○ Management:

CARE OF OLDER ADULTS ■ sufficient fluid intake

■ use of sugar free hard candy and
gums
OUTLINE ■ importance of nutrition

I. GASTROINTESTINAL SYSTEM ● Decrease gustatory

● MOUTH
○ taste buds atrophy with age
● ESOPHAGUS
● STOMACH ○ decreased ability to discriminate sweet, sour,
● SECRETIONS salty, and bitter tastes
● SMALL BOWEL ○ elevated threshold for salt and bitter taste
● LARGE BOWEL
● ANORECTAL ● Decrease olfactor
II. ACCESSORY ORGAN ○ Increases by about 50%
● LIVER
● GALLBLADDER
● PANCREAS ESOPHAGUS
III. COMMON GASTROINTESTINAL PROBLEMS
● Preserved esophageal functioning until around 80
AMONG THE ELDERLY
● Stiffening of the esophageal wall
● DIVERTICULA
● DIVERTICULITIS ● les sensitivity to discomfort and pain
● CONSTIPATION ● gag reflex appears to be around 40% of health older
● STOMACH CANCER adults
● PANCREATIC CANCER ● common complaints: dysphagia, heartburn and chest
IV. RENAL SYSTEM pain
● KIDNEY
● HORMONES
● BLADDER STOMACH
● UTERUS AND URETHRA
● Declines in peristaltic contractions and stomach
emptying do no appear to be clinically significant
GASTROINTESTINAL SYSTEM
SECRETIONS
MOUTH ● No change in gastric acid secretions
● Decline in pepsin, bicarbonate and sodium ion
secretions and prostaglandin content
● Difficulty chewing and swallowing
○ Edentulous with decayed for diseased teeth
○ Age related changes in teeth (less sensitive SMALL BOWEL
and more brittle)
○ Atrophy of muscles
● 40% older adults complain of dry mouth ● No change or minor changes in contraction
○ Stable salivary gland function ○ No change in transit time
○ May be due to medications, nutritional ● Bacterial overgrowth is a common clinical
deficiencies, disease, and treatment therapies ○ Results to malabsorption and malnutrition
● No changes in nutrient absorption
● PERIODONTAL DISEASE ● Vitamin absorption
○ inflammation of gums extending to the ○ INCREASE: Vitamin A
○ DECREASE: Vitamin D, Zinc, and Calcium
underlying tissue, roots of tooth shrinks and
○ NO CHANGE: Vitamins B1, B12, C, and Iron
the gingiva retracts.
○ causes tooth loss in elderly
○ predispose older adult to systemic infection
LARGE BOWEL
Additional Notes:
Health Promotion to Prevention:
- soft bristle for elderly clients ● Loss of intestinal neurons and inhibitory nerve
connection to the smooth muscle
- avoid smoking ○ Decreased ability to inhibit colonic contractions
- dental floss (for natural teeth) and/or by decreased colonic relaxation
○ Increased transit time
○ Increased colonic pressure
● XEROSTOMIA (dry mouth) ● Increased fibrous tissue in the rectum
○ lead to changes in taste sensation ● Thinning external anal sphincter with thickening internal
sphincter
○ Cause: reduced production of saliva
■ Oral mucosa susceptible to infection
○ Factors: some medications and smoking

1
 ○ Chronic constipation
ANORECTAL ○ Hiatal hernia
○ Low fiber diet
● Increased fibrous tissue in the rectum
● Thinning external anal sphincter with thickening internal
sphincter DIVERTICULITIS

ACCESSORY ORGANS

LIVER

● Decrease size and perfusion by 30-40%

● Hepatocytes undergo structural alterations
● Compensated due to liver’s large reserve capacity and
the hepatocytes’ ability to regenerate after damage

GALLBLADDER
● 15% diverticulosis results to diverticulitis
● No structural changes except bile ducts ● Inflammation of or around a diverticular sac caused by
● Less bile during digestion retention of undigested food, stool and bacteria
○ Increasing bile volume ● Manifestation
○ Increasing risk for gallbladder stones ○ constipation/diarrhea
○ Left sided quadrant pain
○ Mucous and/or blood in the stools
○ Flatulence, nausea and vomiting
PANCREAS

● Decreases in weight with age CONSTIPATION

● Histological changes: fibrosis and cell atrophy
● COMPENSATED by large reserve capacity of the
pancreas ● Common concern for older adults
● Condition which there is an infrequent passage of dry
hard stools
● Decrease frequency of bowel (as compared to usual
COMMON GASTROINTESTINAL PROBLEMS AMONG pattern)
THE ELDERLY ● Contributing factors:
○ Inactive lifestyle
○ Low fiber and low fluid intake
○ Depression
DIVERTICULA ○ Laxative abuse
○ Some medications

NURSING DIAGNOSIS
1. Constipation related to decreased fluid and/or bulk in
diet
2. Pain related to bowel obstruction
3. Knowledge deficit: disease process, prevention and
treatment

NURSING MANAGEMENT
● High fiber diet
● Adequate fluid status (2000ml/day)
● Avoiding foods with high roughage
○ Nuts, popcorn, celery and other fresh
vegetables
● 20% of over 60 years old
● Pain management
● Unknown cause
○ May be related to lack of blood supply or ○ Antispasmodic, analgesics
nutrition of bowel in older adults ● Bowel rest (IV fluids and NPO status)
● Risk factors
○ Obesity
PRINCIPLES OF BOWEL PROGRAMS TO PREVENT
CONSTIPATION
● Start with a clean bowel prior to initiating a program or
protocol.
● Try all natural means first: fiber, fluids, activity, timing,
positioning.
● Be sure the person is taking adequate fiber and fluids
before adding medications
● Change only one item at a time in the program
● Stool softeners are given for hardened stool and the
person must drink at least a liter of fluid per day for
them to be effective
○ Colace
○ Suppositories: dulcolax
○ Soap suds Enema
● Peristaltic stimulators are useful when the person is
unable to move the stool down into the rectum.
● Use the least causative type of suppository that is
effective for the older person.
● Avoid the use of bedpans – have the person sit upright
on the toilet or commode.
● Avoid the regular use of enemas.
KIDNEY
● Shrink in length and weight
● Decrease in size and number of nephrons
- # of glomeruli decreases to 30-40% by 90
● Glomerular filtration rate of 300ml/min
- Decreases 10% per decade beginning 20
- No elevation of serum creatinine due to
decline in muscle mass
● Decreased number and length of renal tubules
- Decrease in reabsorption and excretion
functions
HORMONES
●
● Decrease level of plasma renin and aldosterone
beginning 40 years of age
- Impaired ability to conserve salt
● Increased release of antidiuretic hormone
● Decreased serum calcium levels
- Increased parathyroid hormone
● Decreased vitamin D metabolism
- Increase need for vitamin D supplementation

Additional notes: BLADDER

● Diarrhea - increase peristaltic movement
● Constipation - decreased peristaltic movement
● Decreases in size and develops fibrous matter in the
● Best time/ most time to feel the urge to defecate: bladder wall
morning - Decrease in filling capacity and ability to
● If stool is impacted, remove stool manually withhold voiding
● Detrusor muscle dysfunction

URETERS AND URETHRA

STOMACH CANCER
● Insidious
● Often seen in older men age 65-74
● Unknown cause, contributed by H. pylori infection
● Mimics ulcers and gastritis
- Symptoms are vague until cancer has spread
throughout the body
- Epigastric pain, anorexia, nausea, and
difficulty swallowing
● NO age-related changes in the ureters
● URETHRA:
- Women: decreased length and thinning of the
urethra; weakening of sphincters
- Men: prostate enlargement around the bladder
and urethra

PANCREATIC CANCER
● Found more often in older adults
● Leading cause of death for this age group (men)
● Strikes those between 60 and 80 years of age
● Poor prognosis
- Fewer than 20% survive after 1 year of
diagnosis and only 3% 5 year survival rate
RISK FACTORS:
- Cigarette smoking
- Family history
- Diabetes
SYMPTOMS:
- Generally occur late in the course
- 90% individuals have metastases upon diagnosis
● Nausea, vomiting, anorexia
● Weight loss, depression
● Excessive belching
● Jaundice and itching

RENAL SYSTEM