Physiological changes with aging

Physiological
changes of
aging
Under Supervision Of
Assist Prof Dr. Aziza
Mahmoud
Prepared By
De. Doaa Mohamed Zein
Elabdeen
2019/2020

Outlines Introduction
Factors affecting
age-related
changes
Changes
of CVS
Changes of
RES.
Changes of
GIT
Changes of
Endocrine
System
Changes of
Immune S.
Changes of
Urinary S.
Changes of
Neurologic S.
Changes of
MSS
Changes of
Integumentar
y S.
Changes of
Reproductive
S.
Changes of
Sensory System
a) Hearing
b) Smell
c)Vision
d)Taste
e)Touch
References

Introduction
Ageing is a natural process. Everyone
must undergo this phase of life at his or her own
time and pace, ageing reflects all the changes
taking place over the course of life. These
changes start from birth& then develops. To the
young, ageing is exciting. Middle age is the
time when people notice the age-related
changes like greying of hair, wrinkled skin and
a fair amount of physical decline. No one can
escape these changes.

ageing is a course of biological reality which starts at changes and
ends with death. In most of the developed countries, the age of 60
is considered equivalent to retirement age and it is said to be the
beginning of old age. Aging is characterized by progressive and
broadly predictable changes that are associated with increased
susceptibility to many diseases. Aging is not a homogenous
process. Rather, organs in the same person age at different rates
influenced by multiple factors.

Factors affecting
age-related
changes
 Environmental
Factors
 Genetic Factors
 Psychosocial
Factors
 lifestyle choices

Physiological changes of aging
in different body system include:
i. Cardiovascular System
The cardiovascular system helps maintain
homeostasis by bringing O2 and nutrients to
organs and tissues and by transporting CO2 and
other waste products to other body system for
removal. Aging alters CVS both structurally
and physiologically.

1.Heart muscle
 Heart size doesn't change with
age unless there is cardiac
disease.
 collagen and elastin in
the heart muscle; these changes
decrease myocardium contraction
and thus decrease cardiac output.
 Heart rate.

Atria
 Decline in left ventricular compliance provides an increase
workload on the atria, resulting in hypertrophy of the atria.
Cardiac output: -
 Cardiac output at rest is unaffected by age.
 Maximum cardiac output and aerobic capacity are reduced
with age.

Valve:
 It increases in valvular circumference has been reported in all four
cardiac valves.
 Thicker and stiff as a result of lipid accumulation, collagen
degeneration and fibrosis, which lead to reduction of valve
flexibility .
 Weakness of the valve in the rectal veins can lead to hemorrhoids.
 Decreased efficiency of venous valves lead to decrease venous
return and increase incidence of varicosities and dependent edema

Vessels Calcification of vessel occurs.
 Elastin in the vessel wall decreases which lead to
thickening and rigidity of the vessels especially
the coronary arteries (Arteriosclerosis)
 Decrease baroreceptor mechanism leads to
orthostatic hypotension which occurs because the
circulation doesn’t respond quickly to postural
changes.
 Circulations in the coronary arteries diminish by
approximately 35% after the sixth decade.

pulse and cardiac output: -
Cardiac output at rest is unaffected by age. Maximum cardiac
output is reduced with age.
Sinus bradycardia less than 50 beats /min common in elderly.
Blood pressure: -
Blood pressure is a measure of cardiovascular efficiency.
Although blood pressure is characteristically heightened among
older adults, there is evidence suggesting that there are no
effects of aging .
The myocardium becomes more irritable, extra systoles and
sinus arrhythmias may occur.

Common problems related to
cardiovascular system changes:
 High risk to cardiovascular diseases, particularly
coronary heart disease.
 Atherosclerosis.
 High risk to hypertension.
 High risk to heart failure.
 Varicosities (lower limbs).
 Hemorrhoids.
 Orthostatic hypotension.

2.Respiratory System
The primary functions of respiration are to
supply O2 to and remove CO2 from the blood.
Upper respiratory structures:
 Structural change in nose cause septal
deviations that interfere with the flow of air
through the nasal cavity and thus contribute to
mouth breathing during sleep, causing snoring
and obstructive apnea.
 With aging, blood flow to the nose diminished
and affects the sub-mucosal glands, causing
decreased secretions.

Nose, mucous membranes
become drier as the fluid content
of body tissue decreases.
Decrease vocal cord elasticity lead
to change in voice pitch and
quality.
The number of cilia decreases
which diminishes their ability to
trap and remove debris, which
increased risk of infection.

Chest wall and musculoskeletal
structure:
Calcification of costal cartilage makes
the ribcage more rigid,
increased the anterior posterior chest
diameter often demonstrated by
kyphosis .
weakness of thoracic inspiratory and
expiratory muscles which reduce the
mobility of ribcage.
These changes reduce respiratory
efficiency and reduce maximal
inspiratory and expiratory force.

C- Lung structure:
 Lungs become smaller and flabbier, and
their weight diminishes by approximately
20% lead to decrease in lung capacity.
 The alveoli progressively enlarge, and their
walls become thinner.
 Decrease in alveoli elasticity and the
number of capillaries surrounding the
alveoli can interfere with gas exchange
leading to decrease of O2saturation.

Oxygen saturation
 Age-related changes to the respiratory tract
ultimately result in a reduced delivery of O2
to the blood and a decrease in O2 saturation
Common problems related to respiratory
system changes:
 Increased susceptibility to infection
 Increased susceptibility to aspiration
 Inadequate oxygenation

Gastrointestinal System
 Digestion of food and maintenance of nutrition are influenced to a
small degree by age related gastrointestinal changes and to a large
degree by risk factors that commonly occur in older adults.
a- Oral cavity and pharynx:
 Increase dental decay and teeth loss
 Gingival tissue may withdraw and the periodontal bonds that hold
the teeth in place may loosen, these effect on ability to bite and
chew.

Con. Oral cavity and pharynx
 Jaw muscle become weak and shrinkage of bony structure of
the mouth.
 Taste buds may atrophy with age leading to decreased ability
to discriminate between flavor especially between salts and
sweat.
 The volume of saliva can be reduced in the elderly resulting in
dry tongue .
 There is marked decrease in salivary ptyalin causing difficult
with the digestion of starch.

B-Esophagus
 In older adults, the esophagus stiffens and the
peristaltic decrease lead to pres- byphagia (slowed
swallowing) and increase the risk of aspiration.
 The gag reflex is depressed in older adults, which
lead to episodes of chocking and aspiration.

c- The stomach
 Degeneration of gastric mucosa, a decrease in digestive enzymes,
and decrease of motility.
 Decrease in hydrochloric acid intrinsic factor may lead to mal
absorption of iron, vitamin B12, calcium and folic acid, which
increased incidence of, peptic ulcer, and stomach cancer.
 Age-related changes may also affect the solubility and absorption
of some drugs

D-The small intestine
 Atrophy of the muscle and mucosal surface, thinning in
the villi, and a decrease in epithelial cells. This results in
some decrease in absorption of fats .
E - Large intestine
 Peristalsis of intestine low with aging leading to increase
occurrence of constipation.
f- Liver
 With age, the liver become smaller and more fibrous,
lipofuscin (a brown pigment) accumulates, and blood
flow to the liver decrease by approximately one third.

The pancreas
 Pancreas becomes more fibrotic. There is a
decline in pancreatic secretion .
h- Gall bladder
 Decrease production of bile and incidence of
gallstones increased by age.
 Gall stones develop in approximately 40% of
elderly by the age of 80 years.

Common problems related to gastro-intestinal
system changes:
 Heartburn
 Chewing problems
 Denture problems
 Lake of enjoyment of food and lack of appetite
 Decreased food intake
 Constipation and fecal impaction
 Difficult in swallowing

Endocrine System
 The endocrine system is made up of
organs and tissues that produce hormones.
Hormones are natural chemicals produced
in one location, released into the
bloodstream, and then used by other target
organs and systems.
Thyro
id
Pancr
eas
Pituit
ary
Adr
enal
Ovari
es
test
es

a- Thyroid
Thyroid gland often becomes
nodular
Decrease in production of
thyroid stimulating hormone
Thyroid function decreases
leading to decrease of basal
metabolic rate.

b-Pituitary Gland
 gradually diminishes in size
 Pituitary gland produces less
growth hormone, which lead
to decrease in muscle mass

c- Pancreas
 Although pancreatic function decreases with aging, its
function remains adequate to meet normal functioning
except in cases of onset of DM.
 Pancreas secretes insulin, a hormone which is critical to
the metabolism of glucose (blood sugar).
 Insulin continues to be produced in sufficient quantities
in older adults, but their muscle cells may become less
sensitive to the effects of insulin

d- Adrenal glands
 It produces the hormones aldosterone and cortisol.
 Aldosterone is important in regulating fluid and
electrolyte balance.
 Aldosterone levels are 30% lower in adult's age 70 to
80 years old than in younger adults this may cause
orthostatic hypotension
 Cortisol is a stress response hormone that has anti-
inflammatory and anti-allergy effects. Secretion of
cortisol diminishes by 25% with ageing

e-Ovaries and testes
In female
 Diminish in estrogen may lead two metabolic
effects: coronary thrombosis and osteoporosis
 The estrogen hormone decreases
 Decrease in size of the ovaries, uterus, cervix,
fallopian tubes
 Decrease in number of mammary ducts

In men
Decrease level of
testosterone and seminal
fluid
Decrease sperm production
but doesn’t prevent
reproduction
Penile erection is slowed.

Common problems related to endocrine system changes:
 High risk to develop DM.
 High risk to develop osteoporosis
 High risk to vaginal infection
 Arrhythmias
 Coronary thrombosis
 Has an effect on self-image

5-Immune System (lymphatic) system
 Age-related changes in the immunity increase
vulnerability to infections, tumors and immune
disease.
 The immune system loses its ability to differentiate
between self and non-self, increase risk of
autoimmune diseases
 Diminished immunoglobulin production

 Decreased levels of antibody response
increase risk of infection (RTI)
 Diminished response to antigens.
 Blood cell production in bone marrow
decrease slightly. (Total WB cells)
 The size of lymph nodes, spleen
reduces slightly.

 Common problems related to immune system
changes:
 High risk for infection, particularly, RTI infections
 acquiring nosocomial infections
 Increase risk of cancer
 Reduction of erythrocyte mass
 decreased hemoglobin and hematocrit
 Increase incidence of autoimmune disease
 Decrease in total body fluid
 Decrease in total WB cells

6- Urinary System: -
The kidneys filter the blood and help remove
waste and extra fluid from the body.
The kidneys also play an important role in
controlling the body's chemical balance.
Aging changes

a- Kidneys: -
 Overall amount of kidney tissue decreases.
 Number of filtering units (nephrons)
decreases. Nephrons filter waste material
from the blood.
 Blood vessels supplying the kidneys can
become hardened. This causes the kidneys
to filter blood more slowly.
 Kidney loss mass and decrease in size.

B - Bladder: -
 Bladder capacity decrease
 involuntary bladder contraction increase, these can
lead to urgency and frequency of urination.
 The bladder wall changes. The elastic tissue becomes
tough and the bladder becomes less stretchy. The
bladder cannot hold as much urine as before.
 The bladder muscles weaken.
 Increased urine formation at night leads to nocturia.

c- Urethra: -
 In older women, decreases of
estrogen can affect the
urethra.
 Urethra become thin and
increased fragility of urethra
mucous can contribute to
urgency and frequency of
micturition.

In women:-: -
this can be due to weakened muscles that cause the bladder
or vagina to fall out of position (prolapse).
In men:-
enlarged prostate, which interfere with bladder
emptying leading to problem with voiding as
hesitancy, frequency, inability to maintain steady
stream of urine and urinary retention.

Common problems related to urinary system changes:
Urgency and frequency of micturition
Nocturia
High risk for infection
Liable to stress incontinence
Urinary problems can affect the elderly self-steam and his
social Activities

The nervous system: -
 Reduction in brain size and weight due to a
decrease in the volume of the cerebral cortex.
 Reduction in the number of functioning
neurons.
 Blood flow to the brain is decreased as a
result of fatty deposits that gradually
accumulate in the walls of blood vessels and
reduce the rate of arterial blood flow. This
condition is called atherosclerosis.

 The nerves and the spinal cord slowly
lose weight and the number of nerve
cells slowly decreases.
 Slower transmitted signals from nerve
cell to nerve cell, which leads to slower
reflexes and a gradual loss of the senses.
 Nerve cells may begin to transmit
messages more slowly than in the past.

 The breakdown of nerves can affect
the senses. You might have reduced or
lost reflexes or sensation, leading to
problems with movement and safety.
 Some slight slowing of thought,
memory, and thinking seems to be a
normal part of aging. Although these
changes are natural.

Common problems related to
nervous system changes:
Increased risk of injury
Increased risk of fall
Increased risk of accident
Decreased memory
lost reflexes
 Effects in memory, & thinking.

Musculoskeletal System: -
 The bones, joints, and muscles are the
body structures most closely associated
with aging process.
A-Bone: -
 Increase bone resorption
 Diminished calcium absorption
 Impaired bone formation
 Fewer function marrow cells

B- Vertebral column:-
 There is a decrease of height (1.2 cm of height every 20
years).
C- Posture and gait:-
 In men, the walking of the elderly shows a short steps
and wider leg distance in order to achieve better balance
and stable weight distribution.
 Women become bow-legged, with a narrow standing
base and walk with a wadding gait.

D- Muscle: -
 Muscle losses size and strength as we get
older, which can contribute to fatigue,
weakness and reduced tolerance to
exercise.
 Loss of motor neurons.
 Less glycogen is stored in aging muscles.
 Diminished protein synthesis.

E- Joints: -
 Movement becomes stiffer and less flexible
because the amount of lubricating fluid inside
your joints decreases
 The cartilage becomes thinner.
 Ligaments tend to shorten and lose some
flexibility, making joints feel stiff.
 Being inactive causes the cartilage to shrink and
stiffen, reducing joint mobility.

Common problems related to musculoskeletal system
changes:
 Pain
 Impaired mobility
 Self-care deficit
 Increased risk of falls
 Increased risk of infection
 Increased risk of fracture
 Osteoporosis
 Rheumatoid arthritis

9) Integumentary system
Integumentary system, which includes the
skin, hair, and nails, undergoes significant
changes with age.
a- Skin: -
Skin changes are among the most visible signs
of aging. Evidence of increasing age includes
wrinkles and sagging skin.

b- Epidermis: -
Superficial outer layers of the skin that
contain nerve endings but no blood vessels.
 declines by 50 %, this decline results in
slower healing, reduce barrier protection.
 Epidermis becomes increasingly fragile and
thin, and this leads to increased risk of
damage such as tears maceration, and
infection.

 The skin loses the ability to retain moisture
and become dry and scaly. This condition is
called Xerosis.
 Melanocytes production decreases,
melanocytes cluster are form areas of
deepened pigmentation causing brown spots
called senile lentigo.
 Increase rashes .

c- Dermis: -
Layer of skin that below the epidermis
that consists of several layers and
contains blood vessels, hair follicles,
glands, and nerves.
 Dermis decrease in thickness by
approximately 20 % with aging.
 The number of sweat glands, blood
vessels, and nerve endings decrease.

 diminishing thermoregulatory
function and inflammatory response,
 tactile sensation, reduced pain
perception.
 collagen and elastin fibers.
 Loss of subcutaneous fat(wrinkles) in
face around eyes, mouth and nose.

d- Subcutaneous fat:-
 Decreased amount of subcutaneous tissue
 redistribution of fat to the abdomen and thighs.
 Breast tissue also changes and become more granular and
atrophic in appearance.
 As a result of a loss of padding .
 The loss of this padding increases vulnerability of pressure
points.

E- Gland (sweat and sebaceous):-
 Sweat gland function decrease, and the amount of
perspiration decreases
 decrease in the amount of subcutaneous fat .
 The sebaceous gland and pores become larger.
 Sebaceous gland secretion decline leading to
dry skin.

F-Blood vessels: -
 The wall of the capillaries become increasingly fragile
which lead to senile purpura, on the legs and arms.
 Plasma and extracellular volume remain somewhat
constant, but intracellular fluid decreases.
g- Hair: -
Hair thins, and growth declines.
Hair tends to gray as a result of progressive melanin
loss.

con. Hair
women may have increased lip and
chin hair while experience a
thinning of hair on the head, axillae
and perineal area.
Men lose scalp and beard hair, yet
experience increased growth over
eyebrows and in ear and nostrils.

h- Nails: -
 Nails grow slower with age and become
thicker, more brittle and they also develop
ridges or longitudinal lines.
 Fingernails grow more slowly and become
thick and more brittle
 Toe nails may discolor and become so
thick that require special equipment for
trimming.

Common problems related to integumentary system changes:
 Slow healing
 Increase risk of damage
 Dryness of skin
 hypothermia
 Decreased tactile sensation
 heat intolerance
 Reduce pain perception
 Increased susceptibility of pressure points
 delay absorption of medication and chemicals placed on the skin.

Reproductive System: -
Aging changes in the female reproductive
 menstrual cycles often become irregular.
 The ovaries become less responsive to stimulation by
follicle-stimulating hormone (FSH) and luteinizing
hormone (LH). The level of these hormones will decrease.
 The ovaries continue to produce small amounts of
testosterone and some estrogen.
 The vaginal walls become less elastic, thinner, and less
rigid, shorter. Secretions become scant and watery.

b- Aging changes in the male reproductive system
 Testicular tissue mass decreases
 the level of the male sex hormone stay the same or decreases very
slightly.
 Decrease in libido
 Prostate gland enlargement
 Seminal fluid decreases in volume and viscous
Common problems
Risk of vaginal infection, ovarian cyst, Risk of Lower self-image.

11) Aging changes in the senses: -
When you age, senses (taste, smell, touch, vision, and hearing).
become less acute..
a) Hearing: -
Hearing loss is very common with aging. It contributes significantly
to social isolation.
b) External ear:-
 External ear can be appearing larger .
 Increased hair on the ear (especially in men).

c) Middle and internal Ear: -
 Membranes in the middle ear, including the
eardrum, become less flexible.
 Changes in the middle ear with advancing
age also contribute to a weakening sense of
balance.
 Older individuals may complain of
dizziness and find it difficult to move
quickly without losing their balance.

b) Vision: -
 Aging eyes produce fewer tears(artificial tears
 Cornea becomes less sensitive
 The pupil may also react more slowly in response to
darkness or bright light.
 The lens becomes yellowed, less flexible, and slightly
cloudy.
 The fat pads supporting the eye decrease and the eye
sinks back into the socket.
 Visual acuity may gradually decline.

c) Smell: -
 After the age of 50 the sense of smell decreases rapidly. By
age 80, the sense of smell is reduced by about half.
d) Taste: -
 Some atrophy of the tongue occurs with age.
 Receptor cells for taste are found in the taste buds on the
tongue and are replaced continuously.
 Other factors that contribute to changes in taste among
seniors include poorly fitting dentures.

 e) Touch: -
 touch and response to painful stimuli
decreases.
 Reduce tactile sensation.
 The warm-cold difference threshold
increases with age.

 Common problems related to changes in the senses:
 Increase dependency
 Dry eye
 Dryness of the ear
 Decreased light adaption
 Decreased visual acuity
 Decrease food intake and interest in food
 Accidents such as falls, burn, and poisoning
 Problem related to driving
 Lack of socialization

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