Physiological Changes &

Processes in Aging
 Normal Aging

Normal ageing is the result of a complex process that is progressive in
nature, in the absence of disease. ...
 Commonly described as healthy lifestyle habits, the following actions -
physical exercise, a healthy diet, restorative sleep, abstaining from tobacco
and alcohol use - contribute positively to normal ageing.
 Stages of Aging.
 1. Independence
 this stage lasts through their 50s and 60s. They can handle everyday needs
on their own. Transportation, finances, health care, and house chores
present no big challenge. Mental and physical activity may exhibit a minor
decline, but not enough to impact their lives.
 For women, this stage often encompasses the significant hormonal shifts of
menopause
 Aging males also see somewhat decreased levels of testosterone. This can
result in lower energy levels and loss of muscle mass
 2. Interdependence- this stage between 70 and 80 years of age
 An interdependent senior may need a caregiver to handle certain
monthly, weekly, or daily activities (i.e. paying bills, mowing the lawn, or
driving). Another common scenario: they can still do everything solo… Just
slower.
 3. Dependency – 80 & above have trouble handling quite a few everyday
tasks by themselves. This stage is usually less dependent on age and more
dependent on how their medical narrative progresses.
 many seniors in this situation end up feeling disoriented and even
depressed
 4. Crisis management – the final stage of aging
 5. End of life
 vast majority of people reach these last two stages, they need more or less
round-the-clock care.
 Integument
 the dermis decreases in thickness by about 20%.
 As it thins it loses vascularity, cellularity and sensitivity. The skin's ability to
dissipate or retain internal heat is diminished.
 The skin becomes thin, fragile and slow to heal.
 Evaporative heat loss is reduced due to reduced efficacy of sweat glands
and diminished peripheral circulation.
 Subcutaneous fat deposition is altered in the elderly.
 Muscle, blood vessels and bone become more visible beneath the skin
due to thinning of subcutaneous fat on the extremities.
 Fat deposition occurs mainly on the abdomen and thighs.
 Integument
 This is the system with the most obvious changes because this involves the
skin, hair, and nails.
 The skin loses its moisture and elasticity which makes older people more
susceptible to skin tears and shearing injuries.
 The hair loses color and the nails become thickened and brittle.
 Progressive loss of subcutaneous fat and muscle tissue accompany the
previously mentioned integumentary changes.
 As a result, muscle atrophy, “double” chin, wrinkling of skin, and sagging of
eyelids and earlobes are frequently observed in older people. In older
women, breasts become less firm and may sag.
 Tolerance to cold also decreases because of loss of subcutaneous fats.
 Muscles of the face are capable of tremendous movement.
 “Smiles, laughter, frowns, disappointment, ager, rage, and surprise are all
recorded.
 The hand of time captures these expressions and outlines them on the
face….By the age of 40, most people bear the typical lines of their
expressions.”
 Musculoskeletal
 Muscle mass is a primary source of metabolic heat. When muscles contract,
heat is generated. The heat generated by muscle contraction maintains
body temperature in the range required for normal function of its various
chemical processes.
 third decade of life there is a general reduction in the size, elasticity and
strength of all muscle tissue.
 The loss of muscle mass continues throughout the elder years. Muscle fibers
continue to become smaller in diameter due to a decrease in reserves of
ATP, glycogen, myoglobin and the number of myofibrils.
 As a result, as the body ages, muscular activity becomes less efficient and
requires more effort to accomplish a given task.
 Neuromusculoskeletal

 Normal ageing is characterised by a decrease in bone and muscle mass

and an increase in adiposity
 Speed and power of muscle contractions are gradually reduced with age.
While exercise can strengthen muscles, there would be steady decrease in
muscle fibers by age 50.
 This condition is called sarcopenia.
 Also, loss in overall stature occurs with age. Kyphosis, osteoporosis, and
pathologic fractures are consequently common.
 reaction time also slows with age. Decreased muscle tone further reduces
reaction time. This is because diminished physical activity can decrease
muscle tone.
 Skeletal muscle strength (force-generating capacity) also gets reduced
with ageing depending upon genetic, dietary and, environmental factors
as well as lifestyle choices. This reduction in muscle strength causes
problems in physical mobility and activity of daily living.
 The total amount of muscle fibres is decreased due to a depressed
productive capacity of cells to produce protein. There is a decrease in the
size of muscle cells, fibres and tissues along with the total loss of muscle
power, muscle bulk and muscle strength of all major muscle groups like
deltoids, biceps, triceps, hamstrings, gastrocnemius
 Respiratory System
 physiologic changes of the respiratory system associated with aging
 Decrease in static elastic recoil of the lung, in respiratory muscle
performance, and in compliance of the chest wall, resulting in increased
work of breathing compared with younger subjects and a diminished
respiratory reserve in cases of acute illness).
 Decrease in expiratory flow rates (small airway disease). Expiratory muscles
become weaker so their cough efficiency is reduced and the amount of air
left in the lungs is increased.
 Less vigorous cough and slower mucociliary clearance, leading to
increased frequency of infections
 Cardiovascular System
 Decreased aortic compliance, which results in an increased left ventricular
afterload, increased systolic blood pressure, decreased diastolic blood
pressure, and an increase in pulse pressure.
 ■Modest left ventricular hypertrophy in response to a dropout of myocytes,
along with increased left ventricular afterload and prolonged relaxation of
the left ventricle during diastole.
 ■Dropout of atrial pacemaker cells, resulting in a decrease in intrinsic heart
rate.
 ■Thickening of the annulus of both the aortic and mitral valves, with
development of valvular calcification.
 .
 ■Apoptosis of sinoatrial pacemaker cells, fibrosis, and loss of His bundle
cells, as well as fibrosis and calcification of the fibrous skeleton of the heart
that can lead to various auriculoventricular blocks.
 ■Decreased responsiveness to beta adrenergic receptor stimulation,
decreased reactivity to baroreceptors and chemoreceptors, and
increased circulating catecholamines, resulting in a marked decrease in
the maximum heart rate in response to exercise or other stressors
 Hematopoietic and Immune Systems
 Bone marrow is considered a self-renewing tissue. However, hematopoietic
stem cells (HSC) experience phenotypic and functional changes with
aging: expansion of the HSC compartment, skewing of differentiation
toward myeloid progenitors, and decreased regenerative capacity (These
changes lead to:
 a.Immunosenescence: decreased efficiency of adaptive immune
responses. Naive T and B cells decline, although the functions of memory
cells are relatively preserved.
 b.Inflammation (“inflammaging”): dysfunction in innate immunity
associated with a pro-inflammatory profile. The increase in functional CD8+
lymphocytes T with aging also contributes to inflammation, due to their
production of pro-inflammatory cytokines.
immune
 Immunosenescence has clinical consequences such as increased risk of
infections, cancer, and autoimmune disorders, and less effective responses
upon exposure to new antigens (e.g., through vaccinations) Inflammaging
and in particular elevations in levels of tumor necrosis factor (TNF),
interleukin-6 (IL-6), IL-1, and C-reactive protein (CRP) are strong
independent risk factors for morbidity and mortality in older people.
 Aging is associated with myeloid-biased blood cell composition and
increased prevalence of myeloid malignancies such as myelodysplasia
and myeloproliferative neoplasms. There is increased incidence of anemia,
and also increased incidence of chemotherapy-induced short-term and
long-term toxicities with increased and cumulative risk of chemotherapy-
induced neutropenia, secondary myelodysplasias, and acute leukemias
 Gastrointestinal

 Age-related changes include reduced saliva, decreased esophageal and

stomach motility, decreased stomach emptying time, decreased
production of intrinsic factor, and decreased intestinal absorption, motility,
and blood flow.
 In addition, tooth enamel becomes harder and more brittle, making teeth
more susceptible to fractures.
 the composition of saliva is altered in elderly persons (they have higher
levels of mucin, resulting in a more viscous secretion) Diminished salivation is
almost always attributable to secondary factors, such as medication.
 The sensitivity of the taste buds decrease altering pleasure in eating.
 They may also lose the ability to differentiate sour, salty and bitter tastes.
 There is decreased salivation, so there is difficulty in swallowing food.
 Reduced gastrointestinal motility results in delayed emptying of stomach
contents and early satisfaction( feeling of fullness).
 Urinary
 “The bladder of an elderly person has a capacity of less than half (250ml)
that of a young adult (600 ml) and often contains as much as 100 ml of
residual urine”.
 Micturation reflex is delayed-- usually activated when bladder is half full; in
OAs, not until bladder is nearly at capacity
 Urinary

 The function of the kidney decreases with age but is still able to carry out
excretory functions unless a disease process intervenes. Waste products
may be filtered and excreted more slowly. Therefore, nurses must include in
their responsibility the effect of drugs that elders take to their kidneys.
 Aside from the kidneys, the bladder makes more noticeable changes.
Complaints of urinary urgency and frequency are common because the
capacity of the bladder and its ability to completely empty diminish with
age. It is important to note that urinary incontinence (UI) is never normal so
the nurse must promptly investigate it, particularly when of new onset.
 Good urinary function in elders can be promoted by sufficient fluid intake,
reducing bladder-irritant foods in the diet (e.g. sugar, caffeine, spicy and
acidic foods), and practicing pelvic muscle exercises.
Nervous
Sensory
 The sensitivity of the taste buds decrease altering pleasure in eating.
 They may also lose the ability to differentiate sour, salty and bitter tastes.
Reproductive