Chapter 5 Common Aging Changes

Terms to Know Crystallized intelligence: knowledge accumulated over a lifetime; arises from the dominant hemisphere of the brain Fluid intelligence: involves new information emanating from the nondominant hemisphere; controls emotions, retention of nonintellectual information, creative capacities, spatial perceptions, and aesthetic appreciation Immunosenescence: the aging of the immune system

Terms to Know (cont.) Presbycusis: progressive hearing loss that occurs as a result of age-related changes to the inner ear Presbyesophagus: a condition characterized by a decreased intensity of propulsive waves and an increased frequency of nonpropulsive waves in the esophagus Presbyopia: the inability to focus or accommodate properly due to reduced elasticity of the lens

Introduction Living is a process of continual change. Changes of aging are highly individualized. Changes differ in various body systems of and among older adults. Alterations are influenced by Genetic factors, environment, diet, health, stress, and lifestyle choices

Changes to the Body: Cells Aging changes start at the basic cellular level Cell number reduces, leaving decreased number of functional cells Lean body mass decreases Total body fat increases Extracellular fluid remains constant; intracellular fluid reduces, resulting in less total body fluid

Changes to the Body: Physical Appearance Noticeable changes occur after the fourth decade of life Hair loss, gray hair, and wrinkles Loss of tissue elasticity: elongated ears, baggy eyelids, and double chin Loss of subcutaneous fat results in a decline in body’s natural insulation Diminished stature related to reduced hydration, loss of cartilage, and thinning of vertebrae

Changes to the Body: Respiratory System Reduction in respiratory activity Calcification of costal cartilage makes the trachea and rib cage more rigid Reduction of cough and laryngeal reflexes Increased residual capacity and reduced vital capacity High risk for respiratory infection

Question Which of the normal age-related changes in the respiratory system can increase the risk of infection in the older adult population? Decrease in the anterior–posterior diameter of the chest. Increased strength of the thoracic musculature. Increase in residual volume and reduction in vital capacity. Decreased calcification of costal cartilage.

Answer C. Increase in residual volume and reduction in vital capacity. Rationale: As residual volume increases, the vital capacity is reduced and maximum breathing capacity decreases, placing older adults at high risk for developing respiratory infections.

Changes to the Body: Cardiovascular System Heart dimensions are unchanged in the absence of pathology Heart muscle loses efficiency and contractile strength, which results in reduced cardiac output with physiologic stress Valves become thick and rigid Blood vessels reduce elasticity Oxygen used less efficiently

Changes to the Body: Gastrointestinal System Tooth loss not normal part of aging Less acute taste sensations Decreased esophageal motility Atrophy of the small and large intestines Increased risk of aspiration, indigestion, and constipation

Question Is the following statement true or false? Atrophy of the small and large intestine, with fewer cells present on the absorbing surface of the intestinal wall, causes certain vitamins and minerals to have a decreased rate of absorption.

Answer True Rationale: Absorption of vitamin B, vitamin B12, vitamin D, calcium, and iron is decreased in the intestine of the older adult.

Changes to the Body: Urinary System Decline of renal blood flow and glomerular filtration by approximately 50% by age 90 Reduced bladder capacity Urinary frequency, urgency, and nocturia are common in older adults Incontinence is not a normal part of aging

Changes to the Body: Reproductive System Male: Reduction in sperm count Prostate enlargement Female: Atrophy of vulva; dried vaginal canal Estrogen depletion Both sexes engage in and enjoy intercourse

Changes to the Body: Musculoskeletal System Thinning disks and shortening vertebrae cause decreased height Reduced muscle mass, strength, and movement Decreased bone mineral and mass Diminished calcium absorption Increased risk of fractures

Changes to the Body: Nervous System Decline in weight and reduced blood flow of the brain; not affecting thinking and behavior Reduction in neurons, nerve fibers, and cerebral blood flow Slower response to change in balance Hypothalamus less effective in temperature regulation Changes in sleep patterns with frequent awakening during sleep

Question Which of the following is a normal age-related change of the nervous system? Decline in the weight of the brain Increase in cerebral blood flow Stages I and II sleep are interrupted Higher nerve conduction velocity

Answer A. Decline in the weight of the brain Rationale: There is a decline in brain weight and a reduction in blood flow to the brain. Stages III and IV sleep become less prominent. Nerve conduction velocity is lower, which causes slower reflexes and delayed response to multiple stimuli.

Changes to the Body: Sensory Organs All senses less proficient with advanced age: vision, hearing, taste, smell, and touch Decreased efficiency of the senses can affect well-being, activities of daily living, safety, and health

Changes to the Body: 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

Changes to the Body: Sensory Organs—Hearing Presbycusis: progressive loss of hearing Distortion of high-pitched sounds Cerumen increased in ear canal: affects hearing Alteration in equilibrium

Changes to the Body: Sensory Organs—Taste and Smell Sense of smell altered with age: safety issue Taste acuity dependent on smell Atrophy of tongue can diminish taste Decreased saliva, poor oral hygiene, and medications can affect taste

Changes to the Body: Sensory Organs—Touch Reduction of tactile sensation Reduced ability to sense pressure, discomfort, and deviations in temperature Safety jeopardized

Changes to the Body: Endocrine System Thyroid gland activity decreases ACTH secretion decreases with age Pituitary gland decreases in volume Insulin release by beta cells delayed and insufficient Ability to metabolize glucose reduced Higher blood glucose in nondiabetics possible

Changes to the Body: Integumentary System Skin less elastic, more dry, and fragile Decreased subcutaneous fat Increased benign and malignant skin neoplasms Thinning, graying of hair Reduced sweat gland activity

Changes to the Body: Immune System Depressed immune response: T-cell activity declines Cell-mediated immunity declines Risk for infection becomes significant Inflammatory defenses decline; inflammation presents atypically

Changes to the Body: Thermoregulation Normal body temperatures lowered in older age: mean body temperature can range from 96.9°F to 98.3°F orally Ability to respond to cold temperatures reduced Response to heat altered

Question Is the following statement true or false? Mean body temperatures of the older adult range from 96.9°F to 98.3°F orally.

Answer True Rationale: Normal body temperatures are lower later in life than in younger years.

Changes to the Mind Psychological changes influenced by Health status Genetic factors Educational achievements Activities Physical changes Social changes

Changes to the Mind: Personality Personality remains consistent with that of the earlier years in the absence of disease. Changes in personality may be affected by retirement, death of spouse, loss of independence, reduced income, and disability. No personality type labels all older adults.

Changes to the Mind: Memory Three types of memory: Short term Long term Sensory Age-related forgetfulness

Changes to the Mind: Intelligence Basic intelligence is upheld Crystallized intelligence is maintained Fluid intelligence may decline Chronic psychological stress associated with increased incidence of mild cognitive impairment

Changes to the Mind: Learning Learning ability usually not changed Learning best when new information relates to previous learned information Sometimes difficult to break bad habits for better habits

Nursing Implications of Age-Related Changes Understanding of aging changes is essential for competent gerontological nursing practice Acknowledgment of factors that can alter function with aging Emphasis on capabilities and assets possessed by the older adult