Medicine & Research

MS and the Older Population

By Marijean Buhse, Ph.D., RN, NP-C, MSCN, FAAN
Multiple sclerosis is an inflammatory and demyelinating disease of the central nervous system. Most people present with relapsing forms of MS and are diagnosed between ages 18-40, although diagnosis can be earlier or later in some. Regardless of age or type of MS when diagnosed, it is no longer only a disease of early adulthood. Research shows that MS, once thought to shorten lifespan, does not, and persons diagnosed in their 20s may live at least 50 years with this disease. It is estimated that more than 25 percent of persons living with MS are adults older than 55.

As people age, the immune system ages also. The role of the immune system is to protect the body against disease from foreign and harmful substances. This includes, but is not limited to, bacteria, viruses, cancer cells, and other microorganisms that can cause disease. With age, the immune system is less able to adequately respond to disease and less able to repair when a person gets a disease. There is an increased risk of getting sick and slower healing. It is thought that because of the aging of the immune system, chronic illnesses such as cancer, heart disease, and autoimmune diseases such as diabetes are more frequent in adults. 

In 2021, the National Council on Aging reported that 68 percent of people older than 65 have two or more chronic diseases. The presence of two or more diseases in a person at one time, called comorbidities, are much more common in older adults than younger ones. In persons with MS, the immune system is already dysregulated and with aging they are just as susceptible to disease as their aging counterparts. 

Comorbidity and MS

Significant improvements in treating MS and comorbidities have increased life expectancy. Disease-modifying therapies have changed the course of MS, in that early and continuous treatment may prevent permanent damage to the central nervous system. However, little is known about treating older adults with DMTs. Clinical trials for all approved drugs included few persons over the age of 55, so it was difficult to confirm whether these treatments are safe and effective. Studies are ongoing to determine if or when an older person should be taken off a DMT because of aging and comorbidity. 

Comorbidities treated in older persons with MS may differ slightly from the general aging population. For instance, the most frequent comorbidity in the aging population is arthiritis. In MS, the most common comorbidities include cardiovascular disease (e.g., vacular disorders, high blood pressure, high cholesterol), psychiatric disease (depression and anxiety), diabetes, thyroid disease, and cognitive impairment. Also, symptoms of MS may affect persons with MS negatively as they age. Fatigue, pain, low vision, weakness, spasticity, decreasing mobility, and bladder and bowel dysfunction can impair the ability of persons with MS to get to their primary care provider for diagnosis and treatment. 

Activity and Exercise 

Sedentary behavior is common in the older population. The levels of exercise are very low, and in a study of older adults, it was found that most engaged in 13 minutes of exercise daily compared to 423 minutes of sitting. Older persons with MS have even more sedentary behavior and less exercise than their elder counterparts. Inadequate exercise is very common and may be the result of disability, comorbidities, and other symptoms of MS. Physical inactivity, no matter how disabled the person may be, is associated with decreased functioning in the older persons with MS. 

The importance of exercise cannot be overstated. It is well-known that exercise increases endorphins and gives the participant a sense of wellness. It has both physical and mental benefits. Joining an exercise class for adults not only provides exercise but can also offer social interaction. Various exercise programs for older persons with MS are available to anyone who wants to begin. For instance, if a person with MS is disabled and cannot get to a class, chair yoga is a good way to begin, and classes can be accessed through the Internet. 

During the pandemic, many exercise programs for disabled people went online and now YouTube is filled with free videos for those who want to try. If a person with MS can walk, beginning a program of walking is very beneficial. While it's safe for most people to begin an exercise program, all new attempts at exercise should begin slowly and safely. As always, discussing the exercise plan with a healthcare proivder is advised. 

Quality of Life

Quality of life has been defined as the degree to which a person or group is healthy, comfortable, and able to enjoy the activities of daily living. Good quality of life can be challenging when living with any chronic disease and older people with MS may be living with comorbidities. In MS, certain comorbidities have been shown to decrease quality of life. 

Depression is the most common mood disorder in the MS population and can affect more than half of the people with MS at some point of their lifetime. It has been shown to be the main contributor to decreased quality of life. Depression not only affects mental quality of life, but it can affect a person's physical quality of life. It can impair motiviation to do things and can limit progress physically. Importantly, depression is often unrecognized and undertreated by healthcare providers. 

However, studies of mental health in older and younger persons with MS found older persons are better able to cope with changes as they occur and are less reactive to problems. The ability to adapt to disease and disability over time may be the reason older people with MS report fewer mental health issues than their younger counterparts. In one study, older people with MS were in better mental health than physical health and a common theme was they had lived with MS for a long time and learned how to better manage the effects. 

According to the National Council on Aging, older adults report improved well-being while socially active, working or volunteering, and during exercise. Although many older people with MS do not work, maintaining social interaction and an exercise program can improve quality of life. During the pandemic, social isolation was common because of the need to quarantine to avoid COVID-19.

However, many people used the Internet to engage with others. Remaining socially engaged with friends and family through direct contact, technology, or phone can improve quality of life. Physical activity, as listed above, is known to increase mood and helps slow disability in people with MS. Joining a program specifically for those with MS may increase social activity and mood. 

Living long with MS

An important goal of healthy aging is living a longer and better life. A longer life for people with MS can be wonderful yet challenging. Physical and psychological problems can cause unique challenges in patients with MS because of age-related and MS-related comorbidities. Seeking advice regarding any new or changing symptoms of MS from your healthcare provider and completing age-related and preventative health screenings will guide treatment to minimize the effects of comorbidities on MS.

Maintaining an exercise program, being socially active, and receiving treatment for mental health issues has been shown to increase quality of life in older people with MS. As a person ages, it becomes very important to reflect on and accept one's life. Changes occur and challenges may seem daunting but with guidance and help from family, friends, and healthcare providers, older people with MS can have a long and fulfilling life.