Twin Contributors to the Physiology of Ambulatory Wellbeing and Falls Prevention in Ageing Populations: Functional Senescence and Abnormal Pathological Change

Introduction

With increasing numbers of older adults living beyond the age of 65 years, so too is there a corresponding increasing number of falls in the home, which constitute the most significant number of injuries in adults of this specific age group (Moreland, Kakara and Henry, 2020). Statistical analysis reveals that the risk of falls increases exponentially with age, which can lead to potentially long term issues and challenges with the maintenance of ambulatory wellbeing as a consequence of resultant physical disability or impairment, and consequently contributes to poorer outcomes in quality and longevity of life (Tornero-Quiñones et al, 2020). Fatalities arising as a consequence of falls in those aged over 65 years and can be attributed to up to one third of all accidental deaths in this age group (Mielenz et al, 2020). These rates of mortality are largely preventable in relation to those necessitating long term care within nursing home and residential care settings (Drake et al, 2021). It is the normal processes of senescence, which impact on the physiological decline of ageing adults (Katsuumi, 2018; Faragher, 2017). Being able to accommodate and account for these within complex individual physical and social care provides a sound rationale for the integration of falls prevention strategies in the overall health continuum for older adults, where modifications can be made to prevent risk of future falls (Khong et al, 2017). Since once an older adult has fallen once, they are statistically two thirds more likely to fall again over the next 12 months, this can be a significant means of avoiding elevated rates of morbidity and mortality in this age group (Bartosch et al 2020; Gazibara et al, 2017). This chapter constitutes a theoretical contribution to the gerontology of ageing, so that the target audience can potentially develop a comprehensive knowledge and understanding of the physiological processes of senescence. For those professionals seeking to align strategic interventions with what is practically achievable remains one of the greatest challenges in this field of gerontology (Schapmire et al, 2018; Skinner, Andrews and Cutchin, 2017). Encouraging active and healthy processes of ageing not only benefits individual members of society, it has wider economic implications for health services, which deal with the implications of normal physiological senescence as greater numbers of older adults live into old age and, as a consequence of this, are more likely to live with morbidities which impact on their ambulatory health and wellbeing (Alcañiz, and Solé-Auró, 2018).

Functional senescence is part of a normal process of physiological ageing. This encompasses the gradual deterioration of the organs and systems of the body alongside a progressively decreasing capacity for function by the body’s processes of homeostasis (He and Sharpless, 2017). In terms of finality, the process of senescence leads to progressive dysfunction and eventual death. The fact that this is a normal trajectory for the ageing body also provides an insight into how disease and ageing synergistically contribute to the acceleration of death in older adults (Herranz and Gil, 2018). Providing an understanding of the basic physiological knowledge within the context of the process of senescence and disease, and their relevance to potential falls prevention initiatives is the overall aim of this chapter