Normal Changes of Aging

Young Old

65-74

Old

75-84

Old-Old

85-99

Elite-Old

100+

Frail Elderly

75 or older with ongoing health concerns

Pharmacokinetics

What the body does to the drug

Pharmacodynamics

What the drug does to the body

Absorption

Least affected, decreased saliva, longer gastric emptying, decreased stomach acid, skin decreased subcutaneous fat

Distribution

Decreased body water, albumin decreases with illness

Metabolism

Decreased liver mass & blood flow, 1st pass, less drug breakdown

Excretion

Decreased kidney function, smaller size, decreased nephrons

Physiological changes with aging... normal part of ___ - begins at ___, nearly never ___; varies - ___ factors (less modifiable, genetics), ___ factors (lifestyle)

aging, birth, pathological, intrinsic, extrinsic

Normal changes of aging... may not always be possible to differentiate normal ___ from ___; aging results in diminished ability to maintain ___ and ___ body systems; normal changes with aging reduce your ___ capacity; accompanied by ___ (different body sy

aging, disease, homeostasis, regulating, reserve, heterogeneity

Normal integumentary changes of aging... slower replacement of ___ - slower ___; ___ content decreases; increased ___ fragility; ___cytes decrease - __-20% per decade, ___ of skin, decreased ___ from UV rays; ___ incidence of skin cancer

epidermis, healing, moisture, capillary, melanocytes, 10, lightening, protection

Normal integumentary changes of aging... ___ thins, becomes less elastic & vascular - loses 20% of skin ___, affects ___ of topical meds, pallor and ___ temperatures; ___ fat and ___ glands decrease - decreased ability to ___, decreased bact___ properties

dermis, thickness, absorption, cooler, subcutaneous, sweat, sweat, bacteriocidal

In the elderly decreased sweating masks s&s of a what?

heart attack

Normal integumentary changes of aging... nails - become more ___, flat, concave (can also be sign of malnutrition, thyroid level), ___ becomes less thick and wide; hair - unwanted ___ hair, diffuse ___ (baldness), becomes gray as ___ production in hair bu

brittle, cuticles, alopecia, melanin

Normal integumentary changes of aging... decreased ___ synthesis - skin ___; by age ___ lose 1/3 of sensory function - decreased two-___ discrimination, light touch, ___ (i.e. railroad tracks)

collagen, tears, 90, point, vibration

Musculoskeletal changes of aging... decreased ___ in discs - ___ disc causes ___ trunk, by age 80, average of ___ inches of height loss; ___ mass decreases - peak bone mass by age ___, dis___ in bone maintenance develops when ___ is more rapid than deposi

fluid, thinning, shortening, 2, bone, 30, disequilibrium, resorption

What are the 3 muscle types?

skeletal, smooth, cardiac

Musculoskeletal changes of aging... ___ (normal muscle loss with aging) - age-related changes to ___, ___ tissue mass decreases (atrophies) while ___ tissue increases, decrease in ___-___% muslce mass between ages 30-90, increased ___ tissue

sarcopenia, muscles, muscle, adipose, 30, 40, adipose

Musculoskeletal changes of aging... ___ & tendons shrink & harden - ___-linkage, age-related changes in ___ result from biochemical changes, ___ may shorten and move from usual positions; decreased ___ elasticity; decreased ___ supply to muscles

ligaments, cross, cartilage, tendons, tissue, blood

Cardiovascular changes of aging... all structures ___; ___ muscle loses efficiency and ___ strength; ___maker cells decrease in number - ___ heart rate, aberrant rhythms, _ _ node cells decrease in number as myocardial fat, collagen, and elastin fibers __

stiffen, heart, contractile, pace, decreased, SA, increase, AV, HIS

Cardiovascular changes of aging... baro___ are less senstive - ___ hypotension; hemopoetic activity ___; ___ vessels - elasticity ___ because of changes in collagen, elastin, and possible ___-linking, vessel walls ___, pooling of ___ increases venous ___,

baroreceptors, orthostatic, slows, blood, diminished, cross, thicken, blood, pressure

Cardiovascular changes of aging... HEART - thickens up to ___% between ages 25-80; decrease in blood flow by ~___% by age 60; valves - may be ___ and stiffer as result of lipid deposits, collagen degeneration, and fibrosis, 4th heart sound ___, S3 (___ _

50, 35, thicker, normal, not a normal, abnormal, less, build, 50

Cardiovascular changes of aging... BLOOD VESSELS - ___ elasticity, ___ of vessel walls, ___ deposited in the vessels, arterial __ stiffening, reduced ___ flow

diminished, thickening, calcium, wall, blood

Cardiovascular changes of aging... ___ (reduced cardiac reserve) - at rest: ___ ___ in heart rate, cardiac output; under physiological stress and exercise - ___ maximal heart rate and cardiac output, resulting in ___, _ _ _, slow recovery from ___cardia

presbycardia, no changes, decreased, fatigue, SOB, tachycardia

Cardiovascular changes of aging... ___ systolic ___ (systolic BP > ___ and diastolic BP <___) - arterial wall ___ and stiffening, decreased compliance; ___ ventricular and atrial hyper___; ___ of atrial and mitral valves

isolated, hypertension, 140, 90, thickening, left, hypertrophy, sclerosis

Cardiovascular nursing care... safety precautions for ___ hypotension - avoid prolonged ___ position; rise slowly from ___ or ___ position; wait ___-___ minutes after position change to ___ or transfer; institute ___ prevention strategies

orthostatic, recumbant, lying, sitting, 1, 2, standing, fall

Cardiovascular nursing care... encourage ___ practices - ___ blood pressure; healthful ___, ___ activity, ___ cessation

lifestyle, normal, diet, physical, smoking

Healthy heart promotion... engage in ___ exercise; eat a ___-___, low-___, balanced diet; maintain tight control of ___; maintaing adequate ___ pressure; do not ___, avoid exposure to smoke; avoid ___ pollutants; practice ___ management; minimize ___ inta

regular, low-fat, cholesterol, diabetes, blood, smoke, environmental, stress, sodium, weight, 18.5, 24.9

Respiratory changes of aging... larynx, ___, & rib cage become more rigid due to ___; anterior-posterior chest diameter ___; inspiratory and expiratory muscles ___ - by age 70, respiratory muscle strength decreases by ___%, ___ breath sounds

trachea, calcification, increases, weaker, 20, diminished

What happens to respiratory reserve in elderly persons? They are at increased risk for what? What happens to ciliary movement?

reserve increases, risk for atelectasis, decreased ciliary movement

Respiratory changes of aging... ___ surfaces decrease in size and are less elastic; ___ action decreases, ___ increases; ___ elongates downward as support of upper and lower lateral ___ weakens

alveolar, ciliary, mucus, nose, cartilage

Respiratory assessment... assess respiration ___, rhythm, regularity, ___, depth, exercise ___; ___ breath sounds throughout lung fields

rate, volume, capacity, diminished

Respiratory changes of aging... inspect ___, symmetry of chest ___ - diminished chest ___; obtain ___ history; monitor ___, breathing rate during ___, positioning, ___ blood gases, ___ oximety

thorax, expansion, excursion, smoking, secretions, sedation, arterial, pulse

Respiratory changes of aging... assess ___, need for ___

cough, suctioning

What health condition can give a falsely high SpO2 reading?

anemia

(Respiratory in-patient management) maintain patent ___ through ___ positiong/repositioning, suctioning, and ___dilators; provide ___ as needed

airways, upright, bronchodilators, oxygen

(Respiratory in-patient management) ___ spirometry as indicated; maintain ___ and ___; ___ on cough enhancement, ___ cessation

incentive, hydration, mobility, smoking

(Healthy lungs promotion) obtain ___; obtain annual ___ vaccine; avoid exposure to ___ and pollutants; seek prompt treatment for ___ illness

pneumovax, flu, smoke, respiratory

(Healthy lungs promotion) ___ hands frequently; eat meals in ___ atmosphere; practice thorough ___ hygiene

wash, relaxed, oral

(Changes of urinary system) ___ tissue growth decreases; number of ___ decrease; ___ blood flow and GFR ___

renal, nephrons, renal, declines

(Changes of urinary system) ___ capacity diminishes; ___ are 20-30% smaller by the 8th decade; renal ___ flow decreases by ___% in the 8th decade or about 10% per ___ of adult life

bladder, kidneys, blood, 50, decade

(Changes of urinary system) ___ contractions = residual ___ - some tone and ___ lost; capacity declines from about ___ to 600 mL of urine in younger adult to about ___ mL in older adult

weakened, urine, elasticity, 500, 250

(Changes of urinary system) ___ urine production; in males, ___ enlargement with risk of _ _ _; dependent edema fills up ___ while in bed

nocturnal, prostate, BPH, bladder

(Changes of urine) ___ ___ ___ (GFR) - ___ rate of filtered fluid thru kidney, may reduce by ___% by age 75

glomerular filtration rate, flow, 50

(Changes of urine) GFR is aka the ___ cleareance - volume of blood ___ that is cleared of creatinine per unit of time

creatinine, plasma

(Changes of urine) creatinine is byproduct of ___ metabolism; ___ in elderly; increased BUN = ___, meds; <___ renal clearance requires med dosage adjustment

muscle, decreased, dehydration, 60

(Changes of urine) by the time _ _ _ and creatinine are increased in the elderly there is ~___% reduction of ___ function

BUN, 60, kidney

What is the Cockcroft-Gault equation?

equation used to calculate GFR in adults

(Urinary system implications) risk of ___ injury and ___ reactions from drugs; reduced renal ___ reserve; risk of renal ___ in illness

nephrotoxic, adverse, functional, complications

(Urinary system implications) increased risk of ___ urgency; incontinence - affects ___ of seniors, ___ A ___ FINDING

urinary, 1/3, NOT, NORMAL

CKD 5

< 15

CKD 4

~ 16-30

CKD 3

~ 31-60

CKD 2

~ 61-90

CKD 1

> 90

(Urinary system implications) risk of volume ___ (in heart failure); de___; ___natremia (with thiazide diuretics)

overload, dehydration, hyponatremia

In elderly persons hypernatremia is associated with what? What can cause hyperkalemia? There is a reduced excretion of what load (K+ = acid)?

fever, potassium sparing diuretics, acid

What must be done when initiating thiazide diuretic?

lab test within one week

What is an example of a potassium sparing diuretic?

spironolactone

(urinary system implications) _ _ _ - confusion may be the only symptom, 20% have ___ bacteremia

UTI, asymptomatic

(Urinary system implications) ___ polyuria; potential for ___; monitor ___ and renally cleared drug levels

nocturnal, falls, nephrotoxic

(Urinary system implications) maintain ___/electrolyte balance; minimum ___-___mL/day from fluids and foods prevent ___

fluid, 1,500, 2,500, dehydration

(Urinary system implications) for ___ polyuria, limit fluids in ___, avoid ___, used prompted ___ schedule

nocturnal, evening, caffeine, voiding

(Urinary system implications) ___ prevention for nocturnal or urgent voiding; ___ path to bathroom; use _ _ _

fall, clear, BSC

What must be added to the food pyramid for the elderly?

eight 8 oz glasses of water, calcium citrate, vitamin D and B12

(endocrine changes) basal metabolic rate ___; ability to metabolize glucose ___ - tissues become less ___ insulin

decreases, decreases, sensitive

(endocrine changes) most hormone levels ___ - thyroid ___, fibrosis, and ___occur, para___ gland produces less PTH

decrease, atrophy, inflammation, parathyroid

(endocrine changes) What must be known for diabetes patients?

A1c

What is a normal A1c range?

4.9 - 5.4

What is pre-diabetes A1c range?

5.5 - 6.3

What is diabetes diagnosis range?

> 6.4

(endocrine changes) adrenal gland - becomes more ___, decreases metabolic clearance rate of gluco___; endocrine pancreas - secretion does or does not decrease?

fibrous, glucocorticoids, does NOT decrease

(changes in GI system) delayed ___ emptying; gastric _ _ increases; decreased ___ efficiency - decreased liver ___ and ___ flow

gastric, pH, liver, mass, blood

(changes in GI system) ___ may form; slower transmission of ___ impulses; ___ of oral mucosa, ___, and intestinal ___

diverticula, nerve, atrophy, stomach, lining

(changes in GI system) increased serum ___; teeth - ___ surface of teeth wears down; eventually lose ___ and dentin, and become more vulnerable to ___

cholesterol, chewing, enamel, caries

(changes in GI system) ___ more susceptible to ___ disease; decreased ___ in mouth, stomach, and intestines

gums, periodontal, secretions

What is a term for very dry mouth?

xerostomia

(GI changes) esophageal ___ is decreased; esophageal ___ less efficient (GERD)

motility, sphincter

(GI changes) stomach - delayed ___ time; decreased ___ motility, volume and reductions in ___ of bicarbonate and gastric mucus

emptying, gastric, secretion

(GI changes) decreased production of what factor? More susceptible to what disease?

intrinsic factor, peptic ulcer

(GI changes) decrease in strength of muscles of ___, taste, and ___ perception; ___ of protective mucosa; malabsorption of ___, vitamins B___ and D, ___ acid, and calcium

mastication, thirst, atrophy, carbohydrates, 12, folic

(GI changes) impaired ___ to defecate; reduced ___ reserve; decreased ___ of drugs

sensation, hepatic, metabolism

(GI changes) liver and gallbladder - liver decreases in ___ and mass; incidence of ___stones increases

weight, gallstones

(GI implications) risk of chewing ___, ___/electrolyte imbalances, ___ nutrition; gastric changes - altered drug ___

impairment, fluid, poor, absorption

(GI implications) gastric changes - increased risk of _ _ _ _; mal___; _ _ _ _ _-induced ulcers

GERD, absorption, NSAID

(GI implications) ___ not a normal finding; risk of ___ incontinence with disease (not healthy aging); stable ___ function tests; risk of ___ drug reactions

constipation, fecal, liver, adverse

What tests remain stable?

AST, ALT

What can long term use of PPI's cause?

bone loss

Achlorhydria can mimic what?

a heart attack

What is proprioception?

sense of balance, space, time, allows recovery from tripping

Is atrophy of the frontal lobe a normal change of aging?

yes

What is the median oral temperature of elderly person?

96.8

What is normal temperature of the old-old?

95 - 97

Is fever a reliable indicator of infection in elderly?

no

What is the first sign of infection in the elderly?

confusion or change in mentation

Which colors are more difficult to distinguish in the elderly?

blue, greens

Which colors are easier to distinguish in the elderly?

red, oranges, yellows

What may result in tinnitis in the elderly?

otic nerve changes

What meds increase risk of ototoxicity?

ASA, gentamycin

Which hormones are not detectable by age 60?

thymic hormones

What is the percent of body water for the newborn, adult male, and adult female?

newborn is 80%, adult male is 60%, adult female is 40-50%