Altered Health in Older Adults

Concepts of Altered Health in Older Adults
What physiological factors would typically increase Joseph’s risk of falling while walking outdoors?
Considering Joseph's age, he is likely to suffer from fatigue when walking outdoors and this might increase his likelihood of falling. Walking is considered to be a tiring exercise and Joseph walks for a long period. This increases his chances of getting tired and with tiredness, fatigue will check in. Fatigue results in Joseph's reaction and they might not be able to respond appropriately. A person is most likely to lose balance control when they are tired and this increases for persons who are elderly (Morrison et al., 2016). Therefore, as Joseph walks for long distances when his body is getting fatigued, he might lose balance and this might result in him falling. The mechanisms that are related to balance control are impacted, which increases their risk of falling. It is not uncommon to find there are uneven walking surfaces outside, and as the body gets tired its reaction to such surfaces decreases and this makes it hard for elderly persons to control their balance (Morrison et al., 2016). This is because their balance is affected and they will react quite slowly when tired as compared to when they are relaxed. Cyclists and other joggers or people walking can bump into Joseph making him lose balance. Joseph is old and with age, his balance is affected and any slight bump or attempt to avoid hitting someone will have a considerable impact on his balance. This is because they have a reduced reaction to situations due to age. Therefore, any obstacle that they have to maneuver through becomes harder especially if they have to do this fast. When fatigued, an elderly person will have an increased postural sway, which will increase their risk of falling. With increased walking, Joseph is likely to increase his walking speed as he goes along and this might impact their gait.
Walking is a risk factor for falls in elderly people. Older people are likely to reduce their walking speed which comes with age. This means that they will not be able to evade obstacles as fast as others would. Depth perception does also increase the risk of falling. As one gets older, their vision might get impacted and this will, in turn, affect how they see outside. With poor depth perception, they are likely to not perceive the ground properly and this will result in them making a misjudging their steps, which can result in their fall. Vision being slightly impaired will make it hard for him to see obstacles on the road as he is walking (Nyman, Ballinger, Phillips, & Newton, 2013). He might also see the obstacles when they are too close making it hard for him to avoid them. Concentration can also be impacted and one can lose focus on their walking. This mostly happens when they have to perform dual tasks like watching for traffic and crossing the road. As one gets older, they lose focus on things and they find it hard to pay attention to multiple things at the same time. Therefore, concentrating on foot placement and watching out for traffic or other obstacles might be harder for Joseph and this will increase his risk of falling.
What are the common changes in blood pressure regulation that occurs with aging?
Baroreceptors are the receptors that monitor blood pressure and make changes to assist in maintaining fairly constant blood pressure when an elderly person switches position or is performing other activities. As a person ages, the baroreceptors will become less sensitive, which explains the reason why many older people have orthostatic hypotension. This is a condition where blood pressure will fall when the person comes from lying down to sitting or standing (Cho, Hoshide, Nishizawa, Fujiwara, & Kario, 2017). The elderly person will feel dizzy due to reduced blood flow to the brain. Blood pressure regulation is impacted since the baroreceptors are not as sensitive as they used to be and this reduces blood pressure. The loss of sensitivity means that the elderly person is not able to maintain constant blood pressure as a normal healthy person. While blood pressure will resume after a while, it explains why elderly people are not required to move immediately they wake or change positions. There is a decrease in heart-rate response to any change in posture in the elderly.
The aorta, which is the main artery of the heart does become stiffer, thicker, and less flexible as one age or during the aging process. This is mostly related to changes in the connective tissues of the blood vessel wall that makes the blood pressure to be higher and forces the heart to work harder. This leads to the thickening of the heart muscle. As one age the other arteries will also thicken and stiffen (Cho et al., 2017). This means there is increased blood pressure throughout the body and blood takes longer to be pumped to all the organs in the body. Capillary walls will also thicken slightly. The thickening of the capillary walls results in a slower rate of exchange of nutrients and wastes. These changes result in the rise in systolic blood pressure. This happens for people with high blood pressure and those with no history of high blood pressure. For those elderly people whose blood pressure is well controlled will still experience an increase in blood pressure.
As a person gets older the body's performance in pumping blood is affected. This is because the heart's pathways might have fat deposits that affect how the heart works. This will happen even if the elderly person has a healthy diet and frequently does exercise. When the heart's pacemaker system is affected it will be working harder to pump blood and this will increase the person's blood pressure. Heart muscles might degenerate with age and with thicker cell walls blood pressure get affected. The heart will take longer to fill with blood, which will increase pressure on the vessels. There are changes in blood volume as one age. This is because the body loses the ability to retain fluid, which means that there is less fluid int eh bloodstream. In theory, the decreased volume of blood flow would cause less pressure in the blood vessels. However, the reality is that this condition results in the opposite effect.
Joseph enjoys fruit juice when he walks. Considering the renal system in the older adult, why would dehydration be a particular concern?
The elderly do not easily recognize dehydration. This is because of the physical changes that take place within the body with aging. In as much as Joseph does enjoy taking fruit juice when walking, he should ensure that he does take water as frequently as possible. Aging causes a person to be less aware of their thirst and it gradually lowers their body's ability to regulate its fluid balance (Frangeskou, Lopez-Valcarcel, & Serra-Majem, 2015). As a result of aging, the elderly do not feel thirst as readily as the younger people do, which increases their chances of consuming less water. Therefore, an older person should not rely on feeling thirsty for them to consume water. They should be constantly taking water to ensure that they stay hydrated at all times. There is reduced renal function as one gets older. Kidney function deteriorates with age, which does impair the hormonal response to dehydration. The kidney function of removing toxins from the body progressively declines with age. This results in the kidneys not been as efficient as before in concentrating urine in less water, which causes older people to lose more water. With reduced functioning of the renal system, it becomes harder for Joseph to retain water and though he does consume fruit juice when walking, this is not a substitute for water. Since the narrowed arteries might not supply enough blood for the kidney, the size of the kidney does reduce. This has a direct impact on the functioning of the kidney. The walls of the small arteries that flow into the glomeruli will thicken. This will decrease the functioning of the remaining glomeruli. The nephrons are impacted in that their ability to excrete waste products declines.
Aging causes the bladder to hold less urine as compared to a younger person. This means that they will be frequently going to the toilet to urinate. Even with the increased urination, the amount of urine that is removed from the bladder is less and with each bathroom break, there is an increase in the residual urine (Frangeskou et al., 2015). This forces an elderly person to urinate even more. There is also an increased risk of urinary tract infections. For this reason, elderly people will prefer to reduce their urinary intake in order to reduce the urge to go to the toilet. For Joseph, considering that he does walk frequently he is likely to suffer from dehydration that is caused by sweating.
Changes in the renal system have a direct impact on Joseph’s body and his ability to recognize thirst. If the amount of juice that Joseph takes is not enough to hydrate his body, he is likely to suffer from dehydration. This is especially true considering that he likes taking long walks and he also does exercise in order for him to stay in shape. While the fruit juice does give him some fluid in his body, it might not be enough because he only takes it when walking. Therefore, his body might not have enough fluids and this could lead to dehydration.


References
Cho, N., Hoshide, S., Nishizawa, M., Fujiwara, T., & Kario, K. (2017). Relationship between blood pressure variability and cognitive function in elderly patients with good blood pressure control. American journal of hypertension, 31(3), 293-298.
Frangeskou, M., Lopez-Valcarcel, B., & Serra-Majem, L. (2015). Dehydration in the elderly: a review focused on economic burden. The journal of nutrition, health & aging, 19(6), 619-627.
Morrison, S., Colberg, S. R., Parson, H. K., Neumann, S., Handel, R., Vinik, E. J., . . . Vinik, A. I. (2016). Walking-induced fatigue leads to increased falls risk in older adults. Journal of the American Medical Directors Association, 17(5), 402-409.
Nyman, S. R., Ballinger, C., Phillips, J. E., & Newton, R. (2013). Characteristics of outdoor falls among older people: a qualitative study. BMC geriatrics, 13(1), 125.