# The Older Adult --- **Older adults** are those who are in the last [[stage of development]], which we typically categorize as starting at age 65 and up. ## Genetic Theory of Aging The **genetic theory of aging** holds that lifespan depends to a great extent on genetic factors. Genes within the organism determine the occurrence and rate of metabolic processes, including cell division. Because there is an inevitable shortening of the gene's [[telomere|telomeres]] there is a finite number of cell divisions possible before irrevocable data loss in the DNA occurs. >[!health] Exercise as an Older Adult >Being inactive is one of the worse things an older adult can do. [[Exercise]] is an important factor in living a health, active life at any age. ## Normal Changes of Older Adults Our bodies change as we get older, we haven't found a way around that. However, there is sometimes an unfair tendency to assume problems for older adults as simply due to "getting old". The truth is healthy older adults can life fulfilling relatively independent lives, and many problems go untreated. It's important to understand the normal physiological changes that occur in older adulthood in order to recognize abnormal—yet sometimes "expected"—changes. The physiological changes in the older adult are largely due to the body's dwindling ability to make and maintain [[collagen]] and [[elastic fiber|elastin]] (which reduces flexibility in almost every system), and a loss of [[skeletal muscle|muscle mass]]. In addition to this there as an accumulation of emotional stressors, or [[allostasis|allostatic load]] that naturally build up over time that can psychologically wear someone down. Additionally, many older adults have [[pharmacology#Drug Interactions|polypharmacy]], or are taking many drugs that can all interact with each other, increasing their risk of adverse reactions like a [[cascade iatrogenesis]]. >[!tip]- SPCES Assessment >A **SPICES assessment** should be done at a regular interval when caring for an older adult, because it addresses the risks associated with normal signs of aging. It doesn't have to be in this exact format, but something along these lines. Whatever it looks like it should be done once a day. > >S = [[sleep]] disorders >P = problems with eating >I = [[urinary incontinence|incontinence]] >C = confusion >E = evidence of [[falls]] >S = [[pressure injury|skin breakdown]] ### Integumentary System As we age the [[skin]] becomes thinner and less firm. There are a reduced number and activity of the [[stem cell|stem cells]], which means skin repair slows and there is simply less of it. This is why old people are cold more often. This also means they have less protection from trauma. - Thin skin hinders [[thermoregulation]], and can cause older people to feel cold. - Less elasticity causes wrinkling and sagging of skin. - Dryness and scaling are common. - There are fewer skin-based [[dendritic cells]]. - Changes to [[hair|hair follicles]] produce thinner hair—or none at all. Balding becomes common in men, though women also experience thinning of hair. Additionally the hair loses pigmentation. - Skin pigmentation and moles are common, although the skin may become pale because of loss of [[melanocytes]]. - [[Nails]] typically thicken, becoming brittle and yellowed. - The blood vessels in the dermis become more fragile, causing increased bruising and purpura (hemorrhaging into the skin). ### Musculoskeletal System As we age we see a decrease in [[skeletal muscle|muscle mass]], [[hypodermis|subcutaneous tissue]], and [[body weight]]. Thus strength diminishes. [[joint|Joints]] tend to stiffen and lose flexibility, and range of motion may decrease. Overall mobility commonly slows, and posture tends to stoop. Height may decrease 1 to 3 inches. - [[Bone remodeling]] starts to favor resorption, so our bones become porous and brittle due to demineralization (of [[calcium]]), and the loss of organic material (specifically [[collagen]]). - If [[osteoporosis]] develops, [[bone repair|fracture]] is more common. #### Dental - Tooth decay and loss continue for most older adults. - Eating habits may change, particularly if the older adult lacks teeth or has ill-fitting dentures. ### Neurologic System - The central nervous system responds more slowly to multiple stimuli. - Hence, the cognitive and behavioral response of the older adult may be delayed. - Rate of [[reflexes|reflex response]] decreases. - Temperature regulation and pain/pressure perception become less efficient. - There may be a loss of sensation in the extremities. - The older adult may also experience difficulty with balance, coordination, fine movements, and spatial orientation, resulting in an increased risk for falls. - Sleep at night typically shortens, and the older adult may awaken more easily. Catnaps become common. #### Special Senses - Diminished visual acuity ([[eye assessment|presbyopia]]) occurs, with increased sensitivity to glare, decreased ability to adjust to darkness, decreased accommodation, decreased depth perception, and decreased color discrimination. Cataracts may further obscure vision. As a result of these changes, the older adult may have difficulty reading small print, and daytime or night driving maybe compromised. - Diminished hearing acuity ([[ears#Problems with The Ear|presbycusis]]) occurs, particularly diminished pitch discrimination in the presence of environmental noises. Cerumen (wax) buildup is common. As a result of hearing problems or amplification issues with hearing aids, the older adult may withdraw from social events. - The senses of taste and smell are decreased. Sweet and salty tastes diminish first. Sensitivity to odors may be reduced. Problems with nutrition may result. ### Cardiopulmonary System - Blood vessels become less elastic and often rigid and tortuous. Venous return becomes less efficient. Fatty plaque deposits continue to occur in the linings of the blood vessels. Lower-extremity edema and cooling may occur, particularly with decreased mobility. Peripheral pulses are not always palpable. Orthostatic hypotension can occur. - The body is less able to increase heart rate and cardiac output with activity. - Pulmonary elasticity and ciliary action decrease, so that clearing of the lungs becomes less efficient. Respiratory rate may increase, accompanied by diminished depth. ### Gastrointestinal System Many of the normal physiological changes in an older adult affect their nutrition. There is a general decrease in [[basal metabolic rate|BMR]] and [[physical activity]], which leads to less energy expenditure, and thus less of a caloric need. Despite that, their need for [[nutrients]]—especially protein, [[vitamin B|B vitamins]], [[vitamin D]], and [[calcium]]—actually increases. 1/3 of people over 65 suffer from nutritional deficiencies, such as [[dehydration]]. - Digestive juices continue to diminish, and nutrient absorption decreases. - Malnutrition and anemia become more common. - Because they're right on the brink, if patients fall, and are stuck there, even by 24 hour they can start to suffer kidney damage and [[rhabdomyolysis]]. - With reduced muscle tone and decreased peristalsis, [[constipation]] and indigestion are common complaints. - Diminished [[salivary glands|saliva]] production leads to dry mouth problems. ### Urinary System - Blood flow to the kidneys decreases with diminished cardiac output. - The number of functioning nephron units decreases by 50%; waste products may be filtered and excreted more slowly. - Fluids and electrolytes remain within normal ranges, but the balance is fragile. - Bladder capacity decreases by 50%. Voiding becomes more frequent; two or three times a night is usual (nocturia). A decrease in bladder and sphincter muscle control may result in stress incontinence or incomplete bladder emptying (overflow incontinence). - About 75% of men over 65 years of age experience benign (not cancerous) [[benign prostatic hyperplasia|hypertrophy of the prostate]] (i.e. BPH); surgery may be required if urinary retention occurs. ### Reproductive System - [[menopause]] in women. - The older woman’s genital tract atrophies and is associated with thinning and a decrease in vaginal secretions. ### Psychological There is a perception that older adults are just get forgetful and disoriented, and loose their mental faculties just as a natural process of aging. This is a myth! There is some reduction in processing speed and mental agility, but significant changes are unexpected and warrant investigation. There are three main causes behind neurocognitive disruptions in older adults: **depression**, **delirium**, and **dementia**. - [[Depression]] is the most common psychological condition in older adults, though it is not necessarily a normal or expected part of aging. Older adults retire from their careers, have lost their spouses or friends or family…or even loose their own health or fear their own death. These are really heavy emotional problems, and it can be a real struggle to maintain their emotional homeostasis. Additionally, physiological [[sensory deficit|losses of senses]] like hearing may make someone think there is a cognitive change, when they might just be [[confusion|confused]]. - [[Delirium]] is a common psychological condition in older adults, because a lot of the risk factors for delirium have older age as a risk factor, such as new medications, hospitalization, or infection. - [[Dementia]] is most common in older adults, but *not* a natural *cause* of aging. Multiple different disease processes can cause it, and it's characterized by a gradual onset and loss of cognitive ability. ___