NORMAL AGING CHANGES Nursing Standard of Practice Protocol: Age-Related Changes in Health Constance M.

Smith, PhD, RN, Valerie T. Cotter, MSN, CRNP, FAANP Evidence-Based Content - Updated March 2008 Goal To identify anatomical and physiological changes which are attributed to the normal aging process.

Overview Age-associated changes are most pronounced in advanced age of 85 years or older, may alter the older persons response to illness, show great variability among individuals, are often impacted by genetic and long-term lifestyle factors, and commonly involve a decline in functional reserve with reduced response to stressors. Statement of Problem Gerontological changes are important in nursing assessment and care because the changes can adversely affect health and functionality and require therapeutic strategies. These changes must be differentiated from pathological processes to allow development of appropriate interventions; predispose to disease, thus emphasizing the need for risk evaluation of the older adult; and can interact reciprocally with illness, resulting in altered disease presentation, response to treatment, and outcomes.

Age-Associated Cardiovascular Changes A. Definition: Isolated systolic hypertension: systolic BP >140 mmHg and diastolic BP <90 mmHg. B. Etiology 1. Arterial wall thickening and stiffening, decreased compliance. 2. Left ventricular and atrial hypertrophy. 3. Sclerosis of atrial and mitral valves. C. Implications 1. Decreased cardiac reserve. a. At rest: No change in heart rate, cardiac output. b. Under physiological stress and exercise: Decreased maximal heart rate and cardiac output, resulting in fatigue, SOB, slow recovery from tachycardia.

2. Risk of isolated systolic hypertension; inflamed varicosities. 3. Risk of arrhythmias, postural and diuretic-induced hypotension. May cause syncope. 4. Strong arterial pulses, diminished peripheral pulses, cool extremities. Parameters of Cardiovascular Assessment A. Cardiac assessment: ECG; heart rate, rhythm, murmurs, heart sounds (S4 common, S3 in disease). B. Assess BP (lying, sitting, standing) and pulse pressure. C. Palpate carotid artery & peripheral pulses for symmetry. Nursing-Care Strategies for cardiovascular A. Safety precautions for orthostatic hypotension: Avoid prolonged recumbency; rise slowly from lying or sitting position; wait 1-2 minutes after position change to stand or transfer. Institute fall prevention strategies. (See Falls topic). B. Encourage lifestyle practices to attain a healthy body weight (BMI 18.5-24.9 kg/m2). and normal blood pressure. Healthful diet, physical activity, smoking cessation. Age-Associated Changes in the Pulmonary System A. Etiology 1. Decreased respiratory muscle strength; stiffer chest wall with reduced compliance. 2. Diminished ciliary & macrophage activity, drier mucus membranes. Decreased cough reflex. 3. Decreased response to hypoxia and hypercapnia. B. Implications 1. Reduced pulmonary functional reserve. a. At rest: No change. b. With exertion: Dyspnea, decreased exercise tolerance. 2. Decreased respiratory excursion and chest/lung expansion with less effective exhalation. Respiratory rate 12 to 24 bpm. 3. Decreased cough and mucus/foreign matter clearance. 4. Increased risk of infection and bronchospasm with airway obstruction.

Parameters of Pulmonary Assessment A. Assess respiration rate, rhythm, regularity, volume, depth, exercise capacity. Ascultate breath sounds throughout lung fields. B. Inspect thorax, symmetry of chest expansion. Obtain smoking history. C. Monitor secretions, breathing rate during sedation, positioning, , arterial blood gases, pulse oximetry. D. Assess cough, need for suctioning. Nursing-Care Strategies A. Maintain patent airways through upright positioning/repositioning, suctioning, and bronchodilators. B. Provide oxygen as needed. C. Incentive spirometry as indicated, particularly if immobile or declining in function. D. Maintain hydration and mobility. E. Education on cough enhancement, 8 smoking cessation.

Age-Associated Changes in the Renal and Genitourinary Systems A. Definitions: Cockroft-Gault Equation: Calculation of creatinine clearance in older adults: For Men

For Women, the calculated value is multiplied by 85% (0.85). B. Etiology 1. Decreases in kidney mass, blood flow, glomerular filtration rate (10% decrement/decade after age 30). Decreased drug clearance. 2. Reduced bladder elasticity, muscle tone, capacity. 3. Increased post-void residual, nocturnal urine production. 4. In males, prostate enlargement with risk of benign prostatic hyperplasia (BPH). C. Implications 1. Reduced renal functional reserve; risk of renal complications in illness.

2. Risk of nephrotoxic injury and adverse reactions from drugs. 3. Risk of volume overload (in heart failure), dehydration, hyponatremia (with thiazide diuretics), hypernatremia (associated with fever), hyperkalemia (with potassium-sparing diuretics). Reduced excretion of acid load. 4. Increased risk of urinary urgency, incontinence (not a normal finding), UTI, nocturnal polyuria. Potential for falls. Parameters of Renal and Genitourinary Assessment A. Assess renal function (creatinine clearance). B. Assess choice/need/dose of nephrotoxic agents and renally cleared drugs. C. Assess for fluid/electrolyte and acid/base imbalances. D. Evaluate nocturnal polyuria, urinary incontinence, BPH. Assess UTI symptoms. E. Assess fall risk if nocturnal or urgent voiding Nursing-Care Strategies A. Monitor nephrotoxic and renally cleared drug levels. B. Maintain fluid/electrolyte balance. Minimum 1,500-2,500 ml/day from fluids and foods for 50 to 80 kg adults to prevent dehydration. C. For nocturnal polyuria: limit fluids in evening, avoid caffeine, use prompted voiding schedule. D. Fall prevention for nocturnal or urgent voiding

Age-Associated Changes in the Oropharyngeal and Gastrointestinal Systems A. Definition: BMI: Healthy: 18.524.9 kg/m2; overweight: 2529.9 kg/m2; obesity: >30 kg/m2. B. Etiology 1. Decreases in strength of muscles of mastication, taste, and thirst perception. 2. Decreased gastric motility with delayed emptying. Atrophy of protective mucosa. 3. Malabsorption of carbohydrates, vitamins B12 and D, folic acid, calcium. 4. Impaired sensation to defecate. 5. Reduced hepatic reserve. Decreased metabolism of drugs.

C. Implications 1. Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition. 2. Gastric changes: altered drug absorption, increased risk of gastroesophageal reflux disease (GERD), maldigestion, nonsteroidal anti-inflammatory drug-induced ulcers. 3. Constipation not a normal finding. Risk of fecal incontinence with disease (not in healthy aging). 4. Stable liver function tests. Risk of adverse drug reactions. Parameters of Oropharyngeal and Gastrointestinal Assessment A. Assess abdomen, bowel sounds. B. Assess oral cavity ; chewing and swallowing capacity, dysphagia (coughing, choking with food/fluid intake). If aspiration, assess lungs (rales) for infection and typical/atypical symptoms. C. Monitor weight, calculate BMI, compare to standards. 21 Determine dietary intake, compare to nutritional guidelines. D. Assess for GERD, constipation and fecal incontinence; fecal impaction by digital examination of rectum or palpation of abdomen. Nursing-Care Strategies A. Monitor drug levels and liver function tests if on medications metabolized by liver. Assess nutritional indicators B. Educate on lifestyle modifications and OTC medications for GERD. C. Educate on normal bowel frequency, diet, exercise, recommended laxatives. Encourage mobility, provide laxatives if on constipating medications D. Encourage participation in community-based nutrition programs; educate on healthful diets.

Age-Associated Changes in the Musculoskeletal System A. Definition: Sarcopenia: Decline in muscle mass and strength associated with aging. B. Etiology

1. Sarcopenia with increased weakness and poor exercise tolerance. 2. Lean body mass replaced by fat with redistribution of fat. 3. Bone loss in women and men after peak mass at 30 to 35 years. 4. Decreased ligament and tendon strength. Intervertebral disc degeneration. Articular cartilage erosion. Changes in stature with kyphosis, height reduction. C. Implications 1. Sarcopenia: increased risk of disability, falls, unstable gait. 2. Risk of osteopenia and osteoporosis. 3. Limited ROM, joint instability, risk of osteoarthritis. Nursing-Care Strategies A. Encourage physical activity through health education and goal setting. to maintain function. B. Pain medication to enhance functionality. Implement strategies to prevent falls C. Prevent osteoporosis by adequate daily intake of calcium and vitamin D, physical exercise, smoking cessation. Advise routine bone-mineral density screening.

Age-Associated Changes in the Nervous System and Cognition A. Etiology 1. Decrease in neurons and neurotransmitters. 2. Modifications in cerebral dendrites, glial support cells, synapses. 3. Compromised thermoregulation. B. Implications 1. Impairments in general muscle strength; deep-tendon reflexes; nerve conduction velocity. Slowed motor skills and potential deficits in balance and coordination. 2. Decreased temperature sensitivity. Blunted febrile response to infection. 3. Slowed speed of cognitive processing. Some cognitive decline is common but not universal. Most

memory functions adequate for normal life. 4. Increased risk of sleep disorders, delirium, neurodegenerative diseases. Parameters of Nervous System and Cognition Assessments A. Assess, with periodic reassessment, baseline functional statusB. Evaluate, with periodic reassessment, baseline and sleep disorders. C. Assess impact of age-related changes on level of safety and attentiveness in daily tasks (e.g., driving). D. Assess temperature during illness or surgery. Monitor atypical symptoms of infection, absent fever. Nursing-Care Strategies A. Institute fall preventions strategies B. To maintain cognitive function, encourage lifestyle practices of regular physical exercise. intellectual stimulation, and healthful diet. Recommend reaction time training and safe driving courses to improve safety. C. Recommend behavioral interventions for sleep disorders.

Evaluation and Expected Outcomes (For All Systems) A. Older adult will experience successful aging through appropriate lifestyle practices and health care. B. Health care provider will: 1. Identify normative changes in aging and differentiate these from pathological processes. 2. Develop interventions to correct for adverse effects associated with aging. C. Institution will: 1. Develop programs to promote successful aging. D. Will provide staff education on age-related changes in health. Follow-up Monitoring of Condition A. Continue to reassess effectiveness of interventions. B. Incorporate continuous quality improvement criteria into existing programs.

Source: http://consultgerirn.org/topics/normal_aging_changes/want_to_know_more

Geriatric nursing is a nursing subfield which involves caring for older adults. Older adults have special needs which can become very complex, making employment prospects in the field ofgeriatric nursing very good. As people live longer with the assistance of modern medical developments, many older people require extended special care from members of the healthprofession who specialize in geriatric health issues. To become a geriatric nurse, someone must generally qualify as a nurse and take additional courses in geriatric nursing to learn to meet the specific needs of older patients. You may also hear this nursing field referred to as gerontological nursing, depending on regional preferences. Numerous professional organizations for geriatric nursing can be found around the world, offering additional training, certification, and support for people who work in this field. Geriatric nurses can also take advantage of trade journals, research programs, conferences, and other things which are designed to promote knowledge and cooperation in the field. Caring for the elderly can be very complex. In addition to providing basic nursing services, ageriatric nurse must also offer emotional support to patients, watching out for their mental health and keeping a close eye out for medical conditions which can emerge quickly in the elderly. Geriatric nurses must also be able to coordinate with the families of their patients, and sometimes they work side by side with family caregivers, offering training to help them care for their family members while taking care of complex nursing tasks.

Source: http://www.wisegeek.com/what-is-geriatric-nursing.htm

A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression

Taking Care of Yourself with DepressionHealthy Lifestyle Choices In addition to seeking professional medical help, you can take additional steps to enhance your treatment. An important part of getting better is modifying some of your lifestyle choices to promote healthier living. There are steps that you can take to help you manage your life and focus on the positive. Healthy lifestyles not only improve your quality of life but are also a strong disease prevention strategy. If you have been diagnosed with depression, ask for support from a good friendor family member and tell them how you feel. Ask them to listen to you and not to judge or criticize. Keep names and phone numbers of people that you can talk to and that can help you. Talking with those who have had similar experiences and feelings can be very helpful because they will understand how you feel. Spend time with people you enjoy and avoid people who are not supportive. Pace yourselfdo not expect to do everything that you did before you had depression. Set a realistic schedule. Ask a friend or family member to take over some of the things that you need to do for a period of time. Think positively and try to avoid blaming yourself or expecting failure. Identify areas of your life that are positive. Identify problems in your life and list problems that you think may have triggered the depression. Work out a strategy to deal with the problems. Discuss them with family, friends, and your health care provider. Develop a step-by-step action planbut plan realistic steps. Identify pleasant activities and routines that you enjoyed before you became depressed. Think about those activities as well as those you would like to do. Once identified, start to return to that routine. Choose one activity each week from the pleasant activity and routine list. Avoid making major life decisions. If you do need to make a major decision that will impact your life, ask a friend or family member for assistance. Get exercise and spend time outdoors. Exercise and natural light can be effective natural treatments for depression. Eat a healthy diet and limit your intake of sugar, caffeine, alcohol, and salt. Be patientit will take time to get better.

Source: http://www.gmhfonline.org/gmhf/consumer/healthy_lifestyle.html

GOLDEN ACRES: HAVEN FOR THE ELDERLY A FITTING CULMINATION OF OUR CRUSADE TO IMPROVE PLIGHT OF ELDERLY VP DE CASTRO

by: Ramil Friday, 30 April 2010 11:19

Vice-President Noli de Castro said that the DSWDs Golden Acres: Haven for the Elderly serves as a fitting culmination of our shared crusade for the improvement of the plight of the elderly in our country. Vice President de Castro was the guest of honor during the inauguration of the Golden Acres: Haven for the Elderly in Barangay Sampaloc, Tanay, Rizal on April 28, 2010. In his message, the Vice-President emphasized that a decent nation knows how to take care of its elderly citizens. He further said that a sound and responsive program and policy for the elderly is an expression of our eternal gratitude to our parents and grandparents who paved the way and opened many doors for our present generation. More than 300 people led by Social Welfare and Development Acting Secretary Celia Capadocia-Yangco, Rizal Governor Casimiro Ynares III, and Tanay Mayor Rafael A. Tanjuatco attended the inauguration. Vice President De Castro also led the unveiling of the marker of the new facility together with Acting Secretary Yangco, Governor Ynares III, Mayor Tanjuatco, DSWD officials and guests. The Golden Acres: Haven for the Elderly is now the new home of abandoned and neglected older persons replacing the old Golden Acres in Bago Bantay, Quezon City. Vice President de Castro also lauded the efforts of Acting Secretary Yangco saying, she has been an inspiration, not only for me, but also to other public servants because of the more than four decades of service to the DSWD; genuinely working without expecting credits and political reward in return. He added that, Acting Secretary Yangco always projects hope and optimism and is the personification of boundless joy and energy in the service of others. She will definitely be young forever because her heart is pure and always full of love for our people.

Likewise, Vice President de Castro acknowledged Governor Ynares and Mayor Tanjuatco for wholeheartedly accepting Golden Acres in their locality. Meanwhile, Acting Secretary Yangco said that some 300 older persons can now be served at any given time in the new facility. The Golden Acres: Haven for the Elderly has 16 buildings. These include the nine cottages for the older persons, two staff houses, a multi-purpose building, an infirmary unit, central kitchen, central laundry, and an administration building. The facility, which is situated in a hilly sprawling ten-hectare lot, has a more conducive environment that is good for the health of the older persons. "The Golden Acres: Haven for the Elderly is designed to be a center of excellence, equipped with brand new facilities to ensure the well-being of older persons," Acting Secretary Yangco explained. It will be recalled that President Gloria Macapagal-Arroyo provided P200 million for the transfer of Golden Acres from Bago Bantay in Quezon City to Tanay, Rizal and Congress approved this in 2008. ### (DSWD Social Marketing Service) April 30, 2010 Source: http://dswd.gov.ph/index.php/component/content/article/1-latest-news/2026-

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