CLARISSE Z.
MANANGO
PHYSIOLOGICAL CHANGES
Cardiovascular System
 Decreased number of pacemaker cells in
sinoatrial node (Meiner, 2015, p.388)
 Extensive deposits of fat and fibrous tissue
throughout the conduction system (Meiner,
2015, p.388)
Respiratory System
 Osteoporosis and calcification of the costal
cartilage led to increased rigidity and
stiffness of the thoracic cage (Meiner,
2015, p.442)
 Progressive loss of elastic recoil of the lung
parenchyma and conducting airways and
reduced elastic recoil of the lung and the
opposing forces of the chest wall (Meiner,
2015, p.442)
Endocrine System
 Hypersecretion of insulin
 Decreased receptor – ligand binding
(Corporate Medical Director for Medicare Howard M
Fillit et al., 2017, p. 724-747)
Integumentary
 Increased lentigines (brown-pigmented
spots, or age spots) (Meiner, 2015, p.608)
 Loss of thickness, elasticity, vascularity,
and strength that may delay the healing
process and increase the risk of skin tears
and bruising (Meiner, 2015, p.608)
Hematopoietic and lymphatic
 Leukocyte production decreases
 Hemoglobin levels decrease
Gastrointestinal
 Increase in transit time, sensation to
defecation decreased leading to
constipation and fecal impaction (Meiner,
2015, p.490)
 Atrophy of gastric mucosa and decreased
blood flow in the stomach leading to food
intolerances, signs of anemia as a result of
cobalamin malabsorption of fat-soluble
vitamins (Meiner, 2015, p.490)
 Gingival retraction and atrophy of its tissue
leading to loss of teeth, presence of
dentures and difficulty chewing (Meiner,
2015, p.490)
BSN III-A
NURSING INTERVENTIONS
 Encourage to have regular endurance exercise or
habitual aerobic exercise as tolerated
 Advise to eat a heart-healthy diet with reduced
amounts of saturated fat and cholesterol, and
control weight.
(Meiner, 2015, p.396-418)
 Advise on the avoidance of cigarette and
secondhand smoke
 Teach stress management and relaxation for
breathing control
 Education about the importance of immunization
(Meiner, 2015, p.429-451)
 Establish a diet plan through dietitian’s
recommendation and assess client (Meiner, 2015,
p.463)
 Monitor blood glucose level and maintain desired or
normal level (Meiner, 2015, p.459)
 Educate to protect skin from sun exposure by
applying a sunscreen of at least SPF 15, wear hats
with wide brims and long-sleeved shirts. (Meiner,
2015, p.616)
 Advise to use heavy emollient lotions or creams
containing urea or lactic acid (e.g., Lubriderm,
Nivea, Eucerin, Aveeno, Cetaphil) after bathing when
skin is moist. Mineral oil, petroleum jelly, and
shortening are less expensive alternatives. (Meiner,
2015, p.616)
 Monitor closely for early signs of infection (eg,
increased fatigue, anorexia, or mental confusion)
because the body may not show fever or elevated
leukocyte count.
 Assess for evidence of gastrointestinal or other
internal bleeding before concluding that anemia is
due to aging. Ensure adequate dietary intake of iron-
rich foods. Encourage regular medical check-ups,
including colon and bladder exams. Assess PSA in
men
 Educate on the importance of eating high-fiber
foods, which include beans, whole grains, brown
rice, fruits (e.g., apples, bananas, and pears) and
vegetables (e.g., broccoli, carrots, corn and squash)
and drink eight cups of fluids each day, unless
contraindicated by cardiac status. (Meiner, 2015,
p.497)
 Optimizing nutritional status and preventing further
weight loss is accomplished with small, frequent
feedings; high-protein, high-calorie foods;
supplements such as Ensure; and tube feedings, if
necessary (Meiner, 2015, p.505)
 Promote regular hygiene and regular preventive
dental care by flossing regularly, brushing teeth or
dentures and using saline mouth rinses, as needed.

Urinary
 Bladder capacity decreases, the prevalence
of involuntary bladder contractions
increases, and more urine is produced at
night. The reduction in bladder capacity
and increased involuntary bladder
contractions may lead to urgency and
frequency (Meiner, 2015, p. 541)
 Decreased renal mass of 80 grams by 40 to
90 years of age and decrease blood flow
leading to fall of GFR (Meiner, 2015, p.550)
Nervous
 Physiologic changes in the RAS results in
decrease in stages 3 and 4 of the sleep
cycle (Meiner, 2015, p.563)
 Significant decreases in neurotransmitters,
including ACh, glutamate, serotonin,
dopamine, and gammaaminobutyric acid
(Meiner, 2015, p.563)
Reproductive
 Female:
The labia majora and minora become less
prominent and pubic hair thins. The
ovaries, cervix, and uterus slowly atrophy.
The vagina shortens, narrows, and loses
some of its elasticity, typical of aging
muscle and skin. Vaginal walls also lose
their ability to lubricate quickly, especially if
the woman is not sexually active. More
stimulation is needed to achieve orgasm
 Male:
Decreased sperm motility and more
stimulation is needed to achieve a full
erection, ejaculation is slower and less
forceful, and the period between the ability
to have an erection increase. Prostatic
enlargement also occurs.
(Theris A. Touhy & Kathleen F Jett, 2013, p. 63-64)
Muscoskeletal
 The actual number of muscle cells
decreases, and they are replaced by fibrous
connective tissue. As a result, muscle mass,
tone, and strength decrease. The elasticity
of ligaments, tendons, and cartilage
decreases, as does bone mass, which
results in weaker bones. (Meiner, 2015,
p.511)
Professional dental care should be sough routinely
evert 6 months or more often, as needed. (Meiner,
2015, p.487)
 Restrict fluids after dinner. It is important to drink
enough fluids (usually six to eight glasses a day),
but the bulk of fluids should be ingested during the
day, eliminate caffeine in the evening (e.g.,
caffeinated cola, tea, chocolate) and elevate the legs
in the afternoon so the feet and ankles are not
swollen when going to bed. (Meiner, 2015, p. 547)
 Maintain fluid and electrolyte balance, monitor
nephrotic symptoms, educate about treatment
regimen and its usage, and dietary management
that may include low-protein, low-sodium, low-
potassium, and low-phosphorus diet. (Meiner, 2015,
p.553)
 At bedtime, warm drink (milk or herbal tea),
relaxation tapes or music, and back massage. Sleep-
enhancement protocol: unit-wide noise-reduction
strategies (e.g., silent pill crushers, vibrating
beepers, and quiet hallways) and schedule
adjustments to allow sleep (e.g., rescheduling of
medications and procedures) (Meiner, 2015, p.570)
 Orientation protocol: board with names of care team
members and day’s schedule; communication to
reorient to surroundings
 Therapeutic-activities protocol: cognitively
stimulating activities three times daily (e.g.,
discussion of current events, structured
reminiscence, or word games) (Meiner, 2015, p.570)
 Older women should be informed that water-soluble
lubricants may relieve the pain and discomfort and
allow sexual activity to continue
 Emphasize that the changes are normal so as to
alleviate the client’s anxieties and fears of failure,
which can give rise to impotency. Once these fears
and anxieties are removed, the man’s sexual
functioning will be normal for his age
 Teach the use of walkers, canes, and clutch.
(Meiner, 2015, p.516)
 Instruct to allow sufficient periods of rest and to limit
activities that produce pain. Physical therapy for
range of motion and muscle strengthening may also
be ordered by the physician. (Meiner, 2015, p.521)
  The intervertebral disks lose water, causing
a narrowing of the vertebral space. This
shrinkage may result in a loss of 1.5 to 3
inches of height. The lordotic or convex
curve of the back flattens, and both flexion
and extension of the lower back are
decreased. Posture and gait change.
(Meiner, 2015, p.511)

Reference

Corporate Medical Director for Medicare Howard M Fillit, Division of Geriatric Medicine Kenneth Rockwood;
Frcpc, & Young, J. B. (2017). Brocklehurst's textbook of geriatric medicine and gerontology (8th ed.). Elsevier.

Hogstel, M. O., 1988. Nursing Care of the Older Adult. 2nd ed. USA: John Wiley & Sons, pp.33-60.

Meiner, S. E. (2015). Gerontologic Nursing (5th ed.). Elsevier Health Sciences.

Theris A. Touhy, C., & Kathleen F Jett, G. (2013). Ebersole and Hess' gerontological nursing & healthy
aging (4th ed.). Elsevier Health Sciences.