VISION

Age-related changes in the eye

1. thinning of the skin surrounding the eye
2. decrease in musculature in the eyelids
ectropion bottom lid sags outward
entropion the lid turns inward
3. arcus senilis ((corneal calcium deposits)
4. smaller pupil size
5. decreased reading & color discrimination ability
6. atrophy of lacrimal glands results in dry eyes
7. intraocular pressure
Changes in vision among older persons are preceded
by the following
1. Decreasing sensitivity to light.
2. Increased sensitivity to glare.
3. Altered color vision
Presbyopia a universal age-related change in the lens
of the eye involving loss of accommodation.
- objects held closer than 1-2 feet become difficult
to see.
COMMON ILLNESSES of the EYE
1. Cataracts
2. Glaucoma
3. Age-related macular degeneration (ARMD)
4. Diabetic retinopathy
Visual impairment defined as visual acuity of 20/40 or
worse
Legal blindness is 20/200 or more
Implications of age-related eye changes to
nursing:
a. Urge older adults to schedule routine eye
examinations
b. Assess older clients ability to perform ADL
b. Consider safety measures like
- adequate lighting
- nonskid surfaces on stairs
- use of stair rails
- toxic substances & medicines with labels
that are readable

HEARING
Age-related changes in the ear
1. auricle tends to wrinkle & sag
2. drier and harder cerumen that accumulates in
the ear canal impacted cerumen
3. dry ear canal pruritus
4. atrophy of the inner ear structures hearing
loss (presbycusis)
Approximately 30% to 50% of people older than 65
have significant hearing loss.
Hearing loss increases with age and is greater in men.
NURSING IMPLICATIONS
1. Assess clients ability to communicate
2. Check if client is able to hear alarms and
doorbells
3. Emphasize on safe driving & taking of public
transportation
4. Encourage client to engage in leisure &
recreational activities
TASTE, SMELL & TOUCH
a. decrease in taste buds ( gradual)
- taste deficits results to weight loss,
malnutrition, impaired immunity
b. atrophy of olfactory bulbs
- diminished sense of smell (hyposmia)
c. slower conduction of nerve impulses &
diminished function of the peripheral nerves
- decreased sensitivity to pain, temperature
extremes and vibration

NURSING IMPLICATIONS
Taste
1. Appetite enhancement strategies
2. Check dentures for fit & cleanliness
3. Inspect mouth for ulcers or gingivitis
4. Identify possible offenders known to
affect taste (ex. medications)
5. Encourage fluid intake
Smell
1. implement safety precautions
- placing natural gas detectors
- placing smoke detectors
- date and label food containers
2. house cleaning & personal hygiene
3. encourage daily waste disposal to prevent
garbage smell
Touch
Focus assessment on:
- impaired sense of touch
- intactness of the skin
- safety risks

THE INTEGUMENTARY SYSTEM

Normal Changes of Aging
a. thinning of the 3 layers of the skin.
b. loss of subcutaneous fat
> visible veins
> wrinkled, dry & sagging skin
> skin prone to damage
c. decrease in collagen
> loss of skin turgor
d. nails grow more slowly, brittle; dull, yellow or gray
color
e. Loss of eyelid elasticity
f. Epidermal mitosis slows by 30% - skin heals more
slowly
g. decrease melanocytes hair appears gray or white
h. scalp, pubic & axillary hair declines due to the
decline in the hormones
i. less efficient manufacturing of Vit. D from sunlight
j. changes in pigmentation with accumulation of
discoloration
photoaging

Common Skin Problems

1. skin cancer
2. pressure ulcers
3. cellulitis
NURSING IMPLICATIONS
1. Instruct client to avoid excessive use of soap,
hot water & brisk rubbing when bathing
- Pat skin dry instead of briskly rubbing.
3. Lubricate the skin with a moisturizer multiple
times a day.
- Dry skin causes itchiness.
4. Avoid prolonged pressure on bony
prominences.
5. Protect skin from temperature extremes.
6. Soak nails before trimming.
7. Dress appropriately for weather and climate.
8. Protect skin from sun exposure risk of
photodamage
9. Evaluate and manage incontinence.
> If soiling occurs, skin should be cleansed
per routine.
> Plastic- lined bed pads should not contact
with the persons skin.
10. Monitor nutrition.
11. Provide Vitamin C & zinc to promote skin
healing.
12. Adequate fluid intake.

Advise to stay mentally active

Socialize with others

. RESPIRATORY SYSTEM
Changes that occur with aging:
a. Lungs appear larger due to loss of elasticity
(stiffening of elastin & the collagen connective
tissue) lungs become more rigid.
b. Weaker respiratory muscles.
c. increased chest wall stiffness
d. Decreased ciliary action.
e. decreased number of alveoli
f. increased respiration due to chest wall & thoracic
spine
deformities.
g. lower amount of oxygen carried by the blood
h. slower & less efficient gas exchange
i. maximum breathing reduced.
j. tendency to trap air (not able to exhale fully)

1.
2.
3.
4.
5.

Common Illnesses:
Pneumonia
Asthma
COPD
Tuberculosis
Lung Cancer

Interventions to maintain effective breathing &

circulation
1. Ensure airway patency clean nostrils
2. Allow rest periods all throughout the day.
3. Avoid exposing the elderly to cold & flu germs.
4. Encourage plenty of fluid intake
5. Proper nutrition
6. Avoid smoking/ exposure to smoke
CARDIOVASCULAR SYSTEM
Changes that occur with aging
1. More prominent arteries in head, neck, and
extremities.
2. Stiffening of the heart valves
3. Aorta become elongated and dilated.
4. increase peripheral resistance and decrease
cardiac output BP increases to compensate
5. Less efficient oxygen utilization.
6. Less elasticity of vessels.
> arterial stiffening due to lipid deposits &
calcification
> veins thicken
7. decreased number of normal pacemaker cells in
the sinus node altered electrical activity of the
heart
8. Decreased cardiac output produces renin
increases BP & retains sodium retention

Common Illnesses:
1. Hypertension/ hypotension
2. hyperlipidemia
3. metabolic syndrome condition
characterized by elevated waist
circumference, BP, fasting serum
triglycerides & serum glucose
4. MI
5. Angina
6. Varicosities due to valvular reflux
7. Postural or orthostatic hypotension

Nursing Interventions to ensure a healthy

cardiovascular system

Advise elderly to avoid/stop smoking

Encourage daily exercises

Promote healthy diet low salt, low cholesterol

- calcium-rich foods

Encourage client to control his weight

Schedule regular check-ups

NEUROLOGIC SYSTEM
Normal Changes of Aging
1.Brain decreases in size (by approximately 7%)
2. Loss of neurons in the brain (up to 20% ).
3. Slowing of coordinated movements.
4. Deterioration of balance mechanisms.
5. Decreased sensation ( touch, taste, hearing, vision ).
6. Decrease in cerebral blood flow.
7. Diminished deep sleep.
8. Little decline in intellect.
9. Some memory changes :
> Losses in short term memory.
> Clarity of long term memory.

Common Illnesses:

1. Dementia
> Alzheimers Disease
> Vascular dementia
2. Parkinsons Disease
3. Stroke / Transient Ischemic Attack (TIA)
4. Multiple Sclerosis

Preventing neurological problems in the older

adults:

1. Clients must remain active & engaged in life

2. Develop hobbies and interests
3. Eat a well-balanced diet
4. Avoid stress & anxiety enjoy life
5. Exercise to remain or become fit
6. Stay connected with at least one person on a
daily basis
URINARY SYSTEM
Normal renal changes of aging
1. Kidneys shrink & become less efficient.
> UTI
2. Bladder capacity declines.
> increased frequency in urination especially during
the night
3. Decreased ability to concentrate urine risk for
dehydration
. Detrusor muscle less contractile
> inability to empty bladder completely UTI and
Incontinence
5. Decreased glomerular filtration rate
6. Decreased renal blood flow
7. Increased renal threshold for glucose
See separate sheet for additional info about the renal
system
GASTROINTESTINAL SYSTEM
Normal age-related changes in the older adult
1. Decreased blood supply to intestines digestive
disorders / malabsorption syndrome.
2. Decreased liver size & function.
decreased metabolism , decreased drug
detoxification.
3.
Delayed gastric motility & emptying.
diarrhea, or constipation, fecal incontinence
4.Changes in the mouth including loss of teeth &
decreased salivation secretion

Common Illnesses:
1. Esophageal disorders

2.
3.
4.
5.
6.

Dysphagia
Gastroesophageal Reflux Disease
Gastritis
Peptic and Duodenal Ulcer
Crohns Disease

HEMATOLOGIC SYSTEM
Changes in older adults
1.Number of stem cells in the marrow is decreased
2. Decreased number of RBC
decline in phagocytosis & ability to fight
pathogen.
3. Reduced ability to accelerate RBC production
inspite of administration of erythropoietin.
anemia

Measures to prevent GIT problems in older adults:

1. Eat a balanced diet that is high in fiber & low in fat &
processed carbohydrates
2. Maintain a normal weight.
3. Decrease the size of portions at mealtime
4. Avoid lying down for 2 3 hours after eating
5. Stop smoking or using tobacco products.
6. Limit use of nonsteroidal anti-inflammatory agents

Common Illnesses:
1. Anemia
2. Thrombocythemia increased number of
circulating platelets in the blood
3. Lymphomas evidenced by presence of
excess lymphocytes
MUSCULOSKELETAL SYSTEM

. ENDOCRINE SYSTEM
Normal changes of aging:
Normal changes in the endocrine system
Decrease or increase secretion & action of insulin.
> peripheral tissues may become insulin-resistant
2. Changes in secretion & action of thyroid hormone.

1.

Common Illnesses:
1. Diabetes Mellitus
2. Thyroid disorders
> Hyperthyroidism
> Hypothyroidism
Nursing Implications:
1. Weight management
2. Avoid or reduce alcohol intake
3. Exercise
4. Refer to dietician for
basic food & meal plan
guides
IMMUNE SYSTEM

a.

Normal changes of aging

decreased number of B cells in the circulation
> tissues slower to repair / more vulnerable to
diseases
b. production of IgE declines
> decrease in allergic reaction
c. Increase antibody production that reacts against the
persons own body cells
> development of autoimmune diseases

Common Illnesses:
1. Hypersensitivity
2. Primary Immunodeficiency disorders
> HIV/ AIDS
3. Susceptibility to Infections
> pneumonia
> UTI
> Skin infections

Nursing Implications:
1. Assist older people in identifying active, positive
coping strategies
2. Educate people about effects of stress
3. Emphasize importance of obtaining yearly
influenza immunization
4. Encourage clients to develop an exercise
plan appropriate for their physical status.

1. Decrease in height is common ( range of 2 to 4

inches from spinal column ).
2. Decrease ROM in some joints.
3. Decreases in lean body mass - muscle atrophy
especially with disease
4. Shrinking of vertebral discs. Loss of bone mass.
6. Decrease in reflexes.
7. Calcium loss in bones
> bones become brittle/ may break easily
8. Joint degeneration with arthritic changes.
9. Increase postural sway & difficulty maintaining
balance.
10. Slower & shorter gait
11. Foot problems like bunions, corns, calouses,
can contribute to gait problems and falls.
Older persons are prone to develop
1. Osteoporosis
2. Osteomalacia
3. Osteoarthritis
3. Kyphosis hunchback
Nursing Implications:
1. promote diet adequate in calcium & Vit D
2. Encourage weight-bearing exercises
3. Reduce or eliminate smoking/ alcohol intake
4. Monitor safety measures
5. Active ROM Exercises
> stretching 10 mins per day

JRU2013-14