CHANGES

PHYSIOLOGIC CHANGES

The WHO defines de health as a physical mental and social well-being and not merely the absence of disease

The ageing process represents the biological changes without influence of environmental, diseases or other factors. This process is natural and not all this changes are bad.

The process of ageing is influenced by the environmental, lifestyle and deseases.

The old age, depend of the country, culture and genetic. In most countries, the old age becomes when they finish the job.

I think, in many countries the old men are very valued and respected in Africa, China, Japan… than in other countries (like Spain, or some countries of Europe). In this book La vejez desconocida. Una mirada desde la biología a la cultura (page 18 and further on) are explained different cultures of ageing in different countries. We can see, when someone of this cultures achieve the old age, are more important that the youngers.

In my view, in Spain, the old men see them like a burden to the society because they loss their work, loss capacities with the ages… so we must extol more the figure of old men. They are such as important like young people.

BIOLOGIC CHANGES

Integumentary system: the epidermis becomes more fragile so it can cause skin damages (tears, maceration and infection).

• Liver spots are seen in the areas that are more exposed to the sunlight.
• Hair color: it tends to become gray and be thinner, as pubis and axilla hair. The change of hair color is hereditary.
• Decrease subcutaneous fat, that it increases the probability of traumas.
• Increased androgen/estrogen ratio that it causes the increased of facial hair in women.

Care strategies:

1. Provide adequate fluid to prevent dehydration.
2. Institute measures to reduce pressure over bony prominences; possible dermatology referral
3. Keep skin dry. Pad surfaces to reduce friction. Report abnormal observations for treatment.
4. Modify skin care reduce drying. Refer to podiatrist.

Liver spots

Liver spots

Graying

The musculosketal system

• Decrease bone calcium, increased osteoporosis.
• Decreased fluid in intervertebral disks.
• Decreased blood supply to muscles, decreased muscle strength.
• Decreased muscle mass.
• Osteoporosis: porus, brittle and fragile bones that are susceptible to breakage.
• Osteoarthritis: the cartilage on the bone’s articulating surfaces this and begins to wear out.
• Rheumatoid arthritis: is an autoimmune process and a collagen disease. This process causesinflammation of the synovial damage to the cartilage and bone.
• Bursitis: inflammation of bursa and the surrounding fibrous tissue can result from excessive stress on a joint or from a localized infection. This problem can occur at any age.
• Gouty arthritis: is caused by an elevated level of uric acid in the body. Crystals of these acid cause episodes of severe painful joint swelling.

Osteoporosis

Rheumatoid arthritis

Rheumatoid arthritis

Bursitis

Bursitis

Gouty arthritis

Gouty arthritis

The respiratory system:

• Decreased body fluid.
• Decreased number of cilia.
• Decreased muscle strength and endurance.
• Decrease number of capillaries.
• COPD (chronic obstructive pulmonary disease): it’s a group of 3 respiratory disorders: asthma, emphysema and chronic bronchitis. Symptoms: productive caught, wheezing, cyanosis and dyspnea on exertion.
• Influenza: is a contagious respiratory infection caused by a variety of influenza viruses.
• Pneumonia: acute inflammation of the lungs caused by bacterial, viral, fungal, chemical or mechanical agents. 

  Viral pneumonia: headache, fever, aching muscles and cough with mucopurulent sputum.

  Bacterial pneumonia: abrupt and dramatic in onset, tachycardia, and tachypnea.

In this image you can see the Pneumonia physiology. In this page ( Pneumonia) you can find the causes, symptons or treatments about this disease.

Care strategies:

1. Position to facilitate ease of respiration. Encourage incentive spirometry.
2. Encourage adequate fluid intake and smoking cessation and avoidance of environmental  pollutants.
3. Teach careful hand washing and disposal of contaminated secretions.

The cardiovascular system:

• Decreased cardiac muscle tone.
• Increased heart size left ventricular enlargement.
• Decreased cardiac output.
• Decreased pacemaker cells.
• Increased incidence of vascular sclerosis.

   

In this picture there are some hearts problems with hearts murmurs. In National Heart, Lung and Blood Institute are explained the symptons and signs of these diseases.
In the same page you cand find the treament too.

Hemorrhoids

Varicosities

  In this article: Morbilidad cardiovascular enel adulto mayor, we can see that the cardiovascular diseases are the first cause of death in old people because of the aging. The most common disease is the hypertension.

Care strategies:

1. Determine presence and strength of peripheral pulses.
2. Hypotension is likely to occur while changing position.
3. Instruct patient to rest if short breath or fatigued.

 The hematopoietic and lymphatic systems:

• Increased plasma viscosity.
• Decreased red blood cell production.
• Increased immature T cells repose.

Care strategies:

1. Report abnormal findings, promptly to physician.
2. Administer nutritional supplements as ordered.

 The gastrointestinal system:

• Decreased thirst perception.
• Decreased muscle tone ay sphincters.
• Decreased saliva and gastric secretions.
• Decreased live size and enzyme production.

Care strategies:

1. Educate regarding importance of good oral hygiene. Dental referral as necessary.
2. Encourage posture that facilitates swallowing.
3. Educate regarding recommended dietary intake.
4. Administer laxatives stool softeners suppositories or enemas as needed to prevent   constipation.

 The urinary system:

• Decreased number of functional nephrons.
• Decreased blood supply.
• Decreased tissue elasticity.
• Increased nocturnal urine production.
• Increased size prostate.

Enlarged prostate

Care strategies:

1. Promptly notify physician of relevant observations.
2. Establish a toileting schedule based on an assessment data.
3. Palpate bladder after voiding or user Doppler.

The nervous system:

Many cellular changes have been observed in the aging brain including a reduction in its size and weight. Brain Shrinkage has been linked to a decrease in the numeral of functional cortical neurons.

Care strategies:

1. Slowed thought processes decreased ability to respond to multiple stimuli and tasks.
2. Decreased perception of stimuli.
3. Report abnormal findings to physician. Refer for neurologic evaluation.
4. Educate regarding safety precautions and use of assistive devices.

I think the changes and problems as consequence of the aging are inevitable, but we, like nurses, can do a lot of techniques, cares, evaluations, assessments, scales… that can reduce the consequences of ageing.

In the best place we can act is in the medical center, considering that we have more time with the patients, and there is a computer program that contains all of nurse’s diagnostics, interventions and objectives nurses. So, with this is easier to help de old people.

PSYCHIC CHANGES

Changes in intellectual capacity: the capacity to resolve problems becomes slower and there is a lack of spontaneity in one’s thought processes. There are alterations in memory which leads to amnesia over time

Character and personality: the ability to adapt becomes harder due to the fear of unknown situations.

SOCIAL CHANGES

Change of role and personality:

Three different dimensions:

• The old person as an individual: there are some old person who accept the death is near and live their life without stress, and there are other people who don’t accept the death, so their last days are so stressing or live with fear.
• The old person as a member of the family: first, the old person can help in the house and the relationship is good, but, when the old person begins to have physical or mental diseases, the relationship change.
• The old person as a person capable of facing up to his losses: the feeling of loneliness stars when the old person lost his abilities, her wife or her husband… This situation is difficult to recover from.

Change of role in the community:

When the old person finishes to work, they must look for many activities that they can do to not be boring or feel they are useful.

Change of role at work: the old person must brace about to leave the work and the consequences about this, like relationships and economic are reduced.

In my opinion, I prefer to have a physical problem that a mental problem (like dementia senile or Alzheimer) because you leave to be yourself. So I think we can do an important work whit physic changes. 

One advertence we would do is to the family: if they notice about some change in the memory, behavior or personality, they would say us quickly to catch the problem on time and treat it.

On the other hand the change of role in the society its important because if the feel that they don’t be used for, it can finish in depression.

So, our labor is informing them about associations where the can play with other people, learn…