Physiological Function

There are frequently observed physiological changes in older adults that are called normal. These
physiological changes are not always pathological processes in themselves, but they make older adults
more vulnerable to some common clinical conditions and diseases. Some older adults experience all of
these physiological changes, and others experience only a few. The body changes continuously with age,
and specific effects on particular older adults depend on health, lifestyle, stressors, and environmental
conditions. The nurse needs to know about these normal, more common changes in order to provide
appropriate care for older adults and to assist with adaptation to changes.

Integumentary

 Loss of skin elasticity (wrinkles, sagging, dryness, easily tears)

 Pigmentation changes
 Glandular atrophy (oil, moisture, sweat glands)
 Thinning hair (Facial hair: decreased in men, increased in women)
 Slower nail growth
 Atrophy of epidermal arterioles

Respiratory

 Decreased cough reflex

 Decreased removal of mucus, dust, irritants from airways (decreased cilia)
 Decreased vital capacity (increased anterior-posterior chest diameter)
 Increased chest wall rigidity
 Fewer alveoli
 Increased airway resistance
 Increased risk of respiratory infections

Cardiovascular

 Thickening of blood vessel walls

 Narrowing of vessel lumen
 Loss of vessel elasticity
 Lower cardiac output
 Decreased number of heart muscle fibers
 Decreased elasticity and calcification of the heart valves
 Decreased baroreceptor sensitivity
 Decreased efficiency of venous valves
 Increased pulmonary vascular tension
 Increased systolic blood pressure
 Decreased peripheral circulation

Gastrointestinal
 Periodontal disease
 Decrease in saliva
 Gastric secretions
 Pancreatic enzymes
 Smooth muscle changes with decreased esophageal peristalsis and small intestinal motility

Musculoskeletal

 Decreased muscle mass and strength

 Decalcification of bones
 Degenerative joint changes
 Dehydration of intervertebral disks (decreased height)

Neurological

 Degenerative of nerve cells

 Decrease in neurotransmitters
 Decrease in rate of conduction of impulses

Sensory

EYES

 Decreased accommodation to near/far (presbyopia)

 Difficulty adjusting to changes from light to dark
 Yellowing of the lens
 Altered color perception
 Increased sensitivity to glare
 Smaller pupils

EARS

 Loss of acuity for high-frequency tones (Presbycusis)

 Thickening of tympanic membrane
 Sclerosis of inner ear
 Buildup of earwax (cerumen)

TASTE

 Often diminished, often have fewer taste buds

SMELL

 Often diminished

Touch
 Decreased skin receptors

Proprioception

 Decreased awareness of body positioning in space

Genitourinary

 Fewer nephrons
 50% decrease in renal blood flow by age 80
 Decreased bladder capacity
 Male: Enlargement of prostate
 Female: Reduced sphincter tone

Reproductive

 Male: Sperm count diminishes, smaller testes, erection less firm and slow to develop
 Female: Decreased estrogen production, degeneration of ovaries, atrophy of vagina, uterus, breasts

Endocrine

 General: Alteration on hormone production with decreased ability to respond stress

 Thyroid: decreased secretion
 Thymus: Involution of thymus gland
 Cortisol, glucocorticoids: Increased anti-inflammatory hormone
 Pancreas: Increased fibrosis, decreased secretion of enzymes and hormones

Integumentary System

Older patients usually have spots and lesions present on their skin. Smooth, brown, irregularly shaped
spots (age spots or senile lentigo) initially appear on the backs of the hands and on the forearms. Small,
round, red or brown cherry angiomas occur on the trunk. Seborrheic lesions or keratoses appear as
irregular, round or oval, brown, watery lesions. Years of sun exposure contribute to the aging of the skin
and lead to premalignant and malignant lesions. As a nurse, you need to rule out three malignancies
related to sun exposure when examining skin lesions: melanoma, basal cell carcinoma and squamous
cell carcinoma.

Head and Neck

Facial features appear asymmetrical because of missing teeth or improperly fitting dentures. Common
vocal changes include a rise in pitch and a loss of power and range. Visual acuity declines with age.
Presbyopia, a progressive decline in the ability of the eyes to accommodate for close, detailed work, is
common. Older person has a reduced ability to see in darkness and abrupt changes from dark areas to
light areas (and the reverse).
More ambient light is necessary for tasks such as reading, as well as for other activities of daily living.
However, older adults also have increased sensitivity to the effects of glare, so make sure interventions
to increase ambient light do not increase glare.

Changes in color vision and discoloration of the lens make it difficult to distinguish between blues and
greens and among pastel shades. Dark colors also appear the same.

Most of the time older adults ignore the earlier signs of loss of hearing acuity until friends and family
members comment on compensatory attempts such as turning up the volume on televisions and radios.

Presbycusis affects the ability to hear high-pitched sounds and sibilant consonants such as s, sh and ch.
Before the nurse assumes Presbycusis, it is necessary to inspect the external auditory canal for the
presence of cerumen. Impacted cerumen, a common cause of diminished hearing acuity, is easy to treat.

Salivary secretion is reduced, and taste buds atrophy and lose sensitivity. The older adult is less able to
differentiate among salty, sweet, sour and bitter tastes. The sense of smell also decreases, further
reducing taste.

Thorax and Lungs

After age 55, respiratory muscle strength begins to decrease. Vertebral changes due to osteoporosis
lead to dorsal kyphosis, the curvature of the thoracic spine sometimes called “dowager’s hump.”
Calcification of the costal cartilage causes decreased mobility of the ribs. The chest wall gradually
becomes stiffer. Lung expansion decreases. If kyphosis or chronic obstructive lung disease is present,
breath sounds are distant.

Heart and Vascular System

Decreased contractile strength of the myocardium results in decreased cardiac output. The decrease is
significant when the older adult experiences anxiety, excitement, illness or strenuous activity. The body
tries to compensate for decreased cardiac output by increasing the heart rate during exercise. However,
after exercise, it takes longer for the older adult’s rate to return to baseline.

Sytolic and/ or diastolic blood pressures are sometimes abnormally high. Baroreceptor sensitivity
declines, decreasing the ability to produce a compensatory response to hypotensive or hypertensive
stimuli.

Peripheral pulses are frequently weaker, although still palpable, in the lower extremities. Older adults
sometimes complain that their lower extremities are cold, particularly at night. Changes in the
peripheral pulses in the upper extremities are less common.

Breasts

Decreased muscle mass, tone, and elasticity result in smaller breasts in older women. Atrophy of
glandular tissue, coupled with more fat deposits, results in a slightly smaller, less dense, and less nodular
breast.
Gynecomastia, enlarged breasts in men, is often due to medication side effects, hormonal changes, or
obesity.

Gastrointestinal System and Abdomen

Aging leads to an increase in the amount of fatty tissue in the trunk. As a result, the abdomen increases
in size. Because muscle tone and elasticity decrease, it also becomes more protuberant. As a result, the
abdomen increases in size. Gastrointestinal function changes include a slowing of peristalsis and
alterations in secretions. The older adult experiences these changes as the development of intolerance
to certain foods and discomfort due to delayed gastric emptying. Alterations in the lower
gastrointestinal tract lead to constipation, flatulence or diarrhea.

Reproductive System

Hypertrophy of the prostate gland is common on older men aged over 50. This hypertrophy enlarges the
gland and displaces pressure on the neck of the bladder. As a result, urinary retention, frequency,
incontinence and urinary tract infections occur. It also results to difficulty initiating voiding and
maintaining a urinary stream.

Older women, particularly those who have had children, experience stress incontinence, an involuntary
release of urine that occurs when they cough, sneeze or lift an object. This is a result of a weakening of
the perineal and bladder muscles. Other types of urinary incontinence are urge, overflow, functional and
mixed incontinence.

Musculoskeletal System

With aging, muscle fibers become smaller. Muscle strength diminishes in proportion to the decline in
muscle mass. Bone mass also declines. Older adults who exercise regularly do not lose as much bone
and muscle mass or muscle tone as those who are inactive.

Postmenopausal women experience a greater rate of bone demineralization than older men. Women
who maintain calcium intake throughout life and into menopause have less bone demineralization than
women with low calcium intake. Older men with poor nutrition and decreased mobility are also at risk
for bone demineralization.

Neurological System

The function of neurotransmitters, chemical substances that enhance or inhibit nerve impulse
transmission also changes with aging due to the decrease in neurons. All voluntary reflexes are slower,
and individuals often have less of an ability to respond to multiple stimuli. Older adults frequently report
alterations in the quality and quantity of sleep. It includes difficulty falling asleep, difficulty staying
asleep, difficulty falling asleep again after waking during night, waking too early in the morning and
excessive daytime napping. These are the age-related changes in the sleep-wake cycle.
Health Promotion and Maintenance

General preventive measures to recommend to older adults include the following:

 Participation in screening activities (e.g., blood pressure, mammography, depression, vision and
hearing testing, colonoscopy)
 Regular exercise
 Weight reduction if overweight
 Eating a low-fat, well-balanced diet
 Regular dental visits
 Smoking cessation
 Immunization for influenza, pneumococcal pneumonia, and tetanus

Pneumococcal vaccine is recommended for adults at age of 65.

For Tetanus immunization, providers recommend booster injections every 10 years for adults who have
had the primary series of injections.

Wellness

Initial screenings establish baseline data that can be used to determine wellness, identify health needs,
and design health maintenance programs. Following initial screening sessions, share with older adults
information on the nutrition, exercise, medications and safety precautions. You can also provide
information on specific conditions such as hypertension or arthritis or on self-care procedures such as
foot and skin care. By providing information about health promotion and self-care, the health and well-
being of older adults will significantly improve.

Heart Disease

Common cardiovascular disorders are hypertension and coronary artery disease.

Nursing Management:

 Weight reduction which includes exercise, dietary changes (Limit salty and fatty foods.)
 Stress Management
 Smoking Cessation
 Health teaching which includes information about medications, blood pressure monitoring,
nutrition, stress reduction techniques and the symptoms indicating the need for emergency
care.

Cancer

Malignant neoplasm are the second most common cause of death among older adults.
Nurse participates in programs to educate older adults about early detection, treatment and risk factors.
It includes smoking cessation, teaching BSE, and encouraging all older patients to have annual screening
for fecal occult blood.

Stroke (Cerebrovascular Accident)

It occurs as brain ischemia or brain hemorrhage. Brain ischemia is where there is inadequate supply of
blood to areas of brain due to blockage of blood vessels or general circulatory failure. Brain hemorrhage,
either subarachnoid or intracerebral hemorrhage, is less common. Treatment includes hospitalization
for days or months. It often impairs the functional abilities of older adults and thus limits the ability to
live independently. The scope of nursing interventions ranges from teaching older clients about risk
reduction strategies and caring for them during recovery and rehabilitation.

Smoking

Chronic Obstructive Pulmonary Disease and coronary artery disease are common in older adults who
smokes. There is what we called the “4As”, a sequential approach to encourage smoking cessation.