The Normal Aging Process

General Model of Aging

Structural changes:

• ↑ Atrophy

• ↑ Dystrophy

• ↑ Edema

==>

• ↓ Elasticity

• ↑ Demyelinatization

• ↑ Neoplasm

• ↑ Mutation

General Model of Aging

Functional consequences:

• ↓ Accuracy

• ↓ Speed

• ↓ Range

• ↓ Endurance

• ↓ Coordination

• ↓ Stability

• ↓ Strength

Factors Influencing Aging

• genetics

• environmental factors and exposure

• injuries

• personalities and attitude

• lifestyle

  • exercise!!!

• advancesin medicine

Nervous System Changes:

Central Nervous System

• Cerebral Atrophy

  • e.g., front lobe deterioration (e.g., decreased filter)

• Reduced cerebral blood flow

• Plaque deposits and neurofibrillary tangles

Nervous System Changes:

Peripheral Nervous System

• Changes in peripheral receptors

• Slower nerve conduction and velocities

Musculoskeletal Changes

• Sarcopenia age related loss of muscle mass

• Muscles: decrease in strength and mass

  • More pronounced in LE (flexors) than in UE

  • Changes in flexibility and reaction time

  • “use it or lose it” (i.e., being in bed rest, you lose SO much muscle mass)

• Bone: loss of skeletal mass

  • Osteoporosis

    • bone weakens to a fracture threshold, even under mild stress

    • double in women than in men

• Joints: More prone to injury

  • Decrease in cartilage, synovial fluid

  • Osteoarthritis

  • Postural changes

    • forward head

    • rounded shoulders

    • flattened back

  • Ligaments are less elastic

Integumentary System

• Changes in the skin, glands, hair, and nails

  • Skin: thinning and atrophy, “age spots”, wrinkling

    • results in more susceptibility to abrasions, blisters, pressure ulcers, etc.

    • so, you must avoid having older adults sit in the same spot for hours and not move!!!

    • also, use kinesiotape with caution (especially on the face; more hypersensitivity)!!!

  • Glands: decrease in number of sebaceous and sweat glands

  • Hair: graying, thinning, and loss

  • Nails: thickening

    • more susceptibility to skin infections if the nails are digging into the hand

Cardiovascular Changes

• Structural changes to the heart

• Changes in electrical conduction system

• Decrease in maximal heart rate

  • Changes in ability of heart to meet demands

  • Leads to decreased ability to oxygenate which leads to fatigue and decreased endurance

    • —> exercises should look different older adults

• Changes in blood vessels

  • Increased resistance makes heart work harder

  • Increased systolic BP

Vascular System

• Vessels thicken and become less elastic

  • “Stiff Arteries”

  • Increased resistance: heart works harder

• Atherosclerotic changes

  • Narrowing

  • Reduced blood flow: Ischemia

  • Arterial Occlusion

Respiratory System

• Decline in pulmonary functioning

  • e.g., more susceptibility to pulmonary embolism

• Changes in lungs and chest wall lead to problems with ventilation and gas exchange

• Less efficient breathing

• Decreased capacity to cough

  • Increased susceptibility to infections and complications

Digestive System Changes

• Structural changes- orally

  • e.g., dry mouth, reduced swallowing and speech, working with dentures

• Changes in ability to break down substances

  • e.g., gastritis, altered drug metabolism

Genitourinary System Changes

Less efficient functioning of kidneys and other urinary structures

• e.g., problems with incontinence, decreased bladder, hypertrophy of prostate, loss of nephrons

Endocrine System Changes

Changes in thyroid function

• e.g., decreased ability to regulate body temperatures

Sexual Function (+ men vs women)

• Changes in hormone levels

• Men:

  • Testosterone level decrease very little

  • Decreased size and firmness

  • Decreased sperm production and ejaculatory force

  • Prostate enlargement

  • Erectile dysfunction and problems with vascular blood flow

• Women

  • Women

  • Vaginal dryness

  • Changes in shape and muscle tone

  • Thinning of vaginal wall

  • Reduce size of clitoris

***all impacts sexual ADLs!!!

Cognitive Functions

• Attention

  • May be more distractible

  • Complex attention tasks are more difficult

• Language

  • Word-finding problems common

• Executive function-changes

  • Decreased processing speed- some increased difficulty with complex multi-step tasks

• Memory

  • Semantic, procedural, and long-term memory are intact

  • Changes in short-term and episodic memory (decreases over time)

    • reminiscence groups are so important!!!

  • Prospective- decreases but can often compensate

Does Personality Change with Age?

personality ~generally~ stays the same, but behaviors may look different over time

• Neuroticism

• Extroversion

• Agreeableness

• Conscientiousness

• Openness

• Importance of promoting self efficacy for successful aging

Sensory Changes

• Occurs in all modalities

• May affect ADLs, ability to interact with your environment, or even just safety in general!

  • Vision

    • e.g., can’t drive

  • Hearing

    • e.g., can’t drive, can’t hear safety alarms

  • Taste

    • e.g., sweet taste diminishes as you get older (may discourage people from eating, resulting in dehydration and malnutrition)

  • Smell

    • e.g., can’t smell smoke, can’t smell if a food has gone bad

  • Somatosensory

    • e.g., decreased ability to experience pleasure and pain (e.g., tactile stimulation)

Somatosensory Changes

• Decline in sensitivity to tactile stimuli

• Temperature sensitivity

  • e.g., decreased ability to detect temperature could lead to burns when bathing

• Alterations in kinesthetic sensitivity

• Alterations in peripheral nervous system

• Functional Implications

  • Safety-increased risk of injury

  • Diminished fine motor skills

Visual Changes

• Reduced visual acuity

• Decreased ability to accommodate/focus

• Decreased ability to adjust to changes in illumination

• Decreased resistance to glare

• Changes in color sensitivity

• Presbyopia

  • decreased tissue elasticity and tone in the eye

  • age-related farsightedness (i.e., can see far but have trouble focusing on near objects)

  • e.g., needing reading classes

Hearing Loss

• Presbycusis

  • Age-related hearing loss

• ***Difficulty hearing high frequencies

  • especially when in a crowded environment

• Diminished ability for pitch/tone threshold

• Most age-related hearing loss is sensorineural

• Interferes with ability to interact with environment (social and physical)

  • Diminished speech reception, discrimination, and understanding

  • may even result in suspicion and paranoid behavior

• may see depression and anger

• functional implications

  • e.g., can you hear a car coming? can you hear an alarm? should you be giving visual instructions, instead of just verbal ones?

Vestibular System

• Loss of receptor organs and structures

  • Saccules, utricles, semi-circular canals

• Increased postural sway, wide-based gait (beyond shoulder width)

• Unsteadiness in standing/walking

• Alterations in righting and equilibrium reactions

• Presbyastatis

  • Age-related disequilibrium

Taste

• Overall decrease in taste perception

  • sweet, salty, sour, bitter

• Decreased sensitivity to sweet substances

• Related to decreased number of papillae and taste buds on tongue

• Atrophy of neurons in taste centers

• Mild dysgeusia

  • chronic bad taste in your mouth (e.g., usually due to medication or diseases)

  • results in people not wanting to eat, even just for things like water

• Decreased saliva flow

• Due to medication, dental problems, and conditions

Olfactory System

• Decline in threshold sensitivity for odors

• Due to combination of changes

  • Changes in CNS ability to detect smell

  • Nerve damage

  • Changes in nasal passages and membranes

• can impact episodic memory

• can impact a person’s appetite

• can bring safety concerns

  • e.g., can you smell smoke? can you smell bad food?

Older Adults and Disease

• Average older adult has 3-4 different diseases

• Diseases tend to occur in clusters

• Interaction may result in “Geriatric Syndromes”

• More common in advanced older age

Geriatric Syndrome

• Used to capture conditions in older adults that do not fit into discrete disease categories

• Impact quality of life

• Disability is great

• Multiple underlying factors including multiple organ systems contribute to syndrome

Normative Aging vs. Pathology

• Normal physiological changes occur during the aging process

• Pathology is not an expected part of aging although there is a higher prevalence

• Prevention and health promotion are key in decreasing the risk of onset and for promoting successful aging