Session 2
Ageing Process and Common Aging
Changes
Contents
Introduction, p
2.1 Ageing Process, p
2.2 Common Changes in Ageing, p
Learning Outcomes, p
Reference, p
Introduction
This session is focused on introducing students to the aging process and the common
ageing changes people experience when they get older. Understanding about the
ageing process will help you to have a deeper understanding of older people and
realize that there are a number of changes that take place at different time points.
Further, understanding of common changes in ageing will give you an insight into
older people and their subjective needs that arise as a result of the ageing process.
Therefore, this session will help you as a nurse in general develop an empathetic
understanding towards older people to plan and provide tailored care for the older
population.
2.1 Aging
The ageing process is experienced by different individuals in different ways as a
result of their subjective contexts. However, the obvious fact is that the ageing
process occurs for everyone. Therefore, nobody can escape getting old. People in all
age categories experience ageing. For example, for those who are young, ageing is a
growing process of maturation. For adults, ageing is differently characterized in
people depending on their unique nature. For some people, ageing is manifested by
gray hair, appearance of wrinkles in the skin, poor vision, moving difficulties and
decline in fertility. Some other people show their ageing by hearing impairment, poor
memory, speech difficulty and body weakness. Given its diverse nature, having a
universally accepted definition for ageing is problematic. Yet, many scientists
around the world have tried to define the ageing process for their own scientific
operations. Rose in 1991, identified that ageing is a persistent decline in the age-
specific fitness components of an organism due to internal physiological
degeneration. Bronikowski and Flatt (2010) defined ageing as an age-dependent or
age-progressive decline in intrinsic physiological function leading to an increase in
age-specific mortality rates or a decrease in the survival rate and a decrease in age-
specific reproductive rates.
Both definitions identify that with age, people experience a decline and deterioration
in body function and become incapable of functioning in a regular way. Though
everybody experiences physical changes and health deteriorations during the ageing
process, there are many differences in terms of speed of happening and the ways
those changes happen from person to person.
However, it is recognized that ageing is a physiological process associated with
changes in appearance and functions. Functional changes happen at a cellular level.
Extracellular components are intensified by internal and external lifestyle factors
resulting in progressive changes to how the body functions.
Older people are generally known as those aged 65 years and older (Eliopoulos,
2014). However, as mentioned in recent literature, older people are further
categorized under three main areas:
▪ Young – old (age 60 – 74 years)
▪ Middle – old (age 75 to 84 years)
▪ Old – old (age 85 – 100 years)
▪ Centeanarians (age over 100 years)
This segmentation of the aging population is very important for health care
professionals because the health care needs, preferences and health challenges of
each of these age groups can be very different. These differences mean health care
professionals must design different health care plans to meet their diversified needs,
their unique preferences and prepare them for any future health and wellbeing
challenges. This diversity among different subsets of older people places health care
professionals, especially nurses, to learn more about older people and the aging
process. For example, a 64-year-old woman may desire to have cosmetic surgery to
remove wrinkles on her face while a man of the same age may want to maintain his
physical fitness to play outdoor games. Another example: a 75-year-old woman may
be more concerned about her limited mobility due to her arthritis and seek treatment
while an 86 year old man may worry about his poor vision which impedes him from
watching television.
In addition to the diverse needs of the old population in different age segments, it is
imperative for nurses who aim to specialize in Gerontology to know about the
different classifications of being older. Age can be classified in different ways as
mentioned below.
Chronological age
This is a person’s age in years or the number of years a person has lived since birth.
Chronologic age is based exclusively on the passage of time. With the increase in
the chronological age, people are more prone to health deteriorating leading them to
have functional limitations in older age. Therefore, the chronological age of people
is a potential predictor for health problems in older groups.
Functional age
Functional age is used to describe people’s physical, psychological and social
functioning. Most of the time, people’s functional age is more indicative for their
actual needs than their chronological age. Functional age refers to the bodily changes
that commonly occur when people are ageing. Functional age may be different
among people who are of the same chronological age. For example, a person who is
35 years old may seem to be in his 50s in functional age due to mobility issues when
compared to someone else of the same age. Changes in functional age may affect
some people earlier than others. These differences among people of the same
chronological age are highly influenced by factors such as life-style, genetics and
biological reasons.
Perceived age
Refers to how people assess an individual’s age based on the appearance and the way
that particular person acts.
Age identity
This is how people perceive or feel their own age. Some older people tend to think
that they themselves seem younger than their peers who are of a similar age. Some
studies have shown there is a significant correlation between perceived age and their
health status (Christensen et al. 2009).
2.2 Common Changes in Ageing
Living itself is a process of moving from birth to death. Therefore, as people age,
there are many changes taking place throughout the body. All these changes occur
from cellular level to impact the whole body. These changes are obviously seen if
we look across the human life-span. The infant becomes the toddler, the dependent
adolescent becomes a responsible adult and this changing process is continued right
through to later life where many other physiological and structural changes happen.
2.2.1 Cell Level Changes
When we consider the body at a cellular level, the lowest structural level of the body,
as we age, the number of cells in the body is gradually reduced. This reduction leads
to fewer functioning of cells in the body. The lean muscle mass is decreased and fat
cells increase by the 60s because of the reduction in the number of body cells (Woo,
Leung, & Kwok, 2007). While extracellular fluid remains fairly constant,
intracellular fluid is decreased, and as a result of body fluid change, the total body
fluid volume is decreased. This fluid change means older people are at risk of
becoming dehydrated.
2.2.2 Physical Appearance
▪ Most of the physical changes happen in old age leading to observable changes
in people’s body thus, changes in their appearance. Some of the many observable
changing effects of the aging process can be seen when people are in their 40s.
Due to the loss of body tissue elasticity, wrinkles begin to appear on the face,
double chin, and elongated ears can be seen in many older people. Further, hair
becomes gray, and there may be a decrease in height. Due to the reduction of
subcutaneous fat, skin-fold thickness is reduced leading to a decrease in the
body’s natural insulation making older people more vulnerable to be intolerant
of the cold environment. However, this characteristic is not common for every
older person because obesity is also an issue among some older people.
2.2.3 Respiratory System Changes
Nose, as the starting point of the respiratory tract, begins to show some changes in
shape. Reduced elasticity of the connective tissue in the nose causes the lower end
of the nasal septum to relax, and therefore, the nose tip to rotate downward. Nasal
septum deviation can also occur at the same time leading to mouth breathing during
sleep. Due to these septal changes, older people may be at a risk of having obstructive
apnea and snoring. Submucosal gland secretion is reduced and the reduced ability to
dilute nasal secretion may consequently make older people experience nasal
stuffiness.
In addition to these functional changes, there are some structural changes in the
respiratory tract that lead to reduced respiratory activity at old age. The calcification
of the costal cartilage causes the trachea and rib cage to be more rigid leading to
anterior-posterior chest diameter increase showing the effect in the form of kyphosis.
The respiratory muscles become weaker and there is a blunting of cough and
laryngeal reflexes. The number of cilia in the lungs reduces as well as a decline in
mucus gland activity in the bronchus. This may lead to difficulties in older people to
expel mucus and debris and also difficulty in breathing. This condition may further
lead to a chronic tickle in the throat and coughing. Expiratory function becomes less
efficient, increasing the residual volume thereby making maximum breathing
capacity to decline. These respiratory changes mostly happen after the age of 60
years of age, and therefore, older people are more prone to respiratory infections.
2.2.4 Cardiovascular System Changes
Age related changes in the cardiovascular system also occur. With age, thickness and
the rigidity of the heart valves increase due to fibrosis and sclerosis. Thickening of
the left ventricular wall and slight ventricular hypertrophy can be seen and the aorta
dilates as age increases. In old age, the myocardial muscle also becomes less efficient
as well as a decrease in contractility of the heart. These changes in the heart lead to
reduced cardiac output as demand increases. Relatively, more time is required for
the heart to complete a cardiac cycle: diastolic filling and systolic emptying. Heart
vessels become calcified and have reduced elasticity, and therefore, are less sensitive
to blood pressure regulation. All these changes are typical in old age and these
happen gradually. The changes become more obvious when older adults face some
crisis or stressful situations like engaging in higher level activities or have an
infection. As good health of the heart muscle depends on tissue perfusion, it is very
important to maintain arterial pressure within normal range.
2.2.5 Gastrointestinal Changes (GI Changes)
Aging process significantly affects changes in the GI tract. The tongue becomes
atrophied, and therefore, affects the taste buds resulting in decreased taste sensation.
Saliva secretion is reduced, and therefore, older people can have dry mouth called
xerostomia. A dry mouth may also be the result of other conditions such as smoking,
medications and other diseases. A decrease in saliva production may lead older
people to have difficulties in swallowing. Esophageal contractions and sphincter
activity are reduced due to degenerative changes in the smooth muscle lining of the
oesophagus and this condition can lead to decreased esophageal motility. This
decreased motility causes food to remain in the upper gastrointestinal system
resulting in a risk of aspiration and indigestion in old age. The stomach capacity is
also reduced due to decreased elasticity of the muscles lining the stomach. Therefore,
older people cannot accommodate large amounts of food at any one time. Stomach
secretions such as pepsin and Hydrochloric acid concentrations also decline.
Reduced pepsin concentration leads to poor absorption of protein and reduced
concentration of Hydrochloric acid causing reduced absorption of calcium, iron,
folic acid and vitamin B. Therefore, older people are more prone to having nutritional
deficiencies. Reduced peristalsis in the GI tract, reduced food and fluid intake, drugs
and low fibre diets may be leading causes for constipation among older people.
The structure of the gallbladder and the bile duct remain unchanged with age but
functional changes result in a reduction of bile salt synthesis. Decreased bile salts
cause gallstones to develop. Due to fibrosis and atrophy of the pancreas, pancreatic
secretions reduce and this affects fat digestion. Therefore, older people may be at
risk of fatty food indigestion and intolerance. However, liver function remains within
normal limits although it decreases in size with age.
2.2.6 Urinary Tract Changes
With age, many different changes can happen in the urinary tract for older people.
Increase in the frequency of urination is the most commonly observed problem in
this age group. Urinary frequency among old people is caused by thickening of the
bladder muscle and atrophy of the bladder. Both these changes contribute to a
decrease in bladder capacity to store urine. Urine retention in large amounts is caused
by poor neurologic control and weakness of the bladder muscle. With increasing age,
filtration efficiency of the kidney is decreased and this condition may affect the
elimination of drugs from the body. Therefore, it is the nurse’s responsibility to
observe for adverse drug reactions if older people are on drug treatments. In addition
to drug reactions, there may be other toxic conditions to be observed in old age. Due
to reduced renal function, other chemical substances like blood urea and nitrogen
levels can accumulate in the body leading to the clinical manifestation of lethargy,
confusion, headache and drowsiness. Increases to the renal threshold in old age is a
serious problem because older people can have hyperglycemia without showing
glycosuria making the identification of diabetes difficult. It is imperative to mention
at this point that urinary incontinence is not a normal consequence of being old. If
any older person is having urinary incontinence, it may be due to some physical or
mental disorder, and therefore, such people may need to have a thorough assessment
to identify the underlying reasons.
2.2.7 Reproductive System Changes
Changes in the reproductive system due to age brings about very unpleasant
experiences especially for women. Hormonal changes cause atrophy in vulva, loss
of pubic hair and a flattering of the labia can occur. A decrease in the amount of fat
in the pubic area and the previously mentioned changes increase the risk of
discomfort and dissatisfaction with sexual life. The vagina becomes drier and more
alkaline. The internal organs of the system, cervix, uterus, ovaries and fallopian tubes
become atrophied and the uterus decreases in size. The fallopian tubes become
shorter and straight. The breasts drop and are less firm with age and the mammary
glands are replaced with fat. Nipple retraction can sometimes be seen.
Males’ genitalia also undergoes changes. Seminiferous tubules become fibrosis and
the sperm count is reduced since the epithelium layer in the seminal vesicles become
thinner. Testes atrophy and while the power of ejaculation remains the same, the
number of living sperm decreases. Erections take more time to achieve and are lost
easily.
2.2.8 Musculoskeletal System Changes
With age, muscle fibres are reduced both in number and size. As a result, a reduction
in muscle mass in the body leads to reduced body and grip strength. The elasticity of
connective tissues leads to reduced flexibility of joints and muscles. As a whole,
muscle mass, muscle movements and muscle strength are reduced resulting in
structural changes like shortening in a person’s height, kyphosis, enlarged joints and
flabby muscles. Shortening of the individual’s height is not because of the shortening
of the long bones but because of thinning of discs, shortening of vertebrae, backward
tilting of the head, kyphosis and some flexion at the hip and knees. The number of
muscle fibres lost is replaced by fibrous tissue. Age related reduction in muscle mass
is known as sarcopenia. Sarcopenia is a result of increased muscle protein
degradation and reduction of protein synthesis, and can be mostly seen among
inactive people. Therefore, it is important to advise people to remain as active as
possible. Bone minerals and bone mass are also reduced with advanced age leading
to brittle bones in old age. This is especially evident in women after menopause who
experience bone loss more than men. Bone density is significantly decreased after
the age of 30 leading to a greater risk of bone fractures in old age. Joint activities
and mobility are also reduced in old age due to deterioration of cartilage surfaces
that may limit activity and movements in older populations.
2.2.9 Nervous System Changes
With the advancement of age, many changes take place in the nervous system and
these changes create many difficulties for older people. As occurs in other body
systems, the nervous system also deteriorates with age. Nerve cells decline in
numbers causing the atrophy of many organs in the nervous system. The brain and
spinal cord become atrophied, and therefore, the weight of the brain decreases. Nerve
cells become demyelinated. As a result of these structural changes of the brain and
nerves, nerve conduction becomes slow and response and reaction times become
slow and reflexes become weak. Blood supply to the brain is impaired in about 20%
of people due to fat accumulation in brain vessels. The ability of the brain to
compensate after injury decreases with age. Increased risk of stroke can be seen in
the aged especially in those with small vessel cerebrovascular diseases affected by
diabetes and hypertension. Therefore, nurses have to be cautious when caring for
older people with those diseases. No relationship can be seen between brain atrophy
and cognitive functions. Older people can maintain their intellectual performance
until at least 80 years of age but they may require more time to perform the tasks
because of delayed central processing in the brain. Many elderly people are capable
of maintaining their regular verbal skills up until the age of 70, and afterwards, there
is a tendency to reduce the vocabulary, changes in the rhythm and semantic errors
and also experience difficulties in learning languages thereby having a risk of
reducing the intellectual functions and forgetfulness among some elderly people.
However, some older people are capable of maintaining the same skills beyond the
age of 70s or even beyond the 80s or 90s. In addition to these changes, people may
experience some sensory deprivation in advanced age.
One of the most affected sensory functions in old age is vision. Around the age of
40 years, people begin to lose their vision due to reduced elasticity and stiffening of
the muscle fibres in the eye lenses. Visual ability is reduced due to decreased pupil
size, opacification in eye lenses and loss of photoreceptor cells in the retina. Light
and dark adaptation reduces in old age due to loss of eye lens adaptation caused by
poor elasticity of muscle fibres attached to the eye lens. Distortion of depth
perception occurs, thereby deciding the height of the walking surface is difficult.
Peripheral vision is reduced because of a smaller visual field. Eyes become dry due
to reduced tear production. Hearing ability also becomes weaker in old age. Ability
to hear some sounds like “s”, “sh”, “f”, “ph” and “w” is reduced and can lead to
communication difficulties.
The Understanding of sensory deprivation among older people helps nurses and also
other healthcare professionals to be aware that older people need a strong sense of
taste, sounds and lighting to increase their sensitivity levels. The other important fact
nurses and health care professionals must keep in mind is that all these changes do
not happen in the same way in all old people; rather, it depends on their unique nature
and lifestyle habits, genetic potential and other environmental inputs that affect their
health.
2.2.10 Endocrine System Changes
Thyroid, pituitary and the adrenal glands are the most affected endocrine glands in
old age. Thyroid gland atrophies and secretion activity is reduced resulting in a
reduced basal metabolic rate. The size of the pituitary gland is decreased as we get
older and this reduces the production of somatotropic growth hormone. Secretion
activity of the adrenal gland decreases due to reduced activity of the
adrenocorticotropic hormone resulting in reduced secretion of progesterone,
estrogen and androgen hormones. Insulin secretion is also reduced in old age due to
decreased activity of the beta cells in the pancreas. Due to the decline of many
hormones in the body, older adults are more prone to having metabolic disorders.
2.2.11 Integumentary System Changes
Many alarming signs of aging are related to the integumentary system known as the
skin. Gray hair, skin wrinkles and pigmentations remind people of their advancing
age, and these are all visible changes in a person’s external appearance. Therefore,
skin changes in old age cause people to bother and worry about their advancing age
and lead to adversely affecting older people’s body image. Many of these skin
changes occur due to degeneration of elastin fibres and reduced thickness and
vascularity of the dermis. The number of melanocytes in the skin reduces thus
reducing pigment cells leading to scalp, pubic and axillary hair becoming gray and
fragile. Most of the skin changes are influenced by diet, activity level, genetics and
health behaviours of people thus taking some control on skin changes by behavioural
modifications and treatment compliance.
2.2.12 Immune System Changes
Aging of the immune system is known as immunosenescence. In this process,
immune responses become depressed leading to more infections in old age. Activity
of T cells decline and many T cells are immature in the thymus gland. Cell mediated
immunity is declined. T cell changes cause reactivation of some viruses like varicella
zoster and mycobacterium tuberculosis giving more chances for infections among
many older people. Some changes of serum immunoglobulin can occur. IgM
concentration is lower and IgA and IgG become higher. Responses to influenza,
parainfluenza, pneumococcal and tetanus vaccines are less effective and may have
less desired outcomes including having a high risk for infections responsible for
those viruses. Therefore, one of the main responsibilities of nurses caring for older
people is concerning the older people’s high risk for infections and care should be
planned accordingly to prevent them from infections.
Activity
1. Discuss about the different dimensions of ageing
1. Explain how the age-related changes in the musculoskeletal system affect the
day-to-day life of older people
1. Discuss why it is important for nurses to know about the unique nature of the
ageing population
Learning Outcomes
At the end of this session, you should be able to;
▪ Describe the ageing process
▪ Critically analyze the different dimensions of ageing
▪ Examine the age-related changes that happen in human body systems
▪ Apply the knowledge of the age-related changes in planning nursing
interventions for older people
References
Ebersole & Hess (2014) Gerontological Nursing and Healthy Aging (4th
ed). USA
Eliopoulos, C. (2014). Gerontological Nursing (8th ed), Lippincott Williams and
Wilkins, Philadelphia, USA
