Essentials of Clinical Geriatrics, 7e

Table 1–1. Pertinent Changes that Commonly Occur with Aging

System Common age changes Implications of changes

Atrophy of muscle fibers that line the endocardium Increased blood pressure
Atherosclerosis of vessels Increased emphasis on atrial contraction with an S4 heard
Increased systolic blood pressure Increased arrhythmias
Cardiovascular
Decreased compliance of the left ventricle Increased risk of hypotension with position change
Decreased number of pacemaker cells Valsalva maneuver may cause a drop in blood pressure
Decreased sensitivity of baroreceptors Decreased exercise tolerance

Increased risk for neurological problems: cerebrovascular accident

Decreased number of neurons and increase in size and number of Parkinsonism
neuroglial cells Slower conduction of fibers across the synapses
Neurological Decline in nerves and nerve fibers Modest decline in short-term memory
Atrophy of the brain and increase in cranial dead space Alterations in gait pattern: wide based, shorter stepped, and flexed
Thickened leptomeninges in spinal cord forward
Increased risk of hemorrhage before symptoms are apparent

Decreased lung tissue elasticity Decreased efficiency of ventilatory exchange

Thoracic wall calcification Increased susceptibility to infection and atelectasis
Respiratory Cilia atrophy Increased risk of aspiration
Decreased respiratory muscle strength Decreased ventilatory response to hypoxia and hypercapnia
Decreased partial pressure of arterial oxygen (Pao2) Increased sensitivity to narcotics

Loss of dermal and epidermal thickness

Flattening of papillae Thinning of skin and increased susceptibility to tearing
Atrophy of sweat glands Dryness and pruritus
Decreased vascularity Decreased sweating and ability to regulate body heat
Integumentary Collagen cross-linking Increased wrinkling and laxity of the skin
Elastin regression Loss of fatty pads protecting bone and resulting in pain
Loss of subcutaneous fat Increased need for protection from the sun
Decreased melanocytes Increased time for healing of wounds
Decline in fibroblast proliferation

Decreased liver size

Less efficient cholesterol stabilization and absorption
Fibrosis and atrophy of salivary glands Change in intake caused by decreased appetite
Decreased muscle tone in bowel Discomfort after eating related to slowed passage of food
Atrophy of and decrease in number of taste buds Decreased absorption of calcium and iron
Gastrointestinal
Slowing in esophageal emptying Alteration of drug effectiveness
Decreased hydrochloric acid secretion Increased risk of constipation, esophageal spasm, and diverticular
Decreased gastric acid secretion disease
Atrophy of the mucosal lining
Decreased absorption of calcium

Decreased GFR
Decreased sodium-conserving ability
Reduced renal mass Decreased creatinine clearance
Loss of glomeruli Increased BUN
Urinary Decline in number of functioning nephrons Decreased renal blood flow
Changes in small vessel walls Altered drug clearance
Decreased bladder muscle tone Decreased ability to dilute urine
Decreased bladder capacity and increased residual urine
Increased urgency
 Atrophy and fibrosis of cervical and uterine walls Vaginal dryness and burning and pain with intercourse
Decreased vaginal elasticity and lubrication Decreased seminal fluid volume and force of ejaculation
Decreased hormones and reduced oocytes Reduced elevation of the testes
Reproductive
Decreased seminiferous tubules Prostatic hypertrophy
Proliferation of stromal and glandular tissue Connective breast tissue is replaced by adipose tissue, making
Involution of mammary gland tissue breast examinations easier

Decreased muscle strength

Decreased muscle mass Decreased bone density
Decreased myosin adenosine triphosphatase activity Loss of height
Musculoskeletal
Deterioration and drying of joint cartilage Joint pain and stiffness
Decreased bone mass and osteoblastic activity Increased risk of fracture
Alterations in gait and posture

Decreased rod and cone function

Decreased visual acuity, visual fields, and light/dark adaptation
Pigment accumulation
Increased sensitivity to glare
Decreased speed of eye movements
Increased incidence of glaucoma
Sensory: Vision Increased intraocular pressure
Distorted depth perception with increased falls
Ciliary muscle atrophy
Less able to differentiate blues, greens, and violets
Increased lens size and yellowing of the lens
Increased eye dryness and irritation
Decreased tear secretion

Decreased hearing acuity and isolation (specifically, decreased

Loss of auditory neurons
ability to hear consonants)
Loss of hearing from high to low frequency
Sensory: Hearing Difficulty hearing, especially when there is background noise, or
Increased cerumen
when speech is rapid
Angiosclerosis of ear
Cerumen impaction may cause hearing loss

Decreased number of olfactory nerve fibers Inability to smell noxious odors

Altered ability to taste sweet and salty foods; bitter and sour tastes Decreased food intake
Sensory: Smell, taste, and touch
remain Safety risk with regard to recognizing dangers in the environment:
Decreased sensation hot water, fire alarms, or small objects that result in tripping

Decreased ability to tolerate stressors such as surgery

Decreased testosterone, GH, insulin, adrenal androgens, Decreased sweating and shivering and temperature regulation
aldosterone, and thyroid hormone Lower baseline temperature; infection may not cause an elevation
Decreased thermoregulation in temperature
Endocrine
Decreased febrile response Decreased insulin response, glucose tolerance
Increased nodularity and fibrosis of thyroid Decreased sensitivity of renal tubules to antidiuretic hormone
Decreased basal metabolic rate Weight gain
Increased incidence of thyroid disease

BUN, blood urea nitrogen; GFR, glomerular filtration rate; GH, growth hormone.
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