Conceptsof Altered Health in Older Adults
1.Physiological aging is perceivable as the changes that occur in aperson`s body as time passes by (Farley, McLafferty, and Hendr,2011). These changes are manifested by alterations in the structureand processes of tissues, behaviour, bodily systems and major organsthat can impact an individual`s health, survival, and functionalcapabilities. However, not all changes seen in older adults can beattributed to aging: some changes are not inevitable. Longitudinalstudies have revealed two main distinctions about physiologicalaging: The first is between "inevitable" and "usual"aging while the second is about "disease" and "normal"aging (2011).
Joseph,an 82-year-old male, is bound to experience some inescapable changesdue to old age. For example, increases in weight and blood pressureand low hearing and visual acuity (usual aging). Inevitable changes,however, can be linked to biological processes. These changes includegreying of the hair, facial wrinkles, and balding. Thus, by usualchanges in aging, the implication is that these changes are typical,and, are not inextricably linked to the process of aging. More oftenthan not, they are precipitated by lifestyle choices: smokingexposure to pollution, the sun, noise, etc. poor diet, and leading asedentary lifestyle (Farley, McLafferty, and Hendr, 2011). A case inpoint is where some groups suffer some of the "usual changes"earlier than others: African Americans, for instance, are morevulnerable to blood pressure increases when compared to Asians,Africans, and Euro-Caucasians (2011). The implication of thebefore-mentioned, therefore, is that "usual changes" aretypical, but not necessarily precipitated by aging.
Inessence, pathophysiology is a field of study that concerns itselfwith the examination of unusual mechanical, physical, and biochemicaloperations, which may be caused by an ailment, an abnormal syndrome,or a condition that does not qualify to be categorised as a diseases(Farley, McLafferty, and Hendr, 2011). Using Joseph`s case study asan example, one may predict the occurrence of the followingpathophysiological changes:
Theabove considered, there is a myriad of physiological ageing processesthat may be perceived as diseases, if these ailments are severe(Sigelman and Rider, 2012. The loss of bone density through the lossof calcium culminates into osteoporosis. Also, severe loss of braincells may lead to the development of dementia in extreme cases. Thus,the type of change is not the determining factor when it comes tolabelling a condition a disease, but rather the severity of thecondition: pathophysiology (2012). Someof these physiological factors may put Joseph at the risk of falling,as discussed below.
Behaviourdisorders have been connected to old age. Individuals aged 65 andabove have been reported to become physically aggressive, overlyengaged in disruptive verbal outbursts, and affected by motoroveractivity (Sigelman and Rider, 2012). The before-mentioned may beprecipitated by conditions such as depression, delirium, psychosis,and dementia. Thus, precipitating and predisposing factors in theenvironment may expose Joseph to particular dangers. As pointed outin the case study, Joseph enjoys taking long walks on a regular basisor riding a stationary bicycle during rainy days.
Rapidmuscle weakness. Over the years, medication, for instance, the use offour or more prescription tablets, conditions such as arthritis, theuse of assistive devices due to old age (in most cases individualsover age 80), day-to-day activities, etc. have been linked to olderadults (Sigelman and Rider, 2012). As a result, Joseph may sufferfrom a pathophysiological process that may lead to the development ofany one of the above ailments, and, by extension the development ofrapid muscle weakness. Muscle weakness, especially in older adultslike Joseph, has been attributed to increased risk of falling whileone caters to his day to day activities.
Alzheimer`sdisease. This disease is manifested by a person`s inability to formnew memories, in addition to the degeneration of other mentalfunctions. One of the symptoms of Alzheimer`s is the inability torecall new information, for instance, a new address. Alzheimer`sdevelops over a period of between eight and 20 years, where thevictim begins losing memory, displaying childish behaviour, andeventually developing to the extent of a person losing the ability todress himself. Changes in cognition, which may affect mentalprocesses such as perception and sensation, language, memory,thought, problem-solving, etc. may impair Joseph`s ability to takecare of himself. Thus, he may easily forget the positioning oflow-lying objects such as stairs, floors that have been slightlyelevated, etc., which may expose him to tripping and falling moreregularly (Farley, McLafferty, and Hendr, 2011).
2.Among the primary functions of the renal system is excretion (Rogers,2012). Through excretion, the urinary system maintains the requiredfluid volume by ensuring that the amount of water produced in thebody is excreted in the urine. The kidneys play a key role inexcretion: they maintain homeostasis for tissue and optimal cellmetabolism. The kidneys achieve the before-mentioned through theseparation of mineral salts, toxins, urea, and other unwantedmaterials from the blood. The six primary roles of the kidneys areregulating plasma ionic composition, plasma osmolarity, plasmavolume, plasma hydrogen ion concentration, eliminating unwantedsubstances from the plasma, and secreting hormones (2012).
Thekidneys are also connected to the renal veins and renal arteries,uterers, urinary bladder (Rogers, 2012). The renal arteries driveblood to the kidneys while the renal veins drain the kidneys of theoxygen depleted blood. The ureters draw off the urine from thekidneys to the urinary bladder. After the urine finds its way intothe bladder, the small folds located in the bladder mucosa preventthe back and forth flow of urine, the folds act as valves. When thebladder is full, it stimulates the sensory nerves located on thebladder wall to relax the sphincter so as to give way to the releaseof urine. The released urine goes into the urethra. The urethra thenremoves the urine from the body (2012).
Epidemiologicalresearch reveals that arterial stiffness independently predicts theadvent of adverse cardiovascular events that lead to systolichypertension, diastolic dysfunction, impaired ventricular-arterialcoupling, the progression of kidney disease, and impairment ofmyocardial oxygen supply (Aroor et al., 2013). Over the past years,studies reveal that aging is closely linked to arterial stiffnessalthough, conditions such as diabetes and obesity accelerate itsprogression. However, in spite of the before-mentioned, the exactcause of arterial stiffness is somewhat hazy: researchers have alsoattributed sedentary lifestyles, high fat, salt, and high fructosediets to arterial stiffness (2013). Accumulating evidence,nevertheless, points the role of endothelial dysfunction and insulinresistance to the development of arterial stiffness. Thus, RAAS(Renin-Angiotensin-Aldosterone System), which is a local tissuewithin the immune cells, vascular tissue, and perivascular adiposetissue, precipitates the onset of endothelial dysfunction, which, byextension, precipitates arterial stiffness (2013).
Theabove considered, human aging is attributable to the progression ofchanges in the RAAS, which influences a significant reduction in itsplasma activity (Musso, and Jauregui, 2015). As a result, thecapacity to handle potassium and sodium, in the distal tubule, amongthe elderly population is brought down quite significantly. A myriadof studies reveal that senile renal structural modifications could becaused by the [local] manufacture of angiostatin II, in addition tothe fact that enalapril brings down senile mesangial expansion,medullar and peritubular interstitial sclerosis, glomerulosclerosis(2015).
Therefore,due to age-associated reduced renal concentration capacity, decreasedsodium-conserving ability, reduced production ofrenin-angiotensin-aldosterone, and an enhanced manufacture of theatrial natriuretic hormone, a change of the circadian rhythm of waterexpulsion leads to heightened nighttime urine production among theelderly (Miller, 2015). As a result, symptoms such as nocturia,urinary frequency, and incontinence are realised due to theinteraction of age-related diminution in operational bladder volumeand nocturnal polyuria. Additionally, the bearing of Alzheimer`sdisease on aging and physiological changes, in addition to adecreased ability to perceive bladder fullness, leads to a muchhigher risk or urinary incontinence among the older population. DDAVP(desmopressin), a hormone used in the treatment of nocturnalpolyuria, can cause a decrease in nocturnal urine production thus,improving symptoms of nocturia, and incontinence (2015).
3. As discussed above, the urinary system comprises two kidneys, whichconnect to the urinary bladder through two tubular structures knownas the ureters. The kidneys function as filtering apparatuses whilethe urinary bladder serves as a urine reservoir. The bladder, whichis regulated by a sphincter, empties into the urethra to excreteurine from the body (Rogers, 2012).
Inessence, dehydration is perceivable as the loss of water from thehuman body (Huether, 2012). Dehydration becomes pathophysiologicalwhen the amount of body fluids being excreted exceeds the amount offluid/water getting out of the body. The loss of essentialelectrolytes and water may impair the normal functioning of bodyorgans like the kidney, the heart, and the brain. The impact ofchronic dehydration may be fatal. The elderly adults are moresusceptible to becoming dehydrated, compared to younger individuals,since the thirst sensation lulls with age, in addition to thealterations in sodium and water balance that occur with senescence.To a certain degree, the before-mentioned [thirst] also occurs sincethe elderly are more likely to be disabled, impaired or handicapped(comorbidity). In addition, most old persons also tend to takemedication (polypharmacy). Multimorbidity and polypharmacy, in mostcases, can be attributed to overstressing the normal physiologicalchanges in water and sodium balance thus, exposing the elderly tohigher risks of dehydration. Dehydration among the elderly isheightened in times of warm weather and intercurrent infections(2012).
Aspointed out earlier, the loss of essential electrolytes and water mayimpair the normal functioning of body organs like the kidney, theheart, and the brain (Huether, 2012). The adjustment of arterialpressure is closely linked to the proper functioning of kidneys todischarge sodium chloride in sufficient quantities to maintainextracellular fluid volume, normal sodium balance, and blood volumeat ideal arterial pressures. Thus, if the kidney is impaired due todehydration, the problem could be extended to other regions of thebody such, for instance, the heart. In fact, the renal disease hasbeen advanced as the most common secondary cause of hypertension(2012).
Indetermining what affect drinking fruit juice has on elderly patientswhile exercising versus drinking water, and the affect thebefore-mentioned has on the body, for example renal system, bladder,kidney function, the following is considered.
Thespeed of absorption of electrolytes, water, and sugar into the bloodstream determines the type of beverage that one should consume. Thus,the higher the carbohydrate content in the beverage being consumed,the slower the rate of absorption. The before-mentioned means, it maybe difficult to try to maintain ideal electrolyte levels and properhydration with sugary fruit juices or sports drinks. However, if theexercise is too intense, plain water will permeate the body tooquickly, and, as a result, fail to provide the requisite sugar totrigger an insulin response. Therefore, the ideal beverage iddependent on the particular need of the body: rehydration or energyreplenishment (DeNysschen, Ford, Rao, and Zimmerman, 2014).
Studieshave revealed that older people tend to have a lulled sense ofthirst. In addition, medication may also prevent sufficient waterabsorption into the body, or in the case of diuretics, precipitatethe excretion of water from the body thus, precipitating the problem(Wilson, 2014). In the case study, therefore, Joseph, an 82-year-oldadult, should ensure that he constantly hydrates himself as heexercises since he may not realise that his body is in need of water– because of his diminished thirst sensation. In addition, researchalso reveals that adequate fluid intake in older adults has beenlinked to few rates of constipation, laxative use, and mostimportantly, fewer falls. Also, orthopaedic patients who haveadequate body fluids enjoy better rehabilitative outcomes (2014).
Extracellularfluid (ECF) enables body cells to maintain their energy consumingcapacities and the ability to pump sodium out and keep potassium inthe body, in a bid to counterbalance the negative protein and otherion charges (Lobo, Lewington, and Allison, 2013).
Optimaltissue functioning depends on maintaining the "milieu interieur"within the slim confines of normal acid-base composition. The lungs,the liver and the kidneys play a significant role in the maintenanceof ideal arterial blood pH and acid-base balance. The kidneysregenerate bicarbonate and excrete acid. The lungs control thedischarge of CO2 by varying, as required, the respiratory rate. Andthe liver excretes and reuses lactate. Thus, individuals sufferingfrom kidney disease, an underlying respiratory ailment, or liverdisease, are more exposed to suffering from acid-base disorders(Lobo, Lewington, and Allison, 2013). With the before-mentionedconsidered, extracellular fluid volume, sodium balance, and bloodvolume can only be maintained at normal arterial pressure if thekidneys maintain the capacity to discharge sodium chloridesufficiently. If not, the renal disease may lead to the developmentof hypertension.
Aroor,A. R., DeMarco, V. G., Jia, G., Sun, Z., Nistala, R., Meininger, G.A., & Sowers, J. R. (2013). The Role of TissueRenin-Angiotensin-Aldosterone System in the Development ofEndothelial Dysfunction and Arterial Stiffness. Frontiers inEndocrinology, 4. doi:10.3389/fendo.2013.00161
DeNysschen,C. A., Ford, A., Rao, T., & Zimmerman, B. (2014). ThePhysiological Effects of Gatorade® Versus Diluted Fruit Juice duringExercise: A Preliminary Study. Journal of Food and Nutrition, 1(101).doi:10.17303/jfn.2014.101
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Huether,S. E., & McCance, K. L. (2012). Understanding pathophysiology(5th ed.). St. Louis, MO: Mosby/Elsevier.
Lobo,D., Lewington, A., & Allison, S. (2013). Basic Concepts of Fluidand Electrolyte Therapy. Retrieved fromhttp://www.bbraun.com/documents/Knowledge/Basic_Concepts_of_Fluid_and_Electrolyte_Therapy.pdf
Miller,M. (2009). Fluid Balance Disorders in the Elderly. American Societyof Nephrology. Retrieved fromhttps://www.asn-online.org/education/distancelearning/curricula/geriatrics/Chapter17.pdf
Musso,C., & Jauregui. (2014). Renin-angiotensin-aldosterone system andthe aging kidney.Expert Review of Endocrinology & Metabolism.Retrieved fromhttp://www.tandfonline.com/doi/pdf/10.1586/17446651.2014.956723
Rogers,K. (2012). The kidneys and the renal system. New York, NY: BritannicaEducational Pub. in association with Rosen Educational Services.
Sigelman,C. K., & Rider, E. A. (2012). Human development across the lifespan. Belmont, Calif.?: Wadsworth Cengage Learning.
Wilson,L. (2014). Hydration and Older People in the UK: Addressing theProblem, Understanding the Solutions. Parliamentary Hydration Forum.Retrieved fromhttp://www.scie.org.uk/publications/guides/guide15/files/hydration-and-older-people-in-the-uk.pdf?res=true