Learning Guide
Ageing process
23387 Demonstrate knowledge of the ageing process
and its effects on individual support needs
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Issue 3.0
Level 3
7 credits
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Ageing process (US 23387) Learning Guide © Careerforce – Issue 3.0 | May 2015
Contents
Introduction ................................................................................................................................1
The physical impact of ageing ....................................................................................................3
The musculoskeletal system ...................................................................................................4
Digestive system .....................................................................................................................9
Urinary system ......................................................................................................................14
Cardio-vascular system .........................................................................................................18
Nervous system ....................................................................................................................20
Sensory system .....................................................................................................................26
Reproductive system ............................................................................................................30
Endocrine system..................................................................................................................30
Respiratory system ...............................................................................................................32
Integumentary system ..........................................................................................................36
Immune system ....................................................................................................................41
The impact of ageing on a person’s daily life ...........................................................................44
Daily activities .......................................................................................................................44
Lifestyle and wellbeing .........................................................................................................48
Ageing process (US 23387) Learning Guide © Careerforce – Issue 3.0 | May 2015
Ageing process (US 23387) Learning Guide © Careerforce – Issue 3.0 | May 2015
Introduction
This learning guide is about the ageing process and how ageing affects
people’s health and wellbeing.
How to use your learning guide
This guide supports your learning and prepares you for the unit
standard assessment. The activities and scenarios should be used as a
general guide for learning.
This guide relates to the following unit standard:

23387 Demonstrate knowledge of the ageing process and its effects
on a person’s lifestyle and wellbeing. (level 3, version 3).
This guide is yours to keep. Make it your own by writing notes that help
you remember things, or where you need to find more information.
Follow the tips in the notes column.
You may use highlight pens to show important information and ideas,
and think about how this information applies to your work.
You might find it helpful to talk to colleagues or your supervisor.
Finish this learning guide before you start on the assessment.
What you will learn
This topic will help you to understand:

the physical impact that ageing has on a person

how a person’s needs change as they age.
Ageing process (US 23387) Learning Guide © Careerforce – Issue 3.0 | May 2015
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1
The ageing process
The ageing process is individual and can vary
significantly from person to person. Ageing
occurs at different rates in different people.
How a person ages depends on the effect of
factors such as:

health factors, such as our bodies and our
systems.

lifestyle factors, such as diet and exercise.

heredity factors, such as family history of
health.

cultural factors, such as ethnicity or practices.

environmental factors, such as housing and social support.
A healthy lifestyle is an especially important factor in healthy ageing.
We all change physically as we grow older, some systems slow down
while others just lose their ‘fine tuning’.
Ageing causes changes in cells. The rate at which cells multiply tend to
slow down as we age, meaning injuries and cuts take longer to heal.
Certain cells that are important for our immune system to work
properly also change with age.
Age also causes changes in our responses to environmental stresses or
exposures, such as ultraviolet light, heat, poor nutrition, and toxins
(poisons).
Lifelong influences, such as illnesses, also affect how a person ages.
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The physical impact of ageing
Changes due to ageing
Throughout life, our body goes through physical changes to body tissues
and organs. These changes are not due to disease but are part of the
normal ageing process.
Ageing changes occur in bones and joints and may result in thinning of
the bones and osteoarthritis. Muscle structure and strength are also
generally reduced and pains are common.
Elderly people have poorer balance and tend to walk with short,
shuffling steps, and there is less of a tendency to swing their arms.
Changes in structure of connective tissue can result in stiff joints or
muscles and body aches.
The ageing process can have a significant impact on the person’s
physical wellbeing and lifestyle. The changes generally occur gradually,
allowing people to adapt to the changes and to be able to continue
their normal functioning.
The impact of these ageing changes is more apparent when an older
person is in an unfamiliar environment or experiencing physical or
psychological stress. The effects of ageing on a person who has an
existing disability can be greater than for other people.
Exercise and diet can make a difference to the rate of changes and can
slow down the processes. In spite of the normal, age related changes,
many people can function well for many years by making minor
adaptations in the way they do activities of daily living.
By understanding how the body functions we are able to appreciate the
changes that occur as we age. The human body is made up of a number
of complex systems:

musculoskeletal.

reproductive.

digestive.

endocrine.

urinary and excretory.

respiratory.

cardio-vascular.

skin.

nervous.

immune.

sensory.
Next we will take a look at some of these complex body systems, and
how ageing affects them.
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Two of the most obvious changes due to
ageing are sight and hearing.
Many people need reading glasses in
midlife due to changes which may occur
within the lens of the eye.
A person may have difficulty hearing in a
crowded room due to changes in the range
of sound their ears detect.
The musculoskeletal system
The musculoskeletal system is a framework of muscles, tendons and
ligaments which work together with the bones and joints to help the
body move and maintain its form.
Bones are made up of living cells which constantly grow and reshape
themselves throughout our life. As we age, this process slows down.
Calcium helps make bones strong, which allows them to support our
weight. They also store calcium and release some into the bloodstream
when it's needed by other parts of the body.
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these body systems.
Bones are attached to other bones by long, fibrous straps called
ligaments.
Joints are where two bones meet together, usually at a socket. Joints
help make our skeleton flexible so that we can move easily and in many
different ways.
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Cartilage is a flexible, rubbery substance on the face of the joints which
helps to support bones. Cartilage acts like a shock absorber, protecting
bones from rubbing against each other.
Muscles are made of tough, elastic tissues that pull our bones by
contracting (tightening) and relaxing as we move. Muscles tend to work
in pairs with one contracting and the opposite muscle relaxing.
Muscles are connected to our bones by tough, cord-like tissues called
tendons, which allow the muscles to pull on bones and control
movement. When you wiggle your fingers, you can see the tendons on
the back of your hand move as they do their work.
Joints
Tendons, ligaments and
cartilage work together
to help the body move
and maintain its form.
There are more than 650 muscles in the body. They not only help with
movement but also assist the body perform other functions such as
chewing food and moving it through the digestive system. Other kinds
of muscles keep the heart working efficiently and help the blood to
circulate. Some muscles can be controlled by our conscious thought,
while others are controlled automatically without us thinking about it.
How ageing affects the musculoskeletal system
Ageing affects all bones, muscles and joints. Bones lose density and
become more brittle. They are more likely to break (fracture) as they
weaken. Muscles also lose strength, and joints (as well as tendons,
ligaments, and cartilage) can be damaged by injury or disease.
Bone tissue also becomes brittle and spongy as we age. These
connective tissues lose water and start to dry up causing the tissue to
become less stretchy. This increases the likelihood of injuries occurring
as flexibility is reduced. This can result in less movement, and walking
and bending may be difficult or even painful.
Inactivity or lack of exercise affects our musculoskeletal system and can
speed up the ageing process. It is important to keep the body moving so
that a normal range of movement is maintained for as long as possible.
Exercises are one of the best ways to slow or prevent problems with the
muscles, joints, and bones as this helps maintain strength and flexibility
and keeps the bones strong.
Health problems associated with the musculoskeletal system include
arthritis, rheumatoid arthritis, osteoarthritis and osteoporosis.
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Arthritis
Arthritis literally means ‘inflammation of the joint’. Joints become
inflamed, causing swelling, stiffness, pain and difficulty in movement.
The two most common of these diseases in older people are
rheumatoid arthritis and osteoarthritis.
Severe arthritis can limit the ability to walk, dress, or bathe easily. There
are a number of devices available to help people with arthritis have an
easier time with simple tasks. Examples include, easy-to-open bottles,
handles on poles to reach high objects and electric scooters that can
help people with severe arthritis to live independently.
Rheumatoid arthritis
Rheumatoid arthritis is a condition thought to occur when the immune
system attacks the body’s joints. There is inflammation and finally longterm damage to the joint lining, resulting in pain, loss of movement and
disability. Soft lumps called rheumatoid nodules (from the size of a pea
to a walnut), also occur in about a quarter of people with the condition.
Rheumatoid arthritis is a chronic disease that flares up and goes into
remission over time. It is mostly a condition that occurs in older adults,
but it can also occur in young people in a severe form.
Rheumatoid arthritis can start in any joint, but
most commonly in the smaller joints of the fingers,
hands and wrists. Joint involvement is usually
symmetrical, meaning that if a joint hurts on the
left hand, the same joint will hurt on the right
hand.
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Symptoms of rheumatoid arthritis include fatigue, stiffness, weakness,
and swelling, flu-like symptoms, pain, loss of appetite and sometimes
depression and weight loss.
The condition affects almost twice as many women as men.
Rheumatoid arthritis is often worse first thing in the morning, but
improves as the day goes on and the joints are used.
Treatment aims are to relieve pain and inflammation with medication,
improve mobility and limit the damage to the joints. Lifestyle changes,
such as exercise, stress reduction, healthy eating and a balance
between rest and exercise to boost muscle strength will improve overall
health and reduce the pressure on joints.
Osteoarthritis
Osteoarthritis is the most common form of
arthritis. There is wear and tear in the joints which
causes pain, swelling and a reduced range of
movements. The condition can occur in any joint,
but usually affects the hands, and weight bearing
joints such as the knees, hips or ankle.
Osteoarthritis gets worse as the day goes on.
Osteoarthritis occurs when the cartilage breaks down in the joints. As
cartilage is lost, the bones rub together and, over time, this rubbing can
permanently damage the joint. The rubbing causes pain, swelling, and
loss of motion and, over time, the joint may lose its normal shape. Also,
bone spurs may grow on the edges of the joint. Pieces of bone or
cartilage can break off and float inside the joint space, which causes
more pain and damage.
Useful ways to manage osteoarthritis pain and improve function are
regular exercise, control weight, rest and pain relief when it is needed.
Sometimes surgery is helpful to replace a severely damaged joint.
Osteoarthritis occurs most often in older people although it can occur
much earlier for people who have had an injury to the joint. Before age
45, osteoarthritis occurs more frequently in males but after age 55, it
occurs more commonly in females.
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Osteoporosis
The word ‘osteoporosis’ means ‘porous bones.’ Bones cells are
constantly being produced and destroyed. After middle age, bone loss
takes place faster and bones become smaller and weaker.
Osteoporosis occurs when bones begin to lose some of their essential
calcium, losing their strength and becoming fragile, and thus becoming
more likely to break.
The most common places for a break are the hip, spine, and wrist. Hip
and spine injuries are the most serious and require hospitalisation and
usually major surgery.
Women are five times more likely to develop the condition than men.
They have smaller, weaker bones to begin with, so the effect of bone
loss is greater for women. Menopause also has an effect, as oestrogen
levels fall after menopause. This leads to greater bone cell loss and a
higher risk of developing osteoporosis.
Treatment is aimed at retaining bone density by slowing the loss of
bone cells or increasing the rate of replacement of bone cells.
Bones need protein and calcium through a balanced diet to remain
healthy. Foods rich in calcium include milk, cheese, yoghurt, and other
dairy products, green leafy vegetables, Brazil nuts and almonds, tofu,
shellfish and sardines. Vitamin D helps the body absorb calcium
obtained through exposure to the sun.
Alcohol consumption and tobacco use are thought to increase risk for
osteoporosis. Lack of exercise may have the same effect. Regular
exercise builds strong bones. The forms of exercise likely to be most
effective include aerobics, dancing, jogging, stair climbing, tennis,
walking and lifting weights.
Osteoporosis
The most common places for a break are the hip,
spine, and wrist.
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Digestive system
The gastro-intestinal (digestive) system changes food into fuel ready for
the body to use. The nutrients in food give the body's cells the energy
and the other chemicals they need to function. Before food can do any
of these things, it has to be digested ready for the body to absorb and
use.
The alimentary canal (also called the digestive tract) is a long tube which
connects the oesophagus, stomach, and the small and large intestine. It
runs from the mouth to the anus. In an adult, the digestive tract is
about nine metres long.
The smooth muscle in the walls of the digestive tract helps move the
food through the system in a wave-like action called peristalsis.
The gastro-intestinal system includes associated organs which help
digestion. These include the salivary glands which produce saliva to help
moisten food and start the digestive process.
Digestive
system
The digestive
system has many
parts.
The liver produces bile to help digest fats properly and the pancreas
produces chemicals which help digest proteins, fats and carbohydrates.
The liver also plays a major part in processing nutrients which are
carried to the liver from the small intestine in the bloodstream.
During the process of absorption, nutrients that come from the food
(including carbohydrates, proteins, fats, vitamins, and minerals) pass
through channels in the intestinal wall and into the bloodstream which
carries the nutrients to the rest of the body. The waste parts of food
that the body cannot use are passed out of the body as faeces.
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How ageing affects the digestive system
With age, the intestinal tract becomes stiffer and contractions along its
length decrease. Other diseases, such as hardening of the arteries and
diabetes, and many medications commonly used by older adults, also
have an effect on the gastrointestinal tract.
The kinds and amounts of food a person eats and how the digestive
system processes this food is vital for maintaining good health. Eating a
healthy diet is the best way to prevent common digestive problems.
The chance of developing a digestive disorder does increase with age.
Nearly 40% of all older adults have one or more digestive symptoms,
often related to changes that occur in their digestive tract.
Digestive disorders
The mouth and oesophagus
Swallowing can become difficult as a result of dry mouth or tooth decay. A
stroke, dementia, or conditions such as Parkinson's disease can lead to
swallowing difficulties. The strength of the muscle movements in the
oesophagus reduces with age making heartburn and indigestion more common.
The stomach
With age, the stomach takes longer to empty into the small intestine, making
older adults more vulnerable to ulcers and bleeding from medications such as
aspirin and some anti-inflammatory drugs. The longer these drugs are in the
stomach, the more likely they are to cause these problems. The stomach also
becomes less elastic and holds less food, meaning that older adults feel full
more quickly.
The small intestine
The small intestine becomes less able to absorb certain vitamins and minerals
(such as vitamin D, vitamin B12, and calcium). Bacterial activity changes can
lead to bloating and flatulence, diarrhoea and sometimes weight loss in older
adults.
The large intestine
A loss of muscle strength can lead to diverticulosis, small pouches that bulge
outward through weak points in the intestinal wall. Food also takes longer to
move through the large intestine, resulting in constipation. Polyps (small stalkshaped growths) and colon cancer are more common in older adults although
doctors are unsure what effect age has on the development of these growths.
Other digestive changes
The liver becomes less able to break down medications, so it is more likely to be
damaged. The gallbladder produces less bile, which may lead to gallstones. The
pancreas, however, does not seem to change much with age.
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Faecal incontinence
Faecal incontinence is the inability to control bowel movements, so that
faeces leak from the rectum. Faecal incontinence can range from an
occasional leakage when passing wind to a complete loss of bowel
control.
The digestive tract processes food as it passes through the body,
sending nutrients into the bloodstream and collecting waste that the
body cannot digest in the intestine.
As food waste passes through the upper portion of large intestine
(colon), the body absorbs nearly all of the water from the waste. The
remaining residue, called faeces, is usually soft but formed. It consists of
undigested foods such as fibre, unabsorbed water, bacteria, mucus and
dead cells.
Waste collects in a short canal called the rectum, above the outlet from
the body at the anus. This is controlled by a sphincter muscle which acts
rather like a valve.
As the rectal walls stretch, it signals the need to have a bowel
movement. When this happens the sphincter muscles relax and the
rectal walls contract to increase pressure. Abdominal muscles may also
be used to help increase downward pressure so that faeces are passed
out through the anus.
The person must have the physical and mental capabilities to recognise
and respond to the urge to go to the toilet. Being physically disabled in
some way can make it more difficult to reach a toilet in time.
Faecal incontinence is more common among older people who
sometimes have to cope with a lack of bladder control (urinary
incontinence) as well. The condition is more common in women than in
men because it can be a complication of childbirth.
A person with faecal incontinence may try to hide the problem or avoid
social settings. The loss of dignity associated with losing control over
bodily functions can lead to frustration, anger and depression.
Faecal incontinence can also irritate the skin because the skin around
the anus is delicate and sensitive. The constant exposure to faeces can
lead to pain, itching and sometimes skin breakdown or ulceration.
Treatment for faecal incontinence tries to restore bowel control or at
least reduce the severity of the condition.
Depending on the cause of the incontinence, treatment may include
dietary changes. Spicy foods, fatty foods, dairy products, caffeine and
some food additives can cause problems. The diet should include fibre
from cereals, grains, fruit and vegetables.
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If chronic constipation is a cause of faecal incontinence, it may be
recommended to drink plenty of fluids and eat fibre-rich foods that
aren't constipating.
If diarrhoea is contributing to the problem, increasing intake of highfibre foods to add bulk will make faeces less watery.
Other treatments include:

bowel training aimed at restoring muscle strength, practicing
tightening the anal sphincter and setting regular toileting times.

treatment for faeces build up (impaction) which breaks up the
bowel motion into small pieces which are then easier to pass.

surgery for underlying damage to the sphincter.
Tips for managing bowel incontinence include:

eat smaller meals.

drink plenty of water.

use the toilet before going out.

wear a pad.

carry wipes and a change of clothing.

know where toilets are before you need them so that you can get to
them quickly.
Constipation
Constipation means that a person has three or fewer bowel movement
in a week. The faeces can be hard and dry and sometimes painful to
pass. Almost everyone gets constipated at some point in their life.
While it is not important to have a bowel movement every day, it is
important to discuss any bowel changes with the doctor.
As food passes through the gastrointestinal tract, the body takes
nutrients and water from the food. Wastes are produced and form
faeces which move through the intestines with muscle contractions
(squeezing motions). The faeces remain in the rectum until they can be
passed out of the body.
There are many things that can cause the faeces to move more slowly
through the intestines, leading to constipation. This can be avoided by:

eating plenty of fruits, vegetables and grains high in fibre.

drinking plenty of water and other liquids.

getting enough exercise.

taking time to have a bowel movement when you need to.

avoiding laxatives and medications which cause constipation.
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Urinary system
The urinary system and the digestive system are closely interconnected.
They each play a major part in disposing of body wastes.
The urinary system extracts
nutrients from the liquids we
drink and liquids that are
separated by the digestive
system. It is made up of two
kidneys and the bladder, which
are connected by two hollow
tubes called ureters. Another
tube called the urethra drains the
bladder to the outside.
The kidneys are located just under the rib cage at the back, one on each
side, surrounded by a layer of fat to cushion and hold them in place.
The kidneys have a variety of functions including:

filtering the blood and removing water, salts and wastes.

regulating the blood volume (blood pressure) and composition.

producing essential hormones (rennin).
Urine, which is produced by the kidneys, contains these wastes, salts,
toxins and water. The kidneys also help maintain the fluid balance of
the body.
Every day, about 1600 litres of blood pass through the kidneys. About a
quarter of our blood is in the kidneys at any one time. The kidneys
cleanse all of the blood in the body about every 50 minutes, as well as
regulate blood pressure and the level of salts in the blood. Urine is the
concentrated solution of waste material that is produced by the kidneys
and stored in the bladder.
The bladder is a muscular sac which expands as it fills with urine. Adults
produce about six cups of urine per day. Producing too much or too
little urine may be a sign of illness. When the bladder is full, nerve
endings in its walls send a message to the brain. When a person is ready
to urinate, the bladder walls contract and the ring-like muscle (called a
sphincter) at the exit from the bladder relaxes to release the urine
through the urethra. The male urethra ends at the tip of the penis; the
female urethra ends just above the vaginal opening.
Incontinence of urine is more common in people with a dementing
illness and cerebrovascular disease as this causes interference with the
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brain control of urinary function. The reasons for incontinence of urine
are many, but the result can be embarrassing and worrying and can
limit the ability to take an active part in life.
The doctor will decide if treatment with antibiotics is required, based on
laboratory tests or symptoms. However, when an infection is suspected,
drinking plenty of fluid is helpful to dilute the urine and reduce the
chance of complications.
How ageing affects the urinary system
Many elderly people have problems with disturbances of urinary
function. They have to empty their bladders more frequently, and wake
up in the night more often to pass urine, particularly men with
enlargement of the prostate gland.
In addition, they may suddenly feel the desire to pass urine but may not
be able to get to the toilet in time, partly because their feelings occur so
suddenly and also due to their slower mobility and possibly weakness of
bladder muscles.
From about age 40 onwards, kidney function slowly declines. By age 70,
it may be only reaching 65% of previous capacity. This causes a reduced
ability to concentrate urine, meaning that more water is needed to
excrete the same amount of waste from the body.
This can cause:

dehydration.

drugs to be excreted more slowly.

less water and sodium to be re-absorbed and more potassium to be
lost in the urine.
Bladder and sphincter muscles lose their tone (stretchiness) which can
lead to leakage of urine from the bladder or there is a need to empty
the bladder more frequently (often at night). Because the bladder does
not empty as well, the incidence of bladder infection increases,
especially for women.
In addition, the ability to control urination can be lost after a stroke,
Alzheimer's disease, or some diseases of the nervous system. Men can
develop urinary retention due to an enlarged prostate gland. Pressure
from this swelling on the urethra can restrict or prevent the flow of
urine. An enlarged prostate also increases the urgency for urination.
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Urinary tract infection
Urine in the healthy bladder is normally free of bacteria. However,
bacteria from the rectal area can enter the urinary tract through the
urethra and travel the short distance to the bladder where they can
multiply rapidly and cause a urinary tract infection (UTI). Up to 90% of
UTI’s are caused by intestinal bacteria, such as E. coli that are normally
found in faeces. These bacteria can multiply rapidly causing infections
anywhere in the urinary tract, including the kidneys. However, most
UTI’s occur in the lower urinary tract, especially in the bladder and
urethra.
The risk for UTI’s is highest in women after menopause. Up to 25% of
women over 65 years old will get a UTI due, in part, to reduction in the
hormone oestrogen and its effect on the walls of the urinary tract which
become thinner and weaker. This makes it less able to resist bacteria
and at greater risk of recurring infections.
Urinary tract infections (UTI’s) can lead to acute illness in the elderly.
The condition usually affects more women than men and it is common
for re-infections to occur.
Factors that can lead to urinary tract infections in older people include:

recent use of a catheter.

diuretic use. Some diuretic (fluid) medications can cause a person's
urine to be very concentrated, requiring as many as 10 glasses of
water per day to compensate.

prostate enlargement.

certain types of incontinence, which prevent a full bladder emptying
properly.

people not drinking enough fluid, especially water, increases the risk
of UTI’s.

diabetes that is not well controlled.
A person with an infection of the urinary tract commonly experiences:

frequent and urgent need to urinate.

painful urination.

cloudy urine.

lower back or abdominal pain.

blood in the urine.
There can also be fever, chills, nausea and vomiting. However, many
older people may have few symptoms (up to 50% in women), so it can
be hard to know whether there is an infection present. UTI’s are the
most frequent infection in residential care settings.
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Urinary incontinence
At least one in 10 people aged 65 or older suffer from some loss of
urine. There may be only a slight or occasional loss of urine or ongoing
and severe wetting.
Many people with incontinence problems withdraw and become
socially isolated, or try to hide the problem. In most cases incontinence
can be treated and controlled. It can result from changes in the body
tissues or from the effect of some medications that can lead to
incontinence. It may also be brought on by any illness, hospital
admission or difficulty getting to the toilet on time. It can also be the
only symptom of a developing urinary tract infection.
People who have problems controlling urination should see their
doctor. Treatment of urinary incontinence depends on the cause. It can
include exercises to strengthen bladder muscles, or medication or
surgery to treat an enlarged prostate.
Management of the condition is generally very effective, including using
special underwear or continence products, regular toileting or
improving access to the toilet if poor mobility is a factor. Catheterization
or an external collection system (for men) is sometimes used, but can
lead to problems with infection.
There are several common forms of incontinence.

Stress incontinence - the leakage of urine during exercise, coughing,
sneezing, laughing, lifting heavy objects or other activity that puts
pressure on the bladder. It is the most common type of
incontinence and can almost always be cured.

Urge incontinence - the inability to hold urine long enough to reach
a toilet. It is often found in people who have conditions such as
diabetes, stroke, dementia, Parkinson’s disease and multiple
sclerosis. It can also be a warning sign of early bladder cancer, or for
men, an enlarged prostrate.

Overflow incontinence - the leakage of small amounts of urine from
a bladder that is always full. In older men, this can occur when the
flow of urine from the bladder is blocked. Another cause is loss of
normal bladder contractions in some people with diabetes.

Functional incontinence - occurs in many older people who have
normal urine control but who have difficulty reaching a toilet in time
because of mobility problems.
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Cardio-vascular system
The cardio-vascular system is the circulatory system and consists of the
heart, blood vessels and the blood.
The cardio-vascular system functions by pumping blood around the
body, delivering oxygen and nutrients to cells. The blood is transported
by arteries, which carry it away from the heart, and by veins which
return it to the heart.
How ageing affects the cardio-vascular system
The ageing process affects the cardio-vascular system in
a number of ways. Some of these effects are:

the heart is less able to pump efficiently, and less
blood pumped results in lowered blood oxygen
levels.

the limits of the heart to exert itself are reduced
with age.

blood vessels lose elasticity with age, resulting in the
heart having to pump harder to circulate the blood.

medications are processed and eliminated
differently in comparison with young adults.
Heart failure
Heart failure (congestive heart failure) occurs when the heart muscle
becomes weak. This can be caused by a heart attack or high blood
pressure and can happen slowly, but usually gets worse over time.
Gradually the heart loses its ability to pump enough blood to supply the
body’s needs. Chronic heart failure occurs when the heart is unable to
pump enough blood for adequate circulation to the body’s tissues.
Heart failure is more common in people over the age of 65. Medication
may include a combination of drugs. Lifestyle modifications include the
minimal use of salt, which increases fluid build-up. Exercise is also
helpful for maintaining general heart fitness and independence.
Some people experiencing heart failure can benefit from surgery to
improve blood flow, through and from the heart.
The symptoms of heart failure can seem like the normal signs of ageing
and include:




shortness of breath, even during mild activity such as walking a
short distance.
difficulty breathing, especially when lying down. The person often
requires extra pillows to avoid these breathing problems.
weight gain with swelling in the legs and ankles from fluid retention.
general tiredness and feeling weak all the time.
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Stroke
A stroke is also called a cerebrovascular accident or CVA. It is a sudden
event in which a part of the brain has an interruption to its blood supply
or a blood vessel inside the brain bursts. The brain cells around the
affected area die as they stop receiving necessary oxygen and other
nutrients. There are two forms of stroke:

ischemic. blockage of a blood vessel supplying the brain (85% of
strokes).

haemorrhagic. bleeding into or around the brain (15% of strokes).
A ‘mini-stroke’ or transient ischemic attack (TIA) may be a warning for a
stroke. About 25% of people who recover from their first stroke will
have another one within five years.
The symptoms of a stroke include the sudden onset of some or all of the
following:

numbness or weakness, especially on one side of the body.

confusion.

speech difficulties - speaking or understanding speech.

trouble seeing in one or both eyes.

difficulty walking, with dizziness, loss of balance or coordination.

a severe headache.
Risk factors for stroke include high blood cholesterol, high blood
pressure (hypertension), heart disease, obesity, smoking and diabetes.
Men have a higher risk for stroke, but since men do not live as long as
women, women are generally older when they have strokes and are
more likely to die from them. The hormonal changes during pregnancy,
childbirth and menopause also increase women’s risk for stroke.
A stroke can affect the whole body, depending on the location of the
obstruction to the blood supply and the extent of brain tissue affected.
For example, there can be:

complete paralysis on one side of the body called hemiplegia, or
one-sided weakness called hemiparesis.

problems with thinking, awareness, attention, learning, judgment
and memory.

difficulty controlling emotions or making expressions that are not
appropriate for the situation.

numbness or strange sensations especially in the hands and feet,
made worse by movement and temperature changes, especially
cold temperatures.
Stroke recovery is ongoing and special challenges for a person include:

coping with the frustrations and emotional changes.

learning to accept and deal with communication difficulties.
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
accepting the physical limitations.

tiredness.
Nervous system
The nervous system comprises the brain, the spinal cord and a network
of nerves that go through all the organs and muscles, and out to the
skin. It is divided into two parts, the central nervous system (CNS) and
the peripheral nervous system.
The nervous system is responsible for a wide variety of functions
including relaying messages, triggering the muscles, carrying out
automatic reflexes, responding to the senses, thinking, and memory and
giving us the capacity to analyse information and make judgements.
There are two types of cells in the peripheral nervous system: sensory
nervous cells and motor nervous cells. Chemical activation of the cells
transmits messages through the nerves. Messages, to make muscles
work, are decided by the brain and travel outwards from the brain
through the motor nervous cells. Cells of the sensory nervous system
send information to the CNS from internal organs or from external
stimuli to the brain for analysis.
Certain body activities controlled
by the peripheral nervous system
operate automatically and
include the functioning of the
digestive system, heart and
breathing. These are under the
control of the autonomic system
(involuntary).
The somatic system is controlled
directly by the person. This is
voluntary activity and includes
seeing, hearing, smelling, tasting
and touching. Our sense of taste
and smell deteriorate with age, as
does our ability to see and hear.
The reflex system is a third
system that is mainly involuntary
and is a reaction to danger. The
danger generates a message and
triggers an immediate reaction in
the appropriate muscles. Reflexes
vary from a simple arm or knee
jerk to pulling your hand away
from a hot object.
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How ageing affects the nervous system
Alzheimer’s disease
Alzheimer's disease is a form of
dementia. Dementia is a progressive
neurological disorder, with
increasing brain dysfunction. A
reduction in the neurotransmitter
acetylcholine causes changes within
the brain cells which disrupts the
electrical charges and the cells’
ability to connect or ‘communicate’
with other cells. Cell destruction or
changes causes a loss of brain
function controlled by those cells.
Alzheimer's is a degenerative disease that progresses over years.
Memory, thinking, judgement, emotion and behaviour are affected.
People's ability to perform tasks is affected, from complex tasks like
driving a car to simple tasks like eating. There is no known cure.
For people living with dementia, the changes in the brain make it more
difficult for them to act in the ways they have ‘normally’ done in the
past. The effects of these changes can be made worse with changes in
the environment, the person’s health, or with the medication the
person takes. Sometimes, the loss of memory and resulting confusion
can cause different emotional reactions and behaviour patterns that
take a special effort to manage.
The resulting behaviour of a person with dementia can become very
challenging for the people who provide support. Repetitive behaviour is
one of those challenges. This means repeating words, asking or doing
the same things over and over again, even when a question has been
answered just a few minutes before. Sometimes the person will follow
you around, or constantly be ‘in your space’. This can cause anger and
frustration for the person providing support.
People with dementia are often at their best early in the day. As the day
progresses, however, the person’s memory and ability to carry out tasks
can deteriorate. ‘Sundowning’ is the term used to describe the
increased confusion, restlessness and agitation that occur later in the
day and evening and sometimes into the night in the moderate to
severe stages of dementia.
Wandering is common among people with dementia. It can be are real
cause for concern when their failing memory and difficulty in
communicating make it hard for them to get the help they need to
return home. Helping the person with dementia to remain safe is the
most important part of managing wandering.
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Parkinson’s disease
Parkinson’s disease is a progressive condition of the nervous system. It
usually begins slowly with symptoms developing quite gradually. People
often think slowness of movement relates to old age, and Parkinson’s
disease may not be diagnosed until other symptoms occur.
The condition affects about one in 500 people and the condition is more
common from late middle age onwards. About 1% of people over age
60 have Parkinson’s disease. Men develop Parkinson’s disease slightly
more often than women.
The cause of Parkinson’s disease is related to the degeneration of nerve
cells in the centre of the brain. These nerves produce dopamine, which
acts as a chemical messenger to transmit messages from one nerve cell
to another. The nerve cells fire ‘out of control’ messages, causing
difficulty with directing or controlling movements. When 80% of
dopamine is lost, the person starts to experience symptoms of the
condition.
People experience tremors, stiffness, slow movement (called
bradykinesia), and poor balance and coordination. As these symptoms
worsen, people with Parkinson’s disease can have difficulty walking,
talking, or completing other simple tasks.
Tremors can make people very tired. Not everyone with Parkinson’s
disease will have a tremor. The shaking usually begins in one of the
hands or arms, especially when that part of the body is at rest, and
usually decreases with use. Shaking may become more noticeable when
stressed or anxious.
Starting movement, such as getting out of a chair, can become difficult,
and everyday tasks can take longer to complete.
Muscles are tense due to stiffness. This makes facial expression, fine
finger movements (such as writing), turning over in bed or turning
around much more difficult.
Falls are a risk due to poor balance and a slight foot drag which makes
tripping likely. There may be episodes of ‘freezing’ which leaves people
‘stuck in place’ when starting a step.
People with Parkinson’s disease often have less facial expressions,
making it difficult to show emotion and use body language effectively.
They may have a quiet voice and speak without expression of the voice,
slurring words, or talking in a rush.
They may also experience other problems such as:

depression or emotional changes.

difficulty swallowing and chewing with risk of choking episodes.
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The cause of Parkinson’s disease is not fully understood and currently
there is no cure. In the early stage, there may be no need for treatment,
but as the condition develops, medication is used to control symptoms
and help maintain quality of life.
The brain recharges its dopamine overnight. People with Parkinson’s
may have good mornings but deteriorate over the day, so adequate
sleep makes a difference.
People with Parkinson’s disease can benefit from regular exercise which
seems to improve the body’s response to dopamine. At least 20 to 30
minutes of exercise each day, including stretching, helps relieve muscle
spasms.
Keeping things simple and doing tasks in the least tiring way helps
conserve energy. This requires:

planning for the day, to avoid rushing and to maintain energy for
heavier activities.

setting priorities about what is important.

keeping the body in a good position, for example, sitting, standing,
resting.

pacing activity to avoid exhaustion by breaking down a task into
smaller tasks including breaks when necessary.
Medication aims to restore the balance between dopamine and other
chemical transmitters. Some medication must be taken regularly and at
specific times if the person is to get the most benefit. You may need to
assist the person to take their medication at the right times. There may
be unwanted side effects such as mood swings, hallucinations, dry
mouth and constipation.
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Depression
Depression is the most common mental health problem amongst older
adults and has a significant impact on individual patients, their families
and society.
Depression is an illness that involves the body, mood and thoughts. It is
a mood disorder showing symptoms such as persistent feelings of
hopelessness, low mood, poor concentration, lack of energy, inability to
sleep, and, sometimes, suicidal tendencies.
Depression affects the way a person eats and sleeps, the way they feel
about themselves and the world around them. Without treatment,
symptoms can last for weeks, months, or years. Appropriate treatment,
however, can help most people.
Most people experience periods of sadness or feeling down during their
life. Most are able to return to normal activities within a short period of
time. But when these feelings of sadness and other symptoms make it
hard to get through the day, and when the symptoms last for more than
a couple of weeks, it is called clinical depression.
Major depression interferes with the ability to work, study, sleep, eat
and enjoy what were once pleasurable activities. Such a disabling
episode of depression may occur only once but more commonly occurs
several times in a lifetime.
About 12% of men and up to 25% of women suffer from depression
during their lifetimes. More women attempt suicide but men are more
likely to be successful. Depression is three to five times more common
in the elderly than in young people but it is not a normal part of ageing.
Common features of depression include:
 loss of interest in activities that were once interesting or enjoyable,
including sex.

loss of appetite with weight loss, or overeating with weight gain.

loss of the ability to express emotion.

a persistently sad, anxious or empty mood.

feeling hopeless, pessimistic, guilty, worthless or helpless.

avoiding social activities.

unusual fatigue, low energy level, or a feeling of being slowed down.

sleep disturbances, including insomnia, early-morning awakening or
oversleeping.

trouble concentrating, remembering things or making decisions.

unusually restless or irritable.

physical problems such as headaches, digestive problems or chronic
pain that do not respond to treatment and are persistent.

thinking about death or suicide or making a suicide attempt.
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Alcohol or drug abuse may also be signs of depression.
The cause of clinical depression is likely to be different for different
people. Sometimes a depressive episode can occur suddenly when
everything seems to be going fine. Other times, depression may be
directly related to a significant event in life such as losing a loved one,
experiencing trauma, losing a job or battling a chronic illness.
There are risk factors which make people more likely to experience
depression, such as:

a previous depressive experience.

a poor system of support.

a family history of depression.
Depression in older adults is often related to changes that they face
such as bereavement, loss of independence, health problems and
chronic pain. Older adults are likely to complain more about the
physical rather than the emotional signs and symptoms of depression,
and so the mood disorder may not be recognised.
Different types of depression require different types of treatment and
are quite individual. There are effective, self-help ways of dealing with
mild to moderate depression, such as regular physical exercise,
relaxation techniques and being involved in social activities.
Older people sometimes find that these self-help techniques are
difficult to implement when they have other medical conditions to
manage as well.
More serious depression is most effectively treated by a combination of
drugs (anti-depressants), and psychological therapies in which the
person discusses their situation with a trained professional (called a
psychotherapist). There are a variety of antidepressant medications,
and more than one may need to be tried to get the best effect. Most
antidepressant drugs can take several weeks before an improvement is
noticed. Early intervention and treatment usually reduce the time and
intensity of depression.
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Sensory system
Our human sensory systems include the ability to taste, smell, touch,
hear and see.
Hearing
Your ears have two jobs: hearing and maintaining balance. Hearing
occurs after vibrations cross the eardrum to the inner ear. They are
changed into nerve impulses and carried to the brain by the auditory
nerve. Balance is controlled in a portion of the inner ear. Fluid and small
hairs in the semi-circular canal stimulate the nerve that helps maintain
balance.
How ageing affects hearing
As you age, your ear structures deteriorate. The eardrum often thickens
and the inner ear bones and other structures are affected. It often
becomes difficult to maintain balance.
Some hearing loss is almost inevitable as we age and it may decline,
especially in the region of high frequency sounds. This age related
hearing loss is called presbycusis.
It is estimated that 30% of all people
over 65 have hearing impairment
and about 5% of people over 60 will
need a hearing aid.
The sharpness of hearing may decline slightly beginning about age 50,
possibly caused by changes in the auditory nerve. The brain may also
have a slightly decreased ability to process or translate sounds into
meaningful information and it may be difficult to hear in a crowded
noisy setting.
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Vision
Vision occurs when light is processed by your eye and interpreted by
your brain. Light passes through the transparent eye surface (cornea).
Your pupil is an opening to the eye interior. It becomes larger or smaller
to control the amount of light that enters your eye. The coloured
portion, or iris, is a muscle that controls the pupil size.
The inside of your eye is filled with a
gel-like fluid. There is a flexible,
transparent lens that focuses light
on your retina (the back of the eye).
Your retina converts light energy
into a nerve impulse that is carried
to the brain and interpreted.
How ageing affects vision
All of the eye structures change with ageing. The cornea becomes less
sensitive, so injuries may be noticed. Your pupils decrease in size and
focussing becomes less accurate. The pupil may also react more slowly
in response to darkness or bright light.
From the fourth decade of life, normal vision begins to decline including
changes to depth, light, colour and the ability to read small print.
There may be difficulty adjusting or estimating distance and to refocus
from close-up to distance. It may take a person a few seconds longer to
recognise someone who is across the room when the older person has
been reading or doing handwork.
The lens of the eye yellows making it more difficult to see red and green
colours. Sensitivity to glare increases. Night vision is not as acute. These
all affect driving safely.
It is common for older people to have corrective lenses, either glasses
or contact lenses. Telephone books, newspapers, and forms may be a
challenge to read without glasses.
Changes in depth perception can make it difficult to judge the height of
curbs or steps, increasing the risk of falls or tripping. Depth perception
has an effect on mobility as the floor may appear to be rolling or
moving, resulting in people shuffling along to counteract the perception
and ensure stable footing.
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Taste and smell
The sense of smell begins at nerve receptors
high in the membranes of the nose. It is thought
to decline with age, although poor health status
or smoking may have greater impact than
ageing.
The senses of taste and smell interact closely,
helping you appreciate food. Most taste really
comes from odours. Lack of smell can affect
pleasure and satisfaction obtained from food.
Changes in the ability to smell also have implications for safety,
personal hygiene and enjoyment of life. Loss of smell can put an older
person at risk of the dangers associated with eating spoiled food or not
responding to smoke or leaking gas. Some medical conditions, such as
Alzheimer’s disease or head trauma, can cause loss of smell or the
inability to understand or distinguish smells.
We all have approximately 9,000 taste buds. Taste buds are primarily
responsible for sensing sweet, salty, sour and bitter tastes. It is natural
for older people to lose some of their ability to taste. However, most
can still identify sweet, sour, bitter or salty foods, especially when these
flavours are concentrated. The ability to taste has a huge effect on
health because lack of taste may lead to older people making food
choices that do not have sufficient nutrients for good health.
How ageing affects taste and smell
The number of taste buds decreases as we age, beginning at about age
40 to 50 in women and at 50 to 60 in men. Each remaining taste bud
also begins to atrophy or lose mass. The sensitivity to the four taste
sensations does not seem to decrease until after age 60. If taste
sensation is lost, usually salty and sweet are lost first, with bitter and
sour tastes lasting slightly longer.
Age changes the sense of taste
because:

there is less saliva that is needed
for taste.

the number of taste buds
decreases.

there is less ability to determine
sweet/sour tastes.
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Touch
The skin is the largest organ of the body and has millions of nerve
endings. People thrive on stimulation through touch. The sense of touch
may be the most important of the senses, yet is often the most
neglected.
The sense of touch also includes awareness of vibrations and pain. The
skin, muscles, tendons, joints and internal organs have receptors that
detect touch, temperature, or pain.
The brain interprets the type and the amount of touch sensation. It also
interprets the sensation as pleasant, such as being comfortably warm,
unpleasant, such as being very hot, or neutral such as being aware that
you are touching something.
How ageing affects touch
It is believed that with ageing, you may have reduced or changed
sensations of pain, vibration, cold, heat, pressure and touch.
It is hard to tell whether these changes are related to ageing itself or to
its disorders that occur more often in the elderly. Regardless of the
cause, many people experience changes in touch related sensations as
they age. It may be harder, for example, to tell the difference between
hot and cold.
Decreased temperature sensitivity increases the risk of injuries such as
frostbite, hypothermia and burns.
The loss of the sense of touch can be caused by a number of factors
including:

Parkinson’s disease.

mini strokes (TIA).

lack of blood flow to the hands because of swelling.

arthritis.

not using limbs or muscles (as the person may be bedridden or
continually sitting).
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Reproductive system
The reproductive system consists of the organs which work together for
the purpose of sexual reproduction.
Unlike the other body systems we have discussed, the reproductive
systems of men and women are different.
The female reproductive system has two functions: The first is to
produce egg cells, and the second is to protect and nourish the offspring
until birth.
The male reproductive system has one function, and it is to produce and
deposit sperm.
Many non-living substances such as fluids, hormones, and pheromones
are also important accessories to the reproductive system.
How ageing affects the reproductive system
As we age, the reproductive system changes in both men and women,
but sexual activity usually continues.
Menopause usually starts in women from about 40 years onwards. The
ovaries shrink in size and stop producing eggs and the hormone balance
changes. Tissues become thinner, drier and less elastic. Reduced vaginal
secretions may give discomfort during sexual intercourse. Menopause is
usually completed by the mid-50s.
Male menopause (the termination of the reproductive function) is
generally from the mid 50’s onwards. Testosterone production reduces,
and genitalia may shrink.
More info
Menopause is a
natural biological
change as we age,
and is the body’s way
of signalling that a
person can no longer
reproduce.
A common condition that occurs is an enlarged prostate gland which
can lead to difficulty in urinating and gaining an erection. The prostate
gland sometimes needs removing.
Endocrine system
The endocrine system produces a variety of hormones (body chemicals).
These hormones trigger organs to function. Some of these hormones
include:
Adrenaline makes the heart beat faster, circulating the blood and
oxygen through the body more quickly in times of stress or exercise,
when they are most needed.
Testosterone is a male hormone produced by the testes. It controls
male functions like development of body shape and the growth of facial
and body hair, and voice depth.
Oestrogen controls femaleness such as the development of breasts and
shape of the hips. Reduced production of the oestrogen after
menopause can lead to osteoporosis, which is a gradual weakening and
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loss of bone substance that results in decreased height and brittle
bones.
Progesterone stops the production of eggs (ovulation) during
pregnancy. Ovaries produce both oestrogen and progesterone.
Insulin is produced in the pancreas and is vital in processing sugars. Too
little or too much insulin can lead to diabetes.
Other hormones are produced by different organs and glands. For
example, the thyroid gland in the throat produces thyroxin, which
controls growth and development by regulating the body’s metabolism.
Diabetes
This is a condition where there is too much or too little sugar or glucose
in the blood. When food reaches the stomach it is changed into sugar.
The sugar enters the bloodstream and then the body cells where it is
used for energy. For the sugar to reach the cells, the cell membrane
needs to be opened. This is called osmosis. Insulin is the hormone that
opens the body’s cells and is also how the blood sugar level is kept
within normal limits.
When a person has diabetes, the pancreas is unable to make enough
insulin to accommodate the amount of sugar in the bloodstream. If the
problem is not managed, the sugar stays in the blood stream and can
accumulate in the body, causing damage to blood vessels, the retina in
the eye and the kidneys.
There are two types of diabetes, Type 1 and Type 2.
Type 1 diabetes occurs in a variety of people, including young people,
but can happen to people of all ages. Type 1 diabetes is also known as
insulin-dependent diabetes. This is when the pancreas makes little or no
insulin. People suffering from this type of diabetes need insulin
injections all their lives.
Type 2 diabetes is more common and usually affects older, overweight
people whose pancreas does not make enough insulin so the insulin
does not work properly. The symptoms include tiredness, thrush
(itchiness around the vagina or penis) and blurred vision. Diet and
exercise are used to control the insulin levels.
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Respiratory system
The respiratory system enables us to breathe air. Air is a mixture of
gasses with oxygen being the most important for humans.
The respiratory system consists of
the lungs, airway and diaphragm
How ageing affects the respiratory system
As the respiratory system begins ageing the lungs begin to lose their
elasticity. This causes the lungs to become less efficient in processing
oxygen and decreases the amount of carbon dioxide that can be
expelled.
As a result, the respiratory system ageing process affects all organs and
tissues in the body. The less oxygen the body is receiving, the harder it
is for the body’s systems to function at peak capacity. How well the
lungs supply the body with oxygen seems to relate directly to age.
The amount of oxygen delivered to the bloodstream and the rate of
blood flow declines with age. Even with the lung capacity remaining
normal, the lung tissues seem to lose the facility for making the oxygento-blood transfer to the bloodstream.
Since older people cannot breathe as fast, there is less oxygen entering
the blood per minute. Less oxygen in the system cuts down the amount
of work that can be done.
Diseases that can occur more frequently as we age include:

pneumonia.

chronic bronchitis.

chronic obstructive pulmonary disease.

asthma.
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All of these illnesses occur as the respiratory system ageing process
advances. These common illnesses can be fatal in a person with a
compromised respiratory system.
Maintaining the respiratory system involves a healthy lifestyle that
includes a good diet, plenty of exercise and enough rest.
Chronic obstructive pulmonary disease (COPD)
This is a general term for people who have long term breathing diseases
such as asthma, emphysema and chronic bronchitis.
Chronic obstructive pulmonary disease (COPD) is an incurable condition
in which the lungs are damaged, making it hard to breathe. The airways
(tubes that carry air in and out of the lungs) become partly obstructed,
making it difficult to breathe air in and out. COPD It is a major cause of
chronic illness and death.
The airways branch out like an upside-down tree, and at the end of each
branch are many small, balloon-like air sacs called alveoli. In healthy
people, each airway is clear and open. The air sacs are small and the
airways and air sacs are elastic and springy. When breathing in, each air
sac fills up with air like a small balloon; when breathing out, the balloon
deflates and the air goes out.
In COPD, the airways and air sacs lose their shape and become floppy.
Airways may also become inflamed and thickened.
COPD
COPD affects the air sacs ability to
transfer oxygen.
Less air gets in and less air goes out because:

the airways and air sacs lose their elasticity (like an old rubber
band).

the walls between many of the air sacs are destroyed.

the walls of the airways become thick and inflamed (swollen).

cells in the airways make more mucus (sputum) than usual. This
tends to clog the airways, and reduces airflow.
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Smoking is the most common cause of COPD. Breathing second hand
smoke can also be a factor in developing the condition as can other
kinds of lung irritants, like pollution, dust, or chemicals, which, over a
long period of time, may also cause COPD or make it worse.
COPD develops slowly and the damage is irreversible. The person may
start to notice symptoms such as shortness of breath. COPD is often
diagnosed in middle-aged or older people. COPD includes conditions
such as emphysema or chronic bronchitis. Many people will have one or
both of these conditions.
The signs and symptoms of COPD include:

a cough that does not go away (although not everyone with COPD
has a cough).

mucous (sputum) production.

shortness of breath.

wheezing and chest tightness.
Other terms for COPD are chronic obstructive airway disease (COAD)
and chronic obstructive lung disease (COLD).
Lung infections are a common complication, because the damage that
has occurred makes the lung tissue prone to infections. If the lungs are
severely damaged, the heart may also be affected, reducing the amount
of oxygen getting to the body's organs and tissues. As the symptoms of
COPD get worse over time, a person may have more difficulty with
walking and exercising and carrying out day-to-day activities. This can
severely affect quality of life.
Treatment for COPD is aimed at slowing the progress of the disease,
preventing complications, prolonging life, and improving quality of life
for the affected person.
There are several treatments and medication.

Bronchodilator medicines help the airways remain open. They are
inhaled and go directly into the lungs where they are needed. There
are many kinds of inhalers, and it is important to know how to use
them correctly. You may need to support someone to use their
inhaler and spacer.

Steroids work to reduce airway inflammation. These are often
inhaled through inhalers or nebulisers. Tablet forms are also used.

Antibiotics are used to treat infections at an early stage.

Oxygen treatment is for people with low levels of oxygen in their
blood. Using extra oxygen for more than 15 hours a day can be
helpful as it allows people to do tasks or activities with less
shortness of breath, be more alert, limit damage to their heart and
sleep better.
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Although there is no cure for COPD, symptoms can be managed, and
damage to the lungs reduced. The person should:

keep away from smokers, pollution, dust, fumes and strong smells.

have a flu vaccination every year.

avoid people who have upper respiratory infections such as colds
and coughs.

exercise regularly within their ability.

eat healthy foods including plenty of fruit and vegetables and
protein food like meat, fish, eggs and milk.

seek medical attention if symptoms are getting worse.
Hospitalisation may be necessary if the condition gets worse and the
person:

has a lot of difficulty getting enough air or is experiencing
breathlessness.

has lips or fingernails that show a blue or grey tinge.

feels mentally sluggish.

has a rapid heartbeat.
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Integumentary system
The integumentary system consists of the skin, hair, nails and exocrine
glands. These glands produce sweat, oil and wax to cool, protect and
moisturise the skin’s surface.
The skin is the largest organ of the body and grows faster than any
other organ. It has three layers, from the surface of the skin inwards,
called the epidermis, dermis and subcutaneous layers.
The epidermis keeps producing new cells that push to the top of the
skin surface. Its thickness varies depending on the part of the body. For
example, the eyelid is only 1mm thick, while the soles of the foot and
palms of the hand are much thicker. The pigment (melanin) which
colours the skin is in the epidermis. Every 24 hours, the surface of the
skin sheds a layer of dead cells, constantly renewing every 28 days.
The dermis is strong, elastic tissue. It contains blood vessels, lymph
vessels, oil (sebaceous) glands, and sweat glands. The hair follicles,
which contain the roots of the hair, are also in the dermis. Hair and nails
are special types of skin cells. Small involuntary muscles attached to the
hair follicles cause the hair to stand up in response to certain emotions
or temperature. The dermis provides nutrients to the epidermis.
The subcutaneous layer is the deep underlying layer made of fat cells
that act as a shock absorber between the skin and more delicate
internal tissues and organs.
The skin’s biggest job is protection. It is a tough, elastic, flexible and
waterproof covering that helps protect other organs and body parts.
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The skin has three main functions.
1. Protective - your skin’s main job is to insulate and protect the body
against bacteria and other foreign things. It resists moderate injury
and can return to its previous shape and withstand considerable
trauma without permanent damage.
2. Sensory - the skin can sense five different kinds of stimulation:
touch, pressure, heat, cold and pain.
3. Regulatory - the skin helps to control body temperature by
distributing heat through the skin rather like a thermostat. It also
provides a waterproof barrier and regulates the balance of fluids to
prevent dehydration. It is able to absorb substances through the
skin, for example, creams containing drugs. It also helps eliminate
waste and salts from the body through sweat.
How ageing affects the integumentary system
Skin changes are among the most visible signs of ageing. These changes
are related to environmental factors, genetic makeup, nutrition and
other factors. The greatest single factor, though, is exposure to the sun.
Effects of ageing of the skin include:

wrinkles and sagging skin which develop as skin loses strength and
elasticity. Blue eyed, fair skinned people show more skin changes as
they age.

whitening or greying of the hair is an obvious sign of ageing.

gradual thinning (although the skin still has the same three layers).
Appears paler and becomes more sensitive to sun damage.

large pigmented spots (called age spots, liver spots or lentigos) may
appear in sun-exposed areas.

the blood vessels of the dermis become more fragile, which can lead
to bruising and bleeding under the skin. Rubbing or pulling on the
skin can cause skin breakages called skin tears. Bruises, flat
collections of blood (called purpura), and raised collections of blood
(called haematomas) may form after even a minor injury.

sebaceous (oil) glands produce less oil. For women, this becomes
more noticeable after menopause. This results in dryness and
itchiness.

the subcutaneous fat layer thins, meaning the body is less able to
maintain body temperature. With less natural insulation, older
people often feel the cold.

the sweat glands produce less sweat, making it harder to keep cool
in hot weather.

growths such as skin tags, warts and blemishes become more
common.
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
a reduction in the ability to sense touch, pressure, vibration, heat
and cold.

skin changes and loss of subcutaneous fat, combined with a
tendency to be less active, as well as some nutritional deficiencies
and other illnesses, contribute to pressure ulcers.

slower healing of ageing skin. Wound healing may be up to four
times slower leading to pressure ulcers and infections. Conditions
such as diabetes, blood vessel changes, and lowered immunity, also
affect healing.
More than 90% of all older people have some type of skin condition.
Because most skin changes are related to sun exposure, prevention is a
lifelong process. Excessive exposure to strong sunlight has also been
directly linked to a variety of skin cancers.
Other skin problems can be associated with diabetes, liver conditions,
heart disease and arteriosclerosis. Stress, reactions to medications,
obesity and nutritional deficiencies can be other causes. Chemicals,
indoor heating, clothing, allergies to plants and other allergies and
many other common exposures can also cause skin changes.
Prevent skin problems by:

maintaining good nutrition and drinking adequate fluids.

keeping skin moist with lotions. Avoid using soaps that are heavily
perfumed. Moist skin is more comfortable and may heal better.

preventing sunburn by using sun screen and covering up in the sun.
Wear a hat, sunglasses, and sunscreen when outdoors in the sun
even on cloudy days.
Ulcers
Terms used to describe skin damaged by pressure are bedsore,
decubitus ulcer, or pressure ulcer. An ulcer is a crater-like lesion on the
skin or mucous membrane that may or may not heal. An ulcer can be
internal, for example, gastric, or external, for example, venous or
pressure ulcer. There is always some degree of tissue destruction
involved.
Leg ulcers may be acute or chronic with skin loss occurring on the leg or
foot.
Acute usually follow a leg injury (trauma) or surgery and heal in a
normal timeframe (up to 4 weeks).
Chronic may follow a minor trauma, skin cancers, or systematic disease.
They do not heal in the usual timeframe and may breakdown and recur
at the same or a nearby site. They affect 1% of middle aged and elderly
people.
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Ulcer
An ulcer is a crater-like lesion
on the skin or mucous
membrane that may or may
not heal.
Causes and treatment
Most leg ulcers develop due to poor circulation in the legs, either within
the veins (causing a venous leg ulcer) or the arteries (causing an arterial
leg ulcer). People with diabetes are also at particular risk of leg ulcers.
Leg ulcers may be caused or made worse by conditions such as:

poor circulation often associated with blood vessel disease.

venous insufficiency (a failure of the valves in the veins of the leg
that causes congestion and slowing of blood which collects in the
lower limbs).

blood clotting problem.

diabetes.

renal (kidney) failure.

hypertension (treated or untreated).

lymphoedema (a build-up of fluid that causes swelling in the legs or
feet).

history of smoking (either current or past).

pressure caused by lying in one position for too long.

a malignancy (tumour or cancerous mass).

infections.

certain medications.
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The person may have a swollen leg and may feel burning or itching.
There may also be a rash, redness, brown discolouration or dry, scaly
skin.
Leg ulcers become more common with age. Although leg ulcers are
often thought to only affect the elderly, about 20% of those who
develop a leg ulcer are under the age of 40. Leg ulcers affect more
women than men.
Treatment is aimed at relieving pain and improving wound healing
along with treating or managing any underlying medical conditions.
Treatments for leg ulcers may include:

topical wound treatment. Dressings managed by the person
themselves or overseen by specialist staff. There are a variety of
special dressings used.

compression. Venous ulcers are treated with compression of the leg
to minimise oedema or swelling. Compression treatments include
wearing compression stockings or bandages. Support workers must
be fully trained if they are to assist with this treatment.

antibiotics. Present infections may require specific medications.
Pressure points
Pressure points are points of pressure that may cause skin integrity
breakdown. Skin integrity means that the skin is healthy, undamaged
and able to perform its basic functions. A skin integrity issue might
mean that the skin is damaged, vulnerable to injury or unable to heal
quickly.
A pressure wound (also called a pressure sore, bed sore or pressure
ulcer) is an injury to the skin and surrounding tissue. Pressure wounds
usually form over bony parts of the body, such as the, hips, sitting
bones, shoulder blades or base of the spine. Position changes are used
to alleviate these pressure points. These position changes need to occur
every two hours.
Pressure points when standing, sitting or lying.
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Immune system
The immune system is a network of organs, glands and tissues that
protects the body from foreign substances. It is important for keeping
our bodies healthy. It protects us against viruses, bacteria and parasites
as well as identifying and removing cancer cells and toxins.
The major components of the immune system are:

organs such as the thymus, spleen and lymph system.

bone marrow and white blood cells.

antibodies.

hormones.
How ageing affects the immune system
Our immune system’s ability to perform decreases with age. These
changes happen at all levels, from chemical changes in how our cells
‘communicate with one another’ to changes in immune organs
altogether. As the immune system fails, elderly people are subject to
infections, cancer, auto-immune disorders, or disorders directed against
the body’s own tissue, and many chronic diseases. Many diseases
develop slowly and symptoms do not show up until later in life.
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Usually, the immune system is extremely effective in performing its
work of defending the body. The immune system has defences, (the
skin and mucous membranes), which are the first defence for
preventing pathogens from entering the body. Pathogens can cause
disease, for example, a bacteria or a virus. Other specific defences come
into action when any pathogens get past the first line of defence and
invade the body.
A major part of our immune system is the disease-fighting cells, called
T-cells, or T lymphocytes. As we age, these calls lose the ability to
function. The body retains the same number of T-cells as before, but
these cells are less able to control illness than the cells were in the
earlier years.
Another function of the immune system is to produce antibodies to
ward off foreign invaders in the body, such as bacteria and viruses.
These antibodies are produced in smaller quantities. This means that
vaccinations such as flu shots may provide less protection than when a
person was younger.
For the immune system to work properly, the body must recognise that
it has been invaded, either by pathogens or toxins or by some other
outside threat. The immune response must be rapid if it is to prevent
the body being overrun by the invading pathogens. Once inside the
body, a pathogen meets different defences that the immune system has
available.
Diseases and problems with the immune system can be divided into two
basic categories:

those in which the body’s ability to fight disease is impaired.

those in which the immune system overreacts to stimuli, causing
damage to the other organs or systems of the body.
The body can lose its ability to distinguish what is foreign and what is
part of itself. When this occurs, it can lead to auto-immune disease. It
also means that the immune system cannot identify and fight cancerous
or malignant cells. This is one of the reasons that the risk of many
cancers increases with age.
Conditions that are associated with problems with the immune system
in which healthy normal cells are attacked for unknown reasons include
rheumatoid arthritis, lupus, juvenile onset diabetes, multiple sclerosis,
and psoriasis. Even allergies are believed to be related to dysfunction of
the immune system, since the immune system overreacts to allergens.
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Write
Describe one effect of ageing for each of body systems below:
Body system
Effect of ageing
Musculoskeletal
Digestive
Urinary
Cardio-vascular
Nervous
Reproductive
Endocrine
Respiratory
Skin
Sensory
Immune
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The impact of ageing on a person’s
daily life
In this section we’ll talk about
ageing in terms of a person’s:

daily activities

lifestyle and wellbeing
Now let’s have a look at what
these mean.
Daily activities
Healthy ageing is about maintaining health, function and independence
for physical, social and emotional wellbeing. An older person may need
support with their personal needs and activities of daily living.
Eating
The digestive system is one of the least affected by age, but some
changes do occur.
Changes that can occur
Examples of effects
Mouth - changes in the mouth can
affect eating patterns and appetite.
The bone structure of the jaws may
change, which can alter the way
dentures fit. Saliva necessary to
swallow food decreases and teeth
become more brittle.
Ill-fitting dentures make chewing
difficult. Food choices become
limited leading to nutritional
deficiencies.
Taste and smell - the sensitivity of
taste buds and the sense of smell
decreases with age, especially with
men. The tastes that decline first
are sweetness and saltiness, with
bitter and sour decreasing more
slowly.
Changes mean that foods may not
taste like they used to so extra
seasonings are added.
Changes in taste and smell may
lead to a loss of appetite, which
can result in nutritional
deficiencies.
Stomach and intestines - peristalsis
(the movement of the intestines) is
slower, decreasing speed and
effectiveness of digestion and
elimination.
Constipation.
Person may not feel like eating or
eats only small amounts resulting
in weight loss.
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Drinking
Changes that can occur
Examples of effects
The amount of body water
decreases by approximately 15%
between 20 and 80 and the body
becomes more susceptible to
dehydration from a loss of a small
amount of body water. The person
may not recognise the need to
drink more in hot weather or when
there is an excessive loss of fluid
through sweating, vomiting, or
diarrhoea.
Inadequate fluid intake can lead to
constipation. This can occur as the
bowel absorbs fluid back into the
body which makes the stools
harder and dry.
Dry mouth and bad breath can
result from insufficient fluid intake.
Mild dehydration occurs from
inadequate intake of fluids.
Mobility
Changes that can occur
Examples of effects
Changes in gait, with steps
becoming wider based with smaller
steps and poorer balance. Elderly
people tend to walk with short,
shuffling steps, and with less of a
tendency to swing their arms.
Falls associated with risk factors
and slower reaction times.
Age related changes include a
decrease in bone density and
vitamin D metabolism which can
cause a decrease in bone strength.
An increased risk of falls due to
factors such as physical weakness,
impaired vision, medication,
changes in the centre of balance
and posture.
The need for aids to assist with
mobility, for example, walking
sticks, or frames.
Fractures
due to more
brittle bones
and reduced
ability to
react to a
fall.
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Elimination patterns
Changes that can occur
Examples of effects
A general weakening of the bladder
muscles means that the impulse to
urinate cannot be delayed as long
as in earlier years.
The bladder doesn’t stretch to hold
as much as it used to, so urination
may be more frequent.
The kidneys filter the blood more
slowly than in younger years.
Slowing of the digestive system.
With weakened muscles the
bladder may not empty completely
increasing the chance of urinary
infections.
Leakage of urine causing
incontinence, especially when
lifting, stretching or coughing.
Needing to get up at night to go to
the toilet or going to the toilet
more often and more urgently.
Cannot ‘hold on’ as easily as in the
past.
Medications remain in the
bloodstream longer meaning doses
have to be carefully controlled to
avoid over-medication.
Constipation or occasional episodes
of diarrhoea.
Personal hygiene
Changes that can occur
Examples of effects
A reduced range of movement due
to stiffness, pain, arthritis or other
health conditions.
Maintaining personal hygiene is
made more difficult and
compounded by mobility, dexterity
or elimination difficulties. This may
be assisted by easy access
bathrooms, seating arrangements
and rails.
Continence problems may require
additional time and frequency of
personal care activities.
Toileting may be made more
difficult through reduced mobility,
and environmental issues, such as
poor access.
Assistance may be required to
successfully complete the task.
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Dexterity
Changes that can occur
Examples of effects
Dexterity is the ease and skill in
physical movement, especially in
using the hands and manipulating
objects.
Pain, arthritis and a loss of strength
in the muscles affects dexterity.
Loss of dexterity can lead to an
inability to perform simple daily
tasks, such as opening jars or cans,
coping with buttons or other
closing devices on clothing, and
using knives and forks, a pen to
write, or using a telephone.
Dressing and undressing
Changes that can occur
Examples of effects
A reduced range of movement due
to stiffness, pain, arthritis or other
health conditions, for example,
stroke.
Dressing is slower and more
difficult.
Easy to put on clothes are required
to allow the older person to dress
independently. Simple openings,
easy access, loose and easy fitting
clothes are easiest.
Continence problems may require
modified clothing or specialised
products to enable easy toileting.
Sleeping patterns
Changes that can occur
Examples of effects
Older people generally need less
sleep. Sleeping patterns can
become disturbed and lack of sleep
creates additional physical stress
on the body.
Sleep needs change during the
lifetime, but all ages need sleep for
good mental and physical health.
Good quality sleep allows the body
to produce the human growth
hormone that helps build muscle
mass, thicken skin and strengthen
bones. Hormonal and immune
system changes can also occur
when the person does not get
enough sleep.
Older people often wake earlier
and may take a short daytime nap
to make up for any ‘sleep deficit’.
Medication can mean a person
needs to get up to go to the toilet
at night which disturbs sleep.
Constant tiredness and irritability.
More prone to developing
conditions related to hormone
imbalances or deficiencies, for
example, diabetes.
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Lifestyle and wellbeing
Everyone experiences becoming older. The process of ageing has other
effects apart from the obvious physical changes to the body. While
these changes are individual to the person, they can still have a huge
impact on the way in which people are able to live their lives. Each
person must adapt and adjust to the normal changes that are occurring
as they age, and the success that a person has in making these
necessary changes will have a major impact on the quality of life that
they enjoy.
Support may be needed for emotional and social aspects. This is known
as psychosocial needs.
Housing
The housing needs of people change throughout their lifespan as family
size increases or decreases. For example, death of a spouse can lead to
a rethink of housing needs.
As people age, the type of housing they require can become very
important if they are to remain independent for the longest possible
time.
Factors to consider are:

the size of the house (for a person with reduced mobility).

the levels (stairs, changes of level indoors and outdoors).

the location (including access to public transport, shops and services
such as medical, social and recreational, schools and work).

affordability due to an increased or reduced income, changes in
family size or makeup, mortgage or rent costs.

the need for additional support and 24 hour care can mean a move
to a residential facility or other type of supported accommodation.
Work and income
Work can be defined as any activity that contributes to producing goods
or services whether or not the person is paid for this activity. As people
age, they often change the nature of the work they do. People may:

change from full-time to part-time work.

retire from paid employment.

stop or start doing voluntary work.

take ‘time out’ from the workforce to study or care for
family/whānau, or travel.

work for short periods between travel or study.

choose casual or part-time work for social contact and interest.
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Increasingly, older people are continuing to work past the accepted
retirement age, and value being able to make a meaningful contribution
to their community whether this is in paid or unpaid employment.
When people are no longer in paid employment, they are likely to
experience a change in their income level. People may have a variety of
resources available to support them for this period of their life, for
example, superannuation, investments, and pension schemes.
Recreation
People of all ages use recreation as a way of refreshing their body and
mind, and relieving stress. As people age, their choice of recreation is
likely to change because other factors such as mobility, transport and
health may mean that they cannot continue with their previous
interests in the same way.
Examples of changes that a person might make include:

changing from playing a full round of golf to playing a few holes and
using a golf buggy.

a person who played tennis every week may change to a less
physical activity such as yoga.

a person who enjoys art may no longer be able to do the fine
detailed work necessary for china painting; instead they may choose
to do water colour landscape painting instead.
Relationships and family/ whānau
Relationships are about the connections we have with people or groups
and how we behave towards and feel about one another. We have
relationships with a wide variety of individuals and groups such as
family, friends, work colleagues, service people, professionals, officials,
etc. With age, some of these relationships remain the same, for
example, we remain our child’s parent throughout life. Other
relationships will change, for example, we may no longer be an
employee or an employer.
Our family are the group of people who are most closely related to us
by birth, marriage, or adoption. For others, it is the extended family unit
or group of families in the same general area. As we age, we are more
likely to rely on support from our family or whānau. Such reliance may
relate to transport, shopping, decision making and support for medical
appointments.
For some elderly people, the absence of family available for support
severely impacts on their ability to live independently.
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Cultural and spiritual
Culture is about who we identify with, be it of ethnic origin, or where
we live, or what we believe. Culture influences how a person behaves.
In some cultures family/whānau is expected to support their elders. This
may include preparing and sharing meals, helping with their personal
care and helping them take medication.
Spirituality is about our beliefs. It may be a church or a similar spiritual
group, or other people who share the same beliefs and values.
Companionship, sharing activities and outings are important. Elderly
people can easily become isolated and lonely, especially if they are
living alone.
Learning and memory
Brain experts believe that active learning helps maintain brain health by
preventing loss of brain function and skills such as memory, reasoning
and judgment. Age alters the structure of the brain; it shrinks slightly in
some people from about the age of 60 or 70. This affects how signals
between different regions of the brain are relayed. The chemicals
(called neurotransmitters) that relay messages within the brain become
less available resulting in a decline in memory among older people.
The effects of brain changes are influenced by environmental factors,
such as the amount of intellectual stimulation the person has. Formal
education, leisure activities, and professional interests can all help keep
the mind stimulated and healthy. The brain works better when it
acquires more knowledge because it helps build more connections
throughout the brain.
Memory is the ability to retain knowledge and experience and to be
able to recall this knowledge when it is needed. Memory is both short
term and long term. It is the long term memory that is most affected by
the changes that occur in the brain as we age.
Long-term memory involves the information that needs effort to retain.
This may be because it is meaningful, for example, information about
family and friends; or because we need it, for example, job procedures,
study material for an exam; or because we have had an emotional
experience, for example, we cry when watching a sad movie, or when
someone special dies, or we cry with joy when celebrating a great
achievement.
Another kind of long-term memory involves the skills and routines we
perform so often that they do not require conscious recall or effort. For
example, dressing ourselves or cooking a meal.
In short-term memory, the mind stores information for a few seconds
or a few minutes and is soon lost when it is no longer needed. The brain
is designed to hold an average of seven pieces of information.
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Anxiety and depression
Anxiety is a normal part of life. It is the feeling of worry, nervousness or
agitation, often about something that is going to happen. It can make us
feel extremely apprehensive or fearful even though the concern may be
imagined rather than real.
Older adults may worry about health, family, finances, and the end of
their life. Elderly people may react with fear or panic when unexpected
things arise, much like young people.
Most people do experience periods of sadness or feeling down during
their life. Depression occurs when these feelings do not go away.
In older adults, it is often related to changes that they face such as
bereavement, loss of independence, health problems and chronic pain.
Older adults are likely to complain more about the physical (rather than
the emotional) signs and symptoms of depression, so it may go
unrecognised.
Depression in the elderly is associated with poor health, a high mortality
rate, and an increased risk of suicide, so diagnosis and treatment are
extremely important.
There is more information about depression on page 26.
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