Digestion usually becomes weaker than in earlier years, and less food is needed. It should be simple, hot, and divided into four or five meals
rather than three. Old people often wake at an early hour, and hot nourishment will prevent them from growing weak and faint while waiting for the family breakfast. Both constipation and looseness of the bowels are common ailments in old age. So far as possible the bowels should be regulated by means of diet; but muscular weakness resulting in inability to control the bowels should not be mistaken for and treated as diarrhœa.
It is unwise for old people to undertake unaccustomed or sudden muscular exertion, since the muscular system including the heart muscle grows weak and is generally unable to endure great strain. The bones, moreover, grow brittle and heal with difficulty if broken, so that persons of advanced years no matter how active should avoid walking on icy pavements, climbing on chairs to reach high shelves, and placing themselves in other insecure positions. Assistance must be tactfully given, however, as active old people are inclined to resent it. On the other hand, old people should be encouraged to continue moderate and safe activities, and to take regular exercises suited to their strength. Although increasing muscular weakness tends to make most old people indolent, it is far better for them both in mind and in body to remain as active as they can without danger of too great fatigue. At all
events, they should be prevented if possible from becoming bedridden.
Since in old age sight, hearing, and other special senses become less acute, one should remember that an old person may not notice the odor of escaping gas, the light of a smouldering match, or the sound of an approaching motor car, and that he must be specially guarded from such dangers of every day life. On account of their dulled perceptions old people are sometimes unjustly considered to be less intelligent than they really are. Young people moreover should be told, if an aged person is untidy and careless in personal habits, that the apparent negligence is caused by dulled perceptions and diminished muscular control for which old people are no more responsible than they are for failing eyesight or for inability to hear.
Families should also realize that changes in mind and character are beyond an aged person's control and that they should not be made the cause for remonstrance or arguing. Just as the arteries harden with advancing years, as the bones become brittle and as other tissues become less flexible, so changes are likely to occur in the nervous system. It is not surprising when the brain substance like other tissues is becoming less flexible, that the powers of attention should
weaken, that memory for recent events should diminish, or that other mental powers should fail. Changes in disposition are not uncommon: previously controlled persons sometimes become querulous and exacting, while excitable and irritable persons become more placid. With most old people emotions become less intense; feeble old people hardly realize great joy or great sorrow, and seldom look forward to death with apprehension.
Among the most important changes that occur in the nervous system is its gradual loss in power to respond to new demands. New habits are difficult or impossible to form, and old habits are hard to break. Attempts to break the habits of a life time are therefore dangerous, and radical changes in old people's ways of living are attended by risk as well as by unhappiness. Such loss of adaptability in the nervous system makes it increasingly difficult for old people to assimilate new ideas and to understand new points of view. The feeling that the world is strange and that the next generation has gone on without them accounts for the tragic loneliness of many old people. Clearly it is for those who are younger and more flexible to bridge the gulf between the generations by their understanding and their sympathy.
Physical care to whatever extent it is needed should be given to all old people as soon as they
are unable to care for themselves, and thought should be given to adapting their surroundings and ways of living to their strength and needs, just as they should be adapted to the strength and needs of chronic patients. But a warning should be given against managing old people too much. It is hard for people who have managed their own lives successfully for many years to be managed, even for their own good. Indeed, it is questionable kindness to deprive old people of all freedom of action, even if following their own inclinations occasionally has disastrous results. Few persons would wish to prolong their lives if long life involved being thwarted in every desire, and sometimes real kindness consists in allowing old people to do certain things that are not good for them. Keeping them warm and letting them do as they please will go far to make old people happy.