You may become depressed and frustrated from hearing loss, since people may assume you are confused, combative or uncooperative.
Hearing: What can help?
- Consult an audiologist (hearing specialist) and get regular hearing tests to evaluate your hearing.
- Protect your hearing by wearing ear plugs or headphones when noise levels are high.
- Try to limit background noise.
- Consider hearing aids- which are now superior to older models. They should be comfortable, affordable and easy to operate.
- Special phones can print out words of your conversation so you can read them during the conversation, which eliminates frustration.
- Mobile Apps may be helpful.
- Special training is offered by organizations for the hearing impaired.
- Learn to read lips.
- There are surgical procedures for certain types of hearing loss. Consult with your doctor.
Gum disease and your teeth
Aging can cause tooth loss due to gum disease. There is less saliva production and dry mouth can result. Dry mouth also occurs when you are taking multiple medications. Gingivitis and gum disease increase with age causing pockets around your teeth. Gums grow thinner and cavities can develop at the root of your teeth. Old fillings may chip making your teeth weaker. Bacteria around the teeth accumulates, and if not treated tooth loss can occur. Tooth enamel wears away making teeth more likely to split, chip and crack.
Healthy Teeth and Gums: What can help?
- Go for routine dental exams with deep dental cleanings.
- See a periodontist if you have actual gum deterioration.
- Brush with an electric toothbrush, floss and use a therapeutic rinse.
- Eat fewer sweets. Do not drink fruit juice, fruit drinks, sport drinks with sugar or regular soda (which you should already be doing if you have diabetes).
- Use a fluoride toothpaste to strengthen enamel.
- Stop smoking.
- Chew sugarless gum (xylitol) after meals.
- Rinse your mouth with water 20 minutes after a meal.
Bruises to your skin are usually from trauma or an injury. As you age you lose fat pads, and the outer layer of your skin thins out. Fat pads act as cushions for skin protection and to help consume heat. Your skin becomes more fragile and less sensitive to pain. Blood vessels become weaker, and bruises easily appear. Thin skin can tear more easily leading to more skin infections. Diabetes has a huge effect on your skin health. 90% of damage to your skin is from years of exposure to the sun.
Wrinkles, brown spots, red spots and dry patches accumulate over time. Collagen and elastin are no longer produced which makes your skin less flexible and more droopy. You also produce less sebaceous oil which increases the chance of dry, itchy skin. Nerve endings decrease, so you experience less sensitivity to pain, temperature and pressure. Sweat glands decrease making it hard to regulate body temperature; heat stroke is more common as you age. Dry itchy skin is seen in aging, especially when you have diabetes which is uncontrolled.
Skin Care: What can help?
- Moisturize at least twice a day with a simple OTC white moisturizing cream; cream is thicker than lotion. Put cream on after a bath or shower while skin is still moist.
- Become aware of your surroundings to prevent banging into surfaces and objects which can cause unnecessary bruising and injuries.
- Use ice as soon as possible – Use an ice pack or bag of frozen vegetables to relieve swelling and bruising. Do not put it directly on your skin- wrap the ice pack in a wash- cloth or thin towel. Ice helps reduce blood leakage and swelling.
- Compression and elevation- Depending on the extent of your bruise and /or tear, you may need to compress it in an elastic bandage to reduce swelling. You can elevate the swollen area above the level of your heart to drain fluid, reduce inflammation and relieve pain.
- Vitamin K cream, Arnica or Aloe vera- These are all topical treatments which may help with bruising, swelling, pain and inflammation.
- Vitamin C rich foods- Citrus foods-oranges, limes and lemons, and other vitamin C rich foods promote wound healing.
- It may take a few weeks for the bruise to completely disappear. It will change colors as it heals. Contact your physician if you do not improve.
- Always wear sunscreen- SPF-35 or higher to protect over-all skin health.
Aging naturally causes mental decline as the brain shrinks with age. It is universally more difficult to learn a new language, your attention span decreases, and you easily forget new things. Short term memory decreases making it hard to learn new material and remember. “Senior moments are normal, dementia is not.” Nerves conduct signals more slowly; blood flow to your brain decreases and your reaction time is slower. This is normal aging not dementia or Alzheimer’s which is a type of dementia and a diagnosed, medical disorder.
Mental Health: What can help?
- Play mental games – word or number puzzles, chess, card games. Challenge your long and short-term memory.
- Read all types of books. Pick up something different from your usual selection.
- Be social
- Adopt and care for a pet
- Try a new hobby
- Plan ahead by keeping a written calendar
- Accept and be ready for change and be flexible
- Talk to someone if you feel overwhelmed
- Drink less alcohol
- Eat whole, natural foods, as much as possible
- Choline in eggs and cooking with olive oil may help the aging brain
Even without diagnosed diabetes, blood sugars can rise after eating a large meal or a meal heavy in carbohydrates, as you age. Pre-diabetes (fasting blood sugars between 100-125mg/dl) is very common as we get older. Aging adults with established diabetes have more issues with hypoglycemia- low blood sugar (compared to younger type 2s) often due to being over medicated with insulin and sulfonylurea pills. These blood glucose lowering medications should be carefully monitored by your physician as you get older. High blood sugars can have a direct effect on your heart, kidneys and nerves as you age. Blood vessels in these organs become stiffer, blood pressure goes and stays up. Kidney function decline can be directly related to poor blood sugar control.
Controlling Blood Sugar: What can help?
- If you have diabetes make sure your blood sugars are well controlled.
- Take medications as prescribed.
- Exercise daily. “nearly one in four women over age 65 are unable to walk 2-3 blocks at a stretch.”
- Test blood sugars daily or as recommended by your health care provider.
- Wear a CGM (continuous glucose monitor)to recognize blood sugar trends.
- Lose weight if necessary.
- Establish and keep a healthy weight.
- Watch portion sizes and food choices.
- Join a Diabetes Management program.
- Join a diabetes support group.
- Visit a dietitian well-versed in diabetes.
- If you have pre-diabetes continue to monitor blood glucose levels at MD appointments.
- Carry glucose tablets and snacks if you have hypoglycemia.
There is evidence that living to a very old age of 100 or older runs in families; this is your genetics. Inheriting genes can also cause a path of developing a specific familial disorder. High cholesterol runs in families as does hypertension, type 2 diabetes, heart disease and certain cancers. “Studies have shown that 25% of the variation in human longevity is due to genetic factors.” You can’t change your genes, but you can definitely change your lifestyle.
Your Genetics: What can help?
- Know your family history as best as possible.
- Consider genetic testing if your family history warrants it.
- Change your lifestyle since you can’t change your genes.
You have control of this aspect at any age, with or without diabetes. Just by not smoking, not taking recreational drugs and limiting your alcohol intake, you can live a better, disease free, longer life. Add a well- balanced diet, eating less processed foods, exercise, a good quality of sleep, reducing mental stress and staying at a healthy weight, can all contribute to an extended life expectancy.
Healthy Lifestyle: What can help?
- If you are unmotivated to make lifestyle changes get help. Some people do need coaching and counseling to make the lifestyle changes.
- Use lifestyle Apps which may be enough to motivate you.
Environmental toxins may be out of our control, but they do take a toll on your aging process, even when you have great genes. Included would be: air quality, car and truck exhaust, levels of air pollution, particle matter floating in the air, fires, along with water quality, pesticides and herbicides. These all play a part in your aging process. So does radiation, chemotherapy, metals, lead in paint, and mercury in fish and parasites. Mental stress is an environmental toxin. Chronic inflammation and chronic infection, constant and loud noise, weather changes, very hot and humid weather or frigid, windy weather and chemicals all play a part in our aging process. Trying to limit exposure to these extremes is critical for better health. Change what you can.
Environmental Toxins: What can help?
- Use a water filter. Either attach the filter thru your ice maker or just use a simple pitcher with a filter.
- Use a HEPA filter in your AC and vacuum.
- Wash your hands frequently with soap and water. Use a hand sanitizer gel only when soap and water is not available. Make sure the gel contains at least 60% alcohol.
- Buy organic food when possible. Look at the dirty dozen list to make choices when buying organic foods. Established by the Environmental Working Group-EWG, a non-profit group based in Washington states the dirty dozen are especially high in pesticides. “Strawberries, spinach, kale, nectarines, apples, grapes, cherries, peaches, pears, bell peppers, celery and tomatoes are included.”
- Use soy candles instead of artificially scented candles.
- Avoid artificial fragrances and room freshener sprays.
- Use natural cleaning products. Use vinegar and baking soda to clean, when possible. Avoid mixing cleaning products which can create dangerous fumes.
- Use less plastic and Styrofoam.
- Never microwave food in plastic containers.
- Try to store left- overs in glass containers.
- Take off your shoes when inside your house.
- Check air pollution levels daily on an APP. If pollution levels are high, stay indoors, exercise indoors.
- Avoid artificial flavors, additives, colors and dyes in foods.
- Keep an air filter tower by your bed. Remember to change filters as needed.
- Invest in house plants that increase your indoor oxygen levels and decrease your indoor carbon dioxide levels. Jade plants, snake plants, Areca palms, spider plants and peace lilies are all excellent choices.
Having good and easily available healthcare can help you add to your longevity, rapid diagnose and treatment of a medical condition increases your life span. Sometimes it is possible to cure the illness with proper treatment and care.
Healthcare: What can help?
- Ask questions and be prepared when you visit your health care provider. No question should go unanswered.
- Ask around to see which physician and hospital has done the most cases if you need a specific type of surgery.
- Understand which tests you may need and why before you set up all appointments.
- Organize a team which can be essential especially when you have diabetes. An internist, cardiologist, endocrinologist, podiatrist, dietitian and eye doctor should be part of your team.
- Update your insurance program yearly during open enrollment if you are not satisfied with your current plan. Use a health insurance agent for advice if you are uncertain of the choices.
- Make sure you have a drug plan set up. Look into all OTC discounts and bring cards when ordering medications.
As you age your immune system tends to react more slowly and help you heal more slowly. “Your immune system helps protect your body from foreign and harmful substances. The immune system makes cells and antibodies that destroy these harmful substances.” It is more difficult to fight foreign substances like bacteria and microbes. Your ability to correct cell defects declines and cancer rates rise. The incidence of chronic diseases goes up including heart disease and diabetes. Flu, bronchitis and pneumonia cases are more common in older people. The need for vaccines is higher as we age, for flu, pneumonia, COVID-19 and shingles since our response to them is lower, than in younger people.
Immune System: What can help?
- Do not smoke
- Get vaccinated with flu yearly, shingles – one time, pneumonia every 5 years, COVID-19 as recommended and update tetanus every 10 years.
- Limit alcohol
- Do not smoke
- Get regular and restful sleep
- Reduce stress with techniques such as deep breathing, yoga or meditation
- Eat whole foods- fruits and vegetables, avoid processed foods
- Talk to your health care provider about adding supplements like zinc to raise immunity
Ligaments, Tendons, Bones, Joints and Muscles
Age related changes to these specific areas are often from inactivity and disuse more than from disease. Bones shrink and lose their density (become more brittle) as you age causing a bigger risk of fractures and breaks. Vertebrae at the top of your spine start to slip compressing your throat causing more difficulty in swallowing; older people choke and cough more frequently. Spinal stenosis (a narrowing at the end of the spinal canal) is common in aging.
Height is affected since the cushions between your vertebrae start to lose fluid and you become shorter by ½-2 inches. Cartilage, which protects bones, thins and disintegrates due to years of wear and tear; this leads to osteoarthritis; pain, swelling and a reduction in flexibility occurs. Hormonal changes in women causes a decrease in bone mass, or osteoporosis. Calcium is more difficult to absorb from foods as you age. Many older people have low vitamin D levels which add to weakened bone health. Muscle fibers reduce in total numbers.
Changes in your nervous system cause reduced muscle tone and their ability to contract. There is reduced muscle size due to less growth hormone production. Muscle mass and strength decreases by 15 %, as we age. Fat deposits swell in our middle. Waist size expands and, “love handles” appear on our hips. “By the age of 75, the percentage of body fat typically doubles compared to young adulthood.” Balance is impacted by our vision and inner ear as well as loss of sensation in our legs or feet, you tend to fall more easily breaking and fracturing bones.
Your Body: What can help?
- Lifting weights or using resistance bands 3 times a week for about 30 minutes. Get help if you are not sure how to do it. Talk to your health care provider before starting any new exercise regimen.
- Weight bearing exercise, even a simple daily walk can add to bone growth.
- Increase foods with calcium such as low-fat yogurt, low fat milk and low fat cheese.
- Consider taking a vitamin D supplement after you get your blood level tested. You may need a prescription strength or just an OTC supplement.
- Stay at or achieve a healthy weight. Excess weight impacts joints, tendons and ligaments in a negative way.
- Do not smoke.
- Drink water and stay hydrated. Water makes up 80% of your cartilage.
- Work on balance and coordination- Tai chi and yoga are strong additions to maintaining balance. Stand on one foot for 30 seconds a day.
- Develop a strong core by trying Pilates or simple abdominal core exercises.
- Stretch – warm up and cool down when exercising.
Bladder muscles weaken, which makes it difficult to fully empty your bladder. This can easily lead to a bladder infection. Holding urine for extended periods of time can also lead to bladder infections called UTIs. The bladder is less elastic which means you will need to urinate more frequently. Your bladder may also become, “over- active” making the muscle contract in unpredictable ways. You may experience incontinence when you laugh or move since the urinary sphincter can’t fully tighten. Pelvic floor muscles weaken. Your urethra (tube where urine comes out) may be blocked or partially blocked due to a falling bladder. Aging men often have an enlarged prostate which makes it harder to fully empty their bladder. Diabetes when uncontrolled adds to difficulty with your bladder function; nerve damage can occur around the bladder.
Healthy Bladder: What can help?
- Kegel exercises. Tense and release bladder muscles. start with 3 seconds tightened and then 3 seconds released. Work up to 15 sets, 3 times a day.
- Drink plenty of water to reduce the risk of bladder or kidney infections.
- Talk to your health care provider about adding a cranberry extract pill. It is supposed to reduce the chance of bacteria sticking to the bladder walls. There are mixed results stated in the literature.
- Artificial sweeteners may irritate your bladder, along with spicy foods, citrus and tomato- based foods. Test them to see how it affects you.
- Do not hold your urine which may increase risk of a UTI.
- Consider bladder training which encourages you to urinate on a schedule.
Your muscles used in breathing begin the weaken after the age of 35. Air sacs and capillaries in your lungs decrease. Less oxygen is absorbed and breathed in. Your lung tissue has less elasticity, and you are unable to fight respiratory infections as well as when you were younger. Your diaphragm gets weaker. Coughing which clears your lungs becomes weaker due to changes in nerves that stimulate the coughing reflex. Your rib cage gets smaller and stiffens making in difficult for the lungs to expand. Lungs are designed to keep out dirt and germs but over time that do not do a good job. Your lungs have been exposed to toxins for years-air pollution, industrial dust, infections and more inflammation. This is all aging related.
Lung Health: What can help?
- No smoking – it is never too late to stop.
- Avoid second and third hand smoke, as well.
- Watch for indoor and outdoor pollution. Check phone apps for daily check air quality.
- Wash your hands frequently.
- Get your flu, pneumonia and COVID-19 vaccines.
- Avoid large, indoor crowds during cold and flu season.
- Practice good oral hygiene.
- Do aerobic exercise which makes the lungs work harder and become stronger.
- Sing or play a harmonica – good for lung strength.
- Check for radon in your home.
Aging may make you more at risk for developing lactose intolerance (intolerance to dairy products), this is because we produce less lactose- an enzyme your body needs to digest milk. You may feel more bloated and gassy. Taste bud sensitivity decreases, and food should be spiced with fresh or dried spices, not salt. Aging also heightens the risk of constipation. This is related to inactivity and a slower contraction process -materials moving slowly thru the digestive tract. Older people are frequently dehydrated which increases the risk of constipation. Hemorrhoids are common (swollen veins) due to constipation. You have less liver cells and have a harder time filtering out toxins. Medications, alcohol and recreational drugs stay in your system longer. Acid reflux is common as you age. Gravity over time decreases the ability of the sphincter to close between your stomach and esophagus, causing a hiatal hernia.
Healthy Digestion: What can help?
- Add fiber to alleviate constipation. Eat raw fruits, vegetables and whole grains. Consider a fiber supplement if that does not help.
- Eat fewer spicy foods, mint and citrus to help reduce reflux. Talk to your physician about OTC remedies to lower reflux problems.
- Do not eat after dinner or lay down for at least 3-4 hours after dinner. If you have diabetes, you can eat a small snack before bedtime.
- Stay active for digestion to function well.
- Eat protein but stay away or limit red meat. It is difficult to digest.
- Drink water to aid digestion.
- Talk to your health care provider about taking a probiotic.
Fat pads relocate and other feet maladies
Although your waist gets bigger, the fat pads located in the soles of your feet tend to disappear. The cushioning layer which absorbs and protects your feet and toes is no longer there. Walking becomes more painful and difficult. In- grown toenails are common in older people. They are more dangerous when you have diabetes. Toes can swell, develop pus under the nail and become infected. Stress fractures develop in your feet since the bones thin out and pounding the pavement may lead to injury. Being overweight can make this worse.
Cracked, dry heels occur since you produce less oil and elastin. Your heels then split, allowing an infection to form in the cracks. Feet fungal infections increase as we age due to lower immunity and less skin elastin. Itching and flaking occurs. Diabetes can make fungal infections worse; it can cause Athlete’s foot or nail fungus, which is difficult to cure.
Your Feet: What can help?
- Talk to your podiatrist about special orthotics which can help with padding and foot placement in your shoe.
- Always wear socks to protect your feet.
- Schedule podiatrist appointments to trim your nails. Do not try to remove ingrown toenails on your own.
- Wash and check feet daily.
- Do not wear pointy toe or high heel shoes.
- Use anti-fungal creams as needed for fungal infections. Severe fungal infections may require prescription liquids or oral pills.
Differences in taste and smell
As we get older your ability to taste, and smell diminishes. Taste buds lose sensitivity affecting your taste for sweet and salty foods. We over- compensate by salting our foods and craving sweets. The lining of your nose becomes thinner, drier and the nerve endings in your nose deteriorate. Your mouth stays dry since you produce less saliva. Medications cause dry mouth as does breathing thru your mouth.
Taste and Smell: What can help?
- Always check your food temperature before tasting to prevent mouth burns.
- Try new dishes which may seem exciting.
- No smoking.
- Use good mouth hygiene to prevent infections.
- Chew sugar free gum or sugar free mints to keep your mouth moist.
- Make mealtime social.
- Try new herbs, low sugar sauces and spices to kick up food flavor.
What other factors can influence healthy aging?
- Living alone may be harmful. Many times, health issues go unnoticed or unattended.
- Limited income may affect proper housing, transportation, medication and food availability.
- Loss of loved ones can make you feel powerless and lonely.
- Loss of independence such as driving yourself, can make you depressed and alienated.
- Retirement may lower your self-esteem and money tight.
- Consider social services if you need them.
The Bottom Line on Aging Healthy
Aging is normal and can be dealt with in a positive way. One study showed, “thinking positively about getting older can extend your lifespan by 7.5 years”. Staying hopeful, happy, content and satisfied from day to day, will make you actually feel better. “Seeing the glass as half full can increase life span by about 4 years.” Remain optimistic. Keep up with social contacts. Try to laugh and smile. Create a gratitude list. Have and show compassion for others. Sing and dance. Snack wisely. Try to lose or break bad habits. Accept what you can’t change and focus on what you can change. Growing older gracefully can be as easy or as challenging as you make it. Work on your positive self-talk and remind yourself that you can do this!
- http://lunginstitute.com/blog/top-5-plants-for- increasing oxygen/
- https://health.clevelandclinic.org/stomach-trouble-5-steps-help-prevent-digestive-problems-as you-age./