6- Physiological Changes in Aging Flashcards
Age-Related Changes in the Integumentary System
- Fewer nerve cells
- Reduced circulation
- Decrease in collagen
- Less subcutaneous fat
- Reduced sweat glands
What is true about aging?
Increased risk of heat stroke = elderly should wear hats
- Elderly adults have a decreased ability to regulate body temperature, making them more susceptible to heat stroke. Wearing hats can help protect them from direct sun exposure and reduce the risk of overheating
Loss of protection and warmth = wear layers/more clothes
- Older adults often experience a reduction in subcutaneous fat, which provides insulation
Increase susceptibility to skin tears
- As people age, their skin becomes thinner and loses elasticity, increasing the likelihood of skin tears
Reduced circulation/output
- Aging can lead to reduced cardiac output and circulation,
Fewer nerve cells = negatively affects touch, pain, temperature, and pressure
- the number of nerve endings can decrease, diminishing sensations related to touch, temperature, pain, and pressure
Bathing/showering needs decrease
- While mobility and energy levels might impact the frequency of bathing, the actual need for hygiene doesn’t decrease
Nursing care implications related to changes in the integumentary system
- Use skin products: moisturizer and barrier lotion
- Pat skin dry after hygiene e.g. avoid rubbing
- Be careful with routine care e.g. dressing to avoid skin tears
- Monitor pressure areas e.g. earlobes, heels, hips, back sacrum
- Inspect skin, nails, & scalp daily
Age-related Changes in Neurological, Mood, & Behaviours
Having more difficulty learning new things
- Skills, knowledge and insights remains relatively stable
- Recognition and remembering a familiar task remains good
- Learning new skills and problem solving the unfamiliar is more difficult
Sleep patterns change
- Circadian rhythm changes = affects sleep
Thinking is a bit slower, and reaction time has increased
- Decrease in size and connections of neurons leads to:
- slower speed of thinking
- poorer short-term memory
- may lead to increase in reaction time and changes in balanced and/or coordination (e.g. difficult to correct a near fall)
Care Implications for Neurological, Mood, and Behaviours
- Provide more time to complete a task and time to respond to conversation
- Use short and simple statements
- Ask about a person’s life experiences, past interests and accomplishments
- Encourage familiar and routine tasks
- Provide verbal and visual cues to prompt memory (e.g. looking at photos)
- Use memory tools to support self-care (e.g. written schedule of activities, clock, auditory prompts)
Age-Related Changes: Sensory (Eyes)
- difficulty focusing on near objects
- poor night vision
- dryer eyes
- Lens are less flexible
-Smaller pupil size - Decrease in tear production
Age-related changes: Sensory (Ears)
- Decrease ability to hear high frequency sounds
- Less able to follow conversations
- Slower processing of auditory information
- Thicker earwax
- Tympanic membrane thins and stiffens
- Vestibular system may lead to dizziness
Age-related changes: Sensory (Smell & Taste)
- sense of smell and taste have diminished
- Less smell & taste = may affect appetite
- Greater chance of nose bleeds
- Less saliva production
Sensory Care Nursing Implications
Environment
- Position yourself so the person can see you directly when you speak
- Reduce background noise when speaking (e.g. turn off the TV)
- Leave bathroom light on
Communication
- Use black print on light paper for written materials
- Speak using a lower voice and a little more loudly than normal
- Check hearing aids and that ears are not blocked by wax
- Ensure eyeglasses are clean and used if appropriate
- Maintain eye contact and use facial expression and gestures
Respiratory Age-related changes
- Stiffer chest wall, less lung muscle strength, and harder to inflate the lungs
- Decreased gas exchange (a smaller number of alveoli)
- Decreased effective cough response and cough reflex
- Easier to lose breath when working harder than normal, which leads to less ability to tolerate exercise
Respiratory: Care Implications
- Arrange for rest breaks while walking or doing activities
- Encourage person to
periodically take deep breaths
Reduce the risk of infection with regular oral hygiene - Monitor/treatment of respiratory infections
- Vaccination
Cardiovascular: Age-related changes
(heart can not increase output)- Cardiac changes can be related to lifelong practices (e.g. exercise, smoking)
- The heart needs to work harder due to thicker heart muscles, stiffer arteries and heart valves
- Less cardiac reserve= more tiredness, shortness of breath, and a slow recovery from activity
- Higher risk for a drop in blood pressure and light-headedness when changing positions (postural hypotension)
- Blood pressure may be overestimated due to stiff arteries; systolic blood pressure may increase
- Ankle swelling may occur from pooling of blood from changes in calf veins
Cardiovascular: Care Implications
- Encourage physical activity most days (e.g. walking and/or seating exercises)
- Arrange for rest breaks while walking or doing activities
Change positions slowly (e.g. r/t: risk of dizziness or orthostatic hypotension) - Prevent dehydration: Offer water/fluids ~ 6-8 glasses a day
- Encourage person to pump their ankles before standing
- Prevent prolonged sitting
Musculoskeletal: Age-related changes
- Less muscle mass & coordination = weakness and diminished exercise tolerance
- Less cartilage-forming cells = more joint damage
Cartilage erodes = changes in how one stands, height, range of motion (limited), more joint instability, higher risk of falls and fractures?, less flexibility and less mobility
- Bone mass decreases = higher risk of osteoporosis (risk of fractures?)
Musculoskeletal: Care Implications
- Enable the person to participate maximally in activities (e.g. dressing)
“If you don’t use it, you lose it” - Assist with daily active and passive exercises
- Apply universal fall prevention approaches (e.g. good footwear, clear pathways, lighting)
- Promote walking, weight-bearing, strength and balance exercises
- Attention to bone health: dietary calcium, vitamin D supplement, and exercise
- Aid with transfer and mobility as determined
Gastrointestinal: Age-related changes
Cause of minimal bowel movements
- Less able to taste and feel thirst
- Decrease lean body mass and water stores= risk of dehydration
- Less calories needed but same nutritional needs
Concern for Loosing teeth
- Decreased strength of chewing muscles & loose dentures can affect nutrition
- Dry mouth with decreased saliva (may also be caused by medications)
- Swallowing muscles are less effective = risk of swallowing difficulty (concern? Refer to?)
Gastrointestinal: Care Implications
- Encourage to drink even if not thirsty/offer water or fluids throughout day ~ 6-8 glasses/day (min 1500 mL/d)
- Consult dietitian if intake is <50% or if weight loss
- Optimize nutrition
- Support physical activity efforts, regular toileting routine
- Regular/good oral hygiene is imperative
- Consult loose dentures
Genitourinary (Kidneys): Age-related changes
- Kidney size may decrease due to less blood flow = reduced ability to regulate sodium and H2O
- Therefore, higher risk of electrolyte imbalance
- Higher risk of water retention and dehydration
- Renal function is usually adequate to meet demands but may be challenged with illness, fever and co-morbidities
Genitourinary (Bladder): Age-related changes
- Decrease bladder capacity (from 500-600 mL to 150-250 mL)
- Incomplete emptying after voiding (residual) (may increase risk of infection)
- May experience more frequent voiding and need to void at night =
-The sensation of needing to void maybe delayed
- Weaker pelvic floor muscles (female)
- Decreased estrogen leading to tissue shrinkage and less lubricating secretions
- Shorter and vulnerable urethra increases risk of infection
- Larger prostate compresses the urethra and leads to difficulty voiding
- voiding and notbeing able to control it
Genitourinary: Care Implications
- Changes in kidney function require a review of medications
- Avoid and manage constipation(!)
- Offer water/fluids throughout day~ 6-8 glasses/day (min 1500 mL/d), consider evenings
- Minimize caffeine intake
- Do not treat asymptomatic bacteriuria (i.e. no symptoms arising from the genitourinary tract such as urgency, frequency, discomfort)
- Use prompt voiding, routine or scheduled toileting as appropriate
Safety: Age-related Changes
- Decreased immune response
- Increase risk for infection due to age related changes (e.g. skin thinner, changes in bladder and respiratory systems)
- Reduced immunity (decrease in T-cell function)
- A fever with infections is less likely
- Delay in elevated WBC with infection may occur
- Less able to regulate heat
Safety: Care Implications
- Be alert to atypical presentation of infection e.g.?
- Apply universal precautions and infection control measures
- Practice medication reconciliation and medication review
Geriatric Syndromes
- common clinical conditions that do not fit into specific disease categories but have implications for functionality and life satisfaction
- not the result of a specific underlying disease; the presenting symptoms is multifactorial
- results from accumulation of many impairments in body systems and an inability for individual to compensate for impairments
Examples of Geriatric Syndromes
Delirium
Incontinence
Falls
Pressure ulcers
Functional Decline
Depression
Frailty
Malnutrition
Sleeping problems
Polypharmacy
Dementia
Geriatric Syndromes can lead to:
- Increased mortality
- Disability
- Decreased financial resources
- Longer hospitalization
- Diminished quality of life
Urination
Normal urination =
- Typically 6-8 times per day
- Clear to pale yellow in color
- Mild odor
- Steady, comfortable flow with no pain or discomfort
- Complete emptying of the bladder
Abnormal urination
- Increased frequency or urgency beyond usual patterns (e.g., going more than 8 times per day or needing to go urgently)
- Dark yellow, cloudy, or strong-smelling urine
- Pain, burning, or discomfort during urination
- Incomplete emptying of the bladder
- Blood in the urine (hematuria)
- Urine leakage or incontinence
- The kidneys lie on either side of the vertebral column behind the peritoneum and against deep muscles of the back.
- Ureters are tubular structures that enter the urinary bladder obliquely through the posterior wall at the ureterovesical junction.
- Urine travels from the bladder through the urethra.
- Urination is AKA micturition or voiding.
- Normally, the left kidney is higher than the right one because of the anatomical position of the liver
Urinary Incontinence
- Refers to the involuntary leakage of urine
- Mistaken as a normal part of aging
- Underreported, underdiagnosed, and undertreated
- more females than men over 85 experience UI
- 79% of residents in LTC experience UI
Urinary Terms
Anuria: The absence of urine production (urine output of < 100 mL/ day)
Polyuria: The production of abnormally large volumes of dilute urine (> 3 liters/day in adults.
Dysuria: Painful or difficult urination, often described as a burning sensation.
Nocturia: The need to wake and urinate during the night, interrupting sleep.
Hematuria: The presence of blood in the urine, which can be visible (gross hematuria) or detectable only under a microscope (microscopic hematuria).
Pyuria: The presence of pus in the urine, indicating a urinary tract infection.
Oliguria: A decreased urine output (< 400 milliliters/ day in adults)
Ketonuria: The presence of ketone bodies in the urine, which can occur in conditions like uncontrolled diabetes mellitus or during periods of fasting
Risk Factors for Urinary Incontinence
- Increased Age
- Immobility or limited mobility
- Dementia
- Certain medications that may - increase the frequency and/or urgency of voiding
- High caffeine intake
- History of pregnancy and vaginal childbirth
- Pelvic floor weakness
Types of Urinary Incontinence
Transient (acute) UI
- Sudden onset
- Present for less than 6 months
- May be secondary to treatable causes such as UTIs, delirium, metabolic conditions causing increase urination, bedrest, or certain medications
Established (chronic) UI
- Lasts longer than 6 months
- Further divided into subtypes
Types of Established Urinary Incontinence
1) Urge incontinence (overactive bladder)
- overactive bladder muscles create a sensation of ‘I need to go now’ (urgency)
- the individual is unable to supress the urge to void before reaching the bathroom
- Most common type
2) Stress incontinence (outlet incompetence)
- involuntary loss of a small volume of urine when the intra-abdominal pressure increases (during activities such as coughing, sneezing, lifting)
- More common in women
3) Urge or stress incontinence with a high post-void residual (previously called overflow incontinence)
- When the bladder does not empty properly, it becomes overdistended.
- The individual experiences frequency ‘dribbling’ of urine and a feeling of incomplete emptying of the bladder
E.g. In men with enlarged prostate
4) Functional incontinence
- the lower urinary tract is functional, but the individual cannot reach the bathroom before of other factors, including environmental barriers, cognitive impairment, or physical limitations
- Common in LTC
5) Mixed incontinence
- combination of more than one type
Nursing Care for Patients with UI: Interventions
Behavioural Interventions
- Scheduled voiding (q2-4hr) for urge UI and functional UI
- Bladder training (gradually increasing intervals between voids to retrain bladder muscles) for urge UI
- Pelvic floor muscle exercises (Kegels) for urge, stress, and mixed UI
Lifestyle modifications
- Drink more during the daytime/less after dinner
- Weight loss if appropriate
- Eliminate or reduce caffeine and alcohol consumption
What is included in a urinary elimination assessment?
1) Health History
2) Physical Exam
Skin
Kidneys
Bladder
3) Urinalysis
Testing for UI
Urinalysis:
pH (4-6), protein, glucose, ketones, blood, specific gravity
WBC
Bacteria (none)
Casts (none)
Culture
Managing Incontinence
1.
2.
3.
4.
Consequences of Urinary Incontinence
Urinary incontinence is associated with an increased risk of:
- Falls
- Skin breakdown
- Pressure ulcers
- Urinary tract infections
- Anxiety & depression
- Social isolation
- Avoidance of sexual activity
- UI is associated with a loss of independence, confidence, and dignity
Bowel Management Assessmenr
- MedicalHistory
- Surgical history
- Current bowel habits
- Diet
- Medications
- Physical assessment of GI tract (mouth, abdomen, rectum)
Risk Factors for FecalIncontinence
- Increasedage
- Loose bowel movements
- Bowel-related disorders
- Dementia
- Spinalcord injury & otherneurological conditions
- Impaired mobility
Bowel Management: FECAL IncontinencePrevention and Management
- Comprehensive assessment of bowel habits, diet, medications, and health history
- Psylliumfibre supplements may bebeneficial
- Establish a boweltraining program(fibre, fluids, exercise)
- Take an interdisciplinary approach
- Ensure properperi-care
- Usebedpans and commodes when able
Bowel Management: CONSTIPATION Prevention and Management
- 30-60 minutes oflow-intensity physical activity at least 3x per week
- Adequatefibre intake
- Adequate fluid intake
- Individualized bowel protocol
What is the most appropriate way for the nurse to reduce the chance of infection with a client who has an indwelling urinary catheter?
Handwashing and catheter care
