Review of The Issue of Ageing, Its Factors and How to Slow It Down

Aging is not just about greying hair and wrinkles, a lot goes on inside our bodies. What are the challenges of old age and how do we overcome them? We asked doctors, to hear it from the horse's mouth. Introduction:As we get older, life seems to demand more from us; it wants us to run, while we can barely manage a stroll. Soon, we can see the early signs of ageing appear – grey hair, fatigue, dull skin, wrinkles etc. But there’s more to it than appears on the surface. Consultant at DR Panwelkar`s Multispeciality Dental Clinic, spoke to us to help us understand the finer nuances of the natural ageing process, and learn to take a holistic approach towards it.

What Is Physiological Ageing?

Most of us already know what physical ageing is, i. e. growing old. But physiological ageing is a whole other story. While on one hand, physical means ‘of the body itself', the term physiological refers to functions ‘within’ the body. In the words of DR Sarfaraz Shaikh, “Our body is continually adapting and adjusting to the ever-changing external environment, by continuous life processes in the milieu interior harmoniously, by turnover of cells. With each generation of new cells, there occurs some changes in their genetic makeup.

So, with the passage of time, the milieu interior of the body finds it difficult to cope up with the external changes of environment. This is nothing but physiological ageing. ”In short, as we age, our internal organs do too; and they go through many changes that in turn affect our physical appearance. We tire easily, our digestive system becomes weak, taking a toll on our appetite, even our eyesight starts to deteriorate, we lose teeth, the bones and gums in our mouths degenerate too. As we age, we lose a good amount of our muscle tissue and the subcutaneous fat tissue that lies beneath the skin starts to lose its volume.

DR Sameer Shaikh explains, “Just as every organ of the human body ages, the musculoskeletal system does too. In the absence of any disease or pathological process going on in the body, the musculoskeletal system starts, in early twenties, an ongoing repair-regeneration-remodeling process, and tries to maintain the ecosystem. But it’s never really the same. With age, the quality keeps retarding. Unlike a lot of other organs, there’s a gender bias in the physiological ageing of the musculoskeletal system, putting women at a higher risk of accelerated ageing after menopause. Men, by nature, have a better and more durable musculoskeletal system, attributable to the male hormone, testosterone. Genetics, race, ethnicity, and geological factors are other few physiological factors affecting ageing in humans. ”

DR Panwelkar also threw light on the fact that dental/oral health is utterly important but due to neglect right from childhood to adulthood, it worsens in old age, "Oral health is the most important part of the body. The oral cavity comprises of the teeth and the supporting structures (gums, bone etc) but they are the least cared for part of the body as well. One’s oral health should be in place, in order to live a healthy life. Imagine if you cannot eat or chew your food, for the rest of your life properly - just the thought is scary.

As one reaches old age, the quality of our teeth and gums diminishes and results in different types of conditions, for instance; tooth decay, attrition (wearing of enamel from the top), abrasion (wearing of enamel from sides mainly due to hard and faulty tooth brushing), erosion due to various chemicals external as well as internal, mobility (loosening of teeth), recession of gums, loss of bone and darkening or yellowing of the teeth due to thinning of enamel which leads to an unpleasant embarrassing smile, "he explained, adding, "Due to loss of teeth, the appearance of a person changes, making them look older than their actual age. The bite collapses, causing stress on the joint between the jaw and skull viz. temporomandibular joint. This can lead to pain in the area of the joint (in front of the ear) which later travels to the neck and back causing extreme discomfort. However, that can be treated only after restoring the bite and smile back. But few people realize that."

Another visible physiological aspect of ageing is one that we feel the most conscious about - our appearance. Dermatologist Nausheen Khan, who practices in Mumbai confirms, “Skin changes are among the most visible signs of ageing. From around the age of 25, the first signs of ageing start to become apparent on the surface of the skin. Fine lines appear first, and over the course of time, wrinkles, loss of volume and density too, become noticeable. Other common changes are rough skin, dryness, itching, enlarged pores, pigmentation including age spots, liver spots (also called lentigo), may appear in sun-exposed areas. Skin becomes increasingly transparent, paler, thinner and bruises easily. ”

With all these changes happening inside our body, it takes a toll on our social life. We make desperate attempts to reverse the ageing process without realizing that, it is a universal truth, bound to happen to each and everyone of us. We must instead accept it with our head held high. Although with a few precautions and healthy habits, we can easily reduce the severity of it’s effects.

What Lifestyle Factors Are Responsible For Faster Ageing?

Although ageing is a naturally occurring phenomena, there are certain unhealthy habits and poor lifestyle choices, that we make, which affect the quality of life and accelerate the process of ageing. Some of the poor lifestyle factors that affect and speed up ageing are, smoking, alcohol consumption, sedentary lifestyle, unhealthy diet, excessive use of technology which limits physical activity, obesity, lack of sleep and not providing enough rest to the body, stress, improper nutrition, poor working environment and ergonomics, et cetera.

When it comes to premature skin ageing, it can be caused by both internal factors as well as external factors. Internal factors are the changes within our body, that occur with the passage of time and may or may not be caused by genetics. DR Nausheen informed us that genetics play a key role in how the skin changes with the advancement of one’s age. Apart from that, our ethnicity, race and the skin type we are born with, makes a big difference as to how sooner or later the different signs of ageing start to show up on the surface of our skin. Equally important are, our hormones, and any co- existing health conditions, that may affect how our skin changes. So those are some examples of how internal factors affect the skin. But we bet you didn’t know that it’s the external factors that generally affect the speed with which our skin ages.

Sun exposure: The ultraviolet radiation from the sun is perhaps the most common cause of skin-ageing. Damage to the skin caused by prolonged exposure and/or everyday exposure to the harmful UV rays is called ‘Photo-ageing', which is also responsible for uneven pigmentation. Research suggests that UV rays are also the number one cause of skin cancer.

Pollution: The relationship between pollution and our skin, is a well researched and well documented one. Few people know that not only outdoor air pollutants, but also indoor pollutants are extremely harsh on our skin. Exposure to outdoor/indoor pollution can potentially cause a profound negative effect on the skin. It may manifest itself in many ways/shape and forms. The most common ones being, rashes, acne, eczema, dryness, dullness, wrinkles and dark liver spots. All these further take a toll on our sensitive skin and accelerate premature ageing.

Unhealthy lifestyle: Unhealthy lifestyle habits like smoking, alcohol, obesity, lack of exercise and those already mentioned above, are one of the greatest causes of the deteriorating condition of the body, including the skin, muscles and bones. Especially a wrong diet and lack of exercise. As DR Sarfaraz Shaikh likes to put it, “Eat to live, don’t live to eat!” Over eating of junk food, sugar and processed foods can lead to an increase in free radicals leading to oxidative stress in the body.

What lifestyle changes can we incorporate into our lives to slow down the ageing process? Taking a holistic approach to maintain a healthy lifestyle is the stepping stone towards preventing premature ageing. With a few simple and easy steps, we too can counter the harmful effects (both external as well as internal) on our overall health. Follow these tips to maintain optimal health, slow down the ageing process and learn to age gracefully. Stress is a major factor that contributes to ageing faster, and its effects can be seen on our mental, physical and physiological health. So the first step is to get de-stressed. Make time daily, to meditate and calm down your senses and attract positive vibes.

Eat a healthy and nutritious diet, rich in all types of fruits and vegetables, nuts and seeds, whole grains, healthy fats like Omega 3 and Omega 6, and lean protein. This is vital to maintain optimum condition of our body including our heart, brain, eyes, bones and muscles, skin, hair etc. Also increase your water intake, try to consume 8-12 glasses of clean water every day, this will help to flush out the toxins in your body. Eliminate all processed foods, starchy food, saturated fats, and harmful sugars. Exercise for 4-5 hours per week. You may choose to exercise daily for a short amount of time or on every alternate day for longer durations. Whatever your choice of activity may be (brisk walk, running, yoga, pilates, weight training, cycling etc) always ensure that you remain consistent with it. Or even if you switch it up, always stay active.

Quit smoking and drinking, as well as drastically reduce the amount of time spent on technological devices. They emit radiation that can have irrevocable adverse effects on the body. Another highly important step is to go for regular health check-ups. Many times, health experts may be able to diagnose a concern in its initial stage and help you combat it. So get the blood-work done, get regular eye check-up, dental check-ups, general health check-up, and skin analysis as well.

Lastly, care for yourself well. Don’t just love your outer appearance, learn to love your inner self and provide adequate care and attention to yourself and your family. With technological advancement, what are the newest treatments available today, to help slow down or retard the process of ageing? When it comes to musculoskeletal health, some of the most common conditions that older adults face are osteoporosis (which means loss of the bone mass/density), osteoarthritis (which is damage to the cartilage and surrounding tissue), fibromyalgia and polymyalgia rheumatica (characterized by stiffness and pain in the shoulder and hip joints) and an increased risk of fractures.

Treatment options for osteoporosis and osteoarthritis range from administration of analgesics, Non-steroidal anti-inflammatory drugs, topical creams, physiotherapy, and joint replacement surgery for example, knee and hip surgeries. Corticosteroids for polymyalgia and splinting, plaster casts, or surgery are the treatments for fractures. There are various conditions that may affect our eyes as we age.

The most common being age related macular degeneration (AMD), cataracts, diabetic eye disease, glaucoma, poor vision, and dry eyes. It is highly important to get a comprehensive dilated eye exam, for early diagnosis of these conditions, to help prevent them as soon as possible. Unfortunately there is no known cure available for AMD and the only treatment option is anti-VEGF injections, which are given directly in the eye. Cataract surgeries are pretty common but performed once the cataract affects our vision to a great extent. Diabetic eye surgery is a common cause of blindness and can be treated by photo coagulation, which is a laser treatment; or vitrectomy. Poor vision needs vision aids like glasses, contact lenses or a Lasik eye surgery.

Dental treatment varies for different conditions. If the health of the gums is good and the tooth can be salvaged then it can be restored back to health by means of caps, veneers, fillings. The line of treatment for attrition is ceramic or composite onlays/veneers/caps; where as abrasions need composite restoration. In case of missing or lost teeth, we have surgical procedures such as dental implants for fixed teeth and also removable dentures. Periodontal (gum) disease is also quite common in old age and the treatment ranges from scaling and root planing, curettage, to flap surgery. For aesthetic enhancement, the yellowness and cracked teeth can be veneered or crowned to achieve a pleasing smile. Due to old age and loss of teeth, the bones also become weak making them vulnerable to fractures on fall or due to trauma, that calls for surgical intervention.

Types of treatment

Dermatology is a branch of medicine that has evolved greatly in terms of treatment options. Many types of treatments are available today to help reduce the appearance of the signs of ageing.

Chemical Peels

Chemical peels are gel based substances that when applied to the skin exfoliate the top layer, causing dead skin cells to peel off. After a few sessions, collagen production is stimulated in response to the wounding. It helps reduce fine lines, small scars, discoloration and sun-damaged skin. Dermal rolling and micro-needling: This line of treatment involves rolling a cylinder covered in tiny needles over your skin and causing controlled micro trauma to stimulate collagen production. It is effective in treating acne scarring, fine lines and wrinkles.

Microdermabrasion

Microdermabrasion uses fine crystals to sand the face and remove dead skin cells. Over the counter face cleansers and scrubs are available at drugstores, which include micro beads or walnut shell particles that claim to slough off dead skin cells. However, they could be potentially harmful. It is best to get it done by a trained esthetician at a skin clinic. When done right, it may help reduce the appearance of fine lines, wrinkles, blackheads, and improve skin texture, but don't expect a major anti-ageing effect.

Laser And Similar Procedures

Fractional, ablative and non-ablative laser treatments, use heat to create controlled injury in the epidermal and dermal layers of the skin. This in turn induces the body to respond by producing more collagen in the treated area. The increased collagen plumps and thickens the skin, reducing the appearance of fine lines, acne scarring and stretch marks.

Intense Pulsed Light

This type of treatment uses light energy to heat the epidermis and dermis, stimulating collagen production. It's best for improving skin tone and texture, as well as discoloration, and fine lines.

Radiofrequency And Ultrasound

These too heat the skin and the deeper tissues beneath it, improving skin tone, texture, and tightness.

Dermal Fillers

The most commonly used treatment by the glamour industry - dermal fillers, are injections of hyaluronic acid that are given under the skin, to fill in deep folds, such as nasolabial folds (also known as "smile lines" or "laugh lines"), create fuller lips and pad out hollow cheeks and eyes and create a lift. Rather than just smoothing or tightening skin, they can change the facial profile to a more youthful one making them highly sought after treatments.

Neurotoxin Injections

Also known as Botox, these injections help relax the muscles of expression, thereby smoothening lines and wrinkles.

Platelet Rich Plasma

Also known as the vampire’s face lift or vampire facial, it involves segregating the platelets from the blood, which is then re-injected under the skin. Platelets are a powerhouse of cell growth thereby stimulating collagen and elastin, improving skin texture, fine lines, and scars.

We would like to thank the health care providers for giving us their valuable time. I leave you with my favorite quote on ageing gracefully, by celebrated writer Betty Friedan, "Ageing is not lost youth, but a new stage of opportunity and strength".