Chapter 4

Physical Changes

Lecture guidelines

This chapter contains a great deal of information about specific aspects of the physical aging process. The purpose of the lecture is to present highlights of the most significant information so that students will know how to focus their efforts in reading and studying the chapter. The PowerPoint slides contain material from the text as well as additional graphics that further illustrate the age-related changes discussed in the chapter. Discussion in class can also focus on the psychological implications of normal age-related physiological changes. A goal of this section of the course is to encourage students to adopt some of the practices that are recommended within the category of "use it or lose it" (i.e. exercise). Students will also gain a more optimistic approach to the aging process if they see specific ways in which they can "control" their own rate of aging.

Videos and films

There are ample resources available to supplement these lectures. One outstanding video is the National Geographic program, “Inside the Living Body:” http://www.imdb.com/title/tt1086781/

You can also find videos of master athletes such as Charles Eugster (highlighted in the text). Students can also be assigned exercises in which they gather online material such as advertisements and news stories to share with the class.

Discussion questions:

Appearance

Why might people be concerned about the effects of aging on the face?

What evidence can you find from popular cosmetics products to support the notion that people are concerned about this aspect of the aging process?

Why do fair-skinned people in Western society place value on having a tanned appearance?

Why are people in our society so concerned about their hair turning gray?

What social factors make it difficult for men (and women) to experience hair loss?

Body build and mobility

Do you exercise on a regular basis? Why?

How could older adults be encouraged to exercise on a regular basis?

How much can loss of muscle strength be slowed by exercise?

Do some adults seem obsessed with muscle strength? Why do you think they are so obsessed?

What is the research evidence in favor of strength training as a way to compensate for sarcopenia?

What are the risks of bone loss in adulthood?

In addition to exercise, what other measures can people use to slow or compensate for bone loss?

What types of activities do young adults engage in that could lead to a higher rate of joint damage in later life?

What challenges exist in the environment of [insert names of closest city or town] that can make present problems for older adults with mobility issues?

Vital bodily functions

How do normal changes in the cardiovascular system affect the daily life of the middle-aged and older individual?

Given what is known about the negative effects of smoking on the respiratory system, why do you think people continue to engage in this bad habit? What about vaping?

Do you know people of college age who smoke (or do you)? How do you feel about this behavior when the effects of smoking are so widely known to be negative?

Given that age-related changes in the urinary system are relatively minor, why is it that the media portray older adults as suffering from incontinence by showing ads for diaper-like products?

Rather than teach people with urinary incontinence bladder control methods, why do health care practitioners have them use adult diapers?

Why are adult diapers given so much attention in the media when urinary incontinence affects only a

What are the psychological and social factors that can contribute to nutritional and digestive problems in older adults?

Bodily control systems

Which forms of hormone replacement therapy would you consider using?

Why is the menopause given so much negative attention by the media? How might this attention alter the way that women experience the menopause?

If you were a woman going through the menopause, would you consider estrogen replacement therapy? Why or why not?

Given the risks of testosterone replacement therapy, why is it considered by some people to be an attractive option?

With the complexity of the immune system and its interaction with lifestyle factors, how is it possible for researchers to separate the effects of aging from those due to cohort?

What are the implications of changes in the immune system for other areas of functioning in later adulthood?

Nervous system

How do brain imaging technologies help to advance the field of research on age changes in the nervous system?

Which model do you think has more support from the literature, the neuronal fallout or the plasticity model? Why?

Why is an older adult more likely than a younger adult to be a "morning person"?

Are you a morning or an evening person? How do you think your lifestyle as a college student affects your circadian rhythms?

If you were a clinician working with an older adult with sleep problems, what steps would you recommend to intervene? Would you prescribe sleeping pills? Why or why not?

Sensation and perception

What steps should public health officials take to ensure that older adults are not victims of extreme temperatures?

To what extent are temperature-related deaths due to normal aging and to what extent are they do to other factors including disease?

What are the implications of prevalence data on sensory impairments in later adulthood?

Do you know people who need to wear bifocals to correct their vision for presbyopia? How do they feel about wearing bifocals?

Do you know anyone who has had cataract surgery? What was the experience like?

Have you heard of macular degeneration prior to learning about it in this course? Why is such a common condition given such little attention?

Why have older adults traditionally been embarrassed about hearing loss and reluctant to wear hearing aids?

What effect on communication does hearing loss have for older adults?

What are the effects of prolonged exposure to loud music on the hearing of young people? Will we see an increase in hearing loss among this generation of young adults?

What steps can middle-aged and older people take to avoid falling?

Can you balance for a minute on one foot holding onto the other foot behind you? (Try this as a class exercise.) If not, this is something you should work on to improve your own balance.

Do you know any older people who have experienced loss of taste or smell sensitivity? How have these changes affected their daily lives?

How do changes in position and movement contribute to increased risk of falling in older adults?

Do older adults feel more or less pain than younger adults, and what factors seem to affect the willingness of older adults to state that they are in pain?

Look at physical situations that could present problems for older adults at risk of falling. How could these be improved to reduced this risk?

Multiple choice questions

AgeFeed

Cosmetic procedures

As reported in AgeFeed, in 2018 what was the total number of cosmetic procedures performed in the U.S.?

1. 4.2 million
2. 50,000
3. 180,000
4. 927,000

Why 55+ seek plastic surgery

As reported in AgeFeed, one of the primary reasons that individuals 55 and older seek plastic surgery in 2018 was reported to be:

1. feeling personally satisfied.
2. satisfying a spouse’s request.
3. rejoining the dating scene.
4. qualifying for a new job.

Appearance

Dermis layer

Changes with age in the _______ layer of the skin are associated with age-related alterations in collagen, a protein also found in connective tissue throughout the body.

1. epidermis
2. dermis
3. subcutaneous
4. elastin

Photoaging

The effect of ultraviolet rays on the skin, accelerating the process of wrinkling, is known as:

1. adrenopause.
2. dysthermia.
3. presbycusis.
4. photoaging.

Hair graying

The graying of the hair associated with aging is a result of changes in which pigment?

1. alopecia
2. melanin
3. keratin
4. melatonin

Tooth loss

By the age of 75, what percent of adults in the U.S. have lost all their natural teeth?

1. 19
2. 55
3. 26
4. 12

Flossing

Increased rates of flossing in contemporary adults is likely to be associated with which change in physical functioning?

1. Lower prevalence of tooth loss.
2. Higher rates of gum disease.
3. Fewer wrinkles in the mouth area.
4. Reductions in photoaging.

Androgenic alopecia

In the condition known as androgenic alopecia, middle-aged and older individuals experience:

1. thickening of the nails.
2. accumulation of age spots.
3. graying of the hair.
4. patterned hair loss.

Fat-free mass

Unless an individual exercises, he or she can expect to show a lowering of _________, or a measure of the proportion of body weight that includes muscle and bone.

1. basal metabolism
2. melatonin
3. fat-free mass
4. growth hormone

Mobility

Bone mineral content

The loss of height that often occurs in later adulthood is due primarily to which physiological change?

1. decrease in joint cartilage
2. thinning of epithelial cells
3. loss of bone mineral content
4. changes in elastin

Magnesium and bone loss

Research shows that foods high in _____________ can help minimize bone loss in later adulthood.

1. cholesterol
2. magnesium
3. potassium
4. sugars

Sarcopenia

A 79-year-old woman's exercise routine includes resistance training three times a week for an hour alternating with one-hour workouts on an elliptical machine. As a result, she will experience less of which particular age-related change in physical functioning?

1. photoaging
2. tinnitus
3. presbycusis
4. sarcopenia

BMI

The World Health Organization estimates that between 1975 and 2016, Americans increased in BMI from 25 to:

1. 27
2. 30
3. 33
4. 29

Recommended exercise

The American Heart Association recommends that adults engage in moderate exercise for how many minutes per week?

1. 300
2. 90
3. 150
4. 30

Stretching

Which type of exercise would be best to prevent damage to the joints in adulthood?

1. jogging
2. basketball
3. tennis
4. stretching

Safe work station

To maintain a safe working posture, researchers recommend that people whose work involves sitting at computers take which precautions?

1. use low-rise desks
2. keep feet off the floor
3. look up at their monitors
4. sit at chairs with back support

Difficulty: Moderate

Your friend’s great aunt shares with you the fact that she seems to be less able to lift weight than she could when in her 40s. She is experiencing which normal age-related change?

1. dysthermia
2. somatopause
3. anorexia
4. sarcopenia

Vital bodily functions

Plaque

The accumulation of _________ in the arteries of the cardiovascular system leads to lowering of blood flow across adulthood.

1. alveoli
2. muscle
3. plaque
4. minerals

Aerobic capacity

Normal changes in the cardiovascular system with age in adulthood are reflected in a lowering of which measure?

1. Triglycerides
2. Left ventricular thickness
3. Blood pressure
4. Aerobic capacity

Aerobic capacity loss

By the age of 70, the average person loses _____% aerobic capacity per decade:

1. 30
2. 20
3. 15
4. 5

Master athletes

One of the difficulties in interpreting the findings of research on aerobic capacity in master athletes is that these individuals:

1. do not reliably report their exercise habits.
2. are self-selected for high levels of fitness.
3. tend not to engage in healthy behaviors.
4. have higher average body weights.

Fitness trackers

Research shows that older adults most likely to use wearable technology in their daily lives tend to have:

1. poorer self-concepts.
2. high internal motivation.
3. greater risk of heart disease.
4. low bone mineral content.

HDLs

The so-called “good” type of cholesterol is called:

1. high-density lipoprotein.
2. trigylceride.
3. low-density lipoprotein.
4. monoglyceride.

Lung age

The concept of “lung age” uses what type of physical measurement in its calculation?

1. respiration rate
2. alveoli size
3. blood oxygen level
4. forced respiratory volume

Bladder control

A psychologist consulting in a nursing home, after observing daily routine tasks performed by staff, finds that few engage in behavioral treatment for incontinence among patients. Such treatment might include which measures?

1. Teaching residents to strengthen their pelvic muscles.
2. Encouraging residents to use adult diapers.
3. Asking family not to bring liquids when they visit.
4. Using “time-outs” when residents have accidents.

Bodily control systems

Nephron

The effect of aging on the excretory system reflects, in part, changes in which type of cell?

1. neuron
2. alveolus
3. nephron
4. B cell

Incontinence in women

Which of the following conditions appears to be related to incontinence in women?

1. height of over 5’8”
2. active participation in exercise.
3. low education
4. history of falls

Malnutrition

Malnutrition in older adults can be contributed to by which normal age-related change?

1. greater salivary production
2. overconsumption of fiber
3. less effective esophagus
4. higher levels of gastric juices

Somatopause

Normal changes in growth hormone and IGF-1 with age are referred to as the:

1. adrenopause.
2. melanopause.
3. perimenopause.
4. somatopause.

Melatonin

Older adults may take melatonin to offset age-related changes in which aspect of physical functioning?

1. efficiency of the immune system.
2. loss in ability to manage stress.
3. changes in sleep-wake cycles.
4. basal metabolic rate.

HRT

Researchers are concerned that hormone therapy for women during and after the menopause might increase the risk of:

1. cancer and deep vein thrombosis.
2. sexually transmitted diseases.
3. lowering bone mineral content.
4. memory declines.

Immune senescence

A study of “semisupercentenarians” suggested that resistance to ________________ could be an important factor in longevity.

1. glucose accumulation
2. immune senescence
3. T cell activity
4. overactive thyroid

Nervous system

Neural fallout

According to the _____________ model of aging, the nervous system of older adults is subject to inevitable declines.

1. neuronal fallout
2. CRUNCH
3. plasticity
4. hippocampal

CRUNCH model

According to the CRUNCH model of neural plasticity and aging, an older adult experiencing declines in some areas of the brain can make up by using which process?

1. Using more heavily the areas not affected by aging.
2. Switching from the right to the left hemisphere.
3. Relying more heavily on notepads and reminders.
4. Taking more frequent naps and rest periods.

PASA model

According to the PASA model of neural plasticity and aging, an older adult experiencing declines in the occipital (visual) cortex, located at the back of the brain, could compensate by using more of the ____________ region of the brain.

1. prefrontal cortex
2. right hemisphere
3. left hemisphere
4. subcortical

White matter hyperintensities

What information does the identification of white matter hyperintensities in the brains of older adults provide about the aging nervous system?

1. An understanding of the causes of age-related declines in brain tissue.
2. Knowledge about the effect of exercise on brain plasticity.
3. Demonstration of age-related changes in the brain’s electrical activity.
4. No specific connections to brain functioning have been demonstrated.

Circadian rhythm and aging

The investigators in a hospital-affiliated cognition and aging lab require that their assistants test older adults at certain times of day to lessen the impact on performance of age changes in circadian rhythm. What are the times of day that would preferentially benefit the older adult participants?

1. Mid-afternoon.
2. Late in the evening.
3. At or around noon.
4. Early morning.

Sleep habits and aging

Steps to improve an older adult’s sleep habits should include which actual behaviors?

1. Napping early in the afternoon
2. Avoiding a sedentary lifestyle
3. Relaxing before bed with an e-reader
4. Exercising early in the day

Hypothermia

In the period 2015 to 2017, the greatest increase in number of cold-related deaths, or hypothermia, occurred for which group of adults in the U.S.?

1. 65-74 years old in urban areas
2. 75 years and older in high-wealth counties
3. 85 years and older in rural areas
4. 25-34 years old in urban areas

Sensation and perception

Presbyopia

The age-related change known as presbyopia causes which change in the senses?

1. Loss of smell sensitivity.
2. Increases in ability to hear low-pitched tones.
3. Decreased ability to focus on near objects.
4. Greater tendency to experience back pain.

Presbyopia

Which part of the body is affected by normal aging to cause the condition known as presbyopia?

1. cochlea
2. thymus
3. retina
4. lens

Talking to older adult

If you are trying to make yourself heard to an older adult, communication experts recommend that you avoid the mistake of:

1. keeping your voice pitch low.
2. using child-like vocabulary.
3. use as little context as possible.
4. making eye contact.

Age-related macular degeneration

In the form of blindness known as age-related macular degeneration, individuals experience loss of vision in which part of the visual field?

1. central
2. periphery
3. right side
4. no one specific area

Age-related macular degeneration

Around the world, the fourth most common form of blindness is:

1. Age-related presbycusis.
2. Glaucoma.
3. Age-related macular degeneration.
4. Cataract.

Age-related macular degeneration

Which dietary substance is recommended to reduce the risk of an older adult for developing age-related macular degeneration?

1. beta-carotene
2. vitamin D
3. folic acid
4. potassium

Presbycusis

Changes with age in the tissue of the wall of the cochlea is associated with which form of hearing loss?

1. sensory presbycusis
2. tinnitus
3. metabolic presbycusis
4. vertigo

Tinnitus

Difficulty: Easy

The disorder known as tinnitus involves which symptom that can affect older adults?

1. ringing in the ears
2. watering of the eyes
3. feelings of dizziness
4. excessive dry mouth

Fall prevention

A new high tech company decides to focus its work on fall prevention for older adults. They begin with the simplest, “low-tech” method recommended by gerontologists of:

1. putting furniture in the middle of long hallways.
2. dimming the lights to prevent glare from windows.
3. providing handrails from halls and stairways in the home.
4. raising the thermostat so older adults don’t get cold.

Fall prevention

Exercises focusing on the _______ would be particularly helpful to prevent falls in older adults.

1. upper arms
2. core muscles
3. thighs
4. shoulders

Smell changes

The safety of older adults in the home can be affected by smell sensitivity, with ____% of individuals 70 and older having difficulty smelling the odor of natural gas.

1. 45
2. 15
3. 31
4. 22

Memory and back pain

A higher rate of memory loss appears related to which chronic physical condition often experienced by older adults?

1. taste insensitivity.
2. presbyopia.
3. chronic back pain.
4. glaucoma.

Short answer questions

Appearance

1. Summarize the major changes in the skin and hair.
2. Explain the major changes in height and weight in adulthood.

Body build and Mobility

1. Describe the major changes that occur with age in the muscles, bones, and joints.
2. Indicate next to each change what steps individuals can take to prevent or offset these changes.
3. Indicate for changes in bone what variations exist by sex and race.

Vital bodily functions

1. Describe the major changes in the cardiovascular system.
2. What are three effects of aerobic exercise on cardiovascular functioning? How do these effects differ by sex?
3. Summarize the effects of aging on the lungs.
4. What are the two most important changes in the urinary system?
5. What are the lifestyle and social factors that can contribute to changes in digestion in older adults?

Bodily control systems

1. Summarize the effects of aging on the seven major hormones in the endocrine system.
2. Compare the forms of hormone replacement therapy in terms of their demonstrated effectiveness and side effects.
3. What are the two major forms of immunity? Name the cells involved in each form of immunity.

Nervous system

1. Contrast the neuronal fallout and plasticity models of the aging nervous system.
2. What do the HAROLD and PASA models predict about aging and the brain?
3. What are the four major changes in sleep patterns and circadian rhythms in adulthood?
4. Name the four conditions that can interfere with sleep in older adults.
5. Describe four ways in which chronic medical conditions can interfere with body temperature control in later adulthood.

Sensation and Perception

1. What are three forms of blindness that become more common in later adulthood? What is the cause of each?
2. List three hearing problems that are more prevalent among older adults.
3. Describe eight strategies that are recommended for improving communication with an older person who has hearing loss?
4. List three ways that older adults can compensate for changes in balance to reduce the likelihood of a fall.
5. List five possible causes of reduced smell sensitivity in older adults.
6. Describe strategies that older adults can use to compensate for changes in smell and taste sensitivity.
7. Describe how changes in the somatosensory system can contribute to changes in balance to increase the older adult's risk of falling.

Essay questions

1. Describe an ideal exercise program that you would develop for older adults. Indicate which aspects of the program you would emphasize and how these would help to compensate for age-related losses in a variety of bodily functions.
2. How does the description of age-related changes in physical and sensory functioning relate to the theories presented in Chapter 2?
3. Critique the research methods that were used to obtain the majority of findings presented in the chapter. What improvements would you suggest in the research procedures used to determine the effects of aging on various bodily systems?
4. What do you believe are the most significant age-related changes in the body? Why are these so important?
5. What areas of functioning are most in need of further research on aging? What would be the theoretical implications of such research? What would be the practical implications of the findings derived from this research?
6. Take stock of the factors in your own environment that can create the greatest challenge for older adults (or anyone) with mobility issues. List five ways you would improve these features of the environment.