Aging & Health A to Z
Unique to Older Adults
This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.
As older adults live longer, they may have more than one chronic disease. Or, they may have a health problem that can lead to another condition or injury if not properly managed. The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility or at home. These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.
Some of the most common conditions that occur in adults with cancer include:
- Loss of appetite and weight loss
- Changes in thinking or memory
Here is some information about how you can work with your healthcare team to manage these conditions.
The most common complaint of older adults with cancer is fatigue. Many people report feeling exhausted, weak, unusually “slow,” and without any energy at all. Once radiation or chemotherapy treatment ends, the tiredness usually improves, but it can often take quite a while to feel that your energy is really back.
Older cancer patients may think that age is the reason for feeling exhausted, but most cancer patients, young or old, share this experience.
Many things can cause cancer fatigue, including:
- the cancer itself
- your cancer treatment (drugs, radiation, surgery)
- anemia (low blood cell count)
- food intake which is too small or lacks nutrition due to poor appetite or treatment side effects like nausea
- disturbed sleep
- lack of physical activity or exercise
- breathing problems causing low oxygen levels in your blood
- nerve and muscle problems
Fatigue from cancer can have an effect on your daily functions and quality of life. Even if you sleep well and take naps, you may not feel refreshed afterward. Activities that you used to do easily may now seem exhausting. Because of this lack of energy, you may face new challenges with:
- social interactions and relationships
- ability to concentrate or to think clearly
- sense of self, and general feeling of well-being.
Fatigue management: Tell your healthcare team if you have feelings of tiredness, especially if they have a negative impact on your daily activities. Your healthcare team will evaluate you and find out if there are specific problems causing your fatigue. Many of these causes can be helped once they are identified. Some approaches that may be beneficial include:
- stimulant and antidepressant medications to give you energy and improve your mood
- blood transfusions, iron supplements, and anemia drugs that encourage your body to make new blood cells
- exercise programs
- working with a dietician to develop a healthy eating plan that gives you more energy
- programs that teach you how to use the energy you have wisely, and how to rest better
- changing pain medications and other drugs that may be adding side effects.
When you are facing a serious illness such as cancer, you can sometimes feel overwhelmed or hopeless. For older patients who are already handling other difficult changes of aging (physical limitations, chronic diseases, death of friends or a spouse), it can be hard to cope with the diagnosis of cancer.
When older adults with cancer are depressed, they often report more problems with their symptoms, relationships, and general outlook. They are more likely to feel that they are a burden to their friends and families.
You may not realize you are depressed, and your healthcare providers and family members may not notice it either. Try to be honest to be with yourself if you feel you are not able to cope with your situation. Just because you have received a diagnosis of cancer does not mean you have to live with depression. You can still achieve a healthy and positive attitude and quality of life. Depression can and should be treated.
Since depression has been found to last longer in older people, it is important to tell your healthcare provider as soon as you are aware that you are feeling “down.” Remember that there is no shame in seeking help in a difficult situation such as having cancer.
Factors specific to cancer patients that can increase the chances of depression include:
- an advanced stage of cancer
- pain that is not well controlled
- physical limitations
- treatment with certain chemotherapy drugs.
Treatment for depression in older cancer patients: Treatment options in older cancer patients who are depressed are similar to treatments for depression in other people. They include medications (antidepressants), counseling (psychotherapy), support groups, or a combination of these.
- Medications: Antidepressant drugs work well in older people, but the amount you take may need to be lowered, and more attention may need to be paid to side effects. Also, your healthcare professional must be careful to choose antidepressants that will not interact negatively with the chemotherapy or other drugs you may be taking, and will not make you too drowsy or lower your blood pressure too much.
- Counseling: Talking to a professional counselor or psychotherapist about your depression is one of the best ways to understand your feelings and improve them. Psychotherapy is especially effective if antidepressants are taken as well, or if drugs are not an option because of side effects or drug interactions. Even if you feel hopeless because of your cancer diagnosis, talking about your feelings with someone you trust can improve your outlook and allow you to enjoy your life again.
- Support groups: Many older people are helped by attending a support group with other older people with the same type of cancer. Researchers have found that belonging to a support group can improve mood and quality of life and provide important coping skills. Check with your healthcare provider, the American Cancer Society, social work departments of hospitals or clinics in your area, as well as community centers or places of worship to find the right support group for you.
- Suicide prevention: Cancer patients have a higher suicide rate than the general population. It is extremely important, particularly in the first six months after learning that you have cancer, to talk to your healthcare team, family, or caregivers if you are having suicidal thoughts. Remember that your depression can be helped, and your outlook can improve significantly with treatment.
Changes in Thinking or Memory
Some people who are treated for cancer experience “fuzzy” thinking or memory problems, particularly if they are treated with chemotherapy. This effect is now known as “chemo brain” according to the American Cancer Society. Older cancer patients may be more likely to experience changes in thinking during cancer treatment.
Most of the effects of “chemo brain”—also called mild cognitive impairment—do not last long, are not serious, and often get better on their own. However, for some older people, this “fuzzy thinking” can make it harder to carry out daily activities, such as balancing a checkbook or grocery shopping.
Some older people report problems such as:
- forgetting things they use to have no trouble remembering, such as names, dates, words, or events
- trouble focusing or concentrating
- being more disorganized and slow with routine tasks; having difficulty making plans
- slower reaction times
- needing more time to learn new things.
These changes can be alarming, even if no one but you notices them. If your healthcare providers don’t take your complaints seriously, or blame them on your age, you may feel even more worried.
To help you manage problems with a decrease in mental function, the American Cancer Society and other groups suggest the following tips:
- Use a daily planner, with details about appointments and schedules.
- Keep “to do” lists – even for movies you want to see or books you want to read.
- Keep an easy-to-read list of addresses and phone numbers.
- Exercise your brain by taking a class, doing word puzzles, or using memory training websites on the Internet.
- Get plenty of sleep and rest.
- Exercise regularly.
- Eat a balanced diet, including lots of brightly colored vegetables (full of vitamins and plant chemicals that keep your body healthy as you get older).
- Try to keep to the same daily routines and schedules.
- Focus on one thing at a time rather than trying to “multi-task.”
- Get help when you need it.
- Keep a diary of mental problems that you experience so you can report them to your healthcare provider. This will also help you to notice when these problems are most likely to occur.
- Write down questions about your problems as they occur to you, so that you can check with your doctor at your next appointment or phone call.
If the problems do not improve, your healthcare professional may send you to a specialist for an evaluation and recommendations for how best to cope with your mental symptoms.
Weight Loss and Loss of Appetite
Most older people with cancer experience loss of appetite, weight loss, reduced muscle mass, loss of fat reserves, and reduced protein and calorie intake at some point during their illness.
It is important to work with your healthcare team before you begin cancer treatment, to develop a plan that will help you maintain your weight and appetite. Nutritional therapies and medications can both be helpful.
- Drug treatments: A variety of drugs can be used to help maintain your weight, muscle mass, and appetite. Other medications can help manage problems with nausea and other aspects of eating and digestion that are disturbed by either the cancer or the treatment you may be receiving. These drugs are prescribed depending on your specific needs.
- Nutritional strategies: You may experience other symptoms in addition to a general lack of appetite, including:
- Nausea or vomiting
- Changes in taste and smell
- Feeling “full” very quickly
- A new dislike of eating meat.
- Helpful hints for a better diet:
- Eat small but frequent meals
- Focus on high protein and high calorie foods
- Limit your fat intake
- Avoid extremes in taste or smell because of changes in your senses
- Eat in a pleasant environment, with appetizing food presentation whenever possible
- Take supplements according to your healthcare professionals’ recommendations.
If you have been diagnosed with cancer, you may worry that you will experience pain at some point during your illness. Pain is not inevitable, however, and if it does occur, there are many effective ways for your healthcare team to treat the pain. Keeping your pain under control is one of the most important things your healthcare team can do.
Be sure to tell your healthcare professional as soon as you start having pain, so that they understand what you are feeling and can help you stay as pain-free as possible.
If you do have pain, either from the cancer or from your treatment, it may vary from mild to severe, and change from day to day. It may be “acute” pain, which starts quickly and doesn’t last very long, or “chronic” pain, which is more constant and lasts longer.
Keep a pain diary and be sure to let your healthcare team know when you are experiencing any pain or other side effects. Treating symptoms early can prevent them from getting worse and keep them under control.
Opioids, also referred to as narcotics, include drugs such a codeine, morphine, and oxycodone and are the most commonly used medications for controlling pain. The most common side effect of opioids is constipation, particularly in older patients. You should talk to your healthcare professional about taking stool softeners or laxatives along with your medicine to avoid this problem. Also remember to drink plenty of fluids, eat fiber-rich foods, and get regular exercise.
Make sure to take your pain medications exactly as directed by your physician, and tell your healthcare team about all side effects immediately. Do not break or crush your pills unless your doctor tells you to do so.
You may feel drowsy or nauseated when you first take an opioid pain medication, but these side effects usually go away after a few days, once you are used to the medication.
Although many patients worry that they will become addicted to an opioid medication, this does not happen if it is taken according to your healthcare provider’s directions to treat your pain.
Many patients develop a “tolerance” for their pain medication, which means that it seems to work less well as time goes on. Tell your healthcare provider if the pain medicine is no longer working as well as it used to. He or she can change the dosage, or switch you to a more effective medication.
Do not stop taking an opioid medication unless you are under a doctor’s care and instruction. Stopping an opioid drug suddenly can bring on dangerous withdrawal symptoms.
Other Pain Medications
Other types of medicine can also be helpful in pain control. Some of these treat causes of pain or increase the effect of your narcotic medications. These include:
- anti-epileptic (anti-seizure) drugs
Radiation for pain control
Radiation may be used to control pain by targeting specific areas where cancer is causing pain symptoms. This focused radiation therapy has been found to be effective for bone pain, in lymphomas and cancers of the prostate, bladder, cervix, esophagus, breast, and head and neck.
Alternative or complementary approaches
Many older people receive great benefit from non-medical approaches to their pain. Although scientists don’t yet understand why some of these treatments are effective, they often are very helpful in cancer pain. These include:
- heat or cold applications
- relaxation methods
- distraction techniques
- gentle exercise such as Tai Chi, yoga, or gentle physical therapy.
Updated: March 2012
Posted: March 2012