Care of the Older Adults

Physiological Changes
in Aging affecting the
Endocrine System
 The Endocrine System

The endocrine system works in conjunction with the nervous

system to regulate, and coordinate the activities of, the body’s
tissues and organs. It consists of a collection of glands located in
different parts of the body – the main ones being the pituitary,
pineal, thyroid, parathyroids, adrenals, pancreas, ovaries and
testes. These glands produce a variety of blood-borne chemical
signals called hormones, which play an essential role in
maintaining balance (homoeostasis) in the body, helping to
ensure that variables such as blood glucose and electrolytes are
kept within normal ranges.
Pituitary gland and somatopause

Changes in aging

Around the age of 25-30, somatotropin secretion begins to decline in both

men and women. In men it is estimated to halve every seven years –
although there appears to be much variation between individuals

Nursing implication

The decline in somatotropin secretion in later years is often referred to as

the somatopause and is associated with a variety of physiological changes
(Jonas et al, 2015; Veldhuis et al, 2005), including:

A general reduction in protein synthesis;

A progressivereduction in lean body mass (muscle) contributing to a
decline in metabolic rate;
An increased deposition of adipose tissue, particularly abdominal fat
(‘middle-age spread’);
A reduction in bone mass and density leading to an increased risk of
osteoporosis and fractures;
A general decrease in immune function and higher susceptibility to
infection.
Pineal glands
As we age, the pineal gland undergoes a process of calcification, detectable even in young
children. Melatonin levels progressively decrease: 60- year-olds have 80% less melatonin
in their blood than teenagers. Some drugs commonly prescribed to older people, such as
beta blockers and non-steroidal anti- inflammatory drugs, can reduce melatonin levels even
further. Decreased melatonin levels are linked to an increased prevalence of sleep
disturbances Since sleep is essential for cognitive function, sleep disturbances can
exacerbate age-related changes in the brain.

Nursing interventions

Check effect of medication on sleep and wakefulness

Keep a regular bedtime-waketime schedule
Avoid naps or limit to 1 nap a day, no longer than 30 minutes
Restrict naps to late morning or early afternoon

Avoid caffeine, alcohol, and tobacco after lunch

Increase over all daytime light exposure (e.g., spend more time outside, especially
late in the day)
Exercise regularly
Eat a light snack (i.e. milk, bread)before bed
Limit liquids in the evening
Thyroid gland and metabolism

Decreased basal metabolic rate to middle and old age

Some of the nurse’s responsibilities include the provision of

careful patient education. Patients will most likely be on some
type of medication for the remainder of their lives.

They need to understand the importance of taking their

medication as prescribed. They also need to be aware of the
signs and symptoms of hyper- and hypothyroidism. Patient
education efforts should focus on disease management and
adherence to treatment regimens.
Parathyroid glands and
hyperparathyroidism

Several studies have shown that most people, as they grow older, have
significantly increased levels of circulating PTH

Calcium and vitamin d supplementation

weight-bearing exercise, muscle strengthening, and fall prevention.

Pancreas and
diabetes risk
Diabetes mellitus (DM) is quite prevalent, and its incidence is increasing in people
who are over the age of 65. type 1 DM is usually an autoimmune disease and most
often affects children and young adults. Type 2 DM most often begins as insulin
resistance because of changes in the endocrine system and is linked to old age,
family history and obesity. The incidence of type 2 DM is increasing in the geriatric
population.

Checking blood glucose: Evaluate the older adult’s ability to perform blood glucose monitoring
and evaluate the results. As necessary, teach other family members or caregivers to perform
this task.

Medications: Teach patients, families and/or caregivers about the medications the patient is
taking and the potential for side effects.

●Diet: The dietician should be involved in helping the patient understand dietary implications. If
the patient is unable to adhere to dietary restrictions, programs such as Meals on Wheels may
be initiated.
●signs and symptoms: Teach patients, family members and caregivers the signs of
hyperglycemia and hypoglycemia and what to do in the event of occurrences.
●Blood pressure: Help the patient to adhere to blood pressure management regimen. If he is
not hypertensive, teach him ways to avoid developing high blood pressure.
●Exercise: In conjunction with the patient’s physician, physical therapy and others, nurses
must helpthe patient to design an exercise program appropriate for his state of health and
wellness.
● The elderly patient may have difficulty adjusting to some aspects of the ongoing nature
of DM management. Physical limitations may prevent him from performing foot care or
administering insulin, if needed. Nurses need to make sure that the patient has adequate
resources and support systems to help him manage his care.
The adrenal glands

Ageing is associated with a decline in the secretion of adrenaline, but

adrenaline plasma levels remain relatively constant as clearance by the
kidneys is usually reduced.
There is some evidence that older men secrete less adrenaline in response to
acute

Decreased aldosterone secretion may contribute to postural

hypotension and the light-headedness that is often experienced by
older people when they stand up. This is supported by research
demonstrating significant reductions in serum aldosterone levels in
older people when they are upright, as opposed to recumbent
(Hegstad et al, 1983).

Nursing interventions:
● Elevate head of the bed
● Avoid abrupt position changes
Gonads

Women: Decline in estrogen secretion.

Men: Decline in testosterone secretion.

Women experience symptoms associated

with menopause and have increased risk for
atherosclerosis and osteoporosis.
 Assessment

A. Production of most hormones is reduced.

B. Parathyroid function and secretion are unchanged.
C. Pituitary decreases in weight and changes in cell type
proportion. Significance is undetermined.
● Growth hormone present, but in lower blood levels.
● Reduced adrenocorticotropic hormone (ACTH),
thyroid-stimulating hormone (TSH), follicle-stimulating
hormone (FSH), and luteinizing hormone (LH)
production.
D. Reduced thyroid activity.
● Decreased basal metabolic rate.
● Reduced 131I uptake.
E. Reduced aldosterone production.
F. Reduced gonadal secretion of progesterone, estrogen,
testosterone.
 1.
Le Imba
req ss th lance
2. uire an b d N o u
m
3. Risk ent dy t r i t i o
D i s f o r n:
t u r I n j
b e ur
Nursing Diagnosis

d y
S l e e p P a tt e rn
Goal

1. Ingest appropriate amounts of

calories/nutrients
2. Free of Injury
3. Optimal balance of sleep
Thank You
for
Listening