Nursing Care and Pulmonary Changes in Elders

Elder Pulmonary Changes and Nursing Care

Pulmonary Changes in Elders,Affects of Smoking,Mainly Associated Symptoms,Typical and Atypical Symptoms,Pulmonary and Neurological Issues

Pulmonary Changes in Elders

    Most of the pulmonary changes associated with aging are gradual, giving elders the opportunity to adapt (Stanley &Beare , 1999). Normal lung aging is a benign process with relatively few clinical implications. 

    A decline in physiologic reserve is the only consistent finding in healthy adults. This does not affect usual activities of daily living and only has a minor effect on exercise capabilities (Braunwald et al., 2001). 

    However, the physiologic and functional consequences of age-related anatomic changes, altered gas exchange, ventilatory changes, and altered pulmonary protective mechanisms are important considerations in the comprehensive assessment of the older adult.

Affects of Smoking

    Smoking accelerates the age-related decline in pulmonary function. Smoking, unlike other risk factors, can be eliminated. Smoking cessation, even after the age of 60, has been found to halt the progressive decline in pulmonary function (Higgins et al., 1993). 

    Smoking cessation strategies for elders should encompass appropriate modalities, including the use of nicotine patches, oral medications, and behavioral interventions. Smoking cessation interventions must be planned, should consider any medications being taken concurrently, and should be sensitive to the difficulties associated with a long-standing nicotine addiction.

Mainly Associated Symptoms 

    Dyspnea or shortness of breath is a frequently reported symptom associated with illnesses such as chronic obstructive pulmonary disease (COPD), asthma, lung cancer, and heart failure. Dyspnea is the most common reason for emergency department visits and increases the likelihood for hospital admission (Parshall, 1999). 

    Studies have shown that self-report of dyspnea does not always correlate with pulmonary function testing. In a longitudinal study of elders with COPD, individual ratings of dyspnea were not directly linked to changes in lung impairment (Lareau, Meek, Press. Ansholm , &Roos , 1999). 

    This blunted perception is thought to be caused by physiological adaptation over time. Assessment of dyspnea can be accomplished using several available scales. The use of a visual analogue scale (VAS) to measure dyspnea in elderly persons with COPD has been validated by Gift (1989). 

    This type of measure provides a quick and reliable measure of dyspnea. The Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ)designed by Lareau, Carrieri-Kohlman , Janson- Bjerklie , and Roos (1994) is another reliable scale which has been used to measure dyspnea intensity and changes in functional ability in elderly persons with pulmonary disease.

 Typical and Atypical Symptoms 

    Elders who present with a pulmonary infection often do so atypically. Often this is due to poor patient perception of their symptoms. Initial symptoms of pulmonary infection can be misdiagnosed as a pulmonary embolism or as heart failure (Blair, 1990). 

    The classic triad of cough, elevated temperature, and pleuritic pain may not be present, or it may be blunted in elders. Instead, such subtle changes as increased respiration, increased sputum production, confusion, loss of appetite, and hypotension can be clues to possible pulmonary infection. 

    Signs of sepsis may already be evident when elders present with a pulmonary infection (Stanley &Bearc , 1999). 

Pulmonary and Neurological Issues

    Elders who have neurological illnesses such as Alzheimer's disease or Parkinson's disease, or who have sustained a cerebrovascular accident (CVA), are at risk for aspiration pneumonia and should be closely monitored for dysphagia. 

    Interventions aimed at diminishing the risk for aspiration are critical. Altered pulmonary-protective mechanisms have implications for elders undergoing surgery. In any given year, about 25% of the 600,000 elders who undergo major abdominal or thoracic surgical procedures in the United States experience postoperative pulmonary complications. 

    Common interventions aimed at preventing such complications include cessation of smoking, bronchial hygiene, and incentive spirometry. Prevention of venous thrombosis with possible pulmonary embolization is critical in the elder population undergoing abdominal, thoracic, or orthopedic surgery. 

    This is best accomplished with low-dose heparin, administered subcutaneously every 12 hours, and with the use of pneumatic stockings. For elders at high risk for pulmonary embolism, more frequent subcutaneous dosing of heparin may be used, or coumadin may be ordered.