PHYSIOLOGICAL CHANGES - GERIA

inc residual urine

UTI

chewing problems

• aspiration risk

• nutrition problems

know the sx/s

atypical presentation

constipation

• inc activity

• increase fluid and fiber

Medications

• Safety precautions, adverse reactions

• Polypharmacy

• “Start low, Go slow”

• aspiration risk

• enteric coated

  • swallow whole

enteric coated

swallow whole

safety precautions

signs of abuse

theories of aging

disengagement theory

The Biological Theory of Aging

• Free radical theory

• The immunological theory

Free radical theory

• is based on the assumption that aging is caused by the accumulation of damage to DNA, proteins, and lipids in cells caused by the action of free radicals.

• ______ are atoms or molecules with incompatible internal electrical charges damaging tissues. These substances are present in all environments surrounding people (Baş, 2018)

Free radical theory Nursing Implications

• preventing and combating conditions predisposing to the appearance of free radicals and eliminating their effects

• such as maintaining proper nutrition

• limiting stress.

The immunological theory

• suggests that aging is caused by a decline in the immune system.

• lead to the deterioration of the body’s protective functions

• higher frequency of infections in older people

The immunological theory Nursing Implications

• involve healthy activity

• proper use of alcohol and drugs

• use of medications that can support a healthy immune system

The Disengagement Theory

• suggests that people age as a result of accepting and adapting to the reduction of various functions that they used to carry out in the past

• aging is associated with a decrease in the number of resources available to the individual, such as time, money, and friends.

• As a result of fewer external activities and restrictions on social relationships, aging becomes more accepted (Holding et al., 2020).

The Disengagement Theory Nursing Implications

• support and improve the quality of life of the elderly by

  • providing them with necessary activity programs,

  • social connections, and

  • adaptation to changes.

The Sociological Theory

• aging is a process related to the change in the roles that a person plays in society. At the core of the social role theory is the idea that each generation has its own set of social roles that they need to perform (Schneider & Bos, 2019).

• aging is considered the process of transitioning from one role to another.

The Sociological Theory Nursing Implications

supporting patients in the process of transitioning to new roles and helping them adapt to a new environment.

The Discrimination Theory

• Assumes that aging leads to negative stereotypes and discrimination in society

  • social isolation

  • poverty

The Discrimination Theory Nursing Implications

• creating an environment and policies that prevent age-based bias.

• Nurses must support patients in their rights and access to resources and services.

Categories of the AGING

• Young Old

• Middle Old

• Old Old

Young Old

• 65-74 years

Middle Old

• 75-84 years

Old Old

• >85 years

• over 100 years

Aging

• is the biopsychosocial process of change that occurs in a person between birth and death.

Gerontology

• is the study of the aging process.

CNS - Changes with ageing

• Neuronal loss

• Cochlear degeneration

• Increased lens rigidity

• Lens opacification

• Anterior horn cell loss

• Dorsal column loss

• Slowed reaction times

CNS - Clinical consequences

• Increased risk of delirium

• Presbycusis/high-tone hearing loss

• Presbyopia/abnormal near vision

• Cataract

• Muscle weakness and wasting

• Reduced position and vibration sense

• Increased risk of falls

Respiratory System - Changes with ageing

• Reduced lung elasticity and alveolar support

• Increased chest wall rigidity

• Increased V/Q mismatch

• Reduced cough and ciliary action

Respiratory System - Clinical consequences

• Reduced vital capacity and peak expiratory flow

• Increased residual volume

• Reduced inspiratory reserve volume

• Reduced arterial oxygen saturation

• Increased risk of infection

Cardiovascular system - Changes with ageing

• Reduced maximum heart rate

• Dilatation of aorta

• Reduced elasticity of conduit/ capacitance vessels

• Reduced number of pacing myocytes in sinoatrial node

Cardiovascular system - Clinical consequences

• Reduced exercise tolerance

• Widened aortic arch on X-ray

• Widened pulse pressure

• Increased risk of postural hypotension

• Increased risk of atrial fibrillation

Endocrine system - Changes with ageing

• Deterioration in pancreatic ẞ-cell function

Endocrine system - Clinical consequences

• Increased risk of impaired glucose tolerance

Renal system - Changes with ageing

• Loss of nephrons

• Reduced glomerular filtration rate

• Reduced tubular function

Renal system - Clinical consequences

• Impaired fluid balance

• Increased risk of dehydration/overload

• Impaired drug metabolism and excretion

Gastrointestinal system - Changes with ageing

Reduced motility

Gastrointestinal system - Clinical consequences

Constipation

Bones - Changes with ageing

• Reduced bone mineral density

Bones - Clinical consequences

• Increased risk of osteoporosis

Integumentary System Physiological Changes

• Loss of pigment in hair and skin

• Wrinkling of the skin

• Thinning of the epidermis and easy bruising and tearing of the skin

• Decreased skin turgor, elasticity, and subcutaneous fat

• Increased nail thickness and decreased nail growth

• Decreased perspiration

• Dry, itchy, scaly skin

• Seborrheic dermatitis and keratosis formation → overgrowth and thickening of the skin

Neurological System - Physiological Changes

• Slowed reflexes

• Slight tremors and difficulty with fine motor movement

• Loss of balance

• Increased incidence of awakening after sleep onset

• Increased susceptibility to hypothermia and hyperthermia

• Short-term memory decline possible

• Long-term memory usually maintained

Some Common Neurological Disorders in Elderly

• Neuropathy

• Parkinson’s disease

• Amyotrophic Lateral Sclerosis

• Myasthenia Gravis

• Alzheimer’s disease

• Myopathy

• Stroke

• Muscular Dystrophy

Musculoskeletal System - Physiological Changes

• •Decreased

  • muscle mass

  • strength

  • atrophy of muscles

  • mobility

  • range of motion

  • flexibility

  • coordination

  • stability

• Change of gait, with shortened step and wider base

• Posture and stature changes causing a decrease in height

• Increased brittleness of the bones

• Deterioration of joint capsule components

• Kyphosis of the dorsal spine (increased convexity in the curvature of the spine)

• The older client is at risk for falls because of the changes that occur in the neurological and musculoskeletal systems

• Osteoporosis

Cardiovascular System - Physiological Changes

1. Diminished energy and endurance, with lowered tolerance to exercise

2. Decreased compliance of the heart muscle, with heart valves becoming thicker and more rigid

3. Decreased cardiac output and decreased efficiency of blood return to the heart

4. Decreased compensatory response, so less able to respond to increased demands on the cardiovascular system

5. Decreased resting HR.

6. Weak peripheral pulses

7. Increased blood pressure but susceptibility to postural hypotension

Respiratory System - Physiological Changes

• Decreased stretch and compliance of the chest wall

• Decreased strength and function of respiratory muscles

• Decreased size and number of alveoli

• Respiratory rate usually unchanged

• Decreased depth of respirations and oxygen in take

• Decreased ability to cough and expectorate sputum

GI system slows down

• less efficient absorption of nutrients

Changes in the oral cavity

• loss of appetite

Delayed gastric emptying

• bloating and discomfort

Changes in pH and dec secretion

• malabsorption of B vitamins

Decrease hepatic and renal reserves

• harder to metabolize meds and alcohol

Thirst regulation affected

• risk for dehydration

Gastrointestinal System - Physiological Changes

• Decreased need for calories because of lowered basal metabolic rate

• Decreased appetite, thirst, and oral intake

• Decreased lean body weight

• Decreased stomach emptying time

• Increased tendency toward constipation

• Increased susceptibility for dehydration

• Tooth loss

• Difficulty in chewing and swallowing food

Endocrine System - Physiological Changes

• Decreased secretion of hormones, with specific changes related to each hormone’s function

• Decreased metabolic rate

• Decreased glucose tolerance, with resistance to

• insulin in peripheral tissues

• Increase risk of glucose tolerance

Renal System - Physiological Changes

• Decreased kidney size, function, and ability to concentrate urine

• Decreased glomerular filtration rate

• Decreased capacity of the bladder

• Increased residual urine

• Impaired medication excretion

• Impaired fluid balance

• Increased risk of dehydration/overload

• increased incidence of infection and possibly incontinence

• Increased risk of drug toxicity

Special Senses - Physiological Changes

• Possible loss of hearing ability; low-pitched

• tones are heard more easily

• Inability to discern taste of food

• Decreased sense of smell

• Changes in touch sensation

• Decreased pain awareness

• Decreased visual acuity

• Decreased accommodation in eyes, requiring increased adjustment time to changes in light

• Decreased peripheral vision and increased sensitivity to glare

• Presbyopia and cataract formation