Ageing and disease

In many older people, the ageing process is compounded by overt disease, which may affect functional capacity, quality of life and independence, cause frailty, a reduction in well being and independence and which may result in increased care and mobility needs.

Some of the commonest disease processes affecting older people are described below:

Nervous System (Physical)

• Parkinson's disease
• Strokes - paralysis/weakness
• Epilepsy often as a result of a stroke
• Mini strokes - TIAs

Nervous system (mental)

• Depression
• Memory (impaired or short term)
• Cognitive impairment (Alzheimer's, diffuse vascular disease)
• Confusion - acute or chronic
• Paranoia

Cardiovascular

• Ischaemic heart disease
• Peripheral vascular disease
• Aortic stenosis and Valvular heart disease
• Arrhythmias/such as atrial fibrillation)
• Varicose Veins

Skin

• Pressure sores
• Delayed wound healing
• Varicose ulcers
• Easy bruising

Immune System

• Increased prevalence of cancers
• Increased prevalence of autoimmune diseases
• Increased infection

Genitourinary

• Prostatic enlargement
• Incontinence (weak bladder)

Sensory (Eyes)

• Glaucoma & reduced visual fields
• Cataract
• Macular degeneration
• Retinopathy

Lungs

• COPD (Chronic bronchitis & emphysema) usually from smoking and mining
• Bronchiectasis
• Lung Fibrosis (Silicosis & Asbestosis)

Bones

• Osteoarthritis
• Rheumatoid Arthritis
• Joint problems
• Foot problems
• Osteoporosis and fracture

Metabolic

• Adult – onset diabetes (NIDDM)
• Thyroid disease - hyper or hypothyroidism

Incontinence

Many elderly people not only have problems with disturbance of urinary function but have problems with incontinence. It affects around 50% of residents in care homes [and is often a reason for institutionalisation because of the extra burden it imposes on carers] and around 30% living at home. It causes a great deal of embarrassment and can significantly limit the person’s lifestyle.

The four main types of incontinence are:

• Stress
• Urge
• Overflow
• Functional

Stress incontinence:

Urinating regularly to avoid a full bladder,

Kegel (pelvic muscle) exercises,

Oestrogen tablets or cream,

Surgical procedures (lift bladder and tighten bladder outlet).

Usually occurs in women, as a result of weakness of muscles in the pelvis or at the neck of the bladder. It results in leakage of urine in certain specific situations, such as when coughing, laughing, sneezing or during exercise. It tends to affect older women, particularly after the menopause and the tendency may be increased by stresses to the pelvic muscles during childbirth many years ago.

Urge incontinence:

Regular urination,

Pelvic muscle exercises,

Drugs to relax the bladder (such as Oxybutinin).

Is the result of instability of the bladder muscles, and is more common in older people. It results in an urgent need to pass urine at frequent intervals both day and night; incontinence results if there is delay in reaching a toilet or suitable receptacle. Urge incontinence may result from a problem with the bladder itself, or it may arise as a consequence of damage to the central nervous system and nerves controlling bladder function.

Overflow incontinence:

Surgery to treat a blockage,

Drugs to relax bladder outlet,

Manual pressure on abdominal wall,

Catheterisation.

Occurs when the bladder fails to empty completely; urine builds up and in the end overflows resulting in either intermittent or continuous dribbling. It may result from obstruction to the neck of the bladder, as occurs in older men due to enlargement of the prostate gland at the base of the bladder. It may also result from disease or injury of the brain or spinal cord, e.g. multiple sclerosis, traumatic paraplegia, which affects the nerves that control bladder function. In such cases there may be complete lack of control of bladder function.

Functional incontinence:

Regular toileting,

Physical and psychological support.

Is the passing of urine in inappropriate places. It may be a result of varying degrees of immobility, for example making it difficult or impossible for the person to reach a toilet or to manage their clothing. It may also be the result of disturbed mental function, e.g. dementia, severe behaviour disorders, in which normal awareness of acceptable social behaviour is lost.

These factors may be alleviated considerably with treatment.

Other useful links

• Effects of ageing
• Normal ageing
• Clinical features
• Effects of multiple conditions
• Side effects of treatment
• Case example

Other aspects of ageing

• Frailty
• Falls in older people