Changes in Old Ag Flashcards
Changes in Old Age
key points
Key Points
The human body has the ability to age for approximately 115 years
However, the amount of cell death usually surpasses the amount of cell regeneration leading to tissue death, organ death and, eventually, death of the body
Ageing of the body systems makes the older person more prone to the effects of disease states
Seemingly minor ailments can be excessively burdensome to an already compromised older person
Changes in Old Age
Key Points
Anatomical and physiological changes occur in old age however, growing old does not naturally or normally include
Key Points Anatomical and physiological changes occur in old age however, growing old does not naturally or normally include Confusion Dementia Delirium Depression Falls Weakness Syncope
Anatomical and Physiological Changes in Old Age
Cardiovascular system changes
Cardiac function declines with age largely due to the high incidence of coronary disease caused by atherosclerosis
Age-related changes typically include a decrease in heart rate, a fall in cardiac output secondary to lowered stroke volume, and the inability to elevate cardiac output to match demand
Arrhythmias become more common as ageing alters the hearts electrical system
By the age of 75 the number of cells in the SA node decrease by 90%
This hinders the heart’s ability to produce a normal sinus rhythm
AV node also has a decline in pacemaker cells
There is also a progressive loss of bundle branch fibres
Common arrhythmias are atrial fibrillation and junctional rhythms
These result in a uncoordinated filling of the ventricles and a loss in atrial kick
As the atria fibrillate they pool small amounts of blood which can clot
If these clots flow into the system they can block small vessels and cause ischaemia
AF increases the risk of PE, MI and CVA
With age blood vessels stiffen resulting in increased systolic blood pressure
Systolic BP increases cause the left ventricle muscle to work harder and thicken
The muscle also loses elasticity
Thickening and stiffening of the muscle decreases ventricular filling and therefore cardiac output
This stiffening also occurs within the heart valves reducing their effectiveness
Older patients are prone to a 20mmHg drop in systolic BP when moving from sitting to standing because baroreceptors become less sensitive to changes in blood volume
Anatomical and Physiological Changes in Old Age
Neurological system changes
Neurological system changes
Nervous System
Brain weight reduces by 10-20%
Loss of 5-50% of neurons and remaining neurons shrink
Frontal lobe loses 20% of it’s synapses
Motor and sensory networks slow and become less responsive
Age-related atrophy of the brain produces a void between it and the dura mater
Atrophy of brain tissue can result in 25% loss of deep sleep as well as 55% loss of short term memory
Brain atrophy provides room for movement following trauma
Peripheral nerve function slows causing peripheral sensations to become diminished and misinterpreted
Pain from an injured area may not be felt in the affected tissue
This can alter the classic presentation of disease states
Optic neuropathies can cause reduced vision. Pupillary reaction slows. Night vision reduces
Hearing loss is more common that vision loss.
Anatomical and Physiological Changes in Old Age
Respiratory system changes
Respiratory system changes
Musculature of the upper airway weakens with age
Results in a narrowing of the airway at times of exertion
Bones and teeth alter the shape of the face and mouth
Dentures increase the risk of airway obstruction either due to being ill fitting or due to loss of sensation of the hard palate
Loss of mechanisms that protect the upper airway
Decreased ability to clear secretions
Decreased cough and gag reflexes
Cilia lining the airways lessen with age, hindering bodies ability to move mucus
Smooth muscle of the lower airway weakens with age
Strong inhalation can cause the walls of the airway to collapse
The collapsing airways result in less air moving through the smaller airways
Air doesn’t completely leave the alveoli
Gas exchange becomes more problematic as the alveoli lose their shape
By the age of 75 vital capacity can drop by 50%
This occurs due to loss in respiratory muscle mass, increases in the stiffness of the rib cage, and decreases in the available surface area for the exchange of air
Ageing adversely affects ventilatory function
Muscles of the chest wall and the diaphragm weaken
Curvature of the upper spine (Kyphosis) can further reduce the body’s ability to compensate during respiratory distress
The sensitivity of chemoreceptors decreases with age
Nerve impulse transmission from the brainstem through the phrenic nerve and intercostal nerves slows
This leads to a lowered arterial oxygen concentration meaning an SpO2 reading of 93-95% may be normal
: Musculoskeletal/Integumentary system changes
: Musculoskeletal/Integumentary system changes
The muscle system atrophies and weakens with age
Muscle fibres become smaller and fewer and strength declines
Ligaments, tendons and cartilage lose their elasticity and synovial fluid degenerates, contributing to arthritis
Muscle is replaced by fat which alters the bodies capacity to use some drugs
Osteoporosis occurs as the skeleton ages
Epidermis atrophies causes the skin to become thinner, drier, less elastic and more fragile
Injuries to the skin occur more easily
Injuries to the skin are slow to heal because of diminished capillary blood flow
Pressure sores may occur when an older patient remains stationary and the weight of their body compresses already thinned skin
There is little blood flow to regenerate cells damaged by the pressure resulting in tissue death
Focus on Falls
Falls are a leading cause of injury and death among the elderly
Approximately one-third of the population over the age of 65 experiences falls each year
This figure rises to over 50% among individuals aged 80 and above
Elderly patients in fall accidents tend to experience a higher injury severity and a worse outcome
If a patient has fallen once there is a 60% chance of them having another fall
Prolonged on floor times
Studies carried out in the UK in 2017 suggested that 20% of elderly patients who were admitted to hospital following a fall had been on the floor for more than one hour
Evidence suggests that 50% of those patients will die within 6 months from related complications, even if they were uninjured in the fall
Complications from prolonged on floor times
Pressure sores/pressure ulcers – can start to form within 30 mins of falling
Incontinence
Dehydration
Hypothermia
Psychological
Rhabdomyolysis
Frailty
Six Syndromes of Frailty Falls Dementia/Delirium Poly-pharmacy Incontinence Immobility End of Life
Frailty Assessment – Prisma 7 Tool
A score of 3 or more is considered to identify frailty
