Changes in Older Adults

Integumentary System

Immune System

Reproductive System

Cardiovascular System

Urinary System

Respiratory System

Digestive System

Musculoskeletal System

Endocrine System

Neurological/Nervous System

Body fat atrophies

Intercostal and subclavian spaces deepen

More bony appearance

Reduced skinfold thickness in the forearms and back of hands

Decline in body's natural insulation

Increased intolerance/sensitivity to cold temperatures

Loss of cartilage

Shorter stature, may lose up to 3 inches

Compression of vertebrae

Long bones appear disproportionately long

Changes in connective tissue

Tip of nose rotates downward

Increase in septal deviations

Mouth breathing at night

Obstructive Sleep Apnea

Decreased secretions from submucosal glands

Reduced ability to dilute mucus

Secretions are thicker and more difficult to remove

Less lung expansion; increase in residual volume, and decrease in vital capacity

Calcification of costal cartilage

Weakened thoracic inspiratory and expiratory muscles (related to musculoskeletal system)

Loss of elasticity

Trachea and rib cage become more rigid

Lungs become smaller, less firm and have less recoil (they are more stiff)

Aorta becomes dilated and elongated

Sclerosis and fibrosis of the atrioventricular valves

The valves become thick and rigid

Systolic and diastolic murmurs

Incomplete valve closure

Reduced cardiac output

Loss of contractile strength

Irregular pacemaker cells and a decrease in number

Prolonged isometric contraction phase and relaxation time of left ventricle

Diastolic filling and systolic emptying take loinger

Vascular Changes

Impaired baroreceptor function (impaired ability to self regulate blood pressure)

Increased postural hypotension

Increased postprandial hypotension

Signs and Symptoms: excessive daytime sleepiness, loud snoring, morning headache, observed episodes of stopped breathing in the night

Treatment: weight loss, sleep on your side, CPAP, avoid alcohol, surgery to remove tonsils if necessary

Risk Factors; excess weight, smoking, diabetes, hypertension, narrowed airway

Blunting of cough and laryngeal reflexes

Decreased cilia in the lungs

Hypertrophy of bronchial mucus glands

Pneumonia

Pleuritic pain may not be present

Minimal or no fever

S/S; slight cough, fatigue, rapid respirations

Confusion, restlessness and changes indicate cerebral hypoxia

Could cause paralytic ileus if it further progresses

Tunica media becomes calcified and increases in collagen

Fibrosis of the tunica intima

Cellular proliferation and calcium and lipid accumulation

Hypertension

Elevated systolic BP 120-129
Stage I HTN: Systolic BP 130-139 or diastolic BP 80-89
Stage II HTN: Systolic BP 140+ or diastolic BP 90+
Hypertensive crisis: Systolic BP > 180 or diastoli. BP > 120

S/S: usually non but if there are any they would include awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor

S/S indicating hypotension if on antihypertensive meds: dizziness, confusion, syncope, restlessness, and drowsiness

Treatment should be focused on lifestyle modification because older adults are more prone to adverse effects from anti-hypertensive meds;

Rest, biofeedback, yoga, meditation, reduce weight

Reduce sodium intake and increase consumption of garlic, probiotics, fish oil, and whole grains

DASH diet; rich in fruits, vegetables, whole grains and low-fat dairy foods

Vessels become stiffened and thicker

Arteriosclerosis

Usually affects smaller vessels farthest away from the heart

Diagnosed with arteriography and radiography

Treatment: bed rest, warmth, Buerger-Allan exercises and vasodilators

Buerger-Allan exercise consists of lying flat with legs elevated, then sitting on edge of bed, then lying back down completely flat

Alveoli become distended and decrease un surface area

Emphysema

S/S: dyspnea that is not relieved with rest, chronic cough, fatigue, anorexia, weight loss, and weakness

Can lead to life threatening complications: recurrent respiratory infections, malnutrition, congestive heart failure, and cardiac arrythmias (related to cardiovascular system because this causes circulation and cardiac dysfunction)

Treatment: postural drainage, bronchodilators, avoidance of stressful situations, and breathing exercises

Be careful with supplemental oxygen because LOW O2 STIMULATES RESPIRATORY DRIVE!!! Increasing oxygen may then cause respiratory depression

Pt education: pace activities, avoid extremely cold weather, recognize symptoms of infection

Assessment: barrel chest, pink puffer, distant and quiet breath sounds, wheezes, pulmonary blebs on an X-ray

Slight ventricular hypertrophy and thickening of left ventricular wall

Dysrhythmias are more common with age

Decline in systolic blood pressure of 20 mmHg or more after changing positions

Can cause falls, strokes, syncope, or other coronary complications

Heart Failure; inability of the heart to pump enough blood to meet the tissue's oxygen demands

Left sided: pulmonary edema, pulmonary congestion, dyspnea, crackles, cough, tachycardia, fatigue, anxiety, restlessness, confusion

Right sided: peripheral edema, weight gain, distended neck veins, anorexia, weakness, hepatomegaly, ascites (related to respiratory system: with right sided heart failure all the blood and fluid backs up into the lungs and causes respiratory complications)

Decreased taste sensations

Eating becomes more difficult

Tongue atrophies

Xerostomia (Dry Mouth)

Causes; age related decline in saliva production, medications, mouth breathing

Management: frequent oral hygiene, saliva substances , adequate fluid intake, hard sugarless candy and gum

Swallowing is harder due to reduced saliva

Thinning of oral mucosa

Weakening of muscles involved in mastication (related to musculoskeletal system)

Presbyesophagus: degenerative changes in the smooth muscle lining of the lower esophagus which results in weaker contractions and weaker lower esophageal sphincter (related to musculoskeletal system)

Increased risk for aspiration and indigestion

Alterations in absorption

Stomach has a higher pH from a decrease in HCl and pepsin

Reduced pepsin interferes with absorption of protein

Reduced HCl interferes with absorption of calcium, iron, folic acid, and vitamin B12

Fewer cells on absorbing surface of intestinal walls which affects absorption of dextrose, xylose, calcium, iron, and vitamins B, B12, and D

High incidence of constipation

Decreased peristalsis

Reduced activity

Reduced food and fluid intake

Diet low in fiber

Fecal Impaction

Keeping an elimination record will allow identification of changes in bowel habbits

Decreased sensory perception

Chronic Constipation

Pt Education: Encourage a diet high in fiber and fluid and regular physical activity. Rock trunk side to side and back and forth while sitting on the toilet. Ensure they know how to safely use laxatives because laxative abuse could cause this.

Foods to aid in defecation: Raisins, prunes, dates, and currants

Nursing Interventions: Provide a regular time for bowel elimination (mornings are often best time). Keep an elimination chart.

Prevention of constipation is the #1 focus to prevent this

S/S: distended rectum, abdominal and rectum discomfort, oozing of fecal material around the impaction, palpable and hard fecal mass, fever

Slower response and reaction times and weaker reflexes

Loss of nerve cell mass

Atrophy of the brain and spinal cord

Decreased number of nerve cells

Less dendrites and some demyelination of the nerves

Slower nerve conductions

Cerebral blood flow decreases about 20% from fatty deposits slowly accumulating in the blood vessels (related to cardiovascular system)

Delay in time required to perform and complete tasks

Slowing of central processing

Plaques and tangles occur in the brain

Free radicals accumulate

Changes in senses

Decreased sense of taste and smell due to decline in function of these cranial nerves and loss of cells in the olfactory bulb

Dulling of tactile sensation from a decrease in number and sensitivity of sensory receptors, dermatomes, and neurons

Increased levels of taste, sound, scents, touch, and lighting are required for perception in older adults

Nursing actions: give the pt adequate time to respond and keep questions short and to the point

Increased risk for stroke

Ischemic from a thrombus or embolis

Hemorrhagic from a ruptured cerebral blood vessel

Warning S/S: light headedness, dizziness, headache, drop attack and memory or behavioral changes

Nursing interventions during acute phase: maintain patent airway, provide adequate nutrition and hydration, monitor neurologic status and vital signs, and prevent complications with immobility

Presbyopia: decreased ability to focus because of reduced elasticity and stiffening of the muscle fibers of the lens (related to musculoskeletal system)

Visual acuity declines due to opacification of the lens and vitreous

Cataracts

Risk factors: exposure to UV light, diabetes, cigarette smoking, high alcohol consumption, and eye injury

S/S: vision becomes distorted, night vision decreases, objects appear blurred, glares are more bothersome eventually complete lens opacity and vision loss

Treatment: Surgery to remove the lens

Lower BMR due to thyroid gland atrophy and decreased activity

Diminished adrenal function

Volume of pituitary gland decreases

Reduced ability to metabolize glucose

Further caused by decrease in ACTH

Reduced secretion of estrogen, progesterone, androgen, and glucocorticoids

Insufficient release of insulin

Reduced tissue sensitivity to circulating insulin

Reduced exercise and movement

Diabetes Mellitus (Type 2)

S/S: orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathy, confusion, glaucoma, Dupuytren's contracture (fixed flexion of the hands), and infection

Nursing considerations: older adults have have a higher renal threshold for glucose so pt may be hyperglycemic without glycursuria (the higher renal threshold is a normal urinary system change in the older adult)

Diagnostics: glucose tolerance test is the most effective (minimum of 150 g of carbs must be ingested for several days before the test)

Diagnosis is established on one of the following: symptoms of diabetes and a random blood glucose of 200 or higher, HbA1C 6.5% or higher, fasting blood glucose of 126 or higher, or blood glucose 200 or higher after 2 hours of glucose intake for glucose tolerance test

If sufficiently decreased: Hypothyroidism

S/S: fatigue, weakness, lethargy, depression, anorexia, weight gain, puffy face, impaired hearing, periorbital edema, constipation, cold intolerance, dry skin, and coarse hair

Treatment: levothyroxine (give on empty stomach in the morning 1 hour before other medications and meal)

Pt education: medication is lifelong, always wear a Med Alert band, eat a diet that is high calorie and protein and low caffeine and fiber

Reduced sensitivity of pharyngeal reflexes can lead to a higher risk of aspiration pneumonia

Size and weight of the kidney decreases

Hypertrophy and thickening of the bladder muscle

Decrease in bladder's ability to expand

Capacity of the bladder decreased by about 50%

Emptying of the bladder becomes more difficult

Urinary frequency and nocturia increases

There is inefficient neurological control of the bladder emptying which could lead to reflux of urine and increased risk of urinary retention

Bladder muscle becomes weaker (due to musculoskeletal changes)

Increased risk of Urinary Tract Infection

S/S: burning while urinating, urgency, and fever are the first indications

Can cause delirium if left untreated (related to neurological system)

Dementia vs Delerium

Delirium: reversible, identifiable cause, rapidly progressive

Dementia: irreversible, slowly progressive, could be damage or injury to the brain

Nursing interventions and pt education: carefully monitor the pt's I&O, encourage fluid intake, observe for new S/S (bladder distention, skin irritation, any other unusual signs), encourage intake of cranberry juice, avoid catheters if possible

Filtration efficiency of kidneys decreases

Slower elimination of drugs

Higher BUN

Reduced ability to concentrate and dilute urine based on the body's needs

Increase in renal threshold for glucose

Renal calculi can result from changes in the concentration of urine

S/S: pain, hematuria, and symptoms similar to urinary tract infection, GI upset may occur

Management: prevent urinary stasis, provide adequate fluid intake, if calcium stone...decrease calcium intake

Changes in the female

Changes in the male

Atrophy of the vulva, cervix, uterus, fallopian tubes, and ovaries

Reduction in sperm count

Flattening of the labia

Loss of subcutaneous fat and hair

The vaginal epithelium becomes thin and the vaginal environment becomes dry and more alkaline

Breasts sag and are less firm due to the replacement of mammary glands by fat tissue

Atrophy of testes and reduction in testicular mass

Less living sperm in ejaculation

Slight decrease in testosterone

Erection takes longer to achieve and typically is easier lost

Enlargement of the prostate

Erectile Dysfunction

NOT A NORMAL CHANGE OF AGING!! However, caused by chronic conditions that many older adults may have: diabetes, thyroid conditions, hypertension, renal failure, alcoholism, drug abuse, multiple sclerosis, and spinal cord injuries
Also can be caused by several medications that many older adults may be on: anticholinergics, antidepressants, antihypertensives, digoxin, sedatives, and tranquilizers

Treatment: oral erectile agents, drugs injected into the penis, penile implants, vacuum pump devices, surgical implantation of devices, and penile artery reconstruction

Benign prostatic hyperplasia

S/S: dysuria, hesitancy, decreased force of urinary stream, frequency, nocturia, dribbling, poor urinary control and incontinence

Treatment: prostatic massage, urinary antiseptics, and prostatectomy

The change in pH make older adult women more prone to vaginitis

S/S: soreness, pruritus, burning, reddened vagina, and foul smelling vaginal odor that is clear, brown, or white

Treatment: local estrogens in suppository or cream form

Depressed immune response

T-cell activity declines

Cell mediated immunity declines

Increased risk for infections

Decline in inflammatory defenses

Loss of elasticity

Baggy eyelids

Elongated ears

Double chin

Decline in number and size of muscle fibers

Reduced endurance

Reduced grip strength

Decrease in bone density (especially women due to decrease in estrogen after menopause)

Increase risk of fractures

Osteoporosis

Osteoarthritis

Abrasion of joint cartilage with formation of new bone at the joint surfaces

Leading cause of physical disability

Does not cause deformity and crippling

Treatment/Management: analgesics (preferably acetaminophen), rest, heat or ice, aqua-therapy, gentle massage, and acupuncture

Fractures should be suspected anytime an older adult falls or experiences trauma to the bones

S/S: pain, change in shape or length of limb, abnormal or restricted motion, edema, spasms of surrounding tissue, or bone protruding through tissue

Heal slower and higher risk for complications with older adults; pneumonia, thrombus formation, pressure injuries, and contractions

Treatment/Management: calcium or vitamin D supplements, selective estrogen receptor modulators, and hormone therapy

Pt education: avoid heavy lifting, jumping, and other activities that could result in a fracture, encourage range of motion activities and ambulation

Flattening of the dermal-epidermal junction

Reduced thickness and vascularity of the dermis

Decreased rate of epithelial turnover

Reduction in melanocytes

Increased fragility of the skin

Higher risk for skin tears

Bruising easier

Increased risk for pressure injuries

Increased risk for skin infections

Decreased ability to self-regulate temperature and increased intolerance to hot and cold environments

Necrosis, sloughing and/or ulceration may be present

Many different stages

Stage 1: Redness of skin but no breakage of skin

Stage 2: Partial thickness loss of skin, typically involves blisters

Stage 3: Full thickness loss of skin, exposing the subcutaneous tissue, may include tunneling

Stage 4: Full thickness of skin and subcutaneous tissue, exposing bone, muscle or both, tunneling and undermining often present

Unstageable: If covered with slough and/or eschar it cannot be staged until this is removed

Pruritis

Most common dermatologic problem in older adults

Can be caused by anything that dries the pt's skin; excessive bathing and dry heat

Several conditions can contribute to this; diabetes, arteriosclerosis, hyperthyroidism, liver disease, and cancer

The itching may lead to breaking of the skin which puts the pt at risk for infections

Immunosenescence: term meaning aging of the immune system

Leads to the reactivation of varicella zoster and mycobacterium tuberculosis

Pt education for promoting a healthy immune system

Include foods that positively affect the immune system: milk, yogurt, nonfat cottage cheese, eggs, fresh fruits, vegetables, nuts, garlic, onion, sprouts, pure honey, and unsulfured molasses

Supplement with a daily multivitamin

Encourage regular physical activity

Avoid stressful situations/environments