Age-related changes
myocardium:
- decreasing cardiac contractility
- less responsive to the impulses from the sympathetic nervous system
- fewer pacemaker cells
- irregular shape of pacemaker cells
- increased deposits of fat, collagen, and elastic fibers around the sinoatrial node (SA node)
Vasculature:
- changes in tunica intima and media
- irregular size and shape of endothelial cells
- diameter of lumen of aorta increases to compensate for arterial stiffening
- veins, like arteries, become thicker, more dilated, less elastic
- increased vascular resistance= slight increase in systolic BP
- increased peripheral resistance= slight increase in systolic BP
- due to peripheral resistance, the left ventricle has to work harder and becomes larger and thicker
- valves of larger veins become less effective in returning blood to the heart
- Baroreceptors in the large arteries (carotid and aorta) less effective in controlling BP
Risk factors
affecting CV function
- arrhythmias
- heart failure
- myocardial infarction (heart attack)
- peripheral vascular disease
- venous thromboembolism (PE)
- stroke (CVA)
- transient ischemic attack (TIA) -temporary, no perm. damage to brain
- atherosclerosis
-note: most CV diseases are preventable through intervention to reduce risk factors
Risk factor: Atherosclerosis
- disorder of the medium and small arteries
- deposits of lipids and Atherosclerotic plaques reduce or obstruct blood flow
-process begins in childhood and can progress to plaque formation
-plaque lesions can rupture = acute events occur
or
-plaque lesions can remain stable and continue to grow= causing chronic disease
Risk factor: Physical In-Activity
-more than 30 min of moderate PA 5x/week
or
-more than 20 min of vigorous PA 3x/week
- any PA reduces risk of CV disease
- older adults often have compounding conditions that make PA goals difficult to reach
Risk factor: Smoking
- any type of smoke increases risk of CV diseas and mortality
- life expectancy is reduced by 13-15 years
- 2nd hand smoke at risk for developing Coronary Artery Disease (CAD)
Risk Factor: Dietary habits
-high sat fats= bad
good to reduce:
- whole grains
- oily fish
- fruit, veg
- LOW SODIUM
Risk factor: Obesity
- BMI 30+
- pear shape = better waist
- associated with pathologic conditions ex stroke, HTN, CAD
Risk Factor: Hypertension
- risk factors for developing HTN:
- age
- ethnicity
- heredity
- overweight
- physical inactivity
- psychological stressors
- sleep apnea
- low education and socioeconomic status
Risk Factor: Dyslipidemia
-lipoprotein metabolism
-HDL (high. density cholesterol)
=good cholesterol
-want to have a HIGH number
- LDC (low density cholesterol) = bad cholesterol
- want to have a low number
- Non-HDL (total cholesterol subtract HDL)
- want to have a high number
- triglycerides - want to hav a low number
- Statin and other cholesterol lowering meds can be prescribed
Risk factor: Psychological
- anxiety
- depression
- social isolation
- poor social support
- specific personality traits
-broken heart syndrome (“Takotsubo cardiomyopathy”) - shape of heart changes due to major life event ex heart break
Risk factor: Heredity, gender, race
-inherited conditions cannot be changed = focus on modifiable risk factors like PA, diet …
- symptoms differ between genders
- men= pain
- women=SOB, anxiety, dizziness, nausea (aren’t easily recognizable)
-low income and lack of education = little use of preventative health care ex. diet…
Functional consequences
affecting CV wellness
- decreased adaptive responses to exercise
- slightly lower heart rate
- increased susceptibility to HTN and HOTN
- increased susceptibility to arrhythmia (atrial fibrillation)
- decreased vertebral blood flow
2 Pathologic conditions
affecting CV wellness
- Orthostatic Hypotension
- rt reduced baroreflex sensitivity
- risk factors:
- hypotension, CAD, CHF, antihypertensive, diuretic, beta-blocking meds, Parkinson’s disease
- symptoms:
- syncope upon standing,
- lightheadedness,
- fatigue,
- blurred vision - Postprandial Hypotension
- a reduction in just systolic BP of 20mmhg + within 2 hours of eating (after eating, more blood goes to the stomach and less to the brain)
- affects people with HTN
- causes:
- impaired autonomic function (receptor problems)
- contributing factors: diabetes
Assessment
Atypical symptoms of CV disease:
- anxiety
- cough
- fatigue
- nausea
- SOB
- pain in arm, jaw, neck, throat vs typical chest/shoulder pain
- visual changes
assessment of CV function
- head to toe (murmur, arrhythmia, BP
- determine baseline BP
- assess modifiable risk factors
- assess pt knowledge of what to do and who to call when experiencing symptoms of heart attack
- self-measurement of BP by capable pts
Interventions
to promote healthy CV function
Detect risks:
- annual BP. check
- screening for diseases that increase risk of heart disease ex diabetes, hyperlipidemia
Reduction of modifiable risk factors:
- smoking cessation
- moderate PA
- maintain normal weight
- stress management activities
- eat heart-healthy foods:
- whole-grain carbs, dark leafy veg, low-fat dairy, 25 g fiber, lean meats, LOW SODIUM, avoid trans fats
Pharmacologic:
-encourage BABY aspirin for men 45-79 yrs, women 55-79 yrs for those who have had a cardiac event
Prevent and manage Orthostatic and Postprandial Hypotension:
- maintain adequate fluid intake
- wear TED stockings to promote venous return
- eat many smaller meals
- avoid sit/standing for long periods esp. after meals
- change positions slowly
- avoid hot tubs that cause vasodilation
- avoid strenuous exercise esp. for 2h after meals
- take antihypertensive meds
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midterm46
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7. HEARING8
-
7. Vision9
-
8. GI/GU16
-
8. Cardiovascular15
-
9. Respiratory6
-
9. Mobility and Safety6
-
10. Integumentary function & Sleep12
-
10. Thermoregulation & Sexual14
-
11. Pain14
-
11. Cancer & End of Life Care15
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12. Caring for Older Adults During Illness - diabetes11
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3. Dementia & Delirium7
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5. Depression5
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2. Aging theories3
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3. Functional1
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4. Medication12
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4. Med Admin11
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5. Emotional and Spiritual (Psychosocial)5
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n224- definitions21
