HDI Aging
Physiological Changes of Aging
Integumentary System:
Loss of skin elasticity, wrinkling, sagging, dry and fragile skin, thick nails, hair thinning, graying, and liver spots.
Increased vulnerability to skin tears, bruising, and pressure sores at key anatomical contact points.
Musculoskeletal System:
Muscle atrophy, loss of flexibility, stiff joints, arthritis, decreased muscle mass/strength, and unsteady gait.
Reduced bone density leads to osteoporosis, increased risk of fractures, and height loss from kyphosis (Dowager's hump).
Estrogen plays a critical role in retaining calcium within the bones.
Nervous System:
Loss of nerve cells, slower nerve conduction, delayed reaction time, and slower learning and pain perception.
Reduced cerebral circulation leads to vertigo, balance loss, frequent falls, and elevated cardiovascular disease risk.
Sensory Changes:
Eyes: Reduced visual acuity, cataracts (cloudy lens), presbyopia (farsightedness from reduced lens flexibility), and glaucoma (increased intraocular pressure).
Ears: Presbycusis, loss of auditory hair cells affecting upper frequencies, causing missed cues and strained hearing.
Taste & Smell: Diminished taste and smell lead to loss of appetite, poor nutrition, and reliance on excess salt or spices.
Cardiovascular System:
Thickened and hardened heart valves cause murmurs and ineffective pumping.
Dilated aorta leads to ventricular enlargement (hypertrophy), weakened myocardial muscle, and loss of blood vessel elasticity impairing blood pressure regulation.
Respiratory System:
Decreased elasticity in upper and lower airways, reduced muscle strength in the thorax, diminished air exchange, and increased retained secretions.
Reduced body fluids create drier mucous membranes and heighten infection risk.
Gastrointestinal System:
Tongue atrophy, reduced saliva, impaired swallowing/chewing, and receding gums (losing teeth is not a normal part of aging).
Presbyesophagus (weakened esophageal lining), reduced absorption of vitamins and minerals, and constipation due to decreased peristalsis and diminished sensory perception.
Urinary & Endocrine Systems:
Urinary frequency, bladder hypertrophy, nocturia (influenced by antidiuretic hormone ADH and improved lying-down renal circulation), retention (linked to nerve damage, enlarged prostate, or fecal impaction), and incontinence.
Decreased renal blood flow impairs drug elimination.
Decreased enzyme activity, menopause, slower metabolism, and non-insulin-dependent glucose intolerance.
Reproductive & Immune Systems:
Female: Decreased egg and estrogen production, diminished perineal muscle tone.
Male: Decreased penile/testicle size, benign prostatic hyperplasia (BPH), and atherosclerosis/arteriosclerosis.
Immune: Decreased T-cell and B-cell production/function, reduced distinction of "self" from non-self (increasing autoimmune disease), and lower infection resistance.
Geriatric Nutrition and Hydration
Nutritional Requirements:
Carbohydrates & Fats: Primary energy sources; stored fat (triglycerides) maintains cell membrane structure.
Proteins: Form muscle, connective tissue, glands, organs, clotting factors, antibodies, and hormones; essential for tissue repair and fluid balance.
Fiber: Prevents constipation, lowers glucose/cholesterol levels, and assists in weight management.
Vitamins & Minerals: Regulate body processes, build bones/teeth, maintain muscle tone, and sustain acid-base balance.
Older adults require fewer calories due to lower activity, reduced stomach hunger contractions, decreased peristalsis, and lower digestive enzyme secretion.
MyPlate for Older Adults:
Developed by Tufts University HNRCA with the AARP Foundation; emphasizes fruits, vegetables, whole/fortified grains, low-fat dairy, lean proteins, healthy oils, herbs/spices, and active fluid intake.
Hydration Management:
Water comprises approximately of total body weight.
Losses occur via perspiration, respiration, urination, diarrhea, bleeding, and wounds.
Dehydration risks increase due to diminished thirst sensation, fear of incontinence, limited fluid accessibility, or cognitive impairment.
Daily target fluid intake goal is.
Management of Gastrointestinal Threats:
Indigestion: Serve small, frequent, non-fried meals in High Fowler's position ().
Anorexia: High-calorie meals, weight monitoring, intake/output tracking, and social support referrals.
Dysphagia: Speech pathologist evaluation, High Fowler's positioning (), suction availability, pureed or mechanical soft diets with thickened liquids, and eliminating distractions during eating.
Constipation: Ensure bowel movement occurs by encouraging fluids, dietary fiber, physical activity, and cautious use of ordered laxatives or stool softeners.
Sleep, Rest, and Pain Management
Sleep Disturbances:
Normal aging alters sleep latency, decreases REM sleep, and increases daytime naps.
Conditions include insomnia, nocturnal myoclonus, phase advance, restless leg syndrome, and sleep apnea.
Non-pharmacological interventions: Maintain sleep routines, expose client to sunlight, limit daytime naps and caffeine, provide a high-protein/carbohydrate bedtime snack, adjust environmental lighting/temperature, and consider valerian root, melatonin, or warm baths.
Pain Classification & Assessment:
Pain is subjective and considered a vital sign.
Acute Pain: Sudden onset lasting.
Chronic Pain: Discomfort lasting increasing risk for depression, powerlessness, and frustration.
Types: Neuropathic (abnormal nervous system processing), nociceptive (normal response), referred (felt away from origin site), and intractable (untreatable).
Non-verbal cues in cognitively impaired clients include grimacing, moaning, agitation, increased vital signs, and guarding.
Pain Interventions:
Non-pharmacological therapies: TENS, acupuncture/acupressure, guided imagery, relaxation techniques, hot/cold therapy, and distraction.
Anti-inflammatory dietary changes: Include Omega-3 rich foods (salmon, tuna, sardines, mackerel), walnuts, and pineapples while limiting animal fats, egg yolks, and corn oil.
Safety, Fall Prevention, and Environmental Assessment
Home & Facility Environmental Safety:
Ensure functional smoke detectors, uncluttered and even walkways, handrails on stairs, non-slip bathtubs, adequate lighting, safe electrical outlets, accessible shelves/faucets, and water heaters set below.
Fall Risk Factors:
Age over fall history, gait disturbances, postural hypotension, dementia, delirium, poor vision, indwelling catheters, long clothing, and inappropriate footwear.
Sedatives, antihypertensives, or improper restraint use increase fall risk.
Delayed response to call bells significantly increases fall rates.
Safety Nursing Interventions:
Maintain beds in the lowest position with call bells, remotes, and personal items within easy reach.
Orient clients to new environments, encourage prescribed adaptive devices/ambulatory aids, instruct slow position changes, and avoid physical or chemical restraints unless used as an absolute last resort.
Psychosocial, Spiritual, and Sexual Health
Spiritual Needs:
Essential needs include unconditional love, meaning and purpose (ego integrity), hope, dignity, forgiveness, gratitude, transcendence, and expression of faith.
Interventions: Provide active presence, facilitate religious practices, assist in contacting clergy, and pray with or for the patient if requested.
Sexuality & Intimacy:
Intimacy includes warmth, caring, and emotional connection beyond sexual intercourse.
Average life expectancy differs between males and females, resulting in high rates of widowhood among older women.
Physical changes include slower erection development, dyspareunia, and reduced vaginal secretions.
Violations of respect include dressing residents in asexual clothing, denying requests for same-gender aides, exposing clients unnecessarily during care, or ridiculing romantic interests.
Safe Medication Administration and Polypharmacy
Polypharmacy & Error Risk Factors:
Complex regimens increase drug-drug, drug-food, and drug-herb interactions.
Risk factors for medication errors include cognitive impairment, visual/hearing deficits, poor manual dexterity (arthritis), financial limitations, illiteracy, and keeping expired or borrowed drugs.
Nursing Interventions:
Maintain a complete drug list including exact dose, purpose, schedule, side effects, storage, and special administration directions.
Monitor laboratory values to assess therapeutic effectiveness and safety.
Educate clients never to stop prescribed medications abruptly and explore non-pharmacological symptom management options where appropriate.
End-of-Life, Hospice Care, and Elder Abuse
Stages of Grief (Kübler-Ross):
Denial, Anger, Bargaining, Depression, Acceptance.
Advance Directives & End-of-Life Care:
Living Will, Durable Power of Attorney, Health Care Proxy, and DNR / MOLST orders.
Hospice care focuses on terminally ill clients to maximize quality of life across four domains: physical, psychological/emotional, social/cultural, and spiritual.
Post-Mortem Protocols:
Confirm and record the time of death, notify the primary care physician and coroner, and document client status over the preceding period, along with last medication doses.
Assist family with funeral arrangement coordination and refer to bereavement support (available to families up to the following death).
Elder Abuse Recognition & Reporting:
Indicators: Unexplained bruising/injuries (including genital area), untreated wounds, malnutrition/dehydration, poor hygiene, unsafe living conditions, caregiver substance abuse, or sudden atypical financial transactions.
Nurses are mandated reporters and must initiate referrals to social service agencies, home healthcare, respite services, and meal delivery programs such as Meals on Wheels or God's Love We Deliver.
Theories of Aging
Disengagement Theory: Suggests that aging involves a natural withdrawal from social interactions and relationships, allowing for a smooth transition of roles from old to young.
Activity Theory: Emphasizes that staying active and engaged leads to greater satisfaction and better quality of life in older adults.
Continuity Theory: Proposes that older adults will typically maintain the same activities, behaviors, and relationships as they did in their earlier years, adapting strategies to cope with aging.
Clock-Work Theory: Suggests that aging follows a predetermined biological timeline, akin to a clock, where physical changes occur in a consistent and expected manner, influencing behavior and social roles.
Wear&Tear Theory: Postulates that the body gradually suffers damage as a result of aging due to environmental stressors and the cumulative effect of everyday use, leading to decreased physiological function and increased susceptibility to disease.
Immunological Theory: Suggests that the immune system gradually weakens with age, resulting in an increased vulnerability to infections and diseases, as well as a diminished capacity to respond to vaccinations.
Cross-linking Theory: Proposes that aging results from the gradual cross-linking of proteins and other macromolecules, leading to stiffness and loss of elasticity in tissues, ultimately affecting normal cellular functions and contributing to age-related decline.
Free Radical Theory: Suggests that aging results from the accumulation of damage caused by free radicals, which are highly reactive molecules that can harm cellular components, leading to cellular dysfunction and contributing to the overall aging process.
Subculture Theory: Proposes that older adults form unique subcultures within society due to shared experiences and lifestyles, influencing their perspectives on aging, health care, and social interactions.
Age Stratification Theory: Suggests that society categorizes individuals based on their age, resulting in different roles, expectations, and privileges associated with each age group, thereby impacting social interaction and individual identity throughout the aging process.
Developmental Tasks: Refers to the challenges and responsibilities that individuals face at different stages of life, particularly in later adulthood, which include adjusting to retirement, coping with loss, and maintaining social connections, all of which are critical for emotional well-being and successful aging.
The challenge of old age is to accept and find meaning in the life the person has lived; this gives the individual ego integrity that aids in adjusting and coping with the reality of aging and mortality. Feelings of anger, bitterness, depression, and inadequacy can result in inadequate ego integrity (e.g., despair).
Refining Erikson’s description of old age tasks in the eighth stage of development, Robert Peck (1968) detailed three specific challenges facing older adults that influence the outcome of ego integrity or despair:
Ego differentiation versus role preoccupation: to develop satisfaction from oneself as a person rather than through parental or occupational roles
Body transcendence versus body preoccupation: to find psychological pleasures rather than become absorbed with health problems or physical limitations imposed by aging
Ego transcendence versus ego preoccupation: to achieve satisfaction through reflection on one’s past life and accomplishments rather than be preoccupied with the finite number of years left to live