older adult

• Aging


  Changes in physiologic reserves over time that are independent of and not induced by any disease
• Types of age


  • Chronological age - number of years lived
  • Physiologic age - age by body function
  • Functional age - ability to contribute to society
• Vital signs


  • Blood pressure
  • Heart rate and rhythm
  • Respiratory rate and temperature
• Aorta and large arteries stiffen and become atherosclerotic


  • Aorta becomes less distensible - rise in systolic pressure
  • Diastolic pressure stop rising - postural hypertension
• Heart rate and rhythm

  • Resting heart rate remains unchanged
  • Pacemaker cells decline in the SA node - affects response to stress
• Respiratory rate and temperature

  • Hypothermia
  • Changes in temperature regulation
• Skin, hair, and nails


  • Skin becomes lax, loses turgor, wrinkles
  • Vascularity of dermis decreases
  • Actinic purpura - purple patches or macules
  • Nails lose luster, may yellow and thicken
  • Scalp hair loses pigment, normal hair loss elsewhere
• Head and neck


  • Atrophy of bony orbit of eyes
  • Skin of eyelids become wrinkled
  • Soft bulges on lower lids
  • Dry eyes due to fewer lacrimal secretions
  • Cornea loses lustre
• Eyes and visual acuity

  • Predisposed to glaucoma
  • Presbyopia - lens gradually loses elasticity, less able to accommodate and focus on nearby objects
  • Cataracts - thickening and yellowing of lenses
  • Macular degeneration - becoming more frequent, results in blindness
• Presbycusis


  Irreversible, sensorineural hearing loss with age, more affected in men, loss occurs in higher range of sound
• Mouth


  • Diminished salivary secretions
  • Decreased olfaction and increased sensitivity to bitterness
  • Teeth may wear down, loss
  • "Purse-string" wrinkles
  • Angular chelitis - maceration of skin due to overclosure of mouth
• Thorax and lungs


  • Capacity for exercise decreases
  • Chest wall becomes stiffer
  • Respiratory muscles weaken
  • Loss of elastic recoil
  • Cough becomes less effective
• Cardiovascular system


  • Kinking or buckling of artery due to lengthening and tortuosity of aorta
  • Physiologic 3rd heart sound may persist as late as age 40
  • Maximum heart rate decreases, takes longer for heart rate and blood pressure to return to normal after exertion
  • Aorta and other arteries become thicker and stiffer, may increase systolic blood pressure
  • Heart valves thicken and stiffen, heart murmurs common
  • Pacemaker cells decline, may cause slower heart rate and heart block, more common arrhythmias
  • Baroreceptors become less sensitive, may cause orthostatic hypotension
• Gastrointestinal system


  • Increased prevalence of atrophic gastritis and achlorhydria
  • Liver less efficient in metabolizing drugs and repairing damage
  • Diverticuli in colon may cause pain
  • Reduced peristalsis increases risk of constipation
• Urinary system


  • Kidney mass and glomeruli decrease, reducing filtration and concentration
  • Reduced hormonal response and impaired salt conservation increases dehydration risk
  • Bladder capacity decreases, more residual urine and frequency, increases infections, incontinence, and obstruction
• Male reproductive system


  • Reduced testosterone, testes atrophy and soften, decreased sperm production, seminal fluid decreases and becomes more viscous, erections take more time, refractory period after ejaculation may lengthen
• Female reproductive system


  • Declining estrogen and progesterone, ovulation ceases, introitus constricts and loses elasticity, vagina atrophies, uterus shrinks, breasts become pendulous and lose elasticity
• Musculoskeletal system


  • Skeletal muscles decrease in bulk and power, ligaments lose tensile strength, range of motion diminishes, subtle losses in height begin, significant shortening obvious in old age, kyphosis, flexion at knees and hips contribute to shortened stature
• Nervous system


  "Benign forgetfulness" - difficulty recalling names, details, slower data retrieval and learning, impaired complex task performance, slower motor responses, muscle wasting, benign essential tremor, diminished gag reflex
• Immune system


  • Decline in immune function, trouble differentiating self from non-self, decreased antibody response, fatty marrow replacing red marrow, decreased vitamin B12 absorption, decreased ability to tolerate stress, decreased hormone levels