Know the physical and physiological changes in the elderly
*Appendix A pgs 643-650*
3 Primary Points 1. Reduced physiological reserve of most body systems, especially cardiac,
respiratory, and renal. 2. Reduced homeostatic mechanisms that fail to adjust regulatory
systems such as temperature control and fluid and electrolyte imbalances. 3. Impaired
immunological function: risk for infection is higher and autoimmune diseases are more
prevalent.
Never be complacent and assume the issue is only age related (pg 2-3)
How aging effects Lab values in elderly
**Appendix B pgs 651- 652**
Many factors influence lab results in the elderly, including physiologic changes with aging, the
prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle and activities, and
medications being taken. Biochemical individuality is important in detecting asymptomatic
abnormalities in older adults. Significant homeostatic disturbances in the same individual may
be detected through serial lab tests, even though all individual test results may lie within normal
limits of the reference interval for the entire group. Lab work can be affected by inadequate
protein stores within the body, and the elderly loose these protein stores. The serum creatinine
levels may be WNL yet indicate renal impairment in pt’s with inadequate protein stores. The
calculation of the creatinine clearance, used to estimate renal function, is significant to the
provider.
Reduced renal function, especially the GFR, affects the clearance of many drugs, and CrCl
provides an index of renal function for use in choosing renally eliminated or nephrotoxic drugs
such as digoxin, H2 blockers, lithium, and water soluble antibiotics. (pg 3-4)
How disease presents in elderly
4 factors: 1. nonpresentation of illness – underreporting of s/s r/t erroneous association of
aging with disease, disuse, and disability. The elderly basically see these changes as inevitable so
they either do not go to the doctor or if they do, they do not challenge the doctor when they are
told it is age related. 2. multiple complaints – because of the prevalence of chronic disease in
the elderly population, they may present with multiple complaints. The provider should explore
the possibility of a constellation of symptoms and signs that when analyzed may represent more
than one condition/problem. After careful exploration, depression can also be considered given
depression can manifest atypically in older adults and somatic s/s are not uncommon. 3. An
altered pattern of illness – patterns of disease may be different in the elderly. For example,
jaundice in a younger pt indicates viral hepatitis but in the elderly may indicate a malignancy or
gallbladder disease. Another example is delusions and hallucinations in a younger pt can
indicate bipolar disorder but in the elderly can indicate dementia or medication side effects.
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