| Aging Changes and Implications | Assessment and Care Strategies |
Cardiovascular System
Aging changes
- Left ventricle hypertrophy
- Decreased force of contraction, contractile efficiency, stroke volume
- Decreased baroreceptor sensitivity and beta adrenergic response
- Arterial stiffening and all thickening, decreased compliance
- Decreased O2 uptake by tissues
Implications - Decreased cardiac reserve & output
- Slow recovery from tachycardia
- Fatigue, SOB
- Increased premature or ectopic beats
- Risk of valvular dysfunction & systolic murmurs, conduction abnormalities
- Risk of postural & diuretic-induced hypotension
- Strong arterial pulses, diminished peripheral pulses;cool extremities
- Risk of inflamed varicosities
| Assessment
- Assess BP (lying, sitting, standing) & pulse pressure
- Cardiac assessment: rate/rhythm/heart sounds
-note altered landmarks, distant heart sounds, extra heart sounds (S3 in CHF) - Palpate cartoid artery, peripheral pulses for symmetry
- Monitor heart rate and rhythm, note irregularity, ECG
- Assess for dyspnea with exertion, exercise intolerance
Care strategies
- Referral for irregularities in heart rhythm, decreased or asymmetry of pulses
- Safety precautions for orthostatic hypotension
- Rise slowly from lying or sitting position
-Wait 1-2 minutes after position change to stand or transfer
-Monitor for overt signs of hypotension: change in sensorium/mental status, dizziness, orthostasis -Institute Fall prevention strategies (See Falls Topic) |
Respiratory System
Aging changes
- Decreased response to hypoxia & hypercarbia/li>
- Diminished ciliary & macrophage activity
- Increased airway reactivity
- Decreased muscle strength & endurance
- Drier mucus membranes
- Decreased alveolar function, vascularization, elastic recoil
- Thorax & vertebrae rigid
Implications - Decreased cough, deep-clearance
- Risk of infection & bronchospasm (airway obstruction)
- Altered pulmonary function - lower maximal expiratory flow (FEV, FEV1/FVC1
- increased residual volume
- reduced vital capacity
- unchanged total lung capacity - Dyspnea after exertion, decreased exercise tolerance
- PO2, SpO2 decreased. Decreased capacity to maintain acid-base balance
- Respiratory rate12-24
- Decreased respiratory excursion & chest/lung expansion with less effective exhalation
- Diminished breath sounds at lung bases - risk of atelectasis
| Assessment - Respirations - rate, pattern, breath sounds throughout lung fields
- Note thorax appearance, chest expansion
- Assess cough, deep breathing, exercise capacity
- Monitor arterial blood gases, pulse oximetry
- Monitor secretions, sedation, positioning which can reduce ventilation/oxygenation
Care strategies
- Maintain patent airway through repositioning, suctioning, bronchodilators
- Prevention of respiratory infections with pulmonary
- Incentive spriometry as indicated, particularly if unable to ambulate or decline in function
- Education on cough enhancement, avoidance of environmental contaminants, smoking cessation
- Maintain hydration and mobility
- Provide oxygen as needed
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Genitourinary System
Aging changes
For kidney
- Decreased functional reserve when water/salt overload/deficit
- Decreased blood flow, oxygenation, glomerular filtration rate (often < 50%, measured by creatinine clearance)
- Tubule degeneration
- Reduced response to vasopressin
- Impaired capacity to dilute, concentrate, acidify urine; impaired sodium regulation - Reduced bladder elasticity, muscle tone, capacity
- Weakend urinary sphincter
- Decreased or delayed perception of voiding signal
- Increased nocturnal urine production
- In males, benign prostatic hypertrophy
Implications - Risk of renal complications in illness; susceptibility to acute ischemic renal failure & embolism
- Risk of dehydration, volume overload, hyperkalemia (with potassium-sparing diuretics), hyponatremia (with thiazide diuretics), hypernatremia (with NSAIDs). See addendum
- Reduced excretion of acid load
- Risk of postural hypotension
- Decreased drug clearance
- Risk of nephrotoxic injury by drugs
- In bladder, increased post-void residual urine
- Risk of urinary tract infection (UTI), incontinence (not a normal finding) (See Urinary Incontinence Topic)
- Nocturnal polyuria- risk for falls
- In males, risk of urinary hesitancy dribbling, frequency, incontinence (BPH)
| Assessment - Assess renal function, particularly in acute/chronic illness
- Monitor blood pressure (orthostatic)
- Assess for dehydration, volume overload, electrolyte imbalances, proteinuria- See addendum at end of table
- Determine source of fluid/electrolyte imbalance, monitor laboratory data
- Assess choice/dose/need for nephrotoxic agents (e.g., aminoglycoside antibiotics, radiocontrast dye) and renally excreted medications (See Medication Topic)
- Palpable bladder after voiding due to retention
- Assess for urinary incontinence, UTI
- Assess for abnormal urine stream, urinary retention with BPH
- Assess fall risk in nocturnal or urgent voiding
Care strategies
- Maintain hydration, baseline fluid/electrolyte balance. Prepare for fluid/electrolyte correction as indicated
- Monitor drug levels of renally cleared medications
- Calculate creatinine clearance - see addendum
- Monitor for normal renal function: constant serum creatinine level to baseline
- Safety precautions in nocturnal or urgent voiding & postural hypotension, institute fall prevention strategies
- Referral to incontinence specialists with follow-up for incontinence management
- Referral to renal or urology as indicated
- Caution providers regarding medications that increase urinary retention in BPH, renal toxic drugs (See Medication Topic)
- See addendum at end of table for signs and symptoms of dehydration, UTI, electrolyte imbalances (See Atypical Presentation Topic
|
Gastrointestinal System
Aging changes
- Decreased thirst perception
- Decreased esophageal motility & lower esophageal sphincter pressure
- Decreased stomach motility; mucosal atrophy
- Decreased small intestine motility, villi, digestive enzyme secretion
- Decreased large intestine blood flow, motility, defecation sensation
- Decreased liver size, blood flow, enzymatic metabolism of drugs; increased biliary lipids
Implications - Risk of dehydration, electrolyte imbalances, poor nutritional intake
- Risk of dysphagia, hiatal hernia, aspiration
- Delayed emptying of stomach with risk of maldigestion
- Gastroesophageal Reflux Disease (GERD)
- Constipation, flatulence common
- Risk of fecal impaction
- Risk of adverse drug reactions due to slowed liver metabolism
- Decreased absorption of fat, carbohydrate, protein, vitamin B12, iron, folate, calcium, and vitamin D with risk of anemia, osteoporosis, malnutrition
- In mouth, risk of gingivitis, tooth loss with chewing impairment
| Assessment - Assess abdomen (note smaller liver), bowel sounds
- Monitor weight, dietary intake, elimination patterns, fluid intake
- Assess dentition, chewing & swallowing abilities, eating habits/nutrition
- Assess lungs for basilar crackles, infection from aspiration
- Evaluate poor food intake
Care strategies - 3 day calorie count, consultation with dietician for poor intake/unplanned weight loss. (See Mealtime Difficulties Topic)
- Monitor drug levels and liver function tests if on medications metabolized in liver; electrolytes, BUN/creatinine, albumin (nutritional indicator and if low effects drug levels like digoxin)
- Monitor for signs of dysphagia, coughing or choking with solids/liquids. Speech &/or swallowing evaluation as indicated
- Monitor for signs of aspiration particularly if decline in function/weakness; GERD
- Monitor nutrition/diet intake, fluid intake, elimination particularly if immobile. Maintain mobility.
- Provide laxatives if on constipating medications, e.g., narcotics
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Musculoskelatal System
Aging changes
- Narrowed intervertebral disks
- Decreased bone mass
- Lean body mass replaced by fat with redistribution of fat
- Decrease in muscle mass & regeneration of muscle fibers
- Increased latency/contraction time of muscle
- Increased hip/knee flexion
- Tendon & ligament stiffening
- In joints, articular cartilage erosion; increased bone overgrowth & calcium deposits
Implications
- Giat & balance instability common
- Risk of osteoporosis & fractures, osteoarthritis
- Decreased total body water & intercellular/interstitial fluid
- Decreased muscle strength & agility; slowed reflexes and reaction time-fall risk
- Decreased endurance
- Joint stiffness with decreased mobility
- Risk of injury, pain on ROM, joint subluxation, crepitus
| Assessment
Care strategies - Maintain maximal function, encourage/provide active or passive ROM
- Assess for pain and provide pain medication to enhance functionality
- Demonstrate/encourage muscle strengthening exercises
- Referrals to physical/occupational therapy
- Fall risk interventions, avoid restraints. (See Falls Topic and Restraints Topic)
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Nervous System & Cognition
Aging changes
- In CNS, decrease in neurons, brain size, neurotransmitters
- Slowed nerve impulse conduction. Decreased peripheral nerve function
Implications - Risk of poor balance, postural hypotension, falls, injury
- Decreased proprioception; potential for extrapyramidal Parkinson-like gait
- Ischemic paresthesia in extremities common
- Slowed thought processing, response to stimuli, reflexes.
- Risk of mild cognitive impairment, delirium in acute illness (See Delirium topic)
| Assessment
Care strategies
- Monitor for delirium during acute illness
- Institute fall prevention strategies (See Falls Topic)
- Rise slowly from lying, sitting positions; wait 1-2 minuted prior to transfer
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Addendum
Dehydration symptoms: orthostatic hypotension, weight loss, tachycardia, hyperthermia, weakness, nausea, anorexia, oliguria, dry mucus membranes & skin, poor skin turgor, increased thirst
Volume overload symptoms: weight gain >2%, I >O, bounding pulse, tachycardia, increased BP & CVP, distended neck/peripheral veins, crackles, dyspnea, SOB, confusion
Hyponatremia (serum sodium < 135 mEq/L) symptoms: hypotension, tachycardia, hyperthermia, nausea, malaise, lethargy, somnolence, confusion, poor skin turgor, increased thirst, muscle twitching, abdominal cramps, headache, seizure, coma, elevated BUN & Hct
Hypernatremia (serum sodium > 148 mEq/L) symptoms: orthostatic hypotension; increased thirst; poor skin turgor; dry mucus membranes; weight loss; oliguria; lethargy; hyperthermia; elevated BUN, Hct, creatinine
Hyperkalemia (serum potassium > 5.0 mEq/L) symptoms: diarrhea, cardiac arrhythmias/arrest, ECG abnormalities, irritability, apathy, confusion, muscle weakness, loss of reflexes, paresthesias
Calculation of creatinine clearance in elderly:
For Men Creatinine clearance (ml/min) =
140 - age (years) X body weight (kg)
72 X serum creatinine (mg/dL)
For women above x 85% (0.85)
Urinary tract infection symptoms: dysuria, flank or suprapubic pain, hematuria, urinary frequency/urgency, cloudy/malodorous urine, anorexia, confusion, nocturia, enuresis
See Atypical Presentation Topic |
