1. 3-14-05 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 http://www.nyu.edu/education/nursing/hartford.institute/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.

2. 3-14-05 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

3. 3-14-05 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

4. 3-14-05 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

5. 3-14-05 Age-Related Endocrine Changes Specific changes in endocrine function may offset other age-related changes, thereby reducing overall net functional effect of endocrine changes

6. 3-14-05 Age-Related Endocrine Changes Menopause  incidence of diabetes  incidence of thyroid abnormalities

7. 3-14-05 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

8. 3-14-05 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

9. 3-14-05 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

10. 3-14-05 Diabetes Mellitus Atypical signs Fatigue, blurred vision, weight changes, infection, dehydration, confusion, delirium These signs are often attributed to “aging”

11. 3-14-05 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

12. 3-14-05 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

13. 3-14-05 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

14. 3-14-05 Thyroid Disease Hypothyroidism Hyperthyroidism

15. 3-14-05 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”

16. 3-14-05 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

17. 3-14-05 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