Vital Signs in the Aging
Vital signs are basic health status indicators. They include temperature, pulse, rate of respiration, and blood pressure. Several physiologic changes occur in the elderly which may impact the measurement of vital signs by the health care practitioner.
Vital signs are measured to obtain basic indicators of a patient's health status. If outside of a normal range of values, they may point to dysfunction or a disease state.
There are no significant contraindications to the measurement of vital signs in the aging patient.
Some normal vital sign values may change as a person ages because of normal physiologic processes. The health care practitioner should be aware of these normal changes when assessing vital signs.
Normal body temperature does not significantly change as a person grows older. However, heat regulation may be altered due to physiologic changes that occur as a result of normal aging and from diseases that frequently occur in the elderly. For example, the elderly have a more difficult time maintaining body heat because of a loss of subcutaneous fat and may frequently complain of being too cold. Conversely, an older person, especially one who is obese, may have a harder time keeping cool in warmer weather. The overall ability to perceive temperature decreases, contributing to the problem. The elderly patient may not always be able to mount a fever during an infection.
Changes in the heart may cause the resting heart rate to slow down as a person ages. The pulse may take longer to quicken when exercising and longer to return to normal afterwards. The elderly person who exercises attains a lower maximum heart rate. When assessing heart rate, the pulse should be measured in both arms for a period of 30 seconds and any irregularities noted.
The range of values for normal blood pressure does not change with aging. However, arterial stiffness tends to increase, causing blood pressure measurements to sometimes be falsely high. In addition, many older people, especially women, are nervous in the doctor's office, sometimes elevating the blood pressure above the individual's typical values. Proper measurement technique is important. Because occlusive atherosclerotic disease often decreases the systolic pressure in one arm, blood pressure measurements should be taken in both arms. In addition, blood vessels tend to respond more slowly to changes in body position as a person ages. For this reason, measurements should be made while the patient is in a sitting or supine (lying down on back) position, then immediately after the patient stands, so that orthostatic hypotension can be detected.
The normal respiratory rate in the older patient may be as high as 16 to 25 breaths per minute. Breathing may appear somewhat shallower than in the younger population. However, even a very elderly person should be able to breathe without effort in the absence of disease. A rate higher than 25 breaths per minute may indicate congestive heart failure or a lower respiratory tract infection.
Instruct the patient regarding the rationale for vital sign measurement. The patient should be sitting or lying in a comfortable, relaxed position.
Orthostatic hypotension—Hypotension occurring immediately after a person gets up from a sitting or reclining position.
A normal temperature range is 97.5°F to 99.5°F (36°C to 38°C). The resting heart rate may be lower than the normal 60-100 beats per minute in a younger person. Normal blood pressure is the same as for a younger adult: less than 140 mm Hg (systolic) over less than 90 mm Hg (diastolic). The normal respiratory rate of an older person ranges from 16 to 25 breaths per minute.
Health care team roles
Vital sign readings may be obtained by the physician, the nurse or nursing assistant, and the physical therapist.
Beers, Mark H. and Robert Berkow, eds. The Merck Manual of Geriatrics. Whitehouse Station, NJ: Merck & Co., Inc., 2000.
Currey, Chuck. "Biology and Physiology of Aging" University of Florida PA Program Introduction to Medicine II (Spring 2001).
Administration on Aging 330 Independence Avenue SW, Washington DC, 20201. (202) 619-7501.
Deanna M. Swartout-Corbeil, R.N.