Age-Related Changes

Strange how these things creep up on you. I

really was surprised and upset when I first
realized it was not the headlights on my car
that were dim but only my aging night
vision. Then, I remembered other bits of
awareness that forced me to recognize that
I, that 16-year-old inside me, was
experiencing changes that go along with
getting older.
~Sally, age 60
• The well-being of older people depends on
several factors
• Physical
• Psychosocial
• Mental
• Social
• Economic
• Environmental
• Cellular and extracellular changes of old age
cause a change in physical appearance and a
decline in function.
• Measurable changes in shape and body
makeup occur.
• The body’s ability to maintain homeostasis
becomes increasingly diminished with cellular
aging, and organ systems cannot function at
full efficiency because of cellular and tissue
deficits.
Age related changes reduce the efficiency of
the heart and contribute to decreased
compliance of the heart muscle these include:
• Thickened cardiac valves
• Decreased myocardial contractibility
• Decreased elasticity of blood vessels
• Decreased elasticity and increased stiffness
of the arterial wall
• Loss of atrial pacemaker
• Reduction of hemapoietic activity
• Increased blood coagulability
• Decreased efficiency of baroreceptors
Subjective and Objective Findings
• Complaints of fatigue with increased
activity
• Increased heart rate recovery time
• Optimal blood pressure 120/80 mm Hg
• Prehypertension
• 120–139/80–89 mm Hg
• Hypertension 140/90 mm Hg
Health Promotion Strategies
• Exercise regularly
• Pace activities
• Avoid smoking
• Eat a low-fat, low-salt diet
• Participate in stress-reduction activities;
• Check blood pressure regularly;
• Medication compliance;
• Weight control
The respiratory system is the one system that seems
to be the most able to compensate for the functional
changes of aging. These are:
• Reduced chest compliance
• Increased AP diameter of thorax
• Reduced breathing capacity
• Reduced vital capacity
• Increased residual volume
• Decreased cough and laryngeal reflex
• Decreased ciliary activity
• Decreased elasticity of tissue
Subjective and Objective Findings
• Fatigue and breathlessness with sustained
activity
• Decreased respiratory excursion and
chest/lung expansion with less effective
exhalation
• Difficulty coughing up secretions
Health Promotion Strategies
• Exercise regularly
• Avoid smoking
• Take adequate fluids to liquefy secretions;
• Receive yearly influenza immunization and
pneumonia vaccine at 65 years of age;
• Avoid exposure to upper respiratory tract
infections
• Loss of subcutaneous supporting tissues
• Sensitive to pressure and ulcer
• Wrinkle and sag
• Dry, wrinkled , loss elasticity
• Decreased perspiration and sebum
• Fragile, easily injured
• Decreased skin turgor
• Decreased sebaceous secretions
• Dry, flabby, prone to itching
• Atrophy of tiny arterioles near epidermis
• Impaired vasomotor homeostatic
mechanism
• Poor temperature regulation (feels cold
even in warm climate)
• HAIR- decreased number of hair follicles,
scant, fine, graying, hirsutism, possible
hereditary baldness
• NAILS- dry, thick, brittle
Subjective and Objective Findings
• Thin, wrinkled, and dry skin
• Complaints of injuries, bruises, and sunburn
• Complaints of intolerance to heat
• Bone structure is prominent
Health Promotion Strategies
• Limit solar exposure to 10–15 minutes daily
for vitamin D
• Use protective clothing and sunscreen
• Dress appropriately for temperature
• Maintain a safe indoor temperature
• Take shower rather than hot tub bath if
possible
• Lubricate skin with lotions that contain
petroleum or mineral oil
• Increase fat substitution for muscle
• Muscle atrophy
• Decreased muscular strength and function
• Loss of Calcium from bones
• Osteoporosis is common
• Deterioration of cartilage
• Wear, friction, stiffness of joints
• Easily tired, less stamina
• Impaired range of motion resulting from
stiff joints
• Generalized loss of 6-10 cm in stature
because of: flexion of knee and hip joint,
narrowing of intervertebral disks
• Body takes on bony angular apperance
Subjective and Objective Findings
• Height loss
• Prone to fractures
• Kyphosis
• Back pain
• Loss of strength, flexibility, and endurance
• Joint pain
Health Promotion Strategies
• Exercise regularly
• Eat a high-calcium diet;
• Limit phosphorus intake
• Take calcium and vitamin D supplements as
prescribed
• Decreased salivation
• Difficulty swallowing food
• Decreased sense of thirst, smell and taste;
• Minimal loss of digestive enzymes
• Delayed esophageal and gastric emptying
• Decreased absorption
• Increased food intolerance
• Redistribution of body fat; increased fat in
trunk, especially in abdomen
• Teeth and gum problems common
• Decreased peristalsis, slowed digestion
• Reduced gastrointestinal motility
• Atonia constipation in common
• Decreased metabolism: caloric requirement
approximately 1000 calories per day
Subjective and Objective Findings
• Risk of dehydration, electrolyte
imbalances, and poor nutritional intake
• Complaints of dry mouth
• Complaints of fullness, heartburn, and
indigestion
• Constipation, flatulence, and abdominal
discomfort
Health Promotion Strategies
• Use ice chips, mouthwash
• Brush, floss, and massage gums daily
• Receive regular dental care
• Eat small, frequent meals
• Sit up and avoid heavy activity after eating
• Limit antacids
• Eat a high-fiber, low-fat diet
• Limit laxatives
• Toilet regularly
• Drink adequate fluids
• Reduced speed in nerve conduction
• Increased confusion with physical illness and loss of
environmental cues
• Reduced cerebral circulation (decreased
coordination and balance )
• Some impairment of sensory perception
• Gradual decrease of visual and auditory acuity
• Altered capacity to retain new information and learn
new tasks
• Some impairment of memory and metal endurance
Subjective and Objective Findings
• Slower to respond and react
• Learning takes longer
• Becomes confused with hospital admission
• Faintness
• Frequent falls
Health Promotion Strategies
• Pace teaching
• With hospitalization, encourage visitors
• Enhance sensory stimulation
• With sudden confusion, look for cause
• Encourage slow rising from a resting
position
• Diminished ability to focus on close objects
(presbyopia)
• Inability to tolerate glare
• Difficulty adjusting to changes of light intensity
• Decreased ability to distinguish colors
• Narrowed field of vision (tunnel vision)
• Color in the iris may fade, and the pupil may
become irregular in shape
• Decrease in production of secretions by the
lacrimal glands
Subjective and Objective Findings
• Holds objects far away from face
• Complains of glare
• Poor night vision
• Confuses colors
Health Promotion Strategies
• Wear eyeglasses, use sunglasses outdoors;
• Avoid abrupt changes from dark to light;
• Use adequate indoor lighting with area lights
and nightlights
• Use large-print books, use magnifier for
reading
• Avoid night driving
• Use contrasting colors for color coding
• Avoid glare of shiny surfaces and direct
sunlight
• Decreased ability to hear high frequency
sounds
• Sesorineural hearing deficit (presbycusis)
gradual loss of ability to discriminate to high
frequency tools
• Tympanic membrane thinning and loss of
resiliency
Subjective and Objective Findings
• Gives inappropriate responses
• Asks people to repeat words
• Strains forward to hear
Health Promotion Strategies
• Recommend a hearing examination
• Reduce background noise
• Face person
• Enunciate clearly
• Speak with a low-pitched voice
• Use nonverbal cues
• Cell loss in the nasal passages and in the
olfactory bulb in the brain
• Decreased ability to taste and smell
Subjective and Objective Findings
• Uses excessive sugar and salt
• Loss of appetite
Health Promotion Strategies
• Encourage use of lemon, spices, herbs
• Recommend smoking cessation
Male and Female:
• Decrased blood flow
• Reduced GFR
• Reduced nephrons
• Decrased creatinine clearance
• Increased propensity to toxic effects of drugs
• Decreased renal capacity to concentrate urine
at night
Male:
• Benign prostatic hyperplasia
Female:
• Relaxed perineal muscles, detrusor
instability (urge incontinence), urethral
dysfunction (stress urinary incontinence)
Subjective and Objective Findings
Male:
• Urinary retention
• Irritative voiding
• Symptoms including frequency, feeling of
incomplete bladder emptying and multiple
nighttime voidings
Subjective and Objective Findings
Female:
• Urgency/frequency syndrome
• Decreased “warning time”
• Drops of urine lost with cough, laugh,
position change
Health Promotion Strategies
Male:
• Limit drinking in evening (eg, caffeinated
beverages, alcohol)
• Do not wait long periods between voiding
and empty bladder all the way when
passing urine.
Health Promotion Strategies
Female:
• Wear easily manipulated clothing;
• Drink adequate fluids
• Avoid bladder irritants (eg, caffeinated
beverages, alcohol, artificial sweeteners)
• Pelvic floor muscle exercises, preferably
learned via biofeedback
• Consider urologic workup
Female:
• Vaginal narrowing and decreased elasticity;
• Decreased vaginal secretions
• Menopause secondary to decreased Estrogen
Male:
• Less firm testes and testosterone,
spermatogenesis, and size of testes,
Male and Female:
• Slower sexual response
Subjective and Objective Findings
Female:
• Painful intercourse
• Vaginal bleeding following intercourse
• Vaginal itching and irritation
• Delayed orgasm
Male:
• Delayed erection and achievement of orgasm
Health Promotion Strategies
• May require vaginal estrogen replacement;
• Gynecology/urology follow-up
• Use a lubricant with sexual intercourse
• Successful psychological aging is reflected in the
ability of older people to adapt to physical, social,
and emotional losses and to achieve life
satisfaction.
• A positive self-image enhances risk taking and
participation in new, untested roles.
• Ageism is based on stereotypes, simplified and
often untrue beliefs that reinforce society’s negative
image of older people.
• Fear of aging and the inability of many to confront
their own aging process may trigger ageist beliefs.
• Coping patterns and the ability to adapt to stress
develop over the course of a lifetime and remain
consistent later in life.
• A person’s abilities to adapt to changes, make
decisions, and respond predictably are also
determined by past experiences.
• Experiencing success in younger adulthood helps a
person develop a positive self-image that remains
solid through old age.
• However, losses may accumulate within a short
period of time and may become overwhelming.
Common stressors of old age include:
• Normal aging changes that impair physical
function, activities, and appearance
• Disabilities from injury or chronic illness
• Social and environmental losses related to
loss of income and decreased ability to
perform previous roles and activities
• Deaths of significant others
• Most older people want to remain in their
own homes; in fact, they function best in
their own environment.
• Older people tend to relocate in response to
changes in their lives such as retirement or
widowhood, a significant deterioration in
health, or disability.
• The type of housing they choose depends on
their reason for moving.
Continuing Care Retirement Communities
• Independent Single Dwelling Houses or
Apartments for people who can manage all
of their day-to-day needs
• Assisted Living Apartments for those who
need limited assistance with their daily
living needs;
• Skilled Nursing Services when continuous
nursing assistance is required.
Assisted Living Facilities
• An option when an older person’s physical
or cognitive changes necessitate at least
minimal supervision or assistance.
• allows for a degree of independence while
providing minimal nursing assistance with
administration of medication, assistance
with ADLs, or other chronic health care
needs.
Long-Term Care Facilities
• Offer continuous nursing care.
• Long-term Facility
• Short-term Rehabilitation facility
• Subacute Care Facility offers a high level of
nursing care that may either avoid the need for
a resident to be transferred to a hospital from
the nursing home or allow a hospitalized
patient to be transferred back to the nursing
facility sooner.
• the family has been and continues to be an
important source of support for older people
• older family members provide a great deal
of support to younger family members
• Cognition can be affected by many
variables, including sensory impairment,
physiologic health, environment, and
psychosocial influences.
• Test scores for older adults show a progressive
decline beginning in midlife when intelligence
test scores from people of all ages are
compared.
• Environment and health have a considerable
influence on scores
• Decline in spatial perceptions and retention of
nonintellectual information
• Improvement or retention of problem-solving
ability based on past experiences, verbal
comprehension, mathematical ability.
Positive effect on intelligence are noted with:
• Cardiovascular health
• A stimulating environment,
• High levels of education, occupational
status, and income
Intelligence, memory, and the capacity for
learning are demonstrated continuously by
older adults who have:
• higher levels of education
• good sensory function
• good nutrition, and
• jobs that require complex problem-solving
skills.
In general, there is :
• A decline in Fluid intelligence, the
biologically determined intelligence used for
flexibility in thinking and problem solving.
• An intact Crystallized intelligence, that
gained through education and lifelong
experiences (eg, verbal skills)
Strategies to allow adults to learn:
• Supply mnemonics to enhance recall of related
data
• Encourage ongoing learning
• Link new information with familiar information
• Use visual, auditory, and other sensory cues
• Encourage learners to wear prescription
glasses and hearing aids
Strategies to allow adults to learn:
• Provide glare-free lighting
• Provide a quiet, nondistracting environment
• Set short-term goals with input from the
learner
• Keep teaching periods short
• Pace learning tasks according to the
endurance of the learner
• Encourage verbal participation by learners
• Reinforce successful learning in a positive
manner
1. Severe physical illness or mental illness
2. Death of a spouse
3. Threat of extreme dependency or
institutionalization
4. Retirement
5. Pathological personal relationship
6. Alcoholism and drug addiction
• Depression: most common affective disorder
of old age; results from changes in reuptake of
neurochemical serotonin in response to
chronic illness, emotional stresses related to
physical, social changes associated with aging
process
• Delirium: acute, confused state that begins
with disorientation
– If not immediately evaluated and treated, can
progress to changes in level of consciousness,
irreversible brain damage, sometimes death
• Broad term for syndrome characterized by
general decline in higher brain functioning
(reasoning) with pattern of eventual decline
in ability to perform even basic activities of
daily living (toileting, eating)
– Alzheimer’s disease
– Vascular Dementia
• Geriatrics: field of practice that focuses on
physiology, pathology, diagnosis, management of
disorders, diseases of older adults
• Gerontological/geriatric nursing: field of nursing
that relates to assessment, nursing diagnosis,
planning, implementation, evaluation of older adults
in all environments, including acute, intermediate,
skilled care as well as within community
• Gerontology: combined biologic, psychological,
sociologic study of older adults within their
environment
• Supporting cognitive function
• Promoting physical safety
• Promoting independence in self-care
activities
• Reducing anxiety, agitation
• Improving communication
• Providing for socialization, intimacy needs
• Promoting adequate nutrition
• Promoting balanced activity, rest
• Supporting home-, community-based care
• Polypharmacy: administration of multiple
medications at same time; common in
older persons with several chronic illnesses
• Aging changes alter drug:
– Absorption
– Metabolism
– Distribution
– Excretion
• Need adjustment of dosage due to age;
“start low, go slow”
• Assess medication knowledge, use
• Need for medication review, coordination of
prescriber
• Problem of noncompliance:
– Factors that affect compliance
– Keep medication regimen as simple as possible
– Strategies to improve compliance
• Impaired mobility
• Dizziness
• Falls, falling
• Urinary incontinence
• Susceptibility to infection
• Altered pain, febrile responses
• Altered emotional impact
• Altered systemic response
• Social services
• Health care costs of aging
• Home health care
• Hospice services
• Aging with a disability
1. Refusing medication
2. Not following physician’s orders and
recommendations
3. Smoking and drinking against medical
advice
4. Refusal to eat or eating minimally
5. Placing self in a hazardous environment
 AGING is an
issue of
mind over
matter…

If you don’t MIND,

it doesn’t MATTER...