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Aging, Arthritis, and Exercise

iStock 000024427240Small“You’re just getting older.”  
“You’re too old for surgery.”  
“There’s not much we can do at your age.”  

How often have you heard these refrains from doctors? Did you believe them? Why do doctors say these kinds of things to older patients? And how often is it actually true? Let’s take a look at some of the myths regarding arthritis, exercise and aging.

I can’t count the number of patients who have come to me over the past twenty years after getting discouraging news about aging from their doctors. Every time I hear such stories, I cringe and ask myself, “Will physicians ever become well enough educated in the field of Geriatric Medicine to know that these statements are rarely true?” As a Board-certified Geriatrician, I believe it is my responsibility to provide hope to my patients if hope exists. It is also my duty to be honest with them. If it’s true that, in their case, nothing can be done, then of course I will say so. But can I blame that reality on their age? Rarely. As I tell my patients, perhaps when they’re in their mid- to late-90’s I can actually attribute their problems to the aging process itself. Otherwise, it’s just not that simple.

So, why do many doctors say these things to their patients? There are several possibilities. First, the physician may not know the real reason for the patient’s problem. Or, they may know the reason, but don’t know what to do about it. When doctors don’t know something, they often do not like to admit it. The vague explanation “aging,” serves as a broad and easy answer. It also shifts the burden of responsibility to the patient, which is unfortunate. Patients then suffer not only from the difficulties related to the disease they are already facing, but also from the feeling that it’s their fault that they can’t get better. Finally, many doctors are truly uneducated in Geriatrics. Because they can’t do something specific to cure a problem, they reason that there is no hope or help for the patient. They are not looking at the big picture.

As an example, several years ago, I saw a woman who was 85 years old. She had spent the previous two years in a wheelchair because of bad arthritis in her knees. Her doctor had told her that she was “too old’ for surgery; she believed this diagnosis and became wheelchair bound. She felt that she was a burden to her family and that there was no hope for her. She became depressed and even less functional. When I saw her and did a complete Geriatric Assessment, we determined that there was no reason for her not to have surgery on her knees. She successfully underwent the operation and was walking again within a few months!

So, what do we do for arthritis?  While we can not reverse the wear and tear that causes arthritis, we can strengthen the muscles around the joints. This can reduce pain and lead to improved function at any age. In fact, one study took nursing home residents in their 90’s who were confined to wheelchairs and put them through an intense weight training and exercise program. They ended up being able to walk!

iStock 000009128599XSmallThis is consistent with a more important message: the older people get, the more important it is to exercise. When a younger person doesn’t exercise, it slows them down a little.  When an older person doesn’t exercise, it can have a significant affect on their functional capacity and ultimately lead to complete immobility.

Exercise gets more and more crucial to your well-being as you get older. And the good news is: it’s never too late to start exercising. Furthermore, refraining from exercise should never be considered a treatment for any health related problem. In fact, people with heart disease and emphysema can also benefit from being on a regular exercise program.

How do you start an exercise program? There are many ways, but some simple ones include walking or doing water exercises. Gradually increase the amount of exercise you do by a few minutes at a time. And, of course, consult your doctor if you have chest pain, shortness of breath, or increased fatigue.  

Those of us who practice geriatric medicine must always remember that hope is often the lifeline to functional independence in our older patients. Once this hope is gone, withdrawal and decline soon follow. If at first we see no hope, we must keep looking for it. If the options are risky, we must discuss them openly and directly with our patients. It is their decision to make, not ours. To some people, the risk of surgery is far outweighed by the consequences of not having surgery. The goal of Geriatric Medicine is to promote optimal function in our patients and that looks different for everyone.

If your doctor tells you that you’re just getting old, question them! Point out the 90 year old marathon runner who doesn’t seem to be just getting old. Ask for another opinion. Stick up for yourself. And keep moving!

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