By the end of this chapter, the learner should be able to:

Recognise the symptoms of a range of age-related conditions and be able to assist older persons to assess the impact of these conditions on their daily lives.

General physical changes associated with ageing

As people age, their body naturally deteriorates – this can lead to changes in their physical conditioning.

Some common factors are:

Vision – eyes dry up and lens becomes less accurate. Therefore, sight can become blurry and out of focus – glasses and contact lenses may need to be used as corrective measures.
Hearing – the changing ear structure and nerves can lessen hearing ranges, with higher frequencies more difficult to hear.
Taste and smell – the senses of smell and taste can fade, leading to a decreased appetite and weight loss.
Immunity – the immune system gets weaker as we age, with white blood cells being less effective – leading to more frequent infections.
Hair and nails – hair becomes thinner and drier, leading to possible itching and discomfort, as well as hair loss. Nails become brittle and fungal infections can become more common.
Hormones – these can result in a multitude of problems and can affect metabolism, endocrine glands and sexual function.
Teeth and gums – teeth weaken and dry out, with less saliva produced by glands. Coupled with receding gums, these can result in a dry mouth, tooth decay/loss, bad breath, infections and gum disease.
Face – as well as wrinkles and age spots, facial contours may shift, leading to droopy, sagging skin.
Body shape – bone changes can lead to spine curvature and a decrease in standing height. Muscle may waste away and fat metabolism can become impaired, making maintaining weight more difficult.
Skin – skin oil is produced less, leading to dry and itchy skin. It becomes less flexible and more fragile – this can lead to easy bruising, wrinkles, age spots and skin tags.
Bones, joints and muscles – bones become less dense and shrink, making them more prone to breaks; muscle mass decreases and they become weaker; joints become painful, less flexible and inflamed.

Arthritis and other musculoskeletal problems

This condition causes pain, stiffness and inflammation within a joint – it can affect people of all ages, with 3.85 million Australians affected by it (set to rise to seven million by 2050). In actual fact, the term arthritis covers over 100 medical conditions, so the degree and impact it has on a particular person can vary depending on the type of arthritic condition they have. The three most common conditions are osteoarthritis, rheumatoid arthritis and gout, with over 95 per cent of cases in Australia being these.

In general, it impairs the ability to move the joints freely and can interfere with daily tasks such as driving, walking and handling things.

However, it is not a natural part of ageing and shouldn't be accepted as such – 2.4 million of those affected in Australia are of working age. The problem is that it's not curable yet, and can only be managed via medication (such as anti-inflammatory drugs, painkillers) or physiotherapy.

Common arthritic symptoms include:

Joint pain, tenderness and stiffness
Inflammation in and around the joints
Restricted movement of the joints
Warmth and redness of the skin over the affected joint
Weakness and muscle wasting

Diabetes

This is where insulin is not produced in sufficient amounts by the body to convert sugar (glucose) into energy. Instead, it stays in the bloodstream – this can be harmful to internal organs. It can be controlled with medication though, and most diabetics carry a medical alert bracelet, necklace or card (as well as glucose sources for emergencies).

Symptoms are:

Confusion
Sweating
Dizziness
Weakness
Headache
Lack of focus
Hunger
Numbness (lips and fingers)
Trembling
Irritability
Slurred speech
Fitting
Loss of coordination
Loss of consciousness.

There are two types of diabetes – type 1 and type 2.

Type 1 diabetes is an auto-immune condition where the immune system destroys insulin-producing cells in the pancreas. There is no known cause a there is no known prevention or cure for it at present. It accounts for around 15 percent of all diabetes cases, with symptoms including excessive thirst and urination, inexplicable weight loss, blurred vision, fatigue and weakness. The management of the condition is done by multiple daily insulin injections or the use of an insulin pump. Making healthy lifestyle choices can also minimise the impact of it, even though bad lifestyle choices didn't cause the condition.

Type 2 diabetes is where insulin is not produced in sufficient amounts by the pancreas to convert sugar (glucose) into energy. Instead, it stays in the bloodstream – this can be harmful to internal organs. It can be controlled with medication though, and most diabetics carry a medical alert bracelet, necklace or card (as well as glucose sources for emergencies). This is the most common form of diabetes, accounting for around 85 percent of cases. While the cause is partly genetic, lifestyle factors such as being overweight, having a poor diet, high blood pressure and having excess fat around the weight.

Frailty and deconditioning

Frailty is closely linked to ageing and covers disability, chronic diseases or dependency. It can result in things like delirium and falls and means that those who are considered "frail" must be closely monitored.

Heart and lung disease

Causes of heart and lung disease are:

Smoking
Obesity
High cholesterol.

The types of lung disease are:

Asthma
Chronic obstructive pulmonary disease (COPD)
Bronchitis
Emphysema
Cystic fibrosis
Pneumonia
Tuberculosis
Lung cancer
Acute respiratory distress syndrome (ARDS)
Pneumoconiosis
Interstitial lung disease (ILD)

Heart disease happens when the blood supply to the heart becomes blocked or interrupted by a build-up of fatty substances in the coronary arteries. If left untreated, it can lead to a heart attack.

The best way to deal with heart and lung disease is through positive lifestyle changes and some medications that may thin the blood.

Incontinence

This is when people pass urine unintentionally and becomes more common with age, affecting about twice as many women as men. There are two types of incontinence – stress and urge incontinence. Stress incontinence is when the pelvic muscles are too weak to contract and prevent urination – this can cause leakage when the bladder is under pressure when people laugh or cough. Urge incontinence is when urine leaks soon after you have passed urine or when there is an intense urge to urinate.

Again, it is not an inevitable part of ageing and can affect younger people too. Effective treatments include making positive lifestyle changes, strengthening the pelvic floor muscles and bladder training (waiting longer between urination).

Other treatments include:

Absorbent pads
Portable external bladder systems
Surgical treatment
- to reduce pressure on the bladder
- to strengthen the muscles preventing urination
- to increase the bladder size
- to implant a device to stimulate the detrusor muscles.

Skin disorders (including skin cancers)

Skin cancer is the abnormal growth of skin cells and occurs often on areas of skin that have been heavily exposed to sunlight. The three major types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. It is vital that early detection is facilitated, as this gives the best chance of curing the cancer.

Other skin conditions include things like eczema, and warts, etc. These need to be managed with appropriate creams and lifestyle choices, which should be prescribed by a doctor.

Stroke

This happens when the blood supply to part of the brain is cut off. In this case, prompt medical treatment is essential in preventing lasting damage to the body. You will need to phone 000 if you suspect a client is having a stroke.

It is diagnosed used the concept of FAST – face, arms, speech, time:

Face – drooping of the face on one side, around the eyes and mouth, an inability to smile

Arms – may not be able lift one or both arms and maintain their position

Speech – slurred and muddled speech, inability to talk at all

Time – dial 000 immediately if you see any of these symptoms

People most at risk of strokes are over-65s and underlying conditions such as heart disease and diabetes increase the risk. Things like being overweight, high cholesterol, poor diet, lack of exercise, high blood pressure, and an irregular heartbeat are all contributing factors to a stroke.

They can be treated with medications but surgery may be required at times. In terms of aged care though, the most common things you will be dealing with are people after a stroke. This can involve long rehabilitation periods which may or may not recover the independence of the affected individual. It can involve specialists such as physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors.

Vascular disease

This is a hardening of the arteries caused by a thickening of the artery lining from fatty deposits. This makes it hard for blood to flow freely around the body – the areas where the blood cannot get will suffer impaired function, tissue damage and it can even cause death if vital organs are not receiving enough blood. The most common arteries affected are those of the heart, brain and legs.

Symptoms can include:

Pain at and beyond the site of the blockage
Heart attack (heart)
Stroke (brain)
Cramping (legs)

Again, in terms of managing the disease, it is about adopting a healthy lifestyle – however, medication may cause strokes or heart attacks as a side effect, so this is avoided. If you are already on treatment for high blood pressure or diabetes, you should maintain this.

As people age and their bodies and minds may cease to function as well as in their younger days, the activities they can carry out will change. However, people may struggle to accept the lifestyle changes that this entails.

When working with older people, you may need to inform them of their limitations; for example, they cannot carry out routine physical tasks like they may have done in their younger days. Things like home DIY tasks that involve coordination and balance can cease to be safe if your senses are not functioning at their best – if they are going up and down a ladder, they may fall off and seriously injure themselves.; if they are using sharp objects, they may cut themselves, etc.

This may affect their scheduling – they cannot simply get up and do things as freely as they used to and they may require assistance in daily life. This does not necessarily mean they are incapable of performing everyday tasks.

Other changes on their living activities may include:

Taking medication at specified times
Budgeting (as they may have limited income)
Need to rest more (as muscles and body weaken)
More visits to the doctors (to monitor and identify conditions associated with ageing)
Cannot drive anymore (due to deteriorating vision)
Need for home help

Older people who are affected by any of the above need to be aware of their limitations by their carers and family; however, you should work with them to ensure that they can enjoy as much of the activities they desire as possible. This can involve making provisions for assistance or the encouragement for them to partake in new activities more suited to their ability, so that their life doesn't feel void.

Gender and sexuality

Whilst it may be expected that older people may experience changes in the areas of gender and sexuality as they age, this belief may actually be a form of ageism that is damaging to the individual. Older persons may still experience sexual desire, and will still identify with a sexual orientation, which may be heterosexual, homosexual, or bisexual.

As they age, older people may find that they are discriminated against in the fields of gender and sexuality, and are unable to express or engage in sexual activity for this reason. As a care provider for the elderly, it is important to recognise the presence of sexual desire in your clients, and to allow them to express this as part of their lifestyle.

However, it is also important to recognise when sexual behaviour becomes inappropriate and to intervene appropriately. For example, if an elderly person is displaying inappropriate sexual behaviour toward a staff member or other service users.

Mental health and sexual behaviour

The sexual behaviour of older people may be affected by the presence of conditions such as Alzheimer’s or dementia.

As these conditions affect the brain, they may cause unpredictable changes in a person’s sexual attitudes and behaviours.

This may involve:

More or less interest in sex
Less sexual inhibition
Decreased ability to engage in sexual activity
Sexual aggression
Challenging sexual behaviour.

These changes in sexual behaviour can create difficulties for the client and their families as they adjust to the person’s changing mannerisms.

Other difficulties may arise for a care provider. Issues may include misinterpretation of non-sexual behaviours as sexual; for example, if a person with dementia believes that a person in the room is a previous or deceased partner, they may act affectionately, or even sexually, towards them.

More information may be found at: https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=129 (Links to an external site.) (Access date: 26/10/16)

Policy and procedure

You must be aware of your own legal and ethical obligations when handling issues of gender and sexuality in the aged care sector.

This includes:

Following your organisation’s sexuality policy
Complying with privacy law
Respecting the rights of individuals to express their sexuality

Following policy and procedure to respond to inappropriate sexual behaviours, or suspicion of sexual abuse.