Gerontological

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Gerontological Community Based Nursing
Physiologic Changes of Aging
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Physiologic Changes of Aging

• Physical Changes
• Normal Aging
• Pathologic conditions

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Aging

• Aging starts at birth
• Continues throughoutlife span
• It is universal, progressive, intrinsic, and
  unavoidable

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Biologic Theories of Aging

• Stochastic theories
• Nonstochastic theories

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Stochastic Theories

• Stochastic- Aging occurs randomly and progresses
  over time.
• Error- DNA/RNA Cell replication errors causes
  failure of cellular activity and thus the changes
  we see with aging.
• Free Radical- Oxidation of fats, proteins and
  carbohydrates creates free radicals that attach
  to other molecules/cells and damage them. Random
  damage accumulates, aging results, and eventually
  death of the damaged person.
• Wear Tear- Repeated and random overuse and
  injury of the human body cells, tissues, organs
  or body systems.

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Nonstochastic Theories

• Nonstochastic- Cell aging in the body is
  genetically programmed for the life span of an
  organism. Includes the following
• Programmed- Biological clock in each cell
  determines number of replications and eventual
  death of cell and organism.
• Immunological- Alteration in cell is recognized
  as a foreign body and antibody are produced to
  fight them just as in autoimmune diseases.
• Neuroendocrine- Over time, the ability of a cell
  to auto regulate itself becomes altered or lost
  resulting in aging and death.

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Normal Changes of Aging Integument
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Normal Changes of Aging Integument

• The largest most visible organ of the body think
  protection, personal identity, security, temp.
  regulation
• Integumentary- Skin Changes due to intrinsic and
  extrinsic factors such as
• _____________
• _____________
• _____________
• _____________

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Normal changes of Aging Hair and Nails

• Hair (head)
• Thinner
• Coarser
• Dryer
• Facial hair
• Nails
• Harder, thicker, more brittle, dull and opaque

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Normal changes of Aging Musculoskeletal

• Influencing Factors
• Age
• Gender
• Race
• Environment
• Average loss
• 2 inches between ages 40-80

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Normal changes of Aging Musculoskeletal

• Bone strength/Bone mineral density

This graph shows how the bone density of the
total hip decreases with age. The units are
standardized bone density in (mg/cm2). The lines
show the average values, and for each age, race
and gender a range of values occurs in the
ordinary population.
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Osteoporosis

• Kyphosis

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Osteoporosis

• Affects women 4x more often than men
• ? Estrogen loss after menopause
• ? Long term steroid use

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Normal Changes of Aging

• Ligaments, Tendons, Joints
• rigid, hardened, stiff
• Arthritis is the 1 cause of disability in
  elderly

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• Did you know?During the course of your lifetime,
  your heart will typically beat 2.5 billion
  times--about once a second, every minute of your
  life. The heart pumps about five or more quarts
  of blood a minute, nearly 2,000 gallons of blood
  throughout your body. A healthy heart is strong
  enough to drive a single drop of blood throughout
  your entire body in about 24 seconds

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Normal Changes of Aging Cardiovascular System

• Presbycardianormal changes in the healthy heart
• ? stroke volume
• ? cardiac output
• Left ventricle wall thickens
• As much as 50 by age 80
• Left atrium enlarges (to compensate)
• Possible development of a fourth heart sound (S4)

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Normal Changes of Aging Cardiovascular System

• The maximum heart rate decreases and it takes
  longer for heart rate and blood pressure to
  return to normal resting levels after exertion.
• The aorta and other arteries becomes thicker and
  stiffer which may bring a moderate increase in
  systolic blood pressure with aging. In some
  individuals, this may result in hypertension.
• The valves between the chambers of the heart
  thicken and become stiffer. As a result heart
  murmurs are fairly common among older adults.
• The pacemaker of the heart loses cells and
  develops fibrous tissue and fat deposits. These
  changes may cause a slightly slower heart rate
  and even heart block. Aberrant heart rhythms and
  extra heart beats become more common.
• The baroreceptors which monitor blood pressure
  become less sensitive. Quick changes in position
  may cause dizziness from orthostatic hypotension.

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Peripheral Vascular Changes

• Arteries become less elastic and more brittle
• Calcium leaving the bones is deposited in the
  blood vessels
• Lumen size of the vessels is ?d
• May lead to increased blood pressure

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Normal Changes of Aging in the Respiratory System

• The lungs become stiffer, muscle strength and
  endurance diminish, and the chest wall becomes
  more rigid.
• Total lung capacity remains constant but vital
  capacity decreases and residual volume increases.
  
• The alveolar surface area decreases by up to 20
  percent.
• Alveoli tend to collapse sooner on expiration.
• There is an increase in mucus production and a
  decrease in the activity and number of cilia.
• The body becomes less efficient in monitoring and
  controlling breathing.

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Urinary System Changes with Aging

• Kidney mass decreases by 25-30 percent and the
  number of glomeruli decrease by 30 to 40 percent.
  
• These changes reduce the ability to filter and
  concentrate urine and to clear drugs.
• With aging, there is a reduced hormonal response
  (vasopressin) and an impaired ability to conserve
  salt which may increase risk for dehydration.
• Bladder capacity decreases and there is an
  increase in residual urine and frequency.
• These changes increase the chances of fluid
  electrolyte imbalances, urinary infections,
  incontinence, and urinary obstruction.

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Age-related Changes in the Endocrine System

• Insulin resistance may prevent efficient
  conversion of glucose into energy.
• A decrease in aldosterone and cortisol may affect
  immune and cardiovascular function

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Major Gastrointestinal Changes with Aging

• Decreased peristalsisreflux and hiatal hernias
• Increased stomach pH increase susceptibility
  to gastric irritation ulcers.
• The liver is less efficient in metabolizing drugs
  and repairing damaged liver cells.
• Diverticuli from weakened intestinal walls in the
  colon may cause pain.
• Reduced peristalsis of the colon can increase
  risk for constipation.

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Age-related Changes in the Female Reproductive
System

• Ovulation ceases and estrogen levels drop by 95.
  
• Vaginal walls become thinner and lose elasticity
  
• Most women experience a decrease in the
  production of vaginal lubrication.

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Age-related Changes in the Male Reproductive
System

• In some men, testosterone levels drop by up to
  35.
• The size of the testes decreases.
• There is a decline in the rate of sperm
  production although the extent varies among
  individuals.
• Erectile dysfunction (impotence), in which an
  erection cannot be achieved is experienced by 15
  of men by the age of 65 and increases to 50 by
  age 80

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Normal Age-related Changes in the Neurological
System

• Delayed neurological function
• NOT the loss of cognitive function
• Intellectual performance remains intact
• Performing tasks may take longer

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Normal Age-related Changes in the Central Nervous
System

• The brain and spinal cord lose nerve cells and
  weight
• Nerve cell transmission may slow
• Waste products may collect in the brain tissue
  causing plaques and tangles
• Reflexes may be reduced or lost
• Slight slowing of thought, memory and thinking
  are part of normal aging

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Normal Age-related Changes in the Peripheral
Nervous System

• ? in tactile sensitivity
• Loss of nerve endings in skin
• ?risk for injuries and burns
• Altered kinesthetic sense (ones position in
  space)
• ?risk for falling

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Normal Age-related Changes in the Eyes

• Drooping eyelids (senile ptosis)
• ? orbicular muscle strength
• Arcus senilis
• Gray/white/silver ringinside the outer edge of
  iris
• Decrease in number of goblet cells producing eye
  lubrication

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Normal Age-related Changes in the Eyes contd

• Presbyopia-the crystalline lens begins to have so
  many layers of accumulated tissue built up that
  it becomes stiff and the iris muscles must work
  harder to bring near objects into focus
• Increased time to accommodate to changes in light
• ? sensitivity to glare
• Pupils decrease in size
• Require increased lighting

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Cataracts

• A cataract is a clouding of the normally clear
  lens of the eye. It can be compared to a window
  that is frosted or "fogged" with steam.
• Common symptoms of cataract include
• Painless blurring of vision
• Glare, or light sensitivity
• Frequent eyeglass prescription changes
• Double vision in one eye
• Needing brighter light to read
• Poor night vision
• Fading or yellowing of colors

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Intraocular Changes of Eye
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Intraocular Changes of Eye

• Sclera may become yellowish (imitating jaundice)
• Floatersbits of vitreous that have broken off
  the retina
• Retina becomes dull
• Glaucoma is an abnormal condition resulting when
  intraocular pressure becomes higher than what is
  healthy for the optic nerve

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Aging Changes in Ears Hearing

• Function of Ears
• Hearing
• Maintenance of balance

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Aging Changes in Ears Hearing

• Presbycusis
• age-related hearing loss
• ? hearing acuity
• ? speech intelligibility
• ? auditory threshold
• ? discrimination of pitch

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Classroom activity

• Changes of Aging Activity
• This activity is intended to simulate the feeling
  of some of the physical changes of aging and the
  potential difficulties they can produce.
• Stand with feet apart at least 14 inches (to
  provide a wide base) and do the following
• Round the shoulders and upper back
• Tuck the buttocks and relax the abdominal
  musculature, making the umbilicus point toward
  the ceiling
• Remaining in this position, take a deep breath
  (simulating the change in respiratory function
  that accompanies change in stature)
• Still remaining in this position, bend the knee
  while keeping the foot of that leg on the ground
• Take a few steps forward (simulation of slowed
  mobility with aging)
• Have students discuss what they were feeling,
  physically and emotionally, and thinking during
  various steps of this exercise. Ask them to
  consider and share with the rest of the class how
  they might feel if these physical changes were
  permanent. What challenges can they anticipate
  these physical limitations will cause?

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NURSING DIAGNOSIS OF THE ELDER ADULT IN THE
COMMUNITY

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