BIOLOGY OF AGING Learning Objectives: 1. Describe the normal age-related changes in anatomy and physiology. 2.

Relate these age-related changes to physical assessment findings. 3. Identify selected common physical disorders affecting elders. 4. Discuss differences in disease manifestation among elders. Outline: I. II. Introduction: Changes of senescence and overall appearance. The Integument: Skin, Hair and Nails A. B. C. D. E. F. G. H. III. HEENT A. B. Facial changes. Eyes 1. 2. 3. 4. 5. 5. 6. C. D. E. Ears: Nose Mouth Vision: Night, peripheral; presbyopia Pupil size, less accommodation. Reduced depth perception Decreased tears Increased glare Senile ptosis Arcus senilis. Presbycusis Loss of subcutaneous fat, water, elasticity. Decreased collagen. Epithelial cells renew themselves slower. Decreased number and function of sweat glands. Decreased melanin in hair, deposited in skin. Hair loss. Nails grow slower, striations. Foot care can be a major problem!

IV.

The Heart A. Anatomic and physiologic changes. 1. 2. 3. 4. 5. 6. 7. B. Cardiac walls thicken, but heart does not enlarge. Coronary artery blood flow. Cardiac output. Valves thicken. Conductive cells decrease in number. Resting HR is same as younger, maximal HR less. May not see usual increase in pulse with pain.

Common cardiac disorders. 1. Myocardial infarction. a. b. 2. Cardinal symptoms of MI. Symptom variations in elders.

Congestive heart failure. a. b. c. Pathophysiology and cardinal symptoms. Left-sided vs. right-sided failure. Decreased renal perfusion. (1) (2) d. e. Renin-angiotension-aldosterone. Increased ADH.

Incidence and risk factors. Nursing care.

V.

The Lungs A. Anatomic and physiologic changes. 1. 2. 3. 4. 5. 6. Reduced efficiency in ventilation. Respiratory muscles weaker, less elastic. Gradual alveolar enlargement and breakdown. Lowered vital capacity and expiratory flow. Diminished exercise tolerance (PaO2 = 75). Decreased cough reflex.

B.

Common pulmonary disorders. 1. Pneumonia. a. b. 2. Prognosis in elders Strategies for prevention.

Chronic obstructive pulmonary disease. a. Pathophysiology and classic S&S. (1) (2) (3) (4) (5) b. Alveolar diffusion. Respiratory failure. Heart and lung sounds. Decreased PaO2, increased PaCO2. Barrel-shaped chest, cachexic appearance.

Incidence, treatment and nursing care. (1) (2) (3) Smoking cessation. Oxygen, medications. Positioning, pursed-lip breathing.

VI.

The Peripheral Vascular System A. B. Anatomic and physiologic changes. Common vascular disorders. 1. Hypertension a. b. 2. PVD a. b. c. Pathophysiology and incidence. Symptom presentation. Treatment. Diagnostic criteria. Antihypertensive therapy.

VII.

The Endocrine System A. Anatomic and physiologic changes. 1. 2. B. Pituitary gland. Pancreas.

Common disorder: Diabetes (NIDDM). 1. 2. 3. Diagnosis and incidence. Diabetic complications. Nursing care. a. b. Lifestyle management/monitoring. Diabetic foot care.

VIII.

The Gastrointestinal System A. Anatomic and physiologic changes. 1. 2. B. Loss of HCl producing cells. Reduction in peristalsis.

Common disorder: Constipation. 1. 2. 3. 4. Contributing factors and diagnosis. Treatment and nursing care. The medication dilemma. Fecal impaction. a. b. Signs and symptoms. Resolution.

C.

Common disorder: Fecal incontinence. 1. 2. Causes and incidence. Nursing care. a. b. Assess and modify causes. Implement bowel training.

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The Urinary System A. Anatomic and physiologic changes. 1. 2. 3. 4. Decreased GFR. Diminished renal function. Reduced bladder capacity. Gender-specific alterations in function. a. b. B. Females - Cystocele. Males - BPH.

Common disorder: Urinary incontinence. 1. Types: a. b. c. d. 2. Urge Stress Overflow Functional -

Treatment a. b. c. d. Determine cause. Strengthen pelvic muscles. Retrain bladder, monitor emptying Use urinary catheter only as a last resort.

X.

The Neurological System A. Anatomic and physiologic changes. 1. 2. 3. 4. B. Fewer neurons, less dopamine. Decreased peripheral nerve conduction. Slower voluntary movement, slowed startle response. Retained thought processes, learning, reasoning and memory.

Common disorder: Cerebrovascular event 1. 2. 3. Causes and cardinal S&S. TIAs; left-sided vs. right-sided CVA. Prevention, treatment and nursing care.