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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
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)
Weight
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
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TABLE 15-4
Physical Changes and Characteristics of Middle Age and Health Promotion Implications—continued
Body System or
Physical Parameter
Skin
Women
Hair
Women
Men
Change/Characteristic
Implications for Health Promotion
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 transplant.
Muscular System
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
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.
Skeletal System
Men and women
At age 70, osteoporosis risk equal in men and
women unless vitamin D has been taken to
increase bone density
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Body System or
Physical Parameter
Women
Change/Characteristic
Implications for Health Promotion
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.
Neurologic System
Vision
Hearing
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
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TABLE 15-4
Physical Changes and Characteristics of Middle Age and Health Promotion Implications—continued
Body System or
Physical Parameter
Voice
Women
Men
Change/Characteristic
Implications for Health Promotion
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.
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.
Women
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.
Men
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.
Respiratory System
Urinary System
the dose of estrogen and decreasing the duration of use may
decrease risks. For isolated vaginal symptoms, administering estrogen in a vaginal cream, tablet, or ring may decrease risks since the
estrogen remains localized and does not circulate throughout the
body (61, 110, 123).
HRT should not be used (123) (a) if there is a history of breast
cancer or blood clots, or (b) as a preventative measure of memory
loss, heart attacks, or strokes. Other medications or lifestyle modifications can prevent these conditions. For women with breast cancer, consider the use of medications such as clonidine, venflaxafine,
and megestrol, which are associated with significantly decreased hot
flashes. Vitamin E, black cohosh, isoflavones (soy), magnets, and
the antidepressant fluoxetine appear to have no statistical effect. Results for nonvasomotor symptoms are mixed (123).