Age-related physical changes occur gradually as we age and are not always visible. Some scientists have stated that we begin to age as soon as we are born, and this continues throughout our lifetime. It is impossible to generalize about the physical, psycho-social and emotional changes that occur with aging. Each one person is unique. There are many factors that contribute to aging, such as family history, occupation, nutritional status, social-economic status and so forth. What I am going to discuss is the more common health problems which occur among our aging population.
Cardiovascular Disease:
As we age, our cardiac output decreases. The heart muscle is less effective as a pump. The heart rate remains the same or slightly lower at rest, but the heart requires more time to recover after physical exertion or an extremely stressful situation. Also, the electrical conductive system functions less perfectly, leading to cardiac arrhythmias, such as atrial fibrillation. Blood pressure frequently rises with age as the blood vessels become sclerotic and narrowed.
Heart disease is the leading cause of death in the United States. Contributing factors are probably obesity, smoking, poor diet, more sedentary lives, stress and our longer lifespan. Common cardiovascular problems are: angina, heart attack, arrhythmias, congestive heart failure, hypertension, stroke and ASHD (arterial sclerotic heart disease) or "hardening of the arteries" of the extremities (arms and legs).
With moderate to severe heart disease, there is a marked change in the person's tolerance for physical activity as exhibited by shortness of breath and fatigue. He is unable to perform many of the tasks or roles that he could easily do at one time. Due to these changes, it is not uncommon to find these individuals are depressed and feeling like a "burden" on their families. These individuals tend to be anxious over the loss of their role as the "breadwinner" and are fearful about dying. It is imperative that they be involved in rehabilitative programs to cope with the changes in their lives.
Respiratory Diseases:
Many respiratory changes occur with aging. The efficiency of the entire respiratory system is decreased. The capacity for adequate air exchange is diminished due to the reduction of muscular tissue in the diaphragm and intercostals (muscles between the ribs). Additional deficits are caused by smoking and prolonged exposure to polluted air in urban and certain environmental occupations, such as coal mining.
Common respiratory diseases are chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. COPD's predisposing factors are recurrent or chronic respiratory infection, allergies and hereditary factors. Smoking is the number one and most important cause of COPD. COPD is ranked third only to heart disease and cancer for causing death or disability in the United States.
Behavioral characteristics associated with respiratory diseases may include: dependence on others because of inability to perform activities of daily living, depression and anxiety because of the fear of not getting enough oxygen to breathe (a feeling of suffocating). When oxygen intake is decreased, there are signs and symptoms of confusion, weakness and irritability. Like the cardiac person, rehabilitation and oxygen programs are required for the person to live comfortably.
Digestive System:
Malnourishment is the number one digestive problem among senior citizens. A substantial number of older people are considered malnourished. Many require assistance in preparing meals but have no one to assist them. Other causes are: Fixed incomes do not keep up with the rising cost of food, lack of an appetite, poor dentition and loneliness ("I do not enjoy eating by myself.")
Poor nutrition affects all body systems but especially the cardiovascular, nervous and musculoskeletal systems. It is demonstrated by weakness, listlessness, depression and irritability. These individuals should be encouraged to eat at least one meal per day with family members, or go to senior centers that serve hot lunches or other places that serve meals in a communal atmosphere. Meals on wheels program can be ordered for individuals, who need assistance with meals, as the program delivers between one to two hot meals daily to clients.
Cancer:
Cancer affects people in all age groups but is more common among very young children and older people. Cancer ranks second to cardiovascular disease as the leading cause of death in the United States. One out of four deaths is from cancer. Some epidemiologists predict that cancer will out rank cardiovascular disease by the year 2015.
In most cases, early detection of cancer enables more effective treatment and a better prognosis for the person. Some risk factors are: smoking, family history of cancer, and exposure to potential hazards. Cancer is an uncontrolled growth. There is no single cause but probably results from a complex interaction between viruses, physical and chemical carcinogens, and genetic, dietary, immunologic (body's ability to fight off infection) and hormonal factors.
A cancer diagnosis is devastating. To most people, cancer still means a "death sentence". Cancer patients have to cope with changes in body image, weakness, and anorexia from surgeries and radiation and chemotherapy treatments. These individuals frequently experience stress and lowered self-esteem. Listlessness, loneliness and feelings of isolation frequently occur after receiving the diagnosis of cancer. Anticipatory grief may occur as the person grieves for the "loss of his former life and body image."
Caregivers must pay particular attention to how the person is coping and try to understand the cancer patient's feelings and encourage him to continue with his therapy as well as attending support groups to discuss his concerns about his cancer and treatment modalities.
Musculoskeletal Diseases:
Aging is frequently accompanied by increased fragility and degeneration of the bones and joints throughout the body resulting in chronic pain and diminished activity. Additionally, muscle strength and function also decline due to loss of muscular fiber and diameter.
In osteoporosis, the bones become weaker and thinner due to interference in the bone rebuilding process, with backache and other skeletal pain as common symptoms. Osteoporosis affects one out of three women and one out of five men over the age 50 years. Persons with osteoporosis tend to be very irritable due to constant, nagging pain. They may tire easily, feel weak and shaky when standing, and become extremely apprehensive about falling. Depression may occur due to their inability to perform activities of daily living due to pain and the resulting immobility. Osteoporosis is treated with a diet high in calcium, phosphorus, protein, Vitamin D and exercise.
Osteoarthritis is the most common musculoskeletal disease as people age. It results from the degeneration of the cartilage that lines the joints, but occurs most frequently in the knees, hips, fingers and spine. The most common symptom is a deep, aching joint pain, particularly after exercise or weight bearing that usually is relieved by rest. Other signs and symptoms of osteoarthritis are: stiffness in the morning and after exercise, aching during changes in the weather, "grating" of the joint during motion, altered gait and limited movement. Depending upon severity of pain and degree of loss of mobility, there are three treatment modalities: drug therapy; strengthening exercises developed by Physical Therapists and stabilization of the joint through braces, traction, etc.; and surgical intervention.
Endocrine Diseases:
Diabetes mellitus is the most common endocrine disease in the United States, affecting several million people. It occurs more frequently in those individuals who have relatives with the disease and in overweight persons over the age of 40. Diabetic complications may significantly older person. It is the number cause of blindness in the United States today. Chronic kidney disorders, increase susceptibility to infections, peripheral neuropathy, cardiovascular disease, and vascular degeneration resulting in gangrene and loss of limbs are common complications.
Most people who develop diabetes as adults have what is called Type 2 diabetes. This type of diabetes is usually controlled by diet to control blood glucose level and to reach optimal weight, oral anti-diabetic medications and exercise. For many older diabetic patients, diet becomes a major score of frustration, depression and anxiety due to the fact that many of their favorite foods like ice cream, sweets, etc. are restricted. Education and counseling are critical in helping the individual regain control of his life situation.
Central Nervous System Diseases:
It is normal for the brain to age like the rest of our body does, and with aging there are changes in our memory, too. We do not learn as quickly as we did when we were younger but we are able to learn new information. We do have moments where we forget what we were doing or cannot recall someone's name, but all this is a normal part of the changes that occur with aging.
Between four and five million people in the United States have some degree of cognitive impairment, and this number is increasing as the population referred to as "Baby Boomers" increases in age. Alzheimer's is just one kind of dementia. In recent years, Alzheimer's disease has been widely publicized through the media and within health-care professionals.
Clinicians can now diagnose Alzheimer's with up to 90 percent accuracy, but can only be confirmed by autopsy, where the pathologists look for disease's characteristic plaques and tangles in brain tissue. Clinicians diagnose "probable" Alzheimer's disease by taking a complete medical history and conducting lab tests, a physical exam, brain scans and neuropsychological tests that gauge memory, attention span, language skills and problem-solving abilities.
The most common symptom of Alzheimer's disease is memory loss, which is accompanied by mood swings, behavior and personality changes, impaired judgment and speech, confusion and restlessness. As the disease progresses, the patient becomes more and more a shell of a person as he loses his awareness of what makes us human-sense of self and his identity, memories, awareness of family and friends, etc. Not only is the patient a victim but so is the family as they watch daily their loved one physically and mentally deteriorate before their eyes and become a "stranger" they no longer know and who no longer knows them. In the middle and late stages, Alzheimer's patients require total, custodial care. Both patient and family require intense support and direction in coping with the ravages of Alzheimer's. Many family members feel very guilty about placing their loved one into a facility. It is not uncommon for family members to run down their health in a desperate attempt to care for the patient at home.
The earlier the onset of Alzheimer's disease, the shorter the patient's life expectancy is. For example if someone is diagnosed with Alzheimer's at age 50, he may have a life expectancy of ten years. While someone who is diagnosed at age 70 may have a life expectancy of 20 years or more. In the final stage of Alzheimer's, death usually results from a combination of factors. The most common cause of death is pneumonia. Currently, there is no known cure, but there are several new medications that slow down the process of Alzheimer's in the early stages.
Psychological Disorders:
Most psychological disorders occur later in life usually precipitated by the crises of aging and the changes that occur physically, cognitively and socially. There is significant alteration in body image with aging and its' accompanying diseases; decrease in self-esteem due to retirement and role change status; and, loss of family and friends because of death or physical separation in another state. All these factors impact greatly on the psychological well-being of senior citizens. Another aspect that contributes to psychological disorders is that many senior citizens accept these disorders, such as depression and pain, as part of the aging process and do not seek help until acute or severe problems appear.
Common symptoms of psychological disorders include: withdrawal from activities that were enjoyed before, lack of interest in physical appearance, insomnia, loss of appetite, constipation or diarrhea, suspiciousness, hostility, delusions, feelings of inferiority and a wide variety of somatic complaints. If an elderly parent or friend is exhibiting any of these symptoms, it is imperative that this person be physically assessed by a medical person first hand before any other treatment modalities are instituted as many of these symptoms are associated with medical diagnoses.
Many gerontologists believe that disease causes aging rather than vice versa. Treatment of underlying pathologic conditions will frequently remove many of the characteristics attributed to old age.
