Pathological conditions in older adults

After studying Module 3: Lecture Materials & Resources, discuss the following:

Describe and discuss the pathological conditions that might affect the sexual responses in older adults.
How and why do you think Nutritional factors, psychological factors, drugs and complementary and alternative medications affect the immune system in older adults.

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.

Chapter 14

Infection and Inflammation

Infection is one of the 10 most common causes of death in older adults.

The presentation of infections in older adults is often masked, which can lead to delayed treatment.

The immune system enables the body to defend itself against disease-causing microorganisms and other foreign bodies.

With aging the immune system exhibits a diminished ability to provide such protection.

Introduction

For infection to occur, there must be a reservoir of an infectious disease, a portal of entry, and a susceptible host.

Source may be a person’s own microbial flora (endogenous) or something in the environment (exogenous).

Nosocomial infections: acquired in the hospital

Community acquired: acquired outside the health care facility

The Chain of Infection

Changes in both cell-mediated and antibody-mediated immune response

Atrophy of the thymus

Diminished cellular (T cell–mediated) and humoral (B-lymphocyte) immunity

Production of autoantibodies increases

Skin becomes more fragile and prone to breakdown or abrasion.

Age-Related Changes in the
Immune System

Nutritional factors

Malnutrition

Iron and trace element deficiency

Psychosocial factors

Depression

Drugs

Complementary and alternative medications

Factors Affecting Immunocompetence

Every adult over the age of 65 should receive the influenza vaccination annually.

Community-acquired pneumonia is caused by multiple pathogens.

Pneumococcal vaccine is recommended for everyone over the age of 65.

Infection control measures help to reduce the risk of illness.

Many older adults present with atypical or diminished signs and symptoms.

Influenza and Pneumonia

Neoplasms occur with greater frequency in older adults.

Common types include lung cancer, breast cancer, and prostate cancer.

Presence of the cancer reveals presence of decreased immune response.

Cancer and cancer treatment can induce additional immune deficits.

Cancer

Symptoms: extreme fatigue, painful or swollen joints, unexpl

Chapter 10

Sleep and Activity

Regulation of sleep and wakefulness occurs primarily in the hypothalamus.

Sleep is a state of consciousness characterized by the physiologic changes of reduced blood pressure, pulse rate, and respiratory rate along with a decreased response to external stimuli.

Biologic Brain Functions and Sleep

Sleep begins with the four stages of non-REM sleep, continues with a period of REM sleep, and then cycles through non-REM and REM stages of sleep for the rest of the night.

Variations in the REM and non-REM sleep stages occur with advancing age.

REM sleep is interrupted by more frequent nocturnal awakenings, and the total amount of REM sleep is reduced.

The amount of stage 1 sleep is increased, and stage 3 sleep and stage 4 sleep are less deep.

Stages of Sleep and
the Older Adult

The sleep-wake cycle follows a circadian rhythm, which is roughly a 24-hour period.

The decrease in nighttime sleep and the increase in daytime napping that accompanies normal aging may result from changes in the circadian aspect of sleep regulation.

Sleep and Circadian Rhythm

Difficulty falling asleep, difficulty staying asleep, frequent nocturnal awakenings, early morning awakening, and daytime somnolence

May be transient, short term, or chronic

Affects the older adult’s quality of life with excessive daytime sleepiness, attention and memory problems, depressed mood, nighttime falls, and possible overuse of hypnotic or over-the-counter medications

Insomnia

Insomnia: the inability to sleep

Increased sleep latency, reduced sleep efficiency, nocturnal awakenings, increased early morning awakenings, and increased daytime sleepiness

Older adults awaken four or more times a night.

Daytime napping is common.

Daytime sleepiness may suggest underlying disease.

Other sleep changes are associated with chronic disease and other health problems.

Age-Related Changes in Sleep

Environment

Pain

Lifestyle

Dietary influences

Medication use and medical conditions

Depression and dementia

Factors Affecting Sleep

Chapter 11

Safety

The leading cause of fatal and noninjuries in older adults

Results in higher rates of morbidity and mortality among those older than 75 because of the higher incidence of frailty and a limited physiologic reserve

Leading cause of hip fractures

Education is the cornerstone of fall prevention and management.

Falls

Older individuals may not perceive a slip that results in a fall to the floor to be an actual “fall”; rather it may be termed a slip, trip, or accident, but not a fall.

Anything that causes a person to unintentionally move from one level plane to another

Definition of Falling

Is a concept that holds negative connotations because it is associated with a decline, drop, or descent to a lower level

Involves several related variables and most likely is determined according to an individual perception of how serious the fall is in terms of daily living

The health care professional may equate a fall with a decline in patient health or function or a worsening of a patient’s condition

Meaning of Falling to Older Adults

Vision—depth perception, problems with glare

Hearing—decrease in directional hearing, hearing loss

Cardiovascular—orthostatic hypotension

Musculoskeletal—osteoarthritis, muscle weakness, reduction in steppage height, which may increase risk for tripping

Neurologic—slowed reaction time

Normal Age-Related Changes That Contribute to Falling

Is not determined solely on the basis of number and kind of diseases, but on how risk factors influence areas of mobility, transferring, and negotiating within the environment

Best determined by observation of mobility

Risk categorized according to intrinsic (illness or disease-related) or extrinsic (environmental) risk

Research has shown that the individual with frailty and physical functional limitations is at greatest risk for falling.

Fall Risk

Combined effect of normal age-related changes and concurrent disease

Relates to gait, balance, stability, and cognition

Intrinsic Fall Risk

Environmental hazards, both indoors and outdoors

Steps

Floor surfaces

Edges and cur

Chapter 12

Sexuality and Aging

Sexuality is an important part of health, general well-being, and quality of life.

Sexuality includes various types of intimate activity, as well as the sexual knowledge, beliefs, attitudes, and values of individuals.

Nurses play a key role in the assessment of changes related to aging, disabling medical conditions and drugs, and can intervene at an early point to enhance sexuality.

Older Adults’ Sexual Needs

“Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction … is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships …. Sexuality is influenced by the interaction of biologic, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors”

The World Health Organization’s
View on Sexuality

Despite evidence supporting not only the need for, but the importance of, sexual expression in older adults, health care professionals carry out few interventions to facilitate expressions of sexuality.

Benefits of sexual expression include increased happiness, energy, and relaxation, decreased pain, improved cardiovascular health, decreased depressive symptoms, increased self-esteem, and improved satisfaction with relationships.

Sexual Expression

Society regards sexuality in older adults as undignified.

Nurses often share society’s ageist beliefs about the asexuality of older adults, which may lead to nurses discouraging sexual activity.

Older adults may face difficulties with sexual expression.

Because of discomfort, myths, ageism, and lack of training in sexual health, problems with newly developed or chronic sexual dysfunction are ignored.

Barriers to Sexual Expression

The orgasm response changes in both sexes.

Reduced availability of sex hormones results in less rapid and less extreme vascular responses to sexual arousal.

Erectile dysfunction

Sexual dysfunction in older women encompasses loss of sexual desire, problems with arousal, inability to achieve orgasm, and painful intercourse.

Normal Changes of the
Aging Sexual Response

Chapter 9

Nutrition

Food means life, comfort, and security.

Older adults living in the community may suffer from loneliness and depression, leading to weight gain or loss, and ultimately malnutrition.

Food

Social factors include isolation, loneliness, poverty, dependency, lack of caregivers, and transportation.

Psychological factors include depression, anxiety, and dementia.

Weight loss, psychotropic drugs = anorexia, apraxia

Biological factors include hypermetabolism, anorexia, swallowing difficulty, or malabsorption.

Stroke, tremors, arthritis, infection, COPD, Parkinson’s

Nutritional Risks in Older Adults

Several medications associated with poor appetite and weight loss

Interactions between nutrients and medicines may affect metabolism, absorption, digestion, or excretion of drugs.

Carefully assess all medications including over-the-counter drugs for drug–drug and drug–nutrient interactions.

Drug Nutrient Interactions

Nutritional interventions that do not take into account the social, cultural, and emotional aspects of food are rarely effective because few individuals “eat to survive”; most of us “survive to eat.”

Three main forms

Isotonic dehydration—results from the loss of sodium and water, as during a gastrointestinal illness

Hypertonic dehydration—results when water losses exceed sodium losses. Most common, from fever or limited fluid intake

Hypotonic dehydration—may occur with diuretic use when sodium loss is higher than water loss

Dehydration

Micronutrients—vitamin D, calcium, and vitamin B12 are commonly found deficient in older adults

Vitamin D deficiency—cancer progression, osteoporosis, and fractures

Vitamin B12 deficiency—pernicious anemia, bone health, and cognitive decline

Supplementation might be necessary.

Micronutrient Deficiency

Sarcopenia is defined as “the decline in skeletal muscle mass that can result from physical inactivity, disuse of muscles, reduced levels of growth hormone and testosterone, neuromuscular changes, insufficient dietary protein and impaired protein metabolism.”

Can occur after long hospitalization

Cachexia is characterized by a loss of fat and muscle mass accompan

Chapter 13

Pain

Is a common experience for many older adults

Is not an expectation of aging

Pain is under recognized, highly prevalent, and undertreated among older adults.

Degenerative changes, musculoskeletal changes, and pathologic and comorbid conditions from disease or injury lead to pain in older adults.

Pain

Pain is “Whatever the experiencing person says it is, existing whenever he or she says it does” McCaffery (2000)

“A subjective, personal, unpleasant experience involving sensations and perceptions that may or may not relate to bodily or tissue damage” Aronoff (2002)

Pain is individual and may be very different for different persons with the same disease or injury.

Defining Pain

Acute pain: rapid onset and relatively short duration and a sign of a new health problem requiring diagnosis and analgesia

Treat underlying cause—short-term analgesia

Chronic or persistent pain: continues after healing or is not amenable to a cure; usually has no autonomic signs and is associated with longstanding functional and psychologic impairment

Pain Classification

Somatic pain—well defined. It may be aggravated by movement, due to articular disorders, deep and aching, may be sharp

Visceral pain—caused by organ stretch, inflammation or ischemia, diffuse and not well defined, may be referred, intense pressure, a deep squeeze, or dullness

Nociceptive Pain

Results from a pathophysiologic dysfunctional process involving the peripheral or central nervous system

Do not respond as predictably to analgesic therapy as nociceptive types of pain

Includes paresthesias (the tingling, pins and needles sensation), burning, lancinating (stabbing, cutting, shooting)

Responds to drugs such as tricyclic antidepressants (TCAs), anticonvulsants, or antiarrhythmic drugs

Neuropathic Pain

Mixed or unspecified pain has unknown mechanisms, treatment is unpredictable requiring more trials of different approaches.

Other types of pain can be caused by conditions such as conversion reaction or psychological disorders, may benefit from specific psychiatric treatments.

Mixed or Unspecified and
Other Types of Pain

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Pathological conditions in older adults

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