Chapter 5

Theories of Aging and Physical

Changes
Objectives
• Identify the physical changes that are associated with normal
aging
• Begin to differentiate normal age-related changes from those
that are potentially pathological
• Describe at least one age-related change for each body system
• Develop a plan of care for the older adult that targets
prevention and health promotion

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Changes with Aging
• Changes are:
• Intrinsic, which comes from within
• Extrinsic, which comes from environmental factors (e.g.,
exposure to smoke or pollutants)
• Triggers of aging are influenced by genetics or by injury
or abuse to the body.

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Biological Theories of Aging
• Theories indicate that:
• Cells in the body become disorganized or chaotic.
• Cells no long replicate.
• Cellular death occurs.

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Error (Stochastic) Theories
• Errors are accumulated in the synthesis of cellular DNA
and RNA.
• With the accumulation of replication errors, cells are no
longer able to function.
• Most common theories are:
• Wear and tear
• Cross link
• Oxidation stress (free-radical)

• https://www.youtube.com/watch?v=7CEqUWl7sBM
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Programmed Aging
(Nonstochastic) Theories
• Attributes aging to be predetermined or “programmed” at
the cellular level.
• As more cells cease to replicate, signs of aging occur.

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Neuroendocrine-Immunological
Theory
• Cells of the immune system become more diversified
with age.
• T-lymphocytes show more signs of aging than B-
lymphocytes.

• This will be a good review for you:

http://www.wisc-online.com/Objects/ViewObject.aspx?ID
=OTA2505

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Physical Changes of Aging: Skin
• Changes occur as a result of genetic (intrinsic) and environmental
(extrinsic) factors.
• Changes occur as a result of genetic (intrinsic) and environmental
(extrinsic) factors.
• Dryness, thinning, and a decrease in elasticity occur.
• As a result of a decrease in the epidermis, blood vessels and bruises
are more visible.
• Fewer melanocytes result in a lighter appearance of the skin.
• Age spots or liver spots (lentigines) appear on the backs of hands and
wrists and on the face.
• Seborrheic keratoses and thick, brown, and raised lesions appear.
• Thinning of the dermis causes a decrease in the stretching ability of
the skin.
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• Areas of the hypodermis atrophy, which causes the person to be more
sensitive to cold.
Physical Changes of Aging:
Hair and Nails
• Hair thins on the head.
• Hair increases in the ears, nose, and eyebrows.
• Pigmentation is lost (graying occurs).
• Older woman develop chin hair, and leg, axillary, and pubic
hair decrease.
• Nails are hard and thick.
• Vertical ridges appear.
• Nails are slower growing.

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Physical Changes of Aging:
Musculoskeletal
• Aging affects the ligaments, tendons, and joints, which
causes the older person to be more rigid and stiff in his
or her movements.
• Muscle mass decreases.
• Posture changes as a result of the intervertebral disks
that dehydrate.

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Physical Changes of Aging:
Cardiovascular
• Myocardial and blood vessels become stiff.
• The left ventricle wall thickens, and the size of the left atrium
slightly increases.
• Maximum coronary artery blood flow, stroke volume, and
cardiac output decrease.
• The heart takes longer to accelerate and then to return to
normal.
• Elasticity decreases, and blood vessels recoil.
• Veins become stretched, and the valves become less efficient.

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Physical Changes of Aging:
Respiratory
• Recoil is lost.
• The chest wall stiffens.
• Gas exchange is less efficient.
• Resistance to air flow increases.
• Effectiveness of cough response is reduced.

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Physical Changes of Aging: Renal
• Kidney blood flow decreases.
• Size and function of the kidneys decrease.
• Urine creatinine clearance decreases.

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Physical Changes of Aging:
Endocrine
• Glands atrophy, and the rate of secretion decrease.
• The rate of type II diabetes is high in older adults.
• The rate of hypothyroidism increases as a result of changes in
the structure and function of the thyroid in the older person.

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Physical Changes of Aging:
Reproductive
• Women are unable to procreate after the cessation of
ovulation.
• Female breasts appear smaller, are more pendulous,
and are less firm.
• Ovaries, uterus, and cervix atrophy.
• Estrogen levels decrease.
• Vaginal wall loses its ability to lubricate.
• Testes atrophy and soften.
• Ejaculation is slower and less forceful.
• Testosterone level reduces. 15
• Men may experience urinary retention.
Physical Changes of Aging:
Gastrointestinal
• Teeth lose enamel and dentin, making them vulnerable to
decay.
• Teeth lose enamel and dentin, making them vulnerable to
decay.
• Taste buds decline in number.
• Salivary secretion lessens; consequently, a dry mouth exists.
• Pleasure in eating decreases, and weight loss occurs.
• Esophagus and stomach sluggishly empty.
• Villi in the intestines are less functioning, which affects
absorption.
• Peristalsis slows.
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• Constipation is common.
Physical Changes of Aging:
Accessory Organs
• Liver function tests are unaltered.
• Incidence of gallstones increase.
• Serum cholesterol level increases.

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Physical Changes of Aging:
Neurological Cognition
• Brain size and weight decrease.
• Sleep disturbances occur.
• Mild memory disturbances are evident.
• Balance difficulties develop.
• Injuries increase as a result of a decrease in tactile
sensations in the fingers and palms.
• Reaction time is delayed.
• Risk for falls increases.

• https://www.youtube.com/watch?v=45qlm6cfHgg
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Physical Changes of Aging:
Eyes and Ears
• Senses of smell, sight, and touch decrease.
• Near vision decreases, and the lenses thicken.
• Eyelids lose elasticity and droops, and color perception
decreases.
• Lower eye lids turn out, and dry eye syndrome is common.
• Ear lobes sag, elongate, and wrinkle; hearing loss occurs; and
ear hair is more stiff and course.
• Ear wax is more thick and dry.

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Physical Changes of Aging: Immune
• Immunity is reduced at the cellular level.
• Oral temperature is lower.
• Decreased response to foreign antigens
• Immunoglobulins increase.

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Maslow’s Hierarchy and Physical
Changes
• Physical changes affect all levels of Maslow’s hierarchy
• Level 1 - Physiologic needs in every body system
affected by aging
• Upper level needs can be affected by inability to
adequately meet physiologic needs.

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Question
Stan arrives at your clinic. His daughter reports a decrease in
cognitive function. Which of the following could be causes for this
event?

A.Urinary tract infection

B.Eye infection
C.Change of residence
D.Muscle atrophy

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Chapter 6
Social, Psychological, Spiritual, and
Cognitive Aspects of Aging
Objectives
• Explain the major psychological and sociological theories of
aging
• Discuss the influence of culture and cohort on psychological
and social adaptation
• Discuss the importance of spirituality to healthy aging
• Explain cognitive changes with age and strategies to enhance
cognitive health
• Discuss factors influencing learning in late life, including health
literacy, and appropriate teaching and learning strategies

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Life Span Development Approach
• Development is lifelong.
• Each person’s development is defined by time and place.
• Development involves growth and decline.
• Development is limited and varies

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Types of Aging
• Chronological aging is defined by years.
• Biological aging is predicted by a person’s physical
condition.
• Psychological aging is expressed through ability, control
of memory, learning capacity, skills, emotions, and
judgment.

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Sociological Theories of Aging
• The following sociological theories explain and predict
changes in the roles and relationships of older adults
with an emphasis on adjustment:
• Disengagement theory
• Activity theory
• Continuity theory
• Age-stratification theory
• Social exchange theory
• Modernization theory

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Disengagement Theory
• Aging is inevitable.
• Aging results in a decrease in interaction between the
aging person and others or society.
• Withdrawal in natural and accepted.

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Activity Theory

• The ideal of life is to remain as active as possible.

• The ideal of life is to remain as active as possible.
• Activity is possible when living in a stable society.
• The older person has:
• Access to positive influences and significant others.
• Opportunities to participate in the broader society if he or she
chooses to.

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Continuity Theory
• Life satisfaction with engagement or disengagement
depends on personality traits.
• In normal aging, personality traits remain stable.
• Personality influences role activity and the individual’s
interest in a role.
• Personality influences life satisfaction.

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Age-Stratification Theory
• Believes in age categories of older adults as young,
middle-aged, and old.
• Historical content is the key to the age-stratification
theory.
• Social and cultural expressions of age are examined.

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Social Exchange Theory
• Is based on the consideration of the cost-benefit model
of social participation.
• Withdrawal or isolation is the result of an imbalance
between exchanges of an older person and a younger
person.
• Balance determines an older person’s satisfaction.

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Modernization Theory
• Value in older adults is lost when their skills are no longer
considered useful.
• Is due to technology, urbanization, and mass education.

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Symbolic Interaction Theories
• Focus on the interaction between the older adult and his
or her environment.
• When confronted with change, the older person tries to
master the new situation while extracting a positive self-
concept from the environment.

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Implications for Gerontological
Nursing and Healthy Aging
• Sociological theories
• provide the gerontological nurse with useful information and
a background for enhancing healthy aging and adaptation
• Have been adapted and applied to contemporary
approaches to aging in many ways

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Psychological Theories of Aging
• Psychological theories of aging presuppose that aging is
a developmental process experienced between birth and
death; they include:
• Jung’s theory of personality
• Developmental theories
• Theory of gerotranscendance

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Jung’s Theory of Personality
• Defines the last half of life as having a purpose of its own
allowing for inner growth, self-awareness, and reflection
• Personality is directed either toward the external world
(extrovert) or the internal world (introvert).
• Midlife presents questions of one’s own dreams, values,
and priorities.

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Developmental Theories
• Erikson’s hierarchy presents developmental stages and
tasks.
• Erikson’s last stage of life is to look back and reflect (ego
integrity or despair).
• Peck expanded on Erikson with identification of specific
tasks of old age to establish “ego integrity”.
• Havighurst also proposed specific tasks to be
accomplished in middle age and later maturity

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Theory of Gerotranscendance
• Human aging brings a shift from the material world to the
cosmic world with increased satisfaction.
• This shift is ongoing and associated with wisdom and
spiritual growth.

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Spirituality and Aging
• Spirituality is the quality of the person resulting from faith,
a search for meaning, connection to others, and
transcendence itself.
• Physical health, loss of a loved one, and understanding
that his or her life may be coming to an end causes a
reflection of life.

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Spirituality and Nursing
• Spirituality is the deepest resource for healing.
• Neuman, Parse, and Watson are nursing theorists who
addressed this concept.
• Evidence-based guidelines promote spiritual assessment
and interventions.

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Implications for Gerontological
Nursing and Healthy Aging
• Older adults want nurses to address spiritual needs, as well
as their physical needs.
• Religious needs are important and can enhance the healing
process.
• The framework of the spiritual assessment tool, FICA, is
Faith, Importance or Influence, Community, and Address).
• The Joint Commission requires spiritual assessments in
hospitals, nursing homes, and any care setting for older
adults.

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Nurturing the Spirit of the Nurse
• Nurses must consider
• What gives their own life meaning and value
• What assists them in offering spirtual support to patients
• Taking care of nurses’ own spiritual needs help them to
better meet the patient’s spiritual needs

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Cognition and Aging
• Cognition is the process of acquiring, storing, sharing,
and using information.
• Its components include language, thought process,
memory, execution of function, judgment, attention, and
perception.
• Cognition can remain stable or decline with aging.

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Scenario
John’s wife of 57 years died 4 years ago. John has several
children, but he still feels lonely since his wife’s death. He only
goes to the grocery store when needed and rarely goes out for
any occasion. He stays home reading and watches television in
the evenings.

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Question Regarding John
John’s daughters notice that he is having difficulty with
conversation, as well as moving throughout his condominium.
These difficulties could be the result of:

A.Loneliness
B.Lack of nutrition
C.“Don’t use it, you lose it” theory
D.Depression

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Fluid and Crystalized Intelligence
• Fluid intelligence or “native intelligence” consists of skills
that are biologically determined and independent of
experience or learning.
• Examples include:
• Flexibility in thinking
• Inductive reasoning
• Abstract thinking
• Integration with people to draw conclusions

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Crystalized Intelligence
• Crystalized intelligence is the knowledge and abilities a
person acquires through education and life and includes:
• Verbal reasoning
• Word association
• Social judgment
• Number skills

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Memory

• Is the ability to retain and store information and thus retrieve

the information when needed:
• Immediate memory
• Short-term memory
• Long-term memory
• Familiarity, previous learning, and life experiences can
compensate for memory loss.
• Age-associated memory impairment (AAMI) is memory loss
that is considered normal in light of person’s age and
educational level

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Implications for Gerontological
Nursing and Healthy Aging
• The following strategies maintain and enhance cognition and
a vitality for life:
• Managing chronic conditions
• Maintaining a healthy weight
• Avoiding excess caloric intake
• Limiting sodium and fats
• Increasing antioxidants
• Participating in physical activities
• Participating in stimulating activities
• Being social

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Learning Late in Life
• Must be relevant information.
• New learning must relate to what the older person
already knows.
• Literacy level and cultural variations play a role.
• Many older adults have computers and make up the
fastest growing age group who owns them.

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Health Literacy
• Is the ability to obtain, process, and understand basic
health information and services to make appropriate
decisions regarding health care.
• Requires more than the ability to read and write.
• Is the ability to interpret and understand prescriptions,
appointment slips, medical education brochures, provider
instructions, and consent forms, as well as interact with
health professionals.

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Implications for Gerontological
Nursing and Healthy Aging
• Nurses have gained knowledge about life and the aging
“norms.”
• Nurses ensure that the “inner self” of their client has
meaning and purpose as they care for the older adult.

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References
• Touhy, T.A., & Jett, K.F. (2014). Ebersole and Hess'
Gerontological Nursing & Healthy Aging (4th ed.). St.
Louis, Elsevier.
• Touhy & Jett Powerpoint
• www.youtube.com
• Healthy People 2020

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