Physiological Changes of Aging Flashcards
Changes in cardiovascular circulation
- Decrease contractibility, increase fat and collagen
- myocardial hypertrophy (esp. left ventricle)
- decrease cardiac reserve
- thickening and fibrosis of heart valves
What happens in cardiovascular circulation?
- decrease cardiac output
- decrease blood flow to vital organs and periphery
-Incomplete closure of valves, therefore heart murmurs - Baroreceptors in the aortic arch & carotid sinus become less sensitive
- Arterial blood vessels thicken, becoming more rigid and loosing elasticity
-Blood supply to various organs decreases & peripheral resistance increases. Rigid arteries contribute to CAD, HTN & PVD - Lower extremity edema develops, risk for DVTs
Changes in cardiovascular electricity
- Cellular aging and fibrosis, changes the conduction system
- There is a ↓ number of pacemaker cells in SA node (by 75, only 10% of normal # of pacemaker cells)
What happens in cardiovascular electricity?
-There is a ↓ in amplitude of the QRS complex & lengthening of the PR, QRS & QT intervals
(these are defined as cardiac arrhythmias = atrial fibrillation, atrial flutter, etc.)
-Sinus bradycardia, premature beats
Sinus Bradycardia
Rate ˂ 60 Regularity regular rhythm P wave normal, upright, uniform PR interval 0.12 – 0.20 seconds QRS 0.06 – 0.10 seconds T wave normal
Atrial Fibrillation
Rate atrial rate 350–450, vent rate varies with AV conduction
Regularity irregularly irregular
P wave no P waves, replaced by fine fibrillatory waves
PR interval indiscernible
QRS 0.06 – 0.10 seconds
T wave indiscernible
Structural changes in respiratory system
- ↑ anteroposterior diameter of the thoracic cage
- ↓ elastic recoil of the lung and ↓ chest wall compliance
- Alveolar ducts and bronchioles enlarge and the number of alveoli decreases
What happens in structural changes of respiratory system
- Barrel chest appearance, displacement of apical pulse
- ↓ vital capacity, ↑ residual volume; therefore diminished breath sounds particularly at lung bases
- Reduced overall efficiency of ventilatory exchange, therefore a decrease in PaO2
Changes in respiratory defenses
- A decline in cell-mediated immunity and formation n of antibodies (↓ in alveolar macrophages)
- ↓ cough force and less functional cilia
What happens in changes in respiratory defenses
- ↑ risk of respiratory infections
- ↓ cough effectiveness and ↓ secretion clearance
Changes in respiratory control
- ↓PaO2
- ↑PaCO2
What happens in changes of respiratory control
- ↓ response to hypoxemia
- ↓ response to hypercapnia
- Ability to maintain acid-base balance ↓
- In addition, retained secretions, excessive sedation, or positioning that impairs chest expansion may substantially alter PaO2 or SpO2 values
Changes in muscle, ligaments, and tendons
- Muscle fibers decrease and have atrophy of muscle cells
- Loss of elasticity and ↓ flexibility in ligament/tendons
- Gradual reduction in the speed and power of skeletal or -voluntary muscle contractions
What happens in changes in muscle, ligaments, and tendons
- ↓ muscle mass, tone & strength
- Movement is more rigid, changes in gait and ↓ in agility
- Slowed reaction time and reflexes
Changes in joints
- Deterioration of joint cartilage
- Loss of water from disk between vertebrae, therefore narrowing of intervertebral spaces
What happens in changes in joints
- Osteoarthritis; pain & joint stiffness, ↓ ROM, and crepitation on movement
- Loss of height from disk compression
Changes in bones
- ↓ in bone density
- Decalcification of bones
- Osteoporosis
- Posture and structural changes (deformities such as dowager’s hump)
Changes in mouth
- Loss of teeth
- ↓ taste buds, ↓ sense of smell
- ↓ salivary production
- Atrophy of gingival tissue
What happens in changes of mouth
- Difficulty chewing may lead to decrease in appetite
- Diminished sense of taste (esp. with salty & sweet) may leads to excessive use
- Diminished sense of taste & smell may result in ↓ appetite and weight loss
- Dry oral mucosa
- Poor-fitting dentures
Changes in esophagus or stomach
- ↓ tone & motility of the esophagus
- Lower esophageal sphincter pressure is decrease (or becomes incompetent)
- ↓ gastric acid secretion, atrophy of gastric mucosa and less resistant to damage
What happens in changes in esophagus or stomach
- ↓ esophageal peristalsis, therefore propulsion of food is less effective, complaints of dysphagia & heartburn (GERD)
- Entry of food is delayed into the stomach, causing a premature feeling of fullness
- Food intolerance
Changes in small intestine
- ↓ motility and ↓ secretions of digestive enzymes in the small intestines
- Liver - ↓ hepatic blood flow, ↓ in actual size, and ↓ in production of enzymes
- Pancreas - ↑ fibrosis, decreased secretion of enzymes and hormones
What happens in changes in small intestines
- Slowed intestinal transit, delayed absorption
- Impaired drug metabolism
- Impaired fat absorption and decreased glucose intolerance
Changes of the bottom of the barrel or your ass
- ↓ anal sphincter tone and nerve supply to rectal area
- ↓ muscle tone, ↓ motility in large intestines
- ↑ transit time
What happens in changes of your ass
- Fecal incontinence
- Flatulence, abdominal distension
- Constipation, fecal impaction
Changes in kidneys
- ↓ number of nephrons, ↓ function of loop of Henle and tubules
- ↓ renal blood flow, ↓ glomerular filtration rate
What happens in changes of the kidneys
- A reduced ability to concentrate urine and conserve water (potential for hydration is increased)
- ↓ creatinine clearance – excretion of toxins/drugs is decreased, ↑ BUN level
Changes in urinary bladder
- ↓ elasticity and muscle tone of bladder, weakening of urinary sphincter
- ↓ ability of bladder to completely empty
- ↑ residual urine
What happens in changes of the urinary bladder
- Stress incontinence, frequency, urgency
- Nocturia
- Retention
Changes in male reproductive system
- ↓ testosterone levels
- Prostate enlarges
- Testes atrophy
- ↓ sperm count
- ↓ rate & force of ejaculation
- ↑ refractory period after orgasm
Changes in female reproductive system
- ↓ estrogen levels
- Ovaries, uterus, cervix slowly atrophy
- ↓ in vaginal secretions
- Vaginal pH becomes alkaline
- Cessation of menses
- ↑ refractory period after orgasm
Changes in skin
- ↓ subcutaneous fat, ↓ elasticity, collagen stiffens and ↓ thickness of epidermis
- ↓ sebaceous and sweat gland activity
- Skin tissue fluid ↓
What happens in changes of skin
- Appearance of wrinkles
- Tendon, veins & knuckles are more prominent
- Skin has transparent, tissue-like appearance and is fragile (prone to breakdown)
- Day flaking skin with minimal to no perspiration
- ↓ skin turgor (dehydration)
- ↑ melanocytes
- ↓ blood supply & sensory receptors in skin
- ↑ capillary fragility
- ↓ proliferative capacity
- Lentigines on face & back of hands
- Skin is cool to touch, ↓ awareness of pain, touch, temperature & vibration
- Evidence of bruising
- ↓ rate of wound healing
Changes in hair
-Melanin in hair is decreased
-↓ oil
-↓ density of hair follicles
Cumulative androgen effect, ↓ estrogen levels
What happens in changes of hair
- Hair colour becomes gray or white
- Dry, coarse hair with scaly scalp
- Thinning/loss of hair
- Older men have more nasal hair and hair in ears
- Older women have increase facial hair
Changes in nails
- ↓ blood supply to nail beds
- Longitudinal ridges/striations increased
What happens in changes of nails
- Thick, brittle nails with diminished nail growth
- Nails prone to splitting – potential for fungal infection
Changes in central nervous system
- Reduction in cerebral blood flow
- Brain weight decreases from loss of neurons
- The number of synapses, axons and dendrites also decreases
What happens in changes of central nervous system
- Alterations in selected mental functions
- Mild memory impairment
- Intellectual performance without brain dysfunction remains constant, however the performance of tasks may take longer (fluid intelligence)
Changes in the nervous system
- ↓ neurotransmitters and ↓ in rate of nerve cell conduction impulses
- ↓ motor response and ↓ reflexes
- Decrease in efficiency of temperature regulating mechanism
What happens in changes of the nervous system
- Monoamine oxidase and norepinephrine production often increase with age while serotonin production may go up or down (depression may be the result)
- Sluggish reflexes and ↓ reaction time (impaired response to imbalance = falls)
- Less able to adapt to extremes in environmental temperatures
Changes in peripheral nervous system
- Diminished sense of touch and vibration
- Kinesthetic sense or proprioception (one’s position in space) is altered
What happens in changes of peripheral nervous system
- Decreased sensitivity is translated into delayed reactions to things such as hot surfaces, significant increasing the risk for burns
- If one is less aware of body position and has less tactile awareness, the risk for falling is dramatically increased
Changes in sleep
- Modification of hypothalamic function, loss of deep sleep
- REM sleep is decreased in the elderly over 85
What happens in changes of sleep
- Increased frequency of spontaneous awaking (sleep is lighter)
- Interrupted sleep, insomnia, tiredness
Changes in visual system
-Elasticity and tone of eyelid muscles is decrease and have loss of orbital fat (shrunken appearance of eyes)
-Presbyopia – gradual decline in the ability to focus on close objects
-Lens becomes less elastic, thickened, more dense and visual acuity decreases as the lens becomes more opaque (↑ sensitivity to glare)
-Pupils become smaller and slower to react to changing levels of illumination
-↓ colour perception especially to blue, green and violet
-Tear production is decrease (dry eyes)
-↓ peripheral vision & distorted depth perception
↑ risk for glaucoma
Changes in auditory system
- Presbycusis – hearing loss, ↓ ability to hear high-pitched sounds
- ↑ production of and drier cerumen (ear wax) results in impacted wax
- Atrophic changes of tympanic membrane
- Hair cells degeneration, neuron degeneration in the auditory nerve and central pathway, reduced blood supply to cochlea - ↓ sensitivity to high-pitched sounds
- Alterations in balance and body orientation due to less effective vestibular apparatus in semicircular canals
Changes in immune system
- Antibody function is impaired
- Response to foreign antigens decrease
- Thymus decreases in size and activity
- Both T and B cells show deficiencies in activation
- Increased prevalence of autoimmune disorders
- Therefore: susceptibility to infections increases
Changes in endocrine system
- ↓ production of TSH - ↑ incidence of hypothyroidism
- ↑ levels of PTH - ↑ calcium resorption (loss) from bone
- ↑ glucose intolerance and ↓ sensitivity to insulin (contributes to increase incidence of DM)
- Adrenal glands’ secretion of glucocorticoids decrease by -25% by age 70 (involved in reactions to stress)
- Plasma renin levels and aldosterone concentrations decline (may have fluid and electrolytes abnormalities)
- ↓ sensitivity of renal tubules to ADH (fluid deficits)
- Defects in thermoregulation – poor perception of changes in temperature
- Reduction of febrile response (fever not always present with infectious process)
Nursing interventions to promote drug therapies
- Monitor clinical responses and plasma drug levels to provide a rational basis for dosage adjustment
- Employ the simplest regimen possible
- Monitor for drug-drug interactions
- Periodically review the need for continued drug therapy
- Encourage the patient to dispose of expired medications
How to promote compliance
- Clear & concise verbal & written instructions
- Suggest a dosette box
- Evaluated if patient able to self-administer or not
Cardiovascular implications
- Irregular cardiac rhythms
- Decrease capacity for physical work
- Risk of orthostatic hypotension
- Circulatory changes in periphery (PVD)
- Possible anemia, dehydration
Cardiovascular interventions
- Monitor pulses (ECG)
- Monitor for weakness, SOB, dizziness, chest pain
- Assess BP supine vs. standing
- Encourage rising slowly when getting up
- Neurovascular assessment
- Monitor labs –hemoglobin, hematocrit
Respiratory implications
- Exercise tolerance diminished
- Cough and deep breathing diminished, dyspnea
- Mucus thickens
- Decreased ability to bring up secretions
- Increase risk for infections
Respiratory interventions
- Monitor exercise, tailor to patient
- Monitor RR, lung sounds, O2 saturation, encourage inspirometer, DB&C
- Promote adequate fluid intake to keep secretions liquefied
- Encourage influenza and pneumonia immunization
Musculoskeletal implications
- Muscle atrophy, ↓ strength
- ↓ ROM and flexibility
- ↓ ability to perform ADLs
- Pain and joint stiffness
- Changes in gait
- Increase risk of falls
Muscoloskeletal interventions
- Exercise as per patient’s tolerance
- Passive ROM, consult with PT
- ADL assessment scales
- Pain scale, pharm/non-pharm strategies
- Encourage use of walking aids
- Protect patient from injury (safe environment assistive device)
- Morse fall scale, Timed up-and-go test
Consequences of immobility
- Muscle atrophy
- Orthostatic hypotension
- Recurrent sepsis
- Pressure sores
- Contractures
- Risk for falls
Changes in sleep interventions
- Establish a bedtime ritual & wake-up time
- Avoid long naps during the day
- Avoid caffeine products after 16:00
- Relaxation methods
Nutrition implications
- ↓ taste can make eating less enjoyable
- Difficulty chewing or swallowing
- Possible malnutrition
- Diabetes increasingly prevalent
- Heartburn, indigestion & food intolerance
Nutrition interventions
- Promote herb seasoning & salt replacement
- Cut food into small bites
- Food diary, monitor albumin, BMI (weight)
- Encourage smaller meals
- Reduce acidic/spicy foods
- The Nestle Mini Nutritional Assessment tool
Fluid and electrolytes implications
- Fluid imbalances
- Risk of hypernatremia
- Risk of hypokalemia
Fluid and electrolytes interventions
- Promote adequate fluids
- Monitor I/Os, monitor for signs of fluid overload or dehydration
- Monitor electrolytes
Urinary implications
- Decrease in GFR affects excretion of drugs
- Nocturia
- Urinary retention, risk of UTI
- Urgency and frequency is common
- Prone to fluid and electrolyte imbalances
Urinary interventions
- Monitor for toxicity – Cr clearance
- Limit fluids prior to bed
- Urinary analysis, promote cranberry juice
- Encourage kegel exercises, absorbent products, assistive toileting equipment
- Monitor I/Os, weight, electrolytes
Bowel implications
- Decrease motility in large intestines
- Risk for constipation, fecal impaction
Bowel interventions
- Explore bowel pattern
- Explore diet
- Encourage fluids & fiber intake with mobilizing
- Assess need for stool softener
Protection implications
- Dry, fragile skin, prone to abrasions and skin lacerations
- Decrease rate of wound healing
- Less ability to control temperature
- Risk for infections
Protection interventions
- Prevent skin breakdown
- Positioning, lotions, bed sheet to be taut, Braden Scale
- Keep extremities warm & room at moderate temperature
- Monitor WBC, obtain baseline temp., encourage immunization
Neurological implications
- Slowed reaction time & reflexes (falls)
- Kinesthetic sense is altered (falls)
- Memory impairment
- Fluid intelligence changes (takes longer to perform task)
Neurological interventions
- Schedule task so as to give patient enough time
- Ensure safety (environment)
- Offer orienting, leave notes
- Allow time for the patient to process questions
Visual implications
- Presbyopia
- Decreased capacity to adjust to changing levels of illumination
- Diminished night vision
- Increased sensitivity to glare
- Decreased depth perception
Visual interventions
- Encourage eye exams and use of eye glasses
- Write clearly and largely
- Ensure appropriate lighting
- Nightlights
- Encourage non-glare lighting
- First and last step of stairs can be marked
Auditory implications
- Generalised hearing loss
- Risk of social isolation
- Decrease in sebaceous gland causing cerumen to become dry
- Alteration in balance & body orientation
Auditory interventions
- Reduce background noise, speak closely and clearly
- Check ears for impacted wax and infection
- Walking aids – walkers, canes
Taste, smell and sensations implications
- ↓ taste buds
- ↓ sense of smell
- Reduced tactile sensation, therefore ↓ ability to sense pressure, pain & temperature
Taste, smell, and sensation interventions
- Promote herb seasoning & salt replacement to enhance flavour
- Promote safe environments, smoke detectors
- Reduce environmental risks i.e. risk of burns
Teaching strategies
- Make sure patient is ready to learn
- Sit facing the patient so that lips and facial expressions are readily seen by patient
- Speak slowly
- Keep your tone of voice low
- Give the patient enough time to response
- For concentration, focus on a single topic at a time
- Keep environmental distractions to a minimum
- With patient permission, invite another member of household to participate
- Use auditory, visual, and tactile cues to enhance learning
- Ask for feedback to ensure information has been understood
- Refer to patient’s past experienced (connect new with old)
- Compensate for physical discomfort and sensory alterations if needed
