M5

• Aging


  Anatomy and Physiology of Older Adults
• Physical Changes in Eyes

  • Decreased visual acuity
• Total Lung Capacity (TLC)


  • Decreases in older adults
• Stomach


  Physical changes in the digestive system of older adults
• Physical Changes in the Nervous System

  • Decreased nerve conduction velocity
  • Decreased sensory perception
  • Decreased motor function
• Altered Thought Process


  Changes in cognitive function in older adults
• Eliciting Symptoms in the Older Adult

  • Older adults may not report symptoms clearly
  • Older adults may have atypical presentations of illness
  • Older adults may have multiple, complex health problems
• Vision and Hearing


  Physical changes in the sensory systems of older adults
• Aging


  Reflects changes in physiologic reserves over time that are independent of and not induced by any disease
• 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
• General Appearance


  • Lengthening and broadening of the nose and ears
  • Shoulder becomes narrower and the pelvis becomes wider
  • Unintentional weight loss/ weight gain
  • Asymmetric facial or extraocular muscle weakness or paralysis
• Skin

  • Wrinkles and sagging
  • Dry, flaky and rough often itchy
  • Less vascular causing lighter skin to look paler and more opaque
  • Fragile, loose and transparent skin
  • Easy bruising and tearing of skin
  • Presence of "Actinic Purpura"
• Nails


  • Loses luster or sheen
  • Dull, brittle, hard and thick
  • May turn yellowish and thicken
• Hair

  • Loses its pigment (gray hairs)
  • Receding hairline usually begins at the temples of the head
  • Normal hair loss at the scalp
  • Normal hair loss may not occur in the axilla, presternum or pubis, especially in women
• Eyes and Visual Acuity

  • Predisposed to glaucoma
  • Lens becomes less transparent
  • Skin of the eyelids becomes wrinkled; may hang in loose folds
  • Watery eyes can sometimes result from true lacrimal obstruction
• Presbyopia


  Lens gradually loses its elasticity; less able to accommodate and focus on nearby objects
• Cataracts


  Thickening and yellowing of the lenses
• Glaucoma


  Vision loss and blindness by damaging the optic nerve
• Macular Degeneration


  Affects the central part of the retina, the macula, and resulting in distortion or loss of central vision
• Ears and Hearing


  • Hearing high-pitched sounds becomes more difficult
  • Earwax, which interferes with hearing, tends to accumulate more of the ears
• Presbycusis


  Irreversible, sensorineural loss with age; hearing declines more quickly in men than women; loss occurs in higher range of sound
• Mouth


  • Diminished salivary secretions
  • Decreased olfaction and increased sensitivity to bitterness
  • Changes in taste
  • Teeth may wear down; loss
  • Atrophy of the muscle and bones of the jaw and mouth that control mastication
  • "Purse-string" wrinkles or wrinkles that form around the mouth
• Angular Cheilitis


  Maceration of skin due to overclosure of mouth; dry, cracked lip corners can also trigger or cause
• Head and Neck


  • Atrophy of the bony orbit of the eyes
  • Skin of the eyelids become wrinkled
  • Soft bulges on the lower lids
• Thorax and Lungs


  • Capacity for exercise decreases
  • Chest wall becomes stiffer
  • Respiratory muscles weaken
  • Loss of elastic recoil
  • Cough becomes less effective
• Alveoli and Lung Elasticity


  • Alveoli becomes flatter and shallower; decrease in alveoli surface area
  • Decrease lung elasticity, which causes a change in the elastic recoil properties of the lungs
• Major Physical Changes in the Respiratory System

  • Total Lung Capacity (TLC) - No Change
  • Vital Capacity (VC) - Decrease
  • Inspiratory Capacity (IC) - Decrease
  • Tidal Volume (TV) - Decrease
  • Inspiratory Reserve Volume (IRV) - Decrease
  • Expiratory Reserve Volume (ERV) - Decrease
  • Forced Expiratory Volume (FEV) - Decrease
  • Residual Volume (RV) - Increase
  • Functional Residual Capacity (FRC) - Increase
• Chronic Obstructive Pulmonary Disease (COPD)


  Characterized by limited airflow and impaired gas exchange; encompasses chronic bronchitis, chronic obstructive bronchitis and emphysema
• Pneumonia


  Characterized by lung inflammation generally brought on by infection; mortality is known to be significantly higher in those age 60 years or older
• Heart and Cardiovascular System

  • Heart muscles thicken with age
  • Kinking or buckling of the artery due to lengthening and tortuosity of the aorta
  • A physiologic 3rd heart sound may persist as late as age 40 years
  • Susceptible to Postural Hypotension
• Major Cardiovascular Changes with Aging

  • Decreased Myocardial Cells, Aortic Distensibility and Vascular Tone
  • The maximum heart rate decreases and it takes longer for heart rate and blood pressure to return to normal resting levels after exertion
  • Aorta and other arteries become thicker and stiffer which may bring a moderate increase in systolic blood pressure
  • The chambers of the heart thicken and become stiffer; Heart Murmurs are fairly common
  • The pacemaker of the heart loses cells and develops fibrous tissue and fat deposits; may cause a slightly slower heart rate and even heart block
  • Aberrant Heart Rhythms and extra heart beats become more common
  • The baroreceptors which monitor blood pressure become less sensitive
  • Quick changes in position may cause dizziness; Orthostatic Hypotension
• Digestive System


  • Esophagus: Stiffening of the esophageal wall and less sensitivity to discomfort and pain; affect the ability to swallow; Gag reflex appear to be absent in around 40% of healthy older adults; Gastroesophageal Episodes appear to be more prolonged
• Stomach


  • Peristalsis and gastric contractile force are mildly reduced
  • Secretion changes cause a decline in gastric defense mechanism and create an increased potential for mucosal injury
  • Cannot hold as much food because it is less elastic
• Older people are more likely to develop intolerance of dairy products (lactose intolerance)
• Liver


  • Size as well as its blood flow and perfusion can decrease by 30% to 40%
  • May be slightly less able to help remove drugs and other substances from the body
• Major Gastrointestinal Changes with Aging

  • Increased prevalence of Atrophic Gastritis
  • Increased prevalence of Achlorhydria
• Atrophic Gastritis


  Chronic inflammation and thinning of your stomach lining