Physiological Changes of Aging

• Introduction
• Factors affecting age-related changes
• Changes of Cardio
• Changes of Respi
• Changes of GIT
• Changes of Endocrine System Changes of Immune S.
• Changes of Urinary S. Changes of Neurologic S.
• Changes of MSS
• Changes of Integumentary S.
• Changes of Reproductive S.
• Changes of Sensory System
• a) Hearing b) Smell c) Vision d) Taste e) Touch
Introduction
➢ Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and pace,
ageing reflects all the changes taking place over the course of life. These changes start from birth& then
develops. To the young, ageing is exciting. Middle age is the time when people notice the age-related
changes like greying of hair, wrinkled skin and a fair amount of physical decline. No one can escape these
changes.
➢ ageing is a course of biological reality which starts at changes and ends with death. In most of the developed
countries, the age of 60 is considered equivalent to retirement age and it is said to be the beginning of old
age. Aging is characterized by progressive and broadly predictable changes that are associated with increased
susceptibility to many diseases. Aging is not a homogenous process. Rather, organs in the same person age
at different rates influenced by multiple factors.
Factors affecting age-related changes
❑ Environmental Factors ❑ Genetic Factors
❑ Psychosocial Factors ❑ lifestyle choices

Physiological changes of aging in different body system include:

i. Cardiovascular System
➢ The cardiovascular system helps maintain homeostasis by bringing O2 and nutrients to organs and tissues
and by transporting CO2 and other waste products to other body system for removal. Aging alters CVS
both structurally and physiologically.
1.Heart muscle
➢ Heart size doesn't change with age unless there is cardiac disease.
➢ high in collagen and low in elastin in the heart muscle; these changes decrease myocardium contraction and
thus decrease cardiac output.
➢ Low Heart rate
Atria
➢ Decline in left ventricular compliance provides an increase workload on the atria, resulting in hypertrophy
of the atria.
Cardiac output: -
➢ Cardiac output at rest is unaffected by age.
➢ Maximum cardiac output and aerobic capacity are reduced with age.
Valve:
➢ It increases in valvular circumference has been reported in all four cardiac valves.
➢ Thicker and stiff as a result of lipid accumulation, collagen degeneration and fibrosis, which lead to
reduction of valve flexibility
➢ Weakness of the valve in the rectal veins can lead to hemorrhoids.
➢ Decreased efficiency of venous valves lead to decrease venous return and increase incidence of varicosities
and dependent edema
➢ Calcification of vessel occurs.
 ➢ Elastin in the vessel wall decreases which lead to thickening and rigidity of the vessels especially the
coronary arteries (Arteriosclerosis)
➢ Decrease baroreceptor mechanism leads to orthostatic hypotension which occurs because the circulation
doesn’t respond quickly to postural changes.
➢ Circulations in the coronary arteries diminish by approximately 35% after the sixth decade.
pulse and cardiac output: -
➢ Cardiac output at rest is unaffected by age. Maximum cardiac output is reduced with age.
➢ Sinus bradycardia less than 50 beats /min common in elderly.
Blood pressure: -
➢ Blood pressure is a measure of cardiovascular efficiency. Although blood pressure is characteristically
heightened among older adults, there is evidence suggesting that there are no effects of aging.
➢ The myocardium becomes more irritable, extra systoles and sinus arrhythmias may occur.

Common problems related to cardiovascular system changes:

• High risk to cardiovascular diseases, particularly coronary heart disease.

• ▶ Atherosclerosis.
• ▶ High risk to hypertension.
• ▶ High risk to heart failure.
• ▶ Varicosities (lower limbs).
• ▶ Hemorrhoids.
• ▶ Orthostatic hypotension.

2.Respiratory System
The primary functions of respiration are to supply O2 to and remove CO2 from the blood. Upper respiratory
structures:
▶ Structural change in nose cause septal deviations that interfere with the flow of air through the nasal cavity
and thus contribute to mouth breathing during sleep, causing snoring and obstructive apnea.
▶ With aging, blood flow to the nose diminished and affects the sub-mucosal glands, causing decreased
secretions.
▶Nose, mucous membranes become drier as the fluid content of body tissue decreases.
▶Decrease vocal cord elasticity lead to change in voice pitch and quality.
▶The number of cilia decreases which diminishes their ability to trap and remove debris, which increased
risk of infection.
Chest wall and musculoskeletal structure:
▶Calcification of costal cartilage makes the ribcage more rigid,
▶increased the anterior posterior chest diameter often demonstrated by kyphosis.
▶weakness of thoracic inspiratory and expiratory muscles which reduce the mobility of ribcage.
▶These changes reduce respiratory efficiency and reduce maximal inspiratory and expiratory force.
C- Lung structure:
▶ Lungs become smaller and flabbier, and their weight diminishes by approximately 20% lead to decrease in
lung capacity.
▶ The alveoli progressively enlarge, and their walls become thinner.
▶ Decrease in alveoli elasticity and the number of capillaries surrounding the alveoli can interfere with gas
exchange leading to decrease of O2saturation.
Oxygen saturation
▶ Age-related changes to the respiratory tract ultimately result in a reduced delivery of O2 to the blood and a
decrease in O2 saturation
Common problems related to respiratory system changes:
 ▶ Increased susceptibility to infection
▶ Increased susceptibility to aspiration
▶ Inadequate oxygenation

Gastrointestinal System
▶ Digestion of food and maintenance of nutrition are influenced to a small degree by age related gastrointestinal
changes and to a large degree by risk factors that commonly occur in older adults.
a- Oral cavity and pharynx:
▶ Increase dental decay and teeth loss
▶ Gingival tissue may withdraw and the periodontal bonds that hold the teeth in place may loosen, these
effect on ability to bite and chew.
Oral cavity and pharynx
▶ Jaw muscle become weak and shrinkage of bony structure of the mouth.
▶ Taste buds may atrophy with age leading to decreased ability to discriminate between flavor especially
between salts and sweat.
▶ The volume of saliva can be reduced in the elderly resulting in dry tongue.
▶ There is marked decrease in salivary ptyalin causing difficult with the digestion of starch.
B-Esophagus
▶ In older adults, the esophagus stiffens and the peristaltic decrease lead to pres- byphagia (slowed
swallowing) and increase the risk of aspiration.
▶ The gag reflex is depressed in older adults, which lead to episodes of chocking and aspiration.
c- The stomach
▶ Degeneration of gastric mucosa, a decrease in digestive enzymes, and decrease of motility.
▶ Decrease in hydrochloric acid intrinsic factor may lead to mal absorption of iron, vitamin B12, calcium
and folic acid, which increased incidence of, peptic ulcer, and stomach cancer.
▶ Age-related changes may also affect the solubility and absorption of some drugs
D-The small intestine
▶ Atrophy of the muscle and mucosal surface, thinning in the villi, and a decrease in epithelial cells. This
results in some decrease in absorption of fats .
E - Large intestine
▶ Peristalsis of intestine low with aging leading to increase occurrence of constipation.
f- Liver
▶ With age, the liver become smaller and more fibrous, lipofuscin (a brown pigment) accumulates, and
blood flow to the liver decrease by approximately one third.
The pancreas
▶ Pancreas becomes more fibrotic. There is a decline in pancreatic secretion .
h- Gall bladder
▶ Decrease production of bile and incidence of gallstones increased by age.
▶ Gall stones develop in approximately 40% of elderly by the age of 80 years.

Common problems related to gastro-intestinal system changes:

▶ Heartburn ▶ Chewing problems ▶ Denture problems ▶ Lake of enjoyment of food and lack of
appetite
▶ Decreased food intake ▶ Constipation and fecal impaction ▶ Difficult in swallowing

Endocrine System
▶ The endocrine system is made up of organs and tissues that produce hormones. Hormones are natural
chemicals produced in one location, released into the bloodstream, and then used by other target organs and
systems.
a- Thyroid
▶Thyroid gland often becomes nodular
▶Decrease in production of thyroid stimulating hormone
▶Thyroid function decreases leading to decrease of basal metabolic rate.
b-Pituitary Gland
▶ gradually diminishes in size
▶ Pituitary gland produces less growth hormone, which lead to decrease in muscle mass
c- Pancreas
❑ Although pancreatic function decreases with aging, its function remains adequate to meet normal
functioning except in cases of onset of DM.
❑ Pancreas secretes insulin, a hormone which is critical to the metabolism of glucose (blood sugar).
❑ Insulin continues to be produced in sufficient quantities in older adults, but their muscle cells may become
less sensitive to the effects of insulin
d- Adrenal glands
❑ It produces the hormones aldosterone and cortisol.
❑ Aldosterone is important in regulating fluid and electrolyte balance.
❑ Aldosterone levels are 30% lower in adult's age 70 to 80 years old than in younger adults this may cause
orthostatic hypotension
❑ Cortisol is a stress response hormone that has antiinflammatory and anti-allergy effects. Secretion of
cortisol diminishes by 25% with ageing
e-Ovaries and testes In female
❑ Diminish in estrogen may lead two metabolic effects: coronary thrombosis and osteoporosis
❑ The estrogen hormone decreases
❑ Decrease in size of the ovaries, uterus, cervix, fallopian tubes
❑ Decrease in number of mammary ducts
In men
❑Decrease level of testosterone and seminal fluid
❑Decrease sperm production but doesn’t prevent reproduction
❑Penile erection is slowed.
Common problems related to endocrine system changes:
❑ High risk to develop DM. ❑ High risk to develop osteoporosis
❑ High risk to vaginal infection ❑ Arrhythmias
❑ Coronary thrombosis ❑ Has an effect on self-image

5-Immune System (lymphatic) system

 ❑ Age-related changes in the immunity increase vulnerability to infections, tumors and immune disease.
❑ The immune system loses its ability to differentiate between self and non-self, increase risk of autoimmune
diseases
❑ Diminished immunoglobulin production
❑ Decreased levels of antibody response increase risk of infection (RTI)
❑ Diminished response to antigens.
❑ Blood cell production in bone marrow decrease slightly. (Total WB cells)
❑ The size of lymph nodes, spleen reduces slightly.

Common problems related to immune system changes:

❑ High risk for infection, particularly, RTI infection ❑ acquiring nosocomial infections
❑ Increase risk of cancer ❑ Reduction of erythrocyte mass
❑ decreased hemoglobin and hematocrit ❑ Increase incidence of autoimmune disease
❑ Decrease in total body fluid ❑ Decrease in total WB cell

6- Urinary System:
➢ - The kidneys filter the blood and help remove waste and extra fluid from the body. The kidneys also play
an important role in controlling the body's chemical balance.
Aging changes
a- Kidneys: -
❑ Overall amount of kidney tissue decreases.
❑ Number of filtering units (nephrons) decreases. Nephrons filter waste material from the blood.
❑ Blood vessels supplying the kidneys can become hardened. This causes the kidneys to filter blood more
slowly.
❑ Kidney loss mass and decrease in size.
B - Bladder: -
❑ Bladder capacity decrease
❑ involuntary bladder contraction increase, these can lead to urgency and frequency of urination.
❑ The bladder wall changes. The elastic tissue becomes tough and the bladder becomes less stretchy. The
bladder cannot hold as much urine as before.
❑ The bladder muscles weaken.
❑ Increased urine formation at night leads to nocturia.
c- Urethra: -
▶ In older women, decreases of estrogen can affect the urethra.
▶ Urethra become thin and increased fragility of urethra mucous can contribute to urgency and frequency of
micturition.
women:-

→ this can be due to weakened muscles that cause the bladder or vagina to fall out of position (prolapse).
In men:-

→ enlarged prostate, which interfere with bladder emptying leading to problem with voiding as hesitancy,
frequency, inability to maintain steady stream of urine and urinary retention.

Common problems related to urinary system changes:

❑Urgency and frequency of micturition ❑Nocturia ❑High risk for infection ❑Liable to stress
incontinence ❑Urinary problems can affect the elderly self-steam and his social Activities

The nervous system: -

❑ Reduction in brain size and weight due to a decrease in the volume of the cerebral cortex.
❑ Reduction in the number of functioning neurons.
❑ Blood flow to the brain is decreased as a result of fatty deposits that gradually accumulate in the walls of
blood vessels and reduce the rate of arterial blood flow. This condition is called atherosclerosis.
❑ The nerves and the spinal cord slowly lose weight and the number of nerve cells slowly decreases.
❑ Slower transmitted signals from nerve cell to nerve cell, which leads to slower reflexes and a gradual loss of
the senses.
❑ Nerve cells may begin to transmit messages more slowly than in the past.
❑ The breakdown of nerves can affect the senses. You might have reduced or lost reflexes or sensation, leading
to problems with movement and safety.
❑ Some slight slowing of thought, memory, and thinking seems to be a normal part of aging. Although these
changes are natural.
Common problems related to nervous system changes:
❑Increased risk of injury ❑Increased risk of fall
❑Increased risk of accident ❑Decreased memory
❑lost reflexes ❑ Effects in memory, & thinking.

Musculoskeletal System: -
❑ The bones, joints, and muscles are the body structures most closely associated with aging process.
A-Bone: -
❑ Increase bone resorption ❑ Diminished calcium absorption
❑ Impaired bone formation ❑ Fewer function marrow cells
B- Vertebral column:-
❑ There is a decrease of height (1.2 cm of height every 20 years).
C- Posture and gait:-
❑ In men, the walking of the elderly shows a short steps and wider leg distance in order to achieve better
balance and stable weight distribution.
❑ Women become bow-legged, with a narrow standing base and walk with a wadding gait.
D- Muscle: -
❑ Muscle losses size and strength as we get older, which can contribute to fatigue, weakness and reduced
tolerance to exercise.
❑ Loss of motor neurons. ❑ Less glycogen is stored in aging muscles.
❑ Diminished protein synthesis.
E- Joints: -
❑ Movement becomes stiffer and less flexible because the amount of lubricating fluid inside your joints
decreases
❑ The cartilage becomes thinner.
❑ Ligaments tend to shorten and lose some flexibility, making joints feel stiff.
❑ Being inactive causes the cartilage to shrink and stiffen, reducing joint mobility.
Common problems related to musculoskeletal system changes:
 ❑ Pain ❑ Impaired mobility ❑ Self-care deficit
❑ Increased risk of falls ❑ Increased risk of infection
❑ Increased risk of fracture ❑ Osteoporosis ❑ Rheumatoid arthritis

9) Integumentary system Integumentary system,

➢ which includes the skin, hair, and nails, undergoes significant changes with age.
a- Skin: -

→ Skin changes are among the most visible signs of aging. Evidence of increasing age includes wrinkles and
sagging skin.
b- Epidermis:
- Superficial outer layers of the skin that contain nerve endings but no blood vessels.
❑ declines by 50 %, this decline results in slower healing, reduce barrier protection.
❑ Epidermis becomes increasingly fragile and thin, and this leads to increased risk of damage such as tears
maceration, and infection.
❑ The skin loses the ability to retain moisture and become dry and scaly. This condition is called Xerosis.
❑ Melanocytes production decreases, melanocytes cluster are form areas of deepened pigmentation causing
brown spots called senile lentigo.
❑ Increase rashes .
c- Dermis: -

→ Layer of skin that below the epidermis that consists of several layers and contains blood vessels, hair
follicles, glands, and nerves.
❑ Dermis decrease in thickness by approximately 20 % with aging.
❑ The number of sweat glands, blood vessels, and nerve endings decrease.
❑ diminishing thermoregulatory function and inflammatory response
❑ tactile sensation, reduced pain perception.
❑ collagen and elastin fibers. ❑ Loss of subcutaneous fat(wrinkles) in face around eyes, mouth and nose.
d- Subcutaneous fat:-
▶ Decreased amount of subcutaneous tissue
▶ redistribution of fat to the abdomen and thighs.
▶ Breast tissue also changes and become more granular and atrophic in appearance.
▶ As a result of a loss of padding .
▶ The loss of this padding increases vulnerability of pressure points.
E- Gland (sweat and sebaceous):-
❑ Sweat gland function decrease, and the amount of perspiration decreases
❑ decrease in the amount of subcutaneous fat .
❑ The sebaceous gland and pores become larger.
❑ Sebaceous gland secretion decline leading to dry skin.
F-Blood vessels: -
▶ The wall of the capillaries become increasingly fragile which lead to senile purpura, on the legs and arms.
▶ Plasma and extracellular volume remain somewhat constant, but intracellular fluid decreases.
g- Hair: -
▶Hair thins, and growth declines.
▶Hair tends to gray as a result of progressive melanin loss.
Hair
▶women may have increased lip and chin hair while experience a thinning of hair on the head, axillae and
perineal area.
▶Men lose scalp and beard hair, yet experience increased growth over eyebrows and in ear and nostrils.
h- Nails: -
❑ Nails grow slower with age and become thicker, more brittle and they also develop ridges or longitudinal
lines.
❑ Fingernails grow more slowly and become thick and more brittle
❑ Toe nails may discolor and become so thick that require special equipment for trimming.

Common problems related to integumentary system changes:

❑ Slow healing ❑ Increase risk of damage ❑ Dryness of skin ❑ hypothermia
❑ Decreased tactile sensation ❑ heat intolerance ❑ Reduce pain perception
❑ Increased susceptibility of pressure points ❑ delay absorption of medication and chemicals placed on the skin.

Reproductive System:

→ - Aging changes in the female reproductive

❑ menstrual cycles often become irregular.
❑ The ovaries become less responsive to stimulation by follicle-stimulating hormone (FSH) and luteinizing
hormone (LH). The level of these hormones will decrease.
❑ The ovaries continue to produce small amounts of testosterone and some estrogen.
❑ The vaginal walls become less elastic, thinner, and less rigid, shorter. Secretions become scant and watery.
b- Aging changes in the male reproductive system
❑ Testicular tissue mass decreases
❑ the level of the male sex hormone stay the same or decreases very slightly.
❑ Decrease in libido
❑ Prostate gland enlargement
❑ Seminal fluid decreases in volume and viscous Common problems Risk of vaginal infection, ovarian cyst,
Risk of Lower self-image.
11) Aging changes in the senses: - When you age, senses (taste, smell, touch, vision, and hearing). become less
acute..
a) Hearing: -

→ Hearing loss is very common with aging. It contributes significantly to social isolation.
b) External ear:-
▶ External ear can be appearing larger .
▶ Increased hair on the ear (especially in men).
c) Middle and internal Ear: -
▶ Membranes in the middle ear, including the eardrum, become less flexible.
▶ Changes in the middle ear with advancing age also contribute to a weakening sense of balance.
▶ Older individuals may complain of dizziness and find it difficult to move quickly without losing their
balance.
b) Vision: -
❑ Aging eyes produce fewer tears(artificial tears
 ❑ Cornea becomes less sensitive
❑ The pupil may also react more slowly in response to darkness or bright light.
❑ The lens becomes yellowed, less flexible, and slightly cloudy.
❑ The fat pads supporting the eye decrease and the eye sinks back into the socket.
❑ Visual acuity may gradually decline.
c) Smell: -
❑ After the age of 50 the sense of smell decreases rapidly. By age 80, the sense of smell is reduced by about
half.
d) Taste: -
❑ Some atrophy of the tongue occurs with age.
❑ Receptor cells for taste are found in the taste buds on the tongue and are replaced continuously.
❑ Other factors that contribute to changes in taste among seniors include poorly fitting dentures.
e) Touch: -
❑ touch and response to painful stimuli decreases. = ❑ Reduce tactile sensation.
❑ The warm-cold difference threshold increases with age.
Common problems related to changes in the senses:
❑ Increase dependency ❑ Dry eye ❑ Dryness of the ear ❑ Decreased light adaption
❑ Decreased visual acuity ❑ Decrease food intake and interest in food ❑ Accidents such as falls, burn, and
poisoning
❑ Problem related to driving ❑ Lack of socialization