1. Reproductive
1.1. Prevalent conditions in men
1.1.1. Andropause
1.1.1.1. Testosterone levels decline
1.1.1.2. Doesn't occur in all men
1.1.1.3. Low testosterone levels can result in reduced muscle mass, energy, strength, and stamina
1.1.2. Erectile dysfunction
1.1.2.1. Unable to attain or maintain erection of penis for sexual intercourse
1.1.2.2. Causes
1.1.2.2.1. Atherosclerosis
1.1.2.2.2. Diabetes
1.1.2.2.3. Hypertension
1.1.2.2.4. MS
1.1.2.2.5. Thyroid dysfunction
1.1.2.2.6. Renal failure
1.1.2.2.7. Other: alcoholism, structure abnormalities, meds, psychological factors
1.1.3. BPH
1.1.3.1. Common with increased aged men
1.1.3.2. Signs are dysuria, hesitancy, decreased force, frequency, nocturia, dribbling, poor control, imcomtinece, and bleeding
1.1.3.3. Treatment is most often a TURP procedure
1.1.4. Scrotum Tumors
1.1.4.1. Usually benign
1.1.5. Cancers
1.1.5.1. Penis
1.1.5.1.1. Rare
1.1.5.1.2. Signs are painless lesion/ wort on prepuce or glands
1.1.5.2. Testicular
1.1.5.2.1. Uncommon in older men
1.1.5.2.2. Signs are testicular enlargement, pain, and enlarges breasts
1.1.5.3. Prostate
1.1.5.3.1. Increased incidence with older age
1.1.5.3.2. A symptomatic until later disease progression
1.1.5.3.3. Signs are benign hypertrophy, back pain, anemia, and weakness
1.1.5.3.4. Diagnose with DRE, confirm with PSA test and biopsy
1.1.5.3.5. Treat by monitoring BPH and use estrogen
1.2. Male
1.2.1. Changes in seminal vessels
1.2.1.1. Smoothing of the mucosa
1.2.1.2. Thinning of the epithelium
1.2.1.3. Replacement of muscle tissue with connective tissue
1.2.1.4. Reduction of fluid-retaining capacity
1.2.2. Reduced sperm count
1.2.2.1. Result of structural changes
1.2.3. Venous & arterial sclerosis and fibroelastosis of the corpus spongiosum can affect the penis
1.2.4. Prostate enlarges
1.2.4.1. 3/4 of men over 65 have some degree of prostatism
1.2.4.1.1. Causes problems with urinary frequency
1.2.4.2. Most are benign but it does pose a greater risk for malignancy
1.2.4.2.1. Need regular evaluation
1.2.5. Changes in seminiferous tubules
1.2.5.1. Increased fibrosis
1.2.5.2. Thinning of the epithelium
1.2.5.3. Thickening of the basement membrane
1.2.5.4. Narrowing of the lumen
1.2.6. Increase in FSH and LH levels
1.2.7. Decrease in serum and bioavailable testosterone levels
1.2.8. Don't fully loose the ability to achieve erection or ejaculation
1.2.8.1. These do become less intense with age
1.2.8.2. More time required to achieve an erection
1.2.8.3. Ejaculation fluid contains less live sperm
1.2.9. Decreased capacity to retain fluids
1.2.10. Testosterone levels stay the same or decrease slightly
1.3. Females
1.3.1. Fallopian tubes atrophy and shorten
1.3.1.1. Become more straight
1.3.2. Ovaries atrophy, thicken and become smaller
1.3.2.1. Can shrink to the point that they aren't palpable during an exam
1.3.3. Cervix atrophies and becomes smaller
1.3.3.1. Endocervical epithelium also atrophies
1.3.4. Stier, less elastic vagina canal
1.3.5. Uterus becomes smaller and shrink
1.3.5.1. Ligaments supporting the uterus weaken and cause backward tilting of the uterus
1.3.5.1.1. These two things combined make it difficult to palate the uterus during an exam
1.3.6. Endometrium atrophies
1.3.6.1. Continues to respond to hormonal stimulation
1.3.6.1.1. Can be responsible for incidents of postmenopausal bleeding in older women on estrogen therapy
1.3.7. Atrophy of the vulva
1.3.7.1. From hormonal changes
1.3.7.2. Accompanied by the loss of subcutaneous fat and hair and flattening of the labia
1.3.8. Vagina changes
1.3.8.1. Pink and dry with smooth shinny canal
1.3.8.1.1. Due to loss of elasticity and rugae
1.3.8.2. Vaginal epithelium thin and avascular
1.3.8.3. Vaginal environment more alkaline
1.3.8.3.1. Accompanied by change in type of flora and a reduction in secretions
1.3.8.3.2. Result of lower estrogen changes
1.3.9. Breast sag and are less firm
1.3.9.1. Some retraction of nipples related to shrinkage and fibrotic changes
1.4. Prevalent conditions in women
1.4.1. Infections of the vulva
1.4.1.1. Vulva becomes more fragile and more susceptible to irritation and infection
1.4.1.2. Senile vulvitis
1.4.1.2.1. Hypertrophy or atrophy
1.4.1.2.2. Incontinence and poor hygiene lead to it
1.4.1.2.3. #1 sign is pruritus
1.4.1.2.4. Treat the underlying cause, Sitt baths, steroid creams, good nutrition
1.4.2. Tumors of the vulva
1.4.2.1. Gynecological malignancy
1.4.2.2. Large painful foul-smelling ulcerative tumor
1.4.2.3. The clitoris is the number one site for this
1.4.2.4. Treat with radical vulvectomy or radiation
1.4.3. Atrophic vaginitis
1.4.3.1. In postmenopausal women
1.4.3.2. Increase vaginal fragility which increases risk of irritation
1.4.3.3. Signs are itching, foul-smelling, discharge
1.4.3.4. Treat with topical estrogen creams and estrogen replacement therapy
1.4.4. Problems of the cervix
1.4.4.1. Endocervical glands seal over leading to form nabothiancysis
1.4.4.1.1. Secretions can increase and a palpable tender mass is present
1.4.4.2. Smaller cervix, endocervical epithelium atrophies
1.4.5. Perineal herniation
1.4.5.1. Stretch/ tear muscles during birth
1.4.5.2. Signs are lower back pain, pelvic heaviness, pulling sensation, and incontinence
1.4.5.3. Treat with surgery
1.4.5.4. Makes sex very painful and uncomfortable
1.4.6. Dyspareunia
1.4.6.1. Accompanies hormonal changes
1.4.6.2. Increases in nullparus women
1.4.6.3. Not a normal part of aging
1.4.7. Cancers
1.4.7.1. Vagina
1.4.7.1.1. Decreased risk in older adults
1.4.7.2. Cervix
1.4.7.3. Endometrium
1.4.7.3.1. Most common in increased age
1.4.7.3.2. Number one sign in postmenopausal bleeding
1.4.7.4. Ovarian
1.4.7.4.1. Increases with age
1.4.7.5. Breast
1.4.7.5.1. Need yearly mammogram at 40
2. Respiratory
2.1. PO2 reduced
2.1.1. 15% between ages 20-80
2.2. Loss of elasticity & increased rigidity
2.3. Decreased ciliary action and numbers
2.3.1. Hypertrophy of bronchial mucous gland
2.3.1.1. These complicate the ability to expel mucus and debris
2.4. Forced exploratory volume reduced
2.5. Blunting cough & laryngeal reflexes
2.6. Increased residual capacity
2.6.1. 50% increase by age 90
2.7. Alveoli change
2.7.1. Fewer in number
2.7.2. Larger in size
2.7.2.1. Stretch due to progressive loss of elasticity
2.7.2.1.1. Begins by the sixth decade of life
2.8. Thoracic muscles more rigid
2.9. Reduced basilar inflation
2.10. Mouth breathing during sleep is more common
2.10.1. Contributing to snoring and obstructive apnea
2.11. Submucosal glands have decreased secretions
2.11.1. Reducing ability to dilute mucus secretions
2.11.1.1. More difficult to remove and give sensation of nasal stiffness
2.12. Calcification of costal cartilage
2.12.1. Makes trachea and rib cage more rigid
2.13. AP chest diameter increases d
2.13.1. Demonstrated by kyphosis
2.14. Thoracic inspirations and exploratory muscles are weaker
2.15. Lungs become smaller, less firm, lighter, and more rigid and have less recoil
2.16. Less lung expansion, insufficient basilar infiltration, and decreased ability to expel foreign or accumulated matter
2.17. Lungs exhale less effectively
2.17.1. Increasing residual volume
2.17.2. Vital capacity decreased
2.17.3. Maximum breathing capacity decreases
2.18. Lower pulmonary reserve
2.18.1. Results in dyspnea
2.19. Less effective gas exchange and lack of basilar infiltration
2.19.1. Results in higher risk for developing respiratory infections like pneumonia
2.20. Prevalent conditions
2.20.1. Asthma
2.20.1.1. High risk for complications of bronchiectasis and cardiac problems
2.20.1.2. High rates of mortality
2.20.1.3. Assess for causative factors and educate patient
2.20.2. Chronic bronchitis
2.20.2.1. Causes persistent productive cough, wheezing, recurrent respiratory infections, SOB
2.20.2.2. Manage it by removing bronchial secretions, prevent obstruction of airway, and maintaining adequate fluid intake
2.20.3. Emphysema
2.20.3.1. From chronic bronchitis, chronic irritation, and morphological changes in the lung
2.20.3.2. Smoking has a major role in its development
2.20.3.3. Symptoms develop slowly, delaying diagnosis and treatment
2.20.3.4. Treatment is postural drainage, bronchodilators, avoid stress, and breathing exercises
2.20.4. Lung cancer
2.20.4.1. Increase incidence in >65
2.20.4.2. Symptoms include dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections
2.20.4.3. Treat with surgery, chemo, and radiotherapy
2.20.5. Lung abscess
2.20.5.1. Causes are pneumonia, TB, malignancy, trauma, and aspiration
2.20.5.2. Symptoms include anorexia, weight loss, increased temp, and chronic cough
2.20.5.3. Treatment is postural drainage, and a high protein, high calorie diet
3. Urinary
3.1. Decreased size of renal mass
3.1.1. Contributes to cortical loss rather than a loss of the renal medulla
3.2. Decreased tubular function
3.2.1. Less efficient tubular exchange of substances, conservation of water and sodium, and suppression of ADH secretion in hypo-osmolarity
3.2.1.1. Less ability to conserve sodium in response to sodium restriction
3.2.1.1.1. Can contribute to hyponatremia and nocturnal
3.2.1.1.2. Have no affect on specific gravity
3.2.2. Causes decreased reabsorption of glucose from the filtrate
3.2.2.1. Can cause 1+ proteinurias and glycosurias
3.3. Decrease in nephrons
3.4. Renal blood flow decreased
3.4.1. By 53% between ages 20-90
3.5. Glomerular filtration rate decreases
3.5.1. By 50% between ages 20-90
3.6. Renal tissue growth declines
3.6.1. Atherosclerosis may promote atrophy of thenkidneysn
3.7. Bladder changes
3.7.1. Urinary frequency
3.7.2. Urgency
3.7.3. Nocturia
3.7.4. More difficult to empty bladder
3.7.4.1. Retention of large volumes of urine may result
3.7.5. Weaker bladder muscles
3.7.6. Decrease bladder capacity
3.8. Delayed micturition reflex
3.9. Urinary incontinence is not a part of normal aging
3.9.1. Although stress incontinence may occur from weak pelvic diaphragm
3.9.1.1. Common in multiparous women
3.10. Prevalent conditions
3.10.1. Bladder cancer
3.10.1.1. Increase indecency with age >55 and in men
3.10.1.2. Chronic bladder irritation, exposure to dyes, smoking
3.10.1.3. Signs include frequency, urgency, dysuria, and most commonly hematuria
3.10.1.4. Assess for metastasis
3.10.1.4.1. Pain back and pelvic pain
3.10.2. Renal calculus
3.10.2.1. Due to immobility, infection, pH change, urine concentration, chronic diarrhea, dehydration, and hypercalcemia
3.10.2.2. Signs include pain hematuria and UTI signs
3.10.2.3. Treat with increased fluids UTI treatment, and prevent urinary stasis
3.10.3. Glomerulonephritis
3.10.3.1. Chronic condition
3.10.3.2. Subtle, nonspecific signs
3.10.3.3. Signs include fever, fatigue, nausea, vomiting, anorexia, pain, anemia, edema, increased BP, oliguria, and hematuria
3.10.3.4. Treat with antibiotics, decreased protein and sodium diet
4. Neurological
4.1. Decreases brain weight
4.1.1. Doesn't affect thinking and behavior
4.2. Reduced blood flow to brain
4.2.1. Doesn't affect thinking and behavior
4.3. Changes in sleep pattern
4.3.1. Circadian and homeostatic Factors of sleep regulation are altered
4.3.2. Less time in stages III and IV and more in stages I and II
4.3.3. Frequent awakening during sleep
4.3.4. Common sleep disorders
4.3.4.1. Insomnia
4.3.4.1.1. Difficulty falling or staying asleep
4.3.4.1.2. Prematurely waking
4.3.4.1.3. Short-term causes
4.3.4.1.4. Chronic causes (>3 weeks)
4.3.4.2. Leg movements
4.3.4.2.1. Nocturnal myoclonus
4.3.4.2.2. Restless leg syndrome
4.3.4.3. Sleep apnea
4.3.4.3.1. Five episodes of cessation of breathing lasting 10 seconds
4.3.4.3.2. Can cause disorder in CNS affecting diaphragm
4.4. Slower response and reaction time
4.4.1. Due to lower nerve conduction velocity
4.4.2. Slower response to changes in balance
4.4.2.1. A factor contributing to falls
4.4.3. Associated with a decrease in new axon growth and nerve rein-nervation of injured peripheral nerves
4.5. Decline in nervous system function may go unnoticed due to the slow progression and no specific nature
4.6. Reduction in neurons, nerve fibers, cerebral blood flow, and metabolism
4.6.1. Reduced cerebral blood flow is accompanied by a reduction in glucose utilization and metabolic rate of oxygen in the brain
4.7. Presence of B-amyloid and neurofibrillary tangles
4.7.1. Although these can also be seen in Alzheimer's patients
4.8. Kinesthetic senses lessen
4.9. Hypothalamus regulates temperature less effectively
4.10. Prevalent conditions
4.10.1. Dementia
4.10.1.1. Irreversible and progressive
4.10.1.2. Impairment in cognitive function affects memory, orientation, reasoning, attention, language, and problem solving
4.10.1.3. Caused by damage to the brain
4.10.1.3.1. Alzheimer's
4.10.1.3.2. Others such as decreased oxygen, infection, trauma, hydrocephalus, tumor, alcohol, or circulatory problem
4.10.1.4. Slow onset
4.10.1.5. Level of consciousness is normal and alert
4.10.2. Delirium
4.10.2.1. Acute confusion that is reversible
4.10.2.2. Rapid onset
4.10.2.3. Disrupted brain function from medication side effects, circulatory disturbances, dehydration, BP change, and blood glucose level changes
4.10.2.4. Level of consciousness is changes
4.10.2.4.1. Highly agitated or very dull
4.10.2.5. Short term memory loss, suspicious behavior, hallucinations, illusions, and exaggerated personality
4.10.3. Top causes of delirium: UTI, pneumonia, fluid and electrolyte imbalance (dehydration)
5. Endocrine
5.1. Fibrosis, cellular infiltration, and increased modularity of thyroid gland
5.1.1. Decreased thyroid gland activity
5.1.1.1. Lower basically metabolic rate
5.1.1.2. Reduced radioactive iodine uptake
5.1.1.3. Less thyrotropin secretion and release
5.2. Total serum iodine reduced
5.2.1. 17-ketosteroids declines
5.3. Thyroid gland progressively atrophies
5.3.1. Loss of adrenal function
5.3.1.1. Decreases thyroid activity
5.4. Reduced T3 levels
5.4.1. From reduced conversion of T4 to T3
5.5. ACTH secretion decreases
5.5.1. Secretory activity of the adrenal gland decreases
5.5.2. Decreases aldosterone produced and excreted in the urine
5.6. Pituitary gland decreases in volume by 20%
5.7. Decreased levels of ACTH, TSH, FSH, luteinizing hormone, and luteotropic hormone
5.8. Gonadal secretions decrease
5.8.1. Decreases in testosterone, estrogen, and progesterone
5.9. Delayed and insufficient release of insulin by beta cells of the pancreas
5.9.1. Decreases tissue sensitivity to circulating insulin
5.10. Decreased ability to metabolize glucose
5.10.1. Sudden concentrations of glucose cause higher and prolonged hyperglycemia levels
5.10.1.1. Higher blood glucose levels in non-diabetic older adults
5.11. Prevalent conditions
5.11.1. Diabetes Mellitus
5.11.1.1. No glucose tolerance or glucose intolerance
5.11.1.2. Screening with FBS eve very 3 years for people over 45
5.11.1.3. Diagnose with FBS >126, random blood glucose concentration >200
5.11.1.4. Need education on diet, exercise and monitoring
5.11.2. Hypothyroidism
5.11.2.1. Effects of aging on the thyroid gland
5.11.2.2. Subnormal concentration of thyroid hormone
5.11.3. Hyperthyroidism
5.11.3.1. Secretion of excess amounts of thyroid hormone
6. Musculoskeletal
6.1. Shortening vertebrae
6.1.1. Due to thinning disks
6.2. Slight kyphosis
6.2.1. Backward tilting of the head and some flexion at the hips and knees
6.2.2. Contributes to shorter height
6.3. Limited joint activity and motion
6.3.1. Hip, wrist and knee especially
6.3.2. Due to deterioration of the cartilage surface of joints and the formation of points and spurs
6.3.3. Causes slight flexion of joints
6.4. Impaired flexion and extension movements
6.5. Decreased bone mass and mineral
6.5.1. Contributing to brittleness of the bones
6.5.1.1. Especially in older women who have an accelerated rate of bone loss after menopause
6.6. Bone density decreases
6.6.1. At a rate of 0.5% each year after third decade
6.7. Height decrease
6.7.1. Between ages 20-70
6.7.2. Approximately 2 inches
6.8. Muscle fibers atrophy and decrease in number
6.8.1. With fibrous tissue gradually replacing muscle tissue
6.9. Muscle mass, strength, and movements are decreased
6.9.1. Arm and leg muscles that become flabby and weak show these changes
6.9.2. AKA sarcopenia
6.9.2.1. Seen mostly in inactive people
6.9.3. Exercise will help prevent this loss in older adults
6.10. Muscle tremors possibly present
6.10.1. Associated with degeneration of the extrapyramidal system
6.11. Tendons shrink and harden
6.11.1. Causes a decrease in tendon jerks
6.12. Reflexes are lessened in the arms and nearly totally lost in the abdomen
6.12.1. Reflexes maintained in the knee
6.13. High risk for fractures
6.13.1. Diminished calcium absorption
6.13.2. Gradual resorption of the interior surface of the long bones
6.13.3. Slower production of new bone on the outside surface
6.14. Prevalent conditions
6.14.1. Osteoarthritis
6.14.1.1. Progressive deterioration of joint cartilage with the formation of new bone at joint surface
6.14.1.2. No inflammation or deformities
6.14.1.3. Affects several joints
6.14.1.4. From wear and tear, obesity, genetics, and decreased vitamin D and C
6.14.1.5. No systemic symptoms
6.14.1.6. Treat with analgesics and arthroplasty
6.14.2. Rheumatoid arthritis
6.14.2.1. Deformities and disability begin at an early age, peak during middle age, and increase systemic involvement in older age
6.14.2.2. Red, swollen, warm, stiff, and painful
6.14.2.3. Systemic signs
6.14.2.3.1. Weak, decreased weight, fever, anemia, and wasting
6.14.2.4. Take anti inflammatory meds like prostaglandins
6.14.3. Osteoporosis
6.14.3.1. Most prevalent metabolic disease of the bone
6.14.3.2. Risk factors
6.14.3.2.1. Inactivity, disease, reduction in anabolic sex hormone, diet, and drugs
6.14.3.3. Causes kyphosis, spinal pain, and increased risk for fractures
6.14.3.4. Asymptomatic often
6.14.3.5. Treat with calcium and vitaminD supplements, progesterone, estrogen, anabolic agents, or phosphate
6.14.3.6. Diagnosis with bone density test
6.14.4. Frailty
6.14.4.1. Impaired capacity to withstand intrinsic and environmental stressors
6.14.4.2. Limited capacity to maintain physiological and psychological homeostasis
6.14.4.3. Found in20-30% of elderly >75
6.14.4.4. Behavioral adaptation made in response to declining physiologic reserve and capacity with which to meet environmental challenges
6.14.4.5. Causes are multifactorial
6.14.4.5.1. Environmental challenges
6.14.4.5.2. Intraindividual challenges
6.14.4.6. Signs include weakness, weight loss,muscle wasting, exercise intolerance, decrease group strength, frequent falls, immobility, and instability of chronic disease
6.14.4.7. Possible causes
6.14.4.7.1. Hormonal dysregulation, immune-aging, pro-coagulation, pro-inflammatory status
6.14.4.8. Failure to thrive
6.14.4.8.1. Mean age 79
6.14.4.8.2. Average of 6 diagnosis
6.14.4.8.3. Symptoms similar to clinical syndrome
6.14.4.8.4. Malnourished, dehydrated, skin ulcers, falls, cognitive
7. Immune
7.1. Immunosenescence
7.1.1. Depressed immune response
7.1.1.1. Can cause infections to be significant risk
7.2. Thymine mass decreases steadily
7.2.1. To the point that serum activity of thymus hormones is almost undetectable
7.3. T-cell activity declines
7.3.1. More immature T cells are present in the thymus
7.4. Significant decline in cell-mediated immunity
7.4.1. T cells less able to proliferate in response to mitogens
7.5. Changes in the at cell contribute to reactivation of infections
7.5.1. Varicella zoster
7.5.2. Mycobacterium tuberculosis
7.6. IgM concentration decreases
7.7. Less effective response to influenza, parainfluenza, pneumococcus, and tetanus vaccines
7.7.1. Although vaccinations are still recommended
7.8. Inflammatory defense decline
7.8.1. Inflammation presents atypically
7.8.1.1. Low grade fever
7.8.1.2. Minimal pain
7.9. Increase in pro-inflammatory cytokines
7.9.1. Linked to atherosclerosis, diabetes, osteoporosis, and other diseases that increase with age
7.10. IgA and IgG concentration are increased
7.11. Prevalent conditions
7.11.1. UTI
7.11.1.1. Most common infection of older adults
7.11.1.2. Asymptomatic bacteriuria
7.11.1.3. Urosepsis
7.11.2. Pneumonia
7.11.2.1. One of he leading causes of death in older adults
7.11.2.2. Need to have close observation for subtle changes
7.11.2.3. Pneumococcal vaccine
7.11.3. Influenza
7.11.3.1. Serious infection in older adults
7.11.3.2. Two types: A and B
7.11.3.3. Age related changes leading to high susceptibility
7.11.3.4. Secondary bacterial infections and other complications increase the risk of death
7.11.3.5. Prevention measures are annual influenza vaccination
7.11.4. TB
7.11.4.1. Reactivation of a previous infection
7.11.4.2. Potential for delayed diagnosis
7.11.4.3. Screening is a two step Mantoux test
7.11.4.4. Treatment includes rest, good nutrition, meds
8. Cardiovascular
8.1. More prominent arteries
8.1.1. Head
8.1.2. Neck
8.1.3. Extremities
8.2. Valves become thicker more rigid
8.2.1. Result from sclerosis and fibrosis
8.3. Stroke volume decreases
8.3.1. 1% per year
8.4. Heart pigmented with lipofuscin granules
8.5. Less efficient O2 utilization
8.6. Aorta dilated and elongated
8.7. Cardiac output decreased
8.8. Resistance to peripheral blood flow increases
8.8.1. 1% per year
8.9. BP increases
8.9.1. Compensates for increased peripheral resistance and decreased cardiac output
8.10. Decreased elasticity of arteries
8.10.1. Responsible for vascular changes to the heart, kidney, and pituitary gland
8.11. Slight left ventricular hypertrophy
8.12. Heart muscle losses it's efficiency and contractile strength
8.12.1. Resulting in reduced cardiac output
8.13. Pacemaker cells increasingly irregular and decreased in number
8.13.1. She'll surround sinus ode thickens
8.14. Isometric contraction phase and relaxation time of ventricles is prolonged
8.14.1. Cycle of filling and emptying takes more time to complete
8.15. Changes are most apparent when unusual demands are placed on the heart
8.16. Tachycardia will last longer
8.16.1. Stroke volume may increase to compensate
8.16.1.1. Results in elevated BP
8.17. Tunica intima
8.17.1. Innermost layer with the most changes
8.17.2. Calcium and lipid accumulation
8.17.3. Fibrosis
8.17.4. Cellular proliferation
8.17.5. Contribute to development of atherosclerosis
8.18. Tunica media
8.18.1. Middle layer
8.18.2. Thinning and calcification of elastin fibers
8.18.3. Increase in collagen
8.18.3.1. Causes stiffening of vessels
8.18.4. Impaired baroreceptors function and increased peripheral resistance
8.18.4.1. Leads to a rise in systolic BP
8.19. Tunica adventitia
8.19.1. Outermost layer
8.19.2. Not affected by the aging process
8.20. Decreased elasticity of vessels, thinner skin, and less subcutaneous fat
8.20.1. Causes more prominent vessels
8.21. Reduced sensitivity of blood pressure-regulating baroreceptors
8.21.1. Increased risk for postural hypotension and postprandial hypotension
8.22. Prevalent conditions
8.22.1. CHF
8.22.1.1. Increase incidence with age
8.22.1.2. Complication of arteriosclerosis heart disease
8.22.1.3. Coronary artery disease responsible for most cases
8.22.1.4. Symptoms include SOB, dyspnea, confusion, insomnia, agitation, depression, Orthopnea, wheezing, weight gain, edema
8.22.2. CAD
8.22.2.1. Ischemic heart disease
8.22.2.2. Prevelance increases with age
8.22.2.3. Angina
8.22.2.3.1. Typical presentation includes coughing, syncope, sweating, and confusion
8.22.2.3.2. Nitroglycerin ismeffective
8.22.2.4. MI
8.22.2.4.1. Atypical presentation includes confusion, decreased BP, SOB, increased temp, and sedimentation rate
8.22.3. Arrhythmias
8.22.3.1. Causes are digitalis toxicity, hypokalemia, acute infection, hemorrhage, angina, syndrome, and coronary insufficiency
8.22.3.2. Sy,proms include weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, and syncope
8.22.3.3. Treat is antiarrhythmic drugs, digitalis, potassium supplements and cardioversion
8.22.3.4. Educate on modifying diet, stop smoking, increase activity, and decrease alcohol
9. Physical appearance
9.1. Gray/ thin hair
9.2. Ectropion of eyelids
9.3. Loss of tissue elasticity
9.3.1. Elongated ears
9.3.2. Double chin
9.3.3. Baggy eyelids
9.4. Arcus senilis
9.5. Decreased heights
9.5.1. 2 inches by 80 years of age
9.5.2. Due to reduced hydration, loss of cartilage, and thinning vertebrae
9.5.3. Curvature is the spine, hips, and knees can cause decreased height
9.6. Thicker ear and nose hair
9.7. Darkening/ wrinkling skin around orbits
9.8. Diminished muscle mass and skin fold thickness
9.8.1. Back of the hands and forearm
9.8.2. Responsible for a decline in body's natural insulation
9.8.2.1. More sensitive to cold temperatures
9.9. Most appear around the fourth decade of life
9.10. Body fat atrophies
9.10.1. Bony appearance
9.10.2. Deepening the hollows of intercostal and supraclavicular spaces
9.10.2.1. Orbits
9.10.2.2. Axillae
10. Gastrointestinal
10.1. Decreased taste sensation
10.1.1. Nerve chambers become narrow and shorter in teeth
10.1.2. Tongue atrophies
10.1.2.1. Affecting the taste buds
10.1.3. Chronic irritation
10.1.3.1. Such as smoking
10.1.4. Sweet sensations suffer the greatest loss
10.1.4.1. On the tip of the tongue
10.1.4.2. Excessive seasoning of foods is often done to compensate for this loss
10.1.4.2.1. This can lead to more health problems
10.2. Reduced saliva & salivary ptyalin
10.2.1. Increased in viscosity from certain meds to treat gastric conditions
10.2.2. Decreased salivary ptyalin interferes with the breakdown of starches
10.3. Liver smaller in size
10.3.1. Reduced weight and volume
10.3.2. Less able to regenerate damaged cells
10.3.3. Less efficient cholesterol stabilization and absorption
10.3.3.1. Results in an increased incidence of gallstones
10.3.4. Pancreatic ducts more dilated and distended
10.3.4.1. Often the entire glam prolapses
10.4. Reduced intestinal blood flow
10.5. Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes
10.5.1. Higher pH of the stomach contributes to an increased incidence of gastric irritation
10.6. Fewer cells of absorbing surface of intestine
10.6.1. Atrophy throughout the small and large intestines
10.6.1.1. Gradual reduction in weight of small intestine
10.6.1.2. Shortening and widening of villi
10.6.1.2.1. Causing them to develop in parallel ridges shape instead of finger-like projections
10.7. Slower peristalsis
10.8. Tooth enamel becomes harder and more brittle
10.8.1. Dentin becomes more fibrous and decreased in production
10.9. Bones supporting teeth decrease in density and height
10.9.1. Contributing to tooth loss
10.9.1.1. Tooth loss is not a normal consequence of older age
10.10. Periodontal disease
10.10.1. After 30 is the major cause of tooth loss
10.10.2. Teeth in port condition
10.10.2.1. Fracture easily
10.10.2.2. Have flatter surfaces and stains
10.10.2.3. Varying degrees of erosion and abrasion of the crown and root structure
10.11. Tooth brittleness could lead to aspiration of tooth fragments
10.12. Presbyesophagus occurs
10.12.1. Decreased intensity of propulsive waves and an increased frequency of non-propulsive waves in the esophagus
10.12.2. Decreased esophageal motility
10.13. Esophagus slightly dilated
10.13.1. Slower emptying
10.13.1.1. Causing discomfort due to food remaining in the esophagus for a longer time
10.14. Relaxation of the lower esophageal sphincter
10.14.1. Combine this with a weaker gag reflex and delayed esophageal emptying causes a risk for aspiration
10.15. Decreased stomach motility
10.15.1. Decreased hunger contractions
10.16. Absorption of vitamin B, B12, D, calcium, and iron is less effective
10.17. Large intestine has reduced mucous secretions and elasticity of the recital wall
10.17.1. Normal gaining doesn't interfere with the mobility of feces through the bowel
10.17.2. Loss of time of the internal sphincter can affect bowel elimination
10.18. Prevalent conditions
10.18.1. Dysphasia
10.18.1.1. Swallowing difficulties
10.18.1.2. Caused by GERD, stroke, structural disorders
10.18.1.3. Prevent aspiration and promote adequate nutritional status
10.18.2. Cancers
10.18.2.1. Esophageal
10.18.2.1.1. Cause is Barrers esophagus
10.18.2.2. Stomach
10.18.2.2.1. Adenocarcinomas
10.18.2.3. Colorectal
10.18.2.3.1. Along the large intestine sigmoid colon and rectum
10.18.2.4. Pancreatic
10.18.2.4.1. Difficult to detect
10.18.2.4.2. Diagnosed at an advanced stage
10.18.2.5. Gallbladder
10.18.2.5.1. Rare but poor prognosis
10.18.3. Cholelithiasis
10.18.3.1. Gallstones that increase with age and in women
10.18.3.2. Pain is the number one sign
10.18.3.3. Treat with shock treatment or surgery
11. Sensory
11.1. Sight
11.1.1. More opaque lens
11.1.2. Decreased pupil size and less reactive to light
11.1.3. More spherical cornea
11.1.4. Presbyopia
11.1.4.1. Inability to focus on close objects clearly
11.1.5. Narrowing of the visual field
11.1.5.1. Decreased peripheral vision
11.1.6. Depth perception distorted
11.1.7. Decline in visual acuity
11.1.8. Prevalent conditions
11.1.8.1. Cataracts
11.1.8.1.1. Clouding of the lens
11.1.8.1.2. Loss of transparency
11.1.8.1.3. Leading cause of low vision in older adults
11.1.8.1.4. Treatment includes possible surgery
11.1.8.2. Glaucome
11.1.8.2.1. Damage to the optic nerve from an above normal intraoculae pressure
11.1.8.2.2. Second leading cause of blindness in older adults
11.1.8.2.3. Acute (narrow angle or closed)
11.1.8.2.4. Chronic (open angle)
11.1.8.3. Macular degeneration
11.1.8.3.1. Most common cause of blindness in adults over 65
11.1.8.3.2. Damage or breakdown the macula leading to loss of central vision
11.1.8.4. Detached retina
11.1.8.4.1. Forward displacement of the retina
11.1.8.4.2. Promote treatment to prevent continued damage and eventual blindness
11.2. Smell
11.2.1. Impaired ability to identify and discriminate odors
11.3. Taste
11.3.1. High prevalence of taste impairment
11.3.1.1. Most likely due to factors other than aging
11.3.2. Taste acuity is dependent on smell
11.3.2.1. Sense of smell altered with age
11.3.3. Atrophy of the tongue
11.3.4. Decreased saliva, poor oral hygiene and medications all affect taste sensation
11.4. Touch
11.4.1. Reduction in tactile sensation
11.4.2. Reduced ability to sense pressure, discomfort, change in temperature
11.5. Hearing
11.5.1. Atrophy of hair cells in organ of Corti
11.5.2. Tympanic membrane sclerosis and atrophy
11.5.3. Alteration in equilibrium
11.5.4. Cerium increases which affects hearing
11.5.5. Prevalent conditions
11.5.5.1. Inner ear problems
11.5.5.1.1. Due to vascular disorders and viral infections
11.5.5.2. Presbycusis
11.5.5.2.1. Progressive loss of hearing with older age
11.5.5.3. Tinnitus
11.5.5.3.1. Raining in the ears
11.5.5.4. Otosclerosis
11.5.5.4.1. Hearing loss due to the ears inability to amplify sound
11.6. All senses are less proficient and have a decreased efficiency
11.6.1. This can affect well-being, ADL's, safety and health
12. Integumentary
12.1. Flattening of the dermal-epidermal junction
12.2. Reduced thickness and vascularity of dermis
12.3. Slowing of epidermal proliferation
12.4. Increased quantity and degeneration of elastin fibers
12.5. Collagen fibers become coarser and more random
12.5.1. Reduced skin elasticity, more dry and fragile
12.5.1.1. Lines, wrinkles, and sagging becomes evident
12.6. Dermis becomes more avascular and thinner
12.7. Skin becomes irritated and breaks down more easily
12.8. Reduced number of melanocytes
12.8.1. 10-20% each decade beginning in the third decade
12.8.2. Melanocytes cluster
12.8.2.1. Causes skin pigmentation
12.8.2.1.1. AKA age spots
12.8.2.2. More prevalent in areas of the body exposed to sun
12.8.3. Causes older adults to tan more slowly and less deeply
12.9. Skin immune response declines
12.9.1. More prone to skin infections
12.9.2. Benign and malignant skin neoplasms occur more often
12.10. Scalp, pubic, and axillary hair thins and grays
12.10.1. From progressive loss of pigment cells
12.10.2. From atrophy and fibrosis of hair bulbs
12.10.3. By 50 mout white men have some degree of baldness and half have gray hair
12.10.4. Growth rate of hair declines
12.10.5. Facial hair in women may occur
12.10.6. Increased eyebrow, ear, and nostril hair in men
12.11. Nose and ear hair becomes thicker
12.12. Fingernails grow more slowly
12.12.1. More fragile and brittle
12.12.2. Develop longitudinal stristions
12.12.3. Experience a decrease in lunula size
12.13. Perspiration is slightly reduced
12.13.1. Due to number and function of sweat glands are lessened
12.14. Prevalent conditions
12.14.1. Pruritus
12.14.1.1. Most common dermatological problem with older age
12.14.1.2. Potential for skin breakdown and infection
12.14.1.3. Prompt recognition
12.14.2. Keratosis
12.14.2.1. Referred to as actinic or solar keratosis
12.14.2.2. A rough scaly patch on the skin caused by years of sun exposure
12.14.2.3. Treated by removing patch to be cautious as some could be cancerous
12.14.3. Skin cancer
12.14.3.1. Basal cell carcinoma
12.14.3.2. Squamous cell carcinoma
12.14.3.2.1. Due to sun exposure and other factors that facilitate growth
12.14.3.3. Melanoma
12.14.3.3.1. Tends to be more easily metastasize
12.14.3.3.2. Rising incidence in the US
12.14.4. Vascular lesions
12.14.4.1. Age-related changes of weakened vein walls
12.14.4.1.1. Reduce ability of veins to respond to increased venous pressure
12.14.4.1.2. Obesity and hereditary factors compound problems
12.14.4.2. Patho
12.14.4.2.1. Varicose veins
12.14.4.2.2. Lower extremity edema
12.14.4.2.3. Pigmented appearance
13. Thermoregulation
13.1. Normal body temperatures are lower
13.1.1. Oral mean body temperature 96.9-98.3 degrees Fahrenheit
13.1.2. Rectal mean body temperature 98-99 degrees Fahrenheit
13.2. Rectal and auditory temperatures are most accurate and reliable
13.3. Reduced ability to respond to cold temperatures
13.3.1. Inefficient vasoconstriction
13.3.2. Decreased cardiac output
13.3.3. Diminished shivering
13.3.4. Reduced muscle mass and subcutaneous tissue
13.3.5. Impaired sweating mechanisms
13.3.6. Decreases cardiac output
13.4. Maintaining adequate environmental temperature is significant
13.4.1. Room temperature should be 75 degrees
13.4.1.1. If it is lower than that, there is risk for hypothermia