Process of Aging-Part II
(6/11/14)- According to a recent article in the Wall Street Journal by Barbara Sadick, entitled “A Geriatric Gap Looms”, ‘By 2030, one out of every five Americans-or about 70 million total-will be older than age 65, according to the American Geriatrics Society. Yet today, there are only 7,000 certified geriatricians in the U.S., or one for every 2,600 Americans age 75 and older and their ranks aren’t growing.”
A chart that accompanies the article which is based on data from the National Resident Matching Program, geriatric medicine has the lowest percentage of fellowships filled for positions starting in July.
(6/2000)- With normal aging, there is a decrease in bone mass, muscle strength and lean body mass and an increase in fat body mass. Physiological and anatomical changes related to aging include increased susceptibility to heat and cold exposure, decreased immune responses to infections, increased falls, and toxicity to medications. These factors place older adults at risk of worsening health and premature death.
A National Health Interview Survey revealed that 39% of persons over 65 years of age suffered some limitation of activity due to chronic conditions and that 11% were unable to carry out some major activity. Those over 65 also experienced approximately 50% more disability days due to acute conditions than did younger persons. There would appear to be a need to develop standards for a health risk appraisal, which includes not only an assessment of current health status but also an evaluation of risk factors for future health outcomes. (See: Breslow, L. (1997) Development of HRA for the Elderly. Am J of Health Promotion Vol. 11, #5, May.)
In general, women experience compromised life quality while men experience compromised longevity as they age. The latest figures indicate that the current life expectancies for males is 71.4 years, while for females it is 78.3 years. Males have higher mortality from all leading causes of death. Women tend to have more illnesses and lower self-rated health.
As people age, their sense of well being seems tied in with their relations with peers and in particular with friendship (See: Jerome, D (1993) Intimate relationships. In Aging in Society-An Introduction to Social Gerontology, 2nd edition (J. Bond, P. Coleman & S peace Eds.) Sage, London)
Gender differences in friendship are particularly marked and, over the years, research has increasingly pointed to the value of a special relationship or confidant in adjusting to the stresses and strains of later life. For women especially, this is also a life course issue in that the presence of a confidant or close friend has been found to be important in terms of social support as well as in the maintenance of psychological well-being and mental health. Moreover, rather than fulfilling this need for a confidant within the marriage relationship, women tend to look to other women or an adult child for this kind of support. Men, by contrast, name their wives as their main source of emotional support and the only person that they talk with about personal problems and difficulties.
Women's friendship are said to be person-oriented, emotionally richer than men's, and characterized by emotional support, intimacy, self disclosure and mutual assistance. This is conveyed by talk: conversation being one of the main activities of female friendship from early childhood onwards. Men's friendships on the other hand, tend to be activity oriented and based on shared experiences.
Studies showed that among those older people with children, proximity tended to increase with age, with widowhood resulting is a move nearer to children. In a study by Clare Wenger, over half of the parents saw a child at least once a week and this rose to three-quarters in the case of parents over 80. Only 2% of the parents never saw their children. (See: Wenger, C. (1992) Help in Old Age-Facing up to Change. Institute of Human Aging, Liverpool University Press, Liverpool.)
For those older people unable to carry out domestic tasks unaided, relatives were the usual source of help. Research has also confirmed that women are more likely than men to take the main responsibility, as well as to devote long hours to the tasks associated with informal care (See: Allen, N.H.p. & Burns, A.B. (1995) The non-cognitive features of dementia. Rev Clin Gerontol, 5(1), 57-75.
Early retirement has meant an increase in the amount of time couples can choose to spend with each other, ahead of some of the health changes associated with late old age. There has been a decline of joint residence between elderly parents and their adult children, a change, which gathered momentum from the 1960's onward.
Gender differentiation in household work may diminish after retirement, with greater participation by husbands in traditionally "female" tasks such as cleaning and shopping. Such participation is defined as "helping" wives and therefore doesn't change the basic division of household chores. Husbands tend to encroach on wives personal time and space and the husband's presence begins to create different forms of domestic work for their wives.
Retirement can bring out the negative aspects of a marriage, especially for women. Women tend to benefit less from their husband's retirement than do retiring husbands.
In America, it is estimated by 2005 over half of those reaching retirement age will be divorced at least once. Remarriage is more frequent at all stages of the life span. Currently one in every three marriages involves remarriage of one partner. The remarriage rate is higher for men than for women of all ages, leading to an increased likelihood of women being alone in future years. Widowhood among women in late life is a high probability event and this is particularly the case for women aged 75 years or over. For example, 65% of women in this age group are widowed. This reflects both women's greater life expectancy and their tendency to marry men older than themselves. Nearly one-third of widows suffers from depression six months following bereavement. Widowhood contributes to lower morale and declines in physical health in the short term, but stability in social functioning.
Eight of the ten leading causes of death among persons 65 years and older were related to chronic diseases, including diseases of heart, malignant neoplasm, cerebrovascular disease, arteriosclerosis, diabetes, emphysema and nephritis. Eighty percent of persons 65+ have at least one chronic disease. In one US national study, 49% of non-institutionalized people aged 60 or older had 2 or 3 of the nine chronic conditions surveyed, 23% had 3 or more and 8% had 4 or more. (See: Guralnik et al. Aging in the 80's: The prevalence of comorbidity and association with disability. Advanced Data from Vital and Health Statistics, # 170, National Center for Health Statistics, Public Health Service, Hyattsville, MD. 1989.)
Sleep disturbances increase with age and a variety of factors have been implicated in contributing to this phenomenon. Surveys indicate a correlation between poor sleep and female gender, anxiety, self-rated health, depressive symptoms, use of medication, nocturia, chronic pain and somatic disease. Another factor that disturbs sleep is dementia, the incidence of which is high in nursing homes.
Nursing home residents show anywhere from a 45% to 75% incidence of poor sleep. This a high percentage is probably due to a combination of factors, including age related changes; medical, psychiatric and primary sleep disorders; medications, circadian rhythm disturbances and nursing home environment.
Not uncommonly, the sleep-wake cycle of older residents does not coincide with the institutions schedule and therefore, residents are sometimes put in bed before they are ready to go to sleep.
Pain is the most common complaint among nursing home residents with the most common cause being musculoskeletal disorders. Pain is often inadequately treated in nursing homes. By providing better analgesia, sleep disturbances might be curtailed.
Nursing homes should try more individualized night-time care practices, such as aides doing hourly rounds and providing care only if the patients are awake, at high risk for pressure sores or still asleep at the third checking. Need to stress the importance of resident sleep to the nurses and aides, emphasizing they should try to be less noisy and use quieter carts. For the agitated patient, they may try "white noise" machines as well as audiotapes of mountain streams or gentle ocean sounds, which have been shown in some studies to calm people down.
Previously, we had written of the problem of decrease in bone mass with aging. Recently, studies have indicated a role for recombinant human growth hormone (rhGH) in increasing the lean body mass in growth-deficient adults. Studies further indicate that low doses of recombinant growth hormone "are able to modify bone composition by increasing lean body mass, increasing lipogenesis, promoting lipolysis in opposition to the action of insulin on adiopocytes and enhancing the anabolic effects mediated by IGF-1 on protein synthesis in muscle mass." By increasing the muscle strength, it produces an improvement in muscle mass and function. (See: Clemmons, D.R., Underwood, L.E.: Role of insulin-like growth factors and growth hormone in reversing catabolic states. Hormone Research 38 (Suppl. 2): 37-40, 1992.) It should be noted that this study also indicated that the hormone does not improve bone density, but does effect bone metabolism, influencing bone formation and resorption.
Possible side effects of this hormone include impaired glucose tolerance and reduced insulin sensitivity and increase in triglyceride levels, all factors in increasing morbidity rates in the aged.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME".
by Harold
Rubin, M.S., ABD, CRC, Guest Lecturer
updated June 11, 2014
To e-mail: hrubin12@nyc.rr.com or allanrubin4@gmail.com