Identify normal age-related changes
- Cognitive Decline is not normal.
- Slower is normal
- Pathology is not normal - Older people have decreased baroreceptor response
- “Stiff and thick”
- Stiff and thick with MSK- Ligaments and the attachments points become
stiff and thick - There is a normal height loss
- Abnormal height loss associated with osteoporosis. - Older people are at risk for constipation
- High fiber diet
- Exercise
- Hydration - Eyes.
- Cataracts- pathology - Clouding of the lens.
- They take the blurry
lens out and put a clear one in. Blurred vision.
- A little bit yellow
- Macular Degeneration- Loss of Central vision.
- Glaucoma- tunnel vision
What are the 3 consequences of inappropriate assessment?
- increased morbidity & mortality.
- missed diagnosis.
- may think that someone is confused just because they are older, but this could actually indicate an infection. - unnecessary use of emergency rooms
Volume overload 9 symptoms
- weight gain
- I>O
- bounding pulse
- tachycardia, increased BP & CVP
- distended neck/peripheral veins
- crackles
- dyspnea
- SOB
- confusion
Hyponatremia 16 symptoms
(Serum Na+ < 135 mEq/L)
- hypotension
- tachycardia
- hyperthermia
- nausea
- malaise
- lethargy
- somnolence
- confusion
- poor skin turgor
- increased thirst
- muscle twitching
- abdominal cramps
- headache
- seizure
- coma
- elevated BUN & Hct
Hypernatremia 9 symptoms
(Serum Na+ > 148 mEq/L)
think dehydration
- orthostatic hypotension
- increased thirst
- poor skin turgor
- dry mucus membranes
- weight loss
- oliguria
- lethargy
- hyperthermia
- elevated BUN, Hct, creatinine
Hyperkalemia 9 symptoms
(Serum K+ > 5.0 mEq/L)
- diarrhea
- cardiac dysrhythmias/arrest
- ECG abnormalities
- irritability
- apathy
- confusion
- muscle weakness
- areflexia
- paresthesias
13 Lab changes in the older adult.
🔸 RBC—Production ↓’d
- speed at which the new
blood cells can be produced in older adults is reduced
- (decreased marrow reserve)
🔹 Hct & Hgb —Changes with nutrition & fluid status
- Usually rise & fall with RBCs
- Elevations in hgb and hct are often early signs of hypovolemia from malnutrition, dehydration, or severe diarrhea.
🔸 WBC—Change may be absent or delayed with infection; immunity aging theory
- WBCs don’t respond as quickly which can lead to worsening of infection.
🔹 ESR (Erythrocyte Sedimentation Rate) ↑’d
- Indicates inflammation & is higher in elderly.
🔸 Vitamins B, C
- Water soluble vitamins.
- Its reduction indicates acute malnutrition.
🔹 Vitamins A, E, B12, K
- Fat soluble vitamins.
- Its reduction caused by long-term malnutrition.
🔸 Vitamin D↓’d
- Vitamin D helps maintain bone strength.
- Its produced in the skin when exposed to UV light.
- It decreases in older adults due to their aging skin which decreases the synthesis of Vit D.
🔹 Na+ ↓’d
- Low intake, altered ADH, increased H2O.
- Sodium decreased in pt’s in long term care facilities
- Concerned with patient’s hydration, can result in hyponatremia.
🔸 K+
- Alterations result from medications & changes in endocrine system.
🔹 Ca2+ ↓’d
- Increased bone resorption, 99% of calcium is stored in bone;.
- Older adults have breakdown of bone mass, therefore calcium is pulled from blood to bone causing a decrease in calcium levels.
🔸 Glucose
- Low Glucose is most dangerous
- Due to Insulin & malnutrition
- Signs of hypoglycemia are often masked in older adults. Elderly don’t sweat as often.
- More frequent episodes of hypoglycemia result in less noticeable symptoms.
🔹 Albumin—↓’d
- Albumin is a protein that is always a part of a nutritional Assessment.
- It indicates chronic malnutrition.
- Pre-albumin indicates acute malnutrition.
🔸 PSA (Prostate Specific Antigen)
- Limited use (>75 and high risk)
- Can be elevated by a number of conditions, not just prostate cancer.
- It indicates inflammation of prostate gland.
Creatinine vs Cockcroft Gault equation.
🔸 Creatinine
-I n general, more accurate measure of renal function.
- Used to diagnose & monitor renal insufficiency.
- Normal: 0.6-1.2
🔸 Cockcroft Gault equation
- Estimates renal function
- Creatinine clearance
- Used instead of 24 hr urine
- Used to dose possible toxic drugs
Where is the best place to check the skin turgor of the older adults?
Forehead or Chest
UTI symptoms
- dysuria
- flank or suprapubic pain
- hematuria
- urinary frequency/urgency
- cloudy/malodorous urine
- anorexia
- confusion
- nocturia
- enuresis (involuntary urination)
Dehydration 11 symptoms
- Orthostatic hypotension
- Weight loss
- Tachycardia
- Hyperthermia
- Weakness
- Nausea
- Anorexia
- Oliguria
- Dry mucus membranes & skin
- Poor skin turgor
- Increased thirst
Hyposmia
Decrease in smell acuity.
Presbycardia
- Its impaired cardiac function attributed to the aging process, occurring in association with recognizable changes of senescence in the body and in the absence of convincing evidence of other forms of heart disease.
Somatesthesia
- Its the faculty of bodily perception; sensory systems associated with the body; includes skin senses and proprioception and the internal organs
Presbyopia
Decreased accommodation & ner vision.
Presbycusis
- Its the risk of hearing loss (Initially of high pitches)
Immunosenescence
- Its a process of immune dysfunction that occurs with age and includes remodeling of lymphoid organs, leading to changes in the immune function of the elderly.
Hypoalbuminemia
- Its the decreased Albumin, indicates malnutrition.
Inflammation
- Indicates infection.
