Age Related Changes Flashcards
Cognition: fluid intelligence
Includes: abstraction, calculation, common sense. Breadth of knowledge Prefrontal cortex - depends on persons inherit abilities
- allows someone to draw conclusions about complex relationships
- with age related changes fluid intelligence may decline
Sexual and reproductive changes
- Decrease sexual activity is more situational 2. Drug side effects 3. Decrease in estrogen and testosterone 4. Sexual dysfunction is NOT normal part of aging 5. Decrease ovarian function
Cognition: crystal intelligence
Hippocampus: Congnitive skills, such as vocab, info, verbal comprehension. = wisdom, judgement and life experiences.
Ie. How do I do a dressing change while fluid intelligence is what dressing do I use - cognition skills that are acquired through culture, education, information learning and other life experiences “School smarts”
- does not disapear with age related changes. only speed is affected by age.
What is the mmse good for?
Memory
What is moCa for
Abstract thinking, frontal lobe, fluid intelligence
Cognitive Function: Nursing assessment
- risk factors
- mental status exam
- self perceptions about cognition
age related changes: cognitive function
-↓ number of neurons
-↓ weight of brain
-Histological changes in brain; ↑ intracellular pigment,↓ protein synthesis, **senile plaques **
-↓rate of conduction in peripheral nerves
**Change in sleep patterns
-**Depletion of dopamine and some of the enzymes in the brain
- ↑ accumulation of lipofuscin
-query diminished brain cholinergic reserve
** slower reaction time
Consequences to age related changes in cognition/neuro function
• ↓ Adaptability
• Slower response to stimuli
• ↓ Sensation
• Impaired proprioception
• Gait changes
• ↓ deep tendo n reflexes
• Slower voluntary movement
• Sleep pattern disturbances
• Susceptibility to
environmental temperature
changes
• ↓ short-term memory
Risk factors to age realted changes in cognition
- myths about cognitive aging
- decreased vision and hearing
- adverse effects of alcohol and medications
- diseases (dementia and depression)
- nutritional deficiencies
Nursing intervtions for change in cognition
- teaching about cognition changes in aging
- memory enhancing techniques
- activities to promote brain fitness
- develop strong social netwroks
- physical exercise
- activities where they have a sense of control
what is scaffolding theory of aging?
explains the adaptive response of the brain to the declining nerual structures and function.
Scaffolding is a normal process that involves using ulternate routes in the mind to achieve cognitive goal
Brain and white matter changes
Loss of white matter
Decreased cerebral flow and corticol volume
loss, especially in the frontal lobes
Decreased brain weight
Decreased blood flow
Nerve cell changes
Number of nerve cells (neurons) in the braindecreases
Varies from person to person
Remaining cells do not function as well as they should
Decreased rate of conduction in peripheral nerves
Change in blood flow to the brain
Decreased blood flow to the brain as you age can be caused or cause a stroke or other impairments. Leads to decrease in cognitive ability
Change in Conduction Velocity
Slower conduction along nerve pathways result in decreased reaction time, slower thought processes, etc
Change in reaction time
Decreased rate of conduction in peripheral nerves, along with slower processing time,causes a slower reaction time. Decrease in adaptability
Change in central processing
In ability to learn new things, inability to process new information
change in verbal skills
- Loss of ability to communicate what they are thinking and what they are trying to say
- Visual changes include: yellowing, opacity and rigidity of the lens, decrease pupil size, decreased accommodation, less efficient absorption of intracellular fluid, narrowing of the visual field, decreased lacrimal secretions, decreased number of cones in the retina
- Hearing changes include: decreased number of nerve cells in 8th, Increased production of cermen, Atrophy of rigidity of ossicles. Decreased elasticity of tympanic membrane cranial nerve
what is presbyopia
inability to focus properly
- Distorted depth perception
- Decreased color perception
- Need for stronger light
- Increased sensitivity to glare
- Drier cornea
Presbycusis
- High frequency losses occur first
- Tone discriminating loss
- Difficulty following conversations
- Difficulty following conversations
- Cerumen impaction
- Social isolation
Cranial nerve change
Loss of elasticity can result in a loss of ability to control facial muscles, changes in eyesight, hearing, etc
Change in hypothalamus
Changes in ability to control homeostasis in body can result in heat flashes or feeling cold all the time. Susceptibility to environmental temperature changes
Change in sleep patterns
Less time spent in deep sleep, shorter REM cycles. Waking during sleep very common
Cause of change in personality and emotions
Decrease of dopamine and some of the enzymes in the brain
change in intelligence and intellectual performance
Decreased brain weight and blood flow can cause cognition problems, inability to learn new things, shorter attention span, and memory loss
Change in memory
Slower processing affect, Motivation, expectation, experience, personality may all decrease, Limited memory effortful memories decrease due to limited task demands learning ability, IQ, cognitive ability, background health history, and overall health.
Both primary (short) and secondary (long) memory decline in older adults, however have long term memory storage and a decrease of short term memory.
5 health promotion strategies for promoting neurological health
- Influence positive attitudes toward aging and memory skills, so that memory may improve
- Engage in activities that promote memory skills and brain functions, such a simple word games
and puzzles
- Physical activity can promote brain flow to the brain, and improve thinking and cognition ability
- Stretch and relaxation exercise along with more physical ones
- Eat a healthy diet with foods that promote brain activity
Explain the importance of sensory function and the impact of sensory deficits on older adults
- Performance of many important daily activities like communication, protecting oneself from danger, enjoying music and visual images, food enjoyment and etc depend on healthy sensory activity.
age related changes: hearing
↓ number of nerve cells in 8th cranial nerve
↑ production of cerumen
↑ amount of keratin in cerumen
Atrophy of rigidity of ossicles
↓ elasticity of tympanic
membrane
change in shape and size of pinna
age related Changes in sight
Yellowing, opacity, rigidity of
the lens
↓ pupil size
↓ accommodation
Less efficient absorption of
intraocular fluid
Narrowing of visual field
↓ lacrimal secretions
↓ number of cones in retina
Change in touch senstation
-changes in Pacinian and Meissner’s corpuscles (skin receptors that respond to vibration).
how does change in taste occur?
-decline in receptor cells in the taste buds, which are located on the tongue, palate, and tonsils.
what can nurses do for clients with change in senstation
-educating older adults with modifiable risk factors, such as smoking and the use of ototoxic medication
on alleviating the risk factors.
- using assistive listening devices.
- improving the clarity of words, slowing rate of speech, and eliminating environmental noise and
distractions. - teaching older adults about preserving optimal visual function by reducing or eliminating risk factors.
Example: use of broad-brimmed hats and close-fitting sunglasses with UV-B absorbing lenses.
-educating about preventing eye disease through nutritional interventions like consumption of foods high
in lutein.
- teaching about over-the-counter artificial tears or ocular lubricants for dry eyes.
- teaching on use of low-vision aids like magnifiers and reading glasses.
Consequences of changes in sight
Presbyopia –inability to focus
properly
• Distorted depth perception
• ↓ colour discrimination
• Need for Stronger light
• Increased sensitivity to glare
• Drier cornea
Consequences of changes in hearing
• Presbycusis (hearing loss
due to age-related
changes in the inner ear)
• High frequency loss occurs
first
• Tone discrimination loss
• Difficult following
conversations
• Cerumen impaction
• Social isolation
Gastrointestinal Aging
Changes
Poor dentition
↓ number of taste buds
↓ muscle strength for chewing
↓ saliva production
↓ ptyalin in saliva
Weakened gag reflex
↓ gastric acid secretion
↓ emptying of esophagus and
stomach
↓ intrinsic factor
Thickened bile
Thinned gastric mucosa
↓ ability of small intestine to absorb
sugars and lipids
↓ hepatic enzyme stroage capacity
Consequences of change in GI health
- ↓ taste sensation
- ↓ appetite
- ↓ chewing ability
- ↓ digestion of starch
- Possible swallowing difficulty
- Indigestion, flatus
- Risk of pernicious anemia
- problems with elimination
- ↓ tolerance for fats
- Possible change in drug metabolism
- Difficulty gaining weight
Nursing interventions for change in GI
Increase fluid intake-stay hydrated. Drink 8-10 glasses of noncaffeinated liquid everyday, including fruit juices
Increase activity
Promoting oral and dental health- use a toothbrush with soft nylon bristles
Increase intake of whole grains, consume less sodium and saturated fat
Promote wellness through interventions that improve the older adults independence in procuring and preparing satisfying meals.
Encourage older adults to maintain a sitting or upright position during eating and for 1⁄2 hr to 1 hr after
eating to compensate for any effects of slowing swallowing.
Changes in Genitourinary system
Genitourinary Aging Changes
↓ number of nephrons
↓ glomerular filtration rate and tubular
reabsorption
Change in renal threshold
↓ blood flow to kidneys
↓ bladder capacity from 500 ml to 250
ml
↓ elasticity of bladder
↓ bladder tone
↓ muscle tone of urethra
Benign prostatic hyperplasia common
in males
Consequences in changes of geniturinary systme
↓ creatinine clearance
• ↓ ability to concentrate urine
• risk of urinary retention
• incidence of incontinence
• urinary frequency; nocturia
• Effects on drug clearance via
kidneys
changes in musculoskeletal system
Musculoskeletal Aging
Changes
Muscle cells atrophy
Generalized symmetrical muscle
wasting
Demineralization of bones
Deterioration of cartilage surface
of joints
Thinning of intervertebral discs
Loss of cartilage in vertebral
column
Loss of elastic fibers in muscle
tissue
Kyphosis
Consequences of change in MSK
Consequences:
• ↓ muscle strength after
age 70
• Two-inch loss of height
between ages 20 and
70
• incidence of
osteoporosis
• ↓ joint range of motion
• ↓ flexibility
• ↓ mobility
• risk of falls
• Gait changes
• Changes in body image
what is this?
Kyphosis
Cardiovascular changes
- ↑ amount of collagen and fat in
- cardiac muscle
- Thickening and rigidity of valves
- ↓ oxygen utilization
- Myocardial hypertrophy, but over-all heart size is not affected by age
- Coronary artery blood flow decreased
- ↑ peripheral resistance
- myocardial irritability
- ↓ blood flow to all organs
Consequences of cardiovascular changes
• ↓ stroke volume, cardiac output
• ↓ ability to increase heart rate in
response to stress
• aortic volume and systolic blood
pressure
• No change in resting heart rate
• risk of extra systoles
• Electrocardiogram changes
Integumentery changes
- Thinning and atrophy of epidermis
- ↓ strength and elasticity of epidermis
- ↓ blood flow
- vascular fragility
- Loss of subcutaneous fat
- ↓ size and function of sweat glands
- ↓ sebaceous secretions
- “Clustering” of melanocytes
- ↓ number of nerve cells
- Thinning and graying of scalp, pubic, and axilla hair
- Thickening of nasal and ear hair
- facial hair in women
- ↓ blood supply to nailbed
- longitudinal striations in nails
- Accumulation of “debris” under nails
nursing interventions for urinary changes
Keeping a bladder diary- document about fluid intake, times of urination, and other factors that can affect continence. Obtaining information about patterns of urinary elimination identifies potential causes of and interventions for incontinence.
Assess environment for safety and assistive devices ex. Elevated toilet seat, grab bars near toilet, grab bars on walls leading to toilet.
Assess home environments for barriers that may interfere with quick performance of urinary elimination-
stairways, long hallways, poor lighting, cluttered surroundings; all which can lengthen time needed to get to toilet.
Health education regarding control of continence, environmental modifications, and surgical procedures.
Pelvic floor muscle training. Kegel exercises.
interventions for circulatory changes
- Relaxation techniques (yoga, meditation) to reduce stress
- Smoking cessation
- Proper nutrition (lipid levels), limited alcohol intake
- Physical activity (and maintaining ideal body weight)
- Counseling (or involvement in other activities) for anxiety/depression/isolation
interventions for cardiac changes
- Encouraging smoking cessation and prevention of second hand smoke
- Strategies for secretion clearance, energy conservation, relaxation
- Flu and pneumococcal vaccinations
- Pulmonary rehab and exercise training
- Disease self-management strategies
Consequences of integumentary changes
Consequences:
• susceptibility to infection,
trauma, malignant lesions,
pressure ulcers
• Skin is dry, scaly, wrinkled
• ↓ skin turgor
• ↓ ability to maintain body
temperature and
homeostasis; baseline
temperature may be lower
than normal
• Slower rate of healing
• Slower absorption of drugs by
subcutaneous route
• “Liver Spots”
• Nails thicken, grow slowly,
become brittle and yellowed
• risk of splitting
interventions for integumentary changes
Increased risk of skin cancer: apply sunscreen, stay out of sun, wear protective clothing. Always look for abnormal moles/ skin lesions,
Pressure ulcers: encourage patients to change positions often (help if necessary). Use protective barriers for high risk patients. Evaluate skin integrity. Increase nutritional status, avoid hot water and excessive rubbing, do not massage bony prominences.
Avoid scented soaps, and harsh chemicals (such as bleach)
Respiratory changes
↓ elasticity of lungs
↓ number of alveoli
↑ size of alveoli
↑ diameter of alveolar ducts and
bronchioles
↓ ciliary action
↑ anteroposterior chest
diameter
Weakening of
respiratory muscles
↓ coughing reflex
Calcification of costal
cartilages
Consequences of respiratory changes
Consequences
• 50% increased residual
capacity
• ↓ vital capacity
• ↓ mobility of bony thorax
• ↓ arterial blood oxygen
level
• ↓ oxygen uptake during
exercise
• risk of infection
• amount of dead air
space
• ↓ exercise tolerance
Neurological Aging Changes: • ↓ gas exchange
List and describe at least 5 Health Promotion Considerations or Health Promotion Activities
- Encouraging smoking cessation and prevention of second hand smoke
- Strategies for secretion clearance, energy conservation, relaxation
- Flu and pneumococcal vaccinations
- Pulmonary rehab and exercise training
- Disease self-management strategies
Risk of pnuemonia
- dysphagia
- tube feeding
- malnutrition and dehydration
- poor oral hygiene
- decreased cough reflex
- diminished salivary flow
- diminished level of consciousness
- tobacco use
- lung disease
- CHF
- residence in long term care facility
symtoms of pnuemonia
fatigue, tachypnea, cough, dyspnea, history of fever, productive sputum, tachycardia, fever (sometimes), and chest pain (sometimes)
care considerations for pneumonia
pneumonia in older adults is nonspecific, change in mental or functional status may be big clue
risks for developing tuberculosis
Risks- smoking, diabetes, malnutrition, long term use of corticosteroids
Considerations for developing tuberculosis
• Care considerations- nonspecific symptoms, nurses must be alert for symptoms especially in those with history of disease
risks for COPD
COPD (emphysema, chronic bronchitis, asthma)
- tobacco use genetic predisposition,
- low socioeconomic status,
- childhood respiratory disease,
- secondhand smoke exposure
symptoms of COPD
cough, dyspnea, wheezing, increased sputum
prevention for respiratory condition
- Promoting smoking cessation and second hand smoke avoidance
- Vaccinations
- Wash hands and avoid hand to mouth and hand to eye contact
- Avoid individuals with the flu
- Adequate nutrition and hydration
- Oral hygiene
Threshold of disability
what is primary memory?
has short duration and a very small capacity, past few seconds.
what is Secondary Memory?
longer duration and therefore is more important in terms of retrieval as well as storage of info
what is recall or recognition memory?
Tertiary memory: has to be pulled from remote parts of the mind.
Stress Urinary Incontinence
involuntary leakage as a result of activty that increase abdominal pressure (ie. lifting something, coughing, sneezing, laughing or exercise)
Urge Urinary Incontinence
Involuntary Leakage due to the inability to hold urine long enough to reach the toilet after the sensation of urgency
Mixed Urinary Incontinence
leakage of urine with both the sensation of urgency and an acitivity such as coughing or sneezing
overactive bladder
sydrome characterized by bothersome urgency, usually accompanied by nocutria and daytime frequency and sometimes urge urinary incontinence.
Conductive hearing loss
abnormalilites of the external ear and middle ear impair the sound conduction mechansim
Sensorineural Hearing Losses
abnormalities of the inner ear interfere with the sensory and neural structures
mixed hearing loss
involves both conductive and sensorineural impairments
