Age Related Changes in Health

1. Age Related Changes in Health Geriatric Nursing Protocol: Age-Related Changes in Health Research Cited from: Constance M. Smith, PhD, Valerie T. Cotter, MSN

2. Overview • When are age-associated changes most advanced/pronounced? • Complications? • May alter the person’s response to illness • Show great variability among individuals • Often impacted by genetic & long-term lifestyle • Common decline in functional reserve with reduced response to stressors

3. Statement of Problem • Why are gerontological changes important in care and assessment? • Can affect health and functionality and require therapeutic strategies • MUST be differentiated from pathological processes • Predisposed to disease • Altered disease presentation • Responses to treatment and outcomes

4. Cardiovascular Changes • A. Definition • Arterial wall thickening and stiffening • B. Implications: • Decreased cardiac reserve • C. Assessments: • ECG, heart rate, rhythm, murmurs, heart sound • Assess BP and Pulse Pressure

5. Pulmonary System • A. Definition • Decreased respiratory muscle strength; stiffer chest • B. Implications: • Drier mucus membranes; decreased cough reflex • Decreased exercise tolerance • Decreased cough/mucus clearance • Increased risk of infection/airway obstruction

6. Pulmonary System • C. Assessments: • Assess respiration rate, regularity, volume, depth, and exercise capacity • Inspect thorax appearance; obtain smoking history • Monitor secretions, breathing rate

7. D. Care Strategies • Maintain patient airways through upright positioning • Provide oxygen as needed • Maintain hydration & mobility • Education on cough enhancement • Smoking cessation

8. Renal & Genitourinary System • A. Definition • Determine renal function • Calculation of creatinine clearance • B. Implications: • Decreased in kidney mass, blood flow • Reduced bladder elasticity, muscle tone, capacity • Males; prostate enlargement • Reduced renal functional reserve; risk of renal complications in illness • Risk of volume overload, dehydration • Increased risk of urinary urgency, incontinence, UTI

9. Renal & Genitourinary System • C. Assessments: • Assess renal function • Assess for fluid/electrolytes and acid • Evaluate urinary incontinence • Assess UTI symptoms

10. D. Care Strategies • Monitor nephrotoxic and renally cleared drug levels • Maintain fluid and electrolyte balance • For nocturnal polyuria: limit fluids in evening, avoid coffee, prompt a voiding schedule

11. Oropharyngeal & Gastrointestinal Systems • A. Definition: • Healthy BMI: 18.5-24.9; overweight: 25–29.9; obesity, 30+ • B. Implications: • Decreases in strength of muscles of mastication, taste, and thirst perception • Decreased gastric motility and delayed emptying • Decreased metabolism of drugs

12. Oropharyngeal & Gastrointestinal Systems • B. Implications: • Risk of chewing impairments • Fluid imbalances; poor nutrition • Maldigestion-induced ulcers • C. Assessments: • Assess oral cavity • Bowel sounds • Stable liver function tests • Monitor weight; calculate BMI • Constipation and fecal incontinence

13. D. Care Strategies • Monitor drug levels and liver function tests • Assess nutritional indicators • Educate on lifestyle modifications and OTC medications • Education on normal bowel frequency, diet, exercise • Encourage mobility • Encourage participation in community-based nutrition programs

14. Musculoskeletal System • A. Definition: • Decline in muscle mass and strength • B. Implications: • Increased weakness & poor exercise tolerance • Body mass replaced by fat/redistribution of fat • Bone loss in women/men after peak mass at 30-35yrs • Decreased ligament/tendon strength • Intervertebral disc degeneration; cartilage erosion • High reduction

15. Musculoskeletal System • B. Implications: • Increased risk of disability, falls, and unstable gait • Risk of osteoporosis • Limited ROM, joint instability

16. D. Care Strategies • Physical activity through health education and goal setting • Pain medications • Strategies to prevent falls • Prevent osteoporosis by adequate daily intake of calcium and vitamin D, physical exercise, bone mineral density, smoking cessation

17. Nervous System and Cognition • A. Definition: • Decrease in Neurons and Neurotransmitters • B. Implications: • Impairments in general muscle strength • Nerve conduction velocity • Slower motor skills; imbalance and coordination deficits • Decreased temperature sensitivity • Slower cognitive speed • Increase risk of sleep disorders

18. Nervous System and Cognition • C. Assessments: • Evaluate with periodic reassessment • Assess temperature during illness or surgery

19. D. Care Strategies • Institute fall prevention strategies • Encourage lifestyle practices of regular physical exercise • Intellectual stimulation • Healthful diet • Recommended behavioral interventions for sleep disorders

20. Immune System • A. Definition: • B. Implications: • Increased susceptibility to infection • Reduced efficacy of vaccination • Chronic inflammatory state • C. Assessments: • D. Care Strategies: • Follow immunization recommendations; seasonal, influenza, tetanus, hepatitis