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Background

Although gastroesophageal reflux disease (GERD) is common among older adults, the true prevalence is not known. Many patients with GERD-related symptoms never discuss their problems with their primary care provider. GERD is thought to occur in 5–7% of the world’s population, with 21 million Americans affected (International Foundations for Functional Gastrointestinal Disorders, 2008). It is found in both men and women.

Signs and symptoms

Pathophysiological changes that occur in the esophagus, hiatal hernia, and certain medications and foods increase the risk for GERD. Obesity (Corely , Kubo, Levin et al., 2007) and activities that increase intra-abdominal pressure such as wearing tight clothes, bending over, or heavy lifting have also been linked to GERD (MedlinePlus, 2005a). The cardinal symptom of GERD is heartburn; however, older adults may not report this, but rather complain of other symptoms such as pulmonary conditions (bronchial asthma, chronic cough, or chronic bronchitis), a hoarse voice, pain when swallowing foods, chronic laryngitis, or non-cardiac chest pain (Pilotto & Franceschi, 2009). The chronic backflow of acid into the esophagus can lead to abnormal cell development (Barrett esophagus) that increases the risk for esophageal cancer.

Diagnosis

Older adults often have atypical symptoms, making the diagnosis of GERD very challenging. As people age, the severity of heartburn can diminish, while the complications, such as erosive esophagitis, become more frequent. Therefore, endoscopy should be considered as one of the initial diagnostic tests in older adults who are suspected of having GERD (Pilotto & Franceschi, 2009). Examination of the esophagus, stomach, and duodenum through a fiber-optic scope (endoscopy) while the person receives conscious sedation, allows the gastroenterologist to visualize the entire area, identify suspicious areas, and obtain biopsies as needed. Helicobacter pylori (H. pylori), a chronic bacterial infection in humans, is a common cause of GERD, affecting about 30% to 40% of the U.S. population. Testing for H. pylori can be done during the endoscopy or by other tests (Ferri, 2011).

Treatments

The objectives of treatment for GERD include: (1) relief of symptoms, (2) healing of esophagitis, (3) prevention of further occurrences, and (4) prevention of complications (Pilotto & Francheschi, 2009). Lifestyle and dietary modifications are important aspects of care. It is widely recommended that persons with GERD should stop smoking, limit or avoid alcohol, and limit chocolate, coffee, and fatty or citrus foods. Medications should be reviewed and offending medications modified, since certain medications decrease the lower esophageal sphincter (LES) tone, allowing acid to backflow into the esophagus. These include anticholinergic drugs, some hormones, calcium channel blockers, and theophylline. Avoidance of food or beverages 3–-4 hours prior to bedtime, weight loss, and elevation of the head of the bed on 6-to-8 inch blocks are some other interventions that may help alleviate symptoms. Pharmacological treatments with antacids in conjunction with histamine 2 (H2) -blockers (Tagmet, Zantac, Axid, and Pepcid) are used for mild GERD. If these are ineffective in controlling symptoms, then the proton pump inhibitors (PPIs) are the next drugs of choice. These include medications like Nexium and Dexilant. With lifestyle modifications and appropriate medications, older adults can manage their GERD symptoms so that quality of life is maintained.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

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Group of older mature people lifting weights in the gym

Bone spurs, which are small projections that develop on the edges of bones, are a highly common ailment that affects about 2 percent of the U.S. population.

People of any age can develop bone spurs, but they’re especially common in senior citizens since they are often associated with osteoarthritis-related joint damage.

Bone spurs don’t always require medical treatment, but, depending on their location, they can contribute to joint inflammation, pain, and stiffness that limit mobility. Bone spurs along the spine are particularly problematic, as are ones that develop in the knee or ankle joints.

For seniors who are struggling with bone spurs, there are lots of different treatment options available, including the four listed below.

1. Weight Loss
Weight loss is one of the most effective treatments for managing bone spurs, especially spinal bone spurs.

Changing your diet will is, generally speaking, the most effective weight loss tool. Focus on limiting your caloric intake and cutting out greasy fast food and highly processed snacks. Replace them with high-quality protein, fruits, vegetables, and healthy fats like avocados and olive oil.

Foods rich in omega-3 fatty acids can also help lubricate the joints and relieve inflammation.

2. Lifestyle Aids
There are lots of tools out there as well that can help relieve pain caused by bone spurs. Some good options to invest in include:

Supportive shoes that cushion the feet and avoid putting extra strain on the joints
Orthotic inserts to provide extra support
A shoe horn to help you avoid bending over and aggravating your back while getting dressed

3. Regular Exercise
Exercise releases natural painkillers in the form of endorphins. It also strengthens the muscles to help support the joints and relieve pressure placed on them.

Resistance training, walking, and swimming are all good exercise options for people struggling with bone spurs. Work with a trainer or physical therapist to make sure you’re practicing proper form and not doing anything to aggravate your condition.

4. Minimally Invasive Surgery
Finally, some people require minimally invasive surgery to get rid of their bone spurs. When you undergo surgery, a doctor will use state-of-the-art equipment to identify the spur and extract it.

This is typically an outpatient procedure, and the recovery time only lasts a few hours — you’ll be up and walking shortly after and won’t have to deal with an extended hospital stay.