Ageing is a complex process that involves a decline in biological functions and is accompanied by psychological, behavioral, and other changes.

• All cells experience changes with ageing, becoming larger and less able to divide and multiply. 

• There is an increase in pigments, and vital organs begin to lose some function as we age.

  • Ageing changes occur in all of the body's cells, tissues, and organs, and these changes affect the functioning of all body systems as well as the overall health and well-being of an individual. This can lead to a range of age-related conditions, including decreased mobility, cognitive decline, and increased susceptibility to diseases.

Some systems begin ageing as early as age 30, while other ageing processes are not common until much later in life

• Unlike the changes of adolescence, which are predictable to within a few years, each person ages at a unique rate.

• Some signs of ageing can be seen from the outside, such as wrinkles and grey hair, while others are not visible.

Respiratory Health

• Respiratory problems can develop more easily and be more difficult to manage

• Changes can be noted in upper airway passages.

• Decreased in:

  • Lung capacity

  • Tissue elasticity

  • Weaker respiratory muscles

• All these combine, increases the amount of work or effort that it takes for elderly to breathe efficiently.

• Increase in the anterior-posterior chest diameter

o   Decrease cough reflex

§  Harder and more work to expel foreign material or phlegm

§  Risk for pneumonia

§  Breathing difficulties

§  Abnormal breathing patterns (sleep apnea)

Nose

·        Experiences connective tissue changes

o   Reduces support

o   Can cause septal deviations

§  Can interfere with the passage of air

·        Reduced secretions from submucosal gland

o   Mucus in the nasopharynx to be thicker and harder to expel

§  Causes chronic tickle in the throat and coughing

·        Hair in nostrils (cilia) becomes thicker with age

o   Can accumulate greater amount of dust and dirt particles during inspiration

Nursing Interventions

·       Blowing nose and mild manipulation using tissue may adequately rid the nostrils of these particles

·        If particles are difficult to remove, use a cotton-tipped applicator moistened with warm water or saline solution to loosen them

o   Do not insert cotton-tipped applicator too far into the nose; trauma can easily result.

·        Any nasal obstruction not easily removed should be brought to the physician’s attention.

Trachea

·        Stiffens due to calcification of its cartilage

·        Reduced cough due to blunting of laryngeal and coughing reflexes

·        Gag reflex is weaker due to reduced number of nerve endings in the larynx

Lungs

·        Becomes smaller in size and weight

·        Weaker connective tissues responsible for respiration and ventilation

·        Decreased elastic recoil of the lungs during expiration

o   Less elastic collagen and elastin

o   Expiration requires active use of accessory muscles

·        Alveoli are less elastic

o   Develop fibrous tissue

o   Contain fewer functional capillaries

·        Loss of skeletal muscle strength in the thorax and diaphragm

·        Loss of resilient force that holds thorax in a slightly contracted position

o   Contributes to slight kyphosis

o   Barrel chest

The net effect of these changes is a reduction in vital capacity and an increase in residual volume—in other words, less air exchange and more air and secretions remaining in the lungs.

Further age-related changes external to the respiratory system can affect respiratory health in significant ways.

·        Reduction in body fluids and reduced fluid intake

o   Drier mucous membranes

o   Difficulty in removal of mucus

§  Development of mucus plugs and infection

·        Altered pain sensations can cause:

o   Unnoticed signals of respiratory problem

o   Mistaken for non-respiratory disorders

·        Different norms for body temperature

o   Cause fever to present at an atypically lower level;

§  Potentially being missed

§  Allowing respiratory infections to progress without timely treatment.

·        Loose or brittle teeth

o   Can dislodge or break;

§  Lung abscesses

§  Infections from tooth fragments aspiration

§  Relaxed sphincters and slower gastric motility

·        Contribute to the risk of aspiration

·        Impaired mobility, inactivity, side effects from numerous medications

o   Decrease respiratory function

o   Promote infection

o   Interfere with early detection

o   Complicate treatment of respiratory problems

Selected Respiratory Conditions

Chronic Obstructive Pulmonary Disease (COPD)

·        represents a group of diseases including a form of asthma, chronic bronchitis, and emphysema

·        incidence is higher in women and smokers

Asthma

·        Some older persons are affected with asthma throughout their lives; others develop it during old age.

·        older asthmatics have a high risk of developing complications such as

o   bronchiectasis and cardiac problems.

·        have higher rates of mortality from this condition

Nursing Interventions

·        The nurse should help detect causative factors (e.g., emotions, mouth breathing, and chronic respiratory infections)

·        Educate the patient regarding early recognition of and prompt attention to an asthma attack when it does occur.

·        Careful assessment of the older asthmatic patient’s use of aerosol nebulizers is advisable

o   Due to the difficulty some older people have in properly using inhalers, a spacer or holding chamber may be helpful to allow the inhalant medication to penetrate deep into the lungs

o   review the use of these devices as part of every assessment of patients who use them

·        Precautions to avoid adverse drug effects are important

o   Overuse of sympathomimetic bronchodilating nebulizers creates a risk of cardiac arrhythmias leading to sudden death.

Chronic Bronchitis

·        Many older persons demonstrate a persistent, productive cough; wheezing; recurrent respiratory infections; and shortness of breath caused by chronic bronchitis (chest pain is not a symptom)

o   These symptoms may develop gradually, sometimes taking years for the full impact of the disease to be realized

o   because of bronchospasm, patients notice increased difficulty breathing in cold and damp weather.

·        The condition results from recurrent inflammation and mucus production in the bronchial tubes, which, over time, produce blockage and scarring that restrict airflow.

·        Individuals with chronic bronchitis experience more frequent respiratory infections and greater difficulty managing them.

·        Episodes of hypoxia begin to occur

o   mucus obstructs the bronchial tree and causes carbon dioxide retention

Management

·        removing bronchial secretions

·        preventing obstruction of the airway

·        maintain good fluid intake

·        expectorate secretions

·        discouraging chronic respiratory irritation

o   smoking

Emphysema

Factors causing emphysema

·        Chronic bronchitis

·        Chronic irritation from dusts or certain air pollutants

·        Morphologic changes in the lungs

o   distension of the alveolar sacs

o   rupture of the alveolar walls

o   destruction of the alveolar capillary bed

·        Cigarette smoking

Symptoms are slow in onset and initially may resemble age-related changes in the respiratory system

·        Causing many patients to experience delayed identification and treatment

·        increased dyspnea is experienced

o   not relieved by sitting upright

·        chronic cough develops

·        more effort is required for breathing and hypoxia occurs, leading to these s/s:

o   fatigue

o   anorexia

o   weight loss

o   weakness

Life-threatening complications

·        Recurrent respiratory infections

·        Malnutrition

·        congestive heart failure

·        cardiac arrhythmias

Treatment

·        postural drainage

·        bronchodilators

·        the avoidance of stressful situations

·        breathing exercises

·        cessation of smoking

·        nurses need to assess for this and arrange for dietary interventions that can facilitate intake

o   older patient may have insufficient energy to consume adequate food and fluid

·        If oxygen is used, it must be done with extreme caution and close supervision

o   A low oxygen level rather than a high carbon dioxide level stimulates respiration

o   older patient with emphysema is a high-risk candidate for the development of carbon dioxide narcosis

·        Sedatives, hypnotics, and narcotics may be contraindicated

o   patient will be more sensitive to these drugs

·        if possible, consult with patients’ physicians regarding the possibility of lung volume reduction surgery

o   a procedure in which the most severely diseased portions of the lung are removed to allow remaining tissues and respiratory muscles to work better

·        patient must learn to:

o   pace activities

o   avoid extremely cold weather

o   administer medications correctly

o   recognize symptoms of infection

Pneumonia

·        bronchopneumonia

·        common in older adults and is one of the leading causes of death in this age group

Several factors contribute to its high incidence

·        Poor chest expansion and more shallow breathing due to age-related changes to the respiratory system

·        High prevalence of respiratory diseases that promote mucus formation and bronchial obstruction

·        Lowered resistance to infection

·        Reduced sensitivity of pharyngeal reflexes, which promotes aspiration of foreign material

·        High incidence of conditions that cause reduced mobility and debilitation (Fig. 18-2)

·        Greater likelihood for older adults to be hospitalized or institutionalized and to develop nosocomial pneumonia than for younger persons

S/S of Pneumonia

·        altered in older persons

·        serious pneumonia may exist without symptoms being evident

·        Symptoms may include

o   slight cough

o   fatigue

o   rapid respiration

·        Result of cerebral hypoxia

o   Confusion

o   Restlessness

o   Behavioral changes

·        Nursing care for the older patient with pneumonia is similar to that used for the younger patient.

·        The older patient can also develop the complication of paralytic ileus

o   can be prevented by mobility

Respiratory Health Promotion

Infection prevention is an important component.

In addition to the precautions any adult would take, older persons need to be particularly attentive to obtaining influenza and pneumonia vaccines and avoiding exposure to individuals who have respiratory infections.

·        Nurses should teach all older adults to do deep breathing exercises several times daily

o   full expiration is more difficult than inspiration for older individuals

§  these exercises should emphasize an inspiratory–expiratory ratio of 1:3

o   link them with other routines, such as before meals or every time the person sits down to watch the news

o   Yoga is another practice that can aid in respiration.

·        Smoking cessation is an important health promotion measure

o   Because smoking is the most important factor contributing to respiratory disease

§  bronchoconstriction

§  early airway closure

§  reduced ciliary action

§  inflammation of the mucosa

§  increased mucous secretions and coughing

o   by the time signs and symptoms become apparent, considerable damage to the respiratory system may have occurred, compounding age-related changes to the system

·        Preventing fractures, pain, weakness, depression, and other problems that could decrease mobility is an essential goal.

o   As immobility is a major threat to pulmonary health, and older adults frequently experience conditions that decrease their mobility.

o   Older adults, their family members, and caregivers all need to be educated about the multiple risks associated with immobility.

o   When immobility is unavoidable, hourly turning, coughing, and deep breathing will promote respiratory activity; blow bottles and similar equipment can also be beneficial.

·        Older persons should be advised against treating respiratory problems themselves

o   Many over-the-counter cold and cough remedies can have serious effects in older adults and can interact with other medications being taken.

o   These drugs can also mask symptoms of serious problems, thereby delaying diagnosis and treatment.

o   Older adults should know that a cold lasting more than 1 week may not be a cold at all, but something more serious that requires medical attention.

·        Review all medications used by older persons for their impact on respiration; alternative drugs should be used whenever possible

o   Decreased respirations or rapid, shallow breathing can be caused by many of the drugs commonly prescribed for geriatric conditions;

§  these drugs include analgesics, antidepressants, antihistamines, antiparkinsonian agents, synthetic antispasmodics, sedatives, and tranquilizers.

·        Environmental factors also influence respiratory health.

o   Indirect room ventilation is best for older people who are more susceptible to drafts; fibrosis

§  can be aggravated by chilling and drafts.

·        the quality of indoor air can be improved by:

o   installing and maintaining air filters in heating and air-conditioning systems

o   vacuuming regularly (preferably using a central vacuum system or a water-trap vacuum that prevents

o   dust from returning to the room)

o   damp-dusting furnishings

o   discouraging cigarette smoking

o   opening windows to air out rooms

o   maintaining green houseplants to help detoxify the air

·        Nurses should assist older adults in identifying and reducing sources of indoor pollutants.

o   Housecleaning hints may be shared (e.g., dusting with a damp cloth, airing out blankets, and removing unnecessary stored paper and cloth objects);

o   helping older adults locate housecleaning services can prove beneficial to improving their respiratory health.

·        Infections of the oral cavity can lead to respiratory infections or can decrease appetite and facilitate a generally poor health status.

o   teeth can break or dislodge, leading to lung abscesses, infections, and aspirated tooth fragments.

o   Respiratory infections may decline when loose or diseased teeth are removed.

Additional Interventions in the mode of ineffective breathing

·        Instruct the patient in breathing exercises

·        Control symptoms (e.g., pain) that could threaten effective respirations.

·        Raise the head of the bed at least 30°when the patient is lying down, unless contraindicated.

·        Instruct the patient to turn, cough, and deep breathe at least once every 2 hours.

·        Monitor rate, depth, and rhythm of respirations; coloring; coughing pattern; blood gases; and mental status.

Vaccines

·        pneumococcal vaccines are recommended for persons over 65 years of age.

o   vaccine should not be administered during a febrile illness.

·        Concurrent administration with influenza and some other vaccines is acceptable

o   provided that different injection sites are used

·        pneumococcal vaccination and a one-time booster after 5 years if the person was under 65 years of age when the initial vaccination was administered

·        Nurses should be sure to document the administration of the vaccine, along with the name of the manufacturer, lot number, and expiration date

·        if there is doubt whether the vaccine has already been given, it is best to administer the vaccine rather than risk pneumonia.

Common Side Effects

·        local tenderness

·        fever

·        myalgia

·        malaise

Other Side Effects

·        arthritic flare-ups

·        more rarely paresthesias and other neuropathies

Influenza

Two subtypes of influenza

Influenza A

·        most frequent cause of serious illness and death in older adults

Influenza B

·        less severe

·        but can produce serious problems for older adults

o   due to age-related changes

§  impaired immune response to the virus

Influenza causes

·        fever (not as high as in younger adults)

·        myalgia (muscle pain)

·        sore throat

·        nonproductive cough

Pathophysiology

·        it destroys ciliated epithelial cells of the respiratory tract and depress mucociliary clearance

·        secondary bacterial infections and other complications increase the risk of older adults dying

o   Patients with chronic respiratory, cardiac, or metabolic disease are at particularly high risk for developing secondary bacterial pneumonia

·        Nonpulmonary complications

o   Myositis (disease that makes your immune system attack your muscles)

o   Pericarditis

o   Guillain-Barré syndrome (rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system)

o   Encephalitis (inflammation of the active tissues of the brain caused by an infection or an autoimmune response)

o   Temporary loss of smell or taste

Interventions

·        Influenza is acquired through inhalation of infected droplets

o   reducing contact with persons with known or suspected influenza is important

·        annual influenza vaccination

o   recommended for persons over age 65 years

·        older persons have lower antibody titers after vaccination than do younger adults

o   vaccination can prevent severe complications associated with influenza, even if it does not prevent the disease itself

·        2 weeks are needed for an antibody response to the vaccine; therefore, administration of the vaccine in October is recommended so that immunity is present before the flu season peaks

·        vaccine is contraindicated in persons with febrile conditions and egg allergy and those with a history of Guillain-Barré syndrome

·         

Cardiovascular System

·        Decrease heart muscle efficacy and strength

·        Since heart is not pumping as efficiently and not quite as strong

o   Decrease cardiac output

o   Experience incomplete valve closure

§  Risk for murmurs

o   As those vessels experiences stiffening and calcification

§  Atherosclerosis

·        All these factors lead to a higher risk for an elevated systolic blood pressure

·        Higher risk for orthostatic hypotension

Immune System

Decrease in T cell function

Decrease in general immune function

Higher risk for infections

Higher risk for cancers and autoimmune disorders

Integumentary System

Skin will become: