As an age, the big 5-0 is not quite old but certainly not young. You can embrace it with a big birthday bash or contemptuously tear up the inevitable invitation to join AARP.
Nevertheless, visiting the doctor for a checkup at the half-century mark is bound to be a sobering reality check. Even using the word "century" in relation to one's own age ... ouch. "What a doctor sees is the sum total of what's happened for those 50 years," said Dr. Jerome Fleg, head of cardiovascular studies for the Baltimore Longitudinal Study of Aging, a project begun in 1958.
Consider a car metaphor: Did you squeal around corners, zip through yellow lights, jam on the brakes at stop signs and change the oil, oh, every 15,000 miles or so? And you think this baby could last another 50 years? Even 20? Better have a long look at the owner's manual to see where you go from here.
Dr. Halina Brukner, a general internist and vice chairman of the department of medicine at the University of Chicago, called age 50 a "threshold point, where you need to add some screening tests that haven't been done previously." Still, "it's not one size fits all," cautioned Dr. Carolyn Lopez, chairwoman of family practice at Cook County Hospital and a spokesman for the American Academy of Family Physicians.
"There's tremendous variability among 50-year-olds. We all have both different lifestyles and different genes."
Going back to the car metaphor, some of us had lemons from the start. No matter how much we babied these vehicles, stretching more mileage out of them just might not be so easy. Acknowledging this variability and the fact that disease and deterioration do not suddenly start at 50, we asked these physicians to go through their mental checklists and provide a sort of snapshot of the human body at 50, with the idea of what needs checking for the 50-year tuneup.
The prostate gland enlarges with age, and some men might already be experiencing urinary changes --a narrower stream, trouble getting started and needing more time to empty the bladder--that may be evaluated for treatment. For men of average risk for prostate cancer, a prostate-specific antigen (PSA) screening might be recommended.
Testosterone levels decline with age, and some men might experience changes in erectile function, although only a relatively small percentage will experience impotence. Sexual desire may begin to wane. Nevertheless, a screening test can determine if men have an abnormally low level of testosterone, and hormone replacement is available for males, but risks are not documented.
Menopause either has arrived or is imminent. It's time for a discussion of hormone replacement therapy and perhaps a baseline bone mineral-density test. Menopausal hormone changes accelerate the bone loss that occurs naturally and set the stage for osteoporosis, a bone disease that may not be apparent until symptoms develop.
Despite ongoing controversy over their efficacy, yearly mammograms are recommended for those at average risk of breast cancer, because the risk increases after menopause.
Men and Women
The arteries develop stiffer walls, indicated by the systolic blood pressure (the top number in a reading) going up. The incidence of hypertension increases, especially among men, although it is not limited to them. Doctors may consider intervening with medication to lower blood pressure, preventing further wear and tear on the system.
The heart muscle thickens; it doesn't fill quite as rapidly. Angina, or heart pain, may develop as a result of disease in the coronary arteries. The level of HDL (good cholesterol) starts to decrease. It goes down more rapidly in women, who start out with higher levels than men. A test measuring cholesterol and other lipids in the bloodstream becomes important.
During exercise, aerobic capacity, or maximal oxygen consumption, decreases by the decade, so a 50-year-old typically would have a 20% to 30% lower maximal oxygen consumption than a 20-year-old. A major reason is that the heart cannot pump as much blood per minute. A test of the cardiovascular system under stress would reveal more striking changes than tests done when it is at rest.
The ratio of muscle and fat in the body changes. Muscle mass begins to decline, manifested by a modest decline in muscle strength by age 50. The percentage of body fat goes up significantly with age. Slowed metabolism, poor eating habits and low levels of physical inactivity contribute to fat increases. An overall physical would be a great way to get clearance to become more active and attack the fat. An active lifestyle can at least slow the pull of age.