Gerontological & Community Gerontological & Community Based Nursing:Based Nursing:

Physiologic Changes Physiologic Changes of Agingof Aging

Physiologic Changes of AgingPhysiologic Changes of Aging

Biological TheoriesBiological TheoriesNormal Aging changesNormal Aging changesCommon Pathologic Common Pathologic

conditionsconditions

AgingAging

Aging starts at birth Aging starts at birth Continues throughoutContinues throughout

life spanlife span It is: universal, progressive, intrinsic, It is: universal, progressive, intrinsic,

and unavoidableand unavoidable

Biologic Theories of AgingBiologic Theories of Aging

Genetic Theory Genetic Theory Stochastic theoriesStochastic theories Nonstochastic theoriesNonstochastic theories

Genetic TheoryGenetic Theory

Aging is an involuntarily processAging is an involuntarily process Occurs over timeOccurs over time Alters cellular or tissue structuresAlters cellular or tissue structures

(belief that life-span, longevity (belief that life-span, longevity changes are predetermined)changes are predetermined)

IIncludes ncludes DNA theory, Error and Fidelity theory, DNA theory, Error and Fidelity theory, Somatic Mutation and Glycogen theories.Somatic Mutation and Glycogen theories.

Eg. Eg. ↑cancers & autoimmune d/o’s in aging suggest errors in ↑cancers & autoimmune d/o’s in aging suggest errors in mutation at molecular & cellular levels.mutation at molecular & cellular levels.

Error (Stochastic) TheoriesError (Stochastic) Theories

Error (Stochastic): Aging occurs Error (Stochastic): Aging occurs randomly and progresses over timerandomly and progresses over time..

Error- DNA/RNA transcription causes Error- DNA/RNA transcription causes failure of cellularfailure of cellular activity –lead to aging activity –lead to aging and cell mutation or death.and cell mutation or death.

Three types of Error theoriesThree types of Error theories

Wear & TearWear & Tear – – Accumulation of metabolic waste Accumulation of metabolic waste → → products/nutrient deprivation damage to products/nutrient deprivation damage to

DNA synthesisDNA synthesis→→ cells, tissues, organs or body systems cells, tissues, organs or body systems

deteriorate & malfunction with repeated deteriorate & malfunction with repeated use of body in specialized functions.use of body in specialized functions.

Cross-Link TheoryCross-Link TheoryCross –Link Theory- Cross –Link Theory- Cellular division threatened by radiation or Cellular division threatened by radiation or

chemical reactionschemical reactions A cross-link agent attaches self-to DNA A cross-link agent attaches self-to DNA

standsstands With accumulation over time With accumulation over time → dense → dense

aggregates formaggregates form Intracellular transport impaired –Intracellular transport impaired – Results in systems & organ failure Results in systems & organ failure

Free Radical TheoryFree Radical Theory

Free Radical –Free Radical – Reactive molecules with an extra electrical Reactive molecules with an extra electrical

charge from Oxygen moleculescharge from Oxygen molecules Oxidation of fats, proteins and Oxidation of fats, proteins and

carbohydrates creates free radicals carbohydrates creates free radicals These attach to other molecules -proteins, These attach to other molecules -proteins,

enzymes & DNA and damage them –creating enzymes & DNA and damage them –creating genetic disorders genetic disorders

Random damage accumulates, aging Random damage accumulates, aging results, and eventually death of the results, and eventually death of the “damaged” person.“damaged” person.

Antioxidants (vitamins B carotene, A,C,E,) Antioxidants (vitamins B carotene, A,C,E,) can counteract effectscan counteract effects

Nonstochastic TheoriesNonstochastic TheoriesProgrammed AgingProgrammed Aging

Cell aging in is genetically programmed for Cell aging in is genetically programmed for life. life.

Includes the following:Includes the following: ProgrammedProgrammed- - “Inner Biological clock“Inner Biological clock” ” in each cell in each cell

determines number of replications and eventual determines number of replications and eventual death of cell and organism.death of cell and organism.

Immune theory-Immune theory- Alteration in cell is recognized as Alteration in cell is recognized as a foreign body and antibody are produced to fight a foreign body and antibody are produced to fight them just as in autoimmune diseases.them just as in autoimmune diseases.

Neuroendocrine- Over time, the ability of a cell to Neuroendocrine- Over time, the ability of a cell to auto regulate itself becomes altered or lost auto regulate itself becomes altered or lost resulting in aging and death. resulting in aging and death.

Normal Changes of Aging: Normal Changes of Aging: IntegumentIntegument

Normal Changes of Aging: Normal Changes of Aging: IntegumentIntegument

largest most visible organ of the body; largest most visible organ of the body; protects, identifies us, temp. regulation protects, identifies us, temp. regulation & security& security

Integumentary- Skin Changes due to Integumentary- Skin Changes due to intrinsic and extrinsic factors such as:intrinsic and extrinsic factors such as:

• __________________________• __________________________• __________________________• __________________________

Normal changes of Aging: Hair Normal changes of Aging: Hair and Nailsand Nails

Hair (head)Hair (head)– ThinnerThinner– CoarserCoarser– DryerDryer

Facial hair Facial hair NailsNails

– Harder, thicker, more brittle, dull and Harder, thicker, more brittle, dull and opaqueopaque

Age related skin changesAge related skin changesChange---------------EffectChange---------------Effect

Flattening of the Flattening of the dermoepidermal junctiondermoepidermal junction

↓↓collagen & elastincollagen & elastin ↓ ↓ epidermal cell turnover rateepidermal cell turnover rate ↓↓vascular responsivenessvascular responsiveness

↓↓subcutaneous fatsubcutaneous fat

↓↓epidermal cells epidermal cells Atrophy of eccrine & sebaceous Atrophy of eccrine & sebaceous

cellscells

↓↓resistence to shearing resistence to shearing forces, thinning of skinforces, thinning of skin

WrinklingWrinkling Prolonged Prolonged healing timehealing time ↓↓vasodilation (cooling vasodilation (cooling

effect) & effect) & ↓ transdermal ↓ transdermal absorptionabsorption

↓↓protection-bony prominences & protection-bony prominences & thermporegulationthermporegulation

Delayed hypersensitivity responseDelayed hypersensitivity response ↓↓sweating & oilsweating & oil→ →

↓thermoregulation↓thermoregulation

Aging processAging process

Hand & nail changesHand & nail changes

Normal changes of Aging: Normal changes of Aging: MusculoskeletalMusculoskeletal

Influencing FactorsInfluencing Factors– AgeAge– GenderGender– RaceRace– EnvironmentEnvironment

Average loss: Average loss: – 2 inches between ages 40-802 inches between ages 40-80

Normal Musculosketal Aging ChangesNormal Musculosketal Aging ChangesChange-----------------Clinical ImplicationChange-----------------Clinical Implication

Progressive Progressive ↓ height↓ height Stiffening of thoracic cageStiffening of thoracic cage ↓↓production of cortical & production of cortical &

trabecular bonetrabecular bone

↓↓lean body mass w/loss lean body mass w/loss subcutaneous fatsubcutaneous fat

Prolonged time for muscular Prolonged time for muscular contraction & relaxationcontraction & relaxation

Stiffening of joints & Stiffening of joints & ligamentsligaments

Stooped postureStooped posture Barrel-chestBarrel-chest ↑↑risk –hip fracturerisk –hip fracture

Sharp body contours & Sharp body contours & ↓↓muscular strengthmuscular strength

↓ ↓ reaction timereaction time

↑↑risk for injuryrisk for injury

Normal changes of Aging: Normal changes of Aging: MusculoskeletalMusculoskeletal

Bone strength/Bone mineral densityBone strength/Bone mineral density

This graph shows how the bone density of the total hip decreases with age. The units are standardized bone density in (mg/cm2). The lines show the average values, and for each age, race and gender a range of values occurs in the ordinary population.

OsteoporosisOsteoporosis

KyphosisKyphosis

OsteoporosisOsteoporosis

Affects women 4x more often than Affects women 4x more often than menmen– ♀ ♀ Estrogen loss after menopauseEstrogen loss after menopause– ♂ ♂ Long term steroid useLong term steroid use

Normal Changes of AgingNormal Changes of Aging

Ligaments, Tendons, JointsLigaments, Tendons, Joints

=>rigid, hardened, stiff=>rigid, hardened, stiff

Arthritis is the #1 causeArthritis is the #1 cause of disability in elderly of disability in elderly

Did you know?Did you know?During the course of your lifetime, your During the course of your lifetime, your heart will typically beat 2.5 billion times--heart will typically beat 2.5 billion times--about once a second, every minute of your about once a second, every minute of your life. The heart pumps about five or more life. The heart pumps about five or more quarts of blood a minute, nearly 2,000 quarts of blood a minute, nearly 2,000 gallons of blood throughout your body. A gallons of blood throughout your body. A healthy heart is strong enough to drive a healthy heart is strong enough to drive a single drop of blood throughout your entire single drop of blood throughout your entire body in about 24 seconds body in about 24 seconds

Normal Changes of Aging: Normal Changes of Aging: Cardiovascular SystemCardiovascular System

Presbycardia=normal changes in Presbycardia=normal changes in the healthy heartthe healthy heart stroke volumestroke volume cardiac outputcardiac output– Left ventricle wall thickens Left ventricle wall thickens

As much as 50% by age 80As much as 50% by age 80– Left atrium enlarges (to Left atrium enlarges (to

compensate)compensate)– Possible development of a fourth Possible development of a fourth

heart sound (Sheart sound (S44))

Age-related changes Cardiovascular SystemAge-related changes Cardiovascular SystemCardiac Change -------------------EffectCardiac Change -------------------Effect

↑↑mass & fibrosismass & fibrosis ↑↑thickness –L Ventriclethickness –L Ventricle ↑↑pericardial stiffnesspericardial stiffness

Thickened valve Thickened valve leafletsleaflets

↓ ↓ # of pacemaker cells# of pacemaker cells ↓↓responsiveness to responsiveness to

catecholaminescatecholamines

Reduction in ventricular Reduction in ventricular fillingfilling→ ↓cardiac output→ ↓cardiac output

Impaired flow access Impaired flow access valvesvalves

Dysrhythmias commonDysrhythmias common ↓ ↓ HR with exerciseHR with exercise

Peripheral Vascular ChangesPeripheral Vascular Changes

Arteries become less elastic Arteries become less elastic and more brittleand more brittle

Calcium leaving the bones is Calcium leaving the bones is deposited in the deposited in the blood vesselsblood vessels

Lumen size of the Lumen size of the vessels is vessels is dd

May lead to May lead to increased blood increased blood pressurepressure

Age-related Changes in the Respiratory SystemAge-related Changes in the Respiratory SystemChange ----------------------------Effect Change ----------------------------Effect

Upper AirwayUpper Airway Changes in nasal Changes in nasal

structurestructure ↓↓in # of submucosal in # of submucosal

glandsglands

↑↑obstruction of nasal obstruction of nasal breathingbreathing

Thickened mucus Thickened mucus gets trapped in nasal gets trapped in nasal pharynxpharynx

Age-related Changes in the Respiratory SystemAge-related Changes in the Respiratory SystemChange ----------------------------EffectChange ----------------------------Effect

Lower AirwayLower Airway ↓ ↓ in ciliain cilia Calicification of Calicification of

ribs/vertabraeribs/vertabrae Atrophy of Atrophy of

respiratory musclerespiratory muscle Enlargement of Enlargement of

aveolar duct & resp aveolar duct & resp bronchiolesbronchioles

↑↑residual vol.residual vol. ↓↓tidal vol.tidal vol. ↑↑ventilation & ventilation &

perfusionperfusion

↓↓in the mucocillary in the mucocillary escalatorescalator

↓↓compliance –compliance –thorasic cagethorasic cage

↓↓respiratory effortrespiratory effort ↓↓surface area for surface area for

gas exchangegas exchange Prolonged Prolonged

expiration timeexpiration time ↓↓response to response to

hypoxia & hypoxia & hypercapniahypercapnia

↑↑alveolar arterial alveolar arterial gradientgradient

Kidney changes in agingKidney changes in aging

↓↓size & size & efficiencyefficiency ↓↓nephronsnephrons ↓↓blood flow blood flow

↓ ↓ glomerular glomerular filtration rate;filtration rate;

renin-angiotensin renin-angiotensin systemsystem

↑↑arterial pressurearterial pressure ↑↑NA, H2O retentionNA, H2O retention

Age-related Changes in the Renal SystemAge-related Changes in the Renal SystemChange ----------------------------EffectChange ----------------------------Effect

Kidney mass Kidney mass ↓↓ 25-30 % 25-30 % # glomeruli # glomeruli ↓↓ 30 to 40 30 to 40 %%

↓↓ hormonal hormonal response response (vasopressin) & (vasopressin) & impaired ability to impaired ability to conserve saltconserve salt

↓↓Bladder capacity & Bladder capacity & ↑↑residual urine and residual urine and frequency. frequency.

↓↓ ability to filter/ ability to filter/ concentrate urine & concentrate urine & clear drugsclear drugs

↑↑risk for dehydrationrisk for dehydration

↑↑ risk for fluid & risk for fluid & electrolyte electrolyte imbalances, UTI’s, imbalances, UTI’s, incontinence, and incontinence, and urinary obstruction. urinary obstruction.

Changes in lower urinary track-bladderChanges in lower urinary track-bladderChange-----------------------EffectChange-----------------------Effect

↓↓bladder capacitybladder capacity atrophy of bladderatrophy of bladder pelvic relaxation pelvic relaxation

&reduced &reduced estrogenestrogen

↑↑residual volumeresidual volume ↑↑prostate sizeprostate size ↑↑urinary retentionurinary retention

frequency in frequency in urination;urination;

↑↑involuntary involuntary bladder bladder contractionscontractions

↑↑nighttime urine nighttime urine flow ratesflow rates

↑↑risk for UTI’srisk for UTI’s

Age-related Changes in the Endocrine Age-related Changes in the Endocrine SystemSystem

ChangeChange Insulin resistance Insulin resistance

↓ ↓ in aldosterone in aldosterone and cortisoland cortisol

EffectEffect may prevent may prevent

efficient conversion efficient conversion of glucose into of glucose into energy. energy.

may affect immune may affect immune and cardiovascular and cardiovascular function function

Major Gastrointestinal Changes with AgingMajor Gastrointestinal Changes with AgingChange---------------------------EffectChange---------------------------Effect

Decreased peristalsisDecreased peristalsis Increased stomach pHIncreased stomach pH

↓↓liver function liver function

weakened intestinal weakened intestinal walls in the colon. walls in the colon.

↓↓ peristalsis of colonperistalsis of colon

reflux and hiatal reflux and hiatal herniashernias

↑↑susceptibility to susceptibility to gastric irritation & gastric irritation & ulcers. ulcers.

Drugs metabolized Drugs metabolized slowly;slowly;↓↓ repair of liver repair of liver cells.cells.

Diverticuli / painDiverticuli / pain can increase risk for can increase risk for

constipation. constipation.

Age-related Changes in the Female Age-related Changes in the Female Reproductive System Reproductive System

Ovulation ceases and estrogen levels Ovulation ceases and estrogen levels drop by 95%. drop by 95%.

Vaginal walls become thinner and Vaginal walls become thinner and lose elasticity lose elasticity

Most women experience a decrease Most women experience a decrease in the production of vaginal in the production of vaginal lubrication. lubrication.

Age-related Changes in the Male Age-related Changes in the Male Reproductive System Reproductive System

testosterone levels may drop by testosterone levels may drop by up to 35%. up to 35%.

size of testes decreases. size of testes decreases. decline in sperm production - the decline in sperm production - the

extent varies among individuals. extent varies among individuals. erectile dysfunction (impotence), erectile dysfunction (impotence),

in occurs in15% of men by the in occurs in15% of men by the age of 65 age of 65 ↑to↑to 50% by age 80 50% by age 80

Age-related Changes in the C N SAge-related Changes in the C N S

Brain is resilientBrain is resilient ∆ ∆ in cognitive function---NOT normalin cognitive function---NOT normal DelayedDelayed neurological function neurological function NOT the loss of cognitive functionNOT the loss of cognitive function Intellectual performance remains intactIntellectual performance remains intact Performing tasks may take longerPerforming tasks may take longer ↓↓levels of neurotransmitters - levels of neurotransmitters -

choline,acetylase,choline,acetylase,Catecholamines,Catecholamines,↑MAO↑MAO

Age-related Changes in the Neurological SystemAge-related Changes in the Neurological SystemChange-----------------------effectsChange-----------------------effects

↓↓peripheral nerve peripheral nerve conductionconduction

↑↑lipofuscin along lipofuscin along neuronsneurons

↓↓thermo-regulation by thermo-regulation by hypothalamushypothalamus

Differential Differential rate/distribution of rate/distribution of dopaminedopamine

↓↓deep tendon reflex w/↑ deep tendon reflex w/↑ reaction timereaction time

∆ ∆ in vasodilation & in vasodilation & constriction constriction

Heat/cold intoleranceHeat/cold intolerance Slowing motor Slowing motor

movements & fine movements & fine motor skillsmotor skills

Age-related Changes in the Neurological SystemAge-related Changes in the Neurological SystemChange-----------------------effectsChange-----------------------effects

↓ ↓ neurons in autonomic neurons in autonomic nervous systemnervous system

↓↓neurons in cerebral & neurons in cerebral & cerebellar cortexcerebellar cortex

↓↓sensorimotor sensorimotor processingprocessing

Impaired barorecpetor Impaired barorecpetor responsiveness,vaso-responsiveness,vaso-constrictor & postural constrictor & postural responseresponse

↓↓visual/auditory reaction visual/auditory reaction time;↓Short –time;↓Short –memory,↓visual/spatialmemory,↓visual/spatial

↓↓neurotransmitter neurotransmitter coordinationcoordination

↓↓reaction time /↑ risk for reaction time /↑ risk for fallsfalls

Normal Age-related Changes in the Normal Age-related Changes in the Peripheral Nervous SystemPeripheral Nervous System

in tactile sensitivityin tactile sensitivity Loss of nerve endings in skinLoss of nerve endings in skin

risk for injuries and burnsrisk for injuries and burns Altered kinesthetic sense (one’s Altered kinesthetic sense (one’s

position in space)position in space) risk for fallingrisk for falling

Normal Age-related Changes in the Normal Age-related Changes in the EyesEyes

Drooping eyelids (senile ptosis)Drooping eyelids (senile ptosis)

orbicular muscle strengthorbicular muscle strength

Arcus senilisArcus senilis– Gray/white/silver ringGray/white/silver ring

inside the outer edge of irisinside the outer edge of iris Decrease in number of goblet cells Decrease in number of goblet cells

producing eye lubricationproducing eye lubrication

Age related changes of eyeAge related changes of eye

Normal Age-related Changes in the Normal Age-related Changes in the Eyes cont’dEyes cont’d

PresbyopiaPresbyopia-the -the crystalline lens crystalline lens accumulates tissue accumulates tissue built up that built up that becomes stiff becomes stiff →→iris iris muscles work muscles work harder to bring near harder to bring near objects into focusobjects into focus

• ↑↑ accommodation - accommodation - lightlight

• ↑ ↑ sensitivity to glaresensitivity to glare• ↓↓ in pupil sizein pupil size• require require ↑↑lightinglighting

Intraocular Changes of EyeIntraocular Changes of Eye

Common Diseases Affecting VisionCommon Diseases Affecting Vision

Cataracts—Cataracts—heredity & advanced heredity & advanced ageage

↑↑risk high exposure to sunlight, diabetes, risk high exposure to sunlight, diabetes, hypertension,hypertension,

Kidney disease, eye traumaKidney disease, eye trauma Glaucoma- Glaucoma- 22ndnd most common eye most common eye

diseasedisease Macular DegenerationMacular Degeneration

Detached RetinaDetached Retina

CataractsCataracts

A cataract is a clouding of the normally clear A cataract is a clouding of the normally clear lens of the eye. It can be compared to a lens of the eye. It can be compared to a window that is frosted or "fogged" with steam. window that is frosted or "fogged" with steam.

Common symptoms of cataract include:Common symptoms of cataract include:– Painless blurring of visionPainless blurring of vision– Glare, or light sensitivity Glare, or light sensitivity – Frequent eyeglass prescription Frequent eyeglass prescription ∆∆– Double vision in one eye Double vision in one eye – Needing brighter light to read Needing brighter light to read – Poor night vision Poor night vision – Fading or yellowing of colors Fading or yellowing of colors

Age related eye disordersAge related eye disorders

Age related disorders of eyeAge related disorders of eyeCataractCataract

Nursing Interventions Nursing Interventions Post Cataract SurgeryPost Cataract Surgery

Most common surgical procedure Most common surgical procedure in U.Sin U.S..

Lens is removed-replaced with plastic Lens is removed-replaced with plastic intraocular lensintraocular lens

Patient teachingPatient teaching:: Avoid heavy lifting, straining, Avoid heavy lifting, straining,

bending at the waistbending at the waist Can resume activities within a dayCan resume activities within a day

Intraocular Changes of EyeIntraocular Changes of Eye

Sclera may become yellowish (imitating Sclera may become yellowish (imitating jaundice)jaundice)

Floaters—bits of vitreous that have broken Floaters—bits of vitreous that have broken off the retinaoff the retina

Retina becomes dullRetina becomes dull Glaucoma is a degenerative Glaucoma is a degenerative abnormalabnormal

condition resulting when intraocular condition resulting when intraocular pressure (IOP) becomes higher than what pressure (IOP) becomes higher than what is healthy for the optic nerveis healthy for the optic nerve

GlaucomaGlaucoma Occurs after 40 years of ageOccurs after 40 years of age Major cause of blindnessMajor cause of blindnessRisk factors:Risk factors: Family history (any type of glaucoma)Family history (any type of glaucoma) Diabetes, Endocrine imbalance, cardiovascular Diabetes, Endocrine imbalance, cardiovascular

disease, steroid use, past eye injurydisease, steroid use, past eye injury Older women 2X’s incidence than menOlder women 2X’s incidence than men Japanese ancestryJapanese ancestry African AmericanAfrican American Mexican AmericansMexican Americans

Types of GlaucomaTypes of Glaucoma

Chronic – Chronic – open-angle glaucomaopen-angle glaucoma ((morecommon)morecommon)

80% asymptomatic until late stage80% asymptomatic until late stage Gradual impairment in peripheral visionGradual impairment in peripheral visionSigns/symptoms:Signs/symptoms: bumping into items at their sidebumping into items at their side Frequent Frequent ∆ of eye glasses∆ of eye glasses Changes in central visionChanges in central vision c/o tired feeling in eyes, headaches, misty vision, c/o tired feeling in eyes, headaches, misty vision,

halos around lights, (worse in the morning)halos around lights, (worse in the morning)

Treatment –Chronic- Open Angle GlaucomaTreatment –Chronic- Open Angle Glaucoma

Miotic and carbonicanhydrous Miotic and carbonicanhydrous inhibitorsinhibitors

Surgery – to create a channel to filter Surgery – to create a channel to filter the aqueous fluid (eg. the aqueous fluid (eg. Iridectomy,iridencleisis,cyclodialysis,Iridectomy,iridencleisis,cyclodialysis,

corneoscleral trephining)corneoscleral trephining)

InterventionsInterventions

MioticsMiotics (azetazolamide) eye gtts- use tear (azetazolamide) eye gtts- use tear duct occlusion technique (increases duct occlusion technique (increases amount of med absorbed by 50%)amount of med absorbed by 50%)

Do NOT USE Mydriatic ,stimulants or other Do NOT USE Mydriatic ,stimulants or other agents that agents that ↑ blood pressure.↑ blood pressure.

Instruct to carry a medical card or wear bracelet Instruct to carry a medical card or wear bracelet Avoid abuse/overuse of eyesAvoid abuse/overuse of eyes Patient teaching re: compliance with regime.Patient teaching re: compliance with regime. Frequent re-screeningFrequent re-screening

Acute -Closed Angle GlaucomaAcute -Closed Angle Glaucoma

Rapid rise in (IOP) intraocular pressureRapid rise in (IOP) intraocular pressure S/Sx: redness & severe eye pain, S/Sx: redness & severe eye pain,

blurred vision, headache, nausea, vomitingblurred vision, headache, nausea, vomiting Path of aqueous humor is blocked IOP Path of aqueous humor is blocked IOP ↑’s ↑’s

to 50mm Hg.to 50mm Hg. Edema of ciliary body & dilation of pupilEdema of ciliary body & dilation of pupil Blurred vision –followed by blindness if not Blurred vision –followed by blindness if not

corrected within two days!corrected within two days!

Interventions-Acute – closed angle Interventions-Acute – closed angle glaucomaglaucoma

Effective medications include: Effective medications include: carbonic anhydrase inhibitors carbonic anhydrase inhibitors (reduce formation of aqueous fluid)(reduce formation of aqueous fluid)

Mannitol, urea or glycerine (reduce Mannitol, urea or glycerine (reduce fluid -ability to increase osmotic fluid -ability to increase osmotic tension in circulating blood)tension in circulating blood)

Iridectomy – may be performed- Iridectomy – may be performed- prevents future episodes of acute prevents future episodes of acute glaucomaglaucoma

Age-related Macular Age-related Macular Degeneration(AMD)Degeneration(AMD)

Most common cause of visual impairment & Most common cause of visual impairment & legal blindness in persons >50 y/olegal blindness in persons >50 y/o

Damage /breakdown of the macularDamage /breakdown of the macular→loss of →loss of central visioncentral vision

Risk factorsRisk factors: aging process, injury , infection, : aging process, injury , infection, exudate macular degenerationexudate macular degeneration

White Women > 80 & Asian Americans more White Women > 80 & Asian Americans more vulnerable than African & Mexican Americansvulnerable than African & Mexican Americans

Macular DegenerationMacular Degeneration

Early Signs/symptomsEarly Signs/symptoms:: Difficulty reading, driving, Difficulty reading, driving, ↑need for bright ↑need for bright

light, Colors appear dim /gray, blurry spot in middle light, Colors appear dim /gray, blurry spot in middle of visionof vision..

Two forms of AMDTwo forms of AMD: Dry & Wet: Dry & Wet ““Dry” AMD – 3 stages Dry” AMD – 3 stages ““Wet” AMD –abnormal blood vessels behind Wet” AMD –abnormal blood vessels behind

retina grow under the macula (more rapid retina grow under the macula (more rapid >legal blindness within 2 years)>legal blindness within 2 years)

Aging Changes in Ears & Aging Changes in Ears & HearingHearing

Function of EarsFunction of Ears

1.1. HearingHearing

2.2. Maintenance of Maintenance of balancebalance

Aging Changes in Ears & Aging Changes in Ears & HearingHearing

PresbycusisPresbycusis– age-related hearing lossage-related hearing loss hearing acuityhearing acuity speech intelligibilityspeech intelligibility auditory thresholdauditory threshold discrimination of pitchdiscrimination of pitch

Age related Hearing changesAge related Hearing changes

Slow decline in Slow decline in sensoneural sensoneural

functionfunction

(presbycusis)(presbycusis) Conductive hearing Conductive hearing

loss r/t cerumen loss r/t cerumen impaction,impaction,

otosclerosis, otosclerosis, chronic exposure to chronic exposure to loud noisesloud noises

loss of hearing loss of hearing acuity, especially acuity, especially sounds at the sounds at the higher end of the higher end of the spectrum.spectrum.

↓↓ ability to ability to distinguish sounds distinguish sounds when there is when there is background noisebackground noise

NURSING DIAGNOSIS OF THE NURSING DIAGNOSIS OF THE ELDER ADULT IN THE COMMUNITYELDER ADULT IN THE COMMUNITY

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NURSING DIAGNOSIS OF THE NURSING DIAGNOSIS OF THE ELDER ADULT IN THE COMMUNITYELDER ADULT IN THE COMMUNITY Impaired Physical Impaired Physical

MobilityMobility Self Care DeficitSelf Care Deficit Care-giver Role StrainCare-giver Role Strain AnxietyAnxiety FearFear Knowledge DeficitKnowledge Deficit Altered Thought ProcessAltered Thought Process Ineffective Health Ineffective Health

MaintenanceMaintenance Social IsolationSocial Isolation Disabled Disabled

Family/Individual CopingFamily/Individual Coping

Age related sensory changesAge related sensory changesChange --------------------EffectChange --------------------Effect

TasteTaste - decreased - decreased taste buds and taste buds and saliva; loss of taste saliva; loss of taste cells (papillae on cells (papillae on tongue) tongue)

SmellSmell & Touch& Touch – –

Loss of olfactory Loss of olfactory sensory neurons; sensory neurons; decreased sensory decreased sensory nerve fibersnerve fibers

Decreased Decreased discrimination of discrimination of sweet, salt, bitter, sweet, salt, bitter, sour.sour.

Decreased sense of Decreased sense of smell; decreased smell; decreased sensitivity to touch; sensitivity to touch; altered pain altered pain perceptionperception

Changes of Aging ActivityChanges of Aging ActivityGoal:Goal: to simulate the feeling of some of the to simulate the feeling of some of the physical changes of aging and the potential physical changes of aging and the potential

difficulties they can produce.difficulties they can produce.

Stand with feet apart at least 14 inches (to Stand with feet apart at least 14 inches (to provide a wide base) and do the following:provide a wide base) and do the following:– Round the shoulders and upper backRound the shoulders and upper back– Tuck the buttocks and relax the abdominal Tuck the buttocks and relax the abdominal

musculature, making the umbilicus point musculature, making the umbilicus point toward the ceilingtoward the ceiling

– Remaining in this position, take a deep breath Remaining in this position, take a deep breath (simulating the change in respiratory function (simulating the change in respiratory function that accompanies change in stature)that accompanies change in stature)

Still remaining in this positionStill remaining in this position

– ,Bend the knee while keeping the foot of that leg ,Bend the knee while keeping the foot of that leg on the groundon the ground

– Take a few steps forward (simulation of slowed Take a few steps forward (simulation of slowed mobility with aging)mobility with aging)

– What they you feeling, physically and What they you feeling, physically and emotionally, and thinking during various steps of emotionally, and thinking during various steps of this exercise.this exercise.

– Share with the rest of the class how you might Share with the rest of the class how you might feel if these physical changes were permanent. feel if these physical changes were permanent.

– What challenges do you anticipate these What challenges do you anticipate these physical limitations will cause?physical limitations will cause?