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Gerontological & Community Based Nursing: Physiologic Changes of Aging.

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Presentation on theme: "Gerontological & Community Based Nursing: Physiologic Changes of Aging."— Presentation transcript:

1 Gerontological & Community Based Nursing: Physiologic Changes of Aging

2  Biological Theories  Normal Aging changes  Common Pathologic conditions

3 Aging  Aging starts at birth  Continues throughout life 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/o’s 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 Theories Programmed 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  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 changes Change---------------Effect  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


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 Changes Change-----------------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 =>rigid, 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  Presbycardia=normal 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 (S 4 )

26 Age-related changes Cardiovascular System Cardiac 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 System Change ----------------------------Effect Upper Airway Changes in nasal structure Changes in nasal structure ↓ in # of submucosal glands ↓ in # of submucosal glands  ↑ obstruction of nasal breathing  Thickened mucus gets trapped in nasal pharynx

29 Age-related Changes in the Respiratory System Change ----------------------------Effect Lower Airway ↓ in cilia ↓ in cilia Calicification of ribs/vertabrae Calicification of ribs/vertabrae Atrophy of respiratory muscle Atrophy of respiratory muscle Enlargement of aveolar duct & resp bronchioles Enlargement of aveolar duct & resp bronchioles ↑ residual vol. ↑ residual vol. ↓ tidal vol. ↓ tidal vol. ↑ ventilation & perfusion ↑ 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 System Change ----------------------------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, UTI’s, incontinence, and urinary obstruction.

32 Changes in lower urinary track-bladder Change-----------------------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 UTI’s

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 Aging Change---------------------------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 System Change-----------------------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 System Change-----------------------effects  ↓ neurons in autonomic nervous system  ↓neurons in cerebral & cerebellar cortex  ↓sensorimotor processing  Impaired barorecpetor responsiveness,vaso- constrictor & 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 (one’s 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 ring inside 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 cont’d  Presbyopia-the crystalline lens accumulates tissue built up that becomes stiff → iris muscles work harder to bring near objects into focus ↑ accommodation - light ↑ accommodation - light ↑ sensitivity to glare ↑ sensitivity to glare ↓ in pupil size ↓ in pupil size require ↑ lighting require ↑ lighting

44 Intraocular Changes of Eye

45 Common Diseases Affecting Vision  Cataracts—heredity & advanced age ↑ risk high exposure to sunlight, diabetes, hypertension, Kidney disease, eye trauma  Glaucoma- 2 nd 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 Age related eye disorders

48 Age related disorders of eye Cataract

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)  Floaters—bits 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 2X’s 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,cyclodialysis, corneoscleral trephining) 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 >50 y/o  Damage /breakdown of the macular → loss of central vision  Risk factors : aging process, injury, infection, exudate macular degeneration  White Women > 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 >legal blindness within 2 years)

59 Aging Changes in Ears & Hearing Function of Ears 1. Hearing 2. 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) (presbycusis)  Conductive hearing loss r/t cerumen impaction, otosclerosis, chronic exposure to loud noises 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  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 changes Change --------------------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 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 Activity Goal: 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?

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