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; • Absorption is delayed but the
increased pH extent of absorption is not
• Reduced gastrointestinal affected
motility
• 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 • Decreased metabolism and delay
liver due to decreased cardiac breakdown of medications
output resulting in prolonged duration of
 action, accumulation and drug
toxicity

Excretion
• Decreased renal blood flow
• Reduced functioning nephrons
• Decreased renal efficiency
• Decreased rates of elimination
• Increased duration of action
• 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