Age Associated Physiological changes:
Age-Associated Cardiovascular Changes
A.Definition: Isolated systolic hypertension: systolic BP >140 mmHg and diastolic BP <90 mmHg.
B. Etiology
1. Arterial wall thickening and stiffening, decreased compliance.
2. Left ventricular and atrial hypertrophy.
3. Sclerosis of atrial and mitral valves.
C. Implications
1. Decreased cardiac reserve.
a. At rest: No change in heart rate, cardiac output.
b. Under physiological stress and exercise: Decreased maximal heart rate and cardiac output, resulting in fatigue, SOB, slow recovery from tachycardia.
2. Risk of isolated systolic hypertension; inflamed varicosities.
3. Risk of arrhythmias, postural and diuretic-induced hypotension. May cause syncope.
4. Strong arterial pulses, diminished peripheral pulses, cool extremities.
Age-Associated Changes in the Pulmonary System
A. Etiology
1. Decreased respiratory muscle strength; stiffer chest wall with reduced compliance.
2. Diminished ciliary & macrophage activity, drier mucus membranes. Decreased cough reflex.
3. Decreased response to hypoxia and hypercapnia.
B. Implications
1. Reduced pulmonary functional reserve.
a. At rest: No change.
b. With exertion: Dyspnea, decreased exercise tolerance.
2. Decreased respiratory excursion and chest/lung expansion with less effective exhalation. Respiratory rate 12 to 24 bpm.
3. Decreased cough and mucus/foreign matter clearance.
4. Increased risk of infection and bronchospasm with airway obstruction.
Age-Associated Changes in the Renal and Genitourinary Systems
A. Definitions: Cockroft-Gault Equation: Calculation of creatinine clearance in older adults:
For Men
For Women, the calculated value is multiplied by 85% (0.85).
B. Etiology
1. Decreases in kidney mass, blood flow, glomerular filtration rate (10% decrement/decade after age 30). Decreased drug clearance.
2. Reduced bladder elasticity, muscle tone, capacity.
3. Increased post-void residual, nocturnal urine production.
4. In males, prostate enlargement with risk of benign prostatic hyperplasia (BPH).
C. Implications
1. Reduced renal functional reserve; risk of renal complications in illness.
2. Risk of nephrotoxic injury and adverse reactions from drugs.
3. Risk of volume overload (in heart failure), dehydration, hyponatremia (with thiazide diuretics), hypernatremia (associated with fever), hyperkalemia (with potassium-sparing diuretics). Reduced excretion of acid load.
4. Increased risk of urinary urgency, incontinence (not a normal finding), UTI, nocturnal polyuria. Potential for falls.
Age-Associated Changes in the Oropharyngeal and Gastrointestinal Systems
A. Definition:
BMI: Healthy: 18.5–24.9 kg/m2; overweight: 25–29.9 kg/m2; obesity: >30 kg/m2.
B. Etiology
1. Decreases in strength of muscles of mastication, taste, and thirst perception.
2. Decreased gastric motility with delayed emptying. Atrophy of protective mucosa.
3. Malabsorption of carbohydrates, vitamins B12 and D, folic acid, calcium.
4. Impaired sensation to defecate. 5. Reduced hepatic reserve. Decreased metabolism of drugs.
C. Implications
1. Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition.
2. Gastric changes: altered drug absorption, increased risk of gastroesophageal reflux disease (GERD), maldigestion, nonsteroidal anti-inflammatory drug-induced ulcers.
3. Constipation not a normal finding. Risk of fecal incontinence with disease (not in healthy aging).
4. Stable liver function tests. Risk of adverse drug reactions.
Age-Associated Changes in the Musculoskeletal System
A. Definition:
Sarcopenia: Decline in muscle mass and strength associated with aging.
B. Etiology
1. Sarcopenia with increased weakness and poor exercise tolerance.
2. Lean body mass replaced by fat with redistribution of fat.
3. Bone loss in women and men after peak mass at 30 to 35 years.
4. Decreased ligament and tendon strength. Intervertebral disc degeneration. Articular cartilage erosion. Changes in stature with kyphosis, height reduction.
C. Implications
1. Sarcopenia: increased risk of disability, falls, unstable gait.
2. Risk of osteopenia and osteoporosis.
3. Limited ROM, joint instability, risk of osteoarthritis.
Age-Associated Changes in the Nervous System and Cognition
A. Etiology
1. Decrease in neurons and neurotransmitters.
2. Modifications in cerebral dendrites, glial support cells, synapses.
3. Compromised thermoregulation.
B. Implications
1. Impairments in general muscle strength; deep-tendon reflexes; nerve conduction velocity. Slowed motor skills and potential deficits in balance and coordination.
2. Decreased temperature sensitivity. Blunted febrile response to infection.
3. Slowed speed of cognitive processing. Some cognitive decline is common but not universal. Most memory functions adequate for normal life.
4. Increased risk of sleep disorders, delirium, neurodegenerative diseases.
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