1. Cellular changes
1.1. Functional cell number decreases
1.2. Lean body mass decreases
1.3. Total body fat increases which results in less muscle mass
1.4. Intracellular fluid reduces
1.4.1. Results in less total body makes dehydration a significant risk in older adults
1.5. Decline in immune function
1.6. High prevalence chronic conditions
1.7. T cell functions declines
1.8. Cancer
1.8.1. Changes in immune system Impair body’s ability to recognize cancerous cells and destroy
1.8.2. Prolonged closure to carcinogens
1.8.3. Additional screening with increased age
1.8.4. Conventional treatment: surgery, radiation, chemotherapy, biological therapy
1.8.5. New Topic
2. Physical appearance
2.1. Hair loss, graying and wrinkles
2.1.1. This can result in
2.2. Loss of tissue elasticity, elongated ears, baggy eyelids, double chin
2.3. Loss of subcutaneous fat
2.3.1. As body fat starts to atrophy, the body’s contour starts to gain a bony appearance with a deepening of hollows of the intercostal and supraclavicular spaces
2.4. Diminished stature resulting from reduced hydration, loss of cartilage and thinning vertebrae
3. Respiratory system
3.1. Calcification of costal cartilage and trachea and rib cage more rigid
3.2. Increased residual capacity and reduced vital capacity
3.3. Reduction on body fluids and reduced fluid intake can lead to development of mucus plugs and infection
3.4. Loose or brittle teeth can dislodge which can lead to lung abscess and infections—>
3.5. High risk for respiratory infection
3.5.1. COPD is a group of diseases that include asthma, chronic bronchitis and emphysema
3.5.1.1. Incidence of COPD is higher in women and in smokers
3.6. Coughing is reduced due to a blunting of the laryngeal and coughing reflexes
3.6.1. It is important to promote productive coughing and, the use of bronchodilators or inhalers can also be helpful
4. Cardiovascular system
4.1. Myocardial muscle less efficient which leads to Decreased contractile strength and Decreased cardiac output when demands increase
4.2. Valves become thick and rigid and blood vessels reduce elasticity - clots form easier
4.3. Heart muscle loses efficiency and contractile strength and reduced cardiac output with physiologic stress
4.4. Blood less oxygenated and issued less efficiently
4.5. Good tissue health is important p, however, older adults are likely to suffer from conditions that can alter tissue perfusion
4.5.1. Such as: cardiovascular diseases, diabetes, renal failure, anemia, hypotension, antihypertensives, edema and inflammation
4.6. Important for older adults to have an adequate diet that controls cholesterol, maintain adequate exercise and avoid cigarette smoking
5. GI system
5.1. Less acute taste sensations
5.1.1. This can result from the tongue atrophying, xerostomia, diseases and some medications
5.2. Decreased esophageal motility
5.2.1. Risk for aspiration and indigestion
5.3. Atrophy of the small and large intestines
5.4. Slower peristalsis, inactivity and reduced fluid intake
5.4.1. Risk for constipation
5.4.2. Incomplete emptying of the bowel
5.5. Bile salt synthesis decreases
5.5.1. Can lead to gallstone development
5.6. Saliva production decreases resulting in difficulty swallowing
5.7. Reduction in pepsin and hydrochloride acid
5.7.1. This can interfere with absorption of protein, calcium, iron, folic acid and vitamin B12
6. Urinary system
6.1. Hypertrophy and thickening of bladder muscle
6.1.1. Increases urinary frequency
6.2. Decreased ability of bladder to expand , reduced storage capacity
6.2.1. Leads to daytime frequency and nocturia
6.3. Inefficient neurological control of bladder emptying and weaker bladder muscle
6.3.1. Fecal impaction in women and prostatic hypertrophy in men
6.4. Kidney filtration ability decreases
6.4.1. Affects the ability to eliminate drugs
6.4.2. Reduced ability to concentrate and dilute urine in response to water or sodium excess or depletion occurs
6.5. Urinary retention
6.5.1. Symptoms include urinary frequency, straining, dribbling and the sensation that the bladder has not been emptied
7. Musculoskeletal
7.1. Thinning disks and shortened vertebrae
7.1.1. Osteoarthritis and osteoporosis are both common in older adults
7.2. Decreased bone mineral and mass
7.3. Reduced muscle mass, strength and movement
7.3.1. Sarcopenia-decline in walking speed or grip strength
7.3.1.1. This can be caused by disease, immobility, decreased caloric intake, poor blood flow to muscle or mitochondrial disfunction
7.4. Diminished calcium absorption
7.4.1. Increased risk of fractures
7.5. The loss of a spouse or friends can limit recreational activities and reduce opportunity for physical activity
7.5.1. Inactivity can lead to more musculoskeletal problems
7.6. Slight kyphosis
7.7. Osteoarthritis
7.7.1. Progressive deterioration of joint cartilage
7.7.2. Leading cause of disability in older adults
7.7.3. Excessive use of joint, trauma, obesity, low vitamin d levels can predispose
7.7.4. Acetaminophen is the first drug of choice
7.7.5. Arthroplasty may be recommended
7.8. Rheumatoid arthritis
7.8.1. Most develop earlier in life before 65
7.8.2. Inflammation of synovial fluid causing pain and edema
7.8.3. Anti-inflammatory meds, corticosteroids, immunosuppressive drugs
8. Sleep
8.1. Insomnia, daytime sleepiness and napping are all common
8.1.1. Including activity and stimulation during the day can be a solution to promote rest
8.2. Sleep-Wake Cycle
8.2.1. Older adults are more likely to fall asleep earlier in the evening and awake earlier in the morning
8.2.1.1. Daytime naps may be needed
8.3. Older adults sleep less soundly and shift in and out of stage 1 sleep and have a decline in the time spent in the deeper stages of sleep
8.3.1. Urinary problems like nocturia also contribute to disrupted sleep
8.4. Alters perception of the night time environment which results from visual and hearing deficits
8.5. Restless leg syndrome
8.5.1. Uncontrollable urge to move the legs
8.5.2. Uncomfortable, itching, pins and needles
8.5.3. Causes- iron deficiency anemia ,
8.5.4. Uremia, Parkinson’s disease, rheumatoid arthritis,
9. Reproductive
9.1. Female
9.1.1. Vulva atrophys and flattening of the labia due to hormonal changes
9.1.2. Vaginal epithelium becomes thin and the vaginal environment is drier and more alkaline
9.1.2.1. These changes can cause sexual intercourse to be uncomfortable for older women
9.1.3. Breasts sag and are less firm due to the replacement of mammary glands by fat tissue after menopause
9.2. Male
9.2.1. Reduction in sperm count related to the seminal vesicles having a thinner epithelium
9.2.2. Atrophy of the testes and reduction in the testicular mass
9.2.3. More time is required for an erection and it is more easily lost
9.2.4. Enlargement of the prostate gland, with increased risk of malignancy
9.3. HIV
9.3.1. Incidence increasing twice as quickly in patient over 50
9.3.2. 44% are among gay men
9.3.3. Less use of condoms because no risk of becoming pregnant
10. Nervous system
10.1. Decline in brain weight and atrophy of the brain and spinal cord
10.1.1. Decline in nerve cells and slows response and reaction times, reflexes become weaker
10.2. Cerebral blood flow decreases as fatty deposits gradually accumulate in the blood vessels
10.2.1. This contributes to increase risk in stroke
10.3. Slowing in central processing delays the time require to perform tasks
10.4. Number and sensitivity of sensory receptors and neurons decrease
10.4.1. Dulling of tactile sensation
10.5. Some decline in the function of cranial nerves
10.5.1. Older adults require increased levels of taste, scents, touch and lighting
11. Vision and hearing
11.1. Presbyopia
11.1.1. Reduced elasticity and stiffening of muscle fibers in the eye interferes with the brain ability to focus on objects clearly
11.2. Narrowing of the visual field
11.2.1. This decreases peripheral vision
11.3. Pupil sizes is reduced which leads to eyes being less reactive to light
11.4. Depth perception distorted due to visual acuity declining
11.5. Visual limitations can make communication problematic because facial expressions and gestures may be missed to
11.6. Presbycusis- the progressive loss of hearing reduces the ability to hear s, sh, f, ph and w sound
11.6.1. Also affected by impacted cerumen
11.7. Alteration in equilibrium and distortion of high pitched sounds
12. Sensory
12.1. Sense of smell decreases with age due to drier mucus membranes
12.2. Taste acuity declines
12.2.1. Decreased saliva, poor oral hygiene, some medications
13. Endocrine
13.1. Thyroid gland atrophies and thyroid activity decreases resulting in a lower basal metabolic rate, reduced radioactive iodine outage and less secretion and release of thyrotropin
13.1.1. Can also be reduced by diminished adrenal function
13.2. Adrenocorticotropic hormone secretion decreases with age
13.2.1. Reduced secretion of estrogen, progesterone, androgen and glucocorticoid
13.3. Volume of pituitary gland decreases which may lower somatotropic growth hormone blood levels
13.4. Insufficient release of insulin by beta cells in the pancreas and reduced tissue sensitivity to the circulating insulin
13.4.1. Reduced insulin secretion
13.5. Reduced ability to metabolize glucose
13.5.1. Increase in body fat