Good Aging Gerontology Geriatrics

Lecture no. 11 Critical illness in old age By Dr. Hala Yehia

Objectives At the end of this lecture the student will be able to: List critical diseases Identify non- modifiable risk factors Mention modifiable risk factors Discuss nursing interventions

Introduction The rapid rising number of older adults are contributing to increase numbers of people with health problems and to increase economic costs of disease in that age group. The risk factors for diseases in older adults are the same as those any age. However older adults are often at higher risk for disease in anyone of any age. Older adults are more likely to have one or more coexisting conditions, may have a less healthy lifestyle, and often have less economic ability to cope with major illness.

When older adults become ill, their symptoms are often less specific to the body system that is involved than true in younger adults. As results the health care provider must be alert to subtle or nonspecific condition changes and seek the cause.

Critical illness Cardiovascular diseases MI &CHF Respiratory diseases COPD Infectious diseases Cancer

Non-modifiable risk factors 1- Age Although CV disease can occur in any age group the vast majority of cases occur in those who are age 65 or over in which the first ranked cause of death.

Non-modifiable risk factors cont, 2- Gender 3- Race & Ethnicity All types of CV disease occur at a higher rate in blacks than non-black and the conditions are more severe.

Modifiable risk factors 1- Smoking: Stopping smoking is the one most important thing that anyone including older adults can do to promote optimal health. 2- Elevated cholesterol and triglycerides : elevated cholesterol and triglycerides have been recognized as major risk factors.

Non-modifiable risk factors cont. 3-Sedentary lifestyle: older adults are more at risk for the hazards of immobility and the development of disease because of lack of exercise. 4- Obesity: may studies conform that obesity is a risk factor e.g. CV disease,

modifiable risk factors cont. 5- Stress: older adults may have high stress level caused by a variety of factors : loss of job, lifestyle, home, friend, roles, economic stressors, and many other factors. Any program or support system that reduces stress can promote a better outlook on life and potentially reduce problematic lifestyle behaviors and disease risks.

Cardiovascular Thick rigid valves and blood vessels Max HR / aerobic capacity decrease. Once elevated, takes longer to return to baseline. Slower response to stress Decline in maximum oxygen consumption. Normal BP 120/80 mm Hg and below BP 121 to 129/81 to 89 mm Hg pre HTN BP 130 to 159/90 to 109 mm Hg grade 1 HTN BP 160/110 mm Hg and above grade 2 HTN

Nursing Considerations Encourage –regular BP eval and lifestyle modifications and medication adherence –longer cool-down period after exercise –regular aerobic exercise: walking, biking, or swimming for 20 minutes at least three times per week.

Pulmonary Respiratory muscles become weaker, Decreased elastic recoil of the chest wall Total lung capacity unchanged but residual volume and functional residual capacity increase. Partial pressure of oxygen decreases due to ventilation perfusion mismatches Decreased mucus, foreign body clearance Prolonged cough & inability to raise secretions therefore increased frequency of infections

Nursing Considerations C&DB post surgery Avoid crowds during cold and flu season, wash hands frequently, report early signs of infection. Avoid smoking and exposure to secondhand smoke.

Nursing intervention Interventions nursing are based on palliative goals, namely, stabilizing the diseases, reducing the risk of increasing hospitalization, promoting maximal functional capacity and preventing premature disability.

Nursing intervention Health education Diet Exercise Medications

Nursing intervention Rehabilitations Increase the level of independence Maintain individuality and autonomy Improve function in his/ her environment Decrease the no. of hospitalization Increase exercise tolerance Improve the quality of life

The number of goals achieved depends on many factors, including extent of illness and of co- existing conditions

Good Aging