Ptosis (Drooping of the eyelid, and patient
PHYSIOLOGIC CHANGES IN
AGING AFFECTING THE
INTEGUMENTARY SYSTEM
2  Loss of subcutaneous tissue
Collagen – A protein that is responsible to the elasticity
and integrity of the skin.
Keratin – A protein that helps form hair, nails and your
skin’s outer layer (epidermis).
Melanin – A substance in the body that produces hair,
eye and skin pigmentation.
SKIN AGE RELATED CHANGES DURING 20s
Environmental damage and constant exposure to
damaging UV rays begin to take their toll on skin. Free
radical search attacks the skin’s structural integrity. Cell
renewal and turnover rates to decline.
High collagen production keeps skin plump and firm;
some dynamic wrinkles around the eyes and cheeks are
normal.
SKIN AGE RELATED CHANGES DURING 30s
After the age of 20s, collagen levels decrease by roughly
1% per year; wrinkles are deeper-set and more prone to
discoloration and environmental damage.
In our 30s, collagen elastin degrades, resulting in our
first wrinkles. Cell renewal and turnover continue to
decline, leading to a duller complexion and uneven skin
tone.
SKIN AGE RELATED CHANGES DURING 40s
By our 40s, the skin is thinner, barrier lipids are not as
pronounced and dehydration can be an issue. More
prominent signs of skin aging may also appear, such as
dark spots and significant dullness.
Volume loss makes sagging more noticeable; wrinkles
and skin damage are more visible and harder to treat.
SKIN AGE RELATED CHANGES DURING 50s
The protective barrier lipid layer lessens, leading to less
efficiency in retaining moisture and more potential for
sensitivity and dehydration. Skin shows wrinkles, fine
lines and pigmentation.
Bone and tissue volume shrinks, leaving more loose skin
and a hollow appearance; skin is prone to damage.
SKIN AGE RELATED CONSEQUENCES
 Weakened facial musculature (Skin sagging)
 Loss of subcutaneous tissue around the face
and eyes (Subcutaneous tissue stores fats which
protect our internal organ)
 Creases and lines appear on the face in areas of
expression
 Wrinkles (noticeable on the face)
 Frown lines and “Crow’s feet” (Also known as
Laugh Lines, these small lines and wrinkles form
from tiny muscles contracting in the outer
corner of the eyes)

usually presents with the complaint of the
defect in vision and cosmesis)
SKIN AGE RELATED CONSEQUENCES
 Less insulation/padding
 Increases skin injuries
 Potential hypothermia
 Affects Lipophilic medicines
 Thermoregulation is affected, body fat generally
increases and total body water decreases, and
our body changes the way we absorb medicine.
SKIN AGE RELATED CONSEQUENCES
 Changes in the connective tissue
 Reduce the skin’s strength and elasticity
 Worse with UV exposure
 Elastosis (Solar Elastosis) – Degenerative
changes in the dermal tissue with increased
disposition of elastin materials. Yellowish
thickened appearance to skin.
SKIN AGE RELATED CONSEQUENCES
 SWEAT GLAND ATROPHY – Sweat Glands
decreases
 Reducing perspiration – Decrease in sweating
 Axilla and groin area
 Hyperthermia
 Heat Stroke
 When our body temperature increases,
hypothalamus tells eccrine sweat glands to
start cooling down our body by producing
sweats. However, because of sweat gland
atrophy, our body experiencing difficulty in
releasing the heat that is why elderlies our
prone to Hyperthermia and Heat Stroke.
SKIN AGE RELATED CONSEQUENCES
 SEBACEOUS GLANDS DECLINE
 Produce less “oil” (Harder to keep moisture
resulting to dryness)
 Dry, itchy skin
 Xerosis – Abnormally dry skin or membranes,
such as those found in the mouth or the
conjunctiva of the eye.
SKIN AGE RELATED CONSEQUENCES
 Loses the ability to retain moisture
 Becomes abnormally dry and scaly
 Xerosis
 Contributes thinning of skin
 Oily Skin (Natural Moisture) – it serves as
protection of our skin to UV damage.
SKIN AGE RELATED CONSEQUENCES
 Area of extra pigmentation found on hands,
face, arms and legs
 Most areas exposed to ultraviolet light on a
regular basis
 Age Spots
 Liver Spots
 Lentigo Senilis
  Age spots, liver spots and lentigo senilis are
cause by overactive pigment cells. Ultraviolet
light speeds up the production of melanin, a
natural pigment that gives skin color. On skin
that has had years of sun exposure, age spots
appear when melanin becomes clumped or is
producing in high concentrations.
SKIN AGE RELATED CONSEQUENCES
 Loss of subcutaneous layer
 Decreased number of blood vessels available to
supply the skin – Angiogenesis (formation of new
blood vessels) is impaired aged tissues.
 Vessels more fragile and easily
 injured
 Reduced sense to touch, pressure, vibration,
heat, and cold – Because of decreased of blood
flow to the nerve endings r to the spinal or brain.
 Senilis Purpura (Bruising) – Typically affects older
patients as their dermal tissues atrophy and
blood vessels becomes more fragile.
 Cherry Angiomas – A noncancerous (benign) skin
growth made up of blood vessels.
SKIN AGE RELATED CONSEQUENCES
 Seborrheic Keratoses “Barnacles of Aging” –
Epidermal skin tumors that commonly present in
adult and elderly patients.
 Age Related
 Skin Tags – Tend to develop when the skin rubs
together.
 Warts – Infections in the skin caused by the
human papillomavirus.
SKIN AGE RELATED CONSEQUENCES
 A major cause of skin changes is UV radiation
(Sunlight)
 Squamous Cell Carcinoma – A type of cancer that
starts as a growth of cells on the skin.
 Basal Cell Carcinoma – Develops mostly in areas
expose to sun. Common type of Skin Cancer and
if not treated, it will spread.
 Malignant Melanoma – A disease in which
malignant (cancer) cells form in melanocytes
(cells that color the skin).
SKIN AGE RELATED CONSEQUENCES
 Loss of subcutaneous fat
 Sedentary lifestyle
 Nutritional deficiencies
 Comorbidities
 Decubitus Ulcer, Pressure Ulcer and Pressure
Sore – Skin and soft tissue injuries that form as a
result of constant or prolonged pressure exerted
on the skin.
 Bed Sore – Ulcers that happen on areas of the
skin that are under pressure from lying in bed,
sitting in a wheelchair, or wearing cast for a
prolonged time.
NURSING MANAGEMENT
 Prevention - Lifelong Process
 UV protection/PPE when outdoors
 Good Nutrition and adequate fluids -
Dehydration increases the risk of skin injury
 Use skin moisturizers - Moist skin may heal
better
 Do not use soaps that are heavily perfumed
 Use sunscreen
AGE RELATED PROBLEMS
 Wound Healing 4x longer - Skin gets thinner and
the body shows decrease inflammatory
response. Slow rates of cell division translate
into slow skin regrowth.
 Nutritional deficiencies
 Stress - Stress can cause inflammation to DNA
cells, which intern can accelerate aging
(Increase Cortisol)
 Medication Reactions
 Comorbidities
HAIR AGE RELATED CONSEQUENCES
 Gray or White Hair – Follicles less make less
melanin.
 Facial Hair – Menopausal Women – Estrogen
and progesterone levels falls meaning the effect
of androgen which is the male hormone
increase.
 Hair Loss – Men and women – Hair might
become thinner because of hair follicle shrinks.
NAIL AGE RELATED CONSEQUENCES
 Decreased circulation causes nails to become
brittle and thick
 Longitudinal lines may appear and growth of
nails is slower
 Toenails become particularly thickened
AGING CHANGES OF THE MUSCULOSKELETAL SYSTEM
What is musculo-skeletal?
 Your musculoskeletal system supports you and
helps you move. It's made up of your bones and
joints. It also includes muscles, tendons, and
ligaments.
 Bones and skeletal muscles undergo a gradual age-
related degeneration that accelerates frailty and
makes older people more prone to sarcopenia,
osteoporosis, osteoarthritis and falls
HOW OUR MUSCLES RESPOND
As we age, our muscles lose mass and begin to shrink.
This is a natural process but can be accelerated with an
inactive lifestyle.
Our muscle fibers will shrink in size and numbers
making it harder for our muscles to respond as we get
older. This also leads to a decrease in water content in
our tendons (the cord-like tissues that attach our
muscles to bones), thus creating stiff tissues.
You may also notice your handgrip strength begin to
weaken, making simple activities like opening a jar more
difficult.
HOW OUR BONES RESPOND
Our bones begin to lose mineral content causing them
to become less dense and more fragile. As they lose
their mass, they become more susceptible to fracture. It
is common to develop osteoporosis, which can cause
crush fractures of the vertebrae and hip fractures in
both older men and women.
HOW OUR JOINTS RESPOND
The changes in our tendons and ligaments cause our
joint motion to become more restricted and lose
flexibility. Over time, our cartilage begins to break
down, resulting in our joints becoming inflamed and
arthritic.
OFFSET THE EFFECTS OF AGING
Knowing what to expect and taking the right steps to
counteract the effects of aging can help you maintain a
strong and healthy body. Maintaining a healthy diet
and participating in daily exercise helps to slow the loss
of muscle mass. Stretching and weight training are great
ways to help maintain flexibility and muscle. Your
exercise program doesn’t need to be strenuous in order
to be effective. Just 30 minutes of activity a day such as
walking, biking, or swimming can provide long-term
health benefits.
PHYSIOLOGICAL CHANGES IN CARDIOVASCULAR
SYSTEM IN ELDERLY.
AGING CHANGES: Heart
The heart has a natural pacemaker system that controls
the heartbeat. Some of the pathways of this system
may develop fibrous tissue and fat deposits. The natural
pacemaker (the sinoatrial or SA node) loses some of its
cells. These changes may result in a slightly slower heart
rate.
A slight increase in the size of the heart, especially the
left ventricle, occurs in some people. The heart wall
thickens, so the amount of blood that the chamber can
hold may actually decrease despite the increased
overall heart size. The heart may fill more slowly.
Heart changes often cause the electrocardiogram (ECG)
of a normal, healthy older person to be slightly different
than the ECG of a healthy younger adult. Abnormal
rhythms such as atrial fibrillation, are more common in
older people. They may be caused by several types of
heart disease.
Normal changes in the heart include deposits of the
"aging pigment," lipofuscin. A heart murmur caused by
valve stiffness is fairly common in older people.
AGING CHANGES: Blood Vessels
The baroreceptors become less sensitive with aging.
This may explain why many older people have
orthostatic hypotension. This causes dizziness because
there is less blood flow to the brain.
The main artery from the heart (aorta) becomes thicker,
stiffer, and less flexible. This is probably related to
changes in the connective tissue of the blood vessel
wall. The other arteries also thicken and stiffen. In
general, most older people have a moderate increase in
blood pressure.
The blood itself changes slightly with age. Normal aging
causes a reduction in total body water. As part of this,
there is less fluid in the bloodstream, so blood volume
decreases.
The speed with which the rbc are produced in response
to stress or illness is reduced. This creates a slower
response to blood loss and anemia.
Most of the white blood cells stay at the same levels,
although certain white blood cells important to
immunity decrease in their number and ability to fight
off bacteria. This reduces the ability to resist infection.
COMMON PROBELMS IN AGING
Angina- chest pain caused by temporarily reduced blood
flow to the heart muscle.
- feel like pain, pressure, tightness, discomfort,
squeezing, heaviness, or burning in the chest.
 Shortness of breath
 Extreme fatigue
 Light-headedness or fainting
 Nausea, or feeling sick to the stomach.
 Heartburn or indigestion
 Sweating
ARRYTHMIAS- occurs when the electrical signals that
coordinate the heart's beats don't work properly. The
faulty signaling causes tachycardia, bradycardia or
irregularly.
Atherosclerosis (hardening of the arteries)- It is caused
by a buildup of plaque in the inner lining of an artery.
Risk factors:
 High cholesterol and triglyceride levels
 High BP
 Smoking
 Obesity
 Physical Inactivity
 High Saturated Fat Diet
Congestive heart failure, or heart failure, is a long-term
condition in which your heart can’t pump blood well
enough to meet your body’s needs.
  Your heart is still working. But because it can’t
handle the amount of blood it should, blood
builds up in other parts of your body. Most of
the time, it collects in your lungs, legs and feet
Aortic stenosis occurs when the aortic valve narrow and
blood cannot flow normally. The condition may range
from mild to severe.
SUMMARY
 Angina (chest pain caused by temporarily reduced
blood flow to the heart muscle), shortness of breath
with exertion, and heart attack can result from
coronary artery disease.
 Abnormal heart rhythms (arrhythmias) of various
types can occur.
 Anemia may occur, possibly related to malnutrition,
chronic infections, blood loss from the
gastrointestinal tract, or as a complication of other
diseases or medicines.
 Atherosclerosis (hardening of the arteries) is very
common.
 Congestive heart failure is also very common in
older people.
 Coronary Artery Disease. It is usually a result of
atherosclerosis.
 High blood pressure and orthostatic hypotension.
Older people on blood pressure medicines need to
work with their doctor to find the best way to
manage their high blood pressure. This is because
too much medicine may cause low blood pressure
and could lead to a fall.
 Heart valve diseases. Aortic Stenosis or narrowing of
the aortic valve, is the most common valve disease
in older adults.
 Transient ischemic attacks or strokes can occur if
blood flow to the brain is disrupted.
ASSESSMENT:
A. Peripheral circulation, pulses, color, warmth
 Widened pules pressure.
 Jugular vein distention
B. Circulatory status, orthostatic hypotension,
hypertension
 Dizziness; Fainting
 Auscultate heart sounds.
C. Premature beats and dysrhythmias
D. Edema --- decreased venous return.
E. Activity intolerance
 Weakness
 Fatigue
F. Dyspnea
G. Transient Ischemic attacks (TIAs)
H. Anemia
DIAGNOSIS:
1. Risk for decreased cardiac output.
2. Activity intolerance
3. Fatigue
GOALS:
1. Reduced BP/ Cardiac Workloads
2. Increased energy and improved well-being.
IMPLEMENTATION:
A. Monitor vital signs --- pulse, blood pressure.
 Apical pulse for 1 minute so premature beats is
not missed.
 Take blood pressure in both arms.
B. Monitor Medications—digital, diuretics, etc.
C. Maintain dietary restrictions (low salt)
D. Change position slowly, especially from horizontal to
vertical, to prevent hypotension reaction.
E. Maintain circulatory homeostasis.
 Encourage activity to increase circulatory
stimulation, leg exercise, leg elevation while
sitting.
 Provide warmth by applying blankets and
clothing.
 Use gentle friction during bath.
 Avoid tight/restrictive clothing.
EVALUATION:
1. Patient maintained BP within individual
acceptable range.
2. Patient verbalized increased energy and
improved well-being.
Heart disease risk factors that you have some control
over:
 High blood pressure
 Cholesterol levels
 Diabetes
 Obesity
 Smoking
PREVENTION:
Eat a heart-healthy diet.
Get more exercise.
Have regular check-ups for your heart.
PHYSIOLOGIC CHANGES IN AGING
AFFECTIN THE HEMATOPOIETIC AND
LYMPHATIC SYSTEM
THE HEMATOPOIETIC SYSTEM
The Hematopoietic system consists of organs and
tissues involved in the production of the cellular
components of blood. Because most blood cells have a
short lifespan, the need for the body to replenish its
supply of cells is continuous; this process is termed
hematopoiesis. The primary site for hematopoiesis is
the bone marrow.
BONE MARROW - Soft tissue that fills space in the
interior of the long bones and spongy bones of the
skeleton manufactures blood cells. (2 types: Red
marrow and Yellow marrow.)
BLOOD - It consists of cells suspended in fluid called
plasma. The cellular component of blood consists of
three primary cell types erythrocytes, leukocytes, and
thrombocytes.
GERONTOLOGIC CONSIDERATION (HEMATOPOIETIC
SYSTEM)
 The Red Blood Cells become less flexible and
fewer in number.
 The Red Blood Cells become less flexible and
fewer in number.
 The Red Blood Cells become less flexible and
fewer in number.
 The immune system decrease in response due
to diminished production and function of
blood cells designed to protect the body is
called immunosenescence.
 Decreased renal perfusion can result in
inadequate erythropoietin production
resulting in decreased Red blood cell
production.
THE LYMPHATIC SYSTEM
The Lymphatic system is a group of organs, vessels and
tissues that protect you from infection and keep a
healthy balance of fluids throughout your body.
Function: Filter and destroys pathogens, Removes
other harmful substances, Lymphoid stem cells are
converted to lymphocytes
SPLEEN: It is an emergency reservoir of blood and
removes bacteria and old or damaged red blood cells
from circulation.
THYMUS GLAND: Produces lymphocytes during fetal
development. After birth, thymus glands program T
lymphocytes to become regulators or effector T cells.
and it becomes smaller during adolescence.
LYMPH NODES: Are small lumps of tissue that contain
white blood cells, which fight infection.
They filter your lymph fluid, which is composed of fluid
and waste products created by the body's tissues.
GERONTOLOGIC CONSIDERATION (LYMPHATIC)
 The decreases in primary antibody T cell and B
cell responses.
 Decreased antibody production that results in
increased susceptibility of older adults to
infection and malignancies
AGING is known to affect immune function, a
phenomenon known as immune senescence (aging of
the immune system) includes a depressed immune
response, which can cause infections to be a significant
risk for older adults.
Anatomy and Physiology
 The urinary system consists of two kidneys, two
ureters, the urinary bladder, and the urethra.
 The urinary system supports homeostasis by
eliminating wastes and excessive fluid from
the body. The kidneys continuously filter the
blood and selectively save or eliminate water,
electrolytes, and wastes. Those substances not
reabsorbed by the kidneys are eliminated from
the body as urine.
KIDNEYS
 The kidneys are two bean-shaped organs
located on each side of the spine behind the
peritoneal lining of the abdomen and at the
lower edge of the rib cage. The left kidney is
usually located slightly higher than the right
kidney. Each kidney is surrounded by an adipose
tissue pad and is further protected from trauma
by the muscles of the back.
 Within each kidney is a maze of nearly a
million nephrons, the functional portion of the
kidney. Blood is filtered in the glomerulus of the
nephron, and this filtrate is destined to become
urine. This highly vascular organ receives blood
from the renal artery, which branches off the
abdominal aorta. Blood returns to the
circulation through the renal vein, which
connects to the inferior vena cava.
 Adequate blood flow to the kidneys is very
important; any condition that decreases renal
blood flow interferes with normal kidney
function.
 The kidneys play an important role in fluid and
electrolyte balance and acid-base balance in
the body. They remove nitrogenous wastes,
excess glucose, and drug metabolites from the
bloodstream.
 They also help regulate blood pressure. The
kidneys typically produce between 1 and 2 L of
urine every 24 hours. If excessive fluid is lost
elsewhere (e.g., in perspiration or diarrhea),
urine output normally decreases. Excessive fluid
or alcohol intake tends to increase urine
production. A single kidney can meet the needs
of the entire body.
URETERS AND BLADDER
 The ureters are tubes of smooth muscle that
allow urine to drain from each kidney into the
bladder. When the body is upright, urine drains
by means of gravity. Pressure of the enlarging
bladder against the lower portion of the ureter
 keeps the ureter closed and prevents urine from
flowing back toward the kidneys.
 The bladder is a hollow muscular sac located
below the peritoneum and normally entirely
within the pelvic cavity. The bones of the pelvis
protect the bladder from trauma. In women,
the bladder is located anterior to the uterus; in
men, it is superior to the prostate gland.
 The muscular wall of the bladder is lined with a
mucous membrane and is capable of stretching
to hold large volumes of urine (up to 1000 mL
or more). Urine is retained in the bladder by
means of the sphincter muscles. The internal
sphincter is located at the outlet from the
bladder into the urethra. Control of the internal
sphincter is involuntary. The external urethral
sphincter comes under voluntary control at
approximately 2 to 3 years of age. Voluntary
contraction of the external sphincter prevents
urine from leaving the body. Relaxation of the
external sphincter allows urine to drain from
the body.
 Voluntary control of urination may be
overcome if the bladder becomes overly
enlarged with urine. In adults, the urge to
urinate typically occurs when urine volume in
the bladder reaches approximately 200 to 400
mL.
 The urethra is a tubelike passage that leads
from the bladder to the outside of the body. At
the point of exit, it is referred to as the urinary
meatus. The female urethra is 1 to 1.5 inches
long; the male urethra is 7 to 8 inches long. The
urethra is part of the reproductive system in
men and is used to transport semen as well as
urine; however, ejaculation and urination
cannot take place simultaneously. The prostate
gland surrounds the urethra. Although this
normally causes no problems, an enlarged
prostate can interfere with urination.
CHARACTERISTICS OF URINE
 Urine is approximately 95% water, with the
remainder composed of waste products and
salts. The specific gravity (which measures the
amount of solids dis- solved in water) of urine
is normally maintained within close limits. A
specific gravity of 1.010 to 1.025 is considered
normal. Dilute urine has a low specific gravity,
and concentrated urine has a high specific
gravity. Urine is normally clear, and its color
ranges from pale yellow to dark amber. It may
be alkaline or acidic, depending on the diet of
the individual. High- protein diets tend to
make the urine more acidic; vegetarian diets
tend to lead to alkaline urine. Acidic urine is
less compatible with bacterial growth than is
alkaline urine and may help reduce the risk for
a UTI.
EXPECTED AGE-RELATED CHANGES
 The kidneys decrease in size from
approximately 400 g at age 40 to only 250 g by
age 80. By age 70, they lose approximately one-
third of their efficiency and they lack functional
reserve.
 Despite this, the kidneys are usually able to
remove waste adequately to maintain normal
blood levels. As a person ages (Table 3-7), the
number of functional units or nephrons
decreases.
 In addition, the kidneys lose mass and decrease
in size. Vascular changes, such as those that
occur with atherosclerosis or arteriosclerosis,
lead to decreased blood supply to the kidneys.
Decreased blood flow results in a diminished
glomerular filtration rate. At 90 years of age,
the glomerular filtration rate can be as little as
half of what it was at age 20.
 The blood urea nitrogen remaining in the
blood increases significantly with age, from a
normal of 10 to 15 mg/dL in young adult- hood
to 21 mg/dL by age 70.
 The nephrons and collecting system of the aging
body are less sensitive to the effects of
antidiuretic hormone. Less sodium and water
are reabsorbed and more potassium is lost,
resulting in the production of less concentrated
urine with aging.
 Aging results in reduced urinary bladder size,
which leads to decreased bladder capacity (i.e.,
the volume of urine the bladder can hold before
a person experiences the urge to void). Many
older people need to void when only 100 mL of
urine is present. In addition, overactivity of the
detrusor muscle can result in contraction of
the bladder before the bladder is full. Either or
both of these factors can lead to the urinary
urgency and frequency that is common in older
adults. To further aggravate the situation, loss
of muscle tone can impair voluntary control of
the external sphincter muscle. Atonic muscular
changes may also occur in the wall of the
bladder. Loss of tone may result in reduced
urinary stream, incomplete or unsuccessful
voiding, continuous dribbling of urine, or
urinary retention with overflow voiding (a
condition in which the person voids frequently
but never completely empties the bladder).
 Urinary retention contributes to the risk for
UTIs, especially in older adults, because
retained urine is a good medium for bacterial
growth. The prostate gland enlarges with age.
Most men older than 60 years of age
experience some degree of prostate gland
enlargement as a result of benign prostatic
hyperplasia or prostate cancer. Because it
surrounds the urethra, an enlarged prostate
gland can compress and narrow the
passageway, which, in turn, causes problems
with voiding. Hesitancy, frequency, the inability
to maintain a steady stream of urine, and
urinary retention are common indicators of
prostatic hypertrophy.

COMMON DISORDERS SEEN WITH AGING
Urinary Incontinence
 Urinary incontinence, the involuntary loss of
urine, is not a routine or normal occurrence
with aging. Incontinence may occur as a result
of physiologic changes, other medical problems
such as UTIs, neurologic problems, or changes
in the ability to function. Several classifications
of medication can contribute to incontinence.
Urinary incontinence is discussed in greater
detail in Chapter 18.
Urinary Tract Infection
 The incidence of UTIs increases significantly
with age. Women are more likely to develop a
UTI because of anatomical reasons; 40% will
experience a UTI at some point in their lives.
Men also develop UTIs, but they are less
common in men and develop at an older age.
Both the normal changes of aging and the
increased incidence of health problems
contribute to this increased incidence of UTIs
(Box 3-5).
Chronic Renal Failure
 Chronic renal failure may be a result of other
chronic health conditions, such as hypertension,
DM, chronic UTIs, or urinary tract obstructions.
It may also result from acute renal failure
caused by hypovolemia, hypotension, or
antibiotic toxicity.
 The symptoms of chronic renal failure are
extensive and often mimic those of other
conditions. These symptoms include changes in
urine output, muscle weakness, edema, nausea
and vomiting, itchy and dry skin, and numerous
neurologic symptoms. Blood tests reveal
significant changes, particularly elevated levels
of blood urea nitrogen and creatinine. Chronic
renal failure consists of medications and dietary
changes to attempt slowing of the disease
process. Chronic renal failure may become end-
stage renal failure, which is treated by dialysis
or kidney transplant.
Nocturia
 Nocturia is defined as excessive urination at
night. While having to urinate multiple times in
the night is not serious in itself it can contribute
to insomnia. Between 60 and 80% of people
over the age of 65 experience nocturia.
Renal Calculi
 Renal calculi, also know as kidney stones,
become progressively more common with age.
The presence of stones in the kidney do not
typically cause problems severe enough to be
detected. However, the passage of renal calculi
from the kidney through the ureters, bladder,
and urethra can be extremely painful.
Additionally the stones may become lodged in
the ureter or cause ulcerations in the lining of
the urinary tract.
AGE RELATED CHANGE IN NERVOUS
SYSTEM
The nervous system controls the activities of all body
organs and tissues, receiving input from sensory
organs and responding via effector organs. With
around 100 billion interconnected neurons, the brain is
an extremely complex, and still poorly understood,
organ. However we do understand, to some degree,
how age affects it, as well as the nervous system as a
whole.
 The main organ of the nervous system is the
brain, which, with around 100 billion
interconnected neurons, is extremely complex;
despite decades of research, its function
remains poorly understood.
 Ageing leads to a progressive loss of neurons
and depletion of neurotransmitters (Mather,
2016), these changes are usually associated
with a gradual decline in cognitive function and
influenced by environmental, genetic and
lifestyle factors (Nyberg et al, 2012).
As we age, all of us notice changes in our hair, skin and
joints that let us know we are getting older. Along with
these visible changes, our brains and central nervous
system are going through the aging process too. This is
one reason you are more likely to suffer from a
neurological problem after the age of 65.
 Some of the more common neurological
disorders that affect seniors include strokes,
neuropathy, Alzheimer’s disease and
Parkinson’s disease.
These are some of the more common neurological
disorders you are likely to encounter:
Neuropathy – this nerve disorder causes symptoms
such as numbness and weakness, often affecting the
hands and feet. It can be the result of systemic diseases
such as diabetes, as well as medications and other
causes.
Peripheral neuropathy happens when the nerves that
are located outside of the brain and spinal cord
(peripheral nerves) are damaged. This condition often
causes weakness, numbness and pain, usually in the
hands and feet. It also can affect other areas and body
functions including digestion and urination.
 The peripheral nervous system sends
information from the brain and spinal cord, also
called the central nervous system, to the rest of
the body through motor nerves. The peripheral
nerves also send sensory information to the
central nervous system through sensory nerves.
 most common causes of neuropathy is diabetes.
Risk factors
Peripheral neuropathy risk factors include:
 Diabetes, especially if your sugar levels are not
controlled well.
 Alcohol misuse.
 Low levels of vitamins in the body, especially
vitamin B-12.
 Infections, such as Lyme disease, shingles,
hepatitis B and C, and HIV.
 Autoimmune diseases, such as rheumatoid
arthritis and lupus, in which the immune system
attacks your own tissues.
 Kidney, liver or thyroid disorders.
 Exposure to toxins.
 Repetitive motion, such as those performed for
certain jobs.
 Family history of neuropathy.
Treatment
Treatment either targets the underlying cause, or it
aims to provide symptomatic pain relief and prevent
further damage. Treatments may includeTrusted
Source:
 Maintaining nerve health by keeping a healthy
lifestyle. This can include exercising, eating
healthy, keeping a healthy weight, correcting
any vitamin deficiencies, and not drinking
alcohol or smoking.
 Managing blood sugar in cases of diabetic
neuropathy, to prevent further nerve damage.
 Taking immunosuppressive drugs when the
cause is an autoimmune disorder, or using
plasmapheresis, a procedure that cleans the
blood to reduce inflammation.
 Removing the exposure to a suspected toxin, or
stopping a problematic drug, to halt further
nerve damage.
 Using hand and and foot braces or orthopedic
shoes to help cope with physical disability from
motor symptoms.
Alzheimer’s disease – a form of dementia,
Alzheimer’s is a progressive disease that destroys cells
in the brain and ultimately interferes with a person’s
most basic mental and physical functions. The exact
cause is still unknown.
S&S:
The signs and symptoms of Alzheimer’s disease (AD)
vary based on the stage of the condition. In general, the
symptoms of AD involve a gradual decline in some, most
or all of the following:
 Memory.
 Reasoning and handling of complex tasks.
 Language.
 Understanding visual form and space
relationship.
 Behavior and personality.
People with memory loss or other signs of Alzheimer’s
may have difficulty recognizing their mental decline.
These signs may be more obvious to loved ones.
Anyone experiencing dementia-like symptoms should
see a healthcare provider as soon as possible.
Prevention
Can I reduce my risk of developing Alzheimer’s
disease?
While there are some risk factors for Alzheimer’s you
can’t change, like age and genetics, you may be able to
manage other factors to help reduce your risk.
Risk factors for Alzheimer’s disease include:
 Age (increasing age is the main risk factor).
 Genetics.
 Traumatic head injury.
 Depression.
 Cardiovascular disease and cerebrovascular
disease.
 High blood pressure.
 High cholesterol.
 Diabetes.
 Smoking.
 Obesity.
Research shows that having a healthy lifestyle helps
protect your brain from cognitive decline. The following
strategies may help decrease your risk of developing
Alzheimer’s disease:
 Stay mentally active: Play board games, read, do
crossword puzzles, play a musical instrument or
do other hobbies that require “brain power.”
 Get physically active: Exercise increases blood
flow and oxygen to your brain, which may affect
brain cell health. Wear protective headgear if
you’re participating in activities that increase
your risk of a head injury.
 Stay socially active: Regularly talk with friends
and family and join in on group activities, such
as religious services, exercise classes, book clubs
or community volunteer work.
 Eat healthily: Follow the Mediterranean or
DASH diet or another healthy diet that includes
antioxidants. Consume alcoholic beverages in
moderation.
 Parkinson’s disease – a chronic and progressive
movement disorder, Parkinson’s disease
 involves the malfunction and death of vital
nerve cells in the brain. Treatment options
include medication and surgery to manage
symptoms.
Stroke – this dangerous, life-threatening event occurs
when the blood supply to a part of the brain is suddenly
interrupted or when a blood vessel in the brain bursts.
Warning signs include face drooping, arm weakness,
and speech difficulty. Call 911 immediately if you see
the warning signs of stroke.
The stroke treatments that work best are available
only if the stroke is recognized and diagnosed within 3
hours of the first symptoms. Stroke patients may not
be eligible for these if they don’t arrive at the hospital in
time.
If you think someone may be having a stroke, act
F.A.S.T. and do the following test:
F—Face: Ask the person to smile. Does one side of the
face droop?
A—Arms: Ask the person to raise both arms. Does one
arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is
the speech slurred or strange?
T—Time: If you see any of these signs, call 9-1-1 right
away.
Note the time when any symptoms first appear. This
information helps health care providers determine the
best treatment for each person.
Do not drive to the hospital or let someone else drive
you. Call 9-1-1 for an ambulance so that medical
personnel can begin life-saving treatment on the way to
the emergency room.
Lower your risk of stroke
Some risk factors for stroke, such as age, race and
ethnicity, and family history, can’t be controlled. But
there are steps you can take to help lower your risk,
including:
 Control high blood pressure. Regularly check
your blood pressure. If it is high, follow a
doctor’s advice on how to lower it. Treating
high blood pressure lowers the risk of both
stroke and heart disease.
 Don’t smoke. Smoking increases your risk for
stroke. It’s never too late to quit.
 Control your cholesterol. High blood
cholesterol levels can lead to plaque buildup in
your arteries. In time, this can block blood flow
and lead to a stroke. If you have high
cholesterol, work with a doctor to lower it.
 Control your diabetes. Untreated diabetes can
damage blood vessels and lead to narrowed
arteries and stroke. Follow a doctor’s
suggestions for keeping diabetes under control.
 Eat healthy foods. Eat foods that are low in
cholesterol and saturated fats. Include a variety
of fruits and vegetables every day.
 Exercise regularly. Try to make physical
activity a part of your everyday life. Do things
you like; for example, take a brisk walk, ride a
bicycle, or go swimming. Talk with your health
care provider if you haven’t been exercising and
you want to start an exercise program or
increase your physical activity.
 Manage blood thinners. Too much blood
thinning medication, such as aspirin or
anticoagulants, can lead to bleeding. If you take
these medications, a doctor can help to ensure
your dosage is correct.
Parkinson’s disease – a chronic and progressive
movement disorder, Parkinson’s disease involves the
malfunction and death of vital nerve cells in the brain.
Treatment options include medication and surgery to
manage symptoms
Risk factors for Parkinson's disease include:
 Age. Young adults rarely experience Parkinson's
disease. It ordinarily begins in middle or late
life, and the risk increases with age. People
usually develop the disease around age 60 or
older. If a young person does have Parkinson's
disease, genetic counseling might be helpful in
making family planning decisions. Work, social
situations and medicine side effects are also
different from those of an older person with
Parkinson's disease and require special
considerations.
 Heredity. Having a close relative with
Parkinson's disease increases the chances that
you'll develop the disease. However, your risks
are still small unless you have many relatives in
your family with Parkinson's disease.
 Sex. Men are more likely to develop Parkinson's
disease than are women.
 Exposure to toxins. Ongoing exposure to
herbicides and pesticides may slightly increase
your risk of Parkinson's disease.
How to Reduce Risk
 Parkinson’s disease is notoriously difficult to
treat and there is no cure. Ensuring proper and
timely diagnosis is critical for managing the
condition, and several tests help in that task. To
slow its progression, certain lifestyle and dietary
changes may help.
 There's currently no cure for Parkinson's
disease, but treatments are available to help
relieve the symptoms and maintain your
quality of life.
These treatments include:
 supportive therapies, such as physiotherapy
 medication
 surgery (for some people
Parkinson’s disease is notoriously difficult to treat and
there is no cure. Ensuring proper and timely diagnosis is
critical for managing the condition, and several tests
help in that task. To slow its progression, certain
lifestyle and dietary changes may help.
Neurological Tests
There’s no specific test for Parkinson’s disease, so
neurologists—doctors who specialize in the treatment
of brain and spine disorders—rely on information from
your medical history and testing your motor and
physical ability for diagnosis. There are a number of
neurological tests to identify signs of the disease,
including:89
 Tests of repetitive movement: This is used to
assess motor coordination. You will perform
repetitive movements, such as opening and
closing a hand or tapping fingers, while a
neurologist observes.
 Observation: Spontaneous, uncontrolled
movements are a cardinal sign of Parkinson’s
disease. You may be observed while you are
asked to sit still, stand up, or walk down a hall.
 Tremor assessment: Rest tremors, or
uncontrollable shaking when not moving, are
another typical sign. The neurologist will ask
you to stay still and focus on a task while
observing and noting any symptoms.
 Rigidity assessment: To screen for stiffness and
rigidity in the joints—another cardinal sign of
the condition—the neurologist will move your
hand around to feel how much resistance there
is.
 Pull test: Stooped or irregular posture and
difficulty balancing also are signs of Parkinson’s
disease. To check for effects, the neurologist
will pull you back while you’re standing and
gauge how well you’re able to keep balanced.
Genetic Tests
Since some cases of Parkinson’s are linked to genes,
genetic testing can also play a role in identifying the
condition. Though not a standard aspect of diagnosis,
it’s considered when genetic-linked cases are suspected
and especially if you have a family history of the
disease.
Exercise
 Conferring numerous all-around health
benefits, regular exercise has been found to
slow the progression of Parkinson’s disease and
potentially delay its onset. Researchers have
found a distinct effect, particularly if practiced
during middle adulthood and late in life.
According to a 2015 study, people ages 35-39
who regularly took part in regular physical
activity had a 40% lower risk of developing the
condition.
 Regular exercise can also improve motor
function, help with balance and gait (how you
walk), and promote strength in diagnosed
patients.11 Physical exercise and physical
therapy have long been recommended
alongside traditional therapy for Parkinson’s
disease, especially when aerobic activity is
combined with strength and balance training.
Diet
There are studies that show that changing what you eat
may help with prevention, but more research is needed
in this area. Potential approaches include:
 Mediterranean diet: Adopting a Mediterranean
diet, which is high in vegetables, fruit,
unsaturated fat, whole grain, and nut-intake,
may help delay the onset of Parkinson’s disease.
 Reducing dairy: Diets that are lower in dairy
products, such as cheese, milk, and yogurt, may
also reduce the risk of developing Parkinson’s
disease.
 Increasing caffeine: Studies have shown caffeine
—as in coffee or tea—to be a protective factor,
meaning it may help delay onset.
 Reducing alcohol: Among other health benefits,
stopping alcohol consumption is associated with
a reduced risk of the disease.
Fortunately, there are some steps you can take to
minimize your chances of a neurological disorder. The
first step is controlling risk factors such as smoking, high
blood pressure, high cholesterol, obesity, and lack of
exercise which can contribute to stroke, and possibly
other neurological issues. Even if you do suffer from a
neurological problem when you get older, the healthier
you are the better able you will be able to deal with it.
Age-related changes to the central
nervous system
Neural tissue
The ageing brain gradually loses neurons and supporting
neuroglial cells. Between the ages of 20 and 60, the
brain loses around 0.1% of neurons per year, after
which the process speeds up. By the age of 90, brain
mass will have decreased by around 11% compared
with individuals in their 50s, which equates to a loss of
about 150g of neural tissue. The remaining tissues
harbor an increased concentration of potentially
harmful materials such as iron, aluminium and free
radicals.
Cerebral cortex
 The loss of neurons is most apparent in the
cerebral cortex. The grooves (sulci) that mark
the surface convolutions (gyri) of the cerebral
cortex are visibly deeper in brains of older
people. It was originally thought that the frontal
lobes were particularly vulnerable to neural
loss, but similar losses have been observed in
other cortical regions such as the parietal lobes.
 Structural changes in the frontal and parietal
lobes are related to poor memory. Many people
in their 80s have modest levels of amyloid
 protein deposition and retain their memory,
while individuals with higher levels typically
have a poorer working (short-term) memory
(Nyberg et al, 2012). However, the role of
amyloid deposition in impairing memory has
recently been questioned and other factors,
such as accumulation of tau proteins, may play
a more important role (Brier et al, 2016).
Hippocampus
 The hippocampus has a key role in memory and
the acquisition of new skills. With age, it loses a
significant amount of neural tissue , which may
explain why activities such as learning a new
language become more difficult with advancing
age.
Somatic motor cortex
 Around 35% of people over the age of 70 years
have gait problems; while there are many
contributing factors, including age-related
changes to muscles and joints, the nervous
system is also implicated. The somatic motor
cortex – located in the frontal lobes of the brain
– controls the movement of muscles involved in
walking. From middle age onwards the neurons
in this region show signs of atrophy, which can
contribute to gait problems, potentially
reducing mobility in older people.
Brainstem and autonomic function
 The medulla oblongata and other areas of the
brainstem lose fewer neurons than other
regions of the brain. The brainstem is probably
the best-preserved region of the brain, which
probably reflects its essential role in supporting
life: it controls breathing, peristalsis, heart rate
and blood pressure. However, the autonomic
function of the brain does decline with age and
this can compromise the body’s ability to
respond quickly to internal and external
environmental changes. Both branches of the
autonomic nervous system (ANS) – the
parasympathetic and sympathetic branches –
are compromised with age.
These changes can negatively affect older people. For
example, the blunting of baroreceptor responses
increases the risk of postural hypotension, so standing
up suddenly can lead to falls and injury. Another
negative consequence is the gradual loss of bladder
control. To control micturition, the body relies on the
interplay of sensory stretch receptors and the ANS
(which together monitor bladder filling) and the
conscious areas of the cerebral cortex (which signals
when the bladder is full). To initiate micturition, the
body needs motor control of the urinary sphincter. All
these elements function less well with age, and these
age-related changes combine with those in other body
systems – such as prostate enlargement in men and
weakened pelvic floor muscles in women – to reduce
bladder sensitivity and, which can lead to continence
problems.
Cerebral blood flow and the blood-brain barrier
 Cerebral blood flow decreases by around 0.38%
per year, equating to a 27% decline over
70 years of life. This is a direct consequence of
the age-related changes in the cardiovascular
system, and may be exacerbated in patients
with atherosclerotic occlusion of the carotid
arteries.
 The blood-brain barrier (BBB) is formed
primarily of tight junctions between adjacent
endothelial cells within the blood vessels in the
brain. Additionally, specialised neuroglial cells
called astrocytes wrap around the cerebral
vessels, forming a further physical barrier
between the blood and neural tissues.
 The BBB is essential to prevent most pathogens
and many toxic materials crossing into the
neural networks and pathways of the brain, but
its integrity appears to diminish with age. A
recent study indicates that, during normal
ageing, the BBB is first weakened in the
hippocampus, thereby allowing harmful
substances and pro-inflammatory mediators to
cross into this vital region of learning and
memory. This breaching of the BBB may
contribute to hippocampal shrinkage, and
therefore to cognitive decline
Neurotransmitters
 Ageing is associated with a declining production
of many neurotransmitters, including
noradrenaline, glutamate, dopamine and
serotonin. The decline in dopamine appears to
be particularly important: dopamine modulates
motor function and the acquisition of new skills,
while also acting as one of the brain’s reward
chemicals
 The number of dopamine-producing neurons
decreases as part of the normal ageing process,
and this can adversely affect the ability to learn
from past experiences. Recent studies show
that many older people who boosted their
levels of dopamine by taking L-DOPA (a drug
normally used to treat Parkinson’s disease)
were learning as quickly as young adults again
Spinal cord
 Age-related changes to neurons and neuroglial
cells appear to have little effect on spinal cord
function. However, age-related changes to the
vertebrae and intervertebral discs may increase
pressure on the spinal cord and its branching
nerve roots.
 This can slow down the conduction of nerve
impulses along motor neurons, contributing to
reduced muscular. Reduced sensory and motor
 conduction will increase the risk of injury due to
poor coordination, poor balance and poor fine
motor control.
Age-related changes to the peripheral
nervous system
 With age, some peripheral neurons show a
‘dying back’ (shrinkage of axonal length), loss of
mitochondria and a degeneration of their
insulatory myelin sheaths. Some of this damage
may be caused by a rise in the concentrations of
pro-inflammatory mediators in the body. The
ageing body becomes less effective in clearing
toxic metabolites and, as peripheral nerves are
not afforded the protection of the BBB, this may
contribute to peripheral nerve damage.
 The loss of myelin slows the conduction of
peripheral nerve impulses by around 5-10%
(Joynt, 2000). In health, this reduction in
conductivity causes few problems, but in older
people with diabetes it may contribute to, and
exacerbate, diabetic neuropathy. Damaged
peripheral nerves are not repaired as efficiently
in older people as in their younger
counterparts, and some of these nerves are
never repaired. This can contribute to reduced
sensation and motor control.
How does age affect brain function?
In the absence of disease, intellectual ability can be
retained throughout life. However, the gradual loss of
neurons, depletion of neurotransmitters and slowing of
nerve conduction may act together to slow down the
processing of information. As a result, older people may
take longer to complete certain tasks, and commonly
experience the functional brain changes described
below.
Short-term and episodic memory
The loss of short-term and episodic memory is probably
the earliest indication of age-related changes in the
brain. Unlike what happens in dementia, the loss of
short-term memory in the absence of disease does not
affect life skills (such as the ability to cook), but
manifests as inconveniences (such as forgetting an item
from the shopping list). Episodic memory (that is,
remembering autobiographical events and their timings
and sequence) also gradually declines in many older
people.
Verbal and word skills
Verbal communication skills generally remain strong
throughout life, but people over the age of 70 years
may have increasing problems using or recalling words.
The ability to quickly name a common object usually
remains stable up to the age of 70, but then declines
with advancing years.
Reaction time
The progressive loss of neurons, reduction in impulse
velocity and minor changes in the spinal cord lead to a
slowing down of reaction times. This can create
problems, particularly when a fast reaction is essential
(for example, to step out of the way of oncoming
traffic).
Emotional reactions
On the whole, older people are less prone to emotional
outbursts than younger people. This may be related to
the relative structural stability of some of the brain
regions linked to emotions. Most studies of the
amygdalae – which are heavily involved in impulsive
behaviours and emotional reactions – reveal little
evidence of atrophy or shrinkage at a much slower rate
than in other brain regions. Additionally, the amygdalae
also appear to retain most of their functional activity in
older age.
Neuroactive drugs
Because the overall neural mass reduces with age,
neuroactive drugs such as antidepressants and
neuroleptics can be more potent in older people. Doses
normally prescribed to adults may induce confusion or
delirium, and may therefore need to be adjusted.
Encouraging healthy mental ageing
 Keeping mentally active throughout life can
reduce the effects of age on the nervous
system, and engaging in social, sporting and
mentally challenging activities can slow
down the decline in cognitive performance. It
appears the more intellectually demanding and
complex an individual’s occupation, the better
their cognitive performance in later years;
however, in retirement, when the mental
challenges of work are removed, this effect
appears to decline.
 Older people should be encouraged to engage
in stimulating activities such as socializing,
reading and games, which are thought to
improve cognitive function and memory, as well
as reduce the risk of depression. It is a common
misconception that ageing naturally leads to
conditions such as confusion, dementia, and
delirium. The human brain’s in-built redundancy
allows it to adequately cope with the physical
changes associated with ageing. Indeed, in the
absence of disease, adequate mental function
can be retained throughout life.
PHYSIOLOGIC CHANGES OF AGING
AFFECTING THE SPECIAL SENSES
Most older people cannot see, hear, feel, taste, or smell
as well today as they did ten, twenty, or thirty years
ago. Why? The normal aging process causes gradual
losses to the sensory system. Generally, these changes
begin around the age of 50 years. Families and
caregivers notice that changes have occurred when
older family and friends start using bifocals, turn up the
sound on the television, or add more seasoning to make
food taste good. All of these symptoms just go along
with growing older, and there is no reason to be
alarmed. However, if a change occurs suddenly to
vision, hearing, taste, smell, or touch it should be a red
flag that something may be wrong. It is critical that a
doctor checks the problem immediately.
SENSORY LOSS
It is a condition in which one or more of our special
senses (sight, hearing, smell, touch, taste and spatial
awareness) are no longer normal.
SENSORY DEPRIVATION
It is the deliberate reduction or removal of stimuli from
one or more of the senses.
VISION
 Decreased visual acuity and color and light
perception.
ACUITY - the ability to hear, see, or think
accurately and clearly.
Difficulty to distinguish color especially blue and
green.
 Presbyopia
In middle age, the lens of the eye becomes less
flexible and less able to thicken and thus less
able to focus on nearby objects. Reading glasses
or bifocal lenses can help compensate for this
problem.
 Increased sensitivity to glare
 Risk of age-related eye conditions (cataracts,
glaucoma, macular degeneration).
Arcus senilis (a deposit of calcium and
cholesterol salts) appears as a gray-white ring at
the edge of the cornea. It is common among
people older than 60. Arcus senilis does not
affect vision.
Cataract is a cloudy area in the lens of your
eye (the clear part of the eye that helps to focus
light)
Glaucoma is a group of eye diseases that can
cause vision loss and blindness by damaging a
nerve in the back of your eye called the optic
nerve.
Age-related macular degeneration (AMD) is an
eye disease that can blur your central vision. It
happens when aging causes damage to the
macula — the part of the eye that controls
sharp, straight-ahead vision. The macula is part
of the retina (the light-sensitive tissue at the
back of the eye).
INTERVENTIONS
 Provide appropriate eyewear.
 Avoid night driving.
 Provide lighting without glare.
 Give meds as ordered.
 Laser photocoagulation
-an eye surgery using a laser to shrink or
destroy abnormal structures in the retina.
 Photodynamic therapy
HEARING
 Presbycusis
-gradual sensorineural loss that progresses from
the loss of ability to hear high frequency tones
to a generalized loss of hearing
 Difficulty hearing high-pitched sounds.
 Impaired ability to distinguish between sounds
in noisy environments.
INTERVENTIONS
 Speak clearly, slowly, and in a low pitch.
 Decrease background noise.
 Hearing aids
 Assistive devices like telephone amplifiers or
technology that converts speech to text.
TASTE
The number of taste buds decreases as you age. Each
remaining taste bud also begins to shrink. Sensitivity to
the five tastes often declines after age 60. In addition,
your mouth produces less saliva as you age. This can
cause dry mouth, which can affect your sense of taste.
 Reduced taste sensitivity.
 Decreased appetite
 Less saliva
INTERVENTIONS
 Give attractive, palatable meals.
 Switch to a different medicine if the medicine
you take is affecting your ability to taste.
 Use different spices or change the way you
prepare food.
SMELL
Your sense of smell can also diminish, especially after
age 70. This may be related to a loss of nerve endings
and less mucus production in the nose. Mucus helps
odors stay in the nose long enough to be detected by
the nerve endings. It also helps clear odors from the
nerve endings.
 Decreased sense of smell.
INTERVENTIONS
Once diminished smell is diagnosed, the goal of
management entails preventing injury related to this.
 Visual stimulating gas detection devices are
good for those with a gas stove, as the person
may not be able to smell gas leaks.
 Relatives or neighbors need closer involvement
to check for spoiled food that if eaten could
lead to food poisoning.
TOUCH
The sense of touch makes you aware of pain,
temperature, pressure, vibration, and body position.
Skin, muscles, tendons, joints, and internal organs have
nerve endings (receptors) that detect these sensations.
Some receptors give the brain information about the
position and condition of internal organs. Though you
may not be aware of this information, it helps to
identify changes (for example, the pain of appendicitis).
Your brain interprets the type and amount of touch
sensation. It also interprets the sensation as pleasant
(such as being comfortably warm), unpleasant (such as
being very hot), or neutral (such as being aware that
you are touching something).
With aging, sensations may be reduced or changed.
These changes can occur because of decreased blood
flow to the nerve endings or to the spinal cord or brain.
The spinal cord transmits nerve signals, and the brain
interprets these signals.
With decreased temperature sensitivity, it can be hard
to tell the difference between cool and cold and hot and
warm. This can increase the risk of injury
from frostbite, hypothermia (dangerously low body
temperature), and burns.
Reduced ability to detect vibration, touch, and pressure
increases the risk of injuries, including pressure
ulcers (skin sores that develop when pressure cuts off
blood supply to the area). After age 50, many people
have reduced their sensitivity to pain. Or, you may feel
and recognize pain, but it does not bother you. For
example, when you are injured, you may not know how
severe the injury is because the pain does not trouble
you.
You may develop problems walking because of reduced
ability to perceive where your body is in relation to the
floor. This increases your risk of falling, a common
problem for older people.
PARESTHESIA- The abnormal sensation of prickling,
tingling, or pins and needles
DYSESTHESIA- abnormal feelings of itching, crawling,
stinging, tingling, or prickling
HYPOESTHESIA- loss of sensation or numbness
Older people can become more sensitive to light
touches because their skin is thinner.
 Decreased sensitivity to touch and pressure.
 Reduced ability to detect temperature changes.
 Implications for safety and skin care.
INTERVENTIONS
 Lower the water heater temperature to no
higher than 120°F (49°C) to avoid burns.
 Check the thermometer to decide how to dress,
rather than waiting until you feel overheated or
chilled.
 Inspect your skin, especially your feet, for
injuries.
WHY IS IT IMPORTANT TO KNOW HOW OUR SENSES
CHANGE AS WE GET OLDER?
Tailored Care Plans: Knowledge of these changes allows
healthcare providers to create individualized care plans
that address the specific needs and challenges of each
elderly patient. A one-size-fits-all approach may not be
suitable when dealing with age-related sensory
changes.
Early Detection and Intervention: Awareness of age-
related sensory changes enables healthcare
professionals to detect potential issues early. For
example, identifying vision problems or hearing loss in
their early stages can lead to interventions that may
slow down the progression of these conditions or
alleviate their impact.
Improved Communication: Understanding hearing and
vision changes helps healthcare providers adapt their
communication methods. They can speak clearly, use
appropriate lighting, and provide written information
when necessary to ensure effective communication with
elderly patients.
Enhanced Safety: Reduced sensation in touch and
pressure can make elderly individuals more susceptible
to injuries, such as falls and pressure ulcers. Healthcare
providers who are aware of these changes can take
preventive measures to minimize the risk of such
incidents.
Nutritional and Medication Management: Changes in
taste and smell can affect an elderly person's appetite
and dietary choices. Healthcare professionals can
provide guidance on nutrition and medication
management that takes these sensory changes into
account, helping patients maintain their health and
well-being.
Quality of Life: By addressing the challenges posed by
age-related sensory changes, healthcare providers
contribute to improving the overall quality of life for
elderly patients. Maintaining functional vision, hearing,
and other senses can enhance independence and
engagement in daily activities.
Psychological Well-being: Age-related sensory changes
can have a psychological impact, potentially leading to
social isolation or feelings of frustration. Healthcare
providers who understand these changes can offer
support and counseling to address the emotional
aspects of sensory decline.
Prevention of Complications: Awareness of sensory
changes helps healthcare providers prevent
complications associated with these changes. For
instance, managing vision problems can reduce the risk
of accidents, and addressing hearing loss can improve
social interactions and mental health.
In summary, understanding the physiologic changes of
aging in special senses is not only about recognizing the
physical changes but also about providing holistic care
that considers the emotional, social, and psychological
aspects of aging. This knowledge empowers healthcare
providers to offer comprehensive and compassionate
care that enhances the overall well-being of elderly
patients.
ENDOCRINE SYSTEM
INTRODUCTION
The endocrine system consists of a group of
glands and organs that regulate and control
various body functions by producing and
secreting hormones. Hormones are chemical
substances that affect the activity of another
part of the body. In essence, hormones serve
as messengers, controlling and coordinating
activities throughout the body.
ANATOMY OF ENDOCRINE SYSTEM
HYPOTHALAMUS - The hypothalamus (a small region of
the brain that connects to the pituitary gland) secretes
several hormones that control the pituitary gland.
PITUITARY GLAND - The pituitary gland is sometimes
called the master gland because it secretes hormones
that control the functions of many other endocrine
glands.
THYROID GLAND - The thyroid gland produces
hormones that regulate the body's metabolic rate,
growth and development. It plays a role in controlling
heart, muscle and digestive function, brain
development and bone maintenance.
PARATHYROID GLAND - The parathyroid glands lie
behind the thyroid. They produce parathyroid hormone,
which plays a role in regulating the body's blood level of
calcium and phosphorus.
ADRENAL GLANDS - are small, triangular-shaped glands
located on top of both kidneys. Adrenal glands produce
hormones that help regulate your metabolism, immune
system, blood pressure, response to stress and other
essential functions.
PANCREAS - The pancreas is an organ located in the
abdomen. It plays an essential role in converting the
food we eat into fuel for the body's cells. The pancreas
has two main functions: an exocrine function that helps
in digestion and an endocrine function that regulates
blood sugar.
OVARIES - The ovaries are small, oval-shaped glands
located on either side of your uterus. They produce and
store your eggs (also called ovum) and make hormones
that control your menstrual cycle and pregnancy.
TESTES - The testes are responsible for making sperm
and are also involved in producing a hormone called
testosterone. Testosterone is an important hormone
during male development and maturation for
developing muscles, deepening the voice, and growing
body hair.
ENDOCRINE FUNCTION
Upon reaching a target site, a hormone binds to a
receptor, much like a key fits into a lock. Once the
hormone locks into its receptor, it transmits a message
that causes the target site to take a specific action.
Hormone receptors may be within the nucleus or on the
surface of the cell.
Ultimately, hormones control the function of entire
organs, affecting such diverse processes as growth and
development, reproduction, and nutrient metabolisms.
Hormones also influence the way the body uses and
stores energy and control the volume of fluid and the
levels of salts and sugar (glucose) in the blood. Very
small amounts of hormones can trigger very large
responses in the body.
So, for example, the pituitary gland senses when blood
levels of thyroid hormone are low and releases thyroid
stimulating hormone, which tells the thyroid gland to
make more hormones. If the thyroid hormone level gets
too high, the pituitary senses that and decreases the
amount of thyroid-stimulating hormone, which then
decreases the amount of thyroid hormone produced.
This back-and-forth adjustment (feedback) keeps
hormone levels in proper balance.
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.
Some hormones that decrease with Aging include:
 Estrogen in women
 Testosterone in men
 Growth hormone
 Melatonin
In women, estrogen levels decline with menopause. In
men, testosterone levels usually decrease gradually.
Decreased levels of growth hormone may lead to
decreased muscle mass and strength. Decreased
melatonin levels may play an important role in the loss
of normal sleep-wake cycles (circadian rhythms) with
aging.
EFFECTS OF AGING ON THE FEMALE REPRODUCTIVE
SYSTEM
Menopause occurs because as women age, the ovaries
stop producing estrogen and progesterone. During the
years before menopause, production of estrogen and
progesterone begins to fluctuate, and menstrual
periods and ovulation occur less often. Eventually,
menstrual periods and ovulation end permanently, and
pregnancy can no longer occur naturally. A woman’s
final period can be identified only later, after she has
had no periods for at least 1 year.
The aging of the female reproductive system before and
after menopause is described in stages:
 Reproductive stage includes the time from a
woman's first menstrual period through the
menopausal transition.
 Menopausal transition is the phase that leads
up to the final menstrual period. It is
characterized by changes in the pattern of
menstrual periods.
 Perimenopause is part of the menopausal
transition and refers to the several years before
and the 1 year after the final menstrual period.
 Postmenopause refers to the time after the final
menstrual period.
SYMPTOMS OF MENOPAUSE
Irregular menstrual periods may be the first symptom of
perimenopause. Typically, periods occur more often,
then less often, but any pattern is possible. Periods may
be shorter or longer, lighter or heavier. They may not
occur for months, then become regular again. In some
women, periods are regular until menopause.
Hot flashes affect 75 to 85% of women. Hot flashes
usually begin before periods stop. What causes hot
flashes is unknown. But it may involve a resetting of the
brain's thermostat (the hypothalamus), which controls
body temperature. As a result, very small increases in
temperature can make women feel hot. Hot flashes may
be related to fluctuations in hormone levels.
SYMPTOMS AFTER MENOPAUSE
 Reproductive tract: The lining of the vagina
becomes thinner, drier, and less elastic (a
condition called vaginal atrophy). These
changes may make sexual intercourse painful.
Other parts of the female anatomy—the labia
minora, clitoris, uterus, and ovaries—decrease
in size. Sex drive (libido) commonly decreases
with age. Most women can still have an orgasm,
but some require more time to reach orgasm or
feel that their orgasm is less intense.
 Urinary tract: The lining of the urethra becomes
thinner, and the urethra becomes shorter.
Because of these changes, microorganisms can
enter the body more easily, and some women
develop urinary tract infections more
frequently.
 Skin: The decrease in estrogen, as well as aging
itself, causes a decrease in the amount of
collagen (a protein that makes skin strong) and
elastin (a protein that makes skin elastic). Thus,
the skin may become thinner, drier, less elastic,
and more vulnerable to injury
 Bone: The decrease in estrogen often leads to a
decrease in bone density and sometimes to
osteoporosis because estrogen helps maintain
bone. Bone becomes less dense and weaker,
making fractures more likely. During the first 5
years after menopause, bone density decreases
rapidly. After that, it decreases at about the
same rate as it does in men (by about 1 to 3%
each year).
 Cholesterol (lipid) levels: After menopause,
levels of low-density lipoprotein (LDL—the
unhealthy) cholesterol, increase in women.
Levels of high-density lipoprotein (HDL—the
good) cholesterol remain about the same as
before menopause. The change in LDL levels
may partly explain why atherosclerosis and thus
coronary artery disease become more common
among women after menopause.
 production has decreased enough to cause significant
symptoms is sometimes described as male andropause.
However, the gradual hormone decline in men differs
greatly from what women experience in menopause,
during which female hormones almost always decline
rapidly over just a few years. The rate of testosterone
decline varies greatly among men. Some men in their
70s have testosterone levels that match those of the
average man in his

30s.

Whether young or old, men with low testosterone

levels may develop certain characteristics associated
with aging, including decrease libido, decreased muscle
mass, increased abdominal fat, thin bones that easily
fracture (osteoporosis), decreased energy level, slowed
thinking, and a low blood count (anemia). Low
testosterone levels also increase the risk of coronary
artery disease. Possible causes include psychologic
factors (such as depression, anxiety, or relationship
EFFECT OF AGING ON THE MALE REPRODUCTIVE problems), drugs, and low blood levels of testosterone.
SYSTEM Depending on the cause, doctors may suggest
psychologic counseling, prescribe a different drug, or
It is not clear whether aging itself or the disorders recommend testosterone supplementation therapy.
associated with aging cause the gradual changes that
occur in men's sexual functioning. The frequency, When libido is decreased, men have fewer sexual
duration, and rigidity of erections gradually decline as thoughts and fantasies and less interest in sex, and they
men age. Levels of the male sex hormone (testosterone) engage in sexual activity less frequently. Even sexual
tend to decrease, reducing sex drive (libido). Blood flow stimulation, by sights, words, or touch, may fail to
to the penis decreases. Other changes provoke interest. Men with low libido often retain the
include: capacity for sexual function and may sometimes
continue to engage in sexual activity to satisfy their
partner.

AGE-RELATED CHANGES IN GROWTH HORMONE

SECRETION

Somatotropin secretion begins to decline in both men

and women. In men it is estimated to have every seven
 Decrease in sensitivity of the penis.
years – although there appears to be much variation
 Decrease in volume of fluid released during
between individuals. The decline in somatotropin
ejaculation
secretion in later years is often referred to as the
 Reduced forewarning of ejaculation
somatopause and is associated with a variety of
 Orgasm without ejaculation
physiological changes. The exact causes of somatopause
 After orgasm, penis becomes limp
are yet to be fully established, however, the age-related
(detumescent) more quickly
decrease in somatotropin secretion mirrors the
 After orgasm, longer period before an erection
decrease of growth-hormone releasing hormone
can occur
(GHRH) secretion by the hypothalamus. Recent research
indicates that some of the negative physiological
Beginning at about age 20, the production of changes that come with declining levels of
testosterone (the main male sex hormone) in men somatotropin can be reversed by growth hormone
usually begins to decrease an average of 1 to 2% per replacement therapy. In clinical trials, recombinant
year. The period later in life when testosterone
human growth hormone has been shown to improve
lean muscle mass retention and quality of life scores in Effects of Aging on the Gastrointestinal Health
older people.
3rd slide:

As we all know, the function of our gastrointestinal

system is to help us to digest and absorb nutrients from
the food we eat. However, as we age, there are some
disruptions to our digestive system’s function.

Here are the organs consisting our gastrointestinal

system.

4th slide:

 Napapansin niyo ba kadalasan ng mga lolo at

DECREASE MELATONIN
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.
 Next, is our taste sensation, our tongue become
Decreased melatonin levels are linked to an increased
prevalence of sleep disturbances and, in some people,
may ultimately lead to geriatric insomnia. Since sleep is
essential for cognitive function, sleep disturbances can
exacerbate age-related changes in the brain. There is
some evidence that exposure to bright light – either
sunlight or artificial light – in the morning increases the
speed of sleep onset by triggering an earlier release of
melatonin in the evening. Similarly, the therapeutic use
of prolonged-release melatonin has been shown to
improve sleep onset time, sleep quality, morning
alertness and quality of life in people aged 55 and over
who have insomnia.
lola natin ay bungal na? or minsan naka-
pustiso? Nangyayari yan kasi as we age mas
nagiging brittle na yung ngipin natin. The
enamel in our teeth or yung protective layer ng
ngipin natin is natatanggal or nawe-wear out na
since toddler pa lang tayo, nagagamit na natin
yung teeth natin to breakdown our foods.
Another factor is yung pagkain ng acidic foods
like citrus fruits and carbonated beverage, yan
nadi-dissolve yung protective layer ng teeth
natin. If yang enamel natin, nasira or Nawala,
magkakaroon tayo ng dentin exposure (dentin is
yung soft and flexible layer ng teeth,just
beneath the enamel) which is mas vulnerable
for tooth decay, since mas madali na lang ma-
reach ng plaque at bacteria ang layer na to.
Mapapansin niyo din na pwedeng magkaroon
ng tooth sensitivity once we have dentin
exposure. Additionally, yung gingiva ng mga
matatanda or gums nila may also retract,
exposing more of the tooth and the nerves of
the teeth. And also, yung bone na nagsusupport
sa teeth natin may also become thinner and
may less able to support them.
smaller as we age and this affects our taste buds
and also less adept na yung pag re-generate ng
taste buds natin pag tumanda na kesa nung
kabataan nila (example pag napaso yung dila
natin diba, hindi natin masyado malasahan
kinakain natin the after a few days, okay na). So,
one factor din na nakakaapekto dito is yung
chronic irritation from smoking, yung mga toxic
chemical sa cigarette pag nag-interact yan with
the tongue, the taste buds lose its shape and
become flatter (vascularization). As we age, our
sweet sensation which is nasa tip of the tongue,
suffer a greater loss however, yung salt, sour,
and bitter flavor natin nababawasan naman
pero konti lang kesa sa sweet. Kaya minsan ang
mga lolo at lola natin gustong-gusto nila ng
matamis na matamis to compensate for their
excessive loss ng sweet buds and pag nagluluto
sila minsan masyadong maalat, minsan naman
matabang ganun. However, excessive seasoning
 sa food and pagkain ng sweets should be in mas matagal sa esophagus kesa nung medyo
moderation since they are vulnerable na sa mga bata-bata pa ang isang tao. And dahil nags-stay
sakit like diabetes. pa yung food particles na nasa esophagus ng
 Our mouth also loses their ability in producing longer, feeling ng elderly minsan na they are
saliva as we age. It is said that older adults only unable to swallow and nagiging uncomfortable
produce 1/3 of saliva of their younger years. ito sakanila.
Saliva is decreased and yung viscosity is mas  Yung lower esophageal sphincter ng elderly
lumalapot siya, result ana din to ng tine-take na may also lose some of its tone or mas
mga medications nila. If the amount of saliva is nagrerelax siya. So itong sphincter pini-prevent
decreased, the ability to break down starches niya na magback flow yung food from the
also decreases. In addition to this, yung muscle stomach to the esophagus. So all this changes
sa tongue and jaw natin tend to become weaker including the decrease of gag reflex, places the
making it difficult for us to chew and swallow. older adult with the risk of aspiration. As well
as the development of GERD.
5th slide:
7th Slide:
So, we have here the conditions that may arise
regarding sa changes sa ating mouth.  Dysphagia – is the difficulty of swallowing. It
happens because of dental changes or muscle
 Xerostomia – Dry mouth or also known as
weakness, kagaya ng nasabi kanina humihina
xerostomia. Nabanggit kanina na as we age, our
yung propulsion waves natin. Other factors that
saliva also decreases. However, it doesn’t mean
may contribute is yung decrease ng saliva,
na when our saliva decreases, we will have a dry
impaired coordination ng swallowing process,
mouth. There are factors na nangyayari kaya
narrowing ng esophagus, and neurological
nagkakaroon ng xerostomia. An example is yung
disorder. If one has a difficulty of swallowing,
pag inom ng mga gamot like antihypertensive
dapat when eating the food, we need to chew it
and diuretics, nakakaapekto ito sa saliva
well para ma break down siya ng maayos and
secretion. Meron din yung Sjogren’s syndrome
Madali lang lunukin, in addition to this, pag
which is a disease sa immune system, na can
kumain ang matatanda dapat hinay-hinay lang
reduce salivary gland function and cause severe
sa pagsubo, dapat hindi nagmamadali and
dryness of the mucous membrane. Pag breathe
remaining sitting in upright position.
din sa mouth can also contribute sa problem na
 GERD- Nadedevelop siya since nagrerelax yung
to. So our saliva, siya ang lubricating agent natin
lower esophageal sphincter or hindi nagco-close
sa mouth diba? Having a dry mouth, mas
ng maayos kaya yung stomach content nags-
mahihirapan tayo sa paglunok ng food since
splash up siya papuntang esophagus kaya
walang naga-add ng moisture dito.
minsan nakakaramdam yung mga elderly ng
 Dental Problems – It may be caused by altered
heart burn kasi not like sa stomach, walang
taste sensation, excessive intake of sweets since
protective lining yung esophagus and is not
naa-alter nga or nagkakaroon ng excessive loss
meant for so much contact with stomach acid.
sa sweet buds nila. Additionally, kagaya ng
sinabi kanina, yung enamel and other layers ng 8th slide:
teeth natin is nawe-wear down nadin ang nagbi-
 The gastric mucosa tends to atrophy. So, itong
brittle na since bata pa tayo nagagamit na natin
mucosa, ito yung nagsisilbing protection sa
yung teeth natin. Furthermore, xerostomia may
lining ng stomach. So dahil nga, lumiliit yung
also contribute sa dental problem kasi our saliva
gastric mucosa, nagde-decrease din yung ability
helps prevent tooth decay by neutralizing the
niya to protect our stomach from the acids and
acids produced by bacteria and limiting
enzymes. In addition, nagdedecrease din yung
bacterial growth and washing away yung mga
ability ng stomach to produce hydrochloric acid
natirang food particles.
and pepsin which nagre-result sa pagtaas ng pH
6th slide: leading to more problems or gastric irritation.
Dahil nga nabawasan yung presence ng pepsin
 We all know that esophagus, ito yung nagpo-
natin, it can interfere with the absorption of
propel ng food natin from our mouth to the
protein and decrease of hydrochloric acid,
stomach. So, this is done by what we call
interferes with the absorption of calcium, iron,
“propulsion waves”. Habang tumatanda, yung
foli acid and vit. B12. This is also the reason why
intensity ng propulsion waves ay bumababa, so
food stays longer sa stomach causing older
it is also called as “Presbyesophagus”.
adults to have reduced appetite.
esophagus natin is nagda-dilate siya and
because of this, yung food, imbes na dire- 9th slide:
diretso na siya sa stomach, nags-stay pa siya ng
  Gastric ulcer – open sores that develop on the  Chronic constipation – This is common for older
lining of the stomach. So, nagkakaroon usually adults. So, madaming nakakaapekto dito like
ang mga elderly nito since yung protective lining yung decrease in peristalsis since nagkakaroon
ng stomach is lumiliit and dahil na din sa ng atrophy ng mucosa and muscle layers ng
pagtaas ng pH sa stomach. colon, physical inactivity since pag hindi na nae-
exercise yung abdominal muscle natin especially
10th slide:
yung diaphragm, wala yang lakas para mag-
 Some atrophy occurs in the small and large exert ng force in assisting the contraction ng
intestines. So at dahil nga lumiliit yung parts ng muscle ng anterior abdominal wall para ma-
intestines which includes the thinning of villi raise din nito yung pressure sa intra-abdominal
and epithelial cells, nagkakaroon din ng for defecation. Additionally, low intake ng fiber
decrease of intestinal function and decrease of since hindi masyadong naaabsorb ang mga
cells sa absorption surface of the intestinal walls nutrients na kailangan and fluids ay
that leads to reduction of absorption ng nagcocontribute din dito, older adults are prone
nutrients that disturbs the overall health. An in dehydration since they are unaware na
example of particular nutrient is calcium, so this madaming fluids na ang nababawas sa kanila
requires vitamin D for more efficient absorption due to aging changes in kidney and sa pag-take
from the intestine to the blood stream, ang kaso din ng mga medications nila. So para maiwasan
lang is nagkakaroon din ng decrease ng of Vit. D to, we need to encourage elderly to engage in
natin as we age. So, dahil nangyayari ang physical activities like simply walking, higher
decrease of calcium absorption, pwedeng intake of fiber and fluids, and encourage a
magkaroon ng osteoporosis ang isang tao, regular time for bowel elimination- preferably sa
osteoporosis is mas common sa mga babae. morning.
 So ayan, decrease of mucus secretion resulting 12th slide:
sa protective layer ng intestine from the
bacteria.  With advancing age, the liver tends to become
 Decrease of rectal elasticity is caused by smaller.With increasing age, the liver decreases in
volume, mass, and blood flow. These changes are
decrease of muscle tone. Then we also have the
significant because the liver acts to metabolize many
decrease in tone of inner anal sphincter. So,
drugs. If a patient has impaired liver function, toxic
inner anal sphincter ito yung inner ring muscle levels of a drug may be present in the blood.
which is involuntary muscle siya and we cannot  Decreased lipase level results in decreased fat
voluntarily control it like sa heart. The inner anal absorption and digestion. Steatorrhea, or excess fat
sphincter is programmed to stay shut. So since in the feces, occurs because of decreased fat
nagto-tone down yung IAS, maaaring digestion.
magkaroon ng fecal incontinence (loss of control
in bowel movements).
 Slower transmission of neural impulses to the
lower bowel which reduces awareness of the
need
 to evacuate the bowels. Kaya din most
commonly nagkakaroon ng constipation ang
mga elderly dahil sa mabagal na pag transmit ng
signal or neural impulses sa lower bowel which
reduces yung awareness ng mga elderly the
need to expel or evacuate ng bowel. In addition
to this, hindi minsan nagkakaroon ng
incomplete bowel emptying yung mga lolo at
lola natin? Minsan nakikipag-unahan pa sa cr
tapos sasabihin na mabilis lang sila and totoong
mabilis lang talaga, parang isang blob lang yung
inexpel nila and dapat hindi ganun, since
nagkakaroon ng mabagal na pag-transmit ng
neural impulses, they need to wait for another
30-45 minutes after the initial movement para
mag-occur yung rest ng bowel movement, and if
hindi tayo nag pay attention dito, maaaring
magkaroon ng complication.

11th slide: