EFFECT OF AGEING & COMMON

PROBLEMS RELATED TO
DIFFERENT SYSTEM & THEIR
MANAGEMENT

MODERATOR PRESENTED BY
Ms. MILAN TIRWA SHUBHAM GAUR
ASSOCIATE PROFESSOR Msc (N) 1ST YEAR
CON,AIIMS CON,AIIMS
OBJECTIVES
At the end of the class, students will be
able to;
• Describe physical aspects of ageing
• Explain cognitive aspects of ageing
• Describe pharmacological aspects of
ageing
• Describe mental health problems in older
adults
• Describe older patients in acute care
setting
PHYSICAL ASPECTS OF
AGEING
 • MUSCULO-SKELETAL SYSTEM
Muscles
 Loss of muscle mass, by 23% by age 80.
 Decrease in muscle strength, endurance,
size and weight.
 Both the number and size of muscle fibres
decrease.
BONES
 Bone loss in both sexes.
 Accelerates in women following
menopause.
 More fragile, susceptible to fractures
Joints
 Cartilage becomes thinner.
 May lead to osteoarthritis.
 Additionally, tendons and ligaments
become more rigid and brittle which
makes joints more stiffer and limits the
range of motion of joints.
MANAGEMENT
• Regular exercise program.

• Well balanced, calcium and vitamin D rich

diet.
• Identify and correct safety hazards.

• Assist in correct use of assistive devices

 • NERVOUS SYSTEM
• Nerve cell degeneration & atrophy
• Neuronal loss occurs
• Decrease in rate of nerve cell conduction
impulses
• Reduced cerebral blood flow
• Decreased sense of balance or
uncoordinated motor response
• More brain activity is needed to maintain
cognitive performance.
MORPHOLOGICAL CHANGES
• Cerebral volume loss and
ventriculomegaly
• Cellular and sub-cellular alterations
• The white matter loss

• Loss of neural circuits and brain plasticity

• Neurofibrillary tangles
ETIOGENESIS OF CHANGES IN
AGEING BRAIN

• Increased oxidative stress has been

linked with cognitive impairment
• Oxidative stress can damage DNA
replication and inhibit repair through
various complex processes, including
telomere shortening.
• The DNA damage increasingly
accumulates with age in the brain.
CONTD..

• DNA damage may reduce the expression

of selectively vulnerable genes involved
in learning, memory and neuronal
survival, initiating a pattern of brain aging
that starts early in life.
PROTECTIVE MEASURES

• Engage in mental activities and

maintaining social and friendship
networks, and underline the importance
of regular intellectual exercise.
• Non-specific and delay the aging process
in general, like maintaining a healthy diet,
including omega-3 fatty acids, and
protective antioxidants.
• The concept of calorie restriction with
adequate nutrition protects the brain
against aging and neuro degeneration.
• REPRODUCTIVE SYSTEM
Female Reproductive System
• Menopause is a normal part of a
woman’s aging process.
• The ovaries stop making the hormones
estrogen and progesterone.
• Vaginal walls become thinner, dryer, less
elastic and possibly irritated.
• Risk of vaginal yeast infections increases.
• The external genital tissue decreases and
thins, 
COMMON REPRODUCTIVE CHANGES

• Atrophic vaginitis
• Uterine prolapse
• Hormonal changes
• Hot flushes
• Decrease breast tissue
• Vaginal yeast infections
• Dysparenuia
• Decrease breast tissue
• Increased risk of bone loss (osteoporosis)
MANAGEMENT

• Hormone therapy with estrogen or

progesterone, alone or in combination,
may help menopause symptoms such as
hot flashes .
• Getting regular exercise and eating
healthy foods
CHANGES IN MALE REPRODUCTIVE
SYSTEM
• Andropause occurs.
• Physiologically the testes decrease in
size and firmness with age.
• This is associated with a gradual age
related decline in the secretion of
testosterone. 
• The prostate gland atrophy occurs which
reduces the secretory capacity.
• By the age of 70 the prostate gland may
enlarge due to masses of potentially
cancerous tissue. 
• Seminal vesicles decrease in weight
COMMON PROBLEMS
• BPH

• Prostatitis

• Testicular cancers
• Prostate cancer
• Bladder cancer

• Erectile dysfunction
• HEALTH RISK IN OLDER ADULTS
• Sleep disturbance

• Falls

• Accidents caused by fire

• Accidental poisoning
NURSING INTERVENTIONS
• Teaching about the adverse effects of
medication if they are taking any

• Advising to take precautions like

changing position slowly

• Rearranging furniture for a clear pathway

• Safe use of assistive devices like canes,

walkers and wheel chairs
• NUTRITIONAL HEALTH
• Older adults require fewer calories &
much more nutrient-rich, healthy diet in
response to alterations in body mass &
more sedentary lifestyle.

• The goal of nutrition therapy is to

maintain or to restore maximal
independent functioning & health

• Daily calcium & Vit D supplementation is

required for older than 50 yr age
RESEARCH INPUT
Age-Dependent Disparities in the
Prevalence of Single and Clustering
Cardiovascular Risk Factors: A Cross-
Sectional Cohort Study in Middle-Aged
and Older Adults
Pawel Macek, Marek Zak et al
Purpose: Assessment of the prevalence of
single and clustered CRFs and their
association with age.
 Patients and methods: 
• The survey involved 4735 people (33.6%
men) who were aged 45-64.
• The study protocol comprised the Health
Status Questionnaire, general medical
examination,anthropometric measurements,
and blood and urine sampling.
• The prevalence of single and clustered
CRFs (hypertension, dyslipidemia,
diabetes mellitus, and obesity) in the
incrementally split age groups was
calculated.
Results: 
The prevalence of CRFs was established
in 90% of the respondents. Except
dyslipidemia and CRFs, prevalence of
risk factors increased with age, although
this trend was the weakest in men.
• In women, prevalence of dyslipidemia
and CRFs was unrelated to age, whereas
in men, it was on the rise in the younger
age groups.
• The incidence rate of CRFs was strongly
related to age, and, with the exception of
dyslipidemia, was higher in the older age
groups
COGNITIVE ASPECTS OF
AGEING
• Older adults may experience temporary
changes in cognitive function when
hospitalised

• Good sleep hygiene can improve

cognition, as can treatment of depression
& anxiety
NURSING INTERVENTIONS
• Supply mnemonics to enhance recall of
related data
• Encourage ongoing learning
• Link new information with familiar
information
• Use visual, auditory & other sensory cues
• Encourage learners to wear prescription
glasses & hearing aids
• Provide glare free lighting
• Provide a quiet nondistracting environment
PHARMACOLOGIC ASPECTS
OF AGEING
NURSING INTERVENTIONS
• Explain the purposes ,side effects &
dosage of each medication

• Provide medication schedule in writing

• Destroy or remove old expired unused

medications

• If the patient competence is doubtful,

identify a reliable family member for
adherence
MENTAL HEALTH PROBLEMS
IN OLDER ADULTS
DEPRESSION
• most common affective or mood disorder
of old age

• Signs of depression include feelings of

sadness, fatigue, diminished memory and
concentration, feelings of guilt or
worthlessness, sleep disturbances,
appetite disturbances with excessive
weight loss or gain, restlessness,
impaired attention span, and suicidal
ideation.
• Geriatric depression and symptoms of
dementia often overlap, so cognitive
impairment may be a result of depression
rather than dementia.

• Depressive illness in late life should be

vigorously treated with antidepressants
DELIRIUM
• Delirium, often called acute confusional
state, begins with confusion and
progresses to disorientation.

• The patient may experience an altered

level of consciousness ranging from
stupor to excessive activity.

• Thinking is disorganized, and the

attention span is characteristically short.

• Hallucinations, delusions, fear, anxiety,

and paranoia may also be evident
• Delirium occurs secondary to a number of
causes, including physical illness,
medication or alcohol toxicity,
dehydration, fecal impaction, malnutrition,
infection, head trauma, lack of
environmental cues, and sensory
deprivation or overload.

• To increase orientation and provide

familiar environmental cues, the nurse
encourages family members or friends to
touch and talk to the patient.
• Ongoing mental status assessments
using this baseline are helpful in
evaluating responses to treatment and to
the hospital or extended care facility
admission.
DEMENTIA
• In order for a diagnosis of dementia to be
made, at least two domains of altered
function must exist—memory and at least
one of the following: language,
perception, visuospatial function,
calculation, judgment, abstraction, and
problem-solving

• The three most common non reversible

dementias are Alzheimer’s disease, multi-
infarct dementia, and mixed Alzheimer’s
and multi-infarct dementia.
• Alzheimer’s disease accounts for more
than 60% of all dementias, and multi-
infarct dementia (vascular dementia)
accounts for another 5% to 20%
NURSING INTERVENTION
• Nursing interventions are aimed at
maintaining the patient’s physical safety;
reducing anxiety and agitation; improving
communication; promoting independence
in self-care activities; providing for the
patient’s needs for socialization, self-
esteem, and intimacy; maintaining
adequate nutrition; managing sleep
pattern disturbances; and supporting and
educating family caregivers.
OLDER ADULT IN ACUTE
CARE SETTING
INCREASED SUSCEPTIBILITY TO
INFECTION
• Pneumonia, urinary tract infections,
tuberculosis (TB), gastrointestinal
infections, and skin infections are some
of the commonly occurring infections in
older people.
ALTERED PAIN & FEBRILE RESPONSES
• The response to pain in older people may
be lessened because of reduced acuity of
touch, alterations in neural pathways, and
diminished processing of sensory data

• The baseline body temperature for older

people is about 1°F lower than it is for
younger people. In the event of illness,
therefore, the body temperature of an older
person may not reach a sufficient elevation
to qualify as a traditionally defined “fever.” A
temperature of 37.8°C (100°F), in
combination with systemic symptoms, may
signal infection.
ALTERED EMOTIONAL IMPACT
• Admission to the hospital is often feared
and actively avoided. Economic concerns
and fear of becoming a burden to the
family often lead to high anxiety in older
people.

• The nurse must recognize the

implications of fear, anxiety, and
dependency in elderly patients. Autonomy
and independent decision making are
encouraged.
RESEARCH INPUT
Friendships in Old Age: Daily
Encounters and Emotional Well-
Being

-  Meng Huo , Marci E Gleason , Lisa A

Neff , Susan T Charles , Karen L
Fingerman
• Having friends in old age is linked to
higher levels of happiness and life
satisfaction.
• This study examined whether older
adults reported
(a) more pleasantness,
(b) fewer conversations about stressful
experiences, and
(c) better mood
when they had contact with friends
compared to when they had contact with
other social partners or were alone
throughout the day.
• Method: Adults aged 65+ (n = 313) from
the Daily Experiences and Well-being
Study provided background information
and listed and described their close social
partners. Participants then completed
ecological momentary assessment (EMA)
surveys every 3 hr for 5 to 6 days where
they reported their encounters with social
partners, rated the pleasantness and
indicated whether they discussed
stressful issues during these encounters,
and rated positive and negative mood.
• Results: Multilevel models revealed that
encounters with friends were more
pleasant and were associated with fewer
discussions about stressful experiences
compared to encounters with romantic
partners or family members throughout
the day. Encounters with friends were
also associated with better mood, though
this link only held for encounters with
friends who were not considered close.
ALTERED SYSTEMIC RESPONSE
• The decline in organ function that occurs
in every system of the aging body
eventually forces one or more body
systems to function at full capacity.

• The older person may be unable to

respond effectively to an acute illness or,
if a chronic health condition is present, he
or she may be unable to sustain
appropriate responses over a long period.
Furthermore, the older person’s ability to
respond to definitive treatment is
impaired
SUMMARY
• Physical aspects of ageing
• Cognitive aspects of ageing
• Pharmacological aspects of ageing
• Mental health problems in older adults
• Older adults in acute care setting
CONCLUSION
• Elderly persons experience normal
physiological changes associated with
aging in all of their solid organ systems.
Together, these changes lead to a
diminished physiological reserve.

• Elderly face various problems and

require a multisectoral approach
involving inputs from various disciplines
of health, psychology, nutrition, sociology
REFERENCES
• Gerontologic nursing, Annette G
Lueckenotte, Mosby publications
• Medial surgical nursing, Phipps.W.J,
Monahan.F.D,7th edition, Mosby
publications
• CRIME AGAINST ELDERLY:A CRITICAL
ANALYSIS BY Shri PARANTAP. K.
DAS ,Lok Nayak Jayaprakash Narayan
National Institute of Criminology and
Forensic ScienceMinistry of Home
Affairs,Government of IndiaNew Delhi
REFERENCES
• file:///C:/Users/ASEN/Downloads/Ageing
_Process_and_Physiological_Changes%
20(2).pdf
• https://www.merckmanuals.com/home/bo
ne,-joint,-and-muscle-disorders/biology-o
f-the-musculoskeletal-system/effects-of-a
ging-on-the-musculoskeletal-system