Lesson 1, Topic 1
In Progress

Changes in Anatomy, Physiology, and Diseases of the Endocrine and Gastrointestinal Systems

April 11, 2024

Learning Objective: Examine the changes in anatomy, physiology, and diseases of the endocrine and gastrointestinal systems.
      TABLE 30.2 summarizes the changes to the endocrine and gastrointestinal systems and what can be done to promote healthy aging. The following sections provide more detail about the changes to those systems.

Endocrine System
Learning Objective: Explain the changes in the anatomy and physiology of the endocrine system caused by aging.
      Hormonal changes that occur with aging are related to a general decrease in hormone production combined with changes in tissue receptor binding. The most common endocrine system disorder seen in aging patients is type 2 diabetes mellitus (DM). As a person ages, insulin production by the beta cells in the pancreas decreases and insulin resistance at the tissue level increases. According to the National Institutes of Health, more than half of the 16 million Americans diagnosed with type 2 diabetes are over age 65. Older adult patients with diabetes are at increased risk of developing the following vascular diseases:
                • Renal disorders
                • Retinopathy
                • Neuropathy
                • Myocardial ischemia
                • Angina
                • Myocardial infarction
                • Cerebrovascular accidents
                • Peripheral vascular disease, such as lower extremity ulcers
Older patients do not always experience the classic symptoms of diabetes, which are polyuria, polydipsia, and polyphagia. They may show a variety of problems:
                • Unexplained weight loss
                • Slow wound healing
                • Recurrent bacterial or fungal infections
                • Changes in mental state
                • Cataracts
                • Macular disease
                • Muscle weakness and pain
                • Angina
                • Foot ulcers
                • Uremia
      The range of symptoms is due to the insidious onset of diabetes in older people, who may have been gradually developing hyperglycemia for years before diagnosis.

      The treatment protocol for aging patients with diabetes is the same as for other age groups; however, special consideration must be given to the patient’s ability to understand and comply with the therapeutic plan. In addition, the person may have other health problems that are being treated with medications. Therefore, an aging patient newly diagnosed with diabetes may face a complicated treatment plan that requires explicit instruction and continual follow-up in the ambulatory care setting.
      The medical assistant must be aware of any sensory abnormalities, such as diminished vision or problems with fine motor skills that may interfere with the patient’s ability to follow treatment guidelines. Coaching and treatment plans must be adapted to meet the individual needs of each patient. For example, if the patient has vision difficulties, an injector pen with audible clicks can be used to deliver a preset amount of insulin.

Factors That Can Affect Diabetes Management in Older People
                • Modifying lifestyle risk factors may be more difficult because of poor nutrition, inability to exercise, and long-standing habits, such as smoking and a diet high in saturated fats and calories.
                • Previously diagnosed health conditions, such as hypertension and heart disease, in addition to an age-related decline in kidney and liver function, increase the challenge of treating diabetes.
                • Older people are more likely to be prescribed multiple medications, which increases the risk of adverse drug interactions.
                • Older adult patients with diabetes are more prone to hypoglycemia and may not recognize and respond quickly to the signs of low blood glucose levels.
                • Diabetic complications can develop quickly because of a long history of prediabetes before diagnosis.
                • Older people may have decreased physical or mental abilities that make it difficult for them to understand and adhere to a complicated treatment regimen.
                • Older patients may be unable to afford the medications and supplies needed to maintain health.

30.2 Critical Thinking Application
Quite a few of the older adult patients at WMFM Clinic have diabetes type 2. Based on what you have learned about the difficulty of managing diabetes in aging people, what factors do you need to consider when conducting patient education for an older adult with diabetes? Are there any community resources that might be useful for patients and their families?

Gastrointestinal System
Learning Objective: Explain the changes in the anatomy and physiology of the gastrointestinal system caused by aging.
      Age-related changes in the gastrointestinal system begin in the mouth with dental problems:
                • A decrease in the number of taste buds
                • A decrease in the production of saliva
                • A diminishing sense of smell
      Older people generally find eating less pleasurable, have a reduced appetite, and are unable to chew and lubricate their food as well as younger people. This makes dysphagia (difficulty swallowing) a common age-related problem. Aging also brings a decrease in the production of hydrochloric acid, which affects the digestion of calcium and iron. Secretion of intrinsic factor, a protein needed to absorb vitamin B12, also declines. This affects the function of the nervous system. It also affects the formation of red blood cells, resulting in excessive fatigue. It is not unusual for aging patients to be on regular vitamin B12 replacement therapy, either by oral dosage or injection.
      Food passes more quickly through the small intestine, resulting in poorer absorption of vitamins and minerals. Peristalsis in the colon decreases, making aging patients more susceptible to constipation and diverticular disease. Poor eating habits, reduced fluid intake, and some medications (e.g., antidepressants, diuretics, antacids containing aluminum or calcium, and medications for Parkinson disease) also contribute to constipation. The liver decreases in size and weight after age 70. It is still able to perform vital functions, but more time is required to metabolize drugs and alcohol. All of these factors combine to increase the potential for adverse drug reactions in older adults.
Aging individuals have a higher incidence of several gastrointestinal system diseases, such as the following:
                • Gastroesophageal reflux disease (GERD)
                • Peptic ulcers
                • Diverticulosis (related to lack of dietary fiber and constipation)
                • Cholelithiasis
                • Colorectal cancer
Dietary counseling and annual screenings should be part of the routine care of aging patients.