Xavier University Ateneo de Cagayan

In partial fulfillment of the requirements for

Care of the Older Adult NCM 114

Submitted by:
Dalagan, Maria Rafaela Julliana Q.
Danseco, Danna Francesca S.
del Rosario, Carylle M.
Escojedo, Dennise Ann H.
Eslit, Lynn Chantal
Famacion, Kyra Bianca R.
Hallazgo, Rex G.
Jardiolin, Roland Laurence B.
Kho, John Carlo
Lagbas, Raphaella
Macaibay, Erika France

BSN 3 - NA

Submitted to:

Ma’am Gemma V. Panal, RN, MN, LPT

September 2, 2021
 Normal Physiologic Changes in Aging Affecting Various Systems

System Normal Physiologic Changes

Cardiovascular ● There is a reduction in the efficiency of the heart

which contributes to decreased compliance of the
heart muscle like:
- myocardial hypertrophy, which changes the
left ventricular strength and function;
- fibrosis and stenosis of the valves; and
- decreased pacemaker cells.
● As a result, the heart valves become thicker and
stiffer, and the heart muscle and arteries lose their
elasticity, resulting in a reduced stroke volume.
● Increase in the workload of the heart due to:
- Accumulation of calcium and fat deposits
within arterial walls
- Increasing arterial resistance due to veins
become increasingly tortuous
● Others include:
- decreased cardiac output;
- diminished ability to respond to stress;
- heart rate and stroke volume do not
increase with maximum demand;
- slower heart recovery rate; and
- increased blood pressure.
● Structural changes
- Decreased:
- myocardial cells, aortic distensibility,
vascular tone
- Increased:
- heart weight, myocardial cell size,
left ventricle wall thickness, artery
stiffness, elastin levels, collagen
levels, left atrium size
● Functional changes
- Decreased:
- Diastolic pressure (during initial
filling), diastolic filling, reaction to
beta-adrenergic stimulus
- Increased:
- Systolic pressure, arterial pressure,
wave velocity, left ventricular
end-diastolic pressure
- Elongation of:
 - Muscle contraction phase, muscle
relaxation phase, ventricle relaxation

Respiratory ● Diminished respiratory efficiency and reduced

maximal inspiratory and expiratory force may
occur as a result of calcification and weakening of
the muscles of the chest wall
● Lung mass decreases and residual volume
increases.
● Conditions of stress, such as illness, increase the
demand for oxygen and affect the overall function
of other systems.
● Increase in residual lung volume; decrease in
muscle strength, endurance, and vital capacity;
decreased gas exchange and diffusing capacity;
decreased cough efficiency
● Alveoli
- Become flatter and shallower, and there is a
decrease in the amount of tissue dividing
individual alveoli
- Decrease in the alveolar surface area
- The volume of blood distributed to
pulmonary circulation declines with age due
to a decreasing number of capillaries per
alveolus
● Lung Elasticity
- Loss of elastic recoil causes the lungs to
close prematurely, trapping air inside and
preventing the lungs from emptying
completely, resulting to unexpired air to
remain in the lungs and, consequently,
during the next inhalation less air can be
inspired
● Chest Wall
- Becomes stiffer due to a loss of rib elasticity
as well as age-related calcification of the
cartilage that attaches the ribs to the
breastbone, decreasing the ease with which
the thoracic cavity can expand.
- Weakening of diaphragm, combined with an
age-associated loss of overall muscle
mass, reduces the contractual abilities of
the diaphragm thus limiting respiration
● Changes in Respiratory Measures
a. Vital capacity decreases by approximately
40%
 b. Forced expiratory volume (FEV) decreases
c. Ventilatory rate decreases
● Most prevalent respiratory diseases among older
adults
- Chronic obstructive pulmonary disease
(COPD)
- Pneumonia

Integumentary ● Changes can be classified as either intrinsic

aging (chronological) or extrinsic aging
(photoaging); Chronological aging refers to
changes due only to the passage of time;
Photoaging results after chronic exposure to UV
radiation
● Skin
○ Decreased turnover rate of keratinocytes
along with the slowing
exfoliation-replacement rate of dead
keratinocytes results in prolonged exposure
of epidermal cells to harmful carcinogens
and increased risk of skin cancer
○ Decreased number of active melanocytes;
remaining melanocytes generally have
fewer pigment granules making aged skin
less likely to tan; melanocytes also tend to
increase in size and group producing the
so-called aged spots on elderly skin
○ Decreased Langerhans cells and decline in
production of vitamin D3
○ Interdigitated structure of epidermal-dermal
junction is lost which results to the flattening
of the junction and epidermis can be more
easily separated from the dermis
○ Decreased epidermal proliferation and
general loss of number and flexibility of
collagen leads to thinner dermis
○ Elastin becomes brittle and less resilient;
results in loss of its ability to return to its
original tension after it is stretched by
movement
○ Loss of subcutaneous fat in the face and
extremities but increase in fat in other areas
such as in the abdomen (men) and hips
(women); results in loss of insulator and
cushioning function of the subcutaneous
layer
 ○ Diminished blood supply due to the
decreased number of capillaries in the skin;
results in decrease in skin temperature,
impaired thermoregulation, and a general
paler appearance to the skin which make
bones and blood vessels more visually
prominent
● Hair
○ Germination centers that produce hair
follicles can change or be destroyed; results
in thinning and loss of scalp hair
○ Thinning of facial hair in men but eyebrow
and hair inside ears may become longer
and coarser
○ Women may develop unwanted facial hair
following hormonal changes
○ Gradual loss of functional melanocytes from
hail bulbs and general decline in melanin
production results in graying of hair; onset
may vary according to heredity and race
● Nails
○ Decreased linear growth rate
○ Undergoes change in shape; becomes
flatter or more concave instead of convex
○ Longitudinal grooves or ridges may form
○ Tend to become thinner, drier, and more
brittle
● Glands
○ Sweat Glands
- Number of glands decrease and
efficiency declines; results in less
sweat production and in turn impairs
thermoregulation
○ Sebaceous Glands
- Do not decrease in number but in
size and glandular activity; results in
increased dryness, roughness, and
itchiness of the skin

Reproductive (Male) ● Age-related changes to the male reproductive axis

include increases in FSH and LH levels,
decreases in both serum and bioavailable
testosterone levels, and a decline in Leydig cell
function.
● Testosterone levels in men decline with age, but
can show variability from small decreases to major
 decreases depending on health status.
● As testosterone levels decline in older males the
amount of estrogen remains stable, leading to a
decline in testosterone-to-estrogen ratio.
○ A decline in testosterone is often
associated with decreases in libido,
spontaneous erections, sexual desire, and
sexual thoughts.
● Decreased libido and erectile dysfunction may
develop but are more likely to be associated with
factors other than age-related changes.
○ Risk factors
■ Cardiovascular disease
■ Neurologic disorders
■ Diabetes
■ Respiratory disease
■ Pain
■ Medications (Vasodilators,
Antihypertensive agents, and
Tricyclic antidepressants)
● The Testes
○ In aging, the testes decrease in both size
and weight, but with high variability among
men.
○ The Leydig cells decrease in number but
not in structure.
■ These cells decrease their
production of testosterone.
○ The small amount of estrogen that the
testes secretes does not decline with age,
nor does the estrogen that is aromatized
from androstenedione.
■ As a result, the ratio of
estrogen-to-testosterone increases
in older males.
○ The seminiferous tubules show thinning of
the walls and narrowing of the lumen over
time.
■ The lumen becomes so narrow that
the seminiferous tubules become
blocked.
○ Other dynamics that may contribute
to/enhance the aging of the structure and
function of the seminiferous tubules include:
■ Decreased blood flow
■ Changes in testosterone production.
 ○ Although a decline in sperm production
occurs in aging males, production never
ceases. As a result, older males remain
fertile.
● Glands
○ The seminal vesicle and the bulbourethral
glands demonstrate no age-related
changes.
○ The biggest concern in older males is
changes in the prostate gland:
■ The lining and muscle layer of the
prostate gland become thinner with
age, probably due to reduced blood
flow to the area.
■ Benign prostatic hyperplasia (BPH)
is dependent on age and androgen
production remains very common in
aging males with ~50% of men
experiencing nodules by age 60 and
~90% by age 85.
● By age 60, ~13% of males will
be diagnosed with BPH that
requires medical attention.
● By age 85, percentage will
increase to 23%
■ BPH causes the prostate to grow
very large which may cause urethral
blockages.
■ Common complaints with BPH
include :
● Urination discomfort
● Bladder and kidney infections
● Ejaculatory dysfunction
● The Penis
○ Begins to show fibrous changes in erectile
tissue around the urethra starting in the 30s
and 40s.
○ Increased fibrosis occurs in all tissues by
ages 55 to 60 years.
○ The fibrosis in erectile tissue causes an
increase in the amount of time it takes to
achieve an erection in the older male.
● Andropause
○ A decline in testosterone levels and
eventual deficiency significant enough to
cause clinical symptoms.
 ○ Andropause occurs overtime and does not
occur in all aging males.
○ A decline in the functional ability of the
entire reproductive axis causes decreased
production of testosterone in aging males.
○ When testosterone is produced in the adult
male it stimulates negative feedback of
GnRH, FSH, and LH secretion.
■ In the older male, this negative
feedback is enhanced.
○ Androgen deficiency in the aging male
(ADAM) include:
■ Symptoms of low libido
■ Decreased energy, strength, and
stamina
■ Increased irritability
■ Cognitive changes
○ Physiological symptoms of ADAM include:
■ Erectile dysfunction
■ Osteopenia
■ Osteoporosis
■ Breast enlargement
■ Decreased muscle mass
■ Shrinkage of the testes
■ Increased fat deposition

Reproductive (Female) ● Changes in neuroendocrine function include a

change in gonadotropin levels and occurs before
ovarian-age related changes, implicating
involvement of the hypothalamus
● With age, FSH levels increase before menopause
and continues to increase throughout and after
menopause
● Estradiol levels increase right before and while
transitioning into menopause then drastically
decrease during meno
● Inhibin B decreases in older women
● age -related changes in circulating hormones
affect hypothalamic and pituitary responses to
positive & negative hormone feedback systems
● Age-related decline in estrogen affects the brain
resulting in cognitive changes, and other areas of
the body
● The Ovaries:
○ With age, ovaries atrophy to a small size
that they may become impalpable
 ○ Number of ovarian follicles decrease with
age resulting to a decline in fertility and
usually begins in the 30s or 40s
○ By the age of 50-65, a woman will no longer
have viable follicles
○ Around age 45, when fertility declines, FSH
levels increase earlier in the follicular phase
due to age-related decline in inhibin B
○ Decline in inhibin B along with the increase
in FSH establishes the earliest age-related
changes in ovaries
○ Reproductive aging causes a decline in
estrogen due to a decrease in ovarian
follicles
○ Decline in progesterone also occurs
○ Changes in ovaries, including ovarian
failure and oocyte depletion, are causally
linked to the triggering of menopause
● The Uterus:
○ Decreases in uterine endometrial thickening
during menstrual cycles occur as result of
decreased estrogen and progesterone
○ Thickening leads to a decline in menstrual
flow, eventually causing missed cycles and
permanent cessation of ovulation and
menstruation
○ Supporting ligaments attached to the uterus
are weakened with age, causing the uterus
to tilt backwards
○ Decreases in size by as much as 50% and
may become impalpable over the age of 75
○ The cervix may also be unrecognizable on
physical examination in postmenopausal
women due to stenosis and possible
retraction
● The Vagina:
○ Thinning and narrowing of vaginal walls
○ Loss of mucosal layers in the vagina as well
as a large decrease in discharge causes a
loss of lubrication
○ Dry vagina causing painful sexual
intercourse
○ Less elastic
○ Due to decreasing glycogen levels in
vaginal tissue, vaginal pH values shift from
acidic to alkaline, creating an environment
 where microorganisms thrive
○ Risk for vaginal yeast infections
○ External genital tissue decreases and thins
(ex. Shrinkage of labia majora)
○ Vaginal infections increase
○ These changes increase chances for
vaginal injury in older females
● During perimenopause:
○ Frequent periods at first followed by
occasional missed periods
○ Periods either longer or shorter
○ Changes in the amount of menstrual flow
● Menopause (around 51 years, but can be earlier
~45)
○ Around the age of 35, the late reproductive
stage begins with a drop in progesterone, a
minor increase in estradiol, and an increase
in FSH
○ In both the early and late stages of
menopause, estradiol levels drop
simultaneously with the onset of irregular
menstrual periods
○ Ovaries stop producing hormones like
estrogen, progesterone and
androstenedione
○ Ovaries stop releasing eggs
○ One year following the last menstrual
period, menopause is said to have occurred
○ Menstrual periods stop
● Other common changes:
○ Collagen in skin decreases
○ Sweat and sebaceous glands become dry
○ Hair follicles begin to dry
○ Hot flashes, moodiness, headaches,
insomnia, fatigue
○ Weight gain
○ Bladder infections
○ Depression
○ Problems with short-term memory
○ Decrease in breast connective tissue but
gain adipose tissue
○ Lipoproteins increase
○ Decreased libido and sexual response
○ Loss of pubic muscle tone, resulting in the
vagina, uterus, or urinary bladder falling out
of place (prolapse)
Musculoskeletal ● A reduction in muscle mass occurs
● Loss of muscle strength or the muscle’s capacity
to generate force
● Loss of muscle quality or the strength generated
per unit of muscle mass
● Overall loss in the number of both fast and slow-
twitch muscle fibers. In addition, a reduction in the
size of muscle fibers has been observed, with the
greatest reduction seen in fast-twitch muscle fibers
● The number of functional motor units begins to
decline precipitously
- The loss of motor units with age is due to
an age-related loss of muscle innervation
● With age, levels of hormones decline, thereby
contributing to muscle atrophy and sarcopenia
● Reduced capacity of skeletal muscle to synthesize
protein, and such reduction is likely to lead to a
decrease in muscle mass
● Loses its ability to maintain balance between bone
resorption and formation
● Loss of bone strength that are attributed to at least
2 different processes:
- Increased porosity of bone occurs due to
continuous remodeling. Greater porosity
reduces the structural strength of bone
- Age-related loss of collagen due to
decreased protein synthesis, which
increases the ratio of bone minerals to
collagen, leading to increased brittleness of
bone
● Trabeculae becomes thinner and weaker. Some
may disappear entirely and cannot be replaced.
- As a result, the bone becomes
permanently weaker at the site of
trabeculae thinning or loss. Furthermore,
some trabeculae may be disconnected from
others, resulting in a decline in bone
strength
● With age, immovable joints improve as the
collagen between the bones of immovable joints
become coated with bone matrix
● Ligaments become stiffer and less elastic
● Cartilage lining the bone becomes calcified,
thinner, and less resilient
● Vertebral movement is decreased and there is a
decline in the ability of intervertebral disks to
 support the body and cushion the spinal cord
● Synovial membrane becomes stiffer and less
elastic
- It loses some of its vasculature, which in
turn reduces its ability to produce synovial
fluid

Genitourinary ● System continues to function adequately in older

people
● Decreased kidney mass due to a loss of nephrons
● One third of elderly people show no decrease in
renal function
● Changes in renal function may be due to a
combination of aging and pathologic conditions
such as hypertension.
● The changes most commonly seen include:
○ a decreased filtration rate
○ a diminished tubular function with less
efficiency in resorbing and concentrating
the urine
○ a slower restoration of acid–base balance
in response to stress.
● Older adults who take medications may
experience serious consequences due to a decline
in renal function because of the following:
○ impaired absorption
○ decreased ability to maintain fluid and
electrolyte balance
○ decreased ability to concentrate urine.
● Certain genitourinary disorders, like urinary
incontinence and benign prostatic hyperplasia, are
more common in older adults than in the general
population.
 Nervous ● Homeostasis is difficult with aging however most
older people function adequately and retain their
cognitive and intellectual abilities in the absence of
pathologic changes.
● Structure and function of the nervous system
change with advanced age
- changes are accompanied with reduction in
cerebral blood flow
● Reports of the loss of nerve cells are highly varied
with variations in neuron loss in different parts of
the brain
● There is a loss of nerve cells that contributes to a
progressive loss of brain mass.
● The synthesis and metabolism of the major
neurotransmitters are also reduced.
- Nerve impulses conducted more slowly
- Older people take longer to respond and
react
● Autonomic nervous system performs less
efficiently
- Postural hypotension may occur which
causes older people to feel lightheaded
when standing up quickly
● Older people have poor gait and have imbalance
with mobility.
● Mental function is threatened by physical or
emotional stresses.

Hematopoietic ● Reduced proliferative and self-replicative capacity

of stem cells
- Continual shortening of telomeres
- Decline in CD34+ Progenitor Stem Cells
● Changes in the cytokine network
- Peripheral blood reduces capacity to
produce IL-3 and GM-CSF
- thereby limiting the efficiency in
stimulating the production of
hematopoietic cells
- IL-6 and TNF-alpha increase in
concentration
- Disrupt homeostatic regulation of
hematopoiesis
- May be responsible for poor
 response to hematopoietic stress
- Increased IL-6 show an association
with increased risk of death, anemia,
and functional decline

Gastrointestinal ● Mouth
○ Affect ability to chew
○ Age-related changes in teeth cause them to
be less sensitive and more brittle
○ Atrophy of those muscles and bones of the
jaw and mouth that control mastication
○ Although almost 40% of older adults
complain of dry mouth, salivary gland
function remains stable with age due to the
large secretory reserve in the main salivary
glands
○ Dry mouth can be attributed to prescription
and over-the-counter medications,
nutritional deficiencies, disease, and
treatment therapies such as chemotherapy

● Esophagus
○ Impaired esophageal motility function in
older individuals led to the development of
the term presbyesophagus
○ Aging until around age 80, when some
changes occur such as decline in upper
esophageal sphincter pressure, increased
time for the upper esophageal sphincter to
relax, and decreased intensity of
esophageal contractions, potentially caused
by loss of muscle abilities and nerve
innervations
○ Stiffening of the esophageal wall and less
sensitivity to discomfort and pain in the
esophagus affecting the older patient’s
ability to swallow
○ The gag reflex also appears to be absent in
around 40% of healthy older adults
○ Dysphagia (difficulty swallowing), reflux,
heartburn, and chest pain are common
complaints that relate to changes in the
pharynx and esophagus
○ Duration of gastroesophageal episodes
appears to be more prolonged
● Stomach
○ Peristalsis and gastric contractile force are
mildly reduced in the elderly and that the
reduction reaches significance in less active
elderly subjects rather than in those who
maintain an active lifestyle
○ Pepsin, bicarbonate, and sodium ion
secretions and prostaglandin content show
age-related decline causing a decline in
gastric defense mechanisms and create an
increased potential for mucosal injury in the
stomach

● Small Intestine
○ Decrease in gastric acid secretion in
approximately 32% of elderly people
○ This decreased acid production along with
motility disturbances in the small intestine
can lead to bacterial overgrowth in the
small intestine, a common clinical finding in
the older population, causing malabsorption
and malnutrition

● Large Intestine
○ Older adults experience longer colonic
transit time (the amount of time needed for
fluid and excrement to travel the length of
the colon). This change again relates to
age-related loss of neurons and receptors
in the enteric nervous system. Increased
colonic transit time also correlates with
increased fibrosis in the colon.
○ Colonic pressure in the intra-lumen also
increases with age, but can be lowered with
fiber supplementation.
○ The rectum shows an age-related increase
in fibrous tissue. This increase reduces the
rectum’s ability to stretch as feces pass
through
○ In the anus, the external anal sphincter
shows an age-related decrease in motor
neurons responsible for sphincter control.
○ This sphincter also thins with age
○ The internal anal sphincter thickens with
age, possibly as a compensatory
 mechanism. It shows a decline in
contractile abilities.
○ Aging women experience a greater risk of
anal sphincter changes due to laxity of the
pelvic floor, decreased pressure in the
rectum, and even menopause.

● Liver
○ The liver’s size as well as its blood flow and
perfusion can decrease by 30% to 40%. In
addition, hepatocytes, or liver cells, can
undergo structural alterations. However,
due to the liver’s large reserve capacity and
the hepatocytes’ ability to regenerate after
damage, no functional changes result from
the changes in structure
○ Decreased drug clearance due to the
declines in liver size and blood flow as well
as age-related changes in the kidneys

● Gallbladder
○ Appears to demonstrate declines in
emptying rates so that less bile is secreted
when food is digested
○ Increased bile volume in the gallbladder
has been correlated with gallstones in older
adults. This increase in bile volume is more
common in older women than men.
○ The bile ducts tend to widen with age,
allowing potential gallstones to pass
through more easily; however, the duct near
the opening of the small intestine becomes
narrower, trapping the gallstones and
leading to abnormal changes.

● Pancreas
○ Decreases in weight with age and shows
some histological changes such as fibrosis
and cell atrophy.

● Immunity
○ Decline in immunological function in the
aging gastrointestinal system. This decline
can increase rates of infections that occur
via the gastrointestinal system. Infection
may, in turn, lead to mortality and morbidity.
 ○ A decline in gastrointestinal immunity can
be attributed to a change in lymphoid cells
or epithelial cells, or possibly both cell
types.
○ Changes that occur increase the risk for
diseases and disorders.
○ Age-related changes, compounded by other
influential factors such as comorbidity and
medication use, place older individuals at
increased risk for gallstones, constipation,
fecal incontinence, and infection.

Sensory

Vision ● Accumulation of older central cells in the lens of

the eye
○ Due to the continuing formation of cells
outside the surface of the lens
○ Leads to the lens to turn yellow, rigid,
dense, and cloudy which:
i. causes the outer portion of the lens
to be the only part elastic enough to:
● change shape
● focus at near and far
distances
ii. Leads to presbyopia
● the near point of focus gets
farther away
● Occurs when the lens
becomes less flexible
● usually begins in the fifth
decade of life and requires the
person to wear reading
glasses to magnify objects
iii. Increases sensitivity to glare
● Sensitivity is due to how the
yellowing, cloudy lens causes
light to scatter
iv. Progresses to color blindness
● The ability to discern blue
from green decreases
v. Slow and less complete dilation of
the pupils
● Due to the increased stiffness
of the muscles of the iris
● Causes the old person to
 ○ take more time to
adjust when going to
and from light and dark
settings
○ need brighter light for
close vision
○ Eye diseases become more common
i. Cataracts
ii. Glaucoma
iii. Diabetic retinopathy
iv. Age-related macular degeneration
● Primary cause of vision loss in elderly: Age-related
macular degeneration
○ does not affect peripheral vision, which
means that it does not cause blindness
○ affects the following:
i. central vision
ii. color perception
iii. fine detail
○ greatly affecting common visual skills such
as reading, driving, and seeing faces
● there is no definitive treatment and no cure that
restores vision

Hearing ● changes begin to be noticed at about 40 years of

age
● In line with age-related changes in hearing are the
factors of:
○ exposure to noise, medications, and
infections, as well as genetics
○ Wax buildup or other correctable problems
● Presbycusis
○ a gradual, sensorineural loss
■ progresses from:
● the loss of the ability to hear
high-frequency tones to a
generalized loss of hearing
○ attributed to irreversible inner ear changes
○ Older people often cannot follow
conversation because tones of
high-frequency consonants all sound alike
■ the sounds f, s, th, ch, sh, b, t, p
● Effects of hearing problems:
○ may cause older people to:
■ respond inappropriately
■ misunderstand conversation
 ■ avoid social interaction
○ behavior may be erroneously interpreted as
confusion

Touch ● Age-related changes in touch are the following

○ reduction in
■ number of receptors
■ blood flow
■ Tactile and vibration sensations
■ Sensitivity to warm or cold stimuli
○ The mentioned reduction of aspects are
elements in the sensation of touch which
overall gets affected
● Predisposing factors that impact somatosensory
functioning:
○ Dementia
○ Parkinson’s disease
○ Diabetes

Movement ● Gross and fine motor movements are affected by

the aging process, aging-related diseases, and a
sedentary lifestyle associated with aging.
● Characterized by reduced velocity (speed) and
accuracy and greater variability across individuals.
● Caused by decline in many sensory organs,
cognitive functioning, and bodily strength
● Walking pattern (gait) becomes slower and
shorter; walking may become unsteady, and less
arm swinging
● Get tired more easily and have less energy
● Loss of muscle mass reduces strength

Taste ● After age 60, sensitivity to five tastes declines.

● Number of taste buds decreases as age increases
● Each remaining taste buds begins to shrink
● Dry mouth can affect sense of taste
● Sweet taste are dulled among all five tastes

Smell ● Changes are related to cell loss in the nasal

passages and in the olfactory bulb in the brain
● Environmental factors like long-term exposure to
toxins contribute to cellular damage.
○ e.g., dust, pollen, smoke
● Sense of smell decreases after age 70
Sources:

Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of

(0000)Medical-surgical Nursing (14th ed., Vol. 1). Wolters Kluwer.

Mauk, K. L. (2010). Gerontological Nursing: Competencies for Care (2nd ed.). Jones &

(0000)Bartlett Learning.

Mauk, K. L. (2017). Gerontological Nursing: Competencies for Care (4th ed.). Jones &

(0000)Bartlett Learning.

Aging changes in the senses. (n.d.). MedlinePlus. Retrieved September 2, 2021, from

https://medlineplus.gov/ency/article/004013.htm