Geriatric Assessment: Physiological Changes

• Physiological changes occur in various systems during geriatric assessment.

Integumentary System

• Decreased sebaceous and sweat gland activity results in dry skin and reduced sweating.
• Poor skin elasticity, collagen, and mass lead to wrinkles.
• Subcutaneous fat distribution shifts from the face and extremities to the abdomen and hips.
• Decreased subcutaneous and cutaneous tissue causes deepening in thoracic, axillary, and supraclavicular hollows.
• Joints and bony areas appear sharp and angular.
• Reduced melanin production causes gray hair, while decreased hormonal function leads to thinning of scalp, axillary, and pubic hair.
• Nails become thick, brittle, hard, and yellow, making them prone to splitting.
• Skin cancer is a common skin condition.

Musculoskeletal System

• Bone mass decreases, increasing the risk of stress fractures.
• Intervertebral disks lose water, narrowing disk space and causing height loss.
• The lordotic curve of the back flattens, reducing flexion and extension.
• Increased back flexion alters posture, shifting the center of gravity.
• Tendons and muscles lose mass and strength.
• Stiff neck may indicate cervical arthritis.
• Osteoporosis, fractures, osteoarthritis, and gout are common conditions.

Cardiovascular System

• Heart size tends to decrease, leading to a less efficient response to stress or increased oxygen demand, and a longer time to return to baseline heart rate.
• Cardiac function is affected by fibrosis and sclerosis of the sinoatrial node and mitral and aortic valves.
• Common cardiac conditions include hypertension, angina, MI, valvular heart disease, HF, and peripheral arterial disease.

Respiratory System

• Kyphoscoliosis leads to thorax shortening and an increased anteroposterior diameter.
• The chest wall may stiffen due to calcification at rib articulation points, reducing chest wall compliance.
• Diminished respiratory muscle strength reduces maximal inspiratory and expiratory force.
• Alveoli become less elastic and more fibrous, increasing dyspnea on exertion.
• Fewer cilia and less effective mucociliary clearance occur.
• Mucous membranes become drier, reducing the ability to clear retained mucus.
• Asthma, chronic obstructive pulmonary disease, and pneumonia are common airway conditions.

Gastrointestinal System

• Increased fat deposits occur over the abdominal area, even with decreased subcutaneous fat over extremities.
• The abdomen may feel soft due to decreased abdominal muscle tone, facilitating organ palpation.
• Gastrointestinal reflux disease is a common condition.

Genitourinary System

• In females, after menopause, the labia and clitoris become smaller and paler.
• Decreased estrogen causes epithelial layers to thin and lose subcutaneous fat.
• The vaginal introitus may diminish in size, with shortening and narrowing of the vagina.
• Vaginal mucosa becomes dry and thin.
• The uterus and ovaries decrease in size as ovarian follicles gradually disappear.
• Ligaments and connective tissue of the pelvis may lose muscle tone and elasticity.
• In males, prostate hyperplasia is associated with aging, and excessive enlargement can obstruct urinary flow.
• Benign prostatic hyperplasia is a common condition.

Neurological System

• Changes in sensory and motor function, memory, cognition, and proprioception occur at different rates.
• Short-term memory, like names and recall of recent events, may decline with age, but long-term memory is maintained.
• Common conditions include Alzheimer's disease, cerebrovascular accident (stroke), and Parkinson's disease.

Sensory System

• Eyes

  • Tearing production decreases, causing dry eyes.
  • Corneal sensitivity is often lost, potentially leading to unawareness of infection or injury.
  • Presbyopia, where the lens becomes rigid around age 45 and ciliary muscle weakens, leads to accommodation changes.
  • Color perception is lost, particularly with blue, violet, and green.
  • Common vision conditions include cataracts, macular degeneration, glaucoma, and diabetic retinopathy.

• Ears

  • Hearing loss can result from various factors:
    • Cerumen becomes dry and blocks the auditory canal.
    • Conductive hearing loss occurs when the tympanic membrane becomes more translucent and sclerotic.
    • Excessive bone cell deposits along the ossicle chain can fixate the stapes in the oval window.
    • Sensorineural hearing loss develops as hair cells in the organ of Corti degenerate after age 50.
  • Hearing loss initially affects high-frequency sounds before progressing to lower-frequency tones.
  • Common hearing conditions include conductive and sensorineural hearing loss.

• Smell

  • The number of sensory cells in the nasal lining decreases.

• Mouth

  • Gingival tissue becomes less elastic and more vulnerable to injury, exposing tooth root surfaces to caries formation.
  • Tooth enamel becomes harder and more brittle.
  • Teeth darken and become worn from use, losing translucency.
  • The tongue becomes more fissured, which leads to swallowing problems.
  • Taste perception may diminish due to gradual atrophy of the tongue and a decrease in the number of papillae and taste buds.
  • Muscle weakness may result in chewing and swallowing difficulties.

• Throat

  • The size of the thyroid decreases due to atrophy.
  • An increased concave cervical curvature may cause the head to position forward and downward.
  • Lymph nodes may decrease in size and number with age.

• High blood pressure, pain, urinary incontinence, and memory loss are not part of normal aging.

During geriatric assessment, notable physiological changes occur across various systems. The integumentary system experiences reduced gland activity leading to dry skin and wrinkles. The musculoskeletal system sees decreased bone mass, increasing the risk of fractures.