Developmental changes Physiological
1. Reduced physiological reserve of most body systems, particularly cardiac, respiratory, and renal.
2. There are red... [Show More] uced homeostatic mechanisms that fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance.
3. There are changes in the sympathetic response, which contribute to orthostasis and falls, as well as lack of hypoglycemic response.
4. There is impaired immunological function: infection risk is greater and autoimmune diseases are more prevalent.
Laboratory: Reference ranges for older adults might be the intervals within which 9%% of persons over 70 fall.
Causes: Physiologically: fasting or activity status.
Pharmacologically: medication, tobacco, or alcohol use.
Physiological aging
Age related Change
Functional Change
Implications
Integumentary System
Loss of dermal and epidermal thickness
Loss of subcutaneous tissue and thin epidermis.
Prone to skin breakdown and injury
Decreased vascularity
• Atrophy of sweat glands resulting in decreased sweat production
• Decreased body odor
• Decreased heat loss
• Dryness
• Alteration in thermoregulatory response
• Fluid requirements may change seasonally
• Loss of skin water
• Increased risk of heat stroke
Respiratory System
Decreased lung tissue elasticity
Decreased vital capacity
Reduced overall efficiency of ventilatory exchange
Cilia atrophy
Change in mucociliary transport
Increased susceptibility to infection
Decreased respiratory muscle strength
• Reduced ability to handle secretions and reduced effectiveness against noxious foreign particles
• Partial inflation of lungs at rest
Increased risk of atelectasis
Cardiovascular System
Heart valves thicken and become fibrotic
Reduced stroke volume, cardiac output; may be altered
Decreased responsiveness to stress
Fibroelastic thickening of the sinoatrial node; decreased number of pacemaker cells
Slower heart rate
Increased prevalence of arrhythmias
Decreased baroreceptor sensitivity (stretch receptors)
Decreased sensitivity to changes in blood pressure
Prone to loss of balance, which increases the risk for falls
GI
Liver becomes smaller
Decreased storage capacity
Decreased muscle tone
Altered motility
Increases risk of constipation, functional bowel syndrome, esophageal spasm, diverticular disease
Decreased basal metabolic rate (rate at which fuel is converted into energy)
May need fewer calories
Lab results Dunphy table 77.2
UA Normal Changes with age Comments
Protein 0-5 rises slightly Due to kidney changes, UTI, renal
SG 1.005-1.020 Lower 1.016-1.022 Decline in nephrons impairs ability to
Concentrate urine
Hematology
ESR M: 0-20 W: 0-30 Sign increase Neither sensitive nor specific
Iron binding 50-160 230-410 Slight decrease
HGB M: 13-18 W:12-16 M: 10-17 W: none Anemia is common in elderly
HCT M: 45-52 W: 37-48 Slight decrease Decline in hematopoiesis
Leukocytes 4,300-10,800 Drop to 3,100-9,000 Decrease may be due to drugs or sepsis
Lymphocytes 500-2,400 Tcells Fall infection risk higher
50-200 Bcells Immunizations encouraged
Platelets 150,000-350,000 no change
Blood chemistry
Albumin 3.5-5.0 Decline R/T decreased liver size and enzymes.
Protein-energy malnutrition common.
Globulin 2.3-3.5 Slight increase
Total serum
Protein 6.0-8.4 no change Decrease may indicate malnutrition
Infection, liver disease
BUN M: 10-25 Increases significantly Decline in GFR
W: 8-20 up to 69 Decreased cardiac output
Creatinine 0.6-1.5 increases to 1.9 RT lean body mass
Creatinine Decreases 10% Used for prescribing meds
Clearance 104-124 after 40 yrs old for drugs excreted by kidney
GT 62-110 (after fasting) Slight increase 10 Diabetes increase in prevalent
<120 (2h PP) after 30 yrs drugs may cause intolerance
Alk Phos 13-39 increase by 8-10 Elevation >20% usually due to disease
Elevations may be found with bone
Abnormalities, drugs (narcotics), and
Eating fatty meals.
Atypical disease presentation
Acute abdomen: absence of symptoms or vague symptoms. Acute confusion. Mild discomfort and constipation. Some tachypnea and possibly vague respiratory symptoms. Appendicitis pain may begin in RLQ and become diffuse.
Depression: Anorexia, vague abdominal complaints, new onset of constipation, insomnia, hyperactivity, lack of sadness
Hyperthyroidism: Hyperthyroidism presenting as "apathetic thyrotoxicosis," (fatigue and weakness; weight loss may result instead of weight gain; patients report palpations, tachycardia, new onset of atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism).
Hypothyroidism: Often presents with confusion and agitation; new onset of anorexia, weight loss, and arthralgias may occur.
Malignancy: New or worsening back pain secondary to metastases from slow growing breast masses. Silent masses of the bowel.
Myocardial infarction: Absence of chest pain. Vague symptoms of fatigue, nausea, and a decrease in functional and cognitive status; classic presentations: dyspnea, epigastric discomfort, weakness, vomiting; history of previous cardiac failure. Higher prevalence in females versus males. Non-Q-wave MI.
Overall Infectious disease process: Absence of fever or low-grade fever. Malaise. Sepsis without usual leukocytosis and fever. Falls, anorexia, new onset of confusion, and/or alteration in change in mental status, decrease in usual functional status.
Peptic ulcer disease: Absence of abdominal pain, dyspepsia, early satiety. Painless, bloodless. New onset of confusion, unexplained tachycardia, and/or hypotension.
Pneumonia: Absence of fever; mild coughing without copious sputum, especially in dehydrated patients; tachycardia and tachypnea; anorexia and malaise are common; alterations in cognition.
Pulmonary edema: : Lack of paroxysmal nocturnal dyspnea or coughing; insidious onset with changes in function, food, or fluid intake, or confusion.
TB: Atypical signs of TB in older adults include hepatosplenomegaly. Abnormalities in liver function tests, and anemia.
UTI: Absence of fever; worsening mental or functional status, dizziness, anorexia, fatigue, weakness.
Geriatric syndrome
SPICES
Sleep Disturbances
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
They are starting to experience bladder control problems, sleep problems, delirium, dementia, falls, gait and balance, depression, visual acuity, and weight loss.
Early implementation of preventive therapies and safety measurement are important. Prevention is best provided using an interdisciplinary team approach. Early detection and correction of problems such as sensory deficits, confusion, and gait and balance issues can increase independence and longevity among this group. The focus of all healthcare should be on maintaining function, dignity, and individual control to promote health and quality of life. Associated with substantial morbidity and poor outcomes. They are multifactorial and although each is distinct, they share several risk factors. For example, older age, cognitive impairment, functional impairment, and mobility impairments are risk factors for falls, functional decline, delirium, and pressure ulcers.
Categories of aging-know age ranges for old, young old, old-old, ect.
TABLE 1-2 Select Bimodal Presentations of Illness in Younger Adults versus Older Adults
TYPE OF CONDITION
YOUNGER ADULTS
OLDER ADULTS
Dermatological Psoriasis
Late teens to 20sIrregular course which tends to generalize Hereditary factors
50s—males60s—femalesSporadic onset
GastrointestinalInflammatory bowel disease Ulcerative colitis (UC) Crohn's disease (CD)
20-40 years oldRight lower UCInsidious onset
>60-75 years old a second peak occursMore often older womenProctitisLeft-sided UCHigher rates of anemiaMay present as chronic diarrheaFistula developmentIncreased cases of associated malnutritionExtraintestinal manifestations including: arthritis spondylitis,uveitis, and erythema nodosumMore comorbid conditionsMay be confused with other forms of colitis
MalignanciesHodgkin's lymphoma
20-30 years oldPossible infectious etiology
>50 years oldIncreased mortality
NeurodegenerativeMyasthenia gravis (MG)
Women 20-40 years oldMore thymus abnormalities
Men—50-70 years oldWomen—70 years oldDysphoniaMore frequent ocular form MGIncreased rate of AChR seropositivity
implementation of preventive therapies and safety measurement are important. Prevention is best provided using an interdisciplinary team approach. Early detection and correction of problems such as sensory deficits, confusion, and gait and balance issues can increase independence and longevity among this group. The focus of all healthcare should be on maintaining function, dignity, and individual control to promote health and quality of life. Associated with substantial morbidity and poor outcomes. They are multifactorial and although each is distinct, they share several risk factors. For example, older age, cognitive impairment, functional impairment, and mobility impairments are risk factors for falls, functional decline, delirium, and pressure ulcers.
Recommended exercises for sleep ad flexibility:
: Preferred amount is 30 minutes per day 5 days a week, if weight management is a part of this, 60 minutes per day is advised.
To maintain the flexibility necessary for regular physical activity and daily life, older adults should perform activities that maintain or increase flexibility on at least 2 days each week for at least 10 minutes each day.
Exercise recommendations for specific diagnosis P. 21
Osteoarthritis: waking, aquatic activities, tai chi, resistance exercises, cycling. *vary type and intensity to avoid overstressing joints, heated pool.
Coronary artery disease: Walking, treadmill, cycle ergometry. *supervised program with BP and heart rate monitoring.
Congestive heart failure: walking, treadmill, cycle ergometry. *Individualized to client, supervised program.
Type 2 diabetes: Resistive, aerobic, aquatic, recreational activities. *Proper shoe fit; may need insulin reduction of insulin dependent.
Anxiety Disorders: Walking, biking, weightlifting. * If able to do high-intensity exercise, this benefits anxiety.
Depression: Walking, cycling, recreational activities. *Group participation helpful to keep patient engaged.
Fibromyalgia: Aerobic, aquatic therapy, strengthening, tai chi, Pilates. *Heated pool, gentle stretches, counsel about possible increased pain initially.
COPD: Cycle ergometer, treadmill, individualized. * Supervised program-consider pulmonary rehab.
Chronic venous insufficiency: Walking, standing exercises. *Supervised program.
Osteoporosis: Weight-bearing, weight training. *Assess balance and risk for falls before beginning.
Parkinson's disease: walking, treadmill, stationary bike, dancing, tai chi, Pilates, boxing. *Assess balance and risk for falls before beginning.
Age-related sleep disorders: tai chi, walking, aqua therapy, biking. *Assess balance and risk for falls before beginning.
Dementia: Walking, recreational activities. *Provide safe environments, assess fall risk and ability to participate. [Show Less]
