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NORMAL AND ABNORMAL CHANGES OF AGING

Eyesight

Normal changes in a person’s eyes that can begin to occur as early as the 40s include:

• a decrease in peripheral (side) vision

• a decrease in the elasticity or flexibility of the lens

• a decrease in the ability to see small print

• decrease in depth and distance perception

• a decrease in the pupil’s ability to change size and to adjust to changes in light and dark.

• Lose some ability to read and see things that are overhead – due to changes in the muscles that raise the eyeballs.

• More farsighted (need for bifocals)

Abnormal changes

• Cataracts (a clouding of the lens)

• Glaucoma (an increase in inner eye pressure)

• Diabetic retinopathy (deterioration of the retina of a person who has diabetes.)

Hearing and Ears

• Some persons do not notice any loss of hearing

• Hearing loss may be environmental

• Presbycusis (age-related hearing loss) – gradual hearing loss where it is more difficult to hear high-frequency pitches in voices or instruments. Consonants –high; vowels – low-pitched. May be difficult to understand speech especially if there are distracting background noises.

• Tinnitus or ringing in the ears. The high-pitched ringing sound is especially acute at night or in silence. Sometimes apparent hearing loss is simply due to a normal build-up of ear wax, which tends to accumulate more rapidly in some older people.

• Hearing loss can be caused by injury or infection.

• Hearing tests can tell loss before purchasing a hearing aid but not all hearing difficulty can be corrected with an aid

• Infections in or damage to the inner ear may cause dizziness and mobility problems.

Sometimes hearing impairment is mistaken for confusion or demention because of the person’s difficulty in understanding and responding to people.

Other senses

• Normal loss of the intensity and sensitivity in the sense of touch (hot and cold harder to distinguish, especially in the extremities – fingers, palms, and lower limbs)

• Hypothermia may be more of a danger to them

• Sense of smell becomes less sensitive also in normal aging, and the ability to distinguish one smell from another declines normally with age. This is because the olfactory nerve becomes less sensitive normally. This change could be dangerous, because an older person may not be able to readily smell gas or smoke.

• People normally lose some ability to judge taste differences, especially saltiness. Because the senses of smell and taste become less acute, the appetite and enjoyment of food can be adversely affected. In addition, an older person may increase the intake of salt because the taste is harder to distinguish, which may not be nutritionally wise. Abnormal change in touch, smell, and taste may be caused by strokes and other nervous system disruptions.

Teeth and gums

• If care of the teeth and gums has been adequate throughout the person’s life, then he or she will probably not lose teeth. Teeth normally change color with time, becoming more yellowish.

• Sometimes oral disease causes cavities or loss of teeth. The increased incidence of losing teeth is due not to normal aging but to historical differences in preventive dental care and in water fluoridation. Since jaws normally shrink a little in later years dentures may need to be refitted. Dentures that are inappropriate size will adversely affect chewing and digestion, as well as cause problems with speech.

• Cancers of the lip, tongue, mouth, gum, pharynx, and salivary glands incrase with age as well. These are not normal occurrences but are the result of disease.

Speech

• Speech should not change at all with age. If it does, it is most likely due to a problem, such as ill-fitting dentures or the occurrence of a stroke.

• Aphasia is a condition that may occur as a result of a stroke, causes a person to lose the ability to remember or pronounce certain words.

• Some persons who have had strokes lose the ability to speak altogether

Skin and Hair

• Normally the skin of older adults is not as elastic as that of younger people, so it is more susceptible to bruises and cuts

• Skin heals more slowly

• Skin gets drier and wrinkles occur. Lighter skin tends to wrinkle more.

• Skin develops dark spots called age spots or liver spots, which are harmless

• Hair becomes drier, more brittle, and thinner and usually turns gray or white.

• Many men and women have a decrease in amount of hair with age.

• Due to hormone reduction, men may experience a receding hair line

• Many skin conditions are illnesses and chronic conditions and should be assessed and treated.

• Skin cancer is more common in older age, due mostly to the cumulative effects of sun exposure.

Body composition

• Generally, over time there is a decline in lean body mass and muscle tissue and an incrase in fat

• In the very old, there is a tendency toward weight loss

Kidney and bladder function

• Kidneys usually lose about half of their function as people age, declining in volume and weight. This means that it is more difficult for toxins, vitamins, chemicals, and medications to be cleaned from the body. This can sometimes lead to accidental overdosing of medications. Regardless of whether there is disease present, changes in the kidneys of older persons are substantial.

• The bladder’s capacity also decreases normally with age, but the sensation for needing to urinate is delayed. Sometimes this results in urinary incontinence (not making it to the bathroom in time). Incontinence can often be managed through exercise and learning to plan ahead for bathroom trips and to urinate more often.

• Renal failure (kidney failure) is caused by different pathological conditions. In some cases patients need kidney dialysis, a mechanical system for cleansing toxins from the blood.

• Urinary incontinence is greatly worsened by diseases of the central nervous system.

Skeletal system

• Humans normally get shorter with age, as the skeletal system changes.

• Between the ages of 65 and 75, a person may be one and one-half inches shorter than middle-age height.

• At age 85, the person may have shrunk as much as three inches.

• The muscles in the spine get a little weaker, and the discs get thinner. There is also a slight decrease in the hardness of bones with age.

• Osteoporosis can be common among women who are post menopausal. It is thought that osteoporosis is linked to a calcium deficiency or to hormonal changes. In this disease, the spine begins to collapse, and bones become very brittle, fracturing more easily. There is also a stooping effect due to the spinal collapse.

Respiratory system

• The lung’s capacity to hold air decreases normally with age, but not drastically.

• Cilia, the hair-like filters in the airways of the lungs are reduced in number; this diminishes the among of oxygen available and reduces the efficiency in removing foreign matter from the lungs.

• Diseases such as emphysema, asthma, and lung cancer are often but not always linked to a history of smoking or to an occupation in hazardous conditions.

Muscular system

• Normal changes include decreased size, tone, flexibility, strength, elasticity, and endurance of muscles.

• There may be increased twitches and spasms in the muscles.

• These normal changes should not usually have an impact on mobility

• Chronic and acute conditions that can affect mobility and function include:

o Arthritis

o Osteoporosis

o Muscular dystrophy

o Multiple sclerosis

o Strokes

There is currently some increased attention in gerontology to the loss of muscle mass, which used to be seen as normal aging and is beginning to be viewed as a condition that may be abnormal and should be treated. Someone who experiences drastic changes in mobility or muscle control should be evaluated for an illness.

Central nervous system

• Normal aging does not result in significant cognitive impairment . There are some mild declines in memory function, known as benign senescent forgetfulness.

• As people age there is usually a slowing of impulses to the brain, which results in reduced reaction time and reflexes.

• There is a higher threshold for pain and heat, which can cause injury, heat exhaustion, or burns.

• Older persons are less able than younger persons to discriminate among levels of perceived pain. If nerves are severed in an accident or operation, it may take longer in the later years for them to grow back.

• The brain reduces its weight by 10 percent in older ages. Brain cells normally are lost steadily from about the age of 30, and they are never replaced or regenerated.

• The overuse of drugs or alcohol, exposure to pollution, and/or smoking cigarettes increases the constant loss of brain cells. However, we tend to function with fewer brain cells than we have, so a moderate loss does not create a significant decline in brain function.

• Changes in brain wave patterns may also affect the sleep of persons as they age; they have shorter sleep cycles and may be more easily awakened. Some older persons shift to a sleep rhythm that includes more daytime naps and fewer nighttime sleeping hours.

• In normal aging, the ability to remember the meaning of wards and symbols does not decline - neither does recall and recognition. Aging normally does make it more difficult to retrieve material that was stored in memory years ago. If problem-solving skills are not practiced and sharpened, they may decline. It is hard to generalize about the intelligence of older persons or to compare it with the intelligence of younger persons, because people in the later years have not usually been exposed to the same educational and technological factors as have younger persons. However, a researcher who followed some older persons over time found that changes in intellectual functioning did not occur until they were in their 60s, and those change were gradual and did not occur across the board.

• There are many abnormal, disease-related changes that can occur to the brain that can cause dementia, which is serious and often fatal neurological impairment. These illnesses include Alzheimer’s disease, Parkinson’s disease, and multi-infarct (many strokes) dementia. Although not part of normal aging, the increase of dementia increases with age. This will be discussed further in the section on mental health and cognitive functioning.

Gastrointestional system

• Normally the esophagus changes slightly in function; a decrease in muscle contraction necessitates a longer time for food to be transmitted to the stomach. This may produce an early sensation of being full, resulting in inadequate nutrient intake.

• Because digestive juices in the stomach diminish after age 50, older persons may develop a chronic inflammation of the stomach lining and may be more susceptible to gastric ulcers.

• Due to normal changes in the intestines, chronic constipation and impaction may be present in many older person

• Persons are also at greater risk as they age for colon and stomach cancer

• Diverticulitis is a chronic condition in which pouches form in the intestines because the walls have become weak

• Older persons are more susceptible to hernias and gall bladder disease

• Chronic constipation is a common problem of some persons as they age but it is not the normal result of growing older. It may be the result of overuse of laxatives, lack of exercise, stress, an unbalanced diet, an obstruction, or an underlying disease.

Cardiovascular system

• With normal aging, the heart gets slightly larger, pumps out less blood, and loses some efficiency. By age 75, the heart has lost 35 percent of its function. The heart and blood vessels both lose some elasticity. The heart increases in size and needs to rest more often. There is also a normal slight increase in blood pressure. The blood flow decreases, and circulation is poorer.

• There are several pathological states in the cardiovascular system that can be very dangerous. Heart disease and strokes are common in elderly persons. Hypertension, or high blood pressure, is not a normal condition and can be treated with medication and/or attention to diet. For this reason, it is very important for older persons to have their blood pressure checked regularly. Hypertension results from the heart pumping too hard. It is estimated that half the population over age 65 has hypertension. Sometimes hypertension is called “the silent killer” because the symptoms are masked or hidden. This is a serious and life-threatening condition that can cause kidney failure, heart disease, strokes, or other medical problems.

• Another possible chronic condition in older adulthood is hypertension, or low blood pressure. Hypotension, which causes dizziness and faintness from exertion or standing rapidly, is a problem only when it leads to a fall.

• Congestive heart failure is a backing up of fluid into the heart, lungs, or limbs due to impaired and decreased pumping function.

• Angina pectoris is pain in the chest when not enough blood flows to the heart.

• An irregular heart beat is also an abnormal condition that may have many causes.

• Atherosclerosis, a building up of fat, plaque, or cholesterol on the inner walls of the blood vessels, is a serious condition that can limit blood flow, causing the vessels and arteries to become small and less elastic.

• Blood clots may therefore develop more easily, which can cause tissue to die.

• If there is persistent lack of blood supply to the heart, an infarct, or dead area, may occur. If heart tissue dies, it is called a heart attack. If brain tissue dies, it is called a stroke.

Reproductive system and sexualitiy

• The reproductive systems of men and women reduce the production of hormones in later middle age, which may affect sleep patterns, moods, or weight. Sexual arousal may be slowed but usually does not stop. Men do not normally lose their ability to produce viable sperm. In women, the expected changes of aging include the slowing and then ceasing of ovulation and menstrual periods (called menopause).

• If sexual dysfunction occurs, it is not necessarily a sign of normal aging but may be sign of another problem, either physiological or emotional. Sometimes stress, illness, or medication will cause a decrease in sexual desire. As in all age groups, relationship difficulties, depression, and the lack of a trusted and available partner will cause sexual difficulties.

Immune system

• The internal and external healing processes in general become slower in old age. A normal loss of antibodies makes it harder to fight infections.

Other abnormal conditions

• Some diseases that can occur at any age, such as cancer and diabetes, are more common in the elderly.

• Injuries due to falls and other accidents are problems for this age group.

• People over age 65 have the highest rate if injuries and death related to traffic accidents (as drivers, passengers, and pedestrians) of any other group EXCEPT TEENS.

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