Aging Part 1

Gerontology - Normal Aging

Definition of Aging

• Aging: Sequence of physical, psychosocial, and cognitive developmental changes over the human lifespan.

• Personal perceptions of what constitutes ‘old age’ vary based on:

  • Self-image

  • Personal adjustment patterns

  • Emotional conflicts

  • Past experiences with the elderly

  • Socio-cultural background

  • Ethnic background

  • Religion

  • Personal age

Nursing Practice with Older Adults

• Recognize seniors as unique individuals affected by personal biases and definitions of aging.

• Reflect on personal:

  • Definitions of old age

  • Values (e.g., beauty vs. wisdom)

  • Attitudes and feelings towards the elderly

Normal Aging Changes - Highlights

Changes

• Loss of independence

• Loss of income

• Role reversal (children have to care for parents now)

• Change in living situation

• More people living into their 100s- advancements in medicine and resources

• When planning care, you have to think about how old these people are

Integumentary System

• Changes: facial wrinkles, gray hair, loss of elasticity leading to sagging, dry skin, and age spots.

• Skin Lesion malignancies are common - Because of sun exposure

• Health Teaching:

  • Use sunscreen.

  • Avoid heat; wear protective clothing.

  • Dress warm in the winter

  • Bathe less frequently to prevent skin drying

  • Maintain skin moisture with lubrication.

  • Be careful with procedures that can damage the skin

Cardiovascular Changes

• Decreased: Cardiac output by 40%, vessel elasticity, and stroke volume.

• Increased: Peripheral vascular resistance and blood pressure (often >140/90).

• Changes in heart valves, peripheral pulses are often weaker

• Cold feet

• Health Concerns: Hypertension, heart disease, stroke.

• Teaching: Regular exercise (as tolerated), weight loss, low-fat diet, stress reduction, keeping extremities warm.

• Nursing Implications: Risk for falls and exercise/activity intolerance

Respiratory System Changes

• Decreased: Respiratory muscle strength (after 55), vital capacity(Barrel chest), number of alveoli, and gas exchange rate.

• Health Concerns: Chronic lung disease, increased infection risk.

• Teaching: Regular exercise, no smoking, hydration, yearly flu vaccine, pneumonia shot, and avoid exposure to URI.

• Nursing Implications: Activity intolerance, Encourage rest periods, teach deep-breathing exercises

Gastrointestinal Changes

• Decreased: Peristalsis (More constipation), digestive enzymes (Food intolerance), gag reflex (choke easier), taste sensation (Put some sugar on it), gum atrophy, saliva production (Pills have a harder time going down).

• More protuberant abdomen because of the abdominal muscle strength loss.

• Health Concerns: Constipation, diarrhea, flatulence, food intolerances, weight loss/gain, drug reactions.

• Nursing Implications: Increase fluid and fiber, use laxatives with caution, and monitor drug effects.

• Teaching: Fluid and fiber intake, dental care, regulate meals.

Urinary System Changes

• Changes: Nephron loss, decreased renal blood flow, decreased filtration rate, decreased muscle tone and bladder capacity, and decreased urge and sphincter control.

• Men- Prostate enlarges

• Health Concerns: Urinary retention (Men- from an enlarged prostate), incontinence (Women- stress incontinence), Infection, and adverse drug effects.

• Nursing Implications: Increase fluid intake, monitor I/Os, regular toileting, and good skin care.

• Teaching: Regular fluid intake, toileting schedules, access to a toilet, perineal hygiene, prostate check, and pelvic exercises.

Musculoskeletal Changes

• Decreased: Height (up to 2 inches), joint flexibility, bone density, muscle mass, and cartilage degeneration.

• Bones are more porous and brittle

• Health Concerns: Osteoporosis (More common in women), arthritis, fractures, height declines, etc.

• Teaching: Weight-bearing exercises, fall prevention, home safety, adequate calcium and vitamin D, smoking cessation, and hormone replacement therapy.

• Nursing Implications: Encourage exercise and activity, weight loss, and safety.

Decline of Physical Strength

• Cause is multifactorial- muscle mass declines, cartilage erodes, membranes harden, and fluid thickens; Sarcopenia starts at 45 with a loss of 1% of muscle mass per year.

• Stiffness, gait problems, less mobility, decrease ROM.

Sensory Perception Changes

• Vision: Decreased pupil size, lens clarity, color discrimination, tear production, adjustment to light; presbyopia prevalent.

• Presbyopia- Better farther away than up close.

• Hearing: Progressive loss, excessive wax, especially at high frequencies (presbycusis).

  • Keep your voice low, give directions clearly, have them repeat, and eliminate background noise.

• Touch: Diminished sensitivity to temperature and pain, particularly in extremities. (due to impaired circulation)

• Taste and Smell: Reduction in taste buds and olfactory fibers leads to diminished sensory experiences.

• Teaching: Regular eye/hearing exams, use of sensory aids, communication adjustments, sunglasses, larger print, background noise reduction, non-verbal cues, be careful with spices.

• Sensory perception: Hearing loss, cataracts/glaucoma, senile macular degeneration (loss of eye sight), and loss of appetite.

• Nursing Implications: Hearing aids, glasses, nightlights, communication problems, and safety.

Reproductive System Changes

• Males: decrease in sexual function (getting it up), thin pubic hair, smaller testes, prostate enlargement, reduced testosterone.

• Females: Thin pubic hair, Menopause leads to accelerated aging changes such as vaginal atrophy, ovaries decrease and sclerotic, fallopian tubes and uterine atrophy, dry and smooth vagina, decrease muscle tone, elasticity resulting in sagging of the breasts breast become smaller.

• DOES NOT affect libido.

• Teaching:sexual counseling, use of lube, medication such as viagra for those men healthy enough for sexual activity, use of estrogen.

HIV/AIDS

26% of the estimated 1.2 million.

Alcoholism

• More common in over 65 than younger people

• 40% of older adults do drink

• men more likely

• tolerance is less

• More sensitive, which increases the effects

Mental Health Considerations

• Suicide Trends: Higher rates in ages 45-64 and second highest at 85+, with males dominating statistics.

• Nursing Strategies for Psychosocial Concerns: To engage older adults and adopt therapeutic communication, validation therapy, and reminiscence techniques.

Psychological Strategies

• Therapeutic Communication: Express concern, kindness, and compassion.

• Touch: convey respect and sensitivity.

• Reality Orientation: help restore a sense of reality to a person, place, or time.

• Validation Therapy: do not challenge or dispute

• Reminiscence: recalling past

• Body Image Interventions: helping the older adult present a socially accepted image.

Neurological Aging Changes

• Changes: Slower reaction times, thinking, reduced reflexes, sleep changes (hardly any stage 4 sleep (deep/restorative)body getting ready for death), slower response to heat and cold, sensory decline, decreased cerebral blood flow (affects thinking, uncoordinated balance (causes falls), dizziness, syncope (fainting)), decreased sense of balance, and uncoordinated motor movements.

• Health Teaching: ALWAYS question sudden confusion, encourage slow rising from reclined positions (dangle on the side of the bed), visitation of family, social interactions, use of walker/cane/etc (safety, look at fall prevention), provide sensory stimulation.

Teaching Strategies for Older Adults

• Teaching Checklist:

  • Quiet Environment

  • Assess readiness to learn

  • Value prior experience

  • assess for sensory deficits

  • Appropriate Language

  • Include family

  • Pace learning

  • Face them

  • Speak slow and low

  • Emphasize concrete concepts

  • Summarize and reinforce

Assessment Tools

• Fulmer SPICES Tool: An assessment tool for older adults. Look at Aging part 2 notes

  • Normal aging brings about inevitable and irreversible changes

  • Increased risk of developing health-related conditions (Stroke and Heart Attack) within the older adult population

  • Familiarity helps prevent unnecessary iatrogenesis (issues caused by health care providers when they perform interventions or diagnosis) and promotes optimal function of the aging individual

  • Flagging conditions for further assessment allow the nurse to implement preventative and therapeutic interventions.