THE OLDER
ADULT
Anatomy and
Physiology
TERMS TO LOOK UP TO:
AGING
Reflects changes in physiologic
reserves over time that are
independent of and not induced
by any disease
TERMS TO LOOK UP TO:
Old and aging depends on the age and
experience of the speaker.
•Chronological age - number of years
lived
•Physiologic age - age by body
function
•Functional age - ability to contribute to
society
Vital Signs
Blood Pressure
 Aorta and large arteries stiffen and become
atherosclerotic
 Aorta becomes less distensible - rise in systolic
pressure
 Diastolic pressure stop rising- postural hypertension
Heart Rate and Rhythm
 Resting heart rate remains unchanged
 Pacemaker cells decline in the SA node– affects
response to stress
Respiratory Rate and Temperature
 Hypothermia
 Changes in temperature regulation
Skin, Hair, and Nail
Skin becomes lax
Loses turgor
Skin wrinkles
Vascularity of dermis decreases
Skin, Hair, and Nail
Actinic purpura
 Purple patches or macules
 Blood that leaked through poorly
supported capillaries and spread within
the dermis
Nails loses luster
 May yellow and thicken
Scalp hair loses its pigment
 Graying of hair
 Normal hair loss elsewhere in the body
Head and Neck
Atrophy of the bony orbit of the eyes
Skin of the eyelids become wrinkled
Soft bulges on the lower lids
Dry eyes due to fewer lacrimal secretions
Cornea loses its lustre
EYES & VISUAL ACUITY
 Predisposed to glaucoma
 Increased pressure in eye
 Decreased absorption of intraocular fluid
 Can result in blindness
PRESBYOPIA
•Lens gradually loses its elasticity
•Less able to accommodate and focus
on nearby objects
EYES & VISUAL ACUITY
•Aging affects lenses
•Cataracts- thickening and yellowing of the
lenses
•Glaucoma
•Macular degeneration
•Lens becomes less transparent
EYES & VISUAL ACUITY
 Macular degeneration
becoming more frequent
 This is the patch of retina
where lens focuses light
 Ultimately results in
blindness
 Reason for current increase
in this condition unknown
HEARING
 PRESBYCUSIS
 Person fails to catch the upper tones of words
while hearing the lower tones
Irreversible, sensorineural loss with age
Men more affected than women
Called presbycusis
Loss occurs in higher range of sound
By 60 years, most adults have trouble hearing
above 4000Hz
Normal speech 500-2000Hz
Mouth
 Diminished salivary secretions
 Decreased olfaction and
increased sensitivity to
bitterness
 Teeth may wear down, loss
 “purse-string” wrinkles
 ANGULAR CHELITIS
Maceration of skin due to
overclosure of mouth
Thorax and lungs
Capacity for exercise decreases
Chest wall becomes stiffer
Respiratory muscles weaken
Loss of elastic recoil
Cough becomes less effective
Cardiovascular system
Kinking or buckling of the artery due to
lengthening and tortuosity of the aorta
A physiologic 3rd heart sound may
persist as late as age 40 years
Major Cardiovascular Changes with
Aging
•The maximum heart rate decreases and it
takes longer for heart rate and blood
pressure to return to normal resting levels
after exertion.
•The aorta and other arteries becomes
thicker and stiffer which may bring a
moderate increase in systolic blood pressure
with aging. In some individuals, this may
result in hypertension.
•The valves between the chambers of the
heart thicken and become stiffer. As a result
heart murmurs are fairly common among
older adults.
The pacemaker of the heart loses cells and
develops fibrous tissue and fat deposits.
These changes may cause a slightly slower
heart rate and even heart block. Abberant
heart rhythms and extra heart beats become
more common.
The baroreceptors which monitor blood
pressure become less sensitive. Quick
changes in position may cause dizziness
from orthostatic hypotension.
Major Gastrointestinal Changes
with Aging
•Increased prevalence of atrophic gastritis
and achlorhydria.
•The liver is less efficient in metabolizing
drugs and repairing damaged liver cells.
•Diverticuli in the colon may cause pain.
•Reduced peristalsis of the colon can
increase risk for constipation.
Urinary System Changes with Aging
•Kidney mass decreases by 25-30 percent and
the number of glomeruli decrease by 30 to 40
percent. These changes reduce the ability to
filter and concentrate urine and to clear drugs.
•With aging, there is a reduced hormonal
response (vasopressin) and an impaired ability
to conserve salt which may increase risk for
dehydration.
•Bladder capacity decreases and there is an
increase in residual urine and frequency.
These changes increase the chances of urinary
infections, incontinence, and urinary
obstruction.
Male
Reduced testosterone level
Testes atrophy and soften
Decrease in sperm production
Seminal fluid decreases and more
viscous
Erections take more time
Refractory period after ejaculation may
lengthen to days
Female
Declining estrogen and progesterone levels
Ovulation ceases
Introitus constricts and loses elasticity
Vagina atrophies - shorter and drier
Uterus shrinks
Breasts pendulous and lose elasticity
MUSCULOSKELETAL SYSTEM
With aging, skeletal muscles decrease in
bulk and power, and ligaments lose some of
their tensile strength. Range of motion
diminishes, partly because of osteoarthritis.
Subtle losses in height begin
Significant shortening is obvious by old age.
Most loss of height occurs in the trunk as
intervertebral discs become thinner and the
vertebral bodies shorten or even collapse
from osteoporosis
MUSCULOSKELETAL SYSTEM
Flexion at the knees and hips may also
contribute to shortened stature. Alterations in
the discs and vertebrae also contribute to the
kyphosis of aging and increase the
anteroposterior diameter of the chest
especially in women. For these reasons, the
limbs of an elderly person tend to look long in
proportion to the trunk.
MUSCULOSKELETAL SYSTEM
• KYPHOSIS
• Accentuation of dorsal curve
due to musculoskeletal
changes
Subtle loses in height begin
Flexion at the knees and hips
also contribute to shortened
stature
Skeletal muscles decrease in
bulk and power and ligaments
lose their tensile strength
The Nervous System
“Benign Forgetfulness”
Difficulty recalling the names of the people or
objects or certain details of specific events
Retrieve and process data more slowly and take
more time to learn new material
Motor responses may slow, and their ability to
perform complex tasks may become impaired
The Nervous System
 Older adults move and react with less speed and
agility
 Skeletal muscles decrease in bulk
 Muscle wasting of hands due to atrophy
 Develops a benign essential tremor in the head,
jaw, lips or hands that may be confused with
parkinsonism
 Gag reflex may be diminished
Immune System
Decline in immune function
Trouble differentiating between self and non-self - more
auto-immune problems
Decreases antibody response
Fatty marrow replaced red marrow
Vitamin B12 absorption might decrease - decreased
hemoglobin and hematocrit
Decreased ability to tolerate stress - best seen in glucose
metabolism
Estrogen levels decrease in women
Other hormonal decreases include testosterone,
aldosterone, cortisol, progesterone