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CHAPTER
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P P P P Physiologic Adaptations With Aging
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Barbara S. Levine
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Agingg is a normall devellopmentall processs during which physio-
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Ag in is a n or ma de ve p en ta pr oc es du ri ng w hi ch p hy Al Although Americans are livinng longer, thhey aree not necesssarily
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logical and psychosocial changges occur. Wide variation in the ag- he heal hier. With increasing age, they are at increased riisk foorr illness.
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ing process exists among individuals as a result of varied envi- Chronic illnesses, such as arthritis, cardiaacc andd vascularr problems,
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ronmental exposures, sociiall rellation hiipss, genetic endowment, an andd diabetes, are the majorr health problems of older people (Fig.
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and health status. Whereas maximum lifespan (the age reached 9-2). Chronic illnessses do not occur in isolation; 80% off older
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by the longest-lived survivors) ffor hhumans is 114 to 120 years, Americans have one chronic illness and 50% have two or more.
the average human lifespan is approximately 75 years. Develop- Because of the lifestyle changes in young and middle-aged adults,
mental changes and adaptations continue throughout aging un- particularly in the areas of diet and exercise, in the near future,
til death. older adults may be sufficiently healthier that definitions and ex-
The lifespan is divided into phases, with the commonly used pectations of the aging process may need to be revised. At present,
periods for these phases being infancy (birth to 1 year), early child- however, heart disease and stroke are the first and third leading
hood (1 to 6 years), late childhood (7 to 10 years), adolescence (11 cause of death of older adults (Fig. 9-3).
to 18 years), young adulthood (19 to 35 years), early middle age When older people become ill, there is frequently an atypical
(36 to 49 years), late middle age (50 to 64 years), young–old (65 presentation, such as missing or altered symptoms. Confusion is
to 74 years), old (75 to 85 years), and old–old (86 years and older). often one of the earliest indications of a change in health status.
The group of people who are aged 85 years or older is the most Restlessness, confusion, or altered mentation often occur in the
rapidly growing segment of the older population (Fig. 9-1). People presence of illness and should not be confused with dementia,
in this age group typically have a noticeable decline in functional providing that dementia was not present before the illness.
ability and have one or more chronic disorders. Acute onset or unexplained deterioration of health should be
Aging is a multifactorial process with genetic and environ- carefully evaluated and not accepted as a normal concomitant of
mental components. Each system in an organism, each tissue aging.
in a system, and each cell type in a tissue appear to have its The older person who is ill has many adjustments and adapta-
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own trajectory of aging. Theories of the biologic aspects of ag- tions to make. The social supports (family and friends) available
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ing have been developed and studied. The theories can be di- to that person may be fewer or less able to be supportive because
vided into three groups: organ theories, physiological theories, of their own debilities, such as a spouse who is also ill or an adult
and genome-based theories. The organ theories examine age child who has other responsibilities. Apprehension, worry, and
changes in the body brought about by the possible initiation fear of becoming dependent and helpless may add to the emo-
from a “master” organ system, such as the immune or neuro- tional burden of the current illness. Of those older adults between
logical system. The physiologic theories analyze cell function- 80 and 84 years of age, 30% require assistance with daily activi-
ing as related to waste product accumulation or molecular ties, and of those adults who are 85 years and older, 50% require
changes. The genome-based theories attribute age changes to assistance.
the individual’s genetic endowment and suggest that a prede- Older patients require careful, thorough nursing management
termined series of events programmed into cells or random during an acute illness and afterward. Discharge planning that be-
mutations or cell errors are responsible for the process of aging. gins with the admission process and includes consideration of liv-
Probably no one theory can totally explain the aging process, ing arrangements, care providers, and support services is especially
but some or all of these theories may be involved in the com- important for older patients, who are often adversely affected by
plete explanation. the shorter hospitalizations and fewer home nursing care visits
The nurse needs to be aware of several concepts in addressing that accompany changes in managed care.
the health care needs of older adults.
1. Age-related changes are gradual and individual, and different
systems age at different rates within an individual. There is GENERAL PHYSIOLOGIC
more intra-individual variability among older people than there CHANGES
is among younger people.
2. Complex functions that require multisystem coordination Aging is an integral part of the continuum that begins at concep-
show the most obvious decline and require the greatest com- tion and ends at death. As contrasted with the developmental
pensation and support. growth and maturation of childhood and adolescence, aging is
3. Vulnerability to disease increases with age. characterized by a decline in function and by changes that are
4. Stressful situations (physiologic or psychosocial) produce a decremental in nature. The inability to maintain homeostasis in a
more pronounced reaction in the elderly and require a longer broad range of environments and with a variety of physiologic
period of time for readjustment. 3 challenges is central to the decline in function.
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