The lungs have two primary functions: to acquire oxygen from the air, which is required for life,

and to
remove carbon dioxide from the body. Carbon dioxide is a byproduct of many of the chemical reactions that
sustain life.
During breathing, air enters and exits the lungs. It flows in through increasingly smaller airways, finally
filling tiny sacs called alveoli. Blood circulates around the alveoli through capillaries (tiny blood vessels).
Where the capillaries and alveoli meet, oxygen crosses into the bloodstream. At the same time, carbon
dioxide crosses from the bloodstream into the alveoli to be exhaled.
The lungs are continuously being exposed to particles in the air, including smoke, pollen, dust, and
microorganisms. Some of these inhaled substances can cause lung disease if enough is inhaled or if the
body is particularly sensitive to them.
AGING CHANGES
People normally make new alveoli until about age 20. After that, the lungs begin to lose some of their
tissue. The number of alveoli decreases, and there is a corresponding decrease in lung capillaries. The
lungs also become less elastic (able to expand and contract) due to various factors including the loss of a
tissue protein called elastin.
Changes in the bones and muscles increase the front-to-back size of the chest. Loss of bone mass in the
ribs and spine bones (vertabrae), and mineral deposits in the rib cartilage, change the curve of the spine.
There may be front-to-back curvature (kyphosis or lordosis) or side-to-side curvature (scoliosis).
The maximal force you can generate when breathing in (inspiration) or when breathing out (expiration)
decreases with age, as the diaphragm and muscles between the ribs (intercostals) become weaker. The
chest is less able to stretch to breathe, and the pattern of breathing may change slightly to compensate for
this decreased ability to expand the chest.
EFFECT OF CHANGES
Maximum lung function decreases with age. The amount of oxygen diffusing from the air sacs into the
blood decreases. The rate of air flow through the airways slowly declines after age 30. And the maximal
force you can generate on inspiration and expiration decreases. However, even elderly people should have
adequate lung function to carry out daily activities, because we have "extra" lung function in our youth. This
is why normal people can tolerate surgical removal of an entire lung and still breathe reasonably well.
An important change for many older people is that the airways close more readily. The airways tend
to collapse when an older person breathes shallowly or when they're in bed for a prolonged time. Breathing
shallowly because of pain, illness, or surgery causes an increased risk for pneumonia or other lung
problems. As a result, it is important for older people to be out of bed as much as possible, even when ill or
after surgery. When this is not possible, it is helpful to do "incentive spirometry." This involves blowing into
a small device to help keep the airways open and clear of mucus.
Normally, breathing is controlled by the brain. It receives information from various parts of the body telling it
how much oxygen and carbon dioxide are in the blood. Low oxygen levels or high carbon dioxide levels
trigger an increased rate and depth of breathing. It is normal for even healthy older people to have a
reduced response to both decreased oxygen and increased carbon dioxide levels.
The voice box (larynx) also changes with aging. This causes the pitch, loudness, and quality of the voice to
change. The voice may become quieter and slightly hoarse. The pitch may be decreased (becoming lower)
in women and increased (becoming higher) in men. The voice may sound "weaker," but most people
remain quite capable of effective communication.
COMMON PROBLEMS
Elderly people are at increased risk for lung infections. The body has many ways to protect against lung
infections. With aging, these defenses may weaken.
The cough reflex may not trigger as readily, and the cough may be less forceful. The hairlike projections
that line the airway (cilia) are less able to move mucus up and out of the airway. In addition, the nose and
breathing passages secrete less of a substance called IgA (an antibody that protects against viruses).
Thus, the elderly are more susceptible to pneumonia and other types of lung infections.
Common lung problems in the elderly include chronically low oxygen levels (which reduces tolerance to
illness), decreased ability to exercise, abnormal breathing patterns includingsleep apnea (episodes of
stopped breathing during sleep), increased risk of lung infections such as pneumonia or bronchitis, and
diseases caused by tobacco damage (such as emphysema or lung cancer).
PREVENTION
Avoiding smoking is the most important way to minimize the effect of aging on the lungs. Exercise and
good overall fitness improve breathing capacity. Exercise tolerance can be affected by changes in the
heart, blood vessels, muscles, and skeleton, as well as in the lungs. However, studies have shown that
exercise and training can improve the reserve capacity of the lungs, even in elderly people.
Second, more than any other group the elderly need to be aware of the need to be up and about and
should consciously try to increase deep breathing during illness or after surgery.
Continued use of the voice helps maintain overall vocal performance.








Alternative Names
Osteoporosis and aging; Muscle weakness associated with aging
Information
Changes in posture and gait (walking pattern) are as universally associated with aging as changes in the
skin and hair.
The skeleton provides support and structure to the body. Joints are the areas where bones come together.
They allow the skeleton to be flexible for movement. In a joint, bones do not directly contact each other.
Instead, they are cushioned by cartilage in the joint, synovial membranes around the joint, and fluid.
Muscles provide the force and strength to move the body. Coordination is directed by the brain but is
affected by changes in the muscles and joints. Changes in the muscles, joints, and bones affect the
posture and gait, and lead to weakness and slowed movement.
AGING CHANGES
Bone mass or density is lost as people age, especially in women after menopause. The bones lose calcium
and other minerals.
The spine is made up of bones called vertebrae. Between each bone is a gel-like cushion (intervertebral
disk). The trunk becomes shorter as the disks gradually lose fluid and become thinner.
In addition, vertebrae lose some of their mineral content, making each bone thinner. The spinal column
becomes curved and compressed (packed together). Bone spurs, caused by aging and overall use of the
spine, may also form on the vertebrae.
The foot arches become less pronounced, contributing to a slight loss of height.
The long bones of the arms and legs, although more brittle because of mineral loss, do not change length.
This makes the arms and legs look longer when compared with the shortened trunk.
The joints become stiffer and less flexible. Fluid in the joints may decrease, and the cartilage may begin to
rub together and erode. Minerals may deposit in and around some joints (calcification). This is common in
the shoulder.
Hip and knee joints may begin to lose joint cartilage (degenerative changes). The finger joints lose cartilage
and the bones thicken slightly. Finger joint changes are more common in women and may be hereditary.
Some joints, such as the ankle, typically change very little with aging.
Lean body mass decreases, caused in part by loss of muscle tissue (atrophy). The rate and extent of
muscle changes seem to be genetically determined. Muscle changes often begin in the 20s in men and the
40s in women.
Lipofuscin (an age-related pigment) and fat are deposited in muscle tissue. The muscle fibers shrink.
Muscle tissue is replaced more slowly, and lost muscle tissue may be replaced with a tough fibrous tissue.
This is most noticeable in the hands, which may appear thin and bony.
Changes in the muscle tissue, combined with normal aging changes in the nervous system, cause muscles
to have less tone and ability to contract. Muscles may become rigid with age and may lose tone, even with
regular exercise.
EFFECT OF CHANGES
Bones become more brittle and may break more easily. Overall height decreases, mainly because of
shortening of the trunk and spine.
Inflammation, pain, stiffness, and deformity may result from breakdown of the joint structures. Almost all
elderly people are affected by joint changes, ranging from minor stiffness to severe arthritis.
The posture may become more stooped (bent) and the knees and hips more flexed. The neck may become
tilted, and the shoulders may narrow while the pelvis becomes wider.
Movement slows and may become limited. The walking pattern (gait) becomes slower and shorter. Walking
may become unsteady, and there is less arm swinging. Older people become tired more easily, and have
less energy.
Strength and endurance change. Loss of muscle mass reduces strength. However, endurance may be
enhanced somewhat by changes in the muscle fibers. Aging athletes with healthy hearts and lungs may
find that performance improves in events that require endurance, and decreases in events that require
short bursts of high-speed performance.
COMMON PROBLEMS
Osteoporosis is a common problem, especially for older women. Bones break more easily, and
compression fractures of the vertebrae can cause pain and reduce mobility.
Muscle weakness contributes to fatigue, weakness, and reduced activity tolerance. Joint problems are
extremely common. This may be anything from mild stiffness to debilitating arthritis (see osteoarthritis).
The risk of injury increases because gait changes, instability, and loss of balance may lead to falls.
Some elderly people have reduced reflexes. This is most often caused by changes in the muscles and
tendons, rather than changes in the nerves. Decreased knee jerk or ankle jerk can occur. Some changes,
such as a positive Babinski's reflex, are not a normal part of aging.
Involuntary movements (muscle tremors and fine movements called fasciculations) are more common in
the elderly. Inactive or immobile elderly people may experience weakness or abnormal sensations
(paresthesias).
Muscle contractures may occur in people who are unable to move on their own or have their muscles
stretched through exercise.
PREVENTION
Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones. A
moderate exercise program can help you maintain strength and flexibility. Exercise helps the bones stay
strong.
Consult with your health care provider before beginning a new exercise program.
A well-balanced diet with adequate amounts of calcium is important. Women need to be especially careful
to get enough calcium and vitamin D as they age. Postmenopausal women, and men over age 65, need
1,200 - 1,500 mg of calcium and 400 - 800 international units of vitamin D per day. If you have
osteoporosis, talk to your doctor about prescription treatments.


Information
As people age, their brain and nervous system go through natural changes. The brain and spinal cord lose
nerve cells and weight. Nerve cells may begin to transmit messages more slowly than in the past. Waste
products can collect in the brain tissue as nerve cells break down, causing abnormal structures called
plaques and tangles to form. A fatty brown pigment (lipofuscin) can also build up in nerve tissue.
The breakdown of nerves can affect the senses. You might have reduced or lost reflexes or sensation,
leading to problems with movement and safety.
Some slight slowing of thought, memory, and thinking seems to be a normal part of aging. Although these
changes are natural, many people have misconceptions about the type and extent of these changes. A
common myth is that all elderly people become senile. Or, many people blame increased confusion on
"getting old" when it may really be caused by an illness.
These changes are not the same in everyone. Some people have many physical changes in their nerves
and brain tissue, others have few changes. Some people will have atrophy and plaques, some will have
plaques and tangles, and some will have other changes.
Furthermore, these changes are not always clearly related to the effects on your ability to think. For
example, plaques and tangles are associated with Alzheimer's disease, but some people with the most
severe symptoms have fewer plaques and tangles than those who have mild or moderate symptoms.
NERVOUS SYSTEM PROBLEMS IN THE ELDERLY
Dementia and severe memory loss are NOT normal processes of aging. They can be caused by
degenerative brain disorders such as Alzheimer's disease.
Delirium can complicate dementia, but is often due to illnesses that are not related to the brain, which can
also cause changes in thinking and behavior. For example, almost any infection can cause an older person
to become severely confused. Certain medications can also cause this.
Poorly controlled blood sugar (glucose) levels in people with diabetes is another common cause of
temporary difficulties with thinking and behavior. Rising and falling blood sugar levels can interfere with
thought.
Discuss any significant changes in memory, thought, or ability to perform a task with your health care
provider, especially if these symptoms occur suddenly or along with other symptoms. A change in thinking,
memory, or behavior is important if it is different from your normal patterns or it affects your lifestyle.
PREVENTION
There is some evidence that both physical and mental exercise can help maintain thinking abilities.
Reading, doing crossword puzzles, and engaging in stimulating conversations -- as well as ordinary
physical exercise -- may all help keep your brain as sharp as possible. Such strategies have not been
proven, however.


Definition
As a woman ages, a number of changes take place in the female reproductive system. For women, the
cessation of menses (menopause) is an obvious sign of aging. But, it is by no means the only change. A
transition period, called the climacteric, lasts for many years before and after a woman's last menstrual
period.
See also: Menopause
Information
For a woman, aging changes involve hormone levels, physical changes in the woman's entire reproductive
tract, and psychological changes. Changes occur in the intricate relationship between the ovarian
hormones and those produced by the pituitary gland (in the brain).
AGING CHANGES
Menopause is a normal part of a woman's aging process. The ovaries stop releasing eggs (ova), and
menstrual periods stop. Most women experience menopause around age 50, although it occurs before age
40 in about 8% of women. Prior to menopause, menstrual cycles often become irregular.
The ovaries become less responsive to stimulation by follicle-stimulating hormone (FSH) and luteinizing
hormone (LH). To try to compensate for the decreased response, the body produces more of these ovary-
stimulating hormones for a time. The level of these hormones will eventually decrease.
The hormones produced by the ovaries include the different forms of estrogen (including estradiol),
progesterone, and androgens (including testosterone). These hormones also decrease around
menopause. The ovaries continue to produce small amounts of testosterone and some estrogen. The
hormones produced by the pituitary gland are also decreased.
Because hormone levels fall, changes occur in the entire reproductive system. The vaginal walls become
less elastic, thinner, and less rigid. The vagina becomes shorter. Secretions become scant and watery. The
external genital tissue decreases and thins (atrophy of the labia).
In both men and women, reproductive system changes are closely related to changes in the urinary
system.
EFFECT OF CHANGES
Prior to menopause, fertility varies depending on hormone levels. Menopause is said to have occurred
when there has been one year without a menstrual period. With menopause, reproductive capacity is lost
(the woman can no longer become pregnant).
Symptoms that accompany menopause vary in severity. Many of the symptoms are triggered by the
hormone changes. Only about 20% to 30% of all women have symptoms that are severe enough that they
seek medical attention.
Changes occur in the woman's breast tissue at the same time as other reproductive changes. A woman
may experience changes in her sex drive (libido) and her sexual response may change, but aging does not
prevent a woman from being able to have or enjoy sexual relationships. Most often, things such as
availability of a partner, symptoms from vaginal dryness and thinning vaginal walls, and psychological and
social factors affect a woman's sexual response more than direct aging changes.
COMMON PROBLEMS
The pubic muscles lose tone, and the vagina, uterus, or urinary bladder can fall out of position. This is
called vaginal prolapse, bladder prolapse, or uterine prolapse, depending on which structure drops. A
prolapse of any of these structures increases the risk of problems such as stress incontinence (urine
leakage). Most prolapses can be treated.
Irritation of the external genitals can occur (pruritus vulvae). The vaginal walls become thinner and dryer
and may become irritated (atrophic vaginitis). Sexual intercourse may become uncomfortable for some
women (dyspareunia). There are changes in the levels of normal microorganisms in the vagina, and there
is an increased risk of vaginal yeast infections.
Similar changes to the bladder and urethra may increase symptoms such as frequency and urgency of
urination, and there is an increased risk of urinary tract infection after menopause.
Hot flashes, mood disturbances, headaches, and sleep disturbances are also common symptoms that
occur during menopause. The causes of these changes are not well understood, but they are also related
to the decreasing amount of estrogen produced by the ovaries.
Osteoporosis risk is greater in older women. This is caused, in part, by decreased estrogen levels.
PREVENTION and TREATMENT
Adequate lubrication (with a water-soluble lubricant) can help prevent painful sexual intercourse. A topical
estrogen (applied inside the vagina) is sometimes recommended to help maintain the structure of the
vaginal tissues. Sexual changes can also be related to factors other than simple aging.
Estrogen replacement (such as pills or patches) can prevent or reduce many of the symptoms associated
with menopause, including vaginal atrophy and hot flashes. It also decreases the risk of complications such
as osteoporosis.
However, hormone therapy (HT) may have side effects such as vaginal bleeding, and it has been
associated with an increased risk of breast cancer, stroke, and heart disease, depending on when it is
started and how long it is used. The risk and benefit of treatment is different for each person so women
should discuss the pros and cons of estrogen treatment with her own health care provider.


Definition
Aging changes in the male reproductive system may include changes in testicular tissue, sperm production,
and erectile function. These changes usually occur gradually.
Alternative Names
Andropause; Male reproductive changes
Information
Unlike women, men do not experience a major, rapid (over several months) change in fertility as they age
(like menopause). Instead, changes occur gradually during a process that some people call andropause.
Aging changes in the male reproductive system occur primarily in the testes. Testicular tissue mass
decreases and the level of the male sex hormone testosterone stays the same or decreases very slightly.
There may be problems with erectile function. However, this is a general slowing, rather than a complete
lack of function.
Fertility:
The tubes that carry sperm may become less elastic (a process called sclerosis). The testes continue to
produce sperm, but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate
gland lose some of their surface cells but continue to produce the fluid that helps carry sperm.
Urinary function:
The prostate gland enlarges with age as some of the prostate tissue is replaced with a scarlike tissue. This
condition, called benign prostatic hypertrophy (BPH), affects about 50% of men. This may cause problems
with slowed urination, as well as with ejaculation.
In both men and women, reproductive system changes are closely related to changes in the urinary
system.
EFFECT OF CHANGES
Fertility varies from man to man, and age is not a good predictor of male fertility. Prostate function is not
closely related to fertility, and a man can father children even if his prostate gland has been removed.
Some fairly old men can (and do) father children.
The volume of fluid ejaculated usually remains the same, but there are fewer living sperm in the fluid.
Decreases in the sex drive (libido) may occur in some men. Sexual responses may become slower and
less intense. This may be related to decreased testosterone level, but it may also result from psychological
or social changes related to aging (such as the lack of a willing partner), illness, chronic conditions, or
medications.
Aging by itself does not prevent a man from being able to enjoy sexual relationships.
COMMON PROBLEMS
Erectile dysfunction (ED) may be a concern for aging men. It is normal for erections to occur less frequently
than when a man was younger, and aging men often have less ability to experience repeated ejaculation.
However, ED is most often the result of a medical or psychological problem rather than simple aging, and
90% of ED is believed to be of medical rather than psychological origin.
Medications (especially those used to treat hypertension and certain other conditions) can cause some
men to be unable to develop or maintain enough of an erection for intercourse. Disorders such
as diabetes can also cause ED.
Erectile dysfunction that is caused by medications or illness is often successfully treated. Talk to your
primary health care provider or a urologist if you are concerned about this condition.
BPH may eventually interfere with urination. The enlarged prostate partially blocks the tube that drains the
urinary bladder (urethra). Changes in the prostate gland make elderly men more likely to have urinary tract
infections.
Backup of urine into the kidneys (vesicoureteral reflux) may develop if the bladder is not fully drained. If this
is not treated, it can eventually lead to kidney failure.
Prostate gland infections or inflammation ( prostatitis) may also occur.
Prostate cancer becomes more common as men age. It is one of the most frequent causes of cancer death
in men. Bladder cancer is also a common cancer in older men. Testicular cancers are possible, but these
occur more often in younger men.
PREVENTION
Many physical age-related changes, such as prostate enlargement or testicular atrophy, are not
preventable. Getting treatment for health disorders (such as high blood pressure and diabetes) that lead to
changes in urinary and sexual health may prevent later problems with urinary and sexual function.
Changes in sexual response are most often related to factors other than simple aging. Older men are more
likely to have good sex if they have continued to have sexual activity during middle age.