4.–7. Sign of Respiratory Aging (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Okay, so let's pause and recall the first 3 signs of respiratory aging.

    00:07 So stop for a minute and see how many you can recall and then I'll walk you through them again.

    00:14 Alright.

    00:15 1. What's the respiratory muscles decline? Remember those three? Right, the diaphragm, the ribcage and the abdominals.

    00:23 Excellent.

    00:23 2. The chest wall stiffens in thoracic compliance goes down.

    00:29 3. Bronchial tubes and the alveolar tissue, they kind of lose their elasticity and their shape.

    00:36 Remember, we talked about the gum.

    00:38 Put all three of those together and we get number four.

    00:43 4. As we age, we have less ability to completely empty our lungs of air when we exhale.

    00:51 Now, why is that? Because lungs lose their ability recoil as efficiently as people age.

    00:56 So breathe in, breathe out.

    01:00 We can't do that as well.

    01:01 When we say recoil, that's our muscles relaxing and air exiting your body.

    01:07 As we age, we just can't do this as well.

    01:10 So we have to use other muscles that will help us to exhale.

    01:14 So complete exhalation as you would in your 20's is almost impossible in your 85 year range.

    01:23 So let's take a look at this because I know you're used to hearing about emphysema.

    01:27 Now emphysema is a disease process and it has air trapping.

    01:31 But even normal aging can lead to some air trapping compared to a younger adult.

    01:36 So take a look at the pictures there.

    01:38 So you see, we have the airway down to the alveoli.

    01:42 On the left, you have healthy alveoli.

    01:45 On the right, you have alveoli that have been affected by emphysema.

    01:49 Now the alveolar walls get destroyed in emphysema.

    01:54 And that's why air gets trapped in there.

    01:56 That's a serious disease process.

    01:59 If we're talking about what happens in aging, I want you to look on the right.

    02:03 So even as we age, you can end up with some air trapping and you'll see that on the one side you see air come in and then you see how it kind of swirls around.

    02:12 That's air trapping and air trapping just means you can't empty the lungs of as much air as you used to be able to.

    02:19 So emphysema that's a disease process.

    02:22 That's a not a normal part of aging.

    02:25 But even normal aging can lead to some air trapping compared to a younger adult.

    02:33 Now heavy smokers like Enrique tend to suffer from emphysema more than a nonsmoker like Jose.

    02:40 Now Jose avoided tobacco for his lifetime and did not experience any emphysema.

    02:46 But poor Enrique in addition to his heart attack, his congestive heart failure is osteoporosis, he has also developed emphysema.

    02:57 Now the fifth sign of respiratory aging, you have to know at age 85, a patient has been exposed to more toxins than most 20 year olds would be.

    03:07 These toxins accumulate over a lifetime.

    03:10 Also the patient's ability to fight off infection declines as they age.

    03:15 So put those together, you're exposed to more things and you can fight off less things.

    03:20 This can be a problem.

    03:22 Let's look at the increased toxin exposure.

    03:25 Well, the first thing is as people age their lungs are exposed, we talked about the accumulation of toxins.

    03:31 But let's talk about what those toxins are.

    03:34 Things like pollution.

    03:35 So that is impacted by where you live and the air quality of where you live.

    03:40 Tobacco smoke, occupational things, dusts, respiratory infections, these are all considered toxins that your body is exposed to.

    03:50 These over time accumulate and can be very problematic.

    03:54 So they can damage your alveoli, makes you more prone to infection.

    03:58 And remember, you have a weakening immune system with age, so you can't really fight those off as much.

    04:05 So that's a bad combination of overtime you're exposed to more toxins, and you have less of an ability to fight it off.

    04:13 That is item 5 on the 7 signs of respiratory aging.

    04:19 Now we talked about how the toxins accumulate and you can't fight off bugs.

    04:23 Well, 6 is also problematic in that process because you don't have a strong a cough, your cough reflex is diminished.

    04:31 So coughing is a really important defensive reflex.

    04:34 Now you'll notice right here, he's coughing into his shield.

    04:38 We've all heard that 1000 times, if you've been through a recent pandemic, those are things that we teach people as far as it's good public health measures.

    04:48 If you're coughing not to cover your cough with your mouth, but to cover it with your shield.

    04:53 But it's a defensive reflex.

    04:54 It's your lungs way of saying, "Hey, get the heck out of here." You don't belong.

    05:00 Now, we have this really complex reflex arc that is our cough reflex.

    05:05 And as we age, it diminishes.

    05:08 So coughing is what we need to help us clear secretions and things that don't belong in our airways.

    05:15 And that also helps us from aspirating things.

    05:18 Aspirating foreign materials means something goes into my lungs that's not air.

    05:23 It's particularly problematic with elderly clients or patients who've had a stroke.

    05:28 Because when they're eating, they can choke on something.

    05:30 My grandmother used to say, "Oh, I got that down the wrong pipe." Meaning she sent it down her trachea instead of down her esophagus into her stomach.

    05:39 But that's what the cough reflex does, it should protect the lungs from things that shouldn't be there.

    05:45 As we age, the cough reflex diminishes.

    05:48 So those nerves that stimulate the coughing reflex, become think of as less sensitive as a person ages.

    05:55 So the strength of their cough also decreases because of what? Right, weaken muscles.

    06:02 Now you've talked about that, we talked about those three main respiratory muscles, diaphragm, muscles in your ribcage or your intercostal muscles and your abdominal muscles.

    06:14 So in normal aging, the overall ability to clear irritants and smoke and German particles or toxins becomes less effective.

    06:23 Now, what is the similarity between item 5 and item 6? Think back in 5, we're exposed to a lot more toxins because you're older.

    06:39 And you don't have the same ability to fight off an infection.

    06:42 Pair it with 6, my cough reflex is diminished.

    06:47 Wow, if I get something into my lungs that shouldn't be there.

    06:51 I'm in an increased risk for an infection that can overtake my body.

    06:55 So the combination of relatively weaker cough and a weaker immune system greatly increases this patient's risk for infections.

    07:03 That's why pneumonia is so serious in an elderly client.

    07:08 Well, you've made it to the 7 signs of respiratory aging.

    07:13 Now, fair warning, there's a dad joke coming ahead.

    07:16 It's kind of a pun, but it really does work to help you remember.

    07:20 Chronic inflammation is a concern throughout the body as a client ages.

    07:25 In fact, they sometimes call it inflammaging.

    07:28 I know.

    07:31 But it really works.

    07:32 So think about inflammaging.

    07:34 As you age, you can experience increased risk of inflammation.

    07:38 Now why do we care about this? Well, chronic inflammation is believed to be a factor in most diseases.

    07:45 So look at the list there.

    07:47 Heart disease, arthritis, cancer, Alzheimer's and most types of lung disease.

    07:52 So the more we can minimize this type of chronic inflammation, the better.

    07:57 Now don't get me wrong.

    07:58 Inflammation plays a role in the body.

    08:00 But anything that gets out of balance is problematic.

    08:04 Chronic inflammation is definitely problematic.

    08:07 So how did Enrique end up here? What was the problem? Well, the inflammation may start in response initially to a bacterium or a virus, but even then it may continue after the threat is gone.

    08:20 This can cause damage to the lungs and may contribute to lung disease.

    08:24 So we talked about chronic inflammation leads to lots of other diseases.

    08:29 But the purpose of this video, the focus of this video is respiratory.

    08:34 So that's the example we talked about where it might start in the lungs and responds to a bacterium or a virus.

    08:39 But even after those guys are gone, the inflammation may continue and cause actual lung damage.

    About the Lecture

    The lecture 4.–7. Sign of Respiratory Aging (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Respiratory System (Nursing).

    Included Quiz Questions

    1. “The majority of older adults will develop emphysema.”
    2. “Air trapping can occur as a result of normal aging.”
    3. “It is difficult for an older adult to exhale completely.”
    4. “The lungs lose their ability to recoil as efficiently with age.”
    1. “As you age, your immune system weakens, and your lungs accumulate toxins, which can damage parts of your lungs and can leave you prone to infection.”
    2. “Preventative measures should have stopped you from developing an infection; it may be a sign that you have an underlying condition”
    3. “There are more respiratory viruses in the world than there were ten years ago, so even though your immune system is just as strong as it was when you were younger, it’s now harder to avoid viruses.”
    4. “With age, the alveoli in your lungs create more lubricant, which assists in breathing but also traps any bacteria that may enter your lungs, which in turn leads to infection.”
    1. The nerves that stimulate the cough reflex become more sensitive.
    2. Weakened muscles decrease cough strength.
    3. The ability to clear the lungs of irritants is impaired.
    4. The risk for aspiration is increased.
    1. Arthritis
    2. Cancer
    3. Heart disease
    4. Alzheimer disease
    5. Depression

    Author of lecture 4.–7. Sign of Respiratory Aging (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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