Physiologic Changes with Aging although kidney mass is decreased,

primarily because of a loss of nephrons.

Genito -Urinary System o Changes in renal function may be
attributable to a combination of aging
URINARY SYSTEM and pathologic conditions such as
 “The bladder of an elderly person has a capacity hypertension.
of less than half (250ml) that of a young adult o The changes most commonly seen
(600 ml) and often contains as much as 100 ml
include a decreased filtration rate,
of residual urine”
diminished tubular function with less
 Micturation reflex is delayed-- usually activated
when bladder is half full; in OAs, not until efficiency in reabsorbing and
bladder is nearly at capacity concentrating the urine, and a slower
restoration of acid– base balance in
GENITAL SYSTEM CHANGES response to stress.
 “The genital system is characterized by a
number of age-related changes in physiology
Nervous System
and anatomy. On the whole, very few age-
• Homeostasis is difficult to maintain with aging,
specific disorders are associated with this body
but older people have a tremendous ability to
system. With the exception of declining levels
adapt and function adequately, retaining their
of testosterone, most of the problems of
cognitive and intellectual abilities in the absence
sexuality and aging are sociogenic or
of pathologic changes.
psychogenic”.
• However, normal aging changes in the nervous
system can affect all parts of the body.
Female genital tract
• Nerve cells in the brain decrease but the
 External genitalia
decrease is compensated for by other neurons.
o Folds become less pronounced
• Overall, the decreases contribute to a small loss
o Skin becomes thinner
of brain mass.
o Vasculariy & elasticity decrease
• Chemical changes include a decrease in the
o Becomes more susceptible to tissue synthesis and metabolism of the major
trauma & itching neurotransmitters.
o # of glands decreas, as does level of • Because nerve impulses are conducted more
secretion slowly, older people take longer to respond and
react.
Internatal reproductive organs • The autonomic nervous system performs less
o Uterus decreases in size & becomes efficiently, and postural hypotension, may
more fibrous occur.
o Uterus has fewer endometrial glands • Neurologic changes can affect gait and balance,
o Cervix reduced in size which may interfere with mobility and safety.
o Uterine tubes become thinner • Adequate nutrition and absorption of vitamin
o Ovaries take on an irreguar shape B12 is important for neurologic health.
o Ovulation stops--menopause (50% • Mental function may be threatened by physical
between ages 45 and 50) or emotional stresses.

Male Genital System

o Continues to produce germ cells Senses
(sperm) and sex hormones • People interact with the world through their
(testosterone) well into old age, senses.
declining with advancing age • Losses associated with old age affect all sensory
o Size & firmness of the testes decrease organs, and it can be devastating not to be able
o Reduced sperm production due to age- to
related fibrosis which constricts the • see to read or watch television, hear
blood supply conversation well enough to communicate, or
o Fibrosis may also affect the penis since discriminate taste well enough to enjoy food.
erection is a purely vascular • Nearly half of older men and one third of older
phenomenon women report difficulty hearing without a
o The genitourinary system continues to hearing aid.
function adequately in older adults,
 • Most older adults have a decrease in visual • Environmental factors, such as exposure to noise,
acuity, a narrowing of the visual field, and may medications, and infections, as well as genetics, may
have trouble seeing at night contribute to hearing loss as much as age-related
changes.

Sensory Loss Versus Sensory Deprivation • PRESBYCUSIS

• In contrast to sensory loss, sensory deprivation • Gradual sensorineural loss that progresses from
is the absence of stimuli in the environment or the loss of the ability to hear high-frequency
the inability to interpret existing stimuli. tones to a generalized loss of hearing.
• Sensory deprivation can lead to boredom,
confusion, irritability, disorientation, and • It is attributed to irreversible inner ear changes.
anxiety.
• Older adults often cannot follow conversation
• A decline in sensory input can mimic a decline in
because tones of high-frequency consonants
cognition that is in fact not present.
• In some situations, one sense can substitute for (the sounds f, s, th, ch, sh, b, t, p) all sound alike.
another in observing and interpreting stimuli. TASTE AND SMELL
IF YOU ARE THE NURSE HANDLING A PATIENT WITH • The senses of taste and smell are reduced in older
SENSORY DEPRIVATION, WHAT INTERVENTIONS CAN YOU adults.
PERFORM?
• Changes in the sense of smell, generally greater than
• Nurses can enhance sensory stimulation in the the loss of taste, are related to cell loss in the nasal
environment with colors, pictures, textures, tastes, passages and in the olfactory bulb in the brain.
smells, and sounds.
• The stimuli are most meaningful if they are • Environmental factors such as long-term exposure to
appropriate for older adults and the stimuli are toxins (e.g., dust, pollen, and smoke) contribute to
changed often. the cellular damage.
• Cognitively impaired people tend to respond well to
touch and to familiar music.
VISION Endocrine Sytem

• As new cells form on the outside surface of the lens

of the eye, the older central cells accumulate and
become yellow, rigid, dense, and cloudy, leaving only
the outer portion of the lens elastic enough to
change shape (accommodate) and focus at near and
far distances.

• As the lens becomes less flexible, the near point of

focus gets farther away.

WHAT CONDITION IS DEVELOPED?

 PRESBYOPIA
o The pupil dilates slowly and less
completely because of increased
stiffness of the muscles of the iris, thus WHICH OF THE FOLLOWING TERM REFERS TO THE CARE
the older person takes more time to OF THE AGING PEOPLE?
adjust when going to and from light A. GERONTOLOGY
and dark settings and needs brighter B. GERIATRICS
light for close vision.
Nursing Care of the Older Adult in Wellness
HEARING
• Auditory changes begin to be noticed at about 40
years of age.
LET’S TEST YOUR KNOWLEDGE!
• GIVEN THE DIFFERENT INFORMATION ON THE
PHYSIOLOGIC CHANGES OF AGING, WHAT 3
PRIORITY INTERVENTIONS SHOULD BE
INCLUDED IN YOUR PLAAN OF CARE?

Planning for Successful Aging

STRESS AND COPING IN THE OLDER ADULT
• Coping patterns and the ability to adapt to
stress develop over the course of a lifetime and
remain consistent later in life.
• A person’s abilities to adapt to change, make
decisions, and respond predictably are also
determined by past experiences.
• The older person often has fewer choices and
diminished resources to deal with stressful
events.
• Common stressors of old age include normal
aging changes that impair physical function,
activities, and appearance; disabilities from
injury or chronic illness; social and
environmental losses related to loss of income
and decreased ability to perform previous roles
and activities; and the deaths of significant
others.
• Many older adults rely strongly on their families
and spiritual beliefs for comfort during stressful
times.
•
LIVING ARRANGEMENTS LONG-TERM CARE FACILITIES

• Many older adults have more than adequate • Many types of nursing homes, nursing facilities, or
financial resources and good health even until very long-term care facilities offer continuous nursing
late in life; therefore, they have many housing care.
options. • The actual number of older people who reside in
• More than 90% of older adults live in the long-term care facilities has risen owing to the large
community, with a relatively small percentage (3.4%) increase in older adults and the use of nursing
residing in nursing homes and a comparable homes for short-term rehabilitation.
percentage living in some type of senior housing. THE RELATIONSHIP BETWEEN WELLNESS AND AGING
• Eighty-one percent of those older than 65 years own
their homes. Promoting wellness in older adults is an ideal; however,
• Twenty-eight percent of noninstitutionalized older nurses may not believe it is achievable in practice because of
people live alone and widowed women barriers such as the following:
predominate.
• Older adults may be pessimistic about their ability to
LIVING AT HOME OR WITH FAMILY improve their health and functioning.
• Survival needs and a multitude of health problems
• Most older adults want to remain in their own may take precedence over the “luxury” of being able
homes; in fact, they function best in their own to focus on wellness and quality of life.
environment. • Despite the purported emphasis on wellness and
• The family home and familiar community may have health promotion, health care environments focus
strong emotional significance for them, and this more on treating disease than on preventing illness
should not be ignored. and addressing whole-person needs.
• However, with advanced age and increasing A NURSING THEORY FOR WELLNESS-FOCUSED CARE OF
disability, adjustments to the environment may be OLDER ADULTS
required to allow older adults to remain in their own
homes or apartments. • During the 1980s, this author proposed a model for
• Many services and organizations can assist older gerontological nursing.
adults to successfully “age in place” in their own • This model has emphasized the significant role of
homes or in assisted living facilities. nurses in using health education interventions to
• Sometimes older adults or couples move in with promote optimal health, functioning, and quality of
adult children. life for older adults.
• This arrangement provides security for the older
adult and privacy for both families.

CONTINUING CARE RETIREMENT COMMUNITIES

• Continuing care retirement communities (CCRCs)
offer three levels of living arrangements and care
that provide for aging in place.
• CCRCs consist of independent single-dwelling houses
or apartments for people who can manage their day-
to-day needs, assisted living apartments for those
who need limited assistance with their daily living
needs, and skilled nursing services when continuous
nursing assistance is required.

ASSISTED LIVING FACILITIES

• Assisted living facilities are an option when an older
person’s physical or cognitive changes necessitate at
least minimal supervision or assistance.
• Assisted living allows for a degree of independence
while providing minimal nursing assistance with
administration of medication, assistance with ADLs,
or other chronic health care needs.
Assessing Health of Older Adults
• Assessment of health and functioning of older
adults is an essential and complex component of
nursing care.