What is defined as elderly?
- Change in social role
- Most countries use age 65, UN uses 60 (age associated with retirements/benefits or pension)
Number of older people is projected to increase
“Rising tide,” reduced death rates for children/young adults as well as the aged population
Consequences of an aging society
- Economic: fewer people supporting more (social security, medicare, services)
- Social/political: what do we prioritize?
- Healthcare: chronic disease rather than acute illness, workforce issues, long term care
Aging
- Normal and inevitable process of change
- Different people age differently
- Multiple aspects
Aging: Physical Changes of Skin
- Hair thinning and greying
- Decreased elasticity and decreased subdermal fat (wrinkles)
- More fragile and injury prone (bruising, tearing)
- Less effective barrier (infection, UV light)
- Decreased sweat and sebaceous gland activity (tend to be dryer so they have to be more careful in the heat)
- Decreased sensitivity to touch and vibration (could get hurt more easily)
Aging: Physical Changes of Vision
- Iris is more rigid, lens more elastic
- Presbyopia, difficulty focusing on near objects
- Pupil is smaller and less responsive (more sensitive to glare, harder to adjust to changes)
- Decreased sensitivity of retinal cells (less sensitive to contrast in colors)
- Dry eyes
- Decreased visual acuity and peripheral vision (implications for driving)
Aging: Physical Changes of Hearing
- Difficulty with higher frequencies
- Difficulty with speech discrimination
- May interfere with communication and contribute to isolation
- May interfere with medical care
- A risk factor for delirium and dementia
Aging: Physical Changes of Taste and Smell
- Decreased sensitivity
- May not detect dangerous odors like gas, rotting food
- Decreased appetite and pleasure in food
- Increased use of salt and sugar
Aging: Physical Changes of Hematopoietic system
- Loss of bone marrow mass and increase in fat
- Marrow less responsive to changes like hypoxia or blood loss
- Platelets less responsive and increased clotting factors, so pro-cagulant state
- Impaired functioning of some white cells, decline in immune function
- Increased infection, cancer, autoimmune disease
Aging: Physical Changes of GI system
- Increased risk for tooth decay (potential malnutrition)
- Changes in esophageal muscle an peristalsis (increased reflux)
- Altered colon mobility (predispose to constipation, diverticulosis)
- Decreased liver mass, hepatic blood flow, P450
Aging: Physical Changes of the Renal System
- Decreased renal mass, blood flow, function
- Decreased creatinine clearance
- Effects how drugs are cleared
Aging: Physical Changes of the Cardiovascular System
- Left ventricular hypertrophy
- Stiffening of the large arteries
- Decrease in HR and BP variability
- Decrease in intrinsic and maximum HR
- Increase in cardiovascular disease states like CAD and hypertension
Aging: Physical Changes of the Respiratory System
- Chest wall thickening and decreased compliance
- Decreased surface area for gas exchange
- Decreased arterial oxygenation
- Decreased functional reserve
- Reduced effectiveness of cough and mucociliary clearance
- Predispose to hypoxia and pneumonia
Aging: Physical Changes of the GU System
- Decreased detrusor contractility, bladder capacity, flow rate (increased rates of incontinence)
- Changes in urethra related to decreased estrogen (predispose women to UTI)
- Vaginal atrophy and dryness related to decreased estrogen (influences sexual fxn in women)
- Decreased sperm count and motility, prostate enlargement, more difficulty with erectile fxn in men
Aging: Physical Changes of the Musculoskeletal system
- Decreased muscle mass, increaed body fat
- Changes in mobility and balance (contributes to insulin resistance, changes volume of drug distribution)
- Decreased bone mass (increased risk for fracture)
Aging: Cognitive Changes
- Slowed information processing
- More difficulty with divided attention and switching tasks
- Able to sustain attention
- Speech and language processing largely intact, though discourse skills may improve
Aging: Cognitive Changes pt. 2
- Declines in working memory
- Impairment in episodic memory (encoding, storage, retrieval)
- Semantic memory generally preserved (fund of knowledge)
- Autobiographical memory generally preserved
- Procedural memory is preserved
Aging: Cognitive Changes pt. 3
- Overall lots of variability in cognitive changes with age because of external influences
- Compensatory mechanisms: calendars, notes
Aging: Psychosocial Changes
- Negative stereotypes about aging (people become withdrawn, lonely, rigid, apathetic)
- Basic personality traits stay stable with age
- Some increase in conscientiousness and agreeableness
- Some decrease in neuroticism, extraversion, and openness
Aging: Psychosocial Changes and Influences
Empty nest, divorce, retirement, caregiving, death of spouses/siblings/friends
Psychosocial Changes: Mental Health
- Grief/Bereavement
- Anxiety
- Depression
- Substance Abuse
- Suicide
Depression
- Not a normal part of aging
- Affects overall mortality; most common with some medical illnesses
- Sad mood, loss of interest, changes in sleep/appetite, decreased energy, poor concentration, guilt, thoughts of suicide
Substance Abuse
- Includes alcohol, illicit drugs, prescription misuse
- Increased risk for falls, cognitive impairment, depression
- Around 17% of older adults abuse substances
Suicide
Adults 65+ have the highest suicide rate. Risk factors: male, caucasian, medical/mental illness, substance abuse, prior attempt, isolation, access to lethal means
