Common Aging Changes

Introduction
• Living is a process of continual change. The continuation of change
into later life is natural and expected.
• The type, rate, and degree of physical, emotional, psychological, and
social changes experienced during life are highly individualized; such
changes are influenced by genetic factors, environment, diet, health,
stress, lifestyle choices, and numerous other elements.
• The result is not only individual variations among older persons but
also differences in the pattern of aging of various body systems within
the same individual.
 CHANGES TO THE BODY
Cells
• The number of cells is gradually reduced, leaving fewer functional
cells in the body.
• Lean body mass is reduced, whereas fat tissue increases until the
sixth decade of life.
• Bone mass are decreased.
• Extracellular fluid remains fairly constant, whereas intracellular fluid is
decreased, resulting in less total body fluid. This decrease makes
dehydration a significant risk to older adults.
Physical Appearance
• The more noticeable effects of the aging process begin to appear
after the fourth decade of life.
• Men experience hair loss, and both sexes develop gray hair and
wrinkles.
• Elongated ears, a double chin, and baggy eyelids are among the more
obvious manifestations of the loss of tissue elasticity throughout the
body.
• The loss of subcutaneous fat content, responsible for the decrease in
skinfold thickness, is also responsible for a decline in the body’s
natural insulation, making older adults more sensitive to cold
temperatures.
• Stature decreases, resulting in a loss of approximately 2 inch. in height
by 80 years of age. Body shrinkage is due to reduced hydration, loss of
cartilage, and thinning of the vertebrae.
Respiratory System
• Connective tissue changes cause a relaxation of the tissue at the lower
edge of the septum; the reduced support causes the tip of the nose to
slightly rotate downward.
• Septal deviations can occur, as well. Mouth breathing during sleep
becomes more common as a result, contributing to snoring and
obstructive apnea.
• The submucosal glands have decreased secretions, reducing the ability to
dilute mucus secretion.
• The calcification of costal cartilage makes the trachea and rib cage more
rigid; the anterior–posterior chest diameter increases, often
demonstrated by kyphosis; and thoracic inspiratory and expiratory
muscles are weaker.
Respiratory changes that occur with aging.
• The sum of these changes causes less lung expansion, insufficient
basilar inflation, and decreased ability to expel foreign or
accumulated matter.
• The lungs exhale less effectively, thereby increasing the residual
volume.
• Immobility can further reduce respiratory activity.
• With less effective gas exchange and lack of basilar inflation, older
adults are at high risk for developing respiratory infections.
• Endurance training can produce a significant increase in lung capacity
of older adults.
Cardiovascular System
• Heart size does not change significantly due to age; rather, enlarged
hearts are associated with cardiac disease, and marked inactivity can
cause cardiac atrophy.
• There is a slight left ventricular hypertrophy with age, and the aorta
becomes dilated and elongated.
• There may be incomplete valve closure resulting in systolic and
diastolic murmurs.
• Extra systolic sinus bradycardia and sinus arrhythmia can occur in
relation to irritability of the myocardium.
• The heart muscle loses its efficiency and contractile strength, resulting
in reduced cardiac output under conditions of physiologic stress.
• Pacemaker cells become increasingly irregular and decrease in
number.
• Relaxation time of the left ventricle are prolonged; the cycle of
diastolic filling and systolic emptying requires more time to be
completed.
Cardiovascular changes that occur with aging
• adults adjust to changes in the cardiovascular system quite well; they
learn that it is easier and more comfortable for them to take an
elevator rather than the stairs, to drive instead of walking a long
distance.
• Tachycardia in older people will last for a longer time.
• Stroke volume may increase which results in elevated blood pressure,
although the blood pressure can remain stable as tachycardia
progresses to heart failure in older adults.
Gastrointestinal System
• Tooth enamel becomes harder and more brittle with age.
• Tooth loss is not a normal consequence of growing old, but poor
dental care, diet, and environmental influences
• After 30 years of age, periodontal disease is the major reason for
tooth loss.
• The tooth brittleness of some older people creates the possibility of
aspiration of tooth fragments.
• Taste sensations become less acute with age because the tongue
atrophies.
• The sweet sensations on the tip of the tongue tend to suffer a greater
loss than the sensations for sour, salt, and bitter ‫مر‬flavors.
• Older adults produce approximately one third of the amount of saliva
they produced in younger years.
• Salivary ptyalin is decreased, interfering with the breakdown of
starches.
• Diminished muscle strength and tongue pressure can interfere with
mastication and swallowing.
• Esophageal motility is affected by age. The esophagus tends to
become slightly dilated, and esophageal emptying is slower.
• Relaxation of the lower esophageal sphincter may occur; when
combined with the older person’s weaker gag reflex and delayed
esophageal emptying, aspiration becomes a risk.
• The stomach is believed to have reduced motility in old age. The
gastric mucosa atrophies.
• Hydrochloric acid and pepsin decline with age; the higher pH of the
stomach contributes to an increased incidence of gastric irritation in
the older population.
• Some atrophy occurs throughout the small and large intestines, and
fewer cells are present on the absorbing surface of intestinal walls.
• Fat absorption is slower, and dextrose is more difficult to absorb.
Absorption of vitamin B, vitamin B12, vitamin D, calcium, and iron is
faulty.
• Normal aging does not interfere with the motility of feces through the
bowel, although other factors that are highly prevalent in late life do
contribute to constipation.
• An age related loss of tone of the internal sphincter can affect bowel
elimination. Slower transmission of neural impulses to the lower
bowel reduces awareness of the need to evacuate the bowels.
• With advancing age, the liver has reduced weight and volume but this
seems to produce no ill effects. Liver function tests remain within a
normal range.
• The pancreatic ducts become dilated and distended.
Urinary System
• The renal mass becomes smaller with age, which is attributable to a
cortical loss rather than a loss of the renal medulla.
• Renal tissue growth declines and atherosclerosis may promote
atrophy of the kidney.
• These changes can have a profound effect on renal function, reducing
renal blood flow and the glomerular filtration rate by approximately
one half.
• There is less efficient tubular exchange of substances, conservation of
water and sodium, and suppression of antidiuretic hormone secretion
in the presence of hypo-osmolality.
• Older kidneys have less ability to conserve sodium in response to
sodium restriction, these changes can contribute to hyponatremia
and nocturia.
• The decrease in tubular function also causes decreased reabsorption
of glucose.
• Urinary frequency, urgency, and nocturia accompany bladder changes
with age. Bladder muscles weaken and bladder capacity decreases.
• Emptying of the bladder is more difficult; retention of large volumes
of urine may result.
• Although urinary incontinence is not a normal outcome of aging,
some stress incontinence may occur because of a weakening of the
pelvic diaphragm, particularly in multiparous women.
Reproductive System
• The structural changes can cause a reduction in sperm count in some
men.
• There is some atrophy of the testes.
• Prostatic enlargement occurs in most older men, which causes problems
with urinary frequency.
• The vaginal environment is more alkaline in older women and is
accompanied by a change in the type of flora and a reduction in
secretions.
• The cervix atrophies and becomes smaller.
• The uterus shrinks and the endometrium atrophies.
• The ligaments supporting the uterus weaken and can cause a backward
tilting of the uterus.
• The fallopian tubes atrophy and shorten with age, and the ovaries
atrophy and become thicker and smaller.
• Estrogen depletion also causes a weakening of pelvic floor muscles,
which can lead to an involuntary release of urine when there is an
increase in intra-abdominal pressure.
Musculoskeletal System
• Muscle fibers atrophy and decrease in number, with fibrous tissue
gradually replacing muscle tissue.
• Overall muscle mass, muscle strength, and muscle movements are
decreased; the arm and leg muscles, which become particularly
flabby and weak, display these changes well.
• Sarcopenia, the age-related loss of muscle mass, strength, and
function, is mostly seen in inactive persons.
• Muscle tremors may be present.
• For various reasons, muscle cramping frequently occurs.
• Bone mineral and bone mass are reduced, contributing to the
brittleness of the bones of older people, especially older women who
experience an accelerated rate of bone loss after menopause.
• Bone density decreases at a rate of 0.5% each year after the third
decade of life.
• There is diminished calcium absorption.
• These changes make fractures a serious risk to the older adults.
• Although long bones do not significantly shorten with age, thinning
disks and shortening vertebrae reduce the length of the spinal
column, causing a reduction in height with age.
• Height may be further shortened because of varying degrees of
kyphosis, a backward tilting of the head, and some flexion at the hips
and knees.
• A deterioration of the cartilage surface of joints and the formation of
points and spurs may limit joint activity and motion.
Nervous System
• Cardiovascular problems can reduce cerebral circulation and be
responsible for cerebral dysfunction.
• Decline in brain weight and reduced blood flow of brain; not affecting
thinking and behavior.
• A reduction in neurons, nerve fibers, and metabolism is known to
occur.
• Reduced cerebral blood flow is accompanied by a reduction in glucose
utilization and metabolic rate of oxygen in the brain.
Sensory Organs
• Vision
• Presbyopiainability to focus on close objects clearly
• Narrowing of the visual fielddecreased peripheral vision
• Pupil size reduced and less reactive to light
• Depth perception distorted
• Visual acuity declined
• The appearance of the eye may be altered; reduced lacrimal
secretions can cause the eyes to look dry and dull.
Hearing
• Presbycusis: progressive loss of hearing
• Distortion of high-pitched sounds
• Cerumen increased in ear canal: affects hearing
• Equilibrium can be altered because of degeneration of the vestibular
structures and atrophy of the cochlea.
Taste and Smell
• The sense of smell reduces with age because of a decrease in the
number of sensory cells in the nasal lining and fewer cells in the
olfactory bulb of the brain.
• Men tend to experience a greater loss in the ability to detect odors
than women.
• The taste acuity is dependent on smell, the reduction in the sense of
smell alters the sense of taste.
• Atrophy of the tongue with age can diminish taste sensations.
• Decreased saliva, poor oral hygiene, and medications can affect taste.
Touch
• Tactile sensation is reduced, as observed in the reduced ability of
older persons to sense pressure and pain and differentiate
temperatures.
• These sensory changes can cause misperceptions of the environment
and, as a result, profound safety risks.
Endocrine System
• With age, the thyroid gland undergoes fibrosis, cellular infiltration,
and increased nodularity.
• The thyroid gland progressively atrophies, and decrease thyroid
activity.
• Overall, the thyroid function remains adequate. Secretion of thyroid-
stimulating hormone (TSH) and the serum concentration of thyroxine
(T4) do not change.
• The pituitary gland decreases in volume by approximately 20% in
older persons.
• Gonadal secretion declines with age, including gradual decreases in
testosterone, estrogen, and progesterone.
• The parathyroid glands maintain their function throughout life.
• There is a delayed and insufficient release of insulin by the beta cells
of the pancreas in older people, and there is believed to be decreased
tissue sensitivity to circulating insulin.
• Ability to metabolize glucose reduced.
• Higher blood glucose in nondiabetics possible.
Integumentary System
• Skin less elastic, more dry, and fragile
• Decreased subcutaneous fat.
• The dermis becomes more avascular and thinner.
• A reduction in the number of melanocytes, and those present cluster,
causing skin pigmentation, commonly referred to as age spots; these
are more prevalent in areas of the body exposed to the sun.
• Increased benign and malignant skin neoplasms
• Skin immune response declines, causing older people to be more
prone to skin infections.
• Thinning, graying of hair.
• An increased growth of eyebrow, ear, and nostril hair occurs in older
men.
• Reduced sweat gland activity.
• Fingernails grow more slowly, are fragile and brittle
Immune System
• A depressed immune response, which can cause infections to be a
significant risk of older adults.
• T-cell activity declines and more immature T cells are present in the
thymus.
• A significant decline in cell-mediated immunity occurs.
• Inflammatory defenses decline, and, often, inflammation presents
atypically in older individuals (e.g., low-grade fever and minimal pain).
• Older people can include foods in their diet that positively affect
immunity, such as milk, yogurt, nonfat cottage cheese, eggs, fresh
fruits and vegetables, nuts, garlic, onion, sprouts, and pure honey.
• Daily multivitamin and mineral supplement is also helpful.
• Regular physical activity can enhance immune function, including
exercises such as yoga .
• Stress can affect the function of the immune system because elevated
cortisol levels.
Thermoregulation
• Normal body temperatures are lower in later life than in younger
years.
• Rectal and auditory canal temperatures are the most accurate and
reliable indicators of body temperature in older adults.
• There is a reduced ability to respond to cold temperatures due to
inefficient vasoconstriction, reduced peripheral circulation, decreased
cardiac output, diminished shivering, and reduced muscle mass and
subcutaneous tissue.
• Differences in response to heat are related to impaired sweating
mechanisms and decreased cardiac output.
CHANGES TO THE MIND
Personality
• Excluding pathologic processes, the personality will be consistent with
that of earlier years.
• Changes in personality traits may occur in response to events that
alter self-attitude, such as retirement, death of a spouse, loss of
independence, income reduction, and disability.
• No personality type describes all older adults.
Memory
• Three types of Memory:
• Short-term; lasting from 30 seconds to 30 minutes.
• Long-term; involving that learned long ago
• Sensory; obtained through the sensory organs and lasts only a few seconds.
• Retrieval of information from long-term memory can be slowed,
particularly if the information is not used or needed on a daily basis.
• Older adults can improve some age-related forgetfulness by using
memory aids.
Intelligence
• Crystallized intelligence is maintained, which is the knowledge
accumulated over a lifetime and arises from the dominant
hemisphere of the brain, is maintained through the adult years; this
form of intelligence enables the individual to use past learning and
experiences for problem solving.
• Fluid intelligence, involving new information and emanating from the
nondominant hemisphere, controls emotions, creative capacities; this
type of intelligence is believed to decline in later life.
• Chronic psychological stress associated with increased incidence of
mild cognitive impairment.
Learning
• Although learning ability is not seriously altered with age, other
factors can interfere with the older person’s ability to learn, including
motivation, attention span, delayed transmission of information to
the brain, perceptual deficits, and illness.
• Learning occurs best when the new information is related to
previously learned information.
• Sometimes difficult to break bad habits for better habits.
Attention Span
• Older adults demonstrate a decrease in vigilance performance (i.e.,
the ability to retain attention longer than 45 minutes).
• They are more easily distracted by irrelevant information and stimuli.
• Less able to perform tasks that are complicated.