Top 10 Geriatric Syndromes: Fall SPECIALS

Many people are living long healthy lives but there are many normal changes that occur due to the aging process and several common problems which present in older individuals. Most elderly individuals are having an increased life expectancy and there is predicted to be an explosion of the older population. Understanding what the expected changes due to normal aging are, as well as what are not expectations, will help individuals and those who care for older individuals develop a more appropriate plan for lifestyle and healthcare. A significant number of older adults will eventually develop one or more of a group of related medical problems referred to as ‘Geriatric Syndromes’. These syndromes are a cascade of problems in an elder’s health and revolve around vision and hearing problems, elimination issues, dizziness, falls, and cognitive impairment including delirium as well as dementia (such as Alzheimer's disease). These syndromes can limit a person’s ability to carry out basic daily activities, may threaten independence, and can diminish quality of life as well as lead to death. These syndromes can be referred to as Fall Specials:

l  Falls

l  Sleep

l  Pain

l  Eating problems

l  Constipation

l  Incontinence (Urinary)

l  Anxiety (Cognition problems including Dementia and Depression)

l  Living abilities (Activities of Daily Living-ADLs)

l  Skin Integrity Issues

The next several posting will address each of these syndromes individually.

Taste

There are thousands of taste buds on a person’s tongues as well as on the sides and roof of the mouth. Aging causes the taste buds to begin to disappear from the sides and roof of the mouth, leaving taste buds mostly on an individual’s tongue. The remaining taste buds eventually become less sensitive. These are called papillae, and there are four kinds of them: fungiform and filiform on the front half, and foliate and vallate on the back. The actual taste buds cluster together in packs of two to 250 within the papillae (Lembert, 2000).  The changes in an older person's sense of smell further changes the ability to taste foods. Taste buds decline with age with the ability to taste sweets declining first, followed by salty, then bitter, and last sour (Changes in Taste, 2009).

Sense of Smell

The sense of smell diminishes to some degree in aging individuals. The olfactory receptors are directly exposed to the outside environment, with their only protection of a thin layer of mucus, making them relatively susceptible to damage from such exogenous agents such as viruses, bacteria, pollutants, and airborne toxins. Moreover, since the axons of the olfactory receptor cells extend through the foramina of the cribriform plate to synapse within the olfactory bulb of the central nervous system (CNS), they are extremely vulnerable to shearing and tearing from movement of the brain relative to the cranium. Smell cells (along with taste cells) are the only sensory cells that are regularly replaced throughout a person's life span. There is an age-related decrease in the ability to identify or recognize different smells. And as an individual’s sense of smell diminishes, their ability to taste foods diminishes since smell enhances one’s ability to taste foods.

Skin changes with aging-

An elderly person’s skin thins with time, becoming less elastic, more fragile, and possibly leading to an increase in bruising. There is a deceased production of natural oils causing skin to be a bit drier and more wrinkled. An older individual may perspire less, making it harder to stay cool in high temperatures. Hair may gray and thin. The nails grow at about half the pace as when younger, age spots can occur, and skin tags are common. Sun exposure over the years is a significant factor in how fast the skin ages, smoking adds to skin damage, and both of these factors can increase an individual’s chances of developing skin cancer. Skin cancer is the most common type of cancer in the United States with evidence that 40 to 50% of individuals after the age of 60 years will have skin cancer. 

Physiological Changes to the Integumentary System: ·         Loss of subcutaneous fat and thus loss of dermal and epidermal thickness (less padding-prominent in the areas around the eyes) ·         Dermal blood vessels closer to the surface of the skin ·           Atrophy of sweat glands·                  Decreased oil production of the skin ·         Slower skin repair and wound healing ·         Increased incidence of skin tags ·         Increased incidence of skin cancer

(Kane, Ouslander, Abrass, & Resnick, 2009)

HEALTH PROMOTION: Tips to keep skin healthy include:

• Avoid sun exposure, especially between 10 a.m. and 3 p.m.
• Use sunscreen
• Wear protective clothing
• Avoid artificial tanning
• Check skin often for discolorations and any new moles as well as changes in existing moles
• Use lotions to moisturize skin