24th November 2023

Normal Ageing and its Impact 

The normal ageing process can be understood to impact each of the following components:

• Psychological, specifically:
  • Memory.
  • Attention.
• Physiological.
• Socio-economic. 

According to Cavanaugh et al., ageing is not a single process but rather 3 states:

1. Primary ageing – Defined as ‘normal disease free development during adulthood’.
2. Secondary ageing – Whereby developmental changes relating to disease, lifestyle and other environmentally induced changes occur which are ‘not inevitable’.
3. Tertiary ageing – The rapid losses occurring shortly before death.

Biological theories of ageing

Overall, it is understood that ageing is likely to comprise a combination of all of the themes set out by Woodford below:

• Hayflick’s limit – Supposes that cells have a finite number of divisions, which is determined by telomeres. The shortening of these non functioning areas of DNA at the end of chromosomes results in cells being capable of dividing a certain number of times (c.50) before this stops. Once they have reached the number of divisions possible, the ageing process commences.
• Free radical theory – Proposes that free radical production from aerobic cellular respiration produces damage to DNA, which, over time, accumulates in the process of ageing.
• Genetic variation – The interaction of genes and environment is likely to account for a significant portion of the variation in ageing between individuals.
• Hormonal decline – Linked with a decline in growth and sex hormone production with age.
• Disposable soma theory – Proposes that humans have finite resources to be used for the process of repair or reproduction.

Physiological changes in ageing

Important anatomical and physiological changes identified as humans age include:

• • 20% brain weight reduction (Nichols and Wilson, 2012).
  • 66% >65 years old have cerebral white matter changes noted on MRI (Woodford, 2010).
  • Increase in visual problems – 13% of over 75s are visually impaired.
  • Presbycusis (age related hearing loss) – noted to develop in 25% older adults.
  • Reduced sense of taste and smell.
  • eGFR reduction in the decade after age 40.
  • Slower gut motility leading to increased risk of constipation.
  • Reduced hepatic mass and blood flow.

Psychological impact of ageing

It is worth noting that cerebral white matter changes can occur in the absence of identified cognitive deficits. However, there are noted changes to memory, specifically working memory and processing speed, associated with advancing age.

• Reduced attention, especially in the context of divided attention.
• Reduced episodic memory.
• Increased prevalence of depression; more commonly, older adults express somatic symptoms in comparison to younger adults and can have implications for diagnosis.
  • This is noted despite evidence from ONS (2013), which reported that, on average, those of retirement age were more satisfied with life than younger adults aged 24-64.

As a consequence of the decline in attention and slowing of cognitive processing, older adults may struggle to process information immediately and may need the information to be given more slowly or repeated to better facilitate the processing.

Glisky (2007) proposed a ‘frontal lobe hypothesis’ of ageing, supposing that the decline in executive function seen in older adults is a key driver in cognitive decline. Evidence for this hypothesis is the noted reduction in volume and function of the frontal lobe seen in imaging studies with age

Social changes with age

Loss

Individuals may experience many different types of loss, including loss of their health, their wealth (especially in the period of time after retirement), and loss of loved ones or bereavement. There may also be a (real or felt) loss of a role or status in society.

The socioeconomic impact of ageing may be felt differently depending on a person’s culture and community. Loss of contact with friends, family and/or social standing can lead to isolation and loneliness and links with poorer health.

Psychological theories of role change

Three main theories were identified:

• Social disengagement theory – Based on the theory that there is a mutual disengagement between the individual as they age and society, which benefits both.
• Activity theory – Suggested as an alternative to social disengagement theory by Robert J Havinghurst, who argued that older people who are more active are more satisfied with their lives.
• Continuity theory – Proposed by Havinghurst, Neugarten et al., who argue that personality influences the roles chosen by an individual, and this is well established by old age. Linked with activity theory – an integrated personality adjusts well to ageing, which is evidenced by activity engagement.

Phases of retirement

According to Robert Atchley, there are a number of stages a person has to work through when faced with retirement. He based his ideas on ‘continuity theory’, which proposes that, rather than being a period of crisis, retirement is a period of adaptation.

Atchley identified 7 phases of retirement:

• Pre-retirement.
• Honeymoon.
• Disenchantment.
• Reorientation.
• Stability.
• Termination.

References

• John C Cavanaugh and Fredda Blanchard Fields: Adult Development and Ageing, (Cengage, 8th Edition, 2019).
• Stephen De Souza, Normal Ageing, Trainees Online (TRoN), available online at: https://www.rcpsych.ac.uk/training [Accessed May 2023]
• Henry Woodford, Essential Geriatrics, (Radcliff, Oxford, 2010), as quoted by Dr De Souza as above.
• Kapila Sachdev – Adaptations in Adult Life, Trainees online (TRoN), available online at: https://www.rcpsych.ac.uk/training [Accessed April 2023]
• Erik Erikson’s 8 Stages of Psychosocial Development. Available online at: https://simplypsychology.org/Erik-Erikson.html#trust [Accessed April 2023]
• Ego Identity – an overview. Sciencedirect topics. Available online at: ‘https://www.sciencedirect.com/topics/immunology-and-microbiology/ego-identity’ [Accessed Feb 2023]
• Thomas Armstrong, ‘The Stages of Ego Development According to Jane Loevinger’, American Institute for Learning and Development, (Jan 2020). Available online at https://www.institute4learning.com/2020/01/31/the-stages-of-ego-development-according-to-jane-loevinger/ [Accessed April 2023]
• Elliot Jaques, Death and the Midlife Crisis, (1965) quoted in Mark Jackson: ‘Life Begins at 40: the demographic and cultural roots of the midlife crisis’, 2019 Wilkins – Bernal- Medawar Lecture, (25th March 2020, https://royalsocietypublishing.org/doi/10.1098/rsnr.2020.0008)
• Bales et al., ‘What is a Pair Bond’, Hormones and Behaviour, vol 136, Nov 2021.
• Constitution of the World Health Organization. WHO. Available online at: https://www.who.int/about/governance/constitution [Accessed March 2023]
• Sree Prathap Mohana Murthy, SPMM Smart Revise, Revision Notes for Paper A
• Marinker M. Why make people patients? Journal of Medical Ethics 1975:I:81–4. quoted in Kenneth M Boyd, ‘Disease, Illness, sickness, health, healing and wholeness: exploring some illusive concepts’, Medical Humanities, (2000, 2:6, pp. 9-17) found at: https://mh.bmj.com/content/26/1/9.info
• Collier et al, Oxford Handbook of Clinical Specialities, 9th edition, (2013).