110 terms

Gerontological Nursing, ch. 5 Aging Changes

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Crystallized intelligence
Knowledge accumulated over a lifetime; arises from the dominant hemisphere of the brain.
Fluid intelligence
Involves new information emanating from the nondominant hemisphere; controls emotions, retention of nonintellectual information, creative capacities, spatial perceptions, and aesthetic appreciation.
Immunosenescence
The aging of the immune system.
Presbycusis
Progress hearing loss that occur as a result of age-related changes to the inner ear.
Presbyesophagus
A condition characterized by a decreased intensity of propulsive waves an increased frequency on non-propulsive waves in the esophagus.
Presbyopia
The inability to focus or accommodate properly due to reduced elasticity of the lens.
Lean body mass
Decreases
Fat tissue
Increases until the sixth decade of life.
ECF and ICF
ECF remains fairly constant, whereas ICF is decreased, resulting in less total body fluid. This makes dehydration a significant risk to older adults.
The loss of subcutaneous fat content
Is responsible for the decrease in skin-fold thickness.
Trachea and rib cage
Are more rigid due to the calcification of costal cartilage.
Bronchial mucous gland
Atrophies, further complicating the ability to expel mucus and debris.
Residual volume
Increases due to the lungs' inability to exhale effectively.
Vital capacity
Decreases as residual volume increases.
Maximum breathing capacity
Decreases.
AV valves
Become thick and rigid as a result of sclerosis and fibrosis, compounding the dysfunction associated with any cardiac disease that may be present.
The heart muscle
Loses its efficiency and contractile strength.
Diastolic filling and systolic emptying
Takes more time to be completed.
Tachycardia
Will last for a longer time in older adults.
Tunica intima
The innermost layer experiences the most direct changes, including fibrosis, Ca and lipid accumulation, and cellular proliferation. The changes contribute to the development of atherosclerosis.
Baroreceptors
Decreases, causing reduced sensitivity to of the BP. Increases problems with postural hypotension and postprandial hypotension.
Teeth
Become less sensitive to stimuli. Tooth loss is not a normal consequence of aging, but poor dental care, diet, and environmental influences have contributed to many older adults being edentulous.
Tongue
Atrophies, affecting the taste buds. The sweet sensations on the tip of the tongue tend to suffer a greater loss than the sensations for sour, salt, and bitter flavors.
Saliva
Produce 1/3 the amount they did in their younger year.
Salivary ptaylin
Decreased, interfering with the breakdown of starches.
Esophagus
Tends to become slightly dilated, and esophageal emptying is slower, which can cause discomfort because food remains in the esophagus for a longer time. Aspiration becomes a risk.
Higher pH
Contributes to an increased incidence of gastric irritation in the older population.
Fat absorption
Is slower, and dextrose and xylose are more difficult to absorb. Absorption of vitamin B, B12, vitamin D, calcium, and iron is faulty.
Motility of feces through the bowel
Not affected by aging.
Loss of tone of the internal sphincter
An age-related loss of tone of the internal sphincter can affect bowel elimination.
Liver function
Liver function tests remain within a normal range.
Cholesterol stabiization
Less efficient cholesterol stabilization and absorption may cause an increase in gallstones.
Pancreatic ducts
Become dilated and distended, and often the entire gland prolapses.
Atrophy of the kidney
May be due to atherosclerosis.
Glomerular filtration rate
May decrease by 50%.
Tubular exchange
There is less efficient tubular exchange of substances, conservation of water and sodium, and suppression of antidiuretic hormone secretion in the presence of hypo-osmolality. May also cause decreased reabsorption of glucose from the filtrate, which can cause 1+ proteinurias and glycosurias not to be of major diagnostic significance.
Urinary retention
Emptying of the bladder is more difficult.
Urinary incontinence
Is not a normal outcome of aging, some stress incontinence may occur because of a weakening of the pelvic diaphragm, particularly in multiparous women.
Sperm count
May be reduced
Penis function
Venous and arterial sclerosis and fibroelastosis of the corpus spongiosum can affect the penis with age. The older man does not lose the physical capacity to achieve erections or ejaculations, although orgasm and ejaculation tend to be less intense.
Prostatic enlargment
Occurs in most older men, may cause problems with urinary frequency. Is most often benign.
Vaginal epithelium
Becomes thin and vascular.
Endometrium
The endometrium continues to respond to hormonal stimulation, which can be responsible for incidents of postmenopausal bleeding in older women on estrogen therapy.
Estrogen depletion
Causes a weakening of pelvic floor muscles, which can lead to an involuntary release of urine.
Fibrous tissue
Replaces muscle tissue. Muscle cramping frequently occurs.
Sarcopenia
The age-related loss of muscle mass, strength, and function, is mostly seen in inactive persons.
Tendons
Shrink and harden, which causes a decrease in tendon jerks.
Bone density
Decreases at a rate of 0.5% each year after the third decade of life.
Spine
Thinning disks and shortening vertebrae reduce the length of the spinal column.
Reduced cerebral blood flow
Is accompanied by a reduction in glucose utilization and metabolic rate of oxygen in the brain.
Nerve conduction velocity
Is lower, and is manifested by slower reflexes and delayed response to multiple stimuli.
Balance
Slow response to changes in balance.
Hypothalamus
Regulates temperature less effectively.
Stages 3 and 4 of sleep
Become less prominent.
Visual field
Narrows, making peripheral vision more difficult.
Pupil
Less responsive to light because the pupillary sphincter hardens.
Macular degeneration
Due to alterations in the blood supply to the retina, causing a loss in central vision.
Opacification of the lens
Leads to the development of cataracts, which increases sensitivity to glare, blurs vision, and interferes with night vision.
Depth perception
Becomes distorted, this change results from a disparity between the retinal images caused by the separation of the two eyes and is known as stereopsis.
Glaucoma
Due to less efficient reabsorption of intraocular fluid.
Floaters
Caused by bits of debris in the posterior cavity that become visible and float across the visual field.
Causes of presbycusis
Include loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph.
High-frequency sounds
2,000 Hz and above are the first to be lost.
The acoustic relflex
Protects the inner ear and filters auditory distractions from sounds made by one's own body and voice. It is diminished due to a weakening and stiffening of the middle ear muscles and ligaments.
Smell
Decreases due to the number of sensory cells in the basal lining and fewer cells in the olfactory bulb of the brain. By age 80 years, the detection of scent is almost half as sensitive as it was at its peak.
Taste
May be caused by the reduced sense of smell. The ability to detect salt is affected more than other taste sensations.
Thyroid gland
Undergoes fibrosis, cellular infiltration, and increased nodularity. The resulting decreased thyroid gland activity causes a lower basal metabolic rate, reduced radioactive iodine uptake, and less thyrotropin secretion and release. Overall, the thyroid function remains adequate.
ACTH secretion
Decreases with age, secretory acitivity of the adrenal gland also decreases.
Aldosterone
Decreases
Parathyroid glands
Maintain their function throughout life.
Glucose
The older person's ability to metabolize glucose is reduced, and sudden concentrations of glucose cause higher and more prolonged hyperglycemia levels; therefore, it is not unusual to detect higher blood glucose levels in nondiabetic older persons.
Melanocytes
Decreased, cause "age spots"
Perspiration
Decreased due to the decrease in function of the sweat glands.
T-cell activity
T-cell activity declines and more immature T cells are present in the thymus.
Serum immunoglobulins
The concentration of IgM is lower, whereas the concentrations of IgA and IgG are higher. Responses to influenza, parainfluenza, pneumococcus, and tetanus vaccines are less effective.
Proinflammatory cytokines
Are increased, which is believed to be linked to atherosclerosis, diabetes, osteoporosis, and other diseases that increase in prevalence with age.
Thermoregulation
Mean body temperature ranges from 96.9°F to 98.3°F orally and 98°F to 99°F rectally. Rectal and auditory canal temperatures are the most reliable indicators of body temperature in older adults.
Response to cold temperatures
Inefficient vasoconstriction, decreased cardiac output, diminished shivering, and reduced muscle mass and subcutaneous tissue.
Response to hot temperatures
Differences in response to heat are related to impaired sweating mechanisms and decreased cardiac output.
Three types of memory
Include short term, lasting from 30 seconds to 30 minutes; long term, involving that learned long ago; and sensory, which is obtained through the sensory organs and lasts only a few seconds.
Working memory function
Reduced.
Intellingence
Basic intelligence is maintained. Fluid intelligence declines. High levels of chronic psychological stress have been found to be associated with an increased incidence of mild cognitive impairment.
Learning
Older adults maintain the capacity to learn, although a variety of factors can easily interfere with the learning process including the older person's ability to learn, including motivation, attention span, delayed transmission of information to the brain, perceptual deficits, and illness.
Attention span
Older adults demonstrate a decrease in vigilance performance (i.e., the ability to retain attention longer than 45 minutes).
Nursing actions related to reduction in ICF
Prevent dehydration by ensuring fluid intake of at least 1,500 mL daily
Nursing actions related to decrease in subcutaneous fat content
Ensure adequate clothing is worn to maintain body warmth; maintain room temperatures between 70°F (21°C) and 75°F (24°C).
Nursing actions related to decreased cardiac output and stroke volume
Allow rest between activities, procedures; recognize the longer time period required for heart rate to return to normal following a stress on the heart
Nursing actions related to decreased lung expansion.
Keep O infusion rate under 4 mL
Nursing actions related to decreased esophageal and gastric motility; decreased gastric acid
Assess for indigestion; encourage five to six small meals rather than three large ones; advise patient not to lie down for at least 1 hour following meals.
Nursing actions related to decrease in renal mass and glomerular filtration rate
Ensure age-adjusted drug dosages are prescribed; observe for adverse responses to drugs; recognize that urine testing for glucose can be unreliable, urinary creatinine excretion and creatinine clearance are decreased, and blood urea nitrogen level is higher.
Nursing actions related to drier skin
Recognize need for less frequent bathing.
Skin Changes
Increase in time for cellular renewal-increase in healing time. Decrease moisture content. Dermis has marked elastosis- aggregated of amorphous elastic fibers, decrease in collagen content. Skin appears, wrinkled, yellowed, lax, rough, or leathery. Skin turgor is not accurate.
Normal age related change
Homeostatic changes.
Type 1 bone loss
Women only: menopausal bone loss.
Type 2 bone loss
Both men and women: senescent bone loss.
Dementia
Abnormal aging.
Cataracts
Abnormal. cloudy cornea is normal.
Presbyopia
Age-related change in sight. Far-sightedness.
Presbycupia
Age-related change in hearing.
Maloclusion
Teeth are not lined up.
EKG
Amplitude may be slightly lower.
Trophic changes
Decreased hair on further extremities.
Liver decreases
Impairs drug functions.
Hemoglobin and gematocrit
Decrease to the lower level of normal.
Creatine and BUN
Increases
Albumin
Decreases
Potassium
Increases
Glucose
Mild increase, increase post meals.
TSH
Increase, because you have a smaller thyroid to compensate.
Healthy people 2020
12 objectives are specific to older adults. Preventive objects for older adults.
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