Suddenly, it seemed as if that old “I’ve fallen and I can’t get up” TV ad had sprung to life.

Louise Macnair, a widow who is now 93, crashed to the floor in the living room of her Cambridge home and thought, “This is the occasion. I’ve got to push that button.” She did, and within minutes, the people at Lifeline Systems, Inc., the oldest and largest personal emergency response system — PERS, to the cognoscenti — called a neighbor whom Macnair had designated as a “responder.” Soon the neighbor and an ambulance arrived.

Macnair spent five months hospitalized with one complication after another from what turned out to be a broken hip. But in May 1995, to her great delight, she returned to the life she loved — living alone in her own home.

“I swear by it, Lifeline. I’ll sing its praises for anybody,” she says of the device that she believes allows her this independence. “It’s security. As long as I have that button, I know I can get help right away.”

Roughly half a million older people in the United States and Canada now have a PERS system, industry figures suggest, and those figures are growing slowly but steadily.

Most systems — there are more than 20 on the market — consist of a small radio transmitter worn on the wrist or around the neck (the help button), a console on the phone that receives the radio message and automatically dials a designated number, and a response center, where people answer calls and dispatch help. They are guided by computerized information given by the subscriber on whom to call in an emergency, including ambulances, doctors, hospitals, family members and neighbors.

But while some people use the systems just as inventors intended — to summon medical help — 95 percent now rely on it for another reason: to combat the isolation of living alone.

There is little doubt that as the ranks of older Americans swell, the need for both emergency medical assistance and psychological support for those living alone is increasing.

Fifty years ago, 10 percent of households had just one person, census figures show. Today, it’s up to 24 percent. And nearly half — 47 percent — of those over 85 live alone.

A recent San Francisco study, published in the New England Journal of Medicine, reported that it is “common for elderly people living alone to be found helpless or dead in their homes,” and that timely help can save lives.

Among the 367 people studied — only one of whom had a PERS device — two-thirds of those who had been helpless for 72 hours or more died, compared to only 12 percent of those who had been helpless for less than an hour.

To be sure, many older people living alone — the majority of whom are women — truly enjoy it, says Scott Bass, the newly-appointed dean of the graduate school of the University of Maryland/Baltimore County. “They’re thrilled. They will thrive. They have resources. They’re alone but not lonely.”

But many others feel isolated living by themselves.

To combat this, some organize daily calling circles, the so-called “girls in the building” approach, says Al Norman, executive director of Mass HomeCare, a nonprofit consumer rights group. This “low-tech, high-touch” solution is often the best, he adds.

Others prefer formal programs, like the “friendly visitor” system run by some Councils on Aging that send volunteers to a person’s house regularly to play cards or just check in.

Some towns go even further. In Needham, the Council on Aging offers a “Ring Every Day” program in which volunteers call people who request it. In Franklin, the police department does likewise.

Still other older people rely on postal workers or Meals on Wheels drivers to make sure they’re up and about every day if friends or families can’t check in on them.

But growing numbers of older people — and the adult children who worry about them — are turning to high-tech solutions for the peace of mind that allows elders to live alone.

Some people who live alone, like Grace Marvin, 86, of West Roxbury, would never think of using their PERS system to assuage loneliness or fill the need to be checked up on.

“Oh, heavens no. I don’t call in to talk,” she says.

Nor does Beatrice Kadetsky, 88, of Chestnut Hill. “I could use somebody to talk to when I’m alone,” she concedes. “But I wouldn’t think of imposing on them.”

Thousands do, though, and PERS companies, far from considering such calls an imposition, are increasingly targeting their services toward these needs.

At Lifeline, for instance, CEO Ron Feinstein says the people who answer 10,000 to 12,000 calls a day in the company’s Cambridge center began to realize a few years ago that the overwhelming majority of calls were not emergencies.

Sometimes, he said, one ear cocked to the hum of phone calls around him, people “accidentally” hit the help button strapped to their wrists or hung around their neck, then linger on the line to chat when Lifeline calls back. Others call and openly acknowledge they just need someone to talk to, which is, he says, fine with Lifeline.

Fred Siegel, sales and marketing analyst for American Medical Alert, shares that view, noting that his company is starting a service whereby PERS operators will initiate regular check-in calls to subscribers.

Some companies also offer electronic monitoring through an “inactivity alarm,” a kind of timer built in to the PERS program. If the subscriber wants this service, she agrees to press a button at a certain time every day. If she doesn’t, the company calls her.

Other companies accomplish the same thing with motion detectors that trigger a call by the company if the subscriber does not move around within a certain amount of time.

Precisely because PERS programs, which cost about $1 a day, can offer peace of mind, they are now mainstream, says Norman. Since 1991, in fact, PERS programs have been part of the benefit package offered by the state to 33,000 home care recipients.

Ruth Harriet Jacobs, a sociologist at the Wellesley College Center for Research on Women who was hired last year by Lifeline to visit and assess 25 subscribers, vouches for what PERS means to people.

“To tell you the truth,” she says, “I was dreading going out on these interviews,” assuming it would be “depressing to see people homebound and frail.”

But she and her colleague “completely reversed our thinking. We came away with tremendous admiration for these people,” she says. “I know this sounds like I’m a hired gun for Lifeline, but the truth is we found their homes meant a great deal to them, and their possessions. To stay out of a nursing home “was really important to them.”

All that makes Newton psychologist Andrew Dibner a happy man.

Twenty-two years ago, while Dibner was shaving one morning, it came to him in a flash that there must be some way for older people to signal for help if they couldn’t get to a phone. The result was the inactivity alarm, later the help button — and ultimately, Lifeline.

Now retired from Lifeline, Dibner is thrilled that his idea has caught on, especially, he says, because “we’ve done a lot of good.”

SIDEBAR:

To learn more

 

— 1-800-AGE-INFO begin_of_the_skype_highlighting              1-800-AGE-INFO      end_of_the_skype_highlighting (800-243-4636 begin_of_the_skype_highlighting              800-243-4636      end_of_the_skype_highlighting).

— For information on the “friendly visitor” or similar programs, call your local Council on Aging.

— For brochures on PERS, write to Product Report: PERS (D12905), American Association of Retired Persons, EE01054, 601 E Street, NW, Washington, D.C. 20049.

The AARP recommends shopping around for PERS products and testing or renting a product in your home before buying it. Most systems cost about $1 a day and are not covered by insurance.

Some systems are marketed directly through hospitals and may be cheaper if you get them this way.

A partial list of companies offering PERS products follows:

Lifeline Systems, 1-800-543-3546 begin_of_the_skype_highlighting              1-800-543-3546      end_of_the_skype_highlighting.

Pioneer Medical Systems, 1-800-234-0683 begin_of_the_skype_highlighting              1-800-234-0683      end_of_the_skype_highlighting.

Medi-Mate (Colonial Medical Alert Systems), 1-800-323-6794 begin_of_the_skype_highlighting              1-800-323-6794      end_of_the_skype_highlighting.

Good Neighbor Program of American Medical Response, Inc., 1-800-877-8978 begin_of_the_skype_highlighting              1-800-877-8978      end_of_the_skype_highlighting.

American Medical Alert, 1-800-645-3244 begin_of_the_skype_highlighting              1-800-645-3244      end_of_the_skype_highlighting.

Responsibility Systems, Inc., 1-800-759-3227 begin_of_the_skype_highlighting              1-800-759-3227      end_of_the_skype_highlighting.

For more information on PERS or personal emergency response systems, call: 

SIDEBAR:

To learn more

 

— 1-800-AGE-INFO begin_of_the_skype_highlighting              1-800-AGE-INFO      end_of_the_skype_highlighting (800-243-4636 begin_of_the_skype_highlighting              800-243-4636      end_of_the_skype_highlighting).

— For information on the “friendly visitor” or similar programs, call your local Council on Aging.

— For brochures on PERS, write to Product Report: PERS (D12905), American Association of Retired Persons, EE01054, 601 E Street, NW, Washington, D.C. 20049.

The AARP recommends shopping around for PERS products and testing or renting a product in your home before buying it. Most systems cost about $1 a day and are not covered by insurance.

Some systems are marketed directly through hospitals and may be cheaper if you get them this way.

A partial list of companies offering PERS products follows:

Lifeline Systems, 1-800-543-3546 begin_of_the_skype_highlighting              1-800-543-3546      end_of_the_skype_highlighting.

Pioneer Medical Systems, 1-800-234-0683 begin_of_the_skype_highlighting              1-800-234-0683      end_of_the_skype_highlighting.

Medi-Mate (Colonial Medical Alert Systems), 1-800-323-6794 begin_of_the_skype_highlighting              1-800-323-6794      end_of_the_skype_highlighting.

Good Neighbor Program of American Medical Response, Inc., 1-800-877-8978 begin_of_the_skype_highlighting              1-800-877-8978      end_of_the_skype_highlighting.

American Medical Alert, 1-800-645-3244 begin_of_the_skype_highlighting              1-800-645-3244      end_of_the_skype_highlighting.

Responsibility Systems, Inc., 1-800-759-3227 begin_of_the_skype_highlighting              1-800-759-3227      end_of_the_skype_highlighting.

For more information on PERS or personal emergency response systems, call:

Last summer, a record-setting, five-day heat wave scorched Chicago, making headlines nationwide not just because of the sizzling temperatures — as high as 106 degrees Farenheit — but because older people died by the hundreds. By the time the heat wave was over, there had been more than 700 “extra” deaths, numbers so shocking that researchers from the city, state and the federal Centers for Disease Control and Prevention began poring over the data, searching for common denominators among people who died and those who did not.

Their conclusions, published earlier this month in the New England Journal of Medicine, and those of other advocates for the elderly, are closer to common sense than rocket science.

But their advice, simple as it is, could save your life or the life of an older person you love:

Lesson One — Don’t ignore the early signs of heat-related problems, because later stages — heat stroke — can be fatal.

Heat-related problems range from the mild and reversible — heat stress and heat fatigue — to heat stroke. In the early stages, you can recover quickly by drinking fluids, taking off excess clothing and getting yourself into a cooler environment, including a cold bath. If you wait until the later stages, it may take emergency medical help — intravenous fluids, ice packs and other interventions — to save your life.

Lesson Two — Drink fluids.

You can’t rely on thirst to tell you when to drink. In older people, the thirst mechanism, a built-in safeguard against dehydration, doesn’t kick in as readily as it does in young people, says Dr. Kate Ackerman, medical director for the geriatric section at Boston Medical Center. This means you must drink before you get thirsty.

The rule of thumb is that everyone should drink six to eight glasses of fluids a day — and more during a heat wave — and this is especially true for older people. You need to drink mainly because you need to sweat — evaporation of moisture from the skin is one of the body’s main ways of getting rid of heat.

But remember, some drinks don’t count. Water is good, as are some juices and drinks that contain minerals and electrolytes that your body also needs. But anything containing alcohol or caffeine — coffee, tea and some sodas — can act as a diuretic, making you lose water through urination, not sweat, and actually making it harder for the body to cool down.

Lesson Three — Be wary of diuretics and other medications.

Many older people take diuretics to control blood pressure. But if you’re dehyrated from the heat, diuretics can make things worse, says Dr. Jeanne Wei, chief of gerontology at Beth Israel Hospital. In heat waves, she says, older people may keep taking their diuretics “because nobody told them not to. So there they are lying on the floor because they forgot to drink, they lost all that water and now they’re too weak to get up.”

If you take diuretics, she says, ask your doctor whether you should continue at the same dose in hot weather. Many of her patients, Wei says, cut back and take diuretics only on a limited, set schedule, either three or four days a week, to prevent dehydration during hot weather.

Tranquilizers, sedatives and some drugs for cardiovascular problems can also interfere with sweating, so ask your doctor whether you should modify your medications during a heat wave.

Lesson Four — Don’t be a stranger.

One of the most sobering findings of the Chicago study was that social isolation raises the risk of heat-related death. The solution is obvious, though difficult to implement for those who are shy or fearful of their neighbors.

If you know an older person living alone, check on her or him every day when the temperature soars. If you are that older person, find someone else in your building or neighborhood and create a “buddy system” for checking on each other.

“Neighbors can do this for each other. This does not require government intervention,” says Al Norman, executive director of Mass Home Care, a consumer organization for the elderly.

Lesson Five — Take off that sweater.

Your ability to perceive temperature declines with age, says Terrie Wetle, deputy director of the National Institute on Aging. Older people “tend to feel colder at higher temperatures, to bundle up in sweaters,” she says, but overdressing can be dangerous. When it’s hot, you’re better off in light-weight, loose clothes, preferably natural fabrics like cotton, not fabrics that cling to your skin like polyester.

Lesson Five — Don’t put too much faith in fans.

Fans can speed evaporation by blowing dry air over sweaty skin, which helps cool you. But when the air gets too hot and humid, “even blowing it across the skin” doesn’t boost evaporation much, says Wetle.

Dr. Knox H. Todd, an Emory University emergency medicine specialist, was even more emphatic in an editorial accompanying the Chicago study: “Many agencies give electric fans to poor citizens to help them cope with the heat, but fans are useless when heat and humidity reach dangerous levels.” Which brings us to . . .

Lesson Six — But do try air conditioning.

In the Chicago study, researchers found that having an air conditioner or spending a few hours a day in air-conditioning can be protective. So if you have an air conditioner, don’t hesitate to use it, even if this means getting someone to help you turn it on.

“I had one patient who called saying she was so hot,” says Wei. “We asked if she had an air conditioner and she said yes, but it was not turned on” because she couldn’t figure it out. Once she did, she called back, amazed that she felt much better.

Wetle adds, “If you have an air conditioner and you know someone who doesn’t, invite them in for the hot part of day.”

And if you’re worried about the electric bill, remember that your health comes first; you can fight with the electric company later. Besides, electric companies, including Boston Edison, may help by setting up a budget plan to spread payments over the year and by offering discounted rates to people on public assistance such as supplemental security income (SSI).

But there’s a caveat to this. If you are in air conditioned area and get too cold, turn it off for a while and move around if you can. Some older people with air conditioning actually win up with hypothermia — a dangerous drop in body temperature — not hyperthermia, overly high body temperature.

Lesson Seven — If you can’t stand the heat. . .

If it’s too hot at home, try to get away to an air-conditioned mall, senior center or apartment lobby. But many older people cannot or will not leave home, even for a few hours, and if that’s your situation, open the windows when it’s cooler outside than in and and cross-ventilate by opening windows on opposite sides of your home. In the morning, however, it may help to trap cooler nighttime air inside by closing windows and blinds.

Lesson Eight — . . .stay out of the kitchen.

Not really, of course, but don’t use the oven when it’s hot. Have salads or sandwiches instead.

Lesson Nine — Get help.

If you think you — or the buddy you’re checking on — are becoming ill from the heat, don’t hesitate to call your doctor, a nearby emergency room or 911.

SIDEBAR:

Heat’s many miseries

 

Heat fatigue is a feeling of weakness brought on by even higher temperatures. Symptoms include cool, moist skin, a weak pulse and feeling faint. Remedy: Same as above. If you don’t feel better in a hour, call someone to check on you.

Heat syncope is dizziness, often after exercising in the heat. The skin is pale, sweaty and cool. The pulse may be weak and the heart rate rapid. Body temperature is normal. Remedy: Lie down immediately. As soon as you can, call a doctor.

Heat cramps are muscle spasms in the abdomen, arms or legs that often follow strenuous activity. The skin is moist and cool and the pulse is normal or slightly raised. Body temperature is usually normal. Heat cramps are caused by a lack of salt, but don’t take salt supplements without checking with a doctor. Remedy: Drink fluids, such as tomato juice, that contain minerals and electrolytes, sodas containing sodium or preparations like Gatorade. Call a doctor if in doubt or if cramps persist.

Heat exhaustion is a sign your body is getting dangerously hot. You may be thirsty, giddy, weak, uncoordinated, nauseous and sweating profusely. Body temperature is usually normal and the pulse is normal or raised. The skin is cold and clammy. Loss of water and salt can cause heat exhaustion but again, don’t take salt supplements without checking with a doctor. Remedy: Drink fluids and call a doctor.

Heat stroke can be life-threatening — in fact it kills 1,300 to 1,500 a year. Body temperature rises above 104 degrees Farenheit. Heat stroke also can cause confusion, combativeness, bizarre behavior, faintness, staggering, strong rapid pulse, dry flushed skin, lack of sweating, possible delerium or coma. If you find someone with these symptoms, call 911 immediately and get patient to an emergency room nearby.

For more information on coping with the heat, call:

– 911 or your local hospital emergency room if you are concerned about someone with dangerous heat-related symptoms.

– Your local council on aging for tips on coping with heat and information on shelters. In Boston, call the mayor’s 24-hour hotline, 617-635-4500 begin_of_the_skype_highlighting              617-635-4500      end_of_the_skype_highlighting or the Commission for the Elderly, 635-4366. During heat emergencies — defined in part as three consecutive days of temperatures of 86 degrees or more — there is also special heat hotline, 635-HEAT (635-4362).

– For general information, call 1-800-AGE-INFO begin_of_the_skype_highlighting              1-800-AGE-INFO      end_of_the_skype_highlighting (or 800-243-4636 begin_of_the_skype_highlighting              800-243-4636      end_of_the_skype_highlighting), a hotline run by Mass Home Care, a consumer rights group.

– For more general information, 1-800-882-2003 begin_of_the_skype_highlighting              1-800-882-2003      end_of_the_skype_highlighting, the hotline of the state Executive Office of Elder Affairs.

– Your local electric company, if you have SSI (supplemental security income) and want a discount on your electric bill.

 

Heat stress is a general term for the strain placed on the body by hot weather. Remedy: Drink fluids — a quart an hour — and try to stay out of the heat. If you can’t, doctors suggest that you sit in a cold bath with light clothes on, get your hair wet, then walk around the house with your wet clothes on. 

SIDEBAR:

Heat’s many miseries

 

Heat fatigue is a feeling of weakness brought on by even higher temperatures. Symptoms include cool, moist skin, a weak pulse and feeling faint. Remedy: Same as above. If you don’t feel better in a hour, call someone to check on you.

Heat syncope is dizziness, often after exercising in the heat. The skin is pale, sweaty and cool. The pulse may be weak and the heart rate rapid. Body temperature is normal. Remedy: Lie down immediately. As soon as you can, call a doctor.

Heat cramps are muscle spasms in the abdomen, arms or legs that often follow strenuous activity. The skin is moist and cool and the pulse is normal or slightly raised. Body temperature is usually normal. Heat cramps are caused by a lack of salt, but don’t take salt supplements without checking with a doctor. Remedy: Drink fluids, such as tomato juice, that contain minerals and electrolytes, sodas containing sodium or preparations like Gatorade. Call a doctor if in doubt or if cramps persist.

Heat exhaustion is a sign your body is getting dangerously hot. You may be thirsty, giddy, weak, uncoordinated, nauseous and sweating profusely. Body temperature is usually normal and the pulse is normal or raised. The skin is cold and clammy. Loss of water and salt can cause heat exhaustion but again, don’t take salt supplements without checking with a doctor. Remedy: Drink fluids and call a doctor.

Heat stroke can be life-threatening — in fact it kills 1,300 to 1,500 a year. Body temperature rises above 104 degrees Farenheit. Heat stroke also can cause confusion, combativeness, bizarre behavior, faintness, staggering, strong rapid pulse, dry flushed skin, lack of sweating, possible delerium or coma. If you find someone with these symptoms, call 911 immediately and get patient to an emergency room nearby.

For more information on coping with the heat, call:

– 911 or your local hospital emergency room if you are concerned about someone with dangerous heat-related symptoms.

– Your local council on aging for tips on coping with heat and information on shelters. In Boston, call the mayor’s 24-hour hotline, 617-635-4500 begin_of_the_skype_highlighting              617-635-4500      end_of_the_skype_highlighting or the Commission for the Elderly, 635-4366. During heat emergencies — defined in part as three consecutive days of temperatures of 86 degrees or more — there is also special heat hotline, 635-HEAT (635-4362).

– For general information, call 1-800-AGE-INFO begin_of_the_skype_highlighting              1-800-AGE-INFO      end_of_the_skype_highlighting (or 800-243-4636 begin_of_the_skype_highlighting              800-243-4636      end_of_the_skype_highlighting), a hotline run by Mass Home Care, a consumer rights group.

– For more general information, 1-800-882-2003 begin_of_the_skype_highlighting              1-800-882-2003      end_of_the_skype_highlighting, the hotline of the state Executive Office of Elder Affairs.

– Your local electric company, if you have SSI (supplemental security income) and want a discount on your electric bill.

 

Heat stress is a general term for the strain placed on the body by hot weather. Remedy: Drink fluids — a quart an hour — and try to stay out of the heat. If you can’t, doctors suggest that you sit in a cold bath with light clothes on, get your hair wet, then walk around the house with your wet clothes on.

After 33 years in the rough and tumble of Cambridge politics, including several stints as mayor, Walter Sullivan, 73, has developed a new — albeit unwanted — preoccupation during retirement: eye troubles.

In fact, there are four major vision problems that often plague older people — cataracts, glaucoma, macular degeneration and diabetic retinopathy — and Sullivan has them all.

His first brush with blindness “scared the hell out of me,” he said last week by phone from Florida. “I was walking along the Charles River at 6 a.m. one day when I went blind in both eyes briefly. . . I didn’t know what the heck was happening. I thought my sight was gone.”

It wasn’t. In fact, by the time Sullivan walked home — very slowly — hisvision had returned as mysteriously as it had disappeared, a phenomenon his doctors still can’t explain, despite his multiple eye problems.

With four different diseases, of course, Sullivan’s case is unusually dramatic. But the fact is that, for all of us, the odds of having eye problems — from the merely annoying to the sight-threatening — increase sharply with age.

People 65 and older constitute only 12 percent of the population but account for more than 50 percent of all cases of blindness, according to the American Academy of Ophthalmology. By age 65, in fact, one in every three people has some form of vision-limiting eye disease.

And with the aging of Baby Boomers, now fumbling with bifocals and trying to read with arms that are suddenly too short, the number of older people with eye problems will soar to more than 66 million, according to Dr. Carl Kupfer, director of the National Eye Institute.

To be sure, some of the problems of aging eyes are nearly universal — and little worse than bad bifocal jokes.

At midlife, almost everybody finds it harder to read or do close work, to see at night, to adjust to sudden changes in illumination and to judge the speed of moving objects, says James Fozard, associate scientific director of the Baltimore Longitudinal Study of Aging, one of the longest-running and most detailed studies of the biology of aging.

One reason is that as we age, the pupil, the black part of the eye, no longer expands as readily in dim light. That means, among other things, that the older you get, the more crucial it is to have good light for reading and close work.

Aging also affects light-sensing cells called rods and cones in the retina, the tissue in the back of the eye. Cones are sensitive to color and bright illumination like daylight; rods are sensitive to movement and dim light.

With age, it takes longer for the rods to activate, which means, Fozard notes wryly, that it takes you longer at 60 to find a seat in a darkened movie theater than it did at 15.

It’s also normal to find glare more troublesome as you get older and to need starker contrast — very dark letters on a very white page — to read well.

But the most obvious normal change is presbyopia, the decreased ability to focus close-up because of changes in elasticity of the lens and in the eye’s focusing muscles. This ability peaks at age 12 — and, sad to say, goes downhill from there.

At some point between 38 and 50, we find “our arms are not long enough to read the phone book. This is absolutely inevitable,” says Dr. Edward Murphy, director of the general eye service at the Massachusetts Eye and Ear Infirmary.

Even people who’ve been nearsighted all their lives aren’t immune from presbyopia. For them, it means taking off glasses or contacts to see up close.

One solution is to wear bifocals with clear glass on the bottom and prescription lenses on top. Another is to adjust contact lenses so one eye sees well at a distance, the other, close-up.

But these annoyances “pale beside the serious, sight-threatening eye diseases of later life such as cataracts, glaucoma, macular degeneration and diabetic retinoapthy,” says Tony Cavallerano, director of the New England Eye Institute.

“All these diseases develop slowly and insidiously, which means early detection through regular eye exams is crucial,” adds Dr. Carmen Puliafito, director of the New England Eye Center and chairman of ophthalmology of Tufts University School of Medicine.

A cataract is a clouding of the lens caused by the buildup of yellow and brown pigments. Eventually, this clouding can become so severe that light cannot pass through.

So far, drugs have proved ineffective against cataracts, but surgery often works extremely well, says Puliafito. In the surgery, performed 1 million times a year in America, doctors make a tiny incision at the edge of the cornea, then use high-frequency ultrasound to break the lens into millions of pieces that can be sucked out through a tube.

Once the old lens is gone, a lens of acrylic or silicone is slipped in. ”The patient goes back to normal activities the next day and vision gets better in a few weeks,” he says.

Glaucoma, too, is an insidious problem.

In a normal eye, there is a slow, constant flow of fluid from the middle of the eye to the bloodstream though a network of drainage cells. In glaucoma, which affects about 2 million Americans, this drainage system becomes blocked, leading to a buildup of pressure inside the eyeball. Untreated, the pressure can damage the optic nerve and eventually cause blindness.

Often, there is no pain or other symptoms, which unfortunately means glaucoma can go undetected until some damage is done.

Once glaucoma is detected, further damage can be prevented with eyedrops containing beta-blockers (the same kind of drugs used to control bloodpressure) to improve outflow of fluid, or with drops such as Trusopt, which contain drugs that decrease the production of fluid.

If drugs don’t work, laser surgery often does. In a procedure that takes about 10 minutes, a laser beam is used to create tiny holes to improve drainage. If this fails, a last resort is non-laser surgery to create a larger drainage channel.

The leading cause of legal blindness in older people is age-related macular degeneration, which strikes about 500,000 people a year. It develops when something, probably dangerous oxygen molecules called free radicals or the buildup of fatty deposits, damages the macula, a tiny spot in the center of the retina.

Typically, it does not affect peripheral vision, but macular degeneration, which often affects both eyes, makes it harder to read, drive and recognize faces. Some controversial research suggests it may be prevented with anti- oxidant vitamins and minerals such as vitamin E and beta-carotene, selenium and zinc.

Once you get it, there is little doctors can do, although magnifying devices and computer-enhanced TV projections may help focus images on healthy cells around the macula.

On the other hand, if the degeneration is complicated by new blood vessels growing underneath the retina and by leakage of fluid from these vessels into the macula, there is a solution: once again, laser surgery, which can shut down the new vessels.

Leaky blood vessels are also the culprit in diabetic retinopathy, a major problem for millions of older Americans with diabetes. In diabetic retinopathy, blood vessels grow into the retina itself, where substances leaking from the vessels can cause swelling. Blood may also leak into the rest of the eye, blocking transmission of light.

In many cases, says Puliafito, laser surgery helps by stimulating the eye to absorb the fluid and by getting rid of abnormal blood vessels.

Walter Sullivan, the veteran of three surgeries at the New England Eye Center, can now see well enough to drive, walk, read and lead a normal life. He counts himself a lucky man.

“I’ve had great results,” he says. But it would have been better to have caught his problems even earlier.

His advice is simple: “Keep getting your eyes checked.”

SIDEBARTO LEARN MORE

 

– New England Eye Center at New England Medical Center, 1-800-231-3316 or 617-636-4600.

– Massachusetts Eye and Ear Infimary, 617-573-4199.

– New England Eye Institute, 617-262-2020. The institute also runs a mobile van for outreach toolder people, at 617-236-6317.

– National Eye Care Project, 1-800-222-EYES (1-800-222-3937). If you’re 65 or older, this service will help you find an ophthalmologist who will do an exam free if you have no insurance, or who will waive the co-pay or deductible if you have insurance, including Medicare and Medicaid.

– American Foundation for the Blind, 1-800-232-5463, for referrals to a low-vision specialist.

– Massachusetts Commission for the Blind, 617-727-5550 or 1-800-392-6450, if you are legally blind (10 percent vision or less). If you use a telecommunications device for the deaf, call 1-800-392-6556.

– Vision Foundation Inc., 617-926-4232 or 1-800-852-3029 (Massachusetts residents only).

– Prevent Blindness America, 617-489-0007 or 1-800-331-2020.

– Massachusetts Association for the Blind, 617-738-5110.

– Carroll Center for the Blind, 617-969-6200 or 1-800-852-3131.

 

For more information or referrals, call: 

SIDEBARTO LEARN MORE

 

– New England Eye Center at New England Medical Center, 1-800-231-3316 or 617-636-4600.

– Massachusetts Eye and Ear Infimary, 617-573-4199.

– New England Eye Institute, 617-262-2020. The institute also runs a mobile van for outreach toolder people, at 617-236-6317.

– National Eye Care Project, 1-800-222-EYES (1-800-222-3937). If you’re 65 or older, this service will help you find an ophthalmologist who will do an exam free if you have no insurance, or who will waive the co-pay or deductible if you have insurance, including Medicare and Medicaid.

– American Foundation for the Blind, 1-800-232-5463, for referrals to a low-vision specialist.

– Massachusetts Commission for the Blind, 617-727-5550 or 1-800-392-6450, if you are legally blind (10 percent vision or less). If you use a telecommunications device for the deaf, call 1-800-392-6556.

– Vision Foundation Inc., 617-926-4232 or 1-800-852-3029 (Massachusetts residents only).

– Prevent Blindness America, 617-489-0007 or 1-800-331-2020.

– Massachusetts Association for the Blind, 617-738-5110.

– Carroll Center for the Blind, 617-969-6200 or 1-800-852-3131.

 

For more information or referrals, call:

Catherine Wright, 61, a retired telephone operator from Quincy who cheerfully admits she wore “fancy high heels” for years, sat propped up, admiring her podiatrist’s handiwork.

On her right foot, where a mish-mash of hammertoes and a nasty bunion had been, Wright had a long incision and a string of neat, black stitches from her big toe halfway along the top of her foot. Her other newly-straightened toes sported smaller incisions — and steel pins to keep them aligned as they healed.

“I don’t think it’ll ever be beautiful,” she said, as her husband Scotty looked the other way, “but I’ll paint up the toenails and be able to walk without pain.”

In the examining room next door, Irene Pozzi, 72, a retired clerical workerfrom Dorchester, gazed at her right foot, a monument to her ongoing battle with rheumatoid arthritis.

Her index toe lay at a right angle to her leg, crunched under her other toes. “I ignore it,” she said matter-of-factly, more interested in her glowing pink, freshly-scraped calluses.

In the waiting room, every seat was taken. A 62-year-old Roslindale man wondered why his foot swelled when he walked. A 57-year-old Dorchester woman wanted her excessively thick toenails cut. A 69-year-old Hingham woman had corns that needed some TLC.

But the crowd this recent January morning was actually nothing special. Business is always booming in the homey South Boston offices of podiatrist Edward Hurwitz, as it is for foot specialists nationwide, because most of us, as we age, either can’t or won’t take good care of our feet ourselves.

Every year, 5.4 million people with sore feet hobble to medical doctors, according to the National Center for Health Statistics.

And that doesn’t include the 68 million of us who take our aching bunions, heels spurs and ingrown toenails to podiatrists, who are not M.D.’s but have four years of post-college training in one of the nation’s seven schools of podiatric medicine.

Indeed, as we walk, run or stumble through life, 75 to 80 percent of us get foot problems of some sort, and the risk goes up sharply with age, says Glenn Gastwirth, deputy executive director of the American Podiatric Medical Association.

Usually, the problems are pedestrian — like hammertoes, a claw-like condition that is triggered by muscle problems and exacerbated by shoes that crunch up the toes; or bunions, which are caused by an inherited tendency toward misaligned big toes and are made worse by bad shoes.

But sometimes, foot problems can be deadly serious, especially for America’s 16 million diagnosed diabetics and another 8 million who have diabetes but don’t know it.

One in four people with diabetes develops foot problems, says podiatrist Pamela Colman of the 10,000-member podiatric association, and for many those problems are tragic.

Every year, government figures show, people with diabetes have more than 50,000 leg amputations above or below the knee, and 34,000 have foot or toe amputations. About half of these surgeries could be avoided with proper foot care.

The problem in diabetes, specialists say, is that excess sugar in the blood triggers a process called glycosylation, in which glucose molecules and their breakdown products infiltrate and stiffen bodily tissues. When this happens in peripheral nerves — like those in the arms, legs and feet — the ability of the nerves to function properly declines markedly.

And without good nerve function, people with diabetes simply don’t feel the pain that tells other people when blisters, calluses or ingrown toenails are becoming infected.

Because diabetes also causes circulatory problems, many people with diabetes also have decreased blood flow to the feet, which means immune cells can’t keep up with otherwise routine infections in the feet, says Geoffrey Habershaw, chief of podiatry at Deaconess Hospital and the Joslin Diabetes Center.

In that joint program and at one other center — the University of Texas Health Science Center in San Antonio — doctors are finding that good foot care reduces amputations.

At the Boston center, many people’s feet are saved by antibiotics — often a combination of several kinds to combat the mixed bag of germs in most foot infections — plus reconstructive surgery and bypass surgery to restore circulation.

The payoff has been dramatic. Fifteen years ago, nearly a third of diabetics with foot infections wound up with an amputation. Today, though the amputation rate is not falling nationwide, it is just 4 percent in the Deaconess-Joslin program.

Specialists are hoping that a two-year-old program called LEAP — Lower Extremity Amputation Prevention program — may bring similar benefits to more people.

Through the government’s LEAP program, health care providers learn to assess nerve function with a simple instrument called the Semmes-Weinstein monofilament, essentially a piece of fishing line that pops out of a plastic handle with 10 grams of force. If the individual cannot feel the tiny pricking sensation, it is a sign of faulty nerve function in the feet.

For most people, though, it’s not the dramatic complications of diabetes but the humdrum effects of aging that cause the most foot problems.

“As people age, ligaments lose elasticity,” especially in those who gain weight,” says Hurwitz of South Boston. “You don’t get bunions because you wore Mary Janes when you were 12, but from bad genes, bad shoes and wear and tear, as ligaments and tendons get loose.”

In fact, years of wearing attractive but orthopedically-disastrous footwear — including shoes that are too narrow and shoes with more than a one-inch heel — are the main reason women have four times the foot problems of men.

So if you’re among the millions who think it’s normal to kick off your shoes at night and moan, “My feet are killing me!” there’s a simple message: Think again.

Feet are not supposed to hurt. If yours do, it’s time to get help, from a podiatrist or an M.D. trained in orthopedics, like the 14,000 members of the American Orthopedic Foot and Ankle Society, who have four years of medical school plus four to six years of residency training.

For most things, like bunions, corns, heel pain and the like, it probably doesn’t matter which type of specialist you see, as long as he or she is licensed. But podiatrists vary widely in surgical training and experience, so be sure to ask.

For problems above the foot — notably the ankle — it may best to see an orthopedic surgeon.

“If I were a patient with an ankle problem,” says Dr. Mark Myerson, director of foot and ankle services at Union Memorial Hospital in Baltimore, ”I would not go to a podiatrist because podiatrists, across the board, are not generally trained in ankle problems but in problems of the feet.”

The same goes, in his view, for bone fractures and deformities of the feet, including arthritis.

But many podiatrists, among them Habershaw of the Deaconess, disagree, noting that many podiatrists take advanced residency training after podiatry school.

Whomever you consult, what counts is getting help before minor problems become major.

Take it from Catherine Wright, who should know: “I just kept putting things off.”

SIDEBAR 1THE MOST COMMON FOOT PROBLEMS

 

– Blisters, caused by skin friction. Don’t pop them. Apply moleskin or a Band-Aid and leave in place until it falls off naturally in bath or shower. Keep feet dry and wear socks to cushion feet. Seek help if blisters become inflamed or painful.

– Bunions, misaligned big toe joints that can become swollen and tender. Bunions tend to run in families, but the tendency is aggravated by shoes that are too narrow in the toe. Surgery is recommended if the bunion affects your lifestyle.

– Corns and calluses, protective layers of dead skin caused by friction of bones against skin. Corns may be caused by too-tight shoes and crooked toes. Calluses are caused by friction from faulty foot mechanics, often from arches that are too high or too low. You should file calluses and corns with a pumice stone, but never cut them with sharp instruments. And don’t try to burn them off with acids.

– Hammertoes, a condition in which the toes are bent in a claw-like position. Usually caused by muscle imbalance, but can be aggravated by bad shoes. Buy shoes with ample toe room and soft uppers, the part of the shoe above the sole. If hammertoes affect lifestyle, surgery may be needed.

– Heel pain or heel spurs, caused by plantar fasciitis, an inflammation of the connective tissue on the bottom of feet. They’re caused by faulty foot structure that puts stress on the heel bones. Try over-the-counter anti- inflammatory drugs and ice. Orthotic devices may help redistribute weight.

– Ingrown nails, which dig into the skin because of improper trimming, shoepressure, injury, fungal infection, heredity or poor foot structure. Nails should be clipped straight across, slightly longer than the end of the toe.

– Neuromas, enlarged, benign growths of nerves, usually between the third and fourth toes, caused by bones rubbing against nerves. Orthotic devices and/ or cortisone injections may help, but surgery may be needed if neuromas affect lifestyle.

– Warts, caused by a virus that enters the skin through small cuts. Warts usually go away without treatment. Over-the-counter medication may help, but don’t use these acids on calluses. Warts can also be treated with minor surgery.

SIDEBAR 2A CHECKLIST FOR FOOT CARE

 

– Check your feet daily for cuts, sores, bumps and red spots, especially if you have diabetes. If you think an infection is brewing, see a foot specialist immediately.

– Have your doctor check your feet at every visit.

– Wash your feet in warm, not hot, water, every day. Do not soak feetbecause this can dry your skin. Dry well between the toes, then put on moisturizing cream to reduce skin cracks.

– Cut toenails straight across. Use an emery board to smooth sharp edges that could cut an adjacent toe.

And when you’re buying shoes:

– Have feet measured while you are standing.

– Try on both shoes and walk around.

– Don’t buy shoes that need “breaking in.” Shoes should feel reasonably comfortable as soon as you buy them.

– Don’t rely on remembering what your size is. Feet get bigger and brands vary.

– Shop for shoes late in the day, because feet swell.

– Get shoes that fit in front, back and sides and distribute your weight well.

– Select shoes with leather uppers, a stiff cup around the heel, appropriate cushioning and flexibility at the ball of the foot.

– If you’re going to wear socks, have them on when you try on shoes.

Specialists offer these tips on foot care:

– Athlete’s foot, a fungal skin disease that starts between the toes or on the bottom of the feet. Symptoms are scaly skin, itching, inflammation and blisters. You can help prevent infection by washing feet daily with soap and warm water, drying thoroughly, and changing shoes and hose often.