Geriatric Nursing: Nursima N. Sampang

GERIATRIC
NURSING
NURSIMA N. SAMPANG
STUDENT NURSE
PHYSIOLOGIC
CHANGES
IN
GASTROINTESTIN
AL TRACT
OF OLDER ADULTS
1. Periodontal disease can lead to tooth
loss.
2. Xerostomia (dry mouth)
3. Decreased esophageal motility can slow
the esophageal emptying process.
4. Stomach motility and emptying time are
decreased.
5. higher pH of the stomach contributes to
increased incidence of gastric irritation in
the older adult.
6. The production of intrinsic factor (protein
needed to make vitamin B12) is
decreased, leading to pernicious anemia.
7. Intestinal absorption, motility, and blood
flow are decreased.
ASSESSMENT
FINDINGS
OF OLDER
ADULTS IN
RELATION TO
GASTROINTESTIN
AL TRACT
Subjective Objective
Assessment Findings Assessment
Client may report the
following
Findings
1. Dry mouth Nurse, upon assessment
2. Dysphagia may find the following
3. Feeling of fullness 1. Risk for aspiration
4. Heart burn 2. Risk for dehydration
5. Indigestion and electrolyte
6. Constipation imbalance
7. Flatulence 3. Poor Nutrition habits
8. Abdominal discomfort
CLINICAL
CORRELATIO
N
Digestion of food is less influenced by
changes associated with aging than by the
risk of poor nutrition. Older adults can
adjust to changes in the gastrointestinal
system but may have difficulty purchasing,
preparing, and enjoying their meals. The
sense of smell diminishes as a result of
neurologic changes and environmental
factors such as smoking, medications, and
vitamin B12 deficiencies.
The ability to recognize sweet, sour, bitter,
or salty foods diminishes over time, altering
satisfaction with food. Salivary flow does
not decrease in healthy adults; however,
approximately 31% to 37% of older adults
may experience a dry mouth as a result of
medications and diseases (Miller, 2015).
Difficulties with chewing and swallowing
are generally associated with lack of teeth
and disease.
Experts disagree on the extent of gastric
changes that occur as a result of normal
aging. However, gastric motility appears to
slow modestly, which results in delayed
emptying of stomach contents and early
satiety (feeling of fullness). Diminished
secretion of gastric acid and pepsin,
seemingly the result of pathologic
conditions rather than normal aging,
reduces the absorption of iron, calcium,
and vitamin B12.
Absorption of nutrients in the small
intestine, particularly calcium and
vitamin D, appears to diminish with
age. Functions of the liver, gallbladder,
and pancreas are generally
maintained, although absorption and
tolerance to fat may decrease. The
incidence of gallstones and common
bile duct stones increases progressively
with advancing years.
Difficulty swallowing, or dysphagia, increases with
age and is a major health care problem in older
patients. Normal aging alters some aspects of 682 the
swallowing function. In addition, dysphagia is a
frequent complication of stroke and a significant risk
factor for the development of aspiration pneumonia
that can be life-threatening. Dysphagia is caused by
interruption or dysfunction of neural pathways. It may
also result from dysfunction of the striated and
smooth muscles of the gastrointestinal tract in
patients with Parkinson disease. Aspiration of food or
fluid is the most serious complication and can occur in
the absence of coughing or choking
Constipation is a common pathologic condition
that affects many older people as they age.
Symptoms of mild constipation are abdominal
discomfort and flatulence; more serious
constipation leads to fecal impaction that
contributes to diarrhea around the impaction,
fecal incontinence, and obstruction. Predisposing
factors for constipation include lack of dietary
bulk, prolonged use of laxatives, some
medications, inactivity, insufficient fluid intake,
and excessive dietary fat. Ignoring the urge to
defecate may also be a contributing factor.
Practices that promote gastrointestinal health
include regular tooth brushing and flossing;
receiving regular dental care; drinking sufficient
fluids; eating small, frequent meals that are
high in fiber and low in fat; avoiding heavy
activity or lying flat after eating; and avoiding
the use of laxatives and antacids. Understanding
that there is a direct correlation between loss of
smell and taste perception and food intake helps
caregivers intervene to maintain the nutritional
health of older patients.
Sources:
1. Kozier and Erbs Fundamentals
of Nursing Practice 10th edition
2. Brunner and Suddart Medical
Surgical Nursing 14th edition
3. Saunders NCLEX RN by Linda
Silvistri 8th edition

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