Physical Changes and Characteristics of Middle Age and ...

[Pages:4]TABLE 15-4

Physical Changes and Characteristics of Middle Age and Health Promotion Implications

Body System or Physical Parameter Change/Characteristic

Implications for Health Promotion

Endocrine and Reproductive Systems

Women Men

Decline in production of neurotransmitters that stimulate hypothalamus to signal pituitary to release sex hormones

Less estrogen synthesized No estrogen produced by ovaries; menses stops Aging oocytes (eggs) destroy necessary genetic

material for reproduction Uterine changes make implantation of blastocyte

unlikely Gradual atrophy of tissues:

Uterus and cervix become smaller Vulvar epithelium thins Labia majora and minora flatten Vaginal mucosal lining thinner, drier, pale (20%?

40% women; some never experience this) Natural lubrication during intercourse decreases Neuroendocrine symptoms, such as hot flashes

and night sweats followed by chilling, fatigue, nausea, dizziness, headache, palpitations, and paresthesias may occur. Testosterone production gradually decreases, which eventually causes: Degeneration of cells in tubules Production of fewer sperm More time needed to achieve erection Less forceful ejaculation Testes less firm and smaller

Reproductive cycle is ended; this may represent sexual liberation or loss of femininity.

Counsel about meaning of femininity. Support group may be helpful. Instruct in Kegel exercises. Hormone replacement therapy may be

prescribed. Artificial (water-soluble) lubrication can be used

during intercourse to reduce discomfort. Regular sexual intercourse maintains lubrication

and elasticity of tissue.

Avoid precipitating factors such as hot drinks, caffeine, alcohol, stress, and warm environment.

Counsel to stop smoking. Sperm production continues to death, so man is

capable of producing children. Premature ejaculation is less likely, which may

contribute to more enjoyable intercourse. Practice Kegel exercises for firmer erections.

Basal Metabolism Rate (BMR)

Minimum energy used in resting state

Weight

BMR declines 2% per decade Gradually reduces as ratio of lean body mass to

adipose tissue decreases (metabolic needs of fat are less than for lean tissue)

Gain should not occur; weight gain occurs if as many calories consumed as earlier: wider hips, thicker thighs, larger waist, more abdominal mass

If eating pattern is maintained, 3 to 4 pounds are gained per decade.

Fewer calories (2%) need to be consumed, even if the person exercises regularly, to avoid weight gain.

Overweight contributes to a number of health problems: crash diets should be avoided.

Integumentary System

Sebaceous oil glands Sweat glands

Produce less sebum secretions, skin drier and cracks more easily

More pronounced in women after menopause than in men of same age

Decrease in size, number, and function

Protect and lubricate skin with lotion or moisturizer.

Avoid excess soap and drying substances on skin. Avoid excessive strong sun and wind exposure. Ability to maintain even body temperature is

affected; dress in layers to maintain comfort.

continued

TABLE 15-4

Physical Changes and Characteristics of Middle Age and Health Promotion Implications--continued

Body System or Physical Parameter Change/Characteristic

Implications for Health Promotion

Skin Women Hair Women Men Muscular System

Skeletal System

Men and women

Skin wrinkles, tissue sags, and pouches under eyes form because: Epidermis flattens and thins with age, collagen in dermis becomes more fibrous, less gellike Elastin loses elasticity, causing loss of skin turgor Loss of muscle tone causes sagging jowls

Estrogen decrease gradually causes skin and mucous membranes to lose thickness and fluids; skin and mucous membranes thinner, drier, and begin atrophy

Estrogen decrease gradually causes breasts to sag and flatten

Progressive loss of melanin from hair bulb causes gray hair in most adults by age 50; hair thins and growth slows; hair rest and growth cycles change

Estrogen decrease may gradually cause increased growth of facial hair

Hair loss not as pronounced as in male Testosterone decrease causes gradual loss of hair Hereditary male-pattern baldness occurs with

receding hairline and monk's spot area on back of head

Wrinkles are less apparent with use of moisturizer or lotion.

Wrinkled appearance of skin is made worse by excess exposure to sun or sunburn; use sunscreen.

Skin is more prone to injury; healing is slower. Use humidifier in home. Avoid burns and bruises. Use lotions. Maintain support with correctly fitted brassiere. Maintain erect posture.

Slow hair loss by gentle brushing, avoiding excess heat from hair dryer, and avoiding chemical treatment.

Accept change. Manage cosmetically.

Accept change. Manage with styling, hairpiece, or hair trans-

plant.

Slight decrease in number of muscle fibers; about 10% loss in muscle size from ages 30 to 60

Gradual loss of lean body mass Muscle tissue gradually replaced by adipose

unless exercise is maintained Most loss of muscle occurs in back and legs Grip strength decreases with age Gradual increase in subcutaneous fat

Physical exercise and fitness, proper nutrition, and healthy lifestyle can improve or sustain muscle strength during middle age.

Variations in peak muscular activity depend on type of exercise.

Gradual flattening of intervertebral disks and loss of height of individual vertebrae cause compression of spinal column

At age 70, osteoporosis risk equal in men and women unless vitamin D has been taken to increase bone density

Maintain erect posture. Maintain adequate calcium intake (1,000?

1,200 mg daily). Exercise maintains bone mass and joint flexibility,

improves balance and agility, and reduces fatigue. Loss of height occurs in later life. Vitamin D decreases risk of fractures.

TABLE 15-4

Physical Changes and Characteristics of Middle Age and Health Promotion Implications--continued

Body System or Physical Parameter Change/Characteristic

Implications for Health Promotion

Women

Neurologic System Vision Hearing

Estrogen reduction increases decalcification of bones, bone resorption, decreased bone density, and gradual osteoporosis

Cultural differences: Caucasians and Asians more likely than Latinos and African Americans to suffer bone porosity because their bones are less dense and they lose mass more quickly

Maintain exercise and calcium intake. Maintain erect posture. Maintain calcium and good nutrition intake. Teach safety factors; forearms, hips, and spinal

vertebrae are most vulnerable to fractures. Supplemental vitamin D and regular small

amounts of exposure to sunlight improve calcium absorption. Avoid smoking, high alcohol intake, and high caffeine intake, all of which interfere with nutrition. Caffeine causes calcium loss. Women may eventually be 3 in. shorter if they have vertebral osteoporosis. Dowager's hump will form in cervical and upper thoracic area if osteoporosis occurs. Women who have taken oral contraceptives for 6 or more years have higher bone density in lumbar spine and femoral neck.

Speed of nerve conduction, nerve impulse traveling from brain to muscle fiber, decreases 5% by age 50, and only 10% through life cycle

Brain structural changes minimal; gradual loss of neurons does not affect cognition

Average 60-year-old requires twice the illumination of 20-year-old to do close work

Eyes begin to gradually change at about 40 or 50, causing presbyopia (farsightedness)

Lens less elastic, loses accommodation Cornea increases in curvature and thickness,

loses luster Iris responds less well to light changes; pupils

smaller Retina begins to lose rods and cones Optic nerve fibers begin to decrease Auditory nerve and bones of inner ear gradually

change Gradual decrease in ability to detect certain

tones and certain consonants Loss of hearing from high-pitched sounds

Sensation to heat and cold and speed of reflexes may be impaired.

Teach safety factors. Functional abilities are maintained, and learning

from life experiences enhances functional abilities. Wear brimmed hat and sunglasses that block UV rays to protect vision. Person eventually needs bifocals or trifocals to see small print or focus on near objects. Eyes do not adapt as quickly to darkness, bright lights, or glare (implications for safety and night driving). More light is needed to see well.

Reduce exposure to loud work machinery or equipment; wear ear protectors.

Reduce exposure to loud stereo, radio, or electronic music.

Cross-cultural studies show our high-tech culture contributes to increasing and earlier impairment.

Hearing aids, correctly chosen, or surgery may correct hearing impairment.

continued

TABLE 15-4

Physical Changes and Characteristics of Middle Age and Health Promotion Implications--continued

Body System or Physical Parameter Change/Characteristic

Implications for Health Promotion

Voice Women

Men

Estrogen decrease gradually causes lower pitch of voice

Testosterone decrease gradually causes higher pitch of voice

Cardiovascular System

Efficiency of heart may drop 80% between 30 and 50

Decreased elasticity in muscles in heart and blood vessels

Decreased cardiac output Cardiovascular disease risk for women equal to

that of men by age 70 because reduced estrogen causes lipid changes, increase in lowdensity lipoproteins (LDLs), decrease in highdensity lipoproteins (HDLs), and gradual increase in total serum cholesterol.

Regular aerobic exercise maintains heart function and normal blood pressure.

Inactivity affects system negatively. Quit smoking. Maintain healthy diet. Take regular low doses of aspirin. Maintain low-cholesterol diet.

Respiratory System

Gradual loss of lung elasticity Thorax shortens Chest cage stiffer Breathing capacity reduced to 75% Chest wall muscles gradually lose strength,

reducing respiratory efficiency

Regular exercise enhances respiratory efficiency. Inactivity affects system negatively.

Urinary System

Women Men

Glomerular filtration rate gradually decreases Loss of bladder muscle tone and atrophy of

supporting ligaments and tissue in late middle age causes urgent urination, possibly cystocele, rectocele, and uterine prolapse.

Hypertrophy of prostate begins in late middle age; enlarging prostate around urethra causes frequent urination, dribbling, and nocturia

Maintain adequate fluid intake; drink 8 glasses of water daily.

Instruct in Kegel exercises as follows: Draw in perivaginal muscles (pubococcygeus muscle) and anal sphincter as if to control urination, without contracting abdominal, buttock, or inner thigh muscles. Maintain contraction for 10 seconds. Follow with 10 seconds of relaxation. Perform exercises 30?80 times daily.

Urinary stasis may predispose to infections. Drink adequate amount of water. Surgery may be necessary.

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