Which one of the following changes is likely to occur in the G.I. system of an elderly client?

MNS 2024

Medical & Surgical Nursing

Medium

Appeared in: MNS 2024

Explanation

With advancing age, the stomach lining (gastric mucosa) undergoes degeneration and atrophy.
This atrophy leads to a reduced number of parietal cells, which are responsible for producing hydrochloric acid (HCl).
The resulting decrease in HCl secretion (hypochlorhydria) impairs protein digestion and the absorption of essential nutrients like vitamin B12, calcium, and iron.
This is a common and expected physiological change in the elderly population.

Option A: This is incorrect. While the composition of gut bacteria changes with age, overall activity does not simply decrease. In fact, decreased intestinal motility in older adults can lead to an increase in bacteria in the small intestine, a condition known as small intestinal bacterial overgrowth (SIBO).
Option C: This is the opposite of what occurs. Due to degenerative changes in the salivary glands, saliva production typically decreases with age. This condition, known as xerostomia or dry mouth, is common in the elderly.
Option D: This is incorrect. The secretion of most digestive enzymes, such as pancreatic lipase, and the production of bile by the liver tend to decrease or remain stable with age, not increase. This contributes to slower digestion, particularly of fats.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Age-related physiological changes in the gastrointestinal system as background academic context rather than a clinical decision trigger.
Nurses must monitor elderly clients for signs of nutritional deficiencies, particularly iron-deficiency anemia and pernicious anemia (from poor iron and B12 absorption), which are direct consequences of decreased HCl.
Patient education should include dietary modifications, such as eating smaller, more frequent meals to ease digestion and choosing nutrient-dense foods.
Management of xerostomia (dry mouth) through frequent sips of water, sugar-free candies, and artificial saliva can improve comfort and food intake.

How to Approach the Question

First, identify the core subject of the question, which is the physiological changes in the gastrointestinal (GI) system specifically related to aging.
Recall the general principle of gerontological changes: most bodily functions tend to decline, slow down, or become less efficient with age.
Evaluate each option based on this principle. An 'increase' in secretions (Options C and D) is generally less likely than a decrease in the context of aging.
Consider Option A: 'Bacterial activity... decreases'. Think about GI motility. Since motility slows in the elderly, it can lead to stasis and bacterial overgrowth, making a simple decrease unlikely.
Consider Option B: 'Hydrochloric acid... decreases'. This aligns with the concept of atrophy of organs and tissues, a hallmark of aging. Atrophy of the stomach lining would logically lead to reduced secretions.
By eliminating the options suggesting an increase in function and the one that misrepresents changes in gut flora, the most plausible answer is the decrease in hydrochloric acid secretion.

Concept Tested & Keywords

Concept Tested: Age-related physiological changes in the gastrointestinal system.
Stem keywords: G.I. system, elderly client, changes
Lead-in keywords: Which one
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Nutrition Kumud Khanna 2e p. 155-157

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 74-76