NCM 114 Care of Older Person - Unit 1

NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H UNIT I: Overview of Aging The nursing practices focuses on: INTRODUCTION (Bickford, 2018) Geriatric...

NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H UNIT I: Overview of Aging The nursing practices focuses on: INTRODUCTION (Bickford, 2018) Geriatric The process of aging and the protection, promotion, geriatric comes from the Greek words and prevention of illness and injury. geras, meaning “old age,” and iatro, Facilitation of healing: meaning “relating to medical treatment. - Alleviation of suffering through the diagnosis geriatrics is the medical specialty that and treatment of human responses focuses on treating and caring for old - Optimization of health and generalized people functions focuses on abnormal conditions and their Restoration: medical treatment. - Advocacy in the care of older adults, Gerontology caregivers, families, groups, communities, comes from the Greek words gero, and populations. meaning “related to old age,” and ology, Demographics meaning “the study of.” A major contributing factor to this rapid the study of all aspects of the aging explosion in the older adult population is process, including the biologic, sociologic, the aging of the cohort commonly called and physiologic changes. the baby boomers. Gerontological nursing ❖ Age cohort is a term used by demographers to is the specialty of nursing pertaining to describe a group of people born within a specified older adults. time period. The baby boomers are people born after Gerontological nurses work in collaboration World War II, between 1946 and 1964. with older adults, their families, and ❖ Medicare is the government program that provides communities to support healthy aging, health care funding for older adults and disabled maximum functioning, and quality of life. persons. Medicare is a popular program, and most The term gerontological nursing, which Americans believe that it must be preserved. replaced geriatric nursing in the 1970s, is seen as being more consistent with the THEORIES OF AGING specialty’s broader focus on health and Biologic theories of aging attempt to explain the physical wellness, in addition to illness. changes of aging. It is an evidence-based nursing specialty Programmed theory that addresses the unique physiological, - proposes that everyone has a certain social, physiological, developmental, biologic time line to follow. In this theory, economic, cultural, spiritual, and advocacy each individual has a genetic “program” needs for older adults (Votter, 2022) specifying an unknown but predetermined Ageism number of cell divisions. involves a negative attitude toward aging Run-out of program theory, and older adults based on the belief that - which proposes that every person has a aging makes people unattractive, limited amount of genetic material that will unintelligent, and unproductive. run out eventually Aging Rate of living theory, Refers to the inevitable, irreversible decline - which proposes that individuals have a finite in organ function that occurs overtime even number of breaths or heartbeats, which are in the absence of injury, illness, used up over time. environmental risks, or poor lifestyle molecular theories choices. - proposed that aging is controlled by genetic is a complex process that can be described material that is encoded to predetermine chronologically, physiologically, and growth decline. functionally. Senescence PHYSIOLOGIC CHANGES biological process of aging or the breakdown of the physical body while INTEGUMENTARY SYSTEM growing older. - To most people, the condition of the skin, Chronologic Age hair, and connective tissue collectively the number of years a person has lived, is represents the ultimate indicator of age (kart most often used when we speak of aging & kinney, p. 74) because it is the easiest to identify and SKIN measure. - muscles of the face are capable of Gerontophobia tremendous movement. "Smiles, lighter, The fear of aging and refusal to accept frowns, disappointment, ager, rage, and older adults into the mainstream of society. surprise are all recorded, Sof | 1 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H - the hand of time captures these COMMON DISORDERS expressions and outlines them on the face Basal cell carcinoma and melanoma - by the age of 40, most people bear the - Common to people who are always typical lines of their expressions." (Kart 8. exposed to the sun. It is an unusual Kinney, p. 75) appearance of moles loss of subcutaneous fat Pressure ulcers o Vulnerability to pressure sores - Breakdown of skin and tissues located over o Less insulation of body to cold (also affected by bony prominences diminished blood flow to skin & extremities & heat Inflammation and infection Skin & nails - Rosacea various from of dermatitis Atrophic changes in sweat glands Hypothermia Thickened fingernails & toenails Osteoarthritis Generalized loss of body hair and head hair - cause not known Decrease in number of functioning pigments - also referred to as degenerative joint producing cells - graying disease o some remaining figment cells enlarge- age spots - a gradual wearing a way of joint cartilage o skin changes increase vulnerability to that results in the exposure of rough infections/disorders underlying bone ends - can do damage to internal ligaments NORMAL AGING CHANGES OF THE INTEGUMENTA - most commonly associated w/ weight RY SYSTEM bearing JNTS Physiologic Change Results Rheumatoid Arthritis Decreased vascularity of Increased pallor in white - a chronic, systemic, inflammatory disease of dermis skin connective tissue Decreased amount of Decreased hair color - 2-3 times more common among women melanin (graying) than men Increased capillary fragility Increased purple patches (senile purpura) - currently viewed as an autoimmune disease Decreased density of hair Decreased amount and - may occur at any age most common onset growth thickness of hair on head between 20 & 50 and body Osteopenia - Osteoporosis Decreased rate of nail Increased brittleness of - gradual loss of bone that reduces skeletal growth nails mass without disrupting the proportions of Decreased peripheral Increased longitudinal minerals & organic materials circulation ridges of nails; increased - for many it is asymptomatic thickening and yellowing of - bones most critically involved vertebra, wrist, nails hip. Increased Increased facial hair in Sarcopenia androgen/estrogen ratio women - loss of muscle mass that occurs with aging - cause not completely understood NURSING CARE STRATEGIES - preventable/reversible with regular physical ASSESSMERNT activity Monitor skin temperature. Adjust room temperature and provide adequate Promoting Healthy Skin clothing or covers to - Avoid excessive exposure to UV light prevent chilling. - Keep moisturized Assess skin turgor over Provide adequate fluid to - Avoid soaps that dry the skin sternum or forehead, not prevent dehydration - Always use sunscreen forearm. Check tongue for - Keep well hydrated dehydration furrows. - Protect the skin from injury Assess for skin breakdown Institute measures to or changes in color or reduced pressure over bony RESPIRATORY SYSTEM pigmentation prominences, possible ✓ The respiratory system provides the body with dermatology referral. the oxy- gen needed for life. Without oxygen, Assess areas where skin Keep skin dry Pad surfaces cells quickly die. surfaces touch and trap to reduce friction Report ✓ The brain cells are the most sensitive cells in the moisture (under breasts, abnormal observations for adipose rolls, etc.) for signs treatment body; they will die if deprived of oxygen for as of maceration or yeast little as 4 min- Utes. infection ✓ Breathing, the process of inhaling to take in Determine adequacy of Modify skin care to reduce oxygen and exhaling to release carbon dioxide, hygiene and need for drying. Refer to podiatrist. occurs at a rate of Al 12 to 20 times per minute toenail trimming for our entire lives. ✓ The respiratory system is typically divided into two parts: the up- per respiratory tract and the lower respiratory tract. Sof | 2 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H Respiratory Changes Associated with Aging Lung Cancer - or bronchogenic cancer - one of the deadliest forms of cance in US. - It results from exposure to carcinogenic or cancer-causing, agents, particularly tobacco smoke, air pollution, asbestos, and other hazardous industrial substances. Pulmonary Function Changes Commonly Observed with Aging Diminished breath sounds Lower maximum expiratory volume Increased residual volume Reduced vital capacity Diminished breath sounds Lower maximum expiratory volume Increased residual volume Reduced vital capacity CARDIOVASCULAR SYSTEM ✓ Cardiovascular system moves blood throughout the body, this continuous closed system is responsible for the transportation of blood with oxygen and nutrients to all body tissues. ✓ It also transports waste products to the organs that remove them from the body. ✓ CVS helps the body to maintain homeostasis. COMMON DISORDERS SEEN WITH AGING CORONARY ARTERY DISEASE - Some degree of coronary artery disease is present in most person over 70 y/o. - Vessels become narrowed or obstructed because of atherosclerosis, resulting to heart not receiving adequate oxygen and nutrients. - Angina Pectoris is the pain that may experienced with ischemia (literally chest pain) - Occlusion of the coronary arteries decreases COMMON DISORDERS SEEN WITH AGING the nutrient and oxygen ow to the Chronic Obstructive Pulmonary Disease myocardium. Total oxygen deprivation - Is an umbrella term for the commonly results in myocardial tissue necrosis, which occurring respiratory disorders of is irreversible. emphysema and chronic bronchitis. CORONARY VALVE DISEASE - Symptoms are productive cough, wheezing, - In heart valve disease, one or more of the cyanosis, and dyspnea. valves in the heart doesn't work properly. Influenza - There are four heart valves. They keep - Influenza, often referred to as the flu, is s blood flowing through the heart in the correct highly contagious respiratory infection direction. caused by a variety of influenza viruses. - Sometimes a valve doesn't open or close all COVID-19 the way. This can change how blood flows - Contagious respiratory illness caused by a through the heart to the rest of the body new coronavirus (SARS-CoV-2). CARDIAC ARRYTHMIAS - It is spread even more easily than influenza - Cardiac arrhythmia (abnormal heart rhythm and can be more deadly. or dysrhythmia) is characterized by a Pneumonia heartbeat that loses its normal rhythm. - Is an acute inflammation of the lungs caused - Cardiac arrhythmias that require medical by bacterial, viral, fungal, chemical, or attention happen when the heart's electrical mechanical agents. system short-circuits and seriously disrupts Tuberculosis the natural rhythm of a beating heart. - is an infectious disease caused by the - The term "arrhythmia" broadly describes any bacillus mycobacterium tuberculosis, which irregular cardiac rhythm, such as heartbeats spreads by means of airborne droplets. that are too fast (tachycardia), slower than Sof | 3 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H usual (bradycardia), or erratic and uncoordinated (fibrillation). HYPERTENSIVE DISEASE HEART FAILURE - Hypertensive heart disease is a long-term - Heart failure is a lifelong condition in which condition that develops over many years in the heart muscle can't pump enough blood people who have high blood pressure. to meet the body’s needs for blood and - It’s a group of medical problems ― like oxygen. heart failure and conduction arrhythmias ― - Basically, the heart can’t keep up with its that can happen when your high blood workload. pressure (hypertension) is unmanaged CARDIOMEGALY Cardiovascular Changes Associated with Aging - Cardiomegaly (sometimes megacardia or megalocardia) is a medical condition in which the heart becomes enlarged. - It is more commonly referred to simply as "having an enlarged heart". - It is usually the result of underlying conditions that make the heart work harder, such as obesity, heart valve disease, high blood pressure (hypertension), and coronary artery disease. - Cardiomyopathy is also associated with cardiomegaly. Cardiomegaly can be serious and can result in congestive heart failure. PERIPHERAL VASCULAR DISEASE - Peripheral vascular disease, also called PVD, refers to any disease or disorder of the circulatory system outside of the brain and heart. - The term can include any disorder that affects any blood vessels. It is, though, often used as a synonym for peripheral artery disease OCCLUSIVE PERIPHERAL VASCULAR PROBLEMS - Occlusive arterial disease, often called occlusive disease, happens when there is inadequate blood flow to the heart due to narrowing of the arteries from buildup or disease. - This condition most commonly shows up in the legs, but it can occur in the arms, the brain or the heart itself. VARICOSE VEINS - Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. - Varicose veins are swollen veins that appear THE HEMATOPOIETIC AND LYMPHATIC just under the skin in your legs, feet or SYSTEMS ankles. - When your vein walls are weak and your ✓ Body fluids distribute essential protective factors, valves aren’t working right, blood backs up nutrients, oxygen, and electrolytes throughout in your vein. the body. ✓ The two major fluids of the body are blood and ANEURYSM lymph. These fluids flow through the body within - Aneurysm is an abnormal bulge or two parallel circulatory systems. ballooning in the wall of a blood vessel. - Aneurysms may be a result of a hereditary COMMON DISORDERS SEEN WITH AGING condition or an acquired disease. ANEMIA - Aneurysms can also be a nidus (starting - Is defined as inadequate levels of RBVs or I point) for clot formation (t thrombosis) and sufficient hemoglobin. embolization. LEUKEMIA - As an aneurysm increases in size, the risk of - It is due to the excessive production of rupture, which leads to uncontrolled immature WBCs. bleeding, increases. Sof | 4 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H - There are both acute and chronic forms, and Decreased gastric motility Increased flatulence, leukemia is also classified by the types of and peristalsis constipation, and bowel abnormal cells present. impaction Decreased liver size and Decreased ability to Hematopoietic and Lymphatic Changes Associated enzyme production metabolize drugs, leading to with Aging risk for toxicity NURSING ASSESSMENTS AND CARE STRATEGIES RELATED TO GASTROINTESTINAL CHANGES NURSING ASSESSMENTS CARE STRATEGIES Assess oral cavity for Educate regarding dentition, condition of importance of good oral mucous membranes, and hygiene; stress need for hygiene adequate fluid intake. Facilitate dental referral as necessary Assess swallow and gag Encourage posture that reflexes facilitates swallowing. Consult with speech therapy for swallow studies and safe dietary regimen Monitor weight changes Measure and record weight at least once per month, more often if fluid balance issues develop Assess intake of nutrients Educate regarding and fluid recommended dietary intake. Establish calorie count and intake and output if problems are suspected Assess bowel sounds and Establish bowel routines. GASTROINTESTINAL SYSTEM bowel elimination patterns Teach importance of adequate fluid, fiber, and - Food and fluids containing the nutrients activity. Administer needed for survival normally enter the body laxatives, stool softeners, through the GI tract. suppositories, or enemas as - The GI tract prepares the food for digestion, needed to prevent it then digests, processes, and absorbs the constipation and impaction nutrients, which are used by the cells of the Assess effectiveness of Observe for therapeutic body. medications effects (or lack thereof); - The GI system also stores and discards observe for signs of toxicity wastes and plays a major role in maintaining fluid balance by absorbing water. COMMON DISORDERS SEEN WITH AGING HIATAL HERNIA Gastrointestinal Changes Associated with Aging - Hiatal hernia is the protrusion of the stomach PHYSIOLOGIC RESULTS into the thoracic cavity through the CHANGES esophageal opening in the diaphragm. Increased dental caries Decreased ability to chew - The primary risk factors for hiatal hernia are and tooth loss normally; decreased obesity and being over age 50. nutritional status - Gastroesophageal reflux disease (GERD) is Decreased thirst Increased risk for a major problem that can occur with hiatal perception dehydration and hernias. constipation GASTRITIS AND ULCERS Decreased gag reflex Increased incidence of choking and aspiration - Chronic atrophic gastritis is an inflammatory Decreased muscle tone Increased incidence of condition of the stomach's mucous at sphincters heartburn (esophageal membranes, where the mucus becomes reflux) thin, unusually smooth, and may develop Decreased saliva and Decreased digestion and hemorrhagic patches. gastric secretions; absorption of nutrients; - This condition can affect all or part of the increased gastric pH altered absorption of some stomach The term "peptic ulcer" medications that are pH encompasses both gastric and duodenal dependent ulcers. - While both can develop with age, gastric ulcers are more common. Sof | 5 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H - The bacterium Helicobacter pylori (H. pylori) Urinary Changes Associated with Aging is a major cause of gastric ulcers, as it damages the protective mucous lining of the stomach and duodenum. DIVERTICULOSIS AND DIVERTICULITIS - Diverticula are small pouches or sacs that develop because of weaknesses in the intestinal mucosa. - Most people with diverticula experience no symptoms, and there are no specific symptoms occur. - Diverticulitis involves inflammation of one or more diverticula. CANCER - The risk of colorectal cancer increases with age, most cases occur after age 50, although the typical age of diagnosis is age 68 for men and 72 for women. - Carcinoma of the colon is more common in women, whereas rectal carcinoma is more common in men. HEMORRHOIDS - Hemorrhoids, also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. - They become a disease when swollen or inflamed; the unqualified term hemorrhoid is often used to refer to the disease RECTAL PROLAPSE - Bulging of the rectum through the anus is most likely to occur in women older than age COMMON DISORDERS SEEN WITH AGING 60, especially those who have given birth to URINARY INCONTINENCE many children. - Involuntary loss of urine, it is not a routine or URINARY SYSTEM normal occurrence with aging. - It may occur as a result of physiologic ✓ Consist of 2 kidneys, 2 ureters, the urinary changes, other medical problems such as bladder, and the urethra. UTI, neurologic problems, or changes in the ✓ It supports the homeostasis by eliminating ability to function. wastes and excessive fluid from the body. URINARY TRACT INFECTION ✓ The urine is approximately 95% water, with the - The incidence of UTIs increases with age remainder composed of waste products and - Women are more 14 times more likely than salts. men to develop UTI. EXPECTED AGE-RELATED CHANGES CHRONIC KIDNEY DISEASE ❖ The kidneys decrease in size from approximately - Formerly called chronic renal failure 400 g at age of 40 only, 250 g by age of 80. By the - It may be a result of other chronic health age of 70, they lose approximately 1/3 of their condition such as HPN, DM, chronic UTI, efficiency and they lack functional reserve. Urinary Tract obstruction. ❖ Vascular changes, such as those that occur with NERVOUS SYSTEM atherosclerosis or arteriosclerosis, lead to a ✓ The nervous system processes and controls decreased blood supply to the kidneys. body functions and links us with the outside ❖ Decreased blood flow results in a diminished world. glomerular filtration rate. ✓ Through the nervous system, we perceive ❖ At 90 years of age, the glomerular filtration rate sensations and detect changes in our can be as little as half of what it was at age 20. environment. ❖ The blood urea nitrogen remaining in the blood ✓ We store information about the world within the increases significantly with age, from a normal of nervous system and use this information to 10 to 15 mg/dl. in young adulthood to 21 mg/dL by respond to the world. age 70. ✓ Internally, the nervous system and the endocrine system maintain homeostasis. ✓ The nervous system functions at an unconscious or reflex level at birth; neurologic control is gained with maturation. Sof | 6 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H ✓ With advanced age, the nervous system - Symptoms usually begin after the age 40 becomes prone to deterioration and is and appear gradually. susceptible to many types of injury and illness - Medications includes levodopa (combined with carbidopa) EXPECTED AGE-RELATED CHANGES DEMENTIA ❖ There is approximately a 3% reduction in brain - General term for a permanent or progressive tissue in each decade from ages 50 to 90. organic mental disorder. ❖ Brain shrinks- age has been linked to a decrease - It is characterized by personality changes, in the number of functional cortical neurons confusion; disorientation; deterioration of ❖ Mental function is often changed as these cells intellectual functioning; and impaired control are lost or undergo functional changes. of memory, judgement, and impulses. ❖ Cerebral blood flow decreases with aging because - This can be a result of drug intoxication, of the gradual accumulation of fatty deposits (ie, trauma, disease process, hormonal arteriosclerosis). Decreased blood flow also results imbalances, and vitamin deficiency. in a slower rate of cerebral metabolism. - Dementia with Lewy bodies (DLB) is caused ❖ A progressive decrease in the number of branches by microscopic protein clumps in the brain and the connections between dendrites occurs that cause damage to nerve cells. over time. - Parkinson Disease Dementia usually occurs ❖ Studies of neurotransmitters show that brain with the progression of Parkinson disease. transmission of serotonin becomes impaired with - Mixed dementia can occur when more than aging (Karrer et al., 2019), which can make the 1 form of dementia is present. older adult vulnerable to developing depression; ALZHEIMER DEMENTIA and norepinephrine levels decrease. - Is one stage in the continuum of Alzheimer ❖ Levels of monoamine oxidase, which metabolizes disease. catecholamines, increase in the peripheral nervous - It is the most common form of dementia and system, the velocity of nerve conduction is strongly is most often seen in people over age 65 associated with aging (Palve & Palve, 2018) - Age is the greatest factor for Alzheimer Neurologic Changes Associated with Aging dementia - The umbrella term for Alzheimer disease now includes not only people with dementia but also people with mild cognitive impairment. o Life stressors have been associated with the development of Alzheimer disease. A single life stressor, such as losing a child, can increase the risk of developing Alzheimer dis ease by 4%; the biggest effect is seen in minority populations. TRANSIENT ISCHEMIC ATTACKS - It is a brief episode of cerebrovascular insufficiency that are usually the result of cerebral blood vessel obstruction. - It occurs without warning, and lasts only a few minutes, but some persists as long as 24 hours. - It may be a warning of an impending stroke. STROKE - Formerly called CVA - Is a disturbance of the blood supply to the brain. - Most strokes are related to atherosclerosis, HPN, DM, or a combination of these. Signs and Symptoms of Damage to the Right Hemisphere of the Brain - Left hemiparesis (weakness of the left arm COMMON DISORDERS SEEN WITH AGING and/or leg) PARKINSON DISEASE - Impaired sense of humor - Also called paralysis agitans - Disorientation to time, place, and person - It is a progressive, degenerative disorder of - Difficulty recognizing people the CNS. - Visual/spatial problems, including loss of depth - The cause is unknown perception - Specific neurons in the brain that produce - Neglect of the left visual field (patient may not the neurotransmitter dopamine are lost see objects or hazards on the left side of body) Sof | 7 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H - Loss of impulse control (patient may strike out, ❖ Refractive errors become increasingly common cry, or shout if upset) as the ciliary muscles lose their ability to - Unaware of neurologic function loss (patient may contract. try to stand or walk despite hemiparesis) - Poor judgment (patient may deny illness or Vision Changes Associated With Aging problems or tend to overestimate her or the ability to perform activities) - Inappropriate responses (patient may smile continually or demonstrate euphoric behavior even in serious or tragic situations) - Confabulation (patient may make up detailed but inaccurate explanations to compensate for memory losses, which can be very believable to persons who are not aware of the facts) Signs and Symptoms of Damage to the Left Hemisphere of the Brain - Right hemiparesis (weakness of the right arm and/or leg) - Language disturbances - Aphasia—defective or absent language skills that may be expressive (motor), in which words cannot be formed; receptive (sensory), in which language is not understood; or mixed, in which both processes are affected - Agraphia—loss of the ability to write - Alexia—inability to comprehend written words; reading problems - Neglect of the right visual ýeld (patient may not see objects or hazards on the right side of body) - Behavioral changes (patient may be slow, cautious, and anxious in attempting new activities) - Mood changes (tendency to worry or feel depressed; patient may verbalize feelings of worthlessness, guilt, anger, and frustration SPECIAL SENSES THE EYES COMMON DISORDERS SEEN WITH AGING EXPECTED AGE-RELATED CHANGES BLEPHARITIS – a chronic inflammtion of the ❖ Refractive errors, or errors in focusing ability, eyelids caused by bacteria and oily flakes at the occur when the cornea is misshapen or the lens base of the eyelid. Pone of the most common cannot appropriately change shape to focus disorders of the eye. images. DIPLOPIA- double vision. It is not normal and ❖ With aging, many structural and functional indicates some disturbances of the nervous changes may occur in the eye. The eyelids system. become less elastic and sag. Eyelashes tend to CATARACTS- which cause a clouding of the be shorter, thinner, and in some cases absent. lens of the eye,are increasingly common with ❖ A grayish haze of the peripheral cornea, referred aging. to as arcus senilis, develops with aging and is GLAUCOMA- a disease characterized in most more common in dark-skinned persons. caes by increased fluid pressure within the eye. ❖ Legal blindness is defined as visual acuity of AGE-RELATED MACULAR DEGENERATION 20/200 or less in the worse eye even with the AND RETINAL DETACHMENT (AMD) – occurs best correction, or a visual field extent of less most often in people over age 50. The cause of than 20 degrees in diam- eter. this disease is unknown. ❖ Vision impairment is defined as having vision 20/40 or worse with correction. Most blind people are age 65 or older, with the rate increasing sharply with age. ❖ Most people older than 50 years of age experience some degree of farsightedness, also called hyperopia or presbyopia, which literally means "aging eye." Sof | 8 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H THE EARS DEAFNESS- the inability to hear sounds fully, may be temporary or permananent, depending EXPECTED AGE-RELATED CHANGES on the cause. MÉNIÈRE DISEASE- a chronic disorder of the ❖ The small muscles that support the membrane inner ear observed in people after age 40. show signs of atrophy with advanced age. Person suffering in this disorde experience ❖ Arthritic changes affect the joints between the vertigo to the point that they may unable to stand small bones of the middle ear, and hair cells in or walk. the inner ear often deteriorate. ❖ Presbycusis, defined as an alteration in hearing TASTE AND SMELL capac ity related to aging, affects two-thirds of Americans over age 70 (Cheslock & De Jesus, EXPECTED AGE-RELATED CHANGES 2021). - Men are more affected by this problem than ❖ With aging, there is a decrease in the number of women. The aging person with presbycusis func- tional receptors in both the nasal cavities loses the ability to perceive high-fre quency and the papil- lae on the tongue tones. ❖ By age 60, it is estimated that half of all adults ❖ Speech sounds, such as s, sh, ch, and soft t will experience some alteration in smell and may not be audible, so the aging person may taste. The changes in taste particularly affect the hear only parts of spoken words. receptors for sweet and salty tastes. ❖ Simple words, such as cat, hat, sat, and that ❖ Because salt enhances the flavor of food, older may all sound the same. adults often add salt in an attempt to add flavor. Complaints of flavorless food are common even Auditory Changes Associated With Aging if the food seems well seasoned and tasty to younger individuals. ❖ The term burning mouth syndrome is used to describe an oral sensation of burning or tingling. This may be associated with a vitamin B deficiency, inadequate saliva production, allergies, GERD, trauma, and diabetes. Olfactory Changes Associated With Aging ENDOCRINE SYSTEM EXPECTED AGE-RELATED CHANGES ❖ The pituitary gland continues to produce adequate levels of critical hormones throughout life. ❖ It produces less growth hormone with age, leading to decreased muscle mass. ❖ A decrease in the production of thyroid-stimulating COMMON DISORDERS SEEN WITH AGING hormone is seen in some older adults. OTOSCLEROSIS – a hardening or fixing of the ❖ The basal metabolic rate begins to decrease in stapes to the oval window, interferes with the young adulthood and continues to decrease transmission of sound waves to the inner ear. gradually throughout life. More often in women than in men. ❖ Because lean body mass also decreases, the over- TINNITUS- or ringing in the ears, is commonly all metabolic rate does not change significantly. reported by aging people. It may be a result of ❖ In response to a decrease in thyroid function, some trauma to the ear, pressure from cerumen older people become more sensitive to cooler against eardrum, otoscleorisis, etc. temperatures. ❖ PTH appears to decrease with age except in osteoporosis, where it appears to increase. Elevated Sof | 9 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H levels of PTH may lead to increased blood calcium REPRODUCTIVE SYSTEM levels. This is of concern particularly for older - In both men and women, the genital and urinary women, who may manifest symptoms of confusion, system are loacted close to each other. kidney stones, and osteoporosis. ❖ Pancreatic function appears to decrease with aging; EXPECTED AGE-RELATED CHANGES however, barring the onset of some form of diabetes, CHANGES IN WOMEN its function remains adequate to meet normal body functioning. ❖ Several significant changes occur with ❖ Adrenal function is not altered significantly with menopause. advancing age. Adequate hormone levels are ❖ The production of progesterone and estrogen produced to meet bodily needs diminishes. There is no longer a need to ❖ The levels of gonadotropic hormones decrease more produce ova to be fertilized, and there is no significantly in women than in men. need to prepare a site to sup- port a pregnancy. ❖ After menopause, the production of estrogen and ❖ Along with other body tissue, the tissues of the progesterone drops significantly. As the production external female reproductive organs atrophy of female sex hormones decreases with aging, some because of vascular changes. changes in secondary sexual characteristics may be ❖ The tissues of the reproductive organs become observed, such as the development of facial hair and less elastic, and the amount of subcutaneous genital atrophy. tissue decreases. This results in a flattening of ❖ Because production of the male hormone the tissue of the external genitalia, or labia, and testosterone decreases gradually with aging, such a decreased amount and distribution of pubic changes are gradual and often barely noticeable. hair. ❖ Vaginal epithelial tissue becomes thinner and Endocrine Changes Associated With Aging less vascular. The tissue of the vagina is drier and more alkaline, and fewer rugae (folds) are present within the vagina. ❖ The uterus, cervix, ovaries, and fallopian tubes decrease in size and may be difficult to palpate on examination. ❖ The decrease in hormone production and resulting tissue changes may lead to more fragile, more easily irritated vaginal tissue. ❖ Decreased vaginal secre- tions may lead to vaginitis, which can cause vulvar sore- ness and pruritus or dyspareunia (painful intercourse). ❖ Once menopause has occurred, vaginal bleeding is considered abnormal. ❖ The breasts are part of the secondary female sexual organs. Because of the decrease in hormones with aging. breast tissue atrophies. As supporting muscle tissue atrophies, the breasts tend to sag and decrease in size. CHANGES IN MEN ❖ Male age-related changes in the reproductive system are less noticeable because testosterone continues to be produced into old age, although the amount decreases. ❖ With aging, there is some change in the size and firmness of the testes. ❖ The penis retains the ability to become erect, although it may take longer to do so and may COMMON DISORDERS SEEN WITH AGING require more stimulation. Once achieved, erec- DIABETES MELLITUS- the incidence of DM tion may last longer than at a younger age. increases with age. ❖ Ejaculation tends to be slower and less forceful HYPOGLYCEMIA- is a potentially serious in aging men and may not occur during each problem for people receiving insulin or oral sexual encounter, particu- larly if intercourse is hypoclycemic agents. frequent HYPOTHYROIDISM- reduced function of the ❖ Enlargement of the scrotum may indicate thyroid gland, called primary hyperthyrodism, is problems with the testes or part of the duct more common in older than in younger person. system. ❖ The penis should remain free from any tissue changes, and the presence of ulcers, nodules, or other changes is abnor- mal. Most aging men Sof | 10 NCM 114 | CARE OF OLDER PERSON LECTURE | CASTILLO | BSN 3H experience some degree of prostate gland achieve and sustain a sufficient erection for enlargement. The signs and symptoms most sexual intercourse. It is prevalent in often experienced include urinary frequency, approximately 70% of men age 70 and over. hesitancy, dysuria, decreased force when Benign Prostatic Hyperplasia (BPH)- is a voiding, dribbling, noс turia, increased incidence condition in which your prostate grows in size. of UTIs, and decreased force during ejaculation. Reproductive Changes Associated With Aging COMMON DISORDERS SEEN WITH AGING UTERINE PROLAPSE- prolapse of the uterus ( into the vagina ) is commonly observed inolder women. VAGINAL INFECTION- change in vaginal pH may lead to increased incdence of vaginal infections. This is most often manefested by increased vagnal discharged, irritation, odor, and itching. BREAST CANCER- this continues to be a major cause of cancer deaths in women, and the incidence of this form of cancer continues to increase with age. PROSTATE CANCER- no obvious changes in function to indicate the presence prostate cance. ERECTILE DYSFUNCTION- also know as impotence, it is defined as the inability to Sof | 11