Chapter 2: How the Body Changes With Age

A Common Situation

A man in his sixties has started to spend more time with his father, who is in his late eighties and lives alone. The son notices many small things that are new to him. His father keeps the television very loud and often asks him to repeat what he has said. His father wears a thick jumper on a mild day and still says he is cold. He takes the stairs slowly, one hand on the wall. At dinner his father adds a lot of salt and says the food "has no taste these days". The son is not sure which of these things are simply part of growing old and which might be a sign that something is wrong. He also wonders how he can make his father's days a little easier.

Questions like these are very common. Our bodies change throughout life, and in later life some of these changes become easier to see. Most of them happen slowly, over many years, and most people learn to live with them well, especially when the home and the daily routine are adjusted a little. This chapter describes the usual changes that nursing and care textbooks explain: in the eyes and ears, taste and smell, skin, muscles, bones and balance, the heart and breathing, digestion and thirst, the bladder and sleep. For each one, it shows how the change may appear at home and offers simple ways to help. It also explains an important difference: the difference between slow change, which is usual, and sudden change, which is worth telling a doctor or nurse about.

Seeing, Hearing, Taste and Smell

The eyes change with age in ways that almost everyone notices. From middle age, most people find it harder to see small things up close, which is why so many people begin to use reading glasses. In later life, the eyes usually need more light to see clearly, take longer to adjust when moving from a bright room into a dark one, and are more easily dazzled by glare, for example from a shiny floor or a low sun. Colours may seem a little less bright, and it can be harder to tell similar shades apart, such as dark blue and black, or the edge of a pale step against a pale floor.

At home, these changes can show up in small ways. A person may stop reading the newspaper, misread the labels on food, or hesitate at the top of the stairs at dusk. Simple steps make a real difference. More light helps, especially in hallways, on stairs, in the kitchen and in the bathroom, and a lamp beside a favourite chair makes reading easier. Light that is even and without glare is kinder to older eyes than one bright bulb. Clear contrast helps too: a coloured mug on a white table, or a strip of contrasting colour on the edge of a step. Glasses should be clean, within reach and the ones the person was given for that purpose. Regular eye checks are worth keeping, and any sudden change in sight is worth telling a doctor about straight away.

Hearing also changes. Many older people first lose some of their ability to hear high sounds, such as some voices, birdsong or a doorbell. Speech may sound clear enough in a quiet room but turn into a blur in a busy place, at a family meal or with the radio on. Because of this, a person with some hearing loss may seem confused or uninterested when in fact they simply did not hear. They may also withdraw from conversation, since it takes so much effort to follow. A common moment is when a family thinks that an older relative "is not listening" when the real problem is noise in the room.

There are gentle ways to help. Turn off the television or radio when you talk. Face the person, in good light, so that your lips and expression can be seen. Speak clearly and a little more slowly, without shouting, because shouting can distort words. If the person has a hearing aid, it helps to keep it clean, to check that it is working and to encourage the person to wear it every day. Hearing checks are worth keeping too. Chapter 4 looks more closely at talking and listening, including how to make conversation easier when hearing or sight has changed.

Taste and smell often become weaker with age. Food may seem bland, which is why some older people add extra salt or sugar, or lose interest in meals. A weaker sense of smell has a safety side as well: a person may not notice that food in the fridge has gone bad, that something is burning on the stove, or that there is a smell of gas or smoke. Checking the fridge together now and then, keeping a working smoke alarm and using dates on food containers are simple, respectful ways to help. Herbs, spices, lemon and colourful food can make meals more inviting without needing more salt. Chapter 7 returns to meals and appetite in detail.

The sense of touch can change as well. Some older people feel heat, cold and pressure less clearly than before, especially in the hands and feet. This matters in everyday life, because a person may not notice that bath water is too hot, that a hot-water bottle is burning the skin, or that a shoe is rubbing the foot. Small habits protect against these risks. Check the temperature of bath and shower water with your own wrist or elbow before the person steps in, wrap any hot-water bottle in a cover and keep it away from direct contact with the skin, and look at the feet now and then for red marks, small cuts or blisters. Soft, well-fitting socks and shoes help too. A wound on the foot that does not heal is worth showing to a nurse or doctor.

Skin, Muscles, Bones and Balance

The skin becomes thinner, drier and less elastic in later life. It also has less of the soft layer of fat beneath it, which normally protects the body and keeps it warm. Thin skin bruises and tears more easily, and small wounds may take longer to heal. This is why an older person may have a bruise and not remember how it happened. Dry skin can feel itchy, especially in winter or after hot baths. Gentle washing with warm rather than hot water, patting the skin dry instead of rubbing, and using a simple moisturising cream if the person likes it all help to keep the skin comfortable. Chapter 8 explains skin care, including how to protect the skin of someone who sits or lies down for long periods.

Many older people also feel the cold more. The body produces less heat, the protective layer under the skin is thinner, and the sense of being too hot or too cold may be weaker. This means that an older person may be cold without fully noticing it, or may stay in a room that is too hot. Layers of light clothing, warm socks and a blanket on the knees are easy ways to help. It is worth keeping the home at a comfortable temperature, especially the rooms where the person sits and sleeps. On hot days, offering drinks often and keeping the person in a cool, shaded room is just as important. Many carers find it helpful to ask the person directly, "Are you warm enough?", and also to touch the back of a hand or the neck gently, since the person's own feeling may not always be a reliable guide.

Muscles lose some of their strength and size with age, especially when they are not used. This is one of the most hopeful facts in this chapter, because it means that activity makes a real difference at any age. Walking, standing up from a chair several times a day, carrying light things and doing gentle exercises suggested by a doctor or therapist all help the muscles to keep their strength. In daily life, weaker muscles may show up as difficulty rising from a low chair, opening jars or climbing stairs. A firm chair of a good height, with arms to push up from, can make standing much easier. Chapter 6 explains how to help someone move safely.

Bones also change. In later life, bones usually become thinner and less dense, so they break more easily if a person falls. Joints may become stiff or sore, especially in the morning or after sitting for a long time. Many people find that their joints move more easily once they have warmed up, so a slow start to the day is often kinder than a rush. A warm shower, a gentle walk around the room or a cup of tea while sitting before dressing can help. If a joint becomes suddenly swollen, hot or very painful, that is worth telling a doctor about.

Balance depends on many parts of the body working together: the eyes, the inner ear, the nerves in the feet, the muscles and the brain. Because several of these change with age, balance often becomes less steady, and reactions become a little slower. Some older people also feel dizzy for a moment when they stand up quickly, especially after lying down or sitting for a long time. A good habit is to sit on the edge of the bed for a short while before standing, and to stand still for a moment before starting to walk. Well-fitting shoes with good grip also help. Falls are the most common accident at home for older people, and Chapter 5 is given to making the home safe and easy.

Reactions in general tend to become a little slower with age. It may take an older person longer to take in what is happening around them, to decide what to do and to move. This is usually not a problem in a calm room, but it matters in busy or fast situations: crossing a road, stepping onto a moving escalator, finding the right coins at a shop counter while others wait in line, or answering a question asked quickly in a noisy room. Rushing an older person often makes mistakes and falls more likely, and it can also make the person feel foolish. Allowing more time, choosing quieter moments for outings and waiting patiently for an answer are simple ways to respect this change. Many older people manage very well when they are allowed to go at their own pace.

The Heart, Breathing, Digestion and the Bladder

The heart and lungs usually work well enough for everyday life in later years, but they have less in reserve. This means that an older person may manage ordinary activities comfortably while becoming tired or out of breath sooner when the effort is greater, such as climbing several flights of stairs, walking uphill or carrying heavy shopping. Rest takes a little longer to work, too. In daily life, it helps to plan the day with this in mind: heavier tasks at the time when the person has most energy, a chair to rest on halfway along a walk, and no hurry. A slower pace is not a sign of weakness. It is a sensible way to use energy well.

Breathlessness that comes on with ordinary effort, when it did not before, is worth telling a doctor or nurse about. So is swelling in the ankles that is new, or a cough that does not go away. Chest pain, or sudden difficulty breathing, is different: in that case, call the emergency number at once. It is not the carer's task to judge what such signs mean. The carer's task is simply to notice them and to tell the right person. Chapter 11 explains how to work with doctors and nurses, and which signs mean calling the emergency number.

Digestion becomes slower with age. Food moves more slowly through the bowel, and many older people have problems with constipation, which means passing stools less often or with difficulty. Less movement during the day, drinking too little and eating little fibre can all make this worse. Fruit, vegetables, wholegrain foods, enough drinks and gentle activity are the everyday basics that care textbooks teach. Some older people also feel full sooner and prefer smaller meals more often during the day. Changes in appetite or weight, or in bowel habits that last, are worth mentioning to the doctor.

One of the most important changes to understand is that the sense of thirst often becomes weaker with age. An older person may not feel thirsty even when the body needs water. At the same time, the kidneys may become less good at holding on to water. Together, these changes mean that older people can become dehydrated, which means short of water in the body, more easily than younger people. Dehydration can make a person tired, dizzy, constipated and sometimes confused. For this reason, care textbooks teach a simple habit: offer drinks regularly through the day, rather than waiting for the person to ask. A glass of water by the chair, a cup of tea with every visit and a jug the person can see are easy ways to start.

The bladder changes too. In later life, the bladder often holds a little less, and the signal that it needs emptying may come later and more urgently. This means that many older people need to use the toilet more often, including at night, and may need to get there quickly. Some people respond by drinking less, hoping to avoid accidents, but this can make things worse, because urine that is too strong can irritate the bladder, and drinking too little brings the problems of dehydration. A clear, well-lit path to the toilet, clothes that open easily and regular visits to the toilet help a great deal. Chapter 9 looks at the toilet and continence with care and respect.

Sleep, and Slow or Sudden Change

Sleep usually changes in later life. Many older people sleep more lightly, wake more often during the night and wake earlier in the morning. Some feel sleepy earlier in the evening and like a short rest during the day. Waking at night to use the toilet is also common. These changes are usual, and many older people feel well rested even though their sleep is different from when they were young. A regular routine, daylight in the morning, some activity during the day and a calm evening all help. Chapter 10 looks at sleep, rest and the shape of the day.

Now we come to one of the most useful ideas in this chapter. Most of the changes described here happen slowly, over months and years. A person who gradually needs more light to read, or who slowly takes longer on the stairs, is usually showing the ordinary signs of a body that has lived a long time. Sudden change is different. When something changes over a few days or hours, such as a person who was walking well and now cannot, a person who was clear in their thinking and now seems very confused, or a person who suddenly stops eating or drinking, it is worth telling a doctor or nurse. Sudden and serious signs, such as sudden weakness on one side, trouble speaking, chest pain or trouble breathing, mean calling the emergency number.

Care textbooks explain that illness in older people does not always look the way it does in younger people. An infection, for example, may not bring a high temperature at all. Instead, the first sign may be that the person becomes unusually tired, confused, unsteady or unwilling to eat. A fall can also be a first sign that something has changed in the person's health. This is why the carer's knowledge of the person's usual self is so valuable. You may be the first to notice that something is not quite right, even if you cannot say exactly what it is. "My mother is not herself today" is useful information for a doctor or nurse.

A simple care notebook helps with this. You might write down the usual things: how far the person walks, how much they usually drink, when they usually sleep, and how they usually are in the morning and in the evening. When something changes, write that down too, with the date. This does not need to be complicated or time-consuming. A few words a day are enough. When you speak with a doctor or nurse, these notes help you describe what has changed and since when. Chapter 11 explains how to keep and use such a notebook.

It also helps to remember that the changes of aging are different for every person. Some people in their nineties walk every day and read without glasses, while others in their seventies need help with many things. Health, life history, activity, illness and many other things all play a part. This is another reason to look at the person in front of you, rather than at their age. Families who stay curious about the person, asking "What helps you?" and "What is hard for you now?", often find the best answers. The older person is the expert on their own body, and their own words are the best guide.

Finally, it is worth saying that the body in later life still has many strengths. It can still grow stronger with use, still heal, still enjoy food, warmth, music, touch and company. Many of the changes described in this chapter can be made easier with small adjustments: more light, a slower pace, regular drinks, warm layers, a firm chair and a clear path at night. These adjustments are not signs of giving up. They are ways of making the home fit the person, so that the person can go on living well in it.

A Question to Think About

Which one small change in the home or in the daily routine, such as brighter light, a drink offered more often or more time for the stairs, might make the biggest difference to the comfort of the person you care for this week? You might ask the person what they would choose, and try that one change together before thinking about the next.