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Changes in Aging, image, image - Coggle Diagram
Changes in Aging
Cardiovascular Changes
Normal Changes
Decreased cardiac output due to physiologic stress
Blood vessels have reduced elasticity, diastolic murmur may be noted
Oxygen is used less efficiently by the body
Dilated aorta
Ventricular hypertrophy
Myocardial muscle is less efficient d/t decreased contractile strength and prolonged cardiac cycle
Calcification and reduced elasticity of the blood vessels
Less sensitive to baroreceptor regulation of blood presure
Pathologies
Cardiovascular Disease
Major cause of disability and death in the older population
Prevalence increases with age, nearly 70% of women over age 65 have cardiovascular diesease
Dysrhythmias
Become more common with aging
Examples include bradycardia, tachycardia, atrial fibrillation, and heart block
Arteriosclerosis
Can cause vascular problems such as edema, peripheral vascular disease, and coronary artery disease
Atherosclerosis
Aspirin may be recommended for patients with atherosclerosis
C-Reactive Protein Screening
Ideal range is < 3 g/dL
Hypertension
Incidence and prevalence increases with age
Must be diagnosed with blood pressure of at least 2 occasions
Systolic > 140 mmHg, diastolic >90 mmHg
Symptoms include dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor
Can cause erectile dysfunction
Heart Failure
Left sided HF causes pulmonary edema due to the inability of the left ventricle to pump to the peripheral circulation. Symptoms include dyspnea, crackles, cough, fatigue, and tachycardia
Right sided HF causes peripheral edema due to the inability of the right ventricle to pump blood into the pulmonary circulation, causing blood to become "backed up" in the peripheral circulation. Symptoms include edema in the extremities, weight gain, distended neck veins, anorexia, and weakness
Congestive Heart Failure
Incidence increases with age
Leading cause of hospitalization
Complication of arteriosclerotic heart disease
Most cases in older adults can be caused by coronary artery disease
Symptoms include crackles on auscultation, SOB, fatigue, confusion, insomnia, depression, and orthopnea
4 Classes of CHF include Class 1-4
Class 1: Cardiac disease without physical limitation
Class 2: Symptoms experienced with normal activity, slight limitations may occur
Class 3: Symptoms experienced with less than ordinary activities, physical activity significantly limited
Class 4: Symptoms experienced with activity and rest
Societal Changes
Improved technology and increased public awareness resulted in a decline in heart disease
Treatments
Lifestyle modifications include increased activity regularly (rather than sporadically), enhance circulation in the older adult through aerobic exercise, yoga, tai chi, and balance exercises
Reduce stress levels to decrease workload of the heart
Dietary Changes including the DASH diet (low sodium, high potassium intake), reduced cholesterol, reduced overall sodium intake
Musculoskeletal Changes
Normal Changes
Decrease in muscle mass
Decrease in bone mineral and mass
Increased risk for fractures
Decreased calcium absorption
Thinning of intervetebral disks and compressed vertebrae
Pathologies
Fraility
Weakness, weight loss, muscle wasting, exercise intolerance, immobility, instability of chronic diseases, decreased grip strength, exercise intolerance
Preclinical signs include sarcopenia, osteopenia, Nutritional problems, nonspecific balance disorders, and deconditioning
Goal is to continually improve how older adults are affected by the diseases and fraility that often accompanies older ages
Failure to Thrive
Mean average of 6 diagnoses
Patient may appear malnourished or dehydrated
There may be skin ulcers or cognitive changes, the patient is at an increased risk for falls
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Sensory Changes
Normal Changes
Decrease in all 5 senses which can alter dietary intake, and sensation of stimuli
Decrease in the efficiency of senses (which can affect the well-being of the patient)
Decrease tactile sensation & ability to sense pressure, discomfort or changes in temperature
Presbyopia: Decrease in the ability to see objects near the individual
Presbycusis: Progressive loss of hearing
Increase in cerumen
Distortion of high-pitched sounds
Pathologies
Cataracts
Clouding of the lens and loss of transparency
Leading cause of low vision in older adults
S/S include blurred, cloudy vision, the eye may appear cloudy open assessment with white glare
Glaucoma
Increased intraocular pressure causing damage to the optic nerve
Acute (closed or narrow angle)
Severe eye pain, headache, rapid increase in tension and edema, need early treatment to prevent blindness
Chronic (Open Angle)
More common form
Early prevention necessary to prevent blindness
Vision loss d/t glaucoma can not be restored
Sensory changes can cause potential musculoskeletal changes with environmental safety. For example, a patient with restricted vision as seen in homologous hemianopsia, may not see an obstacle in their environment. This could cause them to trip and fall over the object, and then have impaired musculoskeletal function such as an injury or reduced mobility.
Physical Appearance
Normal Changes
Decrease in stature due to loss of cartilage between the vertebrae
Vertebrae become compressed
The older adult will have thin, gray hair
The face may have wrinkles
Reduced elasticity of the skin
Diagnoses or Procedures that could alter physical appearance
Colostomy use in patients may put them at risk for impaired self image, these patients may try to hide their ostomy bag and avoid social situations if they are worried about an accident occurring
Barrel chest and kyphosis as seen with many respiratory problems may cause an altered self-image
Urinary incontinence may cause the patient to avoid social surroundings or situations out of fear of being incontinent in public
Respiratory System Changes
Normal Changes
Cartilage calcifies and causes the older adult to have a more rigid rib cage
Decrease in cough reflex and laryngeal reflex
Increased residual capacity and decreased vital capacity
Trachea stiffens d/t calcification
Lungs reduce in the size and weight
Decreased elastic recoil of the aveoli
Increased risk of aspiration d/t loose and brittle teeth
Increased residual volume
Decrease in cilial
Decreased cough and pharyngeal reflex seen in older adults, along with dysphagia, can put the older adult at high risk for aspiration of contents
Pathologies
Pneumonia
Infection of one or both of the lungs caused by bacteria, viruses, fungi, etc.
Air sacs (alveoli) of the lungs can fill with pus or fluid
Vaccinations for pneumococcal and influenza virsuses
Avoid exposure to toxins or others with respiratory infections to prevent worsening of symptoms
Chronic bronchitis
Long-term inflammation of the bronchioles
S/S include chronic cough, dyspnea, SOB
Common among smokers
Blue-Bloaters
Lowest FiO2 possible to prevent CO2 retention
Chronic bronchitis can cause emphysema
Emphysema
S/S: Are slow in onset, include dyspnea that is not relieved by sitting upright, SOB, weight loss, weakness, recurrent respiratory infections, malnutrition, CHF, and cardiac arrythmias
Destruction of the alveoli causing impaired gas exchange
Pink-Puffers
Increased air trapping
COPD
Gastrointestinal Changes
Normal Changes
Decrease in taste perception
Decrease in esophageal motility and GI motility
Increased risk for aspiration, ingestion, and constipation
Decreased elasticity of the stomach which reduces the amount of food that can be accommodated at one time
Increase in gastric pH as a result of the decline in HCl and pepsin
Pathologies
Ulcerative Colitis
Inflammation and ulcers or sores in the digestive tract
S/S will develop over time, rather than suddenly
Diarrhea with pus may occur
Crohn's Disease
Chronic inflammation of the digestive tract
S/S include abdominal pain, severe diarrhea, fatigue, weight loss, malnutrition
Colon cancer
S/S include change in bowel habits, sense of incomplete emptying, abdominal pain, nausea, vomiting, diarrhea, cachexia, abdominal distention, medical or family history of polyps
Diagnosed using colonoscopy, Cologuard, fecal occult stool test, CBC
Older adult with colostomy may be at risk of social isolation and embarassment
Dysphagia
Swallowing difficulties increase in incidence with age
Can be caused by GERD, stroke, structural problems, etc.
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Urinary System Changes
Normal Changes
Decrease in GFR in 50% by age 90
Decrease in renal perfusion
BPH can be a normal change in the older adult
Size and weight of the kidneys decrease with aging
Hypertrophy and thickening of the bladder muscle
Pathologies
Urinary Incontinence
Stress incontinence, urge incontinence, overflow incontinence, neurogenic incontinence, functional incontinence, mixed incontinence
Question medical history of incontinence, assess medications that may be increased the risk for incontinence, assess neuromuscular function in the lower extremities for S/S such as numbness and tingling, asses ROM and strength in lower extremities
Increase fluid intake for the patient
Teach the client to take the full course of antibiotic medication therapy, and to not stop the medication abruptly
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Bladder Cancer
Risk Factors include irritation
S/S include dysuria, frequency, urgency, hematuria
Treatment includes surgery, radiation, immunotherapy, chemotherapy
A S/S of bladder cancer may be incontinence. This can also lead to an altered body image in the older adult. The older population may be fearful of a episodes of incontinence, and may delay seeking help and treatment of this issue. However, the nurse should monitor the patient closely for S/S of incontinence.
Nocturia
Excessive urination at night
Decreased tubular function
Changes in urine concentration, can be indicative of dehydration or fluid overload and hyponatremia
Urinary Tract Infection
S/S include burning, itching painful urination, hematuria may be present, WBC will be elevated as a S/S of an infection
Most causative organism is E. Coli
High risk patients include diabetics, pregnant women, urinary retention, older women experiencing bladder prolapse, immunosuppressed persons
Nursing Interventions: Frequent perineal care, remove indwelling catheters within 24-48 hours, encourage frequent voiding of 3000 ml per day
Nervous System Changes
Normal Changes
Decrease in weight and flow to the brain
Decrease in neurons
Slower response to changes in balance
Hypothalamus is less effective in temperature regulation
Change in sleep patterns
Short term memory declines, long term memory remains the same
Intelligence remains steady
Loss of nerve cell mass
Atrophy of the brain and spinal cord, decrease in brain weight
Accumulation of free radicals
Pathologies
Dementia
Loss of memory, language, problem-solving and other cognitive abilities
Progressive
S/S appear gradually over time
Alzheimer's Disease
Type of dementia that has 7 different stages ranging from normal to severe
Neuritic plaques containing beta-amyloid protein and neurofibrillary tangles in the cortex
Can be due to genetics, environmental factors, chromosomal abnormalities, or a slow-acting virus
No treatment or cure currently available
Can affect sexual behavior
Caused by damage or injury to the brain
Delirium
Serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment
Short-term
Risk factors include infections
S/S appear suddenly
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Parkinson's Disease
Chronic, progressive, debilitating neurologic disease of the basal ganglia and substantia nigra, affecting motor ability and characterized by tremor at rest, increased muscle (rigidity)
Patient has decreased dopamine
Affects the ability of the CNS to control body movements
More common in men and those who have farm backgrounds
Medications include Carbidopa-Levodopa, instruct that the patient needs to take the medications on time and at the same time everyday
S/S include bradydyskinesia, mask-like facial expressions, rigidity of extremities, drooling, tremors at rest, emotional liability, increased tremors with stress or anxiety, slow shuffling gait with chin down and chest towards ground
Immune System
Normal Changes
T cell activity decreases
Cell mediated immunity decreases
Increased risk for infection
Increased risk for infection can be a contributing factor to the development of delirium, as one of the most common causes of delirium is secondary to the development of an infection, more specifically viral infections
Inflammatory defenses decrease
Pathologies
Infections
Causes an increase in WBC
Can potentially cause a fever
Can be precursors to other pathological conditions such as delirium
These infections can be transmitted to other older adults and populations, increasing the spread of the infection
Important care in the hospital setting should be taken to limit the spread of infection such as using personal protective equipment and utilizing isolation rooms
Autoimmune Diseases (such as systemic lupus erythematous or Type 1 Diabetes Mellitus
Endocrine System
Normal Changes
Decreased release of thyroid hormone d/t atrophy of the thyroid gland
Volume of the pituitary gland decreases
ACTH (Adrenocorticotropic hormone) secretion decreases
Diminished adrenal function
Reduced tissue sensitivity to insulin
Pathologies
Diabetes
Type 1 Diabetes
Autoimmune Disease which causes the body to attack the insulin-secreting cells of the pancreas, causing a decreased sensitivity to insulin. S/S of Type 1 Diabetes include symptoms of hyperglycemic episodes, especially polydipsia, polyphagia, and polyuria
Type 2 Diabetes
Patient will need glucose checked freuqently, monitor for the need of insulin, after administration of insulin be aware of the S/S of hypoglycemia including diaphoresis and shaking
Basal-Bolus insulin regimen may be indicated to help maintain adequate blood glucose levels
Metformin is the oral antidiabetic agent of choice in older adults d'/t the decreased risk of hypoglycemia
Hypothyroidism
Decreased level of T3 and T4
Can be primary (due to thyroid problem) or secondary (due to anterior pituitary or outside probelm)
S/S include weight gain, fatigue, hypotension, crepitism
Treatment includes replacing TH using Levothyroxine/Synthroid, etc.
Hyperthyroidism
Increased levels of T3 and T4
Normally due to a secondary cause
S/S include diaphoresis, weight loss, anxiety, shaking, exopthalamus, tachycardia, etc.
Treatment includes ablation of the thyroid gland, surgery, radioactive iodine therapy, etc.
Watch for S/S of thyroid storm, teach about the daily replacement of thyroid hormone and how this treatment will be life-long
Sleep
Normal Changes
Altered circadian rhythm cycles may occur
Phase advance may be common in older adults
Nocturia, a normal change of aging, can cause disrupted sleep patterns in older adults
Pathologies
Insomnia
Difficulty falling or staying asleep or prematurely waking
Short term (Due to changes in environment, illness, stress, anxiety)
Chronic Insomnia (Greater than 3 weeks) (Due to physical or mental illness, substance abuse, or possible medications such as anticholinergics, antidepressants, and caffeine or alcohol)
Sleep Apnea
Five episodes of cessation of breathing, lasting 10 seconds
Disorder of the CNS that affects the diaphragm and therefore breathing
Patient should avoid sleeping in the supine position to avoid aspiration
Positioning the patient in a Semi-Fowlers or High-Fowlers position may decrease the risk of aspiration
Sexuality and Reproductive Changes
Normal Changes
Menopause in women and andropause in men
Andropause is characterized by low testosterone levels in older men and can lead to reduced muscle mass, energy, strength, and stamina
Older adults have the same sex drive as younger populations, despite what some may believe
Sex organs atrophy
Decreased sperm production in men
Cervix, uterus, fallopian tubes, and vulva atrophy
Fallopian tubes will become shorter and straighter
Pathologies
Erectile Dysfunction
Inability to maintain or attain erection during sexual intercourse
Can be due to atherosclerosis, diabetes, hypertension, MS, thyroid dysfunction, renal failure, etc.
Atrophic Vaginitis
Occurs in postmenopausal women
Vaginal fragility is increased which causes irritation which can lead to vaginits
Tell patient to report any changes in signs or symptoms
Frequent perineal care including teh use of creams to aid with vaginal dryness
These changes in sexual function in older adults may cause some patients to feel embarrassed about their scenario. However, this can be avoided by maintaining an open and interpersonal relationship with the patient to foster a safe and open environment for communication
Cellular Changes
Normal Changes
Decrease in the functional cell number
Extracellular fluid remains the same
Increase in Na, K, and water concentration due to reduced excretion of Na, K, and water
