Journal of Gerontological Nursing

CLINICAL OUTLOOK 

Interpretation of Abnormal Laboratory Values in Older Adults

Karen Devereaux Melillo, PhD, RN, C

Abstract

The American Nurses' Association Standards and Scope of Gerontological Nursing Practice (1987) include: "The health status of the older person is regularly assessed in a comprehensive, accurate, and systematic manner. The information obtained during the health assessment is accessible to and shared with appropriate members of the interdisciplinary health care team including the older person and the family."

Biochemical assessment is one of the parameters necessary to construct appropriate nursing management plans for the older adult to achieve an optimal level of function (American Nurses Association, 1983). The selective use and interpretation of biochemical analysis provides data to substantiate clinical judgment and comprehensive evaluation. Yet some authors have suggested that "despite our reliance on the laboratory, our understanding of how to interpret laboratory results. . . lags behind our ability to measure the chemical events" (McClatchey, 1989).

There are myriad variables that are known to affect laboratory values on at least some tests. An upcoming article will summarize what is known about age-related physiologic changes in the older adult and the effect of these changes, if any, on commonly ordered laboratory values (Melillo, 1992). In many cases, drugs, multiplicity of diseases, and dietary factors may affect laboratory results, not all of which have been identified herein. This article is intended to be a helpful resource for frequently seen abnormal laboratory values in older adults, not an exhaustive reference (Tables 1 and 2). The reader is encouraged to refer to comprehensive laboratory manuals and individual laboratory reference intervals for precise interpretation of specific laboratory results and to integrate test results in the clinical context of individual patients.

The first part of this article will discuss the following laboratory studies: red blood cell count, hemoglobin and hematocrit, red blood cell indices, white blood cell differential, platelets, erythrocyte sedimentation rate, vitamin B12, folate, transferrin, total ironbinding capacity, serum iron, electrolytes, and glucose. The second part will cover blood urea nitrogen, creatinine, creatinine clearance, bilirubin, uric acid, liver function tests, total protein, albumin, globulin, lipoproteins, and thyroid function tests.

Table 1

Interpretation of Aknormaf Ltsboratory Values in Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnmalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults…

The American Nurses' Association Standards and Scope of Gerontological Nursing Practice (1987) include: "The health status of the older person is regularly assessed in a comprehensive, accurate, and systematic manner. The information obtained during the health assessment is accessible to and shared with appropriate members of the interdisciplinary health care team including the older person and the family."

Biochemical assessment is one of the parameters necessary to construct appropriate nursing management plans for the older adult to achieve an optimal level of function (American Nurses Association, 1983). The selective use and interpretation of biochemical analysis provides data to substantiate clinical judgment and comprehensive evaluation. Yet some authors have suggested that "despite our reliance on the laboratory, our understanding of how to interpret laboratory results. . . lags behind our ability to measure the chemical events" (McClatchey, 1989).

There are myriad variables that are known to affect laboratory values on at least some tests. An upcoming article will summarize what is known about age-related physiologic changes in the older adult and the effect of these changes, if any, on commonly ordered laboratory values (Melillo, 1992). In many cases, drugs, multiplicity of diseases, and dietary factors may affect laboratory results, not all of which have been identified herein. This article is intended to be a helpful resource for frequently seen abnormal laboratory values in older adults, not an exhaustive reference (Tables 1 and 2). The reader is encouraged to refer to comprehensive laboratory manuals and individual laboratory reference intervals for precise interpretation of specific laboratory results and to integrate test results in the clinical context of individual patients.

The first part of this article will discuss the following laboratory studies: red blood cell count, hemoglobin and hematocrit, red blood cell indices, white blood cell differential, platelets, erythrocyte sedimentation rate, vitamin B12, folate, transferrin, total ironbinding capacity, serum iron, electrolytes, and glucose. The second part will cover blood urea nitrogen, creatinine, creatinine clearance, bilirubin, uric acid, liver function tests, total protein, albumin, globulin, lipoproteins, and thyroid function tests.

The figure above by Anne Rast was omitted from the Clinical Outlook column on "Cardiac Assessment of the Elderly Client" by Marycarol McGovern, MSN, RN, and Janet K. Kuhn, EaD, RN. The figure should have appeared on page 40 of the Journal of Gerontological Nursing 1 992; 18(8).

The figure above by Anne Rast was omitted from the Clinical Outlook column on "Cardiac Assessment of the Elderly Client" by Marycarol McGovern, MSN, RN, and Janet K. Kuhn, EaD, RN. The figure should have appeared on page 40 of the Journal of Gerontological Nursing 1 992; 18(8).

Table

Table 1Interpretation of Aknormaf Ltsboratory Values in Older Adults

Table 1

Interpretation of Aknormaf Ltsboratory Values in Older Adults

Table

TABLE 2Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

Table

TABLE 2Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

Table

TABLE 2Significance of Specific Abnmalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnmalities in Laboratory Assessment of Older Adults

Table

TABLE 2Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

REFERENCES

  • American Nurses Association. Division on gerontological nursing practice, gerontological nurse practitioner certification examination, test content outline, domains of practice. Kansas City, MO: Author, 1983.
  • American Nurses Association. Standards and scope of gerontological nursing practice. Washington, DC: Author, 1987.
  • Andres, R. Aging and diabetes. Medical Clinics of North America 1971; 55:835-846.
  • Blotzer, J. W. Accurate use of laboratory tests in rheumatic diseases. Geriatrics 1984; 39(9):63-73.
  • Caird, RI. Problems of interpretation of laboratory findings in the old. Br Med J 1973;4:348-351.
  • Cavalieri, T.A., Chopra, A., Bryman, PN. When outside the norm is normal: Interpreting lab data in the aged. Geriatrics 1992; 47(5):66-70.
  • Chillag, S.A. Recognizing atypical geriatric illness. Geriatric Consultant 1985; 3(6):25-27.
  • Coodley, E.L., Skowsky, R., Coodley, G. Correlating thyroid and parathyroid function with age. Geriatrics 1984; 39(5):99-110.
  • Damon, L.E. Anemias of chronic disease in the aged: Diagnosis and treatment. Geriatrics 1992; 47(4):47-57.
  • Fischbach, F. A manual of laboratory and diagnostic tests, 4th ed. Philadelphia: JB Lippincott, 1992.
  • Freedman, ML., Weintraub, N.T. Normal aging and patterns of hematological disease. In W.B. Abrams, R. Berkow (Eds.), The Merck manual of geriatrics. Rahway, NJ: Merck Sharp & Dohme Research Laboratories, 1990, pp. 643-684.
  • Garner, B.C. Guide to changing lab values in elders. Geriatr Nurs 1989; 10:144-145.
  • Goldman, R. Decline in organ function with age: The blood. In I. Rossman (Ed.), Clinical geriatrics. Philadelphia: JB Lippincott, 1979, p. 42.
  • Hanger, H.D., Sainsbury, R., Gichrist, N.L., Beard, M.E.J., Duncan, J.M. A community study of vitamin B12 and folate levels in the elderly. Journal of the American Geriatrics Society 1991; 39:1155-1159.
  • Harrell, J.S. Age-related changes in the cardiovascular system. In M. A. Matteson, E.S. McConnell (Eds.), Gerontological nursing: Concepts and practice. Philadelphia: WB Saunders, 1988, p. 195.
  • Henderson, CT. Malnutrition. Clin Geriatr Med 1988; 4:527-547.
  • Henry, R.R., Edelman, S.V. Advances in treatment of type II diabetes mellitus in the elderly. Geriatrics 1992; 47(4):24-30.
  • Hunder, G.G., Bloch, D.A., Michel, BA., Stevens, M.B., Arend, W.P, Calabrese, L.H., et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis and Rheumatism 1990; 33(8):1122-1128.
  • Jernigan, J.A., Gudat, JC, Blake, J.L., Bowen, L. Lezotte, DC. Reference values for blood findings in relatively fit elderly persons. Journal of the American Geriatrics Society 1980; 28:308-314.
  • Jundt, J. W-, Mock, D. Temporal arteritis with normal erythrocyte sedimentation rates presenting as occipital neuralgia. Arthritis and Rheumatism 1991; 34(2):17-219.

Kane-Carlsen, RA. Managing patients with TIAs. Nursing92 1992; 22(l):34-40.

  • Kravitz, S.C. Anemia in the elderly. In W. Reichel (Ed.), Clinical aspects of aging. Baltimore: Williams & Wilkins, 1989, pp. 412-421.
  • Lipson, M. Diabetes in the elderly: Diagnosis, pathogenesis and therapy. American Journal of Medicine 1986; 80(Suppl A):10.
  • Lokich, J.X Principles of cancer chemotherapy. Ih A.H. Goroll, L.A. May, A.G. Mulley (Eds.), Primary care medicine. Philadelphia: JB Lippincott, 1987, pp. 430-435.
  • Malloy, M.J., Lopez, L.M. Management of hypertension and congestive heart failure. In J.C. Delafuente, R.B. Stewart (Eds.), Therapeutics in the elderly. Baltimore: Williams & Wilkins, 1988 pp. 223-246.
  • Martin, D. B12 and folate deficiency dementia. Clin Geriatr Med 1988; 4:841-852.

McClatchey, K.D., McMahon, L.F. Laboratory medicine. In W.N. Kelley (Ed.), Textbook of internal medicine. Philadelphia: JB Lippincott, 1989, pp. 2667-2679.

  • MeIiIIo, K.D. Mnemonics: Use in gerontological nursing practice, journal of in Gerontological Nursing 1991; 17(7):40-43.

Melillo, K.D. Interpretation of laboratory values with older adults. In press, 1993.

  • Mersey, J.E Diabetes mellitius in the elderly patient. In W. Reichel (Ed.), Clinical aspects of aging. Baltimore: Williams and Wilkins, 1989.
  • Miller, M. Disorders of water and sodium balance. In W.B. Abrams, R. Berkow (Eds.), The Merck manual of geriatrics. Rahway, NJ: Merck Sharp & Dome Research Laboratories, 1990, pp. 24-35.
  • National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28:1039.
  • Pseudohyponatremia: When to question lab values. Enter g Med 1989; 21(12):87,90.
  • Rick, M.E., Gralnick, H-R. Abnormalities of platelet and vascular function. In W.N. Kelley (Ed.), Textbook of internal medicine. Philadelphia: JB Lippincott, 1989, pp. 1401-1408.
  • Rock, R.C. Effects of age on common laboratory tests. Geriatrics 1984; 39(6):57-60.

Rowe, J. W. Renal system. In W.B. Abrams, R. Berkow (Eds.), The Merck manual of geriatrics. Rahway, NJ: Merck Sharp & Dohme Research Laboratories, 1990, pp. 601-607.

  • Salive, M.C., Cornoni-Huntley, }., Guralnik, J.M., Phillips, CL., Wallace, R.B., Ostfeld, A.M., et al. Anemia and hemoglobin levels in older persons: Relationship with age, gender, and health status, journal of the American Geriatrics Society 1992; 40:489-496.
  • Sapra, R., Armentrout, S.A. Hematologic complications of the elderly. Geriatrics 1984; 33(6):77-93.
  • Schulman, B.K., Acquaviva, T. Falls in the elderly. Nurse Pracf 1987; 12(1 1):30-37.
  • Sparrow, D., Rowe, J.W., Silbert, J.E. Cross-sectional and longitudinal changes in the erythrocyte sedimentation rate in men. journal of Gerontology 1981; 36:180-184.
  • Talley, L. Laboratory values. In D.L. Carnevali, M. Patrick (Eds.), Nursing management for the elderly. Philadelphia: JB Lippincott, 1987, pp. 81-110.
  • US Department of Health and Human Services, Public Health Service, National Institutes of Health. The 1988 report of the joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Washington, DC: Author, 1988. NIH Publication No. 88-1088.
  • Wallach, J. (Ed.). Interpretation of diagnostic tests: A handbook synopsis of laboratory medicine, 3rd ed. Boston: Little Brown & Co, 1978.
  • Wasserman, M., Levinstein, M., Keller, E., Lee, S., Yoshikawa, T. Utility of fever, white blood cells, and differential count in predicting bacterial infections in the elderly. / Am Geriatr Soc 1989; 37:537-543.
  • Wise, CM., Agudelo, CA., Chmelewski, W.L., McKnight, K.M. Temporal arteritis with low erythrocyte sedimentation rate: A review of five cases. Arthritis and Rheumatism 1991; 34(12):1571-1574.
  • Wong, R.L., Korn, J.H. Temporal arteritis without an elevated erythrocyte sedimentation rate. American jorunal of Medicine 1986; 80:959-964.
  • Zimelman, A.P. Diagnostic approach to anemia in the elderly. Geriatric Medicine Today 1987; 6(5):34-35,37-38,43-44.

Table 1

Interpretation of Aknormaf Ltsboratory Values in Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnmalities in Laboratory Assessment of Older Adults

TABLE 2

Significance of Specific Abnormalities in Laboratory Assessment of Older Adults

10.3928/0098-9134-19930101-11

Sign up to receive

Journal E-contents