Changes of the Cardiovascular Respiratory
As individuals age, the heart’s walls often grow thicker. The left ventricle’s walls become notably larger and thicker especially (Strait & Lakatta, 2012). When the left ventricle’s walls are thickened in an older adult, the ventricle is not able to hold as much blood as it would in a younger heart. It also makes the left ventricle harder, so it is not capable of pumping blood with as much ease. This means the cardiac output in older adults is often decreased because not as much blood is being pumped out of the heart (Potter, Perry, Stockert & Hall, 2017, p. 177). Lower cardiac output causes there to be a lower volume of blood circulating around the body. This results in reduced oxygen perfusion to all areas of the body (Potter et al., 2017, p. 177). It is important for nurses to assess the oxygen saturation of older adults by checking pulse oximetry, skin color, and capillary refill. The nurse should explain to the older adult that their heart will not be able to handle as much physical activity as it used to, and they may experience greater exhaustion upon physical exertion as a result. This means it is important for older adults to take breaks when they are tired during exercise to give their heart the rest it needs (Ignatavicius, Workman, & Rebar, 2018, p. 647).
The mitral, tricuspid, aortic, and pulmonary valves of the heart control blood flow entering, travelling through, and exiting the heart by opening and closing. They often are thicker and calcify with age. When heart valves are thick, their mobility is more limited, and the flow of blood within the heart can be disturbed. The calcification of these valves can also cause a smaller and stiffer opening for blood to travel through. This thickening and calcification of blood vessels can impact heart rhythm and the blood volume that goes into circulation (Ignatavicius et al., 2018, p. 647). The nurse should be aware that older adults may experience heart murmurs and changes in heart rhythm as a result of these valve changes. The nurse should auscultate the heart to assess for any tempo changes or murmurs. The older adult should also be monitored for shortness of breath. This is a sign of poor oxygenation. The nurse should teach the patient to take slow deep breaths when they experience shortness of breath (Ignatavicius et al., 2018, p. 647).
Other aspects of the cardiovascular system that thicken with age are the blood vessels, notably the arteries. When the blood vessels become thicker, the space inside the vessels where the blood flows become smaller. The vessels also become harder. This leads to an increase in blood pressure, especially systolic pressure, as blood pumps through arteries that are not as wide or flexible as they used to be. This increased hindrance to blood flow forces the left ventricle to work harder and causes further enlargement of the left ventricle (Ignatavicius et al., 2018, p. 647). The nurse should monitor the blood pressure of the older adult and be aware of any increases in pressure. The nurse should also monitor the pulses on the limbs of older adults including the radial, posterior tibial, and dorsalis pedis pulses. The older adult may experience shortness of breath and should be taught to breath slowly and deeply when this occurs (Ignatavicius et al., 2018, p. 513).
Changes in baroreceptor function also lead to blood pressure changes in the elderly. Baroreceptors are responsible for sensing and maintaining blood pressure. In older adults, baroreceptors do not sense changes in blood pressure as well as they do in younger adults. Therefore, older adults often experience low blood pressure when they suddenly change positions, a phenomenon termed orthostatic hypotension. This decrease in blood pressure can lead to lightheadedness and can put older adults at an increased risk for falls upon assuming a standing position (Ignatavicius et al., 2018, p. 647). The nurse should assess the patient when standing for dizziness or unsteadiness. The nurse should also educate the older adult on the importance of standing up slowly due to a possible drop in blood pressure. This will decrease the adult’s risk for falls upon standing (Ignatavicius et al., 2018, p. 647).
The parts of the heart associated with conduction are also affected by age. The sinoatrial node, or the pacemaker of the heart, becomes weaker with age because some of the cells of the sinoatrial node become ineffective. In a normally functioning heart, the sinoatrial node sends electricity that stimulates the heart to beat. With a weaker sinoatrial node, the heart often beats slower because of an increase in the time it takes the electricity to signal the heart. A weaker sinoatrial node is also more likely to cause adventitious heart rhythms in older adults (Ignatavicius et al., 2018, p. 647). It is important for the nurse to monitor the electrocardiograms of older adults to assess for abnormal heart rhythm and heart rate changes. The nurse can also do this by listening to the adult’s heart if the adult has not had an electrocardiogram (Ignatavicius et al., 2018, p. 647).
Not only do the structures of the heart and the blood vessels change with age, the blood is also affected by age. Older adults typically have a lower volume of water due to a decreased feeling of thirst and a decrease in kidney function, both which occur normally with age. This decrease in total body water naturally leads to a decrease in blood volume as the plasma of blood is almost entirely composed of water and plasma makes up over half of the total blood volume. Further, red blood cell and white blood cell production decrease with old age. A decrease in red blood cell formation makes wound healing more lengthy and difficult and also increases the risk for anemia. A decrease in white blood cells, specifically neutrophils, that are a part of the immune response lead to an increased risk of infection in older adults. It is important for the nurse to educate older adults of the need to drink adequate fluids even though they may not feel thirsty (Ignatavicius et al., 2018, p. 166).
Changes of the Respiratory System Related to Aging
Age related changes in the Respiratory system involve changes to the alveoli, airways, lungs, pharynx, larynx, pulmonary vasculature, muscle strength, chest wall, endurance with exercise, and risk for infection. The lungs slowly start becoming less effective in these areas after the age of thirty-five (American Lung Association, 2018).
First, the alveoli of the respiratory system are affected by aging. They lose both elasticity and become dilated, this results in a decreased surface area of the alveoli. This change in alveoli structure leads to poorer carbon dioxide and oxygen exchange in many ways. First, the decreased surface area of alveoli limits the volume of gas exchange that is able to occur by the process of diffusion. The loss of elasticity in the alveoli limits the volume of air that can pass into and back out of the lungs, and the alveoli close sooner. When air does get into the lungs successfully, the decreased elasticity of the alveoli can cause the air to be trapped in the lungs. This can lead to a buildup of carbon dioxide and cause respiratory acidosis (Ignatavicius et al., 2018, p. 513). The nurse should assess older adults when they are breathing to listen for productive lung sounds bilaterally. The nurse should also assess for signs of respiratory acidosis like headaches, heavy breathing, tachycardia, altered mental status, and general weakness. The nurse should assess for hyperkalemia if the older adult is experiencing respiratory acidosis as cardiac issues related to high potassium levels can be life threatening (Ignatavicius et al., 2018, p. 192).
The airways of the respiratory system and the lungs become less elastic with age just as the alveoli do. This results in a lower volume of air transported into and out of the lungs compared to a young healthy adult (American Lung Association, 2018). The resulting decreased oxygenation can lead to hypoxia, and retained carbon dioxide can lead to respiratory acidosis. The respiratory system in an older adult is also not able to regulate these changes in carbon dioxide levels and oxygen levels as well as a younger adult. Normally, the lungs respond to high carbon dioxide levels and low oxygen levels by increasing the rate of breathing. However, an older adult’s respiratory system may only have half of the effectiveness it used to in correcting these changes in carbon dioxide and oxygen levels. Hypercapnia can lead to confusion, muscle twitches, irregular heart rhythm, and seizures. Hypoxia is when the tissues do not receive enough oxygen and can lead to cyanosis, changes in heart rhythm, confusion, and organ failure if severe (Ignatavicius et al., 2018, p. 529).
The decline of alveolar, lung, and respiratory airway function may be improved some if the older adult practices pulmonary hygiene. The nurse should teach the older adult proper pulmonary hygiene including coughing and deep breathing often. The nurse should teach the patient that pulmonary hygiene is important because it encourages gas exchange and helps clear respiratory secretions. It may also be helpful for an older adult to keep an incentive spirometer on hand at home to help encourage both alveolar and lung expansion. It is most effective if an incentive spirometer is used several times a day. The nurse should teach the patient the proper way to use an incentive spirometer. The older adult should fully exhale and then place the mouthpiece in their mouth with a tight seal of the lips. The adult should then inhale as deeply as possible. When they are not able to inhale any longer, they should hold their breath for a few seconds and then remove the mouthpiece. The adult is then free to exhale. It may also be helpful to the patient to sit up or lay with their head and chest elevated so the lungs are able to expand fully. Some older adults may find sleeping in a recliner beneficial if they have difficulty breathing while lying down (Ignatavicius et al., 2018, p. 578).
Both the pharynx and larynx experience some degeneration with age and they become weaker. This can make swallowing more difficult for older adults and can increase the risk of aspiration. With weakness of the larynx also comes weakened vocal chords. This means older adults may not be able to talk as loudly and easily as they once did (Ignatavicius et al., 2018, p. 513). It is important for older adults to be educated on the increased risk of aspiration due to a weakened swallowing ability. Eating small bites and smaller more frequent meals can help reduce the risk of aspiration. It may also be helpful to thicken fluids for some older adults if thin liquids seem to cause them to choke often. The older adult should eat while they are fully alert because sleepiness puts people at a higher risk for aspiration. The older adult sould also be educated on the importance of leaving ample time to consume a meal as eating quickly can increase the adults risk for aspiration. Avoiding aspiration ensures the older adult has an open airway and reduces the risk of respiratory infection in older adults (Ignatavicius et al., 2018, p. 543).
Just as air does not pass as easily into and out of the lungs, so blood flow to the lungs is decreased. A combination of decreased oxygenation from decreased air getting into the lungs and decreased blood flow to carry oxygen puts older adults at even greater risk for hypoxia Ignatavicius et al., 2018, p. 513). It is important for the nurse to look for signs of hypoxia in older adults like cyanosis, an increased respiratory rate, confusion and clubbed fingers (sign of prolonged hypoxia). The nurse should also educate the patient and their family to look for these sings of hypoxia. An older adult who is hypoxic may be more likely to fall, may have poor judgement, and may become disoriented. It is important for family members and caregivers to be made aware of these signs of hypoxia in order to keep their loved one safe if it occurs. Home oxygen therapy may be prescribed by a doctor for those older adults who have chronic issues of hypoxia. An individual on oxygen therapy should not smoke or be in the same room as someone smoking and they should avoid open flames because oxygen fuels fire (Ignatavicius et al., 2018, p. 537).
Another issue that effects the abilities of expansion and contraction for inspiration and expiration is a weakened diaphragm muscle and weakened intercostal muscles. This can result in decreased volume of air entering the lungs and less air leaving the lungs (Ignatavicius et al., 2018, p. 513). This further increases the older adult’s risk for hypoxia and hypercapnia. As mentioned previously, the respiratory system of an older adult is not as effective in avoiding aspiration as that of a younger adult and this can also be attributed to weakened muscles (Potter et al., 2017, p. 178). It can be helpful for older adults to practice deep breathing to help work the respiratory muscles. The nurse should teach the older adult the technique of diaphragmatic breathing. Diaphragmatic breathing is when the individual intentionally breathes by lifting the abdominal region rather than the chest (Ignatavicius et al., 2018, p. 578). This encourages the diaphragm to work more and also reduces the airway closure. Daily exercise is also helpful in slowing the decline of respiratory muscle strength. Older adults are encouraged to walk for 30 minutes every day. (Ignatavicius et al., 2018, p. 513)
In older adults, bones lose some of their mass and don’t hold shape as well. This can lead to difficulty breathing due to changes in the ribcage that effect expansion upon inspiration and relaxation upon expiration. Further, the thoracic wall does not expand and contract as well in the older adult due to increased rigidity. In addition, when air is retained in the lungs due to the aging issues of the alveoli, lungs, and airways, air trapping can occur which can give the chest a more barrel like appearance. It is also important for older adults to take frequent breaks when exercising due to the changes in the chest wall (Ignatavicius et al., 2018, p. 513). It is important for older adults to get plenty of calcium and vitamin D through their diet and supplements in order to help keep bones, especially of the ribcage in this case, strong and slow their deterioration. The importance of calcium and vitamin D as they relate to bones will be discussed further in the musculoskeletal section.
Older adults often have a diminished cough reflex and do not cough as productively as young adults. This can lead to the accumulation of debris and fluid in the lungs which can put the patient at risk for respiratory infections such as pneumonia. The cilia also do not work as effectively in older adults. The cilia are responsible for keep debris out of the lungs and preventing infection (Ignatavicius et al., 2018, p. 513). Pulmonary hygiene is not only important for respiratory expansion but also for helping prevent infection. Coughing is especially important because it helps debris come up out of the airways and lungs, and this helps reduce the incidence of infection (Ignatavicius et al., 2018, p. 513).
Age Related Changes of the Musculoskeletal System
As people age, the musculoskeletal system experiences intense decline. First, the bones become weaker and more brittle because they lose minerals necessary for bone strength, such as calcium, with age. This is especially prevalent in thin white females. These weakened bones impact older adults’ posture which can put them at an increased risk for falls. It also makes them more susceptible to bone fractures and breaks (Ignatavicius et al., 2018, p. 1007). It is important for older adults to get plenty of calcium through their diet and supplements in order to help keep bones, especially of the ribcage in this case, strong and slow their deterioration. Foods high in calcium include milk, broccoli, cheese, oranges, and spinach. Getting vitamin D from either sun exposure or supplements is also necessary so that calcium is able to be properly absorbed (site).