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Renal/Genitourinary Changes
Kidney mass decreases, and there is often arteriosclerosis of renal arteries. Function of the glomerular filtration system declines, causing less efficient dilution or concentration of the urine, and imprecise serum creatinine values. The bladder loses tone and the ability to expand, and pelvic floor muscles and the urinary sphincter weaken (Miller, 2004). Many male elders have benign prostatic hypertrophy. These changes can lead to stress incontinence or retention, frequency, and nocturia (Newman & Palmer, 2003). Clinical Alert. Before administering contrast agents, realize that creatinine levels should not be considered independently, provide adequate hydration, and note nephrotoxic drugs (Bettmann, 2004). Older adults may not have the capacity to hold urine for an extended time. Inquire about the need to urinate before beginning the x-ray examination, explaining the approximate length of the procedure. If they ask to urinate, assist them to the toilet as quickly as possible. Be sure there are no obstructions between the patient and the bathroom and have supplies readily available. Provide a commode or bedpan/urinal if the toilet is too far away. Because older adults are more prone to dehydration, be alert for symptoms such as confusion, lethargy, or dry tongue and mucous membranes.
Endocrine System Changes
The very old have a delayed or inadequate response of the immune system to infectious agents. When infections are contracted, they are more likely to be fatal than they would be in a younger adult. Because of adrenal changes, older adults have a diminished ability to respond to physiological stressors. Clinical Alert. Abide by universal precautions. Always wash your hands between patients and assist older patients with hand washing, when appropriate. Keep equipment clean. Adjust the environment to reduce both physical and psychological stressors as much as possible.
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