This document discusses the anatomical and physiological changes that occur with aging, detailing how various organ systems decline over time and the implications for health. It covers changes in homeostasis, skin, musculoskeletal, nervous, cardiovascular, respiratory, endocrine, gastrointestinal, renal, genito-urinary systems, and psychological aspects. Additionally, it addresses diseases associated with aging and emphasizes the role of optometrists in managing visual complaints from elderly patients.

1. GERIATRIC OPTOMETRY
Anatomical and physiologic changes in
ageing

2. Primary Author
Mark Swanson
University of Alabama
Peer Reviewer
Tracy Matchinski
Illinois College of Optometry
Editors
Brien Holden Vision Institute, Public Health Division
Brien Holden Vision Institute Foundation (formerly ICEE) is a Public Health division of Brien Holden Vision Institute
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3. CHAPTER CONTENTS
1. Introduction
2. Homeostasis changes
3. Skin changes
4. Musculoskeletal changes
5. Musculoskeletal disease
6. Nervous system changes
7. Cardiovascular changes
8. Cardiovascular disease
9. Stroke
10. Respiratory system changes
11. Respiratory system diseases

4. CHAPTER CONTENTS
12. Endocrine system changes
13. Endocrine disease
14. Gastrointestinal system changes
15. Gastrointestinal disease
16. Liver, gall bladder and pancreas changes
17. Renal function changes
18. Genito-urinary disease
19. Hemapoietic system
20. Anemia
21. Psychological changes
22. Psychological changes 2

5. INTRODUCTION
• Even in the absence of disease, the body
undergoes anatomical and physiologic
changes with age.
• The process varies and is influenced by
genetics, gender and environmental factors
(nutrition, exercise, access to healthcare,
cigarette smoking and alcohol).
• Beginning around age 30 the body organs
begin a progressive decline.
• Organ systems decline at different rates.

6. INTRODUCTION
• Significant levels of primary ageing are seen
around age 65.
• All vital organ function is decreasing linearly with
age. This is more apparent in some organs than
others.
• In addition to the degeneration of organ systems
and tissue, there is loss of functional reserve of
these systems.
• Loss of functional reserve impairs an individual’s
ability to cope with physiological challenges.

7. HOMEOSTASIS CHANGES
• Impaired baroreceptor reflex
• Increased basal norepinephrine
• Decreased receptor responsiveness
• Decrease in C-AMP response
• Decrease in thermoregulation
• Decrease in thirst response

8. SKIN CHANGES
• Skin more easily damaged
• Delayed wound healing
• Decreased protection form UV light due to
reduced melanocyte activity
• Decrease in skin thickness
• Solar lentigo
• Loss of elasticity
• Keratinosis

9. SKIN CHANGES
• Decrease in endocrine glands output.
• Decrease in sebaceous glands
• Decrease in moisture content and
absorption
• Nail changes (onychomychosis)
• Decreased sensitivity to pain and pressure
• Due to changes in the skin, there is an
increase in wounds and ulcers, infection
and swelling.

10. MUSCULOSKELETAL CHANGES
• Decrease in muscle weight to body weight
• Decrease in muscle fibers
• Enzyme systems (ATP/LDH) decrease
• Cartilage loss of protein, increase in water
• Bone loss, reduced bone mineral density
• Height declines an average of three inches
beginning at age 30. (Decline rate is 1/16
inch per year).
− The spine becomes more curved and the
vertebral discs become compacted.

11. MUSCULOSKELETAL CHANGES
• Shoulder width decreases leading to
reduced range of motion.
• Joint stiffness is characteristic for the elderly
due to loss of cartilage and fluid between the
joints. This results in joint inflexibility
• Grip strength decreases by 50% in men,
slightly less in women.
• Changes in gait, stature and ability to
ambulate

12. MUSCULOSKELETAL DISEASE
• Osteoarthritis
• Rheumatoid Arthritis
• Gout
• Osteoporosis

13. NERVOUS SYSTEM CHANGES
• Loss of brain weight
• Blood flow decline by 20%
• Scattered dendritic loss
• Lipofuscin deposition
• Neurotransmitter loss
• Basal ganglia atrophy

14. NERVOUS SYSTEM CHANGES
• Decreased dopamine and increased muscular
rigidity
• Nerve conduction velocity decreased
• Slowed reaction times
• Peripheral nervous system: decreased vibratory
sensation
• Special Senses
− Presbycusis: high frequency hearing loss
− Vestibular dysfunction
− Decrease smell
− Some loss of taste

15. NERVOUS SYSTEM DISEASE
• Increase risk of delirium
• Hearing loss
• Reduced position and vibration sense
• Increased risk of falls
• Cognitive impairment
− Alzheimer’s disease
− Multi-infarct dementia
− Parkinsonism

16. CARDIOVASCULAR CHANGES
• Increase in Peripheral Resistance
• Systolic BP Increase
• Left Ventricular Hypertrophy
• Stroke volume declines
• Maximum heart rate decline
• Decline in Ventricular Filling
• Greater Degree of Ventricular Arrhythmia
• Organ Specific Declines in Blood Flow
• Dilatation of aorta
• Reduced elasticity of conduit/capacitance vessels

17. CARDIOVASCULAR DISEASE
• Ischemic heart disease
− Myocardial infarction
− Angina
• Congestive Heart Failure
− Among the most common causes of hospitalization >65
• Peripheral Artery Disease
− Claudication
• Arrhythmias and conduction disorders
• Phlebitis
• Hypertension
• Hypotension
• African-Americans more than whites
− Heart Failure
− Renal Failure
− Stroke

18. STROKE
• Ischemic
− Thrombotic
− Embolic
• Hemorrhagic.
− Subarachnoid
− Intracerebral
• Patients who suffer a stroke may present to the
vision clinic with a variety of visual complaints. Visual
symptoms of TIA and stroke are very common and
include transient and permanent altitudinal or
hemianopic visual field loss, diplopia, and disorders
of gaze.

19. STROKE
• Optometrists play an integral role in
rehabilitation of stroke patients.
• Working with other members of the
rehabilitation team allow for comprehensive
and successful rehabilitation of the patient.
• Patients who experience visual field loss may
require training and rehabilitation of the field
loss to improve mobility, reading and
performance of activities of daily living (ADL)

20. RESPIRATORY SYSTEM CHANGES
• Cartilage calcifies
• Decreased alveolar surface area
• Loss of parenchymal elasticity
• Calcification of rib articulations
• Decrease in cilial response
• Decrease in vital capacity (the maximum
amount of oxygen brought into the lungs).
− Average decline is 50% between ages 25 and 70.
• Relative respiratory alkalosis

21. RESPIRATORY SYSTEM CHANGES
• Decrease in oxygen consumption
• Stable oxygen saturation
• Decreased ventilation and gas distribution.
• Loss of elastic recoil of the lungs.
• Decreased mucociliary transport.
• Weakened cough reflex and clearance
• Increased chest wall rigidity
• Reduced cough

22. RESPIRATORY SYSTEM DISEASES
• Chronic obstructive pulmonary disease
(COPD)
− Emphysema
− Chronic. Bronchitis
• Pneumonia
• Asthma
• Tuberculosis

23. ENDOCRINE SYSTEM CHANGES
• Plasma renin level decreases
• Fasting blood glucose increases with age
• T4 stays the same, TSH and T3 decline
• ACTH increases and DHEA declines
• Androgens, estrogens markedly decrease
• Deterioration in pancreatic β-cell function

24. ENDOCRINE DISEASE
• Metabolic syndrome
• Diabetes due to increased risk of impaired glucose
tolerance
− 25%
• Thyroid
− 9% of population
− 24% in older women
• Calcium metabolism disorders
• Menopause associated conditions
• Male Impotence
• Hyperlipidemia

25. GASTROINTESTINAL SYSTEM
CHANGES
• Less changes than in any other system
• Decrease in:
− GI absorptive cells
− GI motility
− Sphincter activity
− GI blood flow
− Gastric acid secretion
− Active transport
− Esophogeal peristasis

26. GASTROINTESTINAL SYSTEM
CHANGES
• 1/3 reduction in the volume of saliva
• 40% edentulous (all teeth lost)
• Decreased thirst perception
• Increase in gastric reflux
• Gastric atrophy
• 1/3 diverticuli

27. GASTROINTESTINAL DISEASE
• GERD (Gastroesophageal reflux disorder)
• Gastritis
• Ulcer
• Gallstones
• Diverticulosis
• Hiatal hernia
• Constipation or diarrhea
• Pernicious anemia due to decreased B-12
absorption

28. LIVER, GALL BLADDER AND
PANCREAS CHANGES
• Age related pancreatic and hepatic failure
do not occur
• Liver function tests remain stable
• Drug metabolism prolonged e.g.
benzodiazepines

29. RENAL FUNCTION CHANGES
• Glomeruli decrease in number
• Sclerosis in remaining glomeruli
• Renal tubules decrease
• Creatinine clearance decreases 1% per year
• Decreased GFR (glomerular filtration rate)
• Poor response to volume depletion
• Decreased renal mass and decreased
number of functioning glomeruli.
• Decreased renal blood flow

30. GENITO-URINARY DISEASE
• Incontinence
− Involuntary loss of urine
− Major cause of nursing home placement
− Sensation signalling the need to urinate is delayed.
• Urinary tract infection
• Chronic renal failure.
• Capacity of the bladder reduces with age.
− For some this can be a reduction of 50%+.
• Efficiency of emptying the bladder is reduced.
• Weakened tissue supporting the bladder up.
• Prostate gland hypertrophy in males

31. HEMAPOIETIC SYSTEM
• Blood counts stay stable
• Reserve for hemapoiesis decreases
• Anemia is pathology

32. ANEMIA
• Anemia of chronic disease
• Nutritional
• Folate.
• Iron deficiency
• B-12 deficiency
• Unexplained

33. PSYCHOLOGICAL CHANGES
• Primary(short term) memory declines
• Secondary (long term) memory intact
• Crystallized intelligence intact
• Working memory declines
• Personality often increases or magnifies
itself
− Positive person in youth will be a more positive
person with age
− Negative person in youth will be a more negative
person with age

34. PSYCHOLOGICAL CHANGES 2
• Attention declines
• Speed of processing declines
• Longitudinal versus cross-sectional
• Personality stays stable
• Changes in roles, relationships, health and
independence
• Physiological decline and psychological
decline can trigger each other
• Fear of loss