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Interpreting laboratory values in older adults.

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 MEDSURG NURSING
Interpreting Laboratory Values
In Older Adults
Results of common labora-
tory tests must be interpreted
with care in older adults.
Laboratory results that vary
with age are presented, along
with possible causes and inter-
pretations of results.
Nancy Edwards, PhD, RN,C, is an
Associate Professor, Purdue University
School of Nursing, West Lafayette, IN.
Carol Baird, DNS, APRN, BC, is an
Associate Professor, Purdue University
School of Nursing, West Lafayette, IN.
220
CE Objectives and Evaluation Form appear on page 230.
Nancy Edwards
Carol Baird
J ohn Doe, 83 years old, comes to
the clinic complaining of in-
creasing fatigue and weakness. His
past medical history includes dia-
betes mellitus, chronic anemia,
and hypertension. The 5’10” man is
thin (148 pounds) with small mus-
cle mass. His skin color is pale
pink. A battery of diagnostic tests
reveals the following: hemoglobin
11.2 g/dL, hematocrit 40%, white
blood cells 5,000/ml, fasting blood
sugar 183 mg/dL, blood urea nitro-
gen 30 mg/dL, serum creatinine 1.9
mg/dL, and serum albumin 2.3
g/dL. The nurse is uncertain which
laboratory values are significant in
considering Mr. Doe’s care plan.
This case illustrates the diffi-
culty in interpreting laboratory
values for older adults, which is a
complex task with varied opinions
about what is normal. Multiple
confounding factors make inter-
pretation and use of laboratory
results in older patients challeng-
ing. Some of the factors include
(a) physiologic changes associat-
ed with aging, (b) the high preva-
lence of chronic conditions, (c)
changes in nutrition and fluid con-
sumption, (d) lifestyle changes,
and (e) pharmacologic regimes
(Brigden & Heathcote, 2000).
Laboratory test results also may
be affected by many factors other
than aging. Influencing factors
MEDSURG Nursing—August 2005—Vol. 14/No. 4
may include gender, body mass,
alcohol intake, diet, and stress
(Fischbach, 2004). Technical fac-
tors such as collection site, col-
lection time, tourniquet applica-
tion, and specimen transportation
also can affect results but usually
can be controlled by following
standardized laboratory proce-
dures (Brigden & Heathcote,
2000).
Results of diagnostic testing
in older adults may have different
meanings from the results found
in younger individuals. Nurses
should recognize that no general
trend exists for the direction of
change in laboratory values for
older adults. For some tests, older
adults have higher than normal
values and for others, lower val-
ues; some remain unchanged.
Changes in laboratory values can
be classified in three general
groups: (a) those that change with
aging; (b) those that do not
change with aging; and (c) those
for which it is unclear whether
aging, disease, or both influence
the values (Tripp, 2000). Common
laboratory tests with interpreta-
tions for older adults are present-
ed.
Interpreting Reference
Ranges
The accepted, normal ranges
of values typically reported may
not be applicable for older adults.

Reference ranges may be more
appropriate. Normal ranges are
obtained by determining the
mean of a random sample of
healthy individuals, usually ages
20 to 40 years, in order to identify
two standard deviations on either
side of the mean. The concept of
normal range, however, is not
useful in determining age-related
norms for older adults (Luggen,
2004).
Reference ranges or reference
values are preferred concepts.
Reference ranges or reference
values are those intervals within
which 95% of the values fall for a
specific population (Lab Tests
Online, 2001). For example, geri-
atric reference ranges are those
intervals within which 95% of val-
ues for persons over 70 years of
age would fall. It must be cau-
tioned, however, that some
researchers recommend not
using reference ranges for labora-
tory test parameters pertaining
to older adults because it is diffi-
cult to differentiate whether
results are a sign of a disease or
are related to normal aging
(Luggen, 2004). However, refer-
ence ranges are useful in some
situations. The use of reference
ranges allows for recognition of
the special needs of the popula-
tion in question. Reference
ranges are calculated not just for
older adults, but also for
neonates (especially low-birth-
rate infants), adolescents, and
pregnant women. In addition, spe-
cific reference ranges are known
for tests for other special popula-
tions (for example, serum ery-
thropoietin in adult athletes such
as marathon runners).
Laboratory values falling out-
side the normal ranges may indi-
cate benign or pathologic condi-
tions in the older adult
(Fischbach, 2004). Values within
the expected normal reference
ranges, however, may also indi-
cate new or progressing patho-
MEDSURG Nursing—August 2005—Vol. 14/No. 4
Interpreting Laboratory Values in Older Adults
logic conditions in certain older
adults. Nurses working with older
adults should consider the total
assessment rather than simply
relying on laboratory diagnostic
testing. For example, goals of
management of diabetes should
be individualized. The principal
goal would be to enhance quality
of life without undue risk of hypo-
glycemia. It usually is best to
achieve fasting blood glucose lev-
els of less than 140 mg/dl.
However, in the frail elderly, it is
best to avoid fasting or bedtime
plasma glucose levels of less than
100 mg/dl if the patient is on
insulin or sulfonylurea treatment
(Reed & Mooradian, 1998).
Serum creatinine is a second
example of a laboratory test in
which results may be within the
specified reference range and yet
indicate pathology for the older
adult. Creatinine is a product of
creatine phosphate, used in
skeletal muscle contraction.
Endogenous creatinine produc-
tion is constant as long as muscle
mass remains constant (Pagana &
Pagana, 2002). The mechanisms
that regulate the older individ-
ual’s serum creatinine levels with-
in the accepted reference range
tend to overestimate renal func-
tioning as a measure of glomeru-
lar filtration rate. Serum creati-
nine and blood urea nitrogen
(BUN) levels in the high-normal
category may represent signifi-
cant renal dysfunction in the
older adult who has inadequate
protein intake (Daniels, 2002).
Specific Laboratory Tests
Hemoglobin (HGB). While the
results of studies of the effects of
aging on the hematologic system
vary (Brigden & Heathcote, 2000;
Nilsson-Ehle, Jagenburg, Landahl,
& Swanborg, 2000), research does
indicate that older individuals
may have changes in hemoglobin
and erythrocyte synthesis caused
by changes in iron and vitamin B12
absorption (Giddens, 2004). Im-
paired erythrocyte production,
blood loss, increased erythrocyte
destruction, or a combination of
conditions have also been identi-
fied as causes for lowered hemo-
globin (Giddens, 2004). Kee
(2002) defines hemoglobin as
abnormal if less than 13.5 gm/dl
for males and 12.0 gm/dl for
females. Recent studies with
older adults, however, suggest
lower levels may be acceptable.
The currently reported lowest
acceptable value for older adults
is 11.5 gm/dl for males and 11.0
gm/dl for females (Brigden &
Heathcote, 2000) (see Table 1).
Hemoglobin may be lower in
older adults due either to normal
aging changes or illnesses such
as anemia. Manson and McCance
(2004) identify impaired erythro-
cyte production, blood loss,
increased erythrocyte destruc-
tion, or a combination of condi-
tions as causes for anemia. Most
instances of anemia are associat-
ed with chronic conditions such
as renal insufficiency or gastric
bleeding (Giddens, 2004). Anemia
may be a serious condition
because it places the older indi-
vidual at greater risk for circula-
tory and oxygenation problems
(Tripp, 2000). A reduction of
hemoglobin can result in a
decrease in oxygen content and
an increase in fatigue. Signs of
anemia may not be noticed if the
anemia is mild, but some individ-
uals may present with shortness
of breath, fatigue, and paresthe-
sia (Manson & McCance, 2004). A
combination of vague symptoms
and an unclear clinical picture
may lead the health care provider
to attribute the symptoms to “old
age” and not to a treatable condi-
tion.
Hematocrit (HCT). Changes in
hematocrit may reflect fluid
and/or nutritional status in the
older adult (Fischbach, 2004;
Giddens, 2004). An increase in the
221
 Interpreting Laboratory Values in Older Adults

Table 1.
Geriatric Laboratory Values and Interpretations of Hematology

Normal Adult Value

Male (M)
Test Female (F) Geriatric Value Implications

Hemoglobin M 13.0 gm/dl M 11.5 gm/dl ↓: Anemias, cirrhosis of liver, leukemias,

F 12.0 gm/dl F 11.0 gm/dl Hodgkin’s disease, cancer (intestine, rec-
tum, liver, or bone), kidney disease
↑: Dehydration, COPD, CHF, polycythemia

Hematocrit M 40% - 54% M 30% - 45% ↓: Anemias, leukemia, Hodgkin’s disease,

F 36% - 46% F 36% - 65% multiple myeloma, cirrhosis of liver, pro-
tein malnutrition, peptic ulcer, chronic
renal failure, rheumatoid arthritis
↑: Dehydration, severe diarrhea, poly-
cythemia vera, diabetic acidosis, emphyse-
ma, transient cerebral ischemia

White Blood Cells 4,500 - 10,000 µl/mm3 3,000 - 9,000 µl/mm3 ↓: Hemotopoietic diseases, viral infections,
alcoholism, systemic lupus erythematous
(SLE), rheumatoid arthritis
↑: Acute infection, tissue necrosis,
leukemias, hemolytic anemia, parasitic dis-
eases, stress

Platelets 150,000 - 400,000 µl Minimal change ↓: Idiopathic thrombocytopenia purpura,

multiple myeloma, cancer, leukemias, ane-
mias, liver disease, SLE, kidney disease
↑: Polycythemia, trauma, post-splenecto-
my, metastatic carcinoma, pulmonary
embolism, tuberculosis

Source: Brigden & Heathcote, 2000

hematocrit may signal volume
depletion, while a decrease may
be a result of conditions accom-
panied by fluid overload or
dietary deficiencies. Hematocrit,
the percentage of total blood vol-
ume that represents erythro-
cytes, may be normal if values are
30% to 45% for older males and
36% to 65% for older females
(Desai & Isa-Pratt, 2002) (see
Table 1).
White blood cells (WBC).
Whether total leukocyte count is
affected by aging is controversial.
However, there are definite
changes in that the T cells are
less responsive to infection
(Fulop et al., 2001; Sester et al.,
2002). Immunity gradually de-
clines after age 30 to 40 years
(Rybka et al., 2003) (see Table 1).
A decreased WBC value may
result from specific disease
(myeloma, collagen vascular dis-
orders), infection or sepsis
(pneumonia, urinary tract infec-
tions), or medications (cytotoxic
agents, analgesics, phenoth-
iazides), and should not be attrib-
uted to advancing age (Fischbach,
2004). This lowered WBC count in
a healthy individual may result in
an absence of elevated white
blood cells in the presence of
severe infection. Medications
such as steroids also may influ-
ence the immune response
(Giddens, 2004). Because of the
slower immune response, com-
mon symptoms of infections,
such as enlarged lymph glands,
fever, or pain, may be decreased
in severity or absent in the older
adult (Beers & Berkow, 2000).
Nurses should be vigilant in
efforts to detect other signs of
infections in the older adult, such
as confusion. Because of the con-
cern for serious undetected infec-
tion, nurses should educate older
adults about infection prevention
techniques, such as hand wash-
ing and timely vaccination for
influenza and pneumonia.
Platelets (Plt). Aging usually
causes a decline in bone marrow
function, which may contribute
to lowered platelet counts and
decreased platelet function
(Luggen, 2004). Studies also sug-
gest that platelet adhesiveness
increases with age, with no

222 MEDSURG Nursing—August 2005—Vol. 14/No. 4


Geriatric Laboratory Values and Interpretations of Erythrocyte Sedimentation Rate,
Iron Metabolism, and Vitamin B12
Normal Adult Value
Male (M)
Test Female (F)
Erythrocyte M 0 - 15 mm/hr
Sedimentation F 0 - 20 mm/hr
Rate (ESR)
Serum Iron 50-150 µg/dl
Ferritin M 15 - 445 ng/ml
F 10 - 235 ng/ml
Vitamin B12 200 - 900 pg/ml
Source: Brigden, 1999; Brigden & Heathcote, 2000; Kee, 2000; Tripp, 2000
changes in numbers (Thibodeau
& Patton, 2004). The ability of the
older adult’s body to respond to
major blood loss by regenerating
platelets may be inadequate,
leading to inadequate clotting
(Beers & Berkow, 2000) (see
Table 1). The patient also must be
assessed for potential or hidden
blood losses, such as occult
blood in stools and emesis.
Erythrocyte sedimentation rate
(ESR). Brigden (1999) noted that
the erythrocyte sedimentation
rate increases with age, but the
cause of this increase is
unknown. ESR measures the rate
at which red blood cells (RBCs)
settle in 1 hour. An annual rate of
increase in time of sedimentation
rate for older adults has been
MEDSURG Nursing—August 2005—Vol. 14/No. 4
Interpreting Laboratory Values in Older Adults
Table 2.
Geriatric Value
M 0 - 40 mm/hr
F 0 - 45 mm/hr
60 - 80 µg/dl
10 - 310 ng/dl
150 pg/ml
quantified at 0.22 mm/hour/year
from age 20 years (Duthie &
Abbasi, 1991). An elevated ESR
may indicate the presence of
inflammation. Inflammation caus-
es an alteration in blood proteins,
making the RBCs heavier and
causing them to settle faster
(Fischbach, 2004). The accept-
able reference range for the older
adult is 40 mm/hour for males
and 45 mm/hour for females
(Brigden & Heathcote, 2000) (see
Table 2). Because a slight eleva-
tion may or may not reflect the
presence of an underlying inflam-
mation, confirmation of a clinical
problem may be difficult. Nurses
should rely on other assessment
factors, such as visible inflamma-
tion, pain, or fever, to determine a
Implications
↓: Polycythemia, CHF, degenerative arthri-
tis, angina pectoris
↑: Rheumatoid arthritis, rheumatic fever,
acute MI, cancer (stomach, colon, breast,
liver, kidney), Hodgkin’s disease, multiple
myeloma, bacterial endocarditis, gout,
hepatitis, cirrhosis of liver, glomeru-
lonephritis, SLE, theophylline use.
↓: Iron deficiency anemia, cancer (stom-
ach, intestine, rectum, breast), bleeding
peptic ulcers, protein malnutrition
↑: Hemolytic, pernicious, and folic acid
anemias; liver damage; lead toxicity
↓: Iron deficiency, inflammatory bowel
disease, gastric surgery
↑: Metastatic carcinoma, leukemias,
lymphomas, hepatic diseases, anemias,
acute and chronic infection, inflammation,
tissue damage
↓: Pernicious anemia, malabsorption
syndrome, liver disease, hypothyroidism
↑: Acute hepatitis
possible clinical condition.
Serum iron. Serum iron is
decreased in many older adults,
resulting in iron deficiency ane-
mia as the most common form of
anemia seen in older adults
(Tripp, 2000) (see Table 2). One
possible explanation is an age-
related decrease in hydrochloric
acid (HCl) in the stomach (Beers
& Berkow, 2000). HCI is important
for facilitating iron absorption in
the intestines. Serum iron, total
iron-binding capacity, and iron
stores decrease with age
(Daniels, 2002). When there is a
decrease in iron stores, serum-
ferritin increases and serum
transferrin decreases. The de-
crease in transferrin levels may
indicate a decrease in liver syn-
223
 Interpreting Laboratory Values in Older Adults

Table 3.
Geriatric Laboratory Values and Interpretations of Serum Proteins
Test Normal Adult Value Geriatric Value Implications

Total Protein 6.0 - 8.0 g/dl 5.6 - 7.6 g/dl ↓: Prolonged malnutrition, low-protein diet,
cancer (GI tract), severe liver disease, chronic
renal failure
↑: Dehydration, vomiting, multiple myeloma

Albumin 3.0 - 5.0 g/dl Slight decrease ↓: Severe malnutrition, liver failure, renal
52 - 68% of total protein disorders, prolonged immobilization
↑: Dehydration, severe vomiting, diarrhea

Source: Beers & Berkow, 2000; Kee, 2002

thesis (Lab Tests Online, 2004).
Decreased iron storage and iron-
deficiency anemia, however, com-
monly are caused by inadequate
dietary intake of iron or loss of
iron through chronic or acute
blood loss (Beers & Berkow,
2000). Nursing assessment should
include a dietary assessment for
reduced intake of iron-containing
foods and assessment of occult
bleeding from the gastrointestinal
tract.
Vitamin B12. Brigden and
Heathcote (2000) report that
serum vitamin B12 levels may
decrease slightly with age (see
Table 2). The deficiency in B12
may be due to chronic atrophic
gastritis, an immune dysfunction
that occurs more often in older
adults, or from a deficiency of
HCl, both leading to insufficient
intrinsic factor and insufficient
absorption of vitamin B12 (Beers &
Berkow, 2000). The low end of the
reference range for vitamin B12 is
150 pg/mL in the older adult as
opposed to 190 pg/mL in a
younger adult (Brigden &
Heathcote, 2000) (see Table 2).
Assessment for pernicious ane-
mia, including checking for neu-
ropathies, such as weakness, dif-
ficulty walking, and numbness or
tingling, should be considered
whenever anemia is present.
Total protein and albumin.
Some serum protein levels, such
as albumin and total protein,
decline in older adults (Beers &
Berkow, 2000). Changes in protein
may reflect decreased liver func-
tioning or inadequate nutritional
intake (Beers & Berkow, 2000).
While all serum proteins are
reduced, albumin is the most sig-
nificantly influenced by aging
(Beers & Berkow, 2000). Albumin
levels decrease each decade over
the age of 60, with a marked
decrease over 90 years of age
(Daniels, 2002). In addition to
being an indicator of disease or
malnutrition, low serum albumin
is the most common cause of a
low serum calcium level in older
adults, because most serum calci-
um is protein-bound (Beers &
Berkow, 2000) (see Table 3).
Renal function. As mentioned
previously, relying on commonly
accepted laboratory values in
determining renal function in the
older adult is difficult. The age-
related 30% to 45% decrease in
functioning renal tissue and the
glomerular filtration rate (GFR)
leads to a decline in the creati-
nine clearance (Brigden &
Heathcote, 2000). Commonly
occurring reduction in lean body
mass, decreased dietary protein
intake, or decreased hepatic func-
tion may lead to decreases in the
end products of metabolism,
BUN, and creatinine (Brigden &
Heathcote, 2000). BUN and creati-
nine levels overestimate renal
functioning, as measured by GFR
or creatinine clearance, because
of the changes in body composi-
tion (Engelberg, McDowell, &
Lovell, 2000; Luggen, 2004). A
decrease in the lean body mass,
relatively common in older
adults, results in reduced protein
degradation and nitrogen byprod-
ucts of metabolism (BUN). The
decline in muscle mass also
results in less creatinine produc-
tion; serum creatinine values thus
remain within normal limits
despite diminished renal clear-
ance capacity (Brigden &
Heathcote, 2000) (see Table 4).
When considering age-related
changes, most physicians and
advanced practice nurses ques-
tion the adequacy of BUN and cre-
atinine as indicators of renal func-
tion (Kennedy-Malone, Fletcher, &
Plank, 2004). Therefore, measure-
ment of urinary creatinine clear-
ance takes on special significance
in the older adult. Serum creati-
nine is affected by both
decreased GFR and body mass,
while urinary creatinine clear-
ance is affected only by glomeru-
lar filtration (Lewis et al., 2004).
Determining renal function by
creatinine clearance examination
is especially useful when treating
the older adult with medications
because of the potential for the
development of drug toxicity,
even with usual doses (Daniels,
2002). Because it may be difficult

224 MEDSURG Nursing—August 2005—Vol. 14/No. 4

 Interpreting Laboratory Values in Older Adults

Table 4.
Geriatric Laboratory Values and Interpretations of Selected Renal Function Tests
Test Normal Adult Value Geriatric Value Implications

BUN 5 - 25 mg/dl 8 - 28 mg/dl or slightly ↓: Liver damage, low protein diet, overhy-
higher dration, malnutrition
↑: Dehydration, high protein diet, GI bleed-
ing, pre-renal failure

Creatinine 0.5 - 1.5 mg/dl 0.6 - 1.2 mg/dl ↓: None for older adult
↑: Renal failure, shock, leukemia, SLE,
acute MI, CHF, diabetic neuropathy

Creatinine 85 - 135 ml/min Formula ↓: Mild-to-severe renal impairment, hyper-

Clearance thyroidism, amyotrophic lateral sclerosis,
thiazide use
↑: Hypothyroidism, renal-vascular hyper-
tension

Source: Brigden & Heathcote, 2000; Engelberg et al., 2000; Kennedy-Malone et al., 2004.

Table 5.
Estimating Creatinine Clearance Values for Men
(140 - age in years) x (body weight in kilograms)
Creatinine clearance =
(72 x serum creatinine in mg/dl)

Table 6.
Geriatric Laboratory Values and Interpretations of Hepatic Enzymes

Normal Adult Value

Male (M)
Test Female (F) Geriatric Value Implications

Serum Alanine 10 - 35 U/I 17 - 30 U/I ↓: Exercise, salicylates

Aminotransferase ↑: Viral hepatitis, liver necrosis, CHF, acute
(ALT, SGPT) alcohol intoxication

8 - 38 U/l 18 - 30 U/I ↓: Diabetic ketoacidosis

Serum Aspartate ↑: Acute MI, hepatitis, liver necrosis, mus-
Aminotransferase culoskeletal disease and trauma, pancreati-
(AST, SGOT) tis, cancer (liver), angina pectoris, muscle
trauma related to IM injections

Alkaline 20 - 130 U/I 30 - 140 U/I ↓: Hypothyroidism, malnutrition, perni-

Phosphatase cious anemia
↑: Cancer (liver, bone), hepatitis, leukemia,
healing fractures, multiple myeloma,
rheumatoid arthritis, ulcerative disease

Gamma-Gluta- M 4 - 23 IU/I 9 - 55 U/I ↓: None

Myltransferase F 3 - 12 IU/I ↑: Cirrhosis of liver, necrosis of liver, alco-
(GGT) holism, hepatitis, cancer (liver, pancreas,
prostate, breast, kidney, liver, lung), dia-
betes mellitus, acute MI, CHF, pancreatitis,
cholecystitis, nephritic syndrome

Source: Brigden & Heathcote, 2000; Kee, 2002

MEDSURG Nursing—August 2005—Vol. 14/No. 4 225

 Interpreting Laboratory Values in Older Adults

Table 7.
Geriatric Laboratory Values and Interpretations of Blood Lipids

Normal Adult Value

Male (M)
Test Female (F) Geriatric Value Implications

Cholesterol <200 mg/dl M may increase by 30 ↓: Hyperthyroidism, starvation, malnutri-

mg/dl tion, anemia
F may increase by 55 ↑: Acute MI, atherosclerosis, uncontrolled
mg/dl diabetes mellitus, hypothyroidism, biliary
obstruction, cirrhosis

High-Density M >45 mg/dl M increases by 30% ↓: Chronic obstructive lung disease

Lipoproteins F >55 mg/dl between ages 30 and 80 ↑: Acute MI, hypothyroidism, diabetes
(HDL) F decreases by 30% mellitus, multiple myeloma, high-fat diet
between ages 30 and 80

Triglycerides M 40 - 160 mg/dl M increases by 30% ↓: Hyperthyroidism, hyperparathyroidism,

F 35 - 135 mg/dl
Source: Brigden & Heathcote, 2000; Kee, 2002
F increases by 50% protein malnutrition, exercise
↑: Acute MI, hypertension, hypothyroidism,
nephritic syndrome, alcoholic cirrhosis,
pancreatitis, high-carbohydrate diet

Table 8.
Geriatric Laboratory Values and Interpretations of Glucose, Selected Electrolytes

Test Normal Adult Value Geriatric Value Implications

Serum Glucose 70 - 110 mg/dl 70 - 120 mg/dl ↓: Hypoglycemia, cancer (stomach, liver),
malnutrition, alcoholism, cirrhosis of liver
↑: Diabetes mellitus, adrenal gland hyper-
function, acute MI, stress, crushing injury,
renal failure, cancer (pancreas), CHF

Calcium 4.5 - 5.5 mEq/l No change ↓: Diarrhea, lack of calcium intake, chronic
renal failure, alcoholism, pancreatitis
↑: Hyperparathyroidism, malignant neo-
plasms (bone, lung, breast, bladder, kid-
ney), malignant myeloma, prolonged
immobilization, multiple fractures, renal
calculi

Potassium 3.5 - 5.3 mEq/l Slight increase ↓: Vomiting, diarrhea, dehydration, malnu-
trition, starvation, stress, diabetic acidosis
↑: Acute renal failure, acidosis (metabolic or
lactic), crushing injury, Addison’s disease
Source: Kee, 2002; Kennedy-Malone et al., 2004; Martin et al., 1997; Tripp, 2000

to perform a creatinine clearance
on the older patient, a formula
can be used to estimate creati-
nine clearance values. For men,
the formula is shown in Table 5
(Brigden & Heathcote, 2000). For
women, the value determined
from the formula is multiplied by
0.85. Normal ranges for creatinine
clearance are 104 to 140
ml/minute for men and 87 to 107
ml/minute for women (see Table
4). Nurses should not assume
that all changes in renal function
are due to aging. Chronic urinary
tract infections, benign prostatic
hypertrophy, prostatic tumors,
and diabetic neuropathy are also
causes and should be ruled out
(Lewis et al., 2004).
Hepatic enzymes. The aging

226 MEDSURG Nursing—August 2005—Vol. 14/No. 4


Geriatric Laboratory Values and Interpretations of Selected Blood Gases
Test Normal Adult Value
PaO2 75 - 100 mmHg
PaCo2 35 - 45 mmHg
Source: Brigden & Heathcote, 2000; Kee, 2002; Martin et al., 1997
process does not significantly
influence most hepatic laborato-
ry test values (for example, biliru-
bin, ammonia, and lipids.) While
lactic dehydrogenase (LDH) is
not affected by aging, the
enzymes gamma-glutamyl-trans-
ferase (GGT), serum aspartate
aminotransferase (AST, SGOT),
and alkaline phosphatase are
affected (Brigden & Heathcote,
2000). GGT levels increase with
aging (Tietz, Shuey, & Wekstein,
1997). AST increases slightly for
individuals 60 to 90 years of age
to 18 U/L to 30 U/L (Tietz et al.,
1997). Serum alanine aminotrans-
ferase (ALT, SGTP) levels peak
about 50 years of age and gradu-
ally fall to levels below those of
younger adults by age 65 (Kelso,
1990). Alkaline phosphate (AP)
increases with age to a level of 30
U/L to 140 U/L and is associated
with age-related malabsorption,
bone disorders, or decreased
liver or renal functioning
(Brigden & Heathcote, 2000) (see
Table 6).
Lipid profile. Lipid-related
changes in aging adults younger
than 70 years old are initially
noted as increases in cholesterol,
high-density lipoproteins (HDL),
very low-density lipoprotein (VLDL),
and triglycerides. Serum cholesterol
increases as much as 40 mg/dl by
age 60 in men and age 55 in women
(Brigden & Heathcote, 2000). No
increase is seen in adults over 90
years old; in fact, some very old
MEDSURG Nursing—August 2005—Vol. 14/No. 4
Interpreting Laboratory Values in Older Adults
Table 9.
Geriatric Value
100.1 - (0.325 x age) ↓: Emphysema, pneumonia, pulmonary
edema
↑: Hyperventilation
2% per decade ↓: Hyperventilation
↑: COPD
adults will have decreased choles-
terol levels (Tietz et al., 1997).
The mean HDL increases 30% in
men but decreases 30% in women
between ages 30 and 80 (Brigden
& Heathcote, 2000). Triglyceride
levels increase by 30% in men and
50% in women between the ages
of 30 and 80 years (see Table 7).
Glucose. Serum glucose levels
increase slightly but steadily with
age in parallel with a decrease in
glucose tolerance. The normal
reference range for serum glu-
cose is broader for older adults,
from 70 mg to 120 mg/100 ml
(Tripp, 2000) (see Table 8). Older
individuals may have lower glu-
cose levels, reflecting poor nutri-
tional status or overall loss in
body mass (Kennedy-Malone et
al., 2004). However, higher serum
insulin levels are more commonly
seen in older adults and may sug-
gest insulin resistance, which is
responsible for impaired glucose
tolerance in 25% of individuals
over age 75 (Kennedy-Malone et
al., 2004). If insulin receptors do
not respond to the same fasting
level of glucose in old age as they
did when the patient was
younger, glucose intolerance
without insulin-secretion changes
could be the explanation. A refer-
ence value for the 2-hour post-
prandial glucose tolerance blood
sugar test (PPBS) is calculated
with the following formula
(Brigden & Heathcote, 2000):
• 2-hr PPBS (mg/dl) = 100 + age
Implications
in years (for patients over age
40)
Serum electrolytes. In most
reports, electrolyte values remain
well within the standard refer-
ence values for older adults.
Calcium levels increase in older
patients (ages 60 to 90) but
decrease in the very old over age
90 (Martin, Larsen, & Hazen,
1997). The initial increase can be
explained by a decrease in serum
pH and an increase in parathyroid
hormone levels found in older
individuals (Tietz et al., 1997). If
the individual has a low serum
albumin, however, the serum cal-
cium level will most likely be low
as mentioned previously. Serum
potassium has been reported to
increase slightly with age
(Kennedy-Malone et al., 2004);
however, most researchers use
the same reference values as for
younger adults (see Table 8).
Arterial blood gases (ABGs).
Reference values for ABGs differ
in older adults from those of
younger adults. Stiffening of the
elastic lung structures, decreased
number of functioning alveoli,
and decreased strength of the
diaphragm are age-related changes
that decrease respiratory function-
ing (Martin et al., 1997). The
decreased respiratory functioning
results in a decrease in the partial
pressure of arterial oxygen ten-
sion (PaO2). The arterial pressure
decreases approximately 5%
every 15 years starting at age 30
227
 Interpreting Laboratory Values in Older Adults
Geriatric Laboratory Values and Interpretations of Thyroxine, Triiodothyronine, Prostate-Specific Antigen
Normal Adult Value
Male (M)
Test Female (F)
Thyroxine (T4) 4.5 - 11.5 µg/dl
Thyroid- 0.5 - 5.0 µlU/ml
Stimulating
Hormone TSH)
Prostate-Specific PSA 1.45 ng/ml
Antigen (PSA)
Source: Beers & Berkow, 2000; Daniels, 2002; Kee, 2002
(Brigden & Heathcote, 2000). A
formula (Brigden & Heathcote,
2000) has been devised to esti-
mate arterial oxygen in older
adults:
• PaO2 (mmHg) = 100.1 – (0.325
X age in years)
Additionally, a corresponding
increase in the carbon dioxide
pressure (pCO2) of approximately
2% per decade occurs after age
50. The bicarbonate-ion concen-
tration also increases with age,
balancing out the pO2 and main-
taining a normal blood pH
(Brigden & Heathcote, 2000) (see
Table 9).
Thyroid function tests.
Changes in thyroid function in the
older adult may be the most chal-
lenging problem for nurses as
they try to separate disease from
aging changes. Hypothyroidism is
seen in 2% to 6% of the general
population over age 70 (Kennedy-
Malone et al., 2004). Free thyrox-
ine (FT4) levels decrease progres-
sively with age (Kennedy-Malone
228
Table 10.
Geriatric Value
3.3 - 8.6 µg/dl
Slight increase
Ages 50 - 59: 0.0 - 2.45
ng/ml
Ages 60 - 69: 0.0 - 5.0
ng/ml
Ages 70 - 79: 0.0 - 6.3
ng/ml
Post-radical prostatecto-
my 0.0 - 0.3 ng/ml
et al., 2004). Triiodothyronine
(T3) shows substantial decreases
in ages 30 to 80 years. Typically, a
20% change in T3 occurs during
the lifetime of the older adult
(Beers & Berkow, 2000) (see
Table 10).
Prostate-specific antigen (PSA).
Relevance of PSA values to sup-
port aggressive treatment is con-
troversial (National Cancer In-
stitute, 2004). Because an eleva-
tion in the PSA could be indicative
of benign prostatic hypertrophy
or prostate cancer, results from
this test alone should not drive
therapy. Because of false posi-
tives and false negatives, the age-
relation variation of PSA increases
difficulty in treatment decisions.
Reference ranges for PSA with age
are (a) 60 to 69 years: 0.0 to 5.0
ng/ml, and (b) 70 to 79 years: 0.0
to 6.3ng/ml. Men who have had a
radical prostatectomy are expect-
ed to have values of 0.0 to 0.3
ng/ml (Daniels, 2002) (see Table
10).
Implications
↓: Hypothyroidism, protein malnutrition,
corticosteroids
↑: Hyperthyroidism, viral hepatitis,
thyroiditis, myasthenia gravis
↓: Excessive thyroid hormone replacement,
Graves’ disease, primary hyperthyroidism
↑: Primary hypothyroidism, thyroid
hormone resistance
↑: Prostate cancer, benign prostatic
hyperplasia
Implications
Laboratory test results in-
form health care providers of a
patient’s changing condition. The
presence of multiple diseases, as
well as the incidence of polyphar-
macy, may be a source of confu-
sion in the clinical interpretation
of laboratory results. Often, nurs-
es must ask, “What test results
are significant and suggest the
presence of disease? Which
results suggest changes in patient
conditions that require further
assessment or interventions?”
Greater understanding of how to
interpret laboratory test values in
relation to the clinical picture for
the older adult allows nurses to
provide age-appropriate assess-
ments and interventions.
Mr. Doe’s laboratory reports
illustrate the confusion surround-
ing evaluating laboratory data for
the older adult. Are his diagnostic
test results helpful in explaining
his fatigue and weakness? What
really is happening with him?
MEDSURG Nursing—August 2005—Vol. 14/No. 4

Perhaps the slightly elevated
renal function tests indicate nor-
mal changes of aging. However,
they also might be due to protein
malnutrition, which is suspected
because of his low body weight
and recent weight loss. Obtaining
serum protein and urinary creati-
nine studies as well as a thorough
nutritional assessment might
assist in defining the diagnosis.
Interpretation of laboratory
test results allows nurses to rule
out diagnoses that are not perti-
nent, but also assists in the exam-
ination of a broad spectrum of
possibilities. Each laboratory
may have variations in the refer-
ence ranges due to techniques
and equipment. Nurses must
work closely with laboratory per-
sonnel and pathologists to be
informed about changes in refer-
ence ranges for older adults in a
specific laboratory. Nurses also
should educate other health care
professionals about age-related
variations in acceptable laborato-
ry values. Better understanding
of interpretation of diagnostic
test results in older adults will
allow nurses to feel confident
about the care they provide. ■
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