Normal Physiological Changes in Older Adults (Final 2024-2025) - Alexandria University PDF

Alexandria University Faculty of Nursing Gerontological Nursing Department Normal physiological changes in older adults Prepared by: prof.Dr. Abeer Abd Elrahman Assisstant.prof.Dr.Marwa Mahfouz Updated and present...

Alexandria University Faculty of Nursing Gerontological Nursing Department Normal physiological changes in older adults Prepared by: prof.Dr. Abeer Abd Elrahman Assisstant.prof.Dr.Marwa Mahfouz Updated and presented by:Dr. Heba Ahmed Mohsen 0 1  Common Aging Changes Introduction:- Living is a process of continual changes. Infants become toddlers, pubescent children blossom into young men and women, and dependent adolescents become responsible adults. The continuation of change into later life is natural and expected. The type, rate, and degree of physical, emotional, psychological, and social changes experienced during life are highly individualized; such changes are influenced by genetic factors, environment, diet, health, stress, and numerous other elements. The result is not only individual variations among aged persons but also differences in the pattern of aging of various body systems within the same individual. Although some similar elements in the aging pattern can be identified among individuals, it must be recognized that each person's pattern of aging is unique. I Physiological Changes of Different Body Systems:- Organ and system changes can be traced to basic cellular-level changes. 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 doubles between ages 25 and 75. Cellular solids and bone mass are decreased. Extracellular fluid remains fairly constant, although intracellular fluid is decreased, resulting in less total body fluid. This makes dehydration a significant risk to the elderly. 2 Cardiovascular system:- Heart size does not change significantly with age; enlarged hearts are associated with cardiac disease, and marked inactivity can cause cardiac atrophy. Heart muscle loses its efficiency and contractile strength, resulting in a reduction in cardiac output under conditions of physiologic stress. There is a slight left ventricular hypertrophy, and the aorta becomes dilated and elongated, and heart rate decreases. Heart valves may be thicker and stiffer as a result of lipid accumulation, collagen degeneration, and fibrosis, these changes occur more in the mitral and aortic valves. Calcification of vessels occurs, making them tortuous. The elastin in the vessel wall decreases, causing thickening and rigidity, especially in the coronary arteries. Systolic blood pressure (SBP) is increased because of loss of arterial distensibility. The diastolic blood pressure remains the same or may be elevated slightly. Impaired baroreceptors function and increase peripheral resistance, leading to fluctuation in blood pressure and contributing to a rise in SBP. The sinoatrial node becomes fibrotic with aging. The number of pacemaker cell located in the sinoatrial node decreases with age resulting in sinus bradycardia. 3 Age-related disorders of the cardiovascular system:  Arteriosclerosis  Hypertension  Acute Coronary Syndrome  Angina Pectoris  Myocardial Infarction  Congestive Heart Failure or Heart Failure  Cardiac arrhythmias and  Vascular disorders (Aneurysm, Arterial conduction disorders Occlusion, Varicose Veins, Phlebitis and Deep Vein Thrombosis). Role of the gerontological nurse:-  Lifestyle and diet can modify some of age-related changes. Unhealthy lifestyle choices such as smoking, obesity, stress, hormonal use by females, chronic diseases such as hypertension and diabetes mellitus play a role in accelerating these changes.  Allow rest between activities, procedures; recognize the longer time period required for heart rate to return to normal rate.  Evaluate presence of tachycardia or any abnormalities.  Assessing blood pressure level frequently and ensure referral if any abnormal findings present. 4 Respiratory system:- The calcification of costal cartilage makes the trachea and rib cage more rigid and stiffness of the thoracic cage. If an older adult has kyphosis, degeneration of the intervertebral disc occurs, resulting in a shorter thorax with an increased anteroposterior diameter. Respiratory muscles weaken with aging, as do all other muscles in the body. Inspiratory and expiratory forces are decreased because of less forceful contractions. Breathing is less efficient because of the increased stiffness of the chest wall and the decreased muscle strength. Respiratory rates are generally higher in older adults, with a normal rate breaths/min. The functional number of alveoli decreased with age. The wall of the alveoli become thinner, stretched and loss its elasticity; fewer capillaries are available for gas exchange; and alveoli enlarge and dilated. The net result is a decrease in the surface area available for gas exchange. There is a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increased difficulty in clearing secretions and increased risk for the development of respiratory tract infections. The cough reflex is blunted in older adults, causing decreased effective coughing. Because coughing is beneficial in clearing the upper airway of small or large particles, there is a greater risk of choking or aspirating materials into the lungs, possibly resulting in aspiration pneumonia. 5  The gag reflex may also be less efficient in older adults due to fewer nerve endings in the larynx, this makes them prone to develop respiratory tract infections. Presbylaryngis refers to aging changes in voice pitch caused by thinning of the vocal cords. This results in a voice that is difficult to hear and requires more effort for an older adult to produce. The lungs decrease in size, become flabbier, and decrease in weight with less elastic recoil because the elastic fibers decrease. The lung exhales less effectively, thereby increasing the residual volume leading to reduced vital capacity and maximum breathing capacity. The oxygen-carrying capacity of the blood is reduced with age. Hemoglobin, which is responsible for the transport of oxygen from the lung to the peripheral tissue, is diminished in older adults. These changes contribute to the greater fatigability of older persons. https://nursekey.com/wp-content/uploads/2016/10/B978032309178700041X_f041-001- 9780323091787.jpg (Difference between young and aged respiratory system) Age-related disorders of the respiratory system  Chronic Obstructive Pulmonary Disease (COPD)  Pneumonia  Pulmonary Tuberculosis  Lung Cancer Role of the gerontological nurse:-  Encourage breathing and coughing exercise.  Avoid exposure to air drafts and sources of infections.  Recognize that atypical symptoms and signs can accompany respiratory infection.  Ensure hydration.  Avoid smoking. 6   Take necessary immunizations. Gastrointestinal system: - Oral Cavity and Pharynx: - The most obvious change in the mouth is the loss of teeth (but it isn't a normal part of aging). A common cause of loss of teeth is periodontal disease, which damages the tissue surrounding the teeth and supporting bones. Taste buds may atrophy with age, resulting in an inability to discriminate among flavors, especially salty and sweet. This may contribute to decreases enjoyment of food, resulting in poor eating habits and nutritional deficiencies. Diminished quantity of saliva is accompanied by increased viscosity. Salivary ptyalin is decreased, interfering with the breakdown of starches. Esophagus:- (Presbyesophagus); weak smooth muscle of the esophagus and decreased sphincter motility. The 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. Relaxation of the lower esophageal sphincter may occur; when combined with the elderly person's weaker gag reflex and delayed esophageal emptying, aspiration, heart burn, dysphagia, poor nutrition and dehydration become a risk. Stomach:- Age-related changes in the stomach include degeneration of the gastric mucosa, decreased secretion of gastric acids and digestive enzymes, decrease in hunger contraction and decreased motility. Early satiation (feeling full with less food intake) is common in older adults and may be explained by delayed gastric emptying. 7  Small intestine:- Age-related changes in the small intestine include atrophy of the muscle and mucosal surfaces, thinning of the villi and a decrease in epithelial cells, and fewer cells are present on the absorbing surface of intestinal walls which may affect the absorption of some nutrients. Decreased muscle tone may result in slower peristalsis, especially in those who are sedentary. Large intestine:- Age-related changes in the large intestine include a decrease in mucous secretion and in the elasticity of the rectal wall, but no documented changes in motility. The tone of the internal anal sphincter decreases, which may lead to incontinence or incomplete emptying of the bowel. Nerve impulses that usually indicate the need to defecate may be dulled. Gallbladder:- The gallbladder and bile ducts are unaffected by aging. However, the incidence of gallstones does increase with age. Pancreas:- The pancreas shows some age-related changes, such as fibrosis, fatty acid deposits, and atrophy, but size is not affected. The volume of pancreatic secretions declines and enzyme output diminishes with advancing age. Liver:- The liver is a sturdy organ and retains most of its functions throughout the life span. The lean body mass decreases, so does the size of the liver. Hepatic blood flow slows leading to reduced drug metabolism. Normal aging may adversely affect liver tissue regeneration. Age-related disorders of the gastrointestinal system: 8  Xerostomia (dry mouth)  Dental caries  Dysphagia(difficulty swallowing)  Periodontal disease  Cancer  Gastritis  Gastroesophageal reflux disease  peptic ulcer  Hernia.  Appendicitis.  Gallstones (cholelithiasis)  Diarrhea.  Cirrhosis.  Constipation.  Diverticulosis and diverticulitis  Hemorrhoids. Role of the gerontological nurse:-  Oral hygiene and preventive dental care; o Daily flossing and brushing of teeth o Semiannual, professional dental care o Inspect oral cavity for periodontal disease o Properly fitting dentures o Have elderly drink before swallowing tablets and capsule, ensure drugs have been swallowed  Nutrition; o Foods that are low in fat and high in fiber o Small portions o Variety of food textures, odors, and colors o Should contain basic food groups o Avoidance of spicy or irritating foods (e.g., hot pepper, coffee) o Maintenance of daily fluid intake unless contraindicate  Habits; o Avoidance of tobacco products e.g. cigarettes  Elimination; o Maintenance of regular bowel routines. o Not avoiding the urge to defecate o Avoidance of laxatives, suppositories, and enemas 9 Genitourinary system:- The renal mass becomes smaller with age, renal tissue growth declines, and atherosclerosis may promote atrophy of the kidney. Decrease renal blood flow resulting in decrease glomerular filtration rate. There is less efficient tubular exchange of substances, conservation of water and sodium, and suppression of anti-diuretic hormone secretion in the presence of hypoosmolality. Also, it causes decreased reabsorption of glucose from the filtrate, which can cause glycosurias not to be of major diagnostic significant. With age, the kidney is not able to concentrate urine. Older persons then are not able to adapt efficiently to dehydration or water overload. The muscle tone and elasticity of the bladder decrease, lead to incomplete emptying of the bladder, with more urine retained in the bladder after voiding (residual urine) with a consequent greater risk of infections. Urinary frequency, urgency, and nocturia accompany bladder changes with age. Bladder muscles weaken and bladder capacity decreases. Total bladder capacity declines from approximately 350 - 450 mL to about 200 - 300 mL in older age. In addition, the need or signal to urinate may be delayed until the bladder is almost full, resulting in even greater urgency. Changes occur in the urethra because of the aging process and the decreased levels of estrogen after menopause. Thinning and increased friability of the urethral mucosa can contribute to urgency and frequency. A decrease in muscle tone and bulk can decrease urethral resistance. In additional to the changes in the urethra, declining levels affect pelvic floor muscle tone and function. 10  The seminal vesicles are affected by age by a smoothing of the mucosa, thinning of the epithelium, replacement of muscle tissue with connective tissue. The older man does not lose the physical capacity to achieve erections or ejaculations. Prostatic enlargement occurs in most elderly men, leads to impaired emptying of the bladder and contributes to bladder contractions, which causes problems with urinary frequency. The female genitalia demonstrate many changes with age, including atrophy of the vulva from hormonal changes, accompanied by the loss of subcutaneous fat and hair and a flattening of the labia. The vagina appears pink and dry with a smooth, shiny canal because of the loss of elastic tissue. The cervix atrophies and become smaller, the uterus shrinks and the endometrium atrophies. The fallopian tubes atrophy and shorten with age, the ovaries atrophy and become thicker and smaller. https://cdn.ps.emap.com/wp-content/uploads/sites/3/2017/08/Fig-1-Ageing-of-the- female-reproductive-tract_660.jpg (Aging of the female reproductive tract). Age-related disorders of the genitourinary system  Urinary Tract Infections  Atrophic Vaginitis  Benign Prostatic Hyperplasia  Pelvic Organ Prolapse  Urinary Incontinence  Acute Glomerulonephritis  Urolithiasis (Kidney Stone Disease)  Renal Failure  Cancer of the Bladder Role of the gerontological nurse:- 11   Ensure age-adjusted drug dosages are prescribed; observe for adverse responses to drugs.  Recognize that urine testing for glucose can be unreliable, urinary creatinine excretion and creatinine clearance are decreased, and blood urea nitrogen level is higher.  Assist elderly with need for frequent toileting; ensure safety for visits to bathroom during the night.  Observe for signs of urinary tract infection; assist elderly to void in upright position.  Ensure client has prostate examined annually.  Observe for signs of vaginitis  Advise elderly in safe use of lubricant for comfort during intercourse. Musculoskeletal system:- A pronounced decrease in muscle mass and muscle strength occurs gradually over time. The actual number of muscle cells decreases, and they replaced by fibrous connective tissue. As a result, muscle mass, tone, and strength decrease. Sarcopenia is a decrease in muscle mass and its contractile force, often noted in older adults. It increases fatigue, frailty, and disabilities; and is considered a major risk factor for falling in older adults; as well as makes daily activities more difficult, therefore compromising independence in many older adults. The elasticity and strength of ligaments, tendons, and cartilage decreases. The intervertebral disks lose water, causing a narrowing of the vertebral space. The shrinkage may result in a loss of 1.5 to 3 inches of older adult's height. 12  Posture and gait changes; posture, as a result of changes in the spine, assumes a position of flexion and kyphosis is more common. Gait become short and slow. Muscle tremors may be present and are believed to be associated with degeneration of the extrapyramidal system. Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee. A deterioration of the cartilage surface of joints and the formation of points and spurs may limit joint activity and motion. Bone mineral and mass are reduced, contributing to the brittleness of the bones of older women. These changes make fractures a serious risk to the elderly. Age-related musculoskeletal system disorders:-  Osteoporosis  Osteoarthritis.  Rheumatoid arthritis  Muscle Cramps Role of the gerontological nurse:-  Encourage regular exercise; advise elderly to avoid straining or overusing muscles.  Instruct client in safety measures to prevent falls and fractures.  Encourage good calcium intake and exercise. Nervous system:- A reduction in nerve cells and cerebral blood flow and metabolism are known to occur. 13 With aging there is also a decreased number of neurons in various areas of the brain and deposits of abnormal substances on neural cellular structure. Large neurons appear to shrink, and few are lost. The changes in neuron function are associated with the accumulation of lipofuscin granules (fatlike substances cross-linked with proteins) and neuritic plaques in the cell body of some neurons. In aging the function of the neurotransmitters is altered due to the decrease of neurons. Older adults exhibit changes in brain wave patterns (as recorded on an electroencephalogram (EEG). Older persons’ EEG patterns are likely to be slower and may resemble the EEG pattern of a child in the early developmental years. Normal aging is associated with changes in the ability to consciously learn and retain new information easily. This occurs as a result of structural changes, synapse loss in the neurons, decreased microvascular integrity, reduction in glucose metabolism, and alterations in the neuroglia cells with aging. A reduction in the turnover of cerebrospinal fluid with age decreases the distribution and efficiency of necessary substance, these substance include the hormones necessary for metabolism, appetite and the nutrients necessary for nerve function (e.g. transferrin, glucose, amino acids, and vitamins). A reduction in the turnover of CSF can affect the removal of waste products, toxins and drugs. The neurodegenerative and neurochemical changes, combined with inner ear and vestibular changes, cause many elderly to experience changes in their balance. These changes can further contribute to postural 14  hypotension because of an inability to quickly respond to changes in position. Because the brain affects the sleep-wake cycle, changes in the sleep pattern occur, with stages III and IV of sleep becoming less prominent. Frequent awakening during sleep is usual. Age-related nervous system disorders:-  Tremors  Parkinson’s Disease  Brain Tumors  Stroke  Dementia  Sleep Disorders Role of the gerontological nurse:-  Allow adequate time for client to respond, process information, perform tasks.  Avoid sleep interruptions at night, assess quantity and quality of sleep, and provide measures to enhance sleep. Sensory function:- 15 Each of the five senses becomes less efficient with advanced age, interfering in varying degrees with safety, normal activities of daily living, and general well- being. Perhaps the greatest of such interferences results from changing in vision. Vision:- Presbyopia, the inability to focus or accommodate properly due to reduced elasticity of the lens, is common among older adults. The eyelids lose tone and become lax, which may result in ptosis of the eyelids, and malposition of the eyelids. Eyebrows may turn gray and become coarser in men, with outer thinning in both men and women. The conjunctiva thins and yellows in appearance. In addition, this membrane may become dry because of diminished quantity and quality of tear production. The cornea yellows and develops a noticeable surrounding ring, made up of fat deposits, called the arcus senilis. Corneal sensitivity is diminished, which can increase the risk of injury to the cornea. The density and size of the lens increases, causing the lens to become stiffer and more opaque. Opacification of the lens leads to the development of cataracts, which increases sensitivity to glare, blurs vision, and interferes with night vision. The lens increases in density and rigidity, affecting the eye’s ability to transmit and focus light. Peripheral vision decreases, night vision diminished, and sensitivity to glare increases. The pupil decreases in size and loses some of its ability to constrict. 16  Depth perception becomes distorted, causing problems in correctly judging the height of steps. Dark and light adaptation takes longer, as does the processing of visual information. Hearing:- The organ of hearing and balance can be divided into three parts: the external ear, the middle ear, and the inner ear. The external ear and middle ear are involved only in hearing; the inner ear is involved in both hearing and balance. Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells. Age-related changes in the external ear can be seen in auricle, which appears larger because of continued cartilage formation and loss of skin elasticity. The lobule of the auricle becomes elongated, with a wrinkled appearance. The auditory canal narrows as a result of inward collapsing. The hairs lining the canal become coarser and stiffer. In addition, cerumen glands atrophy, causing the cerumen to be much drier. In the middle ear, age-related changes to the tympanic membrane result in a dull, retracted, and gray appearance. In addition to hearing problems, equilibrium can be altered because of degeneration of the vestibular structures and atrophy of the cochlea. High-frequency sounds are the first to be lost; middle and low frequencies may be also as the condition processes. 17  Taste: Age-related changes in the sense of taste are related to alteration in the oral mucosa and tongue. The atrophy of the tongue with age can diminish taste sensation. Smell:- The sense of smell is reduced with age because of a decrease in the number of sensory cells in the nasal lining and fewer cells in the olfactory bulb of the brain. In healthy older adults, olfactory losses result from normal aging, medications, viral infections, long term exposure to toxic fumes, and head trauma. Touch:- Touch involves tactile information on pressure, vibration, and temperature. Although touch, pressure, and vibration are commonly classified as separate sensations, they are detected by the same types of receptors. Tactile sensation is reduced, as observed in the elderly’s reduced ability to sense pressure and pain and differentiate temperatures. These sensory changes can cause misperceptions of the environment and, as a result, profound safety risks. Age-related disorders of the sensory system:-  Cataract  Glaucoma  Diabetic Retinopathy  Macular Degeneration  Tinnitus Role of the gerontological nurse:-  Ensure client has ophthalmologic exam annually; for glaucoma and more frequently if having any disease that affect the vision. 18   Use night lights, avoid drastic changes in level of lighting; ensure object used by client are within visual field.  Avoid using shades of greens, blues, and violets together.  Use bright light when performing tasks such as sewing, reading, and cooking; avoid fluorescent light.  Use eyeglasses as prescribed.  Visits to health care provider regularly to detect health problems (e.g. diabetes, hypertension) that might affect the eyes.  Symptoms that require an immediate call to the health care provider or eye care specialist include pain, discharge, excessive tearing, floaters, redness or swelling, and loss of vision.  Avoid use of over-the-counter preparations for eye such as artificial tears.  Advise client to protect eyes by wearing sunglasses for outdoor activities.  Ensure elderly has audiometric exam if problem exists; speak to client in loud, low-pitched voice.  For decrease pain sensation and pressure, ensure client changes position before tissue reddens; inspect body for problems that client may not sense; recognize unique responses to pain. Endocrine function:- Growth hormone (GH) secretion decreases with age and its deficiency may result in decreased lean body mass, decreased bone density, and increased fat mass. With age, the thyroid gland undergoes fibrosis, cellular infiltration, and increased nodularity. The resulting decreased thyroid gland activity causes a lower basal metabolic rate. Loss of adrenal function can further decrease thyroid activity. 19  The secretion of glucocorticoids, progesterone, androgen, and estrogen, also influenced by the adrenal gland, are reduced as well. There is a delayed and insufficient release of insulin by the beta cells of the pancreas in the elderly, and there is believed to be a decreased sensitivity to circulating insulin. The older person’s ability to metabolize glucose is reduced, and sudden concentrations of glucose cause higher and more prolonged hyperglycemia levels; therefore, it is not unusual to detect higher blood glucose levels in nondiabetic older persons. Age related disorders of the endocrine system:- -Hyperthyroidism - Hypothyroidism -Hyperparathyroidism. -Hypoparathyroidism. -Hyperglycemia. -Hypoglycemia. Role of the gerontological nurse:-  Advise client to avoid excess calorie consumption  Advise elderly to avoid high carbohydrate intake; observe for unique manifestations of hyper-or hypoglycemia. Immune system:- Immunosenescence: refers to age-related changes that occur in the immune system and result in a decrease in immune functioning. The depressed immune response of older adults causes infections to be a significant risk for this age group. After midlife, thymic mass is lost steadily, to the point that serum activity of thymic hormones is almost undetectable in the aged. T-cell activity declines and more immature T cells-mediated immunity. A significant decline in cell-mediated immunity occurs, and T lymphocytes are less able to proliferate in response to mitogens. 20  Inflammatory defenses decline and, often, inflammation presents atypically in the elderly (e.g. low-grade fever, minimal pain). Role of the gerontological nurse:-  Prevent direct contact with persons who have infectious diseases.  Encourage vaccinations for pneumococcal, tetanus and annual influenza.  Promote good and proper nutritional status to improve host defenses. Integumentary system:- The skin is an organ that provides the protective outer covering of the body. The skin, hair, nails, and glands make up what is called the Integumentary system. The Integumentary system is the largest organ of the body. The primary function of the skin is to serve as a barrier against harmful bacteria and other threatening agents, making skin the first line of defense for the immune system. Other major functions of the integumentary system include (1) preventing fluid loss or dehydration, (2) protecting the body from ultra violet rays and other external environmental hazards, and (3) protecting underlying organ from injury. In addition, (4) it provides thermal regulation of body temperature. Epidermis:- Slowing epidermal proliferation and reducing replacement rate resulting in slower healing, reduced barrier protection, and delayed absorption of medications and chemicals placed on the skin. The area of contact between the epidermis and dermis decreases with age, resulting in easy separation of these layers. Therefore skin tears occur from harmless activities such as removing a bandage or pulling an older client up in the bed. The number of melanocytes, which provide pigment and hair color, decreases with age, giving older adults less protection from ultra violet 21  rays, paler skin, and graying hair. Melanocytes also produce uneven pigmentation, causing the development of lentigines, also known as "age spots" or "senile lentigo". Dermis:- The dermis decreases in thickness, it consists of strong connective tissue that contains the sweat glands, blood vessels, and nerve ending, which all decrease with age. The sweat glands decrease in number and function, reducing perspiration and predisposing older individuals to hyperthermia. Small blood vessels that supply blood to the epidermis and play a role in regulating body temperature decrease in number with age. These changes lead to diminished thermoregulatory function and inflammatory response, decreased tactile sensation, reduced pain perception, and development of wrinkles and sagging skin as a result of loss of underlying tissue. Collagen, a fibrous protein that provides tensile strength within the dermis, stiffens and becomes less soluble. 22 Subcutaneous fat:- Aging results in a decreased amount of subcutaneous tissue and a redistribution of fat to the abdomen (in men) and thigh (in women). Breast tissue also changes and becomes more granular and atrophic. As a result of a loss of padding supplied by subcutaneous tissue, there is a greater risk of hypothermia, skin shearing and blunt trauma injury. The loss of this protective padding increases vulnerability of pressure points. Appendages:- With age, sweat glands all over the body decreased resulting in reduced evaporative heat loss because of decreased sweating. Hair thins and its growth declines. A progressive loss of melanin occurs, resulting in graying of the hair. Older women may have increased lip and chin hair while experience a thinning of hair on the head, axilla, and perineal area. Men lose scalp and beard hair, yet experience increased growth over eyebrows and in ears and nostrils. The increased hair in ears predisposes men to cerumen impaction, which leads to impaired hearing. Nails grow more slowly with age and become thicker, more brittle (may split or break easily); they also develop longitudinal striation with ridges. 23 Age-related disorders of the integumentary system:-  Xerosis (dry skin)  Rashes  Senile Purpura: results from loss of subcutaneous fat and connective tissue supporting the capillaries which are fragile, even slight physical trauma can cause blood vessels to rupture into the surrounding tissues causing dark areas that may last for weeks.  Pruritis (Severe Itching)  Herpes Zoster  Pressure Ulcers  Skin Cancer Role of the gerontological nurse: -  Older adults are at greater risk of heat stroke as a result of a compromised cooling mechanism so; avoid heat exposure over long periods and areas of 24  high humidity. Hats with wide brims and cool light clothing should be worn when outdoors.  It is important that older adults drink extra fluid (minimum of 2000 ml/day, unless contraindicated by a medical condition, such as renal failure or congestive heart failure) to maintain adequate hydration, particularly during the summer and in hot climates.  Follow principles of pressure ulcer prevention  Provide frequent skin care, recognize need for hygiene, avoid use of harsh soaps and use of skin softeners. Questions: True or false: Statement T F 1- Increased number of touch receptors with age decreases the elders' response to painful stimuli 2- Reduction in liver function affected drug clearance of geriatric patients and lead to toxicity 3- Exercise capacity declines in geriatric patients due to impairment in cilia function with old age 4- Response of older adults to antigens diminishes as production of thymic hormone increased. list:  List three gerontological Nurse's role in overcoming problems related to normal physiological changes related to the gastrointestinal tract. a) b) c) Give reasons: a) Increased incidence of constipation in elderly people b) Voiding pattern is differed in advanced age 25 c) Dehydration is a common problem suffered by older adults 26