Transcript The Middle Adult

Physiologic Changes Due to
Aging
Objectives:
1. Identify normal physical changes in the older adult.
2. Discuss nursing Implications due to changes in the
older adult.
The Middle Adult
 The years are generally considered to be ages 40
to 65.
 This is a period of gradual and individualized
change in both physical and psychosocial
dimensions.
 Visible signs of aging and a heightened awareness
of the time left to live, however, lead middle adults
to evaluate their achievement of goals and
influence their adaptation to older age.
Physiologic Development
 In the early years of this period of life, physical
functions are usually still effective.
 As time passes, gradual internal and external
physiologic changes occur.
 These are not pathologic changes but normal
changes that result from aging.
 The person must modify his or her self-image and
self-concept to adapt successfully to and to accept
these normal changes.
Hormonal changes
 The hormonal changes that take place in midlife affect men and
women differently. Women undergo menopause, a gradual decrease
in ovarian function, with subsequent depletion of estrogen and
progesterone. This change usually occurs between 40 and 55 years
of age.
 With the cessation of ovulation, menstrual periods stop either
gradually or abruptly, and many women experience hot flashes,
mood swings, and fatigue.
 The loss of estrogen also increases the risk for osteoporosis and
heart disease. The process can last for several years, and afterward
the woman can no longer become pregnant.
 Men do not experience physical symptoms from the decreased
levels of hormones, called andropause.
 Androgen levels diminish slowly; the man may have some loss of
sexual potency but is still capable of reproduction.
Climacteric
a. A period of life characterized by physiological and
psychic change that marks the end of the
reproductive capacity of women and terminates with
the completion of menopause.
b. A corresponding period sometimes occurring in men
that may be marked by a reduction in sexual activity,
although fertility is retained.
Physical Changes in the Middle Adult

Fatty tissue is redistributed; men tend to develop abdominal fat, women thicken through the
middle.

The skin is drier.

Wrinkle lines appear on the face.

Gray hair appears, and men may lose hair on the head.

Cardiac output begins to decrease.

Muscle mass, strength, and agility gradually decrease.

There is a loss of calcium from bones, especially in perimenopausal women.

Fatigue increases.

Visual acuity diminishes, especially for near vision (presbyopia).

Hearing acuity diminishes, especially for high-pitched sounds.

Hormone production decreases, resulting in menopause or andropause.
Normal Physiologic Changes of
Older Adults
 General Status
 Progressively decreasing efficiency of physiologic
processes results in a fragile balance and hinders the
body's ability to maintain homeostasis.
 Physical or emotional stressors cause the older adult to
be more vulnerable because of decreased physiologic
reserves.
 The older adult may continue to engage in all activities
of middle age but intuitively adjusts to a modified pace
and more frequent rest periods.
Integumentary
 Wrinkling and sagging of skin occur with
decreased skin elasticity; dryness and scaling are
common.
 Balding becomes common in men, and women
also experience thinning of hair; hair loses
pigmentation.
 Skin pigmentation and moles are common,
although the skin may become pale because of
loss of melanocytes.Melanin production decreases
 Nails typically thicken, becoming brittle and
yellowed
Endocrine System
 Type 2 dm
Musculoskeletal
 Decreases in subcutaneous tissue and weight
commonly are found in the old-old.
 Muscle mass and strength decrease.
 Bone demineralization occurs, and bones become
porous and brittle. Fracture is more common.
 Joints tend to stiffen and lose flexibility, and range of
motion may decrease.
 Overall mobility commonly slows, and posture tends to
stoop. Height decreases slightly.
 Joints develop degenerative changes
Neurologic
 The central nervous system responds more slowly to multiple stimuli.
Hence, the cognitive and behavioral response of the older adult may be
delayed.
 Rate of reflex response decreases.
 Temperature regulation and pain/pressure perception become less
efficient.
 There may be a loss of sensation in the extremities.
 The older adult may also experience difficulty with balance,
coordination, fine movements, and spatial
( space)orientation, resulting in an increased risk for falls.
 Sleep at night typically shortens, and the older adult may awaken more
easily. Cat-naps become common.
 Short term memory diminished w/o changes in long term memory
Special Senses
 Diminished visual acuity (presbyopia) occurs, with increased
sensitivity to glare, decreased ability to adjust to darkness,
decreased accommodation, decreased depth perception, and
decreased color discrimination. Cataracts may further obscure
vision. Difficulty reading small print might result. Daytime or night
driving might be compromised.
 Presbyopia – difficulty of seeing objects that are close because of
the lens of the eye becomes less pliable.
 Diminished hearing acuity (presbyacusis) occurs, particularly
diminished pitch discrimination in the presence of environmental
noises. As a result of hearing problems, the older adult may
withdraw from social events.
 The senses of taste and smell are decreased. Sensitivity to odors
might be reduced. Problems with nutrition may result.
Cardiopulmonary
 Blood vessels become less elastic and often rigid and tortuous.
Venous return becomes less efficient. Fatty plaque deposits continue
to occur in the linings of the blood vessels. Lower-extremity edema
and cooling may occur, particularly with decreased mobility.
Peripheral pulses are not always palpable.
 The body is less able to increase heart rate and cardiac output with
activity.
 Pulmonary elasticity and ciliary action decrease, so that clearing of
the lungs becomes less efficient. Respiratory rate may increase,
accompanied by diminished depth.
 Effectiveness of the cough mechanism lessens increasing risk of lung
infection
 Brain and coronary arteries receiving more blood than other organs
Gastrointestinal
 Digestive juices continue to diminish, and nutrient
absorption decreases.
 Malnutrition and anemia become more common.
 With reduced muscle tone and decreased peristalsis,
constipation and indigestion are common complaints.
 Gag reflex is less effective
Dentition
 Tooth decay and loss continue for most older adults.
 Eating habits may change, particularly if the older adult
lacks teeth or has ill-fitting dentures.
Genitourinary

Blood flow to the kidneys decreases with diminished cardiac output.

The number of functioning nephron units decreases by 50%; waste products may be
filtered and excreted more slowly.

Fluids and electrolytes remain within normal ranges, but the balance is fragile.

Bladder capacity decreases by 50%. Voiding becomes more frequent; two or three times
a night is usual. A decrease in bladder and sphincter muscle control may result in stress
incontinence or incomplete bladder emptying.

About 75% of men over 65 years of age experience hypertrophy of the prostate gland;
surgery may be required if urinary retention occurs.

There is atrophy, decrease of secretions, and thinning of the older woman's genital tract.

Major clinical manifestation for UTI – signs of acute confusion

For freq urination - make no changes in the client’s dietary intake and keep the client
from self-limiting fluids.
Reproductive
 Climacteric
 Andropause
 Menopause
 Risk for breast cancer increases
 Sperm count and viscosity of seminal fluid decreases
Cognitive Development
 The term cognition indicates cerebral functioning, including the
ability to perceive and understand one's world.
 Cognition does not change appreciably with aging. In fact,
intelligence increases into the 60s, and learning continues through
life.
 It is normal for an older adult to take longer to respond and react,
however, particularly in new or unfamiliar surroundings.
 Knowing this, the nurse should slow the pace of care and allow
older patients extra time to ask questions or complete activities.
 Mild short-term (recent) memory loss is common but can be
remedied by an older adult using notes,
Adjusting to the Changes of Older Adulthood
 Older adults use their years of experience as a guide to
adjusting to the changes that come with increasing
age.
 These changes, based on Havighurst's tasks for later
life, involve many areas of life, as described in the
following sections.
Six Major Stages in human life covering birth to old age.
 Havighurst identified Infancy & early childhood (Birth till
6 years old)
 Middle childhood (6-12 years old)
 Adolescence (13-18 years old)
 Early Adulthood (19-30 years old)
 Middle Age (30-60years old)
 Later maturity (60 years old and over)
Physical Strength and Health
 Most older adults gradually modify their lifestyle to
accommodate for declining strength and health.
 They rest more frequently, although continued activity and
exercise are important for maintaining all physiologic
functions.
 An older adult is at high risk for accidents and falls and may
need to curtail driving or use a cane or other aid to remain
mobile.
 Diet modifications and prescribed medications may be
necessary, and because of chronic illness, an older adult may
need to adjust to living with some pain.
 With severe illness, loss of independence can occur.
 The loss of health is difficult to adjust to because it affects
every aspect of life.
Health of the Older Adult
 As the number of older adults increases, nurses
will spend more time providing care for this
population.
 Older adults who require care are in all types of
healthcare settings, including hospitals, long-term
care facilities, emergency departments, outpatient
surgeries, and homes.
 Nursing care for older adults should be based on
two principles:
 Most older people are not impaired but are functional in
the community, thereby benefiting from health-oriented
interventions.
 Older people are more vulnerable to physical,
emotional, and socioeconomic problems than people in
other age groups and may require special attention to
health promotion and maintenance.
Accidental Injuries
 The older adult is at increased risk for accidental injury because of
changes in vision and hearing, loss of mass and strength of
muscles, slower reflexes and reaction time, and decreased sensory
ability.
 A significant percentage of older adults limit their activities because
of fear of falling that might result in serious health consequences
addition, the combined effects of chronic illness and medications
may make an older adult more prone to accidents.
 Older adults with reduced income may live in inadequate housing in
neighborhoods with heavy traffic and high crime rates.
 They may be isolated from family members, and many live alone.
Combined with the normal changes of aging and the effects of any
illness, older people not only are at increased
Organic Brain Syndrome
 Any of various disorders of cognition caused by
permanent or temporary brain dysfunction and
characterized especially by dementia.
 Organic brain syndrome (OBS) is a general term,
referring to physical disorders (usually not psychiatric
disorders) that cause decreased mental function.
Acute - sudden confusion or disorientation
Chronic - long-term, often progressive
Dementia – a non specified clinical syndrome
characterize by a loss of intellectual functioning
Dementia, Depression
 When a serious mental impairment occurs, the effect on the patient and family
can be devastating. refers to various organic disorders that progressively affect
cognitive functioning. Of the dementias that affect older adults, (AD) is the most
common degenerative neurologic illness and the most common cause of
cognitive impairment (Stajduk & Shellenberger, 2004).
 It accounts for about two thirds of cases of dementia in the United States,
affecting adults in middle to late life (Arnold, 2004). Scientists estimate that
more than 4 million people have AD, and the number of people with AD doubles
every 5 years beyond age 65. It affects brain cells and is characterized by
patchy areas of the brain that degenerate.
 Alzheimer's disease is a progressively serious and ultimately fatal disorder. At
first, forgetfulness and impaired judgment may be evident. Over a period of
several years, the person becomes progressively more confused, forgetting
family and becoming disoriented in familiar surroundings.
 A common problem in patients with dementia is , in which an older adult
habitually becomes confused, restless, and agitated after dark. When the ability
to perform simple activities of daily living is lost, the person requires constant
supervision and care, often in a nursing home. There is no effective medical
treatment for AD at this time.
 Comprehensive and empathetic nursing care is important. Both the patient and
family caregivers need emotional support and teaching and may benefit from
community resources that can ease the family's burden.
Nursing intervention for patients with
AD
 Arrange a therapeutic, calm, safe, consistent care
environment
Nursing intervention for patients with
depression
- Give client opportunities for making decisions
Promoting Health in Older
Adults
Physiologic function
 Maintain physiologic reserves. Maintain ongoing
assessments for early detection of problems.
 Review perceptions of current health status, health
problems, and prescribed or over-the-counter medications.
 Include nursing care that maintains physical status, such as
skin care and planned rest and activity.
 Bathe or shower 2 – 3 x a week
 Oral Care daily
 Exercise daily to help in regular bm
 Healthy lifestyle and dse prevention
Cognitive function
 Slow pace of activity and wait for responses.
 Be sure eyeglasses and hearing aids are used; ensure
lenses are clean and batteries are strong.
 Assess cognitive health
Psychosocial needs
 Be aware that illness, hospitalization, or changes in living
arrangements are major stressors.
 Assess and support sources of strength, including cultural
and spiritual values and rituals.
 Encourage use of support systems: family, friends,
community resources, pets.
 Set mutual goals and encourage the patient's role in making
decisions about care.
 Encourage life review and reminiscence.
 Encourage self-care.
 Consider the patient's background, interests, capabilities,
values, culture, and lifestyle when planning care.
Nutrition
 Assess for lost or damaged teeth; ensure dentures fit
properly. Provide foods appropriate to the patient's
ability to chew.
 Assess height, weight, eating patterns, and food
choices. If weight is being lost, assess income, storage,
and transportation.
 Assess swallowing ability.
 Consider using supplements.
Sleep and rest
 Discourage excessive napping.
 Assess normal bedtime, time for rising, bedtime rituals,
effects of pain, medications, anxiety, and depression.
Elimination
 Assess frequency of bladder elimination as well as problems
with incontinence.
 Assess normal times for bowel movements, changes in
activity, privacy, and medications.
 Ensure that the floor is not cluttered, the toilet is easily
accessible, lighting is adequate, and privacy is provided.
 Suggest having safety bars installed in the bathroom.
 Review diet for necessary fluid and fiber content.
 For frequent urination – no change in diet and keep from self
limiting fluids
Activity and exercise
 Assess ability to walk; ensure that assistive
devices (such as a walker or cane) are
available.
 Consider effects of illness, surgery,
medications, and changes in diet and fluid
intake on strength and motor function.
 Ensure an uncluttered environment with good
lighting; suggest using a night light and
removing throw rugs.
 Slow the pace of care, allowing extra time to
carry out activities.
Sexuality
 Assist as necessary with hygiene, hair care, oral
care, clean clothing and bedding, makeup, and
shaving.
 Maintain a clean, odor-free environment.
 Demonstrate genuine caring: ask preferred name,
listen carefully, respect belongings.
 Discuss safer sex if appropriate.
 Discuss water-soluble lubricants with women; refer
men for evaluation if erectile dysfunction is a
concern.
Meeting developmental tasks
 Promote continued development and maintenance
of functional health by identifying unmet tasks,
feelings of isolation, and physical or sensory
limitations.
 Assist in finding creative solutions to
developmental tasks.
 Collaborate with other healthcare providers to
provide information and referral to community
resources for the patient and family.
Health Related Screenings
Physical examination
 Every 3 years to age 40
 Every year from age 40
Breast cancer (women)
 Breast self-examination each month
 Breast clinical examination every 3 years to age 40,
then every year
 Mammogram every year beginning age 40
Cervical cancer (women)
 Pelvic examination with Papanicolaou (Pap) exam
at least every 3 years
 Women who have had a total hysterectomy
(removal of the uterus and cervix) do not need
cervical cancer screening, unless the surgery was
for cervical precancer or cancer.
 Women over age 65 to 70 with at least 3 normal
Pap tests and no abnormal Pap tests in the last 10
years should consult with their healthcare provider
about continuing cervical cancer screening.
Prostate (men, beginning age 50)
 Prostate-specific antigen (PSA) test every year
 Digital rectal examination (DRE) every year
 Begin at age 45 if African American or a family history of
prostate cancer.
 Screening is individualized based on healthcare provider
and individual's concerns.
Testicular cancer (men)
 Testicular self-examination every month
Colorectal cancer (men and women,
beginning age 50)
 Fecal occult blood test every year
 Digital rectal examination (DRE) every year
 Flexible sigmoidoscopy every 3–5 years, OR
 Colonoscopy with follow-up every 3–5 years depending
on size of polyps
Skin cancer (men and women)
 Self-examination every month
 Clinical skin examination every year
Oral cancer (men and women)
 Every year as part of medical or dental checkups
Bone density
 Those at risk: postmenopausal women, maternal
history of hip fracture, fracture after age 50, tall height
at age 25
 Maintain a calcium intake of 1000 – 1500 mg daily
Vision
 Eye examination, with a test for glaucoma, every year
Immunizations
 Tetanus, diphtheria (Td): 1-dose booster every 10 years
 Influenza: 1 dose every year
 Pneumococcal polysaccharide vaccine (PPV): 1 dose
every year up to age 64 for those with medical
indications; 1 dose for those unvaccinated by age 65,
or who received the first dose more than 5 years
previously (before age 65)
Role of the Nurse in Promoting
Health and Preventing Illness
Risk for Imbalanced Nutrition: More Than
Body Requirements
 High calorie diet and sedentary lifestyle
Constipation
 Diet low in fiber and lack of exercise
Risk for Impaired Skin Integrity dt
Lifetime of sun exposure
Sedentary Lifestyle
 Lack of resources (time, money, facilities)
Medicare
 Available for older adults
 May qualify for home health care requiring skilled
personnel.