Neurological system

After studying Module 6: Lecture Materials & Resources, discuss the following:

Describe major changes that occurs on the neurological system associated to age. Include changes on central nervous system and peripheral nervous system.
Define delirium and dementia, specified similarities and differences and describe causes for each one.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

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Meiner, S. E., & Yeager, J. J. (2019).
- Chapter 21
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- Chapter 22
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- Chapter 23
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- Chapter 24
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- Chapter 25
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Chapter 25

Endocrine Function

There is decreased estrogen production in women (menopause), decreased testosterone production in men (andropause), decreased adrenal function (adrenopause), and decreased growth hormone (GH)–insulin-like growth factor (IGF) (somatopause).

Neuroendocrine Aging

Endocrine system uses a delicate balance of chemical messengers in the bloodstream to maintain homeostasis and regulate mood, growth, organ function, metabolism, nutrition, and sexual activity.

Clinical manifestations due to the imbalance include decreased bone remodeling, decreased lean muscle mass, increased adipose tissue, compromised skin integrity, impaired insulin signaling, and impaired immune response.

Endocrine Physiology in Older Adults

Decline in biosynthesis and balance of sex hormones with aging

Both genders may experience hot flashes, night sweats, depression, and sexual dysfunction in response to declines in androgen or estrogen.

Laboratory values—luteinizing hormone and testosterone in men; follicle-stimulating hormone and estrogen in women determine endocrine decline.

Andropause and Menopause

Menopausal and postmenopausal hormone replacement (HR) practices continue to change based on larger, more rigorous research studies.

Although many clinicians continue to prescribe hormone replacements, the benefit must outweigh the risks of developing adverse events.

Menopause

Age-related decreases in mineralocorticoids, glucocorticoids, and androgenic hormones manifest changes in body composition, skeletal mass, muscle strength, body weight, and metabolism.

Age-related decreases in DHEA and norepinephrine can produce fluid and electrolyte imbalances; impair glucose, protein, and fat metabolisms; and impair immune and inflammatory responses.

Adrenopause

Somatotropin (growth hormone), an anabolic protein, is secreted from the hypothalamus–pituitary axis and influences many age-related changes.

Somatopause

Multifactorial syndrome of aging due to chronic low inflammation, and is characterized by central obesity, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, hypertension, and/or hyperglycemia

Primary risk factors for the

Chapter 23

Musculoskeletal Function

Diseases of musculoskeletal system are usually not fatal but can lead to chronic pain and disability.

May cause impairments in ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs)

When dependence occurs, can result in loss of self-esteem, perception of decreased quality of life, and depression

Introduction

Muscle mass, tone, and strength decrease

Elasticity of ligaments, tendons, and cartilage decreases

Bone mass decreases

Intervertebral disks lose water, narrowing the vertebral space.

Posture and gait change leading to shift in center of gravity.

Age-Related Changes in Structure and Function

Musculoskeletal system affected in numerous ways by aging process

All the changes may cause pain, impaired mobility, self-care deficits, and increased risk of falls for older adults.

One-third of people age 65 or older have falls each year.

Moderate to severe injuries included hip fractures, lacerations, and traumatic brain injury.

Falls are the most common cause of accidental death.

Fall experience causes a fear of falling.

Consequences of Changes in
Structure and Function

Common problems and often result in loss of functional ability

May occur because of trauma to bone or joint, or may be the result of pathologic processes

Falls are a common cause.

Most common fractures are hip, the proximal femur, Colles (wrist), vertebral, and clavicular.

Fractures

Most disabling type of fracture for older adults

25% patients with hip fractures die within 1 year after injury.

Complications of hip fractures generally related to immobility.

Classified by location: intracapsular, extracapsular

Affected extremity is externally rotated and shortened with tenderness and severe pain.

Hip Fracture

Assess hips and lower extremities for evidence of fracture such as shortening of the extremity, and abnormal rotation.

Assess for presence of tenderness, swelling, or ecchymosis and pain with movement.

Obtain VS and level of consciousness.

Can you name six nursing diagnoses for hip fracture?

Hip Fracture: Assessment and Diagnosis

Chapter 24

Cognitive and Neurologic Function

Function of neurotransmitters is altered due to a decreased number of neurons in various areas of the brain.

Changes in neuron function are associated with accumulation of lipofuscin granules and neuritic plaques in the cell body of some neurons.

Physiologic changes in the CNS include sensory motor changes, the reticular activating system (RAS) and neuroendocrine system are altered.

Age-Related Cellular and Structural Changes of the Neurologic System (1 of 2)

Hippocampus changes include: structural changes, synapse loss in the neurons, decreased microvascular integrity, reduction in glucose metabolism, and alterations in the neuroglia cells

Reduction in the turnover of cerebrospinal fluid (CSF)

Neurodegenerative and neurochemical changes in the cerebellum

Age-Related Cellular and Structural Changes of the Neurologic System (2 of 2)

Sleep disorders (sleep-wake cycle)

Altered ability to learn new information quickly, memory storage, and memory retrieval

Altered vision, hearing loss, decreased taste and smell, vibratory sensations, and position sense

Balance issues and postural hypotension

Decreased ability to feel pain and cope with temperature changes

Changes may contribute to diseases causing cognitive decline.

How These Changes
Affect the Older Adult

Mental status assessment: attention, memory, orientation, perceptions, thought processes, thought content, insight, judgment, affect, mood, language, and higher cognitive functions

Neurologic assessment: cranial nerves, gait, balance, distal deep tendon reflexes, plantar responses, primary sensory modalities in lower extremities, and cerebrovascular integrity

Include functional assessment

Assessment of Cognitive Function

Dementia Severity Rating Scale (DSRS)

Covers the areas of memory, orientation, judgment, community affairs, home activities, personal care, speech and language recognition, feeding, incontinence, and mobility or walking

Normal score instrument is 4 or less; score increases as older person’s cognition decreases.

Cognitive Function Screening Instrument: Functional Assessment

Montreal Cognitive Assessment (MoCA): a quick screening tool for mild cog

Chapter 22

Urinary Function

Bladder capacity decreases, prevalence of involuntary bladder contractions increases, and more urine is produced at night.

Women: declining estrogen levels, thinning and increased friability of urethral mucosa, and altered pelvic floor muscle tone and function cause urgency and frequency

Men: prevalence of prostatic hypertrophy increases, resulting in incontinence or urinary retention

Age-Related Changes in Structure and Function

UI is common in older adults and is associated with irritant dermatitis, pressure injuries, falls, significant sleep interruptions, and UTIs.

Many health care providers do not ask patients about incontinence, even when patients inform them about incontinence and therefore it is not diagnosed or treated.

Urinary Incontinence (UI)

Acute incontinence: sudden onset, generally associated with some medical or surgical condition, generally resolves when underlying cause has been corrected

Drugs are a common cause.

Chronic incontinence: not related to an acute illness, continues over time, often becoming worse

Five major types include: urge, stress, overflow, functional, and mixed incontinence

Incontinence

Most common type, may be associated with overactive bladder

Causes: urinary tract infection (UTI), medications, bladder irritants, bowel issues, dementia, stroke, Parkinson’s disease, and cancers of the uterus and urinary system

Involuntary urine loss after sudden urge to void

Can be precipitated by sound of running water, cold weather, or sight of toilet

Often accompanied by nocturia and complaints of frequency

Urge Incontinence

Commonly seen in older women who involuntarily lose urine as result of sudden increase in intraabdominal pressure

Caused by lack of estrogen, obesity, previous vaginal deliveries, surgeries

Leak urine with physical exertion: coughing, sneezing, laughing, lifting, and exercise

Unusual in men, and mainly occurs after transurethral surgery or radiation therapy

Stress Incontinence

Chronically full bladder increases bladder pressure to level higher than urethral resistance, causing the involuntary loss of urine

Common in men

Complain of constant dribbling

Causes: urethral blockage

Chapter 21

Gastrointestinal Function

Some changes in the gastrointestinal (GI) tract are due to normal aging; factors such as polypharmacy, stress, poor nutrition, multiple comorbidities, and poor hygiene may also contribute to alteration in GI function.

Many systemic changes in functions of digestion and absorption of nutrients result from changes in older patients’ cardiovascular and neurologic systems rather than GI systems.

Age-Related Changes in Structure and Function

One fourth of those 65 or older are edentulous.

Taste buds may atrophy with age.

Changes in smooth muscle lining lower in the esophagus may contribute to a decrease in the strength of esophageal contractions and sphincter weakness.

Neurogenic, hormonal, and vascular changes may also contribute to decrease in esophageal motility.

Age-Related Changes in Oral Cavity, Pharynx, and Esophagus

Decreased production of gastric acid, pepsin, bicarbonate, prostaglandins, and mucous

Gastric emptying time is increased secondary to decreased elasticity of the stomach wall.

Decreased stomach capacity

Age-Related Changes in Stomach

Atrophy and broadening of the villi leading to a decrease in absorptive surface

Decrease in the production of lactase

Overpopulation of certain intestinal bacteria

Atrophy of the muscle layers and mucosa in colon

Decrease in contraction of the muscle wall when the rectum is filled with stool

Diverticuli are prevalent.

Age-Related Changes in
Small and Large Intestine

Gallbladder and bile ducts are unaffected by aging.

Incidence of gallstones does increase with age.

Fibrosis, fatty acid deposits, and atrophy of pancreas

Volume of pancreatic secretions declines.

Decrease in enzyme activity which affects fat digestion

Increased incidence of pancreatic cancer and pancreatitis

Age-Related Changes in
Gallbladder and Pancreas

Liver size decreases after age 50, but function remains WNL.

Decrease in hepatic blood flow affects drug metabolism.

Decreased ability to compensate for infectious, immunologic, and metabolic disorders

Age-Related Changes in Liver

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