People age 65 and older consume more prescription and over-the-counter (OTC) medicines than any other age group. Older people tend to have more long-term, chronic illnesses such as arthritis, diabetes, high blood pressure and heart disease than do younger people. Because they may have a number of diseases or disabilities at the same time, it is common for older people to take many different drugs.

Many older people owe their health in part to new and improved medicines and vaccines. But using medicines may be riskier for older adults, especially when several medicines are used at one time. Taking different medicines is not always easy to do right. It may be hard to remember what each medicine is for, how you should take it and when you should take it. This is especially true of people with memory problems or dementia.

Medicines may act differently in older people than in younger people. This may be because of normal changes in the body that happen with age. For instance, as we get older, we lose water and lean tissue (mainly muscle) and we gain more fat tissue. This can make a difference in how long a drug stays in the body.

Keep in mind that drugs can mean both medicines prescribed by your doctor and over-the-counter (OTC) medicines, which you buy without a doctors prescription. OTCs can include vitamins and minerals, herbal and dietary supplements, laxatives, cold medicines, and antacids. Taking some OTCs together with prescription medicines can cause serious problems. For example, aspirin should not be taken with warfarin (Coumadin). Be sure your doctor knows what medicines you are taking and assures you that it is safe for you to take your medicines together. Also ask about taking your medicines with food. If you take alendronate (Fosamax) with food, for example, the drug will be less effective. Herbal supplements also should be taken with care. Gingko biloba, for instance, should not be taken with aspirin, acetaminophen, warfarin, or thiazide diuretics because it may increase blood pressure and the risk of bleeding problems.

You and your family should learn about the medicines that you take and their possible side effects. Remember, medicines that are strong enough to cure you can also be strong enough to hurt you if they arent used correctly. Here are some hints to help avoid risks and get the best results from your medicines:

At Home

DO keep a daily checklist of all the medicines you take. Include both prescription and OTC medicines. Note the name of each medicine, the doctor who prescribed it, the amount you take, and the times of day you take it. Keep a copy in your medicine cabinet and one in your wallet or pocketbook.

DO read and save any written information that comes with the medicine.

DO check the label on your medicine before taking it to make sure that it is for the correct person you with the correct directions prescribed for you by your doctor.

DO take medicine in the exact amount and precise schedule your doctor prescribes.

DO check the expiration dates on your medicine bottles and throw away medicine that has expired.

DO call your doctor right away if you have any problems with your medicines or if you are worried that the medicine might be doing more harm than good. He or she may be able to change your medicine to another one that will work just as well.

DO NOT take medicines prescribed for another person or give yours to someone else.

DO NOT stop taking a prescription drug unless your doctor says its okay even if you are feeling better.

DO NOT take more or less than the prescribed amount of any medicine.

DO NOT mix alcohol and medicine unless your doctor says its okay. Some medicines may not work well or may make you sick if taken with alcohol.

At Your Doctor’s Office

DO review your medicine record with the doctor or nurse at every visit and whenever your doctor prescribes new medicine. Your doctor may have new information about your medicines that might be important to you.

DO always tell your doctor or nurse about past problems you have had with medicines, such as rashes, indigestion, dizziness or not feeling hungry.

DO always ask your doctor or nurse about the right way to take any medicine before you start to use it.

DO ask these questions (and write down the answers) before leaving your doctor’s office:

• What is the name of the medicine and why am I taking it?
• What is the name of the condition this medicine will treat?
• How does this medicine work?
• How often should I take it?
• How long will it take to work?
• How will I know if this medicine is working?
• How can I expect to feel once I start taking this medicine?
• When should I take it? As needed? Before, with or between meals? At bedtime?
• If I forget to take it, what should I do?
• What side effects might I expect? Should I report them?
• How long will I have to take it?
• Can this medicine interact with other medicines (prescription and OTCs including herbal and dietary supplements) that I am taking now?
• If I don’t take medicine, is there anything else that would work as well?

At the Pharmacy

DO make sure you can read and understand the medicine name and the directions on the container. If the label is hard to read, ask your pharmacist to use larger type. Let your pharmacist know if you have trouble opening the medicine bottle.

DO check the label on your medicine before leaving the pharmacy to make sure that it is for the correct person you and with the correct directions prescribed for you by your doctor. If not, tell the pharmacist

Source: The National Institute on Aging

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes sometimes affect ones ability to have and enjoy sex with another person.

Some women enjoy sex more as they grow older. After menopause or a hysterectomy, they may no longer fear an unwanted pregnancy. They may feel freer to enjoy sex. Some women do not think things like gray hair and wrinkles make them less attractive to their sexual partner. But if a woman believes that looking young or being able to give birth makes her more feminine, she may begin to worry about how desirable she is no matter what her age is. That might make sex less enjoyable for her.

A woman may notice changes in her vagina. As she ages, her vagina shortens and narrows. The walls become thinner and also a little stiffer. These changes do not mean she can’t enjoy having sex. However, most women will also have less vaginal lubrication. This could affect sexual pleasure.

As men get older, impotence becomes more common. Impotence is the loss of ability to have and keep an erection hard enough for sexual intercourse. By age 65, about 15 to 25% of men have this problem at least one out of every four times they are having sex. This may happen in men with heart disease, high blood pressure, or diabetes either because of the disease or the medicines used to treat it.

A man may find it takes longer to get an erection. His erection may not be as firm or as large as it used to be. The amount of ejaculate may be smaller. The loss of erection after orgasm may happen more quickly, or it may take longer before an erection is again possible. Some men may find they need more foreplay.

What Causes Sexual Problems?

Illness, disability, or the drugs you take to treat a health problem can affect your ability to have and enjoy sex. But, even the most serious health problems usually dont have to stop you from having a satisfying sex life.

Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Joint replacement surgery and drugs may relieve this pain. Exercise, rest, warm baths, and changing the position or timing of sexual activity can be helpful.

Chronic pain. In addition to arthritis, pain that continues for more than a month or comes back on and off over time can be caused by other bone and muscle conditions, shingles, poor blood circulation, or blood vessel problems. This discomfort can, in turn, lead to sleep problems, depression, isolation, and difficulty moving around. These can interfere with intimacy between older people. Chronic pain does not have to be part of growing older and can often be treated.

Diabetes. Many men with diabetes do not have sexual problems, but this is one of the few illnesses that can cause impotence. In most cases medical treatment can help.

Heart disease. Narrowing and hardening of the arteries known as arteriosclerosis can change blood vessels so that blood does not flow freely. This can lead to trouble with erections in men, as can high blood pressure (hypertension).

Some people who have had a heart attack are afraid that having sex will cause another attack. The chance of this is very low. Most people can start having sex again 3 to 6 weeks after their condition becomes stable following an attack, if their doctor agrees. Always follow your doctors advice.

Incontinence. Loss of bladder control or leaking of urine is more common as we grow older, especially in women. Stress incontinence happens during exercise, coughing, sneezing, or lifting, for example. Because of the extra pressure on your abdomen during sex, incontinence might cause some people to avoid sex. The good news is that this can usually be treated.

Stroke. The ability to have sex is rarely damaged by a stroke, but problems with erections are possible. It is unlikely that having sex will cause another stroke. Someone with weakness or paralysis caused by a stroke might try using different positions or medical devices to help them continue having sex.

What About Surgery and Drugs?

Surgery. Many of us worry about having any kind of surgeryit is especially troubling when the genital area is involved. Happily, most people do return to the kind of sex life they enjoyed before having surgery.

Hysterectomy is surgery to remove the uterus. It does not interfere with sexual functioning. If a hysterectomy seems to take away from a womans ability to enjoy sex, a counselor may be helpful. Men who feel their partners are “less feminine” after a hysterectomy may also be helped by counseling.

Mastectomy is surgery to remove all or part of a womans breast. Your body is as capable of sexual response as ever, but you may lose your sexual desire or sense of being desired. Sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Societys (ACS) “Reach to Recovery” can be helpful for both women and men. Rebuilding of the breast (reconstruction) is also a possibility to discuss with your surgeon.

About 1500 American men develop breast cancer each year. In them the disease can make their bodies make extra “female” hormones. These can greatly lower their sex drive.

Prostatectomy is surgery that removes all or part of a mans prostate. Sometimes this procedure is done because of an enlarged prostate. It may cause urinary incontinence or impotence. If removal of the prostate gland (radical prostatectomy) is needed, doctors can often save the nerves going to the penis. An erection may still be possible. Talk to your doctor before surgery to make sure you will be able to lead a fully satisfying sex life.

Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, appetite suppressants, diabetes drugs, and some ulcer drugs like ranitidine. Some can lead to impotence or make it hard for men to ejaculate. Some drugs can reduce a womans sexual desire. Check with your doctor. She or he can often prescribe a different drug without this side effect.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

Am I Too Old To Worry About Safe Sex?

Having safe sex is important for people at any age. As a woman gets closer to menopause, her periods may be irregular. But, she can still get pregnant. In fact, pregnancy is still possible until your doctor says you are past menopause and you have not had a menstrual period for 12 months.

Age does not protect you from sexually transmitted diseases. Young people are most at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis. But these diseases can and do happen in sexually active older people.

Almost anyone who is sexually active is also at risk for being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. One out of every 10 people diagnosed with AIDS in the United States is over age 50. You are at risk if you have more than one sexual partner or are recently divorced or widowed and have started dating and having unprotected sex again. Always use a latex condom during sex, and talk to your doctor about ways to protect yourself from all sexually transmitted diseases. You are never too old to be at risk.

Can Emotions Play a Part?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do. For example, men may fear that impotence will become a more common problem as they age. But, if you are too concerned with that possibility, you can cause enough stress to trigger impotence. A woman who is worried about how her looks are changing as she ages may think her partner will no longer find her attractive. This focus on youthful physical beauty may get in the way of her enjoyment of sex.

Older couples face the same daily stresses that affect people of any age. But they may also have the added concerns of age, illness, and retirement and other lifestyle changes. These worries can cause sexual difficulties. Talk openly with your doctor, or see a counselor. These health professionals can often help.

Don’t blame yourself for any sexual difficulties you and your partner are having. You might want to talk with a therapist about them. If your male partner is troubled by impotence or your female partner seems less interested in sex, don’t assume they dont find you attractive anymore. There can be many physical causes for their problems.

What Can I Do?

There are several things you can do on your own to keep an active sexual life. Remember that sex does not have to include intercourse. Make your partner a high priority. Pay attention to his or her needs and wants. Take time to understand the changes you both are facing. Try different positions and new times, like having sex in the morning when you both may have more energy. Dont hurryyou or your partner may need to spend more time touching to become fully aroused. Masturbation is a sexual activity that some older people, especially unmarried, widowed, or divorced people and those whose partners are ill or away, may find satisfying.

Some older people, especially women, may have trouble finding a partner with whom they can share any type of intimacy. Women live longer than men, so there are more of them. In 2000 women over age 65 outnumbered older men by 100 to 70. Doing activities that other seniors enjoy or going places where older people gather are ways to meet new people. Some ideas include mall walking, senior centers, adult education classes at a community college, or day trips sponsored by your city or county recreation department.

If you do seem to have a problem that affects your sex life, talk to your doctor. He or she can suggest a treatment depending on the type of problem and its cause. For example, the most common sexual difficulty of older women is dyspareunia, painful intercourse caused by poor vaginal lubrication. Your doctor or a pharmacist can suggest over-the-counter, water-based vaginal lubricants to use. Or, your doctor might suggest estrogen supplements or an estrogen vaginal insert.

If impotence is the problem, it can often be managed and perhaps even reversed. There is a pill that can help. It is called sildenafil and should not be taken by men taking medicines containing nitrates, such as nitroglycerin. This pill does have possible side effects. Other available treatments include vacuum devices, self-injection of a drug (either papaverine or prostaglandin E1), or penile implants.

There is a lot you can do to continue an active sex life. Follow a healthy lifestyle exercise, eat good food, drink plenty of fluids like water or juices, dont smoke, and avoid alcohol. Try to reduce the stress in your life. See your doctor regularly. And keep a positive outlook on life.

Source: The National Institute on Aging

Risk Factors for Type II Diabetes

Adults most at risk for diabetes are those who:

• Are over 40 years of age
• Have a parent or sibling with diabetes
• Are of African American, American Indian, or Hispanic descent
• Are overweight
• Are women who had more than one baby weighing over 9 pounds at birth

Exercise can help for the following reasons:

• Exercise burns calories which helps to control obesity.
• Exercise can lower blood sugar and decrease the need for medication.
• Exercise may improve the body’s response to naturally produced or injected insulin.
• Regular exercise can improve circulation, particularly in the legs and feet where diabetics often have problems.
• Heart disease and stroke are the leading causes of illness and death for Type II diabetics, and regular exercise is a great preventative measure for these conditions.

An exercise stress test may be warranted before launching an exercise program, so be sure to consult with your healthcare provider before beginning a program.

Exercise Tips

• Choose shoes carefully and opt for exercises such as swimming or bicycling which can be easier on the feet.
• Always wear an ID tag to ensure proper treatment in case of illness or injury while exercising.
• Avoid exercising in extremely hot or ultra cold conditions.
• Avoid lifting very heavy weights if you have high blood pressure. If you do lift, don’t hold your breath!

Diabetics will certainly benefit from a regular exercise routine as a part of managing the condition, while medical research continues to seek a cure for this chronic disease.

Adrenaline is powerful

The release of adrenaline when you are in a stressful situation stems from the classic fight or flight response which our ancestors needed to escape from danger. Your heart pounds, your breathing becomes shallow, your mouth is parched, and you perspire profusely. You feel apprehensive and tense, ready to respond to danger; but that danger may be a traffic jam, a deadline at work, a heated conversation with your teenager rather than the physical assaults which our ancestors faced. Even positive stress, such as a promotion or marriage, will cause stress. In fact, even boredom is stressful! Unlike our predecessors, you can’t respond to most stress by fighting or running away, yet constant stress keeps pumping more adrenaline into our bloodstream. Excess adrenaline can raise your blood pressure, blood sugar, and heart rate. Over time this adrenaline release may weaken the immune system. In fact, the hormones adrenaline and cortisone are such strong suppressers of the immune system that they are often prescribed for illnesses in which the immune system is overactive, especially allergies and autoimmune disorders. Still it is difficult for researchers to determine whether it is the hormones themselves or the behavior of people under stress, who often sleep less, exercise less, eat poorly, smoke and drink too much, which causes the assault on the immune system.

Reducing the Adrenaline Response

You cannot and should not eliminate all stress from your life, but eliminating the most destructive stress and your reaction to it will decrease the assault on your immune system. The following tips should help you to reduce the adrenaline response:

• Learn relaxation techniques such as visualization, deep breathing, and meditation.
• Find your own specific relaxers such as a hot shower or a walk on a nature trail.
• Be realistic in your expectations; you need not be the perfect parent or the highest achieving employee.
• Establish a regular exercise routine which includes stretching to relieve tension. Exercise gives you a mild jolt of adrenaline while allowing you to work off the extra energy it produces. Your body then becomes more used to processing the adrenaline thats in your bloodstream during stressful times.
• Create action plans to reduce problems at home and work
• Know yourself and embrace your strengths; use positive self-talk to affirm those abilities.
• Develop leisure activities which encourage relaxation and mental stimulation such as golf, bridge, singing, doing crafts.
• Vent your feelings by talking to a friend.
• Get enough rest; most adults need seven or eight hours of sleep a night to feel truly rejuvenated.
• Skip the junk food and eat a balanced diet.
• Stay away from excessive alcohol, caffeine and tobacco which may all increase your adrenaline output.
• Learn to ask for help and remember that most people actually feel grateful for the chance to help others.
• Define misunderstandings before they occur by addressing troubling situations with your family and coworkers.
• Learn to accept and adapt to change optimistically.

By analyzing your stressors and your response to them, you can train yourself to respond more appropriately. This is turn will reduce the amount of adrenaline released and its effect on your immune system.

Adrenaline is powerful

The release of adrenaline when you are in a stressful situation stems from the classic fight or flight response which our ancestors needed to escape from danger. Your heart pounds, your breathing becomes shallow, your mouth is parched, and you perspire profusely. You feel apprehensive and tense, ready to respond to danger; but that danger may be a traffic jam, a deadline at work, a heated conversation with your teenager rather than the physical assaults which our ancestors faced. Even positive stress, such as a promotion or marriage, will cause stress. In fact, even boredom is stressful! Unlike our predecessors, you can’t respond to most stress by fighting or running away, yet constant stress keeps pumping more adrenaline into our bloodstream. Excess adrenaline can raise your blood pressure, blood sugar, and heart rate. Over time this adrenaline release may weaken the immune system. In fact, the hormones adrenaline and cortisone are such strong suppressers of the immune system that they are often prescribed for illnesses in which the immune system is overactive, especially allergies and autoimmune disorders. Still it is difficult for researchers to determine whether it is the hormones themselves or the behavior of people under stress, who often sleep less, exercise less, eat poorly, smoke and drink too much, which causes the assault on the immune system.

Reducing the Adrenaline Response

You cannot and should not eliminate all stress from your life, but eliminating the most destructive stress and your reaction to it will decrease the assault on your immune system. The following tips should help you to reduce the adrenaline response:

• Learn relaxation techniques such as visualization, deep breathing, and meditation.
• Find your own specific relaxers such as a hot shower or a walk on a nature trail.
• Be realistic in your expectations; you need not be the perfect parent or the highest achieving employee.
• Establish a regular exercise routine which includes stretching to relieve tension. Exercise gives you a mild jolt of adrenaline while allowing you to work off the extra energy it produces. Your body then becomes more used to processing the adrenaline thats in your bloodstream during stressful times.
• Create action plans to reduce problems at home and work
• Know yourself and embrace your strengths; use positive self-talk to affirm those abilities.
• Develop leisure activities which encourage relaxation and mental stimulation such as golf, bridge, singing, doing crafts.
• Vent your feelings by talking to a friend.
• Get enough rest; most adults need seven or eight hours of sleep a night to feel truly rejuvenated.
• Skip the junk food and eat a balanced diet.
• Stay away from excessive alcohol, caffeine and tobacco which may all increase your adrenaline output.
• Learn to ask for help and remember that most people actually feel grateful for the chance to help others.
• Define misunderstandings before they occur by addressing troubling situations with your family and coworkers.
• Learn to accept and adapt to change optimistically.

By analyzing your stressors and your response to them, you can train yourself to respond more appropriately. This is turn will reduce the amount of adrenaline released and its effect on your immune system.