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Physical Changes With Aging

By Richard W. Besdine, MD, Professor of Medicine, Greer Professor of Geriatric Medicine, and Director, Division of Geriatrics and Palliative Medicine and of the Center for Gerontology and Healthcare Research, Warren Alpert Medical School of Brown University

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Most age-related biologic functions peak before age 30 and gradually decline linearly thereafter (see Table: Selected Physiologic Age-Related Changes); the decline may be critical during stress, but it usually has little or no effect on daily activities. Therefore, disorders, rather than normal aging, are the primary cause of functional loss during old age.

In many cases, the declines that occur with aging may be due at least partly to lifestyle, behavior, diet, and environment and thus can be modified. For example, aerobic exercise can prevent or partially reverse a decline in maximal exercise capacity (O2consumption per unit time, or Vo2max), muscle strength, and glucose tolerance in healthy but sedentary older people (see Exercise).

Only about 10% of the elderly participate in regular physical activity for > 30 min 5 times/wk (a common recommendation). About 35 to 45% participate in minimal activity. The elderly tend to be less active than other age groups for many reasons, most commonly because disorders limit their physical activity.

The benefits of physical activity for the elderly are many and far exceed its risks (eg, falls, torn ligaments, pulled muscles). Benefits include

  • Reduced mortality rates, even for smokers and the obese

  • Preservation of skeletal muscle strength, aerobic capacity, and bone density, contributing to greater mobility and independence

  • Reduced risk of obesity

  • Prevention and treatment of cardiovascular disorders (including rehabilitation after MI), diabetes, osteoporosis, colon cancer, and psychiatric disorders (especially mood disorders)

  • Prevention of falls and fall-related injuries by improving muscle strength, balance, coordination, joint function, and endurance

  • Improved functional ability

  • Opportunities for social interaction

  • Enhanced sense of well-being

  • Possibly improved sleep quality

Physical activity is one of the few interventions that can restore physiologic capacity after it has been lost.

The unmodifiable effects of aging may be less dramatic than thought, and healthier, more vigorous aging may be possible for many people. Today, people > 65 are in better health than their ancestors and remain healthier longer.

Selected Physiologic Age-Related Changes

Affected Organ or System

Physiologic Change

Clinical Manifestations

Body composition

Lean body mass

Muscle mass

Creatinine production

Skeletal mass

Total body water

Percentage adipose tissue (until age 60, then until death)

Changes in drug levels (usually )


Tendency toward dehydration


DNA damage and DNA repair capacity

Oxidative capacity

Accelerated cell senescence


Lipofuscin accumulation

Cancer risk


Number of dopamine receptors

Alpha-adrenergic responses

Muscarinic parasympathetic responses

Tendency toward parkinsonian symptoms (eg, muscle tone, arm swing)


Loss of high-frequency hearing

Ability to recognize speech

Endocrine system

Insulin resistance and glucose intolerance

↑ Incidence of diabetes

Menopause, estrogen and progesterone secretion

Testosterone secretion

Growth hormone secretion

Vitamin D absorption and activation

Incidence of thyroid abnormalities

Bone mineral loss

Secretion of ADH in response to osmolar stimuli

Vaginal dryness, dyspareunia

Muscle mass

Bone mass

Fracture risk

Changes in skin

Tendency toward water intoxication


Lens flexibility

Time for pupillary reflexes (constriction, dilation)

Incidence of cataracts


Glare and difficulty adjusting to changes in lighting

Visual acuity

GI tract

Splanchnic blood flow

Transit time

Tendency toward constipation and diarrhea


Intrinsic heart rate and maximal heart rate

Blunted baroreflex (less increase in heart rate in response to decrease in BP)

Diastolic relaxation

Atrioventricular conduction time

Atrial and ventricular ectopy

Tendency toward syncope

Ejection fraction

Rates of atrial fibrillation

Rates of diastolic dysfunction and diastolic heart failure

Immune system

T-cell function

B-cell function

susceptibility to infections and possibly cancer

Antibody response to immunization or infection but autoantibodies


Degeneration of cartilaginous tissues


Glycosylation and cross-linking of collagen

Loss of tissue elasticity

Tightening of joints

Tendency toward osteoarthritis


Renal blood flow

Renal mass

Glomerular filtration

Renal tubular secretion and reabsorption

Ability to excrete a free-water load

Changes in drug levels with risk of adverse drug effects

Tendency toward dehydration


Hepatic mass

Hepatic blood flow

Activity of CYP 450 enzyme system

Changes in drug levels



Taste and consequent appetite

Likelihood (slightly) of nosebleeds

Peripheral nervous system

Baroreflex responses

Beta-adrenergic responsiveness and number of receptors

Signal transduction

Muscarinic parasympathetic responses

Preserved alpha-adrenergic responses

Tendency toward syncope

Response to beta-blockers

Exaggerated response to anticholinergic drugs

Pulmonary system

Vital capacity

Lung elasticity (compliance)

Residual volume


V/Q mismatch

Likelihood of shortness of breath during vigorous exercise if people are normally sedentary or if exercise is done at high altitudes

Risk of death due to pneumonia

Risk of serious complications (eg, respiratory failure) for patients with a pulmonary disorder


Endothelin-dependent vasodilation

Peripheral resistance

Tendency toward hypertension

=decreased; = increased; FEV1= forced expiratory volume in 1 sec; V/Q =ventilation/perfusion.

Adapted from the Institute of Medicine: Pharmacokinetics and Drug Interactions in the Elderly Workshop. Washington DC, National Academy Press, 1997, pp. 8–9.

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