A little whiskey at night is not to be sniffed at
In this edited extract from his memoir, internationally renowned doctor and health campaigner Risteard Mulcahy is frank about what it's really like to be old
IN recent years I have noticed the onset of certain limitations which are all part of the functional attrition associated with ageing.
For example, dryness of the mouth occurs in bed because of reduced saliva production, and dry eyes when I read a book or paper close to a reading lamp. A few segments of an orange are effective during the night to stimulate the salivary glands, and dry eyes are relieved immediately by appropriate saline eye drops which are freely available in pharmacies today.
Sleep may be difficult and can be worsened by eating late, by drinking alcohol and caffeine-containing drinks. A mild sedative on going to bed is a great help; it does not have any after-effects, it leads to quick and reasonably profound sleep, and the current small dose remains effective.
I sleep less and tend to dream more, particularly during early waking, the so-called REM stage of sleep. Dreaming time can be quite prolonged, or at least appears to be so.
Dreams are greatly varied in their content, with elements of frustration and paranoia predominating. I tend to get up early, sometimes as early as six o'clock, and dowse my face several times in cold water or drink a cup of hot water or very weak tea.
In this way, the sometimes disturbing reality of the dream quickly fades. On returning to bed, I may have a brief period of natural sleep free from dreaming. Regular bedtime would help sleep and possibly reduce dreaming, but this is a counsel of perfection I do not always follow.
Appetite has diminished, as indeed has the tolerance for alcohol. Food intolerance becomes more frequent and the culprit foods can usually be identified by trial and error.
The high-fibre foods, such as muesli, raw vegetables and crudites, are particularly prone to lead to indigestion and flatus.
A more recent intolerance of wine, particularly red, causes leg cramps and may find me hopping around the bedroom in the middle of the night. Cramps are more likely to occur in cold weather and after strenuous exercise.
My right ear has become seriously deaf over the past 20 years. After years of putting the problem on the long finger, I finally acquired a very flimsy (and expensive) aid for my left ear which helped considerably in one-to-one or small group conversations. I hope to acquire the loop facility provided by cinemas, churches, theatres and on television which helps to overcome the hearing deficit. Those with good hearing, including my nearest and dearest, need to be encouraged to speak clearly to avoid misunderstanding and unwelcome irritation.
Sensitivity to cold is another increasing problem. I need to keep warm in the house, and yet also to reduce our need for central heating. Thermal underwear, a short scarf, a house cap and an extra pullover in the house are helpful. In the winter I wear my old tweed suits.
It is inevitable that sexual activity, so important in a loving relationship, is greatly diminished as we age, although the introduction of the erection-enhancing drugs does add to improved sexual function, if such an issue were to persist into later life.
Like all those with normal vision, I have needed increasingly strong glasses for reading from the age of about 50 years. I eventually needed bifocals to improve fine definition of distant objects, which are useful for television, theatre and cinema, but they are unnecessary for driving, or for other outdoor activities.
I have my vision checked every two years to ensure that there are no changes occurring, such as increasing pressure within the eyes, which might damage the retinal cells and lead to further impairment of vision.
I have arthritis of my left shoulder, which required keyhole surgery, but otherwise I have been well and very active. But as we get older we tend to get arthritis in other joints. In particular, the shoulder joint, the hands and the fingers can be troublesome. I've had chronic long-standing discomfort in the first carpo-phalangeal joints (the joint at the base of each thumb) of my hands for the past seven years or more. The discomfort has increased slowly over the years, but one can learn to live with such discomfort.
I take a paracetemol once in a while, but I'm still not sure whether it actually provides pain relief, or whether it is a placebo effect.
If there is a reasonable alternative, surgery should be avoided at all costs in older people. With appropriate physiotherapy and exercises, and a constructive and optimistic attitude to one's symptom it is best to avoid surgery and its longer recovery required by the older person.
Adding to arthritis and cramps, generalised pains and aches in various parts of the body are non-specific symptoms in an ageing frame. But if none of these are functionally important, I ignore them.
Added to normal hygiene, parts of the skin may benefit by the regular application of a routine skin lotion such as Nivea cream and Intensive Care. This may reduce a tendency to itchiness which is more prone in older skin, but itchiness is best controlled by ignoring it, although an occasional scratch from one's spouse can by very welcome!
A regular drink in the evening before supper with one's wife contributes to the same sense of cohesion which was associated with the shared cigarette in former days, and a pint of Guinness after a round of golf is a fitting end to a pleasant day. An occasional hot whiskey at night on retiring can relieve the discomfort of the common cold or influenza. Whiskey does not interfere with immediate sleep but tends to have a delayed stimulant effect leading to early waking and insomnia.
The single commonest source of anxiety among the elderly is concern about loss of memory and the fear of dementia such as Alzheimer's. Most of the worries about dementia are groundless. There is no doubt that as we get to the eighth or ninth decade our ability to acquire new information declines.
I have largely lost the ability to retain new information of a complex nature. But I have not lost my memory for past or recent events and I am probably as good as ever at doing the simplex crossword. There is compelling evidence from international research that using the brain and exercising the memory regularly is effective in preserving cognitive function.
Like many others much younger than I, I find it difficult to remember names of people, particularly when I encounter them suddenly and unexpectedly, but the problems here are complex and related as much to the frenetic lives we are living nowadays rather than to any organic change in brain function.
The most common complaint among anxious patients has to do with loss of attention rather than loss of memory. And this is not confined to the elderly. Inattention has nothing to do with organic memory loss.
It has to do with failure to record what we are doing. It has to do with a lack of discipline and with the chaos in our lives. Carry a spare car key in your wallet.(And don't forget a spare pair of glasses in the glove department of your car and a spare battery for your hearing aid). Yes, I am talking to myself.
Mental activity is encouraged by reading, becoming a radio buff, solving problems such as the crossword and Sudoku, continuing hobbies and by keeping in contact with family and my surviving friends.
We elderly are aware of the kind, but slightly patronising, attitude of younger colleagues and acquaintances, frequently provided by the introductory greeting, 'You're looking great'. It is necessary to maintain a normal approach and a sense of humour, and to avoid falling into the trap of boasting about one's age!
These can be golden years and can be enhanced by retaining a creative interest in affairs and people, and by having a curiosity, and not a dread, about death. Though, for the very old and the chronic sick and disabled, death must be a gift from God.
This is an edited extract from 'Memoirs of a Medical Maverick' by Risteard Mulcahy, published by Liberties Press, price €19.99