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.