The Physiological Effects of Ageing

ALISTAIR FARLEY, MSc, BSc, DipN, RGN, RMN Lecturer in Nursing, University of Dundee Develop/Teach into pre (CFP and adult branch) and post registration programmes of nursing. ELLA McLAFFERTY PhD, BSc, DipN, RGN, SCM, RNT Senior Lecturer, University of Dundee Senior Lecturer with the strategic responsibility of developing Inter-professional Education. CARLES HENDRY PhD, BA(Hons), DipN, RGN, RMN, RCT, RNT Senior Lecturer in Nursing, University of Dundee Also currently working with the Research Dean in the role of Research Development Facilitator.

Author profi les xiii Preface xv

1 Growing Older 1

Introduction 1

Drivers in the care of older adults 2

Activities of living 3

Overall aims 4

References 5

2 Theories of Ageing 7

Aims 7

Learning Outcomes 7

Introduction 7

Ageing theories 7

Error theory 8

Free radical theory 8

Immune theory 9

Programmed theory of ageing: changes in cell replication 10

Neuroendocrine theory 11

Effects of ageing on homeostasis and body function 11

Summary 12

References and further reading 13

3 Maintaining a Safe Environment 14

Aims 14

Learning Outcomes 14

Introduction 14

Immune system 15

Physical/mechanical and chemical barriers 15

Phagocytosis 15

Acute infl ammatory response 16

Typical immune response to the presence of pathogenic microorganisms 17

Relationship between innate (non-specifi c) and acquired (specifi c) immunity 17

Wound healing 18

Ageing changes in the immune system 19

Changes in the thymus 20

T cell function 20

B cell function 20

Natural killer cells 21

Infl ammatory process 21

Nutrition 22

Changes to the skin and mucous membranes 23

HIV/AIDS 24

Assessment of the immune system 24

HIV/AIDS 26

Stages of HIV infection 26

Modes of transmission related to older adults 26

Issues relating to older people and HIV/AIDS 27

Summary 29

References and further reading 30

Useful websites 31

4 Communicating 32

Aims 32

Learning Outcomes 32

Introduction 32

Normal structure and function 33

The nervous system 33

Ageing changes in the nervous system 39

Brain 39

Neuronal loss 39

Neuronal networks 40

Neurotransmitters 40

Lipofuscin and neurofi brillary tangles 41

Movement 41

Changes in the spinal cord 41

The eye 42

Structures of the eye 42

Aqueous humour and vitreous humour 43

Accessory structures 43

Physiology of vision 43

Refraction 44

Accommodation 44

Constriction 44

Convergence 44

Retina and the conversion of light to an electrical signal 44

Ageing changes in the eye 45

The ear 46

Normal structure and function 46

Physiology of sound 48

Ageing changes in hearing and vestibular function 49

Conditions associated with communication diffi culty in older adults 49

Delirium 49

Assessment for delirium 51

Management 52

Pain in older people 53

Epidemiology of pain for older people 53

Criteria for choosing a pain assessment tool 54

Other factors 58

Management of pain for older people 59

Parkinson's disease 59

Pathophysiology 60

Diagnosis 62

Medical management 62

Nursing management 63

Summary 64

References and further reading 64

Useful websites 66

5 Breathing 67

Aims 67

Learning Outcomes 67

Introduction 67

Normal structure and function 68

Upper respiratory tract 68

Lower respiratory tract 69

Mechanics of respiration 71

The mechanics of breathing 71

Inspiration 71

Expiration 72

Gas exchange 73

Oxygen and carbon dioxide transport 73

Control of breathing 73

Nervous system control 73

Chemical control 74

Ageing changes in the respiratory system 75

Changes in the structure of the respiratory tract 75

The thoracic cage and muscular function 76

Alveoli 76

Elastic recoil 77

Control of ventilation 77

Assessing respiratory function 78

Common respiratory problems associated with ageing 79

Pneumonia 79

Management of the older adult with pneumonia 80

Infl uenza 82

Cardiovascular system 84

Normal structure and function 84

Blood fl ow 85

Changes in the cardiovascular system of the older adult 86

Heart failure 86

Clinical features 87

Classifi cation of heart failure 87

Outlook 87

Management 87

Summary 88

References and further reading 89

Useful websites 90

6 Eating and Drinking 91

Aims 91

Learning Outcomes 91

Introduction 91

Normal structure and function 92

The mouth 93

The stomach 94

The small intestine 95

Absorption of nutrients in small intestine 96

The large intestine 98

The liver 99

The gall bladder 100

The pancreas 100

Ageing changes in the digestive system 101

Oral hygiene 103

Assessment of oral health 105

Nursing management of oral hygiene 105

Nutritional assessment 106

Common GI problems associated with ageing 110

Under-nutrition in older people 110

Food guide pyramid 111

Constipation 112

Summary 116

References and further reading 117

Useful websites 119

7 Eliminating 120

Aims 120

Learning outcomes 120

Introduction 120

Normal structure and function of the urinary system 121

Blood supply to the kidneys 121

Renin–angiotensin mechanism 124

The bladder 124

The urethra 125

Micturition 125

Ageing changes in the urinary system 125

Glomerular fi ltration rate 126

Creatinine 126

Day/night changes in renal function 126

Hormones 127

Common problems of the urinary system 128

Urinary incontinence 128

Urinary tract infection 130

Assessment of continence 132

The urogenital distress inventory 134

Long form of UDI 134

Short form of UDI 135

Management of urinary incontinence 136

Scheduled voiding 137

Prompted voiding 137

Bladder training 137

Pelvic muscle exercises 137

Intermittent catheterisation 138

Summary 139

References and further reading 139

Useful websites 141

8 Controlling Body Temperature 142

Aims 142

Learning Outcomes 142

Introduction 142

Normal structure and function 142

Structure of the skin 143

Gaining and losing heat 143

The effects of ageing on the ability to maintain body temperature 145

Epidermal changes with ageing 145

Conditions affecting thermoregulation in older adults 148

Hypothermia 148

Prevention of hypothermia 149

Acute management of hypothermia 153

Re-warming techniques 154

Heat stroke 155

Summary 155

References and further reading 156

Useful websites 157

9 Mobilising 158

Aims 158

Learning Outcomes 158

Introduction 158

Normal structure and function 159

The locomotor system 159

Control of skeletal muscles 162

Ageing changes related to mobilising 162

Bones 162

Joints 164

Muscles 164

Age-related health problems 166

Osteoporosis 166

Falls in older people 167

Falls risk assessment 169

Interventions 170

Preventative measures 172

Exercise 173

Summary 174

References and further reading 175

Useful websites 176

10 Expressing Sexuality 177

Aims 177

Learning Outcomes 177

Introduction 177

Male reproductive system 178

Normal structure and function 178

General function 179

Sexual arousal and ejaculation 180

Female reproductive system 181

Ovaries 181

The menstrual cycle 181

Meiosis 181

The fallopian tubes 182

The uterus 182

The vagina 182

The external genitalia 183

Breasts 183

Sexual arousal in females 183

Changes in the reproductive systems associated with ageing 184

Maintaining sexuality 184

The ageing man 184

Testosterone 184

Sperm production 185

Changes in sexual arousal 185

The ageing woman 185

Hormonal changes related to the menopause 185

Effects of the hormonal changes on the female body 186

Sexual arousal in older women 187

Sexuality in older people 187

Factors affecting sexuality in older people 190

Assessment of sexual function 191

Permission giving 191

Limited information stage 192

Specifi c suggestions stage 192

Intensive therapy stage 192

Management of health issues related to sexuality 193

Summary 193

References and further reading 194

11 Sleeping 195

Aims 195

Learning Outcomes 195

Introduction 195

The normal sleep cycle 195

Ageing changes with sleeping associated with the sleep–wake cycle 197

Assessment of sleep 199

Sleep disorders in older adults 200

Apnoea 200

Leg movements during sleep 201

Insomnia 201

REM sleep disorder 202

General interventions 203

Specifi c interventions 205

Summary 205

References and further reading 206

12 Final Thoughts on Ageing 207

Index 209