Common Changes in Aging PDF

**Common Changes in Aging** Introduction Human aging, physiological changes that take place in the human body leading to senescence, the decline of biological functions and the ability to adapt to metabolic stress. In humans, the physiological developments are normally accompanied by psychological...

**Common Changes in Aging** Introduction Human aging, physiological changes that take place in the human body leading to senescence, the decline of biological functions and the ability to adapt to metabolic stress. In humans, the physiological developments are normally accompanied by psychological and behavioral changes, and other changes involving social and economic factors, also occur. Aging begins as soon as adulthood is reached and is as much a part of human life as are infancy, childhood and adolescence. Gerontology (the study of aging) is concerned primarily with the changes that occur between the attainment of maturity and the death of the individual. 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, lifestyle choices, and numerous other elements. The result is not only individual variations among older persons but also differences in the pattern of aging of various body systems within the same individual. Although some similarities exist in the pattern of aging among individuals the pattern of aging is unique in each person. One thing is clear: We can all take several steps to hep us age better, because what we do as we enter our older years matters much more than genetics. As the effects of biological and psychological aging are not necessarily inevitable, \"successful aging\" is possible **Learning Objectives** After reading this Chapter, you should be able to: 1\. State common age - related changes to the body in terms of: - cellular changes - physical appearance - respiratory system - cardiovascular system - urinary system - reproductive system - musculoskeletal system - nervous system - sensory organs - endocrine system - integumentary system - immune system - thermoregulation 2. Describe psychological changes (changes to the mind) experienced with age. 3. Discuss nursing actions to promote health and reduce risks associated with age - related changes (nursing implications of age-related changes).
 **Terminologies:** - **Crystallized intelligence**. Knowledge accumulated over a lifetime; arises from the dominant hemisphere of the brain. - **Fluid intelligence -** Involves new information emanating from the non-dominant hemisphere; controls emotions, retention of nonintellectual information, creative capacities, special perceptions, and aesthetic appreciation. - Immunosenescence. The aging of the immune system. - Presbycusis. Progressive hearing loss that occurs as a result of age-related changes to the inner ear. It is characterized by difficulty in understanding high-pitched sounds (e.g., women\'s voice). - Presbyesophagus. A condition characterized by a decreased intensity of propulsive waves and an increased frequency of non-propulsive waves in the esophagus. - Presbyopia. The inability to focus or accommodate properly due to reduced elasticity of the lens. **A. Changes to the Body** Cellular Changes - - - a. b. c. In addition, fewer functional cells in the body profoundly affect organ function. For instance, by the age of 85, lung capacity has decreased by 50%; muscle strength by 45% and kidney function by 30%. - 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. - 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. - All cells change as they age, generally becoming larger. Their capacity to divide and reproduce tend to decrease. Therefore, the ability to repair even minor damage declines in aging cells. Physical Appearance - Many physical changes of aging affect a person\'s appearance. Some of the noticeable effects of the aging process begin to appear after the fourth decade of life. - Men experience hair loss and both sexes may develop gray hair and wrinkles. - As body fat atrophies, the body\'s contours gain a bony appearance along with the deepening of the hollows of the intercostal and supraclavicular space, orbits, and axillae. - Elongated ears, a double chin, and baggy eyelids are among the more obvious manifestations of the loss of tissue elasticity throughout the body. - Skinfold thickness is significantly reduced in the forearm and on the back of the hands. The loss of subcutaneous fat content responsible for the decrease in skinfold thickness is also responsible for a decline in the body\'s natural insulation, making older adults more sensitive to cold temperature. - Stature decreases, resulting in a loss of approximately 2 inches in height by 80 years of age. - Body shrinkage is due to reduced hydration, loss of cartilage, and thinning of the vertebrae. - The decrease in the stature causes the long bones of the body, which do not
shrink, to appear disproportionately long. - Any curvature of the spine, hips and knee that may be present can further reduce height. - These changes in physical appearance are gradual and subtle. Further differences in physiologic structure and appearance can arise from changes to specific body system. Respiratory System - The tip of the nose slightly rotates downward; septal deviations can occur. This is due to connective tissue changes that cause relaxation of the tissue at the lower edge of the septum. - Mouth breathing during sleep becomes more common as a result, contributing to snoring and obstructive apnea. - The submucosal glands have decreased secretions, reducing the ability to dilute mucus secretions; the thicker secretions are more difficult to remove and give the older person a sensation of nasal stuffiness. - The anterior-posterior chest diameter increases, often demonstrated by kyphosis. - Reduced chest wall compliance. This results from increased calcification of coastal cartilage and decreased strength of intercostal and accessory muscles and diaphragm. - Reduced breathing capacity, reduced vital capacity, increased residual volume. - Decreased cough reflex - Decreased residual volume. - Decreased ciliary activity. - These changes in the respiratory system increase the risk for respiratory problems (hypoxia, infections) among older adults. In capsule: Respiratory Changes in Aging - PO2 reduced as much as 15% between ages 20 and 80. - Loss of elasticity and increased rigidity. - Forced expiratory volume reduced. - Blunting of cough and laryngeal reflexes. - By age 90 years, approximately 50% increase in residual capacity. - Alveoli fewer in number and larger in size. - Thoracic muscles more rigid. - Reduced basilar inflation ** Cardiovascular System** - Throughout the adult years, the heart muscle loses its efficiency and contractile strength, resulting in reduced cardiac output under conditions of physiologic stress. - Pacemaker cells become decreased in number, become increasingly irregular, and the shell surrounding the sinus node thickens. - 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. - Incomplete valve closures can result in systolic and diastolic murmurs in older adults. - Endocardial thickening, thickened heart valves, decreased myocardial strength. These lead to decreased cardiac output. eg - Vascular System - Decreased elasticity of blood vessels. This leads to increased blood pressure (BP). - Atherosclerotic plaques develop. This may result to ischemia. - Decreased efficiency of baroreceptors (receptors that are sensitive to changes in blood pressure). This increases risk for postural hypotension. - Usually, adults adjust to changes in cardiovascular system quite well; they learn that it is easier and more comfortable for them to take an elevator rather than the stairs, to drive or take a ride instead of walking a long distance and to pace their activities. - When older persons are faced with an added demand on their hearts, they note the difference. Tachycardia in older people will last for a longer time than in younger people (such as when receiving bad news, running to catch a bus, after exercises such as walking, Zumba exercises, dancing). Stroke volume may increase to compensate for these situations, which results in elevated blood pressure. - The resting heart rate is unchanged. - Age-related cardiovascular changes are most apparent when unusual demands are placed on the heart. In Capsule: Cardiovascular Changes In Aging - More prominent arteries in head, neck, and extremities. - Valves become thicker and more rigid. - Stroke volume decreases by 1% each year. - Heart pigmented with lipofuscin granules. - Less efficient 02 (oxygen) utilization. - Aorta becomes dilated and elongated. - Cardiac output decreases. - Resistance to peripheral blood flow increases by 1% per year. - Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output. - Less elasticity of blood vessels. Gastrointestinal System - Tooth enamel becomes harder and more brittle with age. The tooth brittleness ai of some older adults creates the possibility of aspiration of tooth fragments. - Gums become less elastic and less vascular. The gums recede from remaining teeth, exposing areas of teeth not covered with enamel. - Taste sensations become less acute with age because the tongue atrophies, affecting the taste buds. The sweet sensations on the tip of the tongue tend to suffer a greater loss than the sensation for sour, salty, and bitter flavors. Excessive seasoning of foods may be used to compensate for taste alterations and could lead to health problems for older individuals. - Loss of papillae and sublingual varicosities on the tongue are common - Saliva often is diminished in quantity (one third of the amount of saliva they produced in younger years) and is of increased viscosity as a result of some of the medications commonly used to treat geriatric condition. - Salivary ptyalin is decreased, interfering with the breakdown of starches. - Diminished muscle strength and tongue pressure can interfere with mastication and swallowing. - Esophageal motility is affected by age. Presbyesophagus is a condition characterized by a decreased intensity of propulsive waves in the esophagus. 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 older person\'s weaker gag reflex and delayed esophageal emptying, aspiration becomes a risk. - The stomach believed to have 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. - Some atrophy occurs throughout the small and large intestines, and fewer cells are present on the absorbing surface of intestines. - Fat absorption is slower, dextrose and xylose are more difficult to absorb. - Absorption of vitamin B, vitamin B12, vitamin D, calcium and iron is faulty. - Minimal loss of digestive enzymes. This leads to decreased absorption of nutrients. - Decreased peristalsis. This leads to constipation. - The large intestines have reduction in mucus secretions and elasticity of the rectal wall. Slower transmission of the rectal wall impulses to the lower bowel reduces awareness of the need to evacuate the bowels. - With advancing age, the liver has reduced weight and volume but this seems to produce no ill effects. The older liver is unable to regenerate damaged cells. Liver function tests remain within a normal range. Less efficient cholesterol stabilization and absorption cause an increased incidence of gallstones. - The pancreatic ducts become dilated and distended, and often the entire gland prolapses. ** In capsule: Gastrointestinal Changes In Aging** - Decreased taste sensation. - Esophagus more dilated. - Decreased esophageal motility. - Reduced saliva and salivary ptyalin. - Atrophy of gastric mucosa. - Decreased stomach motility, hunger contractions, and emptying time. - Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes. - Fewer cells on absorbing surface of intestines. - Reduced intestinal blood flow. - Slower peristalsis - Liver smaller in size Urinary System - The urinary system is affected by changes in the kidneys, ureters, and bladder. - The renal mass becomes smaller with age, with subsequent cortical loss. - Renal tissue growth declines and atherosclerosis promotes atrophy of the kidneys. - Decreased blood flow to the kidneys. This causes reduction of glomerular filtration rate (GFR). - Reduced number of nephrons and decreased creatinine clearance. - These changes increase risk to drug toxicity and risk for fluid-electrolyte imbalances. Dehydration and dizziness occur even within short time of food and fluid deprivation. - Tubular function decreases. This causes less efficient tubular exchange of substances, conservation of water and sodium, suppression of antidiuretic hormone in the presence of hypoosmolality. Older kidneys have less ability to conserve sodium in response to sodium restriction. Hyponatremia and nocturia are common among older people. - The decrease in tubular function also causes decreased reabsorption of glucose from the filtrate, which can cause 1+ proteinuria's and glycosuria's no to be of major diagnostic significance. - Urinary frequency, urgency, and nocturia accompany bladder changes with age. - Bladder muscles weakens and bladder capacity decreases. - 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 pelvic diaphragm, particularly in multiparous women. ** In capsule: Urinary Tract Changes in Aging** - Decreased size of renal mass. - Decrease in nephrons. - Decreased tubular function. - Between ages 20 and 90, renal blood flow decreases 53%, and glomerular filtration rate decreases 50%. - Decreased bladder capacity. - Weaker bladder muscles. Reproductive System A. Males - As men age, the seminal vesicles are affected by smoothing of the mucosa, thinning of the epithelium, replacement of muscle tissue with connective tissue and reduction of fluid-retaining capacity. - The seminiferous tubules experience increased fibrosis, thinning of the epithelium, thickening of the basement membrane, and narrowing of the lumen. - These structural changes can cause a reduction in sperm count in some men. - Increases in follicle - stimulating and luteinizing hormone levels occur along with decreases in both serum and bioavailable testosterone levels. - Venous and arterial sclerosis and fibroelastosis of the corpus spongiosum can affect the penis with age. - The older man does not lose the physical capacity to achieve erections or ejaculations, although orgasm and ejaculation tend to be less intense. - There is some atrophy of the testes. - Prostatic enlargement occurs in most older men. Three fourths of men aged 65 years and older have some degree of prostatism, which causes problems with urinary frequency. Although, most prostatic enlargement is benign, it does pose a greater risk of malignancy and requires regular evaluation. B. Females - 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 vaginal epithelium becomes thin and vascular. - The vaginal environment is more alkaline in older women and is accompanied by a change in the type of flora and a reduction in secretions. Thus, there is reduced vaginal lubrication. - The cervix atrophies and becomes smaller, the endocervical epithelium also atrophies. - The uterus shrinks and the endometrium atrophies, however the endometrium continues to respond to hormonal stimulation for incidents of postmenopausal bleeding in older women on estrogen therapy. - 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 exam. - The fallopian tubes atrophy and shorten with age, and the ovaries atrophy and become thicker and smaller. The ovaries can shrink to such a small size that they are not palpable during an exam. - Despite these changes, the older woman does not lose the ability to engage in and enjoy intercourse or other forms of sexual pleasure. - Estrogen depletion also cause a weakening of pelvic floor muscles, which can lead to an involuntary release of urine when there is an increase in inta-abdominal pressure. For both male and female older persons, thee is minimal change in amount of sexual response. Although, there is increase in time for full sexual response. - There is increased refractory period in males. Refractory period. In men, the penis becomes flaccid after an orgasm. A man doesn\'t think about sex or get aroused. His body does not respond to sexual stimulation, and he is unable to reach an orgasm again, until the refractory period is over. The length of refractory period is different for every man. It may take a half hour or more for his body to perform sexually again. Younger men may need only a few minutes of recovery time, but older men usually have a longer refractory period sometimes between 12 to 24 hours. For some men, the refractory period can last a few days. Women do not have refractory periods the way men do. But fatigue after orgasm can make them lose interest in sex temporarily. This can happen after one orgasm or multiple orgasms. - **In capsule: Changes in the Reproductive Structures in Aging** A. Male - Fluid - retaining capacity of seminal vesicles reduces. - Possible reduction in sperm count. - Venous and arterial sclerosis of penis. - Prostate enlarges in most men. B. Female - Fallopian tubes atrophy and shorten. - Ovaries become thicker and smaller. - Cervix becomes smaller. - Drier, less elastic vaginal canal. - Flattening of labia. - Endocervical epithelium atrophies. - Uterus becomes smaller in size. - Endometrium atrophies. - More alkaline vaginal environment. - Loss of vulvar subcutaneous fat and hair. Musculoskeletal System - The kyphosis, enlarged joints, flabby muscles, and decreased height of many older persons result from the variety of musculoskeletal changes occurring with age. - Muscle fibers atrophy and decrease in number with fibrous tissue replacing muscle tissue. This results to decreased muscular strength and function. - Overall muscle mass, muscle strength, and muscle movements are decreased; the arm and leg muscles which become particularly flabby and weak, display these changes well. Sarcopenia, the age- related loss of muscle mass, strength, and function, is mostly seen in inactive persons; thus, the importance of exercise to minimize the loss of muscle tone and strength cannot be emphasized enough. - Muscle tremor may be present and are believed to be associated with degeneration of the extrapyramidal system. - The tendons shrink and harden which causes a decrease in tendon jerks. - Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee. - Muscle cramping usually occurs, for various reasons. - Bone mineral and bone mass are reduced, contributing to the 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. - There is diminished calcium absorption, a gradual resorption of the interior surface of the long bones, and a slower production of new bone on the outside surface. - These changes make fracture a serious risk to the older adults. - Although long bones do not significant shorten with age, thinning disks and shortening vertebrae reduce the length of the spinal column, causing a reduction in height with age. Height may be further shortened because of varying degrees of kyphosis, a backward tilting of the head and some flexion at the hips and the knees. - A deterioration of the cartilage surface of the joints and the formation of points and spurs may limit joint activity and motion (stiffness of joints). - **In Capsule: Skeletal Changes in Aging** - Shortening of the vertebrae. - Between ages 20 to 70, height decreases approximately 2 inches. - Bones become more brittle. - Slight knee flexion. - Decrease in bone mass and bone mineral. - Slight kyphosis. - Slight hip flexion. - Slight wrist flexion. - Impaired flexion and extension movements. - Nervous System - The impact of aging on the nervous system in greatly influenced by function of other body systems. For instance, cardiovascular problems can reduce cerebral circulation and be responsible for cerebral dysfunction. - There is a decline in brain weight and a reduction in blood flow to the brain; however, these structural changes do not appear to affect thinking and behavior. (Rabbit et al., 2007). - Declining nervous system function may be unnoticed because changes are often. nonspecific and slowly progressing. - Degeneration and atrophy of neurons. This causes loss of memory, especially recent memory. In addition, there is decreased muscle coordination, decrease ability to perform fine motor activities (activities done by the fingers). - The nerve conduction velocity is lower. These changes are manifested by slower reflexes and delayed response to multiple stimuli. - Kinesthetic sense lessens. There is slower response to changes in balance, a factor contributing to falls. - Slower recognition and response to stimuli is associated with a decrease in new axon growth and nerve reinnervation of injured peripheral nerves. - Decreased nerve acuity and sensation. This makes the elderly unaware of tissue trauma like burns or pressure. - The hypothalamus regulates temperature less effectively. The elderly has low tolerance to cold. They do not develop fever easily, in the presence of infection. - Brain cells slowly decline over the years, the cerebral cortex undergoes some loss of neurons, and there is some decrease in brain size and weight, particularly after age 55 years. - Decision-making and judgement ability remain intact. - Ability to learn is possible up to 200 years of life. Although, intelligence starts to decline at age 75 years. - Because the brain affects the sleep-wake cycle, and circadian and homeostatic factors of sleep regulation are altered with aging, changes in sleep pattern occur with stages III and IV of sleep becoming less prominent. Frequent awakening during sleep is not unusual, although only a minimal amount of sleep is actually lost. ** In Capsule: Neurologic Changes in Aging** - Decreased conduction velocity. - Slower response and reaction time. - Decreased brain weight. - Decreased blood flow to brain. - Changes in sleep pattern. - Sensory System - Each of the five senses becomes less efficient with advanced age, interfering with varying degrees with safety, normal activities of daily living, and general well-being. A. Vision - Presbyopia, the inability to focus or the loss of accommodation id due to reduced elasticity of the lens. It begins in the fourth decade of life. The stiffening of the muscle fibers of the lens that occurs with presbyopia decreases the eye\'s ably to adapt to light. - This vision problem causes most middle-aged and older adults to need corrective lenses to accommodate close and detailed work, - The visual field narrows, making peripheral vision more difficult. There is difficulty maintaining convergence and gazing upward. These increased risk to accidents. - The pupil is less responsive to light because the pupillary sphincter hardens, the pupil size decreases, rhodopsin content in the rods decreases. As a result, there is reduced sensitivity to glare, and decreased dark adaptation (vision in dim areas or at night is difficult). Red light should be on during the night to prevent falls when the elderly get up and go to the bathroom. - Alterations in the blood supply of the retina and retinal pigmented epithelium can cause macular degeneration, a condition in which there is loss of central vision. - Changes in the retina and retinal pathway interfere with critical flicker fusion (the point at which a flickering light is perceived as continuous rather than intermittent). This affects safety in driving as well as crossing streets with traffic lights. - The density and size of the lens increase, causing the lens to become stiffer and more opaque. - Opacification of the lens, which begins in the fifth decade, leads to the development of cataracts, which increases sensitivity to glare, blurs vision, and interferes with night vision. - Exposure to the ultraviolet rays of the sun contributes to cataract development. - Yellowing of the lens (possibly related to a chemical reaction involving sunlight with amino acids) and alterations in the retina that affect color perception make older persons less able to differentiate the low-tone colors of the blues, greens, and violets (purple). The color that is most difficult to be perceived by older persons is violet (purple). - Depth perception becomes distorted causing problems in correctly judging the height of curbs and steps. This change results from a disparity between the retinal images caused by the separation of the two eyes as is known as stereopsis. - Dark and light adaptation takes longer, as does the processing of visual information. - Less efficient reabsorption of intraocular fluid increases the older person\'s risk of developing glaucoma. The ciliary muscle gradually atrophies and is replaced with connective tissue. - The appearance of the eye may be altered; reduced 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). Corneal sensitivity is diminished, which can increase the risk of injury to the cornea. - The accumulation of lipid deposits in the cornea can cause a scattering of light rays, which blurs vision. - In the posterior cavity, bits of debris and condensation become visible and may float across the visual field these are commonly called floaters. - Vitreous decreases and the proportion of liquid increases, causing the vitreous body to pull away from the retina; blurred vison, distorted images, and floaters may result. - Visual acuity progressively declines with age due to decreased pupil size, scatter in the cornea and lens, pacification of the lens and vitreous, and loss of photoreceptor cells in the retina. - Presbycusis is progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, reduced blood supply, decreased flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production endolymph. This degenerative hearing impairment is the most serious problem affecting the inner ear and retrocochlea. High-frequency sounds (high-pitched sounds) of 2,000 He and above are the first to be lost; middle and low frequency sounds may also be lost as the condition progresses. Men tend to experience presbycusis more than women, Therefore, men with presbycusis have difficulty hearing and understanding women\'s voice high-pitched voice). - A variety of factors including continued exposure to loud noise, may contribute to the occurrence of presbycusis. This problem causes speech to sound distorted as some of the high-pitched sounds (s, sh, i, ph, and ch) are filtered from normal speech and consonants are less able to be discerned. This change is so gradual and subtle that affected persons may not realize the extent of their hearing impairment. - Hearing can be further jeopardized by an accumulation of cerumen in the middle ear; the higher keratin component of the cerumen as one ages contributes to this problem, - The acoustic reflex which protects the inner ear and filters auditory distractions from sounds made by one\'s own body and voice, is diminished due to a weakening and stiffening of the middle ear muscles and ligaments.
 - In addition to hearing problems, equilibrium can be altered because of degeneration of the vestibular structures and atrophy of the cochlea, organ of Corti, and stria vascularis. - On the whole, degeneration of the cochlea and auditory pathways result to loss of hearing of high-pitched sound and difficulty in speech discrimination. C. Taste and Smell - Approximately, half of older persons experience some loss of their ability to smell. The sense of smell decreases 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. - By age 80 years, the detection of scent is almost the olfactory nerve as it was at is peak. Men tend to experience a greater loss in the ability to detect odors than as not of the taste acuity is dependent on smell, the reduction in the sense of smell alters the sense of taste. - Atrophy of the tongue with age can diminish taste sensations, although there is no evidence that the number of responsiveness of the taste buds decreases. The ability to taste salt is affected more than other taste sensations. Thus, some elderly prefer salty diet. They have difficulty with compliance on low salt diet, if indicated. - Reduced saliva production, poor oral hygiene, medications and conditions such as sinusitis can also affect taste. - Decreased sense of taste and smell contribute to lack of appetite to eat among older persons. D. Touch - A reduction in the number and changes in the structural integrity of touch receptors occurs with age. - Tactile sensation is reduced as observed in the reduced ability of older persons to sense pressure and pain and differentiate temperatures. - These sensory changes can cause misperceptions of the environment and, as a result, profound safety risks. ** In Capsule: Effects of Sensory Changes in Aging** A. Sight - More opaque lens. - Decreased pupil size. - More spherical cornea. - Loss of color sensitivity (blue hues especially purple, green). - Decreased dark adaptation. - Decreased peripheral vision. - Reduced sensitivity to glare. B. Hearing - Atrophy of hair cells of organ of Corti. - Tympanic membrane sclerosis and atrophy. - Increased cerumen and concentration of keratin. - Degeneration of cochlea and auditory pathways, This results to or of hearing of high-pitched sound and difficulty in speech discrimination. C. Smell - Impaired ability to identify and discriminate among odors. D. Taste - High prevalence of taste impairment, although most likely due to factors other than normal aging. E. Touch - Reduction in tactile sensation. - **Endocrine System** - The thyroid gland undergoes fibrosis, cellular infiltration, and increased nodularity. The resulting decreased thyroid gland activity causes a lower basal metabolic rate, reduced radioactive iodine uptake, and less thyrotropin secretion and release. - ACTH secretion decreases with age, thus secretory activity of the adrenal gland also decreases.
 - There is delayed and insufficient release of insulin by the beta cells of the pancreas in older people, and there is believed to be 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. - Gonadal secretion declines with age, including gradual decreases in testosterone, estrogen, and progesterone. - **In Capsule: Endocrine Changes in Aging** - Decreased utilization of insulin. Higher blood glucose levels than normal in general adult population are not unusual in nondiabetic older people. - Cessation of progesterone secretion and decreased, then plateau of estrogen. These changes lead to menopause. - Gradual decline in testosterone and increase in level of estrogen in males. These increased risk to develop benign prostatic hyperplasia (BPH). - The thyroid gland progressively atrophies with decreased thyroid activity. There is reduced basal metabolic rate (BMR). This contributes to anorexia. Integumentary System - - - - - - - - - - - - - - - - ** In Capsule: Integumentary Changes in Aging** - Loss of subcutaneous supporting tissues. This causes the stin to wrinkle and sag, and sensitive to pressure and trauma. - Decreased sebaceous secretions. This causes the skin to be dry, flabby, and prone to itching. - Thinning and graying hair. This causes alteration in body image. - Atrophy of tiny arterioles near epidermis. This causes impaired vasomotor homeostatic mechanism and poor temperature regulation. The elderly feels cold even in warm climate. - Skin pigmentation (age spots) develop in areas of the body exposed to sun. Immune System - The aging of the immune system, known as immunosenescence, includes a depressed immune response which can cause infections to be a significant risk of older adults. - After midlife, thymic mass decreases steadily. T-cell activity declines and more immature I cells are present in the thymus. A significant declining in cell-medicated immunity occurs, and T-lymphocytes are less able to proliferate in response to mitogens. Changes in the Icells contribute to reactivation of varicella zoster and mycobacterium tuberculosis, infections that are witnessed in many older individuals. - Responses to infuenza, parainfuenza, pneumococcus, and tetanus vaccines are less effective (although vaccination is recommended because of the serious potential consequences of infections for older adults). - Inflammatory defense declines, and often, inflammation presents atypically in older individuals (ie., low-grade fever and minimal pain). - Proinflammatory cytokines increase with age, which is believed to be linked to atherosclerosis, diabetes, osteoporosis, and other diseases that increase in prevalence with age. - In addition to maintaining a good nutritional state, older people can include foods in their diet that positively affect immunity such as milk, yogurt, nonfat cottage cheese, eggs, fresh fruits and vegetables, nuts, garlic, onion, sprouts, pure honey and unsulfured molasses. A daily multivitamin and mineral supplement is also helpful. - Regular physical activity can enhance immune function, including exercises such as yoga and t\'ai\'chi, which are low impact and have a positive effect on immunity. - Stress can affect the function of the immune system because elevated cortisol levels can lead to a breakdown in lymphoid tissue, inhibition of the production of natural killer cells, increases in T-suppressor cells, and reduction in the levels of T-helper cells and virus-fighting interferon. - Thermoregulation - Normal body temperatures are lower in later life than in younger years. Mean body temperature ranges from 96.9 F to 98.3 F orally and 98 F to 99 F rectally. - Rectal and auditory canal temperatures are the most accurate and reliable indicators of body temperature in older adults. - There is a reduced ability to respond to cold temperatures due to inefficient vasoconstriction, reduced peripheral circulation, decreased cardiac output, diminished shivering, and reduced muscle mass and subcutaneous tissue. - At the other extreme, differences in response to heat are related to impaired sweating mechanisms and decreased cardiac output. - These age-related changes cause older adults to be more susceptible to heat stress. - Alterations in response to cold and hot environments increase the risks for accidental hypothermia, heat exhaustion, and heat stroke. B. Changes to the Mind - There are multitude of factors that can influence psychological changes in aging, to name a few, these are as follows: general health status, genetic factors, educational achievement activity, and physical and social changes. - Sensory organ impairment can impede interaction with the environment and other people, thus influencing psychological status. - Feeling depressed and socially isolated may obstruct maximum psychological function. - Psychological changes in the older individuals may be observed in the personality, memory, intelligence, learning, and attention span. a\. Personality - Drastic changes in basic personality normally do not occur as one ages. - Excluding pathologic processes, the personality will be consistent with that of earlier years; possibly, it will be more openly and honestly expressed. For example, the kind and gentle person was most likely that way when young; on the other hand, the cantankerous older person was not mild and meek in earlier years. - The alleged rigidity of older persons is more a result of physical and mental limitations than a personality change. For example, an older person\'s insistence that her furniture not be rearranged may be interpreted as rigidity, but it may be a sound safety practice for someone coping with poor memory and visual deficits. - Changes in personality traits may occur in response to events that alter self-attitude, such as retirement, death of a spouse, loss of independence, income reduction, and disability. - No personality type describes all older adults, personality in late life is a reflection of lifelong personality. - Morale, attitude, and self-esteem tend to be stable throughout the life span. b\. Memory - The three types of memory are short-term, lasting 30 seconds to 30 minutes; long term, involving that learned long ago; and sensory, which is obtained through the sensory organs and lasts only a few seconds. - Retrieval of information from long-term memory can be slowed, particularly if the information is not used or needed on a daily basis. - The ability to retain information in the consciousness while manipulating other information - working memory function - is reduced. - Older adults can improve some age-related forgetfulness by using memory aids (mnemonic devices) such as associating a name with an image, making notes or lists, and placing objects in consistent locations. - Memory deficits can result from a variety of factors other than normal aging. c\. Intelligence - Basic intelligence is maintained; one does not become more or less intelligent with age. - The ability for verbal comprehension and arithmetic operations are unchanged.
 - Crystallized intelligence, which is the knowledge accumulated over a lifetime and arises from the dominant hemisphere of the brain, is maintained through the adult years; this form of intelligence enables the individual to use past learning and experience for problem solving. - Fluid intelligence, involving new information and emanating from the non-dominant hemisphere, controls emotions, retention of nonintellectual information, creative capacities, spatial perceptions and aesthetic appreciation. - this type of intelligence is believed to decline in later life. - Some decline in intellectual function occurs in the moments preceding death. - High levels of chronic psychological stress have been found to be associated with an increased incidence of mild cognitive impairment (Wilson et. Al., 2007). d\. Learning - Learning ability is not seriously altered with age. However, there are various factors that can interfere with the older person\'s ability to learn, such as, 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 experiences for solutions to problems rather than experiment with new problem-solving techniques. - Differences in the intensity and duration of the older person\'s physiologic arousal may make it more difficult to extinguish previous response and acquire new material. - The early phases of the learning process tend to be more difficult for older persons than younger individuals. However, after a longer early phase, they are than able to keep equal pace. - Learning occurs best when the new information is related to previously learned information. - Although little difference is apparent between the old and the young in verbal or abstract ability, older persons do show some difficulty with perceptual motor tasks. - Some evidence indicates a tendency toward simple association rather than analysis because it is generally a greater problem to learn new habits when old habits exist and must be unlearned, relearned, or modified, older persons with many years of history may have difficulty in this area. e\. Attention Span - Older adults demonstrate a decrease in vigilance performance (i.e., the ability to retain attention longer than 45 minutes). They are more easily distracted by irrelevant information and stimuli and are less able to perform tasks that are complicated or require simultaneous performance. **Nursing Implications of Age-Related Changes** An understanding of common aging changes is essential to ensure competent gerontological nursing practice. Such knowledge can aid in promoting practices that enhance wellness, thereby reducing risks to health and well-being. Differentiating normal from unusual findings in older adults and the atypical presentation of illness can be invaluable in identifying pathology and obtaining treatment in a timely manner. Nurses caring for older adults must realize that despite the numerous changes commonly experienced with age, most older adults function admirably well and live normal, satisfying lives. Although nurses need to acknowledge factors that 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. Age related change Nursing action ----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Reduction in intracellular fluid Prevent dehydration by ensuring fluid intake of at least 1,500 ml daily unless contraindicated. Decrease in subcutaneous fat content decline in natural insulation Ensure adequate clothing is worn to maintain body warmth; maintain room temperatures between 70F (21 °C) and 75F (24 °C). Lower oral temperatures Use thermometers that register below 95F (35C); assess baseline norm for body temperature when patient is well to be able to identify unique manifestations of fever. Decreased cardiac output and stroke volume; increased peripheral resistance Allow rest between activities, procedures; recognize the longer time period required for heart rate to return to normal following a stress on the heart and evaluate the presence of tachycardia; accordingly, ensure blood pressure level is adequate to meet circulatory demands by assessing physical and mental function at various blood pressure levels. Decreased lung expansion, activity, and recoil; lack of basilar inflation; increased rigidity of lungs and thoracic cage; less effective gas exchange and cough response. Encourage respiratory activity that promotes deep breathing; recognize that atypical symptoms and signs can accompany respiratory infection; monitor oxygen administration closely, keep oxygen infusion rate under 4 mL, unless otherwise prescribed. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Brittleness of teeth; retraction of gingiva. Encourage daily flossing and brushing; ensure patient visits dentist annually; inspect oral cavity for periodontal disease, jagged edge teeth, other pathologies. Reduced acuity of taste sensations. Observe for overconsumption of sweets and salt; be sure foods are served attractively; season food healthfully. Drier oral cavity Offer fluids during meals; have patient drink before swallowing tablets and capsules, and examine oral cavity after administration to ensure drugs have been swallowed. Decreased esophageal and gastric motility; decreased gastric acid. Assess for indigestion; encourage five to six small meals rather than three large ones; advise patient not to lie down for at least 1 hour following meals. Decreased colonic peristalsis; duller neural impulses to lower bowel Encourage toileting schedule to provide adequate time for bowel elimination; monitor frequency, consistency, and amount of bowel movements. Decreased size of renal mass, number of nephrons, renal blood flow, glomerular filtration rate, tubular function. Ensure age-adjusted drug dosages are prescribed; observe for adverse response to drugs; recognize that urine testing for glucose can be unreliable, urinary creatinine clearance are decreased, blood urea nitrogen level is higher. Decreased bladder capacity Assist patient with need for frequent toileting; ensure safety for visits to bathroom during the night Water bladder capacity Observe for signs of urinary tract infection; assist patient to void in upright position Enlargement of prostate gland Discuss pros and cons of testing with physician Drier, more fragile vagina Advise patient in safe use of lubricants for comfort during intercourse Increased alkalinity of vaginal canal Observe for signs of vaginitis Atrophy of muscle; reduction in muscle strength and mass Encourage regular exercise; advise patient to avoid straining or overusing muscles. Decreased bone mass and mineral content Instruct patient in safety measures to prevent falls and fractures; encourage good calcium intake and exercise. Less prominent stages III and IV of sleep Avoid interruptions at night; assess quantity and quality of sleep Decreased visual accommodation; reduced peripheral vision; less effective vision in dark and dimly lit areas Ensure patient has ophthalmologic exam annually, use night lights; avoid drastic changes in level of lighting; ensure objects used by patient are within visual field. Yellowing of lens Avoid using shades of greens, blues, and violets together Decreased corneal sensitivity Advice patient to protect eyes Presbycusis Ensure patient has audiometric exam if problem exists, speak to patient in normal tone, low-pitched voice Reduced capacity to sense pain and pressure Ensure patient changes positions before tissue reddens; inspect body for problems that patient may not sense; recognize unique responses to pain Reduced immunity Protect patient from exposure to infectious diseases; recommend pneumococcal, tetanus, and annual influenza vaccinations; promote good nutritional status to improve host defenses Slower metabolic rate Advise patient to avoid excess calorie consumption Altered secretion of insulin and metabolism of glucose Advise patient to avoid high carbohydrate intake; observe for unique manifestations of hyper- or hypoglycemia Flattening of dermal-epidermal junction; reduced thickness and vascularity of dermis; degeneration of elastin fibers Use principles of pressure ulcer prevention Skin drier Recognize need for less frequent bathing, avoid use of harsh soaps; use skin softeners Slower response and reaction time Allow adequate time for patient to respond, process information, and perform tasks Concepts To Remember - Living is a process of continual change. The continuation of change into later life is natural and expected. - The type, rate, and degree of physical, psychological, and social changes experienced during life are highly individualized. Such changes are influenced by genetic factors, environment, diet, health, stress, lifestyle choices and numerous other elements. - Although some similarities exist in the patterns of aging among individuals, the pattern of aging is unique in each person. - Changes at the basic cellular level impact all body systems. - Changes in the appearance of the body with age are due to numerous factors such as atrophy of body fat, loss of tissue elasticity, and reduction in
subcutaneous fats. - Changes to body systems contribute to a higher prevalence in the older population of conditions such as infections, hypertension, poor dental status, indigestion, constipation, urinary frequency, prostatic enlargement, fractures, reduced vision, presbycusis, hypothermia and hyperthermia. - Learning ability is maintained, although a variety of factors can interfere with learning. - Basic intelligence is maintained, there is some reduction in fluid intelligence. The ability to retain new information is reduced and the retrieval of information from long-term memory can be slower. - A variety of nursing actions can be utilized to prevent and reduce the negative impact of aging changes and promote optimal health and function in older adults.