Age related body system changes.pdf

VIVEKANAND COLLEGE OF
NURSING
ASSIGNMENT ON: -
Age related body system changes
SUBMITTED TO,
SUBMITTED BY,
Apurva Dwivedi
M.Sc. nursing 1st
yr.
VCON
SUBMITTED ON,

Age related body system changes
Many normal changes can lead to clear clinical consequences (i.e., Arterialst iffening leading to
hypertension, absence of estrogen in post-menopausal females accelerating bone loss). Not all
these changes with aging are necessessarily bad; for example, autoimmune disease may "burn
out" in later life. However, you should be aware of some general themes, which ma y explain
why disease presentation in the elderly can be atypical (i.e., Diminished perception of acute pain
may alter the presentation of pancreatitis, or myocardial infarction, etc.), and older adults are
more likely to die because of a pneumonia (decreased immune system, decreased respiratory
function and reserve).
Oral Cavity
• 40% of those >65 is edentulous, mostly because of neglect Rather than any natural age-
related process.
• Risk of caries increases with age as a result of gingival Recession and loss of jaw bone
density.
Voice
• Ossification of the laryngeal cartilages causes stiffness; prevents vocal cords coming
together while speaking resulting in a weaker, breathy voice.
• In males, the vocal cords become thin and atrophied with age,
• resulting in a higher pitched conversational voice.
• In females, loss of hormonal influence leads to vocal cords becoming more edematous
after menopause, resulting in a lower pitched voice.
Eyes
• Presbyopia (loss of lens accommodation) due to hardening & thickening of the lens
(making it opaque) and decrease in muscle tone.
• Decreased visual acuity because of narrowed pupil, fewer rods (cones spared) so poorer
night vision; there is also the need for more light to reach the retina (on average e, an
older person needs 4x lighter than a younger person); additional problems with depth and
color perception.
• Flattening of the corneal surface (with diminished refraction) and clouding of lens.
Nursing Considerations and Patient Teaching
• Teach visually impaired patients, about adaptive techniques for daily living activities
such as an extra lighting.
• Advise regular examination by an ophthalmologist.

• Provide pre-operative and post-operative care and teaching to patients who are
undergoing cataract surgery including lifting and bending restrictions as well as measures
to prevent infection.
• Teach proper eye drop administration techniques to all patients to whom physician
prescribed eye drops. Also, teach the patient to hold the drop in the eye with the eyelid
closed for 30 seconds after administration.
• Ensure that older patients have their glasses whenever needed to decrease perceptual and
spatial deficits.
Ears
• Presbycusis: high sound frequencies lo st and impaired speech discrimination.
• More prone to excess cerumen (ear wax) occlusion of ear canal, which becomes narrower
and more tortuous.
1. Assess for ear pain, drainage, inflammation, abnormalities, impacted cerumen,
perforations or surgeries.
2. Evaluate medication regimen and assess for ototoxicity, if medication history reveals
such a risk. Advice hearing testing by an audiologist, if the previous assessment is
negative.
3. Monitor the care and use of hearing aid by older patient with unilateral or bilateral aids.
4. Provide teaching and assistance as needed for cleaning the hearing aids and replacing
batteries.
5. Instruct caregivers and family about the communication and socialization needs of the
patient.
a) For some older patients, either use of small erasable board to augment verbal
questions or communication with written text represents a therapeutic intervention
for hearing impairment.
b) If writing ability is also impaired, a story board that has pictures indicating the
patient's needs (for example, bathroom, food, rest) can assist the patient to
communicate independently to caregivers for their needs.
Respiratory
• Age related changes resemble emphysema:
• Loss of elastic recoil
• Early airway closure (and more dead space where you are ventilating non-perfused lung)
• Decreased arterial P02 (-4 mm/decade)
• Decreased flow rates, FEV 1, and Vital Capacity
• Stiffer chest wall & weak muscles.
• Increased dead space.

Nursing Considerations and Patient Teaching for Respiratory Tract
Infection (RTI)
1. Advice the patient to discuss pneumococcal vaccine with the primary care provider.
2. Advice to obtain annual influenza vaccine.
3. Assist the patient to assume a position of comfort and assist with medication and
respiratory treatment, as ordered.
4. Avoid distention of bowel, bladder or stomach; any of which can increase breathing
discomfort.
5. Allow adequate time for nursing care.
6. Administer humidified oxygen therapy as prescribed.
7. Administer analgesics and antipyretics as prescribed.
8. Assess for signs of dehydration and ensure that fluids are accessible to the patient, unless
contraindicated.
9. Review diagnostic data, monitor lung sounds, intake and output every 8 hours or as
needed given changes in the patient's condition. Weight the patient daily to assess for
fluid retention.
10. Monitor for any signs of respiratory distress (cyanosis of lips, mucous membranes or nail
beds) and obtain pulse oximetry reading as needed.
For Chronic Obstructive Pulmonary Disease (COPD)
1. Assist the patient to position of comfort (tripod position).
2. Teach the patient to use pursed-lip breathing to avoid hyperventilation when shortness of
breath occurs.
3. Teach the patient about diaphragmatic breathing for use when active.
4. Teach proper use of inhalers. Steroid inhalers should be used first, with full 60 second
wait between puffs. After waiting for 3 minutes, any bronchodilator inhalers that are
prescribed should then be used, also with 60 second wait between puffs.
5. Teach the patient to cough and clear the airway.
6. Administer chest physiotherapy (for example, percussion and postural drainage), if
prescribed.
7. Establish a schedule for ambulation, gradually increasing the distance ambulated.
8. Assist with active range of motion exercises.
9. Monitor breathing and pulse rate and administer oxygen if necessary, during the periods
of increased activity.
10. Suggest smoking cessation programmes, if the patient is a smoker.
For Pulmonary Tuberculosis
1. Monitor patients for tuberculosis status and for symptoms including fever, night sweats,
weight loss and cough producing blood-tinged sputum.
2. Inform the patient, family and caregivers about the need for adequate isolation techniques.

3. Evaluate the patient's risk for infection with HIV and related pneumocystis pneumonia.
4. Monitor that the patient's psychosocial needs are being adequately met while the disease is
being pharmacologically addressed with medications like isoniazid.
5. Educate the patient and family that the entire course of medication must be completed.
6. Monitor the patient's nutrition intake and provide supplements as necessary to maintain
adequate body weight.
7. Provide rest period throughout the day.
8. Encourage the older patient with TB to monitor activity level and length of visits by family so
as not to become overtired.
Endocrine
• Progressive decline in carbohydrate tolerance and increasing insulin resistance.
• Decreased aldosterone, renin, calcitonin, and growth hormone.
• Slightly decreased (or no change) in thyroid hormones T3 and T4,
• cortisol, insulin, epinephrine, parathyroid hormone (PTH), and 25-hydroxyvitamin D.
• Increase in follicle-stimulating hormone (FSH), luteinizing hormone (LH), and
norepinephrine.
• In women, decreased estrogen (post menopause) & prolactin.
• In men, decreased testosterone in some (so-called andropause).
1. Arrange for consultation with dietitian to assess nutritional status and to provide food
management instruction.
2. Teach the patient, family members or caregivers (as appropriate) the procedure for blood
glucose monitoring specific to the equipment the patient will be using.
3. Develop personal exercise Programme with the patient based on the patient's physical
condition, mental status, resources and interests.
4. Provide information on prescribed oral hypoglycemic medications.
5. Teach the causes, signs and treatment of hypo glycemia and hyperglycemia.
6. Advice the patient to perform self-car monitoring of the extremities and of sores on the skin,
to minimize threats to skin integrity.
7. Encourage the patient to wear shoes and to have nails trimmed by podiatrist, if unable to
safely perform self-care.

Cardiovascular
• Arterial wall stiffening (true and "pseudo hypertension").
• Increased L atrial size and prevalence of S4 heart sound.
• Reduced LV compliance caused by: increased myocyte size, increased LV and increased
posterior wall thickness (infiltration with lipids, collagen, fat, amyloid).
• Cardiac output decreases at rest/exertion; maximal HR decreases (predicted max is 220-
age in years), much less in physically active elders with disease.
Nursing Considerations and Patient Teaching for Chronic Heart
Failure (CHF)
1. Frequently monitor serum digitalis level and monitor for any signs of digoxin toxicity for
which older patients are at increased risk because of the decreased rate of renal clearance of the
drug.
2. Withhold digoxin and immediately contact the registered nurse and the physician, if abnormal
serum level or signs and symptoms of toxicity are present.
3. Take the apical pulse for a full one minute before administering digoxin.
a. Withhold the medication, if the apical pulse is below 60.
b. Consult the physician, if bradycardia or any other significant changes in vital signs are
noted.
4. Monitor the patient's blood pressure and lung sounds.
5. Monitor electrolyte levels, Blood Urea Nitrogen (BUN) and creatinine level to observe system
changes including decreased kidney efficiency.
6. Monitor for signs of fluid retention such as intake and output, weight gain, shortness of breath
or coughing.
7. Encourage alternating periods of activity with periods of rest.
8. Encourage the patient to maintain a level of exercise, physical activity appropriate to physical
condition.
9. Teach the patient and family about the safe use of the prescribed medications.
10. For the patients on diuretics, which deplete potassium, monitor fluid intake and level of
potassium, ensuring adequacy of each. Encourage. administration of diuretics early in the day,
unless contraindicated, to prevent increased urination at night.

For Hypertension
1. Evaluate fluid retention.
2. Evaluate dietary intake pattern, especially for cholesterol, fat, sodium and carbohydrate. Make
recommendations based on findings.
3. Advice the patient to avoid alcohol use.
4. Recommend smoking cessation programs, if necessary.
5. Recommend and facilitate consistently an appropriate exercise Programme.
6. Discuss the relationship of stress and hypertension and provide resources from which the
patient can learn relaxation techniques.
7. Provide information about medications and the importance of taking daily blood pressure
medications as prescribed.
8. Encourage the patient for regular blood pressure check-ups.
9. Teach the patient or significant others regarding proper use of blood pressure equipment, if
applicable.
For Peripheral Vascular Disease (PVD)
1. Assess the lower extremities, including the peripheral pulses, for signs of arterial or
venous insufficiency and edema due to fluid retention.
2. Evaluate lifestyle factors that may aggravate or advance atherosclerosis, such as high-
carbohydrate, high-fat diet and little exercise.
3. Teach the patient about the disease, including treatment, medication actions and their side
effects and signs of thrombosis.
4. Educate the patient and caregivers about the care and inspection of the lower extremities.
5. Provide instructions on interventions which are specific to the patient's type of PVD
(arterial or venous).
Gastrointestinal
• Reduced Lower Esophageal Sphincter (LES) tone.
• Decreased acid production (leading to decreased emptying less calcium absorption, and
differential medication absorption),
• Reduced intrinsic factor.
• Decreased liver mass and blood flow leading to reduced oxidative metabolism of some
drugs (but not acetylation or sulfur nidation) and protein synthesis.
• Increased transit time.

• Increased rectal resting tone, decreased contracting pressure.
For Dehydration
1. Identify the reason for dehydration, i.e., inadequate fluid intake or excessive fluid output.
2. Identify the reason and corresponding interventions for inadequate fluid intake:
a. Fluids are inaccessible because of the patient's physical limitations. Offer fluids on regular
basis throughout the day.
b. The patient dislikes water or other available fluids. Identify fluid choices.
c. The patient restricts fluids because of the fear of incontinence. Explain the relationship of
decreased fluid intake to bladder infections and arrange assistance as needed for toileting.
3. Identify the reasons for any excessive fluid output and treat accordingly.
Genital/Sexual
• As a rule of thumb, "Everything slows down!".
Male
• More intense stimulation needed for erection.
• Erections less firm.
• Ejaculation takes longer, less volume, & intensity.
• Longer refractory period.
1. Establish rapport and encourage the patient to verbalize feelings and concerns related to
sexuality, body image and self-esteem.
2. Complete sexual history and recommend interventions based on findings. Support the patient's
needs for companionship and intimacy throughout the life span.
3. Provide education to patient and family regarding the signs and symptoms of prostrate
disorders (for example, difficulty in starting the urine stream, a smaller urine stream, frequent
urination, frequent night time awakening for the purpose of urinating or in severe cases, the
failure or inability to urinate).
4. Teach and encourage monthly testicular self-examination and yearly digital rectal examination
of the prostate gland by primary care provider. The benefits of laboratory test performed every 1
to 2 years to facilitate early detection and treatment of prostate cancer are being researched and
debated.

Female
• Estrogen dependent changes [vaginal lubrication slower atrophy (thin epithelium,
honeymoon cystitis)].
• Slower reaction of clitoris.
• Prolonged refractory period.
Hematologic & Immune systems
• T-cell: Numbers decrease, delayed hypersensitivity reaction m decreased, fewer natural
killer and suppressor cells.
• B-cell: numbers stable, but make fewer antibodies.
1. Teach and encourage monthly breast self-examination and yearly mammograms for early
detection and treatment of disorders.
2. Establish rapport and encourage the patient to verbalize feelings and concerns related to
sexuality, body image and self-esteem.
3. Complete sexual history and recommend interventions based on findings. Support the patient's
needs for companionship and intimacy throughout the life span.
4. Recommend that a bone density scan be discussed with the patient's primary care provider to
allow for early detection and treatment of osteoporosis.
5. Encourage annual gynecological examination with the patient's primary care provider.
Renal
• Smaller kidneys (cortical renal mass decreases-20%)
• Renal blood flow decreases
• Glomerular Filtration Rate (GFR) progressively decreases; average decline is 50% from
age 20-80, but those 80+ show little decline.
• More prone to develop SIADH
For Urinary Tract Infections
1. Elderly person frequently do not present with the usual signs and symptoms of UTIS. Falling
or signs of acute confusion (more than usual) may often be the major clinical manifestations.
2. Monitor fluid intake and output. Increase intake unless contraindicated. Offer cranberry juice
frequently as per ordered diet.
3. Teach and encourage patient to empty the bladder every 3 to 4 hours.

4. Use proper infection control techniques to minimize the risk of infection, including
maintaining sterile technique for any urinary catheterization procedure (for urinalysis,
assessment for bladder retention or insertion of indwelling catheter) to prevent unnecessary
introduction of bacteria into the bladder.
5. Teach female patients to wipe from front to back:
a. Cleanse thoroughly after bowel movements.
b. Avoid bubble baths, colored toilet paper, douches and vagianl spray.
c. Wear underwear made from cotton rather than synthetic fibers.
6. Teach the patient and caregivers that hematuria and fever indicate the need for immediate
assessment and intervention as these signs and symptoms can signify potentially serious
infection or condition. Any signs and symptoms of bladder infection should be immediately
reported to the RN and the physician.
For Urinary Incontinence
1. Complete assessment for bladder management.
a. History of infection or other urinary problem.
b. Urinalysis indicates presence of protein, glucose, ketones, RBC, WBC, bacteria, crystal and
specific gravity of urine.
c. Perform urine culture and evaluate results.
d. BUN, serum creatinine (to be completed after 2 weeks of assessment period).
e. Assess frequency of voiding, amount of urine pass, urgency or dribbling, etc.
2. Identify the type of incontinence present.
a. Functional: Bladder emptying is unpredictable but complete. Incontinence is related to
impairment of cognitive, physical or psychological functioning or to environmental barriers.
b. Urge: Incontinence occurs immediately after the sensation to void is perceived.
c. Reflex: Incontinence is related to neurogenic bladder and central nervous system or spinal
cord injury. Bladder fills and uninhibited bladder contractions cause loss of urine.
d. Stress: Increased abdominal pressure is higher than urethral resistance. Stress associated with
coughing or laughing causes incontinence.
e. Total: Unpredictable, involuntary and continuous loss of urine.
3. Implement an appropriate bladder management Programme.
4. Frequently, monitor for skin impairment.
5. Offer absorbent incontinence pads or briefs that draw the moisture away from the skin.

6. Teach all caregivers, the patient and the family about the importance of:
a. Adequate cleansing of the genital area, (proper retraction and cleansing of the foreskin in the
older uncircumcised male and proper cleansing of the skin folds of the older female), legs and
back and use of clean linens to ensure that the patient's skin is kept clean and dry.
b. Apply a moisture barrier cream as needed to prevent skin maceration from excessive exposure
to moisture.
7. Teach and implement effective infection control techniques (for example, wipe and clean from
front to back only after toileting and while bathing).
8. Encourage referral to discuss medical options (in addition to nursing interventions) for the
treatment of incontinence.
9. Allow the patient to voice concerns over incontinence and assist to overcome any adverse
effects on psychosocial functioning.
Musculoskeletal
• Weight decreases, body fat increases, height decreases (in) women especially).
• Sarcopenia (up to 80% decrease in skeletal muscle mass and quality in non-active
seniors).
• Osteopenia (decrease in bone mass).
• Total body calcium and potassium stores decreases.
For Osteoporosis
1. Make dietary recommendations to ensure adequate intake of calcium, protein and vitamin D.
2. Recommend smoking cessation Programme, if necessary.
3. Advice the patient to avoid alcohol.
4. Encourage the patient to take calcium supplement in conjunction with vitamin D as ordered by
the patient's primary care provider.
5. Recommend consultation with the primary care provider regarding either Estrogen
Replacement Therapy (ERT) options for females or the use of medications like alendronate
sodium (Fosamax) to address bone density loss associated with osteoporosis.
6. Teach the patient, family and caregivers about measures to reduce the risk of falling and
sustaining fractures.
7. Recommend evaluation via X-ray for the presence of stress or compression, fractures of the
spine in cases of severe back pain that occurs with or without a fall. In patients with

osteoporosis, these fractures can occur more easily because the vertebrae are compacted by
shrinkage of the intervertebral spaces as a consequence of aging.
8. Provide adequate pain control measures to relieve back pain or other musculoskeletal
discomfort.
9. Monitor for adequate dietary intake of calories and fluids and for effective elimination
patterns.
10. Teach, encourage and assist patients to establish exercise programmes appropriate to their
capabilities. Especially, promote exercise programmes that include walking or other weight
bearing activities, as tolerated.
For Degenerative Arthritis
1. Suggest a schedule for alternating periods of activity and rest.
2. Advice weight reduction plan, if necessary to eliminate extra strain on affected joints.
3. Teach, assist and encourage the patient to establish an exercise Programme that emphasizes
gentle stretching and movement of all joints. For those patients who are more independent,
exercise programmes in warm water can have positive outcomes
4. Provide adequate pain control measures. Teach the patient and caregivers to monitor for GI
distress related to arthritis medications, such as NSAIDs and to be aware that enteric-coated
medications cannot be crushed because they are designed to protect the stomach by dissolving in
the duodenum.
5. Encourage the patient to seek ongoing evaluation by the physician, as new arthritis
medications, such as Celebrex are continually being developed and trailed.
For Fractured Hip
1. Nursing interventions may vary depending on whether the older patient has an Open
Reduction/ Internal Fixation Fracture (ORIF) or Total Hip Replacement or Arthroplasty (THA).
2. Maintain post-operative positioning as appropriate to the patient's form of treatment.
3. Provide adequate pain control measures before physical therapy and on an ongoing basis
throughout the recovery process.
4. Prevent complications including skin breakdown, RTI's, infections at the surgical site and
dislocation of the prosthesis or internal fixation device.
5. Facilitate and monitor with the registered nurse, the patient's consistent use of antiembolism
stockings as ordered and the administration of anticoagulant medications and the related
monitoring of laboratory values, to decrease the risk of pulmonary embolism (which can be a
significant risk to older patients after hip fracture and/or hip replacement).

6. Teach the patient about fall prevention. Evaluate the patient's environment (home, room, and
bathroom) for safety with regard to mobility and make recommendations for rectifying any
threats to safety.
Dermatological
• Flattening of the dermal-epidermal junction, leading to more thin and fragile skin
susceptible to tearing and sheer forces.
• Dermal atrophy, and progressive loss of elastic tissue subcutaneous fat leading to lines
and wrinkling, and problems with thermal regulation.
• Loss of melanocytes, and retreat of the dermal plexus leading to pallor and increased
vulnerability to sun damage and skin cancer.
• Hair graying and hair loss.
Alteration in Skin Integrity
1. Perform skin assessment to identify a pressure ulcer risk upon the patient's admission to the
health care setting.
2. Implement pressure ulcer prevention protocol for patients at risk for pressure ulcer formation.
3. It is important to consider and document pressure relieving interventions for all surfaces that
the patient will sit or lay on during the course of the day.
4. Encourage adequate intake of protein and fluids to ensure good skin integrity.
For Herpes Zoster
1. Treat the pain.
2. Treat the ulcer with medications, acyclovir topical cream as ordered, to reduce the length of
time of the outbreak.
3. Develop a plan to ensure continuity in meeting the patient's psychosocial needs and allow the
patient time to share concerns.
For Skin Cancer
1. Teach the patients and caregivers both about cancer prevention methods and skin self-
examination to detect lesions early. Early detection and treatment of skin cancers are essential to
optimal patient outcomes.
2. Provide information in both verbal and written form and in collaboration with the patient's
multi-disciplinary team, regarding treatment (surgery, chemotherapy, radiation and other
options).
3. Monitor for signs of infection at the lesion site.

4. Ensure that the patient's psychological, psychosocial, spiritual and dietary needs are also
addressed.
Neurological
• Decrease in brain mass and selected loss of cortical neurons (1% per year loss after age
60).
• 20% decrease in cerebral blood flow from age 30 to 70.
• Decreased smell and taste perception.
• Reduced perception of acute pain. Impaired postural reflexes.
• Increased reaction time (up to 30% longer).
• Alterations of neurotransmitter levels:
• Increased MAO levels
• Decreased dopamine (and binding sites), norepinephrine, and a slight decline in GABA
levels.
For Alzheimer's Disease
1. Before diagnosis, encourage medical and psychological diagnostic workup including mental
status examination.
2. Facilitate orientation in the early stages of the disease with calendars, lists and consistent
schedules. 3. Arrange an environment, i.e., therapeutic, consistent, calm and safe and that
alternates rest with activities that require the use of long-practiced skills.
4. Encourage and facilitate access for the patient and family to support groups where they can
independently share their feelings and concerns and have questions addressed.
5. When assistance is needed with ADLs, implement consistent routines with consistent
caregivers but allow for delay of care, if needed because of patient's stress or irritability.
6. Monitor general health status. Treat any underlying medical problems. Provide adequate pain
control, measures as needed and monitor for lack of sleep to minimize the risk of violent
behavior.
7. Build a trusting relationship with the patient. Use clear, simple directions and treat patients
with respect and as individuals, building on their strengths, their unique interests and histories.
8. Be aware that as much is communicated to the patient through the caregiver's non-verbal
behavior, tone and volume of voice as is communicated through actual words. A calm attitude
allows the patient to process and retrieve information when spoken or to ask a question.
9. Support the patient's mobility within a safe environment recognizing that as the disease
progresses, baseline wandering often increases as coping skill, whereas verbal communication
often decreases.

10. Bean bag chairs, low mattresses, bed and chair alarms, ant sliding wedges for chairs, walkers,
etc. that support independent mobility.
11. Encourage assisted-ambulation programmes to build lag strengths are all therapeutic
interventions for the patients as the disease progresses and represent preferable alternatives to the
use of restraints.
12. Monitor for changes in baseline behaviors and the intensity of wandering often indicates
underlying infections, metabolic imbalances or stress. Encourage patients to alternate periods of
activity and rest.
For Depression
1. Assess for signs of physical weakness fatigue (for example, infection, pain, altered nutritional
status or shortness of breath upon exertion).
2. Administer treatment for underlying physiologic problems, if applicable.
3. If symptoms persist, encourage the patient to have a medical diagnostic workup with geriatric
psychiatrist, if such a workup has not yet been done.
4. Monitor for verbal or non-verbal signs of suicidal thoughts. Determine whether the patient has
a plan.
5. Provide one-on-one supervision to the patient as needed and assure the patient that the
caregiver will keep him/her safe. If appropriate for the patient, seek an agreement that he/she will
not try to harm himself/herself.
6. Administer antidepressant medication as ordered.
a. Educate the patient and family regarding medication, including length of time before
therapeutic results and potential side effects occur.
b. Report immediately to the RN and primary care provider about any extrapyramidal side
effects (for example, tremors, drooling, pin rolling of the fingers and shuffling gait).
7. Facilitate the patient's reintegration into a healthy support system and provide small
community group time for the patient to share his/her views.
Sleep
• Less sleep required, but sleep latency increased.
• Reduced slow-wave sleep (sleep stages 3 & 4).
• Increased REM but shorter; decreased REM latency (may compensate with am napping).
• Increased night awakenings and sleep fragmentation.

Conclusion
Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and
pace. In the broader sense, ageing reflects all the changes taking place over the course of life.
These changes start from birth—one grows, develops and attains maturity. To the young, ageing
is exciting. Middle age is the time when people notice the age-related changes like greying of
hair, wrinkled skin and a fair amount of physical decline. Even the healthiest, aesthetically fit
cannot escape these changes. Slow and steady physical impairment and functional disability are
noticed resulting in increased dependency in the period of old age. According to World Health
Organization, ageing is a course of biological reality which starts at conception and ends with
death. It has its own dynamics, much beyond human control. However, this process of ageing is
also subject to the constructions by which each society makes sense of old age. In most of the
developed countries, the age of 60 is considered equivalent to retirement age and it is said to be
the beginning of old age.

Summary
Physiological changes occur with aging in all organ systems. The cardiac output decreases, blood
pressure increases and arteriosclerosis develops. The lungs show impaired gas exchange, a
decrease in vital capacity and slower expiratory flow rates. The creatinine clearance decreases
with age although the serum creatinine level remains relatively constant due to a proportionate
age-related decrease in creatinine production. Functional changes, largely related to altered
motility patterns, occur in the gastrointestinal system with senescence, and atrophic gastritis and
altered hepatic drug metabolism are common in the elderly. Progressive elevation of blood
glucose occurs with age on a multifactorial basis and osteoporosis is frequently seen due to a
linear decline in bone mass after the fourth decade. The epidermis of the skin atrophies with age
and due to changes in collagen and elastin the skin loses its tone and elasticity. Lean body mass
declines with age and this is primarily due to loss and atrophy of muscle cells. Degenerative
changes occur in many joints and this, combined with the loss of muscle mass, inhibits elderly
patients' locomotion. These changes with age have important practical implications for the
clinical management of elderly patients: metabolism is altered, changes in response to commonly
used drugs make different drug dosages necessary and there is need for rational preventive
programs of diet and exercise in an effort to delay or reverse some of these changes.

Bibliography: -
1) "Dr. JOGENDRA WATI" Adult medical surgical nursing, volume 2, 2022,
LOTUS publisher. Page ho- 1922-1934.
2) "B. VENKATESAN", medical surgical nursing, I edition - 2015, EMMESS
publisher, page no- 892-894
Net reference
https://www.intechopen.com/chapters/60564

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