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人的出生 生长 发育
成熟 衰老和死亡
是一个必然的不可逆转的连续的过程
人体发育至20到30岁成熟
体细胞数和器官重量不再增加
各项生理功能达到峰值
此后开始衰退
并随年龄增长而加速
作为人体重要组成部分的
呼吸系统也不例外地经历了这个过程
呼吸系统涉及到的器官包括
鼻腔 咽 喉 气管 支气管和肺
老年人鼻黏膜变薄
嗅觉功能减退
腺体萎缩
分泌功能减退
鼻道变宽
鼻黏膜的加温
加湿和防御功能下降
因此
老年人容易患鼻窦炎及呼吸道感染
加上血管脆性增加
容易导致血管破裂
而经常发生鼻出血
由于咽喉的黏膜 肌肉
发生退行性改变
或神经通路障碍
防御反射变得迟钝
因而老人会出现吞咽功能失调
容易发生呛咳 误吸甚至窒息
由于喉部肌肉和弹性组织萎缩
声带弹性下降
老年人发音的洪亮度也减弱了
老人气管外膜中的软骨
会随年龄的增长而逐渐退化
30岁以后开始钙盐沉着
50岁以后可见明显的钙化以及骨化
弹性降低
气管及支气管的管腔略微扩大
但黏膜上皮萎缩
鳞状上皮化生 部分纤毛倒伏
小气道杯状细胞数增多
分泌功能亢进
黏液 纤毛转运功能减弱
加之有效咳嗽反射功能减退
从而容易导致黏液潴留
小气道管腔变窄
气流阻力增加
老年人容易发生呼吸道感染
及呼气性的呼吸困难
萎缩是老年人肺的主要改变
体积变小
重量减轻
质地松软
肺实质减少
肺内含气量增加
不再有弹性
肺泡壁变薄
弹性的回缩能力下降
导致肺泡隔中的毛细血管数量
和管内的血流量均减少
气体交换面积就减少了
肺不能有效扩张
肺通气不足
肺动脉壁肥厚 纤维化等
使肺动脉压力增高
肺老化对肺功能的影响主要是肺活量下降
残气量上升
弥散功能减退
氧饱和度降低
以及通气反应能力下降
用力肺活量
一秒钟用力呼气量
以及最大吸气流量
等参数随着增龄而下降
胸廓和呼吸肌随着
肺和全身其他部分的老化而老化
并在肺的功能改变过程中起着重要作用
由于老年人出现椎骨退行性变
关节软骨及韧带逐渐发生硬化及钙化
即
由青年时的后上方向前下方倾斜
变成老年时由后向前的水平走行
上部肋间隙增宽
引起肺上叶相对扩大
最终造成胸廓前后径增大
左右缩小而形成桶状胸
并且各关节的活动度减低
整个胸廓的活动度受限
老人呼吸费力
肋间肌和膈肌弹性降低
进一步影响了胸廓运动
从而使肺通气和呼吸容量下降
所以
老年人容易胸闷 气短
咳嗽 排痰动作减弱
痰液不容易咳出
会造成呼吸道阻塞
另外
呼吸系统组织结构的老化
还伴随着免疫能力的下降
肺的上皮表面积
是所有器官中最大的
经常暴露于从周围空气
或上呼吸道吸入的微生物侵害当中
肺内活跃的各种非特异性
清除机制和各种天然免疫监督机制
恶意防止病原菌的入侵
抵御感染的发生
但老化后
呼吸道黏膜分泌性免疫球蛋白A
非特异性核蛋白合成分泌减少
纤毛受损
局部的防御屏障减弱
免疫防御功能降低
加上伴有肺气肿
肺功能差
因此老年人容易发生肺部感染
导致肺功能的进一步损害
严重时可引起呼吸衰竭
老年人的呼吸系统
易受机体内外的各种有害因素影响
是最早出现衰老的器官之一
随着老化
老年人呼吸系统组织学结构和功能变化
为肺部疾患的发生打下了基础
使得老年人容易患肺部疾病的风险明显增加
因此
提高对呼吸系统老化的识别水平
尽早采取预防措施
对预防老年性呼吸系统疾病具有重要意义
-1.1 Human Life Expectancy and Age Classification of the Elderly
--Human Life Expectancy and Age Classification of the Elderly
--【Vedio Recommendation】 How do we measure life expectancy ?
-1.2 Population Aging
--【Literature Recommendation】World Report on Ageing and Health: 2015
-1.3 Influence and Countermeasures of Population Aging
--Influence and Countermeasures of Population Aging
--【Literature Recommendation】World Population Ageing Highlights:2019
-1.4 Goals and Principles of Elderly Care
--Goals and Principles of Elderly Care
--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice
-1.5 Theories Related to Elderly Care
--1.5.1 Personality Development Theory and Life Review
--1.5.2 Disengagement Theory and Activity Theory
--1.5.3 Self-efficacy and Chronic Disease Management
--【Vedio Recommendation】8 Stages of Development by Erik Erikson
--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging
--【Book Recommendation】Self-Efficacy in Changing Societies
-1.6 Elderly Support and Elderly Care
--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care
--1.6.2 Home-based Elderly Care Model
--1.6.3 Institutional Elderly Care Model
--1.6.4 Integrated Medical and Nursing Care Model
--【Vedio Recommendation】Day in the Life of Home Care
--【Website Recommendation】Official Website of the National Institutes of Health
-Concept Map
--【Concept Map】General Introduction to Geronological Nursing
-【Test】CHAPTER 1
-2.1 Aging Changes in the Elderly
--2.1.1 Aging of the Respiratory System
--2.1.2 Aging of the Cardiovascular System
--2.1.3 Aging of the Digestive System
--2.1.4 Aging of the Urinary System
--2.1.5 Aging of the Endocrine System
--2.1.6 Aging of the Motor System
--2.1.7 Aging of the Nervous System
--2.1.8 Aging of the Sensory System
--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging
--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology
-2.2 Comprehensive Health Assessment of the Elderly
--Comprehensive Health Assessment of the Elderly
--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review
-2.3 Principles of Elderly Health Assessment
--Principles of Elderly Health Assessment
-2.4 Assessment of the Functional Status of the Elderly
--Assessment of the Functional Status of the Elderly
--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale
-2.5 Assessment of Cognitive Function in the Elderly
--Assessment of Cognitive Function in the Elderly
-2.6 Assessment and Adjustment of the Living Environment for the Elderly
--Assessment and Adjustment of the Living Environment for the Elderly
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-3.1 Overview of the Psychological Characteristics of the Elderly
--Overview of the Psychological Characteristics of the Elderly
-3.2 Influencing Factors of Psychological Changes in the Elderly
--Influencing Factors of Psychological Changes in the Elderly
-3.3 Common Psychological Issues and Their Management in the Elderly
--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)
--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)
--【Book Recommendation】Development Through the Lifespan
-3.4 Depression in the Elderly
--3.4.1 Overview of Depression in the Elderly
--3.4.2 Clinical Symptoms of Depression in the Elderly
--3.4.3 Caring for Elderly Patients with Depression
--【Documentary Recommendation】Depression:Out of the Shadows
-3.5 Elderly Patients with Dementia
--3.5.1 Identification of Dementia Symptoms in the Elderly
--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia
--3.5.3 Safety Care of Elderly Patients with Dementia
--【Website Recommendation】The Global Voice on Demaentia
-Concept Map
--【Concept Map】Elderly Mental Health and Mental Health Care
-【Test】CHAPTER 3
-4.1 Precautions for Daily Care of the Elderly
--Precautions for Daily Care of the Elderly
-4.2 General Care of Elderly Skin
--4.2.1 Characteristics and General Care of Elderly Skin
--4.2.2 Skin Itching and Its Management in the Elderly
--【Website Recommendation】American Academy of Dermatology
-4.3 Clothing Hygiene for the Elderly
--Clothing Hygiene for the Elderly
--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly
-4.4 Dietary Care for the Elderly
--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs
--4.4.2 Dietary Care for the Elderly
--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics
--【Website Recommendation】Nutrition for older persons
-4.5 Sleep Guidance for the Elderly
--4.5.1 Sleep Characteristics of the Elderly
--4.5.2 Sleep Guidance for the Elderly
--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems
--【Website Recommendation】American Academy of Sleep Medicine
-4.6 Exercises Guidance for the Elderly
--4.6.1 Evaluation of Exercise Intensity in the Elderly
--4.6.2 Precautions Elderly Undertaking Exercises
--【Website Recommendation】American College of Sport Medicine
--【Book Recommendation】Handbook of Activities for the Elderly
-Concept Map
--【Concept Map】Elderly Daily Care
-【Test】CHAPTER 4
-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--【Website Recommendation】How Drugs Work In the Elderly
-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly
--Common Adverse Drug Reactions and Their Causes in the Elderly
-5.3 The Principles of the Use of Medications in the Elderly
--The Principles of the Use of Medications in the Elderly
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-5.5 Medication Compliance in the Elderly
--Medication Compliance in the Elderly
-Concept Map
--【Concept Map】Medication Safety and Care for the Elderly
-【Test】CHAPTER 5
-6.1 Falls in the Elderly
--6.1.1 Epidemiological Characteristics of Elderly Falls
--6.1.2 Risk Factors for Falls in the Elderly
--6.1.3 Prevention of Falls in the Elderly
--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)
-6.2 Dysphagia in the Elderly
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 Dry Mouth in the Elderly
--【Website Recommendation】Academy of Nutrition and Dietetics
-6.6 Elderly Nutritional Deficiencies
--Elderly Nutritional Deficiencies - emaciation
-6.7 Visual Impairment in the Elderly
--Visual Impairment in the Elderly
--【Website Recommendation】Senior Eye Exams
-6.8 Senile Deafness
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【Book Recommendation】The Meaning of Death by Herman Feife
-7.3 Nursing for Pain in the Dying Elderly
--Nursing for Pain in the Dying Elderly
-7.4 Nursing for Major Bleeding in the Dying Elderly
--Nursing for Major Bleeding in the Dying Elderly
-7.5 Nursing for Delirium in the Dying Elderly
--Nursing for Delirium in the Dying Elderly
-7.6 Nursing for Dyspnea in the Dying Elderly
--Nursing for Dyspnea in the Dying Elderly
--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA
-7.7 Psychological Problems and Nursing in the Dying Elderly
--Psychological Problems and Nursing in the Dying Elderly
--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross
-7.8 Grief Counseling for the Widowed Elderly
--Grief Counseling for the Widowed Elderly
--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela
-Concept Map
--【Concept Map】Hospice Care for the Elderly
-【Test】CHAPTER 7