Advance with MUSC Health

Getting Old: What to Expect and What to Do

Joseph Gerald (Jerry) Reves, M.D.
March 28, 2022
People exercising outdoors

After playing tennis last week, I asked our quartet of aged players what I should write about for the next aging column. Their response was: “What about just being old?” So here it is – what happens and what can we do about aging.

“Growing old isn’t so bad when you consider the alternative.”
- Maurice Chevalier

Getting old certainly has its challenges, but as Chevalier quipped, it beats the alternative if we have acceptable health. If you live to be 65, you can expect to live approximately 20 more years. That extension brings physical and situational issues, such as retirement, translocation and death, or major illness of friends and family.


We know that not everyone the same age has the same health status. The variance is a result of our genes, our environment, our financial status, and our habits. About 40% of people 65 or above rate their health as good.

We have written, however, about the frailty syndrome that is defined as age-related deficits in normal function and involves several body systems. People who become frail represent the highest risk group of aged adults. Frailty means loss of muscle, stamina, endurance, and sometimes weight and general fitness.

frailty in elderly: Risk Factors, Signs and Outcomes 
Figure 1.Risk factors, causes, signs, organs/systems affected, and outcome of frailty in the elderly.

Fortunately, it’s relatively uncommon, occurring in 4% of people 65 to 74. It can increase up to o 35% in those 85 or older. The figure illustrates the risk factors, causes, signs, and outcomes of frailty. It’s a problem that can lead to increased morbidity and mortality. As the COVID pandemic showed, the medically frail experienced the worst illness and most deaths. Thus, if your age puts you in this high-risk category, you must do everything possible to avoid further deterioration in function.

The Most Common Problems

As we age, we may also encounter problems other than frailty. The most common are included below.

Arthritis and joint problems afflict about half the population over 65. The problems can be severe or mild, but when severe tend to limit function and quality of life. In addition to arthritis, use and abuse of joints lead to many medical problems with knees, elbows, shoulders, hips, and ankles ranging from cartilage tears to meniscus damage that require physical therapy or surgery.

Heart Disease covers a range of heart abnormalities. It includes arrhythmias, valvular disease, heart failure, and coronary artery disease. Most heart disease is related to atherosclerosis, which is a cause of heart attacks. Heart disease has the greatest mortality of all age-related afflictions.

Cancer is the second-greatest cause of death in the aged. Breast, lung, intestinal, prostate, pancreatic, and many others are prevalent. Early detection can be lifesaving.

Respiratory disease includes chronic obstructive lung disease, which is the third-largest cause of death in older people. Other lung diseases such as asthma, chronic bronchitis, emphysema, and pulmonary fibrosis also limit activity and quality of life.

Alzheimer’s Disease and other dementias are becoming more prevalent as people live longer. Knowing the difference between normal loss of certain mental capacity and dementia is important. Forgetfulness and loss of concentration are normal, but people with dementia have forgetfulness and loss of recent memory that disrupt normal living, rational planning, and task completion, causing frequent confusion and social withdrawal.

Osteoporosis is the loss of bone mass and strength that often results in broken bones and vertebrae from falls. It’s quite common, affecting over 50 million people over age 50 in the United States. Falls, particularly in people with osteoporosis, can be incapacitating and even deadly.

Diabetes is the metabolic disorder that prevents the body from regulating the blood glucose and is associated with heart and vascular disease. Once detected, diabetes can be managed by most people with medication and diet.

Influenza, COVID-19, and pneumonia are infectious diseases that affect the elderly disproportionately, but protective vaccines are available. Unvaccinated people tend to have greater morbidity and mortality than the vaccinated.

Substance abuse primarily consists of alcohol and smoking in older people. Approximately 20% of people over 65 have had an addiction to alcohol or nicotine. It’s a common problem that needs treatment since both these addictions can lead to serious medical issues.

Obesity is defined as a body mass index greater than 30. Obesity is common in females (40%) and slightly less so (36%) in men. Obesity leads to diabetes, joint problems, and a sedentary lifestyle that is harmful to people’s health, especially as we age.

Depression and other mental illness are common (20%) and increase with age. If untreated, it can lead to isolation, itself detrimental to health, and even self-harm.

Oral health deteriorates with age, often the result of gum disease and dry mouth, which lead to greater problems. We also tend to lose teeth as we age.

Herpes Zoster or shingles is very painful and common in the elderly. An estimated 50% of elderly who don’t get vaccinated will develop shingles.

Digestive issues such as acid reflux, gall stones in the gall bladder, and an enlarged colon can result in constipation.

Bladder and urinary tract produce problems such as incontinence, infection, prostate enlargement, and loss of normal bladder function that causes urgency, and incomplete voiding can develop.

Waning libido is more prevalent in women than men, but vaginal dryness and impotence are problems that also contribute to reduced intimacy as people age.

Sleep tends to be more troublesome, which can contribute to health issues. Seven or more hours of good sleep are recommended.

Combating Age-Related Adverse Health Impact

The passage of time causes wear and tear that chip away at physical and mental wellbeing. However, we can do at least 6 general things to blunt the harmful effects of aging.

  1. Visit your physician and dentist; be up to date with all immunizations, take all medicines as prescribed; have all the cancer screening advised, and stay alert for any new symptoms, including depression.
  2. Eat a diet prescribed for you or choose a Mediterranean or similar diet high in fiber, fruits, and nuts and low in saturated fats and red meat.
  3. Exercise regularly, at least 5 times a week for intervals of 20 to 60 minutes with the goal of raising your heart rate. Avoid exercises that put load on joints or weak bones, tendons, etc.
  4. Socialize with family, friends, and others. Avoiding isolation is important. Take advantage of the many opportunities to meet others regularly such as at church, clubs, or volunteer organizations. Getting a pet helps many people maintain their health.
  5. Engage in mindfulness exercises such as yoga, puzzles, gardening, writing, or reading and avoid hours of stress-inducing TV, talk radio, or social media.

The Bottom Line

We all want to be healthy as we age, and maintaining our good health or controlling and mitigating the illnesses we accumulate is possible. The important thing is doing what is healthful so we can enjoy the years of life that our grandparents never could have imagined.