NR 601
Developmental changes Physiological - 1. Reduced physiological reserve of most body systems,
particularly cardiac, respiratory, and renal.
2. There are reduced homeostatic mechanisms that fail to adjust regulatory systems such as
temperature control and fluid and electrolyte balance.
3. There are changes in the sympathetic response, which contribute to orthostasis and falls, as well as
lack of hypoglycemic response.
4. There is impaired immunological function: infection risk is greater and autoimmune diseases are more
prevalent.
Laboratory: Reference ranges for older adults might be the intervals within which 9%% of persons over
70 fall.
Causes: Physiologically: fasting or activity status.
Pharmacologically: medication, tobacco, or alcohol use.
Physiological aging - Age related Change
Functional Change
Implications
Integumentary System
Loss of dermal and epidermal thickness
Loss of subcutaneous tissue and thin epidermis.
Prone to skin breakdown and injury
Decreased vascularity
• Atrophy of sweat glands resulting in decreased sweat production
• Decreased body odor
• Decreased heat loss
• Dryness
,• Alteration in thermoregulatory response
• Fluid requirements may change seasonally
• Loss of skin water
• Increased risk of heat stroke
Respiratory System
Decreased lung tissue elasticity
Decreased vital capacity
Reduced overall efficiency of ventilatory exchange
Cilia atrophy
Change in mucociliary transport
Increased susceptibility to infection
Decreased respiratory muscle strength
• Reduced ability to handle secretions and reduced effectiveness against noxious foreign particles
• Partial inflation of lungs at rest
Increased risk of atelectasis
Cardiovascular System
Heart valves thicken and become fibrotic
Reduced stroke volume, cardiac output; may be altered
Decreased responsiveness to stress
Fibroelastic thickening of the sinoatrial node; decreased number of pacemaker cells
Slower heart rate
Increased prevalence of arrhythmias
Decreased baroreceptor sensitivity (stretch receptors)
Decreased sensitivity to changes in blood pressure
Prone to loss of balance, which increases the risk for falls
,GI
Liver becomes smaller
Decreased storage capacity
Decreased muscle tone
Altered motility
Increases risk of constipation, functional bowel syndrome, esophageal spasm, diverticular disease
Decreased basal metabolic rate (rate at which fuel is converted into energy)
May need fewer calories
Lab results Dunphy table 77.2 - UA Normal Changes with age Comments
Protein 0-5 rises slightly Due to kidney changes, UTI, renal
SG 1.005-1.020 Lower 1.016-1.022 Decline in nephrons impairs ability to
Concentrate urine
Hematology
ESR M: 0-20 W: 0-30 Sign increase Neither sensitive nor specific
Iron binding 50-160 230-410 Slight decrease
HGB M: 13-18 W:12-16 M: 10-17 W: none Anemia is common in elderly
HCT M: 45-52 W: 37-48 Slight decrease Decline in hematopoiesis
Leukocytes 4,300-10,800 Drop to 3,100-9,000 Decrease may be due to drugs or sepsis
Lymphocytes 500-2,400 Tcells Fall infection risk higher
50-200 Bcells Immunizations encouraged
Platelets 150,000-350,000 no change
Blood chemistry
Albumin 3.5-5.0 Decline R/T decreased liver size and enzymes.
Protein-energy malnutrition common.
Globulin 2.3-3.5 Slight increase
, Total serum
Protein 6.0-8.4 no change Decrease may indicate malnutrition
Infection, liver disease
BUN M: 10-25 Increases significantly Decline in GFR
W: 8-20 up to 69 Decreased cardiac output
Creatinine 0.6-1.5 increases to 1.9 RT lean body mass
Creatinine Decreases 10% Used for prescribing meds
Clearance 104-124 after 40 yrs old for drugs excreted by kidney
GT 62-110 (after fasting) Slight increase 10 Diabetes increase in prevalent
<120 (2h PP) after 30 yrs drugs may cause intolerance
Alk Phos 13-39 increase by 8-10 Elevation >20% usually due to disease
Elevations may be found with bone
Abnormalities, drugs (narcotics), and
Eating fatty meals.
Atypical disease presentation - Acute abdomen: absence of symptoms or vague symptoms. Acute
confusion. Mild discomfort and constipation. Some tachypnea and possibly vague respiratory symptoms.
Appendicitis pain may begin in RLQ and become diffuse.
Depression: Anorexia, vague abdominal complaints, new onset of constipation, insomnia, hyperactivity,
lack of sadness
Hyperthyroidism: Hyperthyroidism presenting as "apathetic thyrotoxicosis," (fatigue and weakness;
weight loss may result instead of weight gain; patients report palpations, tachycardia, new onset of
atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism).
Hypothyroidism: Often presents with confusion and agitation; new onset of anorexia, weight loss, and
arthralgias may occur.
Malignancy: New or worsening back pain secondary to metastases from slow growing breast masses.
Silent masses of the bowel.
Myocardial infarction: Absence of chest pain. Vague symptoms of fatigue, nausea, and a decrease in
functional and cognitive status; classic presentations: dyspnea, epigastric discomfort, weakness,
vomiting; history of previous cardiac failure. Higher prevalence in females versus males. Non-Q-wave MI.
Overall Infectious disease process: Absence of fever or low-grade fever. Malaise. Sepsis without usual
leukocytosis and fever. Falls, anorexia, new onset of confusion, and/or alteration in change in mental
status, decrease in usual functional status.
Developmental changes Physiological - 1. Reduced physiological reserve of most body systems,
particularly cardiac, respiratory, and renal.
2. There are reduced homeostatic mechanisms that fail to adjust regulatory systems such as
temperature control and fluid and electrolyte balance.
3. There are changes in the sympathetic response, which contribute to orthostasis and falls, as well as
lack of hypoglycemic response.
4. There is impaired immunological function: infection risk is greater and autoimmune diseases are more
prevalent.
Laboratory: Reference ranges for older adults might be the intervals within which 9%% of persons over
70 fall.
Causes: Physiologically: fasting or activity status.
Pharmacologically: medication, tobacco, or alcohol use.
Physiological aging - Age related Change
Functional Change
Implications
Integumentary System
Loss of dermal and epidermal thickness
Loss of subcutaneous tissue and thin epidermis.
Prone to skin breakdown and injury
Decreased vascularity
• Atrophy of sweat glands resulting in decreased sweat production
• Decreased body odor
• Decreased heat loss
• Dryness
,• Alteration in thermoregulatory response
• Fluid requirements may change seasonally
• Loss of skin water
• Increased risk of heat stroke
Respiratory System
Decreased lung tissue elasticity
Decreased vital capacity
Reduced overall efficiency of ventilatory exchange
Cilia atrophy
Change in mucociliary transport
Increased susceptibility to infection
Decreased respiratory muscle strength
• Reduced ability to handle secretions and reduced effectiveness against noxious foreign particles
• Partial inflation of lungs at rest
Increased risk of atelectasis
Cardiovascular System
Heart valves thicken and become fibrotic
Reduced stroke volume, cardiac output; may be altered
Decreased responsiveness to stress
Fibroelastic thickening of the sinoatrial node; decreased number of pacemaker cells
Slower heart rate
Increased prevalence of arrhythmias
Decreased baroreceptor sensitivity (stretch receptors)
Decreased sensitivity to changes in blood pressure
Prone to loss of balance, which increases the risk for falls
,GI
Liver becomes smaller
Decreased storage capacity
Decreased muscle tone
Altered motility
Increases risk of constipation, functional bowel syndrome, esophageal spasm, diverticular disease
Decreased basal metabolic rate (rate at which fuel is converted into energy)
May need fewer calories
Lab results Dunphy table 77.2 - UA Normal Changes with age Comments
Protein 0-5 rises slightly Due to kidney changes, UTI, renal
SG 1.005-1.020 Lower 1.016-1.022 Decline in nephrons impairs ability to
Concentrate urine
Hematology
ESR M: 0-20 W: 0-30 Sign increase Neither sensitive nor specific
Iron binding 50-160 230-410 Slight decrease
HGB M: 13-18 W:12-16 M: 10-17 W: none Anemia is common in elderly
HCT M: 45-52 W: 37-48 Slight decrease Decline in hematopoiesis
Leukocytes 4,300-10,800 Drop to 3,100-9,000 Decrease may be due to drugs or sepsis
Lymphocytes 500-2,400 Tcells Fall infection risk higher
50-200 Bcells Immunizations encouraged
Platelets 150,000-350,000 no change
Blood chemistry
Albumin 3.5-5.0 Decline R/T decreased liver size and enzymes.
Protein-energy malnutrition common.
Globulin 2.3-3.5 Slight increase
, Total serum
Protein 6.0-8.4 no change Decrease may indicate malnutrition
Infection, liver disease
BUN M: 10-25 Increases significantly Decline in GFR
W: 8-20 up to 69 Decreased cardiac output
Creatinine 0.6-1.5 increases to 1.9 RT lean body mass
Creatinine Decreases 10% Used for prescribing meds
Clearance 104-124 after 40 yrs old for drugs excreted by kidney
GT 62-110 (after fasting) Slight increase 10 Diabetes increase in prevalent
<120 (2h PP) after 30 yrs drugs may cause intolerance
Alk Phos 13-39 increase by 8-10 Elevation >20% usually due to disease
Elevations may be found with bone
Abnormalities, drugs (narcotics), and
Eating fatty meals.
Atypical disease presentation - Acute abdomen: absence of symptoms or vague symptoms. Acute
confusion. Mild discomfort and constipation. Some tachypnea and possibly vague respiratory symptoms.
Appendicitis pain may begin in RLQ and become diffuse.
Depression: Anorexia, vague abdominal complaints, new onset of constipation, insomnia, hyperactivity,
lack of sadness
Hyperthyroidism: Hyperthyroidism presenting as "apathetic thyrotoxicosis," (fatigue and weakness;
weight loss may result instead of weight gain; patients report palpations, tachycardia, new onset of
atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism).
Hypothyroidism: Often presents with confusion and agitation; new onset of anorexia, weight loss, and
arthralgias may occur.
Malignancy: New or worsening back pain secondary to metastases from slow growing breast masses.
Silent masses of the bowel.
Myocardial infarction: Absence of chest pain. Vague symptoms of fatigue, nausea, and a decrease in
functional and cognitive status; classic presentations: dyspnea, epigastric discomfort, weakness,
vomiting; history of previous cardiac failure. Higher prevalence in females versus males. Non-Q-wave MI.
Overall Infectious disease process: Absence of fever or low-grade fever. Malaise. Sepsis without usual
leukocytosis and fever. Falls, anorexia, new onset of confusion, and/or alteration in change in mental
status, decrease in usual functional status.
