Gerontology: Age-Related Changes – Flashcards
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Age-Related Changes
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Are more pronounced in advanced age (85 or older) Can alter response to illness Show variability among individuals Are impacted by genetic and lifestyle factors Can involve a decline in functional status Require therapeutic strategies Differentiate from pathological processes
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Age-Related CV Changes
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Size of heart is unchanged in the healthy. (L) ventricle wall thickens by 80 years of age. (L) atrium slightly increases in size to promote ventricular filling. Decreased responsiveness to sudden changes in cardiac demand. Blood flow, CO, and SV are reduced
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Age-Related Blood Vessel Changes
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Less elasticity-->less blood supply to organs-->increase in resistance. Change in flow to coronary arteries and brain is minimal, but diminished blood flow to liver and kidneys. Venous pooling occurs due to less efficiency in valves (lower extremity edema; risk for DVT).
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Age-Related changes in Pulmonary System
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Decreased respiratory muscle strength Stiffer chest wall Less effective ciliary and macrophage activity Drier mucous membranes Decreased cough reflex Inefficient gas exchange
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Pulmonary Changes: Implications
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Reduced pulmonary function reserve Decreased exercise tolerance; dyspnea Decreased chest/lung expansion; decreased exhalation Ineffective mucous/foreign matter clearance Increased risk of infection and aspiration
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Age-Related changes in GI System
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Decrease in kidney mass, blood flow, GFR (10% per decade after age 30) Decreased drug clearance Reduced bladder elasticity, muscle tone, and capacity Increased postvoid residual NOCTURIA Prostate enlargement with risk of BPH (Benign Prostate Hyperplasia)
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BPH
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An enlarged prostate. Is found in about 50% of men >75. Causes poor urine stream and dribbling. Causes feeling of constant need to urinate; this feeling may even wake you up at night. Causes a sense that your bladder is not completely empty after urination.
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Age-related changes in Renal System
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Kidneys lose as many as 50% of nephrons with little change in ability to regulate fluids. There is a diminished ability to respond quickly to stress of sodium or water excess or loss. !!!Decrease in urinary creatinine clearance impacts dosing of medications, IV fluids!!!
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Creatinine clearance equation (ml/min):
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MEN: (140 - age in years) X (body weight in kg) Divided By: 72 X (serum creatinine, mg/dL) WOMEN: The calculated value is multiplied by 85% (0.85)
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Implications of Renal System/GI changes
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Reduced renal function reserve Risk of renal complications in illness Risk of nephrotoxic injury and adverse reactions from drugs Risk of volume overload (heart failure) Dehydration, Hyponatremia, Hypernatremia, Hyperkalemia Reduced excretion of acid load Increased risk of urinary urgency, UTI
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Parameters of Renal and Genitourinary Assessment
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Assess renal function Assess choice/need/dose of nephrotoxic agents and renally-cleared drugs Assess for fluid/electrolyte and acid/base imbalances Evaluate nocturnal polyuria, urinary incontinence, BPH Assess UTI symptoms (atypical presentation) Assess fall risk if nocturnal/urgent voiding occurs
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Nursing Care Strategies for Renal System/GI
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Monitor drug levels Maintain fluid/electrolyte balance (minimum 1500-2500 mL/day from fluids and foods for 50-80 kg adults) to prevent dehydration Follow fluid restriction, if ordered Nocturnal polyuria: limit fluids in evening; avoid caffeine; use prompted voiding schedule or toileting plan Fall prevention: implement precautions Teach
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Mouth/Teeth Changes
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Teeth lose enamel and dentin Roots are more brittle Reduced mastication muscle strength Taste buds decrease in numbers Diminished thirst perception Salivary secretions lessen Xerostomia is common
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Stomach Changes
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Esophageal movements are less effective with sluggish emptying Malabsorption of carbs, vitamin B12, D, folic acid, calcium Reduction in secretion of bicarbonate and gastric mucous due to gastric atrophy. Loss of smooth muscle delays empting time, which can lead to malnutrition, weight loss.
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Intestines Changes
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Gastric villi shorten affecting absorption of nutrients. Slowing in motility with delayed emptying. Slowed peristalsis with impaired response to rectal filling (impaired sensation to defecate).
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Liver Gall Bladder Changes
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Decrease in liver volume and mass with reduction in blood flow. Impaired drug metabolism with greater half-life of fat-soluble drugs. Diminished bile acid synthesis causes a reduction in the body's ability to rid itself of unnecessary cholesterol.
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Oropharyngeal and GI Changes: Implications
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Risk of chewing impairment, poor nutrition, fluid/electrolyte imbalances Gastric changes: altered drug absorption, increased risk of GERD, NSAID-induced ulcers Constipation not a normal finding Risk of fecal incontinence with disease Stable liver function tests Risk of adverse drug reactions
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Parameters of Oropharyngeal and GI Assessment
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Assess abdomen and bowel sounds Assess oral cavity; chewing and swallowing capacity; dysphagia (coughing, choking with food/fluid intake) Assess lungs if aspiration suspected Monitor weight, calculate BMI, compare to standards Determine dietary intake and compare to nutritional guidelines Assess for GERD, constipation, fecal incontinence/impaction
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Oropharyngeal and GI Nursing Care Strategies
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Monitor drug levels and liver function tests if on meds metabolized by liver Educate on lifestyle modifications and over-the-counter meds for GERD Educate on normal bowel frequency, diet, exercise, laxative use Encourage mobility, participation in community-based nutrition programs Provide education on laxative use/fiber if taking meds that are constipating
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Age-related Changes in Musculature System
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Lean body mass replaced by adipose tissue with redistribution of fat. Bone loss in women and men after peak mass at 30-35 years of age. Decreased ligament and tendon strength and flexibility; intervertebral disc degeneration; cartilage erosion; changes in stature with height reduction and kyphosis
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Age-related Changes in Skeletal System
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Vertebral disks thin as a result of dehydration, causing shortening of the trunk (loss of intracellular body water). Some loss of bone mineral density in women related to estrogen loss after menopause. Bones of arms and legs may appear disproportionate in size with shortened appearance. Loss of 2-3 inches in height is not uncommon.
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Musculoskeletal Changes: Implications
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Sarcopenia: increased risk of disability, falls, unstable gait Risk of osteopenia, osteoporosis, osteoarthritis Limited range of motion Joint instability
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Nursing Care Strategies for Musculoskeletar Changes
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Encourage physical activity, weight-bearing exercise to maintain function. Implement strategies to prevent falls. Assess for pain and implement strategies to enhance function. Adequate intake of calcium, vitamin D Smoking cessation Routine bone mineral density screening
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Age-related Changes of the Nervous System/Cognition
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Shrinkage in neuron size and numbers Structural changes in dendrites Loss of myelin and decreased conduction in peripheral nerves Decrease in neurotransmitters Decrease in electrical conduction system Atrophy of taste buds Alteration in olfactory nerve fibers and nerve cells of vestibular system of inner ear, cerebellum, and proprioception Structural changes in basal ganglia due to slowing of autonomic nervous system Physiologic changes in sleep cycle Decreased temperature sensitivity
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Nervous System and Cognitive Function: Implications
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Impairment in general muscle strength; deep-tendon reflexes; nerve conduction Slowed motor skills and potential deficits in balance and coordination Blunted or absent fever response Slowed speed of cognitive processing; most memory functions are adequate Risk of sleep disorders, delirium, neurodegenerative diseases
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Parameters of Nervous System and Cognition Assessments
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Assess, with periodic reassessment baseline functional status and cognition During acute illness, monitor functional status for decline Early recognition for signs of delirium Assess for sleep disorders Assess impact of age-related changes on level of safety and attentiveness in daily tasks Assess temperature during illness, surgery Use standardized screening tools
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Nursing Care Strategies for NS/Cognition
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Institute fall prevention strategies Encourage lifestyle practices of regular physical exercise, intellectual stimulation, and a healthy diet Recommend behavioral interventions for sleep disorders Educate on wearing appropriate clothing for temperature changes
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Age-related Changes in Immune System
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Diminished immunocompetence Atrophy of the thymus occurs naturally with aging: affects T-lymphocyte function Decrease in suppressor T cells and T cell responsiveness Decrease in CD4 and CD8 cells (lymphocytes) Decrease of T cell-dependent antibody responsiveness Decreased primary response to new antigens Reduced effectiveness of skin barrier
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Immune System
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Oral temperature norms in healthy older adults are lower (95-97 range). Low grade fevers in later years can signify serious illness. Absence of fever or a normal WBC will not necessarily rule out an infectious process: assess changes in cognition, mood, level of consciousness, recent falls/injuries
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Age-related Changes to Integumentary System: Epidermis
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Thinning Blood vessels and bruising more visible T-cell function declines Increase in cell renewal time (30 or more days for new epithelial replacement) Impaired inflammatory response (48-72 hours) Evidence of true skin infection is same as younger adult Decrease in number of melanocytes, with reduction in protection from ultraviolet rays Pigment spots enlarge and become more numerous.
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Age-related Changes to Integumentary System: Dermis
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Loss of thickness (20%) Skin is more transparent and fragile Reduction in dermal blood vessels (cooler skin temp, pallor) Reduction in collagen synthesis (less elastic with more tears) Elastin fibers thicken with sagging and loss of stretch Loss of elasticity accentuates jowls and earlobes become elongated.
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Age-related Changes to Integumentary System: Hypodermis
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More sensitive to cold as thinning occurs Natural insulation of fat decreases Reduced efficiency of sweat glands Glands become fibrotic, connective tissue becomes avascular, leading to a decline in efficiency of the body to cool down Sebaceous glands atrophy and cannot protect the skin from losing water from epidermis.
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Age-related Changes to Hair and Nails
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Thinning of hair Loss of pigmentation Dryer and coarser hair and nails Gender specific distribution of hair changes with hormonal shifts. Nails become harder and thicker with ridges due to water loss. Blood supply and rate of nail growth diminishes. Nail color varies from yellow to gray.
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Age-related Changes to Endocrine System
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Glands atrophy with decrease in rate of hormone secretion. Older adults have highest rate of type 2 diabetes. When stressed with increased glucose levels, blood levels remain higher for longer. Decrease in sensitivity to insulin (unknown). Increase in incidence of hypothyroidism: diminished secretion of TSH, T3, T4; atrophy and fibrotic changes to thyroid.
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Age-related Changes to Reproductive System
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Women lose ability to procreate. Men remain fertile, although sperm lacks motility. Atrophy of ovaries, cervix, uterus, testes. Loss of elasticity in reproductive organs. Loss of lubrication with increased risk of UTIs. By 80 years of age, up to 80% of men have BPH.
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Sarcopenia
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Decline in skeletal muscle mass and strength associated with aging
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Kyphosis
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Referred to as "hunchback" Having an abnormally curved spine. Most common in older women and often related to osteoporosis. Some people have back pain and stiffness. Others have no symptoms other than an exaggerated forward rounding of the back.
