Physical aspects of aging

Physical aspects of aging

• all postmaturational changes and the increasing vulnerability
individuals face as a result of these changes. The group of effects that
lead to a decreasing expectation of life with increasing age
• Ultimately…You Die: Leading cause among OA’s--heart disease 
Higher for older men than for older women
• Certain physical changes occur in everyone, as age advances. All the
systems of the body are affected directly or indirectly.
Age-Related Physiological Changes
• all people age, but not at the same rate
• At age 75 the average person, compared to age 30, 92% of brain
weight & 84% of basal metabolism & 70% kidney filtration rate &
43% of maximal breathing capacity .
Integumentary system
• Epidermal proliferation decreases, and the dermis becomes thinner.
Elastic fibers are reduced in number and collagen becomes stiffer.
Subcutaneous fat diminishes, particularly in the extremities, and less
vasodilation renders the body less able to produce or conserve body heat.
• These changes lead to lack of temperature and reduced tolerance to
temperature extremes (makes the person more sensitive to cold) which
increases the likelihood of hypothermia and hyperthermia (Capriotti &
Frizzell, 2015).
• Skin becomes less elastic.
• Fatty tissue layer is lost which makes the skin thin and sagging. Folds,
lines and wrinkles appear.
• The skin becomes drier and more susceptible to burns, injury, and
infection.
Integumentary system cont…
• There is decreased secretion from oil and sweat glands leading to the
development of dry skin.
• Skin is fragile and easily damaged.
• Skin breakdown and pressure sores develop.
• Nails become thick and tough. Feet usually have poor circulation, a nick
or cut lead to infection.
• Hair pigmentation may change and balding may occur; genetic factors
strongly influence these changes.
• When whitening or greying of hair occurs, men loose a lot of hair.
• Hair gets thin of both men and women, thinning occurs on the head, in
the pubic area and under the arms.
• Hair tends to be more dry due to decreased production of scalp oils.
Musculoskeletal system
• Intact musculoskeletal and neurologic systems are essential for the
maintenance of safe mobility, performance of activities of daily living
(ADLs) (basic personal care activities), and (complex skills such as
shopping, cooking, housework, using the telephone, managing
medications and finances, and being able to travel by car or public
transportation), thus allowing older adults to remain safe and live
independently in the community.
• Age related changes that affect mobility include alterations in bone
remodeling, leading to decreased bone density, loss of muscle mass,
deterioration of muscle fibers and cell membranes, and degeneration
in the function and efficiency of joints.
Musculoskeletal system cont…
• Without exercise, a gradual, progressive decrease in bone mass begins
before 40 years of age. The cartilage of joints also progressively
deteriorates in middle age.
• Degenerative joint disease is found in most adults older than 70 years,
and weight-bearing joint and back pain is a common complaint.
• Excessive loss of bone density results in osteoporosis, which leads to
potentially life-altering hip and vertebral fractures. Osteoporosis is
preventable.
• Muscles atrophy (shrink) and decrease in strength.
• Bone mass decreases, minerals especially calcium are lost from the
bone, causing decreased strength, brittleness and easy break ability.
• Vertebrae shorten, joints become stiff and painful.
• Hip and knee become slightly flexed (bent) leading to gradual loss of
height, loss of strength and decrease in mobility.
ARTHRITIS
• Osteoarthritis – Cause not known
• – Also referred to as degenerative joint disease
• – A gradual wearing away of joint cartilage that results in the
exposure of rough underlying bone ends
• Can do damage to internal ligaments
• – Most commonly associated w/ weight bearing jnts
• Rheumatoid Arthritis: A chronic, systemic, inflammatory disease of
connective tissue
• 2-3 times more common among women than men
• Currently viewed as an autoimmune disease
• May occur at any age –
• Most common onset between 20 & 50
• Osteopenia:
• Osteoporosis: – Gradual loss of bone that reduces skeletal mass
without disrupting the proportions of minerals & organic materials
• – For many, it is asymptomatic
• – Bones most critically involved: vertebra, wrist, hip
• Sarcopenia: Loss of muscle mass that occurs with aging
• – Cause not completely understood
• – Preventable/reversible with regular physical activity
Nervous system
• The structure, chemistry, and function of the nervous system change with advanced
age.
• Nerve cells in the brain decrease but the decrease is compensated by other neurons;
there is high variability among individuals and the quantity of neuronal loss varies in
different parts of the brain.
• Overall, the decreases contribute to a small loss of brain mass (Capriotti & Frizzell,
2015).
• Chemical changes include a decrease in the synthesis and metabolism of the major
neurotransmitters.
• Because nerve impulses are conducted more slowly, older people take longer to
respond and react (Miller, 2015).
• Neurologic changes can affect gait and balance, which may interfere with mobility
and safety.
Nervous system cont…
• Ageing causes a reduction in nerve cells.
• Nerve conduction becomes slower, reflexes are slower causing slower
response to stimuli.
• Slowed reaction time puts older adults at risk for falls and injuries, as
well as driving errors.
• Mental function may be threatened by physical or emotional stresses.
• A sudden onset of confusion may be the first symptom of an infection or
change in physical condition (e.g., pneumonia, urinary tract infection,
medication interactions, and dehydration).
Nervous system cont…
• There is a decreased blood flow to the brain causing dizziness and
increased risk for fall.
• There is a progressive loss of brain cells.
• All these affects the personality and mental function.
• Memory is shorter and forgetfulness increases.
• Confusion, dizziness and fatigue may occur. Memory of distant past is
better than recent past.
• Changes in sleep pattern occurs. Loss of energy and decreased blood
flow cause fatigue.
 Sleep
• Older adults have increased complaints about their sleep as they age, and as
many as 50% of those living at home and 65% of those living in nursing homes
complain of sleep disturbances .
• Many factors affect sleep quality in older adults including respiratory problems
during sleep, nocturia, pain, osteoarthritis, incontinence, menopause-related
problems, depression, loneliness, being bedridden, drug use, and living in
nursing homes (e.g., inadequate lighting, keeping light on during the night,
noises).
• Some of the consequences of poor sleep quality in older adults include cognitive
decline, increased risk of falls, daytime fatigue, and reduced physical and
mental health and health-related quality of life status.
Senses system
• Nearly half of older men and one third of older women report
difficulty hearing without a hearing aid.
• Most older adults have a decrease in visual acuity, a narrowing of the
visual field, and may have trouble seeing at night
• An uncompensated sensory loss negatively affects the functional
ability and quality of life of the older adult.
• However, assistive devices such as visual and hearing aids can
compensate for a sensory loss
Senses system cont…
• Touch, smell, taste, sight and hearing are affected by ageing.
• There is a reduced sensitivity to touch and pain.
• The ability to feel heat and cold is reduced, making the elderly
susceptible to injury.
• Smell and taste are decreased causing a decreased in the appetite.
• The number of taste buds decrease with ageing. Sweet and salty tastes
are lost first.
 Vision
• Many changes occur in the eyes.
• As new cells form on the outside surface of the lens of the eye, the lens become
yellow, rigid, dense, and cloudy, leaving only the outer portion of the lens elastic
enough to change shape (accommodate) and focus at near and far distances.
• In addition, the yellowing, cloudy lens causes light to scatter and sensitivity to
glare.
• The ability to distinguish colors decreases, particularly blue from green.
• The pupil dilates slowly and less completely because of increased stiffness of
the muscles of the iris, thus the older person takes more time to adjust when
going to and from light and dark settings and needs brighter light for close
vision.
 Vision cont…
• Eyelids become thinner and wrinkled.
• Tear secretion lessens.
• This can cause irritation to the eye by dust or air pollution.
• The pupils become smaller and less responsive to light, which cause
decreased vision at night or while in dark rooms.
• There is a reduction in clear vision, necessitating the need for eye glasses.
• Pathologic visual conditions are not a part of normal aging; however, the
incidence of eye disease (most commonly cataracts, glaucoma, diabetic
retinopathy, and age-related macular degeneration) increases in older
adults.
 Vision cont…
• 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.
People with fair skin and blue eyes may be at increased risk.
Hearing
• Auditory changes begin to be noticed at about 40 years of age.
Environmental factors, such as exposure to noise, medications, and
infections, as well as genetics, may contribute to hearing loss as much as
age-related changes.
• 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.
• Older adults often cannot follow conversation because tones of high-
frequency consonants (the sounds f, s, th, ch, sh, b, t, p) all sound alike.
Hearing cont…
• There is a atrophy (shrinking) of ear drums with ageing.
• The capacity for hearing pitched sound is lost.
• As this progresses, severe hearing loss occurs.
• Secretion of the wax decreases and also it becomes harder and thicker
with age. Wax buildup or other correctable problems may also be
responsible for hearing difficulties.
• Hearing loss may cause older adults to respond inappropriately,
misunderstand conversation, and avoid social interaction.
• This behavior may be erroneously interpreted as confusion.
 Taste and Smell
• The senses of taste and smell are reduced in older adults.
• Of the four basic tastes (sweet, sour, salty, and 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.
• 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., dust, pollen,
and smoke) contribute to the cellular damage.
Circulatory system
• Age-related changes reduce the efficiency of the heart and contribute
to decreased compliance of the heart muscle.
• These changes include myocardial hypertrophy, which changes left
ventricular strength and function; increased fibrosis and calcified
tissues that infiltrate muscles and conductive tissues causing 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.
 Circulatory system cont…
• Efficiency of the heart muscle decreases and the force of contraction of
the heart reduces.
• Elasticity of blood vessels reduces.
• A weakened heart has to work harder in order to pump blood through
the narrowed arteries.
• Calcium and fat deposits accumulate within arterial walls, and veins
become increasingly stiff and tortuous, increasing arterial resistance;
this leads to hypertension and increases the workload of the heart.
Respiratory system
• 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, may increase the demand for
oxygen and affect the overall function of other systems.
Respiratory system cont…
• Like cardiovascular diseases, respiratory diseases manifest more
subtly in older adults than in younger adults and do not necessarily
follow the typical pattern of cough, chills, and fever.
• Older adults may exhibit fatigue, lethargy, anorexia, dehydration, and
mental status changes
• Elasticity of lung tissue decreases and respiratory muscles weaken.
• Dyspnoea may occur with activity.
• There may be decreased strength for coughing and clearing the upper
airway.
 Digestive system
• There is a less production of saliva causing difficulty in swallowing.
• Lack of sense of tastes and smell decreases the appetite.
• The sense of smell diminishes as a result of neurologic changes and
environmental factors such as smoking, medications, and vitamin B12
deficiencies.
• The ability to recognize sweet, sour, bitter, or salty foods diminishes over time,
altering satisfaction with food.
• Salivary flow does not decrease in healthy adults; however, approximately 31%
to 37% of older adults may experience a dry mouth as a result of medications and
diseases.
• Difficulties with chewing and swallowing are generally associated with lack of
teeth and disease.
Digestive system cont…
• Gastric motility appears to slow modestly, which results in delayed
emptying of stomach contents and early satiety (feeling of fullness),
constipation and flatulence.
• Decreased secretion of digestive juices causes difficulty in digesting
fried and fatty foods.
• Diminished secretion of gastric acid and pepsin, seemingly the result
of pathologic conditions rather than normal aging, reduces the
absorption of iron, calcium, and vitamin B12.
Digestive system cont…
• Absorption of nutrients in the small intestine, particularly calcium and
vitamin D, appears to diminish with age.
• Functions of the liver, gallbladder, and pancreas are generally
maintained, although absorption and tolerance to fat may decrease.
• The incidence of gallstones and common bile duct stones increases
progressively with advancing years.
 Digestive system cont…
• Difficulty swallowing, or dysphagia, increases with age and is a major
health care problem in older patients.
• Normal aging alters some aspects of the swallowing function.
• In addition, dysphagia is a significant risk factor for the development of
aspiration pneumonia that can be life-threatening.
• Dysphagia is caused by interruption or dysfunction of neural pathways.
• It may also result from dysfunction of the striated and smooth muscles of
the gastrointestinal tract in patients with Parkinson disease.
• Aspiration of food or fluid is the most serious complication and can occur
in the absence of coughing or choking.
 Digestive system cont…
• Constipation is a common pathologic condition that affects many older
people as they age.
• Symptoms of mild constipation are abdominal discomfort and flatulence;
more serious constipation leads to fecal impaction that contributes to
diarrhea around the impaction, fecal incontinence, and obstruction.
• Predisposing factors for constipation include lack of dietary bulk,
prolonged use of laxatives, some medications, inactivity, insufficient
fluid intake, and excessive dietary fat.
• Ignoring the urge to defecate may also be a contributing factor.
Digestive system cont…
• Increasing age alters nutrient requirements; older adults require fewer
calories and a more nutrient-rich, healthy diet in response to
alterations in body mass and a more sedentary lifestyle.
• Recommendations include reducing fat intake while consuming
sufficient protein, vitamins, minerals, and dietary fiber for health and
prevention of disease.
• Decreased physical activity and a slower metabolic rate reduce the
number of calories needed by older adults to maintain an ideal
weight.
Digestive system cont…
• Age-related changes that alter pleasure in eating include a decrease in
taste and smell.
• Older adults are likely to maintain a taste for sweetness but require
more sugar to achieve a sweet flavor.
• They also may lose the ability to differentiate sour, salty, and bitter
tastes.
• Apathy, immobility, depression, loneliness, poverty, inadequate
knowledge, and poor oral health also contribute to suboptimal nutrient
intake.
• Budgetary constraints and physical limitations may interfere with food
shopping and meal preparation.
Urinary system
• The genitourinary system continues to function adequately in older
adults, although kidney mass is decreased, primarily because of a loss
of nephrons.
• However, the loss of nephrons does not typically become significant
until about 90 years of age, and changes in kidney function vary
widely; approximately one third of older adults show no decrease in
renal function (Tabloski, 2013).
Urinary system cont…
• Changes in renal function may be attributable to a combination of
aging and pathologic conditions such as hypertension.
• The changes most commonly seen include a decreased filtration rate,
diminished tubular function with less efficiency in reabsorbing and
concentrating the urine, and a slower restoration of acid– base balance
in response to stress.
• In addition, older adults who take medications may experience serious
consequences owing to decline in renal function because of impaired
absorption, decreased ability to maintain fluid and electrolyte balance,
and decreased ability to concentrate urine.
Urinary system cont…
• Reduction of blood flow to the kidneys affects the kidney function and
results in atrophy of kidneys.
• Concentrated urine is excreted due to lack of adequate fluid intake.
• Weakening of the bladder muscle can lead to incontinence of urine.
• urinary incontinence (i.e., urine leakage or problems controlling urine
flow). This condition should not be mistaken as a normal consequence
of aging (Weber & Kelley, 2014).
Urinary system cont…
• Costly and often embarrassing, it should be evaluated, because in
many cases it is reversible or can be treated.
• 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.
Reproductive system
• Sexuality and interest in sexual intercourse do not necessarily
decreases as a person ages. it is important to have a relationship that
meets the adult’s sexual needs.
• Sexual activity and mental health are the most important
predeterminants of sexual satisfaction.
• Sexual activity increases during 20s and 30s and begins to decline in
30s and 40s.
• Men experiences a decrease in the quality of semen and sperm after
40 years of age.
Reproductive system
• The inability to obtain an erection can occur at any age, but it becomes
more common in the middle age.
• Fertility problem for women increases sharply in their 40s as basal
metabolism declines. In women, after menopause, the rate of
osteoporosis increases.
• Older adults are interested in sexual activity as they were throughout
their life, these patterns remain constant in old age.
Reproductive system cont…
• Sexual activity declines with the loss of a partner, primarily for
women as a result of widowhood and for men as a result of poor
heath, erectile dysfunction, medications, and emotional factors.
• However, older adults with chronic illnesses may be able to have a
sexually active life as well.
• In older men, the testes become less firm but may continue to produce
viable sperm up to 90 years of age.
 Reproductive system cont…
• At about 50 years of age, production of testosterone begins to diminish
(Tabloski, 2013).
• Decreased libido and erectile dysfunction may develop but are more
likely to be associated with factors other than age-related changes.
• These risk factors include obesity, smoking, cardiovascular disease,
neurologic disorders, diabetes, respiratory disease, chronic pain, and
many medications (i.e., vasodilators, antihypertensive agents, and
tricyclic antidepressants) (Miller, 2015; Mola,2015).
 Reproductive system cont…
• Ovarian production of estrogen and progesterone declines with
menopause.
• Changes that occur in the female reproductive system include thinning of
the vaginal wall, along with a shortening of the vagina and a loss of
elasticity; decreased vaginal secretions, resulting in vaginal dryness,
itching, and decreased acidity; involution (atrophy) of the uterus and
ovaries; and decreased pubococcygeal muscle tone, resulting in a relaxed
vagina and perineum.
• Without the use of water-soluble lubricants, these changes may contribute
to vaginal bleeding and painful intercourse.
 Reproductive system cont…
• In both older men and women, it may take longer to become sexually
aroused, longer to complete intercourse, and longer before sexual
arousal can occur again.
• Although a less intense response to sexual stimulation and a decline in
sexual activity occurs with increasing age, sexual desire does not
disappear.
• Many couples are unaware of the causes of decreased libido or erectile
dysfunction and are often reluctant to discuss decreased sexual
function.
AND ON THAT HAPPY NOTE, WE MOVE
ON
What are the various theoretical explanations for
the CHANGES OF AGING?