AGE RELATED CHANGES IN HEALTHGeriatric Nursing Protocol: Age-Related Changes in Health

Research Cited from:Constance M. Smith, PhD, Valerie T. Cotter, MSN

Overview• When are age-associated changes most

advanced/pronounced?• Complications?

- May alter the person’s response to illness- Show great variability among individuals- Often impacted by genetic &

long-term lifestyle- Common decline in functional

reserve with reduced response to stressors

Statement of Problem• Why are gerontological changes important in care and

assessment?- Can affect health and functionality and require

therapeutic strategies- MUST be differentiated from pathological processes- Predisposed to disease- Altered disease presentation- Responses to treatment and outcomes

Cardiovascular Changes• A. Definition

- Arterial wall thickening and stiffening

• B. Implications:- Decreased cardiac reserve

• C. Assessments:- ECG, heart rate, rhythm, murmurs, heart sound- Assess BP and Pulse Pressure

Pulmonary System• A. Definition

− Decreased respiratory muscle strength; stiffer chest• B. Implications:

− Drier mucus membranes; decreased cough reflex− Decreased exercise tolerance− Decreased cough/mucus clearance− Increased risk of infection/airway obstruction

Pulmonary System• C. Assessments:

- Assess respiration rate, regularity, volume, depth, and exercise capacity

- Inspect thorax appearance; obtain smoking history- Monitor secretions, breathing rate

D. Care Strategies• Maintain patient airways through upright positioning• Provide oxygen as needed• Maintain hydration & mobility• Education on cough enhancement• Smoking cessation

Renal & Genitourinary System• A. Definition

− Determine renal function− Calculation of creatinine clearance

• B. Implications:− Decreased in kidney mass, blood flow− Reduced bladder elasticity, muscle tone, capacity− Males; prostate enlargement− Reduced renal functional reserve; risk of renal

complications in illness − Risk of volume overload, dehydration− Increased risk of urinary urgency, incontinence, UTI

Renal & Genitourinary System• C. Assessments:

- Assess renal function- Assess for fluid/electrolytes and acid- Evaluate urinary incontinence- Assess UTI symptoms

D. Care Strategies• Monitor nephrotoxic and renally cleared drug levels• Maintain fluid and electrolyte balance• For nocturnal polyuria: limit fluids in evening, avoid coffee,

prompt a voiding schedule

Oropharyngeal & Gastrointestinal Systems

• A. Definition:−Healthy BMI: 18.5-24.9; overweight: 25–29.9; obesity,

30+• B. Implications:

−Decreases in strength of muscles of mastication, taste, and thirst perception

−Decreased gastric motility and delayed emptying−Decreased metabolism of drugs

Oropharyngeal & Gastrointestinal Systems

• B. Implications:− Risk of chewing impairments− Fluid imbalances; poor nutrition− Maldigestion-induced ulcers

• C. Assessments:− Assess oral cavity− Bowel sounds− Stable liver function tests− Monitor weight; calculate BMI− Constipation and fecal incontinence

D. Care Strategies• Monitor drug levels and liver function tests• Assess nutritional indicators• Educate on lifestyle modifications and

OTC medications• Education on normal bowel frequency,

diet, exercise• Encourage mobility• Encourage participation in

community-based nutrition programs

Musculoskeletal System• A. Definition:

−Decline in muscle mass and strength• B. Implications:

− Increased weakness & poor exercise tolerance−Body mass replaced by fat/redistribution of fat−Bone loss in women/men after peak mass at 30-35yrs−Decreased ligament/tendon strength− Intervertebral disc degeneration; cartilage erosion−High reduction

Musculoskeletal System• B. Implications:

− Increased risk of disability, falls, and unstable gait− Risk of osteoporosis− Limited ROM, joint instability

D. Care Strategies• Physical activity through health education and goal setting• Pain medications• Strategies to prevent falls• Prevent osteoporosis by adequate daily intake of calcium

and vitamin D, physical exercise, bone mineral density, smoking cessation

Nervous System and Cognition• A. Definition:

−Decrease in Neurons and Neurotransmitters• B. Implications:

− Impairments in general muscle strength−Nerve conduction velocity−Slower motor skills; imbalance and coordination deficits−Decreased temperature sensitivity−Slower cognitive speed− Increase risk of sleep disorders

Nervous System and Cognition• C. Assessments:

⁻ Evaluate with periodic reassessment⁻ Assess temperature during illness or surgery

D. Care Strategies• Institute fall prevention strategies• Encourage lifestyle practices of regular physical exercise• Intellectual stimulation• Healthful diet• Recommended behavioral interventions for sleep

disorders

Immune System• A. Definition:• B. Implications:

⁻ Increased susceptibility to infection

⁻ Reduced efficacy of vaccination⁻ Chronic inflammatory state

• C. Assessments:• D. Care Strategies:

⁻ Follow immunization recommendations; seasonal, influenza, tetanus, hepatitis