Transcript Physical changes

Canadian Edition
Susan Krauss Whitbourne
Stacey B. Whitbourne
Candace Konnert
Chapter 4
Physical Changes
Appearance
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EPIDERMIS - the outermost layer of the skin; it protects the underlying tissue.
DERMIS - the middle layer of the skin, it contains protein molecules of collagen
and elastin, among which various nerve cells, glands, and the hair follicles
reside
SUBCUTANEUS – fat layer of the skin; it starts to thin in the middle of
adulthood
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The effects of photoaging on the skin are
clearly seen under UV light
Photo-aging most
preventable of aging
effects
UV rays of the sun
accelerate process of
cross-linking
Use sunscreen (UVA/UVB 30+)
Cigarette smoking also
causes skin damage
Avoid tanning machines
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ANDROGENETIC ALOPECIA
most common form of hair loss with increased age
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Body Build
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Height:
• Decreases across adulthood, particularly for women
• Due to loss of bone mineral content in the
vertebrae
Weight:
• Fat-free mass (FFM) decreases
• Body mass index (BMI) increases
• In later years, weight declines due to loss of bone
and muscle though some still grow obese
Exercise can offset these trends
(and can boost well-being)
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Mobility
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Age-related Changes in Muscles, Bones, and Joints
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Vital Bodily Functions
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Age-related Changes in Vital Organ Systems
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Benefits of prevention and compensation
Cardiovascular system
• Longer maintenance of aerobic capacity
• Improvements in blood pressure
• Better cholesterol metabolism
Respiratory system
• Avoid or quit smoking
• Regulate body weight
• Exercise to strengthen chest wall
Urinary system
• Avoid or quit smoking
• Monitor medication doses
• Use behavioral methods or, if necessary medications to
treat incontinence and overactive bladder
Digestive system
• Changes are relatively minor in esophagus, stomach, and
lower digestive tract and reflect overall health status
• Fecal incontinence affects ~4% of over-65 and can be
controlled with behavior controls and diet
• Lifestyle factors play important role
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Cardiovascular System
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Plaque - clotting material in the blood that consists of cholesterol, cellular waste
products, calcium, and fibrin
Cardiovascular efficiency is indexed by aerobic capacity, the maximum amount
of oxygen that can be delivered through the blood, and cardiac output, the amount
of blood that the heart pumps per minute.
Both indices:
- decline consistently at a rate of about 10 percent per decade
from age 25 and up;
- decline is more pronounced
in males than females.
High-density lipoproteins (HDLs) - the plasma lipid transport mechanism that
carries lipids from the peripheral tissues to the liver, where they are excreted or
synthesized into bile acids.
Low-density lipoproteins (LDLs) carry cholesterol to the arteries.
The ideal combination in terms of heart health is a low overall blood cholesterol
level, in which HDLs are greater than LDLs. Exercise increases HDLs.
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Respiratory System
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Low BMI is the second way to preserve the functioning
of the respiratory system.
All measures of lung functioning in adulthood tend to
show age-related losses after 40 (especially among
women)
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Urinary System
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Around 30% of all adults 65+ suffer from urge incontinence (a form of urinary
incontinence) in which the individual experiences a sudden need to urinate and may
even leak urine.
Stress incontinence – when the individual is unable to retain urine while engaging in
some form of physical exertion.
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Digestive System
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After 65+ - saliva production decreases, fewer gastric juices are
secreted, and the stomach empties more slowly; decrease
in liver volume and blood flow through the liver may also occur
Fecal incontinence affects only 4 percent of the over-65 population
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Bodily Control Systems
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Endocrine system
Hypothalamus-releasing factors (HRFs)
• Produced by hypothalamus
• Partially regulates secretion of hormones
produced by anterior pituitary
Hormones produced by anterior pituitary:
• Growth hormone (GH; somatotropin)
• Thyroid-stimulating hormone (TSH)
• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Prolactin
Other hormones
• Insulin-like growth factor (IGF-1); with GH
is called somatrophic axis
• Partially regulates secretion of hormones
produced by anterior pituitary
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Growth hormone and IGF-1
• Changes in both called somatopause
Loss of bone mineral content
• Increases in fat
• Decrease in muscle mass
• Losses in strength, exercise tolerance, and
quality of life in general
• GH nighttime peak is smaller
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Glucocorticoid cascade hypothesis
• Aging causes dangerous increases
in cortisol
• This, in turn, accelerates loss of
neurons in the hippocampus
• However longitudinal studies
suggest instead that weight loss,
not age, increases risks for higher
cortisol levels.
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Thyroid hormones
• Control Basal Metabolic Rate (BMR)
• BMR slows in middle age partly due to
decreases in thyroid hormones
• Subclinical hypothyroidism may affect
15-18% of 60+
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Melatonin
• Manufactured by the pineal gland.
• Controls circadian rhythm
• Some believe supplements might be helpful to
make up for age-related decreases, but there
are potential risks and questions about its
effectiveness
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DHEA
• Weak male steroid, the most abundant steroid in the body
• Precursor to testosterone and estrogen
• Decreases with age referred to as adrenopause
• However, not clear whether replacement therapy is safe
• Exercise is a less risky alternative
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Female Sexual Changes
• Menopause is technically the end of menstruation.
• Perimenopause is the period preceding menopause
• Throughout this period, estrogen gradually decreases as
does progesterone.
• Anterior pituitary sends out FSH and LH to compensate
• Hypothalamus sends out less gonadotrophin-releasing factor
• There is a range of possible symptoms (e.g. hot flashes), but
not clear how related to physiological change
• Genitals undergo a number of changes that can interfere
with sexual intercourse
• Bones, cardiovascular disease, and memory may be affected
by estrogen decreases
• HRT= Estrogen + Progesterone. Its use is controversial
• Alternatives include exercise, quitting smoking, lowering
cholesterol and having 1 alcoholic drink/day
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Male Sexual Changes
• Andropause refers to age-related declines in testosterone,
~1% per year (also called “late onset hypogonadism”).
• Lower testosterone levels more likely in men who are diabetic
or obese.
• Testosterone supplements are in increasing use, promoting
these bodily functions
Erectile dysfunction (ED) may be treated with a
combination of testosterone supplements and sildanefil
(Viagra), though there may be risks for men with
cardiovascular disease.
Exercise is a safe alternative, at least as initial approach.
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The Immune System
Source: Reprinted from Current Opinion
in Immunology, 21(4), Dorshkind, K., &
Swain, S., Age-associated declines in
immune system development and
function: causes, consequences, and
reversal, 404–407, Copyright (2009),
with permission from Elsevier.
The upper half shows normal age-related changes in the immune system:
1. Decreased secretion of antibodies
2. Reduced production of white blood cells
3. Shrinking with age of the thymus
4. Growth in harmful hormones (CD8+) and reduced function of T helper cells (CD4+)
The lower half shows rejuvenation strategies:
1. Intake of resveratrol
2. Reduction of harmful immune proteins
3. Immunotherapy
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The Nervous System
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Hemispheric Assymetry
Reduction in Older Adults
(HAROLD)
Brains of older adults become
activated in opposite
hemisphere when original
hemisphere suffers deficits
Posterior-Anterior Shift with
Aging (PASA)
Brains of older adults become
activated in opposite
hemisphere compared to
younger adults and are
therefore less lateralized
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Prefrontal cortex
• Area involved in planning and encoding information in
long-term memory (along with temporal cortex)
• Experiences major effects
Hippocampus
• Area responsible for consolidating memories
• Becomes smaller with increasing age, though
plasticity is possible
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Brain Imaging Techniques
EEG – scanning of electrical activity of the brain
CAT or CT – scanning a cross-sectional slice of the brain from
any angle
MRI – scanning of the brain using radio waves;
based on water content of various tissues
fMRI – MRI that provides a look at changes in the brain over the
course of a mental activity
PET scan – provides a brain scan using radioactive compounds
as they pass through the brain
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This study illustrates plasticity model in that more intense exercisers
showed increased brain tissues in areas related to memory.
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White Matter Hyperintensities
ABNORMALITIES in the frontal lobe
Not entirely clear what they represent but may be due to white
matter deterioration
Interfere with cognitive function
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Sleep patterns in later life
• Everyone requires 7-9 hrs of sleep a night
• Midlife adults with sleep problems often are under stress
• Physical conditions also play a role including obesity, activity and
alcohol use
• Older adults have more disrupted sleep due to more frequent
awakenings and less efficient sleep patterns
• Medical illness can disrupt sleep including those involving joint pain,
cancer, lung disease, heart disease, and digestive disturbance
• Changes in the bladder can also interfere with sleep
• Sleep apnea interrupts sleep, a condition found more often in older
adults with certain illnesses
 Exercise can offset as can treatment by sleep specialists
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Self-ratings of circadian rhythm and aging
Source: Hasher, L., Goldstein, F., & May, C. (2005). It’s about time:
Circadian rhythms, memory and aging. In C. Izawa & N. Ohta (Eds.), Human
learning and memory: Advances in theory and application (Vol. 18, pp. 179–186). Mahwah, NJ: Lawrence Erlbaum.
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Temperature Control
• Older adults at greatest risk of dying from dysthermia
• Also less able to adjust internal body temperature to
outside conditions.
• For hyperthermia, older adults with heart disease are
particularly vulnerable
• For hypothermia, risks to older adults seems to reflect
impaired ability to maintain core body temperature.
• Changes in sweat output also contribute as do thinning of
the dermal layer of the skin.
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Sensation and Perception
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Presbyopia
Loss of ability to focus on near
objects
Cataracts
Opacities in the lens of the eye
Presbycusis
Loss of ability to hear highpitched tones
Causes of blindness include age-related macular degeneration (ARMD) and glaucoma.
Age-related macular degeneration (ARMD), a condition caused by damage
to the photoreceptors located in the central region of the retina known as the
macula.
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Exposure to excess noise is the most common cause of hearing loss.
Also caused by noise exposure, tinnitus can also interfere with hearing.
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Communication strategies for talking to older adults
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Look directly at the person
Make sure the other person is in enough light
Turn down background noise
Don’t chew gum or food
Keep the voice low
Enunciate carefully
Do NOT talk to her person as if he or she were a child
Provide context so the listener knows what you’re talking about
Note whether the other person is responding to you
Maintain positive and patient attitude
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Balance
• Loss of balance is one of main factors
responsible for falls which, in turn, can
lead to institutionalization and death
• Previous falls also increase risk of later
falls
• Falls can create a fear of falling which
in turn increases the risk even more
Further exacerbated by
dizziness and vertigo
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Practical fall prevention strategies
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Wear proper eyeglasses
Use prosthesis while walking
Install balance aids in the home
Become trained in taking care while walking
Get shower chair or bath bench
Install hand-held shower head
Sit while grooming
Have sturdy stepstools if needed in kitchen
Keep the cell phone handy
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Exercise and balance training can reduce risk of falls
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Smell and taste
• 1/3 of older adults suffer a form of olfactory impairment;
by 80 almost 1/2 have no ability to smell
• Caused by intrinsic changes as well as disease, injury and
exposure to toxins
• Cigarettes and dentures play important role
• Cognitive changes associated with loss of smell sensitivity
• Nevertheless, there are ways to maximize enjoyment of
food including expanded food choices, planning meals,
and being able to socialize
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Somatosensory system
Touch
• Loss of ability to discriminate touch perhaps as high as 1% per year
• Hands and feet more affected than lip and tongue
• Practical consequences include loss of ability to grasp, maintain
balance, perform delicate handiwork and speak.
Pain
• Lower back pain is chronic problem for as many as 12% of older
adults
• Pain can interfere with cognitive performance
• Current older adults may be more stoic
• Pain is associated with obesity
• Preferable to use non-medicinal methods to control pain which carry
no risk of abuse
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