09 Feb Physical Care of the Elderly
The body gradually changes over time as we age. These changes are expected and usually depend on family patterns of aging or lifestyle choices made throughout the lifespan. Changes that are a result of a pre-existing medical condition are not considered to be a part of healthy aging. Most of the time, normal age-related changes on the physical level include the following:
Age-Related Changes in Skin, Hair and Nails
Changes in the skin are the most visible signs of aging. Since it serves as a barrier from the external environment, skin protects us and keeps our internal organs intact. However, environmental factors, nutrition and genetic makeup cause the skin to sag and lose elasticity as we age. Through time, the outer layer of called the epidermis thins and the pigment-containing cells called melanocytes decrease. This makes aging skin look pale, clear and thin. Large pigmented spots may appear on areas exposed to the sun and the skin’s elasticity will be reduced, making it leathery and saggy. Bruising, bleeding and cherry angiomas are also common among older adults because of fragile blood vessels. Even a simple blow to the skin can tear or bruise it. Older adults are advised to be extra careful in their everyday tasks, especially when dealing with heavy objects.
The skin has several layers, each with various functions. The sebaceous glands that produce oil for skin moisture gradually decrease, usually beginning after a woman’s menopause and for men over the age of 45-50. Dryness and itchiness are very common, resulting in a greater susceptibility to different skin disorders. The subcutaneous fat layers will become thinner over time. This increases the risk of skin injury because of less insulation and padding that subcutaneous fat provides.
Effects of Age-Related Changes in the Skin, Hair, and Nails
Skin injury is common among older adults, along with thinning hair and nails. Since the protective fat layer gradually lessens and becomes more fragile, every wrong move an individual makes can significantly affect his/her integumentary system. Other than skin tears, bruising and bleeding, hair loss is apparent, and nails tend to become brittle. It is very common to see older adults who are bald and have broken nails.
Consequently, rubbing or pulling the skin, hair and nails can cause minor injuries to older adults. Since aging skin repairs slowly, pressure sores are common among the disabled or those with a sedentary lifestyle. Because these changes can affect the sense of touch, vibration, pressure, heat, and cold, it is no wonder that the elderly experience various skin problems throughout their later years.
Age-Related Changes in Oral Mucus Membranes
As an individual ages, several body functions start to decline. Cellular reproduction, blood microcirculation, metabolic rate and tissue repair all tend to slow down. These essential life processes can affect different parts of the body including the oral mucus membranes. As for the oral soft tissue, the epithelium, mucosa, and submucosa thin. Taste bud function declines as does the size and number of sebaceous glands on the cheeks. Furthermore, foliate papillae and lingual varices increase. These are the main reasons why nutritional deficiencies among the elderly are so common.
According to recent studies, a decrease in salivary flow is not purely the result of aging. However, certain medications can affect salivary output, leading to digestive upsets, poor retention of dentures and the diminished ability to chew. The dryness of the mucosa makes it more susceptible to frictional irritation from dentures. Most elderly have a toothless mucosa that is frequently thin and blanches quickly. This is a reflection of a systemic disease, a nutritional disturbance or a side effect of a maintenance medication.
Moreover, the tooth enamel of an elderly person becomes less permeable over time. Although older adults, teeth become brittle, and the rate of the secondary dentine formation still continues at a slower rate. Tooth wear is a normal age-related phenomenon, often caused by parafunction, erosion or abrasion, mostly gastric, dietary or environmental factors.
Systemic Effects of Aging Concerning Oral Mucus Membranes
A decline in cell-mediated response and the number of circulating lymphocytes leads to an increased risk of autoimmune diseases and a decrease in the defense against infection. Any steroid treatment for an autoimmune disease can complicate a dental treatment. Aging also involves a degenerative arterial disease which is visible in the vessels of the oral mucosa, making wounds heal slowly. A decrease of muscle tone even affects chewing strokes and results in a longer chewing time. Several reports showed that this phenomenon causes an abnormal lower jaw movement and a resulting loss of one’s natural teeth.
As an individual ages, several mucosal diseases take place. This includes oral cancer, pemphigus, candida or a yeast infection, lichen planus, herpes zoster and benign mucous membrane pemphigoid. Nutrition is often a huge factor in the occurrence of these diseases. Since some older adults have decreased access to nutritious foods, nutritional deficiency can significantly affect the oral mucosa.
Age-Related Changes in Elimination
Digestive and urinary disorders are the usual health problems faced by older adults. Despite the fact that elderly individuals have more time to relax and enjoy their lives, problems with digestion tend to occur all of a sudden. One of the most common problems with aging individuals is constipation. As people get into their 60s, bowel habits change. Painful and infrequent bowel movements are associated with hard and dry stools that can lead to hemorrhoids and other health-related concerns. These variations in the digestive system are brought on by a decline in muscle contractions, which causes the food to move more slowly through the colon. When food movement slows down, waste absorbs more water, leading to constipation and difficulty removing waste from the bowel.
Constipation among older adults is also caused by daily medications. Anti-hypertension drugs are just some of the drugs that can slow down bowel movement. Aside from this, inactivity can exacerbate constipation, in particular in those elderly individuals with existing medical conditions like diverticular disease, ulcers, arthritis and many others. A sedentary lifestyle can make a person feel constipated and allows other complaints like bloating, cramps and abdominal pain to occur. The best thing to do in this situation is to keep digestion running smoothly through proper diet, exercise, hydration and frequent visits to the doctor.
Changes in the Kidneys and Bladder
The kidneys and the bladder are the two major organs in the urinary system. The kidneys filter blood and remove waste or extra fluid from the body. They also help control the chemical balance of the body to make other organs more functional and efficient. However, as time passes, these organs change and their ability to function effectively declines. There will be a gradual decline of kidney tissue, along with the number of filtering units called nephrons. Nephrons are responsible for filtering waste materials from the blood, and they have a huge role in keeping it clean and free of pathogens. If they decrease in size and the blood vessels harden, the kidneys will not be able to perform their function as well, causing some health issues.
Furthermore, changes in the bladder wall will become apparent as we age. The bladder becomes less elastic and cannot hold as much of urine as before, causing urinary incontinence. The urethra in women can become blocked due to weakened muscles that cause the vagina or bladder to fall out of their normal position. Men with an enlarged prostate gland may also have a blocked urethra. The only way to solve this problem is to undergo a common surgery to promote proper urine output.
Activity and Exercise Among Elderly Adults
A number of factors cause an older individual to limit his/her physical activity. The most common concern in the aging is brittle bones in both the arms and legs. Basically, as we reach 30, bone marrow gradually disappears and calcium production is reduced. Bone marrow is the soft and spongy tissue found inside the large bones responsible for the production of platelets, and red and white blood cells. Changes in bone mass and bone marrow structure can put an elderly at the risk for infection, osteoporosis and other bone-related health issues. In fact, it can change his/her performance of routine day-to-day activities since the bones become frail and brittle over time. However, by limiting daily activities, an older adult becomes more sedentary and experiences its negative impact as well.
Energy Consumption in Older Adults
An individual’s minimum daily energy need comes from the resting metabolism rate or BMR (basal metabolic rate). However, BMR changes over time depending on gender, age and lifestyle choices. BMR starts to decline already after the age of 20 and continues to do so until we die, at a gradual pace of 1-2% per decade. The reason for the declining BMR is the reduction of active muscle mass and increased inert fat deposits. This is caused by the overall decline in cellular metabolism. Thus, food intake must be adjusted accordingly. Diet supervision is crucial as we age because we still need to ingest the necessary vitamins, minerals, and micronutrients, but from fewer calories as before to avoid weight gain.
Aerobic Performance in Older Adults
Older adults often have problems with aerobic performance due to the fact that the maximal oxygen intake of the body declines, especially around the age of 65 onwards. This gradual decline can be caused by limited physical activity, as older adults become more sedentary over time. However, even athletes experience a reduction of vigor as they age.
Metabolic Function in Aging
Several hormonal control mechanisms work less efficiently in older individuals. For instance, the thyroid and pancreas are affected by a decreasing number of secreting cells, and the ventricular muscles experience a decrease in catecholamine receptors. These hormonal changes can result in diabetes and myxedema, which can then be a path to obesity, depression, and poor cold tolerance.
Risks of Exercise
The risk of a cardiac emergency is high when an older person is exercising without previous experience and an active lifestyle. Some physicians believe that the elderly who intend to start exercising at an older age should go through an exhaustive preliminary screening such as an exercise electrocardiogram. This is desirable, especially when the individual plans to embark on strenuous competitive training. However, every older individual who wants to exercise should observe certain precautions. The recommended dose of exercise should not leave an elderly overwhelmingly tired because the normal recovery process is slow. Some exercises like running or jogging should be substituted with walking to minimize stress on the knees.
Age-Related Changes in Sleep and Rest
Sleep patterns change as we get older. Other than physical changes, people in their later adulthood tend to have a difficult time falling asleep, and they have a harder time staying asleep as they age. Although research tells us that sleep does not decline with age, several seniors are still complaining because of changes in their sleeping pattern.
Sleep has multiple stages including deep sleep, dreamless periods of light sleep and occasional periods of active dreaming or REM sleep. This cycle is continuously repeated several times at night, but older people spend more time in the lighter stages than in deep sleep. With aging individuals, continuous sleep tends to become harder, making them stay awake at night and getting up early in the morning. Total sleep time is slightly decreased from 8-9 hours to 6.5 to 7 hours per night. It is also harder to fall asleep and spend more time in bed. In fact, the transition between sleeping and waking becomes more abrupt, making the older people feel that they are they are sleeping lighter than before. The elderly also wake up more often at night and spend less time in deep sleep because of anxiety, nocturia, discomfort or pain from chronic illnesses.
Difficulty in sleeping can be very annoying. Chronic insomnia is often the cause of depression and auto accidents. Since older adults sleep lighter and wake up more often at night, they feel sleep deprived, even if the total sleep time does not change that much. Moreover, sleep deprivation can cause confusion and other types of mental issues like restless legs syndrome, hyper insomnia, narcolepsy and sleep apnea.
Older adults who experience such problems should consult a sleep specialist before taking any medications on their own. Antidepressant medicines can be helpful in alleviating depression, and this can also relieve sleeping problems, but they should only be taken under the strict supervision of a licensed physician. This is also applicable to a mild antihistamine. Nevertheless, a healthy diet and regular exercises can also have a huge impact on improving the quality sleep for older individuals.