Respiratory Function in Older Adults

Respiratory system: Gerontologic considerations

-Age-related changes may be subtle and gradual

-Diminished respiratory efficiency

-Reduced maximal inspiratory and expiratory force

-Lung mass decreases and residual volume increases

-Smoking is most significant risk factor: Smoking, vaping, Weed 

Age-related Changes that Affect Respiratory Function: Upper Respiratory Structures

-Diminished blood flow to the nose

-Stiffening of trachea

-Thicker mucus

-Decreased cilia

-Atrophy of laryngeal nerve endings

-Blunt cough and laryngeal reflexes

Age-related Changes that Affect Respiratory Function: Chest wall and musculoskeletal Structures

• Ribs and vertebrae become osteoporotic

• Costal cartilage stiffen 

• Respiratory muscles weaken

• Increased anteroposterior diameter of the chest 

• Structural changes

  • Kyphosis: curvature of spine

  • Shortened thorax

  • Chest wall stiffens 

  

Age-related Changes that Affect Respiratory Function: Lung structure and function

• Lungs become smaller and flaccid

• Pulmonary artery becomes thicker and less elastic

• Diminished capillaries

• Decrease in capillary blood volume 

• Mucosal bed thickens

• Diminished elastic recoil

• Diminished response to both hypoxia and hypercapnia

Age-related Changes that Affect Respiratory Function: Changes in immune function

Age-related alteration of T cells contribute to increased prevalence of lung diseases

Functional Consequences of age-related changes affecting respiratory function

Degenerative changes affecting nose and upper airway structures

-Snoring, mouth breathing, decreased efficiency of cough and gag reflexes, perception of nasal stuffiness, can’t smell things

Increased anteroposterior diameter, chest wall stiffness, weakened muscles and diaphragm

-Increased use of accessory muscles, increased energy expended for respiratory efficiency

Enlargement of alveoli, thinning of alveolar walls, diminished number of capillaries

-Diminished efficiency of gas exchange, decreased arterial oxygen pressure

Decreased elastic recoil and early airway closure

-Changes in lung volume, slight decrease in overall efficiency

Risk factors affecting respiratory wellness

• Tobacco smoking

  • SIngle most important risk factor 

  • Detrimental due to heat and chemical actions

  • Bronchoconstriction 

  • Impaired air flow 

  • Inflammation of mucosa

  • Inhibited ciliary action 

• Secondhand smoke

  • Passive smoke or environmental tobacco smoke

    • Contains carcinogens

    • Effects: coughing, wheezing, chest tightness, and reduced lung function

• Inhalation of air pollutants

• Occupational exposure to toxic substances 

• Smokeless tobacco

• Previous work with environmental hazards

• Lack of vaccinations

• Medications

• Bedrest

• Obesity

• Chronic illness

Increased susceptibility to lower respiratory infections

-Age-related changes: diminished respiratory efficiency, reduced total pulmonary function

• Functional consequence of age-related changes of respiratory and immune system

• Lower respiratory infections: pneumonia, influenza, West Nile viral infection

• Aspiration pneumonia: inflammation caused by food or secretions entering bronchial tree

• Impaired mobility

Risk factors for Pneumonia in older adults

• Dysphagia

• Dementia

• Post-surgical care

• Frailty

• Dehydration

• Malnutrition

• Impaired function 

• Compromised immunity 

• Poor oral care 

• Confusion 

• May not see usual symptoms of fever, chills, rigors, and sputum production

Vaccinations

• Pneumococcal vaccine: one-time-only immunization

• Influenza vaccine 

• COVID-19 vaccine

TB: Gerontologic considerations

-Over 30% of all new case in older persons.

-As in younger persons, assess for typical presentation

-Recognize atypical manifestations in older adult patients, symptoms may include unusual behavior and altered mental status, fever, anorexia, and weight loss.

-Often dormant for many years and then becomes active case in older adult because of decreased immune system or immunosuppressant meds

-In many older adult patients, the tuberculin skin test produces no reaction (loss of immunologic memory) or delayed reactivity for up to 1 week (recall phenomenon). Therefore, a second skin test is performed in 1 to 2 weeks after the first.

-Older adults who live in long-term care facilities are at increased risk for primary and reactivation TB as compared to those in the community

Nursing Interventions for respiratory wellness

-Promoting respiratory wellness

• Education, prevention, health promotion interventions, patient teaching materials

-Preventing lower respiratory infections

• Prevention of pneumonia and influenza with health promotion and education interventions

-Eliminating the risk from smoking

• Address attitudes that influence health-related behaviors

-Technology to Promote Wellness in Older Adults

Evaluating effectiveness of nursing interventions

-Reassessment of subjective indicators: ease of breathing

-Reassessment of objective indicators: lung sounds, respiratory rate, and rhythm

-History of immunizations for pneumonia and influenza and COVID

-Plan to stop smoking: successful participation in smoking cessation