Vital Signs in the Aging

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Vital signs in the aging

Definition

Vital signs (VS), which are also called simply vitals, are four measurements taken to determine whether a person is alive. The English word vital comes from the Latin vitalis, which means “pertaining to life” or “alive.” There are four standard vital signs: pulse (or heart) rate, blood pressure , breathing (or respiratory) rate, and body temperature.

Some health care professionals have suggested adding pain , skin color, and blood oxygen concentration to the basic list of vital signs, but these suggestions have not been accepted by most doctors.

Vital sign	Age-related changes and effects
source: Adapted from: A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; © 2005. Aging changes in vital signs; [updated 2006 Nov. 6]. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/003247.htm
(Illustration by GGS Information Services. Cengage Learning, Gale)
Blood pressure	Blood vessels become less elastic. The average blood pressure increases from 120/70 mm Hg to about 150/90 mm Hg and may remain slightly high even if treated. The blood vessels also respond more slowly to a change in body position. High blood pressure (hypertension) is a common blood pressure problem. Many older people find that they become dizzy if they stand up too suddenly. This is caused by a drop in blood pressure when they stand called orthostatic hypotension. Use of diuretics can cause low blood pressure and aggravate orthostatic hypotension.
Body temperature	Normal body temperature does not change significantly with aging, however, temperature regulation is more difficult. Loss of subcutaneous fat makes it harder to maintain body heat. Many older people find that they need to wear layers of clothing in order to feel warm. Skin changes include the reduced ability to sweat. Therefore, older people find it more difficult to tell when they are becoming overheated. Older people are at greater risk for overheating (hyperthermia or heat stroke). They are also at risk for dangerous drops in body temperature (hypothermia). Fever is an important sign of illness in the elderly. Many times, fever is the only symptom for several days.
Breathing (or respiratory rate)	Although lung function decreases slightly, changes are usually only in the reserve function. The rate of breathing usually does not change. There may be decreased tolerance to exercise. Some elderly people have a reduced response to decreased oxygen or increased carbon dioxide levels (the rate and depth of breathing does not increase as it should). Breathing problems are seldom normal. Although exercise tolerance may decrease slightly, even a very elderly person should be able to breathe without effort under usual circumstances. Use of pain medications can slow breathing.
Pulse (or heart rate)	Because of changes in the heart, the resting heart rate may become slightly slower. It takes longer for the pulse to speed up when exercising, and longer to slow back down after exercise. The maximum heart rate reached with exercise is lowered. Heart rate and rhythm problems are fairly common in the elderly. Excessively slow pulse (bradycardia) and arrhythmias such as atrial fibrillation are also common. Digitalis (used for heart failure) and certain blood pressure medications, such as beta blockers, may cause the pulse to slow.

Purpose

A senior's vital signs may be taken for a number of different reasons:

As part of a regular physical checkup.
As part of a comprehensive geriatric assessment.
To determine fitness for major surgery.
As part of inpatient preparation for surgery and to monitor the senior's condition after the procedure.
To help the doctor in diagnosing the possible cause (s) of the senior's symptoms. For example, an irregular pulse in an elderly patient as well as the location of the irregularity can help the doctor determine whether the senior has a heart condition that requires immediate attention or is simply experiencing a side effect of a medication.
To monitor the course of a disease or a chronic health condition.
To evaluate the effectiveness of medications and the need to increase or decrease the dosage.
To measure the effects of an exercise program or physical therapy.
To determine time of death.

Precautions

The precautions that should be taken by the health professional taking the vital signs include care to avoid exposing the senior to infection and care in maintaining any equipment used to measure vital signs (to avoid inaccurate measurements).

Precautions that should be taken to ensure the senior's safety during a physical examination include:

Allowing the senior extra time to undress, move to the examining table, and dress afterward. The table should be a comfortable height for the patient. In some cases, the doctor can take the vital signs with the patient seated in a chair.
Frail seniors should not be left alone in the examining room as a safeguard against falls.

Description

Temperature

The senior's temperature is taken with a thermometer. Glass thermometers that used to require placement for 3 minutes have now been replaced almost everywhere by electronic thermometers that record temperature accurately within seconds. The doctor should be careful to use a thermometer that will record temperatures below 95°F, as the major change in the aging body is not temperature level but the ability to regulate body temperature. Many seniors feel chilly much of the time because of the loss of body fat under the skin; it is also possible for a senior to have an infection without a noticeable fever. A temperature below 95°F in an elderly person should be rechecked because it may indicate acute illness or a severe medication reaction. Fever in a senior is usually defined as a temperature above 100°F.

In addition to taking the senior's oral temperature, the doctor may take the temperature again in the armpit or rectum. Seniors who breathe more rapidly than 20 breaths per minute may have artificially low oral temperatures. In some medical emergencies it may also be necessary to take the temperature in the armpit or rectum rather than the mouth.

Breathing

Breathing rate is measured by the physician's counting the number of breaths for a full minute and observing the pattern. Although most adults take between 12 and 18 breaths per minute, seniors in long-term care may take 16–25 breaths per minute. If the senior is taking more than 20 breaths per minute, the doctor will consider the possibility of an upper respiratory infection, congestive heart failure , lung disease, asthma , or pneumonia .

If the senior is taking 10 breaths or fewer per minute, the doctor will consider the possibility of heavy drinking, overuse of benzodiazepine tranquilizers, or high doses of painkillers, as these substances depress (slow down) the central nervous system. Another possible explanation for a low breathing rate is meningitis .

Pulse

The pulse should be taken in both arms in seniors. The reason for this precaution is that some heart problems result in a difference in volume in the blood flow on the two sides of the body, and the doctor can sometimes feel this difference by taking the pulse on both sides at the same time. When the doctor takes a senior's pulse, he or she will be trying to evaluate the stiffness of the blood vessel wall as well as the rhythm and strength of the pulse, as stiffening of the blood vessels in the aging body is a common development. It is not as easy for the doctor to detect the pulse in a stiff artery.

the most common location for taking the pulse is the radial artery, which runs along the side of the wrist and can be felt just below the thumb. The doctor may also take the pulse using the carotid artery just below the jaw or the femoral artery in the leg.

QUESTIONS TO ASK YOUR DOCTOR

Are all my vital signs within the normal range for a person my age?
Can you explain what the numbers indicate?
Why is blood pressure measured in both arms?
Can you tell from taking my pulse whether my arteries are stiffening?

Blood pressure

Blood pressure is measured by a device called a sphygmomanometer, which consists of an inflatable cuff to constrict blood flow connected to a mercury tube or digital gauge to record the pressure. The measurements are expressed in millimeters of mercury, or mm Hg. To take blood pressure, the doctor places the cuff around the upper arm at the level of the heart while the patient is sitting upright. The doctor listens with a stethoscope at the inside of the senior's elbow and inflates the cuff until the brachial artery in the upper arm is squeezed shut. The doctor then slowly releases the pressure in the cuff until a whooshing sound is heard when the blood returns to the artery. This is the systolic pressure (the highest level of blood pressure in the arteries). The cuff is then further released until the sound is no longer heard; this is the diastolic pressure (the lowest level of blood pressure in the arteries).

Blood pressure is usually taken in both arms in seniors for the same reason that the pulse is taken on both sides of the body—to screen for possible heart disorders. In addition, the doctor should be careful to note whether a high reading is an accurate measurement of blood pressure or whether it is caused by stiffening of the patient's blood vessels. This condition is called pseudohypertension.

Preparation

There are no special preparations required for the taking of vital signs, although the patient may be asked to roll up sleeves or remove a shirt or blouse if the measurements are taken as part of a routine office visit.

Aftercare

There is no aftercare required for the taking of vital signs.

KEY TERMS

Diastolic blood pressure —The lowest level of blood pressure in the arteries, which occurs at the point in the heart's cycle when its chambers fill with blood.

Pseudohypertension —A condition in which a senior's blood pressure measures higher than it really is because of stiffening of the arteries.

Sphygmomanometer —A device for measuring blood pressure that consists of an inflatable cuff connected to a mercury column or a digital gauge.

Systolic blood pressure —The highest level of blood pressure in the arteries, which occurs at the point in the heart's cycle when the heart contracts and pushes blood out through the aorta and the pulmonary artery.

Complications

It is rare for serious complications to occur as the result of taking vital signs, since these measurements do not involve drawing blood or other invasive procedures.

Some elderly persons with very fragile skin, however, may notice bruising after the use of a blood pressure cuff.

Results

Normal ranges for vital signs in health adults are as follows:

Temperature: between 97.8 and 99.1°F. This range is the same in seniors as in younger adults.
Breathing rate: 12 to 18 breaths per minute. Changes in the senior's lungs do not always affect the rate of breathing; however, some seniors in long-term care with respiratory problems may have a breathing rate as high as 25 breaths per minute.
Pulse: Between 60 and 80 beats per minute when the person is at rest. In seniors, however, the pulse is often slightly slower than in younger adults. It takes longer for a senior's pulse to speed up during exercise and longer for it to slow down after exercise. In addition, the maximum heart rate with exercise is lower in seniors than in younger adults.
Blood pressure: systolic 120 mm Hg or less; diastolic 80 mm Hg or less. In seniors, however, blood pressure is often higher than normal values in younger adults; it may be as high as 150/90 mm Hg even when the senior is being treated for high blood pressure.

Caregiver concerns

Taking vital signs is a routine medical procedure that does not require a special request. In most cases, a senior's vital signs will be taken by a physician, physician assistant, or registered nurse . In emergencies, vital signs may be taken by an emergency medical technician (EMT), paramedic, member of a rescue squad, firefighter, or police officer.

Resources

BOOKS

Beers, Mark H., M. D., and Thomas V. Jones, MD. Merck Manual of Geriatrics, 3rd ed., Chapter 3, “Physical Examination.” Whitehouse Station, NJ: Merck, 2005.

Gomella, Leonard, M.D., and Steven A. Haist, M.D. Clinician's Pocket Reference, 11th ed. New York: Mc-Graw-Hill, 2007.

PERIODICALS

Cheng, T. O. “Osler Maneuver to Detect Pseudohypertension.” Journal of the American Medical Association 282 (September 8, 1999): 943.

Summerhill, E. M., et a. “Respiratory Muscle Strength in the Physically Active Elderly.” Lung 185 (December 2007): 315–320.

OTHER

Bryan, E. David. “Abdominal Pain in Elderly Persons.” eMedicine, October 5, 2006. http://www.emedicine.com/emerg/topic931.htm [cited February 22, 2008].

Cohen, Sandra, M.D. Aging Changes in Vital Signs. Last reviewed November 2006. Available online at http://www.umm.edu/ency/article/004019.htm [cited February 22, 2008].

ORGANIZATIONS

American Academy of Family Physicians (AAFP), 11400 Tomahawk Creek Parkway, Leawood, KS, 66211, (913) 906-6000, (800) 274-2237, (913) 906-6269, http://www.aafp.org/online/en/home.html.

National Heart, Lung and Blood Institute (NHLBI), P.O. Box 30105, Bethesda, MD, 20824, (301) 592-8573, (240) 629-3246, [email protected], http://www.nhlbi.nih.gov/index.htm.

Rebecca J. Frey Ph.D.

The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers