23/09/2022
Scenario
NORMAL CHANGES
OF AGING
Kennedy C. Bangan, MSN, RN
Faculty
Cardiovascular Normal Aging Changes
System  Heart becomes larger and occupies
a greater amount of space within the
chest
 Reduction in the amount of
functional muscle mass of heart
 Decreased amount of blood that is
pump throughout the circulatory
system
 More adventitiousS4 heart sounds
 Premature contractions and
arrhythmias
 Blood flow is slower
 Low diastolic pressure
 Increased pulse pressure
Peripheral
Vascular System
Normal Aging Changes
 Increase in the peripheral vascular
resistance
 Valves in the vein do not function
efficiently and form edema
 Mr. Alexander is a 70-year-old married man who comes to
your clinic requesting information on sexual dysfunction. On
questioning him further he tells you that his sexual
functioning has declined over the past 10 years. He states
that he can no longer maintain an erection, and generally
he has a hard time even achieving one. He had spoken
with his doctor about Viagra, but was told that it interacted
with “some heart pill” that he is already taking. When you
ask him how his relationship with his wife has changed over
the years he states that they are still very happy together
but that they both miss being intimate. He then states, “I
hate disappointing her, but I guess it’s just a part of getting
old. I wish there was something I could do.”
Nursing Interventions
 Can be cardiomyopathy, refer for diagnostic tests.
 Inform client that exercise can ultimately reduce the strain on the
heart
 Heart murmurs requires further tests to determine its effect
 Fatigue, SOB, DOB, dizziness, chest pain, headache, sudden
weight gain, or changes in cognitive function of cognition
requires full assessment
 Know that the time of effectiveness may take longer when giving
medications
 Inform client that low diastolic pressure is a risk for cardiovascular
accidents or strokes
 Inform client that exercise lowers blood pressure
Nursing Interventions
 Inform the client that age, diet, genetics, lack of exercise can
transform non-pathological to pathological, which can result in
CVD.
 Monitor older adults’ cholesterol levels with lowering agents to
prevent atherosclerosis and arteriosclerosis
 Inform the client that exercise results in lower cholesterol levels
 Discuss the right medications, exercise program, and diet for the
client as means to slow the progression of cardiac changes
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Respiratory Nursing Interventions

System
 Note that auscultating sounds is difficult so it must be done on all
lung fields in a quiet environment
Normal Aging Changes
 Inform that pollution and smoking worsens the cilia
 Decreased vital respiration capacity
 Tell clients that they are at risk for choking
 Lungs lose elasticity
 Make sure client’s respiratory function is frequently assessed
 Loss of water and calcium in bones
causes thoracic cage to stiffen  Encourage regular exercise.

 Decreased amount of cilia lining

system
 Decreased cough reflex

Normal Aging Changes

Integumentary  Skin becomes thinner and more fragile
System  Skin is dry and loses elasticity (wrinkles)
 Sweat glans lessen, which leads to less
perspiration
 Subcutaneous fat and muscular layers
begin to diminish; less padding, more
easily bruised
Nursing Interventions
 Promote the use of sun block and tell client to avoid
overexposure
 Avoid the use of soaps that dry skin and use lotion after baths
 Protects high-risk areas such as elbows and heels with padding
 Refer to podiatrist

 Dryness  Help older adult maintain personal appearance

 Skin tears
 Fingernails and toenails become thick
and brittle
 Hair becomes gray, fine, and thin
 Facial hair on women
 Decreased body hair on men and
women

Gastrointestinal Nursing Interventions

Normal Aging Changes
System
 Inflamed gums  Assess older adult’s ability to chew
 Periodontal disease  Refer older adult for further oral evaluation if necessary
 Sensitive teeth  Assist older adults in making changes with their eating habits
 Tooth loss  Assess nutritional health frequently
 Decreased peristalsis of esophagus  Encourage older adult to drink water (1.5L)
 Decreased gut motility, gastric acid  Add bulk and fiber to diet
production, and absorption of  Promote exercise
nutrients
 Enemas and laxative medications may be given to severe
 Difficulty evaluating wastes situations
(constipation)
 Bowel habit training
 Involuntary leakage of liquid stool
 In severe cases, surgery may be appropriate
(fecal incontinence)

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Urinary Normal Aging Changes Musculoskeletal

System  Kidneys experience a loss of nephrons System Normal Aging Changes
and glomeruli  Decreased in total muscle and bone
 Bladder tone and volume capacity mass
decreases  Muscle units that combine to form
 Incontinence (not a normal change, muscle groups diminish
but occurs in response)

Nursing Interventions
 Assess urinary incontinence Nursing Interventions
 Kegel’s exercises  Encourage older adult to exercise
 Voiding schedules (for cognitively regularly
impaired)

Sexual/ Normal Aging Changes

Reproductive Nursing Interventions
 Decreased in testosterone in men,
System and estrogen, progesterone, and  Help older adult feel comfortable when discussing sexuality
androgen in women  Give vaginal lubricants for females
 For women;  Inform men to increase the time between erections
 Follicular depletion in the ovaries
 Discuss the use of oral erective agents
 Natural breast tissue is replaced by
fatty tissue
 Labia shrinks
 Decreased in vaginal lubrications and
shortening and narrowing of the vagina
 Strength of orgasmic contraction
diminishes, and orgasmic phase
decreased
 For men;
 Increased length of time needed for
erection and ejaculation

Senses Normal Aging Changes Nursing Interventions

 Eyes  Make sure older adult has a baseline eye assessment early in
 Visual acuity declines older adulthood and follow up eye exams yearly
 Ability of pupils to constrict in response  Help older adult remove cerumen
to stimuli decreases
 Peripheral vision declines
 Obtain a thorough history of taste and smell sensations and
physical examination of the nose and mouth
 Lens of the eye often becomes yellow
 Obtain a thorough diet history
 Arcus senilus
 Ears
 Increased amount of hard cerumen
 Taste and Smell
 30% of taste buds deminish

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Neurological Normal Aging Changes

System  The brain weight decreases
 Shift in the proportion of gray matter
to white matter
 Loss of neurons
 Increase in the number of senile
plaques
 Blood flow of cerebrum decreases
Nursing Interventions
 Help older adult maintain an active
body mind
 Encourage older adults to participate
in cognitive activities
Critical Thinking: Case study/ analysis
Situation
 Mrs. Dela Cruz is a pleasant, 90-year-old woman who resides in a skilled nursing
facility. She is alert and oriented but sometimes forgetful. She is near-sighted and
hard of hearing in her left ear. She enjoys dessert with her dinner. She is continent
of bowel and bladder and ambulates independently. Her past medical history
includes frequent episodes of pneumonia, hypertension, and a right breast
carcinoma.
1. What findings in Mrs. Dela Cruz ’s profile would be considered normal changes
of aging?
2. Are there pathological changes present in Mrs. Dela Cruz ’s profile? If so, what
are they?
3. What nursing interventions could be implemented to compensate for normal
changes of aging?
4. Do you feel the role of ageism may impact the nurse’s ability to differentiate
between normal and pathological changes of aging?