Aging & the Endocrine System Content for this module provided by The John A. Hartford Foundation, Institute for Geriatric Nursing, Online Gerontological Nursing Certification Review Course Support for this project provided to School of Nursing, University of Washington by the John A. Hartford Foundation, Geriatric Nursing Education Grant and Nursing School Geriatric Investment Program Grant.

Endocrine Issues in Older Adults Age-related changes make it important to evaluate the patient for thyroid disease and type 2 diabetes mellitus Subtle changes of aging often mimic symptoms of endocrine disorders Signs & symptoms should not be attributed solely to aging

Age-Related Endocrine Changes  estrogen, testosterone, progesterone Delayed/insufficient insulin release  growth hormone  serum aldosterone levels,  cortisol secretion rate  secretion of ADH in response to osmolar stimuli

Age-Related Endocrine Changes  blood glucose concentrations & elevation time Bone changes related to  PTH secretion,  estrogen  hypothalamic sensitivity to feedback inhibition  renal response to hormonal influence Thyroid gland atrophy –  secretion of T 4, thus  T 3

Age-Related Endocrine Changes Specific changes in endocrine function may offset other age-related changes, thereby reducing overall net functional effect of endocrine changes

Age-Related Endocrine Changes Menopause  incidence of diabetes  incidence of thyroid abnormalities

Diabetes Mellitus One of most commonly diagnosed medical problems in persons > age 65 Atypical presentation - often undiagnosed 1 in 2 people > age 80 –  secretion of insulin –altered tissue responsiveness to insulin –  postprandial levels of glucose –  inhibition of glucose output from liver - prolonged glycemic response to meal

Diabetes Mellitus Type 1 –Characterized by autoimmune ß-cell destruction caused by HLA antigens –Commonly diagnosed in youth Type 2 –Onset usually after age 30 –90-95% of all cases –Risk factors: obesity insulin resistance genetics

Diabetes Mellitus Signs and symptoms Polydipsia? –Excessive thirst does not necessarily occur Polyuria –May be evident by new onset incontinence Polyphagia –May be evident by weight loss and anorexia

Diabetes Mellitus Atypical signs Fatigue, blurred vision, weight changes, infection, dehydration, confusion, delirium These signs are often attributed to “aging”

Diabetes Mellitus Nursing considerations  depression & memory problems in older adults Potential organ dysfunction/failure: nerves, eyes, blood vessels –accelerated rates of CV disease, renal disease

Diabetes Mellitus Nursing considerations Cognitive function, vision, motivation, fine motor skills can impact self-administration of therapy Personalized exercise program, based on capabilities & limitations of older adult –consider pre-existing conditions such as cardiac, musculoskeletal, ophthalmic disease

Diabetes Mellitus Nursing considerations Wound infections –common & serious in older adult –require immediate attention –interdisciplinary team management Loss of ability to sweat –leads to dry skin - untreated dry skin can progress to cracked skin and subsequent infection –  ability to regulate body temperature

Thyroid Disease Hypothyroidism Hyperthyroidism

Thyroid Disease Hypothyroidism 40% may present with atypical symptoms: –dry skin, weakness, fatigue, bradycardia, hoarseness, cardiomyopathy, anemia, edema –Confusion and mental status or behavioral changes Diagnosis is often missed - vague symptoms can mimic other illnesses & “old age”

Hypothyroidism Signs & symptoms in order of precedence Depression &/or lethargy Mild anemia, weight loss Dyspnea Muscle weakness &/or unsteady gait Deafness or hoarseness Chest pain or atrial fibrillation Cold intolerance Constipation

Hyperthyroidism 50% present with typical signs & symptoms - others may not present typical hyper-adrenergic signs & symptoms May have sub-clinical, apathetic presentation –depressed mood, failure to thrive, skin changes, anorexia Most prominent symptoms include atrial fibrillation, CHF, weight loss, fatigue, & myopaythy