Gerontological & Community Based Nursing: Physiologic

1
Gerontological Community Based Nursing

• Physiologic Changes of Aging

2
Physiologic Changes of Aging

• Biological Theories
• Normal Aging changes
• Common Pathologic conditions

3
Aging

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

4
Biologic Theories of Aging

• Genetic Theory
• Stochastic theories
• Nonstochastic theories

5
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.

6
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.

7
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.

8
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

9
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

10
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.

11
Normal Changes of Aging Integument
12
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
• _____________
• _____________
• _____________
• _____________

13
Normal changes of Aging Hair and Nails

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

14
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

15
Aging process
16
(No Transcript)
17
Hand nail changes
18
Normal changes of Aging Musculoskeletal

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

19
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

20
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.
21
Osteoporosis

• Kyphosis

22
Osteoporosis

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

23
Normal Changes of Aging

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

24

• 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

25
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)

26
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

27
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

28
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

29
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

30
Kidney changes in aging

• ?size efficiency
• ?nephrons
• ?blood flow

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

31
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.

32
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

33
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

34
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.

35
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.

36
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

37
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

38
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

39
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

40
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

41
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

42
Age related changes of eye
43
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

44
Intraocular Changes of Eye
45
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

46
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

47
Age related eye disorders
48
Age related disorders of eyeCataract
49
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

50
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

51
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

52
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)

53
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)

54
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

55
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!

56
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

57
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

58
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)

59
Aging Changes in Ears Hearing

• Function of Ears
• Hearing
• Maintenance of balance

60
Aging Changes in Ears Hearing

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

61
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

62
NURSING DIAGNOSIS OF THE ELDER ADULT IN THE
COMMUNITY

• ?
• ?
• ?
• ?
• ?
• ?
• ?
• ?
• ?

63
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

64
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

65
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)

66
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?