hormonal, sensory, GI, integumentary, renal, and genitourinary age related changes

hormones maintain what?

homeostasis

- physiological process to maintain stable environment

adaptive homeostasis

ability to adapt to stressors

- and maintain homeostasis

the capacity to tolerate stressors does what?

decreases but remains partially modifiable with lifestyle adaptations

physical stress theory (PST)

changes in amount of physical stress applied to tissues can cause an expected response in all biological tissues

- too much stress = susceptible to injury

- too little stress = no change or atrophy

our goals of therapy

to build up a physiological reserve

causes of age related hormonal changes

- altered central input

- altered function of endocrine glands

- dec in hormone production

- loss of responsiveness of target tissues

- combination

age related hormonal changes - important in regulating

- body temperature

- nutrient intake

- energy balance

- sleep/wake cycle

- sexual behavior

- water/electrolyte balance

- stress adaption

hormone effects

most hormones will dec with age

- estrogen

- GH

- DEHA

- insulin

what hormone does not dec with age?

cortisol

- inc with stress, disease, etc

consequences of reduced testosterone

- inc subQ and visceral fat

- inc risk for obesity

- dec insulin sensitivity

- inc risk for DM2

- inc high blood pressure

- inc triglycerides

- inc risk of metabolic syndrome

- dec muscle mass

- dec strength

- dec bone density

consequences of reduced DHEA

- inc body fat mass

- inc waist to hip ratio

- dec lean body mass

- dec VO2 max

- inc risk of cardiovascular disease

- inc risk of ischemic heart disease

- dec bone density

consequences of reduced GH

- inc risk for obesity

- inc visceral adipose tissue

- dec lean body mass

- dec strength

- inc risk of metabolic syndrome

- inc risk of cardiovascular disease

- dec bone density

changes in hormones impacts what?

- muscle and bone mass (sarcopenia, osteopenia/osteoporosis)

- visceral adipose tissue accumulation

- insulin sensitivity dec = predispose to DM

- low-density lipoprotein (LCL) metabolism (heart disease)

- libido and cognition

- water balance (inc to dehydration)

what can improve hormonal changes with aging?

lifestyle modifications and exercise

3 universal age related visual changes

- dec visual acuity (progressive decline >60 yo)

- dec field of view (peripheral, upper fields)

- dec contrast sensitivity

changes in eye function

- inc thickness of lens, affects light let into retina

- loss of elastic lens

- iris loses ability to change width

- pupil size remains same

visual acuity modifications

inc light source to help accommodate

- need 2-4x more light

- wall mounted lights, background light, inc wattage, move light source closer

- magnifiers

- large print text

- computers (voice or zoom in)

field cut modifications

- lower height for directional/information signs

- put important things in one consolidated area

dec contrast sensitivity modifications

- contrast between colors

- warm colors for handrails, steps and door frames (red, orange, yellow)

inc glare modifications

- multiple light sources

- lampshades

- curtains

- dec reflective surfaces

- cove lighting

dec night vision modifications

- pocket flashlights

- motion sensored or "smart" lights

- properly placed light switches

- lights under fall risk areas

- red light night lights

dec presbyopia modifications

reading glasses, bifocals

dec depth perception modifications

- avoid pattern floor

- inc contrast between depths

dec ability to differentiate colors modifications

- cool colors can promote calmness

- warm colors for sensory stimulus

other age related changes in vision

- dec pupil size and response

- dec blink reflex

- dec oculomotor response

uncompensated visual impairment is correlated with what?

- depression

- poor QoL

- cognitive decline

- falls

- mortality

pathological conditions involving vision

- cataracts

- glaucoma

- macular degeneration

- diabetic retinopathy

- CVA

clinical considerations for visual changes

- examine vision and make referrals to ophthalmologist

- ensure patients have their glasses on

- allow for inc time for visual discrimination

- stand where they can see you

- compensate with other sensory cues

- pay attention to BP and diabetic retinopathy

diabetic retinopathy

red flag

- uncontrolled can cause retina to detach and cause blindness

age related hearing changes

begins as early as the 4th decade

- 40% over the age of 75

- men 2x the rate as women

conductive hearing loss

mechanical dysfunction

- sound transmission to inner ear is lost bc intensity is not enough

causes of conductive hearing loss

- impacted earwax

- perforation of tympanic membrane

- serum or pus in middle ear

- otosclerosis

conductive hearing loss results in what?

- hearing loss of all frequencies

- possible ringing in the ears

- **raising your voice may help

sensorineural hearing loss

dysfunction in the conversion of sound waves into electrical signals

- called PRESBYCUSIS

causes of sensorineural hearing loss

- noise

- trauma

- disease

- drugs

- atherosclerosis

- autoimmune disease

- meniere's infection

- neuromas (acoustic neuroma)

sensorineural hearing loss results in

- b/l hearing loss

- high frequencies at first, then all

- dec auditory discrimination/comprehension (esp with background noise)

- ringing in the ears

how to adjust to sensorineural hearing loss

- limit background noise

- speak in a low tone

- *raising your voice will not help

modifications for conductive hearing loss

- louder speech

- hearing aids

- speaking into ear

- pocket amplifiers

modifications for sensorineural hearing loss

- low frequency pitch/signals

- hearing aids that can selectively adapt frequencies

- dec fluorescent lights

- inc insulating acoustic materials

- cochlear implants

modifications for both (conductive and SN hearing loss)

- visual cues to alarms

- lip reading

- dry erase board

- voice to text

- mime

pathologic hearing conditions

- otosclerosis

- pagets disease

- meniere's disease

- acoustic neuroma

clinical considerations for hearing loss

- hearing aids

- speak slowly and clearly

- minimize background noise

- do not automatically start shouting

- make be the first to pick up on deficits

- assess and refer appropriately

age related changes in taste

taste buds dec by half by age 70

- sweet/salty first to atrophy

- food may taste bitter/sour

age related changes in taste - adaptations

- compensate with other senses

- inc flavor (and color) on the plate

- oral hygiene

- throw spoiled food out

age related changes in smell

dec with age

- dec awareness of fires, spoiled food, fumes, body odor

age related changes in smell - adaptations

- smoke detectors with loud buzzers

- dating all foods

- switching appliances from gas to electrical

- encourage bathing and cleaning routines

age related sensory changes in touch - tactile sensitivity

dec sensitivity in skin of palm/foot

- dec ability to manipulate small objects

- adaptations = texture

age related sensory changes in touch - thermal sensitivity

dec ability to cope with extreme temperatures

- adaptations = carefully inc heat of water, wear shoes on hot surfaces in the summer

age related integumentary changes

- thinning of the dermis (dec in elastin)

- inc risk of bruising

- dec sebaceous activity and decline in hydration of the skin

- dec epidermal cell turnover

appearance of integumentary changes

pale, dry, wrinkled, yellowed, and inelastic skin

- age spots appear

- thinning and graying of hair

- slow growing nails that are brittle and thick

integumentary clinical considerations

- skin is FRAGILE

- skin loses function as a protective barrier

how does skin lose function as a protective barrier

- grows slower + heals slower = inc risk for infection

- sensory changes inc risk for pressure injuries and burns

- dec sweat production/loss of sweat glands = dec temp regulation

age related GI changes - esophagus

dec motility and control of esophageal spincter

- acid reflux, heartburn, hiatal hernias

age related GI changes - stomach

dec mobility, gastric emptying, digestive enzymes, and dec hydrochloric acid

- dec digestion, absorption, inc constipation

what causes poor dietary intake and nutritional deficiencies?

sensory changes + dec salivation + dec chewing + dec swallowing

age related renal changes

kidneys lose mass, nephron atrophy, reduced renal blood flow, dec filtration

- impact on pharmacokinetics

- difficulty regulating Na levels

age related genitourinary changes

- dec capacity of the bladder (inc risk of UTI)

- weakness in pelvic muscles

- enlargement of prostate

- functional difficulty getting to the bathroom

clinical implications of age related genitourinary changes

- improving function and physiological reserve can improve ability to get to the bathroom

- be alert for sn/sx of UTIs and spesis

- incontinence is NOT a normal part of aging