Age-Related Changes in Health

Age-associated changes are most pronounced at the advanced age of 85 years or older, may alter the older person’s response to illness, show great variability among individuals, are often impacted by genetic and long-term lifestyle factors, and commonly involve a decline in functional reserve with reduced response to stressors.

 

STATEMENT OF PROBLEM

Gerontological changes are important in nursing assessment and care because they can adversely affect health and functionality and require therapeutic strategies; must be differentiated from pathological processes to allow the development of appropriate interventions; predispose to disease, thus emphasizing the need for risk evaluation of the older adult; and can interact reciprocally with illness, resulting in altered disease presentation, response to treatment, and outcomes.

AGE-ASSOCIATED CARDIOVASCULAR CHANGES

A. Definition

  1. Isolated systolic hypertension: systolic BP 140 mmHg and diastolic BP 90 mmHg

B. Etiology

  1. Arterial wall thickening and stiffening, decreased compliance
  2. Left ventricular and atrial hypertrophy; sclerosis of atrial and mitral valves
  3. Strong arterial pulses, diminished peripheral pulses, cool extremities

C. Implications

  1. Decreased cardiac reserve
    • At rest: no change in heart rate, cardiac output
    • Under physiological stress and exercise: decreased maximal heart rate and cardiac output, resulting in fatigue, shortness of breath, slow recovery from tachycardia
    • Risk of isolated systolic hypertension; inflamed varicosities
    • Risk of arrhythmia, postural, and diuretic-induced hypotension; may cause syncope

D. Parameters of cardiovascular assessment

  1. perform cardiac assessment: EKG; heart rate, rhythm, murmurs, and heart sounds; and palpate carotid artery and peripheral pulses for symmetry.
  2. Assess BP (lying, sitting, and standing) and pulse pressure (Bettelli, 2018).

AGE-ASSOCIATED CHANGES IN THE PULMONARY SYSTEM

A. Etiology

  1. Decreased respiratory muscle strength; stiffer chest wall with reduced compliance
  2. Diminished ciliary and macrophage activity, drier mucous membranes; decreased cough reflex
  3. Decreased response to hypoxia and hypercapnia

B. Implications

  1. Reduced pulmonary functional reserve
    • At rest: no change
    • With exertion: dyspnea, decreased exercise tolerance
  2. Decreased respiratory excursion and chest/lung expansion with less effective exhalation; respiratory rate of 12 to 24 breaths per minute
  3. Decreased cough and mucus/foreign matter clearance
  4. Increased risk of infection and bronchospasm with airway obstruction

C. Parameters of pulmonary assessment

  1. Assess respiration rate, rhythm, regularity, volume, depth, and exercise capacity. Auscultate breath sounds throughout lung fields.
  2. Inspect thorax appearance and symmetry of chest expansion. Obtain smoking history.
  3. Monitor secretions, breathing rate during sedation, positioning, arterial blood gases, and pulse oximetry.

D. Nursing care strategies

  1. Maintain patent airways through upright positioning/repositioning.
  2. Provide oxygen as needed (Tran et al., 2018); maintain hydration and mobility.
  3. Assess incentive spirometry as indicated, particularly if immobile or declining in function (Cao et al., 2017).
  4. Educate patients on cough enhancement (Cao et al., 2017) and smoking cessation.

AGE-ASSOCIATED CHANGES IN THE RENAL AND GENITOURINARY SYSTEMS

A. Definitions

  1. To determine renal function (GFR):
    • CKD-EPI: Calculate creatinine clearance in older adults (Levey & Stevens, 2010).
    • MDRD: See National Kidney Disease Education Program calculator (National Kidney Disease Education Program, 2012).

B. Etiology

  1. Decreases in kidney mass, blood flow, GFR (10% decrement/decade after age 30 years); decreased drug clearance
  2. Reduced bladder elasticity, muscle tone, capacity
  3. Increased postvoid residual, nocturnal urine production
  4. Prostate enlargement with risk of BPH

C. Implications

  1. Reduced renal functional reserve; risk of renal complications in illness
  2. Risk of nephrotoxic injury and adverse reactions from drugs
  3. Risk of volume overload (in heart failure), dehydration, hyponatremia (with thiazide diuretics), hypernatremia (associated with fever), and hyperkalemia (with potassium-sparing diuretics); reduced excretion of acid load
  4. Increased risk of urinary urgency, incontinence (not a normal finding), UTI, nocturnal polyuria; potential for falls

D. Parameters of renal and genitourinary assessment

  1. Assess renal function (GFR through creatinine clearance; Levey & Stevens, 2010; Lederer & Nyak, 2017; National Kidney Disease Education Program, 2012; Péquignot et al., 2009).
  2. Assess choice/need/dose of nephrotoxic agents and renally cleared drugs (Cutler & Clark, 2018).
  3. Assess for fluid/electrolyte and acid/base imbalance.
  4. Evaluate nocturnal polyuria, urinary incontinence, and BPH (Lederer & Nayak, 2017). Assess UTI symptoms (see “Atypical Presentation of Disease” section; Rowe & Juthani-Mehta, 2017).
  5. Assess fall risk if nocturnal or urgent voiding.

E. Nursing care strategies

  1. Monitor nephrotoxic and renally cleared drug levels (Cutler & Clark, 2018).
  2. Maintain fluid/electrolyte balance (Bettelli, 2018). Minimum ingestion of 1,500 to 2,500 mL/d from fluids and foods for 50- to 80-kg adults to prevent dehydration.
  3. For nocturnal polyuria, limit fluids in evening, avoid caffeine, and use prompted-voiding schedule (Lederer & Nayak, 2017).
  4. Institute fall prevention strategies for nocturnal or urgent voiding (see Chapter 11, “Assessing Physical Function and Promoting Safe Mobility in the Older Adult”).

AGE-ASSOCIATED CHANGES IN THE OROPHARYNGEAL AND GASTROINTESTINAL SYSTEMS

A. Definition

  1. BMI: underweight, less than 18.5 kg/m2; healthy, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; obesity, 30 kg/m2 or greater

B. Etiology

  1. Decreases in strength of muscles of mastication, taste, and thirst perception
  2. Decreased gastric motility with delayed emptying
  3. Atrophy of protective mucosa
  4. Malabsorption of carbohydrates, vitamins B12 and D, folic acid, calcium
  5. Impaired sensation to defecate
  6. Reduced hepatic reserve; decreased metabolism of drugs

C. Implications

  1. Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition
  2. Gastric changes, including altered drug absorption, increased risk of GERD, maldigestion, NSAID-induced ulcers
  3. Constipation not a normal finding; risk of fecal incontinence with disease (not in healthy aging)
  4. Stable liver function tests; risk of adverse drug reactions

D. Parameters of oropharyngeal and gastrointestinal assessment

  1. Assess abdomen and bowel sounds.
  2. Assess oral cavity, chewing and swallowing capacity, and dysphagia (coughing, choking with food/fluid intake; Landi et al., 2017). If aspiration occurs, assess the lungs (rales) for infection and typical/atypical symptoms (High, 2017); see “Atypical Presentation of Disease” section.
  3. Monitor weight, calculate BMI, and compare with the standards. Determine dietary intake and compare with nutritional guidelines (USDA & USDHHS, 2015; see Chapter 11, “Assessing Physical Function and Promoting Safe Mobility in the Older Adult”).
  4. Assess for GERD, constipation and fecal incontinence, and fecal impaction by digital examination of the rectum or palpation of the abdomen.

E. Nursing care strategies

  1. Monitor drug levels and liver function tests if on medications metabolized by liver. Assess nutritional indicators (USDA & USDHHS, 2015).
  2. Educate patients on lifestyle modifications and OTC medications for GERD.
  3. Educate patients on normal bowel frequency, diet, exercise, and recommended laxatives. Encourage mobility and provide laxatives if on constipating medications.
  4. Encourage participation in community-based nutrition programs. Educate on healthful diets (USDA & USDHHS, 2015).

AGE-ASSOCIATED CHANGES IN THE MUSCULOSKELETAL SYSTEM

A. Definition

  1. Sarcopenia: reduced muscle mass, physical performance, and grip strength associated with aging

B. Etiology

  1. Increased weakness and poor exercise tolerance evoked in sarcopenia
  2. Lean body mass replaced by fat with redistribution of fat
  3. Bone loss in women and men after peak mass at 30 to 35 years of age
  4. Decreased ligament and tendon strength; intervertebral disc degeneration; articular cartilage erosion; changes in stature with kyphosis, height reduction

C. Implications

  1. in sarcopenia, increased risk of disability, falls, unstable gait (Ko et al., 2018)
  2. Risk of osteopenia and osteoporosis
  3. Limited ROM, joint instability, risk of osteoarthritis

D. Nursing care strategies

  1. Encourage physical activity through health education and goal setting (Fuggle et al., 2017) to maintain function.
  2. Administer pain medication to enhance functionality. Implement strategies to prevent falls (see Chapter 11, “Assessing Physical Function and Promoting Safe Mobility in the Older Adult”).
  3. Prevent osteoporosis by adequate daily intake of calcium and vitamin D, physical exercise, and smoking cessation (Bijelic et al., 2017). Advise routine bone mineral density screening (U.S. Preventive Services Task Force et al., 2018).

AGE-ASSOCIATED CHANGES IN THE NERVOUS SYSTEM AND COGNITION

A. Etiology

  1. Decrease in neurons and neurotransmitters
  2. Modifications in cerebral dendrites, glial support cells, synapses
  3. Compromised thermoregulation

B. Implications

  1. Impairments in general muscle strength, deep tendon reflexes, nerve conduction velocity; slowed motor skills and potential deficits in balance and coordination
  2. Decreased temperature sensitivity; blunted or absent fever response
  3. Slowed speed of cognitive processing; some cognitive decline common but not universal; most memory functions adequate for normal life
  4. Increased risk of sleep disorders, delirium, neurodegenerative diseases

C. Parameters of nervous system and cognition assessments

  1. Assess, with periodic reassessment, baseline functional status (Cholerton et al., 2017); see Chapter 10, “Assessing Cognitive Function in the Older Adult,” and Chapter 11, “Assessing Physical Function and Promoting Safe Mobility in the Older Adult.” During acute illness, monitor functional status and delirium (see Chapter 21, “Delirium”).
  2. Evaluate, with periodic reassessment, baseline cognition and sleep disorders.
  3. Assess impact of age-related changes on the level of safety and attentiveness in daily tasks (Klaming et al., 2017).
  4. Assess temperature during illness or surgery (Kuchel, 2017).

D. Nursing care strategies

  1. Institute fall prevention strategies.
  2. To maintain cognitive function, encourage lifestyle practices of regular physical exercise, intellectual stimulation (Puglielli & Mattson, 2017), and healthful diet (Schwingshackl et al., 2018).
  3. Recommend behavioral interventions for sleep disorders.

AGE-ASSOCIATED CHANGES IN THE IMMUNE SYSTEM

A. Etiology

  1. Immune response dysfunction, reduced efficacy of vaccinations, and chronic inflammatory state (High, 2017).

B. Nursing care strategies

  1. Follow CDC immunization recommendations for the older adult for pneumococcal infections, seasonal influenza, zoster, tetanus, and hepatitis (CDC, 2023; High 2017).

ATYPICAL PRESENTATION OF DISEASE

A. Etiology

  1. Diseases, especially infections, may manifest with atypical symptoms in older adults.
  2. Symptoms/signs are often subtle and include nonspecific declines in function or mental status, decreased appetite, incontinence, falls, fatigue, and exacerbation of chronic illness (High, 2017).
  3. Fever is blunted or absent in very old (High, 2017), frail, or malnourished (Tieland et al., 2017) adults. Baseline oral temperature in older adults is 97.4°F (36.3°C) versus 98.6°F (37°C) in younger adults.

B. Parameters of disease assessment

  1. Note any change from baseline in function, mental status, behavior, appetite, or chronic illness (High, 2017).
  2. Assess fever. Determine baseline and monitor for changes of 2°F to 2.4°F (1.1°C–1.3°C) above baseline. Oral temperatures 99°F (37.2°C) or greater also indicate fever (High, 2017).
  3. Note typical and atypical symptoms of pneumococcal pneumonia, tuberculosis (Kuchel, 2017), influenza (Talbot, 2017), acute myocardial infarction (Gray-Vickrey, 2010), UTI (Rowe & Juthani-Mehta, 2017), and peritonitis (Dumic et al., 2019), and GERD (Hall, 2017).

EVALUATION/EXPECTED OUTCOMES (FOR ALL SYSTEMS)

A. The older adult will experience successful aging through appropriate lifestyle practices and healthcare.

B. Healthcare provider will:

  1. Identify normative changes in aging and differentiate these from pathological processes
  2. Develop interventions to correct for adverse effects associated with aging

C. Institution will:

  1. Develop programs to promote successful aging

D. Provide staff education on age-related changes in health.

FOLLOW-UP MONITORING OF CONDITION

A. Continue to reassess the effectiveness of interventions.

B. Incorporate continuous quality improvement criteria into existing programs.

ABBREVIATIONS

BMI               body mass index

BP                 blood pressure

BPH              benign prostatic hyperplasia

CDC              Centers for Disease Control and Prevention

CKD-EPI       Chronic Kidney Disease Epidemiology Collaboration

GERD            gastroesophageal reflux disease

GFR               glomerular filtration rate

MDRD           modification of diet in renal disease

NCCDPHP    national Center for Chronic Disease Prevention and Health Promotion

NSAID           nonsteroidal anti-inflammatory drug

OTC               over-the-counter

ROM              range of motion

USDA             U.S. Department of Agriculture

USDHHS        U.S. Department of Health and Human Services

UTI                  urinary tract infection

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Updated: January 2025
 

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents


Chapter 8, Renz, S. (2025) Age-Related Changes in Health.

 

REFERENCES

Bettelli, G. (2018). Preoperative evaluation of the elderly surgical patient and anesthesia challenges of the XXI century. Aging Clinical and Experimental Research, 30, 229–235. https://doi.org/10.1007/s40520-018-0896-y. Evidence Level V.

Bijelic, R., Milicevic, S., & Balaban, J. (2017). Risk factors for osteoporosis in postmenopausal women. Medical Archives, 71(1), 25–28. https://doi.org/10.5455/medarh.2017.71.25-28. Evidence Level IV.

Brandsma, C. A., de Vries, M., Costa, R., Woldhuis, R. R., Konigshoff, M., & Timens, W. (2017). Lung ageing and COPD: Is there a role for ageing in abnormal tissue repair? European Respiratory Review, 26, 1–15. https://doi.org/10.1183/16000617.0073-2017.Evidence Level V.

Bush, A. (2016). Lung development and aging. Annals of the American Thoracic Society, 3(5), S438–S446. https://doi.org/10.1513/AnnalsATS.201602-112AW. Evidence Level V.

Cao, X., White, P. E., & Ma, H. (2017). Perioperative care of the elderly surgical outpatients. Drugs Aging, 34, 673–689. https://doi.org/10.1007/s40266-017-0485-3. Evidence Level V.

Caseli, R. J., Beach, T. G., Knopman, D. S., & Graff-Radford, N. R. (2017). Alzheimer’s disease: Scientific breakthroughs and translational challenges. Mayo Clinic Proceedings,6, 978–994. https://doi.org/10.1016/j.mayocp.2017.02.011.Evidence Level V.

Cederholm, T., & Morley, J. E. (2015). Sarcopenia: The new definitions. Current Opinion in Clinical Nutrition and Metabolic Care, 18(1), 1–4. https://doi.org/10.1097/MCO.0000000000000119. Evidence Level II.

Centers for Disease Control and Prevention. (2023). Adult immunization schedules. https://www.cdc.gov/vaccines/adults/rec-vac/index.html. Evidence Level I.

Cholerton, B., Reger, M., & Craft, S. (2017). Cognitive changes associated with normal and pathological aging. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 931–950). McGraw-Hill. Evidence Level V.

Coetsee, C., & Terblanche, E. (2017). The effect of three different exercise training modules on cognitive and physical function in a healthy adult population. European Review of Aging and Physical Activity, 14(13), 1–12. https://doi.org/10.1186/s11556-017-0183-5. Evidence Level I.

Collins, J. A., Diekman, B. O., & Loeser, R. F. (2018). Targeting aging for disease modification in osteoarthritis. Current Opinions in Rheumatology, 30, 101–107. https://doi.org/10.1097/BOR.0000000000000456.Evidence Level V.

Commisso, A., & Lim, F. (2019). Lifestyle modifications in adults and older adults with chronic gastroesophageal reflux disease (GERD). Critical Care Nurse Quarterly, 42(1), 64–74. https://doi.org/10.1097/CNQ.0000000000000239.Evidence Level V.

Cruz-Jimenez, M. (2017). Normal changes in gait and mobility problems in the elderly. Physical Medicine Rehabilitation Clinics of North America, 28, 713–725. https://doi.org/10.1016/j.pmr.2017.06.005. Evidence Level V.

Cutler, T. W., & Clark, T. R. (2018, March). General principles of geriatric drug therapy. Journal of Contemporary Pharmacy Practice, 65(1), 31–35. http://jcphp.com. Evidence Level V.

Denic, A., Glassock, R. J., & Rule, A. D. (2016). Structural and functional changes with the aging kidney. Advances in Chronic Kidney Disease, 23(1), 19–28. https://doi.org/10.1053/j.ackd.2015.08.004.Evidence Level V.

Dumic, I., Nordin, T., Jecmenica, M., Lalosevic, M. S., Milosavljevic, T., & Milovanovic, T. (2019). Gastrointestinal tract disorders in older age. Canadian Journal of Gastroenterology and Hepatology,2019, 1–19. https://doi.org/10.1155/2019/6757524.Evidence Level V.

Dunkle, L. M., Izikson, R., Patriarca, P., Goldenthal, K. L., Muse, D., Callahan, J., & Cox, M. M. J. (2017). Efficacy of recombinant influenza vaccine in adults 50 years of age or older. New England Journal of Medicine,376(5), 2427–2436. https://doi.org/10.1056/NEJMoa1608862. EvidenceLevel II.

Ellsworth, P., Marschall-Kehrel, D., King, S., & Lukacz, E. (2013). Bladder health across the life course. International Journal of Clinical Practice, 67(5), 397–406. https://doi.org/10.1111/ijcp.12127.Evidence Level V.

Ensrud, K. E., & Crandall, C. J. (2017). In the clinic: Osteoporosis. Annals of Internal Medicine, 167(3), ITC17–ITC32. https://doi.org/10.7326/AITC201708010. EvidenceLevel IV.

Fuggle, N., Shaw, S., Dennison, E., & Cooper, C. (2017). Sarcopenia. Best Practice & Research Clinical Rheumatology, 31, 218–242. https://doi.org/10.1016/j.berh.2017.11.007.Evidence Level V.

Gonzalez del Castillo, J., & Sanchez, F. J. M. (2017). Pneumonia. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1957–1970). McGraw-Hill. Evidence Level V.

Grattagliano, I., Mastronuzzi, T., & D’Ambrosio, G. (2018). Hyponatremia associated with long-term medication use in the elderly: An analysis in general practice. Journal of Primary Health Care, 10(20), 167–173. https://doi.org/10.1071/HC17084.Evidence Level IV.

Gray, M. (2017). Case studies in geriatric urology: Focus on continence in the older adult. Urologic Nursing,37(3), 143–149. https://doi.org/10.7257/1053-816X.2017.37.3.143.Evidence Level V.

Gray-Vickrey, P. (2010). Gathering “pearls” of knowledge for assessing older adults. Nursing, 40(3), 34–43. https://doi.org/10.1097/01.NURSE.0000368816.89851.40.Evidence Level V.

Guo, J., Huang, X., Dou, L., Yan, M., Shen, T., Tang, W., & Li, J. (2022). Aging and age-related diseases: From molecular mechanisms to interventions and treatments. Signal Transduction and Targeted Therapy, 7(391). https://doi.org/10.1038/s41392-022-01251-0.Evidence Level III.

Hall, K. E. (2017). Aging of the gastrointestinal system. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1333–1342). McGraw-Hill. Evidence Level V.

Hassel, E., Stensvold, D., Halvorsen, T., Wisloff, U., Langhammer, A., & Steinshamn, S. (2015). Association between pulmonary function and peak oxygen uptake in elderly: The Generation 100 study. Respiratory Research, 16(156), 1–8. https://doi.org/10.1186/s12931-015-0317-0. Evidence Level IV.

Heckman, G. A., Forman, D. E., & Cheng, S. (2017). Vascular aging and atherosclerosis In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1145–1154). McGraw-Hill. Evidence Level V.

High, K. P. (2017). Infection: General principles. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1943–1956). McGraw-Hill. Evidence Level V.

JafariNasabian, P., Inglis, J. E., Reilly, W., Kelly, O. J., & Ilich, J. Z. (2017). Aging human body: Changes in bone, muscle and body fat with consequent changes in nutrient intake. Journal of Endocrinology, 234, R37–R51. https://doi.org/10.1530/JOE-16-0603.Evidence Level V.

Johanning, J. (2017). Peripheral vascular disease. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1215–1223). McGraw-Hill. Evidence Level V.

Kitzman, D., Upadhya, B., Haykowsky, M., & Taffet, G. (2017). Effects of aging on cardiovascular structure and function. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1129–1144). McGraw-Hill. Evidence Level V.

Klaming, R., Annese, J., Veltman, D. J., & Comijs, H. C. (2017). Episodic memory function is affected by lifestyle factors: A 14 year follow-up study in an elderly population. Aging, Neuropsychology and Cognition, 24(5), 528–542. https://doi.org/10.1080/13825585.2016.1226746.Evidence Level IV.

Ko, S., Jerome, G. J., Simonsick, E. M., Studenski, S., & Ferrucci, L. (2018). Differential gait patterns by history of falls and knee pain status in healthy older adults: Results from the Baltimore Longitudinal Study of Aging. Journal of Aging and Physical Activity,26, 557–582. https://doi.org/10.1123/japa.2017-0225.Evidence Level I.

Kuchel, G. A. (2017). Aging and homeostatic regulation. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 681–690). McGraw-Hill. Evidence Level V.

Landi, F., Picca, A., Calvani, R., & Marzetti, E. (2017). Anorexia of aging assessment and management. Clinical Geriatric Medicine, 33, 315–323. https://doi.org/10.1016/j.cger.2017.02.004.Evidence Level V.

Lederer, E., & Nayak, V. (2017). Disorders of fluid and electrolyte balance. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1317–1332). McGraw-Hill. Evidence Level V.

Levey, A. S., & Stevens, L. A. (2010). Estimating the GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: More accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions.American Journal of Kidney Disease, 55(4), 622–627. https://doi.org/10.1053/j.ajkd.2010.02.337.Evidence Level V.

Lichtenstein, A. H., Appel, L. J., Brands, M., Carnethon, M., Daniels, S., Franch, H. A., . . . Wylie-Rosett, J. (2006). Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation, 114(1), 82–96. https://doi.org/10.1161/CIRCULATIONAHA.106.176158. Evidence Level I.

Liguori, I., Russo, G., Aran, L., Bulli, G., Curcio, F., Della-Morte, D., Gargiulo, G., Testa, G., Cacciatore, F., Bonaduce, D., & Abete, P. (2018). Sarcopenia: Assessment of disease burden and strategies to improve outcomes. Clinical Interventions in Aging,13, 913–927. doi.org/10.2147/CIA.S149232.Evidence Level V.

Lim, E. F., Musa, A., Fredrick, A., & Ousman, S. S. (2017). AlphaB-crystallin expression correlates with aging deficits in the peripheral nervous system. Neurobiology of Aging, 53, 138–149. https://doi.org/10.1016/j.neurobiolaging.2017.01.006. Evidence Level III.

Lorbergs, A. L., O’Connor, G. T., Zhou, Y., Travison, T. G., Kiel, D. P., Cupples, L. A., Rosen, H., & Samelson, E. J. (2017). Severity of kyphosis and decline in lung function: The Framingham study. Journal of Gerontology: Series A, 72(5), 689–694. https://doi.org/10.1093/gerona/glw124. EvidenceLevel I.

Lukacz, E. S., Santiago-Lastra, Y., Aldo, M. E., & Brubaker, L. (2017). Urinary incontinence in women: A review. Journal of the American Medical Association, 318(16), 1592–1604. https://doi.org/10.1001/jama.2017.12137. Evidence Level V.

Manini, T. M., Gundermann, D. M., & Clark, B. C. (2017). Aging of the muscles and joints. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1715–1738). McGraw-Hill. Evidence Level V.

Maruotti, N., Corrado, A., & Cantatore, F. P. (2017). Osteoblast role in osteoarthritis pathogenesis. Journal of Cellular Physiology, 232, 2957–2963. https://doi.org/10.1002/jcp.25969.Evidence Level V.

Matos, F. S., de Jesus, C. S., Carenerio, J. A. O., Coqueiro, R. S., Fernandes, M. H., & Brito, T. A. (2018). Reduced functional capacity of community dwelling elderly: A longitudinal study. Ciencia & Saude Colectiva,10, 3393–3401. https://doi.org/10.1590/1413-812320182310.23382016.Evidence Level IV.

National Kidney Disease Education Program. (2012). Resource center: Estimation of kidney function for prescription medication dosage in adults. http://www.nkdep.nih.gov/resources/CKD-drug-dosing.shtml. Evidence Level I.

Paladina, S., Conte, A., Caggiano, R., Pieratoni, G. M., & Faraonio, R. (2018). Nrf2 pathway in age-related neurological disorders: Insights into microRNAs. Cellular Physiology and Biochemistry, 47, 1951–1976. https://doi.org/10.1159/000491465. EvidenceLevel V.

Paneni, F., Canestro, C. D., Libby, P., Luscher, T. F., & Camici, G. C. (2017). The aging cardiovascular system: Understanding it at the cellular and clinical levels. Journal of the American College of Cardiology, 69(19), 1952–1967. https://doi.org/10.1016/j.jacc.2017.01.064.Evidence Level V.

Patil, S. R., Al-Zoubi, I. A., Raghuram, P. H., Misra, N., Alam, F., & Alam, M. K. (2018). Oral finding in geriatric individuals. International Medical Journal, 25(6), 374–377. Evidence Level V.

Péquignot, R., Belmin, J., Chauvelier, S., Gaubert, J. Y., Konrat, C., Duron, E., & Hanon, O. (2009). Renal function in older hospital patients is more accurately estimated using the Cockcroft–Gault formula than the modification diet in renal disease formula. Journal of the American Geriatrics Society, 57(9), 1638–1643. https://doi.org/10.1111/j.1532-5415.2009.02385.x.Evidence Level II.

Puglielli, L., & Mattson, M. (2017). Cellular and neurochemical aspects of the aging brain. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S.Studenski, K. P.High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 917–930). McGraw-Hill. Evidence Level V.

Puts, M. T. E., Toubasi, S., Andrew, M. K., Ashe, M. C., Ploeg, J., Atkinson, E., Ayala, A. P., Roy, A., Rodríguez Monforte, M., Bergman, H., & McGilton, K. (2017). Interventions to prevent or reduce the level of frailty in community-dwelling older adults: A scoping review of the literature and international policies. Age and Ageing, 46, 383–392. https://doi.org/10.1093/ageing/afw247. EvidenceLevel V.

Qaseem, A., Forciea, M. A., McLean, R. M., & Denbert, T. D. (2017). Treatment of low bone density or osteoporosis to prevent fractures in men and women: A Clinical Practice Guideline update from the American College of Physicians. Annals of Internal Medicine, 166, 818–839. https://doi.org/10.7326/M15-1361.Evidence Level I.

Rabijewski, M., Papierska, L., Kuczerowski, R., & Platkiewicz, P. (2015). Hormonal determinants of erectile dysfunction and lower urinary tract symptoms in middle-aged and elderly men with prediabetes. The Aging Male, 18(4), 256–264. https://doi.org/10.3109/13685538.2015.1083972. Evidence Level IV.

Rich, M. W. (2017). Heart failure. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S.Studenski, K. P.High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1181–1204). McGraw-Hill. Evidence Level V.

Robinson, S. M., Reginster, J. Y., Rizzoli, R., Shaw, S. C., Kanise, J. A., Bautmans, I., Bischoff-Ferrari, H., Bruyère, O., Cesari, M., Dawson-Hughes, B., Fielding, R. A., Kaufman, J. M., Landi, F., Malafarina, V., Rolland, Y., van Loon, L. J., Vellas, B., Visser, M., Cooper, C., & ESCEO Working Group. (2018). Does nutrition play a role in the prevention and management of sarcopenia. Clinical Nutrition, 37, 1121–1132. https://doi.org/10.1016/j.clnu.2017.08.016. Evidence Level V.

Rowe, T., & Juthani-Mehta, M. (2017). Urinary tract infections. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1971–1985). McGraw-Hill. Evidence Level V.

Saxon, S. V., Etten, M. J., & Perkins, E. A. (2015). Physical change & aging (6th ed.). Springer Publishing Company. Evidence Level VI.

Schroder, T. H., Storbeck, B., Rabe, K. F., & Weber, C. (2015). The aging lung: Clinical and imaging findings and the fringe of physiological state. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 187, 430–439. https://doi.org/10.1055/s-0034-1399227.Evidence Level IV.

Schwingshackl, L., Bogensberger, B., & Hoffmann, G. (2018). Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: An updated systematic review and meta-analysis of cohort studies. Journal of the Academy of Nutrition and Dietetics, 118(1), 74–100. https://doi.org/10.1016/j.jand.2017.08.024. Evidence Level I.

Shad, B. J., Wallis, G., van Loon, L. J. C., & Thompson, J. L. (2016). Exercise prescription for the older population: The interactions between physical activity, sedentary time, and adequate nutrition in maintaining musculoskeletal health. Maturitas,93, 78–82. https://doi.org/10.1016/j.maturitas.2016.05.016.Evidence Level V.

Shanker, S., Rojas, M., & Caufield, C. (2017). Aging of the respiratory system. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1235–1240). McGraw-Hill. Evidence Level V.

Sullivan, D. H., & Johnson, J. E. (2017). Nutrition and obesity. In J. B. Halter, J. G. Ouslander, S. Studenski, K. P. High, S. Asthana, C. S. Ritchie, & M. A. Supiano (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 487–509). McGraw-Hill. Evidence Level V.

Supiano, M. A. (2017). Hypertension. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 1971–1985). McGraw-Hill. Evidence Level V.

Talbot, H. K. (2017). Influenza and respiratory syncytial virus. In J. B. Halter, J. G.Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 2005–2010). McGraw-Hill. Evidence Level V.

Tieland, M., Franssen, R., Dullemeijer, C., van Dronkelaar, C., Kyung Kim, H., Ispoglou, T., Zhu, K., Prince, R. L., van Loon, L. J. C., & De Groot, L. C. P. G. M. (2017). The impact of dietary protein or amino acid supplementation on muscle mass and strength in elderly people: Individual participant data and meta-analysis of RCTs. Journal Nutrition Health Aging, 21(9), 994–1001. https://doi.org/10.1007/s12603-017-0896-1. Evidence Level I.

Todorova, V., & Blokland, A. (2017). Mitochondria and synaptic plasticity in the mature and aging nervous system. Current Neuropharmacology, 15, 166–173. https://doi.org/10.2174/1570159X14666160414111821.Evidence Level V.

Tran, D., Rajwani, K., & Berlin, D. A. (2018). Pulmonary effects of aging. Thoracic Anesthesia, 31, 19–23. https:// doi.org/10.1097/ACO.0000000000000546. EvidenceLevel V.

U.S. Department of Agriculture & U.S. Department of Health and Human Services. (2015). Dietary guidelines for Americans, 2015. https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf. Evidence Level I.

U.S. Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Jr, Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Phipps, M. G., Pignone, M., Silverstein, M., Simon, M. A., Tseng, C. W., & Wong, J. B. (2018). Screening for osteoporosis to prevent fractures: U.S. Preventive Services Task Force Recommendation Statement. Journal of the American Medical Association, 319(24), 2521–2531. https://doi.org/10.1001/jama.2018.7498. EvidenceLevel I.

Wallace, J. I. (2017). Malnutrition and enteral/parenteral alimentation. In J. B. Halter, J. G. Ouslander, M. E. Tinetti, S. Studenski, K. P. High, & S. Asthana (Eds.), Hazzard’s geriatric medicine and gerontology (7th ed., pp. 511–525). McGraw-Hill. Evidence Level V.

Woo, J. (2018). Nutritional interventions in sarcopenia: Where do we stand? Current Opinion in Clinical Nutrition and Metabolic Care, 21, 10–23. https://doi.org/10.1097/MCO.0000000000000432.Evidence Level V.

Young, J., Angevaren, M., Rusted, J., & Tabet, N. (2015). Aerobic exercise to improve cognitive function in older people without known cognitive impairment. Cochrane Database of Systematic Reviews, 2015(4), CD005381. https://doi.org/10.1002/14651858.CD005381.pub4. Evidence Level I.

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