2023 MINDS Essay Competition entry

Question:

You watch an elderly gentleman walk down your local high street. Every few metres or so he stops walking, before resuming a short while later.

Why might this gentleman have to stop and resume his journey so frequently?

When society see the elderly, they often assume their slow walking pace and other physical traits are all due to the inevitable frailty that comes with their old age. However, there is often much more complexity to the scientific understanding as to why we may see several elders struggling similarly to this male- who repeatedly stops walking and resumes shortly after. As a society, we should stop making assumptions and accepting that ‘that’s just the way of life and ageing’ and instead understand what the medical causes of this may be. This could then allow us to identify if it’s possible to help the future generations in a way that will prevent these health conditions from increasing in prevalence.

A potential factor that could be resulting in this behaviour is an issue with circulation and the heart. The risk of developing heart disease increases with age. It is usually associated with atherosclerosis, which is the hardening of arteries, because of plaque build-up and is “the most common aging change” of the circulatory system (National Institue on Aging, Jun 2018). Therefore, perhaps this old male’s need to take breaks is related to potential atherosclerosis. The build-up of cholesterol plaques, in the lining of the arteries, will cause them to narrow over time and this narrowing can therefore significantly restrict blood flow (Mayo Clinic, Jul 2022) to certain organs. As this male is having difficulties in walking, perhaps he is experiencing problems with blood flow to leg muscles. This would be because: the potentially blocked arteries, supplying blood to leg muscles, will not be supplying sufficient blood to these muscles. Without sufficient blood, these muscles won’t receive the glucose and oxygen that they need to aerobically respire, and therefore contract. The reduction in the oxygen supplied to the leg muscle cells may mean they begin respiring anaerobically, which can lead to a build up in lactic acid. This build up may result in a leg cramp, which could be the reason to his stopping due to the pain experienced by muscle cramp in the leg.

Additionally, if the arteries were narrowed- instead of blocked- then his walking would result in sudden demand for leg muscle contraction, that may not usually be done regularly due to his age. This exercise causes an increased demand for blood to be supplied to leg muscles, however this can’t be met by the arteries, due to their narrowing, so frequent breaks would be required for sufficient blood to be pumped for movement.

Another organ closely linked to oxygen are the lungs. Many factors often contribute to respiratory disorders, but the main two are: smoking history or habitant of highly polluted areas (World Health Organisation, n.d.). Smoking is notoriously known for its destruction to the respiratory system. This is due to the carbon monoxide which binds to the haemoglobin in the blood, displacing oxygen- therefore, depriving organs of the necessary oxygen required for effective function (FDA, March 2020). Again, this deprivation of oxygen supplied to his leg muscles, may also be a cause to leg cramps and muscle pain, therefore the need to take regular breaks. Smoking causes inflammation and irritation to the lungs, therefore destroying its lining (UPMC: Health Beat, Feb 2023). This irritation to the alveoli will reduce the effective diffusion of oxygen into the blood, and carbon dioxide out, as the membranes of this specialised gas exchange surface would be damaged. This leads to emphysema and chronic bronchitis which are associated with Chronic obstructive pulmonary disease (COPD). COPD is common in aged 40+ adults who smoke or have a smoking history. Emphysema is damaged alveoli, and chronic bronchitis is the long-term inflammation and narrowing of the airways (NHS, Sept 2019). This reduces airflow, making it difficult for the person to breathe- often leads to wheezing. Perhaps this old male is or was a smoker and therefore could be suffering from symptoms of COPD as this shortness of breath (due to reduced airflow) could be causing him to regularly stop for breath. Living in areas of high pollution would also have similar effects as it will irritate your airways, also causing shortness of breath and wheezing.

There may be neurological reasons that cause this behaviour. Perhaps as a result of one of the previously listed conditions, poor blood circulation could damage brain cells, potentially causing light-headedness (Penn Medicine: Lancaster General Health, September 2022). Subsequently, this male could be dizzy because of the lack of blood circulated to his brain, and this dizziness, could be causing him to take frequent breaks to ease this sensation of disorientation.

Furthermore, in more serious cases, reduced blood flow to the brain can lead to people having problems with memory. Vascular dementia is a condition caused by a blood clot (from conditions like atherosclerosis, heart disease, stroke) that causes reduced blood flow, damaging brain tissue. Its prevalence increases for those older than 65years. Symptoms of this condition involve problems with movement or balance and stroke symptoms, like sudden weakness (John Hopkins Medicine, n.d.). These could potentially be causing this male to struggle with moving. Perhaps his balanced has been impaired, prompting these frequent breaks to prevent falling. Despite this, there are other factors that can affect balance, which could be potential conditions this male faces.

For example, the inner ear (labyrinth) is responsible for balance. Labyrinthitis is the term for the condition involving the inflammation of this region of the ear. Furthermore, this can lead to imbalance and vertigo (National Institute on Aging, n.d.). The inflammation could be a result of an infection (which susceptibility for increases with age) in the ear. This could be likely due to the elderly’s decrease in the immune system’s ability to effectively fight against pathogens, therefore making them at a higher risk to develop infections.

The brain is the region which dominantly controls co-ordination and balance. Specifically, it is the cerebellum that leads this, however if damaged then it can cause the reverse, and instead impair movement and balance. A condition linked to this, is cerebellar degeneration which can either be genetically inherited, or for some it may be acquired from a stroke (National Institute of Neurological Disorders and Stroke, 2023). Perhaps this old male has survived a stroke and therefore he may be suffering from cerebellar dysfunction because of this. The blocked blood vessel from the stroke, may have resulted in the neurons in the cerebellum dying, which would deteriorate the region’s overall function, and this is often observed with decreased muscle tone and the co-ordination in both skeletal and smooth muscle tissue being lost (Doll, Jul 2022). Both symptoms could potentially be linked to this male’s irregular walking pattern, as issues in co-ordination may mean he finds it difficult to walk consistently and instead takes breaks to help readjust. This is because decreased muscle tone means there is a decrease in the number and size of the muscle fibres (which can sometimes , otherwise be caused by sarcopenia, which is an age-related condition of thinning muscles (Cleveland Clinic, March 2022)), which will mean that there is a reduced demand for oxygen and glucose to that area of the body. In this case that area may be leg muscles, and this decreased demand would result in less ATP being produced, which would further decrease the rate at which the leg muscles contract, causing the pace to be very slow and making mobility difficult.

Another area which could be researched for this, is the effect of medications (that the male is taking) on his circulation, respiration, and neurology. His doctor would be able to analyse the medications he regularly (or recently) takes and see potential side effects to narrow down the cause. If this were a cause, then it could arguably be easily solved: by withdrawing the medication from his prescriptions. However, there is then the counterargument of if there is another medication with the same medical purpose, but which will not involve the symptoms he had been experiencing.

In conclusion, there is an abundance of potential conditions or reactions that could lead to this male’s disrupted movement, it may be one that has been mentioned above, or it could be a combination of some of them as many medical conditions coexist as comorbidities in patients, and this likelihood increases with age. It may be most effective to analyse the male’s cardiac health first, as this is most likely an issue since many of the potential conditions are linked to oxygen deficits. If it is not, then it is useful to eliminate this and begin analysis of other potential causes.

Those who may have seen this male or similar scenarios on the street, would most probably label it as part of ageing, however ageing isn’t a direct medical cause for a symptom, instead, ageing can lead to a gradual decline in physical and mental capacity, which may make one more susceptible for conditions which cause these specific symptoms that the public may observe. It is not sufficient nor sensitive to title it based on age, instead the real biological and medical roots of this abnormal movement should be analysed.

Perhaps if this curious mindset, that doctors have when observing a patient, begins to be shared amongst the rest of society, then we could have a more sympathetic community where people are more willing to help others that may be clearly struggling in public. Creating a more sympathetic community may even be the key in saving more people’s lives. This would allow society to progress from hiding behind the bystander effect.

Bibliography

Cleveland Clinic, March 2022. Sarcopenia. [Online] Available at: https://my.clevelandclinic.org/health/diseases/23167-sarcopenia

Doll, J., Jul 2022. Kenhub- Cerebellar degeneration. [Online] Available at: https://www.kenhub.com/en/library/anatomy/cerebellar-degeneration

FDA, March 2020. Keep your air clear: How Tobacco Can Harm Your Lungs. [Online] Available at: https://www.fda.gov/tobacco-products/health-effects-tobacco-use/keep-your-air-clear-how-tobacco-can-harm-your-lungs#:~:text=Because%20tobacco%20smoke%20contains%20carbon,of%20the%20oxygen%20they%20need.&text=Other%20chemicals%20found%20in%20cigarette,sore

John Hopkins Medicine, n.d. Vascular Dementia. [Online] Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/dementia/vascular-dementia

Mayo Clinic, Jul 2022. Arteriosclerosis/ Atherosclerosis. [Online] Available at: https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569#:~:text=Atherosclerosis%20is%20the%20buildup%20of,leading%20to%20a%20blood%20clot.

MedlinePlus, n.d. Lipofuscin. [Online] Available at: https://medlineplus.gov/ency/article/002242.htm

National Institue on Aging, Jun 2018. Heart Health and Aging. [Online] Available at: https://www.nia.nih.gov/health/heart-health-and-aging#:~:text=Adults%20age%2065%20and%20older,risk%20of%20developing%20cardiovascular%20disease.

National Institute of Neurological Disorders and Stroke, 2023. Cerebellar Degeneration. [Online] Available at: https://www.ninds.nih.gov/health-information/disorders/cerebellar-degeneration

National Institute on Aging, n.d. Older Adults and Balance Problems. [Online] Available at: https://www.nia.nih.gov/health/older-adults-and-balance-problems

NHS, Sept 2019. Chronic obstructive pulmonary disease (COPD). [Online] Available at: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/

Penn Medicine: Lancaster General Health, September 2022. Heart Failure: Less Common Symptoms. [Online] Available at: https://www.lancastergeneralhealth.org/healthwise-library/condition-categories/heart-and-circulation?lang=en-us&DocumentId=tx4083abc

UPMC: Health Beat, Feb 2023. How Smoking Cigarettes Affects Your Lungs. [Online] Available at: https://share.upmc.com/2016/04/how-smoking-affects-lungs/

World Health Organisation, n.d. Chronic Respiratory diseases. [Online] Available at: https://www.who.int/health-topics/chronic-respiratory-diseases#tab=tab_1