Question

Identify age-related changes that you see in an individual (family member or client/patient) and describe the impact these changes have had on the individual.

Answer 1

Introduction

Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and pace. In the broader sense, ageing reflects all the changes taking place over the course of life. These changes start from birth—one grows, develops and attains maturity. To the young, ageing is exciting. Middle age is the time when people notice the age-related changes like greying of hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit cannot escape these changes. Slow and steady physical impairment and functional disability are noticed resulting in increased dependency in the period of old age.

Ageing process and physiological changes-

Changes in nervous system

Ageing is associated with many neurological disorders, as the capacity of the brain to transmit signals and communicate reduces. Loss of brain function is the biggest fear among elderly which includes loss of the very persona from dementia (usually Alzheimer’s disease). Multiple other neurodegenerative conditions like Parkinson’s disease or the sudden devastation of a stroke are also increasingly common with age.

Alzheimer’s and Parkinson’s diseases are the progressive neurodegenerative diseases associated with ageing. Alzheimer’s is characterised by progressive cognitive deterioration along with a change in behaviour and a decline in activities of daily living. Alzheimer’s is the most common type of pre-senile and senile dementia.

Cognition

A mild decline in the overall accuracy is observed with the beginning of the 60s that progresses slowly, but sustained attention is good in healthy older adults. Cognitive function declines and impairments are frequently observed among the elderly. Normally, these changes occur as outcomes of distal or proximal life events, where distal events are early life experiences such as cultural, physical and social conditions that influence functioning and cognitive development.

Cognition decline results from proximal factors (multiple serial cognitive processes) including processing speed, size of working memory, inhibition of extraneous environmental stimuli and sensory losses. This is a threat to the quality of life of those affected individuals and their caregivers.

Memory, learning and intelligence-

According to various studies the effect of normal ageing on memory may result from the subtly changing environment within the brain. The brain’s volume peaks at the early 20s and it declines gradually for rest of the life. In the 40s, the cortex starts to shrink and people start noticing the subtle changes in their ability to remember or to do more than one task at a time. Other key areas like neurons shrink or undergo atrophy and a large reduction in the extensiveness of connections among neurons (dendritic loss) is also noticed. During normal ageing, blood flow in the brain decreases and gets less efficient at recruiting different areas into operations.

Vision

Ageing includes a decline in accommodation (presbyopia), glare tolerance, adaptation, low-contrast activity, attentional visual fields and colour discrimination. Changes occur in central processing and in the components of the eye. These numerous changes affect reading, balancing and driving.

2.4.2. Hearing

Ageing causes conductive and sensory hearing losses (presbycusis); the loss is primarily high tones, making consonants in speech difficult to discriminate.

2.4.3. Taste acuity

Losing sense of taste is a common problem among adults .Taste acuity does not diminish but salt detection declines. Perception of sweet is unchanged and bitter is exaggerated. The salivary glands get affected, and the volume and quality of saliva diminish. All changes combine to make eating less interesting.Studies show that the physiological decline in the density of the taste acuity and papillae results in a decline of gustatory function .In fact, studies done on taste dysfunction show that ageing-associated changes in the density of taste acuity may affect taste function differently in different regions of the tongue . Taste perception declines during the normal ageing process. A study done on the healthy elderly shows that after about 70 years of age, taste threshold begins to increase resulting in dysgeusia. Chewing problems associated with loss of teeth and use of dentures also interfere with taste sensation and cause reduction in saliva production.

2.4.4. Smell

As we get older, our olfactory function declines. Hyposmia (reduced ability to smell and to detect odours) is also observed with normal ageing [36]. The sense of smell reduces with an increase in age, and this affects the ability to discriminate between smells. A decreased sense of smell can lead to significant impairment of the quality of life, including taste disturbance and loss of pleasure from eating with resulting changes in weight and digestion.

Touch

As we age, our sense of touch often declines due to skin changes and reduced blood circulation to touch receptors or to the brain and spinal cord. Minor dietary deficiencies such as the deficiency of thiamine may also be a cause of changes.The sense of touch also includes awareness of vibrations and pain. The skin, muscles, tendons, joints and internal organs have receptors that detect touch, temperature or pain.

A decline in the sense of touch affects simple motor skills, hand grip strength and balance. Studies have shown that muscle spindle (sensory receptors within the muscle that primarily detects changes in the length of this muscle) and mechanoreceptor (a sense organ or a cell that responds to mechanical stimuli such as touch or sound) functions decline with ageing, further interfering with balance.

Changes in musculoskeletal system-

Normal ageing is characterised by a decrease in bone and muscle mass and an increase in adiposity.A decline in muscle mass and a reduction in muscle strength lead to risk of fractures, frailty, reduction in the quality of life and loss of independence. These changes in musculoskeletal system reflect the ageing process as well as consequences of a reduced physical activity. Skeletal muscle strength (force-generating capacity) also gets reduced with ageing depending upon genetic, dietary and, environmental factors as well as lifestyle choices. This reduction in muscle strength causes problems in physical mobility and activity of daily living. The total amount of muscle fibres is decreased due to a depressed productive capacity of cells to produce protein.With ageing, toxins and chemicals build up within the body and tissues. As a whole, this damages the integrity of muscle cells. Physical activity also decreases with age, due to a change in lifestyle. Somehow, the physiological changes of the muscles are aggravated by age-related neurological changes .Most of the muscular activities become less efficient and less responsive with ageing as a result of a decrease in the nervous activity and nerve conduction.Hormonal disorders can affect the metabolism of bones as well as muscles. Research suggests that menopause in women marks the aggravation in the deterioration of musculoskeletal changes due to lack of oestrogen that is required for the remodelling of bones and soft tissues. Essential vitamins like vitamin D and vitamin C play major roles in the functional growth of muscles and bones. Lack of certain minerals like calcium, phosphorus and chromium can be the result of age-related digestive issues. As such, it results in imbalance in the production of certain hormones like calcitonin and parathyroid that regulate the serum concentration of vitamins and minerals (due to tumours that are highly prevalent in elderly) or it causes a decreased absorption from the gut.

Body composition changes in old age-

The human body is made up of fat, lean tissue (muscles and organs), bones and water. After the age of 40, people start losing their lean tissue. Body organs like liver, kidneys and other organs start losing some of their cells. This decline in muscle mass is associated with weakness, disability and morbidity.

Obesity in elderly: prevalence-

Today, as standards of living continue to rise, weight gain is posing a growing threat to the health of inhabitants from countries all over the world. Obesity is a chronic disease, prevalent in both developed and developing countries, and it is affecting all age groups. Indeed, it is now so common that it is replacing the more traditional public health concerns, such as infectious diseases and undernutrition, as the most common and significant contributors of ill health.

The population in developed countries have proportionally a greater number of older adults living to older ages, and the prevalence of obesity is rising progressively, even among this age group.

The prevalence of obesity among elderly belonging to United States ranges from 42.5% in women to 38.1% in men, belonging to the age group 60–79 years. The prevalence differs for the elderly belonging to the age group 80 years and above, that is, 19.5% for females and 9.6% for males.

Conclusion-

At the biological level, ageing results from the impact of the accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease, and ultimately, death.