Physical aspects of aging/ Biological

Intrinsic Aging ( From within the person ) refers to those changes caused by
the normal aging process that are genetically programmed and essentially
universal within a species.

Cellular and extracellular changes that occur with aging cause functional
decline and measurable changes in physical appearance, including changes in
shape and body make up.
Physical aspects of aging

Cellular aging and tissue deficits also diminished the body’s ability to maintain
homeostasis and prevent organ system from functioning at full efficiency. As
cells become less able to replace themselves, They accumulate a pigment
known as LIPOFUSCIN.. A degradation of elastin and collagen causes
connective tissue to become stiffer and less elastic.. These changes result in
diminished capacity for organ function and increased vulnerability to disease
and stress.
Physical aspects of aging

Age-related changes in the hematopoietic system influence RBC production,

leading to increased rates of anemia.

When assessing the physical aspects of aging, nurses should know that tactile
sensation is reduced and changes in the ability to sense pressure, pain, and
temperature all lead to physical symptoms.
1. Sensory System:
Vision:

PRESBYOPIA ---- is physiological insufficiency of accommodation with the aging

of the eye that results in progressively worsening ability to focus clearly on
close objects. Symptoms include difficulty reading small print, having to hold
reading material farther away, headache and eyestrain.

Usually begins in the fifth decade of life and requires the person to wear
reading glasses to magnify objects.
Changes in vision

Age-related macular degeneration is the primary cause of vision loss in older

adults. Macular degeneration does not affect peripheral vision, which means
that it does not cause blindness. However, it affects central vision, color
perception, and fine detail, greatly affecting common visual skills such as
reading, driving, and seeing faces.

Risk factors include: Sunlight exposure, cigarette smoking, and heredity.

Changes in vision

Age-related macular degeneration is the primary cause of vision loss in older

adults. Macular degeneration does not affect peripheral vision, which means
that it does not cause blindness. However, it affects central vision, color
perception, and fine detail, greatly affecting common visual skills such as
reading, driving, and seeing faces.

Risk factors include: Sunlight exposure, cigarette smoking, and heredity.

Changes in vision:

People with fair skin and blue eyes maybe at increased risk.

Sunglasses and hats with visors provide some protection, and stopping
smoking is paramount in preventing the disease.

Laser photocoagulation and photodynamic therapy are commonly used.

( No definite treatment or no cure that restores vision )

Vision

Arcus Senilis----- is a half-circle of gray, white or yellow deposits in the outer

edge of your cornea, the clear outer layer on the front of your eye. It’s made of
fat and cholesterol deposits. It’s common in older adults and is usually caused
by aging.

Cataract -----is a dense, cloudy area that forms in the lens of the eye. Proteins
in the eye form clumps that prevent the lens from sending clear images to the
retina.
Vision

Glaucoma ----- is a group of eye conditions that damage the optic nerve, the
health of which is vital for good vision. This damage is often caused by an
abnormally high pressure in your eye. One of the leading causes of blinding
for people over the age of 60.
 Health promotion strategies- impaired vision
Wear eyeglasses and use sunglasses outdoors

Avoid abrupt changes from dark to light

Use adequate lighting with area lights and nightlights

Use large print books, use magnifier for reading

Avoid night driving

Use contrasting colors for color coding

Avoid glare of shiny surfaces and direct sunlight

Hearing:

Presbycusis -----is a gradual sensorineural loss that progresses from the loss of
the ability to hear high-frequency tones to a generalized loss of hearing. It is
attributed to irreversible inner ear changes.

A properly prescribed and fitted hearing aid may be useful in reducing some
types of hearing deficits.
Health promotion strategies- hearing
Recommend a hearing examination
Reduce background noise
Face person, enunciate clearly, speak with a low-pitched
voice
Use non-verbal cues
Rephrase questions
SMELL:

Changes in the sense of smell generally greater than the loss of taste, are
related to cell loss in the nasal passages and in the olfactory bulb in the brain.

Environmental factors such as long term exposure to toxins ( e.g. pollen, and
smoke ) contribute to cellular damage.
TASTE:

The sense of taste is also reduced in older adults:

Of the four basic tastes ( sweet, sour, salty, bitter ) Sweet tastes are particularly
dulled in older adults. Blunted taste may contribute to the preference for
salty, highly seasoned foods, but herbs, onions, garlic, and lemon can be used
as substitutes for salt to flavor food.
Health promotion strategies

Encourage use of lemon, spice, herbs

Recommend smoking cessation
2. Changes in the nervous system:
Homeostasis is difficult to maintain with aging, but older people
have a tremendous ability to function adequately, retaining their
cognitive and intellectual abilities in the absence of pathologic
changes. However, normal aging changes in the nervous system
can affect all parts of the body.

The structure, chemistry, and function of the nervous system

change with advanced age.
Nervous system:
Chemical changes include a decrease in the synthesis and
metabolism of the major neurotransmitters. Because nerve
impulse are conducted more slowly, older people take
longer to respond and react.

The autonomic nervous system performs less efficiently,

and postural hypotension, may occur.
Nervous system:
The nurse must advise older adults to allow a longer time to
respond to a stimulus and to move more deliberately. Adequate
nutrition and absorption of vitamin B12 is important for
neurologic health.

Nurses should advice older adults about proper nutrition and

intake of vitamin B12 especially for older adults who follow a
vegetarian diet. Slow reaction time puts older adults at risk for
falls and injuries.
Health promotion strategies- Nervous system
Enhance sensory stimulation

With hospitalization, Encourage visitors

With sudden confusion, look for a cause

Encourage slow rising from a resting position and practice fall

prevention measure

Pace teaching
3. CARDIOVASCULAR CHANGES:
Heart disease is the leading cause of death in older adults.

Careful assessment of older adults is necessary because they

often present with different symptoms than those seen in
younger patients.

Complicating the assessment is the fact that many older

patients have more than one underlying disease.
Cardiovascular changes:
Orthostatic and postprandial hypotension may be a concern as well because of
decreased BAROREFLEX sensitivity and risk factors such as medications.
Therefore, it is important to assess blood pressure in twi positions.

A patient experiencing hypotension should be counseled to rise slowly ( from a

lying, to s sitting, to a standing position.)

Avoid Straining when having a bowel movement, and consider having 5 or 6

small meals each day, rather 3, to minimize the hypotension that can occur
 AGING CHANGES IN THE HEART AND BLOOD VESSELS:

Some changes in the heart and blood vessels normally occur with age. However, many other changes
that are common with aging are due to modifiable factors. If not treated, these can lead to heart
disease.

BACKGROUND

The heart has two sides. The right side pumps blood to the lungs to receive oxygen and get rid of
carbon dioxide. The left side pumps oxygen-rich blood to the body.

Blood flows out of the heart through arteries, which branch out and get smaller and smaller as they go
into the tissues. In the tissues, they become tiny capillaries.

Capillaries are where the blood gives up oxygen and nutrients to the tissues, and receives carbon
dioxide and wastes back from the tissues. Then, the vessels begin to collect together into larger and
larger veins, which return blood to the heart.
CHANGES IN THE HEART:

● The heart has a natural pacemaker system that controls the heartbeat. Some of the pathways of
this system may develop fibrous tissue and fat deposits. The natural pacemaker (the SA node)
loses some of its cells. These changes may result in a slightly slower heart rate.
● A slight increase in the size of the heart, especially the left ventricle occurs in some people. The
heart wall thickens, so the amount of blood that the chamber can hold may actually decrease
despite the increased overall heart size. The heart may fill more slowly.
● Heart changes cause the ECG of a normal, healthy older person to be slightly different than the
ECG of a healthy younger adult. Abnormal rhythms (arrhythmias), such as atrial fibrillation, are
more common in older people. They may be caused by heart disease.
● Normal changes in the heart include deposits of the "aging pigment," lipofuscin. The heart
muscle cells degenerate slightly. The valves inside the heart, which control the direction of blood
flow, thicken and become stiffer. A heart murmur caused by valve stiffness is fairly common in
older people.
CHANGES IN THE BLOOD VESSELS:

● Receptors called baroreceptors monitor the blood pressure and make changes to help
maintain a fairly constant blood pressure when a person changes positions or is doing other
activities. The baroreceptors become less sensitive with aging. This may explain why many
older people have orthostatic hypotension, a condition in which the blood pressure falls
when a person goes from lying or sitting to standing. This causes dizziness because there
is less blood flow to the brain.
● The capillary walls thicken slightly. This may cause a slightly slower rate of exchange of
nutrients and wastes.
● The main artery from the heart (aorta) becomes thicker, stiffer, and less flexible. This is
probably related to changes in the connective tissue of the blood vessel wall. This makes
the blood pressure higher and makes the heart work harder, which may lead to thickening
of the heart muscle (hypertrophy). The other arteries also thicken and stiffen. In general,
most older people have a moderate increase in blood pressure
CHANGES IN BLOOD:

● The blood itself changes slightly with age. Normal aging causes a
reduction in total body water. As part of this, there is less fluid in the
bloodstream, so blood volume decreases.
● The speed with which red blood cells are produced in response to
stress or illness is reduced. This creates a slower response to blood
loss and anemia.
● Most of the white blood cells stay at the same levels, although certain
white blood cells important to immunity (neutrophils) decrease in their
number and ability to fight off bacteria. This reduces the ability to resist
infection.
EFFECT OF CHANGES:

Normally, the heart continues to pump enough blood to supply all parts of the
body. However, an older heart may not be able to pump blood as well when you
make it work harder.

Some of the things that make your heart work harder are:

● Certain medicines
● Emotional stress
● Physical exertion
● Illness
● Infections
● Injuries
COMMON PROBLEMS RELATED TO CARDIOVASCULAR CHANGES:

● Angina (chest pain caused by temporarily reduced blood flow to the heart muscle), shortness of breath with
exertion, and heart attack can result from coronary artery disease.
● Abnormal heart rhythms (arrhythmias) of various types can occur.
● Anemia may occur, possibly related to malnutrition, chronic infections, blood loss from the gastrointestinal tract,
or as a complication of other diseases or medicines.
● Arteriosclerosis (hardening of the arteries) is very common. Fatty plaque deposits inside the blood vessels
cause them to narrow and totally block blood vessels.
● Congestive heart failure is also very common in older people. In people older than 75, congestive heart failure
occurs 10 times more often than in younger adults.
● Coronary artery disease is fairly common. It is often a result of arteriosclerosis.
● High blood pressure and orthostatic hypotension are more common with older age. Older people on blood
pressure medicines need to work with their doctor to find the best way to manage their high blood pressure.
This is because too much medicine may cause low blood pressure and could lead to a fall.
● Heart valve diseases are fairly common. Aortic stenosis, or narrowing of the aortic valve, is the most common
valve disease in older adults.
● Transient ischemic attacks (TIA) or strokes can occur if blood flow to the brain is disrupted
Other problems with the heart and blood vessels include the following:

● Blood clots
● Deep vein thrombosis
● Thrombophlebitis
● Peripheral vascular disease, resulting in intermittent pain in the legs
when walking (claudication)
● Varicose veins
● Aneurysms may develop in one of the major arteries from the heart or
in the brain. Aneurysms are an abnormal widening or ballooning of a
part of an artery due to weakness in the wall of the blood vessel. If an
aneurysm bursts it may cause bleeding and death.
PREVENTION

● You can help your circulatory system (heart and blood vessels). Heart disease risk factors that you have some control over
include high blood pressure, cholesterol levels, diabetes, obesity, and smoking.
● Eat a heart-healthy diet with reduced amounts of saturated fat and cholesterol, and control your weight. Follow your health
care provider's recommendations for treating high blood pressure, high cholesterol or diabetes. Reduce or stop smoking.
● Men between the ages of 65 to 75 who have ever smoked should be screened for aneurysms in their abdominal aorta.Get
more exercise:
● Exercise may help prevent obesity, and it helps people with diabetes control their blood sugar.
● Exercise may help you maintain your abilities as much as possible, and it reduces stress.
● Moderate exercise is one of the best things you can do to keep your heart, and the rest of your body, healthy. Consult with
your provider before beginning a new exercise program. Exercise moderately and within your capabilities, but do it
regularly.
● People who exercise often have less body fat and smoke less than people who do not exercise. They also tend to have
fewer blood pressure problems and less heart disease.
● Have regular check-ups for your heart:
● Have your blood pressure checked every year. If you have diabetes, heart disease, kidney problems, or certain other
conditions, your blood pressure may need to be monitored more closely.
● If your cholesterol level is normal, have it rechecked every 5 years. If you have diabetes, heart disease, kidney problems,
or certain other conditions, your cholesterol may need to be monitored more closely
Cardiovascular changes:

After a large meal. Extremes in temperature,

including hot showers and whirlpool baths
should be avoided.
Health promotion strategies- cardiovascular
Exercise Regularly

Pace activities

Avoid Smoking

Eat a low fat - low salt diet

Participate in stress-reduction activities

Check blood pressure regularly

Adherence to medications Weight control

5. Respiratory changes
The respiratory system compensate well for the functional
changes of aging. In general, healthy, non smoking older
adults show very little decline in respiratory function.

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.
Respiratory changes:
Lung mass decreases and residual volume increases.
Smoking is the most significant risk factor for
respiratory disease and older adults have a higher rate
of smoking. Therefore, a major focus of health
promotion activities should be on smoking cessation
and avoidance of environmental smoke.
 Health promotion strategies..Respiratory
Exercise Regularly

Avoid Smoking

Take adequate fluids to liquify secretions

Receive yearly Influenza immunization and pneumonia

vaccine at 65 years age

Avoid exposure to upper respiratory tract infections

 6. Genitourinary system changes

Genitourinary or urogenital system--- are the organs

of the reproductive system and the urinary system.
These are grouped together because of their
proximity to each other, their common
embryological origin and the use of common
pathways, like the male urethra.
Health promotion strategies
Reproductive system ( Female )
May require vaginal estrogen replacement
Gynecology/Urology follow-up
Use a lubricant with sexual intercourse
Health promotion strategies
Renal/ Urinary

Drink adequate fluids but limit drinking in evening

Avoid bladder irritants ( caffeinated beverages, alcohol, artificial sweeteners)

Do not wait long periods between voiding

Empty bladder completely when voiding

Wear easily manipulated clothing

Consider urologic workup

For WOMEN: perform pelvic floor muscle exercises, preferably learned via biofeedback
7. Urinary system:
Kidney mass is decreased, primarily because of loss of
nephrons, However, the loss of nephron does not typically
become significant until about 90 years of age and changes in
the kidney function vary widely; approximately ⅓ of older
adults show no decrease in renal function.

Changes in renal function may be attributed to a combination

of aging pathologic conditions such as hypertension.
Urinary system changes:
The changes most commonly seen include:

A .Decreased filtration rate.

B. Diminished tubular function with less efficiency in

reabsorbing and concentrating urine.

C. Slower restoration of acid-base balance in response to

stress.
Certain genitourinary disorders more common
in older adults:
1. Urinary incontinence--- i.e.; urine leakage, or problems of
controlling urine flow. This condition should not be mistaken as
a normal consequence of aging. Costly and often
embarrassing, it should be evaluated, because in many cases it
is reversible or can be treated.
2. Benign prostatic hyperplasia - ( enlarged prostate gland ).. A
common finding in older men, causes a gradual increase in
urine retention and overflow incontinence.
Changes in the urinary tract increase the
susceptibility to urinary tract infections.
Adequate consumption of fluids is an important
nursing intervention that reduces the risk of bladder
bladder infections and also helps decrease urinary
incontinence.
 7. MUSCULOSKELETAL SYSTEM CHANGES
Intact musculo-skeletal and neurologic system are essential for the
maintenance of safe mobility, performance of activities of daily living.

( ADL )

ADL -- ( basic personal care activities )

Age-related changes that affect mobility:

1. Alterations in bone remodeling, leading to decreased bone density.

2. Loss of muscle mass
Musculo-skeletal system.
3. Deterioration of muscle fibers and cell membranes.
4. Degeneration in the function and efficiency of
joints.
- Height reduces ( in most of persons above 70 years
height decreases to 2 inches )
- Kyphosis, swelling in joints.
8. INTEGUMENTARY SYSTEM:
- The functions of the skin include protection, temperature
regulation, sensation and excretion.
- Aging can interrupt all functions of the skin and affect appearance.
- Epidermal proliferation decreases, and the dermis becomes
thinner.
- Elastic Fibers are reduced in number and collagen stiffer.
- Subcutaneous fat diminishes, particularly in the extremities, and
less vasodilation renders the body less able to produce or
conserve body heat.
Integumentary
- Loss of resiliency with wrinkling and sagging of the skin,
The skin becomes drier and more susceptible to burns,
injury and infection.
- Hair pigmentation may change and balding may occur:
Genetic factors strongly influence these changes. These
changes in the integument reduce tolerance to
temperature extremes and sun exposure.
- Lifestyle practices are likely to have a large impact on skin
changes.
 Integumentary:
Strategies to promote healthy skin function:

1. Not smoking
2. Avoiding exposure to the sun.
3. Using a sun protection factor of 15 or higher.
4. Wearing protective clothing,
5. Using emollient skin cream containing petrolatum or mineral oil.
6. Avoiding hot soaks in the bathtub.
7. Maintaining optimal nutrition and hydration.
9. Immune system changes

- Ability to prevent diseases or

resistance power decreases
- Probability of infection increases.
Gastrointestinal System
Changes:

Decreased sense of thirst, smell, and taste

Decreased salivation

Difficulty swallowing food

Delayed esophageal and gastric emptying

Reduced gastrointestinal motility

 Assessment findings
Risk of dehydration, electrolyte imbalances, and poor nutritional
intake

Complaints of dry mouth

Complaints of heartburn, fullness, indigestion, constipation,

flatulence and abdominal discomfort

Risk for aspiration

Health promotion strategies
Use ice chips, mouthwash, brush, floss, and massage gums daily

Receive regular dental care

Eat, small frequent meals

Sit up while and after eating and avoid heavy activity after eating

Limits antacids

EAt a high fiber-low fat diet

Limit laxatives

Toilet regularly

Drink adequate fluids