Advanced Old Age/Late Adulthood

free radical theory

Occurs when a paired ion breaks off and is no longer paired (like NaCl → Na+ + Cl-)

Unstable and seeks other molecules to bond to → creates oxidative stress that causes irreparable damage to body cells, DNA and mitochondria

Number of free radicals increases with age

Biological clock theory

AKA apoptosis: the cell membrane breaks down and is phagocytized by surrounding cells

Dictates when menopause occurs and contributes to body changes that results in death

The ovary is the only organ to have programmed senscense and predictable complete loss of function

Wear & Tear theory

Overtime the human body wears down like a machine. Some parts can be easily replaced while others can not

Think hip replacement vs a heart transplant

Immune Theory

As the body ages, it becomes harder for immune cells to differentiate between healthy versus defective cells and the body responds by destroying both types

Ultimately, the immune system is impaired and the body is more susceptible to illnesses and infections. Autoimmune response (immune attacking normal body cells) is also more common

Signs of aging in bones and cartilage

Loss of body water, bone mass, and degeneration of spinal disks → decrease in height

Decreased physical activity → loss of muscle mass and increase of fat

Collagen and elastin fibers become rigid and brittle → decreased cell functions

Loss of estrogen → loss of bone density → increased chance of osteoporosis

Signs of aging in blood vessels

Increased fat and connective tissue → thicker arterial walls and narrower arteries → less oxygenated blood flow to the heart

Heart muscle and arteries become stiffer

Less oxygen → increased blood pressure → prone to dizziness, fainting, and stroke; delayed heart response to pain, stress, or anxiety

Signs of aging in lungs

Ribs and Cartilage are more rigid → more effort for respiratory muscles

Osteoarthritis and reduced height → smaller chest cavity

Lung tissue is more rigid → decreased lung volume and impaired oxygen exchange

Impaired ability to breathe, cough, or swallow → prone to respiratory infections

Signs of aging in Kidneys and Bladder

Slower kidney filtering of the blood → toxic accumulation of medication and waste in the blood

Kidneys are more susceptible to failure

Bladder capacity decreases → frequent urination

In men, enlarged prostate may block urethra → urinary frequency or complete obstruction of urinary flow (urinary retention)

Signs of aging in metabolism

Slower metabolism → increased retention of glucose and lipids

Increased risk of cardiovascular disease and diabetes

Signs of aging in Digestion, Taste, and Smell

Decreased motility of the GI tract → difficulty swallowing and pooping

Digestive enzymes decrease → poor appetite and digestive issues

Taste buds are replaced with connective tissue → only 40% remain after 75 years

Perception of salt decreased, while bitterness increased. Impaired sense of smell and decreased saliva → loss of appetite

Reduced gag reflex → increased risk of choking

Decreased peristalsis → constipation and gas

(Prompts the person to use laxatives and antacids, which may cause other health problems)

Signs of aging in teeth

Jawbone shrinks and circulation to gums decreases → tooth loss

Remaining teeth provide inadequate chewing ability → decreased nutritional intake and negative self-image

Receding gums → ill-fitting dentures and gum lesions

Signs of aging in skin

Repair and replacement of skin cells take longer → prone to skin injury and slower healing

Loss of subcutaneous fat and college → thinner skin and less turgor (elasticity)

Skin develops wrinkles and spots

Decreased perception of hot and cold temperatures → increased risk for burns

Decreased sense of touch → decreased motor skills, hand grip strength, and balance

Decrease of sweat glands → difficulty in temperature regulation

Signs of aging in eyes

Loss of elasticity and reduced fat around eyelids → lashes rubbing on the eye and irritation

Decreased tear production → eye irritation

Cholesterol deposits may form a yellow ring around iris of the eye

Loss of cells in the optic nerve → difficulty seeing details

Degrading of the eye's rod cells → difficulty perceiving contrast → difficulty night driving

Pupil of the eye takes longer to adjust to the surroundings

Cataracts develop, but surgery is common

Development of galucoma (atrophy of the optic nerve and increased intraocular pressure) → leading cause of blindness

Macular degeneration is also common and total blindness is rare

Signs of aging in the ears

Decrease in hearing ability

Significant loss of hair cells → difficulty hearing higher sound frequencies

Signs of aging in the nervous system

Loss of brain function

Neurons atrophy and brain volume shrinks by 5% a decade after 40

Neuron transmission slows

Blood flow to brain slows

Motor responses and reactions slow

What are some ADL

bathing, dressing, transferring, toileting, grooming, feeding, mobility

Aging in place

Ability to live in one's own home safely, independently, and comfortably, regardless of age, income, or ability

Must convert home to have the necessary adjustments

Assisted Living in Residential areas

For minimal or moderate care

Some assistance in everyday tasks

Nursing Homes or Long-Term Care Facilities

Provide long-term care for patients needing extra time to recover from illness or injury before returning home, or for persons who can no longer care for themselves

Often requires relinquishing independence and control over one's life

Sleep problems in old age

High prevalence of sleep disorders

Decrease in total hours required

Increase in nocturnal awakenings, shorter periods of sleep

Female sexual changes in old age

Sexual interest remains

Menopause doesn't decrease sexual response but symptoms may influence reactions

Male sexual changes in old age

Sexual interest remains

Testosterone stabilized

Penis decreases in size and firmness

Reduced production, motility, and lifespan of sperm

Harder to achieve and maintain an erection

Perceptual changes in old age

Negative self-image may affect the ability to function

Role adjustment requires adaptation and acceptance

Symptoms of natural cognitive impairments in aging

Slow progression of symptoms

History of depression is less common

Complains about memory loss

May decrease or increase efforts to perform

Uses notes and memory aids

No lasting mood changes

"Dont know" answers are common

Recent and remote memory losses are equal

Dementia

Not inevitable

Can be chronic or progressive

Usually unaware of memory loss

Conceals disability

Struggles to perform

Needs instructions to use memory aids

Emotional liability and shallowness

Guesses or "near miss" answers are common

Recent memory impaired, remote is intact

Memory gaps for specific events are unusual

Treatment: medications, self-care, routines, stimulation, and safety interventions

Alzheimer's Disease

Most common form of dementia (progressive)

Assessed at every HCP visit and MMSE screening

Symptoms: Forgetfulness, inattentiveness, disorganized thinking, altered level of consciousness, perceptual disturbances, sleep-wake disorders, psychomotor disturbances, disorientation

No treatments

Depression

Higher risk among older adults

Factors: Isolation, loss, change in environment, low self-esteem, medical conditions, medications

Causes of memory issues

Drug toxicity

Depression

Metabolic problems

Sensory problems

Nutritional deficiencies

Illness

Immortality vs Extinction

Reminiscing about the past

Focus on activities that bring pleasure

Adjusting to retirement and the frailties of aging