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Physiologic Changes of Aging


R/t limitations of moving, thinking or communicating. Iatrogenic ... or pulling feeling occur mostly in the legs ... Decreased hair growth on the legs and feet ... – PowerPoint PPT presentation

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Title: Physiologic Changes of Aging

Physiologic Changes of Aging
Gerontological Community Based Nursing
Im Dying of Thirst!
  • In young, water makes up about 2/3 of our body
  • The brain is composed of about 95 water
  • The blood is about 82 water
  • The lungs are about 90 water
  • In the elderly total body water drops to about
    50 of the bodys weight

  • Small changes in water content make a big
    difference in the elderly because
  • Kidneys lose their ability to concentrate urine
    as effectively
  • There is a decreasing sense of thirst in the
  • Recommended daily fluid intake for the elderly is
    1500-2000ml of non-caffeinated fluids

  • Dehydration is one of the most common fluid and
    electrolyte problems experienced by the elderly
  • Types of dehydration
  • Isotonic
  • Hypertonic
  • Hypotonic

  • Dehydration in elderly can cause
  • Delirium
  • UTI
  • URI
  • Urinary incontinence
  • Constipation
  • Pressure ulcers
  • Cardiovascular symptoms
  • Death

  • Factors that can contribute to dehydration
  • Medications
  • Diuretics
  • Sedatives
  • Antipsychotics
  • ETOH abuse
  • Dementia
  • Self feeding defecits
  • Immobility
  • Fever
  • Diarrhea

Physiologic Signs of Dehydration
  • Poor skin turgor
  • On the forehead or sternum, not the hand or arm
  • Sunken eyes
  • Dry mucus membranes
  • Irritability
  • Confusion
  • Dizziness
  • Muscle weakness
  • Acute weight loss (gt 2 pounds in a few days)
  • 2.2 pounds (1 Kg) 1 liter of water
  • ?UOP
  • ? HR
  • Orthostatic hypotension
  • ? SBP gt20 mm Hg with position change
  • BUN/creatinine ratio gt251
  • Tachycardia
  • Pulse gt 100 bpm
  • ? gt 10-20 bpm with position change

Diagnosing Dehydration
  • All must be present to diagnose clinical
  • Suspicion of decreased intake or increased output
  • Two physiologic signs of dehydration

  • Prevention preferable to treatment!
  • Adequate water intake
  • Remember dehydration and malnutrition often go
    hand in hand
  • Oral hydration
  • Water
  • Sports drinks
  • Box 11-2 in your text

Bladder Function in the Elderly
  • Diminished bladder control
  • Warning period between desire to void and
    micturation is shortened or lost
  • Nocturnal frequency is common in men and women

Urinary Incontinence
  • One of the most common conditions in the care of
    older adults
  • Related to
  • Cognitive impairments
  • Difficulty in walking
  • Difficulty manipulating clothing
  • Medications
  • Diuretics
  • Sedatives
  • Hypnotics
  • Risk factors detailed in 11-3

  • Generates feelings of shame, fear, guilt,
  • Psychological consequences include
  • anxiety, embarrassment gtdepressive symptoms
  • Social restriction/isolation
  • Avoidance of sexual activity
  • Physical consequences include
  • Skin problems
  • Pressure ulcers
  • UTIs
  • Falls

Types of Urinary Incontinence
  • Categorized based on symptoms
  • Stress
  • Urge
  • Overflow
  • Iatrogenic
  • Mixed
  • Functional

Stress Incontinence (Anatomic Incontinence)
  • Involuntary leaking of urine while exercising,
    coughing, sneezing, laughing or lifting
  • Most common type in women
  • Often develops after child birth
  • In men usually related to benign prostatic
    hyperplasia (BPH)

Urge Incontinence (Overactive Bladder)
  • Frequent, sudden urge to urinate with little
    control of the bladder
  • Especially when sleeping, drinking, or listening
    to running water
  • May also be a sign of UTI or kidney infection

Overflow Incontinence
  • Incomplete emptying of bladder
  • Frequent urination and/or constant dribbling of
  • Generally caused by weakened bladder muscle d/t
    nerve damage including diabetes

  • Functional Incontinence
  • Unable to control bladder before reaching the BR
  • R/t limitations of moving, thinking or
  • Iatrogenic
  • Associated with medication side effects
  • Mixed Incontinence
  • More than one type of incontinence
  • Typically stress incontinence and urge

Nursing Interventions
  • Understanding type of incontinence
  • Goal setting
  • Curing incontinence versus
  • Minimizing effects
  • Attitude
  • Nurses should not demonstrate
  • Acceptance of inevitability of incontinence
  • Disgustdecreases self-worth of elder and
    increases dependence
  • Nurses should
  • Treat incontinence as curable
  • Adopt a teaching role

Nursing Interventions
  • Environmental
  • Dietary changes
  • Bowel training
  • Sphincter training exercises
  • Biofeedback training
  • Medication
  • Surgery

Nursing Care
  • All health care providers should strive to
    understand the causes of incontinence, risk
    factors and evidence-based interventions
  • Failure to address continence promotion has
    enormous consequences in terms of economics and
    burden of care

Nursing Interventions
  • Therapeutic modalities
  • Behavioral interventions
  • Protective interventions
  • Table 11-1 page 200

Fecal Incontinence
  • Inability to control passage of stool
  • Devastating social implications for individuals
    and families
  • Multifactorial

Nursing Intervention
  • Fecal incontinence is symptom, nurses should seek
    out cause
  • Attitude
  • Goal setting
  • Planned
  • Realistic
  • Consistent

Maslows Hierarchy
  • Elimination is key to maintenance of physiologic
    and biologic integrity
  • What other implications does it have?

Rest Sleep Changes in the Elderly
  • Changes in sleep patterns are a part of the
    normal aging process

Age-related sleep changes
  • As people get older
  • They tend to have a harder time falling asleep
  • They may have more trouble staying asleep
  • Many, not all, report being less satisfied with
    sleep at night and more sleepy during the day
  • Common misconception
  • Sleep needs decline with age
  • In fact our sleep needs remain constant
    throughout adulthood

So whats keeping seniors awake?
  • Changes in sleep patterns
  • Older people spend more time in lighter stages of
    sleep than in deep sleep

Sleep patterns in elderly
  • Studies show
  • An ? in the time it takes to fall asleep (sleep
  • An overall ? in REM sleep
  • An ? in sleep fragmentation (waking during the
    night) with age
  • Also sleep disorders tend to increase with age
  • Much of sleep disturbance among the elderly can
    be attributed to physical and psychiatric illness
    and the medications used to treat them

Other factors affecting sleep in the elderly
  • Circadian rhythms
  • Rhythms that coordinate the timing of our bodily
    functionsincluding sleep
  • Older people tend to become sleepier in the early
    evening and wake earlier in the morning than
    younger adults

  • Prevalence of insomnia is higher among older
  • Chronic (lasting over one month)
  • Chronic medical illnesses
  • Medications
  • Pain
  • ? disorders (depression)
  • Transient (lasting a few days or weeks)
  • Acute stress

Sleep Apnea
  • Obstructive Sleep Apnea (OSA)
  • Affects 10 of those gt65 y.o.
  • Men twice as often as women
  • Associated with hypertension and other health
  • Breathing stops (10-60 seconds)
  • Oxygen level in the blood drops
  • Brain is alerted to hypoxia
  • Brain causes brief arousal (awakening)
  • Breathing resumes
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Restless Leg Syndrome
  • Neurological movement disorder characterized by
    an irresistible urge to move the limbs
  • Tingling, creeping or pulling feeling occur
    mostly in the legs
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Other disorders affecting sleep
  • GERD
  • Diabetes mellitus
  • Renal failure
  • Respiratory disease
  • Parkinsons disease
  • Multiple sclerosis

Nursing Management of Sleep in Healthy Aging
  • Assessment
  • Table 12-3 page 220
  • Sleep history interview
  • Quality of sleep
  • awakenings / night
  • Bedtime rituals
  • Lifestyle factors
  • Exercise
  • Environmental factors
  • Medications
  • Etc.

Nursing Interventions
  • Identifying causes
  • Table 12-3
  • Pharmacological vs. non-pharmacological
  • Behavioral changes
  • Environmental changes

Healthy Skin and Aging
  • Skin is the largest organ in the body
  • Many purposes
  • Protects underlying structures
  • Heat-regulating mechanism
  • Sense organ
  • Metabolism of salt and water
  • Stores fat
  • Gas exchange
  • Conversion of vitamin D

  • Subject to damage
  • Photo aging
  • Development of skin cancer
  • Sunscreen
  • Skin cancers
  • Basal Cell Carcinoma
  • Squamous Cell Carcinoma
  • Melanoma

Other Skin Problems
  • Seborrheic Keratosis
  • Benign growths mainly on trunk, face, scalp
  • Candida albicans
  • Fungal infection
  • Usually found in folds of skin
  • R/t antibiotics, steroid use

Vascular Insufficiency
  • Leads to complications of skin mild dermatitis
    ? ulcerations ? gangrene
  • Arterial insufficiency
  • r/t atherosclerotic plaques ? ischemia
  • Symptoms
  • Pain with exercise
  • Pain at rest
  • Susceptible to infections 2o to even mild trauma
  • Affects 10 of those gt 65 y.o.

Lower Extremity Arterial Disease
  • Claudication
  • discomfort, cramps or pain in the hips, thighs or
    calves with walking

LEAD Risk Factors
  • Same as those associated with coronary artery
  • Smoking
  • High blood pressure (hypertension)
  • High levels of blood cholesterol or triglycerides
    (hypercholesterolemia, hyperlipidemia)
  • Obesity
  • Sedentary lifestyle
  • Diabetes
  • Family history of heart disease or arterial

LEAD Signs Symptoms
  • Decreased hair growth on the legs and feet
  • Discoloration of the affected leg or foot when
    dangling (from pale to bluish-red)
  • Diminished or absent pulses in the affected leg
    or foot
  • Temperature difference in affected leg or foot
    (cooler than other extremity)
  • Change in sensation (numbness, tingling,
    cramping, pain)
  • Presence of non-healing wound on affected lower
  • Shrinking of calf muscles
  • Presence of thickened toenails
  • Development of gangrene

Venous Insufficiency
  • Veins located inside the legs return blood to the
    heart. As people age, these veins may weaken and
  • Veins return blood to the heart in two ways.
    Either the force of the heart pumping fresh blood
    pushes blood back to the heart, or blood flows to
    the heart from the force of gravity. When blood
    has to fight gravity and flow upstream back to
    the heart, as it does through the deep veins in
    the legs, the leg muscles contract to pump blood
    back toward the heart
  • Increased blood pressure can stretch and damage
    vein walls.
  • When veins weaken and lose the ability to pump
    blood effectively, the condition is called
    chronic venous insufficiency, or CVI.
  • The venous pump is most effective when a person
    is walking and leg muscles are contracting. But
    when a person sits or stands, blood pressures in
    leg veins can build. Deep veins are usually able
    to withstand short periods of inactivity, but
    extended periods of increased pressure can
    stretch and weaken vein walls.

Venous InsufficiencySigns Symptoms
  • Symptoms of CVI may include
  • Varicose veins
  • Ulceration or skin breakdown
  • Reddened or discolored skin on the leg
  • Edema or swelling.

CVIRisk Factors
  • CVI can also be caused by
  • A thrombus, or blood clot, that blocks blood flow
    in a vein, called deep vein thrombosis or
  • Phlebitis, an inflammation of a superficial vein
    that causes a blood clot to form.
  • Risk factors may include
  • Heredity
  • Obesity
  • Pregnancy
  • Sedentary lifestyle
  • Smoking
  • Jobs requiring long periods of standing or
    sitting in one place and
  • Age and sex (women in their 50s are more prone to
    developing CVI).

Pressure Ulcers
  • Pressure ulcers develop as a result of
    compression between a bony prominence and another
    hard surface
  • Serious and costly problems
  • Lead to severe complications and death

Determining Risk for Pressure Ulcers
  • Important factors
  • Severity of illness
  • Involuntary weight loss
  • Hypoproteinemia
  • Dehydration
  • Vitamin deficiencies
  • Braden Scalerisk assessment tool
  • Sensory perception
  • Skin moisture
  • Activity
  • Mobility
  • Friction and shearing
  • Nutritional status

Nursing Implication
  • Prevention!!
  • An ounce of prevention is worth a pound of cure
  • Turning schedule
  • Supportive surfaces
  • Activity level
  • Meticulous cleaning and skin care
  • Nutrition

  • Number and severity of foot problems increase
    with age
  • Nursing assessment can identify potential
    problems and actual problems needing attention
  • Useful guide for assessment in box 13-6
  • Guide for comprehensive assessment of the lower
    extremities (LEs) in figure 13-2

Nursing interventions
  • Proper toenail care
  • Reducing dependent edema
  • Promoting foot massage to stimulate circulation