Physical Changes of Aging

  1. Integumentary
    • Changes occur as a result of genetic (intrinsic) and environmental (extrinsic) factors
    • Visible changes of aging: quality of color, firmness, elasticity, and texture affirm that one of aging
    • dryness, thinning, and a decrease in elasticity commonly occure but are NOT normal changes to aging
  2. 3 Layers
    • Epidermis thins: blood vessels and bruising are more visible
    • - inflammatory process takes longer to begin: delay healing and more prone to infection (action: protect the skin, becareful of shearing forces, turn pt, breakdown, moisturized)
    • Dermis layer thins by 20%: decre in the stretching ability
    • - more irritation: breaks down more easily
    • - skin sags, double chin
    • Hypodermis or subcutaneous atrophies: more sensitive to cold (layer them)
    • - decre efficiency of sweat glands: overheated (not able to cool down)
    • elders should be careful in extreme temps
  3. Integumentary (color of skin)
    • Fewer melanocytes: lighter skin color- less protection from UV rays (sunscreen, hats)
    • Melanocytes cluster: age spots or liver spots (lentigines) appear on areas most exposed to the sun
    • Seborrheic Keratoses: thick, brown, raised lesion appear "stuck on'
  4. Integumentary hair, nail
    • Hair
    • - thins dryer coarser loss of color (grey) esp men
    • - women: decr estrogen to testosterone ratio- incr chin and facial hair
    • - loss of leg hair (vs sign of peripheral vascular disease it could be this too)
    • -- know the difference: check circulation PP, cap refill
    • Nails
    • - harder, thicker, brittle dull opaque
    • - changes shapre (flat, concave)
    • - vertical ridges r/t decre water, CA, lipid content
    • - blood supply decr
    • - fungal infection common- though not normal part of aging
  5. Promoting Healthy Skin
    • Avoid excessive exposure to UV light
    • always use sunscreen
    • keep skin moisturized- cracks
    • avoid use of drying soaps
    • keep well hydrated
    • avoid use of take on fragile
  6. Musculoskeletal
    • changes are not life threatening, but can affect functioning and quality of life
    • ligaments, tendons, and joints become dry, hardened, less flexible skeletal muscle mass decrease
    • - joint space is reduce: arthritis
    • (encourage activity)
    • Sacopenia: age related changes
    • - a gradual decrease in muscle tone, strength and mass
    • - tissue mass decre (atrophy) and adipose tissue increases - men in their waist and women are between the umbilicus and symphysis pubis
    • disuse- decre in strength (teach pt if u don't use it u lose it) in up to 3 days u can loss weeks to gain
  7. Posture Changes bones
    • Trunk shortens as a result of dehydration of the intervertebral disk (thinning) and gravity (loss about a half inch)
    • Kyphosis: reduced bone mineral density. curvature of the spine
    • - caused by osteoporosis (which is loss of CA in the bones (if u don't get enough CA ur body will rob your bones of it, it is required for muscle contraction and nerve conduction)
    • estrogen helps to keep the ca in your bones but during menopause women are more suspectible to osteoporosis
    • bones of arms and legs may appear disproportionate
    • bc ur vertebrate decre and arms and legs stay the same
  8. Promoting Healthy Bones and Muscle
    • ensure regular, adequate intake of Vit D. and CA ( vit d helps the absorption of ca)
    • engage in regular weight bearing excerises- maintains bone strength
    • engage in regular flexibility and balance excerise- yoga techi
    • for women consider preventive pharmacotherapeutics
    • regular bone density studies: the denser the better
    • sidebar: women in their child bearing yrs continue to put more ca in the bank (bone)
  9. CV changes
    • Myocardial and blood vessels become stiff:
    • decrease in coronary artery blood flow stroke volume and cardiac output
    • - decrease response to sudden demands (their HR will not speed up if O2 supply goes down, it takes a longer time for them to recover)
    • - **fatigue easily balance between activity and rest
    • Left ventricle wall thickens (up to 50%) it doesn't decrease in size it just becomes less functional
    • left atrium slight increases
    • Arteries: elasticity decreases HTN
    • - peripherihal resistance pressure
    • - slow to respond to stressor
    • - as u age bp incre -so makes sure they are getting enough o2- esp their brain if not they will show signs of confusion
  10. CV cont
    • Heart takes longer to accelerate/return to resting
    • - HR delayed when in pain, febrile, hemorrage, anxiety delayed/not present (different from what we were taught)
    • decrease circulation liver and kidneys (med problematic- bc not being metabolized and execreted) assess for side effect
    • veins become stretched and valves become less efficient- decre in vascular return- venous stasis
    • - risk for edema, emboli
    • - nurse should elevated, circulation TED compression stocking
  11. Promoting a healthy heart
    • engage in regular exercise
    • eat low fat, low cholesterol, balanced diet
    • tight control of diabetes
    • smoking cessation, avoid exposure to smoke
    • avoid environmental pollutants
    • practice stress management
    • minimize sodium
    • maintain IBW
    • Box 5-4 look at this
  12. Respiratory
    • Loss Elasticity
    • - chest wall stiffins
    • - gas exchange is less efficient- biggest change
    • - resistance to air flow increases
    • - less sensitive to decre O2 and incre CO2
    • Effectiveness of cough response is reduced and decre cilary action(little hairs that more up to get rid of things that you breath in) action:
    • - increase risk for respiratory infection and pneumonia (nurse- vaccination to prevent infection)- listen to their lungs
    • (nurse wants an adequate O2, O2 stat if low give oxygen but becareful)
    • hypoxic and carbonic drive- is what triggers us to breath becareful about wiping out these stimulus to breath- don't give more than 4L
  13. Promoting healthy lungs
    • pneumonia immunization
    • annual influenza immunization
    • avoid exposure to smoke and pollants
    • don't smoke
    • avoid persons with respiratory illnesses
    • prompt treatment of respiratory infections
    • wash hands frequently
    • eat meals in relaxed atmosphere
    • regular oral hygiene
    • pg 62
  14. Renal
    • kidney blood flow decreases
    • - by 10% each decaded (by half from young adulthood to 80yo : 1200ml to 600ml)
    • GFR decreases
    • fluid balance decre
    • size and function decre- bladder weakens- have a toileting schedule bc can develop a UTI (1st confusion) if using a bedpan have them sit up
    • urine creatinine clearance decre
    • increa susceptibility to fluid and electrolytes imbalance and structural damage from medications
    • Nurse action: empty bladder, abnomalies in your blood work, BUN and creati higher, hyponatremia, hypomagnesium
  15. Endocrine
    • glands atrophies and rate of secretion decreases
    • pancreas
    • - body tissue decre sensitivity to insulin
    • - rate of type 2 dm is higher in elders (encourage low carb diet)
    • decre TSH by pituary gland
    • thyroid gland atrophies: decre secretion of hormones: t3 t4 (regulate body metabolism)
    • - slowed BMR (thinnning hair, dry skin), this could cause weight, caloric intake needs to adjust to this
    • - medication replacement
  16. Reproductive
    • Women affected more than men
    • - unable to procreate after ovulation cessation
    • - men fertile all their lives
    • Ovaries, uterus, and cervix atrophy
    • - estrogen levels decre
    • - vaginal walls loses its ability to lubricate
    • testes atrophy and softens
    • - ejaculation is slower and less forceful
    • - testerone level reduces
    • many men experience (BPH)- benign prostatic hyperplasia
    • - urinary retention
    • - gets discovered when they come in for UTI- test the PSA
  17. GI- mouth
    • teeth lose enamel and dentin, making them vulnerable to decay and breaking
    • - dentures: ensure fit, dietary intake
    • - peridontal disease: gums inflammed and red (not normal but bc of some of the oral changes like dryness in mouth)
    • Taste buds decline in number (tell them to be mindful of their salt intake so they don't developed edema, HF)
    • salivary secretion lessens= dry mough
    • pleasure in eating decre and lose of weight loss occurs
  18. Stomach and intestines
    • esophagus and stomach sluggishly empty
    • - esophagus dilates= gerd (one of the most common problem in the elders- nurse action- sit up after eating, eat 6 small meals)
    • decreased intrinsic factor: Vit b12 (required for blood formation), pernicious anemia (b-12 injection)
    • decreased gastric motility
    • - peristalsis slows
    • - constipation is common (incre fiber intake)
  19. Liver and Gall Bladder
    • decre in liver's blood volume by 90's
    • - impaired drug metabolism (more prone to side effects)
    • - LFT's are unaltered
    • Increased incidence of gall stone formation
    • - decre in bile (breaks down fat) salt synthesis (u don't absorb and digest it well and if u can't absorb the fat u wont be able to absorb vitamins ADEK
    • - incre in fat content in billary cholesterol
    • - decre in bile acid synthesis
    • (they maybe at risk for developing these things)
  20. promoting healthy digestion
    • practice good oral hygiene
    • wear properly fitting dentures
    • seek treatment of dental caries and peridontal disease
    • eat in relaxed atmosphere with other people
    • adequate intake of fluid
    • eat balance diet- incre fiber intake
    • avoid prolong periods of immobility
    • avoid tobacco products
    • respond to urge to defecate (toileting schedule)
    • avoid laying down after eating
  21. Neurological
    • brain size and weight decrease
    • sleep disturbances occur
    • mild memory impairment
    • - intelluctual performance unchanged
    • **balance difficulties- adequate lighting, grab bars, chairs, getting rid of things they can trip on, no driving at night
    • decrease in tactile sensations in the fingers and palms- injuries
    • reaction time is delayed- no driving at night bc of this...
    • risk for falls increases
    • - risk for brain injury
    • (the changes in neuro is slow bc we have alot of cells in our brain that we don't use. so the decline is slow not like the skin)
  22. Sensory
    • senses of smell, touch, sight, hearing, taste decre
    • - color perception decre
    • Presbyopia: near vision decreases and the lenses thicken (presb- normal age related)
    • - difficulty adjusting to changes in light
    • eyelids lose elasticity droop
    • lower eyelid turns inside out (at risk for corneal infection and abrasion)
    • - dry eye syndrome is commons
  23. Sensory cont ear
    • Presbycusis- sensorineural hearing loss occurs (normal) nurse- speaks slow, direct in their face, don't speak with high pitch,
    • ear lobe sags, elongated and wrinkle
    • - ear hair is more stiff and course
    • - ear wax is more thick and dry
  24. Promoting Health
    • Healthy Eyes:
    • - Protect from UV light
    • - avoid eye strain
    • --use bright light when needed
    • - see provider if changes in vision
    • - yrly dilated eye exam

    • Healthy hearing
    • - avoid exposure to loud noises
    • - avoid injury with q-tip , other cleaning material
    • - assistive devices aids
    • - see provider if changes in hearing
    • - no foreign objects in ears
  25. Immunological
    • Immosenescence- depressed
    • decre Immune response (at risk for infection)
    • - cell mediating response is reduce (t cells memory cell)
    • - less response to infection (at risk)
    • - changes contribute to reactivation of varicella zoster (chicken pox, shingles) and TB
    • - inflammatory defenses decline
    • immunity is reduced at cellular level
    • oral temp is significantly lower (low grade temp could signified a massive infection)
    • decrease response to foreign antigens
    • - harmful substance causes body to produce antibodies
    • Immunoglobulins increase (IGa IGg are responsible to maintain health of oral mucousa and soft tissue and these incre and as incre body attackes itself)
    • - antibodies
    • - autoimmune concerns
    • know temp baseline so u will no when there is an elevation
  26. Thermoregulation
    • normal body temperatures are lower in elders
    • increased difficulty responding to temperature extremes:
    • cold:
    • - decre muscle tissue
    • - decrea muscle activity
    • - diminished peripheral circulation
    • - reduced subcutaneous fat
    • - decre metabolic rate
    • - slower metabolism
    • Heat
    • - impaired sweating mechanisms
    • - decreased cardiac output
  27. Thermoregulation risk for elders
    • exposure to excessively cold and hot environments
    • limited financial resources to pay for heat or clothing that is suitable for environmental temp
    • neurologic, endocrine or CV disease
    • hypometabolic or hypermetabolic disorders
    • - diabetes, cancers, hypothyroidism, hyperthyroidism, malnutrition, obesity)
    • infection of other febrile illness
    • dehydration and electrolyte imbalances
    • inactivity or excessive activity
    • temperature altering medications
    • - (alcohol, antidepressants, barbituarate, benzo, phenothiazines, anticholinergics)
  28. Nursing considerations
    • monitor the environmental temp, humidity and air movement
    • monitor body temp at regular intervals
    • provide clothing and bed covers that are suitable for the environment
    • promote adequate food and fluid intake
    • monitor activity in accordance with environment temp
  29. Maslow heirachy and physical changes
    • physical changes affects all level of maslow hierarchy
    • Level 1: physiologic needs in every body system affected by aging
    • uppers level needs can be affected by inability to adequately meet physiologic (by not mtg basic needs
    • this will help you prioritizes your care...meeting the basic levels first
Card Set
Physical Changes of Aging
changes in elders