Changes Associated with

1
Changes Associated with Normal Aging

• Barbara J. Edlund PhD, ANP, BC
• Professor College of Nursing
• Medical University of South Carolina

2
Aspects of Normal Aging

• Older adults are complex and challenging
• Great variability in aging individuals
• Older adults view themselves healthier than we
  view them
• Older peoples health will be judged by their
  ability to function rather than by their number
  of chronic illnesses
• Because chronic functional impairment increases
  with age, older adults bear a disproportionate
  burden of disability

3

• Older adults may hesitate to mention changes in
  their bodies as they see these changes as a
  normal part of aging
• Changes need to be explored
• Importance of distinguishing normal aging
  characteristics from pathology
• Changes in functional status a better maker of
  overall health that the number of diseases listed
  and medications taken

4
Assessment

• Assessment of older adult differs from that of
  the younger adult
• -Presenting symptoms less acute/more vague
• -Nonpresentation when ill
• -Insidious onset
• -Abrupt change in functional status
• -Interaction acute and chronic illness
• -Complaints may be multiple
• 
  Amella (2004)

5
Older Adults

• Very unique
• May be harboring two or more chronic diseases
• Taking several medications (some 6-10)
• Still be functioning at a high level of health
• 
  Planton Edlund (2010)

6
Demographics

• Older adult population gt35 million Americans 65
  and greater .. 13 of the population
• There are 6 million adults age 62-64
• Fastest growing segment of population
• By 2030 estimated . 70 million Americans over 65
• As many as 50-80 of patients in acute care
  settings are ? 65yrs old
• 
  Guralnik Ferrucci (2009)

7
Demographics

• Life expectancy nearly doubled since 1900s with
  current average gt75 yrs
• Due to advances in sanitation, medicine, hygiene,
  and identifying and treating infectious diseases
• Baby boomers are reaching this age group
• Large post WWII immigration population is now in
  the older adult ranks

8
Defining Old

• Adult 18 to 64 years
• Young Old 65 to 74years
• Middle Old 75 to 84 years
• Oldest Old 85 years and older
• 
  ANCC (2013)

9
Common Myths of Aging

• Most older adults live in nursing homes
• Old age is time of sickness and mental
  deterioration
• Older adults are not interested in sex
• Older adults do not deserve aggressive treatment
  for illness
• Depression is normal in aging
• Dementia is a normal aspect of aging

10
Dimensions Geriatric Assessment

• Cognitive Medical
  Affective
• Economic Functional
  Social
• Status
  Support
• Environmental
  Spirituality
• 
  Reuben Rosen (2009)
  

11
Age-related Changes

• Cognition
• -No decline in IQ in healthy aging
• -Information processing speed declines
• -Multitasking ability decreases
• -Most aspects of language well
  preserved
• - Word fining, naming may slow
• -Visual-spatial task ability declines
• -Abstraction/mental flexibility may
  decline
• -Accumulation of practical experience
  or wisdom
• continues to end of life.
• All age-related changes from Kane et
  al. (2013)

12
Age-related Changes

• Marked changes occur in the Sensory System
• Vision
• - Decreased visual acuity (near/far
  vision) presbyopia,
• and visual fields light/dark
  adaptation smaller
• pupils.
• - Distorted depth perception resulting
  in
• increased falls.
• - Increased sensitivity to glare eye
  dryness
• and irritation
• - Diminished ability to distinguish
  between,
• blues, greens and violet

13
Changes

• Hearing
• - Decreased hearing acuity and ability to
• hear consonants (isolation)
• - Difficulty hearing when speech is rapid or
• background noise present
• - Decreased acuity for high frequency tones,
• presbycussis
• - Increased build up of cerumen

14
Changes

• Taste
• - Decreased taste buds with diminished taste
• - Decreased food intake
• Smell
• - Diminished often with inability to detect
  noxious
• odors
• Touch
• - Decreased skin receptors and sensation,
  problem
• with recognizing hazards, burns and
  tripping over
• small objects

15
Changes

• Neurological System
• - Slowing of voluntary reflexes
• - Decreased kinesthetic perception
• awareness of positon in space and
  response
• to changes (fall risk)
• - Decreased ability to respond to multiple
• stimuli
• - Alterations in quantity and quality of sleep

16
Changes

• Musculoskeletal System
• - Decreases in muscle strength, reaction time,
  and
• mobility, particularly of the
  neck/shoulder/wrist.
• - Decline in grip strength appears to decline
  after
• age 75, although exercise can help
  to strengthen
• - Decalcification of bones
• - Degenerative joint changes
• - Dehydration of intervertebral disks loss of
  3
• inches in height not uncommon
  (trunk) stooped
• posture related to bone changes

17
Changes

• Respiratory System
• - Increased susceptibility to infection
  and atelectasis
• - Decreased lung tissue elasticity
• - Decreased respiratory muscle strength
• - Increased sensitivity of narcotics
• - Increased risk of aspiration
• - Decreased partial pressure of arterial
  oxygen (PaO2)

18
Changes

• Cardiovascular System
• - Increased systolic blood pressure
• - Increased risk of hypotension with
  position change
• - Decreased exercise tolerance
• - Drop in blood pressure may occur with
  Valsalva
• maneuver

19
Changes

• Gastrointestinal system
• - Decrease in intake due to change in
  appetite
• - Discomfort after eating due to slow
  passage of food
• in intestines
• - Increased risk of constipation
• - Decreased absorption of calcium and
  iron
• - Alteration of drug effectiveness

20
Changes

• Urinary System
• - Decreased GFR
• - Decreased sodium conserving ability
• - Altered renal blood flow and drug
  clearance
• - Decreased bladder capacity
• - Increased residual urine
• - Decreased creatinine clearance
• - Increased BUN

21
Changes

• Reproductive system
• - Increased vaginal dryness, burning and
  pain with
• intercourse
• - Decreased seminal fluid and force of
  ejaculation
• - Prostatic hypertrophy
• - Reduced elevation of the testes
• - Increased adipose tissue in the breast
  (decreased
• connective tissue) making examination
  easier

22
Changes

• Integumentary system
• - Thinning of the skin, dryness,
  pruritus, tearing
• - Decreased sweating and ability to
  regulate body
• heat
• - Increased wrinkling and laxity of skin
• - Loss of fat pads protecting bone
• - Increased wound healing time
• 
  

23
Laboratory Values Unchanged

• Hgb and Hct
• WBC
• Platelet Count
• BUN
• Electrolytes (K, Na, Cl-, HCO-3)
• Ca, Phosphorus
• TSH
• Free Thyroxine index (T4)
• Liver Function Tests (PT, Bilirubin,
  Transaminases)
• 
  Kane et al. (2013)

24
Common Abnormal Values

• Sedimentation rate - mild elevations may be age
  related
• Glucose - glucose tolerance decreases increases
  in acute illness (common)
• Albumin - declines with age generally indicates
  inadequate nutrition
• Alkaline phosphatase mild asymptomatic
  elevations common if moderately elevated
  consider liver and Pagets disease
• Serum iron binding, iron binding capacity,
  ferritin - decreased values not an aging change
  consider undernutrition and GI blood loss
• PSA may be elevated in patients with benign
  prostatic hypertrophy marked elevation or
  increasing values should be followed over time
  consider further evaluation

25
Dimensions Geriatric Assessment

• Cognitive Medical
  Affective
• Economic Functional
  Social
• Status
  Support
• Environmental
  Spirituality
• 
  Reuben Rosen (2009)
  

26
Aging Many Losses

• Cognitive short term memory, slowed-down
  reaction time, decreased alertness, confusion
  some changes reversible if due to dehydration,
  drug-drug interaction, infection or need for
  medication
• Economic financial independence, purchasing
  power, work role and status
• Environment lack of transportation (stop
  driving), dependent on public transportation
• 
  Jeffreys (2011)

27
Losses

• Medical - loss of health as previously known,
  multiple health problems not uncommon
• Affective - multiple chronic health problems,
  depression as a comorbid factor
• Social Support - limited social contact due to
  mobility issues, isolation, death of friends,
  loss of role created by work or volunteer
  involvement, difficulty meeting new friends,
  social devaluation
• Spirituality - emphasis on relations
  (transcendent force, self, others) important
  consequences for mental health and coping with
  difficult life situations

28
Interventions

• Supportive helping emphasis is preventative
  emphasize persons strengths/capabilities, help
  to plan for future needs, encourage talking about
  loved one, looking at photo albums, specific
  rituals that preserve the memory of the loved one
  lighting a candle at church
• Clinical helping encourage bereavement
  counseling, prescribing medications (based on
  cognitive and emotional functioning)
• Combination of interventions self-help support
  groups, grief/loss workshops, learning about
  grief a normal process and what grieving can
  look like
• 
  Jeffreys (2011)

29
Successful Aging

• No single well-accepted definition of the term or
  model of successful aging
• Concept - evolved over decades depicting various
  frameworks or schemas
• Havinghurst (early 60s) - adding years to life
  and getting satisfaction from life
• Ryff (early 80s) positive or ideal
  functioning related to developmental work over
  the life course

30
Successful Aging

• Rowe Kahn (late 80s) absence or avoidance
  of disease/risk factors for disease, maintenance
  of physical and cognitive functioning and active
  engagement with life
• Gibson (mid 90s) reaching ones potential at
  a level of physical, social and psychological
  well being in old age, pleasing to self and
  others
• Palmore (mid 90s) combines survival
  (longevity), health (lack of disability), life
  satisfaction (happiness)
• 
  Bearon (1996)

31
Theories of Aging

• Disengagement Theory
• - normally with aging, individuals gradually
  withdraw, disengage from social roles due to
  diminished capabilities/interest, retire from
  work or family life, pursue passive interests.
• - seems dated today, but at that time life
  expectancy was shorter, earlier onset of
  disability, mandatory retirement, few organized
  activities for older adults
• 
  Cumings Henry (1961)
• 
  
• 
  

32
Theories

• Activity Theory
• - people age successfully when they participate
• in daily activities - keep busy
• - explanation for rise in volunteerism, senior
• activism, development of senior centers and
• recreational facilities
• - discarded today as too narrow individuals
• who select less structured lives or do not have
  the
• health to allow engaging in activities
• Lemon, Bengtson Peterson
  (1972)

33
Theories

• Continuity Theory
• - people who age most successfully continue
  their lifestyle, habits, preferences
  relationships from midlife into old age
• - late life not a radical break with the past,
  change usually occurs gradually and sometimes
  imperceptibly
• - research demonstrates that psychological and
  social characteristics are stable across the life
  span continue to use well-practiced coping
  skills
• 
  Atchley (1972)

34
Emerging Trends

• Strength and growth potential of aging
  individuals concepts such as mindfulness,
  self-efficacy, self-control, life enrichment,
  empowerment describe a life reflecting
  self-actualization
• Some aspects of Activity and Continuity Theories
  but the strengths of aging approach ..
  emphasizes the role of experiences, intrinsic
  motivation as the basis for action and resilience
  in later life
• Literature on successful aging for those who
  experience significant hardships over the course
  of life .. who because of social factors
  (poverty, rural, poor nutrition, lack of
  education, significant losses) have reduced life
  chances to age well
• 
  Bearon (1996)

35
Research Successful Aging

• Lay perspectives Qualitative Study, 22
  Interviews
• - Mean age 80, range 64-96 yrs., 59 women
• - Primary themes
• Self-acceptance and self-containment
• Engagement with life and self growth
• - Successful aging balance between the two
• - Perspective supports the concept
  of wisdom as a major contributor to
  successful aging
• - Interventions promote productive
  and social
• engagement along with effective
  coping
• strategies
• Reichstadt et al. (2010)

36
Research

• Spirituality and serenity increase (Baltes et al.
  1990)
• Resilience influences ability to cope with
  difficult life events reflected in
  characteristics of hardiness, high self-efficacy
  (Hardy et al. 2004 Jeste et al. 2013)
• Engagement, family connection, attitudes
  integrating past with present, acceptance,
  feeling secure and sharing humor (Easley
  Schaller 2003)
• Prevention of disability and cognitive decline
  remain of paramount interest health related
  practices (smoking, exercise), chronic illness
  (diabetes, arthritis) and subjective health
  (individuals perception) more robust
  determinants of successful aging than demographic
  or socioeconomic factors (Depp Jeste 2006)

37
Model of Successful Aging

• Minimize Risk
  Disability
• Engage in Active
• Life Successful Aging
  Maximize
  
  Physical/Mental Abilities
• Maximize Positive
• Spirituality
  
• Revised Rowe Kahn
  Model - Crowther et al. (2002)

38
If I had it to do over again

• I would
• Reflect more on self, and relationships
• I would
• Risk more makes you feel heroic, and
• that you are special
• I would
• Do more things that would live on after
  I am
• dead
• 
  Compolo (1986)

39
Going the Distance What Makes Olga Run?

• Swap the Sudoku for Sneakers - exercise works
  better than even those brain games touted to
  boost memory
• Stay on Your feet - simply standing up more is
  the best thing sedentary people can do to start
  becoming healthier (pumps blood from feet - head
  to the vestibular system, which helps maintain
  blood pressure and balance)
• Eat Real Food - limit processed foods, eat 4-5
  smaller meals a day, not much in the evening,
  dont skip meals

40
Going the Distance

• Be a Creature of Habit - structure your days,
  familiar actions cue the body it is show time.
  muscles have memory. Maintain rituals adhering
  to a predictable bedtime, if it is Wednesday, I
  will be at the garden club if it is Monday, I
  will be playing bridge
• Cultivate a Sense of Progress - all need the
  feeling that in some small ways we are improving,
  or at least not backsliding. Chalking up wins
  becomes more difficult from midlife on when it is
  easier to feel like you are getting slower and
  weaker by the day. Reframe progress so it becomes
  a relative measure not an absolute one . move
  the yardstick as you age!!
• Lighten Up - dont sweat the small. Enjoy Life!
• 
  
  Grierson (2013)

41
Final thoughts

• Privilege to care for older adults - we can learn
  much from them
• Treat older adults as individuals - not according
  to their chronological age
• Baseline assessment essential - monitor health,
  early identification of problems
• Provider/patient communication - foundation of
  the relationship
• Deal with loss assist patients to understand
  and cope
• Consider ways to improve care delivery
• Expand your concept of successful aging

42
Final thoughts

• Dan Blazer (2006) . On Successful aging
• We must remember that successful aging is more
  than the absence of disease or dysfunction and is
  perhaps more than we can measure. How do we
  discover more?
• Thankfully, we have the privilege of learning
  from our parents , our patients and our mentors
  the true meaning of successful aging!
• Thank you !

43
References

• Amella, E.J. (2004). Presentation of illness in
  older adults. American Journal of Nursing.
  104(10), 40-50.
• Atchley, R.C. (1972). The social forces in later
  life. An introduction to social gerontology.
  Belmont, CA Wadworth
• Cuming, E. Henry, W.E. (1961). Growing old The
  process of disengagement. New York Basic Books,
  Inc.
• Fisher, B.J. (1992). Successful aging and life
  satisfaction A pilot study for conceptual
  clarification. Journal of Aging Studies. 6(2),
  191-202
• Havinghurst, R.J. (1961). Successful aging. The
  Gerontologist. 1(1), 8-13
• Kane, L., Ouslander, J., Abrass, I., Resnick,
  B. (2013). Essentials of Clinical Geriatrics. New
  York McGraw Hill Medical.
• Palmore, E.B. (1995). Successful aging. In
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  geriatrics 2nd edition. New York Springer
• Ryff, C.D. (1989). Successful aging A
  development approach. The Gerontologist. 22(2),
  209-214

44
References

• Rowe, J.W. Kahn, R. L. (1987). Human aging
  Usual and successful. Science. 237, 143-149.
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References

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• Jeste, D., Savla, G., Thompson, W., Vahia, I.,
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