09 Feb Overview of Aging
No matter where a nurse practices her profession, there will always be a time in her career where she needs to care for older adults. Geriatric or gerontological nursing is one of the fields of nursing that deals with proper care and hospitalization of aged or geriatric patients. This specialized field is very intricate as it involves understanding the aging process and the tremendous changes that every individual has to go through. Life expectancy is steadily increasing nowadays. Thus, nurses are expected to care for a relatively huge number of older people in the next decades. Nonetheless, nurses’ role in this specialized field is essential since they have to promote active aging and should be able to care for various diseases and conditions that each older person has.
How Geriatric Nursing Started
The development of gerontological nursing was made through the efforts of the American Journal of Nursing, John A. Hartford Foundation Institute for Geriatric Nursing and the American Nurses Association. However, it was the American Nursing Association (ANA) who formed a specialized group for geriatric nurses in 1960s and recognized it over the next three decades. There were programs established to solidify the geriatric nursing specialization and nurses were given substantial educational opportunities through the development of Geriatric Research Education and Clinical Centers (GRECCs), allowing them to provide quality care for older veterans. Later on, certificate programs, baccalaureate degrees and master’s degrees were created to allow nurses become a geriatric nurse in their state.
Caring for the aged is not a new concept in nursing, as Florence Nightingale even pioneered insights for this specialized field. She was renowned as the first geriatric nurse because of her nurse superintendent position in an English institution, where she cared for helpers and maids of wealthy women. Nowadays, gerontological care is recognized by the society through the collaboration of several organizations and hardworking individuals in the field of nursing. In time, there were some geriatric nurses trained for this job and an evidence-based geriatric nursing practice was developed, which allowed the production of books, journals, websites and even organizations that are dedicated to caring older adults.
Attitudes Towards Aging
The way we care for aged individuals is influenced by our experiences in our family, friends, neighborhood, school and even at work. Aging is a normal process, and it is common to see older people around in our community. However, negative attitudes toward older adults often exist because of our negative past experiences. Some of us may not have solid beliefs or attitudes about older adults, but separating the myths from reality is a good way of appreciate older adults and care for them in the correct manner.
Demographics of Aging
In the latest census done by the US Census Bureau, a whopping 39.6 million older adults are residing in America, which makes up 12.9% population of the country. By 2035, it is expected that 1 out of 5 individuals will be 65 years or older. These seniors will be different from those of the past decades. They will enjoy better health, longer lives, and more active lifestyles because of the technology and new advancements in medical care.
However, the increased life expectancy has also caused the creation of 3 elderly sub-populations namely; the young old (people aged 65 to 74), the old (people aged 74 to 84) and the oldest-old (people aged 85+). These new retirees will require Medical and Social Security assistance to meet their needs. They will also need long-term care to keep their health and well-being all throughout their life.
Economics of Aging
As more and more people are being born, growing number of them are also becoming elderly. The growing population of older people is due to the declining fertility rates and increased longevity. According to the Centers older Disease Control and Prevention, the life expectancy of a newborn infant born today is nearly 78 years, which is more than twice as long as those who were born thousand years ago. In 1930, people were expected to live for 59.7 years and in 1960, life expectancy increased to 69.7 years. The dramatic increase in life expectancy is not an accident. This is the result of public health initiatives, infectious disease control and new surgical and rehabilitation techniques. In fact, there is a significant decrease in mortality rates (accounted in 2007), which showed a declining percentage of deaths from the 15 leading diseases like stroke, diabetes, accidents, homicide, influenza, pneumonia and many others. Also, the medical breakthroughs are solving our problems with birth, early infancy disorders as well as contagious diseases thereby improving longevity and allowing people to live longer than in the past decades.
Housing arrangement is one of the many things that we have to consider when we get old. Older individuals have specific needs and most of them have fragile bones and lifestyle diseases that need long term care. They may require specialized nursing services, but they also need better housing arrangements. Nowadays, there are a lot of accommodation options for elderly individuals including nursing homes, retirement communities and apartments designed for older people. Some of these options may be suitable for a particular person, while others are not. This is due to several considerations like physical and medical needs, home maintenance, social and emotional needs as well as financial needs. Elderly individuals or family members with older people at home should always take into account their lifestyle, health and finances. Housing arrangement should not affect the old person’s overall health and well-being in order to thrive and have a comfortable aging process. It should be made in a way that it can promote a better quality life, with lesser risk of injury and health issues.
The elderly population is vulnerable to a lot of health problems. Prevention and control of these health predicaments require a multifaceted approach with collaboration on social welfare, health, legal and rural/urban development sectors. A geriatric health care program should have a comprehensive policy to start with. The healthcare provision should go with a strong political will and social action to make the policies efficient and sustainable. Nevertheless, other measures like improving healthcare knowledge, health insurance and promotion of healthy lifestyle are also the keys towards a better elderly care.
However, provision of quality and excellent healthcare services to the elderly population imposes several challenges. It is important to address the factors that hinder these services to develop a better way of life for our elderly. Families with the elderly should take a significant role in ensuring that their needs are met adequately. Failure to address their healthcare needs early can cause costly issues later on. In fact, it can aggravate a condition and can be a major meltdown within the family.
Impact of Aging Members in the Family
Many of our older individuals experience a decline in their physical and cognitive functioning. This has made them lose their ability to live independently, allowing them to seek long-term care services from institutions like long stay hospitals, nursing homes, residential care and assisted living facilities. Families with older people often carry the burden of caring for these individuals, accumulating significant costs when they do so. In less developed countries where affordable long-term care facilities are not available, families with elderly adults withdraw from their employment or school commitments just to care for these family members and make ends meet. They may even end up having debts due to their hospitalization, medication maintenance, home care adjustment costs.
The impact of having an aging family member often varies on how well they handle the changes and demands of day to day living. Most of the families with good economic background and strong financial support from the government seek long-term nursing services to care for the elderly. Unfortunately, this may not apply to families with fewer resources and unemployed family members. The demands of an elderly individual are often unpredictable and changing. Thus, families should be prepared for this day to balance the situation and ensure to provide a safe retirement for their loved ones.
Theories of Aging
There are several theories about the process of aging, yet they are mutually exclusive and often contradict with one another. Nowadays, the biological theories of aging have two main categories; the programmed theory and the damage or error theory.
The programmed theory implies that ageing has a biological timetable and it is regulated by the changes in gene expression affecting the systems responsible for our repair, maintenance and defense responses. On the other hand, the damage or error theories emphasize on environmental impact that induces cumulative damage causing the ageing process. These two theories are based on the evolutionary concepts where ageing is considered to be a result of an individual’s inability to combat the natural deterioration processes and a result of a biological program that allows decay and death to get a direct evolutionary benefit.
There are also some theories that are believed to be related to aging. The disengagement theory refers to the inevitable process by which the relationships of a person and other members of the society are severed and some are altered in quality. This theory is the first formal theory that attempts to explain the process of becoming an elderly or growing older. Moreover, the psycho-social aging process is also described through the activity theory, another kind of theory that emphasizes the relevance of ongoing social activity. This theory suggests that an individual’s self-concept is related to the responsibility or role that is held by the person.
The neuroendocrine theory also elaborates the wear and tear of our neuroendocrine system. This theory of aging is proposed by Professor Vladimir Dilman and Ward Dean MD, emphasizing the importance of hormones in our bodily systems. As we age, the secretion of these hormones declines and become less sensitive. A very famous theory of aging was also developed by Denham Harman MD which is called the free radical theory. This theory focuses on the free radical molecule that exists from an unhealthy lifestyle, drugs, smoking habits and eating habits. The free radicals cause aging and other health related problems associated with this process.
Physiologic Changes in Integumentary System
Skin changes are the most visible signs of ageing. As we age, our skin will become wrinkled and prone to injuries. This is due to the fact that the pigment-containing cells decrease, and connective tissues as well as the blood vessel function deteriorates. An elderly individual usually experience a change in their skin’s elasticity and strength. The sebaceous glands will also produce lesser oil and the dermis becomes fragile. Nevertheless, most elderly men and women have problems with insulation or a reduced ability to maintain its temperature. The subcutaneous fat layer thins and it will lose its protective layer. This means that the skin will be less able to feel touch, vibration, pressure, heat and cold.
An aging skin has a reduced ability to repair itself. Elderly individuals often experience a delayed wound healing thereby, making pressure ulcers and infections worse. Skin disorders among older people are often related to conditions like arteriosclerosis, liver disease, heart disease, nutritional deficiencies, diabetes, obesity, stress and allergies. These skin changes can be alleviated through adequate nutrition and proper hydration. Older people are prone to injuries and nutritional deficiencies. That is why they have to be mindful of what they eat and the lifestyle they choose.
Physiologic Changes in Musculoskeletal System
The physiologic changes of the musculoskeletal system of men and women usually start at the age of 30. The density of bones starts to diminish at this age, especially for women who are on nearing their menopausal stage. As a result, bones are becoming fragile and likely to break.
We often do not notice these musculoskeletal changes of our body as we grow older, but time and time again, the joints are affected by the changes of our connective tissue and cartilage. The cartilage becomes thinner and its components become altered, making it less resilient and susceptible to damage. This is why some people find their joints a bit different than it used to be, and experience a condition called osteoarthritis. In osteoarthritis, joints become stiffer and the tendons become brittle and rigid. Individuals with this condition often have a limited range of motion. They even cannot perform their daily routine because of the pain and inflammation experienced in the joints.
Furthermore, muscle mass also deteriorates in aging. The size of the muscle fibers and the amount of muscle tissue gradually decreases throughout life. This will result in loss of muscle strength which stresses the joins and predisposes them to arthritis as well. Fortunately, muscle mass and muscle strength can be preserved through regular exercise. This will significantly delay the changes in our musculoskeletal system and allow us to maximize the function of our muscles.
Physiologic Changes in the Respiratory System
The effects of aging on the respiratory system are similar to other organs. Through time, the maximum function of our lungs will gradually decline. It will decrease its gas exchange, peak flow, and vital capacity. Respiratory muscles will also weaken as well as its effectiveness in creating a barrier against bacteria, viruses, and other harmful organisms. However, the age-related changes in the respiratory system do not often lead to symptoms in healthy individuals. This can only reduce the ability to perform intense aerobic exercises like biking, running and mountain climbing. Thus, older people have limited capacity to perform certain activities.
Individuals who have existing medical problems such as heart disease and obesity may have a limited lung function as well. They are at higher risk of viral and bacterial infections like pneumonia and lung cancer. Hence, older people often acquire diseases faster than young adults.
Physiologic Changes in the Cardiovascular System
Physiologic changes in the cardiovascular system typically occur as we age. The heart is a natural pacemaker that regulates the heartbeat, but through time, some of its pathways will develop fat deposits and fibrous tissue. This may result in a slower heart rate and a slight increase in its size, especially the left ventricle. Older people often experience an abnormal rhythm like atrial fibrillation and heart murmur, which is caused by the stiffness of the valves. Receptors in the cardiovascular system often monitor the blood pressure whenever a person performs certain activities and changes positions. But as we age, these receptors become less sensitive, which is why several older people experience orthostatic hypotension. The capillary walls of the heart will also thicken and the main artery called the aorta becomes stiffer, thicker and less flexible.
Normal aging can cause a reduction of the total body water (TBW). The blood volume decreases and there is lesser fluid in the bloodstream. Red blood cells, which respond to stress and any kinds of illnesses are produced less while the white blood cells remain at the same levels, though its ability to ward off bacteria and other sorts of infection is reduced.
Physiologic Changes in Hematopoietic and Lymphatic System
The main role of the hematopoietic and lymphatic system is to protect the body against infection and illnesses. With advancing age, this system becomes less effective. The T and B cells, which are the primary cells involved in attacking specific invaders, become less responsive. The T cells are responsible for cellular immunity, and they often respond to infection and invasion of a pathogen. The B cells, on the other hand, are responsible for producing antibodies. However, they become less responsive over time, making the body more susceptible to bacterial and viral infections.
Vaccinations for viruses are strongly recommended for older people. This is because their lymphatic system is not working as well as when they were younger. Moreover, the increased occurrence of cancer in older individuals is due to the declining ability of the lymphatic system to eliminate tumor cells efficiently. This is also caused by nutrition deficiency, which is common in older adults.
Physiologic Changes in Gastrointestinal System
Aging is often a factor in different gastrointestinal disorders. With age, the strength of the esophageal contractions, as well as the tension of the upper esophageal sphincter, will decrease, but this does not affect or impair the movement of food. A peptic ulcer is also common in older people because of the decreasing capacity of the stomach lining to resist any damages, particularly those who are using aspirin and NSAID’s as maintenance. Aging can even affect the ability of the stomach to accommodate more food because of its decreasing elasticity and capacity to empty food into the small intestines. This is why most older adults have a decreased appetite for food.
Other parts of the gastrointestinal system are also affected by aging. For instance, the small intestines will have a decreasing lactase levels, which leads to intolerance of milk and dairy products. There will also be an excessive growth of bacteria which can lead to bloating, pain and weight loss. Pancreas, gallbladder and liver usually decrease in weight as we age. Some of its tissues are replaced by scaring and a number of structural as well as microscopic changes will occur, making these organs prone to injuries and illnesses.
Physiologic Changes in the Urinary System
There is a slow and steady decline in the kidneys weight as people age. At the age of 30 to 40, two thirds of the kidneys function to filter blood is undergoing a gradual decline. The arteries that supply the kidneys become narrower, which makes the healthy kidneys decrease its size. Also, the small arteries that flow to the glomeruli thickens overtime, reducing the capacity of the glomeruli to function. This declining ability will also create an impact on the nephrons to excrete waste products. That is why several drugs are not filtered and removed properly as we age. However, sufficient kidney function can be preserved in order to the meet the body’s needs. The changes that occur in our kidneys may or may not cause disease, but this can reduce the amount of the reserve kidney function. This means that both kidneys have to work in their full capacity to perform the normal kidney function.
Nevertheless, ureters do not undergo a lot of changes compared to the bladder and urethra. The volume of urine that a bladder holds decreases through time, as well as the ability of the person to delay urination after feeling the need to urinate. There is also a decreasing rate of urine outflow to the urethra and the sporadic contractions of the bladder wall muscles are not blocked by the brain, resulting in urinary incontinence. In women, there is a shortening of the urethra and a thinning of its lining. These changes will decrease the urinary sphincter’s ability to close tightly, placing a person at risk for urinary incontinence. In men, prostate gland tends to enlarge and blocks the flow of urine. This blockage can cause urinary retention and kidney damage if left untreated.
Physiologic Changes in the Nervous System
The brain is the primary organ in the nervous system. During childhood, its ability to think and function steadily increases, allowing a child to acquire complex skills. Its abilities will be relatively stable in early adulthood and will decline after a certain age. Although brain functioning as we age varies from person to person, it usually affects the short-term memory, verbal abilities, and intellectual performance. Older people often have a slower reaction time and brain performance compared to young people. The effects of aging on the brain functioning have an influence in certain disorders like stroke, underactive thyroid gland and degenerative brain disorders like Alzheimer disease. However, this still varies from person to person.
The spinal cord and the peripheral nerves will also change as people age. The disks located in the back bones become brittle and hard, losing its capacity to cushion it and start to place pressure on the spinal cord and the nerves emerging from it. Peripheral nerves on the contrary may conduct impulses slowly, resulting in a decrease of sensation, clumsiness and slower reflexes. Degeneration is common among older people. The blood flow decreases and the ability of the nervous system to self-repair becomes slower and incomplete. This makes them vulnerable to injuries and various diseases.
Physiologic Changes in the Endocrine System
Despite the changes caused by aging, the endocrine system functions well in older people. The changes that occur are due to the external factors and genetically programmed changes of the cells. These may affect the hormonal production and secretion, hormonal metabolism, rhythms in the body, target cell’s response to hormones and hormone levels that circulate the blood. For instance, the development of Type II Diabetes is thought to be related to increasing age, especially those individuals who are at greater risk of the disorder. This also affects the size of the pituitary gland which regulates the production of hormones. A decreased levels of hormones can also affect heart function, and cause lean muscles and osteoporosis.
Physiologic Changes in Reproductive and Genitourinary System
Aging also affects woman’s ovaries, resulting in menopause. This usually happens between the ages of 45 and 65 by which ovaries stop producing estrogen and progesterone and stop storing egg cells. When this happens, the menstrual period stops and a woman cannot bear children anymore. But before menopause takes place, there are perimenopause signs that every woman experiences. These symptoms include more frequent periods at first and occasional missed periods in the following months. It also accompanies a change in the menstrual flow and periods that are either shorter or longer.
Menopause is a normal part of the woman’s aging process. It declines the hormone levels, affecting other parts of the genitourinary system. Vaginal walls become dryer, thinner and less elastic, making sex more painful and placing a woman at greater risk for vaginal yeast infections. Meanwhile, men do not have a major or rapid change in fertility as they grow older. Aging can only affect the testicular tissue, erectile function, and sperm production. Although it varies from person to person, most men experience an enlargement of the prostate gland, which causes a condition called benign prostatic hypertrophy. Erectile dysfunction and infertility occur when there is a gradual decrease of production of testosterone, a male hormone found in the testes.