CARE OF THE OLDER PERSONS

PHYSIOLOGICAL AGING OF THE HUMAN BODY BY SYSTEMS

SKIN, HAIR, NAILS

Loss of subcutaneous fat Thinning of skin Decreased collagen Nails brittle and flake Mucous membranes drier Less sweat glands Temperature regulation difficult Hair pigment decreases Hair thins

EYES AND VISION

Eyelids baggy and wrinkled Eyes deeper in sockets Conjunctiva thinner and yellow Quantity of tears decreases Iris fades Pupils smaller, let in less light Night and depth vision less Floaters can appear Lens enlarges

EYES AND VISION CONT.

Lens becomes less transparent Can actually become clouded Results in cataracts

EYES AND VISION CONT.

Accommodation decreases Results in presbyopia Impaired color vision, also especially greens and blues Because cones degenerate

EYES AND VISION CONT.

Predisposed to glaucoma. Increased pressure in eye. Decreased absorption of intraocular fluid. Can result in blindness.

EYES AND VISION CONT.

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.

EARS AND HEARING LOSS

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

RESPIRATORY SYSTEM
Lungs become more rigid Pulmonary function decreases Number and size of alveoli decreases Vital capacity declines Reduction in respiratory fluid Bony changes in chest cavity

CARDIOVASCULAR SYSTEM
Heart smaller and less elastic with age By age 70 cardiac output reduced 70% Heart valves become sclerotic Heart muscle more irritable More arrhythmias Arteries more rigid Veins dilate

GASTROINTESTINAL SYSTEM
Reduced GI secretions Reduced GI motility Decreased weight of liver Reduced regenerative capacity of liver Liver metabolizes less efficiently

RENAL SYSTEM
After 40 renal function decreases By 90 lose 50% of function Filtration and reabsorption reduced Size and number of nephrons decrease Bladder muscles weaken Less able to clear drugs from system Smaller kidneys and bladder

REPRODUCTIVE SYSTEM
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

REPRODUCTIVE SYSTEM
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

NEUROLOGICAL SYSTEM
Neurons of central and peripheral nervous system degenerate Nerve transmission slows Hypothalamus less effective in regulating body temperature Reduced REM sleep, decreased deep sleep After 50% lose 1% of neurons each year

MUSCULOSCELETAL SYSTEM
Adipose tissue increases with age Lean body mass decreases Bone mineral content diminished Decrease in height from narrow vertebral spaces Less resilient connective tissue Synovial fluid more viscous May have exaggerated curvature of spine

IMMUNE SYSTEM
Decline in immune function Trouble differentiating between self and non-self - more autoimmune problems Decreases antibody response Fatty marrow replaced red marrow Vitamin B12 absorption might decrease - decreased hemoglobin and hematocrit

ENDOCRINE SYSTEM
Decreased ability to tolerate stress - best seen in glucose metabolism Estrogen levels decrease in women Other hormonal decreases include testosterone, aldosterone, cortisol, progesterone

2. SOCIAL AND PSYCHOLOGICAL CHANGES

Adjusting to decreasing physical strength and health. Adjusting to retirement and reduce income. Adjusting to the death of ones spouse. Establishing an explicit affiliation with ones age group.

Meeting social and civil obligations. Establishing satisfactory living arrangement. Establishing satisfactory relationships with adult children. Finding meaning in LIFE.

Common Psychosocial Changes

Assume Grandparent Role Adjust to Retirement Increase Volunteer Activity Maintain or Develop New Interests Cope with Death of Spouse, or S.O. Adjust to Change in Intimacy & Sexuality Cope with Relocation Cope with Losses

3. EMOTIONAL CHANGES ERIKSON:Ego Integrity vs. Despair

Ego Integrity vs.
Despair Believes they have made poor choices during life and wish the live life longer. Inability to accept ones fate. Gives rise to feeling with frustration, discouragement, and sense that ones life has been worthless. Views life with a sense of wholeness & derives satisfaction. Views death as an acceptable completion of life. Accepts ones one and only life cycle. Bringing serenity and wisdom.

Ericksons Developmental Stages

Young Adulthood (20-30)

- Intimacy vs. Isolation Middle Adulthood (30-60) - Generativity vs. Stagnation Older Adulthood (60+) - Integrity vs. Despair

IMPLICATIONS OF CARE OF THE OLDER PERSONS

PHYSIOLOGIC CHANGES ASSOCIATED WITH AGING THAT INFLUENCE MEDICATION ADMINISTRATION AND EFFECTIVENESS Altered memory usually cause errors in taking medication Less acute vision Decrease in renal function, resulting in slower elimination of drugs and higher drug concentrations in blood stream for longer periods.

PHYSIOLOGIC CHANGES ASSOCIATED WITH AGING THAT INFLUENCE MEDICATION ADMINISTRATION AND EFFECTIVENESS.

Less complete and slower absorption from the GI tract. Increase proportion of fat to lean body mass, which facilitates retention of fat soluble drugs and increases potential for toxicity.

PHYSIOLOGIC CHANGES ASSOCIATED WITH AGING THAT INFLUENCE MEDICATION ADMINISTRATION AND EFFECTIVENESS

Decrease liver function which hinders biotransformation of drugs. Decrease organ sensitivity which means that the response to the same drug concentration in the vicinity of the target organ is less in older people than in the young. Altered quality of organ responsiveness resulting in adverse effects becoming pronounce before the therapeutic effects are achieved.

End