ANNALS OF MEDICINE
THE WAY WE AGE NOW
Medicine has increased the ranks of the elderly. Can it make old age any easier?
he hardest substance in the human body is the white enamel of the teeth. With age, it wears away nonetheless,
allowing the softer, darker layers underneath to show through. Meanwhile, the blood supply to the pulp and the
roots of the teeth atrophies, and the flow of saliva diminishes; the gums tend to become inflamed and pull away from
the teeth, exposing the base, making them unstable and elongating their appearance, especially the lower ones. Experts
say they can gauge a person’s age to within five years from the examination of a single tooth—if the person has any
teeth left to examine.
Scrupulous dental care can help avert tooth loss, but growing old gets in the way. Arthritis, tremors, and small
strokes, for example, make it difficult to brush and floss, and, because nerves become less sensitive with age, people
may not realize that they have cavity and gum problems until it’s too late. In the course of a normal lifetime, the
muscles of the jaw lose about forty per cent of their mass and the bones of the mandible lose about twenty per cent,
becoming porous and weak. The ability to chew declines, and people shift to softer foods, which are generally higher in
fermentable carbohydrates and more likely to cause cavities. By the age of sixty, Americans have lost, on average, a
third of their teeth. After eighty-five, almost forty per cent have no teeth at all.
Even as our bones and teeth soften, the rest of our body hardens. Blood vessels, joints, the muscle and valves of the
heart, and even the lungs pick up substantial deposits of calcium and turn stiff. Under a microscope, the vessels and soft
tissues display the same form of calcium that you find in bone. When you reach inside an elderly patient during
surgery, the aorta and other major vessels often feel crunchy under your fingers. A recent study has found that loss of
bone density may be an even better predictor of death from atherosclerotic disease than cholesterol levels. As we age,
it’s as if the calcium flows out of our skeletons and into our tissues.
by Atul Gawande
APRIL 30, 2007
Photograph by Richard Avedon. Jacob Israel Avedon, Sarasota, Florida, December 19, 1972. This portrait is part
of a series that the photographer made to record his father’s last years.
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