B.

Sc DEGREE COURSE IN NURSING

MEDICAL AND SURGICAL NURSING ii

UNIT VII CARE OF THE ELDERLY

Topic

AGE RELATED CHANGES IN

VARIOUS SYSTEMS
 LEARNING OBJECTIVES

• List common age related changes at the physical

appearance and changes at the cellular level.
• Discuss the physiological changes in various body
systems, the sensory organs and immunity.
• State the aging related changes and their clinical
correlation.
• Identify signs of aging and their consequences on
functions of living and plan nursing interventions.
INTRODUCTION
Aging is a gradual, continuous process of natural change
that begins in Early adulthood and progressively decline many bodily functions
Old age differ in three ways:
1. Chronologic age: It is persons age in years. Health problem increases as

age increases.
2. Biological age: It refers to changes in body that occur as people age.
3. Psychological age: It is based on how people act and feel.
It is also important for nurses to assist older people in
adapting to the new roles and milestones that come with aging.
Moreover, nurses are instrumental in making elder people
feel cared for, accepted, guided, and understood.
Changes of aging
highly individualized
Changes are also different in
various body systems of the
individual
Changes are influenced by:–
Genetic factors,
environment,
diet,health,
stress, and
lifestyle choices
Commonly involve a decline in
functional reserve with reduced
response to stress
 CELLULAR CHANGES IN AGING

As the cell age, they function less.

As old cells die it is called apoptosis.
The reason for cell death are
1. They divide only a limited number of
times.
2. Damage to a cell causes its death
( Apoptosis )
3. Damage caused by harmful
substances like radiation, drugs,

sunlight.
 Respiratory System: Changes
• Respiratory efficiency is reduced with age as muscles of respiration
become less flexible.
• Decrease in functional capacity results in dyspnea on exertion or
stress.
• Effectiveness of cough mechanism lessens,
• Increasing risk of lung infection.

Bronchial ciliary function↓ Dyspnoea↑ Mucous accumulation ↑

Alveolar exchange surface ↓ Dead space ↑

 Cardiovascular Changes in Aging

• Heart rate slows.

• Blood flow to all organs decreases.
• Arterial elasticity decreases, causing increased rise in blood pressure.
• Veins dilate and superficial vessels become more prominent
Cardiac output and recovery time decline.
• The heart requires more time to return to normal rate after a rate
increase in response to activity
 Nervous System Changes
• Neurons in the brain decrease in number.
• Cerebral blood flow and oxygen utilization decreases
• Decreased dopamine and acetylcholine activity
• Time required to carry out motor and sensory tasks requiring speed,
coordination, balance, and fine-motor hand movements increase
• Short-term memory may somewhat diminish without much change in long-
term memory.
• Night sleep disturbances occur due to more frequent and longer wakeful
periods.
• Deep-tendon reflexes decrease, although reflexes at the knees remain fairly
intact.

• Dementia - losses in intellectual functioning.

Memory Decline -Depression or Dementia
• Normal Age-Related Memory Decline
• Depression-Related Memory Problems
• Dementia-Related Memory Problems
Gastrointestinal changes
reduced salivary secretion,
decreased esophageal and stomach motility,
decreased stomach emptying time,
decreased production of intrinsic factor, and
decreased intestinal absorption, motility, and blood flow.
 In addition, tooth enamel becomes harder and more brittle,
making teeth more susceptible to fractures.
• Health promotion teaching for elders include preventive dental
care and effective oral hygiene, appropriate diet and sufficient
fluid intake, regular bowel maintenance, and importance of
colorectal cancer screening.
 SENSORY CHANGES - VISION

• The lens becomes less pliable

• Accommodation of pupil size decreases
• Vitreous humor changes its consistency, causing blurred vision
• Lacrimal glands secrete less fluids causing dryness and itching
• Lens yellows causing distorted color perception
 CHANGES IN EYES
• Visual deficits –
1. Loss of near vision.
2. Need for brighter light.
3. Changes in color perception

Appearance of eyes changes in several ways:

1. The whites (sclera) of the eyes may turn slightly yellow or brown.
2. A gray -white ring may appear on the surface of the eye. The ring is
made of calcium and cholesterol salts.
3. The lower eyelid may hang away from the eyeball because the
muscles around the eye weaken and the tendons stretch.
4. The eye may appear to sink into the head because the amount of fat
around the eye decreases
 Mouth and Nose

Gum recedes slightly. Teeth loss occur. Salivation decreases

The ability to taste and smell gradually diminish.
 As people age, the taste buds on the tongue decrease in
sensitivity and affects mostly tasting sweet and salt more than
bitter and sour.
The ability to smell diminishes because the lining of nose
becomes thinner and drier and the nerve ending in the nose
deteriorate. With aging the nose tends to lengthen and enlarge
and the tip tends to droop.
CHANGES IN HEARING
The pinna becomes less flexible, hair cells in inner ear
stiffen and atrophy, and cerumen (earwax) increases
Number of neurons in the cochlea decrease and blood
supply lessens, causing degeneration resulting in Age-
associated hearing loss (presbycusis)
The words become harder to understand.
Hearing high-pitched sounds becomes more difficult
Gradually, hearing lower pitches also becomes more
difficult
Loss of tone discrimination
Musculoskeletal System Changes

• Bone demineralization occurs, causing skeletal instability

and shrinking of intervertebral discs.
- The most affected bones are thigh bone (femur), end or arm
bones at wrist (radius and ulna), Bones of the spine (vertebrae)
-The older people becomes shorter because the vertebrae
becomes less dense due to loss of fluid in the cushion of tissues and
becomes thinner
- The joints undergo degenerative changes, resulting in
stiffness, pain, and loss of range of motion
Bones become weaker and more likely to break. In women after
menopause, loss of bone density speeds up because Oestrogen is
produced less. The amount of calcium in body reduced because the
absorption from food decreases.
 Muscle Changes in Aging
Physiologic changes
↓ muscle fibre
↓muscle strength except
diaphragm
leg weaker than arm
↑ fat infiltration
↓ innervation (motor unit)
↑ fatigability
↓ basal metabolic rate by 4 %
Clinical correlation
sarcopenia
intact diaphragmatic activity
tend to fall
↑ fat to lean body mass ratio
poor fine movement
↓ muscle endurance
↓nutritional % requirement
Immune system changes
• The cells of the immune system act more slowly.
• This slowdown of immune system causes:
1. Cancer is more common among older people.
2. Vaccines tend to be less protective in older people.
3. Infections such as pneumonia and influenza, are more common
among older people and result in death more often.
4. Allergy symptoms may become less severe.
Urinary System Changes
• Nephrons in the kidneys decrease in number and function.
• Glomerular filtration decreases.
• Blood urea nitrogen increases.
• Sodium-conserving ability diminishes.
• Bladder capacity decreases its ability to completely empty
diminish
• Renal function increases when the older client lies down.
• Bladder and perineal muscles weaken.
• Incidence of stress incontinence increases in older females.
• Prostate may enlarge in older males, causing urinary frequency
and dribbling.
 REPRODUCTIVE ORGAN CHANGES

• The effects of aging on sex hormone levels are more obvious in

women than in men.
• In women, most of these effects are related to menopause
(termination of Menstruation). The decrease in female hormone
levels causes the ovaries and uterus to shrink. The tissues of the
vagina become thinner, drier, and less elastic .( called Atrophic
vaginitis)
• Men : In men, changes in sex hormone levels are less sudden. Levels
of male hormone testosterone decreases, resulting in lesser sperm
production
 Genitals

• There is gradual degenerative change in the gonads of men. However,

testosterone production continues albeit decrease in number of
sperms produced.
• Changes in the gonads of older women result from diminished
secretion of ovarian hormones. However, shrinking of uterus and
ovaries go unnoticed.
• Other changes are obvious, like breast atrophy and reduced
lubricating vaginal secretions.
 Integumentary system Changes
The skin tends to be thinner, less elastic, drier and finely wrinkled.
The body produces less collagen and elastin. so, the skin tears more
easily.
 The fat layer under the skin thins, this causes wrinkles to appear, and
tolerance to cold decreases.
 The number of sweat glands and blood vessels decreases, and blood
flow to deep layer of skin decreases.
The number of pigment-producing cells (melanocytes) decreases. As
a result, the skin has less protection against ultraviolet radiation
causes large, brown spots appear on skin.
 The skin is less able to form vitamin D when it is exposed to sunlight.
Thus, the risk of vitamin D deficiency increases.
 ENDOCRINE AND METABOLIC CHANGES

CHANGES IMPLICATIONS

• Impaired glucose homeostasis • DM

• Reduced thyroxine clearance
• Increase ADH, reduce renin and
aldosterone
• Reduce testosterone production
• Reduce vitamin D absorption
and activation
• Thyroid dysfunction
• Metabolic abnormalities
(Low Na+, high K+)
• Impotence
• fracture and osteopenia
 AUTONOMIC NERVOUS SYSTEM CHANGES

• Decreased temperature regulation

• Decreased reaction time and coordination
• Decreased sensitivity to baroreceptors
EFFECTS OF AGE ON ANS
-constipation
-dry eyes and frequent eye infections
-orthostatic hypotension
 CONCLUSION
• Older adults are the fastest growing segment of the population. Every
nurse undoubtedly will at some point be challenged to meet the
unique needs of the geriatric clients
• A holistic competency is demanded from the nursing professional in
the areas of assessment, diagnosing, planning, implementing and
evaluating the care of this special population in all areas of setting
• Nurses must understand the normal aging processnand be prepared
to care for clients who comes under their care.
 REFERENCES

• Joyce M. Black (2018) MEDICAL-SURGICAL NURSING 10TH EDITION

Elsevier publications
• Lewis-Bucher. MEDICAL SURGICAL NURSING –Assessment and
management of clinical problems, 11th edition Elsevier Publications
• https://www.nursingtimes.net/roles/older-people-nurses-roles/anato
my-and-physiology-of-ageing
• https://nurseslabs.com/aging-body-systems-explaining-physiological-a
ging/
• https://www.slideshare.net/ProfessorShep/common-aging-changesfal
l-2013-abridged