Title: Physiologic Changes of Aging
1 Physiologic Changes of Aging
Gerontological Community Based Nursing
2Im Dying of Thirst!
- In young, water makes up about 2/3 of our body
weight - The brain is composed of about 95 water
- The blood is about 82 water
- The lungs are about 90 water
- In the elderly total body water drops to about
50 of the bodys weight
3Hydration
- Small changes in water content make a big
difference in the elderly because - Kidneys lose their ability to concentrate urine
as effectively - There is a decreasing sense of thirst in the
elderly - Recommended daily fluid intake for the elderly is
1500-2000ml of non-caffeinated fluids
4Dehydration
- Dehydration is one of the most common fluid and
electrolyte problems experienced by the elderly - Types of dehydration
- Isotonic
- Hypertonic
- Hypotonic
5Dehydration
- Dehydration in elderly can cause
- Delirium
- UTI
- URI
- Urinary incontinence
- Constipation
- Pressure ulcers
- Cardiovascular symptoms
- Death
6Dehydration
- Factors that can contribute to dehydration
- Medications
- Diuretics
- Sedatives
- Antipsychotics
- ETOH abuse
- Dementia
- Self feeding defecits
- Immobility
- Fever
- Diarrhea
7Physiologic Signs of Dehydration
- Poor skin turgor
- On the forehead or sternum, not the hand or arm
- Sunken eyes
- Dry mucus membranes
- Irritability
- Confusion
- Dizziness
- Muscle weakness
- Acute weight loss (gt 2 pounds in a few days)
- 2.2 pounds (1 Kg) 1 liter of water
- ?UOP
- ? HR
- Orthostatic hypotension
- ? SBP gt20 mm Hg with position change
- BUN/creatinine ratio gt251
- Tachycardia
- Pulse gt 100 bpm
- ? gt 10-20 bpm with position change
8Diagnosing Dehydration
- All must be present to diagnose clinical
dehydration - Suspicion of decreased intake or increased output
- Two physiologic signs of dehydration
9Dehydration
- Prevention preferable to treatment!
- Adequate water intake
- Remember dehydration and malnutrition often go
hand in hand - Oral hydration
- Water
- Sports drinks
- Box 11-2 in your text
10Bladder Function in the Elderly
- Diminished bladder control
- Warning period between desire to void and
micturation is shortened or lost - Nocturnal frequency is common in men and women
11Urinary Incontinence
- One of the most common conditions in the care of
older adults - Related to
- Cognitive impairments
- Difficulty in walking
- Difficulty manipulating clothing
- Medications
- Diuretics
- Sedatives
- Hypnotics
- Risk factors detailed in 11-3
12Incontinence
- Generates feelings of shame, fear, guilt,
dependence - Psychological consequences include
- anxiety, embarrassment gtdepressive symptoms
- Social restriction/isolation
- Avoidance of sexual activity
- Physical consequences include
- Skin problems
- Pressure ulcers
- UTIs
- Falls
13Types of Urinary Incontinence
- Categorized based on symptoms
- Stress
- Urge
- Overflow
- Iatrogenic
- Mixed
- Functional
14Stress Incontinence (Anatomic Incontinence)
- Involuntary leaking of urine while exercising,
coughing, sneezing, laughing or lifting - Most common type in women
- Often develops after child birth
- In men usually related to benign prostatic
hyperplasia (BPH)
15Urge Incontinence (Overactive Bladder)
- Frequent, sudden urge to urinate with little
control of the bladder - Especially when sleeping, drinking, or listening
to running water - May also be a sign of UTI or kidney infection
16Overflow Incontinence
- Incomplete emptying of bladder
- Frequent urination and/or constant dribbling of
urine - Generally caused by weakened bladder muscle d/t
nerve damage including diabetes
17- Functional Incontinence
- Unable to control bladder before reaching the BR
- R/t limitations of moving, thinking or
communicating - Iatrogenic
- Associated with medication side effects
- Mixed Incontinence
- More than one type of incontinence
- Typically stress incontinence and urge
incontinence
18Nursing Interventions
- Understanding type of incontinence
- Goal setting
- Curing incontinence versus
- Minimizing effects
- Attitude
- Nurses should not demonstrate
- Acceptance of inevitability of incontinence
- Disgustdecreases self-worth of elder and
increases dependence - Nurses should
- Treat incontinence as curable
- Adopt a teaching role
19Nursing Interventions
- Environmental
- Dietary changes
- Bowel training
- Sphincter training exercises
- Biofeedback training
- Medication
- Surgery
20Nursing Care
- All health care providers should strive to
understand the causes of incontinence, risk
factors and evidence-based interventions - Failure to address continence promotion has
enormous consequences in terms of economics and
burden of care
21Nursing Interventions
- Therapeutic modalities
- Behavioral interventions
- Protective interventions
- Table 11-1 page 200
22Fecal Incontinence
- Inability to control passage of stool
- Devastating social implications for individuals
and families - Multifactorial
23Nursing Intervention
- Fecal incontinence is symptom, nurses should seek
out cause - Attitude
- Goal setting
- Planned
- Realistic
- Consistent
24Maslows Hierarchy
- Elimination is key to maintenance of physiologic
and biologic integrity - What other implications does it have?
25Rest Sleep Changes in the Elderly
- Changes in sleep patterns are a part of the
normal aging process
26Age-related sleep changes
- As people get older
- They tend to have a harder time falling asleep
- They may have more trouble staying asleep
- Many, not all, report being less satisfied with
sleep at night and more sleepy during the day - Common misconception
- Sleep needs decline with age
- In fact our sleep needs remain constant
throughout adulthood
27So whats keeping seniors awake?
- Changes in sleep patterns
-
-
- Older people spend more time in lighter stages of
sleep than in deep sleep
28Sleep patterns in elderly
- Studies show
- An ? in the time it takes to fall asleep (sleep
latency) - An overall ? in REM sleep
- An ? in sleep fragmentation (waking during the
night) with age - Also sleep disorders tend to increase with age
- Much of sleep disturbance among the elderly can
be attributed to physical and psychiatric illness
and the medications used to treat them
29Other factors affecting sleep in the elderly
- Circadian rhythms
- Rhythms that coordinate the timing of our bodily
functionsincluding sleep - Older people tend to become sleepier in the early
evening and wake earlier in the morning than
younger adults
30Insomnia
- Prevalence of insomnia is higher among older
adults - Chronic (lasting over one month)
- Chronic medical illnesses
- Medications
- Pain
- ? disorders (depression)
- Transient (lasting a few days or weeks)
- Acute stress
31Sleep Apnea
- Obstructive Sleep Apnea (OSA)
- Affects 10 of those gt65 y.o.
- Men twice as often as women
- Associated with hypertension and other health
problems - Breathing stops (10-60 seconds)
- Oxygen level in the blood drops
- Brain is alerted to hypoxia
- Brain causes brief arousal (awakening)
- Breathing resumes
- http//www.sleep-solutions.com/cons/cons_videos.ht
m
32Restless Leg Syndrome
- Neurological movement disorder characterized by
an irresistible urge to move the limbs - Tingling, creeping or pulling feeling occur
mostly in the legs - http//www.netwellness.org/healthtopics/sleep/seek
ingrest.cfm - http//www.webmd.com/video/causes-restless-leg-syn
drome
33Other disorders affecting sleep
- GERD
- Diabetes mellitus
- Renal failure
- Respiratory disease
- Parkinsons disease
- Multiple sclerosis
34Nursing Management of Sleep in Healthy Aging
- Assessment
- Table 12-3 page 220
- Sleep history interview
- Quality of sleep
- awakenings / night
- Bedtime rituals
- Lifestyle factors
- Exercise
- Environmental factors
- Medications
- Etc.
35Nursing Interventions
- Identifying causes
- Table 12-3
- Pharmacological vs. non-pharmacological
interventions - Behavioral changes
- Environmental changes
36Healthy Skin and Aging
- Skin is the largest organ in the body
- Many purposes
- Protects underlying structures
- Heat-regulating mechanism
- Sense organ
- Metabolism of salt and water
- Stores fat
- Gas exchange
- Conversion of vitamin D
37Skin
- Subject to damage
- Photo aging
- Development of skin cancer
- Sunscreen
- Skin cancers
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Melanoma
38Other Skin Problems
- Seborrheic Keratosis
- Benign growths mainly on trunk, face, scalp
- Candida albicans
- Fungal infection
- Usually found in folds of skin
- R/t antibiotics, steroid use
39Vascular Insufficiency
- Leads to complications of skin mild dermatitis
? ulcerations ? gangrene - Arterial insufficiency
- r/t atherosclerotic plaques ? ischemia
- Symptoms
- Pain with exercise
- Pain at rest
- Susceptible to infections 2o to even mild trauma
- Affects 10 of those gt 65 y.o.
40Lower Extremity Arterial Disease
- Claudication
- discomfort, cramps or pain in the hips, thighs or
calves with walking
41LEAD Risk Factors
- Same as those associated with coronary artery
disease - Smoking
- High blood pressure (hypertension)
- High levels of blood cholesterol or triglycerides
(hypercholesterolemia, hyperlipidemia) - Obesity
- Sedentary lifestyle
- Diabetes
- Family history of heart disease or arterial
disease
42LEAD Signs Symptoms
- Decreased hair growth on the legs and feet
- Discoloration of the affected leg or foot when
dangling (from pale to bluish-red) - Diminished or absent pulses in the affected leg
or foot - Temperature difference in affected leg or foot
(cooler than other extremity) - Change in sensation (numbness, tingling,
cramping, pain) - Presence of non-healing wound on affected lower
extremity - Shrinking of calf muscles
- Presence of thickened toenails
- Development of gangrene
43Venous Insufficiency
- Veins located inside the legs return blood to the
heart. As people age, these veins may weaken and
stretch. - Veins return blood to the heart in two ways.
Either the force of the heart pumping fresh blood
pushes blood back to the heart, or blood flows to
the heart from the force of gravity. When blood
has to fight gravity and flow upstream back to
the heart, as it does through the deep veins in
the legs, the leg muscles contract to pump blood
back toward the heart - Increased blood pressure can stretch and damage
vein walls. - When veins weaken and lose the ability to pump
blood effectively, the condition is called
chronic venous insufficiency, or CVI. - The venous pump is most effective when a person
is walking and leg muscles are contracting. But
when a person sits or stands, blood pressures in
leg veins can build. Deep veins are usually able
to withstand short periods of inactivity, but
extended periods of increased pressure can
stretch and weaken vein walls.
44Venous InsufficiencySigns Symptoms
- Symptoms of CVI may include
- Varicose veins
- Ulceration or skin breakdown
- Reddened or discolored skin on the leg
- Edema or swelling.
45CVIRisk Factors
- CVI can also be caused by
- A thrombus, or blood clot, that blocks blood flow
in a vein, called deep vein thrombosis or - Phlebitis, an inflammation of a superficial vein
that causes a blood clot to form. - Risk factors may include
- Heredity
- Obesity
- Pregnancy
- Sedentary lifestyle
- Smoking
- Jobs requiring long periods of standing or
sitting in one place and - Age and sex (women in their 50s are more prone to
developing CVI).
46Pressure Ulcers
- Pressure ulcers develop as a result of
compression between a bony prominence and another
hard surface - Serious and costly problems
- Lead to severe complications and death
47Determining Risk for Pressure Ulcers
- Important factors
- Severity of illness
- Involuntary weight loss
- Hypoproteinemia
- Dehydration
- Vitamin deficiencies
- Braden Scalerisk assessment tool
- Sensory perception
- Skin moisture
- Activity
- Mobility
- Friction and shearing
- Nutritional status
48Nursing Implication
- Prevention!!
- An ounce of prevention is worth a pound of cure
- Turning schedule
- Supportive surfaces
- Activity level
- Meticulous cleaning and skin care
- Nutrition
49Feet
- Number and severity of foot problems increase
with age - Nursing assessment can identify potential
problems and actual problems needing attention - Useful guide for assessment in box 13-6
- Guide for comprehensive assessment of the lower
extremities (LEs) in figure 13-2
50Nursing interventions
- Proper toenail care
- Reducing dependent edema
- Promoting foot massage to stimulate circulation