SayPro UNDERSTANDING THE AGEING PROCESS

1.1 INTRODUCTION

The face of Africa is changing. Like every other region in the world, its population is ageing, but in Africa this is happening much more quickly. By 2050, the number of people over 60 living in Africa will increase from just under 50 million to just under 200 million. This unprecedented demographic shift is having profound implications for society, influencing people’s social, economic and political lives.Older men and women throughout Africa make vital contributions to their families and communities. Across the continent, 64 per cent of men over 60 years of age continue to work across the formal and informal sectors.Older women tend to live longer than older men, with a life expectancy at 60 of a further 17 years. They continue their domestic and subsistence farming roles. Increasing numbers of older women whose adult children have migrated in search of work or have died as a result of HIV and AIDS are bringing up grandchildren too. Despite this indispensable contribution, many older people in Africa continue to experience deepening poverty, discrimination, violence and abuse, and are unable to access entitlements that are theirs by right. Many older people live in rural areas, where there are fewer services.Caring and supporting old people is a responsibility of each and every individual in the community. Older people are worth supporting because they play a vital role in African society today. Across the continent, millions of families would not survive without the contribution of older people from caring for orphaned grandchildren to providing much needed household income. Yet older people are often excluded from development programmes and discriminated against by services such as health care.

LEARNING ACTIVITYThink of old people in your community who have contributed to the lives of their families and that of the community. Share these stories with your class mates.

1.1.1 DEFINING AN OLD PERSON According to the Old Persons Act (2005), an older person means a person who, in the case of a male, is 65 years of age or older and, in the case of a female, is 60 years or older.1.1.2 CHARACTERISTICS OF OLDER PERSONSSociety often tends to lump older persons together in a discriminatory way — "He’s getting old and senile," "You can’t teach an old dog new tricks," or "Old people live in the past." This is ageism. It is important to recognize there are great varieties in character, ability, interests, and personality among older individuals.Nonetheless, gerontologist Dr. Robert Butler lists ten late-life characteristics, which tend to appear frequently among older persons:

• Change in the sense of time. Since the future is short, some retreat to the past. Others emphasize the importance of the here and now, of living in the moment.
• Sense of the life cycle. Older persons can experience in a personal sense the entire life cycle.
• Tendency toward life review. The realization of approaching death stimulates older persons to relive and review their past experiences. Through this process, they may resolve troubling conflicts and fears. Attentive listeners may help older persons to recount their lives.
• Reparation and resolution. Older persons may feel guilt for and try to atone for past actions.
• Attachment to the familiar. Familiar objects facilitate the life review and provide a sense of security.
• Conservation and continuity. The old have the opportunity to pass on knowledge to younger generations.
• Desire to leave a legacy. Older persons are concerned about leaving something behind when they die, be it grandchildren, possessions, or a work of art or social importance.
• Transmission of power. One of the psychological issues of old age is when to surrender one’s power and authority to others.
• Sense of fulfilment in life. Some older persons experience a sense of satisfaction and pride upon looking back over their lives.
• Capacity for growth. The capacity for creativity and wonder need not decline with old age.

1.2 THE AGEING PROCESS(117496 SO 1, AC 1, AC 3)The aging process happens during an individual’s lifespan. We are all involved in this process and none can escape it. When one is young, aging is associated with growth, maturation, and discovery. The changes aging individuals experience are not necessarily harmful.CHANGES IN BODY SYSTEMIt is no secret that as we age our bodies change, and that the changes in mid-life and middle age tend to be deleterious to our health. Research has also clearly shown that our lifestyle impacts both positively and negatively on these changes. We shall look at the following body systems and how they change with age.

• The Skin
• The Skeletal System
• The Muscular System
• The Neurosensory System
• The Gastrointestinal Tract
• The Cardiopulmonary System
• The Cerebrovascular System
• The Urinary System
• The Endocrine System
• The Genital System
• The Immune System

1. THE SKIN:As the skin ages, it flattens due to the loss of: sub-cutaneous fat, skin cells, sebaceous (oil) glands, sweat glands, melanocytes (pigment cells), and hair follicles. Lentigo (senile freckles) occur, blood flow to the skin is decreased, and nerve endings are lost or become less sensitive.As a result, the skin loses some of its effectiveness: as a protector against bacteria, as an insulator, as a thermal regulator, and as a sensory receptor. Since these losses cause wrinkling, loss of elasticity, freedom of movement and expression are inhibited. The slowing of circulation results in slower healing. The loss of colour is also seen, as the hair becomes gray.The skin generally functions well throughout life though, and most changes in the skin due to aging are not life-threatening. Most of the deleterious changes in the skin are cosmetic, as the drying and thinning result in sagging and wrinkling, the hair becomes sparser and gray or white, and the fingernails become ridged, tend to yellow, and are prone to splitting.Skin disorders more common in the aging skin are senile pruritis (itching), keratoses (thickening in patches), skin cancer, and decubitus ulcers (pressure sores), and herpes zoster (shingles).

STRATEGIES TO COPE WITH EFFECTS Avoid excessive exposure to the sun, maintain moisture in the skin, provide adequate nutrition so that the skin can be maintained and repaired, and Get regular exercise to maintain circulation in the skin. Use sunscreen when outdoors. Sunscreen with an SPF of 30 or more provides the most protection. Wear a hat, long sleeves and pants when outdoors and sunglasses that block UV rays.

2. THE SKELETAL SYSTEM:The primary factor in the aging of the skeletal system is the loss of bone matter. This loss is called osteoporosis, and refers to bone loss. The basic cause of bone loss is the fact that the relative rates of production of osteoblasts (bone forming cells) and osteoclasts (bone dissolving cells) changes so that more bone matter is dissolved than is laid down. This loss is much greater in women than in men.Other factors in the aging skeletal system are loosened cartilage around the joints, depleted lubricating fluid in the joints, and hardened and contracted ligaments. These factors occur more in men than in women.The effects of these changes on our health status are significant. Bones become brittle and less supportive of our activities, resulting in less activity, which in turn results in poorer health. The excess bone taken up tends to reside in the arteries and local blood vessels, causing decreased circulation. As broken bones occur, less mobilization results in other health hazards.The social implications of these effects are widespread, especially in advanced conditions. One becomes more dependent upon others, who might begin to avoid. One is less able to visit and to participate in social events.The alternatives to immobilization are difficult. Family, friends, and the community must be open to assisting these individuals, and must be alert to avoid ascribing more limitations than are actual. Other alternatives are preventive techniques.The following diseases tend to increase the incidence of osteoporosis, and so should be treated diligently: chronic alcoholism, diabetes, hyperthyroidism, uremia, and collagen disease (rheumatoid arthritis).

STRATEGIES TO COPE WITH EFFECTS The most successful deterrent to osteoporosis so far has been the stress placed upon the bones by exercise, which appears to stimulate the activity of osteoblasts (bone forming cells). Walking aids e.g wheel chairs and walking sticks

3. THE MUSCULAR SYSTEM:Since muscle cells are postmitotic cells (unable to replace themselves once they are formed), all muscle cell loss is permanent. Even though muscular response gradually slows with age even under the best conditions, the loss of muscular capabilities is by far mostly the result of cell loss due to inactivity. As muscle cells are lost, weakness and slowness increase.The effects of these changes on our health status are not, in themselves, greatly deleterious. The muscles, however, are the main tools for effecting strong circulation throughout the body.The social implications of these changes are related both to appearance and to movement.As the muscles become smaller, including the muscles in the face, and as adipose (fat) tissue accumulates, including in the face, the entire appearance changes to that of an older person, with all the ramifications described above in the description of skin changes. In addition, as muscle fibres decrease, weaken, and slow, it becomes increasingly difficult to keep up with younger people, who may make allowances, but who may also become avoidant.

STRATEGIES TO COPE WITH EFFECTS Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones. A moderate exercise program can help you maintain strength, balance, and flexibility. Exercise helps the bones stay strong. A well-balanced diet with adequate amounts of calcium is important. Women need to be especially careful to get enough calcium and vitamin D as they age.

4. THE NEUROSENSORY SYSTEM:The nerve cells (neurons) are postmitotic fixed cells (unable to replace themselves once they are formed). As they age, they lose dendrites, dendritic spines, and end branches; all of which are the intermediary parts necessary for the communication with one another. As the nervous system ages, signal conduction slows, but much more so at the nerve synapses (nerve junctions) than within the nerve cells themselves.We lose taste buds, olfactory cells (sense of smell), nerve endings in the skin, and even brain cells. Our hearing loses sensitivity, especially in the higher ranges, as the ear ossicles harden. Our vision changes as the lens of the eye becomes less flexible and yellows, and we require more light and glasses for close work.The effects of these changes on our health status impact on the ability to drive, read, and communicate; but the most relevant loss is a lessening of ability to organize and integrate information as well. The subsequent lessening of ability to care for oneself can impact on health in many ways.The social implications of these changes are especially significant as communications slow and others become impatient with the slowness and memory deficits, which sometimes occur. Others may avoid the elderly, become impatient with them, and the elderly may then become less interested in interacting.

STRATEGIES TO COPE WITH EFFECTSHelping older persons with visual problems: Positioning of objects in visual field Labelling objects – use large lettering Simplify the visual field – remove objects that are cluttering the area Consistently position objects – do not move or rearrange objects Give pre-warning – announce to person what you are going to do Helping to use other senses as compensation Communicating with those with hearing problems: If person has a hearing aid, make sure it is used, or find out why not. Face the person – allow him/her to read lips Make sure he/she is aware that you are addressing him/her – touch person to ensure having attention Speak slowly and distinctly Use short sentences Assisting person with tactile loss: Use touch therapy – communicating through touch Talk – tell person what you are doing, helps him/her to use multiple senses Gripping – make sure person has adequate hold on object Pressure- increase pressure when touching someone Helping person compensate for loss of smell; Allow person the opportunity to smell food before it is placed in his/her mouth; Explain what food has been prepared – person thinks of smell; and Label items that look alike so person can use other senses to compensate.

5. THE GASTROINTESTINAL TRACT:The mouth, esophagus, stomach, small intestine, gallbladder, liver, pancreas, and large intestine compose the Gastrointestinal tract.In the mouth, taste buds and teeth are lost. Problems with the esophagus in aging can be dysphagia (difficulty swallowing), substernal pain, heartburn, belching, and general epigastric discomfort. Atrophic changes in the stomach, especially hypoacidity and achlorhydria, are common as we age. Cell replacement is active in the small intestine, so few changes occur with aging; but obstructions are not uncommon.Gallbladder problems are most marked after age 65, rather than in middle age. Also, the body’s largest gland, the liver, maintains most of its weight until about age 70, and for the non-alcoholic can remain quite healthy and normal. Problems with the pancreas usually begin to develop about age 40 if they do occur, but they do tend to increase with age, especially if the Islets of Langerhans are damaged, or if they become over stressed by excess sugar consumption. In those instances, diabetes develops.The large intestine is most susceptible to disease with aging, but is also most amenable to preventive measures. Obstructions of the bowel – carcinogenic or otherwise, diverticular disease, hemorrhoids, and Gastrointestinal discomfort are common in the elderly, as is fecal incontinence. These latter problems can cause a severe strain on one’s self-image, but many can often be avoided by simply avoiding straining at the stool early in life.The effects of these changes on our health status can be far-reaching, because they can affect our nutritional sustenance. Every aspect of our health is endangered by severe problems in the gastrointestinal tract.The social implications of these effects relate mainly to the results of most illnesses, except for fecal incontinence, with its obvious discomforts and embarrassments, but which is often easily prevented by not straining at the stool early in life. Straining at the stool weakens the sphincter muscle over time.

STRATEGIES TO COPE WITH EFFECTS Stay active. Getting at least 30 minutes of exercise 5 days week can help prevent many age-related health problems. It will also help keep you regular and decrease the risk for colon cancer. Eat more fiber. Foods high in fiber, including fruits and vegetable, whole grains, and beans also tend to be high in nutrients and low in fat. High-fiber foods can help prevent constipation and ease symptoms of diverticulosis. Drink plenty of fluids. Drink plenty of fluids throughout the day. Drink enough so that you don’t feel thirsty. If you are taking diuretics, talk with your doctor about ways to manage taking your medication so that you don’t become dehydrated. Manage your weight. Maintaining a healthy weight can help prevent many age-related health problems such as heart disease, diabetes, and high blood pressure.

6. THE CARDIOPULMONARY SYSTEM:Heart disease is the most common cause of death in people 65 and over, and is also the most frequent cause of activity limitations. The heart muscles reduce in size and the aorta loses some of its elasticity. Coronary artery disease increases as activity declines. Plaques accumulate on the interior of the arteries (atherosclerosis), and the arteries harden as they lose their elasticity (arteriosclerosis); both of these factors resulting in lessened blood flow.Hypertension (high blood pressure) also increases with age. Several factors can stimulate the onset of congestive heart failure, and all are related to excessive demand on the right side of the heart.The respiratory system also undergoes changes with age. The air sacs, airways, and tissues lose elasticity and become more rigid. In general however, serious disease notwithstanding, the respiratory system can serve one well throughout life. The effects of these changes on our health status need not be severe without such abuses as smoking.The social implications of the effects of these changes are often not such as would hamper reasonable normal functioning.

STRATEGIES TO COPE WITH EFFECTS Eat a heart-healthy diet with reduced amounts of saturated fat and cholesterol, and control your weight. Follow your health care provider’s recommendations for treating high blood pressure, high cholesterol, or diabetes. Reduce or stop smoking. Exercise may help prevent obesity, and it helps people with diabetes control their blood sugar. Exercise may help you maintain your abilities as much as possible and it reduces stress. Have regular check-ups for your heart: Have your blood pressure checked every year. If you have diabetes, heart disease, kidney problems, or certain other conditions, your blood pressure may need to be monitored more closely. If your cholesterol level is normal, have it rechecked every 5 years. If you have diabetes, heart disease, kidney problems, or certain other conditions, your cholesterol may need to be monitored more closely. Moderate exercise is one of the best things you can do to keep your heart, and the rest of your body, healthy. Consult with your health care provider before beginning a new exercise program. Exercise moderately and within your capabilities, but do it regularly. People who exercise usually have less body fat and smoke less than people who do not exercise. They also tend to have fewer blood pressure problems and less heart disease.

7. THE CEREBROVASCULAR SYSTEM:Atherosclerosis (plaque formation inside the arteries) and arteriosclerosis (hardening of the arteries) in the blood vessels that supply the brain is called cerebrovascular disease, and causes strokes. Prior to the complete occlusion of the blood vessels, the brain is deprived of adequate blood flow resulting in less than optimal brain functioning, such as confusion, disorientation, and memory loss. Strokes may result in hemiplegia (paralysis), aphasia (speech disorder), and sensory deprivation in varying degrees.The effects of these changes on our health status can be drastic, ranging from slight discomfort to death.The social implications of these effects can also be severe, as those suffering these indignities become less functional both mentally and physically; and are, in varying degrees a burden to others. Social interactions are doubly inhibited, as from inside, the patient is less able to interact; and from outside, family, friends, and others may be less interested in interacting.

STRATEGIES TO COPE WITH EFFECTSPreventive measures such as diet and exercise, which have been shown to decrease or even prevent cerebrovascular accidents.

8. THE URINARY SYSTEM:The bladder, urethra, urinary tract, prostate, and kidneys all show decremental incidence in most people with age. Urinary incontinence and urinary tract infections are the most common problems encountered. The capacity of the bladder reduces by half in the elderly, so there is a need to urinate more frequently.From the age of 50 on prostate problems increase in frequency in men. A decrease in the number of nephrons, the filtering module of the kidney, results in decrease efficiency of the kidneys.The effects of these changes on our health status range from mild to severe. While 50% of the elderly have no significant urinary health problems, less than 4% have no deterioration.The social implications of these effects can be mild, or severe if there is great incontinence or severe kidney failure.

STRATEGIES TO COPE WITH EFFECTSThe best course of action is good health practices throughout life to maintain the urinary system in good health.

9. THE ENDOCRINE SYSTEM:To some researchers the endocrine system is the most exciting area of research into the basic cause of aging. The pituitary, thyroid, and adrenal glands do, however, tend to function adequately throughout life. While size of the thyroid gland does decrease significantly with age, it is the young and middle aged who experience thyroid problems rather than the elderly.The effects of these changes on our health status can by significant, especially in the event of diabetes; otherwise however, the endocrine system serves us well in our old age.The social implications of these effects are not a major cause for concern for most people. Diabetics require special consideration in severe instances, but for most caregivers and social interactions this is not a large problem.10. THE GENITAL SYSTEM:The changes in the genital system tend to be non-problematic, especially if sexuality has been practiced without long periods of abstinence. The changes that do occur are not as age related as they are sexuality related. Generally, responses slow gradually in both men and women, but both can have normal sexual relations as long as they are healthy, at any age. The subject of optimal sexuality is not an issue of this book, and is not truly an issue of aging. It is more an issue of education and psychological response, since the body changes are not age significant.In men, the prostate may enlarge, and may create urinary problems. More changes occur in women than in men. In women the uterus atrophies some, and several changes occur in the vagina; but all can be dealt with, especially if the woman has maintained some regular level of sexual activity. If after the age of about 40 a woman abstains from intercourse for prolonged periods, 3 to 5 years, the ability to secrete lubricating fluids, and much of the elasticity of the vagina are permanently lost. Masturbation can effectively help to maintain both of these capabilities, especially if object insertion is included. Since most research shows that less than 50% of women practice object insertion during masturbation, these women who also abstain from intercourse lose some vaginal elasticity, even with regular masturbation.The effects of these changes on our health status are not significant, given the above conditions. In the case of prostate problems in men, difficulties can occur.The social implications of these effects need not be severely problematic in most cases, remembering that most sexual problems are social or psychological problems which occur at all ages.11. THE IMMUNE SYSTEM:The earliest deterioration in our bodies is seen in the thymus – the heart of the immune system. The thymus begins significant involution in all of us by the age of three years. Two types of white blood cells, B cells and T cells of the immune system malfunction and weaken with age. B cells lose their vigor in attacking bacteria, viruses, and cancer cells; and the T cells lose their vigor in attacking cells foreign to the body, such as cancer cells and transplant cells. B cells and T cells also malfunction and attack normal healthy body cells.Since our immune system is strongly impacted by our emotions and our moods, less enthusiasm for life or depression over reduced vigor or lost relationships can promote a circle of lessening health.

STRATEGIES TO COPE WITH EFFECTS Get plenty of exercise. Exercise helps boost your immune system. Eat health foods. Good nutrition keeps your immune system strong. Do not smoke. Smoking weakens your immune system. Limit your intake of alcohol. Ask your health care provider how much alcohol is safe for you. Look into safety measures to prevent falls and injuries. A weak immune system can slow healing from falls and injuries.

1.3 EFFECTS OF PHYSICAL AGEING PROCESS ON THE MIND(117496 SO 1, AC 2)The physical ageing process has a considerable effect on the mind. The following are some of the effects;1. Memory and LearningMemory and learning involve our ability to register, retain, and recall experience. Under most circumstances, age-related changes in the primary ability to learn appear to be small. However, there may be problems in sensory perception, control of attention, motivation, or poor general health. In addition, with the general slowing down of responses that come with aging there may be a reduced capacity to handle complex activities and unfamiliar tasks.But usually learning ability does not decline, especially in those who continue to exercise it. It should also be noted that long-term memory in older people generally remains pretty sharp even as their short-term memory skills are decreasing.2. Mental IllnessOne of the most myth-shrouded areas of aging is that of mental illness. For many years, senile brain deterioration has been thought of almost as a normal result of the passage of time. It is true that brain disease in later life occurs more frequently than do the mental illnesses of early life. Even so, only a minute percentage of the total population can expect to be institutionalized for mental illness in later-life.Further, it has been found that mental illness in older persons can occur as a side effect of physical illness. Medications, and poor nutrition and hydration can result in behaviours that are misconstrued as mental illness. Infectious diseases and malnutrition can cause mental symptoms that remain long after the original condition is controlled.4. Attitudes Toward Death and DyingAre elderly persons inordinately anxious about death? According to stereotype, yes. But the fact is that younger persons are more likely to be concerned about death. Older persons are seemingly more concerned with finances.One study comparing interviews with persons who died within the year and interviews with those who survived the year revealed that the individuals closest to the time of their death showed a much greater interest in their immediate environment. This suggests that isolation is a great disservice to the dying. Denying the dying person access to others and to a normal, stimulating environment reduces the likelihood that he/she will be able to resolve his or her own departure with dignity. Isolation of the dying may be a reflection on the attitudes of younger professionals who are contemplating their own morality. None the less, isolation is a problem and must be addressed.5. DepressionMany factors can contribute to the development of depression. Often people describe one specific event that triggered their depression, such as the death of a partner or loved one, or the loss of a job through layoff or retirement. What seems like a normal period of sadness or grief may lead to a prolonged, intense grief that requires medical attention.The loss of a life-long partner or a friend is a frequent occurrence in later life. It is normal to grieve after such a loss. But it may be depression rather than bereavement if the grief persists, or is accompanied by any of the following symptoms:

• guilt unconnected with the loved one’s death
• thoughts of one’s own death
• persistent feelings of worthlessness
• inability to function at one’s usual level
• difficulty sleeping
• Weight loss.

Changes in the older adult’s sensory abilities or environment may contribute to the development of depression. Examples of such changes include:

• changes in vision and hearing
• changes in mobility
• retirement
• moving from the family home
• neighbourhood changes

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