Over the past decades, scientific inquiry into the phenomenon of aging has produced extensive literature. Of great fascination is the mechanism that underlies aging process. From a biological perspective, aging takes a life course when an individual grows to maturity. During this phase in life, aging is not felt as a remarkable biological course due to the excitement that occurs during young age. However, the ageing coincides with explicit biological changes, especially the aspect of physical decline. It is this phase of ageing that has attracted the interests of both scientists and gerontologists. Scientists are focused on understanding the biology of aging. Biological studies indicate that ageing involves biological pathways such as the regulation of genes, metabolism and cellular signaling (López-Otín et al., 2013; Newgard & Pessin, 2014). These pathways play integral roles in controlling how the human body works including response to infection, stress, as well as recovery from injuries. On the other hand, gerontologists are concerned with the aspects of aging, in order to distinguish normal aging from disease. The task here involves establishing a clear boundary between normal aging and age-related health problems which have, for long, been considered as part of aging. For instance, the association of change in personality, especially during old age has been found to be an independent construct that does not have a significant relationship with normal ageing (National Institute of Health, 2015). In this respect, this paper provides a critical discussion on aspects of normal ageing, when combined with a chronic disease, may contribute to the development of disability, iatrogenic illness and geriatric syndromes, as well as elucidating the nurse’s role in limiting this risk. This topic has immense implications to clinical practice. Foremost, ageing is associated with chronic illnesses. Additionally, some aspects of ageing exhibit interplay with chronic illnesses to cause devastating health consequences such as disability, iatrogenic illness and geriatric syndromes. Therefore, nursing care should focus on addressing chronic illnesses, as well as preventing the development of disability, iatrogenic illness and geriatric syndromes. As such, this essay discusses how the combination of normal ageing aspects with chronic illnesses may lead to these adverse health conditions using the case of diabetes.
Impact of Diabetes on Aged Adults
In definition, diabetes is a chronic metabolic disorder that is associated with hyperglycemia (Chentli, Azzoug & Mahgoun, 2015). It is reported to have the highest prevalence and mortality among older adults. As such, Kirkman et al. (2012) cites ageing of the global population as a significant risk factor of diabetes epidemic. Consequently, the combination of ageing with diabetes increases the risk of disability, geriatric syndromes and iatrogenic disease. Evidence indicates that diabetes in old adults leads to geriatric syndromes such as cognitive dysfunction (Punthakee et al., 2012). On the other hand, diabetes in older adults has been found to cause disability due to falls, fractures and visual impairment (Kirkman et al., 2012). Similarly, normal ageing and diabetes increase the risk of iatrogenic disease due to polypharmacy. In most cases, polypharmacy causes drug-disease or drug-drug interactions which result into adverse health outcomes (Onder et al., 2013; Huang et al., 2010).
Ageing and Body Changes
Overall, the mechanisms of ageing are associated to the novel changes that occur in the body, both at cellular and molecular levels. These cause changes in the way tissues, organs and organ systems carry out their biological functions. Therefore, it is possible to elucidate an array of aspects of normal ageing, in order to define their relationship with age-related health problems. In retrospect, there are several aspects of normal ageing, when combined with diabetes, may contribute to the development of disability, iatrogenic illness and geriatric syndromes. Some of these aspects of normal ageing include tissue changes, physical decline, cognitive decline, decreased skeletal strength, visual impairment, and reproductive health decline.
Tissue change during ageing is the most explicit aspect of normal ageing that has significant health implications. From a biological perspective, mammalian cells undergo several biological mechanisms that ensure that all tissues have functional cells to carry out their biological functions. Therefore, tissues are rejuvenated with new cells through a constant replacement of the old tissue cells. At the cellular level, several mechanisms underlie the process of cell ageing. This process occurs at different rates depending with the nature and function of the cells involved. As such, cell ageing occurs differently from the ordinary molecular ageing. Ideally, molecular ageing involves a significant decline in cellular activity, as well as structural changes, rather than the replacement of old cells with new ones. In this context, it is worth elucidating significant tissue changes that are associated with normal ageing. Ordinarily, ageing is known to affect the function of organs, a phenomenon that may increase the risk of chronic illnesses. This explains why chronic illnesses are highly prevalent among the elderly population compared to the other age groups. In most cases, elderly people experience more than one chronic illness. These illnesses are related to other age-related health conditions such as geriatric syndromes and iatrogenic illness.
Hardening of the Blood Vessels
One of the tissue changes with devastating health consequences during the process of ageing is the hardening of the blood vessels. Anatomical studies indicate that ageing is accompanied by changes in the blood vessels. For instance, blood vessels in the heart have been found to lose their elasticity as one grows old. Additionally, fatty deposits accumulate on the coronary blood vessels. This tissue change is of great concern because it increases the risk of heart disease. From a biological perspective, build up of fatty deposits in the blood vessels leads to the formation of plaques, a phenomenon referred to as atherosclerosis. This is the hardening of the arteries which interferes with the laminar flow of blood, especially in the coronary arteries. In adult diabetic patients, the development of atherosclerosis increases the risk of hypertension and other cardiovascular diseases. Evidence from biomedical studies indicates that atherosclerosis serves as the main cause of hypertension, coronary heart disease, heart attack, as well as other cardiovascular conditions. In the elderly, blood vessel tissue changes increases the risk of suffering from cardiovascular diseases. On the other hand, atherosclerosis or rather hypertension is associated with stroke. This explains why most old people are suffering from stroke compared to other populations. Therefore, the combination of this phenomenon with diabetes leads to the development of disability. It is apparent that stroke accounts for a high percentage of disability among the elderly. Global epidemiological data show that stroke is among the chronic conditions that are causing disability (Chappell & Cooke, 2010).
Renal Function Decline
Ageing is also known to influence renal function. Ordinarily, renal function declines with age due to changes in the renal tissue. In most cases, this characteristic decline in renal function raises health concerns, especially in patients with diabetes. Renal failure is one of the complications of diabetes. It has emerged as one of the most challenging health issues among the old diabetic people. Therefore, the combination of renal function decline with diabetes raises concerns among gerontologists. Foremost, renal failure in diabetic patients increases the risk of drug-induced iatrogenic disease. In turn, renal failure increases the incidence of drug-disease, or drug-drug interactions leading to the development of iatrogenic disease. Second, renal failure in diabetic cases leads to catheterization, which in turn increases chances of infection. As a result, treatment for such infections increases the risk of drug-induced iatrogenic disease.
Decreased Elasticity of the Gut Muscles
Finally, changes in the gut tissues during ageing affect the health of old people. Ageing is known to be accompanied by decreased elasticity of the gut muscles. It is also accompanied by a gradual decline in the production of digestive enzymes, as well as gastric secretions that enhance food digestion. These normal changes affect the integrity of the gut, including decrease in food absorption, gastric emptying time and intestinal microbial balance. This is why most old people develop an array of digestive disorders. In the event these normal ageing changes combine with diabetes, the affected people experience an increased risk of iatrogenic disease. Diabetes is associated with metabolic problems including digestion and absorption of food nutrients from the gut. Therefore, the decline in gut function in old people is associated with digestive problems which increase the use of drugs. In turn, drugs used to treat digestive disorders may cause drug-induced iatrogenic disease. In one prospective study, the use of laxatives was found to be associated with falls (Bloch et al., 2010).
Physical decline is also a significant aspect of normal ageing. Biologically, physical decline is characterized by a gradual decrease in mobility or physical activity. Ageing is usually accompanied by a gradual decrease of muscle activity. As a result, decreased muscle activity, especially skeletal muscles which are involved in movement leads to a slowdown in old age. This aspect of normal ageing demonstrates why people in old age are not as active as they were during their adolescent and early adulthood. In the athletic career, ageing is known to slowdown runners. This is why age is considered as one the main determinants of success in sports competitions. Therefore, physical decline is a key aspect of normal ageing. Unfortunately, occurrences of chronic illnesses during ageing, especially those which affect skeletal muscles’ activity have devastating health consequences to the elderly. For instance, the combination of physical decline with diabetes creates a physical challenge to the elderly. In most cases, diabetes causes physical mobility difficult resulting to disability. Similarly, diabetes related complications such as diabetic foot and neuropathy increase the risk of disability in old people due to the effects of physical decline. Biologically, the rate of bone formation decreases with age. This is why osteoporosis is quite prevalent among people aged over 50 years. Therefore, the combination of physical decline with diabetes may lead to the development of disability among the elderly. In practice, the occurrence of multiple chronic diseases serves as one the key risk factors for iatrogenic disease. Therefore, the treatment of diabetes in old people has been found to exacerbate the development of other chronic conditions. According to Permpongkosol (2011), the use of non-steroidal anti-inflammatory drugs in the treatment of inflammation as it is the case in diabetes and arthritis may precipitate chronic gastric irritation as it is the case with ibuprofen. As a result, the treatment and management of these chronic conditions may lead to the development of iatrogenic disease.
Cognitive decline is another aspect of normal ageing which, when combined with some chronic illnesses may lead to the development of disability. Initially, it was perceived that the occurrence of sudden personality changes such as becoming withdrawn, depressed, or cranky was an aspect of normal ageing. However, extensive studies on this aspect by scientists are revealing the biochemical basis of personality changes in old people (National Institute of Health, 2015). Surprisingly, evidence indicates that personality changes during ageing are attributable to pathological consequences. Based on the results of the Baltimore Longitudinal Study of Aging (BLSA), ageing is accompanied by gradual cognitive changes which are attributable to the loss of brain volume. Therefore, scientists in this study conclude that sudden personality changes during ageing reveals the onset of a mental health disorder. Therefore, gerontologists are concerned with the relationship between cognitive decline during ageing and mental health illnesses. For instance, it is likely that the combination of cognitive decline with diabetes related neuropathy may lead to the development of disability. According to epidemiological evidence, dementia accounts for a significant portion of disability cases during ageing. As reported by Chappell and Cooke (2010), mental impairment serves as one of the leading causes of disability among the elderly.