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Aging With MS

By Cherie C. Binns RN BS MSCN

Recently, I had the opportunity to participate in a town hall discussion on aging in multiple sclerosis presented by the International Organization of Multiple Sclerosis Nurses. Marijean Buhse, Ph.D., RN, NP, MSCN, was the featured speaker. As a nursing researcher and faculty member at Stonybrook School of Nursing on Long Island, she has spent several years observing aging patterns in the MS patient.
One of the things that she said that really struck me was that most of us living with MS, will live with the condition for more than 50 years before we die. She said that at least 90 percent of us will live a lifespan that meets or exceeds that of our age group in general. However, those of us with a chronic illness, such as MS, are only now being looked at as aged not at age 65 or 70 but starting as early as 55 because of the long-term strain on our bodies from having a chronic illness and also from the aging of the kidney or liver from processing the symptom management and disease-modifying treatments to improve our quality of life. For us, this may mean drugs are not metabolized as safely or efficiently and we may need lower dosing or avoidance of certain substances altogether.
From data bases available to us, Dr. Buhse stated that in 1964, 9 percent of people with MS were older than 65. As of 2010, 25 percent of us are now over the age of 65. At this point in our lives, we tend to have more visual deficits, cognitive issues, bladder problems (especially for women), slowing of the GI tract and comorbidities such as high blood pressure, diabetes, and elevated cholesterol than our non-MS counterparts.
We often have fewer friends because as our activity level changes we may no longer be included in the theater, golfing, or dinner groups that once were a part of our lives. Accessibility may be an issue to doing things we enjoy, so the friends we enjoyed those activities with often fall away and contact is minimized, if not lost altogether. Also at this age, all of us have friends who have been lost to heart attacks, cancer, accidents. As a result we tend to be lonelier and that often will lead to depression.
In her presentation, she discussed side effects of medications to manage spasticity, cognition, constipation, depression, and bladder problems and how all seem to pile atop each other to magnify side effects. Therefore, her recommendation is to start a low dose of any new medication and go slowly when increasing dosing. She also is a great proponent of using the least expensive medication to treat a problem in this group of patients as there are generally so many medications being utilized that cost is prohibitive, especially in patients receiving Medicare Drug coverage. This is especially true if one is on a disease-modifying therapy, which can cost thousands of dollars each month.
What surprised her when she began working with this age group of people with MS was that only 40 percent were on a DMT. Of the remaining 60 percent, a majority were told by their neurologists that they could no longer be helped by medication and refused to continue prescribing. In a few instances, insurance companies had denied coverage for DMTs past the age of 65. This is a situation that concerns her greatly and she implored the nursing community audience to act as advocates to keep legislation on the table to provide medication that either the patient or the physician sees as necessary with no age bias. She did say that compliance with taking the DMT was at or near 100 percent in this older group versus about 60 percent in the 30-40 age range group. Her theory was that the older person with MS knows what a relapse can do to their quality of life and will do anything in their power to avoid one.
One other point she emphasized was the importance of daily exercise in anyone with MS. “Just Move it!” Do anything that gets you moving and keeps you moving. And she stressed that smoking is the single greatest common factor in decline in multiple sclerosis and urged all of us to stress that our patients have stop smoking programs and support offered as a primary treatment as they move toward wellness with multiple sclerosis.
To listen to the podcast of her talk and the nursing discussion that followed, visit iomsn.org/podcast-2012-13, scroll down to the title “Aging and MS” and click play. It is less than a half hour in length.