Age-related Changes:
Cardiovascular:
Age-Related Changes:
Source: http://www.innvista.com/health/anatomy/cardage.htm
The walls of the arteries thicken, lose their elasticity, and become stiffer. This
causes a decrease in blood flow to vital organs and causes blood pressure to rise.
Major age-related changes include the following:
Blood
Blood Vessels
• Blood vessel walls become thicker and tougher. Since the walls no longer
have the elasticity to adjust to sudden changes in blood pressure, there is an
increased risk of aneurysms.
• As the inner surface of blood vessels become roughened, age-related
changes cause an increased risk in the development of fatty plaques and of
thrombus formation.
• Weakened vascular walls also collect calcium salts, which increase the risk of
heart attack or stroke.
• As the walls of veins weaken and stretch, their valves become incompetent.
This is more likely to occur in the legs where the walls are subject to greater
pressure as the blood struggles to return to the heart against the force of
gravity. As a result, distended superficial veins develop (varicose veins). An
inflammation, called phlebitis, also occurs more often in the elderly.
• Baroreceptors become less sensitive; therefore, adjustments to changes in
position are slowed, causing an increase in dizziness and falling.
Heart
• There is a reduction in exercise cardiac output. Because the heart is not able
to pump the blood as efficiently, circulation is slowed. In addition, the heart
cannot respond as quickly, or as forcefully, to the increased workload of the
exercised heart. Exertion, sudden movements, and changes in position may
cause a decrease in cardiac output, resulting in dizziness and loss of balance.
However, opinions vary as to whether or not there are changes in the resting
cardiac output. In general, heart resting output is decreased to 80% by age
50 and to 70% of capacity by age 70. When output does decline, it is often
associated with such other age-related processes as atherosclerosis. A
reduction in cardiac output leads to pooling of blood in the legs, cold
extremeties, and edema.
• The health of the myocardium (the heart’s muscular wall) depends on blood
supply, and with age, the likelihood of athersclerosis increases, causing the
coronary arteries to narrow, restricting the vital blood supply.
• High blood pressure (hypertension) causes the left ventricle to work harder.
It may enlarge and outgrow its blood supply and thus becomes weaker.
• Several structural changes in the heart contribute to the impaired response
to exercise:
o heart muscle loses elasticity and becomes more rigid;
o heart valves become thickened by fibrosis and more rigid (leading to
murmurs);
o the number of pacemaker cells decreases;
o aging heart cells have a decreased ability to use oxygen;
o arrythmias are more common with age as the cells of the conduction
pathway become less efficient.
• An age-related increase occurs in blood pressure. As a result, the heart
needs to work harder to pump blood into the systemic circulation.
Normal Limits:
Women and blood pressure: Women with high blood pressure have a 3.5-times
greater risk of developing heart disease than women with normal blood pressure.
In 2005
15.7% of Canadian females (12 years and older) had high blood pressure.
21.3% of Canadian women (45-64 years of age) had high blood pressure.
47.9% of Canadian women (65 years and older) had high blood pressure.
1. Age (non-modifiable)
Being older than age 55 is an important risk factor.
2. Ethnicity (non-modifiable)
Being black is associated with a higher risk of developing high blood pressure. New
studies are inconclusive on whether the risk is equivalent between African
Americans and people of African heritage who have never left the African
continent.
3. Gender (non-modifiable)
At younger ages, women are less likely to develop high blood pressure than men.
This risk equalizes later in life, but statistically, women are still less likely to
develop high blood pressure, overall.
Having a family history of high blood pressure places you in a higher risk category
than someone with no family history of high blood pressure. However, what this
actually means is still a topic of research. It is clear that family history plays an
important role in determining risk, but there are probably more important factors,
and they are under your control.
5. Smoking (modifiable)
Smoking is the number 1 risk factor over which you have control. Smoking is such
a powerful risk factor for so many different human diseases that doctors are
encouraged to ask every patient who smokes if they would like to quit - every time
they visit the office! Quitting smoking is the best thing you can do for your health.
A low exercise lifestyle leads to a weak heart, poor exercise tolerance, and obesity.
All of which have been implicated in the development of high blood pressure.
7. Diet (modifiable)
While there is evidence that specific items, such as salt, can worsen high blood
pressure in certain individuals, the main impact that diet plays in high blood
pressure risk is that it is a big factor in how much you weigh.
The kidneys are very important regulators of long term blood pressure, and
damage to the kidneys - such as can occur from diabetes - almost invariably leads
to high blood pressure.
Nutrition:
An individualized eating guide for this group of elderly Americans recognizes their
special nutrient needs. As a result of common health problems and bodily changes
that occur with aging, people over the age of 70 years have:
Hallmarks of previous food selection guides that remain important for older
healthy, active adults include:
Specialized recommendations for the "70 and over" senior crowd are:
1. Choose the lower number of recommended servings from each food group.
2. For grain products, choose whole grain, enriched/fortified products; brown
rice rather than white; and a high fiber breakfast cereal fortified with vitamin
B-12 and folic acid.
3. From the vegetables and fruits, choices should include deeply-colored
produce and the whole food rather than just the juice. Dark green, orange,
red and yellow ones should be chosen often.
4. Dairy choices should emphasize low fat selections, with at least 3 calcium-
rich product servings/d, or the equivalent in calcium-fortified orange juice or
in nutritional supplements.
5. From the meat/poultry/fish/dry beans/egg/nuts food group, choose a variety
of lean cuts of meats and poultry. Eat fish at least once a week and legume
dishes at least twice a week instead of a meat main dish.
6. Most fat choices should be limited. Those chosen should consist primarily of
a variety of liquid oils, or foods prepared with oils, rather than hydrogenated
or saturated fats.
7. Food selections with refined carbohydrates (sugar) should be kept to a
minimum.
Calcium 700 mg
Phosphorus 550 mg
Magnesium 270 mg
Sodium 1600 mg
Potassium 3500 mg
Chloride 2500 mg
Iron 14.8 mg
Zinc 9 mg
Copper 1.2 mg
Selenium 60 μg
Iodine 140 μg
Vitamin A 600 μg
Thiamine 0.8 mg
Riboflavin 1.1 mg
Niacin 12 mg
Vitamin B6 1.2 μg
Vitamin B12 1.5 μg
Folate 200 μg
Vitamin C 40 mg
Vitamin D 10 μg
Explain the negative functional consequences for a client whose
assessment falls outside the normal limits.
Source: http://www.holisticonline.com/Remedies/Heart/hypert_consequences.htm
High blood pressure is dangerous because it makes the heart work too hard.
It also makes the walls of the arteries hard. High blood pressure increases the risk
for heart disease and stroke. High blood pressure can also cause other problems,
such as heart failure, kidney disease, and blindness. The ultimate consequence of
long term high blood pressure could be death.
Stroke
High blood pressure is the most important risk factor for stroke. Very high pressure
can cause a break in a weakened blood vessel, which then bleeds in the brain. This
can cause a stroke. If a blood clot blocks one of the narrowed arteries, it can also
cause a stroke.
Impaired Vision
High blood pressure can eventually cause blood vessels in the eye to burst or
bleed. Vision may become blurred or otherwise impaired and can result in
blindness.
As people get older, arteries throughout the body "harden," especially those in the
heart, brain, and kidneys. High blood pressure is associated with these "stiffer"
arteries. This, in turn, causes the heart and kidneys to work harder.
Kidney Damage
The kidneys act as filters to rid the body of wastes. Over time, high blood pressure
can narrow and thicken the blood vessels of the kidneys. The kidneys filter less
fluid, and waste builds up in the blood. The kidneys may fail altogether. When this
happens, medical treatment (dialysis) or a kidney transplant may be needed.
Heart Attack
High blood pressure is a major risk factor for heart attack. The arteries bring
oxygen-carrying blood to the heart muscle. If the heart cannot get enough oxygen,
chest pain, also known as "angina," can occur. If the flow of blood is blocked, a
heart attack results.
High blood pressure is the number one risk factor for congestive heart failure
(CHF). CHF is a serious condition in which the heart is unable to pump enough
blood to supply the body's needs.
Summarize the priority areas of health teaching you would provide to a client
attending this screening clinic. Identify what teaching strategies you would use.
State the rationale for each area of content. NB: identify teaching content that
addresses prevention and management for this screening topic
Source: http://www.hypertensionfoundation.org/patients.cfm
Explain the desired limits of BP and explain hypertension and its effect on the
heart, blood, vessels, kidneys and brain (see prep guide)
• Rational:
Provides a basis for understanding elevations of BP and clarifies
misconceptions and also understanding that high blood pressure can exist
without symptoms or even when feeling well.
Assist the patient in identifying modifiable risk factors (i.e. diet high in sodium,
saturated fats and cholesterol) that contribute to hypertension.
• Rational: These risk factors have been known to contribute to hypertension
If you are overweight – lose weight – 1–2 lbs a week: avoid fad or rigid diets.
• Rational: Weight loss is the single most effective non-drug method for
lowering blood pressure and helping to correct other risk factors for heart
disease like diabetes and abnormal amounts of cholesterol in the blood.
Exercise Regularly: You do not have to jog or run – walking for 30–45 minutes 3–4
times a week, climbing extra stairs, participating in sports that you enjoy will help
to reduce your heart attack risk and may lower blood pressure
• Rational: Individuals who are less active and less physically fit have a 30%-50% greater
frequency (incidence) of hypertension. Clinical trials have shown that physical activity may
reduce blood pressure in hypertensive and normotensive (having normal blood pressure)
individuals, independent of changes in weight.
Stop Smoking: If you are one of the decreasing numbers of people who still smoke.
• Rational: This may not lower your blood pressure but it will eliminate one of
the most important heart attack risk factors.
Note: If you are put on medication, take it. It won’t do you any good in the
medicine cabinet.