Theories of ageing

5 Theories of ageing



Davina Porock, Wendy L. Walker



CHAPTER AIMS




• To recognise the relevance of biological, sociological and psychological theories of ageing for nursing older people


• To consider the implications of ageing on the specific needs of older people


• To identify complex and competing health needs commonly found in older people and the ways in which the development of effective nursing skills and practice can help



Introduction


One of the things that often come as a surprise when students go into a practice area is how old the patients are. This is often a reality which is not portrayed in hospital scenes on TV or in movies. What we hope to show you in this chapter is that nursing older people is a challenging and complex specialty and that by understanding more about ageing and older people you will be able to work in almost all areas of nursing more effectively.


When you think about the older people you know, your grandparents for example, you may notice a number of things that are not the same for healthy young people. Older people may be slower at walking and may want someone or something to steady them when going up or down steps. They may not eat as much as they used to or even enjoy food as much. They certainly have different looking skin: wrinkling and sagging. The normal colour of their hair may have gone leaving them grey or white haired and often thinning or bald in older men. Their eyes might have become paler in colour and their eyelids droop. Hearing, sight, taste and smell all may diminish in intensity and sensitivity with touch being the one sense that remains relatively intact. Older people talk about friends who are ill or who have died which often makes older people seem preoccupied with illness and a bit morbid. Many older people are forgetful and some are very confused and no longer able to think and plan. Even those who are not confused seem to spend a lot of time reminiscing about ‘the old days’, or ‘when they were young’. Older people can give the impression that things were better then than now or that young people were more respectful, or schools were better and they never got bored even though there is more technology to ‘play with’ now.



Ageing


Ageing is a complex process and is more fully defined in Box 5.1. For those of us fortunate enough to become old (the only way of escaping ageing is to die young which is not generally considered a good alternative), we have to face a barrage of changes rivalled only by the physical and psychosocial changes occurring at puberty. However, ageing takes place over a much longer period of time. Older people were young once and had the same physical and intellectual abilities, work aspirations, family responsibilities, sporting ambitions and romantic ideals that young people have. In other words they are complex, whole people just like you. So what makes them seem so different now? Some of the questions we ask in health sciences are: How does ageing happen? What causes it? Can we stop it? Why do older people spend so much time thinking about the past? These are important questions about ageing and in this chapter we examine some of the ideas and theories about how humans age from biological, sociological and psychological perspectives. Then we examine issues relating to nursing older people which not only draws on these sciences but combines them and identifies ways in which we can learn to promote healthy ageing as well as to care for older adults who are ill or have dementia or are approaching the end of life.



Box 5.1 Effects of physical ageing on the body



The brain




image Some neurones may be lost with ageing along with a drop in neurotransmitter levels causing minor short-term memory loss, and lengthening the time taken to learn new skills or retain new information. Reflexes may be slowed and there may be some loss of co-ordination



Eyes and ears




image The ability to see things up close or in dim light diminishes with age due to stiffening of the lens reducing the ability to focus. Dry eyes can occur from reduced tear production


image Hearing ability reduces due to the accumulative effect of noise over the years as well as deterioration of the cells in the inner ear responsible for picking up sound waves



Mouth and gastrointestinal system




image Saliva production reduces, increasing the risk of gum disease and tooth loss. Taste buds become less sensitive and food becomes less appealing


image The movement of food through the gut slows leading to constipation. Decreased production of digestive enzymes makes digestion less effective



Bones, muscles and joints




image The strength and density of bones decreases with age increasing the risk of fracture. The skeleton overall becomes shorter with time resulting in loss of height. However, this is not all due to ageing; lack of physical activity increases the risk for bone loss


image All muscle types in the body change with age, losing elasticity, bulk and strength. Lack of physical activity compounds the problem


image Smoothness of joint movement is affected by loss of synovial fluid in the joints as well as thinning of cartilage. Stiffness is experienced as ligaments shorten and lose flexibility



Heart, lungs and vascular system




image As the ageing heart muscle becomes more rigid, the ability of the heart chambers to fill with blood reduces. Heart rate may be slower to respond to changes in need such as during physical activity


image The muscles controlling the lungs become stiffer and weaker with age as do the tissues of the lungs and the chest wall. Gas exchange effectiveness reduces and this is most noticeable during times of increased physical activity


image The vascular system is made of muscle and loss of elasticity is evident throughout the body making the heart have to work harder. Fatty deposits (plaques) accumulate in the blood vessels reducing blood flow as well as affecting exchange of nutrients and blood gases. These changes are often noted in higher blood pressure



Skin and hair




image The skin becomes thinner due to the loss of the underlying fat layer and collagen. The natural oils produced by the skin also diminish resulting in dryness. These combined effects produce wrinkles, sagginess of the skin and greater susceptibility to damage


image Pigment loss in hair follicles results in a loss of colour and the characteristic grey or white hair associated with old age. The hair thins in all people, both men and women



Kidney and bladder




image The kidneys become smaller with age but for most people they function adequately throughout life


image The bladder is a muscle and therefore becomes more rigid with age resulting in reduced capacity and risk of not emptying completely. For women after menopause, the pelvic floor muscles including the sphincters become weaker leading to leakage of urine. For men, an enlarged prostate causes reduced flow or complete blockage leading to leakage of urine



Reproductive system




image For women, ovulation and fertility cease with the menopause. This, along with the changes in muscle tone and flexibility, causes shortening and drying of the vagina which can make sexual intercourse uncomfortable


image For men, although they remain fertile, sperm production decreases and it may take longer to achieve an erection. Most men will experience some difficulty in achieving or maintaining an erection in later life



Immune system




image The body’s ability to fight infection and disease reduces with age. This has the effect of increasing not only the risk of infection but the time taken to recover. However, a reduced immune response may also mean a reduced allergic reaction to common antigens



image Activity



Defining ageing


You will have already thought about ageing from a number of different perspectives through reading other chapters in this book. In this exercise we would like you to explore how ageing is defined: for example, you may wish to consider whether this definition is absolute or socially constructed. In particular, how is ageing and old age defined in different societies?


Note down your thoughts about these issues and we will return to this area later in the chapter.


Two issues to remember when considering these questions are :



1. Age can be defined chronologically (years of life), biologically (physical function and longevity), psychologically (motivation and response) and sociologically (impact of society).


2. There is also a distinction between primary ageing, a process that occurs in later life, and secondary ageing; and the disease process that hastens ageing (Miller 2004).



Theories of ageing


There are a number of theories of ageing that can assist clinicians to understand the experience of ageing, and guide interventions that support older people in maintaining health or to cope with ill-health. Through theoretical development, research has attempted to define the ageing process and attempted to identify what ageing is and why it occurs. Research has also asked ‘can the negative aspects of ageing be slowed down; how do we keep people healthy for longer; and what are the factors that have a positive or negative influence on health and wellbeing?’ We discuss these theories and in later chapters we consider them in relation to the care of patients.



1 Biological theories


It has long been recognised that biological ageing can differ from one person to another. Nevertheless, biological theories of ageing endeavour to explore both internal and external forces that may impact on ageing. They attempt to explain the ageing process, and consider not only how we age but also what initiates ageing. Biological theories can be divided into two groups: stochastic and non-stochastic theories.



1. Stochastic theories propose accumulative cellular damage that occurs over time. For example, free radical theory; wear and tear theory; and cross linkage theory.


2. Non-stochastic theories suggest genetically programmed events cause cellular damage and hasten ageing. For example, immunological theory; programmed theory; and biological clock theory.



The effect of ageing on the body


Whatever the causes or processes of ageing that the biological theories suggest, the evidence that these processes are taking place can be seen in all body systems. Ageing affects every organ and system of the body. Box 5.1 summarises the changes that occur with normal ageing – that is, ageing not affected by disease.



image Activity


Consider the issues in Box 5.1 relating to the changes that may occur with ageing. On your next placement, when working with or caring for an older person, examine these changes within the context of patient care. This might form part of an assessment or reassessment of the patient as part of care planning, for example. Consider what needs are identified and how these might impact on the individual. You will also need to consider how you might incorporate this within your plan of care. Depending on where you are on your programme, you might use this as an observation opportunity with your mentor or while working under supervision.

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Mar 1, 2017 | Posted by in NURSING | Comments Off on Theories of ageing

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