Healthcare providers need to be aware of which aspects of aging are reversible and which ones are inevitable. By keeping this distinction in mind, caregivers may be more objective and accurate when diagnosing and treating older patients. And a positive attitude can go a long way toward motivating patients to stick with a health regime. Unfortunately, stereotypes can lead to misdiagnosis. For example, it is estimated that about 10 percent of older patients diagnosed with dementia are actually depressed or suffering from some other psychological illness (Berger, 2005). The failure to recognize and treat psychological problems in older patients may be one consequence of such stereotypes.
Primary Aging
Primary aging refers to the inevitable changes associated with aging (Busse, 1969). These changes include changes in the skin and hair, height and weight, hearing loss, and eye disease. However, some of these changes can be reduced by limiting exposure to the sun, eating a nutritious diet, and exercising.
Skin and hair change as we age. The skin becomes drier, thinner, and less elastic as we age. Scars and imperfections become more noticeable as fewer cells grow underneath the surface of the skin. Exposure to the sun, or photoaging, accelerates these changes. Graying hair is inevitable. And hair loss all over the body becomes more prevalent.
Height and weight vary with age. Older people are more than an inch shorter than they were during early adulthood (Masoro in Berger, 2005). This is thought to be due to a settling of the vertebrae and a lack of muscle strength in the back. Older people weigh less than they did in mid-life. Bones lose density and can become brittle. This is especially prevalent in women. However, weight training can help increase bone density after just a few weeks of training.
Muscle loss occurs in late adulthood and is most noticeable in men as they lose muscle mass. Maintaining strong leg and heart muscles is important for independence. Weight-lifting, walking, swimming, or engaging in other cardiovascular exercises can help strengthen the muscles and prevent atrophy.
Visual Problems
The majority of people over 65 have some difficulty with vision, but most is easily corrected with prescriptive lenses. Three percent of those 65 to 74 and 8 percent of those 75 and older have hearing or vision limitations that hinder activity. The most common causes of vision loss or impairment are glaucoma, cataracts, age-related macular degeneration, and diabetic retinopathy (He et al., 2005).
Auditory Problems
Hearing loss is experienced by 30 percent of people age 70 and older. Almost half of people over 85 have some hearing loss (He et al., 2005). Among those who are in nursing homes, rates are higher. Older adults are more likely to seek help with vision impairment than with hearing loss, perhaps due to the stereotype that older people who have difficulty hearing are also less mentally alert. Being unable to hear causes people to withdraw from conversation and others to ignore them or shout. Unfortunately, shouting is usually high pitched and can be harder to hear than lower tones. The speaker may also begin to use a patronizing form of ‘baby talk’ known as elderspeak (See et al., 1999). This language reflects the stereotypes of older adults as being dependent, demented, and childlike. Image others speaking to you in that way. How would you feel? I am reminded of a man dying at home and a hospice worker, on shift for the first time, comes to his bedside and shouts, “Hi, baby. Want me to rub your little feet?” His response was an indignant look of disapproval.
Hearing loss is more prevalent in men than women. And it is experienced by more white, non-Hispanics than by Black men and women. Smoking, middle ear infections, and exposure to loud noises increase hearing loss.
In summary, primary aging can be compensated for through exercise, corrective lenses, nutrition, and hearing aids. And, more importantly, by reducing stereotypes about aging, people of age can maintain self-respect, recognize their own strengths, and count on receiving the respect and social inclusion they deserve.
Secondary Aging
Secondary aging refers to changes that are caused by illness or disease. These illnesses reduce independence, impact quality of life, affect family members and other caregivers, and bring financial burden. Some of the most prevalent illnesses that cause impairment are discussed below.
Arthritis
Arthritis is the leading cause of disability in older adults. Arthritis results in swelling of the joints and connective tissue that limits mobility. Arthritis is more common among women than men and increases with age. About 19.3 percent of people over 75 are disabled with arthritis; 11.4 percent of people between 65 and 74 experience this disability.
Hypertension
Hypertension or high blood pressure and associated heart disease and circulatory conditions increase with age. Hypertension disables 11.1 percent of 65 to 74 year olds and 17.1 percent of people over 75. Rates are higher among women and Blacks. Rates are highest for women over 75.
Heart Disease and Stroke
Coronary (heart) disease and stroke are higher among older men than women. The incidence of stroke is lower than that of coronary disease. What exactly is a stroke? As explained by the CDC:
A stroke, sometimes called a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death.
If something happens to block the flow of blood, brain cells start to die within minutes because they can’t get oxygen. This causes a stroke.
There are two types of stroke:
- An ischemic stroke occurs when blood clots or other particles block the blood vessels to the brain. Fatty deposits called plaque can also cause blockages by building up in the blood vessels.
- A hemorrhagic stroke occurs when a blood vessel bursts in the brain. Blood builds up and damages surrounding brain tissue.
Both types of stroke damage brain cells. Symptoms of that damage start to show in the parts of the body controlled by those brain cells.
Diabetes
In 2008, 27 percent of those 65 and older had diabetes. Rates are higher among Mexican origin individuals and Blacks than non-Hispanic whites. The treatment for diabetes includes dietary changes, increasing physical activity, weight loss for those who are overweight, and medication (National Institute on Aging, 2011).
Cancer
Men over 75 have the highest rates of cancer at 28 percent. Women 65 and older have rates of 17 percent. Rates for older non-Hispanic Whites are twice as high as for Hispanics and non-Hispanic Blacks. The most common types of cancer found in men are prostate and lung cancer. Breast and lung cancer are the most common forms in women.
Osteoporosis
Osteoporosis increases with age as bones become brittle and lose minerals. Bone loss is four times more likely in women than in men and becomes even more prevalent in women 85 and older. Whites suffer osteoporosis more than do non-Hispanic Blacks.
Alzheimer’s Disease
Between 2.4 and 5.1 million people in the United States suffer with Alzheimer’s disease (AD) (National Institute on Aging, 2011). This disease is not becomes more prevalent with age, but is not inevitable. This typically appears after age 60 but develops slowly for years before it’s appearance. Social support, and aerobic exercise can reduce the risk of Alzheimer’s disease. As the large cohort of Baby Boomers begins turning 65 in 2011, the number of cases of Alzheimer’s disease is expected to increase dramatically. Where will these people receive care? Seventy percent of AD patients are cared for in the home. Such care can be emotionally, financially, and physically stressful. Most AD patients live 8 to 10 years with the disease and long-term care costs an average of $174,000 per patient (He et al., 2005).
Normal Aging
The Baltimore Longitudinal Study on Aging (2006) began in 1958 and has traced the aging process in 1,400 people from age 20 to 90. Researchers from the BLSA have found that the aging process varies significantly from individual to individual and from one organ system to another. Kidney function may deteriorate earlier in some individuals. Bone strength declines more rapidly in others. Much of this is determined by genetics, lifestyle, and disease. However, some generalizations about the aging process have been found:
- Heart muscles thicken with age
- Arteries become less flexible
- Lung capacity diminishes
- Brain cells lose some functioning but new neurons can also be produced
- Kidneys become less efficient in removing waste from the blood
- The bladder loses its ability to store urine
- Body fat stabilizes and then declines
- Muscle mass is lost without exercise
- Bone mineral is lost. Weight bearing exercise slows this down.
