AGE RELATED BODY SYSTEMS CHANGES

Most age-related biologic functions peak before age 30 and gradually decline linearly thereafter, the decline may be critical during stress, but it usually has little or no effect on daily activities. Therefore, disorders, rather than normal aging, are the primary cause of functional loss during old age. As the person ages a number of physical changes occur some are visible, some are not. The normal physiologic changes associated with aging are:

INTEGUMENTARY CHANGES

• Loss of subcutaneous supporting tissues
• Sensitive to pressure and ulcer
• Wrinkle and sag
• Dry, wrinkled, loss elasticity
• Decreased perspiration and sebum
• Fragile, easily injured
• Decreased skin turgor
• Decreased sebaceous secretions
• Dry, flabby, prone to itching
• Atrophy of tiny arterioles near epidermis
• Impaired vasomotor homeostatic mechanism
• Poor temperature regulation (feels cold even in warm climate)
• HAIR- decreased number of hair follicles, scant, fine, graying, hirsutism, possible hereditary baldness
• NAILS- dry, thick, brittle
• Health promotion teaching about skin care for elders, include:
• Maintaining healthy skin
• Ensure optimal function
• Maintain adequate hydration
• Prevent skin dryness by using emollient lotions after bathing or showering when the skin is still moist.
• Avoid skin products that contain perfume or alcohol.
• Assess the frequency of bathing/ showering
• Avoiding sun damage
• Use sunscreen lotions with sun protection factor of 15 or higher.
• Wear wide brimmed hats, sun visors and sunglasses when exposed to sun.
• Observe for any skin changes and seek medical evaluation.
• Preventing skin injury
• Do not use strong detergents to launder clothes.
• Avoid rough texture in clothing
• Avoid highly starched linens
• Use soft wash clothes, towels and bed linens

MUSCULOSKELETAL CHANGES

• Increase fat substitution for muscle
• Muscle atrophy
• Decreased muscular strength and function
• Loss of Calcium from bones
• Deterioration of cartilage
• Wear, friction, stiffness of joints
• Easily tired, less stamina
• Impaired range of motion resulting from stiff joints
• Generalized loss of 6-10 cm in stature because of: flexion of knee and hip joint, narrowing of intervertebral disks
• Body takes on bony angular appearance
• Osteoporosis is common
• For health promotion the nurse assess the musculoskeletal functioning of the elder and identifies any risk factors that may contribute to falls or the ability of the elder to perform ADLs. Health promotion interventions often include providing information about the risk factors for osteoporosis and the importance of adequate intake of calcium and vitamin D.

CARDIOVASCULAR CHANGES

• Thickened cardiac valves
• Decreased myocardial contractibility
• Decreased elasticity of blood vessels
• Decreased elasticity and increased stiffness of the arterial wall
• Loss of atrial pacemaker
• Reduction of hemopoietic activity
• Increased blood coagulability
• Decreased efficiency of baroreceptors
• Health promotion activities involve
• Detecting and reducing risks for cardiovascular diseases.
• To detect risks the elder should have his or her blood pressure checked annually. The elder should be aware of his or her cholesterol level and have it rechecked at appropriate intervals depending on the result of the blood test.
• Smoking cessation if applicable, maintaining ideal body weight, exercising daily, avoiding foods high in sodium and fat and eating fruits and vegetables and discussing the use of low dose aspirin therapy with the elder's primary provider.

RESPIRATORY CHANGES

• Reduced chest compliance
• Increased AP diameter of thorax
• Reduced breathing capacity
• Reduced vital capacity
• Increased residual volume
• Decreased cough reflex
• Decreased ciliary activity
• Decreased elasticity of tissue
• Health promotion teaching includes:
• Cessation of smoking, if appropriate
• Preventing respiratory infections by washing hands
• Ensuring the influenza and pneumonia vaccinations are up to date.

NEUROLOGICAL CHANGES

• General
• slow speed of impulse transmission
• progressive decrease in number of functioning neurons in CNS and sense organs
• normal neurological functioning possible because of tremendous reserve number of neurons
• Mental and cognitive function
• altered capacity to retain new information and learn new tasks
• some impairment of memory and metal endurance
• Sensory
• some impairment of sensory perception
• gradual decrease of visual and auditory acuity
• Motor
• slowed reaction to stimuli; lengthening of reaction time
• decreased coordination and balance
• Degeneration and atrophy of neurons
• Decreased nerve acuity and sensation
• Loss of memory
• Reduced concentration ability
• Decreased attention span
• Decision-making and judgement ability remain intact
• Decreased muscle coordination

GASTROINTESTINAL CHANGES

• Minimal loss of digestive enzymes
• Decreased absorption
• Decreased peristalsis
• Slowed digestion; increased food intolerance
• Decreased metabolism: caloric requirement approximately 1000 calories per day
• Redistribution of body fat; increased fat in trunk, especially in abdomen
• Teeth and gum problems common
• Atonia constipation in common
• Health promotion teaching for elders includes
• Effective oral hygiene and preventive dental care.
• Nutrition is important including appropriate diet, as needed by the elder and sufficient fluid intake.
• Maintenance of a regular bowel routine is helpful and screening for colorectal cancer is important.

RENAL/GENITOURINARY CHANGES

• Decreased blood flow
• Reduced GFR
• Reduced nephrons
• Decreased creatinine clearance
• Increased propensity to toxic effects of drugs
• Decreased renal capacity to concentrate urine at night
• Genital
• Ability to function sexually may continue well in older years
• Female: menopause secondary to decreased estrogen
• Male: decreased testosterone, spermatogenesis, and size of testes, increase in size of prostate
• Health promotion activities for good urinary function in the elder are:
• Drink sufficient fluids daily
• Drink fluids even if you do not feel thirsty
• Avoid foods that can irritate the bladder
• Practice pelvic muscle exercise to stop or control stress incontinence

ENDOCRINE CHANGES

• Decreased utilization of insulin
• Cessatiomn of progesterone
• Decreased then plateau of estrogen
• Gradual decline in testosterone
• Reduced BMR

SEXUAL CHANGES

• Minimal change in amount of sexual response
• Increased in time for full sexual response
• Reduced vaginal lubrication
• Increased refractory periods in male
• Decreased cell mass and weight

IMMUNOLOGICAL CHANGES

• Reduced humoral and cellular immunocompetence
• Slowed, less efficient, response to antigens increases susceptibility to infections

SENSORY CHANGES

• Vision
• Loss of accommodation
• Loss of color sensitivity
• Decreased dark adaptation
• Decreased peripheral vision
• Reduced sensitivity to glare
• Slowed accommodation to light
• Decreased visual acuity-farsightedness d/t slow lens accommodation, narrowed field of vision (tunnel vision)
• Hearing
• Decreased threshold for high frequencies
• Decreased auditory acuity
• Sensorineural hearing deficit (presbycusis) gradual loss of ability to discriminate to high frequency tools
• Taste and smell
• Lack of appetite
• Prefer salty diet
• Touch
• Safety hazard

DENTAL CHANGES

• Gums becomes less elastic; less vascular
• Recede from remaining teeth, exposing areas of teethe not covered with enamel

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