1. AGE RELATED CHANGES IN HEALTH Geriatric Nursing Protocol: Age-Related Changes in Health Research Cited from: Constance M. Smith, PhD, Valerie T. Cotter, MSN

2. 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

3. 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

4. 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

5. 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

6. Pulmonary System C. Assessments: - Assess respiration rate, regularity, volume, depth, and exercise capacity - Inspect thorax appearance; obtain smoking history - Monitor secretions, breathing rate

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

8. 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

9. Renal & Genitourinary System C. Assessments: - Assess renal function - Assess for fluid/electrolytes and acid - Evaluate urinary incontinence - Assess UTI symptoms

10. 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

11. 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

12. 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

13. 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

14. 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

15. Musculoskeletal System B. Implications: − Increased risk of disability, falls, and unstable gait − Risk of osteoporosis − Limited ROM, joint instability

16. 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

17. 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

18. Nervous System and Cognition C. Assessments: ⁻ Evaluate with periodic reassessment ⁻ Assess temperature during illness or surgery

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

20. 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