Aging: physical changes

We all change physically, as we grow older. Many of our changes are caused not by the aging process but by disease, the environment, and lifestyle. The good news is those physical changes occurring from these factors can be prevented or slowed down by taking action now. People who live an inactive lifestyle lose muscle mass and flexibility as they age. However, older adults can keep their muscles strong and improve their health by exercising and keeping active on a regular basis. Yoga, tai chi, water exercises, and daily stretching are some activities that improve flexibility. A healthcare provider should be consulted before starting a new exercise program. Skin changes with age. It grows thinner, takes longer to heal when injured, gets wrinkles, and loses some of its elastic quality. Many changes to the skin that seem to be from aging are actually changes caused by damage from over-exposure to the sun. Wearing a 30 SPF or higher sunscreen now can help prevent skin damage and problems later in life. Use lipstick or other lip protections that have sunscreens, too. Subtle changes in vision and hearing usually are a part of aging. As we age, our vision may slowly decrease. Glasses, or possibly surgery, can often correct the cause for this. Hearing loss may develop gradually and often goes untreated. It is important to have vision and hearing evaluated each year. As the body changes, medications may need to be adjusted and alcohol intake limited to no more than 1 drink per day. As we age, these substances stay in our system longer. Alcohol also has a more rapid effect on the body than when we were younger. A person's response time slows with age. To some extent, this is normal. When people stay both physically and mentally active, reaction time changes at a slower rate. This helps maintain independent functioning, such as driving. Making changes now to a healthier lifestyle can minimize the changes that occur with aging.
How does aging change a person's physical appearance and mental functioning? As we age, a number of changes occur in the skin. Some, such as wrinkles, sagging chins, and age spots, have no health consequences. The risk of skin cancer also increases with age, because of the cumulative effects of a lifetime of exposure to the sun. Age-related changes in the nervous system, which coordinates all other body systems, can affect walking, sleep patterns, learning, and memory. As people age, they spend more time in the lighter stages of sleep and awaken more often during the night. Because of changing sleep patterns, older people are more prone to chronic insomnia. They are also more likely to fall.

Normal Aging A number of physiological changes occur as we grow older. Some of the common changes that we thought represented aging have turned out to be the result of disease. Most of the normal changes of aging have no impact on normal functioning, although they become apparent when the body is placed under stress (e.g., acute illness, physical exertion). For example, the maximum heart rate of older adults is lower than that of younger adults. However, the resting pulse of a younger and older adults would not show this change. It is important to be able to recognize the changes of normal aging versus the effects of disease. Untreated disease can result in "excess disability" and reduce the quality of life of individuals. In this lecture we identify and describe the most important changes in the body that occur with aging. Healthy aging is an issue of increasing importance as the size of the older population continues to grow. Poor health in later life is not inevitable. Much of the illness and disability associated with aging is related to modifiable lifestyle factors that are present in middle age. Diseases make old age miserable, not the normal changes of aging. Although we have more wrinkles, more grey hair, and stiffer arteries the normal changes of aging are unlikely to kill us. No one dies of old age, not even Jeanne Calment in France who died at age 122! Infections or other diseases, most of which might are not life threatining when you are young, are the usual cause of death in old age. Normal changes of aging reduce your capacity to respond to illness. Injuries or infections that only slowed you down when you were young can cause disability and dependency when you are old. An acute illness can cause a "cascade of health problems" that can lead to rapid declines in health and function. Aging diminishes your body's ability to adapt. Older adults are more vulnerable very cold or very hot weather because they are unable to adapt their body temperature as effectively. Heterogeneity increases with age. Everyone ages differently and the rate of aging can vary markedly in individuals. Age-related changes in one system are not predictive of changes in other systems. For example, you may have cataracts in your eyes that severely restrict vision and yet have excellent heart function. In addition, an older person does not age faster than someone who is younger. However, biological age is different from chronological age. Thus, there is tremendous diversity among individuals of similar chronological age. A physically fit 50 year old can have the functional capacity of a thirty year old while someone who smokes and is sedentary may function as if they were several decades older. Cardiovascular System (Heart and Blood Vessels)

The cardiovascular system includes the heart which pumps the blood throughout the body and the network of blood vessels through which the blood is transported. In healthy people, the changes that normally occur in the cardiovascular system with aging do not significantly limit the normal work capacity of the heart. Most of the changes that cause clinically significant declines in cardiovascular function are the result of disease. Heart Muscle As we age, the heart muscle becomes slightly stiffer and may increase slightly in size. Despite this slight increase in heart size, the amount of blood the chamber can hold may actually decrease because the heart wall thickens. The maximum heart rate (the highest rate at which your heart can pump) decreases even among the most fit athlete. However, the resting heart rate and the cardiac output (amount of blood pumped over a period of time) do not change. In response to stress or exertion, older adults compensate for their lower maximum heart rate by increasing their stroke volume (i.e., amount of blood pumped with each contraction of the heart) to maintain cardiac output. Among older adults it takes longer for the heart rate and blood pressure to return to normal resting levels following stress.

Gastrointestinal System The gastrointestinal (G.I.) system consists of the esophagus, the stomach, the small intestine, the large intestine or colon, the liver, gallbladder, and the pancreas. Generally, the physiological changes of an aging digestive system are minor. With this in mind, it is important to recognize and actively treat most new G.I. problems in healthy older people, rather than ascribing symptoms to aging. The following section reviews some of the most common changes among older adults that can affect the functioning of the G.I. system. Pancreas Insulin Response The pancreas secretes insulin, a hormone which is critical to the metabolism of glucose (blood sugar). Insulin continues to be produced in sufficient quantities in older adults but their muscle cells may become less sensitive to the effects of insulin (probably due to a loss in the number of insulin receptor sites in the cell wall). After age 50, the "normal" fasting glucose level rises 6 to 14 milligrams per deciliter every 10 years. Adult onset diabetes or Type II diabetes occurs when the body develops resistance to insulin. It is usually managed through diet, exercise, and oral hypoglycemic medications. Sometimes people stop producing insulin and then insulin injections are needed. A number of studies indicate that adult onset diabetes is related to obesity and inactivity. Adrenal Glands

The adrenals are located just above the kidney's and secrete several hormones including aldosterone and cortisol. aldosterone is important in regulating fluid and electrolyte balance. On average, aldosterone levels are 30% lower in adults age 70 to 80 years old than in younger adults. Lower aldosterone levels may cause orthostatic hypotension (a drop in blood pressure with changes in position). cortisol is a stress response hormone that has anti-inflammatory and anti-allergy effects. Secretion of cortisol diminishes by 25% with age although the significance of this remains unclear. DHEA blood levels decline with age. However, the functional consequences of this decline are not clear. Stomach Atrophic gastritis is a stomach disorder that is unique to the elderly. It involves a shrinking and inflammation of the inner lining of the stomach. While it may not cause any symptoms, it can increase the risk for stomach cancer. While this was once thought to be a normal process of aging, more recent evidence indicates that it is caused by a prolonged infestation with helicobactor pylori (H. pylori) or campylobactor pylori (C. Pylori), which is common in older adults. other than intelligence. After arthritis, memory problems are the second most frequent complaint among older adults.

classic aging pattern". Performance scores which measure problem solving ability tend to decline with age.

bone mass begins to gradually decline as aging disrupts the balance between the cells that produce bone and the cells that absorb bone.

Corneal Flattening. In the aging eye the corneal surface flattens, admitting less light into the eyeball. This change reduces the transmitted light into the elderly eye by one third. Lens Transparency. The transparency of the lens actually diminishes with aging which weakens available light to receive colors with short wavelengths such as blue and violet. When new lens fibers naturally multiply at the edge of the lens, older fibers move to the center to create a dense center of the lens. Over time, the lens accumulates yellow substances which filter out the blue part of the color spectrum. Blue actually appears more green. Warmer colors like reds and oranges, seem stronger in comparison.

 Less Efficient Retina. The most sensitive part of the retina gradually functions less well with age due to decreased blood supply and the cumulative effects of radiation damage. The result is decreased spatial discrimination, black and white contrast, and flicker sensitivity. You become less able to tolerate glare and have more trouble adapting to darkness or bright light. Reduced Lens Elasticity. Over time the lens of the becomes less elastic which diminishes the focusing power of the eye and causes a decline in visual acuity. This changes is usually first noticed around age 40 and is called presbyopia. As presbyopia becomes more pronounced, people hold reading materials further away from their eyes. Some get headaches or "tired eyes" while reading or doing other close work. By age 55, most people require glasses for reading at least part of the time. Those who already wear glasses may need bifocals. Fortunately, only 5% become unable to read and about 20% have enough visual impairment to prevent driving.

Age-related Changes in the Ear A number of age-related changes occur in the ear. Membranes in the middle ear, including the eardrum, become less flexible with age. In addition, the small bones in the middle ear, the ossicles, become stiffer. Both these factors somewhat decrease hearing sensitivity but are not thought to cause significant impairment. Changes also occur in the inner ear but it is unclear whether is it aging or exposure to environmental noise that causes these problems that result in hearing loss. Changes in the middle ear with advancing age also contribute to a weakening sense of balance. The vestibular system is responsible for our sense of balance. The vestibular apparatus begins to degenerate with age in a similar way to the hearing apparatus. Equilibrium becomes compromised and older individuals may complain of dizziness and find it difficult to move quickly without losing their balance.

Presbycusis Presbycusis-- literally "old man's hearing"-- is the most common form of hearing loss with aging. It is characterized by a decrease in perception of higher frequency tones and a decrease in speech discrimination. The magnitude of presbycusis varies widely and it is hard to determine how much of the hearing loss is due to aging and how much is due to exposure to environmental noise, ototoxic drugs, or chronic age-related conditions such as hypertension and diabetes. Beginning around age 55, most older adults experience a loss in threshold sensitivity to pitch as the very high frequencies are lost. The higher frequency consonants, such as t, p, k, f, s and ch, are no longer heard due to the sensitivity loss in the high frequencies. In addition, elders have more difficulty in understanding speech, especially when there are competing sounds such as background noise.

Tinnitus Tinnitus refers to a chronic ringing, buzzing, tinkling, humming or other noise in the ears that only the individual can hear. Nearly 36 million Americans have tinnitus. Tinnitus is more common among older adults because it may represent a lifetime of exposure to loud noise. Treatable causes of tinnitus include high blood pressure, wax in the ear canal, or some medications (e.g., aspirin, antibiotics, antidepressants). Tinnitus may also be a symptom of ear infection, allergy or thyroid problems. If a cause can be identified then tinnitus may be curable. More often though the cause of tinnitus is unclear. Although there are no effective drug therapies, you can do several things which may help:

use a masking devices that produces a noise to distract you from the tinnitus avoid stimulants such as caffeine or nicotine which can increase tinnitus limit stress and use biofeedback or relaxation techniques join a support group.

Diagnosis of Hearing Impairment. Unfortunately, older adults are not routinely screened for hearing loss by health care providers. It is relatively quick and easy to administer a hearing test using an audiometer. This test assesses the magnitude and pattern of the hearing impairment as well as the type of hearing loss (e.g., conductive, sensory, or central).
It takes a more intense smell for it to be identified and differentiated from other smells.

Taste also diminishes with age and older persons often complain that food doesn't taste as good as it used to.

Touch In later life, our sense of touch and response to painful stimuli decreases.