With the increase in the geriatric population, healthcare providers need to be cognizant of the issues specific to this demographic. There are some universal changes of aging that are predictable among humans. Overall, changes in physical appearance and decline in function are caused by cellular and extracellular changes. As humans age, changes in shape and body makeup occur, maintaining homeostasis becomes more difficult, organ systems cannot function at full efficiency because of cellular and tissue deficits, and cells become less able to replace themselves (Smeltzer, Bare, Hinkle, & Cheever, 2008).
Within the cardiovascular system, the efficiency of the heart is reduced with age. There is decreased compliance of the heart muscle, decreased cardiac output (producing fatigue), and slower recovery rate of the heart. The heart rate and stroke volume of the older adult no longer increase as effectively with demand, there is increased blood pressure (which may be more the result of lifestyle behaviors rather than age related), and risk of orthostatic and postprandial hypotension (Smeltzer et al., 2008). Changes in the respiratory system are usually more subtle and gradual if the individual is a nonsmoker. The alveoli gradually become larger and thinner, which increases dead space. Weakening of the chest wall muscles may cause diminished respiratory efficiency and reduced maximal inspiratory and expiratory force (Smeltzer et al., 2008). With age, there is usually a decrease in effective coughing, decrease in vital capacity, decreased gas exchange, and diffusing capacity. The individual can usually compensate for this decline in respiratory function. To avoid major age-related reductions in respiratory function, smoking should be avoided (Smeltzer et al., 2008).
Integumentary changes include alterations in function and appearance; the dermis becomes thinner, collagen becomes stiffer, elastic fibers are reduced, and subcutaneous fat diminishes. There is a diminished blood supply in the skin related to decreased capillaries. This leads to a loss of resiliency, wrinkling, and sagging of the skin. The skin of the older adult is more dry and susceptible to burns, injury, and infection. Hair color may change and balding may occur, which leads to reduced temperature tolerance and sun exposure risks. Skin inspections or cancer are especially important in the older adult age groups because of this loss of protective factors and biologic changes (Smeltzer et al., 2008).
In aging women, menopause causes the halt of estrogen and progesterone production by the ovaries. This leads to thinning and narrowing of the vaginal wall, loss of elasticity, and decreased vaginal secretions (Smeltzer et al., 2008). This can cause symptoms of dryness, itching, decreased acidity of the vagina, and painful intercourse (Smeltzer et al., 2008). In aging men, the penis and testes decrease in size, androgen levels fall, and many experience erectile dysfunction and decreased libido (Smeltzer et al., 2008).
Genitourinary changes with age include decreases in kidney mass, primarily due to loss of nephrons. Despite this, one third of older adults show no decrease in renal function (Smeltzer et al., 2008). Eighty-five percent of older woman experience some type of urinary incontinence because of relaxed perineal muscles. Yet, despite popular belief, this is not a normal consequence of aging and can be treated or reversible with the right care (Smeltzer et al., 2008). Older men commonly experience enlargement of the prostate gland (BPH), which increases urinary retention and overflow incontinence (Smeltzer et al., 2008).
Older adults frequently encounter modest slowing of gastric motility, constipation, and decreased absorption of nutrients in small intestine (Smeltzer et al., 2008). One in seventeen people older than 60 develop swallowing difficulties, or dysphagia. Older adults require fewer calories and need more nutrient dense foods.
Older adults generally take longer to fall asleep, awaken easily and frequently, and spend less time in deep sleep. Sleep disturbances affect more than 50% of adults 65 years of age or older, and sleep apnea affects 24% of those over 65 (Smeltzer et al., 2008).
Within the musculoskeletal system, older adults experience alterations in bone remodeling, leading to decreased bone density, loss of muscle mass, deterioration of muscle fibers and cell membranes, and degeneration in the function and efficiency of joints. Decrease in bone mass actually begins before age forty without exercise as a protective factor (Smeltzer et al., 2008). Degenerative joint disease is present in all adults over 70 (Smeltzer et al., 2008).
Older adults exhibit a slowed reaction time, because nerve impulses are conducted more slowly. There is a reduction in cerebral blood flow as one ages, and this leads to a loss of nerve cells and progressive loss of brain mass (Smeltzer et al., 2008). Neurological changes can also affect gait and balance (Smeltzer et al., 2008). in absence of pathological changes, older people generally function adequately and retain most cognitive and intellectual abilities (Smeltzer et al., 2008).
All sensory organs experience changes with advancing age. Presbyopia, when the lens of the eye becomes less flexible and the near point of focus gets farther away, starts in one’s fifties and is a reason for the common use of magnifying reading glasses (Smeltzer et al., 2008). Macular degeneration is the most common cause of age related vision loss. Although it does not cause blindness, this condition affects central vision, color perception, and fine detail. This affects reading, driving, and seeing faces (Smeltzer et al., 2008). According to Smelter et al. (2008), almost half of older men, and one third of older women, have difficulty hearing without a hearing aid. At about forty years of age, hearing changes begin. Irreversible inner ear changes cause presbycusis, a gradual, sensorineural hearing loss.
Regarding taste, sweet tastes are dulled in older people (Smeltzer et al., 2008). Loss of cells in the nasal passages and olfactory bulb contribute to changes in smell in the older adult. Both of these changes can cause older adults to have less of an appetite, and the need for nutrient dense foods is once again supported (Smeltzer et al, 2008).
Apart from these normal physical changes of aging, there are normal cognitive, intellectual, learning, and memory changes as well. Research has shown that processing speed is affected with age. Older adults experience a slowing of processing speed, or the rate of perceiving and deciding. This can have implications with dangerous tasks, such as driving, or everyday tasks, such as finding the right word (Zelinski, Dalton, & Hindin, 2011). Working memory has also been shown to decrease with age. Studies exist showing these declines can be compensated normally and even managed with training of memory and learning tasks. Summarizing, the more older adults utilize their learning, memory, and thinking, the more intact their skills will remain (Smeltzer et al.,2008).
