Care of the Older Person


Older persons present health providers with a myriad of unique challenges. While aging is inevitable, it is related to the loss of functionality across many organs. However, the rate of declines or susceptibility to becoming frail varies significantly among individuals. Comprehensive geriatric assessment is one of the most appropriate means of evaluating aging. Other standardized mobility performance measures are emerging to be reliable and robust predictors of frailty and vulnerability during aging. Besides, aging can be evaluated from cognition, multiple morbidity, social isolation, nutrition, and continence. These facets can be evaluated along the continuum of physiological, psychological, and social aspects of aging.

Physiological, Psychological, and Social Aspects of Aging

A gradual decline in the physiological processes is one of the hallmarks of aging. It often leads to reduced efficiency in the homeostatic capacity of the body. The physiological aspects of aging include cardiovascular physiology, endocrine physiology, renal physiology, fluid balance, gastrointestinal physiology, and blood and immune system. In aging, the basal heart rate barely changes; however, there is a reduction in its maximal capacity to be elevated in response to stress or exercise. This is caused by a decline in the intrinsic sinus rate and reduced sensitivity to catecholamines. Aging is also associated with increased stiffness of the ventricles, leading to diastolic failure (Kuchel, Robison, and Fortinsky, 2012). Consequently, older individuals are more to congestive heart failure, especially when they use cardiotoxic medications such as doxorubicin.

Another physiological aspect of aging is reducing pulmonary compliance, which is associated with a decline in expiratory flow rates. The respiratory drive of the lungs also drops upon aging and combined with the reduction in the mucosal clearing. Older individuals are more vulnerable to pneumonia. Insulin sensitivity also diminishes upon aging. This contributes to reduced glucose tolerance and a predisposition to type 2 diabetes. The level of growth hormone in blood and estrogen, androstenedione, and testosterone also drop during aging. The reduction in these hormones is responsible for reduced resilience to multiple challenges in older individuals. The renal function also declines in old age, which is observed in the rate of tubular excretion, glomerular filtration, and renal plasma flow. Besides, the potency of antidiuretic hormone and aldosterone to react appropriately to salt and fluid balance fluctuations gets impaired (Kuchel, Robison, and Fortinsky, 2012). Consequently, the person becomes less efficient in retaining sodium and excreting excess fluid.

Old individuals demonstrate a decline in salivary flow rates as well as the protective mechanisms of the mucosa. As a result, mucositis, oral caries, and dry mouth are prevalent, especially when these individuals are given chemotherapeutic and anticholinergic agents, which tend to destroy the mucosal membranes. Gastric acid release in the stomach declines significantly in old age and affects the individual’s capability to retrieve vitamin B12 from foods. The decline in prostaglandin synthesis elevates the risk of gastritis, more so when nonsteroidal anti-inflammatory agents are used (Kuchel, Robison, and Fortinsky, 2012). Besides, there is a reduction in intestinal motility and gastric emptying efficiency, which contributes to the increased risk of constipation and reflux.

Aging also comes with changes in the psychological functioning of the body. However, it is not associated with various mental illnesses such as depression and anxiety. Regardless, there is a marked reduction in the size of the brain and neuronal loss. While these changes occur gradually throughout an individual’s life, the effects are more pronounced in old age. Some parts, such as the cerebral cortex, remain fairly adaptable and facilitate ongoing emotional and cognitive development despite the reduced brain size. While they reduce recall and cerebral processing, the difference is balanced by the accumulated experiences and knowledge. In addition, there is a decline in various memory types, including working memory, episodic memory, declarative memory, and recollection. Other memory types barely affected by aging include non-declarative memory, semantic memory, and familiarity (Kuchel, Robison, and Fortinsky, 2012). The memory deficits emerge from changes in sensory perception and reduced potency for information processing.

There are variations in the social aspects of aging from the perspective of ethnicity, race, age group, and gender. These variations affect the types of social relationships and social support individuals have in old age. Social relationships for old individuals are experienced within family setups, workplaces, and involvement in voluntary groups. Most of the older adults in the country are either married or widowed, which depicts the family’s significance as a social unit for old individuals. Older men are close to their spouses and turn to them for social support.

On the other hand, women turn to their adult children and other relatives for social and emotional support. Besides, the social circle of old individuals diminishes as they retire from their workplaces. This is because workplaces offer some of the most meaningful social relationships for most people. Old people engage in volunteer activities as a lifelong endeavor to maintain social interactions (Kuchel, Robison, and Fortinsky, 2012). They associate this with various positive health outcomes such as reduction in depressive symptomatology, increase in self-reported health status, and enhanced physical function.

Global and National Demographic Trends

Nowadays, people live longer, which is also true in Ireland, where life expectancy has increased significantly in the last 100 years. In 2019, the population of people 65+ years in Ireland was 696,300, and this is expected to rise to 1.56 million by 2051. Life expectancy is now 80.4 years for men and 84.0 years for women. A 65-year man in Ireland expects to live another 12.5 years without health-related problems, 66 percent of their average life expectancy. A 65-year woman expects to live another 13.4 years without health-related problems, which is 63 percent of their average life expectancy. A third of the individuals 65+ years in Ireland have long-standing health complications. (Eurostat, 2017). Thirteen percent of individuals 65+ years in the country smoke, and 39 percent report low physical activity. Older individuals on the lower-income level are more likely to have lifelong health limitations than those with higher income levels; the gap in life expectancy for the two groups is five years for men and 4.5 years for men (Public health. i.e., 2021).

At the global level, there are 703 million individuals with 65+ years by 2019. The number is predicted to increase to 1.5 billion by 2050. survival beyond 65 years has been on the increase across the globe. At the moment, a person who is 65 years expect to live 17 more years, and by 2050, that figure will have risen to 19 years. In Europe and Latin America, older individuals rely heavily on public transfers. In countries where public transfers are limited, older persons rely heavily on assets, common in the United Kingdom, United States, and Southern Asia. Globally, women have more longevity than men, resulting in a predominantly female older population (UN.org., 2021). The role of older persons is influenced by the cultural beliefs and social norms surrounding the aging process. For instance, in Japan, older adults have more positive social relationships than those in the United States (Karasawa et al., 2011). The Japanese older individuals report a higher score in personal growth than a midlife period, which can explain why the population in Japan is predominantly aging.

Range of Services Available to Older People

There is a range of services available in Ireland for the care of older persons. Among the services that the Health Service Executive (HSE) provides include home support service and public health nursing. Caregivers of older persons may qualify for a carer’s support grant, allowance, and carer’s benefit. Besides, older persons who employ caregivers are eligible for tax relief to reduce the overall cost. The individuals also qualify for a medical card to get health services free of charge. Besides, there is an income tax relief for all individuals aged 65 years and above. Also, older persons who move into registered nursing homes are eligible for financial support from HSE under the Nursing Homes Support Scheme. Some of the areas covered by HSE have devised a scheme of boarding out older persons in private homes (Citizensinformation. i.e., 2021). The home support scheme helps older persons in Ireland to continue living in their homes by giving them the necessary support. For instance, they help them with everyday tasks such as moving in and out of bed, dressing, and bathing.

Role of Statutory and Voluntary Agencies

All statutory and voluntary agencies in Ireland are mandated to promote a positive attitude to aging. In the past, older persons were viewed as sick, non-contributors to societal wellbeing, and dependent on the welfare system. However, in recent years, the attitude has changed to portray older persons as healthy and financially secure persons who use state benefits that they can afford to pay. The attitude of the older individuals is that they contribute to the economy by being consumers and producers and contribute to societal wellbeing through families as parents, grandparents, and volunteers. All statutory and voluntary agencies are expected to promote activities that discourage age discrimination from dispelling age-related stereotypes (Dcu. i.e., 2021). They also promote awareness of the significance of intergenerational harmony

Recommendation for Service Improvement for Older Persons

It is imperative that the welfare of older persons continues to be addressed. Their quality of life can be improved further by encouraging the media and opinion-makers to positively image aging to society. Besides, the creation of advocacy services that assist older persons in accessing support and activities they may need could go a long way to enhancing the quality of their life. Policy developers should also consider the needs and preferences of older persons during policy development, and they can do this by including the older individuals in the process.

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