Question

Discuss the systemic changes, manifestation and client teaching for the following Geriatric patient areas:

• Integumentary.
• Gastro- Intestinal.
• Musculoskeletal.
• Urinary.
• Endocrine.

Answer 1

Greetings of the day!

Answer:

Introduction

Ageing is a natural process. Everyone must undergo this phase of life at his or her own time and pace. In the broader sense, ageing reflects all the changes taking place over the course of life. These changes start from birth—one grows, develops and attains maturity.

SYSTEM	SYSTEMIC CHANGES	CLINICAL MANIFESTATIONS	CLIENT TEACHING
Integumentary	SKIN-EPIDERMIS The number of epidermal cells decreases by 10% per decade and they divide more slowly making the skin less able to repair itself quickly. Epidermal cells become thinner making the skin look noticeably thinner. Changes in the epidermis allows more fluid to escape the skin. SKIN-IN BETWEEN The rete-ridges of the dermal-epidermal junction flatten out .Making the skin more fragile and making it easier for the skin to shear. This process also decreases the amount of nutrients available to the epidermis by decreasing the surface area in contact with the dermis. There is slower repair/turnover DERMIS These changes cause the skin to wrinkle and sag. The dermal layer thins. Less collagen is produced. The elastin fibers that provide elasticity wear out. Decrease in the function of sebaceous & sweat glands contributes to dry skin. The fat cells get smaller. This leads to more noticeable wrinkles and sagging. TOES & NAILS Toes & nails become thicker & more difficult to cut. Grow more slowly. May have a yellowish color. HAIR Men: Most men loose the hair about their temples during their 20s. Hairline recedes or male pattern baldness may occur. Increased hair growth in ears, nostrils, & on eyebrows. Loss of body hair. Women Usually do not bald, but may experience a receding hairline. Hair becomes thinner. Increased hair growth about chin & around lips. Loss of body hair.	Decreased elasticity Decreased secretion of natural oil and perspiration Thinning of skin Decreased heat regulation • Decreased protection against trauma and solar exposure The number of pressure and light touch sensors decreases with age Immune, vascular and thermoregulatory responses of the skin decrease with age. • Loss of hair colour and thinning of pubic, axillary and scalp hair. The skin tends to be thinner, less elastic, drier and finely wrinkled. with aging the body produces less collagen and elastin. so, the skin tears more easily. The fat layer under the skin thins, this causes wrinkles to appear, and tolerance to cold decreases. The number of sweat glands and blood vessels decreases, and blood flow to deep layer of skin decreases.	avoid injuries. avoid hard soaps. apply emmolients daipers,pads,sheets must be changed regularly use sunscreen stay hydrated
Gastro intestinal	Basal and maximal stomach acid production diminish sharply in old age. At the same time, the mucosa thins. Very little seems to happen to the small bowel. (J. Clin. Path. 45: 450, 1992) Decline in number of gastric cells results in decreased production of HCL (an acidic environment is necessary for the release of vitamin B12 from food sources). Decrease in amount of pancreatic enzymes without appreciable changes in fat, CHO, or protein digestion. Diminished gastric (eg pepsinogen) & pancreatic enzymes result in a hindrance to the absorption of other nutrients like iron, calcium, & folic acid. Hepatic blood flow, size & weight decrease with age. Overall function, however, is preserved, but may be less efficient in the setting of drug overload. Some sources claim that one can expect atrophy & decrease in the number of (especially) anterior (salty/sweet) taste buds, but this is controversial. NEJM 322: 438, 1990  Constipation is more common in older adults due to slowed circulation, reduced sense of thirst, lessened activity level and decreased tone in stomach & intestines which results in slower peristalsis and constipation.  Emotions play a significant role in appetite and digestion. 	Decreased salivary secretions, loss of teeth Lose of sense of smell and taste so decrease the appetite and desire food Slowing of peristaltic action Altered nutrition, digestion and bowel function Weakening of lower esophageal sphincter Difficult to chew food because of loose teeth. Liver weight and size decreases with age There is decrease in number of hepatic cells and as a result, a diminished capacity for metabolism of drugs and hormones.	Encourage activity Encourage socialization and emotional well-being Encourage intake of fluids avoid gas forming foods avoid too oily and spicy foods avoid directly sleeping after eating.
Musculoskeletal	MUSCLES Sarcopenia (↓ muscle mass & contractile force) occurs with age. Some of this muscle-wasting is due to diminished growth hormone production (NEJM 323: 1, 1990), but exactly how much is due to aging versus disuse is unclear.  Sarcopenia is associated with increased fatigue & risk of falling (so may compromise ADLs). Sarcopenia affects all muscles including, for example, the respiratory muscles (↓ efficiency of breathing) & GI tract (constipation). fulfillment BONES Bone/Tendons/Ligaments: Gradual loss of bone mass (bone resorption > bone formation) starting around age 30s.  Decreased water content in cartilage The “wear-&-tear” theory regarding cartilage destruction & activity doesn’t hold up as osteoarthritis is also frequently seen in sedentary elders. Decreased water in the cartilage of the intervertebral discs results in a ↓ in compressibility and flexibility. This may be one reason for loss of height. There is also some decrease in water content of tendons & ligaments contributing to ↓ mobility.	The amount of muscle tissue and muscle strength tend to decrease as age increases. Muscles cannot contract quickly. aging effects reduce mass and strength by about 10 to 15 % than during an adults lifetime. By the age of 75, the percentage of body fat typically doubles when compared to adulthood. This increase the risk of health problems in old age. Osteoarthritis – Cause not known – Also referred to as degenerative joint disease – A gradual wearing away of joint cartilage that results in the exposure of rough underlying bone ends – Can do damage to internal ligaments – Most commonly associated with weight bearing joints.	A healthy diet and regular exercise can help older people minimize increase in body fat. Always consider medication side effects when assessing mobility concerns. Encourage use of assistive devices if indicated. Modify environment to reduce fall risk Encourage activity- take walks etc
Urinary	The bladder of an elderly person has a capacity of less than half (250ml) that of a young adult (600 ml) and often contains as much as 100 ml of residual urine”. (p. 81) Micturation reflex is delayed-- usually activated when bladder is half full; in OAs, not until bladder is nearly at capacity	Decreased blood supply and loss of nephrons • Less blood can filtered by the kidney • Decreased bladder capacity, and concentrating • Decreased diluting ability • Increased prostate size • Delayed sensation to void • In female relaxed perineal muscles • In men, BPH is associated with aging leads to urinary incontinence (dribbling). • Increasing age is also associated with an increase in involuntary bladder contractions, a reduction in bladder capacity and an increase in residual volume. These contribute to development of incontinence in older adults. • Weak pelvic muscles causes stress incontinence.	drink enough fluids. limit alcohol and caffeine. quit smoking avoid constipation do pelvic floor exercises. have privacy and comfortable position while urinating.
Endocrine	In most glands of the body there is some atrophy & decreased secretion with age, but the clinical implications of this are not known. What may be different is hormonal action. Hormonal alterations are variable & gender-dependent.	poor endocrine health Most apparent in: -Glucose homeostasis -Reproductive function -Calcium metabolism Subtle in: -Adrenal function -Thyroid function	exercise daily maintain proper diet eat nuts and green vegetables. have frequent follow ups or doctor visits.