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How We Age. Physiological Changes of Aging January 27, 2005. Aging America. In 1900 3 million over age 65 In 2003 36 million over age 65 12.4% of the US population In 2011, the first Baby Boomers turn 65 By 2030 71.5 million over age 65 19.6% of the US population. B00MERS !.

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How we age l.jpg

How We Age

Physiological Changes of Aging

January 27, 2005


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Aging America

In 1900

3 million over age 65

In 2003

36 million over age 65

12.4% of the US population

In 2011, the first Baby Boomers turn 65

By 2030

71.5 million over age 65

19.6% of the US population


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B00MERS !

Born between 1946 and 1964

Turning 65 between 2011 and 2031


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Frail Elders: Age 85 and up

In 1900 … only 100,000

In 2000

4.2 million

1.5% of the US population

By 2030

20.9 million

2.6% of the US population (5% by 2050)

Those over 85 tend to be in poorer health and to use more services.


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The growing 100+ age group

In 2000

65,000 centenarians

By 2030

381,000 centenarians


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Aging Missouri

In 2000

745,684 Missourians are over 65

13.6% of the Missouri population





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Living in Poverty

  • Based on money income for community-dwelling older adults


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Life Expectancy

  • At birth

    • In 1900 = 49 years

    • In 1960 = 70 years

    • In 2001= 79.8 years for women & 74.4 years for men

  • At age 65, 19.4 more years for women and 16.4 more years for men

  • At age 85, 6.9 more years for women and 5.7 more years for men


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Causes of Death (2001)

  • Heart Disease

  • Malignant Neoplasm

  • Cerebrovascular Diseases

  • Chronic Lower Respiratory Diseases

  • Influenza & Pneumonia

  • Diabetes Mellitus


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Chronic Conditions(2001-2002)


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Chronic Conditions & Disability

  • Contribute to decreased functional ability … 20% (+65) are disabled

    • Men = 15% and Women = 23%

  • Negatively impact quality of life

  • Affect housing choices and the ability to remain in the community

  • However … 73% of those over 65 years rate their health as good or better !


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Memory Impairment

  • A major indicator of the need for institutional placement

  • Incidence of moderate to severe memory impairment (2002):

    • Age 65 and over … 12.7%

    • Age 65 – 69 …. 5.1 %

    • Age 85 + …. 31.2 %


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Clinically Relevant Depression

  • Having 4 or more symptoms from the list of 8 symptoms in an abbreviated form of the CES-D instrument



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Assisted Living

11,472 facilities

558,400 residents

24 % of the residents need help with 3 or more ADLs

An estimated 33% have moderate to severe cognitive impairment

Hawes, Rose, & and Phillips (1999)


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Nursing Home Placement

  • Nursing home use increases with age

  • In 1999

    • Age 65-74: 11 persons out of 1000

    • Age 75-84: 43 persons out of 1000

    • Age 85 +: 182 persons out of 1000


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Nursing Home Dependence in Activities of Daily Living

Residents over age 65 (1999 data)

ADLs = bathing, dressing, eating, walking, toilet use, transferring in or out of bed or chairs


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By the Numbers

  • www.agingstats.gov/

  • Federal Interagency Forum on Aging. (2005). Older Americans 2004: Key Indicators of Well-Being.


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Causes of Age-Related Changes: Rule of Thirds

  • 1/3rd are the result of functional decline due to disease

  • 1/3rd are due to inactivity or disuse

  • 1/3rd are due to aging itself

  • BUT each of us ages in a way that is unique … because of genetic factors and life history


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A Summary of Aging’s Effects

  • Structure

  • Strength

  • Flexibility

  • Speed

  • Capacity

  • Response to challenge

  • Sensory links to the world


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Structure

  • Distribution of body mass shifts

    • Truncal obesity

    • Center of gravity shifts lower in body

    • Thinner layer of subcutaneous fat

  • Bone mass less

    • Osteoporosis

  • Loss of height

    • 2 inches lost between 20 & 70

  • Postural changes

    • Dorsal kyphosis


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Strength

  • Less muscle strength due to replacement of elastic fibers

  • Changes in peripheral nerves to the muscles

  • Changes in bone (less sturdy)

  • Changes in joints (less stable)

  • Changes in skin (drier, more fragile)


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Flexibility

  • Joint changes due to arthritis

  • Ligament and tendon stiffening

  • Residual effect of trauma


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Speed

  • Slower nerve conduction velocity

    • Slower response to stimuli

    • Slower reflexes

  • Slower adaptation to changes in light

  • Slower recall of information

  • Slower learning


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Capacity

  • Smaller lung volume

  • Smaller cardiac reserve

  • Slower metabolism

  • Smaller urinary bladder volume


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Response to Challenge

  • Hemodynamics

    • Pulse

    • Blood Pressure: Orthostatic hypotension

  • Fluid balance

  • Postural balance

  • Thermal regulation

  • Immunity


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Sensory Links to the World

  • Vision

  • Hearing

  • Taste

  • Smell

  • Touch

  • Kinesthetics


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Sensory Changes: Eye

  • Diminished acuity

    • 18% have decreased vision even WITH glasses

  • Slower accommodation to changes in light

  • Altered color discrimination

    • Especially blue, green, gray, purple

    • Yellowing of lens

  • More brightness needed

    • Ambient and task-focused

  • Sensitivity to glare

    • Lighting, flooring, and windows


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Sensory Changes: Ear

  • 1/2 of men & 1/3 of women have difficulty hearing without amplification

  • Hearing

    • Presbycusis

    • High frequency loss

    • Difficulty distinguishing conversations from background noise

  • Balance

    • Vestibular system


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Sensory Changes: Taste

  • Threshold necessary for taste perception rises

  • Number of taste buds decreases

  • Taste may be altered by disease or medication

  • Taste and smell work together

  • At age 65 and over, 26% of men and 29% of older women have no natural teeth


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Sensory Changes: Smell

  • Decreased number of olfactory nerve endings

  • Impaired sensitivity related to history of smoking, chronic nasal allergies

  • May be altered by disease


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Sensory Changes: Touch

  • Reduced number of peripheral nerve endings

  • Altered perception of temperature, pressure, vibration, pain


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Sensory Changes: Kinesthetic Sense

  • Proprioception

  • Altered balance

  • Altered spatial orientation

  • Slowed responses

    • To avoid obstacles

    • To prevent a fall

    • To regain balance


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The Results of these changes

  • Alterations in function

  • Alterations in how we live our lives

  • Susceptibility to illness and injury


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Special Issues

  • Cognitive impairment

  • ADL/IADL Independence

  • Mobility

  • Assistive devices

  • Falls

  • Safety


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Cognitive Impairment: 4 A’s

  • Amnesia

    • Impaired memory

  • Agnosia

    • Impaired recognition of people and objects

  • Apraxia

    • Impaired task performance

  • Aphasia

    • Impaired language skills


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Cognitive Impairment

  • Reasoning and judgment

  • Communication

  • Independence in IADL/ADL

    • Instrumental activities of daily living

    • Activities of daily living

  • Safety


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Mobility: The Key to Independence

  • Being able to get out of a chair or a bed

  • Being able to get to the bathroom

  • Being able to get to the kitchen

  • Being able to get to the phone

    Mastrian’s study on independence



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Falls

  • 1/3rd of +65 living at home fall at least once in a year

  • Half of those who fall, fall more than once

  • Fractured hips after falling lead to 40% of nursing home admissions

  • In hospitals: 20% of patients fall

  • In LTC facilities: 45% of residents fall


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Safety

  • Accidents in the bathroom

  • Accidents in the kitchen

  • Falls

  • Burns

  • Fires related to smoking

  • Driving accidents

  • Wandering

  • Crime

  • Domestic Abuse … Elder Abuse


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More References

  • Ebersole, P & Hess, P. (1998). Toward Health Aging (5th ed.). St. Louis: Mosby.

  • Hawes, C; Rose, M; & Phillips, CD. (1999). Executive summary: Results of a national survey of facilities. Available online: http://aspe.os.dhhs.gov/daltcp/reports/

    facreses.htm.

  • Mastrian, KG. (2001). Differing perceptions in defining safe independent living for elders. Nursing Outlook, 49, 231-237.


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