Chapter 6: Review of the Aging of the
Physiological System
CARDIOVASCULAR SYSTEM
Overview of the Cardiovascular Structure
and Function
● The heart contains four chambers,
consisting of the two upper atria and the two
lower ventricles (Digiovanna, 2000).
Aging Changes in Cardiovascular
Structure
Cardiac Aging
● Enlargement of heart chambers and
coronary cells occurs with age, as does
increased thickening of heart walls,
especially in the left ventricle (Priebe)
● Overall increase in heart weight of
about 1.5 grams/year in women and 1.0
gram/year in men, measured from age 30 to
age 90 years
● The ability of the heart to exert force
or to contract does not change with age.
● The actual muscle contraction as
well as the relaxation phase does elongate
with age
● The left atrium in the heart enlarges,
contributing to functional changes in the
filling.
● The sarcoplasmic reticulum pump,
which generates energy for the circulatory
system, and its associated enzyme ATPase
diminish with age, which results in prolonged
relaxation of the ventricles.
● With age, When exercising and at
rest, diastolic filling decreases with age at a
rate of roughly 6% to 7% per decade, but
diastolic heart failure is uncommon
(Schulman, 1999).
Vascular Aging
● Extended and twisted arteries are a
result of aging. Endothelial cells also
change, and the decreased elastin and
collagen cause the artery walls to thicken. n
(Ferrari et al., 2003; Lakatta, 1999b; Virmani
et al., 1991)
● Aging does not appear to change the
overall maximum capacity, the maximum
vasodilation, or the perfusion of coronary
vessels (Weisfeldt, 1998).
● Resistance increases with age in the
aorta, arterial wall, and vascular periphery.
In addition, blood viscosity increases
between the ages of 20 and 70 years
(Lakatta & Levy, 2003; Morley & Reese,
1989).
● No age-related changes occur in
blood-tissue exchange via the capillaries,
suggesting a possible compensatory
mechanism such as capillary thickening
(Richardson, 1994).
Cardiovascular Aging Mechanism
● Increased levels of free radicals can
foster apoptosis, or cell death. Due to the
very limited regenerative properties of
cardiomyocytes, or heart cells, apoptosis
can have detrimental effects on
cardiovascular structure and functioning
(Pugh & Wei, 2001).
● Another possible trigger for
apoptosis is gene expression, which causes
changes in the messenger RNA (mRNA)
associated with the sarcoplasmic reticulum
and the related enzyme ATPase (Lakatta,
1993a).
● These mRNA changes lead to both
qualitative and quantitative alterations in the
sarcoplasmic reticulum and ATPase. These
alterations, in turn, lead to functional
changes in relaxation of the heart and
diastolic filling (Lakatta, 1993a; Lompre,
1998; Pugh & Wei, 2001).
In conclusion, The cardiovascular system
undergoes anatomical and functional
changes with aging, although not all
alterations are consistent through time or
between individuals. Some studies that
evaluate cardiovascular function between
different age cohorts do not account for
dietary habits, exercise routines, or lack
thereof, and other factors including older
folks' lifestyles over time and space
compared to younger people. (Lakatta,
1999b).
THE RESPIRATORY SYSTEM
The respiratory system refers to the parts of
the body involved in breathing. This system
works in close collaboration with the
cardiovascular system to provide the body
with a continuous supply of oxygen
necessary to produce energy and to
eliminate unwanted carbon dioxide.
Structure and Function of the Respiratory
System
1
Mouth and nose- Openings that pull air from
outside your body into your respiratory
system.
Sinuses- Hollow areas between the bones in
your head that help regulate the temperature
and humidity of the air you inhale.
Pharynx- Tube that delivers air from the
mouth and nose to the trachea (windpipe).
Trachea- Passage connecting the throat and
lungs.
Bronchial tubes- Tubes at the bottom of your
windpipe that connect into each lung.
Lungs- Two organs that remove oxygen
from the air and pass it into your blood.
Diaphragm- Muscle that helps the lungs pull
in air and push it out.
Ribs- Bones that surround and protect the
lungs and heart.
Alveoli- Tiny air sacs in the lungs where the
exchange of oxygen and carbon dioxide
takes place.
Bronchioles- Small branches of the bronchial
tubes that lead to the alveoli.
Capillaries- Blood vessels in the alveoli walls
that move oxygen and carbon dioxide.
Lung lobes- Sections of the lungs — three
lobes in the right lung and two in the left
lung.
Pleura- Thin sacs that surround each lung
lobe and separate your lungs from the chest
wall.
Cilia- Tiny hairs that move in a wave-like
motion to filter dust and other irritants out of
your airways.
Epiglottis- Tissue flap at the entrance to the
trachea that closes when you swallow to
keep food and liquids out of your airway.
Larynx (voice box)- Hollow organ that allows
you to talk and make sounds when air
moves in and out.
Aging of the Respiratory System
Alveoli
● As a person ages, the alveoli of the
lungs become flatter and shallower, and
there is a decrease in the amount of tissue
dividing individual alveoli.
● A person 30 years of age has an
alveolar surface area of approximately 75
square meters. This surface area decreases
by 4% per decade thereafter to around 60
square meters by age 70 years (Carpo &
Campbell, 1998).
● The volume of blood distributed to
pulmonary circulation declines with age due
to decreasing number of capillaries per
alveolus(Meyer, 2005; Nitzan et al., 1994).
● The age-related reduction in alveolar
surface area as well as the reduced number
of capillaries per alveolus impairs efficient
passage of oxygen from the alveoli to the
blood (De Martinis & Timiras,2003; Meyer,
2005).
Lung Elasticity
● With age there is a decrease in the
lungs’ elasticity, which in turn causes a
change in the elastic recoil properties of the
lungs. During expiration,elastic recoil helps
to keep the lungs open until all air is
expelled and the lungs are forced to collapse
due to the action of the respiratory muscles
● This same upper–lower lung
disparity is seen in young people. However,
because of their greater lung elasticity,
younger individuals are better able to
compensate for the disparity by bringing
more air into the lungs (Krauss Whitbourne,
2002).
● Age related vertebral kyphosis,
arthritis of the costovertebral joints, as well
as the increased rigidity of the thoracic
cavity lead to increased anteroposterior
diameter, which results in flattening of the
diaphragm (El Solh & Ramadan,2006).
● Older persons rely heavily on the
diaphragm for expansion and contraction of
the chest cavity when they breathe
(Digiovanna, 1994).
Changes in Respiratory Measures
● As a result of the age-related
changes in lung tissue and the chest wall,
the respiratory system of older adults is less
able to provide sufficient gas exchange to
2
meet the body’s demand for oxygen,
particularly at times of maximum physical
exertion (Arking,1998).
● Between the ages of 20 and 70
years, vital capacity is reduced by
approximately 40% (Krauss Whitbourne,
2002), and in some cases vital capacity in
the seventh decade may decrease to almost
75% of its value at 17 years of age (De
Martinis & Timiras, 2003).
● As residual volume increases, forced
expiratory volume decreases. Thus,
evidence supporting a marked decrease in
forced expiratory volume with age is
congruent with the age-related increase in
residual volume (Arking, 1998, Hollenberg,
Yang, Haight, &Tager, 2006).
● By the age of 85 years, the
ventilatory rate has decreased to
approximately 75 liters per minute(Arking,
1998).
Age-Related Pathologies of the
Respiratory System
Among persons over 85 years of age,
respiratory disease accounts for 25% of
alldeaths (De Martinis & Timiras, 2003). Two
of the most prevalent respiratory diseases
among older adults are chronic obstructive
pulmonary disease(COPD) and pneumonia.
Chronic Obstructive Pulmonary
Disease(COPD)
COPD is characterized by limited airflow and
impaired gas exchange. COPD
encompasses chronic bronchitis, chronic
obstructive bronchitis,and emphysema, or a
combination of these disorders (Barnes,
2000).
Pneumonia
Pneumonia is characterized by lung
inflammation generally brought on by
infection. Older individuals are more
susceptible to severe pneumonia and
complications of pneumonia than are
younger persons. In addition, mortality from
pneumonia is known to be significantly
higher in those age 60 years or older
(Naughton, Mylotte, & Tayara, 2000).
THE GASTROINTESTINAL SYSTEM
Aging in Key Components of the
Gastrointestinal Tract
The two gastrointestinal areas most affected
by age are the upper tract (the pharynx and
esophagus) and the colon, also referred to
as the large intestine (Hall, 2002).
The Mouth
● Dental decay and tooth loss affect
many older individuals today, making it more
difficult to chew and prepare food to be
swallowed (Hall & Wiley 1999). However, in
the near future tooth decay and loss may
decline
● Dry mouth can be attributed to
prescription and over-the-counter
medications, nutritional deficiencies,
disease, and treatment therapies such as
chemotherapy (Devlin & Ferguson, 1998;
Ghezzi & Ship; Ship, 2003; Pillemer, &
Baum, 2002).
The Esophagus
● A study in 1964 showing impaired
esophageal motility function in older
individuals led to the development of the
term presbyesophagus; however, the study
included many individuals with diseases
such as diabetes and neuropathy that
confounded the findings (Soergel,
Zboralske, & Amber, 1964).
● Older adults demonstrated stiffening
of the esophageal wall and less sensitivity to
discomfort and pain in the esophagus.
● Dysphagia (difficulty swallowing),
reflux, heartburn, and chest pain are
common complaints that relate to changes in
the pharynx and esophagus. Approximately
35% of older individuals report such
complaints (Hall & Wiley, 1999; Orr & Chen,
2002; Reinus & Brandt, 1998; Shaker, Dua,
& Koch, 1998).
The Stomach
● A study by Madsen and Graff (2004)
assessing gastrointestinal motility in aging
concluded that no changes in gastric
emptying occurred with age
● Gastric acid secretions do not
appear to change with age, but pepsin,
bicarbonate, and sodium ion secretions and
3
prostaglandin content do show age-related
decline (Hall & Wiley, 1999).
The Small Intestine
● Small intestine motility needed for
digestion and absorption of nutrients has
been reported to show no change
● A common consequence of
prolonged gastric emptying is a decrease in
gastric acid secretion in approximately 32%
of elderly people (Saffrey, 2004).
● 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 (Madsen &
Graff, 2004; O’Mahony et al., 2002; Orr &
Chen, 2002; Salles, 2007).
● Absorption of nutrients does not
change with age. Changes in vitamin
absorption are seen with particular vitamins
but not others (Hall & Wiley, 1999).
The Large Intestine
● The large intestine, also referred to
as the colon, measures approximately 5 feet
long when stretched out and covers the area
from the small intestine to the anus
● in aging, a loss of enteric, or
intestinal, neurons and nerve connections to
the smooth muscle in the colon occurs
● Madsen and Graff (2004) concluded
that older adults experience longer colonic
transit time
Aging in Accessory Glands and Organs
The Liver
● The liver is the largest gland in the
body and contributes to the conversion of
food by secreting bile into the small intestine
and by screening blood from the stomach
and small intestine for toxic substances,
excess nutrients, and ammonia (Digiovanna,
2000).
● With age, the liver’s size as well as
its blood flow and perfusion can decrease by
30% to 40%.
● Decreased drug clearance in the
older population can occur due to the
declines in liver size and blood flow as well
as age-related changes in the kidneys, but
this is highly variable among individuals
(James, 1998; Le Couteur & McLean, 1998;
McLean & Le Couteur, 2004)
The Gallbladder
● Stores biles for digestion
● 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 (Bates, Harrison, Lowe, Lawson, &
Padley, 1992; Hall & Wiley, 1999).
● The bile ducts tend to widen with
age, allowing potential gallstones to pass
through more easily; however, the duct near
the reè opening of the small intestine
becomes narrower, trapping the gallstones
and leading to abnormal changes
(Digiovanna, 2000).
The Pancreas
● The pancreas decreases in weight
with age and shows some histological
changes such as fibrosis and cell atrophy
(Hall & Wiley, 1999).
Gastrointestinal Immunity
● Research has suggested a 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 (Arranz,
O’Mahony, Barton, & Ferguson, 1992;
Schmucker, Heyworth, Owen, & Daniels,
1996; Schmucker, Owen, Outenreath, &
Thoreux, 2003; Schmucker et al., 2001)
● Although relatively few changes
occur in the aging gastrointestinal system,
changes that do occur increase the risk for
diseases and disorders.
THE GENITOURINARY SYSTEM
The Kidneys
The kidneys filter the blood and help remove
wastes and extra fluid from the body. The
kidneys also help control the body's
chemical balance. The kidneys are part of
the urinary system, which also includes the
ureters, bladder, and urethra.
Changes in the kidneys that occur with
age:
● The kidneys shrink in length and
weight.
● Young adults (20 years) average a
renal blood flow of 600 ml/min whereas
average blood flow in older adults (80 years)
4
averages only 300 ml/min (Beck, 1999a;
Digiovanna, 2000; Jassal et al., 1998;
Lindeman, 1995; Minaker, 2004).
● Changes in blood flow and
glomerular filtration rate (GFR) account for a
majority of functional disability in the kidneys
with age. With disease and some
medications, blood
Add Headings (Format > Paragraph styles) and they will appear in your table of contents.
● flow and GFR can be further
compromised (Beck, 1999a; Digiovanna,
2000; Lindeman, 1995).
● Amount of kidney tissue decreases
and kidney function diminishes.
● Number of filtering units (nephrons)
decreases. Nephrons filter waste material
from the blood.
● Blood vessels supplying the kidneys
can become hardened. This causes the
kidneys to filter blood more slowly.
● In a healthy aging person, kidney
function declines very slowly. Illness,
medicines, and other conditions can
significantly degrade kidney function.
The Bladder
The bladder is a hollow organ lined with a
mucous membrane, contains smooth muscle
including the detrusor muscle, and consists
of two components, the bladder body and
the base (Andersson & Arner, 2004;
Kevorkian, 2004).
Changes in the bladder that occur with
age:
● The bladder muscles weaken.
● With age, the bladder decreases in
size and develops fibrous matter in the
bladder wall, changing its overall stretching
capacity and contractibility (Digiovanna,
2000).
● The filling capacity of the bladder
also declines along with the ability to
withhold voiding (Diokno, Brown, Brock,
Herzog, & Normolle, 1988; Elbadawi, & Arner, 2004; Kevorkian, 2004).
Diokno, & Millard, 1998; Resnick, Elbadawi,
& Yalla, 1995).
Common Problems
Aging increases the risk of kidney and
bladder problems such as:
● Bladder control issues, such as
leakage or urinary incontinence (not being
able to hold your urine), or urinary retention
(not being able to completely empty your
bladder)
● Bladder and other urinary tract
infections (UTIs)
● Chronic kidney disease
Ureters and the Urethra
● The urinary system contains two
ureters that connect each kidney to the
bladder, but ureters do not demonstrate any
age-specific changes (Digiovanna, 2000).
● The urethra forms the canal that
leads from the bladder out of the body, and
also functions in response to excitatory or
inhibitory stimuli (Andersson & Arner, 2004;
Brading, Teramoto, Dass, & McCoy, 2001;
Digiovanna, 2000).
● In the male, the sphincter elevates
from the prostate encompassing the urethra
(Strasser et al., 1996). In the female, the
urethra extends about 3 to 4 cm. Males have
longer urethras; this is due to the urethra’s
anatomical location in the penis (Digiovanna,
2000; Kevorkian, 2004).
● The urethra can become partially or
totally blocked. In women, this can be due to
weakened muscles that cause the bladder or
vagina to fall out of position (prolapse). In
men, the urethra can become blocked by an
enlarged prostate gland.
Urinary Functional Changes with Age
Urination
Urination involves both the central and
peripheral nervous systems and requires
that bladder contraction and urethral
relaxation occur simultaneously (Andersson
THE REPRODUCTIVE SYSTEM
Female Reproductive Aging
Neuroendocrine Function
● Age-related changes in
neuroendocrine function include a change in
gonadotropin levels. This change occurs
5
before ovarian age-related changes,
implicating involvement of the
hypothalamus.
● Age-related changes in circulating
hormones (estrogen and progesterone).
Female System Changes
The Ovaries
● With age, the ovaries atrophy to
such a small size that they can become
impalpable during an exam (Smith, 1998).
● The number of ovarian follicles
decreases with age leading to a decline in
fertility. This decline usually begins in the
30s or 40s, and more rapid declines occur
after age 35 (Digiovanna, 2000; Hall, 2004;
Smith, 1998)
The Uterus
● Age-related decreases in uterine
endometrial thickening during menstrual
cycles occur as the result of decreased
estrogen and progesterone levels
(Digiovanna, 2000).
● The supporting ligaments attached to
the uterus are weakened with age, causing
the uterus to tilt backward (Digiovanna,
2000).
The Vagina
● With age, the vagina becomes
shorter and narrower and the vaginal walls
tend to thin and weaken (Smith, 1998).
● A loss of mucosal layers in the
vagina as well as a large decrease in
discharge causes a loss of lubrication.
● With age, vaginal pH levels also shift
from an acidic environment (3.8–4.2) toward
an alkaline environment (6.5–7.5).
● With all of these changes, vaginal
infections tend to increase with age
(Digiovanna, 2000).
Menopause
● For most women, menopause is
marked by the end of monthly menstruation
(also known as a menstrual period or
‘period’) due to loss of ovarian follicular
function.
● On average, menopause occurs
around 51 years of age, but the reproductive
changes described in this section begin
years earlier (Digiovanna, 2000; Hall, 2004;
Joffe et al., 2003).
● The hormonal changes associated
with menopause can affect physical,
emotional, mental, and social well-being.
● Pregnancy is still possible during
perimenopause. Contraception is
recommended to avoid unintended
pregnancy until after 12 consecutive months
without menstruation.
Male Reproductive Aging
Neuroendocrine Changes
● 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 (Kandeel,
Koussa, & Swerdloff, 2001; Morley et al.,
1997; Sampson et al., 2007; Schlegel &
Hardy, 2002).
● Testosterone levels in men decline
with age, but can show variability from small
decreases to major decreases depending on
health status (Seidman, 2003).
● A decline in testosterone is often
associated with decreases in libido,
spontaneous erections, sexual desire, and
sexual thoughts (Seidman, 2003).
Male System Changes
The Testes.
● In aging, the testes decrease in both
size and weight, but with high variability
among men (Digiovanna, 2000).
● In stages over time, the seminiferous
tubules show thinning of the walls and
narrowing of lumen. The lumen can become
so narrow that the seminiferous tubules
become blocked (Digiovanna, 2000).
Glands
● The seminal vesicles and the
bulbourethral glands demonstrate no age-
related changes (Digiovanna, 2000).
● 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
the reduced blood flow to the area
(Digiovanna, 2000).
● Benign prostatic hyperplasia (BPH),
which is dependent on age and androgen
production, remains very common in aging
males with approximately 50% of men
6
experiencing nodules by age 60 and around
90% by age 85 (Hollander & Diokno, 1998;
Letran & Brawer, 1999).

The Penis
● The penis begins to show fibrous
changes in erectile tissue around the urethra
starting in the 30s and 40s. By ages 55 to 60
years, increased fibrosis occurs in all erectile
tissues (Digiovanna, 2000).
● In addition to the increase in time to
obtain an erection, older males also require
more stimulation in order to maintain the
erection.

Andropause
● Andropause is classified as a decline
in testosterone levels and eventual
deficiency significant enough to cause
clinical symptoms (American Society for
Reproductive Medicine [ASRM].
● During andropause, when
testosterone becomes extremely low, a
recovery mechanism triggers increases in
FSH and LH in an attempt to elevate
testosterone levels (Hafez & Hafez, 2004).
● Diagnosis of andropause generally
occurs via measurement of total serum
testosterone levels;
● LH stimulates testosterone
production from the interstitial cells of the
testes (Leydig cells). FSH stimulates
testicular growth and enhances the
production of an androgen-binding protein
by the Sertoli cells, which are a component
of the testicular tubule necessary for
sustaining the maturing sperm cell.