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Age Related Changes
Terms in this set (103)
What are cataracts caused by? What are the symptoms (4)? Can it be fixed?
cause - accumulation of water and the alteration of the lens fiber structure (clouding of the lens)
symptoms - dim/blurred vision, increased sensitivity to glare, seeing halo around bright lights, diminished color perception
can be fixed with laser treatments (but not cured)
What is glaucoma caused by? What are the symptoms of chronic glaucoma (5)? Acute? Which is a medical emergency?
cause - damage to optic nerve from too much aqueous humor and pressure building up in the eyeball, and may lead to blindness if left untreated
chronic - slow onset, diminished vision in dim light, increased sensitivity to glare, halos around lights, diminished peripheral vision
acute - sudden onset, intense pain, blurred vision, nausea and vomiting; medical emergency
What causes age-related macular degeneration (AMD)? What are the symptoms (3)?
cause - deposits of drusen and abnormal blood vessels that leak blood under the retina
symptoms - loss of central vision, faces or straight lines appear wavy, followed by progressive loss in vision
What is presbycusis?
age related hearing loss
1 in _____ adults between the age of 65 and 74 have problems hearing.
What 5 things can cause presbycusis? Where do they occur?
1. external ear - increased production of and dryer cerumen and causes a mechanical obstruction
2. middle ear - tympanic membrane gets stiff
3. inner ear - calcification of ossicles, hair cells degenerate in the cochlea, cranial nerve VIII (acoustic) degenerates
What is cerumen?
What are the bones of the inner ear? With aging, what happens to these bones?
malleus, incus, stapes; they calcify
Why does CN VIII degenerate?
there is decreased blood circulation to the inner ear
What are the 7 risk factors that affect hearing?
1. history of frequent middle ear infections
2. increased age
3. genetic predisposition - males
4. impacted cerumen (if it is dryer)
5. ototoxic medications (like aspirin and antibiotics that end in -mycin)
6. history of head trauma
7. repeated exposure to noise (like working with motors or loud music)
What is the earliest symptom of hearing loss? What is a later symptom? What makes these symptoms more challenging to hear?
early - loss of high pitched sounds
later - loss of sibilant consonants (those that have a whistling quality) - ch, f, s, g, sh, t, th
background noises makes it more challenging to hear
What are 5 psychosocial consequences of hearing loss?
1. social isolation
3. declines in cognitive function
4. diminished quality of life (suffering relationships)
What is selective hearing?
only hearing what you want to hear
What are 6 possible nursing interventions for hearing problems?
1. teaching about interventions to address modifiable risk factors (taking caution in ototoxic medications, wearing earplugs during loud noises, etc)
2. referring to health care professional for removing the impacted cerumen
3. referrals to audiology services
4. teaching about the use and care of different types of hearing aids
5. using assistive listening devices
6. communication techniques with hearing-impaired older adults
What happens to the appearance of the eye with aging (5)?
loss of orbital fat, extra lid skin as it loses its elasticity, loss of fat pad around the eyes, and brow becomes more prominent
What happens to the lens of the eye with aging (3)?
become more cloudy/opaque letting light in, lets bright light/glare in, gets stiffer
What is presbyopia? What is it caused by? Who experiences it? How do you correct it?
loss of the ability of the lens curve to focus on a near object aka farsightedness; decreased ability of the ciliary muscles to change the concave presence of the lens; eventually 100% of the population (but you start noticing changes around age 40); convex lenses in the form of glasses
Tear production ____________________ with age. What does this lead to?
decreases; dry, irritated eyes
What happens to peripheral vision with age? Why?
decreases; decreased number of receptor cells in the retina
What happens to visual processing with age?
it becomes slower going to the cortex of the brain
Does the lens of the eye flatten with near or far vision?
What is wet AMD? Dry?
wet - more severe and caused by abnormal blood vessels growing under the retina
dry - caused by a chemical drusen in the retina, in which deposits sit inside the eye and cause a problem
What are 5 functional consequences of decreased vision?
1. increased difficulty performing usual activities
2. inability to drive
3. loss of independence
4. increased risk for falls
5. anxiety, depression, and social isolation
What 6 things can you do as a nurse to help those who have vision issues?
1. identify yourself clearly
2. try not to move items in the resident or patient's room
3. make it clear when you are leaving the room
4. use the analogy of clock hands to help locate objects
5. speak descriptively of surroundings; state position of people in the room
6. supply with low vision aids (like using brighter lights, larger print of letters)
What happens to subcutaneous fat with age? What does this cause (2)?
decreases --> wrinkled and sagging skin, skin tents when you pinch
What happens to collagen with age? What does this cause?
stiffens --> skin tents when you pinch
What happens to the sebaceous glands with age? What does this cause?
its activity decreases --> dry, flaky skin
What happens to the capillaries with age? What does this cause?
increases in fragility --> bruising more easily
What happens to the melanocytes in the basal layer with age? What does this cause?
increases --> solar lentigenes (freckles) on the face and back of hands
What happens to blood supply to the skin with age? What does this cause?
decreases --> diminished tactile sensitivity
What happens to skin proliferation with age? What does this cause?
decreases --> slow wound healing
What happens to blood supply to the extremities with age? What does this cause?
decreases --> thick, brittle nails
What happens to melanin with age? What does this cause?
decreases --> gray hairs
What happens to hair follicles with age? What does this cause (2)?
they shrink --> thinning of hair or baldness
What are the 5 most negative consequences of aging when it comes to the skin?
1. delayed wound healing that causes an increased susceptibility to infection
2. thin skin that predisposes to hypothermia
3. cumulative sun exposure that predisposes to skin cancer
4. skin tears - traumatic wounds that involve the dermis and/or epidermis caused by friction, rubbing, and shearing
5. pressure ulcers - localized injury to the skin over a bony prominence due to pressure or with shearing
What are the 3 most common places for pressure ulcers?
sacrum/coccyx, back of heel, trochanter
What are 6 ways to prevent pressure ulcers?
1. reposition every 2 hours
2. apply lotions
3. for daily nutrition needs, give high protein and vitamin C supplementation
4. do not massage bony prominences
5. raise the heels
6. keep the head of the bed lower than 30 degrees (if higher, this puts pressure on the sacrum and increases risk of shearing)
What are 2 age-related changes in sleep? What are the outcomes of (2)?
changes - decreased amount of time spent in deep sleep, increased time taken to fall asleep
outcomes - frequent arousals from light sleep, more time in bed but poorer quality of sleep
What is the sleep recommendations for older adults?
_____% of older adults experience symptoms of insomnia.
What are 8 risk factors in the elderly patient that might cause sleep issues?
1. nocturia (may be caused by benign prostatic hyperplasia)
2. diuretic medications
3. chronic pain
4. caffeine or ETOH/alcohol use
5. respiratory diseases
6. decreased cognitive function
8. institutional setting
How might heart failure affect the kidneys? How does this affect sleep?
edema in the extremities --> gets into the vascular space --> gets into the kidneys (and lungs); causes you to have nocturia
How does caffeine and alcohol/ETOH use affect sleep?
disrupts REM sleep
How does dementia affect sleep?
you might get your days and nights mixed up via losing diurnal rhythm
As a nurse, what can you do to help those who have sleep issues (5)?
1. encourage patients to establish a bedtime routine, avoid alcohol near bedtime, and caffeine after 1 PM
2. suggest environmental modifications
3. teach relaxation and mental imagery techniques
4. manage pain, urinary, and respiratory symptoms
5. time diuretics (like Lasiks - don't give after noon) and avoid OTC medications (like Benadryl - don't want olde adults to take this to help with sleep because it may slow down their cognitive function relating to memory)
What are age related structural changes relating to the respiratory system (3)? What does this cause?
calcification of costal cartilage, kyphosis (barrel chest), and lungs become harder to inflate --> require increased energy expenditure
What is kyphosis? What causes it? What does it alter in the chest?
hunchback that causes a barrel chest shape and using accessory muscles to breathe; little fractures in the spine; landmarks in the chest
What are 3 defense mechanisms in the older adult relating to the respiratory system? What does this cause?
reduced ability to produce antibodies, less forceful cough as there are fewer and less functional cilia, and increased risk of aspiration (especially with a neurological condition) --> increased susceptibility to infection
What are 2 decreases in respiratory control in the older adult? What does this cause?
slower automatic ventilatory response to hypoxemia and hypercalemia, less able to compensate after physical exertion or respiratory illness --> less tolerance to activities
When should you get a pneumonia vaccination?
one time after 65 years old
As a nurse, what can you do to help those with respiratory issues in the aging population (6)?
1. encourage smoking cessation
2. educate the risk about second-hand smoke
3. encourage PNA and influenza vaccination
4. encourage hand hygiene
5. teach to avoid crowds during flu season
6. encourage mobility
What are 4 age-related hematological changes?
1. hemoglobin and hematocrit fall to low-normal values (no reserve)
2. decreased absorption of vitamin B12 and iron due to the lower acidity of the gut
3. decreased bone marrow mass slows the proliferation of blood cells (particularly WBCs) in the event of an infection, hemorrhage, or chronic illness
4. may not have elevation of WBCs, making you more vulnerable to problems with infections
What is the leading cause of death in adults over 85?
What are varicose veins? What is this caused by?
abnormally dilated, tortuous and very visible veins; one way valves on the vein get stiffer and allow for back flow of the blood
What is venous tortuosity?
twisting of the veins
What are 3 cardiovascular changes related to the heart?
1. myocardial hypertrophy (enlargement) - bloods vessels stiffen, which causes extra workload on the heart in which it then enlarges
2. changes in cardiac output in response to exercise or stress
3. rigidity of valves and murmurs
Explain why myocardial hypertrophy occurs in the older adult. What is the problem with this?
blood vessels stiffen --> extra workload on the heart --> enlargement; problem is that it throws off the electrical signal of the heart, which may lead to congestive heart failure
What are 3 cardiovascular changes related to blood vessels?
1. arterial stiffening
2. increase in BP
3. decreased blood return because of edema
Why does blood pressure increase slightly with age? Are there any symptoms of this?
arteries get stiffer; no
What is prehypertension? How should you treat this?
120-139 SBP; treat with diet and exercise
When you start giving a patient hypertensive medications?
if SBP is above 140 and/or DBP is above 90
______% of older adults have hypertension
What does untreated hypertension cause? (2)
myocardial hypertrophy --> heart failure and arrhythmia
Orthostatic hypotension is noted in ______% of hospitalized older patients. What is this defined as?
68%; decrease of SBP > 20 mmHg and DBP > 10 mmHg after standing for 1 minute
Post prandial hypotension is noted in ______% of older adults? What is this defined as? What is the cause of this?
30-60%; decrease of SBP > 20 mmHg within 75 minutes of a meal; after you eat a lot of blood from the brain goes to the digestive system to help with digestive function
What are blood pressure problems usually caused by (primary factor)?
problem with the baroreceptor reflexes (usually much slower in the older adult)
What is a common side effect of cardiovascular medications for the older adult?
syncope (feeling of fainting, which increases change of falls) --> may exacerbate hypotension
What are 5 risk factors for the cardiovascular disease?
1. elevated lipids
3. sedentary lifestyle
4. high alcohol consumption
How does cholesterol build up in blood vessels?
stress put on the blood vessels creates tears and the LDLs catch to these tears
What are 3 age-related changes in the mouth? What do these lead to?
1. gingival (gums) retraction and atrophy
2. decrease in function of taste buds (and sense of smell) because cranial nerves get less blood to them
3. decreased saliva
risk for poor dentition and enjoyment of food
What 2 esophageal changes occur with age? What do these lead to?
1. decreased esophageal sphincter pressure and tone
2. decrease motility
risk for indigestion
What are 3 age-related changes in the stomach? What do these lead to?
1. atrophy of mucosa
2. decreased blood flow
3. decreased acid production
risk for malabsorption of B vitamins and iron
Why does the esophageal sphincter relax with age?
blockage of stomach comes up through the esophagus (aka heartburn)
What are 2 age-related changes in the liver? What do these lead to?
decreased size and decreased protein synthesis --> slower metabolism of drugs, making you more susceptible to toxicity problems and toxic side effects of medications
What age-related change occurs in the pancreas?
decreased lipase production
What 2 age-related changes occur in the small intestines?
1. decreased motility
2. decreased secretion of digestive enzymes
What are 5 age-related changes that occur in the large intestines, rectum, and anus? What do these lead to?
1. decreased motility and muscular tone
2. increased transit time
3. decreased sensation to defecate
4. decreased nerve supply to the rectal area
5. decreased anal sphincter tone
increases risk for constipation
What are 5 risk factors for constipation in the older adult?
2. decreased fiber intake
3. decreased fluid intake
4. medications with constipation as a side effect
5. laxative abuse
What is normal bowel frequency?
anywhere from 3 a day to 2-3 times a week
______% of the elderly population that is not institutionalized has problems with constipation. ______% of the elderly in institutional setting have problems with constipation? Why might this be (4)?
15-30%; 75%; less activity, less vegetables and fruit, no access to maintaining fluid intake, taking lots of medications
What are 6 age-related changes that occur in the kidney?
1. decreased amount of renal tissue (kidneys shrink in size)
2. smaller number of nephrons (number of functioning nephrons decrease by 50%)
3. decrease in renal blood vessels (less blood supply to the kidneys)
4. decreased GFR
5. increased BUN (blood urea nitrogen)
6. increased creatinine
What does the Hallmark Lab test indicate?
when the GFR gets low, nephrons aren't able to clear the body of BUN and nitrogen --> decreased kidney function
What 2 urinary conditions become more prevalent in the older adult?
UTI's and benign prostatic hyperplasia
Why are older females more prone to UTI's?
decreased estrogen --> loss of elasticity and muscle tone, and atrophy/relaxation of the tissue in the perineal area --> easier for bacteria in the anus to retrograde up into the bladder and cause a UTI
What is benign prostatic hyperplasia? What percentage of older males have problems with this? What are 4 symptoms of this?
enlargement of the prostate gland; 50%
1. problems initiating urine stream
3. frequency (polyuria)
What is urinary incontinence normally caused by? How can you potentially treat this? Explain.
decreased muscle elasticity and tone; Kegel exercise - strengthen the muscles by doing a series of pelvic exercises (lifting hips)
How often should you do Kegel exercises?
twice a day for 10 reps
When a patient has a sudden onset of confusion and urinary incontinence, what problem should you suspect if WBC count doesn't spike?
What is a positive cognitive consequence of aging? Normal negative (2)?
positive - accumulated knowledge increases (vocabulary and wisdom)
negative - slowing of cognitive processing speed (decision-making and rapid movements), more errors of omission made
What are 4 age-related changes in the central nervous system (brain)? What do these lead to?
1. decreased cerebral flow
2. decreased efficiency of temperature regulation
3. decreased neurotransmitters released
4. decrease in overall brain weight due to loss of neurons
leads to slower mental function
Why does the brain get smaller with age? What does this lead to?
decreased cerebral blood flow; slower mental function
What are 4 age-related changes in the peripheral nervous system? What do these lead to?
1. loss of myelin
2. decreased conduction time/rate
3. cellular degeneration
4. neuron death
slower reaction time
What are 3 age-related changes in motor and sensory nerves? What do these lead to?
1. decreased muscle mass
2. decreased sensory feedback from the environments of touch, pain, and temperature
3. decreased proprioception (sense of body position)
leads to loss of agility and balance
What is are 2 age-related changes in reflexes?
1. absent patellar and achilles reflex
2. slow reaction
What is a normal reflex score for an older adult?
What healthy lifestyle choices that are made at a younger age might lead to lengthening the time period before cognitive decline occurs/prevent dementia? (6)
1. higher level of education
2. optimal nutrition
3. physical activity
4. stress management
5. not smoking
6. healthy weight
______% of adults 71 or over are affected with Dementia (of all types).
What are 4 age-related changes that occur in the muscles? What do these lead to?
1. decrease in the number and diameter of muscle cells (sarcopenia)
2. decrease in elasticity of tendons, cartilage, and ligaments
3. decreased ability of the liver to store and release glycogen which we need for bursts of energy
4. decreased basal metabolic rate
decreased muscle mass and strength
What are 3 age-related changes that occur in the joints? What do these lead to (2)?
1. increased risk for cartilage erosion
2. loss of water from vertebral disks
3. decreased space between intervertebral spaces
decrease in ROM and mobility and decreased height
What are 3 age-related changes that occur in the bones? What do these lead to (2)?
1. decreased bone density
2. increased bone resorption
3. decreased bone formation
decreased height and risk for fracture
What is sarcopenia?
decreased size and number of muscle cells
What is bone resorption?
decreased formation of strong bones as we lose calcium from the bones (and other minerals)
Why is osteoporosis more common in women?
it is largely caused by decreased estrogen
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