Question

1. Leah Smith, an 87-year-old patient, is at the clinic receiving an annual physical checkup. The patient is wearing a sweater, but complains that the room is cold. The thermostat reads 70°F. The patient has a slow, wide-based gait, and she is flexed forward slightly when she walks. She opens her purse and tries to find the bottle of herbals she bought to make sure it is alright to take the supplement and has problems locating it by feeling for the bottle. She states that she is all thumbs. She complains that food does not smell or taste like she remembered it smelling and tasting 10 years ago. She wonders if it is because she used to grow her food and that is why it had a better taste and smell. She also stated that her family is concerned because she does not seem to have enough peripheral vision to drive, and she wiped out the mailbox yesterday when backing out of the driveway. The nurse performs a neurologic exam. (Learning Objective 5)

a. Explain the changes in the patient’s neurologic function that are related to aging and what risks the patient has related to age-related changes.

b. Because age-related changes have an impact on the neurologic assessment, for what additional areas should the nurse assess the patient, and what findings reflect normal aging?

c. What neurologic assessment findings do not change with aging?

Answer 1

. Ageing causes some natural changes in the nervous system which are normal, in addition to this normal changes some pathological changes or diseases also occurs.

A. The neurological changes in patient :

• Inability to withstand cold.
• Loss of smell and taste.
• Poor hand coordination.
• Decreased peripheral vision.
• Slowered movements.

The patient is at risk of neuropathy, Parkinson's disease and white matter lesions.

B. Advanced age causes nerve cell atrophy, shrinking of brain and change in level of neurotransmitters and hormones which slowers the message passed by neurons which causes normal changes like memory loss, decreased vision, smell and taste, loss of coordination. The nurse should do additional assessment to rule out Alzheimer's disease, Parkinson's disease, white matter lesions and stroke.

C. Neurological factors that doesnot change with age include :

• Remote memory
• Reflexes
• Pupillary reaction