Aging

1

• Aging the
• Endocrine System

Content for this module provided by The John A.
Hartford Foundation, Institute for Geriatric
Nursing, Online Gerontological Nursing
Certification Review Course http//www.nyu.edu/edu
cation/nursing/hartford.institute/course/
Support for this project provided to School of
Nursing, University of Washington by the John A.
Hartford Foundation, Geriatric Nursing Education
Grant and Nursing School Geriatric Investment
Program Grant.
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Endocrine Issues in Older Adults

• Age-related changes make it important to evaluate
  the patient for thyroid disease and type 2
  diabetes mellitus
• Subtle changes of aging often mimic symptoms of
  endocrine disorders
• Signs symptoms should not be attributed solely
  to aging

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Age-Related Endocrine Changes

• ? estrogen, testosterone, progesterone
• Delayed/insufficient insulin release
• ? growth hormone
• ? serum aldosterone levels, ? cortisol secretion
  rate
• ? secretion of ADH in response to osmolar stimuli

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Age-Related Endocrine Changes

• ? blood glucose concentrations elevation time
• Bone changes related to ? PTH secretion, ?
  estrogen
• ? hypothalamic sensitivity to feedback inhibition
• ? renal response to hormonal influence
• Thyroid gland atrophy
• ? secretion of T4, thus ? T3

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Age-Related Endocrine Changes

• Specific changes in endocrine function may offset
  other age-related changes, thereby reducing
  overall net functional effect of endocrine changes

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Age-Related Endocrine Changes

• Menopause
• ? incidence of diabetes
• ? incidence of thyroid abnormalities

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Diabetes Mellitus

• One of most commonly diagnosed medical problems
  in persons gt age 65
• Atypical presentation - often undiagnosed
• 1 in 2 people gt age 80
• ? secretion of insulin
• altered tissue responsiveness to insulin
• ? postprandial levels of glucose
• ? inhibition of glucose output from liver -
  prolonged glycemic response to meal

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Diabetes Mellitus

• Type 1
• Characterized by autoimmune ß-cell destruction
  caused by HLA antigens
• Commonly diagnosed in youth
• Type 2
• Onset usually after age 30
• 90-95 of all cases
• Risk factors
• obesity
• insulin resistance
• genetics

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Diabetes Mellitus

• Signs and symptoms
• Polydipsia?
• Excessive thirst does not necessarily occur
• Polyuria
• May be evident by new onset incontinence
• Polyphagia
• May be evident by weight loss and anorexia

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Diabetes Mellitus

• Atypical signs
• Fatigue, blurred vision, weight changes,
  infection, dehydration, confusion, delirium
• These signs are often attributed to aging

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Diabetes Mellitus

• Nursing considerations
• ? depression memory problems in older adults
• Potential organ dysfunction/failure nerves,
  eyes, blood vessels
• accelerated rates of CV disease, renal disease

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Diabetes Mellitus

• Nursing considerations
• Cognitive function, vision, motivation, fine
  motor skills can impact self-administration of
  therapy
• Personalized exercise program, based on
  capabilities limitations of older adult
• consider pre-existing conditions such as cardiac,
  musculoskeletal, ophthalmic disease

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Diabetes Mellitus

• Nursing considerations
• Wound infections
• common serious in older adult
• require immediate attention
• interdisciplinary team management
• Loss of ability to sweat
• leads to dry skin - untreated dry skin can
  progress to cracked skin and subsequent infection
• ? ability to regulate body temperature

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Thyroid Disease

• Hypothyroidism
• Hyperthyroidism

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Thyroid Disease

• Hypothyroidism
• 40 may present with atypical symptoms
• dry skin, weakness, fatigue, bradycardia,
  hoarseness, cardiomyopathy, anemia, edema
• Confusion and mental status or behavioral changes
• Diagnosis is often missed - vague symptoms can
  mimic other illnesses old age

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Hypothyroidism

• Signs symptoms in order of precedence
• Depression /or lethargy
• Mild anemia, weight loss
• Dyspnea
• Muscle weakness /or unsteady gait
• Deafness or hoarseness
• Chest pain or atrial fibrillation
• Cold intolerance
• Constipation

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Hyperthyroidism

• 50 present with typical signs symptoms -
  others may not present typical hyper-adrenergic
  signs symptoms
• May have sub-clinical, apathetic presentation
• depressed mood, failure to thrive, skin changes,
  anorexia
• Most prominent symptoms include atrial
  fibrillation, CHF, weight loss, fatigue,
  myopaythy