 There

is great variability in the rate if physiological aging among people and among the organ systems of any one person.  Rapidity of aging depends on a person’s heredity, lifelong dietary patterns, the amount of habitual exercise, past illnesses, and the stresses experienced throughout life.  Loss of RESERVE FUNCTIONAL CAPACITY

Those

that assert a preexisting biological clock citing random occurrences

Those

 Finite

doubling potential – theory states the control for aging is found in the nucleus of the cells. Cells are postulated to be able to reproduce themselves a limited number of times  The neucroendocrine theory the endocrine gland secretes hormones that regulate many body functions, such as metabolism, reproduction, and immune function. Hormones can accelerate as well as slow the aging process, such as the role of hormones in reproductivity. The hypothalamus is thought to be one of the biological clocks associated with aging.

 The immunologic theory – the immune system produces fewer antibodies with age. .

. and other substances and disrupts normal chemical bonds or membranes. proteins. Antioxidants inhibit the formation of free radicals and may possibly retard aging  Cross-linking theory – changes in aging occur when macromolecules are linked by a hydrogen bond or by other means. Free Radical theory– free radicals are unpaired electrons that are by-products of oxygen metabolism. DNA may be damaged and result in cell death. The free radicals then react with lipids.

It increases as the person ages but has not clearly been linked to changes in normal cell function. Lipofuscin accumulation – lipofuscin is thought to result from the breakdown of mitochondria or lysosomes. .

 Thinning of the epidermis. Changes in Integument  Skin:  Wrinkling – caused by the loss of subcutaneous fat and water in epidermal layers and exposure to the sun over many years  Fewer elastic fibers – results in reduced skin turgor  Sebaceous gland produce less sebum in the aging adult-the skin feels dry and scaly and itchy. . skin is easily injured and healing is slow.

•Benign . actinic keratoses – raised areas that appear scaly and may bleed at the edges b. Nails  Thick and easily split Changes •Lentigo Senilis – brown pigmented areas on the dorsum of the hands. seborrheic keratoses – yellowish to brownish wartlike areas and are usually covered with an oily scale. a. and arms •Keratoses – frequently occur on the exposed skin of the older person.

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slower decision making and a slower startle response. there is somewhat slower voluntary movement. Decrease in the size and weight of the brain  With some. older adults may not only have more difficulty going to sleep but also awaken with a feeling of inadequate sleep. decrease in the number of functioning neurons  Nerve transmission is slower in older adults  Nerve conduction velocity is reduced  By the age of 70.  Although adults need about the same amount if sleep as other adults (7-8H at night). .

. older adults have increased susceptibility to either heat stroke or hypothermia. Because of physiological and behavioral changes.

 Inability to change the shape of the lens for near vision (presbyopia) affects most people 45-50 y.  Arcus senilis – accumulation of a lipid substance in the outer rim of the cornea. This appears as a grayish or white circle at the edge of a cornea .  Size of pupil decreases with aging. necessiating a brighter light for vision  Sensitivity to glare also increases with age because of changes in the opacity of the lens  Color discrimination decreases with the yellowing of the lens in the aging process.o. Visual changes  Visual accommodation begins in the 30s and progresses with aging.

    Flashes and floaters – usually harmless but may affect vision. Entropion – lower eyelid turning in Ectropion – lower eyelid turning outward . Large flashes of light could indicate a more serious problem such as retinal detachment Lacrimal glands produce fewer tears resulting in a dry. irritated cornea that can be relieved by eye drops.

pause until vision improves when transitioning from light to dark Blue-green and blue-violet colors difficult to differentiate. presbyopia Interventions Assessment of eyes and vision. large-print reading materials. avoid high-gloss reading material Night light. decreased driving at night. establish welllighted areas. red. use warm colors ( orange.Vision Decreased visual acuity. eyeglasses with corrective lenses. yellow) to contrast bacckgrounds. esp. audio books Sunglasses and antireflective coatings for corrective lenses. non-glare environmental lighting. stairs Delayed glare recovery Decreased light/dark adaptation with impaired night vision Decreased color discrimination and depth perception .

install flashing lights for smoke detectors. telephones and all safety devices.HEARING Presbycusis. reduced ability to hear high-pitched sounds INTERVENTIONS Examine for excess cerumen in the ear Use facial expressions and gestures. picture board . Amplify volume of telephone. healring aid. lower pitch of voice.

TASTE Decreased taste acuity with decreased saliva flow INTERVENTIONS Decreased ability to taste sweet and salty. good oral hygiene. Do not increase sodium intake indiscriminately . contrast with hot and cold temperatures. lemon juice and vinegar for seasoning. reduced ability to detect spoiled food. herbs. then sour and bitter. use spices. check stored food for spoilage using dates.

date stored food. visually check pilot light for gas appliances .SMELL Diminished ability to smell and taste INTERVENTIONS Ensure the smoke detector is functioning.

stand firmly. a firmer touch may be needed to elicit a response. particularly when they try to hurry. and be sure of their balance before walking.  The sense of balance is precarious in many very old people. Tactile sensation  Because the sense of touch may be decreased in an older adult. Older adults must be reminded to sit up slowly. .

 Vestibular and Kinesthetic Senses  The response to both vestibular and kinesthetic stimuli is reduced in very old people.  Vestibular sense receptors are located in muscles and tendons and relay signals to the central nervous system concerning joint motion and body position in space.  Because both of these senses help maintain equilibrium. a diminution in their effectiveness produces a general unsteadiness. . and body position. coordination. a lack of coordination in movements. and an increase in the amount of body sway in the older adult.

have a wide stance. and perhaps use a cane for support when walking. there is a great need for very old people to move slowly. . Because a longer time is required for stimuli to reach the central nervous system and be interpreted and for message then to be sent to the periphery.

.  Concomitant loss of elastic fibers in muscle tissue. D.  Women age 65 years and older should consume dairy products to provide 1500 mg calcium daily or take calcium fortified with Vit. leading to reduced flexibility and increased stiffness  Osteoporosis – occurs more frequently and at an earlier age in women than in men. There is gradual loss of muscular strength and endurance because the muscle cells atrophy and because of the loss of lean muscle mass. Both trabecular and cortical bones are affected by osteoporosis.

. An abnormality of increased resorption of bone resulting from reduced absorption of calcium from the small intestines. as is swimming if neither is carried to excess.  Active exercise and a nutritionally adequate diet are now thought to decrease the rapidity at which muscle mass and bone density decrease.  Walking is a good exercise for older adults. Osteomalacia – adult equivalent of rickets.

stress. the heart of an older adult cannot meet the additional demands placed on it. or illness.  .  In aging.  Cardiac output in response to stress declines with age.Cardiac muscles has increased amounts of collagen and fat with increasing age.  Cardiac output may be adequate in normal activity. a greater percentage of the total cardiac output of blood is sent to the brain and coronary arteries< with the result that the skeletal muscles and viscera may receive inadequate blood supplies when there is increased demand for blood flow. but when undergoing vigorous exercise.

further compromising cardiac output. . The valves of older adult’s heart become more rigid and may compromise cardiac function. which can also reduce the amount of blood flow available to tissues and cause further cardiac or cerebral problems.  The aged heart can exhibit arrhythmia. and preexisting valvular heart disease tends to become more pronounced with age.

 Hypoventilation is ineffective for maximal gas exchange.  Pulmonary tissues in older adults has an altered level of functioning because of loss of elasticity. leading to some degree of hyperinflation of the lung. There is generally a decreased functional reserve capacity.  Medications often produce a significant negative effect on respiration so that breathing is very slow and shallow. .  Bony changes in the thorax and vertebrae further reduce the ability of the lungs to distend.

. there is a corresponding.  Lung vital capacity is also reduced with aging. there is a large portion of dead air space in the respiratory tree.  With the gradual decline in respiratory muscle structure and function. so that even if the respiratory rate increases with need. decrease in strength for breathing and/or coughing. resulting in less gas exchange. so that the amount of air that can be forcibly exhaled decreases. During the aging process. the ventilation/perfusion ratio is decreased.

causing a feeling of fullness. Salivary glands secrete less ptyalin and amylase as age advances. the saliva becomes for alkaline. peristalsis is slowed from the esophagus to the colon in the oldest old. .  Because of changes in the smooth muscle of the digestive tract and reduced stimuli to the autonomic nervous system. resulting in dysphagia.  There is delayed emptying of the esophagus and the stomach. and the bony structure of the mouth begins to shrink.

 Slowed peristalsis.. With the shrinking of the gastric mucosa.  Bile tends to be thicker and the gallbladder empties slowly. and reduced food and fluid intake are responsible for a high prevalence of constipation. there is a decrease in the stomach secretions pepsinogen and hydrochloric acid. inadequate exercise. which further decreases digestion and the absorption of nutrients. . delaying digestion. Thus digestion is slowed but remains fairly adequate until and advanced age. reduced abdominal muscular strength.  There is also a slight decrease in the amount of pancreatic enzymes with aging.

or hemorrhoids that lead to constipation. anal ulcers. Some older adults may have problems related to relaxation of the anal sphincter because of cold environments. .

 No major decrease in hormone secretions with aging with the exception of estrogen and testosterone.  It appears that there is a lack of response to some hormones and even an increase in the secretion of some hormones notably antidiuretic hormone.  Less growth hormone is secreted in older adults than in younger people in response of a stimulus such as low blood sugar level. .

2. The aging body produces antibodies against insulin. There are specific cell membrane receptors for insulin on tissue cells and that the number of sensitivity of theses receptors declines with age. 1. . Two theories that attempt to explain the increasing incidence of diabetes mellitus with aging.

 In women. there is and increased incidence of benign prostatic hyperplasia (BPH) and consequent difficulty starting the voiding stream. .  In men. there are changes in breast tissue that results in less glandular tissue. reduced elasticity and more connective tissue and fat. a gradular decline in the secretion of testosterone from young adulthood to old age is assumed to occur  With aging. after menopause and the resulting decrease in estrogen levels.

Because of this. and by the age of 70 or 80 the filtration rate is approximately one-half of the rate at age 30. and uric acid)  Also. . creatinine. The number of nephron units of the kidney decreases during the aging process.  The renal blood flow gradually decreases. there is a decrease in the clearance of substances normally excreted in the urine. but this decrease does not account for the primary agerelated changes of renal function unless the person is severely stressed. (BUN. with the decreased glomerular filtration. drugs previously excreted in the urine may remain in the bloodstream and produce toxic levels.

.  Bladder capacity decreases with age. and because the kidneys no longer concentrate urine well. frequent urination and nocturia result. increasing the risk of retention and cystitis.  Many older women. experience incontinence because of the relaxation of the pelvic muscles with or without the presence of a cystocele. ureters and bladders tend to lose muscle tone and the bladder loses enough tone to result in incomplete emptying that leads to accumulation of residual urine. particularly those who are multiparous. During the aging process.

 Older women should be reminded that the external urethral sphincter is controlled by the pelvic muscles and should be taught to contract these muscles (kegel exercises) several times throughout the day  Older men may experience frequency of urination because of hyperplasia of the prostate and decreased bladder capacity.  Older adults should be encouraged to take at least 2000 ml if liquids in 24 H unless contraindicated.  Urinary incontinence is not a normal part of the aging process. . It is a symptom with an underlying cause.

become less motile.  The uterus becomes smaller and in old age is about one-half the size of the uterus of young-adult women. Physical changes occur after menopause (cessation of menses) and andropause (midlife changes that in the male) that may affect sexuality and sexual activity.  Fallopian tubes decrease in size and with the decline in estrogen levels. the ovaries cease to produce ova (eggs) and have less estrogen hormones that may cause physiological symptoms in some women. .  In the female.

 There is also less vaginal lubrication and penetration is more difficult. The vulva and external genitalia shrink with aging because of a loss of subcutaneous fat.  Vagina loses elasticity and may decrease breadth and depth.  Erectile dysfunction (ED) or impotence is the consistent inability of the male to achieve and/or maintain an erection that is sufficient for intercourse. These physical changes may cause dyspareunia.  In the male. especially if the woman has had a hysterectomy. the penis may decrease in size and conditions/surgery of the prostate gland may affect the ability to have an erection. .

 Nurses should discuss the topic of sexuality with clients when the need is identified. . hugging. such as holding hands.  Older couples may also find increased pleasure in other types of intimacy. and sharing personal thoughts and feelings. not last as long. Erection may take longer to achieve. and require a longer interval between erections.

that.  Nurses should have a high index of suspicion when early warning signs of illness are present in older people. less pain sensation. Older adult have a delayed or inadequate response to the stress of an infection. and minimal leukocytosis. unaltered. so there is a real hazard for the older adult who develops conditions such as pneumonia or cholecystitis.  Altered inflammatory response leads to altered signs and symptoms. such as little or no fever. . would alert both a younger adult and the physician or other health care provider to a medial problem.

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