Endocrine Changes of Aging

Aging alters endocrine signalling gradually. Growth-hormone and insulin-like growth factor-1 activity decline, and sex-steroid production falls. The resulting shift favours less lean muscle, more adipose tissue, reduced bone density, and lower physiologic reserve. A small stressor that a younger adult compensates for—missed meals, gastroenteritis, a medication change, or a fall—can therefore produce a larger clinical effect. These changes do not make endocrine disease “normal.” New weight loss, persistent fatigue, confusion, recurrent falls, polyuria, or a fracture after minimal trauma requires assessment rather than attribution to age. Experienced nurses look for a change from the person’s baseline: the older adult who is no longer walking the usual distance, begins missing medications, becomes newly incontinent at night, or becomes confused before meals may be showing metabolic disease rather than uncomplicated aging. Sex-steroid decline contributes to bone loss in all sexes. In women, the postmenopausal fall in estrogen accelerates loss of bone mass. In men, testosterone production often declines more gradually, but low sex-steroid exposure, chronic illness, glucocorticoid therapy, immobility, alcohol use, and poor nutrition can further increase fracture risk.