Chapter Objectives

• Describe the physical, emotional and social changes associated with ageing
• Discuss the positive and negative outcomes of the ageing process
• Develop a personalized goal for healthy aging

Growing Older

“Beautiful young people are accidents of nature, but beautiful old people are works of art.”  ~Eleanor Roosevelt.

“We don’t stop playing because we grow old; we grow old because we stop playing.”  ~George Bernard Shaw. 

Signs and Symptoms of Ageing

We can all describe physical attributes that may signal to us that someone is “old”. Maybe these include gray hair, wrinkled skin or a strange obsession with music from the 1970’s. These ageing individuals may also seem to have more time to devote to hobbies and better financial security. Changes associated with ageing can be broken into 3 categories: Physical, Emotional, and Social.

Physical Changes Associated with Ageing

Menopause is commonly associated with the female ageing process. This is the point that the female body is depleted of viable eggs to the point that follicular changes to the ovaries affect the hormonal regulation of the mensural cycle.

Perimenopause

The earliest changes occur during the menopausal transition, referred to as perimenopause, when a women’s cycle becomes irregular but does not stop entirely. Although the levels of estrogen are still nearly the same as before the transition, the level of progesterone  is reduced. This decline in progesterone can lead to abnormal growth, or hyperplasia, of the endometrium. This condition is a concern because it increases the risk of developing endometrial cancer. Two harmless conditions that can develop during the transition are uterine fibroids, which are benign masses of cells, and irregular bleeding. As estrogen levels change, other symptoms that occur are hot flashes and night sweats, trouble sleeping, vaginal dryness, mood swings, difficulty focusing, and thinning of hair on the head along with the growth of more hair on the face. Depending on the individual, these symptoms can be entirely absent, moderate, or severe.

Menopause

Female fertility (the ability to conceive) peaks when women are in their twenties, and is slowly reduced until a women reaches 35 years of age. After that time, fertility declines more rapidly, until it ends completely at menopause. Menopause is the cessation of the menstrual cycle that occurs as a result of the loss of ovarian follicles and the hormones that they produce. A woman is considered to have completed menopause if she has not menstruated in a full year. After that point, she is considered postmenopausal. The average age for this change is consistent worldwide at between 50 and 52 years of age, but it can normally occur in a woman’s forties, or later in her fifties. Poor health, including smoking, can lead to earlier loss of fertility and earlier menopause.

Post Menopause

After menopause, lower amounts of estrogens can lead to other changes. Cardiovascular disease becomes as prevalent in women as in men, possibly because estrogens reduce the amount of cholesterol in the blood vessels. When estrogen is lacking, many women find that they suddenly have problems with high cholesterol and the cardiovascular issues that accompany it. Osteoporosis is another problem because bone density decreases rapidly in the first years after menopause. The reduction in bone density leads to a higher incidence of fractures.

Hormone therapy (HT), which employs medication (synthetic estrogens and progestins) to increase estrogen and progestin levels, can alleviate some of the symptoms of menopause. In 2002, the Women’s Health Initiative began a study to observe women for the long-term outcomes of hormone replacement therapy over 8.5 years. However, the study was prematurely terminated after 5.2 years because of evidence of a higher than normal risk of breast cancer in patients taking estrogen-only HT. The potential positive effects on cardiovascular disease were also not realized in the estrogen-only patients. The results of other hormone replacement studies over the last 50 years, including a 2012 study that followed over 1,000 menopausal women for 10 years, have shown cardiovascular benefits from estrogen and no increased risk for cancer. Some researchers believe that the age group tested in the 2002 trial may have been too old to benefit from the therapy, thus skewing the results. In the meantime, intense debate and study of the benefits and risks of replacement therapy is ongoing. Current guidelines approve HT for the reduction of hot flashes or flushes, but this treatment is generally only considered when women first start showing signs of menopausal changes, is used in the lowest dose possible for the shortest time possible (5 years or less), and it is suggested that women on HT have regular pelvic and breast exams.

Cognitive Changes Associated with Ageing

Cognitive changes can also be seen in the aging process and often begin around the age of 60 (though can be seen earlier.) Cognitive change as part of the natural ageing process has been well researched and documented. Some cognitive abilities, such as vocabulary, are resilient to aging and may even improve with age. Other abilities, such as conceptual reasoning, memory, and processing speed, decline gradually over time.

Age-Related Cognitive Decline: Women are More Resilient than Men

Emotional Changes Associated with Ageing

In addition to the hormonal and cognitive effects of perimenopause on a women’s emotional balance, other factors associates with ageing may impact wellbeing in this area:

• fewer responsibilities associated with child rearing
• becoming a grandmother
• more time to dedicate to personal causes or hobbies
• changes in physical appearance

Social Changes Associated with Ageing

One could argue that social changes to the aging progress for women have had the most drematic changes in later generations. Women now (more than in generations past) have has long term careers which bring friendships and financial assests seperat from a partner. The following factors may bring about social changes as women age:

• financial security
• time to travel with or spend time with friends
• romantic relationship stability or stagnation
• friends passing on
• changes to independent living

Planning for Healthy Ageing

Lifestyle choices can have a significant impact on an individuals physical, mental and emotional health as they age. Actions can start well before middle age to improve quality of life in the “golden years” such as:

• Eating a balanced diet
• Maintain a healthy body weight
• Daily physical activity
• Exercise aimed to strengthen the heart and other muscles of the body
• Properly manage health conditions
• Stay mentally active
• Family history of age related illnesses
• Make and maintain healthy social connections
• Financial planning

An an individual approaches retirement age they may want to also consider the following:

• Health benefits and Medicare
• Senior assistance programs
• Retirement and financial resources
• Staying connected to the community
• Managing medications and treatments for chronic illness
• Driving challenges for older adults
• Age related hearing and vision changes
• Emotional and social support

Check for Understanding

1. What are some of the physical, cognitive, social and emotional changes associated with ageing?
2. What are some positive outcomes of the ageing process?
3. What are some challenges associated with ageing?
4. What behaviors can a person manage early in life to improve likelihood of a positive aging experience?
5. What is one goal you could se not to improve your health in 20-40 years?