nursing.elitecme.com Page 95 Complete Your CE Test Online - Click Here ● ● Does the patient use assistive devices for mobility? If so, are they appropriate to the older adult’s needs? If s/he does not use such devices, does s/he need them? ● ● Is the older adult alert and oriented? If not, is there someone in the home to help him or her with safety issues? ● ● Does the adult get adequate amounts of sleep? Does s/he seem to be tired or fatigued? Lack of rest and/or fatigue or weakness increases the risk of falls. EBP alert! More than 95% of hip fractures are the result of falls. Hip fractures are associated with complications such as permanently decreased mobility and death [9]! Nurses must be assertive in their patient/family education when it comes to fall prevention! The immune system The immune system is responsible for defending the body against infection. Changes in the immune system of the older adult increase the risk for infection. The components of the immune system include organs and tissues rich in lymphocytes, and the two primary lymphocyte types are B cells and T cells. These cells are found throughout the body, but are predominant in the lymph nodes and spleen. These cells possess receptors that respond to specific antigens [53]. Antigens are substances (usually proteins) that are recognized by the body as foreign and produce an immune response. This response involves producing antibodies to attack the foreign substance. Antibodies are specific to the antigens that trigger them [53]. As we age, there is a decrease in T cell function and B cell production in the bone marrow. These changes reduce the body’s ability to mount an immune response to new pathogens and lead to a dysfunctional immune system. The older adults’ immune system is not as effective as that of a younger person. However, exercise, diet, and emotional well-being all boost the immune system and enhance health and wellness. Specific age-related immune system changes include [9,14]: ● ● Reduction in the rate and strength of the immune response. ● ● The number of available B cells decreases. ● ● The manufacturing of antibodies that fail to differentiate between the person’s own body and foreign substances increases. This makes the older adult more vulnerable to autoimmune disease development. ● ● There is an overall decrease in cellular immunity. As part of the assessment of the immune system, the nurse must recognize those factors that can have an impact on the immune system [13]. First, as with most body systems, a person’s general state of health and wellness impacts the effectiveness of the immune system. A nutritious diet, adequate rest and relaxation, and social interaction with family and friends all contribute to good health. Research suggests that regular exercise may slow the rate or even prevent age-associated decline in the immune system. Older adults may find that the practice of moderate, slow-movements, such as those performed in Tai Chi, a Chinese exercise, have a positive impact on cardiovascular and respiratory function as well as mental acuity, balance, muscle strength, flexibility, and immune system response. Stress reduction is important to most, if not all, aspects of health. Additionally, many older adults provide caregiver services to a spouse or other older significant others. This, too, is a stressful situation. Stress may have a negative effect on the immune system. The relationship between stress and the effectiveness of the immune system is currently the focus of a number of research endeavors. The effects of long-term and chronic illness can have an adverse effect on the ability of the immune system to function. Both physical and mental health problems can have a negative impact on the immune system. Since the immune system is interrelated with many other body systems, problems in one system can affect one or more other systems. There are a number of diseases related to defective immune system responses. Here are some that are common in the older adult population. Hypersensitivity problems Mrs. Slater is 68 years old. She recently retired from her job and is looking forward to spending more time with her family and friends. Mrs. Slater lives in Florida, where the climate allows her to spend time gardening year round. Mrs. Slater has a lengthy history of coughing and becoming slightly short of breath when working in her garden, especially in the Spring, when her garden is in full bloom. She also sneezes and has watery eyes. These symptoms, especially the coughing and shortness of breath have slowly, insidiously become worse with age. She has always attributed such symptoms to “allergies” but, at her husband’s insistence, she visits their family doctor for evaluation. Mrs. Slater is indeed allergic to some environmental substances, such as pollen, but she also has asthma, a frequently under-diagnosed problem in older adults. Mrs. Slater’s situation illustrates what is referred to as a hypersensitivity problem. Hypersensitivity problems are excessive immune responses that occur when the immune system has an excessive response to various triggers [9]. Hypersensitivity disorders or responses are classified as Type-1 through Type-IV. Classification depends on which immune system activity causes tissue damage [26]. A hypersensitivity response does not usually occur with the first exposure to the antigen, but as the body encounters the antigens on a recurring base, an excessive immune response results in hypersensitivity reactions [9,53]: ● ● Type-1 hypersensitivity disorders are immediate, usually occurring with 15 to 30 minutes after the person is exposed to an antigen (or allergen). These disorders are referred to as anaphylactic, immediate, atopic, or IgE-mediated reactions. Sometimes, as in the case of anaphylactic reactions, the type-1 hypersensitivity reaction may be life-threatening. Other examples include reactions to insect stings, food and drug reactions, and some cases of urticaria (hives) [9,53]. Nursing consideration: Asthma is a common Type-1 hypersensitivity reaction that is often both under-diagnosed and under-treated in older adults [9]. ● ● Type-II hypersensitivity disorders are referred to as cytotoxic, cytolytic, or complement-dependent cytotoxicity reactions [26]. They also occur within 15 to 30 minutes of exposure and include such problems as transfusion reactions, drug reactions, and autoimmune hemolytic anemia [9]. ● ● Type-III hypersensitivity disorders are referred to as immune complex disease reactions [26]. They are characterized by the body’s failure to remove antigen-antibody complexes from the circulation and tissues [9]. Examples of Type-III disorders include reactions that are associated with infections such as hepatitis B and bacterial endocarditis, cancers, and autoimmune disorders such as Systemic Lupus Erythematous (SLE) [9,26]. Rheumatoid arthritis is also thought to be a Type-III disorder that affects older adults [9]. ● ● Type-IV hypersensitivity disorders are referred to as delayed or cell- mediated hypersensitivity reactions [26]. Tissue damage occurs due to a delayed T-cell reaction to an antigen. Reactions after exposure take place within one day to two weeks, but may be even slower in older adults [9]. Examples of Type-IV hypersensitivity disorders include dermatitis from a latex allergy, sarcoidosis, tuberculin reactions, and transplant rejections [9,53].