The following factors can be considered as Ageing and Disease.
NUTRITION – Body mass index (Height calculated from arm demispan or knee height to compensate for the loss of vertebral height) Recent weight loss, e.g. loose skin folds Dentition/oral hygiene.
Hydration- Skin turgor Oedema
Pulse Atrial fibrillation
Erect and supine blood pressure Postural hypotension
Hearing Wax Hearing aid used
Vision Visual acuity Glasses worn/present Cataract
Cognitive function Mini-mental state examination
Muscle Wasting Strength
Per rectum-Faecal impaction Prostate size/consistency in men Anal tone
Skin Wounds/ulcers Infection Swelling
Joints-Deformity Pain Swelling Range of movement
Aging can be defined as a progressive accumulation through the life of random molecular defects that build up within tissues and cells.
Many genes probably contribute to aging, with those that determine durability and maintenance of somatic cell lines particularly important. However, genetic factors only account for around 25% of the variance in human lifespan; nutritional and environmental factors determine the rest.
A major contribution to random molecular damage is made by reactive oxygen species produced during the metabolism of oxygen to produce cellular energy. These cause oxidative damage at a number of sites
Chronic inflammation also plays an important role, again in part by driving the production of reactive oxygen species
PHYSIOLOGICAL CHANGES OF AGEING
some genetic influences contribute to heterogeneity, environmental factors, such as poverty,
nutrition, exercise, cigarette smoking and alcohol misuse, play a large part, and a healthy lifestyle should be encouraged even when old age has been reached. The effects of aging are usually not enough to interfere with organ function under normal conditions, but reserve capacity is significantly reduced. Some changes of aging, such as depigmentation of the hair, are of no clinical significance.
AGEING AND DISEASE
Frailty is defined as the loss of an individual’s ability to withstand minor stresses because the reserves in the function of several organ systems are so severely reduced that even a trivial illness or adverse drug reaction may result in organ failure and death. The same stresses would cause little upset in a fit person of the same age.
Around 30% of those over 65 years of age fall each year, this figure rising to more than 40% in those aged over 80. Although only 10–15% of falls result in serious injury, they are the cause of more than 90% of hip fractures in this age group, compounded by the rising prevalence of osteoporosis.
Falls also lead to loss of confidence and fear and are frequently the ‘final straw’ that makes an
older person decide to move to institutional care. Management will vary according to the underlying cause.
Dizziness is very common, affecting at least 30% of those aged over 65 years in community surveys. Dizziness can be disabling in its own right and is also a risk factor for falls. Acute dizziness is relatively straightforward and common causes include:
- hypotension due to arrhythmia, myocardial infarction, gastrointestinal bleed, or pulmonary embolism
- the onset of posterior fossa stroke
• vestibular neuronitis
Urinary incontinence is defined as the involuntary loss of urine and comes to medical attention when sufficiently severe to cause a social or hygiene problem. It occurs in all age groups but becomes more prevalent in old age, affecting about 15% of women and 10% of men aged over 65. It may lead to skin damage if severe and can be socially restricting. While age-dependent changes in the lower urinary tract predispose older people to incontinence, it is not an inevitable consequence of aging and requires investigation and appropriate treatment. Urinary incontinence is frequently precipitated by acute illness in old age and is commonly multifactorial.
COMMON ADVERSE DRUG REACTIONS IN OLD AGE
NSAIDs Gastrointestinal bleeding and peptic ulceration Renal impairment
Diuretics Renal impairment, electrolyte disturbance Gout Hypotension, postural hypotension
ACE inhibitors Renal impairment, electrolyte disturbance Hypotension, postural hypotension
β-blockers Bradycardia, heart block Hypotension, postural hypotension
Opiates Constipation, vomiting Delirium Urinary retention
Antidepressants Delirium Hyponatraemia (SSRIs) Hypotension, postural hypotension Falls
Benzodiazepines Delirium Falls
Anticholinergics Delirium Urinary retention Constipation
OTHER PRESENTING PROBLEMS IN OLD AGE
Fluid balance problems
Dizziness and blackouts
Bone disease and fracture