Let’s have an honest conversation about what to expect as you age

How many of us have wished for a trustworthy, evidence-based guide to aging that explains how our bodies and minds change as we age and how to adjust to those changes?

This type of work is difficult to create. For one thing, aging changes people gradually over decades, a long period shaped by people’s economic and social circumstances, behaviors, neighborhoods, and other factors. Furthermore, while people experience common physiological issues later in life, they do not follow a well-defined, developmentally predetermined path.

“Predictable changes occur, but not necessarily at the same time or in the same sequence,” said Rosanne Leipzig, vice chair for education at the Icahn School of Medicine at Mount Sinai’s Brookdale Department of Geriatrics and Palliative Medicine. “There’s no more heterogeneous a group than older people.”

I called Leipzig, 72, after reading her new 400-plus-page, information-packed book, “Honest Aging: An Insider’s Guide to the Second Half of Life.” It’s the most thorough examination of what to expect in later life that I’ve seen in a dozen years of researching aging.

Leipzig explained that she wrote this guide with two goals in mind: “to overcome all of the negatives that are out there about growing older” and “to help people understand that there are lots of things that you can do to adapt to your new normal as you age and have an enjoyable, engaged, meaningful life.”

Why is it called “Honest Aging”? “Because so much of what’s out there is dishonest, claiming to teach people how to age backwards,” Leipzig went on to say. “I think it’s time we say, ‘This is it; this is who we are,’ and admit how lucky we are to have all these years of extra time.”

The doctor was referring to the extraordinary increases in life expectancy that have occurred in the modern era. People over the age of 60 live far longer than people at the turn of the twentieth century, thanks to medical advances. Nonetheless, most of us have a poor understanding of what happens to our bodies after middle age.

A medical student asked Leipzig several months ago whether references to age should be removed from a patient’s written medical history, just as references to race have been removed. “I told her no; with medicine, age is always relevant,” Leipzig went on to say. “It gives you a sense of where people are in their life, what they’ve lived through, and the disorders they might have, which are different than those in younger people.”

What are the most frequently asked questions by older adults? Leipzig rattled off a list: What can I do about this potbelly? How can I improve my sleep? I’m having trouble remembering names; is this dementia? Do I really need that colonoscopy or mammogram? What should I do to get back into shape? Do I really need to stop driving?

Underlying these is a poor understanding of what’s normal in later life and the physical and mental alterations aging brings.

Can the stages of aging be roughly divided by decade? No, Leipzig said, noting that people in their 60s and 70s have a wide range of health and functioning. Typically, predictably aging changes “start to happen much more between the ages of 75 and 85,” she explained. Here are a few of the aging issues she discusses in her book:

When older adults become ill, they frequently exhibit a variety of symptoms. A senior experiencing a heart attack, for example, may be short of breath or confused rather than reporting chest pain. Similarly, an elderly person suffering from pneumonia may fall or lose appetite instead of having a fever and cough.
Medication affects older adults differently. Older adults are more sensitive to medications than younger people due to changes in body composition and liver, kidney, and gut function, and often require lower doses. This includes medications that a person has been taking for years. It also applies to alcoholic beverages.
Energy reserves in older adults are depleted. Hearts become less efficient as we age, lungs transfer less oxygen to the blood, more protein is required for muscle synthesis, and muscle mass and strength decline. As a result, older people produce less energy while requiring more energy to perform daily tasks.
Hunger and thirst are decreasing. People’s senses of taste and smell deteriorate, making food less appealing. Appetite loss is becoming more common, and seniors tend to feel full after eating less food. Dehydration becomes more likely.
Cognition slows down. Older adults process information more slowly and have to work harder to learn new things. Multitasking becomes increasingly difficult, and reaction times slow. Finding words, particularly nouns, is common. Medication and illness-related cognitive changes are becoming more common.
The musculoskeletal system is more rigid. As the discs that separate the vertebrae become harder and more compressed, the spine shortens; older adults typically lose 1 to 3 inches in height as a result. Changes in the inner ear, brain, and vestibular system (a complex system that regulates balance and a person’s sense of orientation in space) compromise balance. Muscles in the legs, hips, and buttocks weaken, and joint range of motion contracts. Tendons and ligaments are weaker, and falls and fractures are more common as bones become brittle.
Changes in vision and hearing. Older people require far more light to read than younger people. As color and contrast perception declines, it becomes more difficult for them to see the outlines of objects or distinguish between similar colors. It takes longer to adjust to sunlight and darkness due to changes in the cornea, lens, and fluid within the eye. It is more difficult to hear, especially at high frequencies, due to accumulated damage to hair cells in the inner ear. Speech that is fast and full of information, or that occurs in a noisy environment, is also more difficult to understand.
Sleep fragmentation occurs. Older adults take longer to fall asleep, and they sleep more lightly, waking up more frequently during the night.

This is by no means an exhaustive list of physiological changes that occur as we age. It also ignores the numerous ways people can adjust to their new normal, which Leipzig devotes considerable time to discussing.

A partial list of her suggestions, organized roughly by the topics listed above: Do not disregard sudden changes in functioning; instead, seek medical attention. Ask your doctor why you’re taking medications, if the doses are appropriate, and if the medications can be stopped. Engage in some physical activity. Consume an adequate amount of protein. Even if you aren’t thirsty, drink liquids. Limit multitasking and work at your own pace. Exercise your balance and resistance. Every year, have your eyes checked. Purchase hearing aids. Avoid exercising, drinking alcohol, or eating a heavy meal within two to three hours of going to bed.

“Never say never,” Leipzig admonished. “There is almost always something that can be done to improve your situation as you grow older, if you’re willing to do it.”

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