Cardiovascular Function in Older Adults

Age-related Changes that affect Cardiovascular function

-In the absence of disease, the heart tends to maintain its size

-Aging leads to changes in the walls of the blood vessels that affect the transport of oxygen and nutrients to the tissues

-Changes cause vessels to stiffen and result in: Increased peripheral resistance, Impaired blood flow, and increased left ventricular workload

-BP tends to go up with age: Systolic stabilizes at about age 75, Diastolic stabilizes at about 65 then may gradually decline

-Myocardium and neuroconduction mechanisms: Slight atrophy and enlargement of the myocardium, Decreased ability of the heart to contract effectively, Decreased number of pacemaker cells, and Increased deposits of fat, collagen, and elastic fibers around the SA node to AV node

-Vasculature: changes in inner and middle vascular layers of the arteries

-Baroreflex mechanism: Decreased ability to regulate BP

-There changes do not significantly limit the older adult in normal activity, however, normal changes can negatively affect the persons ability to compensate for risk factors and heart disease is highly prevalent and the most common cause of death

Modifiable risk factors for cardiovascular disease

-Obesity/abdominal obesity→ most dangerous, where heart and organs are

-Hypertension

-Atherosclerosis

-Physical inactivity/physical deconditioning

-Tobacco smoking and secondhand smoke

-Dietary habits

-Lipid disorders/dyslipidemias

-Metabolic syndrome/insulin resistance syndrome

-Psychosocial factors and socioeconomic factors

-Risk of cardiovascular disease in women and minority groups

Orthostatic hypotension/postural hypotension

Reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg when assuming a standing position

Postprandial hypotension

Reduction of systolic blood pressure- drop of 20 mmHg in a supine/sitting position within 120 minutes after eating ameal

Nursing assessment of cardiovascular function

Assess baseline cardiovascular function

-Heart rate, sounds, and rhythm

Assess blood pressure

-Initial blood pressure (sitting, standing, and lying in both arms

-White coat hypertension

-Home blood pressure monitoring

Technology to promote wellness in older adults

-The ability to use technology

-Blood pressure monitoring

Classification of blood pressure for adults

-Normal: Systolic BP- less than 120 and Diastolic- less than 80

-Prehypertension/Elevated: Systolic BP- 120-129 and Diastolic- less than 80

-Stage 1 Hypertension: Systolic BP- 130-139 or Diastolic- 80-89

-Stage 2 Hypertension: Systolic BP- 140 or higher or Diastolic- 90 or higher

-Hypertensive Crisis: Systolic BP- higher than 180 and/or Diastolic- higher than 120

White coat syndrome

• When pt gets nervous around doctors so their BP goes up

• How we diagnose- have them check their bp at home multiple times and if it’s normal and only high when at the doctors 

• We don’t treat since their BP is normal every other time unless they are at the doctors

Nursing Assessment of Cardiovascular function

-Identify modifiable risk factors for cardiovascular disease: HTN, lipid disorders, Hyperglycemia, OSA, smoking cessation

-Assess signs and symptoms of heart disease

-Assess knowledge about heart disease: Older adults should know classic manifestations and atypical presentations

Nursing Interventions to promote healthy cardiovascular function: Maintain BP

• <140/90 mmHg is general guideline

• May need to be less aggressive with <1150/90 mmHg for oldest adult patients (Pt with vascular dementia we want it a little higher to have blood flow to the brain, we also want it higher or else they’ll fall)

Nursing Interventions to promote healthy cardiovascular function: Lifestyle modifications

• Avoidance of tobacco

• Weight reduction when appropriate

• 30 to 45 minutes of exercise, such as brisk walking, at least five times weekly

• Limitation of alcohol intake to one drink per day

• Sodium intake limited to 1.5 g daily

• Avoidance of processed foods

• Daily intake of 7 to 8 servings of grains and grain products and 8 to 10 servings of fruits and vegtables

DASH diet

• High intake of nuts, fruits, and legumes, vegetables, and high-fiber whole grains

• Fish, skinless poultry, and plant-based proteins rather than red meats

• Fat-free or low-fat dairy products

• Use of polyunsaturated and monounsaturated fats (ex. Olive oil, oleic acid from vegetable sources) and avoidance of trans fats ans saturated fats

• Daily sodium intake limited to 1500mg or less

• Limited consumption of sugar and sugar-sweetened drinks

Managing Cholesterol levels

-Normal: <150

-Borderline high: 150-199

-High: 200-499

-Very high- >500

Managing Orthostatic Hypotension

-Maintain adequate fluid intake (8 glasses of non-caffeinated beverages daily)

-Avoid excessive alcohol consumption

-Before standing up, sit at the table of the bed for several minutes after rising from a lying position

-Prevent constipation and avoid straining during bowel movement

-Avoid sources of intense heat which cause peripheral vasodilation

Managing Postprandial hypotension

-Eat small, low carbohydrate meals

-Do not take antihypertensive medications before meals, may take 1 hour after meals

-Avoid strenuous exercise, especially for 2 hours after meals

Coronary atherosclerosis

-The abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen

-Blockages and narrowing of the coronary vessels reduce blood flow to the myocardium

-Cardiovascular disease is the leading cause of death in the US for men and women of all racial and ethnic groups

-CAD is the most prevalent cardiovascular disease in adults

Gerontologic considerations: CAD

-Diminished pain transition that occurs with aging may affect presentation of symptoms

-Silent CAD

-Teach older adults to recognize their “chest-pain like” symptoms

-Pharmacologic stres testing, cardiac catheterization

-Medications should be used cautiously: start low and go slow

Gerontologic considerations: Heart Failure

-May present with atypical signs and symptoms such as fatigue, weakness, and somnolence

-Decreased renal function can make older patients resistant to diuretics and more sensitive to changes in volume

-Administration of diuretics to older men requires nursing surveillance for bladder distention caused by urethral obstruction from an enlarged prostate gland

Planning for wellness outcomes

-Health orientation

-Health promoting behaviors: exercise

-Knowledge: healthy diet

-Knowledge: lipid disorder management

-Risk control: tobacco use

-Weight loss behavior

Evaluation of nursing interventions

-Verbalization of correct information about risks

-Verbalized participation in health promotion interventions

-Follow heart-healthy diet/dietary modifications

-Exercise programs

-Weight reduction

-Smoking cesssation

-Talk to your patient, assess for depression and anxiety