Essay: Health issues in an aging population

The United States of America is aging. The number of Americans over age 65 is increasing dramatically as the ‘Baby Boomers’ grow older. In our nation’s history it has never had so many people live to be in these late stages of their lives, living healthy and productive. The percentage of Americans age 65 and over comprises nearly 13 percent of the U.S. population. In fewer than 20 years, those over age 65 will make up 20 percent of the U.S. population (Foos & Clark, 2008).
Aging, is an inevitable and tremendously complex, multifactorial process, is characterized by the progressive degeneration of organ systems and tissues (Nigam, Knight, Bhattacharya, & Bayer, 2012). It is mainly determined by genetics, and influenced by a wide range of environmental factors, such as diet, exercise, exposure to microorganisms, pollutants, and ionizing radiation. This describes why two people of the same age may differ significantly in terms of both physical appearance and physiological state. Gender also plays a part and women typically outlive men by 7’10 years (Foos & Clark, 2008).
The normal aging process falls physiologically into three groups of changes that occur with advancing age. The first group includes changes in cellular homeostatic mechanisms, for example, body temperature, blood, and extracellular fluid volumes; the second group is related to a decrease in organ mass within all the organ systems; the third and possibly the most important group of changes, in terms of their impact, involve a decline in and loss of the functional reserve of the body’s systems (Nigam, Knight, Bhattacharya, & Bayer, 2012). Maintaining physiological function in an aging population is of prime importance not only to the well-being of the aging individual, but also from a social perspective, helping to reduce the burden on medical services and systems (Nigam, Knight, Bhattacharya, & Bayer, 2012). In other studies it is well known that physiological changes within normal aging are reflected during periods of immobility, such as prolonged hospital bed rest, or after a fractured limb or a fall.
Physiological changes occur in all organ systems as stated earlier in this paper. These systems include cardiovascular, respiratory, renal, gastrointestinal, endocrine, skin and the musculoskeletal system. Beginning with the cardiovascular system, the heart, is a major organ of the body of which we are all aware. When aging the cardiac output decreases after a person turns starts in their thirties at a rate of about one percent per year, this is in a person without any cardiac diseases. The cardiac output of an 80-year-old subject is approximately half that of a 20-year-old (Boss & Seegmiller, 1981). There could be many different factors that could cause this to happen including a decreased inotropic response to catecholamines, both endogenous and exogenous. Also, there is an associated increase in diastolic and systolic myocardial stiffness, this progressive stiffening of arteries with age leads to an increased afterload of the heart (Boss & Seegmiller, 1981). Another disease of the heart when aging is known as hypertension or high blood pressure. The Framingham Study clearly established that high blood pressure is a significant risk factor for stroke, coronary artery disease and congestive heart failure (Boss & Seegmiller, 1981). Cardiovascular disease was a more frequent cause of death and morbidity in the hypertensive adults older than 65 years of age than in the younger generation. As we age the use of anti-hypertensives can be used to lower the blood pressure safely along with decreasing the amount of salt used in their diets. Arteriosclerosis and coronary artery disease are other diseases within the heart that occur as generation’s age. Vessels and arteries lose their pliability, they begin to become hard and the walls begin to thicken. Cholesterol begins to increase along with fibrous plaques that contain lipids. In general, atherosclerosis occurs earlier in the aorta and carotid arteries than in the coronary and cerebral arteries and peripheral vascular disease appears later (Boss & Seegmiller, 1981). The risks of having a myocardial infarction, or a heart attack, from coronary artery disease increases with greatly as we age. Age is the most substantial reason for this occurrence. Prevention at present is aimed at improvement of the other factors, such as hypertension, obesity and cigarette smoking (Boss & Seegmiller, 1981).
The respiratory system is next, lung volume has a decrease of vital capacity that amounts to a decrement of about 26 mL per year for men and 22mL per year for women. The total lung capacity remains constant but the residual volume increases with age (Boss & Seegmiller, 1981). Gas exchange is also affected during the aging process. The alveolar oxygen tension remains constant with age, arterial oxygen pressure shows a progressive decrease, thus increasing the alveolar arterial oxygen difference (Boss & Seegmiller, 1981). A majority of this decrease is due to a mismatch of ventilation and perfusion. With an increase in age the lungs flexibility decreases, making it a greater likelihood for airways to collapse. With lung volume and gas exchange being affected in the elderly it is no surprise of why pneumonia is more common in our elderly. Aspiration pneumonia is one of the more common pneumonias that the elderly contract. This is related to the mucociliary apparatus, the normal mechanical clearing of the throat, becoming slower as we age. This can also be associated with poor oral hygiene, decreased flow of saliva or difficulty with swallowing, older persons have a higher rate of colonization of their oropharynx with Gram-negative bacilli than do younger persons (Boss& Seegmiller, 1981).
The genitourinary system including the kidneys, bladder and the prostate. The kidneys gradually reduce in volume and weight as aging occurs, this is due to the arteries that supply the kidneys begin to become narrower. This decreases the supply of blood causing the kidneys to shrink. The walls of the small arteries that flow into the glomeruli thicken, which decreases the function of the remaining glomeruli (Jaipaul, 2012). This causes a significant decline in the function of the nephrons making to difficult to excrete waste products along with many different types of drugs. This decline also affects the ability for the kidneys to concentrate or dilute urine and to excrete acid. Despite age-related changes, however, sufficient kidney function is preserved to meet the needs of the body (Jaipaul, 2012). As for the bladder, urinary incontinence may happen as aging occurs. Urinary incontinence has been found in 17 percent of men and 23 percent of women older than 65 years (Boss & Seegmiller, 1981). In about half of the women and a fifth of the men this was due to stress incontinence alone. The elderly’s sensation to urinate is much slower than it was when they were younger, this could be the main reason for incontinent episodes to occur. These changes appear to be more often associated with a central nervous system disease than to bladder dysfunction (Boss & Seegmiller, 1981). Finally, enlargement of the prostate occurs in most older men by the age 80 more than 90 percent of men have symptomatic prostatic hyperplasia with varying degrees of bladder neck obstruction and urinary retention (Boss & Seegmiller, 1981).
The gastrointestinal system includes the esophagus, stomach, colon and liver. Age-related changes of the esophagus are due primarily to disturbances of the esophageal motility (Boss & Seegmiller, 1981). In an older adult, the esophagus may have a decreased peristaltic response, an increased nonperistaltic response, a delayed transit time or decreased relaxation of the lower sphincter on swallowing (Boss & Seegmiller, 1981). As the stomach becomes older, the lining’s ability to resist damage decreases making the walls thinner and more susceptible to peptic ulcer disease. An elderly stomach cannot accommodate as much food due to the decreased elasticity, and the rate at which the stomach empties food into the small intestine decreases (Boss & Seegmiller, 1981). This typically does not tend to harm the elderly or show any signs of symptoms of harm. Aging has little effect on the secretion of stomach contents such as acid and pepsin, but conditions that decrease acid secretion, such as atrophic gastritis, become more common (Boss & Seegmiller, 1981). A decrease in intestinal motility occurs with age. The colon becomes hypotonic, which leads to increased storage capacity, longer stool transit time and greater stool dehydration (Boss & Seegmiller,1981). This tends to cause the elderly to have chronic constipation issues. A high fiber diet can be used with a daily laxative to keep the elderly regular with bowel movements. A stool softener may also be used to decrease straining while defecating. The liver decreases in weight by as much as 20 percent as aging occurs (Boss& Seegmiller, 1981). Most liver function tests show a small to no change with aging, but the breakdown of some drugs can be slower than usual in the elderly. Thus, why caregiver’s must watch how much and how often a medication is prescribed. This alteration in hepatic drug metabolism may be due to a decrease in the appearance, amount or distribution of the smooth endoplasmic reticulum (Boss & Seegmiller, 1981).
The endocrine system, dealing with glucose homeostasis, deteriorates in the number and function of insulin producing beta cells (Boss & Seegmiller, 1981). This alters the body’s response time to recognize and respond to changes in glucose levels. Osteoporosis is a skeletal disorder characterized by a decrease in bone mass which may result in mechanical failure of the skeleton (Boss & Seegmiller, 1981). As the body ages it decreases in bone mass which makes osteoporosis an age-related disease. The decrease in bone mass is due to a relative increase of bone resorption over formation (Boss & Seegmiller, 1981). This means that the body continues to break down the bone but fails to rebuild it. This is why physicians encourage men and especially woman to get a daily dose of calcium, in order to help prevent this. Osteoporosis is more common in women especially after menopause due to hormonal changes.
The skin of the elderly begins to become very thin especially on the face, neck, upper chest, hands and forearms. This thinning is due to the turnover rate of cells in the stratum corneum decreasing (Boss & Seegmiller, 1981). Dermal collagen becomes stiffer and less pliable with age; elastin is more cross-linked and has a higher degree of calcification (Boss & Seegmiller, 1981). Results from these changes cause the skin to lose its tone and elasticity, resulting in sagging and wrinkling.
In the aging musculoskeletal system, it is known to decline in lean body mass of the muscles and is primarily due to loss and waste of muscle cells. Within the skeletal system degenerative joint disease occurs in 85 percent of persons older than 70 years of age and is a major cause of disability (Boss & Seegmiller, 1981). It affects both the peripheral and axial skeleton and is characterized by degeneration of cartilage, subchondral bone thickening and eburnation, and remodeling of bone with formation of marginal spurs and subarticular bone cysts (Boss& Seegmiller , 1981). This can cause the elderly pain and discomfort, leading them to have surgery to their joints as in hip replacement or knee replacement surgeries to name a few.
In conclusion, physiological changes occur in all organ systems. These systems include cardiovascular, respiratory, renal, gastrointestinal, endocrine, skin and the musculoskeletal system. Each of these systems have been discussed briefly explaining the major changes in which occur as the American age population increases.