Caring for the Elderly with Renal Failure: Gastrointestinal Changes.

Caring for elderly individuals with renal failure can be a challenging and difficult responsibility. Specific changes that occur as a result of renal failure can have a direct effect on several body systems, including circulatory, musculoskeletal, nervous, and gastrointestinal. Likewise, the aging process has an effect on all body systems. The combined effects of aging and renal disease present a complex dilemma when addressing health care needs. Hence, health care providers cannot expect to effectively address the complexity of renal failure in older adults without incorporating the unique alterations that occur with aging.

Dellefield (1996) defined the elderly as "people 65 years of age or older" (p. 20). According to the U.S. Bureau of the Census (1997), the elderly population increased from 3.1 million in 1900 to 33.2 million in 1994. Of this group, adults 85 years of age and older are the fastest growing segment, comprising 11% of the elderly population by the year 2000 (Eliopoulos, 1999; Tyson, 1999). It is estimated that by 2050, the elderly population will increase to approximately 80 million people (Tyson, 1999).

With the certain rise in the elderly population, health care providers should note that aging is an individualized and unique process. There are some common age-related changes but the rate and degree to which they occur are distinct for each individual. It should also be noted that there are some alterations and problems that are more prevalent as adults advance in age, but these alterations are not directly attributed to the aging process. Genetics, environment, lifestyle, and effects of disease all contribute to an individual's physical and psychosocial response to aging.

According to Parker (1998), renal failure is classified as acute (develops rapidly) or chronic (develops slowly), but is defined as a deterioration of kidney function. There are various causes of renal failure, but in older adults, vascular diseases have been identified as the primary cause of chronic renal failure followed by diabetes (Mathers, 1998). According to Dellefield (1996), four out of five adults over 65 years old will acquire at least 1 of the 10 leading chronic conditions, which includes arthritis, hypertension, hearing dysfunction, heart conditions, sinusitis, orthopedic impairment, arteriosclerosis, diabetes, varicose veins, and visual impairment. It is important to note that vascular diseases comprise 4 of the 10 leading chronic conditions, thereby heightening the possibility of elderly individuals developing renal failure. According to Visovsky (1999) along with Smeltzer and Bare (1996), there is a greater prevalence of renal failure in the older adult population, accounting for an 8% increase in the past 5 years.

With an increasing elderly population and subsequent increase in renal patients, it is imperative to understand how renal failure presents in older individuals. Instead of the usual manifestations of nausea and vomiting, edema and fatigue, older individuals may exhibit decompensation of pre-existing medical conditions (Linton, 1997). One major body system significantly altered by renal failure and aging is the gastrointestinal system. Components of the gastrointestinal system include the oral cavity, esophagus, stomach, small and large intestine, pancreas, and liver. This article highlights the specific and unique changes that occur with each component as a result of aging and renal failure. Therapeutic management and specific nursing implications are also addressed.

Oral Cavity

Age-related changes. It is believed that age-related changes within the oral cavity are most likely caused by disease processes rather than by the normal aging process. With changing attitudes regarding oral health, older adults have experienced less tooth loss and gum disease. The decrease in tooth loss and gum disease is a direct result of a widespread use of fluoridated water and an increase in elderly individuals making preventive care visits to the dentist. Changes that occur as a result of aging do not have a profound effect on oral function, but are significant enough to include. Linton (1997) highlighted certain changes directly related to the aging process. There is a loss of elasticity and thinning of the mucosal lining. Teeth are usually thin and stained secondary to attrition, resulting in a dark and yellow appearance. The tongue may have a smooth and lobular appearance with varicosities present on the ventral surface.