Body System Changes in the Older Adult and Nursing Implications

Body System Changes

Throughout our lives, our bodies begin to change in ways that result in a decline. The elderly population may think these changes are not normal, but in most cases, the changes that occur are typical with aging. Our bodies most often undergo similar stress, but some of these changes depend on lifestyle and genetics. When the human body ages, the cardiovascular, respiratory, and integumentary systems decrease in functioning. Nurses must be able to diagnose and assess, implement safety measures, and provide education to be better humanity as they age.

Cardiovascular Changes (p. 647)

The cardiovascular system undergoes several changes as the body ages. The cardiovascular system is important because it supplies the body with oxygen and blood to vital organs and tissues. The cardiovascular system has two major functions which include perfusion and gas exchange. Without these two vital functions, the cardiovascular system is failing (Ignatavicius et al., 2018).

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As a result of aging, sometimes the heart cannot keep up with the demand the body puts in place. The baroceptors that sense pressure change become less sensitive. These baroceptors help keep blood pressure in a normal range. The lack of sensitivity of these baroreceptors puts them at a risk for orthostatic hypotension because the blood pressure drops when changing from a sitting to a standing position. The arteries become thicker and stiffer causing an increase in blood pressure to compensate for the stiffened arteries. The vascular resistance in the cardiovascular system increase due to the aging effects on the arteries. Due to this, the left ventricle atrophies because of pumping at a greater resistance (Ignatavicius, Workman, Rebar, & Heimgartner, 2018).

The valves in the heart undergo calcification causing them to become stiff, these include the mitral and aortic valves. When these valves become stiff, the heart has to work harder to pump blood which increases blood pressure. The conduction system in the heart sends signals causing contraction. Within the conduction system, the pacemaker cells decrease, but unlike the conduction system, the sinoatrial node includes aspects that increase such as fat and fibrous tissue. The time for conduction to occur increases. The atrial myocardium and the bundle of His contain few muscle fibers (Ignatavicius et al., 2018).

The left ventricle of the heart increases in size. This is a result of the left side of the heart having to pump with greater resistance. The left ventricle also becomes stiff and less flexible. Another change also associated with the left ventricle includes the diastolic filling decreasing in speed (Ignatavicius et al., 2018).

A condition that comes with aging is hypertension. Hypertension is a medical term used to define high blood pressure. Hypertension occurs because the heart has to pump with greater force and pressure to meet the needs of the body. This condition happens when the body ages because the heart becomes stiffer causing the blood to be pumped through the body with greater pressure (Ignatavicius et al., 2018).

Respiratory Changes (p. 513)

Similar to the cardiovascular system, the respiratory system ages with the human body as well. The respiratory is important to our daily functioning in life because it allows our bodies to have the right amounts of oxygen. Although most of these changes that occur are normal, some of them result from disease and ingestion of pollutants over the course of a person’s life (Ignatavicius et al., 2018).

One of the important aspects of the respiratory system are the alveoli. Within the alveoli, the exchange between oxygen and carbon dioxide occurs. Changes that occur in the alveoli include decreased surface area, a decrease in the ability to cough, recoiling decreases, and the airways begin to close (Ignatavicius et al., 2018).

Comparable to the alveoli, the lungs are important to the functioning of this system. The changes that transpire within the lungs include a decrease in the efficiency of exchange between carbon dioxide and oxygen, the vital capacity decreases, and the elasticity of the lungs decreases. Within the lungs, the residual volume increases. The decrease in vital capacity and increase in residual volume are result in the reduction of lung elasticity (Ignatavicius et al., 2018).

The pharynx and larynx also play an important role in this important system. The pharynx acts as a passageway for the respiratory system and the larynx is the body’s voice box which includes vocal cords. The changes occurring with these parts include a loosening of the vocal cords and a degeneration of muscles. The cords in the larynx begin to lose elasticity and the cartilage of the airways is lost (Ignatavicius et al., 2018).

The pulmonary vasculature helps with oxygenation in the respiratory system. Within this, the older adult is at an increased risk for hypoxia. Also, there is a decrease in pulmonary capillary blood volume and the vascular resistance to blood flow increase. The aging adult may not be able to exercise as well due to the body not being able to react to hypoxia and hypercarbia like it should. Hypoxia is decreased oxygen in the tissues and hypercarbia is an increased level of carbon dioxide in the blood (Ignatavicius et al., 2018).

The muscles encompassed in the respiratory muscles decrease; these muscles include the diaphragm and the intercostals. Due to these decreases, the older adult is more prone to infection as a result of a decrease in effectiveness in cilia and a decline in the presence of immunoglobulin A. The chest wall contains several other changes in the respiratory system. These alterations are comprised of a decrease in the mobility of the chest wall, the shortening of the thorax, and the anteroposterior increases causing a barrel chest, which causes the chest to appear more rounded (Ignatavicius et al., 2018).

Chronic obstructive pulmonary disease, COPD, is a common disease that occurs with aging. COPD is a disease that affects the airways and the alveoli. The airways become inflamed, making it hard to breathe (Hanania, Sharma, & Sharafkhaneh, 2010). Those affected with COPD may show signs of trouble breathing, breathing through their mouth using a technique called pursed-lip breathing, and looking extremely fatigued (Ignatavicius et al., 2018).

Integumentary System Changes (p. 434)

As we age, the outside of the body transforms and begins showing several changes that can be embarrassing to some people. An important risk associated with skin changes is exposure to the sun. Beginning with the hair and nails, a decrease in the number of hair follicles present and active melanocytes in the follicle occur. The rate of hair growth also decreases. The glands in the body are decreased as well. This includes a decrease in sebum production and eccrine and apocrine gland activity (Ignatavicius et al., 2018).

The layers of the skin, known as the epidermis, dermis, and subcutaneous layer, start to decrease in function during the aging process. The epidermis is the top layer of skin, and it is the first line of defense when it comes into contact with environmental factors. With the epidermis, this layer becomes thin causing the skin to tear more easily. This becomes difficult because the elderly can get infections in the skin due to it being more susceptible to tears. There becomes a decrease in cell division, melanocyte activity, and vitamin D production. Melanocytes are important in skin pigmentation. The epidermis becomes more permeable to substances and there is a flattening of the junction between the epidermis and the dermis that begins to form. Since the skin becomes thinner with age, the top layer of skin, the epidermis, becomes more permeable, allowing more things to enter into the body (Ignatavicius et al., 2018).

The dermis is the next layer of skin that endures changes. The dermis is important because it gives the skin its flexibility and strength. With aging, there becomes a decrease in blood flow and vasomotor responsiveness. The blood supply is important in the dermis because it allows oxygen exchange and provides heat. Along with the epidermis, the dermis becomes thin and the elastic fibers become to degenerate. Since the dermis is responsible for the skin’s flexibility, the decrease in elastic fibers is detrimental. This causes the skin to look as if it is hanging. The nerve endings begin to decrease their function and reduce in number. The dermis contains a vast number of nerve endings that are important to the body’s senses. With a decrease in these nerves, the elderly can be more prone to injuries. The subcutaneous layer of skin is closest to the bones and contains fat cells which insulate the body and provide it with padding for protection. The subcutaneous layer of the skin decreases in thickness along with the epidermis and dermis (Ignatavicius et al., 2018).

Nursing Implications

Assessment

Cardiovascular system. During the cardiovascular system assessment, the nurse should look at the patient’s skin, position, and level of consciousness. The patient’s skin should show adequate circulation, meaning having an appearance of rosy color and having a warm temperature. If the skin appears to be bluish this could mean cyanosis (Ignatavicius et al., 2018).

In order to check the patient’s level of consciousness, the nurse should ask for the patient’s name, where they are, and what is the date. Depending on the patient’s answers will determine if they are orientated (Ignatavicius et al., 2018).

Assessing the patient’s blood pressure, heart rate, and rhythm are also important to cover with the cardiovascular system. Increased blood pressure is normal as the person ages but assessing the rhythm for any abnormal sounds such as murmurs needs to be completed as it could lead to underlying problems of the heart (Ignatavicius et al., 2018).

Respiratory system. Assessment of the respiratory system entails several different components. Starting with the nose, look at symmetry, color, drainage, and swelling. Deviation of the septum is normal in patients. A deviated septum has a crooked appearance and the septum is the bone that divides the two nostrils. The pharynx can be examined by using a tongue depressor to look for symmetry, edema, and drainage. The neck should be free of masses, swelling, and bruises. Lymph nodes can be palpated for tenderness, shape, size, and consistency. The trachea should be midline and should be assessed for tenderness and mobility (Ignatavicius et al., 2018).

The chest should be assessed looking for scars, discolorations, and lesions. The way the chest rises and also the breath rate and rhythm should be observed. The shape of the chest is important; the anteroposterior diameter should be less than the lateral diameter (Ignatavicius et al., 2018).

Integumentary system. During the integumentary system assessment, the focus is going to be on the patient’s skin and appearance. Assessing the skin needs to be performed in a symmetric fashion. The areas to focus on including the extremities, nails, hair, and mucous membranes. Areas of skinfolds on the body need to be examined closely due to being a warm environment for bacteria to thrive (Ignatavicius et al., 2018).

Lesions on the skin need to be examined as well. They can be assessed by using the ABCDE pneumonic. A is the asymmetry of shape, B is border irregularity, C is color variation within one lesion, D means diameter greater than 6 mm, and E is evolving or changing in any feature including shape, size, and color. These examinations are important to look at especially for noticing changes in the older patient’s skin that they might not have noticed before (Ignatavicius et al., 2018).

Safety measures

Cardiovascular system. The aging population can help prevent further damage to their heart and other parts of their cardiovascular system by performing some safety measures. They should monitor their blood pressure regularly. Keeping up on this can help them know their baseline, and also help them determine if they have significant changes going on in their body such as increased heart rate. Other safety measures include exercising, healthy diet, and also to quit smoking as this can damage the blood vessels and heart (“Heart Health and Aging,” 2018).

Respiratory system. Safety measures used by those who are aging can help keep their lungs from getting further damage. Exercise is important to perform for the respiratory system. Exercise can help your lungs stay active and in tune by walking a few times a week. If an elder person smokes, this should be stopped because smoking damages the lungs and could possibly end up with cancer. The air someone breathes in is also important to the respiratory system. If they are breathing in a lot of air with pollutants in it, this could damage their lungs severely. Keeping their house clean, which includes dusting and sweeping, can decrease the number of irritants and pollutants that enter their respiratory tract (Hanania, et al., 2010).

Integumentary system. Keeping the elderly safe with their skin is significant. Older patients who are in the hospital need to be turned at least every two hours to avoid producing bed sores. Their skin is susceptible to these sores since it is so thin, and it can tear easily. They also might need help when transferring to the bed to a chair or from the chair to their bed. Handling these patients with slow movements and calmness can result in a much easier transition. Protection of open skin lesions need to be implemented for older adults because they can become more at risk for infections. The aging adult also needs to be properly cared for and treated with gentleness related to their skin as it can tear easier (Ignatavicius et al., 2018).

Education

Cardiovascular system. The aging adult should be taught about changing positions slowly. This includes lying to sitting and sitting to standing. This education is important because they are at risk for orthostatic hypotension which could possibly result in injuries. (Ignatavicius et al., 2018). Educating the patient on how to keep the heart healthy includes concepts of exercise, no smoking, and ensuring proper checkups to their primary care physicians. Teaching these ideas to the aging population can help with the further deterioration of the cardiovascular system (“Aging,” 2019).

Respiratory system. Keeping the respiratory system in good shape is important for the elderly and proper education can ensure that. Having the patient turn, cough, and deep breathing can help the alveoli. The use of an incentive spirometer should be taught to the older adult. Teaching them to put mouth around mouthpieces tightly, suck in like a straw, and hold their breath for as long as possible can allow the lungs to expand. When the elderly patient is able to sit upright, it can allow for easier breathing. Since aging adult can be prone to osteoporosis, they should be taught to have an adequate intake of calcium, especially women (Ignatavicius et al., 2018).

Integumentary system. Educating elderly patient on how to care for their skin as they age is important. Due to the skin becoming thinner, the patient should be handled with care to reduce tears caused by friction. They should also be taught to wear sunscreen and hats to protect the skin from the sun due to the decrease in melanocyte activity (Ignatavicius et al., 2018).

Patients should be taught to use moisturizers while the skin is still moist, keep bath water at a moderate temperature to prevent burns, and to use soaps that contain high fat. Elderly patients need to also increase their vitamin D intake since their production of it in their bodies is decreased (Ignatavicius et al., 2018).

References

1. Aging changes in the heart and blood vessels: MedlinePlus Medical Encyclopedia. (2019, October 2). Retrieved October 29, 2019, from https://medlineplus.gov/ency/article/004006.htm.
2. Hanania, N. A., Sharma, G., & Sharafkhaneh, A. (2010, October 28). COPD in the Elderly Patient. Retrieved from https://www.medscape.com/viewarticle/730813 2.
3. Heart Health and Aging. (2018, June 1). Retrieved October 29, 2019, from https://www.nia.nih.gov/health/heart-health-and-aging.
4. Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.