The Aging Process
Older adults require infusion therapy for a variety of conditions or diagnostic ­
indications. An assessment includes a system-by-system examination; a review
of medical, medication, and infusion therapy ­ history; confirmation of ability to
perform activities of daily living (ADLs), ­ functional status, and psychological
and safety assessments. Family and/or ­ caregiver, current contact information, ­
community resources, and advanced directives are included.
Aging Theories
Aging is dependent on nutritional, environmental, educational, socioeconomic,
genetic, physiologic, and spiritual factors. Aging theories range from the biologic
to the psychosocial. No one ages the same, given all the unique factors. Because
the population of older adults is increasing, older people are classified into
3 major groups:
1. Young old: 65 to 74 years
2. Middle old: 75 to 84 years
3. Old old: 85 years and older
The following is a summary of considerations that may affect infusion-based ­
approaches to device selection, vascular access site care and management ­
strategies, and anticipated outcomes.
Physiological Changes and General Infusion Considerations
Integumentary System
Many changes occur in the integumentary system that can have a significant
impact on the provision of infusion therapy services. As the individual ages, there
is a decrease in fluid-to-body mass ratios. In addition to a loss of collagen and
elasticity, this makes the skin texture more pliable. With the loss of ­ subcutaneous
fat, the veins will have a tendency to roll. The number of sweat cells decrease and
diminish in efficiency with less sebum produced, which results in a decreased
ability to perspire, further enhancing skin dryness. Skin will appear looser as the
number of papillae (the cells that hold the 3 layers of the skin tightly together)
Sensory changes that can accompany aging may cause a decrease in the thirst
reflex mechanism, leading to dehydration. Hydration imbalances may make skin
turgor evaluation a poor assessment tool. Hydration as a form of “pretreatment”
may be necessary before infusion therapy can be initiated. Skin turgor assessment
for hydration status should be performed either mid-sternum or between the
eyes, instead of on the hand.
The number of sensory nerve endings decreases with age as does the older adult’s
ability to perceive pain. This increases the risk that damage to the skin will be
delayed or will go unnoticed. Should a medication or solution infiltrate into the
T h e A g i n g P r o c e s s
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