Transcript 3-14-05 - School of Nursing

3-14-05
Aging & the
Endocrine System
Content for this module provided by The John
A. Hartford Foundation, Institute for Geriatric Nursing,
Online Gerontological Nursing Certification Review Course
http://www.nyu.edu/education/nursing/hartford.institute/course/
Support for this project provided to School of Nursing, University of
Washington by the John A. Hartford Foundation, Geriatric Nursing
Education Grant and Nursing School Geriatric Investment Program Grant.
Endocrine Issues in Older
Adults
• Age-related changes make it important to
evaluate the patient for thyroid disease and
type 2 diabetes mellitus
• Subtle changes of aging often mimic
symptoms of endocrine disorders
• Signs & symptoms should not be attributed
solely to aging
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Age-Related Endocrine Changes
•  estrogen, testosterone, progesterone
• Delayed/insufficient insulin release
•  growth hormone
•  serum aldosterone levels,  cortisol secretion
rate
•  secretion of ADH in response to osmolar
stimuli
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Age-Related Endocrine Changes
•  blood glucose concentrations & elevation time
• Bone changes related to  PTH secretion, 
estrogen
•  hypothalamic sensitivity to feedback inhibition
•  renal response to hormonal influence
• Thyroid gland atrophy
–  secretion of T4, thus  T3
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Age-Related Endocrine Changes
Specific changes in endocrine function may
offset other age-related changes, thereby
reducing overall net functional effect of
endocrine changes
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Age-Related Endocrine Changes
• Menopause
•  incidence of diabetes
•  incidence of thyroid abnormalities
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Diabetes Mellitus
• One of most commonly diagnosed medical
problems in persons > age 65
• Atypical presentation - often undiagnosed
• 1 in 2 people > age 80
–  secretion of insulin
– altered tissue responsiveness to insulin
–  postprandial levels of glucose
–  inhibition of glucose output from liver - prolonged
glycemic response to meal
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Diabetes Mellitus
• Type 1
– Characterized by autoimmune ß-cell destruction
caused by HLA antigens
– Commonly diagnosed in youth
• Type 2
– Onset usually after age 30
– 90-95% of all cases
– Risk factors:
• obesity
• insulin resistance
• genetics
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Diabetes Mellitus
Signs and symptoms
• Polydipsia?
– Excessive thirst does not necessarily occur
• Polyuria
– May be evident by new onset incontinence
• Polyphagia
– May be evident by weight loss and anorexia
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Diabetes Mellitus
Atypical signs
• Fatigue, blurred vision, weight changes,
infection, dehydration, confusion, delirium
• These signs are often attributed to “aging”
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Diabetes Mellitus
Nursing considerations
•  depression & memory problems in older
adults
• Potential organ dysfunction/failure: nerves,
eyes, blood vessels
– accelerated rates of CV disease, renal disease
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Diabetes Mellitus
Nursing considerations
• Cognitive function, vision, motivation, fine
motor skills can impact self-administration of
therapy
• Personalized exercise program, based on
capabilities & limitations of older adult
– consider pre-existing conditions such as cardiac,
musculoskeletal, ophthalmic disease
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Diabetes Mellitus
Nursing considerations
• Wound infections
– common & serious in older adult
– require immediate attention
– interdisciplinary team management
• Loss of ability to sweat
– leads to dry skin - untreated dry skin can progress
to cracked skin and subsequent infection
–  ability to regulate body temperature
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Thyroid Disease
• Hypothyroidism
• Hyperthyroidism
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Thyroid Disease
Hypothyroidism
• 40% may present with atypical symptoms:
– dry skin, weakness, fatigue, bradycardia,
hoarseness, cardiomyopathy, anemia, edema
– Confusion and mental status or behavioral changes
• Diagnosis is often missed - vague symptoms
can mimic other illnesses & “old age”
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Hypothyroidism
Signs & symptoms in order of precedence
• Depression &/or lethargy
• Mild anemia, weight loss
• Dyspnea
• Muscle weakness &/or unsteady gait
• Deafness or hoarseness
• Chest pain or atrial fibrillation
• Cold intolerance
• Constipation
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Hyperthyroidism
• 50% present with typical signs & symptoms others may not present typical hyper-adrenergic
signs & symptoms
• May have sub-clinical, apathetic presentation
– depressed mood, failure to thrive, skin changes,
anorexia
• Most prominent symptoms include atrial
fibrillation, CHF, weight loss, fatigue, &
myopaythy