Chapter 1  – The Aging Population: Introduction to Age-Related Changes

The Aging Population

• Persons older than 65 comprise more than 12% of the US population
• Increasing life expectancy
• 20% of the population will be older than 65 by 2030

Subsets of the Elderly

• Old:  60 to 74 years
• Old-old:  75 to 100 years
• Elite old (centenarians):  over 100 years

Life expectancy is increasing

• Disease Management
• Better Sanitation
• Lower Child Mortality
• Better Living Conditions

Life expectancy influences

• Genetics
• Health practices
• Education
• Financial status
• Risk behavior
• Diet/Nutrition
• Exercise
• Environment
• Attitudes and beliefs
• All contribute to “compression of morbidity….”

Socioeconomics of the Elderly

• Women tend to survive longer than men
• Married people live longer
• Most live with another family member
• Most have family contact
• Those in poverty are declining in number
• More favor work continuation

The older population in the U.S. is becoming increasingly diverse….

• It’s important for the Nurse to perform a cultural self-assessment….
  • What self-identity influences my world view?
  • How has my cultural background influenced me?
  • What is my attitude toward people who
    • are immigrants?
    • have difficulty with the English language?
    • have difficulty communicating?
    • have a cultural background different from my own?
    • look or act like the stereotype of people who are gay, lesbian, or transgender?
  • What are my attitudes about and experiences with health practices that differ from my own?
  • How well do I communicate and understand?

The Baby Boomers

• Born between 1946 and 1964
• Most have children, but fewer in number
• Best educated generation yet
• Higher income
• Favor more casual dress
• Enjoy technology
• Less leisure time
• Interest in health and fitness

Social Security and SSI

• Social Security
  • Benefit to retired workers
  • A suplement
• SSI
  • Benefit to 65+
  • Based on financial need

The Role of Chronic Conditions

• More than 50% of persons over 40 years of age have at least 1 chronic condition
• More than 80% of non-institutionalized persons over 65 years of age have at least 1 chronic condition
• Therefore, health care for the elderly should be oriented toward care of chronic disease regardless of the person’s age
• Health care should emphasize:
  • Improving function
  • Postponing deterioration and disability
  • Preventing complications

Common chronic conditions 65+

• Overweight/Obesity (BMI > 25): 76.9% males, 73.8% females
• Arthritis affects 49.7% all people 65+
• Heart disease:  37% males, 26% females
• Cancer:  28% males, 21% females
• Respiratory disease:  20% males, 24% females
• Diabetes:  24% males, 18% females
• Depression:  15-20%
• Alzheimer’s:  11%
• Falls
• Substance abuse

Myths of Aging

• “Old” means being sick
• Older people cannot learn new information
• Health promotion is wasted on older people
• The elderly do not pull their own weight
• It is too late to change bad habits in the elderly
• Older people have no interest in sex

Common Characteristics of Centenarians (1)

• Biocognitive Theory (Mario Martinez)
• Absence of envy
• Live in the present, being optimistic about the present and the future
• No sense of aging, don’t tell their age, age is irrelevant (prevents being “pegged”)
• Usually underweight, not obese
• Active
• No concept of retirement or middle age, no marker for biology to follow
• Rarely seek  medical advice unless complaint is significant
• Usually die by accident or in sleep…death is peaceful and without lamenting
• Low protein, high complex carbohydrate diet
• Live in subcultures that revere the elderly
• Drink alcohol prudently, not addictively
• There are no atheists, a belief in a benign, not wrathful, power

Wellness-focused Nursing

• Includes physical, mental, social, and spiritual well-being
• Views each individual in terms of his or her:
  • Chronologic age
  • Age identity
  • Functional age
• Our goal is “high-level wellness”
  • Maximizing the patient’s potential
  • Maintaining optimal physical health
  • Promote purposeful direction in life

Common Characteristics  of Centenarians (3)

• Longevity in the family is not a requirement
• Definite sense of humor
• Forgive easily
• They are negotiators
• Have commitment to community, a sense of service
• Fearless about life’s challenges
• Believe they are loveable

Changes and loss in the elderly

• Spouse, family, friends, pets
• Work status
• Role identity
• Health status
• Financial status
• Physical ability
• Self-care abilities

Changes at cellular level

• Number of cells is reduced
• Lean body mass is reduced
• Total body fat increases
• Bone mass decreased
• Less total body fluid

Changes in appearance

• Appear after 4^th decade
• Greying and thinning hair
• Facial hair in women
• Decreased height
• Gait changes:  narrower in women, wider in men
• Decreased muscle mass

Changes in respiratory system

• Costal cartilage becomes calcified
• Increased A-P diameter
• Decreased number of cilia
• Reduced number alveoli
• Decreased lung recoil
• Increased residual volume
• Decreased vital capacity

Changes in cardiovascular system

• Left ventricular hypertrophy
• Thickened valves
• Incomplete valve closure
• Pacemaker cell number decreases
• Increased recovery time from stress
• Increased peripheral resistance
• Reduced baroreceptor sensitivity
  • Postural hypotension
  • Postprandial hypotension

Changes in GI system

• Decreased esophageal motility
• Relaxation of LES
• Atrophy of gastric mucosa
• Slower peristalsis
• Changes in liver function
• Changes in pancreatic function

Changes in GU system

• Smaller renal mass
• Reduced renal blood flow
• Decreased GFR
• Less efficient tubular exchange
• Decreased secretion of ADH
• Decreased bladder capacity
• Weakened bladder muscles
• BPH
• Atrophy of vulva
• Reduced vaginal secretions

Changes in musculoskeletal system

• Sarcopenia
• Arm and abdomen reflexes lessened
• Frequent muscle cramping
• Decreased bone mineral and mass
• Decreased calcium absorption
• Thinning discs
• Shortened vertebrae
• Bone spur formation

Changes in neurological system

• Decreased cerebral blood flow
• Slower nerve conduction
• Slower response to change in balance
• Decreased brain size
• Changes in circadian rhythm

Changes in sensory systems

• Decreased ability to change shape of lens
• Visual field narrows
• Pupil less responsive to light
• Macular degeneration or cataracts
• Distorted depth perception
• Presbycusis
• Decreased sense of smell
• Decreased sense of taste

Changes in endocrine system

• Thyroid increasingly fibrotic, nodular
• Loss of adrenal function
• ACTH secretion decreases
  • Decreased secretion of gluco-corticoids
  • Decreased secretion of progesterone, androgen, estrogen
• Decreased TSH secretion by pituitary, risk for depression
• Delayed, insufficient secretion of insulin; blood glucose levels rise in the absence of diabetes

Changes in integumentary system

• Reduced thickness, vascularity of dermis
• Degeneration of elastin fibers
• Reduced skin elasticity
• Clustering of melanocytes (age spots)
• Decreased skin immune response
• Thinning, greying of hair
• Reduced perspiration

Changes in immune system

• Immunosenescence—gradual deterioration of the immune system
• Decline in cell-mediated immunity
• Reactivation of varicella zoster and Mycobacterium TB
• Decreased response to vaccines
• Atypical presentation of inflammation
  • Low grade fever
  • Minimal pain

Cognitive changes

• Slower long-term memory
• Reduced ability to retain information
• Basic intelligence maintained
  • Crystallized—maintained
  • Fluid—declines
• Personality remains consistent
• Ability to learn is maintained
• Longer early learning phase
• Decreased attention span

Age-related changes (Miller) 

• Inevitable, progressive, and irreversible changes that are independent of extrinsic or pathologic conditions
• Inherent physiologic processes that increase vulnerability to detrimental effects of risk factors
• On the physiologic level, changes are typically degenerative
• On psychological and spiritual levels, they include potential for growth
• Identify psychological and spiritual age-related changes to improve/adapt to physiologic decline
• Build on wisdom for problem-solving skills to address risk factors

Risk factors (Miller)

• Conditions that increase vulnerability to negative functional consequences
• Common sources of risk factors include:
  • Disease
  • Environment
  • Lifestyle
  • Support systems
  • Psychosocial circumstances
  • Adverse medication effects
  • Attitudes based on lack of knowledge

Use of functional consequences theory (Miller)

• Assessment of:
  • Age related changes
  • Risk factors
  • Negative functional changes

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• Interventions based on assessment

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• Positive Functional Consequences