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Tracing Physical Aging

Normal aging changes progress into chronic disease and finally, during the old-old years, may result in impairments in activities of daily living (ADL) problems, either less incapacitating instrumental ADL problems or basic ADL problems—troubles with basic self-care.

Futuristic gurus predict that we are about to extend our maximum human lifespan (about a century), especially because underfeeding can extend the maximum life span of rats. But gerontologists believe this goal is unlikely, because the cascade of faults involved in human aging ensure that our bodies must give out at about the century mark.

Socioeconomic status predicts how quickly we age and die, as shown by the wide life expectancy differences between the developed and developing worlds. The socioeconomic health gap refers to the fact that—within each nation—people who are affluent live healthier for a longer time. A variety of forces, starting in early childhood, make poverty a risk factor for early disability and death. Education and close attachments enhance longevity and health.

Gender also affects aging, with males dying at younger ages of heart attacks and women surviving longer but being more disabled. While females are biologically primed to live longer, considering healthy-life years, women only do slightly better than men. Although physical problems are the predictable price of living far into old age, improving children’s lives and constructing caring communities may have dramatic health payoffs during adult life.

The classic age-related vision problems—presbyopia (impairments in near vision), difficulties seeing in dim light, and problems with glare—are caused by a rigid, cloudier lens. Modifying lighting can help compensate for these losses. Cataracts, the endpoint of a cloudy lens, can be easily treated, although the other major age-related vision impairments can cause a more permanent loss of sight. Don’t overprotect visually impaired loved ones. Encourage people to visit a low vision center for help.

The common old-age hearing impairment presbycusis may be emotionally more troubling than vision problems because it limits a person’s contact with the human world. As exposure to noise promotes this selective loss for high-pitched tones, men are at higher risk of having hearing handicaps, especially at younger ages. To help a hearing-impaired person, limit low-pitched background noise and speak distinctly—but avoid elderspeak, the impulse to talk to the older person like a baby. For your own future hearing, protect yourself against excessive noise. Hearing aids, unfortunately, are less user-friendly and effective than we might hope.

“Slowness” in later life is due to age-related changes in reaction time and skeletal conditions such as osteoarthritis and osteoporosis (thin, fragile bones). Osteoporosis is a special concern because falling and breaking a hip is a major reason for entering a nursing home. As mobility is crucial to late-life independence, older people must exercise and modify their homes to reduce the risk of falls.

Although the elderly drive less often, accident rates rise sharply among drivers over age 75. Solutions to the problem, such as mandatory vision tests over a certain age, may not work so well, as driving involves many sensory and motor skills. Modifying the driving environment and especially developing a car-free society are critical challenges today.

Major neurocognitive disorder (also known as dementia) is the label for any illness involving serious irreversible declines in cognitive functioning. The two illnesses causing these symptoms are neurocognitive disorder due to Alzheimer’s disease, defined by neural atrophy accompanied by senile plaques and neurofibrillary tangles, and vascular neurocognitive dementia, caused by small strokes. These diseases typically erupt during the old-old years and progress gradually, with the person losing all functions. The APOE-4 marker predicts developing Alzheimer’s disease at a relatively younger age.

To prevent the accumulation of the plaques, scientists are studying people with mild cognitive impairment and looking for risk factors that foreshadow getting ill. Today, Alzheimer’s cannot be prevented or cured, although physical exercise may help ward off its onset. The key is to make environmental modifications to keep the person safe—and understand that older adults with these problems are still people. Caregivers’ accounts and the testaments of people in Alzheimer’s early stages offer profiles in human courage.

Although, traditionally, older people lived in multigenerational households, with a built-in family support network for when they became frail, even societies historically most committed to family care (such as China and Japan) now need Western options for dealing with disabled older adults. In the United States, the major alternatives to institutionalization—continuing-care retirement communities, assisted-living facilities, day-care programs, and home health services—are typically fairly costly and not covered by Medicare. We need services to help people with disabilities who are not wealthy and do not need the intense care of a nursing home.

Being female, very old, and not having loved ones to take the person in are the main risk factors for entering nursing homes, or long-term-care facilities. While nursing homes vary in quality, and are improving, they still don’t typically provide high-quality care. Even though the certified nursing assistant or aide, the main caregiver, is poorly paid, people can get tremendous gratifications from nursing home work. Society needs to prepare for an onslaught of ADL problems as the baby boomers enter their old-old years. People can develop as human beings even in a nursing home, and reach every Eriksonian milestone during their final years—or months—of life.