Gerontological

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Gerontological Community Based Nursing

• Physiologic Changes of Aging

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Physiologic Changes of Aging

• Biological Theories
• Normal Aging changes
• Common 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

• Genetic Theory
• Stochastic theories
• Nonstochastic theories

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Genetic Theory

• Aging is an involuntarily process
• Occurs over time
• Alters cellular or tissue structures
• (belief that life-span, longevity changes are
  predetermined)
• Includes DNA theory, Error and Fidelity theory,
  Somatic Mutation and Glycogen theories.
• Eg. ?cancers autoimmune d/os in aging suggest
  errors in mutation at molecular cellular
  levels.

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Error (Stochastic) Theories

• Error (Stochastic) Aging occurs randomly and
  progresses over time.
• Error- DNA/RNA transcription causes failure of
  cellular activity lead to aging and cell
  mutation or death.

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Three types of Error theories

• Wear Tear
• Accumulation of metabolic waste ?
• products/nutrient deprivation damage to DNA
  synthesis?
• cells, tissues, organs or body systems
  deteriorate malfunction with repeated use of
  body in specialized functions.

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Cross-Link Theory

• Cross Link Theory-
• Cellular division threatened by radiation or
  chemical reactions
• A cross-link agent attaches self-to DNA stands
• With accumulation over time ? dense aggregates
  form
• Intracellular transport impaired
• Results in systems organ failure

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Free Radical Theory

• Free Radical
• Reactive molecules with an extra electrical
  charge from Oxygen molecules
• Oxidation of fats, proteins and carbohydrates
  creates free radicals
• These attach to other molecules -proteins,
  enzymes DNA and damage them creating genetic
  disorders
• Random damage accumulates, aging results, and
  eventually death of the damaged person.
• Antioxidants (vitamins B carotene, A,C,E,) can
  counteract effects

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Nonstochastic TheoriesProgrammed Aging

• Cell aging in is genetically programmed for life.
  
• Includes the following
• Programmed- Inner Biological clock in each cell
  determines number of replications and eventual
  death of cell and organism.
• Immune theory- 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

• largest most visible organ of the body protects,
  identifies us, temp. regulation security
• 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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Age related skin changesChange---------------Effe
ct

• Flattening of the dermoepidermal junction
• ?collagen elastin
• ? epidermal cell turnover rate
• ?vascular responsiveness
• ?subcutaneous fat
• ?epidermal cells
• Atrophy of eccrine sebaceous cells

• ?resistence to shearing forces, thinning of skin
• Wrinkling
• Prolonged healing time
• ?vasodilation (cooling effect) ? transdermal
  absorption
• ?protection-bony prominences thermporegulation
• Delayed hypersensitivity response
• ?sweating oil? ?thermoregulation

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Aging process
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Hand nail changes
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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 Musculosketal Aging ChangesChange---------
--------Clinical Implication

• Progressive ? height
• Stiffening of thoracic cage
• ?production of cortical trabecular bone
• ?lean body mass w/loss subcutaneous fat
• Prolonged time for muscular contraction
  relaxation
• Stiffening of joints ligaments

• Stooped posture
• Barrel-chest
• ?risk hip fracture
• Sharp body contours
• ?muscular strength
• ? reaction time
• ?risk for injury

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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
• gtrigid, 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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Age-related changes Cardiovascular SystemCardiac
Change -------------------Effect

• ?mass fibrosis
• ?thickness L Ventricle
• ?pericardial stiffness
• Thickened valve leaflets
• ? of pacemaker cells
• ?responsiveness to catecholamines

• Reduction in ventricular filling? ?cardiac output
• Impaired flow access valves
• Dysrhythmias common
• ? HR with exercise

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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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Age-related Changes in the Respiratory
SystemChange ----------------------------Effect

• Upper Airway
• Changes in nasal structure
• ?in of submucosal glands

• ?obstruction of nasal breathing
• Thickened mucus gets trapped in nasal pharynx

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Age-related Changes in the Respiratory
SystemChange ----------------------------Effect

• Lower Airway
• ? in cilia
• Calicification of ribs/vertabrae
• Atrophy of respiratory muscle
• Enlargement of aveolar duct resp bronchioles
• ?residual vol.
• ?tidal vol.
• ?ventilation perfusion

• ?in the mucocillary escalator
• ?compliance thorasic cage
• ?respiratory effort
• ?surface area for gas exchange
• Prolonged expiration time
• ?response to hypoxia hypercapnia
• ?alveolar arterial gradient

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Kidney changes in aging

• ?size efficiency
• ?nephrons
• ?blood flow

• ? glomerular filtration rate
• renin-angiotensin system
• ?arterial pressure
• ?NA, H2O retention

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Age-related Changes in the Renal SystemChange
----------------------------Effect

• Kidney mass ? 25-30 glomeruli ? 30 to 40
• ? hormonal response (vasopressin) impaired
  ability to conserve salt
• ?Bladder capacity ?residual urine and
  frequency.

• ? ability to filter/ concentrate urine clear
  drugs
• ?risk for dehydration
• ? risk for fluid electrolyte imbalances,
  UTIs, incontinence, and urinary obstruction.

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Changes in lower urinary track-bladderChange-----
------------------Effect

• ?bladder capacity
• atrophy of bladder
• pelvic relaxation reduced estrogen
• ?residual volume
• ?prostate size
• ?urinary retention

• frequency in urination
• ?involuntary bladder contractions
• ?nighttime urine flow rates
• ?risk for UTIs

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Age-related Changes in the Endocrine System

• Change
• Insulin resistance
• ? in aldosterone and cortisol

• Effect
• may prevent efficient conversion of glucose into
  energy.
• may affect immune and cardiovascular function

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Major Gastrointestinal Changes with
AgingChange---------------------------Effect

• Decreased peristalsis
• Increased stomach pH
• ?liver function
• weakened intestinal walls in the colon.
• ? peristalsis of colon

• reflux and hiatal hernias
• ?susceptibility to gastric irritation ulcers.
• Drugs metabolized slowly? repair of liver
  cells.
• Diverticuli / pain
• 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

• testosterone levels may drop by up to 35.
• size of testes decreases.
• decline in sperm production - the extent varies
  among individuals.
• erectile dysfunction (impotence), in occurs in15
  of men by the age of 65 ?to 50 by age 80

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Age-related Changes in the C N S

• Brain is resilient
• ? in cognitive function---NOT normal
• Delayed neurological function
• NOT the loss of cognitive function
• Intellectual performance remains intact
• Performing tasks may take longer
• ?levels of neurotransmitters - choline,acetylase,
• Catecholamines,?MAO

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Age-related Changes in the Neurological
SystemChange-----------------------effects

• ?peripheral nerve conduction
• ?lipofuscin along neurons
• ?thermo-regulation by hypothalamus
• Differential rate/distribution of dopamine

• ?deep tendon reflex w/? reaction time
• ? in vasodilation constriction
• Heat/cold intolerance
• Slowing motor movements fine motor skills

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Age-related Changes in the Neurological
SystemChange-----------------------effects

• ? neurons in autonomic nervous system
• ?neurons in cerebral cerebellar cortex
• ?sensorimotor processing

• Impaired barorecpetor responsiveness,vaso-constric
  tor postural response
• ?visual/auditory reaction time?Short
  memory,?visual/spatial
• ?neurotransmitter coordination
• ?reaction time /? risk for falls

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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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Age related changes of eye
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Normal Age-related Changes in the Eyes contd

• Presbyopia-the crystalline lens accumulates
  tissue built up that becomes stiff ?iris muscles
  work harder to bring near objects into focus
• ? accommodation - light
• ? sensitivity to glare
• ? in pupil size
• require ?lighting

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Intraocular Changes of Eye
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Common Diseases Affecting Vision

• Cataractsheredity advanced age
• ?risk high exposure to sunlight, diabetes,
  hypertension,
• Kidney disease, eye trauma
• Glaucoma- 2nd most common eye disease
• Macular Degeneration
• Detached Retina

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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 ?
• Double vision in one eye
• Needing brighter light to read
• Poor night vision
• Fading or yellowing of colors

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Age related eye disorders
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Age related disorders of eyeCataract
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Nursing Interventions Post Cataract Surgery

• Most common surgical procedure in U.S.
• Lens is removed-replaced with plastic intraocular
  lens
• Patient teaching
• Avoid heavy lifting, straining, bending at the
  waist
• Can resume activities within a day

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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 a degenerative abnormal condition
  resulting when intraocular pressure (IOP) becomes
  higher than what is healthy for the optic nerve

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Glaucoma

• Occurs after 40 years of age
• Major cause of blindness
• Risk factors
• Family history (any type of glaucoma)
• Diabetes, Endocrine imbalance, cardiovascular
  disease, steroid use, past eye injury
• Older women 2Xs incidence than men
• Japanese ancestry
• African American
• Mexican Americans

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Types of Glaucoma

• Chronic open-angle glaucoma (morecommon)
• 80 asymptomatic until late stage
• Gradual impairment in peripheral vision
• Signs/symptoms
• bumping into items at their side
• Frequent ? of eye glasses
• Changes in central vision
• c/o tired feeling in eyes, headaches, misty
  vision, halos around lights, (worse in the
  morning)

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Treatment Chronic- Open Angle Glaucoma

• Miotic and carbonicanhydrous inhibitors
• Surgery to create a channel to filter the
  aqueous fluid (eg. Iridectomy,iridencleisis,cyclod
  ialysis,
• corneoscleral trephining)

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Interventions

• Miotics (azetazolamide) eye gtts- use tear duct
  occlusion technique (increases amount of med
  absorbed by 50)
• Do NOT USE Mydriatic ,stimulants or other agents
  that ? blood pressure.
• Instruct to carry a medical card or wear bracelet
  
• Avoid abuse/overuse of eyes
• Patient teaching re compliance with regime.
• Frequent re-screening

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Acute -Closed Angle Glaucoma

• Rapid rise in (IOP) intraocular pressure
• S/Sx redness severe eye pain,
• blurred vision, headache, nausea, vomiting
• Path of aqueous humor is blocked IOP ?s to 50mm
  Hg.
• Edema of ciliary body dilation of pupil
• Blurred vision followed by blindness if not
  corrected within two days!

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Interventions-Acute closed angle glaucoma

• Effective medications include carbonic anhydrase
  inhibitors (reduce formation of aqueous fluid)
• Mannitol, urea or glycerine (reduce fluid
  -ability to increase osmotic tension in
  circulating blood)
• Iridectomy may be performed- prevents future
  episodes of acute glaucoma

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Age-related Macular Degeneration(AMD)

• Most common cause of visual impairment legal
  blindness in persons gt50 y/o
• Damage /breakdown of the macular?loss of central
  vision
• Risk factors aging process, injury , infection,
  exudate macular degeneration
• White Women gt 80 Asian Americans more
  vulnerable than African Mexican Americans

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Macular Degeneration

• Early Signs/symptoms
• Difficulty reading, driving, ?need for bright
  light, Colors appear dim /gray, blurry spot in
  middle of vision.
• Two forms of AMD Dry Wet
• Dry AMD 3 stages
• Wet AMD abnormal blood vessels behind retina
  grow under the macula (more rapid gtlegal
  blindness within 2 years)

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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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Age related Hearing changes

• Slow decline in
• sensoneural function
• (presbycusis)
• Conductive hearing loss r/t cerumen impaction,
• otosclerosis, chronic exposure to loud noises

• loss of hearing acuity, especially sounds at the
  higher end of the spectrum.
• ? ability to distinguish sounds when there is
  background noise

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NURSING DIAGNOSIS OF THE ELDER ADULT IN THE
COMMUNITY

• ?
• ?
• ?
• ?
• ?
• ?
• ?
• ?
• ?

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NURSING DIAGNOSIS OF THE ELDER ADULT IN THE
COMMUNITY

• Impaired Physical Mobility
• Self Care Deficit
• Care-giver Role Strain
• Anxiety
• Fear
• Knowledge Deficit
• Altered Thought Process
• Ineffective Health Maintenance
• Social Isolation
• Disabled Family/Individual Coping

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Age related sensory changesChange
--------------------Effect

• Taste - decreased taste buds and saliva loss of
  taste cells (papillae on tongue)
• Smell Touch
• Loss of olfactory sensory neurons decreased
  sensory nerve fibers

• Decreased discrimination of sweet, salt, bitter,
  sour.
• Decreased sense of smell decreased sensitivity
  to touch altered pain perception

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Changes of Aging ActivityGoal 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)

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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)
• What they you feeling, physically and
  emotionally, and thinking during various steps of
  this exercise.
• Share with the rest of the class how you might
  feel if these physical changes were permanent.
• What challenges do you anticipate these physical
  limitations will cause?