JOSHOUA MALANA – BSN 4B
PSYCHOLOGIC CHANGES IN AGING
AFFECTING VARIOUS SYSTEMS
ENDOCRINE SYSTEM
● Age-related changes in endocrine
function include decreased
hormone secretion and breakdown
of metabolites.
● Levels of most hormones decrease
with aging, but some hormones
remain at levels typical of those in
younger adults, and some even
increase. Even when hormone
levels do not decline, endocrine
function generally declines with age
because hormone receptors
become less sensitive.
● Special concern in older adults is
the onset of Diabetes Mellitus and
Thyroid Disease (hyper of hypo) –
these diseases can be insidious
and silent for years.
DIABETES MELLITUS:
● DM becomes more prevalent w/
age.
● Symptoms such as polydipsia,
polyphagia, and polyuria may go
unnoticed because the thirst
sensation diminishes with age and
older adults may not be aware of
their polydipsia.
● However, by the time the disease is
diagnosed, more serious
complications such as impaired
circulation, foot ulcers, and vision
disturbances may have ensued.
● Type 2 DM is more common in
older adults because w/ age, there
is an increased resistance to the
action of insulin within the body,
and this change, in combination
with lifestyle choices, places some
older adults at inordinate risk for
developing DM-T2.
NURSING ACTIONS
● Assess for the risk of developing
diabetes among older adults
● Monitor changes and symptoms at
every opportunity possible
● Health HX should be assessed as
well:
o Fam Hx
o Weight and appetite
changes
o Fatigue
o Increased thirst and fluid
intake
o Vision problems
o Slow sound healing
o Headache
o GI problems
● Assess for specific symptoms such
as:
o Polyphagia
o Polydipsia
o Polyuria
● Diagnostic tests such as:
o Fasting glucose sugar
**Note that oral glucose tolerance test is of
little value by itself because the older adult
may have impaired glucose tolerance but
not diabetes
THYROID DISEASE:
● Formation of nodules that interfere
w/ normal thyroid functioning
becomes common as people age.
● Thyroid function does not change
significantly with age but production
of thyroxine and triiodothyronine
decreases. – but the cause it not yet
known
● Hyperthyroidism is much more
likely in the older years, but among
older adults, the typical symptoms
of restlessness and hyperactivity
may be lacking signs.
● For older adults, hyperthyroidism
does not usually mean major
changes to everyday life.
● Hypothyroidism and associated
symptoms of fatigue, forgetfulness,
and cold sensitivity may be seen as
normal “slowing down” with age
and go undetected.
● Effects of hypothyroidism in older
adult can cause constipation,
decrease mental activity, and
reduce metabolic rate.
NURSING ACTIONS
● Assess for:
o Fam hx
o Skin changes (dry and
flaky)
o Fluid retention (edema and
weight gain)
o Fatigue
o Forgetfulness
o Constipation
o Unusual sensitivity to the
cold.
JOSHOUA MALANA – BSN 4B
● Diagnostic tests such as:
o TSH test
o TRH test
o Radioimmunoassay
URINARY SYSTEM
● In older adult bladder muscles
weaken and bladder capacity is
lessened – difficulties in sensing
the bladder has not emptied may
mean that residual urine stays
within the bladder, creating a
medium for potential infection.
● As people age, the arteries
supplying the kidneys narrow.
Because the narrowed arteries may
no longer supply enough blood for
normal-sized kidneys, kidney size
may decrease.
● The walls of the small arteries that
flow into the glomeruli thicken,
which decreases the function of the
remaining glomeruli.
● Accompanying these losses is a
decline in the ability of the nephrons
to excrete waste products and
many drugs and an inability to
concentrate or dilute urine and to
excrete acid.
● The ureters do not change much
with age, but the bladder and the
urethra do undergo some changes.
● The maximum volume of urine that
the bladder can hold decreases.
● A person's ability to delay urination
after first sensing a need to urinate
also declines. The rate of urine flow
out of the bladder and into the
urethra slows
IN OLDER MEN:
● Older men may develop problems
with an enlarged prostate that
impedes the flow of urine through
the urethra.
● Unmanaged incontinence can have
significant consequences to daily
life.
● If untreated, enlargement of
bladder may become nearly
complete or complete, causing
urinary retention and possibly
kidney damage.
IN OLDER WOMEN:
● Older women are more likely to
experience incontinence which is
often related to a history of
childbirth or gynecologic surgeries.
**But take note that Gynecologic
assessment of older women is an area of
assessment that is sometimes neglected
because the childbearing years have
passed or because of sexual inactivity, a
gynecologic exam is no longer needed
● The urethra shortens and its lining
becomes thinner. These changes in
the urethra decrease the ability of
the urinary sphincter to close
tightly, increasing the risk of urinary
incontinence. The trigger for these
changes in a woman's urethra
seems to be a declining level
of estrogen during menopause.
NURSING ACTIONS
● Assess for: (in older women)
o Abnormal bleeding
o Vaginal discharge
o Any urinary symptoms
**Pelvic examinations and Pap smears are
usually carried out by physicians, but
nurses have an important role in identifying
the need for this further assessment.
● Health history questions should
attend to any previous or current
difficulties related to the frequency
and voluntary flow of urine during
either the day or night.
● If incontinence is a problem, then
questions should focus on the type
of incontinence:
o Stress
o Urge
o Functional
o Overflow
● If older adults have problems with
continence the nurse should restrict
their fluid intake, which will have
implications for other body
systems, including skin condition
and the gastrointestinal system.
● Assess about fluid intake,
especially caffeine and alcohol
(because these substances affect
bladder tone) and observe the skin
for dehydration.
● Ask about medication use
(prescribed, over the counter, and
herbal remedies).
● Diagnostic tests include:
o Urine analysis tests for
blood, bacteria, and other
components such as
ketones
JOSHOUA MALANA – BSN 4B
o Other diagnostic tests may
be ordered by the physician
to assess bladder muscle
tone and function and
prostate size and potential
obstructions.
SPECIAL SENSES
● Age-related and disease-related
changes in sensory function can
have profound effects on older
adults and their day-to-day
functioning.
● Out of the five senses, the
occurrence of diminished vision
and hearing that seems to have the
greatest impact on older adults. –
Problems with vision or hearing can
have negative effects on social
interaction and hence on social and
psychological health.
● Decrements in vision and hearing
can affect communication ability,
with potential consequences to
older adults’ health, safety,
everyday activities, socialization,
and quality of life.
● Taste and smell are interrelated;
the sense of smell influences the
sense of taste for food as well as
appetite.
● Medical conditions, especially
those affecting the nose;
medication side effects; nutritional
deficiencies; poor oral hygiene;
alcohol use; and smoking can all
detrimentally affect the senses of
smell and taste.
VISION:
● Presbyopia – an age-related
change in vision. – it is when the
lens of the eye becomes less
elastic, and this creates less
efficient accommodation of near
and distant vision.
● Age-related macular degeneration
– is the deterioration of central
vision. Thus, the leading cause of
severe vision loss in older adults.
MANAGEMENT:
● Older adults should undergo
regular eye examinations for
changes in vision (including the
formation of cataracts) and
screening for ocular pressure (for
glaucoma).
NURSING ACTIONS:
The following two screening procedures
are simple tests for functional vision:
● Ask the older adult to read a
newspaper headline and story and
observe for difficulty and accuracy.
● Ask the older adult to read the
prescription bottle and, again,
observe for difficulty and accuracy.
● Conduct follow up questions that
may explore vision problem from
the perspective of the individual
such as:
o Is vision a problem?
o Does it interfere with
everyday activities or with
hobbies and social life?
o Are magnification aids or
enlarged printed material
useful strategies?
o Is home lighting contributing
to the problem?
o Is it more difficult to see in
the evening compared with
other times of the day?
HEARING:
● Presbycusis – refers to age-related
progressive hearing loss.
● Perceived stigma of hearing loss
and attendant shame may lead
some older adults to deny this loss
and reject hearing assessment and
the use of hearing aids.
● Most hearing loss in older adults
are symmetric and bilateral and are
exacerbated due to a noisy
environment.
NURSING ACTIONS:
● Conduct assessment questions
about any hearing problems and
how these problems affect the older
adult’s everyday life such as:
○ Are you experiencing a
hearing problem or any ear
pain, ringing in the ears, or
ear discharge?
○ Do you have hearing
problem now?
○ When is your hearing loss
the biggest problem for
you?
JOSHOUA MALANA – BSN 4B
● For nurses who handle older adults
with hearing aids, it is important to
regularly assess and monitor the
device. – Because most of those
wearing hearing aids, a visual
check indicated problems with
either broken or missing
components, inappropriate volume
setting, or weak or dead batteries,
and this was especially true for
those older adults who were
relatively dependent on nursing
care.
TASTE:
● In many cases, what is perceived
as a taste defect is truly a primary
defect in olfaction (smell)
● Other than smell dysfunction, the
most frequent causes of taste
dysfunction are prior upper
respiratory infection, head injury,
drug use, and idiopathic causes.
● Chewing problems associated with
tooth loss and dentures can also
interfere with taste sensations,
along with the reduction in saliva
production. Rather than whole
mouth taste dysfunction, regional
deficits are much more common.
● Despite their wide prevalence, most
elderly people are unaware of
regional taste deficits.
NURSING ACTIONS:
● People who have taste disorders
may benefit from flavor
enhancement of their foods.
● Flavor enhancers supplement,
enhance, or modify the original
taste or aroma of food but do not
have a characteristic taste or aroma
of their own.
● Flavor enhancement for the elderly
and sick can improve food
palatability and acceptance,
increase lymphocyte counts,
improve grip strength, reverse or
slow functional decline, and
improve the overall quality of life. It
also has the potential to
compensate for anorexia
● Assessments should ask generally
about
o Satisfaction with taste and
smell
o The duration and extent of
the problem
o The impact of the problem
on everyday life.
SMELL:
● Both the number of fibers in the
olfactory bulb, along with olfactory
receptors decrease noticeably with
age.
● The bulb losses are secondary to
sensory cell loss in the olfactory
mucosa, along with a general
deterioration in central nervous
system cognitive processing
functions.
● Olfactory receptor neurons undergo
apoptosis at a baseline rate in each
person (we have the ability to
replace these cells, however, this
process degenerates with ageing).
● Another contributing factor when
considering age-related olfactory
deterioration is mild cognitive
impairment and Alzheimer's
disease.
● Electrophysiological results of
patients with Alzheimer's disease
and pre‐clinical Alzheimer's
disease confirm olfactory
dysfunction.
NURSING ACTIONS:
● Once the diminished smell is
diagnosed, the goal of
management entails preventing
injury related to this. Such as:
o Visual stimulating gas
detection devices are good
for those with a gas stove,
as the person may not be
able to smell gas leaks.
o Relatives need closer
involvement to check for
spoiled food that if eaten
could lead to food poisoning
REPRODUCTIVE SYSTEM
● Several factors associated with
aging do have an impact on sexual
activity, including lack of partner
(often through widowhood), chronic
illnesses, and medication use that
JOSHOUA MALANA – BSN 4B
may negatively affect performance ● Osteoporosis is another problem
and sexual satisfaction. because bone density decreases
● Age-related changes for men rapidly in the first years after
menopause. The reduction in bone
include a decrease in the speed
density leads to a higher incidence
and duration of erection of fractures.
● Decreased vaginal lubrication REDUCTION OF TESTOSTERONE
happens in women. ● A significant reduction I
● Health Factors affecting testosterone levels may occur for
reproduction in older adults: men older than 70. – this is also
○ Osteoarthritis called male menopause.
● It begins around the age of 40 and
● Social Factors affecting
causes decreased testicular
reproduction in older adults: function.
○ Diminished positive self- ● Late-onset hypogonadism
image (reduction of sex hormones) can
○ Lack of privacy cause erectile dysfunction,
NURSING ACTIONS decreased libido and fatigue, as
● Ask about sexual function and well as depression.
sexual activities (But it is important ● Symptoms are subtle and this can
to be knowledgeable about age- go unnoticed for years.
related and disease-associated ● Physiologically the testes decrease
changes in relation to sexual in size and firmness with age. This
function and to be sensitive and is associated with a gradual age-
respectful of privacy because this is related decline in the secretion of
clearly a very personal area of testosterone.
human function.) ● Simultaneously there is a decrease
● Assessment questions should in sexual desire.
focus on sexual function and ● The seminal vesicles decrease in
whether there have been any weight and storage capacity after
changes or concerns (both sexual age 60 and the penis undergoes
and other health related matters). some atrophy with age.
● For erectile dysfunction, great deal MEDICATIONS:
of advertising by pharmaceutical ● Hormone Therapy
companies have been present the
past few years.
● If enhancement medications are
mentioned, it might be best
answered in consultation with a
pharmacist because of potential
side effects and interactions with
other medications.
MENOPAUSE
● One of the most significant age-
related alterations. As women age
inevitable decrease in estrogen
secretion occurs. Thus, ovarian
function decreases significantly. –
Depletion of the number of viable
follicles in the ovaries occurs due to
atresia and affects the hormonal
regulation of the menstrual cycle.
● After menopause estrogen levels
change and cardiovascular disease
becomes prevalent in women
● When estrogen is lacking, many
women find that they suddenly
have problems with high
cholesterol and the cardiovascular
issues that accompany it