Class 2: Physical Changes and Biological Theories of Aging

Maggie Kuhn

American activist known for founding the Gray Panthers movement after her retirement. She dedicated her life to fighting for human rights, social and economic justice, and global peace.

The Gray Panthers

Advocacy group known for advocating nursing home reform and fighting ageism

“Sickness care”

What did Maggie Kuhn coin health care?

Aging

The process of change in properties of a material occurring over a period. Gradual deterioration of physiological function.

The older adult

There is more variability between individuals at what stage of life than any other?

An explanation of observations

What do theories offer?

To predict future events and situations

Theories serve to what?

A language and a framework by which we, as nurses, can understand situations and identify proper action

What do theories provide?

Theory

An explanation that makes sense of a phenomenon. A supposition, or a system of ideas intended to explain something

1. Error theories

2. Predetermined/programmed aging theories

Two main groups of biological aging theories. Both agree that at the end the cells in the body become disorganized, are unable to replicate and cell death occurs.

1. Change due to genetic/environmental factors (sun, pollution, cigarette smoking)

2. Thinning of the epidermis

3. Lightening of the skin= decreased UV filtration

4. Longer wound healing

5. Dermis thins

6. Collagen decreases

7. Hypodermis atrophy

8. Decreased sebum secretion

Physical changes of the skin with age: [8]

Blood vessels and bruises are much more visible.

Results of thinned epidermis in older adults

Dermal blood vessels are reduced resulting in skin pallor and cooler temperature

Results of thin dermis

Skin tears more easily (problematic when accompanied by slow wound healing)

Results of decreased collagen

Older person may be more sensitive to cold. Increased chance of hyperthermia because of inability to produce sweat.

Results of atrophied hypodermis

Sebum contains precursor of vitamin D and when skin is exposed to sunlight vitamin D is produced. Lack of vitamin D effects calcium absorbtion and effects prevention of osteoporosis.

Results of sebum secretion decrease

1. Avoid excessive exposure to UV light

2. Apply moisterizer after bathing

3. Use sunscreens, paying attention to face, ears, neck, and hands

4. Wear a hat in sunshine

5. Keep well hydrated

6. Use humidifier in winter to prevent dry skin

How, as a nurse, can we promote/encourage healthy skin in adults? [6]

Muscolo-skeletal system

system important for movement and posture. Consists of bones, joints, tendons, ligaments, and muscles

they ecome dry, hardened, rigid, and less flexible

Effect of aging on ligaments, tendons, and joints

Arthritis

A condition when joint space is reduced

Bone mass decreases with age, becoming increasingly brittle.

Effect of aging on bones

1. Genetics

2. Decreased hormone levels

3. decreased bone formation

4. vit d-magnesium-calcium deficiencies

5. smoking

6. alcohol use

7. physical inactivity

Age-related bone loss is related to what factors? [7]

Sarcopenia

Age related changes to muscles

30-40%

How much of muscle mass of a thirty year old is lost by the time they reach their 90s?

Vertebral disks become thin

What causes shortening of the trunk in older adults?

Kyphosis

Stooped appearance because of curvature of the cervical vertebrae that results from reduced bone mineral density (BMD)

Osteoporosis

What is diagnosed when bone mineral density (BMD) is too low?

They increase the risk for dehydration in older adults

Why can changes in water distribution have significant implications?

Heart muscles and blood vessels stiffen, and these changes are progressive

What happens to heart muscles and blood vessels with age?

These changes only become significant when there are environmental, physical, or psychological stresses. A sudden increase in oxygen demands may mean that the heart ma not respond adequately. There is a delay in increase in heart rate, may also not respond adequately to infection, anemia, pneumonia, surgery, low blood sugar, dehydration, etc.

When does ventricle wall stiffening become significant?

Cardiac output and blood flow are decreased.

What happens when left ventricle wall thickens and left atrium increases in size?

Heart disease

What is the number one cause of non-accidental death?

1. Don’t smoke

2. Keep cholesterol, BP, BS levels normal

3. Daily exercise/physical activity

4. Healthy weight

5. eat more vegetables and fruits, less fat and red meat

6. Cope with stress in a healthy way

7. Avoid trans fats and saturated fats

8. limit sodium intake

What are some heart-healthy aging lifestyle choices that nurses can promote? [8]

Processed, fast food

In what foods are saturated and trans fats found?

Milk, butter, etc. as long as it isn’t processed

In what foods are healthy (in moderation) trans fats found?

1. Loss of elastic recoil

2. stiffening of the chest wall

3. insufficient gas exchange

Age-related changes in lungs/respiratory system [3]

Environmental toxins: pollution, cigarette smoking, etc.

What is often the cause of respiratory problem (not the aging process?)

These increase the risk for aspiration, and lung infections become a problem

Why is a decreased ability to cough and and less effective respiratory cilia dangerous for the older adults?

1. Obtain pneumonia immunization

2. Obtain annual influenza immuniztion

3. Obtain COVID vaccinations

4. Avoid exposure to pollutants indoor spaces (control dust, clean and maintain appliances and surfaces, ventilate)

5. Avoid smoking and secondhand smoke

6. Avoid persons with respiratory illnesses

7. Seek prompt treatment of respiratory infections and problems

8. wash hands freqently

9. regular oral hygiene

How can nurses promote healthy aging of the lungs?

Bacteria can accumulate in the mouth. That can easily go through the trachea and into the lungs. Potential pneumonia

Why is it important to maintain good oral hygiene with the older adult, in regards to the respiratory system?

Risk to fluid and electrolyte imbalance

Why are age related changes in the kidneys significant?

Disease, surgery or fever

What are some reasons kidney function may deteriorate?

Glands atrophy and decrease their rate of secretion

How do endocrine glands change with age?

Decrease in estrogen

What causes menopause?

Decrease in insulin and glucagon sensitivity in older persons, combined with obesity, can cause type II diabetes

How can the older adult develop type II diabetes?

Monitoring of thyroxine levels

Regular blood test that tests for hypothyroidism (what is monitored?)

1. Slowed basal metabolic rate

2. thinning hair

3. dry skin

What are some characteristics of hypothyroidism that are also normal parts of aging? (hypothyroidism can be harder to diagnose) [3]

1. Menopause (end of reproductive phase)

2. Vaginal epithelium changes

3. pH rises significantly (painful intercourse and higher susceptibility to infection)

Age-related changes to female reproductive system: [3]

1. Fertility decreases due to sperm motility and structural abnormalities

2. erectile changes

3. Prostatic hypertrophy

Age-related changes to male reproductive system: [2]

When enlargement causes compression to the urethra, that can cause retention, urinary tract infections and incontinence

When is prostatic hypertrophy considered problematic?

1. Teeth eventually become more vulnerable to decay

2. roots may break more easily

3. gums more susceptible to disease

Age-related teeth changes: [3]

Taste buds decline in number, reducing sense of taste

Age-related changes to taste buds

Reduced sense of taste can lead to decreased appetite, malnutrition, and weight loss. This is why old people like sweets (because they can taste it better), but it is counterproductive to eat unhealthy foods

Risk of low taste buds in older adults:

Xerostomia

Condition in which decreased salivary secretion causes very dry mouth

GERD (Gastroesophageal reflex disease)

Sluggish emptying of the esophagus creates stress and digestive discomfort

More susceptible to peptic ulcers because the protective alkaline viscous mucus is lose because of an increase in stomach pH. Exacerbates when NSAIDS are taken.

Age-related changesto the stomach:

Aspirin, ibuprofen

Common examples of NSAIDS [2]

1. nutrition absorption is affected

2. Peristalsis is slowed

Age-related intestine changes [2]

1. Side effect of medications

2. habits

3. immobility

4. inadequate fluid intake

Constipation is NOT a normal part of aging, and is problematic

Constipation in the older adult is usually a sign of what? (and NOT a sign of what?) [4]

Liver function slows and medication doses must be adjusted accordingly

Age-related liver changes

1. Gallbladder changes might occur, may result in increases in serum cholesterol levels

2. Older adults have a high incidence of gallbladder stones

Age-related gallbladder changes [2]

1. Practice good oral hygiene

2. wear properly fitting dentures

3. seek treatment of dental caries and gum disease

4. eat meals in a relaxed atmosphere

5. maintain adequate intake of fluids

6. eat a balanced diet

7. Avoid prolonged immobility

8. avoid tobacco products

How can patient promote healthy digestion? [8]

The brain is very resilient to aging, and changes in cognitive function are NOT a normal part of aging

Are cognitive changes a normal part of aging?

1. Less deep sleep

2. More time spent in light sleep (stages 1 and 2)

3. Reason why older people tend to spend more time in bed

Describe changes in the sleep pattern of the older adult:

1. pressure injuries

2. skin breakdown

Can be prevented by using a soft or gel mattress, and continually assessing the integrity of the skin

Risks of increased time in bed, and how they can be prevented [2]

1. Subtle changes in thinking and movement\

2. Mild memory impairments

3. difficulty with balance

4. performance of tasks takes longer (same intellectual ability)

5. sensitivity to touch and vibration decreases

6. proprioception is altered

7. Sensory changes (vision, ocular)

What are some normal neurological age-related changes? [7]

Delayed reactions to hot surfaces, increases risk for burns

What is the risk of lowered sensitivity to touch?

Presbyopia

Age-related decrease in vision. Includes glaucoma, cataracts, and macular degeneration

Ptosis

Age-related extraocular change, eyelids lose elasticity resulting in drooping

1. Have eyes examined regularly

2. Use bright lighting

3. see professional for vision changes

4. don’t smoke

5. reduce glare

6. Wear sunglasses (UV protection)

7. Protect eyes from accidents and injury (safety glasses

How to promote healthy eyes: [7]

1. Reduced immunity at the cellular level (increased risk for infection)

2. Experience of infections in the absence of characteristic symptoms (such as fever)

Age-related changes to immunity