Nursing Care of the Older Adult latest updated 2023
Chapter 19, Section(s):
Age related changes in structure and function
Common cardiovascular problems
Chapter 20, Section(s):
Age related changes in structure and function
Factors affecting lung function
Chapter 21, Section(s):
Age related changes in structure and function
Chapter 22, Section(s):
Age related changes in structure and function
Prevalence of urinary incontinence
Chapter 23, Section(s):
Age related changes in structure and function
Chapter 24, Section(s):
Structural age-related changes of the neurologic system
Chapter 25, Section(s):
Endocrine physiology in older adults
Ch. 17: Integumentary Function
Age-related changes in skin structure and function:
● Loss of thickness, elasticity, vascularity, and strength that may delay the healing process and
increase the risk of skin tears and bruising
● Increased lentigines (brown-pigmented spots, or age spots)
● Loss of subcutaneous tissue causing wrinkling and sagging of the skin, which may affect
self-esteem, temperature control, and drug efficacy
● Loss of hair follicles along with thinning and graying
● Increased hair density in the nose and the ears, particularly in men, which may clog external
ear canals and impair hearing
● Thicker nails with longitudinal lines
● Decreased sebaceous and sweat gland activity, which affects thermoregulation and decreases
sweating
● Higher incidence of benign and malignant skin growths
➔ The primary function of the skin is to serve as a barrier against harmful bacteria and other threatening
agents, which makes the skin the first line of defense for the immune system. Other major functions of
the integumentary system include (1) preventing fluid loss or dehydration, (2) protecting the body from
ultraviolet (UV) rays and other external environmental hazards, and (3) protecting underlying organs
from injury. In addition, the skin provides thermal regulation of body temperature. Radiation,
conduction, convection, and evaporation are facilitated by sensory perceptions that occur in the skin’s
nerve endings. The skin also assists in the regulation of blood pressure through ―local regulation of
,Nursing Care of the Older Adult latest updated 2023
cutaneous blood flow and salt and water metabolism‖ (Johnson, Titze, & Weller, 2016, p. 1). The
integumentary system reveals emotions such as anger, fear, or embarrassment through vasodilatation,
which reddens the skin tissue. In the presence of the sun’s UV rays, the skin synthesizes vitamin D,
which is then used by other parts of the body. Subcutaneous fat, the deepest layer of the integumentary
system, provides insulation and acts as a caloric reservoir.
➔ The epidermis is the outermost layer of the skin. The replacement rate of the stratum corneum, the first
layer of epidermis, declines by 50% as a person ages. This decline results in slower healing, reduced
barrier protection, and delayed absorption of medications and chemicals placed on the skin. The area of
contact between the epidermis and dermis decreases with age, which results in easy separation of these
layers. Therefore skin tears occur from harmless activities such as removing a bandage or pulling an
older patient up in the bed.
➔ The dermis decreases in thickness by approximately 20% with aging. It consists of strong connective
tissue that contains the sweat glands, blood vessels, and nerve endings. These changes lead to
diminished thermoregulatory function and inflammatory responses, decreased tactile sensation, reduced
pain perception, and development of wrinkles and sagging skin because of loss of underlying tissue.
Collagen, a fibrous protein that provides tensile strength within the dermis, stiffens and becomes less
soluble.
➔ Aging results in a decreased amount of subcutaneous tissue and a redistribution of fat to the abdomen
and thighs. Breast tissue also changes and becomes more granular and atrophic. Because of a loss of
padding supplied by subcutaneous tissues, the risk for hypothermia, skin shear, and blunt trauma injury
is greater. The loss of this protective padding increases vulnerability of pressure points. Topical
medication and dermal medication patch absorption may increase because of the changes in the
subcutaneous tissue.
➔ With aging, fewer eccrine glands (sweat glands of the palms, feet, and forehead) and apocrine sweat
glands (sweat glands of the axilla, scalp, face, and genital areas) exist, resulting in decreased body odor
and reduced evaporative heat loss because of decreased sweating. The need for antiperspirants and
deodorants is reduced. However, older adults are at greater risk of heat stroke because of a
compromised cooling mechanism. Sebum oils the skin and provides an antimicrobial property. The
sebaceous glands and pores become larger with aging. Nevertheless, many older adults experience dry
skin, which places them at a greater risk of infection because of an impaired immune response.
, Nursing Care of the Older Adult latest updated 2023
➔ Hair thins, and its growth declines. A progressive loss of melanin occurs, resulting in graying of the hair.
Heredity influences the onset of the graying process. Changes in the patterns of hair growth and
distribution as a person ages are thought to be hormone related. Nails grow more slowly with age and
become thicker, brittle, and dull, developing longitudinal striation with ridges.
➔ Nearly 35% of older adults experience chronic skin fragility. This fragile skin is called dermatoporosis.
The identifying features of dermatoporosis include atopic changes, actinic purpura, and white
pseudoscars. The skin appears nearly translucent. It occurs on sun-exposed areas of the extremities.
Individuals with dermatoporosis frequently experience skin lacerations associated with increased
bleeding and delayed healing.
In a skin assessment of darkly pigmented skin, prioritize the assessment of:
● Skin temperature
● Edema
● Change in tissue consistency in relation to surrounding tissue
Cherry angiomas are common, bright red, 1- to 5-millimeter (mm) superficial vascular lesions that begin around
age 30 and increase in number with age. The cause of these lesions is unknown. They are red or deep purple
dome-shaped papules.
Seborrheic keratoses are benign lesions more commonly seen in the older adult. These are scaly growths that
have a ―stuck-on,‖ crumbly appearance that varies in color from tan to brown to black. The lesions may be
elevated and range in diameter from 2 to 3 mm. Characterized by slow growth, these lesions begin to appear
later in life. The borders may be round and smooth or irregular and notched. If the lesion is ―picked off,‖ it will
recur. Patients should be reassured that the growths are benign and are a commonly occurring skin
manifestation.
Skin tags are common stalk-like, benign tumors often found on the neck, axilla, eyelids, and groin, although they
may occur anywhere on the body. Beginning as early as age 20, these are tiny, flesh-colored or brown
excrescences that develop into a long, narrow stalk (up to 1 centimeter [cm]). As they mature, they can be easily
removed with scissors, electrocautery, or liquid nitrogen. Skin tags are usually excised only on the request of the
patient, usually for cosmetic reasons.
Seborrheic dermatitis is a common, chronic inflammation of the skin. The scalp, ear canals, eyebrows, eyelashes,
nasolabial folds, axilla, breasts, chest, and groin are common sites.The usual pattern of distribution begins with
