ADULT DEVELOPMENT AND AGING CHAPTER 4- PHYSICAL CHANGES

CHANGES IN THE SKIN

**Aging of the Skin:**

- **Overview:**

- Skin, the body's largest organ, undergoes age-related changes.

- Changes become visible from the 20s and continue throughout adulthood.

- Exposed areas (face, hands, arms) show the most noticeable marks of aging.

- **Epidermis (Outermost Layer):**

- Cells lose regular patterning over time.

- **Dermis (Middle Layer):**

- Connective tissue changes:

- Collagen undergoes cross-linking, making the skin more rigid.

- Elastin loses flexibility, leading to sagging.

- Sebaceous glands become less active, causing dryness.

- **Subcutaneous Fat Layer (Bottom Layer):**

- Thins in middle adulthood, providing less support.

- Blood vessels become more visible.

- **Skin Coloring:**

- Fair-skinned people develop age spots, pigmented outgrowths, and small blood vessels.

- Nails (part of the skin) also undergo age-related changes.

- **Face Structure Changes:**

- Bone loss in the skull, especially in the jaw, alters facial structure.

- Cartilage changes in the nose and ears.

- Muscles lose contraction ability, reducing smiling width.

- **Teeth and Eyes:**

- Teeth: Loss, yellowing, stains, and associated health effects.

- Eyes: Bags, crow's feet, dark pigmentation, puffiness, need for eyeglasses.

- **Genetic and Lifestyle Influences:**

- Fair-skinned individuals age more rapidly.

- Lifestyle habits, especially sun exposure, significantly impact aging.

- Sun exposure causes photoaging, accelerating skin changes.

- Harmful habits like smoking interact with sun exposure.

- **Preventive Measures:**

- Sunscreen with SPF of at least 15, blocking UVA and UVB light.

- Use of antiaging products with proven clinical effectiveness.

- Moisturizers with active ingredients, SPF-15, and UVA/UVB protection.

- Antiaging treatments like Botox injections, artificial fillers, laser resurfacing, and
microdermabrasion.

- **Future Trends:**

- Increasing availability of products simulating professional antiaging interventions.

- Ongoing advancements in affordable, effective, and convenient options for facial aging.

**Hair Changes with Aging:**

- **Graying of Hair:**

- Hair doesn't literally turn gray; pigmented hairs decrease, and non-pigmented hairs increase.

- Gray hair results from slowing and ceasing melanin production.

- By age 75 or 80, virtually no naturally colored hairs may remain on the scalp or body.

- Rate of graying varies among individuals.

- **Thinning of Hair:**

- Visible thinning occurs in both men and women.

- Hair loss due to the destruction of germination centers in hair follicles.

- Androgenetic alopecia is a common form, affecting 95% of adult men and 20% of adult women.

- Results in the production of short, fine, unpigmented vellus hair.

- **Hair Growth Patterns:**

- Hair loss pattern differs between men and women.

- Androgenetic alopecia leads to the cessation of terminal hair production.

- **Unwanted Hair Growth:**

- Hair may grow in undesired areas like chin, ears, and eyebrows.

- Various products and treatments, from topical minoxidil to herbal remedies and hair plugs, are
available.

- Pharmaceutical solutions, like oral finasteride (Propecia), are prescription alternatives.

- **Research and Future Prospects:**

- Ongoing research by pharmaceutical companies to find solutions for baldness.

- Products stimulating hair growth and melanin production improvements expected in the future.

- No definitive 'cure' for gray hair or baldness, but advancements in treatment options are likely.

**Changes in Body Build and Composition:**

**Height Changes:**

- Cross-sectional and longitudinal studies show that people get shorter as they age, more
pronounced in women.

- Loss of bone material in the vertebrae leads to a decrease in height.

- Decreases in disk height may be compensated by increases in adjacent vertebra heights.

**Body Shape Changes:**

- Body's lean tissue or fat-free mass (FFM) decreases with age.

- Body Mass Index (BMI), calculated by dividing weight (in kg) by height (in meters squared), reflects
body composition.

- Ideal BMI is between 18.5 and 24.9 according to the Centers for Disease Control and Prevention.

- Upside-down U-shaped trend in body weight in adulthood.

- Weight gain until mid-50s, followed by a tendency to lose weight, especially in the 60s and beyond.

- Weight gain during middle adulthood is often due to increased BMI, representing fat accumulation
around the waist and hips (middle-aged spread).

- Weight loss in later life is more likely due to muscle loss than fat loss, impacting physical
functioning.

- Obese individuals entering later life are at a higher risk of physical decline.

**Global Trends:**

- World Health Organization estimates show an increase in BMIs globally from 1975 to 2016.

- Even countries with historically low BMIs, like Ethiopia, have seen an increase.

- Exercise can offset some aging impacts on body build and composition.

**Exercise and Aging:**

- Exercise can help offset the impact of aging on body build and composition.

- Regular physical activity, including strength training, can maintain muscle mass and bone density.

- Maintaining an active lifestyle is crucial for overall health and well-being throughout adulthood.
**Conclusion:**

- The perception of being 'grown up' is dynamic; bodies continue to change in size and shape
throughout adulthood.

- Height decreases, body composition changes, and weight trends are influenced by factors like BMI,
fat accumulation, and muscle loss.

- Lifestyle choices, particularly exercise, play a significant role in mitigating the impact of aging on
body build and composition.

**Exercise for Older Adults:**

**Benefits of Resistance Training:**

- Resistance training has shown positive effects on body fat percentage, lean mass, and quadriceps
strength in older adults.

- Obese older adults may experience less favorable improvements compared to those with normal
weight or overweight.

**ACSM/AHA Exercise Guidelines for Older Adults:**

- American College of Sports Medicine and American Heart Association recommend specific amounts
and forms of exercise for older adults.

- Guidelines should be adjusted to meet the individual needs of older adults.

**Adaptations for Functionally Limited or Chronically Ill Older Adults:**

- For older adults with functional limitations or chronic conditions, low-intensity and short-duration
activities are recommended initially.

- Individualized progression of activities is crucial, and strength or balance training may precede
aerobic training until sufficient strength is gained.

- Even if the minimum recommended activity level is not achievable, some form of physical activity is
encouraged to avoid sedentary behavior.

**Adaptive Exercise Strategies:**

- Chair aerobics can be prescribed for older adults with impaired balance and mobility.

- Balance training can include progressively difficult postures, dynamic movements, and exercises
performed with eyes closed for those with mobility issues or a history of falls.

**Psychological Benefits of Exercise:**

- Exercise, even in small doses, has positive effects on both physiological and psychological well-
being.

- A 6-month exercise training study showed a decrease in social physique anxiety (fear of others'
perceptions of one's body) and improved feelings of fitness and self-efficacy (confidence in
completing physically demanding tasks) in older adults.

- Psychological well-being and confidence about appearance during exercise influence the level of
involvement in physical activity.

**Conclusion:**

- Tailored exercise programs for older adults, considering individual needs and health conditions, are
crucial for reaping the full benefits of physical activity.

- Psychological well-being and confidence are positively influenced by regular exercise, contributing
to a more active and healthier lifestyle in older adults.

MOBILITY

**Mobility and Muscles in Aging (Continued):**

**Bone Health:**

- Aging affects various components of mobility, including bones, muscles, tendons, and ligaments.

- Changes in gait during later adulthood involve slowing, impaired balance, reduced lower extremity
strength, and a fear of falling.

- Foot problems impact a significant percentage of older adults, leading to pain and limitations in
daily activities.

- Older adults tend to walk more slowly, compensating with longer steps, which may affect their
ability to predict crossing times.
**Muscle Loss and Sarcopenia:**

- Aging leads to a progressive loss of muscle mass, known as sarcopenia.

- Fast-twitch muscle fibers, crucial for speed and strength, decrease in number and size.

- Muscle strength peaks in the 20s and 30s, plateaus until the 40s to 50s, then declines at a rate of
12% to 15% per decade, with more significant decreases in men.

- Muscular endurance is retained, but disrupted nervous system signals and stiffer tendons
contribute to muscle strength decline.

- Sarcopenia is associated with increased fall risk, mobility limitations, and reduced quality of life.

- Sarcopenic obesity may occur, combining muscle loss with body fat gain.

**Preventing Sarcopenia:**

- Strength training with free weights or resistance machines is a crucial preventative measure.

- Even short programs (e.g., 16 weeks) can build fast-twitch muscle fibers, with benefits seen in
adults into their 90s.

- Effective strength training involves 8 to 12 weeks, three to four times per week, at 70% to 90% of
the one-repetition maximum.

- Consistent exercise is necessary to maintain benefits, and resistance training offers cardiovascular
improvements.

**Benefits of Muscle Training:**

- Stronger muscles exert more pull on bones, contributing to bone strength.

- Strength training positively impacts overall health and well-being in older adults.

**Bones and Bone Health in Aging:**

**Dynamic Nature of Bone:**

- Bone is a living tissue that undergoes constant remodeling, with old cells being replaced by new
cells.
- In adulthood, there is an increase in the rate of bone destruction compared to renewal, leading to
greater porosity of the calcium matrix and loss of bone mineral content.

- Sex hormones, estrogen for women and testosterone for men, influence the bone remodeling
process.

**Age-Related Changes in Bone:**

- Aging results in a decrease in bone mineral content, estimated at about 0.5% per year for men and
1% per year for women.

- Women in their 50s may experience higher rates of bone loss (3% to 5% per year).

- Microcracks develop in response to stress, increasing bone susceptibility to fractures.

- Loss of collagen reduces bone flexibility, particularly in areas with less mechanical pressure, such as
the upper part of the thigh bone.

**Factors Influencing Bone Health:**

- Genetic factors and lifestyle choices, including mobility and weight, impact bone loss.

- Lifestyle interventions can offset age-related changes in bone strength, such as engaging in exercise
(both aerobic and resistance), not smoking, and maintaining a balanced diet.

- Adequate dietary protein, calcium, vitamin D, magnesium, and carotenoids contribute to bone
health.

- Resistance training with weights is particularly effective in slowing the rate of bone loss.

- Starting a resistance training program before menopause is important for minimizing bone loss
after menopause.

**Environmental Factors:**

- Climates with sharp demarcations between seasons may contribute to earlier onset of bone loss.

**Benefits of Maintaining Bone Health:**

- Methods to reduce bone loss not only improve physical functioning and mobility but also have
potential longevity benefits.

- People with stronger bones may experience a mortality advantage, independent of other health
measures.
The information emphasizes the importance of proactive measures, including lifestyle choices and
resistance training, to maintain bone health and overall well-being in older adults. If you have any
specific questions or if you'd like to explore another topic, feel free to let me know!

**Joints and Joint Health:**

**Early Changes and Degeneration:**

- Joint changes begin even before reaching skeletal maturity in late adolescence.

- By the 20s and 30s, articular cartilage protecting the joints starts to degenerate.

- Fibers in the joint capsule become less pliable, reducing flexibility.

**Impact on Joints in Adulthood:**

- Joints, especially the knees, may experience greater impact in women starting in their 40s.

- Stress and repeated use cause joints to wear out more rapidly.

- Joints become less flexible, leading to increased difficulty in moving affected limbs, hands, and feet.

- Extreme joint pain and loss of mobility are associated with musculoskeletal diseases that become
more prevalent in later life.

**Exercise and Joint Health:**

- Joints do not benefit from constant use; stress and repeated use can accelerate wear and tear.

- To protect joints and benefit from exercise, focus on strengthening muscles supporting the joints
and increasing flexibility in tendons and ligaments.

- Caution is needed to avoid overuse-related joint pain, especially in individuals exercising for other
health benefits.

- Lowering body fat through exercise is essential, as obesity contributes to joint pain, stiffness, and
loss of cartilage volume.

**Cardiovascular System and Aging:**

**Components of the Cardiovascular System:**

- Includes the heart, arteries (circulating oxygenated blood away from the heart), and veins
(returning blood to the heart).

- Aging impacts the heart muscle and arteries, with veins relatively spared.

**Changes in the Left Ventricle and Arteries:**

- Aging affects the left ventricle's ability to contract efficiently, impacting blood distribution through
the arteries.

- Arteries undergo changes, accommodating less blood flow due to the formation of plaque,
composed of cholesterol, cellular waste, calcium, and fibrin.

**Cardiovascular Efficiency Measures:**

- Cardiovascular efficiency is assessed by aerobic capacity (maximum oxygen delivery) and cardiac
output (amount of blood pumped per minute).

- Decline in aerobic capacity averages 5-10% per decade between 20 and 70 years.

- Exercise, particularly at high intensity, in early life can improve chances of maintaining fitness into
later adulthood.

**Exercise and Cardiovascular Health:**

- High-intensity exercise in middle-aged and older adults slows the decline in aerobic capacity.

- Masters athletes maintain lower body weight and high physical functioning into later years.

- Short-term training studies show benefits, even for previously sedentary individuals.

- Cognitive functioning can also improve with exercise.

**Cholesterol Metabolism:**

- HDLs (good cholesterol) transport lipids out of the body.

- LDLs (bad cholesterol) transport cholesterol to the arteries.

- Moderate exercise has beneficial effects on cholesterol metabolism.

- Endurance athletes with a long-term active lifestyle show the greatest benefits.
**Lifestyle Factors:**

- Cigarette smoking negatively impacts cardiovascular health and increases inflammatory markers in
the blood.

- Wearable technology allows individuals to track workout intensity and daily steps, promoting
motivation for healthy habits.

**Conclusion:**

- While aging brings cardiovascular changes, exercise is a powerful preventive and compensatory
measure.

- Regular aerobic exercise is crucial in slowing down the aging process and maintaining cardiovascular
health.

**Respiratory System and Aging:**

**Function of the Respiratory System:**

- Brings oxygen into the body and removes carbon dioxide.

- Involves breathing, a mechanical process conducted by structures like the diaphragm and chest wall
muscles.

- Gas exchange occurs in the air sacs (alveoli) within the lungs.

**Effects of Aging on the Respiratory System:**

- Aging affects all components of the respiratory system.

- Respiratory muscles lose elasticity, hindering chest wall expansion and contraction.

- Lung tissue becomes less flexible during inspiration.

- Age-related losses in lung function start around age 40, more severe in women.

**Breathing Difficulties and Exercise:**

- Changes in the respiratory system can lead to breathing difficulties, potentially limiting older adults'
exercise capacity.
- Aging contributes to lung age, indicating how much the respiratory system has aged based on
spirometer measures.

- Smoking is a significant risk factor; quitting or avoiding smoking helps preserve respiratory function.

**Strategies to Minimize Aging Effects on Lungs:**

1. **Quit Smoking:** Smoking accelerates age-related declines in lung function. Even after quitting,
some damage persists, but quitting remains beneficial.

2. **Exercise:** Strengthens chest wall muscles, improving lung flexibility and function.

**Conclusion:**

- Aging brings about changes in the respiratory system, impacting lung function.

- Avoiding or quitting smoking is crucial for preserving respiratory health.

- Regular exercise, particularly focusing on chest wall muscles, is an effective strategy to minimize the
effects of aging on the respiratory system.

**Precautions for Joint Health:**

- Reposition work desks to minimize pressure on upper limbs, back, and feet.

- Wear appropriate shoes in high-impact sports or exercises to protect lower extremities.

- For women, choose supportive shoes over high, spiky heels to promote better joint health.

**Preventive Measures in Young Adulthood:**

- Taking precautions in young adulthood can reduce the risk of developing joint pain later in life.

- Consider workplace ergonomics to minimize pressure on joints.

- Protect lower extremities by wearing suitable shoes during high-impact activities.

- Opt for supportive footwear, particularly for women, instead of high heels.

**Aging and the Urinary System:**

**Function of the Urinary System:**

- Primary role: Excretion of waste through urine.

- Key components: Kidneys, bladder, ureters, and urethra.

- Kidneys house nephrons, acting as tiny filters for metabolic waste.

**Age-Related Changes in the Urinary System:**

1. **Kidneys:**

- Decreased filtration rate in nephrons.

- Altered blood flow and reduced urine concentration ability.

- Compromised functional reserve, affecting stress responses.

- Prescription dosage adjustments for medications in older adults.

2. **Bladder:**

- Changes in elastic tissue affecting urine retention and expulsion.

- Altered perception of the need to urinate.

- Prostate enlargement in men leads to frequent urination urges.

**Urinary Incontinence:**

- Affects ~30% of adults aged 65 and older.

- Types: Urge incontinence (sudden urge to urinate), stress incontinence (leakage during physical
exertion).

- Prevalence varies by age and gender.

- Linked to factors like health, mobility, hormone replacement therapy, weight, falls, and heart
disease.

**Psychological Impact:**

- Overactive bladder and incontinence may cause psychological issues.

- Symptoms: Depression, sleep difficulties, sexual dysfunction, embarrassment, shame, and self-
blame.

**Treatment Options:**

- Various treatments available.

- Misconceptions about bladder dysfunction as a normal aging process may deter seeking treatment.

- Treatments include medication, exercise, and behavioral control.

- Behavioral controls: Monitoring fluid intake, regular bladder emptying, and pelvic floor exercises.

- Medications aim to reduce bladder contractions, often used with behavioral treatment.

**Conclusion:**

- Aging impacts the urinary system, affecting kidney function, bladder elasticity, and perceptions
related to urination.

- Urinary incontinence, common in older adults, can be effectively treated through behavioral,
exercise, and medical interventions.

- Understanding age-related changes in the urinary system is crucial for optimal healthcare in the
elderly.

**Female Hormonal Changes and Menopause:**

**Menopause and Climacteric:**

- Menopause: Permanent cessation of menstruation.

- Climacteric: Gradual decrease in reproductive capacity.

- Perimenopause: 3- to 5-year transition to menopause.

- Menopause officially declared after 1 year without menstruation, typically around 50 years.

- Factors influencing timing: nutrition, smoking; average age is 50.

**Hormonal Changes:**

- Decline in estrogen production from ovarian follicles.

- Progesterone levels decrease with declining ovulation.

- Estrogen decline starts around mid-30s, ovaries less effective by mid-40s.

- Menstrual cycles cease in early to middle 50s.

- Ovaries and adrenal glands still produce small amounts of estrogen.

- FSH and LH levels rise during perimenopause.

**Symptoms of Menopause:**

- Hot flashes: Sudden intense heat and sweating.

- Physiological symptoms: Fatigue, headaches, night sweats, insomnia.

- Psychological symptoms: Irritability, mood swings, depression, memory loss, difficulty

concentrating.

- Variability in symptom experience among women.

**Reproductive Tract Changes:**

- Lower estrogen levels result in reduced blood supply to the vagina.

- Thinner, drier tissues with less lubrication during intercourse.

- Possibility of discomfort during intercourse.

- Negative societal attitudes may affect sexual functioning.

**Effects on Other Bodily Systems:**

- Weaker bones, increased risk of high blood pressure, cardiovascular disease.

- Changes in cholesterol levels, higher risk of atherosclerosis.

- Estrogen provides protection against these conditions but is lost at menopause.

**Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT):**

- Introduced in the 1940s to counteract negative effects of estrogen loss.

- HRT includes both estrogen and progestin to reduce cancer risk.

- Initial studies suggested positive impacts on various aspects of health.

- Debates emerged in 2002 regarding the risks of HRT, including breast cancer and blood clots.

- In 2015, the UK's National Health Service extensively documented risks and benefits.

- Women considering HRT should consult health professionals and consider form (oral vs.
transdermal).

**Alternatives to HRT:**

- Locally administered vaginal creams with estrogen.

- Lifestyle changes: Exercise, quitting smoking, lowering cholesterol in the diet.

- Moderate alcohol consumption (one drink a day) as a potential countermeasure.

Understanding the hormonal changes and associated symptoms in menopause is crucial for women's
health, and individualized approaches should be considered based on consultation with healthcare
professionals.