Care of the Older Adults

Physiological Aspect
in Aging affecting
Hematopoietic and
Lymphatic System
 The Hematologic System

Hematology is study of blood and blood forming tissue. This includes bone
marrow, blood, spleen, and lymph system. A basic knowledge of hematology is
useful in clinical settings to evaluate the patient’s ability to transport oxygen and
carbon dioxide, maintain intravascular volume, coagulate blood, and combat
infections.
THE THYMUS IS A SPECIALIZED ORGAN THAT DIRECTS THE DEVELOPMENT AND SELECTION OF T CELLS WHICH
DIRECT ADAPTIVE IMMUNITY

With the thymic involution the naïve T cells in the periphery decreases and the memory
T cells reach senescence accounting for the elderly persons having difficulties
responding to old and new antigens and demonstrate impaired reactions to
vaccinations.
The Hematologic System
Bone marrow changes in adult life
Normal aging is associated with anatomic and functional changes in both bone
marrow and thymus.The percentage of marrow space occupied by the
hematopoietic tissue declines gradually from 90% after birth to 30% by age 70
with the remaining space being taken up by fat.

A similar change occurs in the thymus, where involution begins after birth and is
reflected anatomically by a reduction in lymphoid mass with an increase in fat and
functionally by a steady decrease in the production of naïve T cells.

Peripheral blood cell changes with aging

In normal individuals, erythropoietin levels rise with age, yet a significant portion of the
population becomes anemic (10–50%, depending on the population studied).Approximately
one third of anemia occurring in older persons remains unexplained with regard to cause.
Clinical Consequences of Age-related

Changes in Bone Marrow and Thymus

Anemia and immune deficiency are observed in late life in

individuals without other recognizable disease, but these are
typically mild and associated with minimal morbidity or mortality.
If clinicians detect anemia, they usually will review the mean
corpuscular volume measurement (included in the CBC) to see
if the red cells are smaller or bigger than normal. We do this
because the size of the red blood cells can help point doctors
towards the underlying cause of anemia.
Hence anemia is often described as:
o Microcytic: red cells smaller than normal
o Normocytic: red cells of a normal size
o Macrocytic: red cells larger than normal
The Lymphatic System

The immune system becomes less able to distinguish self from nonself (that is, to identify
foreign antigens). As a result, autoimmune disorders become more common.
FIGHT ITSELF
Macrophages (which ingest bacteria and other foreign cells) destroy bacteria, cancer cells,
and other antigens more slowly. This slowdown may be one reason that cancer is more
common among older people.

T cells (which remember antigens they have previously encountered) respond less quickly to
the antigens.

There are fewer white blood cells capable of responding to new antigens. Thus, when older
people encounter a new antigen, the body is less able to remember and defend against it.

Older people have smaller amounts of complement proteins and do not produce as many of
these proteins as younger people do in response to bacterial infections.

Although the amount of antibody produced in response to an antigen remains about the
same overall, the antibodies become less able to attach to the antigen. This change may
partly explain why pneumonia, influenza, infective endocarditis, and tetanus are more
common among older people and result in death more often. These changes may also partly
explain why vaccines are less effective in older people and thus why it is important for older
people to get booster shots (which are available for some vaccines).
Gerontologic Considerations

Physiologic aging is a gradual process that involves cell loss and organ atrophy.
Aging leads to a decrease in bone marrow mass and cellularity and an increase in
bone marrow fat. However, peripheral blood cell concentrations in healthy older
adults are similar to those of younger adults. Although the older adult is still capable
of maintaining adequate blood cell levels, the reserve capacity leaves the older adult
more vulnerable to possible problems with clotting, transporting oxygen, and fighting
infection, especially during periods of increased demand. This results in a diminished
ability of an older adult to compensate for an acute or chronic illness.

Hemoglobin levels begin to decrease in both men and women after middle age,
with the low-normal levels seen in most older people. Total serum iron, total
iron-binding capacity, and intestinal iron absorption are all decreased in older adults.
Iron deficiency is usually responsible for the low hemoglobin levels. Healthy older
patients are not able to produce reticulocytes in response to hemorrhage or
hypoxemia as well as younger adults.
 Assessment

A. Diagnosis of any concurrent chronic or

progressive illness such as cancer or heart or
kidney disease B. Medication listing, including
over-the-counter and herbal remedies.
C. History of surgery or trauma
D. Baseline level of function and activity level and
documentation of change of status
E. Lifestyle factors: smoking, alcohol use,
depression, obesity, poor nutrition and
sedentary lifestyle
F. Family history of diagnosed blood disorders
in first-degree relatives
G. Occupational exposures during the patient’s work career
to chemicals or pollutants
Nursing Diagnosis

∙ Activity intolerance, related to weakness and

fatigue
∙ Impaired gas exchange, related to decreased
hemoglobin
∙ Nutrition: less than body requirements, related to
poor nutritional intake and anorexia
∙ Ineffective therapeutic regimen
management, related to lack of knowledge
about appropriate nutrition and medication
Goal

● Report the ability to perform

required activities of daily living.
● Consumption of nutritious meals
Implementation

1. Providing support and teaching for the

patient and family
2. Protecting the skin from dryness, cracking,
and injury
3. Encourage recreational and
diversional activities consistent with the
patient’s general functional ability
4. Advising and referral regarding
nutritional intake.
Evaluation

∙ The patient was able carry out

usual daily activities without
shortness of breath or fatigue.
∙ The patient was able eat three
nutritious meals, containing
sufficient iron, folic acid, vitamin C,
and protein daily.
Thank You
for
Listening