AgingRelated Changes Dr Demet Tekd Demirciolu Introduction Changes

Aging-Related Changes Dr. Demet Tekdöş Demircioğlu

Introduction • Changes of aging highly individualized • Changes also different in various body systems of the individual • Changes influenced by: – Genetic factors, environment, diet, health, stress, and lifestyle choices

Changes in the Body: Cells • Changes start at cellular level • Cell numbers reduced • Decreased lean body mass • Increased total body fat • Decreased fluid (cells) • Risk for dehydration

Changes in the Body: Physical Appearance • Begins 4 th decade of life • Hair loss, gray hair, & wrinkles • Reduced subcutaneous body fat • Reduced tissue elasticity • Reduced skin-fold thickness • Decrease in stature

Ectropion of Eyelids

Elongated Ears

Checking Skin Turgor? Not on back of hand or forearm for an elder client Forehead, collarbone, or sternum (elder client)

Changes in the Body: Respiratory System • Reduction respiratory activity • Increased rigidity of thoracic cage • Kyphosis • Increased anterior-posterior diameter of chest • Blunted cough reflex, reduced cilia • Less lung expansion

Changes in the Body: Respiratory System • Increased residual volume (increased air remaining in lungs after the most complete expiration possible) • Reduced vital capacity (decreased capacity to inhale, hold, & exhale breath) • High risk for respiratory infection (pneumonia)

Lung Capacity Decreases

Changes in the Body: Cardiovascular System • Heart size unchanged (in absence of pathology) • Valves thick & rigid • Heart muscle loses efficiency – Reduced cardiac output under physiologic stress • Reduced elasticity of blood vessels • Increased peripheral resistance – HTN not normal part of aging

Normal Changes of Cardiac Output

Reduced cardiac output under physiologic stress

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Changes in the Body: Gastrointestinal System • Tooth loss (edentulism) not a normal part of aging • Decreased taste sensation (dysgeusia) • Decreased saliva (xerostomia) • Decreased hydrochloric acid (achlorhydria) • Increased risk: aspiration, indigestion, & constipation – Constipation: fiber, fluids, & exercise • Decreased esophageal, gastric, & intestinal motility • Atrophy: small & large intestines

Changes in the Body: Urinary System • Reduction renal blood flow & filtration • Reduced bladder capacity – Urinary frequency, urgency, & nocturia common – UTI = confusion • Incontinence not a normal part of aging

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Changes in the Body: 23 Reproductive System • Male: – Reduction sperm count – Prostatic enlargement • Female: – Atrophy – Estrogen depletion

Changes in the Body: Musculoskeletal System • Atrophy of muscles • Tendons shrink & harden • Reduction in bone mineral & mass • Loss of height • Joint activity & motion • Increased risk fractures

Changes in the Body: Nervous System • Reduction: nerve cells, cerebral blood flow, & metabolism • Slower reflexes, delayed responses, & changes in balance – Increased risk falls • Nervous system affected by all other body systems • Changes: sleep patterns (stages III & IV)

Changes in the Body: Sensory Organs— Vision • Presbyopia – normal change of aging • Narrowing of visual field; decreased peripheral vision • Pupil less responsive to light • Potential for macular degeneration • Common eye disorders in the elderly are NOT normal: cataracts, glaucoma, macular degeneration, & retinopathy

Changes in the Body: Sensory Organs— Vision (cont’d) • Opacification/ yellowing of lens: potential for cataracts • Distortion in depth perception • Dry eyes • Arcus senilis – white/gray ring around cornea • Decline visual acuity

Changes in the Body: Sensory Organs— Hearing • Incidence • Causes: age-related changes; loud noises; diseases; trauma; medications – Ototoxic medications: aminoglycoside abx; loop diuretics; aspirin • Inner ear problems • Damage to 8 th cranial nerve • Tinnitus • Alteration in equilibrium (balance) • Presbycusis (sensorineural loss) • Accumulation of cerumen; impaction (conductive loss)

Presbycusis • Part of normal aging – most common cause of hearing loss in elderly • Characteristics: bilateral, symmetric, progressive • 75% people over age 60 • Sensorineural loss • • – Loss of hair cells in cochlea – Degradation of neurons Gradual, bilateral, impaired ability to hear high-pitched tones – High-pitched sounds such as "s" or "th" are hard to distinguish – Unable to distinguish directions of sound No interventions to slow progression • Rarely causes severe hearing loss/ deafness

Cerumen Impaction • One of most common, reversible causes of conductive hearing loss in elderly adults • 35% community-residing older adults • Can greatly affect hearing • Feeling of fullness, itching in ear canal • Recommended aural hygiene – Gentle cleaning of auricles – Use of cotton-tipped applicators to cleanse ear canal NOT recommended

Lavage or Irrigation to 36 Remove Cerumen

Care of the Person With a 37 Hearing Deficit • Encourage audiometric testing – May not be age-related; could be treatable • Learning to live with hearing deficit • Emotional reactions to hearing problems

Changes in the Body: Sensory Organs— Smell & Taste • Loss of ability to smell • Altered sense of taste (dysgeusia) • Reduction in tactile sensation • Potential risk related to safety issues

Changes in the Body: Endocrine System • Decreased thyroid • Decreased ACTH, glucocorticoids, estrogen, testosterone • Delayed & insufficient release of insulin • Decreased tissue sensitivity to insulin • Reduced ability to metabolize glucose – Higher blood glucose

Changes in the Body: Integumentary System • Skin less elastic, more dry, & more fragile • Age spots (solar lentigo) • Increased skin cancer • Thinning & graying of hair • Fingernails longitudinal ridges • Reduced sweat gland

Changes in the Body: 41 Immune System • Depressed immune response: – Decreased fever response – Thymus gland shrinks, T-cell activity declines – Decline in cell-mediated immunity – Increased risk for infection, cancer – Potential for reactivation of dormant varicella-zoster (shingles) & tuberculosis

Changes in the Body: 43 Thermoregulation • Lower normal body temperatures • Rectal most reliable • Reduced ability to respond to cold temperatures • Differences in response to heat

Changes in the Mind • Psychological changes – explore causes • Personality remains consistent • Changes in memory • Intelligence & aging • Learning ability & aging • Attention span