AGING

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AGING
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Simple facts about aging

• Aging commences in utero
• Represents passage of time, not pathology
• No two persons age identically
• Chronological age is not always similar to
  physiological age
• No matter what age we are we need to consider the
  patients individuality

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Life expectancy/ mortality

• Males born in 1990 expect to reach 72.1 years
• Females born the same year can expect to live
  79.1 years
• Leading causes of death are CHD (31), Cancer
  (20), Stroke (gt for Males than Females?

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Finances

• SSI is 90 or more of the income for 20 of all
  elders

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Gerontology

• Def study of aging as it applies to
  psychological, social, and biological factors

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Aging Concepts

• Normal aging biological events occurring to the
  human body as a result of the passage of time.
  AKA Primary aging. Ex Cataracts
• Usual (secondary) aging Pathological changes
  occurring in the organism. Events that may be
  preventable. DMII, CHF, COPD

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Aging concepts cont

• Successful aging In this case usual aging
  problems are compressed in to the last several
  months of life. Good health habits influence
  successful aging
• Frailty lack of physiological, psychological or
  functional reserve. Increased susceptibility
  toward experiencing functional limitations.

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Co morbidities

• More than any other group,elders are
  heterogeneous. Most times upon examination a pt.
  with a CVA will have other significant problems

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Psychosocial factors

• Factors that are good predictors of function
  include being white, higher family income,
  absence of HTN, absence of arthritis, absence of
  back pain, nonsmokers, normal body weight and
  moderate alcohol consumption

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Communicating with elders

• Hearing loss secondary to age related changes of
  the inner ear is called Presbycusis. This is one
  of the most widespread sensory deficits
  associated with aging

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Physiologic changes related to hearing

• Loss of high frequency sounds
• Loss of sound localization
• Impaired speech discrimination esp.gt s, sh ch,
  f, g, t, z.
• Distorted messages are received

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Vision

• Presbyopia, Glaucoma, Macula degeneration.
• Affects of aging on vision
• Ability to see in low light
• Adapt to darkness or changes in light
• Judging distances
• Peripheral fields or objects that are too close
• Blue/green colors are poorly differentiated
• Highly reflective surfaces are difficult

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Speech

• Lower pitched voice, lower volume
• Breathiness, hoarseness, or vocal tremor

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Strategies for Effective Communication

• Visually impaired
• Hearing impaired
• communication

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Facilitating communication and Socialization

• Touch
• Reminiscence
• Humor
• Pets

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Maslows,Hierarchy of Human Needs

• Physiologic survival needs
• Safety
• Love, belonging, affection
• Self actualization

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Theories of Aging

• Genetic
• Non Genetic

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Three types of Somatic Cells

• Continuously proliferating
• Reverting post mitotic cells
• Fixed post mitotic cells

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Genetic theories

• Hayflict Limit Theory
• Error Theory
• Redundant RNA

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Non Genetic Theories

• Cross linkage theory
• Hormonal theory
• Energy-Restriction theory

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Changes associated with aging

• Overall
• Decreased height
• Decreased weight
• Decreased total body water
• Increased fat- to- lean body mass ratio
• Increased wrinkling

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Skin changes

• Atrophy of sweat glands

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Cardiovascular system

• Elongation and tortuosity of arteries, inc aorta
• Increased intimal thickening of arteries
• Increased fibrosis of media of arteries
• Sclerosis of heart valves

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Kidney

• Increased number of abnormal glomeruli

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Lung

• Decreased elasticity
• Decreased activity of cilia

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GI tract

• Decreased hydrochloric acid
• Fewer taste buds

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Skeleton

• OA
• Loss of bone substance

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Eyes

• Arcus senilis
• Decreased pupil size
• Growth of lens

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Hearing

• Degenerative changes to the ossicles
• Increased obstruction of eustachian tube
• Atrophy of the external auditory meatus
• Atrophy of cochlear hair cells loss of auditory
  neurons

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Nervous system

• Decreased brain weight
• Decreased cortical cell count

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Endocrine

• Decreased T3
• Decreased free testosterone
• Increased insulin
• Increased norepi
• Increased parathoromone
• Increased vasopressin

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Lab assessment Parameters unchanged with elders

• HH
• WBC
• Platelets
• Electrolytes (sodium, K, CL, Bicarbonate)
• BUN
• Liver function tests
• Free thyroxine index
• TSH
• CA
• Phosphorus

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Common abnormal lab parameters

• Sed rate
• Glucose
• Creatinine
• Albumin
• Alkaline phosphatase
• Serum iron, iron-binding cap., ferritin
• PSA

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Common abnormal labs cont

• UA
• Chest x-ray
• ECG

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