Late Adulthood And Disease
Course
Pathophysiology
Unit VII
Pathology
Across the Life
Span
Essential
Question
What effect
does aging have
on the body?
TEKS
130.208 (c)
3A,3B,3E
4C
6A,6F
Prior Student
Learning
Pathophysiology
Basics
Estimated time
2-3 hours
Rationale
The physiological and physical changes due to aging increase susceptibility
to disease.
Objectives
Upon completion of this lesson, the student will be able to
• Interpret the changes that occur in each body system due to aging
• Relate the changes that occur with aging to the development of
disease
• Analyze the relationship between aging and disease
Engage
Go to the web link listed below which shows the Texas Report Card on
healthy behaviors of seniors in Texas. Discuss with the students each of the
indicators and how Texas ranks in different areas of the state. You can also
click on an indicator and compare Texas to other states.
This program is the Healthy Aging Program from the CDC. The site also
contains other information on aging.
http://apps.nccd.cdc.gov/SAHA/Default/ReportDetail.aspx?State=TX
Key Points
I. Physical Changes of Aging
A. Integumentary System
1. Decreased glandular activity
2. Dryness, thinning, and scaling
3. Loss of fat and elasticity
4. Loss of hair and hair color
B. Respiratory System
1. Decreased lung elasticity
2. Decreased rib cage expansion
3. Decreased functioning of the respiratory muscles
C. Circulatory System
1. Decrease in blood flow
2. Decreased arterial elasticity and narrowing of the arteries
3. Decrease in pulse and increase in blood pressure
4. Decrease in cardiac output
D. Musculoskeletal System
1. Loss of calcium in the bones and brittleness of the bones
2. Loss of muscle strength, size, and tone
3. Changes in posture
4. Decreased joint flexibility
Copyright © Texas Education Agency, 2012. All rights reserved.
E. Endocrine System
1. Decreased glandular activity
F. Nervous System
1. Changes in the number of nerve cells and brain mass
2. Increase in reaction time
3. Changes in memory
4. Decreased sensitivity of receptors
G. Digestive System
1. Difficulty chewing due to the loss of teeth
2. Decreased functioning capacity of the liver
3. Constipation
4. Slower digestion
H. Urinary System
1. The bladder holds less urine
2. Incontinence
I. Reproductive System
1. Decreased sperm production
2. Menopause
J. Immune System
1. Decreased immunity
II. Diseases Commonly Associated with Late Adulthood
A. Skin lesions, bed sores, decubitus ulcers
B. Upper respiratory infection
C. Chronic obstructive pulmonary disease (COPD)
D. Blood vessel disorders
E. Heart disease
F. Arthritis
G. Stroke
H. Aphasia
I. Parkinson’s Disease
J. Alzheimer’s
K. Deafness
L. Cataracts
M. Osteoporosis
Activity
I. Research a case study relating to the aging process. Create and present a
multimedia presentation. A sample case study is included.
II. Interview a person over 70 to see how they’ve changed physically since
age 50 (have students create an interview form). Report findings to class.
Assessment
Multimedia Rubric
Copyright © Texas Education Agency, 2012. All rights reserved.
Materials
Computers
Accommodations for Learning Differences
For reinforcement pick an organ system, describe the effect aging has on
that system, and include diseases that affect that system.
For enrichment, the student will research and report on why the United
States is falling behind in health and life expectancy.
National and State Education Standards
National Health Science Cluster Standards
HLC01.01 Academic Foundations Health care workers will know the
academic subject matter required for proficiency within their area. They will
use this knowledge as needed in their role. Describe the basic structures
and functions of cells, tissues, organs and systems as they relate to
homeostasis. Analyze the interdependence of the body systems as they
relate to wellness, disease, disorders, therapies and care rehabilitation.
Compare selected diseases/disorders including respective classification,
causes, diagnoses, therapies, and care/rehabilitation to include
biotechnological applications. Analyze body system changes in light of
diseases, disorders and wellness.
TEKS
130.208(c)(3)(A) in all fields of science, analyze, evaluate, and critique
scientific explanations by using empirical evidence, logical reasoning, and
experimental and observational testing, including examining all sides of
scientific evidence of those scientific explanations, so as to encourage
critical thinking by the student;
130.208(c)(3)(B) communicate and apply scientific information extracted
from various sources such as current events, news reports, published journal
articles, and marketing materials;
130.208(c)(3)(E) evaluate models according to their limitations in
representing biological objects or events;
130.208(c)(4)(C) identify factors that contribute to disease such as age,
environment, lifestyle, and heredity;
130.208(c)(6)(A) describe on the nature of diseases according to etiology,
signs and symptoms, diagnosis, prognosis, and treatment options; and
130.208(c)(6)(F) investigate ways diseases affect multiple body systems.
Texas College and Career Readiness Standards
Science Standards
Nature of Science: Scientific Ways of Learning and Thinking
Copyright © Texas Education Agency, 2012. All rights reserved.
D. Current scientific technology
1.Demonstrate literacy in computer use
2.Use computer models, applications and simulations
E. Effective communication of scientific information
1.Use several modes of expression to describe or characterize natural
patterns and phenomena. These modes of expression include narrative,
numerical, graphical, pictorial, symbolic and kinesthetic
2.Use essential vocabulary of the discipline being studied
III Foundation Skills: Scientific Applications of Communication
A.Scientific Writing
1.Use correct applications of writing practices in scientific communication
C.Presentation of scientific/technical information
1.Prepare and present scientific/technical information in appropriate formats
for various audiences
D.Research Sklls/information literacy
1.Use search engines, databases and other digital electronic tools effectively
to locate information
2.Evaluate quality, accuracy, completeness, reliability and currency of
information from any source
Copyright © Texas Education Agency, 2012. All rights reserved.
Chronic Obstructive Pulmonary Disease (COPD)
Case Study
John Davis is a 68-year-old, retired insurance salesman with chronic obstructive pulmonary
disease (COPD). He started smoking when he was 12 years old and had smoked 1 to 2 packs
of cigarettes per day for 48 years when he was diagnosed. He admits that he has had a chronic
cough for years, but saw a physician when he was experiencing constant shortness of breath.
He is a widower and was diagnosed with COPD at age 60. His COPD was determined
according to his history of smoking and by performing a series of pulmonary function tests. His
lung volume was predicted to be 3.05 liters based on his age and height but was actually found
to be only 1.26 liters, showing severe obstructive disease. His chest x-ray also revealed
hyperinflation which is consistent with COPD. In COPD, the diaphragm becomes flattened and
inefficient at expelling air, therefore, the lungs are considered “hyper inflated.” His oxygen
saturation at that time was 82%, and he was started on home oxygen at 2 liters per minute. He
was also given a series of inhalers (albuterol, azmacort, and atrovent) to keep the inflammation
in his lungs down and his airways open. That was eight years ago. Mr. Davis has remained on
oxygen and the prescriptions for the inhalers have continued as well, but there is a problem with
compliance.
Mr. Davis continues to smoke about ¾ of a pack of cigarettes per day. He removes his oxygen
when smoking but often forgets to put it back on. This chronic lack of oxygen is causing his
blood count to rise and his blood to thicken, which contributes to his high blood pressure and
may lead to heart disease. In addition to his continued smoking and inconsistent use of oxygen,
Mr. Davis does not take care of himself in other ways. For example, his eating habits are
unhealthy and he suffers from poor nutrition. He is often too short of breath or tired to eat or
prepare food. His poor health causes him to be more susceptible to colds and flu and he has
had pneumonia twice in the past.
Over the Thanksgiving holiday, Mr. Davis’ daughter, Carol and her family arrived from out of
state for a two week visit. On the morning of November 24th, Carol finds her father asleep in a
chair with his oxygen off. After she wakes him and reapplies his oxygen, he is barely able to
stand. She gets him in the car and takes him to the emergency room. In the ER a respiratory
therapist checks his oxygen saturation and prepares a breathing treatment. A nurse connects
him to the heart monitor and starts an IV. A technician takes his blood pressure. His O2
saturation is 80% on 2 liters of oxygen, his blood pressure is 200/110, and his heart rate is 140.
He is coughing up thick yellow secretions, and a chest x-ray reveals pneumonia. He is admitted
to the Respiratory Care Unit. Over the next 24 hours, he receives an inhaled breathing
treatment every 4 hours, and a therapist claps on his chest 4 times a day to loosen the
secretions in his lungs. He receives intravenous Solumedrol (a steroid to reduce inflammation in
his lungs) and antibiotics. On the second day of admission his nurse is unable to wake him to
take his morning vitals. A respiratory therapist performs a blood test called an arterial blood gas
(ABG). The ABG gives information about oxygenation and acid-base status.
In COPD patients, the level of carbon dioxide in the blood can become dangerously high. CO2 at
high levels can act like a narcotic. When CO2 levels are high and blood pH is low (acidosis) the
condition is called respiratory failure. In order to treat respiratory failure, a patient must have an
Copyright © Texas Education Agency, 2012. All rights reserved.
endotracheal tube inserted through either the nose or mouth. It passes through the vocal cords,
is held in the throat by an inflatable cuff, and is then taped to the face. The tube is connected to
a ventilator which then does all the work of breathing for the patient. Because the tube passes
through the vocal cords, the patient is unable to talk. Because there is a tendency for the patient
to remove the tube, his hands must be restrained.
Mr. Davis’ ABGs show respiratory failure. His physician rushes him to the intensive care unit
and tells the staff to prepare for intubation. A nurse contacts Mr. Davis’ family by phone and tells
them to come to the hospital. As the team is preparing to intubate, Mr. Davis suffers respiratory
arrest. He is immediately intubated and attached to the ventilator. The nurses and therapist
must suction the tube to clear it of secretions. A Foley catheter is inserted into his urethra and
attached to a drainage bag to collect urine. An automated blood pressure cuff records his blood
pressure every 15 minutes, and monitors record his heart rate and oxygen saturation
continuously.
When Mr. Davis’ family arrives, they are asked to make a decision regarding life support. He
has not regained consciousness and the physicians feel that his prognosis is grave.
Mr. Davis does not have a living will or an advanced directive in place. Carol recalls that her
father had always said he would never want any drastic measures to be taken to keep him alive,
but they are unable to make a decision right away and need more time.
Over the next five days, a feeding tube is inserted through Mr. Davis’ nose, and he is given a
high calorie solution through his feeding tube and a special IV. The family consults with the
nurses, physicians, and the hospital chaplain. The family learns it is unlikely that Mr. Davis will
ever be able to breathe on his own again and would need to be attached to a ventilator
indefinitely. He would need to live in a chronic care facility like a nursing home with 24-hour
care. The endotracheal tube cannot be left in place indefinitely as it causes tissue breakdown in
the nose, mouth, and trachea. It would be necessary to perform a tracheotomy in which an
incision must be made in the throat and a tracheotomy tube is inserted then attached to the
ventilator.
The family makes the difficult decision that they do not want this procedure to be performed.
They are sure that Mr. Davis would not want to live in such a way. They decide to have him
removed from life support. The nurses and therapists remove the endotracheal tube and
disconnect the ventilator. The monitors are silenced. Mr. Davis’ family joins him in his room in
the intensive care unit and holds his hands.
He never regains consciousness, and only makes a few feeble attempts at breathing. Within ten
minutes, he has no vital signs. His family is grateful that they had this time to spend with him
and say their good-byes. They are also grateful that he did not have to spend the remainder of
his life on a breathing machine in a nursing home.
Copyright © Texas Education Agency, 2012. All rights reserved.