How We Age

1. How We Age Physiological Changes of Aging January 27, 2005

2. 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

3. B00MERS ! Born between 1946 and 1964 Turning 65 between 2011 and 2031

4. 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.

5. The growing 100+ age group In 2000 65,000 centenarians By 2030 381,000 centenarians

6. Aging Missouri In 2000 745,684 Missourians are over 65 13.6% of the Missouri population

7. Race, Ethnicity, and Aging

8. Marital Status

9. Living Arrangements

10. Living in Poverty • Based on money income for community-dwelling older adults

11. 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

12. Causes of Death (2001) • Heart Disease • Malignant Neoplasm • Cerebrovascular Diseases • Chronic Lower Respiratory Diseases • Influenza & Pneumonia • Diabetes Mellitus

13. Chronic Conditions(2001-2002)

14. 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 !

15. 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 %

16. Clinically Relevant Depression • Having 4 or more symptoms from the list of 8 symptoms in an abbreviated form of the CES-D instrument

17. Functional Ability (2002)

18. 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)

19. 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

20. 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

21. By the Numbers • www.agingstats.gov/ • Federal Interagency Forum on Aging. (2005). Older Americans 2004: Key Indicators of Well-Being.

22. 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

23. A Summary of Aging’s Effects • Structure • Strength • Flexibility • Speed • Capacity • Response to challenge • Sensory links to the world

24. 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

25. 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)

26. Flexibility • Joint changes due to arthritis • Ligament and tendon stiffening • Residual effect of trauma

27. Speed • Slower nerve conduction velocity • Slower response to stimuli • Slower reflexes • Slower adaptation to changes in light • Slower recall of information • Slower learning

28. Capacity • Smaller lung volume • Smaller cardiac reserve • Slower metabolism • Smaller urinary bladder volume

29. Response to Challenge • Hemodynamics • Pulse • Blood Pressure: Orthostatic hypotension • Fluid balance • Postural balance • Thermal regulation • Immunity

30. Sensory Links to the World • Vision • Hearing • Taste • Smell • Touch • Kinesthetics

31. 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

32. 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

33. 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

34. Sensory Changes: Smell • Decreased number of olfactory nerve endings • Impaired sensitivity related to history of smoking, chronic nasal allergies • May be altered by disease

35. Sensory Changes: Touch • Reduced number of peripheral nerve endings • Altered perception of temperature, pressure, vibration, pain

36. Sensory Changes: Kinesthetic Sense • Proprioception • Altered balance • Altered spatial orientation • Slowed responses • To avoid obstacles • To prevent a fall • To regain balance

37. The Results of these changes • Alterations in function • Alterations in how we live our lives • Susceptibility to illness and injury

38. Special Issues • Cognitive impairment • ADL/IADL Independence • Mobility • Assistive devices • Falls • Safety

39. Cognitive Impairment: 4 A’s • Amnesia • Impaired memory • Agnosia • Impaired recognition of people and objects • Apraxia • Impaired task performance • Aphasia • Impaired language skills

40. Cognitive Impairment • Reasoning and judgment • Communication • Independence in IADL/ADL • Instrumental activities of daily living • Activities of daily living • Safety

41. 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

42. Assistive Devices

43. 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

44. Safety • Accidents in the bathroom • Accidents in the kitchen • Falls • Burns • Fires related to smoking • Driving accidents • Wandering • Crime • Domestic Abuse … Elder Abuse

45. 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.