Page 45 Box 4-1 Examples of normal age changes potentially misinterpreted as indicators of pathology Slight delay in reflex response

ponse Loss of hair in lower extremities Decreased spoken word recognition Reduced papillary response (bilateral) Decreased color discrimination

Box 4-2 Examples of indicators of pathology potentially misinterpreted as normal age changes Memory loss Incontinence Falling Sudden confusion Constipation

CASE STUDY from the textbook website: An 88-year-old World War II veteran: He ambulates using a cane that he obtained from the Veterans Administration Clinic to alleviate pain and stiffness in his knees. He is hard of hearing and does not have a hearing aid. He tells you, I am old and things are falling apart. All things break eventually and cannot always be fixed. A 69-year-old widow, a retired nursery school teacher: She tells you that she is pretty healthy, but her major problem is very embarrassing, and she is reluctant to speak about it. On further probing, she reveals that she has to urinate very frequently and sometimes wets herself before she gets to the bathroom. She states, I guess I am going to have to start wearing diapers like my friend did. An 89-year-old divorced woman: She reports that she has a boyfriend who lives in the same apartment building as she does. She reports that she has shrunk over the past few ages and is concerned that she is getting a hunched back like her grandmother had.

For each of the above participants: Which of the changes they described are normal age-related changes? Suggested Answers

88-year-old veteran: Hearing loss is a normal part of aging. Age-related changes affect the structure and function of the ear. Some hearing loss affects about one third of all adults between ages 65 and 74 and about one half of those between 75 and 79. More than 10 million older adults have hearing loss. Knee pain: Age-related changes in cartilage result from biochemical changes. As the cartilage dries, it becomes thinner, causing pain or less movement and pain when moving. Worn-down cartilage around joints causes slower and painful movement. 69-year-old widow: Frequent urination: The capacity of the bladder decreases significantly as one ages. 89-year-old divorced woman: Loss in height: Cartilage in the intervertebral disks shrinks and contributes to the loss of height.

Which are abnormal changes? Suggested Answers The 69-year-old widows complaint of involuntary loss of urine or incontinence is not normal aging. There are normal age-related changes such as a decrease in the capacity of the bladder that would lead to complaints of urinating more frequently, but incontinence is not normal.