PHYSIOLOGIC CHANGES

Aging process within the physiological changes both in the field organic and in mind. These changes, which are normal, over the years predispose a series of pathophysiological events that lead to the elderly to present different diseases.

General Anatomy

It´s between 30 and 40 years when humans have the maximum height reached, decreasing then 5 mm per year from the 50, this change is more pronounced in women. It is explained by postural changes (increased hip and knee flexion), decrease in height of the vertebral bodies and abnormal intervertebral discs.

Skin and Appendages.

The skin, by extension, is the organ most susceptible of environmental damage through the years, especially by the action of sunlight.

Over time it becomes thinner, drier, more transparent and becomes less elastic, wrinkled and yellowish tinge.

Common disorders: Pressure ulcers, Inflamation and infection.

Musculoskeletal System.

Between 30 and 80 years is lost 30-40% of muscle mass. This loss is not linear and accelerates with age.

-Decrease bone calcium: osteoporosis, Kyphosis

-Decreased fluid in intervertebral disks: decreased muscle strength

-Decreased blood supply to muscle: decreased muscle strength

-Decreased tissue elasticity: decreased mobility and flexibility of ligaments and tendons

-Decreased muscle mass: decreased strength, to fell down is increased.

Common disorders: Osteoporosis, Osteoarthritis, Arthritis rheumatoid, Bursitis.

Nervous System.

The nervous system is affected significantly with the passage of time. The brain´s weight decreases with a cerebral blood flow reduced by 20% causing alterations processes flow autoregulation.

Care strategies:

-Slowed thought processes decreased ability to respond to multiple stimuli and tasks

-Decreased reflexes decreased coordination decreased propioception

-Decreased perception of stimuli

-Decreased motor responses increased risk for ischemic paresthesia in extremities

-Report abnormal findings to physician. Refer for neurologic evaluation

-Educate regarding safety precautions and use of assistive devices. Structure tasks to reduce confusion; allow adequate time to performs tasks.

Changes in the senses with age

As you age, the way your senses (taste, smell, touch, sight and hearing) can provide information about the world. Senses become less acute and you may have trouble differentiating details.

Sensory changes can affect the way of life. You may have trouble communicating, enjoy the activities and stay involved with people. Sensory changes can lead to isolation.

Respiratory system

Vital capacity and FEV decrease to 30% at 80 years. The effort

independent of the will expiratory decreases loss of elasticity of the bronchial tree, expiratory effort depending on ventilation decreases to the extent that it loses strength muscle of the respiratory muscles.

All these changes result in a decrease in PaO2.

Here some of nursing cares that we can provide:

·         Assess breathing depth and effort: position to facilitate ease of respiration. Encourage incetive spirometry or nebulizer as ordered.

·         Assess cough and sputum production: encourage adequate fluid intake. Encourage smoking cessation and avoidance of environmental pollutants.

·         Assess for signs and symptoms of respiratory infection: teach avoidance of individuals with active infection. Teach careful handwasing and disposal of contaminated secretions. Encourage annual influenza vaccination.

Common disorders : EPOC, Influenza, Pneumonia, Tuberculosis, Lung cancer

Cardiovascular System.

In the cardiovascular system is extremely difficult to distinguish between changes own age and alterations resulting from various pathologies that manifest through the years. Nevertheless these changes affect other organs variably dependent cardiovascular system close to their right function.

Nursing cares:

-Assess apical and peripheral pulses

-Assess blood pressure lying, sitting and standing

-Assess ability to tolerate activity.

-Observe closely for abnormal sounds: determine presence and strenght of peripheral pulses comparing both sides of the body.

-Hypotension is likely to occur while changing position; encourage patient to change positions slowly and to seek assistance if dizzy

-Instruct patient to rest if short of breath or fatigued.

Homatopoietic and Lymphatic System

Bloody fluids distribute essential protective factors, nutrients, oxygen, and electrolytes throughout the body. The two major fluids of the body are blood and lymph. These fluids flow through the body within two parallet circulatory systems.

Immunosenescence is a complex process that involves multiple changes in lymphocyte subsets. These changes in the elderly increased incidence and severity of infectious diseases and some cancers.

Nursing cares:

-Monitor laboratory test including Hgb, Hct, WBC an differential: report abnormal findings, promptly to physician.

-Assess nutritional intake for adequacy for protein iron and vitamins: administer nutritional supplements as ordered.

Gastrointestinal System

Flood and fluids containing the nutrients needed for survival normally enter the body through the GI tract. Although it is possible to live without food for several days, the cells require a regular supply of nutrients to support their normal physiologic activities.

Nursing plays an important role in monitoring the patient preserve their functions properly to feed themselves.

-Assess oral cavity for dentition, condition of mucous membranes and hygiene: educate regarding importance of goog oral hygiene; stress need for adequate fluid intake. Dental referral as necessary

-Assess swallow and gag reflexes: encourage posture that facilitates swallowing

-Monitor weight changes: weight at least one time per month more often if fluid balance issues presents

-Assess intake of nutrients and fluid: educate regarding recommended dietary intake. Establish calorie count and intake and output if problems are suspected.

-Assess bowel sounds and bowel elimination patterns: establish bowel routines. Teach importance of adequate fluid fiber and activity. Administer laxatives stool softeners suppositories or enemas as needed to prevent constipation.

Urinary system

The urinary system supports homeostasis by eliminating wastes and excessive fluid from the body.

Some of the changes that this system suffers are:

-          Decreased number of functional nephrons: decreased filtration rate with decreased in dug clearance

-          Decreases blood supply: decreased removal of body wastes; increased concentration of urine

-          Decreased tissue elasticity: decreased bladder capacity

-          Delayed or decreased perception of need to void: increased incidence of incontinence

-          Increased nocturnal urine production: increased need to awaken to void or episodes of nocturnal incontinence

-          Increased size prostate: increase risk of infection 

Changes in intellectual capacity

Personally I am very hurt when I see older people who suffer impaired mental capacity. Sometimes they are aware of it, they get sad or angry themselves.

From 30 years old onwards, a decline in intellectual capacity begins which accelerates with old age. The capacity to resolve problems becomes slower and there is a lack of spontaneity in one’s thought processes. Creativity and imaginative capacity survive, but there are alterations in memory which usually leads to amnesia over time.

Changes in their family roll

At my age I think that it gave me time to observe the changes that my grandparents who are still alive have experienced, like for example:

To be parents of children adults.

 To Be a grandparent.

 Eventually being a widower or widow.

 Sometimes this changes are tolerated well, but sometimes this adaptation depressed them, we have to provide them all our support

Changes of role in the community and at work

Getting older modifies the role that has been developed, but not the individual

Retirement is both a state that is reached and compelling to assume a new role, as a process that begins during the same working life and It should be planned to organize many years of our lives.

REFERENCES:

Wold, Gloria. Basic Geriatric Nursing - Milwaukee, Elsevier -5th ed.

 LANDOWNE M, BRANDFONBRENER M, SHOCK NW. The relation of age to                       certain measures of performance of the heart and the circulation. Circulation. 1955 Oct;12(4):567–576. [PubMed]

 Boss GR, Seegmiller JE. Age-Related Physiological Changes and their Clinical Significance. The Western Journal of Medicine. 1981;135(6):434–440. [PMC free article] [PubMed]