Bowel Elimination, Cardiovascular, and Respiratory Physiology in the Elderly

Bowel Elimination Physiology in the Elderly

In the elderly, stools are less frequent and may be harder. Constipation is a common complaint among healthy elderly patients, often without a clear single etiology. Aging produces:

• Slowing of gastrointestinal motility.
• Mucosal and intestinal muscle atrophy.
• Reduced nerve function in the intestine, rectum, and anus.

Subjective Constipation

In the elderly, this is usually related to incorrect assessments or ideas acquired due to cognitive decline.

Manifestations

Unrealistic expectations regarding the quantity and timing of bowel movements, leading to the abuse of laxatives.

Criteria Scores

The elderly person must:

• Recognize their bowel pattern as normal.
• Recognize the negative effects of laxatives.
• Specify activities to encourage defecation.
• Inform care nurses about their normal pattern.
• Advise the person on activities similar to those recommended for true constipation.

Fecal impaction is a complication of constipation. In old age, it presents as follows: Constipation, paradoxical diarrhea, confusional state, urinary incontinence, and pain. Diagnosis is made by rectal examination. Treatment is disimpaction.

Fecal Incontinence

It is accepted that the elderly have less muscle tone, a lower resting anal and rectal tone, and a less dilatable sphincter. Overloading causes the sphincter to weaken, and liquid stool makes it difficult for the anal canal to act as a reservoir.

Care

• Avoid very soft stools, which are more difficult to contain.
• Determine if the cause is fecal impaction, incontinence, or stroke.
• Mobility helps to improve abdominal muscle tone.
• Retrain the pelvic floor to strengthen the external anal sphincter.
• Implement a bowel control program.
• Utilize the gastrocolic reflex to achieve defecation.
• It is advisable to avoid delaying the urge to defecate.
• Assist the patient into a squatting position.
• Encourage leg mobilization.
• Take care of the patient's skin.

Changes in Cardiovascular Physiology

Cardiac muscle rigidity, thickening of the valves, left ventricular hypertrophy, arterial thickening and fibrosis, increased peripheral resistance, and reduced blood flow. These changes cause difficulty in pumping and manifest as: increased blood pressure, orthostatic hypotension, pronounced arterial pulses, decreased heart rate at rest, poorer response to exercise and emotions, and physiological arrhythmias in response to stressful agents.

Changes in Respiratory Physiology

Decreased diameter of the thoracic cavity, loss of respiratory muscle strength, less elastic bronchioles, reduced surface area of the alveolocapillary membrane, and decreased ciliary activity. These changes result in a decrease in air expired after forced inspiration, decreased airway resistance, increased residual volume, a loss of gas diffusion capacity, and a less effective cough.

Activity Intolerance

A situation where a person has insufficient energy to perform desired activities.

Related Factors in the Elderly

• Immobility
• Generalized weakness
• Imbalance between oxygen supply and demand

Manifestations

• Verbal report of fatigue or weakness.
• Abnormal blood pressure or heart rate response to activity.
• Discomfort.
• Dyspnea.

Criteria Result

The elderly person must:

• Identify the causes of activity intolerance.
• Perform activities without difficulty or significant changes in their vital signs.

Nursing Care

• Identify the causes and impact of activity intolerance with the elderly person and their family.
• Identify and use personal and material resources that allow the person to conserve energy and increase their activity level.
• Reinforce the importance of alternating rest and sleep with activities.
• Maintain proper posture for each activity.
• Pain Therapy: Recommend exercises to improve respiratory function.