Exam 3

Gastrointestinal (GI) Health in Older Adults

Overview

• GI issues are common complaints among older adults.

• Not associated with high mortality, but they significantly impact quality of life.

• Several factors can worsen GI health:

  • Aging-related changes

  • Poor diet

  • Medication side effects

  • Misinformation & self-treatment

Age-Related GI Changes

GI Health Promotion

• Good dental hygiene (Box 18-1)

• Proper nutrition (balanced diet, adequate fiber & fluids)

• Understanding medication effects on GI health

• Natural ways to promote elimination:

  • High-fiber diet

  • Drinking plenty of fluids

  • Regular bowel movement attempts (best time: after breakfast)

• Comprehensive GI assessments (Page 276-277)

Common GI Conditions

1. Xerostomia (Dry Mouth)

• Causes: Aging, medications

• Management:

  • Frequent oral care

  • Saliva substitutes

  • Sipping water regularly

  • Sugarless gum or candy

2. Dental & Oral Problems

• Effects:

  • Can restrict diet → Nutritional deficiencies, malnutrition

  • Affects appearance → Low self-esteem

  • Increased risk of oral cancers, periodontal disease

• Age-Related Changes:

  • Enamel/root loss, increased dental decay

• Management:

  • Regular dental check-ups (even with dentures)

  • Good oral hygiene (soft toothbrush, daily flossing)

  • Financial concerns may limit access to care

    • Is not part of insurance, it is separate. Dental care is a luxury

3. Dysphagia (Swallowing Difficulty)

• Types:

  • Oropharyngeal (mouth & throat)

  • Esophageal (food pipe)

• Goals:

  • Prevent aspiration

  • Maintain nutritional status

• Management:

  • Speech therapy evaluation

  • Modified diet recommendations

  • Upright positioning for eating

  • Small bites, slow eating

  • Suction machine accessible

4. Hiatal Hernia

• Increased incidence with aging

• When it is full, want to stretch out but no room, the food will slides up.

• Management:

  • Several small meals

  • Bland diet

  • Weight reduction

  • Elevate head of bed (HOB) during sleep

5. GI Cancers

• Increased incidence of:

  • Esophageal

  • Stomach

  • Pancreatic

  • Colorectal cancer: more prevalent in adults who are 40, not common in children. More common in adults.

• Colostomy: Major lifestyle adjustment, requiring emotional & physical adaptation.

6. Peptic Ulcer Disease (PUD)

• More acute symptoms in older adults

• Complications: Bleeding, perforation

7. Diverticular Disease

• Diverticulosis: Pouches form in the intestine

• Diverticulitis: Inflammation of pouches → pain, infection

• Management: High-fiber diet, hydration, avoiding seeds/nuts, bowel resection (cut out the pockets and sew it back together)

8. Chronic Constipation

• Common in older adults

• Prevention:

  • High fiber intake

  • Hydration

  • Physical activity

• Avoid laxative overuse!

  • Lost of potassium, hypokalemia.

    • Dysthymias can occur

  • Risk of dehydration

9. Flatulence (Gas)

• Increased with aging due to digestion changes.

10. Intestinal Obstruction

• Can be small bowel or large bowel

  • Small bowel happens quickly; it can happen overnight.

  • Large bowl; can just be seen as constipation. Not as aggressive.

• Treatment:

  • GI decompression with NG tube suction

  • Surgery if mechanical obstruction persists

  • Bowel resection

11. Fecal Impaction

• Constipation

• Prevention:

  • Monitor bowel patterns

  • Treat constipation promptly

• Management:

  • Digital removal

  • Enema if needed

12. Biliary Tract Disease

• Cholelithiasis (Gallstones)

  • More common in women > men

  • Treatment: Lithotripsy (shockwave therapy), surgical removal

• Gallbladder Cancer: Rare but poor prognosis

  • More common in women > men

Urinary Elimination Changes in Aging

Age-Related Changes

• Increased frequency

• Urinary retention

  • In women: Most commonly caused by fecal impaction

  • In men: Due to benign prostatic hyperplasia (BPH)

    • Not the same as prostate cancer.

    • It makes it harder to urinate

  • Increases risk of developing UTIs

• Decrease in kidney filtration

  • Higher risk of toxic drug levels

• Diminished ability to dilute or concentrate urine

  • Impaired response to sodium or water excess

• Urinary incontinence

  • Not a normal part of aging but commonly occurs due to other physiological changes

Urinary System Health Promotion

• Adequate fluid intake

• Maintain acidic urine (helps prevent UTIs)

  • Cranberries recommended for UTI prevention

• Avoid unnecessary catheterization

• Frequent voiding to prevent urinary retention and stasis

• Implement safety measures

  • Prevent falls for those with immobility or nighttime voiding issues

Urinary Elimination: Selected Conditions

Urinary Incontinence

Types of Incontinence

1. Transient vs. Established Incontinence

   • Transient Incontinence:

     • Temporary incontinence.

     • Caused by things like infections (UTI), stress, medications, or constipation.

     • Often resolves once the cause is treated.

   • Established Incontinence:

     • Chronic or long-term incontinence.

     • Caused by conditions like weak pelvic muscles, nerve issues, or bladder problems.

     • Requires ongoing management.

2. Stress Incontinence

   • Caused by weak pelvic muscles

     • More common in woman

       • EX: Jumping, moving

3. Urgency Incontinence

   • Related to an underlying pathology

4. Overflow Incontinence

   • Due to excess urine build-up in the bladder

5. Neurogenic (Reflex) Incontinence

   • Caused by neurological dysfunction

   • Inability to sense the urge to void or control urine flow

6. Functional Incontinence

   • Caused by cognitive impairment or inability to reach the bathroom

7. Mixed Incontinence

   • Combination of multiple types

Management & Treatment Goals

• Identify the cause before implementing interventions

• Toileting schedule – Must be consistent across all staff

• Use positive reinforcement and encouragement

• Avoid catheterization when possible

Other Urinary Conditions

Bladder Cancer (Bladder CA)

• Risk increases with age

Renal Calculi (Kidney Stones)

• Causes

  • Immobility

  • Infections

  • Urine pH changes

  • Dehydration

• Symptoms

  • Pain, hematuria (blood in urine), UTI symptoms

Important Considerations

• Patients may feel embarrassed discussing urinary issues

• Maintain dignity and discretion when addressing concerns

• Avoid scolding patients for accidents

Reproductive Changes in Aging

Physiological Changes Over Time

Women

• Hormonal changes lead to:

  • Atrophy of cervix, uterus, fallopian tubes, and ovaries

  • Breast sagging and loss of firmness

Men

• Reduction in sperm count

• Testicular atrophy

• Delayed response time

• Prostate enlargement

Health Promotion & Preventive Care

• Regular Check-Ups Are Essential

  • Women:

    • Annual pelvic exam (including Pap smear and mammogram)

  • Men:

    • Prostatic hypertrophy history? Evaluation every 6 months

    • PSA screening no longer recommended for all men

Selected Problems in Reproductive Health

Women

1. Atrophic Vaginitis

• Vaginal atrophy leads to:

  • Increased irritation

  • Higher risk of vaginitis

2. Cancers of the Vagina, Cervix, and Endometrium

• Most common in 50s and 60s

• Likelihood decreases with age

3. Breast Cancer

• Older women less likely to get mammograms or perform BSE (breast self-exams)

• Detected later, often in more advanced stages

Men

1. Erectile Dysfunction (ED)

• Common with aging due to vascular and neurological changes

2. Benign Prostatic Hypertrophy (BPH)

• Symptoms:

  • Hesitancy in urination

  • Decreased urinary stream force

  • Incomplete bladder emptying

  • Dribbling after urination

• Treatment:

  • Prostatic massage

  • Urinary antiseptics

  • Surgical intervention if necessary

3. Prostate Cancer

• Incidence increases with age

• Often treatable if diagnosed early and has not metastasized

Mobility and Aging

Importance of Mobility

• Activity and movement promote physical and mental health

• Social interaction and stimulation benefits

• Challenges in aging: Maintaining an active lifestyle becomes difficult

Changes Due to Aging

• Muscle & Strength Decline:

  • Reduced muscle mass and body strength

  • Grip strength and endurance decrease

  • Joint and muscle flexibility diminish

• Non-physical factors (e.g., cognitive decline, depression, financial) can also limit activity

Promotion of Physical Exercise

• Key areas of exercise:

  • Cardiovascular endurance

  • Flexibility

  • Strength training

• Exercise Strategies for Older Adults (Box 21-2, pg 314)

  • Creativity is needed to encourage engagement

  • Choose activities based on personal interest

  • Pace activities throughout the day

  • Monitor pulse to prevent excessive cardiac strain

  • For less mobile individuals: Incorporate gentle movements into daily routines

Mind-Body Connection

• Cognitive and emotional health directly impact physical activity levels

• Educate patients, caregivers, and family on benefits of staying active

Nutrition & Mobility

• Balanced diet with adequate protein and minerals supports bone and muscle health

• Obesity or excess weight:

  • Adds stress to joints

  • Makes movement more difficult

Selected Conditions Affecting Mobility

Fractures

• Brittle bones increase fracture risk

Osteoarthritis (OA)

• Affects most people after 55

• Leading cause of physical disability in older adults

• Characteristics:

  • Affects multiple joints

  • No inflammation, deformity, or crippling

• Treatment:

  • First-line: Acetaminophen

  • Other options:

    • Glucosamine & chondroitin

    • Weight loss

    • Anti-inflammatory foods

Rheumatoid Arthritis (RA)

• Not common in late life but when present, can lead to:

  • More systemic involvement

  • Greater joint deformities

Osteoporosis

• Loss of bone mass and density, increasing fracture and kyphosis risk

• Common Causes in Older Adults:

  • Immobility/Inactivity

  • Metabolic disease

  • Hormonal decline

  • Dietary deficiencies

  • Medication use

• Treatment:

  • Identify underlying cause

  • Calcium & Vitamin D supplementation

  • Bisphosphonates

  • Moderate physical activity

Gout

• Buildup of uric acid in joints, causing severe pain

• Treatment:

  • Low-purine diet

  • Colchicine - in the moment use

  • Allopurinol - everyday use and long term use

Foot Problems

• Common Issues:

  • Calluses

  • Corns

  • Bunions

  • Hammer Toe

  • Plantar Fasciitis

• Infections:

  • Ingrown nails

Nursing Considerations

1. Manage Pain

• Pain relief is essential for maintaining functional ability

2. Prevent Injury

• Ensure a safe environment

• Use adaptive equipment when needed

3. Promote Independence

• Loss of independence affects physical, emotional, and social well-being

• Find ways to minimize limitations while encouraging self-sufficiency

Neuro: Age-Related Changes

Neurological Changes with Aging

• Loss of nerve cell mass:

  • Leads to atrophy of the brain and spinal cord

  • Fewer dendrites and demyelination of cells

  • Slower nerve conduction and delayed response/reaction times

  • Weaker reflexes

• Cerebral Blood Flow:

  • Reduced by ~20%

  • Greater reduction in those with diabetes and hypertension

• Cognitive Changes:

  • Decreased intellectual performance

  • Memory decline

• Sensory Function Decline:

  • Dulling of tactile sensation

  • Changes in hearing, vision, taste, and smell

Health Promotion

Strategies for Maintaining Neurological Health

• Limit risk factors for neurological decline

• Conduct a thorough neurological assessment (Assessment Guide 22-1, pg 338-339)

• Prompt recognition of neurological symptoms

Subtle Indications of Neurological Problems (Box 22-1, Pg 338)

• Look for early warning signs such as:

  • Difficulty with balance

  • Changes in reflexes

  • Memory problems

Selected Neurological Conditions

Parkinson's Disease

• Cause: Loss of dopamine production in the CNS

• Common Symptoms:

  • Resting tremor

  • Muscle rigidity and weakness

  • Poor balance

  • Slow movements

• Progression:

  • Functional abilities decline over time, but cognitive function may not always follow the same pattern

• Management:

  • Utilize Physical Therapy (PT) and Occupational Therapy (OT)

    • Keep them active, strengthen their core muscles

  • Incorporate active and passive ROM exercises

  • Minimize frustration

  • As the disease progresses, more skilled care may be required

Transient Ischemic Attacks (TIAs)/Strokes (CVAs)

• CVAs are the 3rd leading cause of death in adults and a major cause of disability

  • Ischemic: blocking

  • Hemorrhagic: bleeding; higher risks

• Risk Factors:

  • Hypertension

  • Diabetes

  • High cholesterol

• Nursing Considerations:

  • Promote independence

  • Prevent injury

Nutritional Info

Clear Liquid Diet

• Definition: Foods or fluids with no residue and are liquid at room temperature.

• Purpose: Used to prevent dehydration and relieve thirst; should not be used long term.

• Examples:

  • Water

  • Tea

  • Fat-free broth

  • Jello

  • Clear juices

Full Liquid Diet

• Definition: Foods that are liquid at room temperature, including items like ice cream.

• Purpose: Offers more options and nutrition than clear liquids; may require supplementation if used longer than 3 days.

• Considerations:

  • Caution with patients who have dysphagia (difficulty swallowing).

Blenderized Liquid (Pureed) Diet

• Definition: Foods are pureed to liquid form.

• Purpose: Offers more variety in foods but requires more effort for digestion compared to clear liquids.

Soft Diet

• Definition: Whole foods that are bland, low in fiber, and easy to digest.

• Purpose: Used for patients with infections or GI difficulties; can be a transition from full liquid to regular diet.

• Considerations:

  • Requires supplements or snacks between meals.

Mechanical Soft Diet

• Definition: A regular diet with modified texture.

• Purpose: Foods that require minimal chewing.

Dysphagia Diets

• Purpose: Used when swallowing is impaired.

• Levels of Solid Textures:

  • Level 1: Pureed or smooth foods (e.g., mashed potatoes, pudding).

  • Level 2: Mechanically altered foods (e.g., finely chopped meats, scrambled eggs).

  • Level 3: Advanced, bite-sized foods (e.g., soft sandwiches, fruits with skin removed).

• Levels of Liquid Consistencies:

  • Thin: Regular liquids (e.g., water, tea).

  • Nectar-like: Slightly thicker than thin liquids, can use powder to thicken, pourable(e.g., fruit nectars).

  • Honey-like: Thicker liquids that drip slowly from a spoon (e.g., honey, yogurt drinks).

  • Spoon-thick: Thick enough to hold their shape on a spoon (e.g., pudding, custard).

Nutrition Guidelines for Diabetes

• Goals:

  • Maintain blood glucose levels within target range.

  • Focus on carbohydrate counting and portion control.

  • Emphasize whole grains, lean proteins, and healthy fats.

  • Limit refined sugars and processed foods.

  • Regular meal timing and monitoring of blood glucose.