1. Chapter 5 Common Aging Changes

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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.

10. 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

11. 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

12. 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.

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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.

20. 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

21. 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

22. 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

23. 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

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

25. 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

26. 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

27. 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

28. 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

29. 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.

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

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

32. 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.

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

34. 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

35. 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

36. 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