Physical changes with healthy aging

Reserve

The Safety Buffer: High reserve means the body can work harder during stress. Low reserve means even a small illness can cause sudden collapse.

Connection to Frailty: When old age or chronic disease lowers reserve across many systems, a person becomes frail.

Physical Resilience: Reserve drives how well an older adult bounces back after a health crisis.

Key Systems Involved

• Heart and Lungs: Pump extra blood and oxygen when demands rise.

• Muscles and Bones: Provide strength to avoid falls and stay active.

• Immune System: Fights off germs and infections quickly.

• Brain: Manages thinking tasks and handles physical stress.

Resilience

Resilience vs. Frailty: Frailty reflects a static, vulnerable baseline state of depleted reserve, whereas resilience describes the dynamic speed and quality of recovery following an acute adverse event.

Multi-system Integration: Depends on cellular repair mechanisms

Predicting Outcomes: Higher resilience reduces hospital length of stay, lowers the risk of permanent institutionalization, and decreases post-operative complications

Atypical presentation

The symptoms that an older adult presents with when they have certain conditions may not be what we expect. For example a younger adult with an acute MI will present with chest pain when having an acute MI, while an older adult will have new onset confusion. when an older adult has an infection they do not mount the same response so they may not have a fever and you may only not vague symptoms and altered mental status.

Why do these age-related changes make health promotion and intervention strategies important

Health promotion and interventions help older adults adapt to age-related sensory changes, prevent further problems, maintain independence and safety, and improve quality of life

head

Eyeballs recede into orbit

Corneas lose luster

Pupils become smaller

Dry eyes are common complaint

Presbyopia occurs to nearly everyone, need readers

Higher risk fro conjunctivities

Loss of eyesight start at 40

Encourage use of sunglasses, retina becomes more and more sensitive to sun

Sensory

Presbycusis is the age-related loss of hearing acuity. Occurs in both ears 50% of those 75, most hearing loss is related to noise exposure hearing aids are great, gradual hearing loss can lead to dementia

Decreased sense of taste and salivary secretions, medications, and disease can exacerbatem not able to tell if food has gone bad, risk for GI problems from spiled food is huge, sugar is the last one to go, more worried about low sugar than high sugar

Sense of smell dimishes, neurologic changes, environmental factors, if they have a gas stove or fireplace can’t tell if there would be a gas leak

Respiratory

Decrease cough and gag reflex

Compromised chest expansion

Increase use of accessory muscles

Decrease efficiency of gas exchange

Diminished lung sounds

No effect in daily functional activity

Diminished pulmonary reserve: fatigue with stressor, increase risk of infection

Intercoastal muscles start to decrease, responding to respiratory distress is less, crackcles is never normal decrease in cough and gag reflex increases risk for aspiration pneumonia

Cardiac function

More prominent arteries in head, neck, and extremities

Valves become thicker and more rigid

Stroke volume decreases by 1% per year

Heart pigmented with lipofuscin granules

Less efficient O2 utilization

Aorta becomes dilated and elongated

Cardiac output decreases

Resistance to peripheral blood flow increases by 1% per year

Blood pressure increase to compensate for increase peripheral resistance and decreased cardiac output

Less elasticity in vessels

GU kidneys

Decrease in volume and weight of the kidneys

Decline in the total # of glomeruli → decrease GFR (anything that is cleared by the kidneys, because of decreased GFR the drug can build up)

Decrease creatnine clearence → risk for drug toxicity

Normal for older adults to loose about 10 points of their GFR every decade, make sure we as nurses are looking at their medication and letting the doctor know if they are going to build up or at risk to

GU Bladder

Bladder capacity decreases

Decreases in detrusor muscle contractility

Alterations in sensation of needing to void (can increase risk for incontinence, if you ignore your bladder stimuli and don’t go pee it’ll stop telling you to go pee until it’s to late)

GU Prostate

Proliferation of prostate epithelial and stromal tissue, known as benign prostatic hyperplasia, 90% of men >80 have symptomatic BPH

Symptoms of BPH

• Urinary urgency and frequency

• Weak stream/dribbling post urination: post micturition

• Incomplete bladder emptying

GU Female genitalia

Menstrual periods cease between ages 48-55; women often experience hot flashes for up to 5 years and may have vaginal dryness, incontinence, or dyspareunia (painful sexual intercourse); within 10 years the ovaries are usually no longer palpable

GU Male genetalia

Sexual intercourse remain intact and aging but frequency declines, gradual decline in fertility; decreased sperm production; erection is more dependent on tactile stimulation

GI

Dysphagia (difficulty swallowing)

Gastric mobility slow modestly → delayed emptying of stomach (think about medication your not supposed to have with a meal and delayed emptying can cross over and stay in the stomach longer)

Diminished absorption of nutrients in the small intestine (calcium and vitamin D)

At risk for constipation (constipation is still not normal)

Endocrine

Progressive deterioration in number and function of insulin producing beta cells

Decrease in lean body mass with relative increase in adiposity

Increase insulin resistance

Decrease in renal concentrating function with even mild hyperglycemia can lead to osmotic diuresis

May develop (transient) hyperglycemia especially with stress (surgery)

Musculoskeletal

Decrease muscle mass

Decrease myosin adenosine triphosphate activity

Deterioration and drying of joint cartiladge

Decrease bone mass and osetoblatic activity

Nervous system

Aging may affect all aspects of the nervous system, from mental status to motor and sensory function and reflexes

Most older adults score well on mental status exam but selected impairments become evident

Nerve cells in the brain decrease → a small loss of brain mass

Decrease in the synthesis and metabolism of the major neurotransmitters

Autonomic nervous system preforms less efficiently → orthostatic hypotension

Neurologic changes affect gait and balance

When it comes to phyical things like tying their shoes something they;ve done a lot that will stay but their quick thinking like driving is what gets impaired

Orthostatic hypotension

A drop in SBP by >=20 mmHg or DBP by >=10 mmHg within 3 minutes of standing from supine or sitting position

Affects >30% of older adults, may lead to falls, decrease function and decrease QOL

#1 cause of falls

Age increases risk

Indicated for patients at risk for falls, hypovolemia, history of syncope or near syncope

Postprandial hypotension

A condition in which there is a systolic blood pressure drop of 20mmHg in a supine/sitting position within 120 minutes after eating a meal

PPH occurs more often then postural hypotension and infrequently together with PH, among older adults

Blood flow goes straight to the gut to compensate for nutrition absorption so you loose blood flow to everywhere else

Small frequent meals is great for this and keeping up with fluids, avoid strenuous activity after eating a large meal

When discharged make sure they have healthy food at home