COMMON HEALTH PROBLEMS ASSOCIATED WITH AGING

Geriatric Syndromes
 Geriatric syndromes refer to a number of problems commonly experienced by the elderly that
do not fit into discrete disease categories.

Frailty
 The term “frail” is used to describe elderly people who are at higher risk for adverse health
outcomes.
 The most widely used criteria include weight loss, weakness, exhaustion, or poor endurance,
slowness and low activity

Impaired Mobility
 Common causes include strokes, Parkinson’s disease, diabetic neuropathy, cardiovascular
compromise, osteoarthritis, osteoporosis, and sensory deficits.
 To avoid the downward spiral of immobility:
o Encouraged to stay as active as possible
o Bed rest should be kept to a minimum
o When bed rest cannot be avoided, patients should perform active range of motion
exercises and strengthening exercises
o Caregivers should perform passive ROM for affected extremities
o Frequent position changes

Dizziness
 Dizziness (a sensation of disorientation in relation to position), vertigo (a spinning sensation),
near syncope and disequilibrium are common in the elderly.
 Causes may include build up of earwax or ear wax impaction, dysfunction of the cerebral cortex,
cerebellum, brain stem, proprioreceptors, or vestibular system.
 These can result to loss of balance and subsequent fall and injury.

Falls and falling

 Injuries rank ninth as a cause of death for older people, and falls are the leading cause of injury
in the elderly.
 The most common fracture occurring from falls is hip fracture, the results from both
osteoporosis and the situation that provoked the fall.
 Causes of falls:
o Extrinsic factors include changes in the environment or poor lighting
o Intrinsic factors are physical illness, neurologic changes or sensory impairment, mobility
difficulties, medication effects, foot problems or unsafe footwear, postural hypotension,
polypharmacy, medication interactions and use of alcohol.
 Prevention of falls:
o Adequate lighting with minimal glare and shadow through the use of a small area lamps,
indirect lighting, sheer curtains to diffuse direct sunlight, dull rather than shiny surfaces,
and nightlights.
o Sharply contrasting colors can be used to mark the edges of stairs.
o Grab bars by the bathtub, shower, and toilet are useful
 o Avoid use of loose clothing, improperly fitting shoes, scatter rugs, small objects, and
pets that can create hazards

Urinary Incontinence
 Transient causes are:
o D – delirium and dehydration
o R – restricted mobility and restraints
o I – inflammation, infection, and impaction
o P – pharmaceuticals and polyuria
 Other causes include neurologic or structural abnormalities like weakened pelvic floor
 Detrusor hyperactivity with impaired contractility is a type of urge incontinence that is seen
predominantly in aging population wherein they have no warning that they are about to urinate.
They often void only small amounts of urine or none at all and then experience a large volume of
incontinence after leaving the bathroom.
 Urinary incontinence has been associated with depression and low self-esteem and may reduce
the patient’s quality of life by causing restriction in social activities.
 Nursing Interventions:
o Kegel’s exercises
o Having quick access to toilet facilities
o Wearing clothing that can be unfastened easily
o Anticholinergics may be inappropriate for elderly due to adverse effects of dry mouth,
slowed GI motility and confusion.
o For detrusor instability, prompted timed voiding and clean intermittent catheterization

Increased Susceptibility to infection

 Age-related loss of physiologic reserve and chronic illnesses contributes to susceptibility to
infection
 Common infections in older people are pneumonia, UTI, TB, gastrointestinal infections and skin
infections
 Influenza and pneumococcal vaccinations decreases the risks of hospitalization of the elderly.

Altered Pain and Febrile Responses

 Physical indication of illness cannot be relied on for the diagnosis of potential life threatening
problems in the older people.
 The response to pain in older people may be lessened because of reduced acuity of touch,
alterations in neural pathways, and diminished processing of sensory data. MI, hiatal hernia or
upper GI distress and acute abdominal conditions may exist without pain.
 The baseline body temp of eldery is 1F lower than it is for younger people. A temp of 37.8C or
100F with systemic symptoms may signal infection and a temp of 38.3C or 101F indicates a
serious infection.
 Nurses must be alert to other subtle signs of infection such as mental confusion, increased
respirations, tachycardia, and skin color.

Altered Emotional Impact

 An illness that requires for hospitalization or a change in lifestyle is an imminent threat to well-
being. Admission to the hospital is often feared and actively avoided.
 Older people admitted to the hospital are at high risk of disorientation, confusion, change in
level of consciousness, and other symptoms of delirium as well as anxiety and fear. In addition,
economic concerns and fear of becoming a burden to families often lead to high anxiety.
 Nursing interventions
o Nurses must recognize the implication of fear, anxiety and dependency.
o Encourage autonomy, independent decision making and early mobilization.

Altered Systemic Response

 The decline in organ functions depletes the body’s ability to respond to full capacity.
 Older people may be unable to respond effectively in acute illness. Homeostasis is jeopardized.
 The ability to respond to definitive treatment is impaired.
 Nurses should monitor all the body system functions closely, and be alert to signs of impending
systemic complications.
Pharmacologic Aspects of Aging
 On average, the elderly especially those people 85 years of age and older, take between 5 or 8
medications each day;
 The most common drug classes prescribed are psychotropic and anti-inflammatory agents.
 Adverse drug reactions are common in elder people because of medication interactions, multiple
medication effects, incorrect dosages, and the use of multiple medications (polypharmacy)
 Combining multiple medications with alcohol, as well as over the counter and herbal
medications complicates the problem.
 Medications such as antipsychotics, anticoagulants, diuretics, and antiepileptics carry high risks
for older patients.
 Effects of medications may also include altering nutritional status and electrolyte imbalance in
the elderly.

Altered Pharmacokinetics
 Alteration in absorption, metabolism, distribution, and excretion occur as a result of normal
aging and may also result from drug and food interactions

Age-Related Changes Effect of Age-related Changes

Absorption
 Reduced gastric acid; increased pH  Absorption is delayed but the extent of
 Reduced gastrointestinal motility absorption is not affected
 Prolonged gastric emptying

Distribution
 Decreased albumin sites
 Reduced cardiac output
 Impaired peripheral blood flow
 Increased percentage of boy fat
 Decreased lean body mass
 Highly protein bound medications have
fewer binding sites leading to increased
effects and accelerated metabolism and
excretion
 Decreased distribution due to decreased
perfusion
 Increased ability to store fat soluble
medications that may cause accumulation,
prolonged storage and delayed excretion
 Higher peak level of medication

Metabolism
 Decreased perfusion of the liver due to  Decreased metabolism and delay
decreased cardiac output breakdown of medications resulting in
prolonged duration of action,
accumulation and drug toxicity

Excretion
 Decreased renal blood flow  Decreased rates of elimination
  Reduced functioning nephrons  Increased duration of action
 Decreased renal efficiency  Danger of accumulation of drug and
toxicity

Nursing Implications:
 A thorough medication history should be comprehensively assessed
 Explain the purpose, adverse effects, and dosage of each medication
 Provide the schedule of medication in writing
 Encourage the use of standard containers without the safety lids
 Use of multiple-day, multiple-dose medication dispenser
 Destroy or remove old, unused medications
 Encourage the patient to inform the health care provider about the use of over-the-counter
medications and herbal agents, alcohol and recreational drugs

MENTAL HEALTH PROBLEMS IN THE OLDER ADULT

 Changes in cognitive ability, excessive forgetfulness, and mood swings are not a part of normal
aging.
 The susceptibility to depression, delirium , and incidence of dementia increases with age

Depression
 Depression is the most common affective or mood disorder of old age
 Among the elderly, depression can follow a major precipitating event or loss and is often related
to chronic illness or pain. It may also be secondary to medication interaction or an undiagnosed
physical condition
 Signs of depression include feelings of sadness, fatigue, diminished memory and concentration,
feelings of guilt and worthlessness, sleep disturbances, appetite disturbances with excessive
weight loss or gain, restlessness, impaired attention span and suicidal ideation.

Alcohol and Drug Abuse

 These may be related to depression.
 Alcohol abuse is especially dangerous in older people because of age-related changes in renal
and liver function and the high risk of interactions with prescription medication.
Delirium
 Delirium, often called acute confusional state, begins with confusion and progresses to
disorientation.
 It is a common and life-threatening complication for the hospitalized elderly and the most
frequent complications of hospitalization occurring to older patients postoperatively or those in
intensive care.
Dementia
 The cognitive, functional, and behavioral changes eventually destroy a person’s ability to
function. The symptoms are usually subtle in onset and often progress slowly until obvious and
devastating
Types of Dementia
 Alzheimer’s disease (AD)
 Vascular or multi-infarct dementia
 Parkinson’s disease
 AIDS-related dementia
 Pick’s disease