09 Feb Physical Care of the Elderly
The body gradually changes over time and as we age. These changes are expected and usually depends on the family patterns of aging or the 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 aspect 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, it protects us and keeps the internal organs intact. However, environmental factors, nutrition and genetic makeup causes the skin to sag and lose elasticity as we age. Through time, the outer layer of the skin called epidermis thins and the pigment containing cells called melanocytes decreases. This makes the aging skin looks paler, clearer and thinner. Large pigmented spots may appear on areas exposed to sun and the skin’s elasticity will reduce, making it leathery and saggy. Bruising, bleeding and cherry angiomas are also common among older adults because of the fragile blood vessels. Even a simple blow to the skin can tear or bruise it. That is why, older adults are advised to be extra careful in their everyday tasks and especially when dealing with heavy objects.
The skin has several layers, and each of them has various functions. The sebaceous glands that produce oil for skin moisture gradually decrease, usually beginning after a woman’s menopause and for men over 45-50. Dryness and itchiness are very common, resulting in a greater susceptibility to different skin disorders. The subcutaneous fat layers will become even thinner over time. This increases the risk of skin injury because of lesser insulation and padding that the subcutaneous fat provides.
Effects of Age-Related Changes in the Skin, Hair, and Nails
Skin injury is common among older adults, along with a thinning hair and nails. Since the protective fat layer gradually lessens and becomes more fragile, every wrong move that 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. This is why 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 disabled individuals or those with a sedentary lifestyle. The fact that these changes can affect the sense of touch, vibration, pressure, heat, and cold, it is no wonder elderly experience various skin problems throughout their later years.
Age-Related Changes in Oral Mucus Membranes
As individual ages, several functions of the body 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. For oral soft tissues, the epithelium, mucosa, and submucosa thins and becomes apparent. An individual’s taste bud function declines while the size and number of sebaceous glands on the cheeks, foliate papillae and lingual varices increases. These are also the main reasons why nutritional deficiencies among elderly are so common.
According to recent studies, the decrease in salivary flow is not purely a result of aging. However, certain medications can affect the 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 of the dentures. Most elderly have a toothless mucosa which 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 becomes less permeable through time. Although the older teeth become brittle, the rate of the secondary dentine formation still continues at a slower rate. Tooth wear is a normal age-related phenomenon, but this is 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 an older patient’s 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 oral mucosa, making wounds heal slowly. The decrease of muscle tone even affects the chewing strokes and longer chewing time. Several reports showed that this phenomenon caused an abnormal lower jaw movement and a resulting loss of natural teeth.
As an individual increases with age, several mucosal diseases take place. This includes oral cancer, pemphigus, candida or 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 which 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 slower through the colon. When the food movement slows down, waste absorbs more water, leading to constipation and difficulty of removing from the bowel.
Constipation among older adults is also caused by their daily medications. Anti-hypertension drugs are just some of the drugs that can slow down the bowel movement. Aside from that, inactivity can also exacerbate constipation, in particular for those elderly individuals with existing medical conditions like a diverticular disease, ulcers, arthritis and many others. A sedentary lifestyle can also make a person feel constipated and allow the existence of other complaints like bloating, cramps and abdominal pain to occur. The best thing to do in this situation is to keep the digestion run smoothly through proper diet, exercise, hydration and frequent visits to the doctor.
Changes in the Kidneys and Bladder
Kidneys and bladder are the two major organs in the urinary system. The kidneys filter the blood and remove waste or extra fluid from the body. They also help to control the chemical balance of the body to make other organs more functional and efficient. However, as the 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 the blood clean and free of pathogens. If they decrease in size and the blood vessels become hardened, the kidneys will not be able to perform its function as well, and it will cause some health issues.
Furthermore, changes in the bladder wall will also become apparent as we age. The bladder becomes less elastic and cannot hold as much of urine as before, causing urinary incontinence. The urethra among women can also become blocked due to the weakened muscles that cause the vagina or bladder to fall out of its position. Men with enlarged prostate gland will 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
There are a number of factors that cause an older individual to limit his/her physical activity. The most common concern is the aging and brittle bones in both arms and legs. Basically, as we reach 30, the bone marrow gradually disappears and calcium production is reduced. The bone marrow is the soft and spongy tissue found inside the large bones and is responsible for the production of platelets, red blood cells, and white blood cells. These changes in the 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 because the bones become frail and brittle over time. However, by limiting their daily activities, an older adult becomes more sedentary and experiences the negative impact of it as well.
Energy Consumption in Older Adults
An individual’s minimum daily energy need comes from resting metabolism rate or BMR (basal metabolic rate). However, BMR changes over time depending on the person’s 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 the increased inert fat deposits. This is also 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 get the necessary vitamins, minerals, and micronutrients, but from fewer calories as before, in order to avoid weight gain.
Aerobic Performance in Older Adults
Older adults often have problems with aerobic performance. This is due to the fact that the maximal oxygen intake of the body declines, especially around the age of 65 onwards. The gradual decline can be caused by the limited physical activity, as older adults become sedentary through time. However, even athletes experience a reduction of their vigor as they age.
Metabolic Function in Aging
Several hormonal control mechanisms work less efficiently in older individuals. For instance, thyroid and pancreas are affected by the 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 way 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 active lifestyle. Some physicians believe that elderly who intend to start exercising in older age should go through an exhaustive preliminary screening like an exercise electrocardiogram. This is desirable, especially when individual plans to embark a 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 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 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 the 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 lighter stages than in a 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 up becomes more abrupt, making the older people feel that they are sleeping lighter than before. 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 time of sleep 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 with a mild antihistamine. Nevertheless, healthy diet and regular exercises can also make a huge impact on improving the quality sleep for older individuals.