OLDER PEOPLE - PATTERNS OF ILLNESS, PHYSIOLOGICAL CHANGES AND

MULTIPLE PATHOLOGY

Good Practice

Distinguishing the accumulation of age related disease (morbidity) from true ageing is difficult.
An important aspect of management of older adults is to recognise and understand how body
systems are interlinked. Awareness of pathological and normal age-related physiological changes
will assist your assessments and help you decide on best management of older people.

Firstly, the reader is forbidden to approach this section with a feeling of impending doom.
Secondly, remember that not everyone experiences all mentioned issues, and those with
disabling conditions have often accommodated to the changes without too much of an impact on
their lifestyle.

In earlier life, the signs and symptoms of illness might be explained by a single diagnosis. In
older people, the number of active or inactive pathological processes might compromise both the
precise diagnosis as a basis of treatment, and include or be impacted on by a further disability.
Hence awareness of different pathological processes and of normal age-related physiological
changes will assist your assessment and management of older people.

Discussion Point

True ageing should be universal and observed in all older members of a species. It should be
intrinsic, that is, attributable to basic mechanisms innate to the organism and not exclusively due
to modifiable environmental effects. It should be progressive in that it is seen as a gradual
process of accumulated damage and decline. (Gershon and Gershon, 2000)

This decade-old statement still holds true. Before you read on either discuss these issues with
colleagues, or revisit earlier sections of the Resource Booklet to ensure you understand ageing
theories.

As we live longer, degenerative problems are becoming pre-eminent in older age and much of
health care practice falls within the category of longer-term / chronic' conditions. In many of
these conditions, by the time they manifest themselves a successful cure is elusive.
Distinguishing the accumulation of age related disease (morbidity) from true ageing is difficult.
Izaks and Westendorp[1] theorise a relationship between age and disease, placing them on either
side of a continuum and finding little to distinguish between them.

Certain commonly seen conditions are liable to be disregarded by the individual, relatives or by
the doctor as they develop slowly. For example, gradual onset of alterations in voice, in facial
appearance, cold sensitivity, lethargy and slowing may be easily attributable to the ageing
process that myxoedema (decreased activity of the thyroid gland) can be overlooked. Postural
changes, stiffness and restricted activity often considered a part of ageing may cause the rigidity
and bradykinesia of Parkinsons to be missed. Investigations are often provoked due to
comments from a visitor, especially one who has not seen the person for a long time and to
whom the changes are noticeable. It is useful to identify underlying mechanisms that lead to true
age related changes, as opposed to age related disease.

Altered responses to illness

Illnesses often present differently in old age than in youth. Regulation of body temperature is
unstable or less responsive, so pyrexia may not be as marked as would be expected even in
severe infections such as pneumonia, appendicitis or pyelonephritis. The converse, a lack of
awareness of cold, or of the capacity to react normally to it, may lead to hypothermia.

Delirium is characterised by an acute, fluctuating change in mental status with inattention and
altered levels of consciousness. Categories include hyperactive delirium, characterised by
agitation and visual hallucinations, as opposed to hypoactive delirium characterised by lethargy
and withdrawal. Precipitating factors including immobility, malnutrition, intercurrent illness,
dehydration and, stress of admission to hospital or other unfamiliar settings[2].

Pain is common in older people. However as people age, they complain less of pain. The reason
may be a decrease in the body's sensitivity to pain or a more stoical attitude toward pain. Some
older people mistakenly think that pain is an unavoidable part of aging and thus minimise it or do
not report it. Even in conditions that cause intense pain in earlier life (e.g. angina or fractures),
there may be so little discomfort, or pain is referred in such a bizarre way, that diagnosis is
delayed sometimes with fatal consequences. Pain is often not correctly recognised and treated
in people with dementia, and use of a scale such as the Abbey pain scale may help to recognise
when a person is in pain.

Response to drugs also alters with age (see section on Medication).

Recovery from illness is often slower, owing to inter-current infections or to the debilitating
nature of the condition. Conversely, some old people may make remarkable and quite
unexpected recoveries from severe mental or physical impairment.