Age-Related Changes

THE LIVED EXPERIENCE

Strange how these things creep up on you.
I really was surprised and upset when I
first realized it was not the headlights on
my car that were dim but only my aging
night vision. Then, I remembered other
bits of awareness that forced me to
recognize that I, that 16-year-old inside
me, was experiencing changes that go
along with getting older.
~Sally, age 60

Age-Related Changes
The well-being of older people
depends on several factors
Physical
Psychosocial
Mental
Social
Economic
Environmental

Physical Aspects of
Aging
Cellular and extracellular changes of old
age cause a change in physical
appearance and a decline in function.
Measurable changes in shape and body
makeup occur.
The bodys ability to maintain homeostasis
becomes increasingly diminished with
cellular aging, and organ systems cannot
function at full efficiency because of
cellular and tissue deficits.

Cardiovascular System
Age related changes reduce the efficiency
of the heart and contribute to decreased
compliance of the heart muscle these
include:
Thickened cardiac valves
Decreased myocardial contractibility
Decreased elasticity of blood vessels
Decreased elasticity and increased
stiffness of the arterial wall

Cardiovascular System

Loss of atrial pacemaker

Reduction of hemapoietic activity
Increased blood coagulability
Decreased efficiency of
baroreceptors

Cardiovascular System
Subjective and Objective Findings
Complaints of fatigue with increased
activity
Increased heart rate recovery time
Optimal blood pressure 120/80 mm Hg
Prehypertension
120139/8089 mm Hg
Hypertension 140/90 mm Hg

Cardiovascular System
Health Promotion Strategies
Exercise regularly
Pace activities
Avoid smoking
Eat a low-fat, low-salt diet
Participate in stress-reduction activities;
Check blood pressure regularly;
Medication compliance;
Weight control

Respiratory System
The respiratory system is the one system that seems
to be the most able to compensate for the functional
changes of aging. These are:
Reduced chest compliance
Increased AP diameter of thorax
Reduced breathing capacity
Reduced vital capacity
Increased residual volume
Decreased cough and laryngeal reflex
Decreased ciliary activity
Decreased elasticity of tissue

Respiratory System
Subjective and Objective Findings
Fatigue and breathlessness with
sustained activity
Decreased respiratory excursion and
chest/lung expansion with less
effective exhalation
Difficulty coughing up secretions

Respiratory System
Health Promotion Strategies
Exercise regularly
Avoid smoking
Take adequate fluids to liquefy secretions;
Receive yearly influenza immunization
and pneumonia vaccine at 65 years of
age;
Avoid exposure to upper respiratory tract
infections

Integumentary System

Loss of subcutaneous supporting tissues

Sensitive to pressure and ulcer
Wrinkle and sag
Dry, wrinkled , loss elasticity
Decreased perspiration and sebum
Fragile, easily injured
Decreased skin turgor
Decreased sebaceous secretions
Dry, flabby, prone to itching

Integumentary System
Atrophy of tiny arterioles near epidermis
Impaired vasomotor homeostatic
mechanism
Poor temperature regulation (feels cold
even in warm climate)
HAIR- decreased number of hair follicles,
scant, fine, graying, hirsutism, possible
hereditary baldness
NAILS- dry, thick, brittle

Integumentary System
Subjective and Objective Findings
Thin, wrinkled, and dry skin
Complaints of injuries, bruises, and
sunburn
Complaints of intolerance to heat
Bone structure is prominent

Integumentary System
Health Promotion Strategies
Limit solar exposure to 1015 minutes daily
for vitamin D
Use protective clothing and sunscreen
Dress appropriately for temperature
Maintain a safe indoor temperature
Take shower rather than hot tub bath if
possible
Lubricate skin with lotions that contain
petroleum or mineral oil

Musculoskeletal System
Increase fat substitution for muscle
Muscle atrophy
Decreased muscular strength and
function
Loss of Calcium from bones
Osteoporosis is common
Deterioration of cartilage
Wear, friction, stiffness of joints

Musculoskeletal System
Easily tired, less stamina
Impaired range of motion resulting
from stiff joints
Generalized loss of 6-10 cm in stature
because of: flexion of knee and hip
joint, narrowing of intervertebral disks
Body takes on bony angular
apperance

Musculoskeletal System
Subjective and Objective Findings
Height loss
Prone to fractures
Kyphosis
Back pain
Loss of strength, flexibility, and
endurance
Joint pain

Musculoskeletal System
Health Promotion Strategies
Exercise regularly
Eat a high-calcium diet;
Limit phosphorus intake
Take calcium and vitamin D
supplements as prescribed

Gastrointestinal System
Decreased salivation
Difficulty swallowing food
Decreased sense of thirst, smell and
taste;
Minimal loss of digestive enzymes
Delayed esophageal and gastric
emptying
Decreased absorption
Increased food intolerance

Gastrointestinal System
Redistribution of body fat; increased fat
in trunk, especially in abdomen
Teeth and gum problems common
Decreased peristalsis, slowed digestion
Reduced gastrointestinal motility
Atonia constipation in common
Decreased metabolism: caloric
requirement approximately 1000 calories
per day

Gastrointestinal System
Subjective and Objective Findings
Risk of dehydration, electrolyte
imbalances, and poor nutritional intake
Complaints of dry mouth
Complaints of fullness, heartburn, and
indigestion
Constipation, flatulence, and
abdominal discomfort

Gastrointestinal System
Health Promotion Strategies
Use ice chips, mouthwash
Brush, floss, and massage gums daily
Receive regular dental care
Eat small, frequent meals
Sit up and avoid heavy activity after eating
Limit antacids
Eat a high-fiber, low-fat diet
Limit laxatives
Toilet regularly
Drink adequate fluids

Nervous System
Reduced speed in nerve conduction
Increased confusion with physical illness and loss
of environmental cues
Reduced cerebral circulation (decreased
coordination and balance )
Some impairment of sensory perception
Gradual decrease of visual and auditory acuity
Altered capacity to retain new information and
learn new tasks
Some impairment of memory and metal
endurance

Nervous System
Subjective and Objective Findings
Slower to respond and react
Learning takes longer
Becomes confused with hospital
admission
Faintness
Frequent falls

Nervous System
Health Promotion Strategies
Pace teaching
With hospitalization, encourage visitors
Enhance sensory stimulation
With sudden confusion, look for cause
Encourage slow rising from a resting
position

Special Senses (Vision)

Diminished ability to focus on close objects
(presbyopia)
Inability to tolerate glare
Difficulty adjusting to changes of light intensity
Decreased ability to distinguish colors
Narrowed field of vision (tunnel vision)
Color in the iris may fade, and the pupil may
become irregular in shape
Decrease in production of secretions by the
lacrimal glands

Special Senses (Vision)

Subjective and Objective Findings
Holds objects far away from face
Complains of glare
Poor night vision
Confuses colors

Special Senses (Vision)

Health Promotion Strategies
Wear eyeglasses, use sunglasses outdoors;
Avoid abrupt changes from dark to light;
Use adequate indoor 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

Special Senses (Hearing)

Decreased ability to hear high
frequency sounds
Sesorineural hearing deficit
(presbycusis) gradual loss of ability
to discriminate to high frequency
tools
Tympanic membrane thinning and
loss of resiliency

Special Senses (Hearing)

Subjective and Objective Findings
Gives inappropriate responses
Asks people to repeat words
Strains forward to hear

Special Senses (Hearing)

Health Promotion Strategies
Recommend a hearing examination
Reduce background noise
Face person
Enunciate clearly
Speak with a low-pitched voice
Use nonverbal cues

Special Senses (Taste & Smell)

Cell loss in the nasal passages and in
the olfactory bulb in the brain
Decreased ability to taste and smell

Special Senses (Taste & Smell)

Subjective and Objective Findings
Uses excessive sugar and salt
Loss of appetite

Special Senses (Taste & Smell)

Health Promotion Strategies
Encourage use of lemon, spices,
herbs
Recommend smoking cessation

Genitourinary System
Male and Female:
Decrased blood flow
Reduced GFR
Reduced nephrons
Decrased creatinine clearance
Increased propensity to toxic effects of
drugs
Decreased renal capacity to concentrate
urine at night

Genitourinary System
Male:
Benign prostatic hyperplasia
Female:
Relaxed perineal muscles, detrusor
instability (urge incontinence), urethral
dysfunction (stress urinary
incontinence)

Genitourinary System
Subjective and Objective Findings
Male:
Urinary retention
Irritative voiding
Symptoms including frequency,
feeling of incomplete bladder
emptying and multiple nighttime
voidings

Genitourinary System
Subjective and Objective Findings
Female:
Urgency/frequency syndrome
Decreased warning time
Drops of urine lost with cough, laugh,
position change

Genitourinary System
Health Promotion Strategies
Male:
Limit drinking in evening (eg,
caffeinated beverages, alcohol)
Do not wait long periods between
voiding and empty bladder all the
way when passing urine.

Genitourinary System
Health Promotion Strategies
Female:
Wear easily manipulated clothing;
Drink adequate fluids
Avoid bladder irritants (eg, caffeinated
beverages, alcohol, artificial sweeteners)
Pelvic floor muscle exercises, preferably
learned via biofeedback
Consider urologic workup

Reproductive System
Female:
Vaginal narrowing and decreased elasticity;
Decreased vaginal secretions
Menopause secondary to decreased Estrogen
Male:
Less firm testes and testosterone,
spermatogenesis, and size of testes,
Male and Female:
Slower sexual response

Reproductive System
Subjective and Objective Findings
Female:
Painful intercourse
Vaginal bleeding following intercourse
Vaginal itching and irritation
Delayed orgasm
Male:
Delayed erection and achievement of
orgasm

Reproductive System
Health Promotion Strategies
May require vaginal estrogen
replacement;
Gynecology/urology follow-up
Use a lubricant with sexual
intercourse

Psychosocial Aspects of Aging

Successful psychological aging is reflected in the
ability of older people to adapt to physical, social,
and emotional losses and to achieve life
satisfaction.
A positive self-image enhances risk taking and
participation in new, untested roles.
Ageism is based on stereotypes, simplified and
often untrue beliefs that reinforce societys
negative image of older people.
Fear of aging and the inability of many to confront
their own aging process may trigger ageist beliefs.

Stress and Coping

Coping patterns and the ability to adapt to stress
develop over the course of a lifetime and remain
consistent later in life.
A persons abilities to adapt to changes, make
decisions, and respond predictably are also
determined by past experiences.
Experiencing success in younger adulthood helps
a person develop a positive self-image that
remains solid through old age.
However, losses may accumulate within a short
period of time and may become overwhelming.

Stress and Coping

Common stressors of old age include:
Normal aging changes that impair
physical function, activities, and
appearance
Disabilities from injury or chronic illness
Social and environmental losses related
to loss of income and decreased ability
to perform previous roles and activities
Deaths of significant others

Living Arrangement
Most older people want to remain in their
own homes; in fact, they function best in
their own environment.
Older people tend to relocate in response
to changes in their lives such as
retirement or widowhood, a significant
deterioration in health, or disability.
The type of housing they choose depends
on their reason for moving.

Living Arrangement
Continuing Care Retirement
Communities
Independent Single Dwelling Houses or
Apartments for people who can manage all
of their day-to-day needs
Assisted Living Apartments for those
who need limited assistance with their daily
living needs;
Skilled Nursing Services when
continuous nursing assistance is required.

Living Arrangement
Assisted Living Facilities
An option when an older persons
physical or cognitive changes necessitate
at least minimal supervision or assistance.
allows for a degree of independence while
providing minimal nursing assistance with
administration of medication, assistance
with ADLs, or other chronic health care
needs.

Living Arrangement
Long-Term Care Facilities
Offer continuous nursing care.
Long-term Facility
Short-term Rehabilitation facility
Subacute Care Facility offers a high level of
nursing care that may either avoid the need
for a resident to be transferred to a hospital
from the nursing home or allow a
hospitalized patient to be transferred back
to the nursing facility sooner.

Family Role
the family has been and continues to
be an important source of support for
older people
older family members provide a
great deal of support to younger
family members

Cognitive Aspects of Aging

Cognition can be affected by many
variables, including sensory
impairment, physiologic health,
environment, and psychosocial
influences.

Intelligence
Test scores for older adults show a progressive
decline beginning in midlife when intelligence
test scores from people of all ages are
compared.
Environment and health have a considerable
influence on scores
Decline in spatial perceptions and retention of
nonintellectual information
Improvement or retention of problem-solving
ability based on past experiences, verbal
comprehension, mathematical ability.

Intelligence
Positive effect on intelligence are
noted with:
Cardiovascular health
A stimulating environment,
High levels of education,
occupational status, and income

Learning and Memory

Intelligence, memory, and the capacity
for learning are demonstrated
continuously by older adults who have:
higher levels of education
good sensory function
good nutrition, and
jobs that require complex problemsolving skills.

Learning and Memory

In general, there is :
A decline in Fluid intelligence, the
biologically determined intelligence
used for flexibility in thinking and
problem solving.
An intact Crystallized intelligence,
that gained through education and
lifelong experiences (eg, verbal skills)

Learning and Memory

Strategies to allow adults to learn:
Supply mnemonics to enhance recall of
related data
Encourage ongoing learning
Link new information with familiar
information
Use visual, auditory, and other sensory cues
Encourage learners to wear prescription
glasses and hearing aids

Learning and Memory

Strategies to allow adults to learn:
Provide glare-free lighting
Provide a quiet, nondistracting environment
Set short-term goals with input from the learner
Keep teaching periods short
Pace learning tasks according to the endurance
of the learner
Encourage verbal participation by learners
Reinforce successful learning in a positive
manner

Suicide in the elderly

1. Severe physical illness or mental
illness
2. Death of a spouse
3. Threat of extreme dependency or
institutionalization
4. Retirement
5. Pathological personal relationship
6. Alcoholism and drug addiction

Mental Health Problems in the

Older Adult
Depression: most common affective
disorder of old age; results from changes
in reuptake of neurochemical serotonin in
response to chronic illness, emotional
stresses related to physical, social
changes associated with aging process
Delirium: acute, confused state that
begins with disorientation
If not immediately evaluated and treated, can
progress to changes in level of consciousness,
irreversible brain damage, sometimes death

Dementia
Broad term for syndrome
characterized by general decline in
higher brain functioning (reasoning)
with pattern of eventual decline in
ability to perform even basic
activities of daily living (toileting,
eating)
Alzheimers disease
Vascular Dementia

Nursing Care of the Older Adult

Geriatrics: field of practice that focuses on
physiology, pathology, diagnosis, management of
disorders, diseases of older adults
Gerontological/geriatric nursing: field of nursing
that relates to assessment, nursing diagnosis,
planning, implementation, evaluation of older
adults in all environments, including acute,
intermediate, skilled care as well as within
community
Gerontology: combined biologic, psychological,
sociologic study of older adults within their
environment

Nursing Management
Supporting cognitive function
Promoting physical safety
Promoting independence in self-care
activities
Reducing anxiety, agitation
Improving communication

Nursing Management
(contd)
Providing for socialization, intimacy
needs
Promoting adequate nutrition
Promoting balanced activity, rest
Supporting home-, community-based
care

Pharmacologic Aspects
Polypharmacy: administration of
multiple medications at same time;
common in older persons with
several chronic illnesses
Aging changes alter drug:
Absorption
Metabolism
Distribution
Excretion

Nursing Implications
Need adjustment of dosage due to age;
start low, go slow
Assess medication knowledge, use
Need for medication review, coordination
of prescriber
Problem of noncompliance:
Factors that affect compliance
Keep medication regimen as simple as possible
Strategies to improve compliance

Geriatric Syndromes

Impaired mobility
Dizziness
Falls, falling
Urinary incontinence
Susceptibility to infection
Altered pain, febrile responses
Altered emotional impact
Altered systemic response

Potential Economic
Effects

Social services
Health care costs of aging
Home health care
Hospice services
Aging with a disability

Life-threatening maneuvers by
the elderly
1. Refusing medication
2. Not following physicians orders and
recommendations
3. Smoking and drinking against
medical advice
4. Refusal to eat or eating minimally
5. Placing self in a hazardous
environment

AGING is
an issue
of mind
over
matter

If you dont
MIND,