Pain in older people is very common and widely accepted as something to be expected and often regarded as ‘normal’ in later life.

For many people as they age– and particularly if they are living with chronic conditions like arthritis – learning to cope with pain can be challenging. However, lots of people have discovered that something can be done. While there are no easy answers, the ideas and suggestions here have been found to work. To appreciate how you experience pain, it is important to understand that everyone reacts to and manages pain differently, and how you deal with your pain can affect the way in which you feel it.

Changing gear by changing your mindset

A way to reduce your pain is to change gear by emphasising things like optimism, humour, a balanced diet, physical activity and enjoying a good social life. It can also include relaxation, medication and keeping pain in perspective. By doing these things, many people discover that they can feel good about themselves. The amount of time you spend consciously thinking about pain will influence how much pain you feel. If you get locked into thinking continuously about it, try to distract yourself by doing something you enjoy. Remember, pain is your body’s message to you to take appropriate action, and not necessarily to cease all activity.

Pain control methods

1. Respect pain. If you have increased pain that lasts for two hours after completing a task, do a little less next time, or go about it in a different way.
2. Avoid being in one position for too long and avoid postures that make you stiffer. Use equipment that reduces stress on joints and makes difficult tasks easier.
3. Control your weight. Extra weight puts extra stress on your weight-bearing joints, like your knees and hips.
4. Use your largest and strongest joints and muscles for daily tasks wherever possible, like using a bag with a shoulder strap rather than carrying the bag with your hands.
5. Try to balance rest with activity. Take breaks when you need them, but too much rest causes muscle stiffness.
6. Plan ahead, organise and simplify any tasks or chores you have to do.
7. Don’t be afraid to ask for help. Take responsibility for yourself and ask for assistance when you need it.

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Atrial fibrillation (AF) is the most commonly diagnosed disturbance of heart rhythm in adults. In AF, your heart beats in a disorganised, irregular and often rapid way which can lead to a range of symptoms and potential complications.

While Atrial fibrillation (AF) itself may not immediately be life-threatening, it can lead to a stroke or heart failure and so has potentially serious effects. AF is responsible for causing one third of strokes in Ireland each year.

One in four people will develop atrial fibrillation and it is estimated that over 33 million people globally have AF. This figure is projected to increase significantly with our ageing population.

What does the public know about AF?

Therefore, public education about AF is vital, as detection and treatment reduces the risk of stroke.

However, studies have shown that public awareness and knowledge of AF are poor. In a recent Irish study, it was found that overall awareness of AF in the population was low, with only 28% of those surveyed reporting they had heard of AF, and just over half of those correctly able to identify AF as an irregular heartbeat.

Following a short national billboard and radio campaign this marginally improved to 30% of people having heard of the condition, with only 35% able to describe it.

Just 28% people before and 22% after the national campaign knew AF was a risk factor for stroke. The nature of messaging and duration of such public awareness campaigns need greater examination if they are to be effective.

Gaps in patient knowledge of AF

Patient awareness of AF is also important to improve compliance with treatment and understanding of the potential associated complications. International studies suggest that even among patients with AF attending a specialist clinic, one third may not know they have the condition or understand what it means.

At Tallaght University Hospital, professionals at the specialist multidisciplinary AF clinic were disappointed that one in five patients were unaware of the term ‘atrial fibrillation’ although almost half had received education on AF and were returning to the clinic for the second time.

While 60% of all patients reported knowing what AF was, most could only describe it in a low level of detail and half did not identify AF as a risk factor for stroke.

How can AF education be improved?

Up to now, successful stroke awareness campaigns have centred mainly on recognition and response to common stroke symptoms. The concept of AF and its risk of stroke can be a more difficult one to explain to patients, and education may need to be more tailored.

A simple, useful analogy is the ‘faulty cement mixer’: the atrium fails to mix the blood correctly, causing ‘lumps’ (clots) to form in the ‘cement’ (blood) which if flowing out of the mixer and into the pump (ventricle of the heart) will be pumped down the ‘pipe-work’ causing blockage in the blood vessels.

Videos of AF are widely available on YouTube and may also be helpful, but their impact is unstudied and education may need to be more individualised and focused using validated questionnaires to decipher what the patient knows, before coming in for consultation, so specific gaps in knowledge can be addressed. Work is currently underway to produce a national educational tool to help patients understand AF. 

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At 84, you can be forgiven for slowing down a bit. Ronnie Delaney does all he can to make sure life doesn’t grind to a halt, however. With swimming now keeping him in shape – he urges people to find something they can still do to keep them improving and moving.

84 year-old Ronnie ‘Ron’ Delany – a poster boy of Irish athletics, since his 1500m Olympic Gold at the 1958 Melbourne Summer Games – strikes a balance that seldom few athletes manage. Delaney remains both humble and proud of what he’s achieved, in his long and varied life.

Since winning gold, the permeating pleasures in his life have been friendship, family and looking after his body. In short, Delaney is content with his lot – an outlook that is infectious to those lucky enough to meet him.  

Family and friends in later life

“I married a very lovely lady, Joan, who’s looked after me so wonderfully. Four beautiful children and eleven wonderful grandchildren followed. What has money or fame to do with anything when you have that?”

But as much as Ron’s everyday is enriched by the friends and family, great age does bring with it the inevitable realities of health issues and preparing to lose those around you.

Anyone out there struggling along, just get it checked out – there’s so much they can do for you now.

“I look around those I’ve come to know through running or business; we’re slowly popping off one by one – we’re in the departure lounge!”

His own health has been predominantly good. Indeed, he was 70 before having to admit defeat and give playing certain sports.

Health and fitness in later life

“Until I was about 70, I played regular tennis and squash. I also played golf – despite being no good at it. The ability to do those things does pass, but latterly I found swimming which is still a lifeblood to me today.”

The importance of taking responsibility for his own body is a priority for Delaney. Back in the day, he maintained his body as any athlete would – and continues to do so now.

“When I was 69, I got a pain in my groin playing tennis and thought ‘oh god I’ve tweaked my groin’. What actually was going on was degeneration in my hip and I had to eventually have it replaced.”

Swimming keeps him as strong and flexible as possible now. However, sometimes even Ronnie Delaney has to take a break. When his eyes started causing him some problems, he went to the doctor to get himself checked out.

“Anyone out there struggling along, just get it checked out”

“I’ve only just had a cataract operation last month! I almost forgot to tell you! I was getting blinded by car lights coming towards me and thought I’d better get it seen to. The specialist said ‘this is what you’ve got and we can sort it out’.”

“A week later it’s done. It’s brilliant, I can’t believe the difference in colour and my distance sight has improved massively. Anyone out there struggling along, just get it checked out – there’s so much they can do for you now.”

Looking after yourself and indeed knowing when a certain activity might be too much for you is key, according to Delaney. But maintaining movement and activity – just finding something that you can still do – is even more vital to staving off some of age’s less appealing declines.

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Why is atrial fibrillation important?

Atrial fibrillation (AF) is the most common abnormality of cardiac rhythm, affecting at least 3% of Irish adults over 60, and 6% over 70 years of age. The risk of developing AF is very much associated with age and the worldwide prevalence of AF has been rising. AF is a common condition of ageing.

Symptoms occur in less than half of those affected with AF, so you may not even know you have it. Some common symptoms of AF can be specific like palpitations (awareness of an excessively fast heartbeat) and shortness of breath/chest discomfort. Or, they may be less specific, more general symptoms such as dizziness, tiredness or feeling less energetic. However, AF may be completely silent until disaster strikes and a clot forms in the heart and travels to the brain, causing a stroke.

How is AF diagnosed?

AF is diagnosed by an electric tracing of the heart called an ECG. AF is often picked up and can be suspected if your pulse is irregular. This can be done by self-examination, visit www.irishheart.ie, which can show you how to do this. Your family doctor will check your pulse routinely if you are older or at risk of AF, and arrange an ECG if your pulse seems irregular. Many wearable applications (e.g ‘Apple Watch’). have cardiac monitoring capability that may alert the wearer to the possibility of AF, but the condition needs a reliable tracing to diagnose AF as other conditions may also cause an irregular pulse.

What causes AF and can I reduce my risk of developing AF?

AF is often an age-related phenomenon and there may be an increased risk or tendency to develop AF within families. Sometimes, AF is provoked by a serious infection such as a pneumonia, or toxic causes such as alcohol withdrawal and may resolve with treatment of the condition. In many cases, AF is paroxysmal or ‘intermittent’ and comes and goes, though the risk of stroke may be equally high even where the condition is intermittent.

High blood pressure, being overweight and overuse of alcohol are important, modifiable risk factors associated with the development of AF. Sometimes, a person may have an underlying cardiac condition, like a damaged heart valve, causing AF at a younger age. Occasionally, AF can be associated with other medical problems, like an overactive thyroid or underlying cancer. There is some evidence emerging that excessive and continuous strenuous exercise, for example doing repeated, vigorous endurance training may also predispose people to developing AF.

Knowing and ensuring your blood pressure is normal, reducing your alcohol intake and keeping your weight within healthy range can all help reduce your risk of developing AF in later life.

Can an AF stroke be treated?

Stroke due to AF can be treated, although it is often difficult as the clot blocking the blood vessel may be large or, alternatively, the clot may break up and go down several different smaller blood vessels at the same time, affecting multiple areas of the brain. The key to reducing the effect of an AF related stroke is speed. Once a stroke is suspected by sudden onset of Facial weakness (F), Arm or leg weakness (A), difficulty with Speech (S) then the Time (T) to act is now and ring 999 – FAST. Sudden loss of vision is another warning sign.

Reduce your risk of AF:

• Check and ensure your blood pressure is normal
• Avoid being overweight
• Avoid excessive alcohol

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While there is no specific age at which one is ‘old’ or ‘young’, it is a fact that populations are getting older. Ageing populations will influence health and social systems in multiple ways.

The emerging issues associated with population ageing impact health, economic and social systems in our own country. 

Ageing populations will influence social and health systems in multiple ways, including the need to increase spend and address management of chronic illness and disease.

In Ireland, recent CSO figures show that the percentage of the population aged over 65 will increase from 13.3% in 2016 to 18.1% by 2031 and 24.6% by 2051. It is predicted that those over the age of 65 in Ireland will reach one million by 2031 and those over 80 will increase by 270% by 2051.

An older population can bring challenges to the health system needed to support them

This significant change in ageing demographics is a global phenomenon. This success challenges us all, as these additional lifespan years are not always lived in good health.

Chronic conditions, such as heart disease, stroke, dementia, respiratory diseases, diabetes, cancer, Parkinson’s disease, osteoporosis, falls, and frailty are among the conditions affecting ageing populations. They are among the reasons a comprehensive public health action on ageing is urgently needed. 

We need a culture that upholds dignity, respect and compassion for each other over the course of our lives.

Working together is the key

Older people, policy makers, clinicians and health professionals must engage proactively in conversations around awareness, prevention, symptoms, solutions and treatments.

Interdisciplinary, cross-specialty, cross community engagement and collaboration are key in ensuring that society, health and social care services become and remain fit for purpose.

There are many examples of this excellence at work already in Ireland. The Royal College of Physicians of Ireland (through the clinical programmes, training and education), in conjunction with the HSE, play a critical role.

They provide the vision and clinical leadership for managing chronic diseases and ageing well, along with the many voluntary organisations like ALONE, the Alzheimer’s Society, the Irish Gerontological Society and the many other voluntary societies around our country. 

Innovations must translate to improvements for older people

We all live and work in a complex and changing world. Digital literacy has become a requirement for participation in most day to day activities. We must ensure that our online, digital, and cloud-dominated tech-world is accessible to all, not just the young.

Innovations in treatments and technologies – in particular in the growing field of gerontechnology – must be translated into improvements in the wellbeing, health and care of older people, and support for us all to age well at home.

We have a wonderful opportunity in Ireland to lead the charge and change in support for all us as we age. We all want to age well. As a country we must strive to become an Ireland that leads the world in becoming age-attuned, age-accommodating and age-friendly.

To do this we need a culture that upholds dignity, respect and compassion for each other over the course of our lives. We also need support to live well into old age, and timely access to supports if and when we need them.

While we each have a personal responsibility, there is also a shared societal and governmental policy responsibility. These are all interconnected. Progress cannot happen unless we all work together. 

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Edel McDaid

Chartered Physiotherapists, Member of Irish Society of Chartered Physiotherapists

Ageing well is like a pension plan. It will match your investment. Pension plans save small amounts over long periods to futureproof your financial self

Society considers pensions so important that many sectors operate a mandatory pension contribution scheme. Yet, as much as we prepare for future loss of income, we rarely consider a loss of strength. Rather than financial futureproofing, why not think about functional futureproofing? There are small ‘contributions’ we can make to our body strength over our lifetime that will accumulate into a bounty worthy of ‘interest’.

The ageing muscle and improving functional ability

At the age of 45, we are generally thinking about our pensions and financial security for later life. But this is also a critical time for your muscles. From the age of 45, the quality and quantity of muscle mass in our body begins to reduce in size, strength and power. Although this is a normal process, it may have a significant impact on our ability to function in our later life.

The benefits translate into all aspects of everyday life; lifting your grandchild with ease, taking all the shopping in one go. It allows you to channel more energy into doing the things that mean something to you.

Functional ability is being able to do essential parts of daily life e.g. get up each day, take care of yourself and others, walk and enjoy your hobbies. The rate at which we are affected depends on our activity levels: inactivity can accelerate the decline.

This age-related loss of muscle is called ‘sarcopenia’, which in Greek means, “poverty of strength.” Sarcopenia is associated with the challenges we strive to combat in later life: reduced balance, loss of independent living and death. But, no need to despair, we’re not saying your muscles are going to go broke and declare bankruptcy. They are just prone to losing some value over time; but you can have the power to change that. 

Boost your muscle bank with resistance training

The answer is within the problem. The ‘poverty of strength’ can be replenished with resistance exercise. If you haven’t already, it’s time to open a muscle bank account. By making deposits (exercising) throughout your lifespan you can slow down the process of sarcopenia.

Research has shown that there are no ‘non-responders’ to resistance exercise so, no matter what your level or exercise history, you can gain from this simple pension contribution. In fact, research shows that, in some cases, resistance training reversed the signs of ageing in muscle, even in the very old.

Along with this delay in the ageing process, resistance exercise is empowering. Confidence blossoms from knowing that you are stronger than you were yesterday. It can strengthen the sense of self. The benefits translate into all aspects of everyday life; lifting your grandchild with ease, taking all the shopping in one go. It allows you to channel more energy into doing the things that mean something to you.

The role of physiotherapists in muscle matters

In this analogy, physiotherapists would be the pension planner, here to tailor the exercise plan to your specific needs, abilities and goals. When looking at strengthening and building up the weight tolerated over time, it is individual to each person and can often be dependent on other health issues. This is where the physiotherapist as an exercise specialist can guide you.

Together with the physiotherapist you can find the plan that works for you. Like all health commitments it needs to be individualised, sustainable and enjoyable. The interest rates are very attractive as resistance training not only combats ageing muscles but also strengthens your bones. Twice the return for a single investment.

A take home message to take to the ‘bank’

Pay into your pension; more muscle in the bank sets you up for retirement. Don’t worry, it’s never too late to start. If you don’t know what works for you and your ability, consult a Chartered Physiotherapist to help you start your strength journey. Growing old is inevitable, growing strong is choice.

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When you picture a heart attack you may think of someone clutching their chest, but in reality, this may not always be the case. Knowing the signs of a heart attack, in both women and men, may save a life.

What is a heart attack?

The coronary arteries supply your heart muscles with oxygen containing blood, however they can become narrowed from a build-up of fat, cholesterol and other substances that form plaque.

A heart attack happens when the artery suddenly becomes blocked so the flow of blood to the heart stops. The heart muscle supplied by that artery will die unless the blood supply resumes quickly.

The image of a man clutching his chest may come to mind when you hear heart attack but in reality, chest pain may not even occur in some cases

What are the symptoms?

Symptoms of a heart attack vary from person to person, but men and women can have different experiences during a heart attack. The image of a man clutching his chest may come to mind when you hear heart attack but in reality, chest pain may not even occur in some cases.

Jaw pain, left arm pain, profound fatigue, weakness, nausea, cold sweats or shortness of breath can also be signs of a heart attack. These symptoms can come on suddenly or may start slowly and persist for hours.

Worryingly heart attack in women is often missed as the symptoms can be different from that in men. In fact, most women think they are going to die from breast cancer when they are six times more likely to die from cardiovascular disease.

The symptoms of a heart attack in women can be quite vague making it hard to diagnose. They can include nausea, tiredness, shortness of breath, back pain or tightness in the jaw rather than the familiar scenario of a crushing pain in the chest that shoots down one arm.

If you or someone you are with are experiencing a heart attack, you should contact the emergency services immediately.

How to reduce my risk of heart attack?

There is a lot you can do to reduce your risk of heart attack. Identifying and managing risk factors early on could help lower your risk of a heart attack in the future. These lifestyle changes will make you more heart healthy.

• Be active
• Eat well
• Watch your weight
• Stop smoking
• De-stress
• Know your family history

It’s also important to get your blood glucose checked and your blood pressure and cholesterol should be checked regularly too.

How to deal with a heart attack?

Having a heart attack can be a frightening experience. Modern medical and interventional treatment means that many people fully recover after their heart attack.

In a heart attack every minute matters. Not all symptoms of a heart attack are always present. If only some are present, don’t wait. If you think you are having a heart attack, get help quickly and dial 999.

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With €206,305,000 spent treating 3,751 hip fractures in 2018, broken bones should be taken more seriously.

What is osteoporosis? 

Osteoporosis is a disease that affects bone density (quality and strength), resulting in bone fragility and susceptibility to fracture (broken bones), particularly of the hip, spine and wrist.

It is one of the most underdiagnosed diseases worldwide, and research shows that the majority of fractures occur in the moderate to marked osteopenia range.

How can we prevent osteoporosis?

Prevention can begin as far back as in utero. One in four men and one in two women over 50 will break a bone due to osteoporosis. It occurs in all age groups; however mature Caucasian females are the highest risk group.

Only 15% of people are diagnosed, which is why everyone should be filling in the risk factor test on the Irish Osteoporosis Society (IOS) website, to check if they have any risk factors for bone loss. 

Why is early detection so important?

Osteoporosis is preventable and treatable in most people. This is why breaking bones should be taken far more seriously.

Considering the secondary effects of fragility fractures (broken bones from a simple fall or less) may cause pain, disability, loss of independence, and premature death.

Ninety per cent of hip fractures are due to osteoporosis. Of those over 60 years of age who fracture their hip, 20% will pass away within 12 months. In 2018, the Irish health system spent €206,305,000, treating 3,751 hip fractures. 

What is the difference between osteoporosis and arthritis?

Osteoporosis and arthritis are two totally different diseases. Confusion can occur due to ‘osteoporosis’ and ‘osteoarthritis’ sounding similar.

Osteoporosis affects bones, has no signs or symptoms prior to fractures, as people cannot feel themselves losing bone. Arthritis has symptoms and affects joints.

How can you manage Osteoporosis?

• Exercise: Appropriate exercise is important, however, regular sit ups, touching toes while standing or sitting, trampolines, high impact, twisting your spine with your feet planted on the ground, are NOT recommended for those with bone loss. 

• Nutrition: Calcium, vitamin D and first-class proteins are essential and those with bone loss should be assessed by a registered dietician.

• Medication:Osteoporosis is a disease and should be treated by medications that have been extensively researched. I would never recommend that people treat this disease alternatively.

• Monitoring: All causes of bone loss should be investigated and addressed. Repeat DXA scanning should be carried out maximum every two years. For anyone worried about radiation exposure, a DXA scan has 10% radiation of a regular chest X-ray, so a person flying from Dublin to New York has received more radiation than a person having a DXA scan.

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