Conditions & Diseases

The purpose of this section is to explain the various changes that occur in the natural aging process and to provide some considerations on how to care for these changes.  As a person grows older certain physiological changes occur as a natural part of the aging process. These changes can impact the elder's health status and may signal the beginning of a disease state. Included in this section are considerations for care caterogized by topic and links for further information.

Click on a link below to jump to that section:

Skin¹

• Skin becomes wrinkled, dry, sagging and loose.
• Skin loses the ability to sweat, to regulate body temperature and to detect temperature change.
• There is increased risk for blisters, bruising, burns and cuts even when contact is considered minimal.

Considerations

• Use lotions to minimize dry or cracking skin especially during winter months or in dry regions.
• Avoid extreme temperatures; monitor water intake when exposed to hot weather.
• Be sensitive to the body’s inability to regulate temperature, allow them to warm or cool themselves as needed.
• Monitor cooking ability through observation and lower the settings on the water heater to minimize risk of burns.
• If the care receiver is bedridden be sure that they are being turned frequently to reduce the risk of pressure sores and blisters.

Bones, Joints & Muscles²

• 10-20% of bone loss is due simply because of aging. 
• Being sedentary increases bone loss. 
• With aging, calcium becomes harder to absorb into the bones.
• Aging leads to increased joint discomfort, inflexibility, immobility and muscle loss. This increases risk for falls.

Considerations

• With bone loss there is an increased risk for osteoporosis.  Bone loss can be easily measured through a simple bone density screening.  These screenings may be offered for minimal cost through your local health care center or may be covered by some health care insurance companies.
• Encourage moderate weight bearing activity such as biking and walking to minimize bone loss.
• Moderate exercise is encouraged to maintain muscle tone. 
• Strength training and stretching exercises will maintain muscle tone, balance and flexibility.
• Talk to your health care provider about solutions for joint pain as some prescriptions or over-the-counter creams may reduce discomfort.

Conditions & Diseases

• Osteoporosis
• Arthritis

For More Information

• Osteoporosis
  • Basic Information: National Osteoporosis Foundation
  • Basic Information: Mayo Clinic
  • Basic Information: U.S. National Library of Medicine/NIH
• Arthritis
  • Basic Information: Arthritis Foundation
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: NIH Senior Health
  • Basic Information: John Hopkins Arthritis Center

Heart & Circulation³

As we age it becomes more difficult to pump the blood in and out of our heart and the veins become more soft making it harder for blood to flow through the body.

Considerations

• Encourage moderate cardiovascular exercise in where heart rate is raised for at least 15 to 20 minutes a couple of times per week.
• If a cardiovascular event (heart attack, bypass surgery, arterial stents) has occurred, participation in a cardiac rehabilitation program may be available.  These programs are often covered by insurance plans, including Medicare. Check with your health care provider for availability. 
• At a minimum, have blood pressure monitored yearly.
• If blood pressure is already a concern; physical activity, diet modification and medications can help.  Talk to your health care provider to discuss these options.

Conditions & Diseases

• Angina
• Angioplasty & Stents
• Artheriosclerosis
• Blood Pressure (High)
• Bypass Surgery
• Congestive Heart Failure
• Heart Attack (Myocardial Infarction)
• Stroke
• Pacemakers/ Defibilators
• Peripheral Artery Disease

For More Information

• Angina
  • Basic Information: National Heart, Lung & Blood Institute
  • Basic Information: American Heart Association
  • Basic Information: Texas Heart Institute
  • Medical Information: National Library of Medicine/NIH
  • Medical Infomration: Cardiology Channel
• Angioplasty & Stents
  • Basic Information: VascularWeb
  • Basic Information: Texas Heart Institute
  • Basic Information: Mayo Clinic
  • Medical Information: Cardiology Channel
• Artheriosclerosis
  • Basic Information: Mayo Clinic
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: BBC
  • Basic Information: American Heart Association
• Blood Pressure
  • Basic Information: American Heart Association
  • Basic Information: National Heart, Lung & Blood Institute
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: Mayo Clinic
• Bypass Surgery
  • Basic Information: American Heart Association
  • Basic Information: Mayo Clinic
  • Basic Information: VascularWeb
• Congestive Heart Failure
  • Basic Information: STUDY LINK #1: American Heart Association
  • Basic Information: STUDY LINK #2: American Heart Association
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: Texas Heart Institute
  • Basic Information: Mayo Clinic
• Heart Attack
  • Basic Information: American Heart Association
  • Basic Information: Mayo Clinic
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: National Heart, Lung & Blood Institute
• Pacemakers / Defibrillators
  • Basic Information Pacemakers: American Heart Association
  • Basic Information Pacemakers: National Heart, Lung & Blood Institute
  • Basic Information Defibilators: American Heart Association
  • Basic Information: U.S. National Library of Medicine/NIH
• Peripheral Artery Disease
  • Basic Information: American Heart Association
  • Basic Information: Mayo Clinic
  • Basic Information: VascularWeb
  • Basic Information: National Heart, Lung & Blood Institute
• Stroke
  • Basic Information: American Stroke Association
  • Basic Information: American Heart Association
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: National Stroke Association
• Transient Ischemic Attack
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Inforamtion: American Heart Association
  • Basic Inforamtion: National Institute of Neurological Disorders & Stroke
  • Basic Information: Mayo Clinic

Hormones⁴

The body contains glands that secrete chemical messages called hormones. With aging the body's ability to respond to hormones decreases. Which causes:

• Inability of the cells to respond to insulin
• Glucose levels are slow to return to normal levels after eating. This leads to an increased occurrence of diabetes mellitus (50% of those over the age of 80)
• Thyroid changes
• Inability to produce energy levels higher than normal resting levels; increasing the feeling of tiredness.
• Change in the body’s ability to use fat and carbohydrates for fuel; increasing the risk of becoming overweight.

Considerations

• Encourage rest and relaxation; may need to nap or rest more frequently.
• If body weight is a concern, talk to a health care provider about options for weight loss and healthy eating.
• Be aware of the symptoms of diabetes and have blood checked as part of an yearly checkup.
• If diabetes is a factor, be sure that the physician’s instructions are being carried out and diet modifications are being adhered to through monitoring (visits or phone calls).
• Diabetes counselors may be available to assist with testing procedures and diet modifications; check with your health care provider.

Conditions & Diseases

• Diabetes
• Hypothyrodism
• Hyperthyrodism

For More Information

• Diabetes
  • Basic Information: American Diabetes Association
  • Basic Information: WebMD
  • Basic Informtion: National Diabetes Information Clearinghouse
  • Diabetic Retinopathy: Vision Channel
• Thyroid
  • Basic Information: U.S. National Library of Medicine/NIH
  • Scientific Information: American Thyroid Associatio

Issues With Eating⁵

With Aging

• Decreased saliva makes chewing and swallowing food more difficult.
• Tooth loss, dentures or gum disease may result in difficulty with chewing and swallowing of food.
• Ability to taste food is decreased or more sensitive.
• Stomach takes longer to empty; more sensitive to spicy and hard to digest foods.
• Digestion in the intestines slows down leading to constipation and/or diarrhea.

Considerations

• Pay attention to elder’s eating habits; slow eating is an indication of problems.
• Be patient; little can be done to increase eating speed.
• Eat smaller portions; eat several small meals per day rather than three large ones.
• Encourage consumption of foods that taste good
• Some medications can change the way food tastes.
• Monitor side-effects of medications as they may increase nausea.  Sometimes another brand or type of medication may reduce side effects.  Ask your pharmacist which side-effects to be aware of.

Urinary Tract⁶

Changes that occur with age

• Inability to adapt to dehydration or water overload
• Increased urinary frequency, especially at night, bladder control problems and incontinence.
• Prostate enlargement in men can lead to urinary hesitancy, increased urinary frequency, urinary straining and increases of residual urine in bladder.
• Urinary tract infection is a common infection in the elderly (5-15% of men; 10-30% of women)

Considerations

• Monitor water intake; too much or too little may be harmful as the body is not able to adapt as well.
• Provide lighting and safe passage to and from bathroom especially at night
• If traveling, be sure to stop in consistent and frequent intervals
• If bladder problems exist, use pads to reduce risk of accidents.  Be sure to carry extra protection and use a pad with plenty of absorption.
• Very important to talk about bowel movments with your loved one to avoid severe health effects of long term diarrhea or constipation.

Conditions & Diseases

• Urinary Tract Infections
• Enlarged Prostate
• Prostate Cancer

For More Information

• Urinary Tract Infection
  • Basic Information: Mayo Clinic
  • Basic Information: Urology Channel
  • Basic Information: National Kidney and Urologic Diseases Information Clearinghouse
• Enlarged Prostate
  • Basic Information: Prostate Information
  • Basic Information: U.S. National Library of Medicine
  • Basic Information: Mayo Clinic
• Prostate Cancer
  • Basic Information: Prostate Cancer Prevention & Screening
  • Basic Information: Prostate Cancer Foundation
  • Basic Information: National Cancer Institute
  • Basic Information: Mayo Clinic
• Diarrhea
  • Basic Information: WebMD
  • Basic Information: Mayo Clinic
• Constipation
  • Basic Information: WebMD
  • Basic Information: Mayo Clinic

Incontinence⁷

Inability to control urination resulting in uncontrolled urine loss especially common in women but occurs in men as well.  In most cases can be cured, but due to the nature of the condition people are often too embarrassed to talk about it.

Types of incontinence

• Stress: leakage of urine during exercise, coughing, sneezing, laughing or other body movements that put pressure on the bladder.  Occurs in women of all ages.
• Urge: inability to hold urine long enough to reach a toilet   Often occurs with conditions such as stroke, senile dementia, Parkinson disease and multiple sclerosis
• Overflow: Leakage of small amounts of urine from a constantly filled bladder.  Common cause in men is blockage of urine outflow from bladder by an enlarged prostate.  Can be due to loss of normal contraction of the bladder in some people with diabetes.

Considerations:

• Establish a schedule; urinate every 3 to 4 hours regardless of need.
• Talk to a health care professional about all prescription and nonprescription medications you are taking to determine if one may be worsening the incontinence problem.
• Practice “double voiding” by urinating as much as possible, relaxing for a few moments, then trying to urinate again.
• Reduce or eliminate caffeinated drinks.
• Avoid drinking too much or too little fluid.
• Strengthen your pelvic muscles by performing Kegel exercises.
• Increase the amount of fiber in your diet.
• Quit smoking

For More Information

• Incontinence
  • Basic Information: WebMD
  • Basic Information: FamilyDoctor.org
  • Basic Information: National Institute on Aging
  • Fecal Incontience: Mayo Clinic
  • Urinary Incontinence: Mayo Clinic

Vision⁸

Aging of the eye can lead to

• Dry eyes and chronic irritation.
• Increasing risk for cataracts, glaucoma and macular degeneration.
• Inability of the eyes to adjust to changes in light (bright to dark) and decreased depth perception.
• Inability to detect green and blue colors.

Considerations

• Have a yearly eye exam
• Communicate to care receiver the importance of reporting sight problems when they occur
• With diminished eye sight it is important to ensure elders safety. 

Diseases & Conditions

• Cataracts
• General Vision Loss with Age
• Glaucoma
• Macular Degeneration

For More Information

• Cataracts
  • Basic Information: Vision Channel
  • Basic Information: All About Vision
  • Basic Information: Mayo Clinic
• General Age Related Vision Loss
  • Basic Information: Saftey Tips for Visually Impaired
  • Nolan, D.E.(2002): Age Related Vision Loss
  • Basic Information: Vision Loss
• Glaucoma
  • Basic Information: Vision Channel
  • Basic Information: All About Vision
  • Basic Informtion: U.S. National Library of Medicine/NIH
  • Scientific Information: Glaucoma Research Foundation
• Macular Degeneration
  • Basic Information: Vision Channel
  • Basic Information: All About Vision
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: Mayo Clinic

Hearing⁹

With aging there is narrowing of the external auditory canal and/or possible obstruction of the Eustachian tubes leading to one or more symptoms including

• Inability to detect speech and to hear low pitch sounds
• Difficulty hearing when background noise is present.

Considerations

• Check to make sure that the hearing aid is turn on, adjusted and has a working battery.
• Be sure the individual sees you approach otherwise you may startle them.
• Face the hard of hearing person directly and be on the same level with him/her whenever possible.
• Try not to eat, chew or smoke while talking, speech will be more difficult to understand.
• Keep your hands away from your face while speaking.
• Recognize that hearing impaired people hear and understand less when they are tired or ill.
• Reduce or eliminate background noise as much as possible when carrying on conversations.
• Speak in a normal fashion without shouting. 
• Make sure that there is no light shining in the eyes of the hearing impaired person.
• If the person has difficulty understanding something, find a different way of saying the same thing, rather than repeating the original words over and over.
• Use simple, short sentences to make your conversation easier to understand.
• Write messages if necessary.
• Allow ample time to converse, being in a rush will compound everyone’s stress and create barriers to having a meaningful conversation.

Conditions & Diseases

• Hearing Loss
• Meniere's Disease

For further information

• Hearing Loss
  • Basic Information: Symptoms of Hearing Loss
  • Basic Information: Mayo Clinic
  • Basic Information: American Speech-Language Hearing Association
• Meniere's Disease
  • Basic Information: National Institute of Deafness & Other Communication Disorders
  • Basic Information: U.S. National Library of Medicine/NIH
  • Basic Information: American Hearing Research Foundation
  • Medical Information: University of Washington

Sensory, Motor & Nervous System Changes¹⁰

Sensory Changes

• Decrease ability to sense changes in touch, pressure, vibration and temperature.
• Decreased sense of balance and location of body parts.

Motor Changes

• Slowing of skilled movements, posture and walk.
• Walk and balance becomes broad based and small stepped leading to a slower walk with diminished arm swing this increases the risk of falls.

Nervous Changes

• Slowed reaction time and coordination.
• Decrease efficiency of working memory, complex learning ability and stimuli awareness.
• These neurological changes may over time lead to dementia, Alzheimer’s disease or Parkinson’s disease.

Considerations

• Monitor memory, movement and learning.
• Remind yourself that some loss of memory, problems with movement and slowed ability to learn new things are common with aging.
• Learning new concepts can be done it just may take more time and repetition.

Conditions & Diseases

• Parkinson's Disease
• A degenerative disorder of the Central Nervous System that impairs motor skills and speech. Characterized by muscle rigidity, temor and slowing of physical movement.
• Lou Gerig's Disease
  • A neurodegenerative disease caused by the loss of nerve cells in the Central Nervouse System that controls muscle movement.

For More Information

• Parkinson's Disease
  • National Parkinson Foundation
  • National Institute of Neurological Disorders & Stroke
  • Mayo Clinic
  • Parkinson's Disease Foundation
  • Living with Parkinson's
  • Caring for A Person with Parkinson' Disease
  • Respite Care from Medical News Today
• ALS: Lou Gerig's Disease
  • ALS Association
  • American Family Physician
  • National Institute of Neurological Disorders & Stroke

Tips to Reduce the Risk of Falls¹¹

• Around the home
• Minimize changes in walking surfaces
• Use slip resistant coverings such as rough tile and carpet with short, dense pile
• Create color contrasts between walls and floors (lighter color floors are preferable)
• Increase lighting
• Install wall mounted light fixtures, accessible while standing on the floor
• Install more outlets to reduce the use of extension cords
• Relocate light switches so that the care recipient does not have to walk through darkened areas
• Kitchen & Bathroom
• Securely install grab bars in tub/shower and near toilet at height and angle best suited for the care receiver
• Tub/shower usually require two bars positioned for support when entering and exiting
• Install slip resistant tile
• Increase door width to 30 inches for care recipient with wheel chairs or walkers
• Clean up grease and liquids immediately
• Do not wax floors
• Avoid climbing or reaching for high cabinets, use a sturdy step stool with handrails
• Always keep a night light on in the bathroom
• Use night lights to light the path from bed to bathroom
• Use bathroom rugs with nonskid backing
• Vary the colors in the bathroom. If everything is one color (tub, toilet and walls) add bright decals or red tape so the care receiver can see the edges.
• Be sure shower stalls have code standard shatterproof glass
• Stairways
• Install handrails on both sides of the stairs and extend them one foot beyond the last step at both top and bottom
• Position handrails at elbow height of the care recipient
• Use handrails that allow the care receiver to use a “power grip” (to encircle their thumb and fingers around it) and allow hand clearance between the handrail and wall.
• Use a different color contrast to mark the first and last step
• Limit stair rise to 7 inches, make tread at least 11 inches
• Install light switches at the top and bottom of stairs
• Be sure carpeting is tightly woven and installed so it doesn’t move or slide

For More Information

• Reducing the Risk of Falling
  • Mayo Clinic
  • American Physical Therapy Association

Sleep¹²

Aging causes

• Increases in sleep interruptions, day time napping, and the time it takes to fall asleep (sleep latency).
• Episodes of apnea, hypoapnea, and snoring with frequent arousals.
• Increases in motor activity (usually the legs) during sleep.
• Decreased time in the deepest sleep phases.

Considerations¹³

• Stick to a regular bedtime schedule and avoid napping during the day.
• Avoid stressful activities and vigorous exercise at least two 2 hours before going to bed.
• Before going to bed try relaxation techniques such as deep breathing, yoga or meditation.
• Be sure your bedroom is dark, quiet and cool.
• Use earplugs or eye shades if needed.
• Leave the bedroom if you cannot sleep; go into another room and read or do something relaxing and quiet.
• Avoid caffeine, alcohol and nictoine before bed.
• Sleep on your side.
• Avoid sleeping pills and other sedatives.
• Seek treatment for any allergies or nasal obstructions.
• Talk to your doctor to determine if prescription or nonprescription medications may be contributing to sleep problems.
• If depression or anxiety is keeping you up for more than a few nights, talk to your health care provide about treatment

Conditions & Diseases

• Sleep Apnea
• Snoring

For More Information

• Sleep Apnea
  • Basic Information: American Sleep Apnea Association
  • Basic Information: National Heart, Lung & Blood Institute
  • Basic Information: Mayo Clinic
  • Basic Information: Stanford University
  • Basic Information: Web MD
• Snoring
  • Basic Information: Sleep Education
  • Basic Information: Mayo Clinic
  • Basic Information: WebMD

Memory & Aging

Dementia¹⁴
General Information

• Deterioration of intellectual and cognitive functions including orientation memory, intellect, and judgment.
• Primary cause is unknown; secondary cause is due to other non-brain diseases.
• Alzheimer’s Disease is a type of dementia which accounts for 50-60% of all dementias.
• Multi-infarct dementia occurs when a stroke occurs in a specific region of the brain. Accounts for: 20-30% of dementia.

Considerations

• Join a support group
• Use respite services
• Try not to talk down to the person or to treat them as a child: conversation should be simple, but remain on an adult level.
• Continue sharing activities and pastimes with the person and show them you value them.
• People still retain their feelings and emotions even though they may not understand what is being said, so do everything you can to preserve their dignity and self-esteem.
• Never discuss the person in front of others as if they were not present, even if you think they do not understand.

For More Information

• Dementia
  • Basic Information: http://www.ncpamd.com/dementia.htm
  • Basic Information: Dementia.com
  • Basic Information: WebMD
  • Basic Information: FamilyDoctor.org
  • Basic Information: Mayo Clinic
  • Scientific Information: National Institute of Neurological Disorders & Stroke

Alzheimer's Disease¹⁵

Physiological changes
Has numerous neurofibrillary tangles and neuritic plaques (i.e. tangles & plaques) as well as amyloid deposition on the brain (cerbral cortex and hippocampus areas of the brain).

• Loss of specific neurons in the brain.
• Decreased size of the brain.
• Accumulations of abnormal cell proteins and metabolites. 
• Decreased brain metabolism; altered immune and hormonal responses.

Other facts about Alzheimer’s Disease

• Diagnosis is complicated and occur once all other factors have been excluded.
• Age and genetics are risk factors.
• Average length of disease is 8 years.
• Different signs and symptoms from other dementias include: delirium, depression, forgetfulness, paranoid and psychotic states and personality changes.

Considerations

• Join an Alzheimer’s support group.
• Do not take what they say or do personally.
• Remember that your loved one cannot control their behavior; they are not saying or doing things to intentionally hurt you.
• Do not try to force them to remember, just move on to the next topic or let them talk about whatever is on their mind.

For More Information

• Alzheimer's Disease
  • Basic Information: Alzheimer's Association
  • Basic Information: National Institute on Aging
  • Basic Information: Mayo Clinic
  • Scientific Information: National Institute of Neurological Disorders & Stroke

Sources:

7. WebMD, 2007. Urinary Control. Retrieved October, 2007 from www.webmd.com/hw/urinary_control/hw220495.asp?printing=true
11. Lockhart, 2003. Virginia Tech University. Retrieved on February, 2006 from http://www.research.vt.edu/resmag/sc2003/whyfall.htm
13. WebMD; http://www.webmd.com/content/article/8/1680_54233.htm

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