General Growth Patterns A. Physiologic Changes There are normal physiological changes anticipated in older adults.

These physiological changes are not pathological processes but may render older adults vulnerable to some common clinical conditions. The body changes continuously with age, but the effects on particular older adults depend on health, lifestyle, stressors, and environmental conditions. I. Integument a) Skin color Spotty pigmentation in areas exposed to the sun; pallor even in the absence of anemia b) Moisture Dry; scaly condition c) Temperature Cooler extremities; decreased perspiration d) Texture Decreased elasticity; wrinkles; folding, sagging condition e) Fat distribution Decreased amount on extremities; increased amount on abdomen f) Hair Thinning and graying on scalp; often, decreased amount of axillary and pubic hair on extremities; decreased facial hair in men; possible chin and upper lip hair in women g) Nails Decreased growth rate II. Head and Neck a) Head Sharp and angular nasal and facial bones; bushier eyebrows in men b) Eyes Decreased visual acuity; decreased accommodation; reduced adaptation to darkness; sensitivity to glare c) Ears Decreased pitch discrimination; diminished light reflex; diminished light reflex; diminished hearing acuity d) Nose and sinuses Increased nasal hair; decreased sense of smell e) Mouth and pharynx Use of bridges or dentures; decreased sense of taste; atrophy of papillae of lateral edges of tongue f) Neck Nodular thyroid gland; slight tracheal deviation resulting from muscle atrophy III. Thorax and Lungs Increased anteroposterior diameter; increased chest rigidity; increased respiratory rate with decreased lung expansion; increased airway resistance IV. Heart and Vascular System

In the cardiovascular system, the cardiac muscle strength diminishes. The heart valves become thickened and more rigid. Accumulation of fats in the blood vessels may occur and leads to a slight drop in RBC and in Hct and Hgb levels. Significant increase in systolic pressure with slight increase in diastolic pressure; usually insignificant changes in heart rate at rest; common diastolic murmurs; easily palpated peripheral pulses; weaker pedal pulses and colder lower extremities, especially at night V. Gastrointestinal System Decreased salivary secretions, which may make swallowing more difficult; decreased peristalsis; decreased production of digestive enzymes, including hydrochloric acid, pepsin, and pancreatic enzymes; constipation; reduced motility VI. Reproductive System Decreased levels of estrogen; decreased egg count; VII. Urinary System Decreased renal filtration and renal efficiency; subsequent loss of protein from kidney; nocturia; decreased bladder capacity; increased incontinence. Urinary frequency and retention resulting from prostatic enlargement VIII. Musculoskeletal System Decreased muscle mass and strength; bone demineralization; shortening of trunk as a result of intervertebral space narrowing; decreased joint mobility; decreased range of joint motion; enhanced bony prominences IX. Neurological System In the nervous system, there is a progressive loss of brain mass, steady loss of neurons in the brain and spinal cord. Balance and coordination is decreased. In sleep, there is increase night awakening and insomnia. Naps are common at this stage. Decreased rate of voluntary or automatic reflexes, decreased ability to respond to multiple stimuli; insomnia; shorter sleeping periods

B. PSYCHOSOCIAL DEVELOPMENT (Generativity vs. Stagnation) They have the impulse to foster development of the next generation, and so they are the mentors of young adults. To have children is instinctual; those childless acknowledge their sense of loss and express these generative impulse in other ways like helping to care for other peoples children. Some stagnation can lead to physical/psychological individualism and expressive concern with selves. C. PYCHOSEXUAL DEVELOPMENT All older adults, whether healthy or frail, need to express sexual feelings. Sexuality involves love, warmth, sharing, and touching, not just the act of intercourse. Sexuality is linked with identity and validates the belief that people can give to others and have the gift appreciated.

The capacity for sexuality is life-long. Theoretically, people can engage on sex as far into old age as they choose. The best indicator for continued sexual satisfaction with aging is regularly active sex life during adulthood and into later life. Older adults often face health concerns and societal attitudes that make it difficult for them to continue sexual activity. Although declining physical abilities may make sex as they knew it difficult, learning alternative ways of sexual expression can allow for satisfying sexual activity. Numerous factors, including lack of a sexual partner or declining health, can affect the sexual activity of the older adult.

D. COGNITIVE DEVELOPMENT (Formal Operational Thought) There is very little change in the cognitive functioning of the older adult. Their crystallized intelligence is improved, accompanied by the deepening of practical intelligence. They are able to integrate logic with intuition and emotion; and also integrate conflicting facts and ideas, and integrate new information with what they hear and see. They also tend to be effective problem-solvers. Although their reaction time and speed of thinking slows down.

E. MORAL DEVELOPMENT (Postconventional Level) Their committed responsibilities for the care and welfare of others promote moral development. They can differentiate between personal wants and needs, duties demanded by society and principles by which they live.