1. Draft 5/21/05 Aging & the Respiratory 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. Draft 5/21/05 Normal Respiratory Changes Upper Airway: Anatomical changes Nose enlargement (from continued cartilage growth) Tonsillar atrophy Deviations in the trachea r/t structural changes in aging spine  # & effectiveness of cillia in tracheobronchial tract

3. Draft 5/21/05 Normal Respiratory Changes Lungs: Anatomical changes Respiratory muscles atrophy & weaken Chest wall stiffens  rigidity of rib cage (calcification of coastal cartilage) Respiratory fluids  30%  elastic recoil

4. Draft 5/21/05 Normal Respiratory Changes Lungs: Anatomical changes  elasticity of alveoli  # and size of functioning alveoli

5. Draft 5/21/05 Normal Respiratory Changes Physiologic changes  vital capacity  cough reflex  breathing efficiency  O 2 carrying capacity of blood  inspiratory & expiratory forces

6. Draft 5/21/05 Normal Respiratory Changes Physiologic changes (cont’d)  surface area for gas exchange  arterial partial pressures of oxygen  responsiveness to hypoxemia & hypercapnia  respiratory rate to 16-25 / min  V T and minute ventilation

7. Draft 5/21/05 Normal Respiratory Changes Functional Implications Breathing patterns are more dependent upon intra-abdominal pressure changes Breathlessness at low exercise levels  breathing effort under stress Muscle de-conditioning

8. Draft 5/21/05 Normal Respiratory Changes Functional Implications (cont’d)  ability to clear secretions  susceptibility to infection  risk of aspiration Snoring

9. Draft 5/21/05 Normal Respiratory Changes Nursing considerations Complaints of dyspnea may not occur until interference with ADLs Determine which ADLs an older person no longer participates in and WHY

10. Draft 5/21/05 Normal Respiratory Changes Nursing considerations Recommend cough suppressants with caution Encourage fluid intake to prevent secretions from becoming thickened

11. Draft 5/21/05 Normal Respiratory Changes Nursing considerations Positioning & increased abdominal pressure can greatly impact breathing patterns Position can be critical to distribution of ventilation, as older adults have increased vulnerability to shallow breathing Assessment findings include diminished breath sounds, particularly at lung bases