Common Aging Changes

Gerontological Nursing by C. Eliopoulos

Jessica Abuel-Sabas
Lecturer
• Crystallized intelligence- knowledge accumulated over a lifetime; arises from
dominant hemisphere of the brain
• Fluid intelligence- involves new information emanating from the nondominant
hemisphere, controls emotion, retention of nonintellectual information, creative
capacities, spatial perceptions and aesthetic appreciation
• Immuno senescence- the aging of the immune system
• Presbycusis- progressive hearing loss that occurs as a result of age-related changes
to the inner ear
• Presby esophagus- condition characterized by decreased intensity of propulsive
waves
• Presbyopia- inability to focus or accommodate properly due to reduced lens
elasticity
• Living is a process, the continuation of change into later life is natural
and expected
• The type, rate and degree of physical, emotional, psychological and
social changes are highly individualized
• It is influenced by genetic, environment, diet, health, stress and
lifestyle choices
• The pattern of aging of various system within the individual, it is the
uniqueness of a person
• Cells reduced, lean body mass, bone mass, ECF constant, ICF
decreased . < total body fluid, dehydration as significant risk
• Physical appearance: noticeable begin to appear after 4th decade of
life. Hair loss , gray hair and wrinkles. Bony appearance, elongated
ears, double chin, baggy eyelids are the obvious manifestations of
tissue elasticity.
• Forearms and hands, sensitive to cold temperatures
• Stature decreases loss of approximately 2 inches by 80yo
• Respiratory: mouth breathing during sleep becomes common, snoring
and obstructive apnea.
• Connective tissue changes cause relaxation of tissue at the lower edge
of the septum, tip of the nose rotate downward
• Decreased submucosal glands secretions, thicker is more difficult to
remove and give a nasal stuffiness sensation.
• Kyphosis, inspiratory and expiratory muscles weaker
• KC: Reduced respiratory activity associated with advanced age puts
older adults increased risk for developing pneumonia easily especially
when they are immobile.
• Cardiovascular : heart size does not change significantly due to age
rather, enlarged hearts are associated with cardiac disease, and
inactivity can cause cardiac atrophy.
• Throughout the adult years, heart muscle loss its efficiency and
contractile strength results in reduced cardiac output under
physiologic stress
• Adults adjust to changes, take elevator rather than stairs, drive
instead walk,
• Key Concept: age-related cardiovascular changes are most apparent
when unusual demands are placed on the heart.
• Tunica intima, experience the most direct changes, fibrosis, calcium
and lipid accumulation and cell proliferation, leads to atherosclerosis
development
• Middle layer- thinning and calcification of elastin fibers, increase
collagen cause stiffening of the vessels
• Impaired baroreceptor and increased peripheral resistance occur
leads to rise in systolic blood pressure.
• Postural and postprandial hypotension: BP reduction at least 20mmHg
within 1 hour of eating
• GI: teeth change, mouth and liver. Decreased dentin production
below the enamel, decreased bone density leads to tooth loss, poor
dental care, diet, periodontal disease as the major reason of tooth
loss.
• Taste sensations, tongue atrophies affecting taste buds, smoking
• Sweet sensation on tip of tongue is loss than sour, salt and bitter
• Excessive seasoning to compensate taste alterations that could lead
to health problems
• Salivary ptyalin is decreased, breakdown of starches, swallowing can
take twice long. Muscle strength and tongue pressure can interfere
• Esophageal motility, presbyesophagus. Food remains for a longer time
• Weak gag reflex , aspiration becomes a risk
• Decreased hunger contractions , HCl acid and pepsin decline with age
• Increase pH of stomach increased incidence of gastric irritation
• The older liver is less able to regenerate damage cells
• Cholesterol stabilization and absorption cause increased incidence of
gallstones.
• Pancreatic ducts become dilated and distended
• Urinary system: affected by the changes in kidneys, ureters and
bladder
• renal tissue growth declines, reducing blood flow and GFR by one half
between ages 20-90 yo.
• Tubular function decreases and suppression of antidiuretic hormone
secretion
• older kidneys have less ability to conserve sodium, hyponatremia and
nocturia
• Reabsorption of glucose from the filtrate, which cause 1+ proteinuria
and glycosuria
• Urinary frequency, urgency and nocturia accompany bladder with age
• Bladder muscles weaken capacity, emptying is difficult,
• large volume of urine retention results
• Micturition reflex is delayed
• Urinary incontinence is not normal outcome of aging, some stress
incontinence may occur due to weakening pelvic diaphragm,
particularly multiparous women.
• Reproductive system:
• as men age, seminal vesicles are affected by smoothing mucosa, thinning
epithelium and reduction of fluid-retaining capacity.
• Seminiferous tubules increased fibrosis, thickening basement membrane and
narrowing of the lumen
• Cause reduction in sperm count in some men, some atrophy of the testes.
• Increased FSH and LH levels occur, along with decreases in serum and
bioavailable testosterone levels.
• Venous and arterial sclerosis of penis
• Does not lose physical capacity to achieve erections and ejaculations, although
orgasm and ejaculations tend to be less intense.
• Prostatic enlargement occurs. Rate and type vary among individuals
• ¾ of men aged 65 years and older have prostatism, problems in
urinary frequency.
• Prostatic enlargement is benign yet pose a greater risk of malignancy
and requires regular evaluation.
• Female genitalia: fallopian tube atrophy and shorten
• Ovaries become thicker and smaller, cervix smaller
• Vaginal canal less elastic and drier
• Flattening labia
• Endocervical epithelium, endometrium atrophies
• Uterus smaller
• More alkaline vaginal environment
• Loss of vulvar subcutaneous fat and hair
• Musculoskeletal system:
• kyphosis, enlarged joints and flabby muscles
• Decreased height, shortening vertebrae, 20-70 yo height by 2 inches
• Bone brittleness, reduced calcium absorption , risk for fracture
• Knee flexion
• Decrease bone mass and mineral, density at 0.5% each year after 3rd
decade of life.
• Hip flexion, wrist
• Impaired flexion and extension movements
• Regular exercise helps maintains muscle strength and tone and reduces some
negative functional consequences of aging.
• Nervous system: there is a decline in brain weight and blood flow to the
brain, however these changes do not appear to affect thinking and behavior
(Rabbit, et al)
• Decline is often nonspecific and slowly progressing
• Decreased conduction velocity
• Reduction in glucose utilization and metabolic rate of O2 in brain
• B-amyloid and neurofibrillary tangles are associated with Alzheimer’s disease
AD, they can be present in older adults with normal cognitive function.
• Slower response and reaction time
• Changes in sleep pattern after age 55. sleep-wake cycle, circadian and
homeostatic factors of sleep regulation are altered with aging
• Stages III and IV of sleep less prominent.
• Frequent awakening is not unusual
• Sensory Organs:
• sight opaque lens, decreased pupil size, spherical cornea
• Smell impaired ability to identify and discriminate odors
• Taste impairment, (saliva, oral hygiene, medications, sinusitis)
• Reduction of tactile sensation (pain and temperature) safety risks
• Atrophy of hair cells of Organ of Corti, tympanic membrane, increased
cerumen and keratin concentration
• KC: hearing declines with age, impaired hearing can occur at younger
ages due to exposure to loud music, traffic and environmental noise, this
noise-induced hearing loss is preventable.
• Endocrine System: group of cells and glands that produce the chemical
messengers known as hormones
• Thyroid gland increased nodularity, lower BMR, reduced radioactive
iodine uptake and less thyrotropin secretion and release.
• Triiodothyronine T3 significant reduction, overall thyroid function is
adequate
• Adrenal cortex is regulated by ACTH, a pituitary hormone, decreases
• Less aldosterone is produced and excreted in urine of older person.
• Gonadal secretion declines with age, testosterone, estrogen, progest
• Delayed and insufficient insulin release of beta cells of the pancreas
• KC: higher blood glucose levels than normal in the general adult
population are usual in nondiabetic older people
• Integumentary System:
• Factors influencing the course of aging skin: diet, general health, activity,
exposure and hereditary factors.
• Collagen fibers coarser, reduce elasticity
• Dermis avascular and thinner. Fat loss, dry and fragile.
• Wrinkles and sagging evident.
• Melanocytes- skin pigmentation, age spots starts 3rd decade, sun
exposed.
• Hair bulbs fibrosis for gray, axillary, scalp and pubic
• Nose ears thicker

• Immune System:
• immunosenescence- depressed immune response that can cause
infections to be a significant risk of older adults.
• Thymic mass decreases steadily after midlife. T-cells activity declines and
more immature t-cells present in the thymus.
• Mycobacterium tuberculosis infections, low grade fever and minimal
pain, osteoporosis
• Thermoregulation: normal body temperature are lower in later life than younger
years
• Rectal and auditory canal temperature are most accurate and reliable indicators of
body
• Reduced ability to respond to cold due to inefficient vasoconstriction, decreased CO,
diminished shivering and reduced muscle mass
• CHANGES TO THE MIND: 5
• Personality: kind and gentle when young, cantankerous old person (difficult or
irritating to deal with)
• Changes in personality traits may occur in response to events that alter self-attitude
(retirement death of spouse, loss of independence, income reduction and disability)
• No personality types describes all older adults
• Morale, attitude, and self-esteem tend to be stable throughout the
lifespan.
• KC: personality in late life is a reflection of lifelong personality
• Memory:
• 3 types as short term 30 seconds-30 minutes, long term (learned long
ago) and sensory (obtained through sensory organs and lasts a few
seconds
• Use memory aids mnemonic devices (name with image, notes, lists,
placing objects in consistent locations
• Intelligence: basic intelligence is maintained.
• Ability for verbal comprehension and arithmetic operations are
unchanged
• Crystallized intelligence over lifetime from dominant Hemisphere is
maintained. Enables past learning and experiences for problem
solving
• Fluid intelligence- decline in later life.
• High levels of chronic psychological stress have been found to be
associated with an increased incidence of mild cognitive impairment
(Wilson, et al)
• Learning:
• Factors can interfere with the older person’s ability to learn: motivation, attention
span, delayed transmission of information to the brain, perceptual deficits and
illness.
• Older persons may display less readiness to learn and depend on previous
experience for solutions to problems rather than experiment with new-problem
solving techniques.
• Early phase tend to be more difficult for older persons
• Learning occurs best when the new information is related to previously learned
information
• Older do show some difficulty with perceptual motor tasks, simple association
rather than analysis.
• KC: older adults maintain the capacity to learn although a variety of
factors can easily interfere with the learning process.

• Attention Span: older adults demonstrate a decrease in vigilance

performance ( ability to retain attention longer than 45 minutes)
• Easily destructed by irrelevant information and stimuli and less able to
perform tasks that are complicated or require simultaneous performance
• Key Concept: By promoting positive practices in persons of all ages,
nurses can help greater numbers of individuals enter late life with high
levels of health and function.
• Nurses caring for older adults must realize that , despite numerous
changes commonly experienced with age,
• most older adults function admirably well and live normal satisfying
lives.
• Although nurses need to acknowledge factors than can alter function
with aging,
• they should also emphasize the capabilities and assets possessed by
older adults and assist persons of all ages in achieving a healthy aging
process.
• Quiz next meeting.
• Assignment: notebook
• List some Nursing Actions Related to Age-Related Changes. at least
30.
• Study: Facilitating Physiological Balance of the different Systems in
connection with NCP, General Observations, and Interview,
Causes/contributing Factors and its Nursing Diagnosis