Normal Changes of Aging

Learning objectives:

At the end of the lecture the students will be able to:

Describe the normal physiological age-related change in

different body systems.

Discuss the common problems associated with normal

physiological age-related changes.

Identify the nursing role toward common problems

associated with normal physiological age - related

 Introduction

 The changes in body function that occur

with aging do not develop suddenly or
without warning.
They are part of continuum that begins at

the moment that life begins.

The pick years of physiological function last
from the late teens through the 30s.
Physiological changes are still occurring, but
they are not easily recognized.
 As a person moves into his or her fifth and
sixth decades, theses physiological changes
become more apparent.
In the seventh and eighth decades and
afterward, they are no longer denoted.
It is important to recognize that although age –
related changes are predictable, the exact time
at which they occur is not determined.
There is a wide person to person variation in
when and to what degree these changes will
occur.
Heredity, environment, and health
maintenance, stress, nutrition, health status and
numerous other elements are significantly affect
the timing and magnitude of age –related
changes
 Why the nurse study age –related
change?

1- Differentiate between normal physiological

changes of aging & illness.

2- Recognize why the elderly are at risk of

developing certain diseases and sustaining
injuries increases
 The nursing goals during caring for
elderly clients are

Protect from injury

Provide comfort

Meeting nutritional needs

Maintain personal hygiene

Prevent complication from drugs therapy

 Normal Changes of Aging

I- physiological
II- Psychological
III-social
Changes of
Musculoskeletal
system
 Changes of Musculoskeletal system

Changes Related out come

Bone: ↓ Bone mass & Bones become brittle &
minerals ------- easy to fracture
increase risk of
osteoporosis
Vertebral column: Narrowing of the
- loss of water in vertebral space causing
intervertebral disks increase of spinal
curvature (kyphosis) &
Height (1.2 cm of
height every 20 years )
 Changes Related out come
↓ Muscle cells, replaced by ------ ↓ Muscle mass and
fibrous connective tissue strength especially the arm
and leg muscles.
Increased risk of falls.
↓ Blood supply to the ↓Muscle function
muscles --------

 Decreased mobility and Decreased tissue elasticity

flexibility
Reflexes: Decreased in the arms,
Totally lost in the abdomen
Maintained in the knee
Changes of Musculoskeletal
cont. system
Changes Related out come
joints and supporting
structures: ↓Flexibility & elasticity
↓ Collagen OF joints & supporting
structures (ligaments,
formation------------------- tendons)----------------
&elasticity of joint& ↓ range of motion
ligaments
Increase viscosity of Painful joint movement
synovial fluid and the
synovial membrane become
more fibrotic.
Problems accompanying age-related
changes in the musculoskeletal system
 Pain

 Impaired mobility
 Self-care deficit
 Increased risk of fall
 Osteoporosis

 Increased risk of fracture

Role of the nurse toward changes of
musculoskeletal system:
 Regular exercise ( range of motion and
walking).
 Provide assistance as needed.
 Provide safety environment to prevent fall.
 Nutrition (calcium).
 Exposure to the sun (vitamin D).
Changes of Integumentary
System (Skin, Hair, & Nails)
Skin
Skin
 Skin
Changes Related out come
↓ Epidermis 50% -High risk to injury
slower healing
↓ barrier protection,
delay absorption of
medication & chemicals.
- Rashes due to contact
with chemicals (detergents
or cosmetics)
dry skin
↓ ability of skin to retain
moisture --
Formation of Melanocytes
cluster brown spots ( senile lentigo), ↑ at
areas exposed to sun
senile lentigo
Xerosis is a dry and scaly skin
 Skin:cont.
Dermis:
↓ in thickness by 20% ↓ thermoregulatory
function
↓ number of sweat glands, ↓ inflammatory response
blood vessels, and nerve
endings --------------------- ↓ tactile sensation
↓ pain perception

↓ collagen & elastin fibers, skin wrinkles especially in

loss of subcutaneous fat, & face around eyes (crow’s
a 50% decline in cell feet), mouth and nose.
replacement.
crow’s feet
 Skin:cont
Lead to
Subcutaneous fat: 1. ↑ risk of hypothermia
2. skin injury
↓ amount of subcutaneous 3. ↑ pressure points
tissue + ↓ vascular 4. ↓ absorption of
supply to dermis medication
. 5. Atrophy in Breast tissue
Also, redistribution of fat to
the abdomen and thighs

Glands(sweat & sebaceous): ↓amount of perspiration i.e.

↓ Sweat gland function ------ ↓ sweating ----- heat
intolerance.
↓ ability to regulate body
temperature(↓
subcutaneous fat
 Skin:cont.
Lead to
Sebum oils the skin and
provides an antimicrobial
property.
↓ Secretion of sebaceous Dry skin
gland & pores become
larger ----
Larger pores
Blood vessels: ----- Senile purpura
The wall of the capillaries common in legs & arms
become increasingly fragile

↓ Totalbody fluid,Plasma & Risk of dehydration

extracellular volume remain
somewhat constant, but
↓ intracellular fluid -----
  Hair:
Hair thins, and growth declines.

Hair tends to gray as a result ↓ melanin loss,

 hair distribution patterns change:

Older women ↑ lip and chin hair & thinning on

the head, axillae and perineal area.

Men lose scalp and beard hair, ↑ growth over

eyebrows & ear and nostrils.

All these changes are related to hormonal

changes
 Nails
Fingernails: grow more slowly and become thick

and more brittle develop ridges or longitudinal

line (longitudinal ridges)
 Toe nails: Nails grow slower become thicker

may discolor and may become so thick that

require special equipment for trimming.

longitudinal ridges develop
problems related to changes in integumentary system

 Changes on body image and self-concept

 Slow healing
 Increase risk of skin damage ( injury,
maceration, blunt trauma injury, and infection)
 Dryness of skin
 Decreased ability to regulate body temperature
problems related to changes in integumentary system

Decreased tactile sensation

Reduce pain perception
Increased susceptibility of pressure points
Increased risk of dehydration
 Role of the nurse toward changes of
integumentary system

 Avoid long setting or sleeping in one position.

 Gentle handling of the elderly.
 Avoid excessive exposure to ultraviolet ray
 Avoid heat exposure over long periods and in
area of high humidity (hats with wide brims,
suitable cloths, fluid intake 200-2500ml /day)
Role of the nurse toward changes of
integumentary system Cont.
 Care of dry skin
 Measures to prevent pressure ulcer
 Safety measures toward burning, injury, infection,
trauma, and hypothermia
 Proper clothing of the elderly
 Nail care is important to older person
 Ensue 2000-25000cc/day
changes of Gastro-intestinal
system
 Changes of Gastro-intestinal system
changes outcome
Oral cavity: ↓ Ability to bite and chew
↑ Dental decay and teeth loss,
withdraw of gingival tissue
loosen periodontal bonds-----
Weak Jaw muscles& shrinkage of ↑ The work chewing -----
bony structure of the mouth increased fatigue with eating and
poor nutrition
Atrophy of taste buds --------. ↓ Ability to discriminate between
salts and sweet
↓ enjoyment of food resulting in
poor eating habits, nutritional
deficiencies, and loss of appetite

↓ Volume of saliva Dry tongue &, chewing

difficulties & ↓digestion of starch
 Changes of Gastro-intestinal system cont.
Esophagus
↓ tone of sphincter muscles
depressed The gag
reflex----
Stomach:
atrophy of gastric gland-----
↓ pepsin may hinder---------
↓ in hydrochloric acid intrinsic
factor --------------
Frequent esophageal reflux or
heart burn or vomiting of
undigested foods---- poor
nutrition
episodes of chocking and
aspiration
↓ of gastric secretions
protein digestion
malabsorption of iron, vitamin
B12, calcium and folic acid
-------- pernicious anemia, peptic
ulcer, and stomach cancer.

Decrease of motility of the sense of fullness can

stomach interfere with absorption of
some drugs
 .Changes of Gastro-intestinal system CONT

Small intestine: It may cause ↓ absorption of

not enough to cause significant fats and vitamin B12
impairment.
Large intestine: constipation, incomplete
slow Peristalsis ------ elimination & fecal impaction

Liver:↓ Liver mass &↓ hepatic less efficient metabolism of

enzymes due to decrease blood drugs and detoxifies substance.
supply ---- liver function test remain
unaltered
Gall bladder: affect fat digestion&↑ incidence
↓ production of bile of gallstones
Pancreas: becomes more ↓ pancreatic secretions
fibrotic----
 problems :

 *Chewing problems
*Denture problems

*Lack of enjoyment of food and lack of appetite

*Difficult in starch and fat digestion

*Heartburn

*Decreased food intake

*Difficult in swallowing

*Constipation and fecal impaction

 Role of the nurse toward changes of GI
system
Oral hygiene and preventive dental care
Food low in fat and high in fibers
Avoidance of spicy foods
Maintain of daily fluid intake (2500ml)
Maintenance of regular bowel routines
Not avoid the urgency to defecate
Avoidance of laxatives, suppositories, and
enema
Maintenance of activity level
Changes of Cardiovascular system
 Changes of Cardiovascular system
The heart size becomes slightly
smaller.
Heart rate decreases
↓ collagen & elastin in the heart
muscle---
↓Elastin in the vessel wall -----
Myocardium becomes more
irritable------
↓ myocardium contraction & ↓
cardiac out put. ↓ blood flow to
body organs
thickening & rigidity of the
vessels especially the coronary
arteries ------ ↓ myocardial
contraction & ↑ the risk of
arteriosclerosis.
occurrence of extra- systoles and
sinus arrhythmias
 Changes of Cardiovascular system
Changes Age related changes

Decrease in vascular Increases the risk of

--- muscle tone
Heart valve in older
thicker and stiff
varicose veins
Rigidity and incomplete
closure of the heart
valves----systolic murmur in
the mitral and aortic valve

- Orthostatic hypotension occurs because the circulation

does not respond quickly to postural changes

- Less effective pumping of the heart muscle, + sclerotic changes in

the veins ----- dependent edema & repeated vasricosities in the lower
limbs
Problems related to age related
:changes in C.V.S. are
- Atherosclerosis
 High risk to cardiovascular diseases, particularly
coronary heart disease.
 Decreased physical ability
 High risk to hypertension
 High risk to heart failure
 Varicosities venous stasis (lower limbs)
 Hemorrhoids
 Orthostatic hypotension
 Decreased blood flow to all body organs, which
affect their function.
Role of the nurse toward changes of
Cardiovascular system

 Nutrition (low fat in fat and cholesterol)

 Exercise

 Avoid stresses
 Avoid sudden changing of position
 Avoidances or stopping of smoking
 Changes of Respiratory system
↓ The number of cilia --- ↓ ability to trap & remove
debris.

↓ vocal cord elasticity ---- change in voice quality

(unsteady) character

Tracheo bronchial tree: ↓ ability to trap & remove

↓ The number of cilia ------ debris----- ↑ risk of infection

Ribs:
calcifies and rigid Costal cartilage ----- ↓ mobility of rib cage

Intercostal muscles and

diaphragm: Diaphragm flatten and become
Atrophy of the intercostal less elastic
muscles.
 .Changes of Respiratory system CONT

Lung ↓ gas exchange -- ↓

↓ lung capacity. oxygen saturation
↓ alveoli elasticity &
number of capillaries ----
↓ physical mobility & ↓ pooling of secretion,
elasticity in lung tissue particularly in the lower
----- lobes of the lung
There is a reduction of lung capacity and the
: interference of pulmonary function as a result of

change in size and shape of the chest cavity due

to muscloskeletal changes(kyphosis).
Calcification of costal cartilage located at the end

of the ribs which intern become rigid.

Intercostals muscle atrophy.

Diaphragm becomes less elastic

problems are:
Decreased physical ability
Increased susceptibility to infection
inadequate oxygenation
Increased susceptibility to aspiration
Role of the nurse :
Exercise
Avoid immobility
Smoking
Position
Measures to prevent infection
Increased fluid intake
 . Changes of the urinary system
Kidneys:
↓ in size. ↓ filtration rate &
↓ nephrons decrease + ↓ impairment in renal
renal blood flow ---- clearance of drugs

↑ blood urea nitrogen (10-15 impairment in renal

mg/dl to 21 mg/dl by age70). clearance of drugs

↓ renal concentrating production of less

ability---- concentrated urine
 . Changes of the urinary system
Bladder:
↓ Bladder capacity & ↑ urgency and frequency of
involuntary bladder contraction urination.
--- weaken of bladder muscles-- ↓
stream of urine, incomplete
emptying of bladder &↑ of
urinary tract infections

weaken bladder muscle tone incomplete emptying of the

--- bladder which increase
incidence of urinary tract
infections

↑ urine formation at night --- nocturia

Urethra:
Women, ↓ of estrogen --urethra become thin
&can contribute to urgency and frequency of
micturation
In men, there is enlarged prostate, which
interfere with bladder emptying.
Prostate enlarged -----to problem with voiding
(hesitancy, frequency, inability to maintain
steady stream of urine & urinary retention.
 problems are:

urgency and frequency of micturation

nocturia
Men, high risk to hesitancy, frequency,
inability to maintain steady stream of
urine and urinary retention
problems are:

Liable to stress incontinence

Delayed execration of body wastes and
medication
Increased risk of infection
Urinary problems can affect the elderly
self-esteem, and his social activities
 Role of the nurse toward changes of
urinary system
Hygienic care.
Self-management techniques (frequent voiding,
restricting the volume or type of fluid).
 Prevent infection.
Accommodation of drug dosage.
Safety measures as adequate light at night,
suitable clothes and easy to removed).
Increase fluids intake.
 :Changes Of Endocrine System

Thyroid

Adrenal

 pituitary

 pancreas

 testes

 and ovaries
Endocrine
System
Changes Of Endocrine System:
(thyroid, adrenal, pituitary,
pancreas, testes, and ovaries)

Thyroid:
↓ Thyroid function --- ↓ basal metabolic rate
Pituitary:
Gland diminishes in size.
Pituitary gland produces less growth hormone-------
↓ muscle mass.
Adrenal glands:
- Adrenal function does not alter
Pancreas:

↓ pancreatic function------intorable

stressed with sudden concentrations of

glucose, leading to higher and prolonged
blood level.
i.e. Fasting blood glucose levels are not

significantly different in old adults. but

after a meal, glucose remain high for a
longer period
Gonads (ovaries and testes):

In females:
↓ in estrogen-------coronary thrombosis &
osteoporosis.
↓ in size of the ovaries, uterus, cervix, fallopian
tubes.
dry & short vaginal canal high risk of infection &
inflammation.

In men:
 Testosterone level and seminal fluid decrease.
:problems are

High risk to develop diabetes mellitus

High risk to develop osteoporosis
Coronary thrombosis
Arrhythmias
Decreased muscle mass
:problems are

Some symptoms are accompanied with

menopause such as depression, insomnia,
headache, fatigue, palpitations and
irritability.
High risk to vaginal infection
Diminish glucose tolerance
Decrease of basal metabolic rate decreases
Has an effect self-image
 Role of the nurse toward changes of
:endocrine system

Nutrition (calcium, fats and

cholesterol)
Exercise.

Adequate fluid intake.

Periodic medical check up
Changes Of Nervous System: Degeneration & atrophy
of nerve cell25- 40%&decrease Cerebral blood flow

Change Results
Decreased number of decreased memory loss(decrease
nerve fibers recent memory )
Decreased coordination
Hypothalamus less Difficult to regulate body
effective temperature
↓ Nerve conduction Slower reflexes, delayed response to
velocity (speed) multiple stimuli& pain threshold
&Decreased amount increased as a result of decreased
of neuroreceptors pain recognition
Brain affects sleep- Change in sleep patterns with stage III
wake cycle &IV sleep become less prominent causing
frequent awaking
 Problems related toChanges Of
Nervous System
Decreased memory specially recent while the

remote memory remain unaffected

Increase risk of injury

Decreased accommodation to heat

Increase risk of fall

Increase risk of accident

 Role of the nurse toward changes of
:nervous system

Safety environment

Frequent repetition of information

Use of assistant aids

Health education about the proper way

of using assistant device

 Immune system changes
Change Results
Immune function starts incidence of autoimmune
declining disease increases
losing its ability to differentiate
.between self and nonself

Diminished immunoglobulin antibody response ↓

..production

,Decreased antibody response diminish immune response.

T-cells does not decrease in → high risk of infection,
number but become respiratory urinary tract
..immature . infections
Depressed immune response high risk of infection
 .Immune system changes cont

Total & deferential

leukocytic count Not
changes

Tonsillar atrophy & Increase incidence of

lymphadenopathy infection
The changes in Immune system cause many
problems to the elderly persons

 High risk of developing infection, particularly,

respiratory urinary tract infections and acquiring
nosocomial infections.
 Autoimmune disease increases
 Increase in cancer among older people..
 Decrease in total white blood cells.
 Reduction of erythrocyte mass and decreased
hemoglobin and haematocrit.
 Changes in sensory organs
Eye And vision:
 many structural and functional changes may occur in
the eye
External eye:
The eyelids become less elastic, wrinkle &sag.
Eyelashes may be shorter, thinner and in some cases
absent.
Internal eye:
↓ Pupil size decreases ----------- ↓ the amount of light that
reaches the retina---------- needs sufficient light to see
objects.
The conjunctiva becomes thinner and yellow
Lens:
1- They loses transparency & elasticity ------ ↓

accommodation &↓ dark adaptation

2- The lens of the eye tends to yellow-----

misperception of color.

*- all dark color perceived black (unable to

differentiate between blue, green, and violet )
↓ Peripheral vision (↓ visual field) ---------
risk of accident and injuries
↓ Ability to focus on close objects
(Presbyopia).
↓ Reabsorption of intraocular fluid------- ↑
risk gloucoma.
Tear:↓ tear production ------- to dry,
burning, or itching eyes ↑ eye infections.
  Ears and hearing:
The function of the ear is hearing and

balance.

External ear:
appears larger ----- continued cartilage

formation & loss of skin elasticity.

↑ hair on the ear.
Middle and internal ear:
“Senile deafness” or “presbycusis” a gradual
slowly progressive deafness of aging, affect
males more than females.
atrophy auditory nerve-------sensory presbycusis
Cerumen impaction--------- ↓ hearing acuity
↓ secretion of sebaceous glands------Dryness of
the ear (pruritus)
↓ Balance ------ ↓ sensory input+ slowing of motor
responses +musculoskeletal changed &
limitations
All lead to high risk to fall
Taste:

↓ taste buds ----- loss o↓ taste buds& dry

mouth ----- bad tastes & alter the taste of

food producing unpleasant taste.
f taste, (sweet & salt).
Smell:

↓ olfactory sensory cells -----↓ sense of smell

The enjoyment of food is enhanced by the

ability to smell.
Touch:

↓ tactile sensation

↓ warm-cold difference threshold

Lower extremities usually manifest by loss of

sensation as a result if impaired blood flow.

The changes in sensory organs cause many problems to the

elderly persons, these are:

 Decrease vision lead to problems with activities of daily
living(ADLS)
 Dry eye
 Decreased light adaptation
 Decreased visual field (peripheral vision is limited)
 Difficult to identify certain colors such blue, green, and
violet (results from yellowing of lens
 Decreased visual acuity
 Increased incidence of cataract, glaucoma and
diabetic retinopathy.
 Accident especially fall
 Problem related to driving
 Lack of socialization
 Dryness of the ear (pruritus)
 Decrease hearing affect on communication
 Decrease food intake and interest in food
 Increase safety hazards
Role of the nurse toward changes of
sensory organs:

Periodic eye examination (Eye care.)

Encourage the use of assistant device.

Safety measures (light, stairs, street, keep objects

in the same place in the environment).

Talk to elderly while facing him, sometime may

use simple touch.

 Role of the nurse cont.

retaining self-care ability, and providing patient and family

teaching to increase under standing of the condition and
who to deal with the elderly.
Assist elderly in activities of daily living.
Dryness of the ear (pruritus), several drop of glycerin or
mineral oil instilled in the ear will moisture the external
ear.
During communication use a suitable tone of voice, do not
shout, use short sentences.
 Role of the nurse toward changes of
.sensory organs cont
Encourage socialization.
Active listening as the elderly express feeling and
emotions .
Attractive presentation of food.
Oral hygiene (brush the teeth several times each day,
and use mouth wash)
Periodic dental examination .
Prevention of accident trauma and injury
Health education about on skin, leg, and foot care