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Unit 3: Common Aging Changes NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Intended Learning Outcomes (ILO) At the end of the unit, you are expected to: List common age-relate...

Unit 3: Common Aging Changes NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Intended Learning Outcomes (ILO) At the end of the unit, you are expected to: List common age-related changes at the cellular level; in physical appearance; and to the respiratory, cardiovascular, gastrointestinal, 1 urinary, reproductive, musculoskeletal, nervous, endocrine, integumentary, and immune systems, the sensory organs, and thermoregulation. 2 Describe psychological changes experienced with age. 3 Discuss nursing actions to promote health and reduce risks associated with age-related changes. 4 NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Changes to 1 the Body NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cells The number of cells is gradually reduced, leaving fewer functional cells in the body. Lean body mass is reduced, whereas fat tissue increases until the sixth decade of life. Total body fat as a proportion of the body’s composition increases, and its distribution changes (e.g., an increase in visceral fat level). NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cells Cellular solids and bone mass are decreased. Extracellular fluid remains fairly constant, whereas intracellular fluid is decreased, resulting in less total body fluid. This decrease makes dehydration a significant risk to older adults. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Physical Appearance Men experience hair loss, and both sexes develop gray hair and wrinkles. The body’s contours gain a bony appearance along with a deepening of the hollows of the intercostal and supraclavicular spaces, orbits, and axillae. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Physical Appearance Elongated ears, a double chin, and baggy eyelids Skinfold thickness is significantly reduced in the forearm and on the back of the hands. There is a decline in the body’s natural insulation, making older adults more sensitive to cold temperatures. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Physical Appearance Stature decreases, resulting in a loss of as much as 3 inches in height by 80 years of age. The decrease in stature causes the long bones of the body, which do not shrink, to appear disproportionately long. Any curvature of the spine, hips, and knees that may be present can further reduce height. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Respiratory System Connective tissue changes cause a relaxation of the tissue at the lower edge of the septum (nose); the reduced support causes the tip of the nose to slightly rotate downward. Septal deviations can occur, as well. Mouth breathing during sleep becomes more common as a result → snoring and obstructive apnea. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Respiratory System The calcification of costal cartilage makes the trachea and rib cage more rigid; the anterior–posterior chest diameter increases, often demonstrated by kyphosis; and thoracic inspiratory and expiratory muscles are weaker. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Respiratory System blunting of the cough and laryngeal reflexes In the lungs, cilia reduce in number and there is hypertrophy of the bronchial mucous gland, further complicating the ability to expel mucus and debris. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Respiratory System Alveoli reduce in number and stretch The lungs become smaller, less firm, lighter, and more rigid and have less recoil. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Respiratory System Less lung expansion, insufficient basilar inflation, and decreased ability to expel foreign or accumulated matter The lungs exhale less effectively, thereby increasing the residual volume. As the residual volume increases, the vital capacity is reduced; maximum breathing capacity also decreases. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Respiratory System Immobility can further reduce respiratory activity. With less effective gas exchange and lack of basilar inflation, older adults are at high risk for developing respiratory infections. Endurance training can produce a significant increase in lung capacity of older adults. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System Heart size does not change significantly due to age; rather, enlarged hearts are associated with cardiac disease, and marked inactivity can cause cardiac atrophy. There is a slight left ventricular hypertrophy with age, and the aorta becomes dilated and elongated. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System Atrioventricular valves become thick and rigid as a result of sclerosis and fibrosis There may be incomplete valve closure → systolic and diastolic murmurs. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System heart muscle loses its efficiency and contractile strength → reduced cardiac output under conditions of physiologic stress Pacemaker cells become increasingly irregular and decrease in number, and the shell surrounding the sinus node thickens. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System The isometric contraction phase and relaxation time of the left ventricle are prolonged; the cycle of diastolic filling and systolic emptying requires more time to be completed. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System Tunica intima: experiences the most direct changes, including fibrosis, calcium and lipid accumulation, and cellular proliferation → contributes to atherosclerosis NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System Tunica media: thins, calcification of elastin fibers and an increase in collagen → stiffening of the vessels Impaired baroreceptor function and increased peripheral resistance → rise in systolic blood pressure NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System Tunica adventitia: not affected by the aging process NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System Arteries: Decreased elasticity is responsible for vascular changes to the heart, kidney, and pituitary gland. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Cardiovascular System reduced sensitivity of the blood pressure–regulating baroreceptors → postural, postprandial hypotension (BP reduction of at least 20 mmHg within 1 hour of eating) reduced elasticity of the vessels, coupled with thinner skin and less subcutaneous fat → more prominent blood vessels in the head, neck, and extremities NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Teeth Tooth enamel becomes harder and more brittle with age. Dentin becomes more fibrous and its production is decreased. The nerve chambers become narrower and shorter and teeth are less sensitive to stimuli. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Teeth The root pulp experiences shrinkage and fibrosis, the gingiva retracts, and bone density in the alveolar ridge is lost. Increasing numbers of root cavities and cavities around existing dental work occur. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Teeth Flattening of the chewing cusps is common. The bones that support the teeth decrease in density and height → tooth loss. The tooth brittleness → possibility of aspiration of tooth fragments. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Tongue Taste sensations become less acute with age because the tongue atrophies, affecting the taste buds; chronic irritation (as from pipe smoking) can reduce taste efficiency to a greater degree than that experienced through aging alone. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Tongue The sweet sensations on the tip of the tongue tend to suffer a greater loss than the sensations for sour, salt, and bitter flavors. Loss of papillae and sublingual varicosities on the tongue are common findings. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Saliva produce approximately one- third (1/3) of the amount of saliva produced in younger years Saliva often is diminished in quantity and is of increased viscosity as a result of some of the medications commonly used to treat geriatric conditions. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Saliva Salivary ptyalin is decreased, interfering with the breakdown of starches. Diminished muscle strength and tongue pressure can interfere with mastication and swallowing NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Esophagus Presbyesophagus – a condition characterized by a decreased intensity of propulsive waves and an increased frequency of nonpropulsive waves in the esophagus. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Esophagus tends to become slightly dilated, and esophageal emptying is slower, which can cause discomfort because food remains in the esophagus for a longer time. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Esophagus Relaxation of the lower esophageal sphincter may occur; when combined with the older person’s weaker gag reflex and delayed esophageal emptying, aspiration becomes a risk. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Stomach reduced motility in old age, along with decreases in hunger contractions The gastric mucosa atrophies. Hydrochloric acid and pepsin decline with age; the higher pH of the stomach contributes to an increased incidence of gastric irritation in the older population. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Intestines Some atrophy occurs throughout the small and large intestines, and fewer cells are present on the absorbing surface of intestinal walls. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Small Intestine There is a gradual reduction in the weight of the small intestine and shortening and widening of the villi Functionally, there is no significant change in mean small bowel transit time with age. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Small Intestine Fat absorption is slower, and dextrose and xylose are more difficult to absorb. Faulty absorption of vitamin B, vitamin B12, vitamin D, calcium, and iron NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Large Intestine has reductions in mucous secretions and elasticity of the rectal wall An age-related loss of tone of the internal sphincter can affect bowel elimination. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Liver has reduced weight and volume but this seems to produce no ill effects The older liver is less able to regenerate damaged cells. Liver function tests remain within a normal range. Less efficient cholesterol stabilization and absorption cause an increased incidence of gallstones. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Gastrointestinal System Pancreas The pancreatic ducts become dilated and distended, and often, the entire gland prolapses. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Urinary System Kidneys The renal mass becomes smaller with age. Renal tissue growth declines, and atherosclerosis may promote atrophy of the kidney. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Urinary System Kidneys These changes can have a profound effect on renal function, reducing renal blood flow and the glomerular filtration rate by approximately one-half between the ages of 20 and 90 years NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Urinary System Ureters tubular function decreases less efficient tubular exchange of substances, conservation of water and sodium, and suppression of antidiuretic hormone secretion NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Urinary System Bladder urinary frequency, urgency, and nocturia Bladder muscles weaken and bladder capacity decreases. Emptying of the bladder is more difficult; retention of large volumes of urine may result. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Urinary System Bladder The micturition reflex is delayed. Although urinary incontinence is not a normal outcome of aging, some stress incontinence may occur because of a weakening of the pelvic diaphragm, particularly in multiparous women. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Male the seminal vesicles are affected by a smoothing of the mucosa, thinning of the epithelium, replacement of muscle tissue with connective tissue, and reduction of fluid- retaining capacity. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Male The seminiferous tubules experience increased fibrosis, thinning of the epithelium, thickening of the basement membrane, and narrowing of the lumen → ↓ sperm count ↑ FSH & LH, ↓ testosterone NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Male Venous and arterial sclerosis and fibroelastosis of the corpus spongiosum The older man does not lose the physical capacity to achieve erections or ejaculations, although orgasm and ejaculation tend to be less intense. some atrophy of the testes NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Male Prostatic enlargement occurs in most older men ¾ of men aged 65 years and older have some degree of prostatism → problems with urinary frequency. most prostatic enlargement is benign NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Female Female genitalia: atrophy of the vulva from hormonal changes, accompanied by the loss of subcutaneous fat and hair and a flattening of the labia NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Female Vagina: appears pink and dry with a smooth, shiny canal (loss of elastic tissue and rugae) The vaginal epithelium becomes thin and avascular. Vaginal environment is more alkaline and is accompanied by a change in the type of flora and a reduction in secretions.  Reproductive System Female Cervix: atrophies and becomes smaller; the endocervical epithelium also atrophies. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Female Uterus: shrinks and the endometrium atrophies; however, the endometrium continues to respond to hormonal stimulation, which can be responsible for incidents of postmenopausal bleeding in older women on estrogen therapy. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Female Uterus: The ligaments supporting the uterus weaken and can cause a backward tilting of the uterus; this backward displacement along with the reduced size of the uterus can make it difficult to palpate during an examination. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Female fallopian tubes: atrophy and shorten with age Ovaries: atrophy and become thicker and smaller, can shrink to such a small size that they are not palpable during an examination NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Reproductive System Female Estrogen: depletes → weakening of pelvic floor muscles → involuntary release of urine when there is an increase in intra-abdominal pressure NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Musculoskeletal System muscle fibers: atrophy and decrease in number, with fibrous tissue gradually replacing muscle tissue. ↓ overall muscle mass, muscle strength, and muscle movements; the arm and leg muscles, which become particularly flabby and weak, display these changes well. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Musculoskeletal System Sarcopenia - age-related loss of muscle mass, strength, and function Muscle tremors Tendons: shrink and harden → ↓ tendon jerks Reflexes: ↓ in the arms, nearly totally lost in the abdomen, but are maintained in the knee. Frequent muscle cramping NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Musculoskeletal System ↓ Bone mineral, bone mass → brittleness of the bones of older people, especially older women who experience an accelerated rate of bone loss after menopause. Bone density decreases at a rate of 0.5% each year after the third decade of life. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Musculoskeletal System ↓ calcium absorption, a gradual resorption of the interior surface of the long bones, slower production of new bone on the outside surface → make fractures a serious risk to the older adults NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Musculoskeletal System thinning disks and shortening vertebrae reduce the length of the spinal column → reduction in height with age Height may be further shortened because of kyphosis, a backward tilting of the head, and some flexion at the hips and knees. Limited joint activity and motion NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Nervous System a decline in brain weight and a reduction in blood flow to the brain reduction in neurons, nerve fibers, cerebral blood flow, and metabolism Reduced cerebral blood flow is accompanied by a reduction in glucose utilization and metabolic rate of oxygen in the brain. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Nervous System nerve conduction velocity is lower → slower reflexes and delayed response to multiple stimuli kinesthetic sense lessens slower response to changes in balance → falls Slower recognition and response to stimuli NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Nervous System Hypothalamus: regulates temperature less effectively brain cells: slowly decline over the years cerebral cortex: undergoes some loss of neurons some decrease in brain size and weight, particularly after age 55 years NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Nervous System circadian and homeostatic factors of sleep regulation are altered with aging → changes in sleep pattern, with stages III and IV of sleep becoming less prominent aging Frequent awakening during sleep is not unusual, although only a minimal amount of sleep is actually lost. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Vision Presbyopia, the inability to focus or accommodate properly due to reduced elasticity of the lens, is characteristic of older eyes and begins in the fourth decade of life. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Vision Alterations in the blood supply of the retina and retinal pigmented epithelium → macular degeneration, a condition in which there is a loss of central vision NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Vision The density and size of the lens increase → lens to become stiffer and more opaque → cataracts → increases sensitivity to glare, blurs vision, and interferes with night vision NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Vision Yellowing of the lens and alterations in the retina that affect color perception make older people less able to differentiate the low-tone colors of the blues, greens, and violets. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Vision Depth perception becomes distorted, causing problems in correctly judging the height of curbs and steps. Dark and light adaptation takes longer Less efficient reabsorption of intraocular fluid → ↑ risk of developing glaucoma NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Vision Eye: ↓ lacrimal secretions can cause the eyes to look dry and dull, and fat deposits can cause a partial or complete glossy white circle to develop around the periphery of the cornea (arcus senilis). NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Vision Cornea: ↓ sensitivity → ↑ risk of injury to the cornea accumulation of lipid deposits in the cornea → scattering of light rays → blurs vision. Floaters in the visual field Visual acuity progressively declines NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Hearing Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear High-frequency sounds of 2,000 Hz and above are the first to be lost; middle and low frequencies also may be lost as the condition progresses. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Hearing accumulation of cerumen in the middle ear weakening and stiffening of the middle ear muscles and ligaments → ↓ acoustic reflex altered equilibrium NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Taste and Smell ↓ number of sensory cells in the nasal lining and fewer cells in the olfactory bulb of the brain. →↓ sense of smell By age 80 years, the detection of scent is almost half as sensitive as it was at its peak. Men tend to experience a greater loss in the ability to detect odors than women. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Taste and Smell reduction in the sense of smell alters the sense of taste atrophy of the tongue → ↓ taste sensations, although there is no conclusive evidence that the number or responsiveness of taste buds decreases NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Taste and Smell The ability to detect salt is affected more than other taste sensations. Reduced saliva production, poor oral hygiene, medications, and conditions such as sinusitis can also affect taste. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Sensory Organs Touch ↓ tactile sensation, as observed in the reduced ability of older persons to sense pressure and pain and differentiate temperatures → misperceptions of the environment → profound safety risks NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Endocrine System Thyroid Gland undergoes fibrosis, cellular infiltration, and increased nodularity → lower basal metabolic rate progressively atrophies, and the loss of adrenal function can further decrease thyroid activity NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Endocrine System Adrenal Gland As ACTH secretion decreases with age, secretory activity of the adrenal gland also decreases ↓ aldosterone ↓ glucocorticoids, 17- ketosteroids, progesterone, androgen, and estrogen NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Endocrine System Pituitary Gland decreases in volume by approximately 20% in older persons ↓ ACTH, TSH, follicle- stimulating hormone, luteinizing hormone, and luteotropic hormone ↓ testosterone, estrogen, and progesterone NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Endocrine System Pancreas delayed and insufficient release of insulin by the beta cells ↓ tissue sensitivity to circulating insulin ↓ metabolism of glucose sudden concentrations of glucose → more prolonged hyperglycemia NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Integumentary System Collagen fibers become coarser and more random →↓ skin elasticity lines, wrinkles, sagging of skin Skin becomes irritated and breaks down more easily. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Integumentary System ↓ melanocytes, melanocytes cluster → skin pigmentation (age spots), tan more slowly and less deeply ↓ skin immune response → more prone to skin infections Benign and malignant skin neoplasms occur more NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Integumentary System progressive loss of pigment cells and atrophy and fibrosis of hair bulbs → scalp, pubic, and axillary hair thins and grays hair in the nose and ears becomes thicker ↓ growth rate of scalp, pubic, and axillary hair; the growth of facial hair may occur in older women. ↑ growth of eyebrow, ear, and nostril hair occurs in older men NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Integumentary System Fingernails: grow more slowly, fragile and brittle, develop longitudinal striations, and experience a decrease in lunula size. Perspiration: slightly ↓ because the number and function of the sweat glands are lessened. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Immune System immunosenescence - aging of the immune system, includes a depressed immune response → infections Thymic mass ↓ steadily responses to influenza, parainfluenza, pneumococcus, and tetanus vaccines are less effective inflammatory defenses decline NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Thermoregulation Normal body temperatures are lower in later life: 35.7°C to 36.9°C orally 35.5°C to 36.3°C axillary 36.1°C to 37.3°C rectally 35.7°C to 37.5°C via auditory canal NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Thermoregulation Reduced ability to respond to cold temperatures due to: Inefficient vasoconstriction Reduced peripheral circulation Decreased cardiac output Diminished shivering Reduced muscle mass and subcutaneous tissue NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Thermoregulation Differences in response to heat related to: Impaired sweating mechanisms Decreased cardiac output. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Thermoregulation More susceptible to heat stress ↑ risks for: - Accidental hypothermia - Heat exhaustion - Heat stroke NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Changes to 2 the Mind NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Personality Personality remains consistent throughout aging: Drastic changes are unlikely to occur. Kind and gentle personalities remain kind and gentle. Cantankerous personalities were likely not mild and meek in earlier years. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Personality Personality changes can be a result of physical and mental limitations: Alleged rigidity is often due to safety practices. Memory deficits and visual impairments can contribute to this behavior. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Personality Personality traits may change in response to life events: Retirement Death of a spouse Loss of independence Income reduction Disability NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Personality No single personality type describes all older adults Personality in late life reflects lifelong personality. Morale, attitude, and self- esteem tend to remain stable throughout the lifespan. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Memory Poorer short-term memory ↓ episodic memory ↓ semantic memory ↓ working memory function Older adults can improve some age-related forgetfulness by using memory aids (mnemonic devices) NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Intelligence Basic intelligence is maintained; one does not become more or less intelligent with age. Unchanged abilities for verbal comprehension and arithmetic operations NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Intelligence Crystallized intelligence is maintained through the adult years; this form of intelligence enables the individual to use past learning and experiences for problem-solving. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Intelligence Fluid intelligence is believed to decline in later life. Some decline in intellectual function occurs in the moments preceding death. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Learning 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 Learning occurs best when the new information is related to previously learned information. NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Attention Span ↓ vigilance performance more easily distracted by irrelevant information and stimuli NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Nursing Implications of 3 Age-Related Changes NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN  Thank you! NCM 114: Care of Older Adults Caesar G. Balatero, RN, MN