Geriatric Nursing: Respiratory System

Respiratory System in Older Adults

• The respiratory system enables gas exchange, primarily oxygen and carbon dioxide, between organisms and their environment.
• Aging leads to significant physiological, anatomical, and immunological changes in the respiratory system.

Changes in Structure and Function

• Lung Function Decline:
  • Loss of elasticity in lung tissue impairs effective expansion and contraction.
  • Decrease in alveoli reduces surface area for oxygen absorption and carbon dioxide removal.
  • Aging decreases immune function, increasing susceptibility to respiratory infections.
• Respiratory Muscle Strength:
  • Aging weakens respiratory muscles, diminishing inspiratory and expiratory forces.
  • Older adults require more effort for breathing; the chest wall becomes increasingly stiff.
  • Decline in muscle strength can hinder effective coughing and airway clearance.
• Ventilatory Response:
  • Breathing patterns in older adults rely heavily on intraabdominal pressure changes.
  • Positioning and abdominal pressure greatly affect breathing patterns.
  • Respiratory rates in older adults can range between 16-25 breaths per minute.
  • Shallow breathing may lead to hypoxia and hypercapnia due to inefficient alveolar gas exchange.

Factors Affecting Lung Function

• Exercise and Immobility:
  • Increased oxygen demands during exercise may surpass the capacity of older adults.
  • Activity intolerance is common in patients with Chronic Obstructive Pulmonary Disease (COPD).
• Smoking:
  • Carbon monoxide in smoke competes with oxygen for binding to hemoglobin, damaging lung function.
  • Smoking causes bronchoconstriction, increased mucus production, and airway resistance.
  • Tobacco cessation is critical; the cessation process contains five components: ask, advise, assess, assist, arrange.
• Obesity:
  • Obesity reduces chest wall compliance and pulmonary function, increasing breathlessness.
  • Diminished ability to take deep breaths may lead to atelectasis, particularly in immobile older adults.
• Sleep:
  • Increased sleep duration in older adults heightens the risk of aspiration and oxygen desaturation.
  • Loss of upper airway tone can lead to apnea and hypopnea during sleep.
  • Reduced cough and arousal reflexes increase the likelihood of aspiration.
• Anesthesia and Surgery:
  • Older adults face higher aspiration risk during surgeries due to loss of laryngeal reflexes.
  • Delayed gastric emptying raises risks in emergency surgeries.
  • Post-operative pain and incisions can lead to decreased deep breathing and elevate the chance of developing atelectasis.

Respiratory System Changes in Older Adults

• The respiratory system is crucial for gas exchange, primarily oxygen and carbon dioxide.
• Aging leads to structural, functional, and immunological respiratory changes, impacting lung performance.

Structural and Functional Changes

• Lung tissue elasticity decreases, hindering lung expansion and contraction.
• Alveoli numbers diminish, reducing oxygen absorption and carbon dioxide removal.
• Immune function declines, increasing susceptibility to infections and complicating recovery.

Respiratory Muscle Strength

• Aging weakens respiratory muscles, lowering inspiratory and expiratory forces.
• Increased effort is required to breathe, causing less efficient breathing patterns.
• Notable declines in muscle strength impair effective coughing and airway clearance.

Ventilatory Response

• Breathing patterns in older adults are influenced by intraabdominal pressure.
• Positioning significantly affects breathing; respiratory rates may reach 16-25 breaths per minute.
• Shallow breathing can lead to hypoxia and hypercapnia due to insufficient ventilation.

Factors Affecting Lung Function

• Exercise and Immobility: Increased oxygen demands during exercise may exceed older adults' abilities; activity intolerance is pronounced in COPD patients.
• Smoking: Competes with oxygen for hemoglobin; damages lungs and hinders gas exchange. Smoking affects cilia function and increases mucus production, leading to airway resistance.
• Obesity: Impairs chest wall compliance and ventilatory function, resulting in breathlessness and diminished lung function.
• Sleep: Increased sleep duration can heighten aspiration and oxygen desaturation risks; diminished ventilatory drive increases apnea and aspiration likelihood.
• Anesthesia and Surgery: Higher aspiration risks post-surgery; immobility leads to decreased ventilation and airway clearance.

Common Respiratory Diseases in Older Adults

• Asthma: A chronic inflammatory condition causing airway obstruction from allergens or irritants; common in older populations.
• Chronic Bronchitis: Characterized by excessive mucus production and a chronic cough lasting at least three months for two consecutive years; exacerbated by smoking.
• Emphysema: Involves progressive destruction of alveoli, often seen in older adults with a history of smoking; may present with a barrel chest and accessory muscle use.
• Chronic Obstructive Pulmonary Disease (COPD): Encompasses airway obstruction and decreased expiratory flow. Factors include age, male gender, air pollution, and smoking.
• Restrictive Pulmonary Disease: Low lung cancer incidence projected; lung cancer remains a significant cause of cancer deaths.

Management and Nursing Considerations

• Promotion of deep breathing and hydration post-operative.
• Frequent position changes and early mobilization are crucial for preventing complications like atelectasis.
• Effective smoking cessation strategies include personalized support and establishing quit dates for older adults.