Normal Changes of Aging

1. Normal Changes of Aging Miss Shurouq Qadous RN, MSN, MCH 5/2/2011

2. Definition of Aging • Physiologic age - age by body function • Functional age - ability to contribute to society

3. Unique Subsets of Elderly At one time all persons over age 65 years were grouped together under the category of old. Now it is recognized that much diversity exists among different age groups in late life, and persons age 65 years and over can be categorized as follows: • Young-Old: 65 to 75 years • Old: 75 to 85 years • Old-Old : 85 to 100 years • Elite old : over 100 years

4. 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 aged persons, but also differences in the pattern of aging of various body systems within the same individual.

5. Age – related changes noticeable upon inspection. Graying and thinning of hair Elongated ears Thicker hair in ears and nose Darkening and wrinkling of skin around orbits Growth of facial hair in women Diminished muscle mass Narrower gait in women wider gait in men Decreased height

6. Changes to the bodyCardiovascular System More prominent arteries in head, neck, and extremities Valves become thicker and more rigid Stroke volume decreases by 1% per year Less efficient O2 utilization

7. - Geriatric heart becomes larger and occupies a greater amount of space within the chest. Unfortunately, this is often a symptom of pathological cardiac diseases, such as cardiomyopathy. - The force of each heart contraction diminishes, which decreases the amount of blood that is pumped through the circulatory system.

8. - The valves that control the flow of blood within the chambers of the heart and between the heart and lungs to the circulatory system become stiffer with calcification, or calcium deposits. This stiffness often prevents the full closure of these valves, resulting in both nonpathological and pathological heart murmurs. S4 heart sound is often heard more commonly in older adults than in a younger population as a result of these anatomical heart changes.

9. Premature contractions and arrhythmias are auscultated more frequently among older adults than in the younger population. These arrhythmias are often not pathological in nature. An occasional missed heart beat or other disruption in heart rhythm that is not accompanied by fatigue, shortness of breath (SOB), dyspnea on exertion (DOE), altered circulation, or chest pain may not be cause for major concern. However, when accompanied by these symptoms, arrhythmias require immediate attention.

10. As a result of the decreased force of contraction and often the ineffective closing of cardiovascular valves, blood flow through the body is slower. Slower circulation often results in slower healing of wounds. The length of time it takes for medications to take effect as a result of altered medication metabolism and distribution.

11. - It is not uncommon for some to experience very low diastolic blood pressure. This occurs as the heart muscle weakens causing the pressure of the heart at rest to become greatly reduced. This may occur even in the presence of systolic hypertension and is known as isolated systolic hypertension (Hill, Tannenbaum, & Salman, 2005). Consequently, an increased pulse pressure is frequently seen among older adults. Lower diastolic blood pressure values have recently been implicated as a risk factor for cerebrovascularaccidents or strokes.

12. In the peripheral vascular system, older adults have an increase in the peripheral vascular resistance, which means that the blood in the peripheral parts of the body (fingers and toes) has greater difficulty returning to the heart and lungs to be reoxygenated and recirculated. The valves in the veins of the lower extremities also become incompetent, resulting in nonpathological accumulation of fluid in the lower extremities (dependent edema).

13. There are several changes in the normal lab values of older adults. For example, hemoglobin and hematocrit , and erythrocyte sedimentation rate (ESR), which are essential measures of oxygen carrying red blood cell production, volume, and function, are slightly decreased among older adults. Leukocytes, or white blood cells, which are essential for immune function, are also slightly decreased among older adults.

14. There are several interventions that nurses may recommend to older adults to slow the onset of these normal changes of aging, such as diet, exercise, and when necessary, medication. What are the significant barriers to exercise among older adults? The role of diet in reducing the effects of aging on cardiovascular function is substantial.

16. Respiratory System PO2 reduced as much as 15% between ages 20 and 80 Blunting of cough and laryngeal reflexes By age 90 years, approximately 50% increase in residual volume Loss of elasticity and increased rigidity Alveoli fewer in number and larger in size Decreased ciliary action Forced expiratory volume reduced Thoracic muscles more rigid Lack of basilar inflation

17. - Changes experienced in the respiratory system include an overall decreased vital respiratory capacity, which means less air is inspired and expired. In addition, older adults’ lungs tend to lose elasticity as they age, making the lungs less flexible and further impairing the ability to effectively inhale and exhale. - Loss of water and calcium in the bones also causes the thoracic cage to stiffen adding an even greater • force against effective respiration. - There is often a decreased amount of cilia lining in older adults’ respiratory systems.

18. The combination of loss of cilia and decreased cough reflex place the older adult at high risk for choking, aspiration of food products, and the development of pneumonia and other infectious respiratory diseases.

19. Integumentary System

20. - The skin of older adults generally becomes thinner and more fragile as they age. The decreased amount of subcutaneous tissue allows for less water, and the skin becomes dry and loses its elasticity. Consequently, small lines and wrinkles appear on the skin. (sun exposure) Moreover, some sun is healthy. The sun produces vitamin D within the body, which is necessary for calcium metabolism. overexposure to the harmful rays of the sun can place the older adult at high risk for the development of pathological skin problems, such as cancer.

21. Nursing interventions to reduce the effects of sun exposure on the skin and prevent against disease onset include the use of sun protection. It is presently recommended that older adults should be counseled to use sun block and avoid over exposure to the sun. - The number of sweat glands diminishes as people age, leading to less perspiration among older adults. - The subcutaneous fat and muscular layers of the skin also begin to diminish. (less padding)

22. These changes have several common and noticeable effects. 1. dryness of the skin, which often is uncomfortable and can lead to skin tears. 2. The dryness of the skin , in combination with decreased perspiration, leads to the need to bathe less frequently.

23. Nurses caring for older adults may recommend : - Avoid the use of soaps that further dry the skin and replace moisturizer. - Use of clothing and protection of high risk areas, such as elbows and heels, with appropriate padding, may be helpful in preventing skin tears.

24. Older adults exposed to extreme heat or cold are at risk for developing hyperthermia and hypothermia. (Changes in subcutaneous tissue, fat, and muscle ) Proper environmental control and adequate hydration are essential to prevent these devastating consequences of normal aging changes. • Fingernails and toenails become thick and brittle. Also changes in vision and pain perception may further complicate the task of nail care. Recommended that older adults enter the care of a podiatrist

25. The hair of older adults may become gray, fi ne, and thin, but there is great variation among change in hair patterns as people age. Some older adults may experience the loss of hair, or alopecia, which may or may not be hereditary. As a result of hormone shifts, the appearance of facial hair may be seen among women, and decreased body hair generally occurs with both sexes. It is important to consider the effect of these changes on the self-concept and self-esteem of older adults. It is important to remember that older adults also take great care in their personal appearance, including personal hygiene, hair, and clothing.

26. Gastrointestinal System

27. - Older adults commonly experience problems chewing and swallowing food. This often results from the lack of availability of fluorinated water in the early years as well as inadequate dental care. Fluorination of drinking water, is done to prevent tooth decay by reducing the effects of harmful bacteria in the water. - Inflamed gums or periodontal disease is common among older adults. - Sensitive teeth and tooth loss is seen regularly among older adults. Tooth and gum problems often prevent older adults from being able to chew (masticate) food.

28. Decreased peristalsis of the esophagus slows the passage of food ,which often results in the need for older adults to chew food longer and eat more slowly. - There are several changes in the normal lab values related to gastrointestinal function: • Total albumin levels, which are essential indicators of both liver function and malnutrition among older adults, lessen with aging, in direct relation to reduced liver size and function.

29. The enzyme alkaline phosphatase (ALP), which is a measure of liver function, increases with age. • Serum potassium, which is essential in helping nutrients cross cell membranes, and serum glucose both increase among older adults.

30. - Decreased peristalsis of the large intestine slows the passage of food through the next stage of the alimentary canal and out of the body. The two major bowel elimination problems that occur in the elderly are constipation and fecal incontinence. Causes • Normal changes of aging • Multiple use medications • The intake of foods low in dietary fiber • The lack of physical activity among older adults • less privacy also contribute to constipation

31. Constipation Abnormally delayed or infrequent passage of accumulated, often dry, feces in the lower intestines. Annells and Koch (2002) report that laxatives are the most commonly sought after treatment for constipation, with approximately one-third of older adults requesting weekly laxatives to reduce constipation.

32. Nursing interventions • Minimize the risk of constipation include encouraging adequate fluids. For older adults who are not severely ill, daily fluid intake should be between 30 and 35 ml fluid/kg (National Collaborating Center for Acute Care, 2006). • Maintaining a diet with sufficient bulk, such as green leafy vegetables and grains, is also helpful in reducing constipation. • Exercise • Dietary modifications, such as the increase of fiber and fluid, can stimulate the colon • Stool softener medications, enemas, and laxative

33. Bowel Incontinence Bowel incontinence is defined as an involuntary unexpected leakage of liquid stool. It is estimated that approximately 45% of nursing home residents suffer from this condition (University of North Carolina Center for Functional Gastrointestinal and Motility Disorders, 2006).

34. Causes of bowel incontinence including: • History of urinary incontinence • Neurological disease • Poor mobility (4) severe cognitive decline (5) age greater than 70 The University of North Carolina Center for Functional Gastrointestinal and Motility Disorders(2006) reports that fecal incontinence is associated with hemorrhoids, diarrhea, constipation, childbirth injuries, diabetes, ulcerative colitis, and dementia.

35. Nursing interventions • Diets high in fiber and bulk • Adequate fluids • Exercise are • In cognitive-impaired older adults, bowel habit training may be helpful.

36. Urinary System • The kidneys experience a total loss of nephrons and glomeruli as people age. • In the older adult, the bladder tone and volume capacity may decrease as well. This results in a high incidence of urinary incontinence (UI), or involuntary loss of urine among older adults. Studies have shown that between 10% and 58% of women and 6% to 28% of men experience daily incontinence (Gray, 2003).

37. There are several changes in the normal lab values of older adults . For example, • BUN values increased as a result of decreased renal function. BUN values among older adults are heavily influenced by dietary protein intake. Because lean body mass declines with age, the total production of creatinine increases, while creatinine clearance declines by almost 10% per decade after age 40.

38. Urinary Incontinence Urinary incontinence (UI) is not a normal change of aging, but it occurs frequently among the older population in response to normal aging changes. Because of the stigma associated with this embarrassing disorder, it is not readily diagnosed. Gray (2003) reports that UI occurs in up to 11% of community-dwelling older adults.

39. Most frequent types of UI in the older population are stress and urge incontinence. Stress incontinence results when the strength of the urethral sphincter decreases and is unable to stop the flow of urine. This most commonly occurs in response to weakened pelvic muscles that support the bladder. Older patients with stress incontinence frequently report losses of small volumes of urine during laughing, sneezing, coughing, or running/jumping. This type of UI occurs very commonly with aging.

40. The other common type of UI is urge incontinence, which results in the loss of a large volume of urine. There are many causes of urge incontinence, including neurological problems or infection. The risk for developing UI increases with age, obesity, chronic bronchitis, asthma, and childbearing. Many older adults experience a combination of both types of incontinence, known as mixed.

41. Nursing intervention • Teach pelvic floor exercises, also known as Kegel exercises. These exercises strengthen pelvic muscles to aid in the retention of urine. • Voiding schedules have also been shown to be effective in the treatment of UI (Wyman, 2003), especially for older adults who are cognitively impaired. - Medications that act as anticholinergics or smooth muscle relaxants assist in increasing bladder capacity to decrease the urge to void. - Indwelling urinary catheters are contraindicated to treat UI in the older population.

42. Musculoskeletal System

44. As people age, there is a decrease in total muscle and bone mass. The decrease in bone mass occurs as bones lose calcium, causing the bone structure to shrink and weaken. All of this places the older adult at a higher risk for fractures. When the bone loss becomes more severe, the older adult may be diagnosed with osteoporosis

45. - Changes in the normal lab values • Decrease in plasma calcium necessary for adequate bone production and maintenance. Moreover . • Total alkaline phosphatase (ALP) may rise as a consequence of Paget’s disease or minor bone trauma or fracture among clients with osteoporosis.

46. Intervention It is important to note that both the decrease in bone and muscle mass may be counteracted with exercise. Exercise is essential to healthy aging, producing positive effects on older adults, including the ability to maintain strength and flexibility throughout older adulthood.

47. Changes in the Senses • Older adults experience changes in the five senses as a result of normal aging. • Overall visual acuity (حدة البصر) declines, and the ability to discriminate colors becomes less acute. • The ability of the pupil to constrict quickly in response to stimuli decreases and peripheral vision declines.

48. The lens of the eye often becomes yellow, resulting in the development of cataracts in the older population. Because of the normal changes in the aging eye, the older adult is at higher risk for diseases such as cataracts (إعتام عدسة العين) and glaucoma ((الزرق في العين. A cataract is a clouding of the lens in the eye. Glaucoma damages the eye's optic nerve. It is a leading cause of blindness in the United States. It usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve.