Age-Related Changes in the Integumentary System
- Fewer nerve cells
- Reduced circulation
- Decrease in collagen
- Less subcutaneous fat
- Reduced sweat glands
What is true about aging?
Increased risk of heat stroke = elderly should wear hats
- Elderly adults have a decreased ability to regulate body temperature, making them more susceptible to heat stroke. Wearing hats can help protect them from direct sun exposure and reduce the risk of overheating
Loss of protection and warmth = wear layers/more clothes
- Older adults often experience a reduction in subcutaneous fat, which provides insulation
Increase susceptibility to skin tears
- As people age, their skin becomes thinner and loses elasticity, increasing the likelihood of skin tears
Reduced circulation/output
- Aging can lead to reduced cardiac output and circulation,
Fewer nerve cells = negatively affects touch, pain, temperature, and pressure
- the number of nerve endings can decrease, diminishing sensations related to touch, temperature, pain, and pressure
Bathing/showering needs decrease
- While mobility and energy levels might impact the frequency of bathing, the actual need for hygiene doesn’t decrease
Nursing care implications related to changes in the integumentary system
- Use skin products: moisturizer and barrier lotion
- Pat skin dry after hygiene e.g. avoid rubbing
- Be careful with routine care e.g. dressing to avoid skin tears
- Monitor pressure areas e.g. earlobes, heels, hips, back sacrum
- Inspect skin, nails, & scalp daily
Age-related Changes in Neurological, Mood, & Behaviours
Having more difficulty learning new things
- Skills, knowledge and insights remains relatively stable
- Recognition and remembering a familiar task remains good
- Learning new skills and problem solving the unfamiliar is more difficult
Sleep patterns change
- Circadian rhythm changes = affects sleep
Thinking is a bit slower, and reaction time has increased
- Decrease in size and connections of neurons leads to:
- slower speed of thinking
- poorer short-term memory
- may lead to increase in reaction time and changes in balanced and/or coordination (e.g. difficult to correct a near fall)
Care Implications for Neurological, Mood, and Behaviours
- Provide more time to complete a task and time to respond to conversation
- Use short and simple statements
- Ask about a person’s life experiences, past interests and accomplishments
- Encourage familiar and routine tasks
- Provide verbal and visual cues to prompt memory (e.g. looking at photos)
- Use memory tools to support self-care (e.g. written schedule of activities, clock, auditory prompts)
Age-Related Changes: Sensory (Eyes)
- difficulty focusing on near objects
- poor night vision
- dryer eyes
- Lens are less flexible
-Smaller pupil size - Decrease in tear production
Age-related changes: Sensory (Ears)
- Decrease ability to hear high frequency sounds
- Less able to follow conversations
- Slower processing of auditory information
- Thicker earwax
- Tympanic membrane thins and stiffens
- Vestibular system may lead to dizziness
Age-related changes: Sensory (Smell & Taste)
- sense of smell and taste have diminished
- Less smell & taste = may affect appetite
- Greater chance of nose bleeds
- Less saliva production
Sensory Care Nursing Implications
Environment
- Position yourself so the person can see you directly when you speak
- Reduce background noise when speaking (e.g. turn off the TV)
- Leave bathroom light on
Communication
- Use black print on light paper for written materials
- Speak using a lower voice and a little more loudly than normal
- Check hearing aids and that ears are not blocked by wax
- Ensure eyeglasses are clean and used if appropriate
- Maintain eye contact and use facial expression and gestures
Respiratory Age-related changes
- Stiffer chest wall, less lung muscle strength, and harder to inflate the lungs
- Decreased gas exchange (a smaller number of alveoli)
- Decreased effective cough response and cough reflex
- Easier to lose breath when working harder than normal, which leads to less ability to tolerate exercise
Respiratory: Care Implications
- Arrange for rest breaks while walking or doing activities
- Encourage person to
periodically take deep breaths
Reduce the risk of infection with regular oral hygiene - Monitor/treatment of respiratory infections
- Vaccination
Cardiovascular: Age-related changes
(heart can not increase output)- Cardiac changes can be related to lifelong practices (e.g. exercise, smoking)
- The heart needs to work harder due to thicker heart muscles, stiffer arteries and heart valves
- Less cardiac reserve= more tiredness, shortness of breath, and a slow recovery from activity
- Higher risk for a drop in blood pressure and light-headedness when changing positions (postural hypotension)
- Blood pressure may be overestimated due to stiff arteries; systolic blood pressure may increase
- Ankle swelling may occur from pooling of blood from changes in calf veins
Cardiovascular: Care Implications
- Encourage physical activity most days (e.g. walking and/or seating exercises)
- Arrange for rest breaks while walking or doing activities
Change positions slowly (e.g. r/t: risk of dizziness or orthostatic hypotension) - Prevent dehydration: Offer water/fluids ~ 6-8 glasses a day
- Encourage person to pump their ankles before standing
- Prevent prolonged sitting
Musculoskeletal: Age-related changes
- Less muscle mass & coordination = weakness and diminished exercise tolerance
- Less cartilage-forming cells = more joint damage
Cartilage erodes = changes in how one stands, height, range of motion (limited), more joint instability, higher risk of falls and fractures?, less flexibility and less mobility
- Bone mass decreases = higher risk of osteoporosis (risk of fractures?)
Musculoskeletal: Care Implications
- Enable the person to participate maximally in activities (e.g. dressing)
“If you don’t use it, you lose it” - Assist with daily active and passive exercises
- Apply universal fall prevention approaches (e.g. good footwear, clear pathways, lighting)
- Promote walking, weight-bearing, strength and balance exercises
- Attention to bone health: dietary calcium, vitamin D supplement, and exercise
- Aid with transfer and mobility as determined
Gastrointestinal: Age-related changes
Cause of minimal bowel movements
- Less able to taste and feel thirst
- Decrease lean body mass and water stores= risk of dehydration
- Less calories needed but same nutritional needs
Concern for Loosing teeth
- Decreased strength of chewing muscles & loose dentures can affect nutrition
- Dry mouth with decreased saliva (may also be caused by medications)
- Swallowing muscles are less effective = risk of swallowing difficulty (concern? Refer to?)
Gastrointestinal: Care Implications
- Encourage to drink even if not thirsty/offer water or fluids throughout day ~ 6-8 glasses/day (min 1500 mL/d)
- Consult dietitian if intake is <50% or if weight loss
- Optimize nutrition
- Support physical activity efforts, regular toileting routine
- Regular/good oral hygiene is imperative
- Consult loose dentures
Genitourinary (Kidneys): Age-related changes
- Kidney size may decrease due to less blood flow = reduced ability to regulate sodium and H2O
- Therefore, higher risk of electrolyte imbalance
- Higher risk of water retention and dehydration
- Renal function is usually adequate to meet demands but may be challenged with illness, fever and co-morbidities
Genitourinary (Bladder): Age-related changes
- Decrease bladder capacity (from 500-600 mL to 150-250 mL)
- Incomplete emptying after voiding (residual) (may increase risk of infection)
- May experience more frequent voiding and need to void at night =
-The sensation of needing to void maybe delayed
- Weaker pelvic floor muscles (female)
- Decreased estrogen leading to tissue shrinkage and less lubricating secretions
- Shorter and vulnerable urethra increases risk of infection
- Larger prostate compresses the urethra and leads to difficulty voiding
- voiding and notbeing able to control it
Genitourinary: Care Implications
- Changes in kidney function require a review of medications
- Avoid and manage constipation(!)
- Offer water/fluids throughout day~ 6-8 glasses/day (min 1500 mL/d), consider evenings
- Minimize caffeine intake
- Do not treat asymptomatic bacteriuria (i.e. no symptoms arising from the genitourinary tract such as urgency, frequency, discomfort)
- Use prompt voiding, routine or scheduled toileting as appropriate
Safety: Age-related Changes
- Decreased immune response
- Increase risk for infection due to age related changes (e.g. skin thinner, changes in bladder and respiratory systems)
- Reduced immunity (decrease in T-cell function)
- A fever with infections is less likely
- Delay in elevated WBC with infection may occur
- Less able to regulate heat
Safety: Care Implications
- Be alert to atypical presentation of infection e.g.?
- Apply universal precautions and infection control measures
- Practice medication reconciliation and medication review
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1 - Foundations of Aging36
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2 - Aging in Place17
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3 - Levels of Residential Care23
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4 - Healthy Aging and Centred Care15
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5 - Safe Medication Use in Older Adults15
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6- Physiological Changes in Aging45
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7 - Hazards of Immobility35
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8 - Nutrition, Safe Feeding, and Oral Care31
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9 - Aging & Mental Health21
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10 - Cognitive Health & Aging37
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11 - Ethical & Legal Issues in Aging35
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12 - Opportunities for Care17
