Review
Vital Signs in Older Patients: Age-Related Changes

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Vital signs are objective measures of physiological function that are used to monitor acute and chronic disease and thus serve as a basic communication tool about patient status. The purpose of this analysis was to review age-related changes of traditional vital signs (blood pressure, pulse, respiratory rate, and temperature) with a focus on age-related molecular changes, organ system changes, systemic changes, and altered compensation to stressors. The review found that numerous physiological and pathological changes may occur with age and alter vital signs. These changes tend to reduce the ability of organ systems to adapt to physiological stressors, particularly in frail older patients. Because of the diversity of age-related physiological changes and comorbidities in an individual, single-point measurements of vital signs have less sensitivity in detecting disease processes. However, serial vital sign assessments may have increased sensitivity, especially when viewed in the context of individualized reference ranges. Vital sign change with age may be subtle because of reduced physiological ranges. However, change from an individual reference range may indicate important warning signs and thus may require additional evaluation to understand potential underlying pathological processes. As a result, individualized reference ranges may provide improved sensitivity in frail, older patients.

Section snippets

Methods

A systematic approach was used to select sources for this review. A literature search was conducted using PubMed and the Medline online encyclopedia. The Medical Subject Headings terms “blood pressure,” “respiration,” “pulse,” and “body temperature” combined with “aged” were used. Additional keyword searches included the terms “vital signs,” “temperature,” “fever,” “thermoregulation,” “respiratory rate,” and “heart rate” merged with “aged.” Abstracts were reviewed if they were published in

The Cardiovascular System—Blood Pressure and Pulse

The cumulative effect of age-related molecular changes results in cardiovascular vital signs (blood pressure, pulse) with altered sensitivity, reliability, and normative ranges. On a cellular level, the endothelial aging process has been postulated to be a result of a combination of accumulating oxidative stress (ie, decreased nitric oxide and increased cyclo-oxygenase production)5, 6 and increased production of elastases and metaloproteinases in vascular smooth muscle that degrade the

Study Strengths/Limitations

Although there is a large body of literature describing the aging of systems, the number of studies that address the change in vital signs with age is limited. Thus, a major limitation is the ability to filter the literature for important articles that are on topic. A second limitation is that most of the literature describes disease-specific changes. Our objective for this review was to describe changes that occur in normal aging and to evaluate how these changes impact vital signs. In some

Conclusions

In the older patient, vital signs are increasingly reflective of age and pathological changes in organ systems. The resultant constriction of homeostatic capacity leads to a loss of regulatory and adaptive mechanisms such that insults are often not always met with an appropriate and timely response (eg, aging-related sympathetic dysregulation leading to postural hypotension). Clinically, this reduced capacity has 2 outcomes: (1) a constriction in the range of the vital signs (reduced

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    This project was supported by funding from the American Federation for Aging Research (5-T35-AG026781–05), the Einstein Research Scholarship, and the VA Rehabilitation Research and Development Career Development Award. The financial sponsors played no role in the design, execution, analysis or interpretation of data, or in the writing of the study.

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