Aging changes (Changes in the elderly)

Effects of aging

All cells are subject to the natural processes of aging. Aging is believed to be caused by the accumulation of DNA damage, hormonal changes, and internally programmed cellular changes. Aging affects all organ systems and leads to progressive functional decline.

Aging changes in the bones, muscles, and joints

  • Increased bone resorption and osteoporosis, increased risk of fracture ( > )
  • Decreased lean body mass due to atrophy and loss of muscle cells (sarcopenia)
  • Degenerative changes in joints: stiffer and less flexible joints, decreased synovial fluid and cartilage, calcification (e.g., in the shoulder), height loss

Regular exercise and a diet rich in protein, vitamin D, creatine, and omega-3 fatty acids are essential to ensure muscle growth and help prevent sarcopenia!

Aging changes in the skin

Increased incidence of

Aging changes in the nails and hair

Aging changes in the cardiovascular system

  • Vascular sclerosis and stiffness→ increased systolic blood pressure
  • Left ventricular hypertrophy and progressive stiffening with a 10% increase in wall size
  • Mitral and aortic valve thickening and calcification
  • Marked decline in stress-induced and exercise-induced maximal heart rate due to decreased response to the action of catecholamines
  • Lipofuscin deposits in cardiac muscle

Aging changes in the respiratory system

Aging changes in the genitourinary system

Aging changes in the immune system

  • Decreased immune response and impaired regulation of inflammation predispose individuals to recurrent infection, impaired wound healing, malignancy, and autoimmune disease.
  • Decreased antibody and cell-mediated immune responses to a new antigen
    • A decline in the counts of most subsets of B cells and T cells (exception: memory T-cell and memory B-cell counts increase)
    • Decreased affinity of antibodies for new antigens
      • Decrease in the variety of B-cell receptors for antigens
      • Increase in the proportion of monoclonal cell lines
      • Impaired affinity maturation and impaired V(D)J recombination
  • Total immunoglobulin level remains the same.
  • Macrophage and neutrophil counts do not decrease but they are less effective in their functions (e.g., phagocytosis).
  • Increased number of NK cells, PGE2, and increased autoantibody production

Among the elderly, a decreased immune response leads to an increased need for booster vaccinations.

Aging changes in the endocrine system

Aging changes in the nervous system

  • Presbycusis: progressive high-frequency hearing loss due to loss of hair cells at the base of the cochlea
  • Presbyopia: impaired accommodation (near object focusing) due to decreased elasticity of the lens; decreased ciliary muscle strength
  • Decreased sense of smell and taste
  • Reduced ability to detect vibration, touch, temperature, and pressure changes (increased risk of pressure ulcers, hypothermia, and burns)
  • Decreased cerebral blood flow and brain volume
  • Altered sleep patterns: early morning awakening, later sleep onset, decreased REM, and decreased slow-wave sleep
  • After the 6th decade of life
    • Decline in executive function, working memory, processing speed, and attention span
    • In most cases, no clinically significant impairment in social and occupational functioning
    • Increased suicide risk in case of physical and mental illnesses (particularly depression), functional impairment, and stressful life events (e.g., loss of a partner)


  • 1. John D. Furber. Extracellular Glycation Crosslinks: Prospects for Removal. Rejuvenation Research. 2006; 9(2): pp. 274–278. doi: 10.1089/rej.2006.9.274.
  • 2. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clinical interventions in aging. 2006; 1(3): pp. 253–60. pmid: 18046878.
  • 3. Watad A, Bragazzi NL, Adawi M, et al. Autoimmunity in the elderly: Insights from basic science and clinics - A mini-review. Gerontology. 2017; 63(6): pp. 515–523. doi: 10.1159/000478012.
  • 4. Eisen HN. Affinity enhancement of antibodies: How low-affinity antibodies produced early in immune responses are followed by high-affinity antibodies later and in memory B-cell responses. Cancer Immunol Res. 2014; 2(5): pp. 381–392. doi: 10.1158/2326-6066.cir-14-0029.
  • 5. Montecino-Rodriguez E, Berent-Maoz B, Dorshkind K. Causes, consequences, and reversal of immune system aging. J Clin Invest. 2013; 123(3): pp. 958–965. doi: 10.1172/jci64096.
  • 6. Mehr R, Melamed D. Reversing B cell aging. Aging. 2011; 3(4): pp. 438–443. doi: 10.18632/aging.100313.
  • 7. Bulati M, Caruso C, Colonna-Romano G. From lymphopoiesis to plasma cells differentiation, the age-related modifications of B cell compartment are influenced by “inflamm-ageing”. Ageing Res Rev. 2017; 36: pp. 125–136. doi: 10.1016/j.arr.2017.04.001.
  • 8. Kogut I, Scholz JL, Cancro MP, Cambier JC. B cell maintenance and function in aging. Semin Immunol. 2012; 24(5): pp. 342–349. doi: 10.1016/j.smim.2012.04.004.
  • 9. Lewis. Physiologic Changes in the Elderly. url: Accessed April 22, 2019.
  • UpToDate. Updated January 1, 2012.
last updated 05/29/2019