Age Related Changes

7/23/2019 Age Related Changes

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Age-Related Changes



THE LIVED EXPERIENCE

Strange how these things creep up on you.I really was surprised and upset when Ifrst realized it was not the headlights on

my car that were dim but only my agingnight vision. Then I remembered otherbits o! awareness that !orced me torecognize that I that "#-year-old insideme was e$periencing changes that goalong with getting older.

%Sally, age 60



Age-Related Changes

• The well-being o! older peopledepends on several !actors

• &hysical

• &sychosocial

• 'ental

•

Social• (conomic

• (nvironmental



Physical Aspects ofAging• Cellular and e$tracellular changes o! old

age cause a change in physicalappearance and a decline in !unction.

• 'easurable changes in shape and bodyma)eup occur.

• The body*s ability to maintain homeostasisbecomes increasingly diminished withcellular aging and organ systems cannot!unction at !ull e+ciency because o!cellular and tissue defcits.



Cardioasc!lar "yste#

Age related changes reduce the e+ciencyo! the heart and contribute to decreasedcompliance o! the heart muscle these

include,• Thic)ened cardiac valves

• ecreased myocardial contractibility

• ecreased elasticity o! blood vessels• ecreased elasticity and increased

stiness o! the arterial wall




• /oss o! atrial pacema)er

• Reduction o! hemapoietic activity

•

Increased blood coagulability• ecreased e+ciency o!

baroreceptors




"!$%ectie and &$%ectie 'indings

• Complaints o! !atigue with increasedactivity

• Increased heart rate recovery time

• 0ptimal blood pressure "12342 mm 5g

• &rehypertension

• "126"78342648 mm 5g

• 5ypertension "92382 mm 5g




Health Pro#otion "trategies

• ($ercise regularly

• &ace activities

• Avoid smo)ing

• (at a low-!at low-salt diet

• &articipate in stress-reduction activities:

• Chec) blood pressure regularly:• 'edication compliance:

• ;eight control



Respiratory "yste#

The respiratory system is the one system that seemsto be the most able to compensate !or the !unctionalchanges o! aging. These are,

• Reduced chest compliance

• Increased A& diameter o! thora$

• Reduced breathing capacity

• Reduced vital capacity

• Increased residual volume

• ecreased cough and laryngeal re<e$

• ecreased ciliary activity

• ecreased elasticity o! tissue



Respiratory "yste#


• =atigue and breathlessness withsustained activity

• ecreased respiratory e$cursion andchest3lung e$pansion with lesseective e$halation

• i+culty coughing up secretions



Respiratory "yste#



• Avoid smo)ing

• Ta)e ade>uate <uids to li>ue!y secretions:

• Receive yearly in<uenza immunizationand pneumonia vaccine at #? years o!

age:• Avoid e$posure to upper respiratory tract

in!ections



Integ!#entary "yste#

• /oss o! subcutaneous supporting tissues

• Sensitive to pressure and ulcer

• ;rin)le and sag

• ry wrin)led loss elasticity

• ecreased perspiration and sebum

• =ragile easily in@ured

• ecreased s)in turgor• ecreased sebaceous secretions

• ry <abby prone to itching




• Atrophy o! tiny arterioles near epidermis

• Impaired vasomotor homeostaticmechanism

• &oor temperature regulation !eels coldeven in warm climateB

• 5AIR- decreased number o! hair !ollicles

scant fne graying hirsutism possiblehereditary baldness

• AI/S- dry thic) brittle

















• Thin wrin)led and dry s)in

•

Complaints o! in@uries bruises andsunburn

• Complaints o! intolerance to heat

•

Done structure is prominent





• /imit solar e$posure to "26"? minutes daily

!or vitamin

•Ese protective clothing and sunscreen

• ress appropriately !or temperature

• 'aintain a sa!e indoor temperature

• Ta)e shower rather than hot tub bath i!possible

• /ubricate s)in with lotions that containpetroleum or mineral oil



(!sc!los)eletal "yste#

• Increase !at substitution !or muscle

• 'uscle atrophy

•

ecreased muscular strength and!unction

• /oss o! Calcium !rom bones

•

0steoporosis is common• eterioration o! cartilage

• ;ear !riction stiness o! @oints




• (asily tired less stamina

• Impaired range o! motion resulting!rom sti @oints

• Feneralized loss o! #-"2 cm in staturebecause o!, <e$ion o! )nee and hip @oint narrowing o! intervertebral dis)s

• Dody ta)es on bony angularapperance





• 5eight loss

•

&rone to !ractures• Gyphosis

• Dac) pain

•

/oss o! strength <e$ibility andendurance

• Hoint pain






•

(at a high-calcium diet:• /imit phosphorus inta)e

• Ta)e calcium and vitamin

supplements as prescribed



*astrointestinal "yste#

• ecreased salivation

• i+culty swallowing !ood

• ecreased sense o! thirst smell and

taste:• 'inimal loss o! digestive enzymes

• elayed esophageal and gastric

emptying• ecreased absorption

• Increased !ood intolerance




• Redistribution o! body !at: increased !atin trun) especially in abdomen

• Teeth and gum problems common

• ecreased peristalsis slowed digestion

• Reduced gastrointestinal motility

• Atonia constipation in common

• ecreased metabolism, caloricre>uirement appro$imately "222 caloriesper day





• Ris) o! dehydration electrolyteimbalances and poor nutritional inta)e

•

Complaints o! dry mouth• Complaints o! !ullness heartburn and

indigestion

• Constipation <atulence and

abdominal discom!ort





• Ese ice chips mouthwash

• Drush <oss and massage gums daily

• Receive regular dental care

• (at small !re>uent meals

• Sit up and avoid heavy activity a!ter eating

• /imit antacids

• (at a high-fber low-!at diet

• /imit la$atives

• Toilet regularly

• rin) ade>uate <uids



Nero!s "yste#

• Reduced speed in nerve conduction

• Increased con!usion with physical illness and losso! environmental cues

• Reduced cerebral circulation decreasedcoordination and balance B

• Some impairment o! sensory perception

• Fradual decrease o! visual and auditory acuity

•

Altered capacity to retain new in!ormation andlearn new tas)s

• Some impairment o! memory and metalendurance



Nero!s "yste#


• Slower to respond and react

•

/earning ta)es longer• Decomes con!used with hospital

admission

•

=aintness• =re>uent !alls



Nero!s "yste#


• &ace teaching

• ;ith hospitalization encourage visitors

• (nhance sensory stimulation

• ;ith sudden con!usion loo) !or cause

• (ncourage slow rising !rom a restingposition



"pecial "enses +Vision,

• iminished ability to !ocus on close ob@ectspresbyopiaB

• Inability to tolerate glare

•

i+culty ad@usting to changes o! light intensity• ecreased ability to distinguish colors

• arrowed feld o! vision tunnel visionB

• Color in the iris may !ade and the pupil may

become irregular in shape• ecrease in production o! secretions by the

lacrimal glands





• 5olds ob@ects !ar away !rom !ace

•

Complains o! glare• &oor night vision

• Con!uses colors





• ;ear eyeglasses use sunglasses outdoors:

• Avoid abrupt changes !rom dar) to light:

•

Ese ade>uate indoor lighting with area lightsand nightlights

• Ese large-print boo)s use magnifer !or reading

• Avoid night driving

• Ese contrasting colors !or color coding• Avoid glare o! shiny sur!aces and direct sunlight



"pecial "enses +Hearing,

• ecreased ability to hear high!re>uency sounds

• Sesorineural hearing defcitpresbycusisB gradual loss o! abilityto discriminate to high !re>uencytools

• Tympanic membrane thinning andloss o! resiliency





• Fives inappropriate responses

• As)s people to repeat words

• Strains !orward to hear





• Recommend a hearing e$amination

• Reduce bac)ground noise

• =ace person

• (nunciate clearly

•

Spea) with a low-pitched voice• Ese nonverbal cues



"pecial "enses +Taste "#ell,

• Cell loss in the nasal passages and inthe ol!actory bulb in the brain

• ecreased ability to taste and smell





• Eses e$cessive sugar and salt

• /oss o! appetite





• (ncourage use o! lemon spicesherbs

• Recommend smo)ing cessation



*enito!rinary "yste#

'ale and =emale,

• ecrased blood <ow

• Reduced F=R

• Reduced nephrons

• ecrased creatinine clearance

• Increased propensity to to$ic eects o!

drugs• ecreased renal capacity to concentrate

urine at night




'ale,

• Denign prostatic hyperplasia

=emale,

• Rela$ed perineal muscles detrusor

instability urge incontinenceB urethral

dys!unction stress urinaryincontinenceB





Male:

• Erinary retention

• Irritative voiding

• Symptoms including !re>uency

!eeling o! incomplete bladderemptying and multiple nighttimevoidings





Female:

• Ergency3!re>uency syndrome

• ecreased warning timeJ

• rops o! urine lost with cough laugh

position change





Male:

• /imit drin)ing in evening egcaeinated beverages alcoholB

• o not wait long periods betweenvoiding and empty bladder all theway when passing urine.





Female:

• ;ear easily manipulated clothing:

• rin) ade>uate <uids

• Avoid bladder irritants eg caeinatedbeverages alcohol artifcial sweetenersB

• &elvic <oor muscle e$ercises pre!erablylearned via bio!eedbac)

• Consider urologic wor)up



Reprod!ctie "yste#

=emale,

• Kaginal narrowing and decreased elasticity:

• ecreased vaginal secretions

• 'enopause secondary to decreased (strogen'ale,

• /ess frm testes and testosteronespermatogenesis and size o! testes

'ale and =emale,

• Slower se$ual response



Reprod!ctie "yste#


Female:

• &ain!ul intercourse

• Kaginal bleeding !ollowing intercourse

• Kaginal itching and irritation

• elayed orgasm

Male:• elayed erection and achievement o!

orgasm



Reprod!ctie "yste#


• 'ay re>uire vaginal estrogenreplacement:

• Fynecology3urology !ollow-up

• Ese a lubricant with se$ualintercourse





Psychosocial Aspects of Aging

• Success!ul psychological aging is re<ected in theability o! older people to adapt to physical socialand emotional losses and to achieve li!esatis!action.

• A positive sel!-image enhances ris) ta)ing andparticipation in new untested roles.

• Ageism is based on stereotypes simplifed ando!ten untrue belie!s that rein!orce society*s

negative image o! older people.• =ear o! aging and the inability o! many to con!ront

their own aging process may trigger ageist belie!s.



Stress and Coping

• Coping patterns and the ability to adapt to stressdevelop over the course o! a li!etime and remainconsistent later in li!e.

• A person*s abilities to adapt to changes ma)e

decisions and respond predictably are alsodetermined by past e$periences.

• ($periencing success in younger adulthood helpsa person develop a positive sel!-image that

remains solid through old age.• 5owever losses may accumulate within a short

period o! time and may become overwhelming.



Stress and Coping

Common stressors o! old age include,

• ormal aging changes that impairphysical !unction activities and

appearance• isabilities !rom in@ury or chronic illness

• Social and environmental losses related

to loss o! income and decreased abilityto per!orm previous roles and activities

• eaths o! signifcant others



Living Arrangement

• 'ost older people want to remain in theirown homes: in !act they !unction best intheir own environment.

•

0lder people tend to relocate in responseto changes in their lives such asretirement or widowhood a signifcantdeterioration in health or disability.

• The type o! housing they choose dependson their reason !or moving.



Living Arrangement

Contin!ing Care Retire#entCo##!nities

• Independent Single welling 5ouses or

Apartments !or people who can manage allo! their day-to-day needs

• Assisted Liing Apart#ents !or thosewho need limited assistance with their daily

living needs:• ")illed N!rsing "erices when

continuous nursing assistance is re>uired.



Living Arrangement

Assisted Liing 'acilities

• An option when an older person*sphysical or cognitive changes necessitate

at least minimal supervision or assistance.• allows !or a degree o! independence while

providing minimal nursing assistance withadministration o! medication assistance

with A/s or other chronic health careneeds.



Living Arrangement

Long-Ter# Care 'acilities

• 0er continuous nursing care.

• /ong-term =acility

• Short-term Rehabilitation !acility• Subacute Care =acility oers a high level o!

nursing care that may either avoid the need!or a resident to be trans!erred to a hospital

!rom the nursing home or allow ahospitalized patient to be trans!erred bac)to the nursing !acility sooner.



Family Role

• the !amily has been and continues tobe an important source o! support !orolder people

• older !amily members provide agreat deal o! support to younger!amily members



Cognitie Aspects of Aging

• Cognition can be aected by manyvariables including sensoryimpairment physiologic health

environment and psychosocialin<uences.



Intelligence

• Test scores !or older adults show a progressivedecline beginning in midli!e when intelligencetest scores !rom people o! all ages arecompared.

• (nvironment and health have a considerablein<uence on scores

• ecline in spatial perceptions and retention o!nonintellectual in!ormation

• Improvement or retention o! problem-solvingability based on past e$periences verbalcomprehension mathematical ability.



Intelligence

&ositive eect on intelligence arenoted with,

• Cardiovascular health

• A stimulating environment

• 5igh levels o! educationoccupational status and income



Learning and Memory

Intelligence memory and the capacity!or learning are demonstratedcontinuously by older adults who have,

• higher levels o! education

• good sensory !unction

• good nutrition and

• @obs that re>uire comple$ problem-solving s)ills.



Learning and Memory

In general there is ,

• A decline in =luid intelligence thebiologically determined intelligence

used !or <e$ibility in thin)ing andproblem solving.

• An intact Crystallized intelligence

that gained through education andli!elong e$periences eg verbal s)illsB



Learning and Memory

Strategies to allow adults to learn,

• Supply mnemonics to enhance recall o!related data

•

(ncourage ongoing learning• /in) new in!ormation with !amiliar

in!ormation

• Ese visual auditory and other sensory cues

• (ncourage learners to wear prescriptionglasses and hearing aids



Learning and Memory

Strategies to allow adults to learn,

• &rovide glare-!ree lighting

• &rovide a >uiet nondistracting environment

•

Set short-term goals with input !rom the learner• Geep teaching periods short

• &ace learning tas)s according to the enduranceo! the learner

• (ncourage verbal participation by learners• Rein!orce success!ul learning in a positive

manner



"!icide in the elderly

". Severe physical illness or mentalillness

1. eath o! a spouse

7. Threat o! e$treme dependency orinstitutionalization

9. Retirement

?. &athological personal relationship

#. Alcoholism and drug addiction

(ental Health Pro$le#s in the



(ental Health Pro$le#s in the&lder Ad!lt

• epression, most common aectivedisorder o! old age: results !rom changesin reupta)e o! neurochemical serotonin in

response to chronic illness emotionalstresses related to physical socialchanges associated with aging process

• elirium, acute con!used state that

begins with disorientation – I! not immediately evaluated and treated can

progress to changes in level o! consciousnessirreversible brain damage sometimes death



De#entia

• Droad term !or syndromecharacterized by general decline inhigher brain !unctioning reasoningB

with pattern o! eventual decline inability to per!orm even basicactivities o! daily living toileting

eatingB – Alzheimer*s disease

– Kascular ementia



N!rsing Care of the &lder Ad!lt

• Feriatrics, feld o! practice that !ocuses onphysiology pathology diagnosis management o!disorders diseases o! older adults

• Ferontological3geriatric nursing, feld o! nursing

that relates to assessment nursing diagnosisplanning implementation evaluation o! olderadults in all environments including acuteintermediate s)illed care as well as withincommunity

• Ferontology, combined biologic psychologicalsociologic study o! older adults within theirenvironment



N!rsing (anage#ent

• Supporting cognitive !unction

• &romoting physical sa!ety

• &romoting independence in sel!-careactivities

• Reducing an$iety agitation

• Improving communication

N!rsing (anage#ent



N!rsing (anage#ent+cont.d,• &roviding !or socialization intimacy

needs

• &romoting ade>uate nutrition

• &romoting balanced activity rest

• Supporting home- community-basedcare



Phar#acologic Aspects

• &olypharmacy, administration o!multiple medications at same time:common in older persons with

several chronic illnesses• Aging changes alter drug,

– Absorption

– 'etabolism – istribution

– ($cretion



N!rsing I#plications

• eed ad@ustment o! dosage due to age:start low go slowJ

• Assess medication )nowledge use

•

eed !or medication review coordinationo! prescriber

• &roblem o! noncompliance, – =actors that aect compliance

– Geep medication regimen as simple as possible

– Strategies to improve compliance



*eriatric "yndro#es

• Impaired mobility

• izziness

• =alls !alling

• Erinary incontinence

• Susceptibility to in!ection

• Altered pain !ebrile responses

• Altered emotional impact

• Altered systemic response

Potential Econo#ic



Potential Econo#icE/ects• Social services

• 5ealth care costs o! aging

• 5ome health care

• 5ospice services

• Aging with a disability

Life-threatening #ane!ers $y



Life-threatening #ane!ers $ythe elderly

". Re!using medication

1. ot !ollowing physician*s orders andrecommendations

7. Smo)ing and drin)ing againstmedical advice

9. Re!usal to eat or eating minimally

?. &lacing sel! in a hazardousenvironment



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Age Related Changes