CE Objectives and Evaluation Form appear on page 230.

Interpreting Laboratory Values In Older Adults
Nancy Edwards Carol Baird Results of common laboratory tests must be interpreted with care in older adults. Laboratory results that vary with age are presented, along with possible causes and interpretations of results.


Nancy Edwards, PhD, RN,C, is an Associate Professor, Purdue University School of Nursing, West Lafayette, IN. Carol Baird, DNS, APRN, BC, is an Associate Professor, Purdue University School of Nursing, West Lafayette, IN.

ohn Doe, 83 years old, comes to the clinic complaining of increasing fatigue and weakness. His past medical history includes diabetes mellitus, chronic anemia, and hypertension. The 5’10” man is thin (148 pounds) with small muscle mass. His skin color is pale pink. A battery of diagnostic tests reveals the following: hemoglobin 11.2 g/dL, hematocrit 40%, white blood cells 5,000/ml, fasting blood sugar 183 mg/dL, blood urea nitrogen 30 mg/dL, serum creatinine 1.9 mg/dL, and serum albumin 2.3 g/dL. The nurse is uncertain which laboratory values are significant in considering Mr. Doe’s care plan. This case illustrates the difficulty in interpreting laboratory values for older adults, which is a complex task with varied opinions about what is normal. Multiple confounding factors make interpretation and use of laboratory results in older patients challenging. Some of the factors include (a) physiologic changes associated with aging, (b) the high prevalence of chronic conditions, (c) changes in nutrition and fluid consumption, (d) lifestyle changes, and (e) pharmacologic regimes (Brigden & Heathcote, 2000). Laboratory test results also may be affected by many factors other than aging. Influencing factors

may include gender, body mass, alcohol intake, diet, and stress (Fischbach, 2004). Technical factors such as collection site, collection time, tourniquet application, and specimen transportation also can affect results but usually can be controlled by following standardized laboratory procedures (Brigden & Heathcote, 2000). Results of diagnostic testing in older adults may have different meanings from the results found in younger individuals. Nurses should recognize that no general trend exists for the direction of change in laboratory values for older adults. For some tests, older adults have higher than normal values and for others, lower values; some remain unchanged. Changes in laboratory values can be classified in three general groups: (a) those that change with aging; (b) those that do not change with aging; and (c) those for which it is unclear whether aging, disease, or both influence the values (Tripp, 2000). Common laboratory tests with interpretations for older adults are presented.

Interpreting Reference Ranges
The accepted, normal ranges of values typically reported may not be applicable for older adults.


MEDSURG Nursing—August 2005—Vol. 14/No. 4

however. It must be cautioned.Interpreting Laboratory Values in Older Adults Reference ranges may be more appropriate. Nurses working with older adults should consider the total assessment rather than simply relying on laboratory diagnostic testing. but also for neonates (especially low-birthrate infants). or a combination of conditions have also been identified as causes for lowered hemoglobin (Giddens. Jagenburg. However. however. 2000).5 gm/dl for males and 12. However. 2000). fatigue. Hematocrit (HCT). A combination of vague symptoms and an unclear clinical picture may lead the health care provider to attribute the symptoms to “old age” and not to a treatable condition. The mechanisms that regulate the older individual’s serum creatinine levels within the accepted reference range tend to overestimate renal functioning as a measure of glomerular filtration rate. 2004). goals of management of diabetes should be individualized. Impaired erythrocyte production. 2000. is not useful in determining age-related norms for older adults (Luggen. 2004). 14/No. blood loss. it is best to avoid fasting or bedtime plasma glucose levels of less than 100 mg/dl if the patient is on insulin or sulfonylurea treatment (Reed & Mooradian. Kee (2002) defines hemoglobin as abnormal if less than 13. and paresthesia (Manson & McCance. Manson and McCance (2004) identify impaired erythrocyte production. increased erythrocyte destruction. 2002). Recent studies with older adults. 2004). 2004). An increase in the MEDSURG Nursing—August 2005—Vol. however. Nilsson-Ehle. 1998). 2001). 2004). specific reference ranges are known for tests for other special populations (for example. Reference ranges or reference values are those intervals within which 95% of the values fall for a specific population (Lab Tests Online. Laboratory values falling outside the normal ranges may indicate benign or pathologic conditions in the older adult (Fischbach. For example. While the results of studies of the effects of aging on the hematologic system vary (Brigden & Heathcote. in the frail elderly. Values within the expected normal reference ranges. For example.5 gm/dl for males and 11. 2004. geriatric reference ranges are those intervals within which 95% of values for persons over 70 years of age would fall. 2002). Endogenous creatinine production is constant as long as muscle mass remains constant (Pagana & Pagana. Specific Laboratory Tests Hemoglobin (HGB). increased erythrocyte destruction. In addition. Reference ranges are calculated not just for older adults. 2004). blood loss. or a combination of conditions as causes for anemia. Giddens. The principal goal would be to enhance quality of life without undue risk of hypoglycemia. may also indicate new or progressing patho- logic conditions in certain older adults. Landahl. The use of reference ranges allows for recognition of the special needs of the population in question. used in skeletal muscle contraction. research does indicate that older individuals may have changes in hemoglobin and erythrocyte synthesis caused by changes in iron and vitamin B12 absorption (Giddens. 2004). Creatinine is a product of creatine phosphate. but some individuals may present with shortness of breath. The concept of normal range. suggest lower levels may be acceptable. in order to identify two standard deviations on either side of the mean. usually ages 20 to 40 years. reference ranges are useful in some situations. A reduction of hemoglobin can result in a decrease in oxygen content and an increase in fatigue. and pregnant women. adolescents. that some researchers recommend not using reference ranges for laboratory test parameters pertaining to older adults because it is difficult to differentiate whether results are a sign of a disease or are related to normal aging (Luggen. Hemoglobin may be lower in older adults due either to normal aging changes or illnesses such as anemia. Normal ranges are obtained by determining the mean of a random sample of healthy individuals. The currently reported lowest acceptable value for older adults is 11. Most instances of anemia are associated with chronic conditions such as renal insufficiency or gastric bleeding (Giddens. Serum creatinine is a second example of a laboratory test in which results may be within the specified reference range and yet indicate pathology for the older adult. 2000) (see Table 1). 4 221 .0 gm/dl for females (Brigden & Heathcote. Reference ranges or reference values are preferred concepts. & Swanborg. It usually is best to achieve fasting blood glucose levels of less than 140 mg/dl. Signs of anemia may not be noticed if the anemia is mild. however. 2004). serum erythropoietin in adult athletes such as marathon runners). Anemia may be a serious condition because it places the older individual at greater risk for circulatory and oxygenation problems (Tripp. Changes in hematocrit may reflect fluid and/or nutritional status in the older adult (Fischbach.0 gm/dl for females. Serum creatinine and blood urea nitrogen (BUN) levels in the high-normal category may represent significant renal dysfunction in the older adult who has inadequate protein intake (Daniels.

tissue necrosis. Nurses should be vigilant in efforts to detect other signs of infections in the older adult. 2003) (see Table 1). SLE. 2004). rheumatoid arthritis ↑: Dehydration.10.0 gm/dl F 12. emphysema. protein malnutrition. cirrhosis of liver.. and should not be attributed to advancing age (Fischbach. nurses should educate older adults about infection prevention techniques. while a decrease may be a result of conditions accompanied by fluid overload or dietary deficiencies. rectum.000 . leukemias. common symptoms of infections. 14/No. kidney disease ↑: Dehydration.. may be normal if values are 30% to 45% for older males and 36% to 65% for older females (Desai & Isa-Pratt.000 µl Minimal change Source: Brigden & Heathcote. Whether total leukocyte count is affected by aging is controversial. collagen vascular disorders). cancer. anemias. analgesics. kidney disease ↑: Polycythemia. 2000 hematocrit may signal volume depletion. may be decreased in severity or absent in the older adult (Beers & Berkow. cancer (intestine. 2002). 2000). parasitic diseases. transient cerebral ischemia ↓: Hemotopoietic diseases. Because of the concern for serious undetected infection. 4 . Hodgkin’s disease.9. 2004). hemolytic anemia.000 .Interpreting Laboratory Values in Older Adults Table 1. cirrhosis of liver. polycythemia ↓: Anemias. liver disease.54% F 36% .45% F 36% .000 µl/mm3 3. However. viral infections. leukemia. systemic lupus erythematous (SLE). or pain. the percentage of total blood volume that represents erythrocytes. 2004). infection or sepsis (pneumonia. polycythemia vera.. peptic ulcer. stress ↓: Idiopathic thrombocytopenia purpura. such as hand washing and timely vaccination for influenza and pneumonia. 2002) (see Table 1). trauma.0 gm/dl Implications ↓: Anemias. 2001.400. White blood cells (WBC). Sester et al. A decreased WBC value may result from specific disease (myeloma.46% M 30% . leukemias. This lowered WBC count in a healthy individual may result in an absence of elevated white blood cells in the presence of severe infection. such as enlarged lymph glands. fever. Hematocrit. multiple myeloma. leukemias. or medications (cytotoxic agents. alcoholism. Immunity gradually declines after age 30 to 40 years (Rybka et al. which may contribute to lowered platelet counts and decreased platelet function (Luggen.5 gm/dl F 11. Because of the slower immune response. such as confusion. liver. multiple myeloma. diabetic acidosis. Geriatric Laboratory Values and Interpretations of Hematology Normal Adult Value Male (M) Female (F) M 13. chronic renal failure. Hodgkin’s disease. tuberculosis Hematocrit M 40% . urinary tract infections). pulmonary embolism. metastatic carcinoma.000 µl/mm3 Platelets 150.0 gm/dl Test Hemoglobin Geriatric Value M 11. or bone). severe diarrhea.65% White Blood Cells 4.500 . phenothiazides). there are definite changes in that the T cells are less responsive to infection (Fulop et al. COPD. rheumatoid arthritis ↑: Acute infection. Studies also suggest that platelet adhesiveness increases with age. post-splenectomy. Platelets (Plt). CHF. with no 222 MEDSURG Nursing—August 2005—Vol. Aging usually causes a decline in bone marrow function. Medications such as steroids also may influence the immune response (Giddens.

leukemias. An elevated ESR may indicate the presence of inflammation. gout. or fever. 2004). 1999.310 ng/dl Vitamin B12 200 . breast.Interpreting Laboratory Values in Older Adults Table 2. hepatic diseases. acute and chronic infection. protein malnutrition ↑: Hemolytic. making the RBCs heavier and causing them to settle faster (Fischbach. When there is a decrease in iron stores. hypothyroidism ↑: Acute hepatitis Serum Iron 50-150 µg/dl 60 . The acceptable reference range for the older adult is 40 mm/hour for males and 45 mm/hour for females (Brigden & Heathcote. Brigden & Heathcote. ESR measures the rate at which red blood cells (RBCs) settle in 1 hour. 2002). such as visible inflammation. SLE. Geriatric Laboratory Values and Interpretations of Erythrocyte Sedimentation Rate. hepatitis. 2000. 1991). rectum. inflammation.45 mm/hr Implications ↓: Polycythemia. and Vitamin B12 Normal Adult Value Male (M) Female (F) M 0 . Erythrocyte sedimentation rate (ESR). cancer (stomach. such as occult blood in stools and emesis.445 ng/ml F 10 . glomerulonephritis. serumferritin increases and serum transferrin decreases. bacterial endocarditis. ↓: Iron deficiency anemia. gastric surgery ↑: Metastatic carcinoma. 2000) (see Table 2). 2000) (see Table 2). leading to inadequate clotting (Beers & Berkow. bleeding peptic ulcers.20 mm/hr Test Erythrocyte Sedimentation Rate (ESR) Geriatric Value M 0 . 2000). cancer (stomach. intestine. The ability of the older adult’s body to respond to major blood loss by regenerating platelets may be inadequate.235 ng/ml 10 . 2004). multiple myeloma. resulting in iron deficiency anemia as the most common form of anemia seen in older adults (Tripp. Serum iron. Kee.22 mm/hour/year from age 20 years (Duthie & Abbasi. acute MI. Brigden (1999) noted that the erythrocyte sedimentation rate increases with age. lead toxicity ↓: Iron deficiency. pernicious. liver. 14/No. tissue damage ↓: Pernicious anemia.900 pg/ml 150 pg/ml Source: Brigden.80 µg/dl Ferritin M 15 . Iron Metabolism. cirrhosis of liver. One possible explanation is an agerelated decrease in hydrochloric acid (HCl) in the stomach (Beers & Berkow.15 mm/hr F 0 . anemias. breast). and folic acid anemias. lymphomas. 2000. liver disease. and iron stores decrease with age (Daniels. HCI is important for facilitating iron absorption in the intestines. degenerative arthritis. malabsorption syndrome. to determine a possible clinical condition. colon. total iron-binding capacity. 2000) (see Table 1). An annual rate of increase in time of sedimentation rate for older adults has been quantified at 0. confirmation of a clinical problem may be difficult. 2000 changes in numbers (Thibodeau & Patton. The decrease in transferrin levels may indicate a decrease in liver syn- MEDSURG Nursing—August 2005—Vol. 4 223 . Serum iron. but the cause of this increase is unknown. angina pectoris ↑: Rheumatoid arthritis. Because a slight elevation may or may not reflect the presence of an underlying inflammation. theophylline use. Nurses should rely on other assessment factors. pain. Inflammation causes an alteration in blood proteins. The patient also must be assessed for potential or hidden blood losses. liver damage. Serum iron is decreased in many older adults.40 mm/hr F 0 . inflammatory bowel disease. kidney). Hodgkin’s disease. rheumatic fever. Tripp. CHF.

relying on commonly accepted laboratory values in determining renal function in the older adult is difficult. or decreased hepatic function may lead to decreases in the end products of metabolism. most physicians and advanced practice nurses question the adequacy of BUN and creatinine as indicators of renal function (Kennedy-Malone. or from a deficiency of HCl. liver failure. severe vomiting. The low end of the reference range for vitamin B12 is 150 pg/mL in the older adult as opposed to 190 pg/mL in a younger adult (Brigden & Heathcote. Because it may be difficult 224 MEDSURG Nursing—August 2005—Vol. Determining renal function by creatinine clearance examination is especially useful when treating the older adult with medications because of the potential for the development of drug toxicity. Nursing assessment should include a dietary assessment for reduced intake of iron-containing foods and assessment of occult bleeding from the gastrointestinal tract. 2000). albumin is the most significantly influenced by aging (Beers & Berkow. an immune dysfunction that occurs more often in older adults. Serum creatinine is affected by both decreased GFR and body mass. Brigden and Heathcote (2000) report that serum vitamin B12 levels may decrease slightly with age (see Table 2). 2000). Assessment for pernicious anemia. decreased dietary protein intake. Fletcher. chronic renal failure ↑: Dehydration. When considering age-related changes. and numbness or tingling. 2000. including checking for neuropathies. however. Some serum protein levels. 14/No. measurement of urinary creatinine clearance takes on special significance in the older adult. renal disorders. decline in older adults (Beers & Berkow. 2000). 2000) (see Table 3). Commonly occurring reduction in lean body mass. The decline in muscle mass also results in less creatinine production. results in reduced protein degradation and nitrogen byproducts of metabolism (BUN). because most serum calcium is protein-bound (Beers & Berkow. In addition to being an indicator of disease or malnutrition. serum creatinine values thus remain within normal limits despite diminished renal clearance capacity (Brigden & Heathcote. relatively common in older adults. 2000). BUN and creatinine levels overestimate renal functioning. severe liver disease. Kee. 2000). 2004). & Plank. low-protein diet. because of the changes in body composition (Engelberg. 2000). Luggen. Vitamin B12. with a marked decrease over 90 years of age (Daniels.5. while urinary creatinine clearance is affected only by glomerular filtration (Lewis et al. Decreased iron storage and irondeficiency anemia. Total protein and albumin. both leading to insufficient intrinsic factor and insufficient absorption of vitamin B12 (Beers & Berkow. multiple myeloma ↓: Severe malnutrition.0 g/dl Geriatric Value 5. vomiting. Therefore. even with usual doses (Daniels. cancer (GI tract).6 g/dl Implications ↓: Prolonged malnutrition. 2004). The agerelated 30% to 45% decrease in functioning renal tissue and the glomerular filtration rate (GFR) leads to a decline in the creatinine clearance (Brigden & Heathcote. prolonged immobilization ↑: Dehydration. 2000) (see Table 2). 2002).7..0 g/dl 52 . Renal function. 4 .0 . 2000. The deficiency in B12 may be due to chronic atrophic gastritis. as measured by GFR or creatinine clearance. Albumin levels decrease each decade over the age of 60. low serum albumin is the most common cause of a low serum calcium level in older adults.Interpreting Laboratory Values in Older Adults Table 3. diarrhea Albumin 3. difficulty walking. 2004). & Lovell. 2002). commonly are caused by inadequate dietary intake of iron or loss of iron through chronic or acute blood loss (Beers & Berkow. As mentioned previously. should be considered whenever anemia is present.8. 2000). and creatinine (Brigden & Heathcote.0 . A decrease in the lean body mass. BUN. McDowell.68% of total protein Slight decrease Source: Beers & Berkow. such as albumin and total protein.6 . While all serum proteins are reduced. Changes in protein may reflect decreased liver functioning or inadequate nutritional intake (Beers & Berkow. 2000) (see Table 4). 2002 thesis (Lab Tests Online. 2004). Geriatric Laboratory Values and Interpretations of Serum Proteins Test Total Protein Normal Adult Value 6. such as weakness.

shock. hepatitis. SGPT) Serum Aspartate Aminotransferase (AST. pre-renal failure ↓: None for older adult ↑: Renal failure. cholecystitis. prostate. Estimating Creatinine Clearance Values for Men Creatinine clearance = (140 . rheumatoid arthritis. necrosis of liver. healing fractures.130 U/I 30 . 4 225 . diabetic neuropathy ↓: Mild-to-severe renal impairment.age in years) x (body weight in kilograms) (72 x serum creatinine in mg/dl) Table 6.. angina pectoris. malnutrition.5 mg/dl 0.1. muscle trauma related to IM injections ↓: Hypothyroidism.5 . 2002 MEDSURG Nursing—August 2005—Vol. 2000.12 IU/I 9 . cancer (liver). CHF. Geriatric Laboratory Values and Interpretations of Selected Renal Function Tests Test BUN Normal Adult Value 5 .25 mg/dl Geriatric Value 8 . acute alcohol intoxication ↓: Diabetic ketoacidosis ↑: Acute MI. Engelberg et al. acute MI. Kennedy-Malone et al. SGOT) Alkaline Phosphatase Geriatric Value 17 . Geriatric Laboratory Values and Interpretations of Hepatic Enzymes Normal Adult Value Male (M) Female (F) 10 .1. pernicious anemia ↑: Cancer (liver. 14/No. ulcerative disease ↓: None ↑: Cirrhosis of liver.35 U/I Test Serum Alanine Aminotransferase (ALT.135 ml/min Formula Source: Brigden & Heathcote. nephritic syndrome 8 .140 U/I Gamma-GlutaMyltransferase (GGT) M 4 . high protein diet.55 U/I Source: Brigden & Heathcote. pancreatitis. low protein diet. 2004. SLE. 2000. bone). alcoholism.28 mg/dl or slightly higher Implications ↓: Liver damage.2 mg/dl Creatinine Clearance 85 . diabetes mellitus. hepatitis. kidney. Kee. thiazide use ↑: Hypothyroidism. pancreas. lung). liver.. Table 5. cancer (liver. multiple myeloma.6 .23 IU/I F 3 .38 U/l 18 .Interpreting Laboratory Values in Older Adults Table 4. malnutrition ↑: Dehydration. GI bleeding. leukemia. acute MI. liver necrosis.30 U/I 20 . hyperthyroidism. liver necrosis. hepatitis. pancreatitis. leukemia. breast. renal-vascular hypertension Creatinine 0. 2000.30 U/I Implications ↓: Exercise. musculoskeletal disease and trauma. overhydration. salicylates ↑: Viral hepatitis. CHF. CHF. amyotrophic lateral sclerosis.

starvation. pancreatitis ↑: Hyperparathyroidism. renal calculi ↓: Vomiting. cancer (pancreas).85.. alcoholism. hypothyroidism.120 mg/dl Implications ↓: Hypoglycemia. alcoholic cirrhosis. malnutrition. dehydration. liver). For women. crushing injury. 2002 Table 8. breast. crushing injury. Addison’s disease Calcium 4. atherosclerosis. diabetic acidosis ↑: Acute renal failure. Kennedy-Malone et al. The aging 226 MEDSURG Nursing—August 2005—Vol.110 mg/dl Geriatric Value 70 . benign prostatic hypertrophy.3 mEq/l Slight increase Source: Kee.5 . stress. biliary obstruction. kidney). anemia ↑: Acute MI. cirrhosis ↓: Chronic obstructive lung disease ↑: Acute MI. Nurses should not assume that all changes in renal function are due to aging. hyperparathyroidism.5. lung. 4 . starvation. prolonged immobilization. acute MI. high-carbohydrate diet High-Density Lipoproteins (HDL) Triglycerides M >45 mg/dl F >55 mg/dl M 40 . 2002. hypertension. 2004).Interpreting Laboratory Values in Older Adults Table 7. malnutrition. protein malnutrition. Normal ranges for creatinine clearance are 104 to 140 ml/minute for men and 87 to 107 ml/minute for women (see Table 4). the value determined from the formula is multiplied by 0. and diabetic neuropathy are also causes and should be ruled out (Lewis et al. high-fat diet ↓: Hyperthyroidism.160 mg/dl F 35 . Tripp. cirrhosis of liver ↑: Diabetes mellitus. 2000 to perform a creatinine clearance on the older patient. 1997. 2000). Martin et al. Geriatric Laboratory Values and Interpretations of Blood Lipids Normal Adult Value Male (M) Female (F) <200 mg/dl Test Cholesterol Geriatric Value M may increase by 30 mg/dl F may increase by 55 mg/dl M increases by 30% between ages 30 and 80 F decreases by 30% between ages 30 and 80 M increases by 30% F increases by 50% Implications ↓: Hyperthyroidism. malnutrition. lack of calcium intake. cancer (stomach. renal failure. the formula is shown in Table 5 (Brigden & Heathcote. Geriatric Laboratory Values and Interpretations of Glucose. 14/No. stress..5 mEq/l No change Potassium 3. diarrhea.135 mg/dl Source: Brigden & Heathcote. a formula can be used to estimate creatinine clearance values. exercise ↑: Acute MI. multiple myeloma. Kee. bladder. diabetes mellitus. Chronic urinary tract infections. malignant neoplasms (bone. hypothyroidism. multiple fractures. acidosis (metabolic or lactic). nephritic syndrome. alcoholism. 2004. Selected Electrolytes Test Serum Glucose Normal Adult Value 70 . prostatic tumors.5. Hepatic enzymes. CHF ↓: Diarrhea. For men. malignant myeloma. adrenal gland hyperfunction.5 . pancreatitis.. hypothyroidism. 2000. chronic renal failure. uncontrolled diabetes mellitus.

14/No. very low-density lipoprotein (VLDL). 1990). from 70 mg to 120 mg/100 ml (Tripp. If insulin receptors do not respond to the same fasting level of glucose in old age as they did when the patient was younger. 2004).. 1997). the enzymes gamma-glutamyl-transferase (GGT). 2004). & Hazen. pneumonia. 1997).. most researchers use the same reference values as for younger adults (see Table 8). 4 . 2000). glucose intolerance without insulin-secretion changes could be the explanation. some very old adults will have decreased cholesterol levels (Tietz et al. A reference value for the 2-hour postprandial glucose tolerance blood sugar test (PPBS) is calculated with the following formula (Brigden & Heathcote. 1997 process does not significantly influence most hepatic laboratory test values (for example. and triglycerides.. 1997). Glucose. 1997). AST increases slightly for individuals 60 to 90 years of age to 18 U/L to 30 U/L (Tietz et al. No increase is seen in adults over 90 years old.(0.1 . however. in fact. & Wekstein. Older individuals may have lower glucose levels. 2000). Serum potassium has been reported to increase slightly with age (Kennedy-Malone et al. Stiffening of the elastic lung structures. Serum alanine aminotransferase (ALT. decreased number of functioning alveoli. and decreased strength of the diaphragm are age-related changes that decrease respiratory functioning (Martin et al. If the individual has a low serum albumin. Shuey. and lipids. Alkaline phosphate (AP) increases with age to a level of 30 U/L to 140 U/L and is associated with age-related malabsorption. 2000. however.. Lipid profile.Interpreting Laboratory Values in Older Adults Table 9.. SGOT).. The decreased respiratory functioning results in a decrease in the partial pressure of arterial oxygen tension (PaO2). the serum calcium level will most likely be low as mentioned previously. 2000) (see Table 8). 2000) (see Table 6). However. 1997). The mean HDL increases 30% in men but decreases 30% in women between ages 30 and 80 (Brigden & Heathcote. high-density lipoproteins (HDL). Serum cholesterol increases as much as 40 mg/dl by age 60 in men and age 55 in women (Brigden & Heathcote. which is responsible for impaired glucose tolerance in 25% of individuals over age 75 (Kennedy-Malone et al. 2000): • 2-hr PPBS (mg/dl) = 100 + age in years (for patients over age 40) Serum electrolytes. 2002. In most reports.325 x age) Implications ↓: Emphysema.. Martin et al. The normal reference range for serum glucose is broader for older adults. Calcium levels increase in older patients (ages 60 to 90) but decrease in the very old over age 90 (Martin. or decreased liver or renal functioning (Brigden & Heathcote. Lipid-related changes in aging adults younger than 70 years old are initially noted as increases in cholesterol. serum aspartate aminotransferase (AST.. The initial increase can be explained by a decrease in serum pH and an increase in parathyroid hormone levels found in older individuals (Tietz et al.100 mmHg Geriatric Value 100. The arterial pressure decreases approximately 5% every 15 years starting at age 30 227 MEDSURG Nursing—August 2005—Vol. and alkaline phosphatase are affected (Brigden & Heathcote. Arterial blood gases (ABGs). Larsen. SGTP) levels peak about 50 years of age and gradually fall to levels below those of younger adults by age 65 (Kelso. Geriatric Laboratory Values and Interpretations of Selected Blood Gases Test PaO2 Normal Adult Value 75 . bone disorders. bilirubin. 1997). higher serum insulin levels are more commonly seen in older adults and may suggest insulin resistance.) While lactic dehydrogenase (LDH) is not affected by aging. ammonia. Serum glucose levels increase slightly but steadily with age in parallel with a decrease in glucose tolerance. GGT levels increase with aging (Tietz. Kee.45 mmHg 2% per decade Source: Brigden & Heathcote. 2000). electrolyte values remain well within the standard reference values for older adults. Reference values for ABGs differ in older adults from those of younger adults. pulmonary edema ↑: Hyperventilation ↓: Hyperventilation ↑: COPD PaCo2 35 . 2004). Triglyceride levels increase by 30% in men and 50% in women between the ages of 30 and 80 years (see Table 7). reflecting poor nutritional status or overall loss in body mass (Kennedy-Malone et al.

69: 0. Are his diagnostic test results helpful in explaining his fatigue and weakness? What really is happening with him? MEDSURG Nursing—August 2005—Vol. Triiodothyronine.45 ng/ml Ages 60 .5. Doe’s laboratory reports illustrate the confusion surrounding evaluating laboratory data for the older adult. nurses must ask.3 ng/ml Post-radical prostatectomy 0. 2000. 2002 (Brigden & Heathcote. Prostate-Specific Antigen Normal Adult Value Male (M) Female (F) 4. The bicarbonate-ion concentration also increases with age.3 ng/ml Source: Beers & Berkow. benign prostatic hyperplasia ThyroidStimulating Hormone TSH) Prostate-Specific Antigen (PSA) 0. Because of false positives and false negatives. “What test results are significant and suggest the presence of disease? Which results suggest changes in patient conditions that require further assessment or interventions?” Greater understanding of how to interpret laboratory test values in relation to the clinical picture for the older adult allows nurses to provide age-appropriate assessments and interventions.1 – (0.0.5 .0 to 6. results from this test alone should not drive therapy.3ng/ml.0 ng/ml Ages 70 .11. as well as the incidence of polypharmacy. 2004). thyroiditis. corticosteroids ↑: Hyperthyroidism..79: 0. 2002.0 to 5. Often.0 . 2004). a 20% change in T3 occurs during the lifetime of the older adult (Beers & Berkow.0 . Changes in thyroid function in the older adult may be the most challenging problem for nurses as they try to separate disease from aging changes. 14/No. Prostate-specific antigen (PSA). Daniels.Interpreting Laboratory Values in Older Adults Table 10. primary hyperthyroidism ↑: Primary hypothyroidism. may be a source of confusion in the clinical interpretation of laboratory results.0 . a corresponding increase in the carbon dioxide pressure (pCO2) of approximately 2% per decade occurs after age 50. A formula (Brigden & Heathcote. Free thyroxine (FT4) levels decrease progressively with age (Kennedy-Malone et al. The presence of multiple diseases.5 .3 ng/ml (Daniels. viral hepatitis.3 . Geriatric Laboratory Values and Interpretations of Thyroxine.0 µlU/ml Slight increase PSA 1. Typically. Men who have had a radical prostatectomy are expected to have values of 0. 2000). protein malnutrition. Triiodothyronine (T3) shows substantial decreases in ages 30 to 80 years. 2000) (see Table 9). 2000) (see Table 10). Reference ranges for PSA with age are (a) 60 to 69 years: 0.. myasthenia gravis ↓: Excessive thyroid hormone replacement.6. 2000) has been devised to estimate arterial oxygen in older adults: • PaO2 (mmHg) = 100.5.0 to 0.0 . Hypothyroidism is seen in 2% to 6% of the general population over age 70 (KennedyMalone et al.325 X age in years) Additionally. Relevance of PSA values to support aggressive treatment is controversial (National Cancer Institute. balancing out the pO2 and maintaining a normal blood pH (Brigden & Heathcote. 2002) (see Table 10). Kee. Graves’ disease.59: 0.45 ng/ml Ages 50 . thyroid hormone resistance ↑: Prostate cancer. Mr.6 µg/dl Implications ↓: Hypothyroidism. and (b) 70 to 79 years: 0.2. Implications Laboratory test results inform health care providers of a patient’s changing condition. 4 228 .0 ng/ml. Because an elevation in the PSA could be indicative of benign prostatic hypertrophy or prostate cancer. Thyroid function tests. 2004).5 µg/dl Test Thyroxine (T4) Geriatric Value 3. the agerelation variation of PSA increases difficulty in treatment decisions.8.

9(12). Pure & Applied Chemistry. Alarcon. Dirkson. 4 229 . J. 46(10). Larsen. & Lacombe..nci.) (pp.F. ■ References Beers. Reed. (1999). Thibodeau. Alterations in hematologic function.S. Pajak.R. R. & Heathcote.. In S. Clinician’s guide to laboratory medicine. J. Engelberg. 69. S. In P. T. A. Emergency Medicine Clinics of North America. pp.R.T. (2000). G. 122(13). McCance (Eds. G... Daniels..). E.. Fulop. Retrieved November 15. A. from http://cis. Kee. Leszek. 1413-1430. Louis: Mosby. S. L.J.. M. (2004). L. S. Delmar’s guide to laboratory and diagnostic tests. Landahl. they also might be due to protein malnutrition. Each laboratory may have variations in the reference ranges due to techniques and equipment... National Cancer Institute. (2000). A. Manson. American Family Physician. Need Additional CE Credits? Visit the MEDSURG Nursing Journal section of the AMSN Web site for online CE articles. S. 241254. Management of diabetes mellitus in the nursing home. Laboratory testing: Current recommendations for older adults. Annals of Long Term Care Nursing Home. (1997). Reference ranges and what they mean. (1998). K. 14/No. N... Postgraduate Medicine.G.. Retrieved November 15. New York: Delmar-Thomson. et al. A. Desai. 1379-1387.). E. which is suspected because of his low body weight and recent weight loss. Lab Tests Online. Clinical laboratory values in the aging population. Clinical utility of the erythrocyte sedimentation rate.html Luggen.D. & Wekstein. Brigden. Huether.. T. Medical-surgical nursing (6th ed.nih. Heitkemper. Martin. et al. Duthie. & S. 3). A manual of laboratory and diagnostic tests (7th ed... M.. (2004). Kelso. Hess (Eds.. J. Linteau. M. et al. Cleveland: Lexi-Comp. 41-50.). (2004). Goulet. & K. 621-626. The Merck manual of geriatrics (Vol. NJ: Pearson Education. J. Zacynska. & Pagana. A. 6. J. (1991). (2001). NJ: Merck Research Laboratories. (2004).. Davis. (2002). Laboratory values and implications for the aged.). R. Orzechowska. Louis: Mosby. Douziech. A. Upper Saddle River.L.). Gerontologic nursing (2nd ed. Siemieniec. from http://labtestsonline.305. Mosby’s manual of diagnostic and laboratory tests (2nd ed). Lueckenotte (Ed.. Geriatrics. (2004). Tripp. & features/ref_ranges-6. M. Better understanding of interpretation of diagnostic test results in older adults will allow nurses to feel confident about the care they provide. St. N. www. 60. J. (2000).org/under standing/analytes/tibc/test..J. B. 65(3). Shuey. Interpreting laboratory values in older surgical AORN Journal. Laboratory values in the older adult. Fischbach. Philadelphia: Lippincott. Louis: Mosby.. (2004).C. St. Sester. Problems in interpreting laboratory tests.. Giddens. R. TIBC and transferrin. 100-107. Fletcher. Toward healthy aging: Human needs and nursing response (6th ed. Heine. Desgeorges. (1997). However. Understanding pathophysiology (3rd ed. Lueckenotte (Ed. Sester. 115135). 65(5). Nurses must work closely with laboratory personnel and pathologists to be informed about changes in reference ranges for older adults in a specific laboratory.) (pp. BR413-417. 185(10).). Louis: Mosby. Pagana. Nurses also should educate other health care professionals about age-related variations in acceptable laboratory values. Age-related antiviral nonspecific immunity of human leukocytes. Philadelphia: F. 297. K. Tietz. 51-53. St. Blood haemaglobin declines in the elderly: Implications for reference intervals from age 70 to 88. Laboratory and diagnostic tests with nursing implications (6th ed. S.A.L. (2001). 2004. 145-158.html Lab Tests Online. Brigden.. Nursing assessment: Hematologic system.). & Isa-Pratt. F. (2004). Louis: Mosby. D. McDowell.) (pp... H.. (Eds. S. Gerndt. P. Age-related decrease in adenovirus-specific T cell responses. T. Retrieved November 15. 14431450. Cyclodextrin modulation of T lymphocyte signal transduction with aging.C. 586-614). R. (1990). Kennedy-Malone. Rybka. G. M. I. & Abbasi. K. St. Management guidelines for nurse practitioners working with older adults. M. (2004). A. & McCance.). B. & Hazen. St. labtestsonline. 537-578).. S. U. Interpretation of laboratory test results allows nurses to rule out diagnoses that are not pertinent. Lipfert. & Patton. European Journal of Haematology. St.Interpreting Laboratory Values in Older Adults Perhaps the slightly elevated renal function tests indicate normal changes of aging. MEDSURG Nursing—August 2005—Vol. (2002). Medical Sciences Monitor.. 2004. (2002). T. 688-704). 8(2).. Pharmacology CE articles now available.. Louis: Mosby.H. Lewis. Louis: Mosby. T. 107(7). Structure and function of the body (12th ed. but also assists in the examination of a broad spectrum of possibilities. from http://www.. St.. In S. Mechanisms of Aging and Development.). S.. The prostate-specific antigen (PSA) test: Questions and answers. & Mooradian. (Eds)..W.htm Nilsson-Ehle. In A.H. Obtaining serum protein and urinary creatinine studies as well as a thorough nutritional assessment might assist in defining the diagnosis. & Berkow. Inc. & Lovell.medsurgnurse. K. Jagenburg.) (pp. (2000). Ebersole & P. In A. (2003)... Whitehouse Station. (2000). D. (2002). Gerontologic nursing (2nd ed. & Plank. Laboratory and diagnostic tests. (2002). K. Journal of Infectious Diseases.. 2004.

Sign up to vote on this title
UsefulNot useful