- 7 Blood Markers Negatively Affected By Aging & Management | Nature Knows
- 7 Blood Markers Negatively Affected By Aging & Management
- What are Blood Markers?
- Blood Markers and Aging
- 1) DHEA-S
- 2) Testosterone (Total, Bioavailable, and Free)
- 3) HDL-C
- 4) C-reactive Protein
- 5) HbA1c
- 6) Triglycerides
- 7) Homocysteine
- Anemia in the Elderly
- Truths About Lupus and Aging
- Blood tests and age-related changes in older people
- The kidney
- Non-inflammatory conditions
- Inflammatory conditions
- Reproductive organs
- Key points
- Also in this series
7 Blood Markers Negatively Affected By Aging & Management | Nature Knows
Our bodies undergo many changes as we age. Some of these changes are noticeable, such as aches and pains, longer recovery from workouts, and stubborn body fat that you just can’t get rid of. Other changes may go unnoticed if you’re not regularly getting the right lab tests done.
As you grow older, many blood markers move in the wrong direction, putting you at an increased risk for some chronic diseases. Read on to find out which blood markers are most affected by the aging process and what you can do to slow and possibly prevent some of these changes.
What are Blood Markers? Blood markers refer to certain blood tests that are used to check certain aspects of your health.For example, cholesterol is a blood marker that doctors used to evaluate your heart health.While researchers don’t know exactly what causes aging, they have observed consistent changes in many blood markers with age.
Every system in the body is negatively affected by aging, with the most prominent being the hormone, immune, and cardiovascular (heart and blood vessels) systems. Changes in specific blood markers clearly reflect this.While some degree of change is inevitable (currently), there are ways to minimize the impact aging has on your lab markers.
Keeping an eye on specific blood markers and taking the appropriate steps to keep them as close to youthful levels as possible will help you live healthier, for longer. Markers That Decrease With Age 1) DHEA-S Dehydroepiandrosterone sulfate ( DHEA -S ) is a steroid hormone produced primarily by the adrenal glands.
It is also produced to a lesser extent by the brain and skin, as well as by the testes (in men) and ovaries (in women) [ 1 ].Together with regular DHEA, DHEA-S is the most abundant steroid hormone circulating in the blood and is the precursor (building-block) to the more powerful sex hormones testosterone and estradiol , the main estrogen [ 2 ].
DHEA-S is important for:DHEA-S levels peak around 20 years of age and begin to decline rapidly in the mid-’20s, with levels decreasing by as much as 80% at 75 years of age [ 6 ].Lower DHEA-S levels have been linked to depression , non-alcoholic fatty liver disease (NAFLD), hardening of the arteries (atherosclerosis), and heart disease [ 7 , 8 , 9 , 10 , 11 , 8 ].
There are a couple of options to help counteract this age-related decline: You can also take DHEA in supplement form to boost your DHEA-S levels. One study in 19 middle-aged men and women found 100 mg of DHEA for six months increased DHEA-S levels to those seen in young adults.
If you have low DHEA-S levels and decide to go this route, make sure to routinely test your levels during supplementation and do so under the guidance of your doctor [ 13 ]. This supplement is great for some people, but there is evidence that supplementing with DHEA may promote the growth of prostate cancer [ 14 , 15 ].
2) Testosterone (Total, Bioavailable, and Free) Testosterone is a hormone mainly produced by the testes in men and the ovaries in women. Less than 10% is produced by the adrenal glands and brain in both sexes [ 16 ].Testosterone has a diverse range of beneficial effects throughout the body.
It [ 17 , 18 , 19 ]: Improves bone health Helps to build and maintain muscle mass (lean body mass) and strength Increases red blood cell production Improves libido and sexual function Increases sperm production Plays a role in mood and brain function After the age of 30, total testosterone levels decrease by 1-2% a year in both men and women [ 20 , 21 , 22 ].
Free testosterone, the type that is not bound to anything and able to affect your cells and tissues, decreases at an even faster rate than total testosterone [ 23 ]!Fortunately, there are ways to optimize your testosterone levels and minimize this decline: If you are overweight, research suggests that the best thing you can do to increase your testosterone levels is to lose weight. Obesity decreases testosterone levels, and low testosterone, in turn, increases fat accumulation, resulting in a vicious cycle. Implement a healthy diet and exercise regime to reach your weight goals [ 24 , 25 , 26 ]. Another important factor in testosterone production is sleep . Make sure you are getting enough uninterrupted sleep. This means avoiding blue light before bed or wearing blue-light blocking glasses, not drinking caffeine too late in the day [ 27 , 28 , 29 , 30 ] Another great way to boost your testosterone levels is to exercise. Engage in moderate-intensity aerobic exercise several times a week [ 31 , 32 , 33 , 34 , 35 ]. Check your zinc and vitamin D levels, and increase them if you’re deficient [ 36 , 37 , 38 ]. Zinc is a crucial mineral for testosterone production. You can boost your zinc levels by eating oysters, beef, crab, cashews, and pumpkin seeds [ 36 , 37 ]. You can boost your vitamin D levels by spending more time in the sun.
Discuss the following supplements with your doctor. Studies suggest they may help increase testosterone levels Remember, always speak to your doctor before taking any supplements, because they may interfere with your health condition or your treatment/medications! 3) HDL-C HDL-C , also known as the “good cholesterol ”, is cholesterol that is being carried away from the cells and blood vessels back to the liver to be removed from circulation [ 51 ].Higher HDL-C levels are associated with a lower risk of heart disease. As we age, our HDL-C levels decrease gradually and our risk of heart disease increases [ 51 , 52 , 53 , 54 ].You can help slow this decline by: Exercising regularly. People who are less physically active have lower HDL-cholesterol levels [ 55 ]. Eat a balanced, healthy diet. Studies suggest that fiber, found in […]
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7 Blood Markers Negatively Affected By Aging & Management
Our bodies undergo many changes as we age. Some of these changes are noticeable, such as aches and pains, longer recovery from workouts, and stubborn body fat that you just can’t get rid of.
Other changes may go unnoticed if you’re not regularly getting the right lab tests done. As you grow older, many blood markers move in the wrong direction, putting you at an increased risk for some chronic diseases.
Read on to find out which blood markers are most affected by the aging process and what you can do to slow and possibly prevent some of these changes.
What are Blood Markers?
Blood markers refer to certain blood tests that are used to check certain aspects of your health.
For example, cholesterol is a blood marker that doctors used to evaluate your heart health.
Blood Markers and Aging
While researchers don’t know exactly what causes aging, they have observed consistent changes in many blood markers with age. Every system in the body is negatively affected by aging, with the most prominent being the hormone, immune, and cardiovascular (heart and blood vessels) systems. Changes in specific blood markers clearly reflect this.
While some degree of change is inevitable (currently), there are ways to minimize the impact aging has on your lab markers. Keeping an eye on specific blood markers and taking the appropriate steps to keep them as close to youthful levels as possible will help you live healthier, for longer.
Dehydroepiandrosterone sulfate (DHEA-S) is a steroid hormone produced primarily by the adrenal glands. It is also produced to a lesser extent by the brain and skin, as well as by the testes (in men) and ovaries (in women) .
Together with regular DHEA, DHEA-S is the most abundant steroid hormone circulating in the blood and is the precursor (building-block) to the more powerful sex hormones testosterone and estradiol, the main estrogen .
DHEA-S is important for:
DHEA-S levels peak around 20 years of age and begin to decline rapidly in the mid-’20s, with levels decreasing by as much as 80% at 75 years of age .
Lower DHEA-S levels have been linked to depression, non-alcoholic fatty liver disease (NAFLD), hardening of the arteries (atherosclerosis), and heart disease [7, 8, 9, 10, 11].
There are a couple of options to help counteract this age-related decline:
- Cut out the sugar. Sugar spikes insulin and high insulin levels decrease DHEA-S .
- You can also take DHEA in supplement form to boost your DHEA-S levels. One study in 19 middle-aged men and women found 100 mg of DHEA for six months increased DHEA-S levels to those seen in young adults. If you have low DHEA-S levels and decide to go this route, make sure to routinely test your levels during supplementation and do so under the guidance of your doctor . This supplement is great for some people, but there is evidence that supplementing with DHEA may promote the growth of prostate cancer [14, 15].
2) Testosterone (Total, Bioavailable, and Free)
Testosterone is a hormone mainly produced by the testes in men and the ovaries in women. Less than 10% is produced by the adrenal glands and brain in both sexes .
Testosterone has a diverse range of beneficial effects throughout the body. It [17, 18, 19]:
- Improves bone health
- Helps to build and maintain muscle mass (lean body mass) and strength
- Increases red blood cell production
- Improves libido and sexual function
- Increases sperm production
- Plays a role in mood and brain function
After the age of 30, total testosterone levels decrease by 1-2% a year in both men and women [20, 21, 22]. Free testosterone, the type that is not bound to anything and able to affect your cells and tissues, decreases at an even faster rate than total testosterone !
Fortunately, there are ways to optimize your testosterone levels and minimize this decline:
- If you are overweight, research suggests that the best thing you can do to increase your testosterone levels is to lose weight. Obesity decreases testosterone levels, and low testosterone, in turn, increases fat accumulation, resulting in a vicious cycle. Implement a healthy diet and exercise regime to reach your weight goals [24, 25, 26].
- Another important factor in testosterone production is sleep. Make sure you are getting enough uninterrupted sleep. This means avoiding blue light before bed or wearing blue-light blocking glasses, not drinking caffeine too late in the day [27, 28, 29, 30].
- Another great way to boost your testosterone levels is to exercise. Engage in moderate-intensity aerobic exercise several times a week [31, 32, 33, 34, 35].
- Check your zinc and vitamin D levels, and increase them if you’re deficient [36, 37, 38]. Zinc is a crucial mineral for testosterone production. You can boost your zinc levels by eating oysters, beef, crab, cashews, and pumpkin seeds [36, 37]. You can boost your vitamin D levels by spending more time in the sun.
- Discuss the following supplements with your doctor. Studies suggest they may help increase testosterone levels
- Tongkat Ali (Eurycoma longifolia) [39, 40, 41]
- Ashwagandha (Withania somnifera) [39, 42, 43, 44, 45, 46]
- Fenugreek [39, 47, 48, 49]
- Mucuna pruriens [39, 50]
Remember, always speak to your doctor before taking any supplements, because they may interfere with your health condition or your treatment/medications!
HDL-C, also known as the “good cholesterol”, is cholesterol that is being carried away from the cells and blood vessels back to the liver to be removed from circulation .
Higher HDL-C levels are associated with a lower risk of heart disease. As we age, our HDL-C levels decrease gradually and our risk of heart disease increases [51, 52, 53, 54].
You can help slow this decline by:
- Exercising regularly. People who are less physically active have lower HDL-cholesterol levels .
- Losing weight if you are overweight [56, 57, 58, 59].
- Eat a balanced, healthy diet. Studies suggest that fiber, found in fruits and vegetables, is beneficial in general, while eating processed carbs can have a negative effect on HDL-cholesterol [60, 61].
- Adding nuts to the diet. Hazelnuts, almonds, pistachios, cashews, walnuts, and macadamia nuts can have a beneficial effect on HDL-cholesterol levels [62, 63, 64, 65, 66, 67, 68, 69, 70].
- Drinking alcohol in moderation (1 drink per day) can increase HDL-cholesterol, but it’s controversial as to whether this is beneficial. Discuss your alcohol consumption with your doctor [71, 72, 73].
4) C-reactive Protein
As we age, inflammatory markers increase, a phenomenon known as “inflammaging”.
One of the most important inflammatory markers that increase with age is C-reactive protein (CRP). CRP is a protein that rises in response to inflammation and infection in the body. High levels have been linked to heart disease and cancer [74, 75, 76].
Besides aging, many things can increase CRP levels – including smoking, heavy alcohol use, poor sleep, obesity, and infections [77, 78, 79, 80, 81].
To reduce your CRP:
- Keep your stress in check [82, 83]. Stress-reducing activities such as yoga, tai chi, and meditation all reduce CRP levels [84, 85, 86, 87, 88, 89].
- Make sure your diet is healthy, well balanced, and contains all the necessary nutrients. Increase the amount of fiber and fruits and vegetables in your diet. Studies show that high-fiber, fruit- and vegetable-rich diets are associated with lower CRP levels [90, 91, 92, 93, 94, 95, 96].
- Exercising regularly also reduces CRP levels .
Find more advice on lowering CRP here.
Hemoglobin A1c (HbA1c) is a measure of your average blood sugar (glucose) levels over the past three months.
As we grow older the cells that release insulin (beta cells) don’t work as well as they used to, and our ability to control our blood sugar levels gets worse. This means that sugar hangs around in our bloodstream longer than it should and starts to stick to proteins on our red blood cells (hemoglobin). This causes a gradual increase in HbA1c as we age [98, 99, 100].
High HbA1c increases the risk of diabetes, and has been associated with cancer, heart disease, and mortality [101, 102, 103, 104, 105, 106, 107].
There are several things you can do to decrease HbA1c:
- Avoid sugary foods and processed carbs [108, 109]
- Increase your fiber intake. Fruits and vegetables are generally rich in fiber, and studies show they can help keep your blood sugar levels under control. Beans, chickpeas, broccoli, berries, pears, avocado, and nuts are all great fiber sources [110, 111, 112, 113].
- Moderate to vigorous exercise will help keep your HbA1c from rising. Exercise improves the way our body uses glucose and lowers HbA1c levels [114, 115].
- Interestingly, gum issues such as inflammation can increase HbA1c, so make sure you are brushing and flossing regularly and visiting your dentist [116, 117].
Read about other steps you can take to decrease HbA1c here.
Triglycerides are fats that circulate in the blood and are used as an alternative fuel source to glucose. High levels are linked to an increased risk of type 2 diabetes and heart disease .
For whatever reason, our triglyceride levels increase as we age. In men, levels peak between 40 and 50 years of age, and then decline slightly after, while in women, triglycerides increase throughout their lifetime [119, 120, 121, 122].
Tweaking your diet and lifestyle can help decrease your triglyceride levels:
- One of the most important things is to avoid overeating in general. Eat smaller portions. Also, eat less sugary and processed foods and minimize your intake of saturated and trans fats. When there’s an excess of calories, the body turns them into triglycerides and stores them as fat [123, 124].
- Aerobic exercise such as running, swimming, or cycling can help lower your triglyceride levels .
Omega-3 (DHA) is a beneficial supplement that can help decrease triglyceride levels [123, 126, 127, 128, 129]. Find more supplements that studies showed to work here.
Homocysteine is an amino acid your body produces from another amino acid called methionine. It is usually found in very small amounts in your body. That’s because your body converts it efficiently into other products with the help of vitamins B6, B12, and folate (B9) .
Homocysteine increases with age, possibly due to deficiencies in one or more of these vitamins [131, 132, 133, 134].
This is concerning because high levels of homocysteine contribute to the narrowing and hardening of the arteries, and may increase the risk of heart disease and cognitive decline [135, 136].
If your homocysteine is high, you should check your vitamin B6, vitamin B12, and folate levels. Correcting deficiencies in these will bring your homocysteine levels down.
These deficiencies are sometimes due to low dietary intake, but are more often caused by underlying health issues, such as gut issues that impair nutrient absorption.
Work with your doctor to address low levels of these vitamins!
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Anemia in the Elderly
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Truths About Lupus and Aging
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Lupus (systemic lupus erythematosus or SLE) can influence your normal aging process, and your normal aging process wise can have an effect on your lupus symptoms and your quality of life. What should you know?
You probably know that lupus is a lifelong illness, and you know how you feel today. But how will the disease treat you as you grow older? Let's take a look not only at some of the problems you may face as you get older with lupus, but at some of the positive aspects of aging with the disease. Aging with lupus is not all negative.
It makes sense that lupus and aging may affect one another. After all, there are immunological similarities between lupus and aging at the clinical, cellular, and molecular level.
Features such as an increased risk of infection and an increased incidence of tumors are common to both lupus and aging.
But how do these features translate into real life? What might you expect as you age with lupus?
Many people are relieved to hear that lupus-related symptoms may improve with age, but we've learned that the severity of the symptoms may increase. Part of the reason behind this is that as you get older you not only have to cope with your symptoms but must also cope with the sum of your disease activity in the past and the damage it has caused.
Chronic pain can be a challenging condition not only because of the pain itself, but also because of an increased risk of side effects related to pain treatments.
Nonsteroidal anti-inflammatory (NSAID) medications such as Advil (ibuprofen) may cause kidney dysfunction or gastrointestinal bleeding, and Tylenol (acetaminophen), when it helps, may not be the best choice if you have abnormal liver function.
The kind of pain that may have been controllable with a single pain-related treatment when you were younger may now require multiple treatments.
Fatigue can also be progressive—and sedentary behavior related to the accumulation of lupus damage aggravates fatigue that is already present.
Physiological damage from lupus accumulates over time, and it can lead to joint destruction and chronic pain. You may need physical therapy to deal with stiffness, or joint replacements to cope with eroded cartilage in your knees or hips. Physical therapy or orthopedic surgery mean additional clinic visits, more pain, and higher health care costs.
With age, progressive bone loss may result in osteopenia or osteoporosis. Having lupus puts you at an increased risk of osteoporosis, for several reasons.
One of these is that some of the medications for lupus, such as corticosteroids (for example, prednisone) can rapidly accelerate bone loss (glucocorticoid-induced osteoporosis).
The sedentary lifestyle that living with lupus often demands also raises the risk. Finally, there appears to be a direct link between lupus and bone loss.
Fractures due to bone loss are more common with lupus, especially spinal (vertebral) fractures. In fact, women with lupus may be up to five times more ly to experience an osteoporosis-related fracture than those without the disease. The risk for men with lupus is elevated as well.
Whether you develop osteoporosis depends on many factors, and your weight, genetics, and whether or not you smoked all play a role. A bone density test is recommended for all women over the age of 65, and earlier in life if risk factors—such as lupus—are present.
Fortunately, there are ways to reduce your risk. Making sure you get adequate vitamin D is helpful and carries other health benefits as well for people with lupus. If your doctor hasn't checked your vitamin D level, ask for it to be done.
Sources of vitamin D include sunlight and some foods, but for low levels or low-normal levels, a vitamin D3 supplement may be recommended. Medications for bone loss, in addition to increasing bone density, can also help lower your risk of fractures.
Because you have a higher risk of fractures if you have lupus, your doctor may recommend using medications not only if you have osteoporosis, but if you are diagnosed with osteopenia (reduced bone mass which may develop into osteoporosis).
Hormone replacement therapy (HRT) has a controversial history because of its presumed connections to breast cancer and cardiovascular disease risks. That said, there are still many women who take these medications with estrogen plus or minus progesterone.
Postmenopausal women with lupus who are considering HRT should discuss the benefits and risks with their doctors. In studies, HRT has been associated with an increased risk of mild to moderate lupus flares, but no increase in severe flares. On the other hand, some women find that HRT significantly improves their menopausal symptoms and improves quality of life.
Each woman is different, and you must weigh all of these factors in making your decision about hormone replacement therapy.
If you are interested in alternative methods of managing hot flashes and other menopausal symptoms, proceed with care and educate yourself: More research is needed to determine the overall safety and effectiveness of herbal and over-the-counter remedies.
Women who have had breast cancer (or are at high risk) should not use HRT, but they should also avoid supplements containing soy and isoflavones, which affect the body's estrogen levels and may be harmful.
We tend to focus on the negative aspects of aging and how it negatively affects chronic medical conditions. The truth, however, is that there is positive news about aging with lupus, and sometimes focusing on these aspects—the so-called silver lining—makes coping a bit easier.
- Symptom Activity Tends to Improve with Age: As a person ages, lupus activity—or the degree of inflammation and autoimmune response present—typically declines. This may lead to adjustments in treatment, which may include reducing the amount of medication you take. This improvement is fairly consistent over time and appears to be unaffected by menopausal status.
- Older People Are Less ly to Develop Lupus Nephritis: When lupus affects the kidneys, it is referred to as lupus nephritis. Some studies have found that older people are less ly to suffer from kidney diseases associated with lupus, though we don't entirely know why. Other studies, however, suggest that the severity of lupus nephritis may worsen with age. For those who do encounter kidney issues, at any age, the treatment is the same.
- Lupus Can Go Into Remission at Any Age: Lupus remission can occur at any age. An Italian study published in 2015 found that 37 percent of people with lupus who got standard treatment went into remission for at least five years. There is not yet a clear definition of remission in lupus, but in this study, those considered to have prolonged remission had no clinical or laboratory signs of the disease and were no longer taking either corticosteroids or immunosuppressant medications.
Living with lupus and feeling as good as you can involves more than simply taking your medications. Even without lupus, people tend to age better when they maintain a healthy diet and get regular exercise. It's well worth the effort to take time to review your life and make any needed changes to keep yourself as healthy as you can be.
For starters—and if you haven't thought specifically about your diet and lupus—find out how to eat in a way that decreases your lupus symptoms. Lupus is a systemic disease, so a diet rich in fruits and vegetables and low in pro-inflammatory foods is a good choice.
No specific foods have been shown to alter the course of lupus; however, two foods to avoid are garlic and alfalfa sprouts.
Scientists believe that three substancs in garlic—allicin, ajoene, and thiosulfinates—increase immune system activity, which may cause flare-ups; and alfalfa sprouts contain an amino acid called L-canavanine that may have a similar effect.
Stress can cause the release of so-called stress hormones that can negatively affect your health. Ask your physician or conduct some research on the many simple stress management techniques that can benefit you whether or not you're living with lupus.
Falls are a leading cause of injury and death as people age, and we already know that people with lupus are more ly overall to fracture a bone (especially the spine and hips) when they fall.
Preventive measures such as eliminating throw rugs, keeping items off the stairs, avoiding icy sidewalks, and turning on the lights when you get up to go to the bathroom at night may all reduce your risk.
Take a moment to review measures you can take to reduce your risk of slips and falls.
Of course, regular physician visits are important to manage any of your potential risk factors.
Since the risk of heart disease is increased with lupus, your doctor may pay special attention to risk factors such as high blood pressure, increased cholesterol, and insulin resistance or diabetes.
Certain types of cancer are more common in people with lupus, and since cancer risk increases with age, it's important to follow guidelines for early detection.
Some people with lupus find that as they age, they have more time to get involved in a lupus support group. These groups not only provide a wonderful source of support, but they can also help you access the latest lupus research.
After all, nobody is as motivated to learn about new treatments and ideas than those living with the disease.
If you are uncertain about where to start, check your local hospitals, or go online to sites such as Lupus Foundation of America or Lupus Research Alliance.
Lupus and aging are associated in several ways, and understanding these issues allows you to be your own advocate in health and medical care. With age, symptom activity with lupus often declines, but symptoms you already have may grow more severe. The accumulation of damage over years may result in the need for joint replacements or other treatments.
The risk of osteoporosis-related fractures is much higher among people with lupus than in the general population.
Whether or not you live with lupus, you should have a bone density scan performed some time before age 65—much sooner if your physician thinks it's warranted.
Several medications can reduce fracture risk if you do develop bone loss. Practicing caution and thinking about fall prevention is probably equally helpful.
Along with a reduction in symptom activity, the risk of lupus nephritis may decline with age. And people of any age with lupus can achieve prolonged remission.
Blood tests and age-related changes in older people
Many signs and symptoms of disease in older patients are attributed to old age without further investigation, leading to conditions being undiagnosed and untreated
Many age-related changes in health can be detected in blood tests. In particular, renal function deteriorates with age, and this is factored in when estimating the glomerular filtration rate.
However, some symptoms may be wrongly attributed to old age, while some medication can mask, exacerbate or cause problems in older people.
This article looks at specific areas of pathology to help practitioners use blood tests to understand, recognise and treat diseases in older patients.
Citation: Blann A (2014) Routine blood tests 3: blood tests and age-related changes in older people. Nursing Times; 110: 7, 22-23.
Andrew Blann is a consultant at City Hospital, Birmingham, and senior lecturer in medicine, University of Birmingham.
Old age is often equated with failing health. However, while the body’s functioning declines as it ages, not all ill health in older people can be attributed to age. This means practitioners often have to determine whether certain physical changes in older patients, such as a loss of energy, appetite or weight, are a normal part of ageing or a sign of an abnormality.
Some common health problems in older people may be related to social factors such as poor diet, the consequences of living alone or the effects of hypothermia. It is vital that such problems are identified and addressed, and this often requires blood testing.
Laboratory results outside normal reference ranges are more common in older patients because they have an increased lihood of disease, and are more ly to be using prescription drugs, sometimes in combinations. This has led to debate as to whether there should be a different set of reference ranges for certain blood tests for older patients.
The kidney’s ability to remove waste products (creatinine and urea) declines with age, possibly due to a progressive loss of nephrons. However, since muscle produces most of the body’s serum creatinine, the loss of muscle mass that is a normal part of ageing may in part counter this by reducing the demands on the kidneys.
The effect of age on renal function is so significant that is factored into both of the most commonly used calculators for the estimated glomerular filtration rate (eGFR): those of Cockcroft and Gault; and of the Modification of Diet in Renal Disease consortium (Blann, 2014). For example, using the latter calculation, a serum creatinine result of 90µmol/L in an 85-year-old woman indicates chronic kidney disease (CKD) stage 3, whereas the same level in her 25-year-old granddaughter indicates less severe CKD stage 2.
Knowing the level of renal function or disease is important because many drugs are excreted through the kidney.
Any degree of renal failure may mean drugs remain in the blood for longer, continuing to have a pharmaceutical effect.
This leads to a prolonged half-life and higher biological action of the drug, so the dose may need to be reduced if a patient is over a certain age or has impaired renal function.
Cholesterol levels are affected by diet and tend to increase with age. This is therefore taken into consideration when assessing the risk of cardiovascular disease, and may trigger the prescription of a statin.
Plasma glucose also tends to rise with age, increasing the lihood of impaired glucose tolerance. However, this does not necessarily increase the risk of diabetes unless the patient is overweight or obese. It is largely presumed that weight goes up with age as older people take less exercise but do not reduce their caloric intake.
Hypothyroidism is often found unexpectedly in older patients, which may justify widespread screening of thyroxine or thyroid stimulating hormone (TSH) through blood tests.
Some hypothyroidism symptoms, such as fatigue, weight gain and the impression of generally “slowing down”, may be incorrectly interpreted as signs of normal ageing.
Hyperthyroidism is found less frequently in older people.
Many prescribed drugs can affect thyroid physiology. For example, L-dopa and glucocorticoids suppress TSH, while lithium inhibits the secretion of thyroxine. Amiodarone (prescribed for atrial fibrillation) has a structure that resembles thyroxine; hypothyroidism is a side-effect of amiodarone, although hyperthyroidism may also occur (Martino et al, 2001).
Osteoporosis is a major public health issue in older people. One in four women and one in 20 men over the age of 60 years has the condition (Blann and Ahmed, 2014), which is often recognised by curvature of the thoracic spine, known as kyphosis or colloquially as “dowager’s hump”.
Osteoporosis is also the leading cause of fractures sustained after a fall; such a fracture may be the first indication of the condition.
In the US in 2005, the two million fractures resulting from osteoporosis exceeded all the new cases of diabetes, coronary heart disease events, stroke, heart failure, breast cancer and overall cancer cases (Curtis and Safford, 2012).
No laboratory tests can help in direct diagnosis or management, but tests can help to identify other conditions affecting the bones.
Osteomalacia is characterised by softening of the bones due to a defect in mineralisation of the bone matrix, cartilage or both. It is rare, but more common in certain ethnic groups, such as those from South Asia, and in older people. It is commonly caused by deficiency in calcium and/or phosphate (both are required for bone mineralisation).
Calcium deficiency may be due to an insufficient intake of vitamin D, which could be dietary or caused by low exposure to sunlight, while phosphate deficiency can be due to malnutrition or malabsorption, and insufficient vitamin D, which is the key blood test.
Paget’s disease, also known as osteodystrophia deformans, is caused by disruption in the process of bone turnover. It is characterised by new bone being laid down in an abnormal pattern, leading to structural changes and enlarged, misshapen bones that are weak and brittle.
The disease is more common in men, and is rarely diagnosed in people aged under 40. As many people with Paget’s disease are asymptomatic, it is difficult to estimate its prevalence, but it may affect about 5% of the UK population over the age of 55 years (Ooi and Fraser, 1997).
Clinical features include bone pain and bone deformities such as bowed tibia and kyphosis.
Serum calcium and phosphate levels tend to be within normal reference ranges in patients with Paget’s disease, but hypercalcaemia may occur in those who are immobilised. The abnormal bone turnover causes increased activities of the enzyme alkaline phosphatase, which can be measured by a blood test.
Bone pain with increased serum calcium, grossly elevated erythrocyte sedimentation rate (ESR) – which measures inflammation – and anaemia may be related to malignant myeloma.
Patients with these symptoms require a full blood count, serum proteins and serum electrophoresis, as well as X-rays of the skull and areas of bone that are painful.
These patients are at risk of renal disease, detectable with urea and electrolytes.
Osteoarthritis (OA), which affects the major joints of the hips and knees, rarely has extra-articular manifestations and cannot be identified in a blood test. Rheumatoid arthritis (RA), is a systemic inflammatory disease and is ly to be associated with the following:
- Reduced haemoglobin, resulting in symptoms of anaemia;
- Increased ESR;
- Increased C-reactive protein (a measure of inflammation);
- Increased rheumatoid factor (an autoantibody).
It could be argued it is normal for ESR to rise with age; however, some contend that this shows a low level of pathology, such as inflammation. There is similar disagreement over low levels of haemoglobin, with some practitioners accepting that levels that would lead to investigations in younger patients are a normal part of ageing.
The leading risk factor for RA is being female, whereas risk of OA is increased by “wear and tear” of major joints, most ly caused by being overweight.
Prostate-specific antigen (PSA) rises with age, but this may also be due to asymptomatic benign prostatic hyperplasia or prostate cancer.
Many cases of ovarian cancer are marked by increased levels of the blood test CA-125. However, raised levels may be present in other cancers, such as lung, breast and bowel. The National Institute for Health and Care Excellence (2011) recommends an abdominal ultrasound if the CA-125 is 35IU/ml or greater.
The relatively high frequency of certain diseases often prompts screening programme initiatives to detect asymptomatic diseases in older people. However, few tests alone have sufficiently robust sensitivity and specificity to fully diagnose the conditions discussed above. Blood tests are far more cost effective when used alongside signs and symptoms.
- Health professionals often need to identify whether health changes are a normal part of ageing or a symptom of disease
- The kidney’s ability to excrete waste products decreases with age
- Cholesterol levels tend to rise with age, making cardiovascular disease more ly
- Osteoarthritis cannot be detected by blood tests
- Few blood tests are sufficiently robust to fully diagnose the diseases commonly found in older people
Also in this series
Blann A (2014) Routine blood tests 1: why do we test for urea and electrolytes? Nursing Times; 110: 5, 19-21.
Blann A, Ahmed N (2014) Blood Science: Principles and Pathology. Oxford: Wiley-Blackwell.
Curtis JR, Safford MM (2012) Management of osteoporosis among the elderly with other chronic medical conditions. Drugs and Aging; 29: 549-564.
Martino E et al (2001) The effects of amiodarone on the thyroid. Endocrine Reviews; 22, 240-254.
National Institute for Health and Care Excellence (2011) The Recognition and Initial Management of Ovarian Cancer. London: NICE.
Ooi CG, Fraser WD (1997) Paget’s disease of bone. Postgraduate Medical Journal; 73: 69-74.
Loeser RF (2011) Aging and osteoarthritis. Current Opinion in Rheumatology; 23, 492-426.
Papaleontiou M, Haymart MR (2012) Approach to and treatment of thyroid disorders in the elderly. Medical Clinics of North America; 96, 297-310.