How to navigate the conversation.
PRINCE PHILIP, WHO’S 97, was recently involved in a car crash that injured two women and prompted a debate on older drivers in Britain. Two days after the accident, he was photographed driving a Land Rover and not wearing a seatbelt. Of course, that reignited a debate about seniors and driving.
An Emotionally Charged Issue
What if I told you that tomorrow, just for a day, you would all of a sudden not have a car available? What if I said a week? You can start to see how your independence would be affected.
A car represents different things to people: a way to get to places for some; status and identity for others; freedom and spontaneity. What it represents also says a lot about how you approach the situation.
Just because you’re older doesn’t mean you have to stop driving. We see so many distracted driving accidents from much younger people on phones or texting, and that’s not representative of how seniors drive.
If you’re geographically close by, the best thing is to observe directly. In other words, go for a ride-along. Buckle up!
Distinguish between serious signs of trouble and those that are less so. For example, confusing the gas with the brake is serious. Riding the brake is perhaps less serious. If a problem is serious, take immediate action. If it’s less so, observe over time, take notes and look for a consistent pattern. These facts will help when having a conversation.
Things to look for:
- Struggling to change lanes.
- Problems turning, particularly with left turns.
- Driving too slow or too fast.
- Reaction time.
- Other drivers honking.
- Hitting curbs.
- Following signals.
- Scrapes on cars.
Often, older adults will start self-correcting, not driving at night, in bad weather and on freeways. My mom started going places by making all right hand turns. Praise these behaviors, but also take them as a sign that things might be changing.
By Elaine K. Howley, Contributor
Arthritis is such a common problem, particularly for older people, that most of us have probably come across an older person with creaky, swollen joints or knobby, gnarled fingers at some point. But this disease of aging can cause significant pain and can severely limit how some people interact with the world. The Centers for Disease Control and Prevention reports that “arthritis affects 54.4 million U.S. adults, about 1 in 4. It is a major cause of work disability in the United States and one of the most common chronic conditions in the nation.”
But what is it exactly? Arthritis can actually refer to a wide range of diseases and conditions, and they’re not all the same thing. “Arthritis is a very global term,” says Dr. Esther Lipstein-Kresch, chief of rheumatology at ProHEALTH Care in New York. But the term “implies that there’s some inflammation involving a joint.” That inflammation could be the result of any of “over 100 different types of inflammatory conditions that can affect the joints. As a result, we have so many different rheumatic conditions, but they all ultimately have arthritis in common, which is inflammation of the joint and the erosion of cartilage and sometimes the erosion of bone depending on the actual arthritic disorder.”
Types of Arthritis
Although there are more than 100 different rheumatic conditions that can cause arthritis, The Arthritis Foundation reports that the most common types include:
Osteoarthrosis is the most common form of arthritis and the one most of us probably think of first when we hear the term arthritis. Dr. David Pugliese, a rheumatologist at Geisinger in Danville, Pennsylvania says that “osteoarthrosis is essentially a wear-and-tear phenomenon” that gets worse over time. “It’s a structural problem. Every joint is made of two bones that come together with an interface of cartilage and fluid that makes a cushion and keeps (the joint) free of infection. With osteoarthritis, over time that cartilage wears away. When the cartilage wears away, the bones start to bang on each other and start to create pain from the direct contact.” This loss of lubrication in the joint makes movement more difficult “and it’s a progressive problem.”
Osteoarthritis tends to get worse with activity, so Pugliese says most osteoarthritis patients will usually feel fairly good upon waking but often develop more pain and stiffness as the day progresses and they move their joints more.
Osteoarthrosis is also essentially unavoidable if you live long enough – it’s just part of the natural aging process. “Everybody gets some osteoarthritis,” Pugliese says, although some people may develop more severe cases or be more prone to pain from it sooner than other people. Why exactly isn’t entirely clear. “There are some genetic determinants – different people have different amounts of it, but everyone is going to get some of it because it’s a function of this wear and tear.”
Naturally, osteoarthritis tends to impact older adults more. People who lead active lifestyles or engage in a lot of manual labor, such as construction workers, may experience the effects of wear on joints sooner than their more sedentary counterparts. If you’ve suffered a trauma to a joint, such as a bone fracture or other injury, that can also increase your chances of developing arthritis in a specific joint.
Unlike osteoarthritis, rheumatoid arthritis is an autoimmune disorder that can affect more than just the joints. “Rheumatoid arthritis doesn’t start out as a structural problem,” Pugliese says. Rather, “it’s an immunologic problem,” meaning that the immune system goes a little haywire and begins attacking the body’s own tissue. This leads to swelling and inflammation that can cause significant pain. “When people get rheumatoid arthritis, what essentially happens is their immune system becomes activated and treats their joints as if they have infections.” Over time, that overactive immune response can lead to destruction of the tissues in the joint, which can lead to pain and a loss of mobility.
Psoriatic arthritis is an inflammatory immune disorder that’s often associated with the common skin disease psoriasis. Lipstein-Kresch says that not every person who has psoriatic arthritis also has psoriasis, but having psoriasis puts you at greater risk for developing this condition that can cause significant pain in the joints and other immune responses throughout the body. People with psoriatic arthritis will often experience swelling of the fingers or toes, and sometimes certain bones can fuse to one another, making movement of the joint difficult or impossible.
Gout is a type of arthritis that’s caused by a buildup of uric acid crystals in the joints, most often the joint at the base of the big toe. It can come on suddenly with severe pain and swelling and the joint may feel hot to the touch or tender. Gout tends to impact older people more, and those whose diets contain items that can elevate the levels of uric acid in the body, such as alcohol, sugar and meat. Certain medications and genetics may also play a role in whether you’re more prone to attacks of gout.
What Causes Arthritis?
With osteoarthritis, the simple cause is wear and tear on joints over time. As we age, our bodies lose some of the fluid that sits between the bones of the joints. As that fluid dissipates, the joint has less cushioning, creating pain and inflammation from the friction of bone-on-bone movement.
With inflammatory arthritis conditions like rheumatoid arthritis or psoriatic arthritis, the cause is a problem with the immune system. Because the immune system begins to treat cells in the joints as though they were foreign invaders to the body, an inflammatory response is triggered that can lead to significant pain, deformity and disability.
Symptoms of osteoarthrosis include:
- Pain, stiffness or swelling of the joints that gets worse with use.
- Deformity of the joints over time (bony growths in fingers or toes are common).
- Decreased range of motion.
- Difficulty walking or muscle weakness.
Osteoarthritis symptoms commonly occur in finger joints, the wrists, knees and hips, but most any joint can develop arthritis, especially if the joint has sustained a trauma or injury in the past.
Symptoms of rheumatoid arthritis can include:
- Swelling, pain or redness in one or more joints throughout the body (although symptoms usually are symmetrical).
- Joint stiffness and pain in the morning that takes a while to loosen up.
- Numbness or tingling in the extremities.
- Decreased range of motion.
If you experience any of these symptoms, be sure to see your doctor. Pugliese says that if you have rheumatoid arthritis, starting on the right treatment as soon as possible is important to improving your outcome. “As soon as the question pops into a primary care doctor‘s mind, ‘Is this inflammatory?’ Then we (rheumatologists) want to see the patient.” He says the American College of Rheumatology has set guidelines aiming to have every patient with rheumatoid arthritis “started on disease-modifying therapy within three months. That’s a pretty lofty goal when you think about the time it takes for someone to present to primary care and for that referral to go through and get the appointment. But we know that as soon as there’s inflammation, the process that causes the damage has started.” Starting the appropriate course of medications as early as possible can slow that progression and significantly delay the development of more severe symptoms and complications.
If your doctor suspects that you have any type of arthritic condition, you’ll likely undergo a thorough physical exam. Most cases of osteoarthritis can be diagnosed based on the findings of a physical exam conducted by your doctor. You may also have some X-rays to look at how much space you have between the bones in symptomatic joints.
“There’s no blood test for osteoarthrosis,” Pugliese says, but you may end up having some tests just to rule out an inflammatory arthritic condition such as rheumatoid arthritis or psoriatic arthritis. And it’s important to know that you can have osteoarthritis and another inflammatory arthritis condition such as rheumatoid arthritis at the same time.
With inflammatory arthritic conditions like rheumatoid arthritis, the diagnosis can be a little more challenging in some cases, because autoimmune disorders aren’t always the easiest to pinpoint straight away. But your doctor will likely order certain imaging and blood tests to take a look at what’s going on.
Currently there aren’t a lot of great drug options for people dealing with osteoarthritis, Pugliese says. “The big challenge with osteoarthritis is that there’s no medication that will stop or reverse the process.” You can take anti-inflammatory medications to help ease some of the symptoms, but the damage has been done and “the big thing is management.” For some patients, surgery, such as a joint replacement, is the best way to cope with an arthritic joint.
For rheumatoid arthritis, the past 15 or 20 years have seen the debut of several new types of medications called biologics that have improved the outlook for many patients with the disease. These drugs target specific molecules that generate inflammation, and the newer drugs are offering some patients a much-improved prognosis. In addition to these newer drugs, many still take the older medications, such as methotrexate, that have long been used to treat rheumatoid arthritis. Some rheumatoid arthritis patients may also take steroids for a time, but Pugliese says many rheumatologists try to wean patients off those as soon as possible, because they can have some difficult side effects if used long-term. In some cases, joint replacement surgery may also be recommended.
Lipstein-Kresch says many patients newly diagnosed with osteoarthritis will ask her whether they should be taking a dietary supplement to help alleviate some of their symptoms. “A lot of people ask about glucosamine (a natural compound found in cartilage) and turmeric (a spice thought to have anti-inflammatory properties) for osteoarthrosis, and the bottom line is that there’s no definitive study that shows that glucosamine is indeed effective for osteoarthrosis. The recommendations are that if you’re already taking it and you think it’s helping, then stick with it. But starting it is probably not something I’d do ordinarily unless I have no other options,” she says. Some people say that adding turmeric to their diets has helped ease some of the symptoms of osteoarthritis. For anyone dealing with this disease, Lipstein-Kresch recommends “eating healthy” and exercising as good ways to help manage the disease.
In addition, if you have osteoarthritis and you’re carrying around a few extra pounds, Pugliese says one of the best things you can do is lose some weight. “Even though we can’t give you a pill to cure it or fix it, there are a lot of things patients can do to make it better and easier on themselves, one of which is weight management.” Dropping just a few pounds can make a difference, because “every pound of weight a person carries translates into 4 or 5 pounds of pressure on the joint. If you extrapolate even a 20-pound weight loss for an obese person, that person may be taking up to 100 pounds of pressure off each of their weight-bearing joints,” which can translate into less pain when moving.
For patients with rheumatoid arthritis, it’s important to keep your doctor apprised of how you’re doing and whether your treatment protocol is helping. Rheumatoid arthritis is a chronic, autoimmune condition that can’t be cured but can be managed. You need to speak up if you’re having difficulties, Pugliese says. “Don’t be afraid to ask for help and tell your doctor if you don’t feel well. A lot of times if you have a 30-year-old, otherwise healthy person, their mindset is, ‘I’m too young to have arthritis. I better just deal with it.’ But we don’t want people letting it go. We would much rather have more people in our office, so we can catch those people before they go on to get damage,” which can occur outside of the joints. Because rheumatoid arthritis is a systemic, autoimmune condition, sometimes the disease can affect the internal organs, such as the heart, kidneys and lungs and it’s important to stay on top of your health as you manage this chronic condition.
No matter which type of arthritis you have, your doctor is likely to recommend that you get plenty of sleep, eat right and get lots of exercise. Pugliese says exercising is important because strengthening the muscles that move the joints can also result in smoother movement and less pain. “The joints are two bolts coming together, but the muscles are what move them. The better the muscles are in shape, the better the arthritis will perform, so we always encourage exercise and strengthening.”