heavily sun-exposed areas, such as the hands, arms, and face, will show an increase in pigment called lentigo senilis. These areas are sometimes called liver spots, although they have no relationship to the liver, or age spots. They are harmless but may result in feelings of self-consciousness. Additionally, skin will droop and sag with age, which is due to the loss of elasticity, also known as elastosis (Aging Changes in the Skin, 2014).
The middle layer of the skin, known as the dermis, is the site of blood vessels and oil glands. In younger years, the blood vessels here are strong, but as one gets older, they weaken and may occasionally break, causing bleeding within; cherry angiomas are commonly what result (benign blood vessel skin growths). Sebaceous glands decrease oil production with time, making it more difficult for the skin to stay hydrated. This can cause problems, including dryness, itchiness, and peeling. This condition can be partially overcome by using tepid rather than hot water when bathing, using less soap or an oily soap, eliminating the use of powder, and applying an emollient lotion after the bath.
Below the dermis is the subcutaneous fat layer, containing fat and sweat glands. This layer thins just as the epidermis does, resulting in difficulty maintaining a reasonable body temperature (homeostasis). This may explain why older adults chill easily and are at an increased risk for hypothermia in cold weather. However, in the warmer months, older adults are at risk for heat-associated conditions due to decreased functioning of sweat glands. The thinning of this subcutaneous layer also limits the normal functioning of nerve receptors associated with touch, pain, and pressure (Aging Changes in the Skin, 2014).
Wrinkling is caused by the loss of subcutaneous fat and water in epidermal layers and exposure to the sun over many years. Highly pigmented skin is less prone to wrinkling and sun damage, which causes thinning of the epidermis. With the thinning of the epidermis, the skin is easily injured and healing is slow if the blood flow to the dermis is impaired. Because of the changes in the skin, prolonged bed rest can cause major problems such as pressure ulcers. Special beds, mattresses, and lotions should be used to help prevent skin breakdown.
Changes in the thickness, shape, color, and growth rate of the nails occur with age. Vascular supply to the nail bed decreases resulting in dull, brittle, hard, and thick nails, with a slowed growth rate. The fingernails may flake and become brittle or develop ridges. The toenails may become discolored or abnormally thickened. The nails of older adults may be thick and easily split. It is imperative that nails be soaked in warm water before being cut or shaped to prevent splintering and to avoid possible trauma leading to infection. The condition of an older person’s toenails may help to indicate whether the person is capable of living alone and caring for personal hygiene needs. Older persons may develop bunions, which are misaligned bone at the base of the big toe, and eventually the big toe may bend abnormally toward the small toes. They may develop calluses and corns, which are dead, yellowish, thickened skin on toes. Hammertoes may develop, which are toe joints that curl up or under, either rigidly or with some flexibility, often resulting in a permanently dislocated joint (Health in Aging, 2012). Finally, ingrown toenails may develop. These foot problems may impede mobility and may necessitate admission to a supervised living facility. Also these problems will make it difficult for these older adults to ambulate to take care of their activities of daily living and instrumental activities of daily living. An older adult client should be encouraged to seek professional care for their feet from a podiatrist at periodic intervals to prevent trauma, especially if the client has a severe visual deficit, vascular problems, and diabetes, or if the client’s body is no longer flexible enough to allow them to care for their feet. It is essential to address all changes in the integumentary system of older adults and also the gastrointestinal system, which undergoes changes as one ages.
Gastrointestinal System
Gastrointestinal issues can have a negative effect on the psychological well-being of older adults. Problems in this area can also adversely affect the ability of older adults to maintain good nutritional habits, which might lead to malnourishment that can precipitate a host of other problems (e.g., susceptibility to illnesses/diseases, hospitalizations, increased use of medications). Another example is problem with the absorption of calcium required for bone growth and maintenance can be disrupted, which may lead to osteoporosis that may precipitate falls, injuries, and subsequent hospitalizations. Mental health practitioners may serve the role of a coach to encourage older adults to maintain their health, maintain appointments with health providers, and recommended tests and encourage healthy behaviors. They can teach coping strategies for dealing with stress and the consequences associated with any abnormalities within the digestive system. Mental health practitioners must also assist in the coordination of care and provide appropriate referrals. They must also encourage older adults to separate their personal experience of the aging process from the disease or illness that they may be experiencing. Mental health practitioners may also need to address issues of social withdrawal, isolation, fear, and depression. These psychological issues will definitely decrease the overall functioning for older adults. The psychological well-being of older adults can be enhanced by the supportive and trusting relationship with the mental health practitioner.
The gastrointestinal (GI) system is the digestive system of the human body. The major functions of this system are the processing of food and the absorption of nutrients, minerals, vitamins, and water (AAHF, 2015). Aging has relatively little effect on GI functioning because of the large functional reserve capacity of most of the GI tract. The digestive system is made up of the mouth, teeth, tongue, salivary glands, pharynx, esophagus, stomach, pancreas, liver, gall bladder, and both the large and small intestines. Essentially normal digestion and absorption occur in the elderly; however, there are many changes in the digestive system that parallel age-related changes seen in the other systems. Like other systems, the rate of new cell growth declines and tissues become more susceptible to damage (AAHF, 2015).
The elderly face changes to their digestive systems. Though the digestive system suffers little from changes related directly to aging, psychological and social strains threaten the system’s functionality (Whitbourne, 2000). The digestive system is a series of tubes and glands that run all the way from the mouth to the rectum. It is responsible for extracting nutrients from food and then eliminating the remaining waste. Anxiety and stress are key components to problems linked to the digestive system. Stress inhibits saliva and gastric juice secretion, which makes swallowing foods and eliminating waste difficult. Saliva secretion is important for lubricating food, making it easier to move down the esophagus (p. 127).
One change associated with aging and the digestive system is known as presbyesophagus. This particular condition is characterized by a weakening of the esophagus muscles. It reduces food movement down the esophagus and leads to difficulty swallowing. Another challenge for older people is maintaining a healthy appetite. A condition known as anorexia of aging is when older adults fail to eat a sufficient amount to satisfy his or her nutritional needs. This can be made worse by poor teeth and taking multiple prescription medications that reduce appetite. Psychological changes, such as anxiety, also affect this system. Anxiety and stress can lead to a loss of sensory functioning such as taste and smell, further ruining a person’s appetite and causing disturbances to the digestive system (Whitbourne, 2000).
Aging causes a slight decrease in the amount of pancreatic enzymes, which further decreases digestion and the absorption of nutrients. Thus digestion is slowed but remains fairly adequate until an advanced age. Slowed peristalsis (involuntary contraction and relaxation of the muscles of the intestine or another canal), reduced abdominal muscular strength, inadequate exercise, and reduced food and fluid intake are responsible for a high prevalence of constipation. Some older adults may have problems related to relaxation of the anal sphincter because of cold environments or ulcers or hemorrhoids that lead to constipation (Talbot & Hogstel, 2001).
The digestive system remains a cause of concern among older adults. They fear that they may lose control of or not be able to have bowel movements. Constipation is problematic because they cannot eliminate waste, which could build up in the system to toxic levels and has been linked to cancer
