1. Respiratory
1.1. PO2 reduced
1.1.1. 15% between ages 20-80
1.2. Loss of elasticity & increased rigidity
1.3. Decreased ciliary action and numbers
1.3.1. Hypertrophy of bronchial mucous gland
1.3.1.1. These complicate the ability to expel mucus and debris
1.4. Forced exploratory volume reduced
1.5. Blunting cough & laryngeal reflexes
1.6. Increased residual capacity
1.6.1. 50% increase by age 90
1.7. Alveoli change
1.7.1. Fewer in number
1.7.2. Larger in size
1.7.2.1. Stretch due to progressive loss of elasticity
1.7.2.1.1. Begins by the sixth decade of life
1.8. Thoracic muscles more rigid
1.9. Reduced basilar inflation
1.10. Mouth breathing during sleep is more common
1.10.1. Contributing to snoring and obstructive apnea
1.11. Submucosal glands have decreased secretions
1.11.1. Reducing ability to dilute mucus secretions
1.11.1.1. More difficult to remove and give sensation of nasal stiffness
1.12. Calcification of costal cartilage
1.12.1. Makes trachea and rib cage more rigid
1.13. AP chest diameter increases d
1.13.1. Demonstrated by kyphosis
1.14. Thoracic inspirations and exploratory muscles are weaker
1.15. Lungs become smaller, less firm, lighter, and more rigid and have less recoil
1.16. Less lung expansion, insufficient basilar infiltration, and decreased ability to expel foreign or accumulated matter
1.17. Lungs exhale less effectively
1.17.1. Increasing residual volume
1.17.2. Vital capacity decreased
1.17.3. Maximum breathing capacity decreases
1.18. Lower pulmonary reserve
1.18.1. Results in dyspnea
1.19. Less effective gas exchange and lack of basilar infiltration
1.19.1. Results in higher risk for developing respiratory infections like pneumonia
1.20. Prevalent conditions
1.20.1. Asthma
1.20.1.1. High risk for complications of bronchiectasis and cardiac problems
1.20.1.2. High rates of mortality
1.20.1.3. Assess for causative factors and educate patient
1.20.2. Chronic bronchitis
1.20.2.1. Causes persistent productive cough, wheezing, recurrent respiratory infections, SOB
1.20.2.2. Manage it by removing bronchial secretions, prevent obstruction of airway, and maintaining adequate fluid intake
1.20.3. Emphysema
1.20.3.1. From chronic bronchitis, chronic irritation, and morphological changes in the lung
1.20.3.2. Smoking has a major role in its development
1.20.3.3. Symptoms develop slowly, delaying diagnosis and treatment
1.20.3.4. Treatment is postural drainage, bronchodilators, avoid stress, and breathing exercises
1.20.4. Lung cancer
1.20.4.1. Increase incidence in >65
1.20.4.2. Symptoms include dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections
1.20.4.3. Treat with surgery, chemo, and radiotherapy
1.20.5. Lung abscess
1.20.5.1. Causes are pneumonia, TB, malignancy, trauma, and aspiration
1.20.5.2. Symptoms include anorexia, weight loss, increased temp, and chronic cough
1.20.5.3. Treatment is postural drainage, and a high protein, high calorie diet
2. Urinary
2.1. Decreased size of renal mass
2.1.1. Contributes to cortical loss rather than a loss of the renal medulla
2.2. Decreased tubular function
2.2.1. Less efficient tubular exchange of substances, conservation of water and sodium, and suppression of ADH secretion in hypo-osmolarity
2.2.1.1. Less ability to conserve sodium in response to sodium restriction
2.2.1.1.1. Can contribute to hyponatremia and nocturnal
2.2.1.1.2. Have no affect on specific gravity
2.2.2. Causes decreased reabsorption of glucose from the filtrate
2.2.2.1. Can cause 1+ proteinurias and glycosurias
2.3. Decrease in nephrons
2.4. Renal blood flow decreased
2.4.1. By 53% between ages 20-90
2.5. Glomerular filtration rate decreases
2.5.1. By 50% between ages 20-90
2.6. Renal tissue growth declines
2.6.1. Atherosclerosis may promote atrophy of thenkidneysn
2.7. Bladder changes
2.7.1. Urinary frequency
2.7.2. Urgency
2.7.3. Nocturia
2.7.4. More difficult to empty bladder
2.7.4.1. Retention of large volumes of urine may result
2.7.5. Weaker bladder muscles
2.7.6. Decrease bladder capacity
2.8. Delayed micturition reflex
2.9. Urinary incontinence is not a part of normal aging
2.9.1. Although stress incontinence may occur from weak pelvic diaphragm
2.9.1.1. Common in multiparous women
2.10. Prevalent conditions
2.10.1. Bladder cancer
2.10.1.1. Increase indecency with age >55 and in men
2.10.1.2. Chronic bladder irritation, exposure to dyes, smoking
2.10.1.3. Signs include frequency, urgency, dysuria, and most commonly hematuria
2.10.1.4. Assess for metastasis
2.10.1.4.1. Pain back and pelvic pain
2.10.2. Renal calculus
2.10.2.1. Due to immobility, infection, pH change, urine concentration, chronic diarrhea, dehydration, and hypercalcemia
2.10.2.2. Signs include pain hematuria and UTI signs
2.10.2.3. Treat with increased fluids UTI treatment, and prevent urinary stasis
2.10.3. Glomerulonephritis
2.10.3.1. Chronic condition
2.10.3.2. Subtle, nonspecific signs
2.10.3.3. Signs include fever, fatigue, nausea, vomiting, anorexia, pain, anemia, edema, increased BP, oliguria, and hematuria
2.10.3.4. Treat with antibiotics, decreased protein and sodium diet
3. Neurological
3.1. Decreases brain weight
3.1.1. Doesn't affect thinking and behavior
3.2. Reduced blood flow to brain
3.2.1. Doesn't affect thinking and behavior
3.3. Changes in sleep pattern
3.3.1. Circadian and homeostatic Factors of sleep regulation are altered
3.3.2. Less time in stages III and IV and more in stages I and II
3.3.3. Frequent awakening during sleep
3.3.4. Common sleep disorders
3.3.4.1. Insomnia
3.3.4.1.1. Difficulty falling or staying asleep
3.3.4.1.2. Prematurely waking
3.3.4.1.3. Short-term causes
3.3.4.1.4. Chronic causes (>3 weeks)
3.3.4.2. Leg movements
3.3.4.2.1. Nocturnal myoclonus
3.3.4.2.2. Restless leg syndrome
3.3.4.3. Sleep apnea
3.3.4.3.1. Five episodes of cessation of breathing lasting 10 seconds
3.3.4.3.2. Can cause disorder in CNS affecting diaphragm
3.4. Slower response and reaction time
3.4.1. Due to lower nerve conduction velocity
3.4.2. Slower response to changes in balance
3.4.2.1. A factor contributing to falls
3.4.3. Associated with a decrease in new axon growth and nerve rein-nervation of injured peripheral nerves
3.5. Decline in nervous system function may go unnoticed due to the slow progression and no specific nature
3.6. Reduction in neurons, nerve fibers, cerebral blood flow, and metabolism
3.6.1. Reduced cerebral blood flow is accompanied by a reduction in glucose utilization and metabolic rate of oxygen in the brain
3.7. Presence of B-amyloid and neurofibrillary tangles
3.7.1. Although these can also be seen in Alzheimer's patients
3.8. Kinesthetic senses lessen
3.9. Hypothalamus regulates temperature less effectively
3.10. Prevalent conditions
3.10.1. Dementia
3.10.1.1. Irreversible and progressive
3.10.1.2. Impairment in cognitive function affects memory, orientation, reasoning, attention, language, and problem solving
3.10.1.3. Caused by damage to the brain
3.10.1.3.1. Alzheimer's
3.10.1.3.2. Others such as decreased oxygen, infection, trauma, hydrocephalus, tumor, alcohol, or circulatory problem
3.10.1.4. Slow onset
3.10.1.5. Level of consciousness is normal and alert
3.10.2. Delirium
3.10.2.1. Acute confusion that is reversible
3.10.2.2. Rapid onset
3.10.2.3. Disrupted brain function from medication side effects, circulatory disturbances, dehydration, BP change, and blood glucose level changes
3.10.2.4. Level of consciousness is changes
3.10.2.4.1. Highly agitated or very dull
3.10.2.5. Short term memory loss, suspicious behavior, hallucinations, illusions, and exaggerated personality
3.10.3. Top causes of delirium: UTI, pneumonia, fluid and electrolyte imbalance (dehydration)
4. Endocrine
4.1. Fibrosis, cellular infiltration, and increased modularity of thyroid gland
4.1.1. Decreased thyroid gland activity
4.1.1.1. Lower basically metabolic rate
4.1.1.2. Reduced radioactive iodine uptake
4.1.1.3. Less thyrotropin secretion and release
4.2. Total serum iodine reduced
4.2.1. 17-ketosteroids declines
4.3. Thyroid gland progressively atrophies
4.3.1. Loss of adrenal function
4.3.1.1. Decreases thyroid activity
4.4. Reduced T3 levels
4.4.1. From reduced conversion of T4 to T3
4.5. ACTH secretion decreases
4.5.1. Secretory activity of the adrenal gland decreases
4.5.2. Decreases aldosterone produced and excreted in the urine
4.6. Pituitary gland decreases in volume by 20%
4.7. Decreased levels of ACTH, TSH, FSH, luteinizing hormone, and luteotropic hormone
4.8. Gonadal secretions decrease
4.8.1. Decreases in testosterone, estrogen, and progesterone
4.9. Delayed and insufficient release of insulin by beta cells of the pancreas
4.9.1. Decreases tissue sensitivity to circulating insulin
4.10. Decreased ability to metabolize glucose
4.10.1. Sudden concentrations of glucose cause higher and prolonged hyperglycemia levels
4.10.1.1. Higher blood glucose levels in non-diabetic older adults
4.11. Prevalent conditions
4.11.1. Diabetes Mellitus
4.11.1.1. No glucose tolerance or glucose intolerance
4.11.1.2. Screening with FBS eve very 3 years for people over 45
4.11.1.3. Diagnose with FBS >126, random blood glucose concentration >200
4.11.1.4. Need education on diet, exercise and monitoring
4.11.2. Hypothyroidism
4.11.2.1. Effects of aging on the thyroid gland
4.11.2.2. Subnormal concentration of thyroid hormone
4.11.3. Hyperthyroidism
4.11.3.1. Secretion of excess amounts of thyroid hormone
5. Musculoskeletal
5.1. Shortening vertebrae
5.1.1. Due to thinning disks
5.2. Slight kyphosis
5.2.1. Backward tilting of the head and some flexion at the hips and knees
5.2.2. Contributes to shorter height
5.3. Limited joint activity and motion
5.3.1. Hip, wrist and knee especially
5.3.2. Due to deterioration of the cartilage surface of joints and the formation of points and spurs
5.3.3. Causes slight flexion of joints
5.4. Impaired flexion and extension movements
5.5. Decreased bone mass and mineral
5.5.1. Contributing to brittleness of the bones
5.5.1.1. Especially in older women who have an accelerated rate of bone loss after menopause
5.6. Bone density decreases
5.6.1. At a rate of 0.5% each year after third decade
5.7. Height decrease
5.7.1. Between ages 20-70
5.7.2. Approximately 2 inches
5.8. Muscle fibers atrophy and decrease in number
5.8.1. With fibrous tissue gradually replacing muscle tissue
5.9. Muscle mass, strength, and movements are decreased
5.9.1. Arm and leg muscles that become flabby and weak show these changes
5.9.2. AKA sarcopenia
5.9.2.1. Seen mostly in inactive people
5.9.3. Exercise will help prevent this loss in older adults
5.10. Muscle tremors possibly present
5.10.1. Associated with degeneration of the extrapyramidal system
5.11. Tendons shrink and harden
5.11.1. Causes a decrease in tendon jerks
5.12. Reflexes are lessened in the arms and nearly totally lost in the abdomen
5.12.1. Reflexes maintained in the knee
5.13. High risk for fractures
5.13.1. Diminished calcium absorption
5.13.2. Gradual resorption of the interior surface of the long bones
5.13.3. Slower production of new bone on the outside surface
5.14. Prevalent conditions
5.14.1. Osteoarthritis
5.14.1.1. Progressive deterioration of joint cartilage with the formation of new bone at joint surface
5.14.1.2. No inflammation or deformities
5.14.1.3. Affects several joints
5.14.1.4. From wear and tear, obesity, genetics, and decreased vitamin D and C
5.14.1.5. No systemic symptoms
5.14.1.6. Treat with analgesics and arthroplasty
5.14.2. Rheumatoid arthritis
5.14.2.1. Deformities and disability begin at an early age, peak during middle age, and increase systemic involvement in older age
5.14.2.2. Red, swollen, warm, stiff, and painful
5.14.2.3. Systemic signs
5.14.2.3.1. Weak, decreased weight, fever, anemia, and wasting
5.14.2.4. Take anti inflammatory meds like prostaglandins
5.14.3. Osteoporosis
5.14.3.1. Most prevalent metabolic disease of the bone
5.14.3.2. Risk factors
5.14.3.2.1. Inactivity, disease, reduction in anabolic sex hormone, diet, and drugs
5.14.3.3. Causes kyphosis, spinal pain, and increased risk for fractures
5.14.3.4. Asymptomatic often
5.14.3.5. Treat with calcium and vitaminD supplements, progesterone, estrogen, anabolic agents, or phosphate
5.14.3.6. Diagnosis with bone density test
5.14.4. Frailty
5.14.4.1. Impaired capacity to withstand intrinsic and environmental stressors
5.14.4.2. Limited capacity to maintain physiological and psychological homeostasis
5.14.4.3. Found in20-30% of elderly >75
5.14.4.4. Behavioral adaptation made in response to declining physiologic reserve and capacity with which to meet environmental challenges
5.14.4.5. Causes are multifactorial
5.14.4.5.1. Environmental challenges
5.14.4.5.2. Intraindividual challenges
5.14.4.6. Signs include weakness, weight loss,muscle wasting, exercise intolerance, decrease group strength, frequent falls, immobility, and instability of chronic disease
5.14.4.7. Possible causes
5.14.4.7.1. Hormonal dysregulation, immune-aging, pro-coagulation, pro-inflammatory status
5.14.4.8. Failure to thrive
5.14.4.8.1. Mean age 79
5.14.4.8.2. Average of 6 diagnosis
5.14.4.8.3. Symptoms similar to clinical syndrome
5.14.4.8.4. Malnourished, dehydrated, skin ulcers, falls, cognitive
6. Immune
6.1. Immunosenescence
6.1.1. Depressed immune response
6.1.1.1. Can cause infections to be significant risk
6.2. Thymine mass decreases steadily
6.2.1. To the point that serum activity of thymus hormones is almost undetectable
6.3. T-cell activity declines
6.3.1. More immature T cells are present in the thymus
6.4. Significant decline in cell-mediated immunity
6.4.1. T cells less able to proliferate in response to mitogens
6.5. Changes in the at cell contribute to reactivation of infections
6.5.1. Varicella zoster
6.5.2. Mycobacterium tuberculosis
6.6. IgM concentration decreases
6.7. Less effective response to influenza, parainfluenza, pneumococcus, and tetanus vaccines
6.7.1. Although vaccinations are still recommended
6.8. Inflammatory defense decline
6.8.1. Inflammation presents atypically
6.8.1.1. Low grade fever
6.8.1.2. Minimal pain
6.9. Increase in pro-inflammatory cytokines
6.9.1. Linked to atherosclerosis, diabetes, osteoporosis, and other diseases that increase with age
6.10. IgA and IgG concentration are increased
6.11. Prevalent conditions
6.11.1. UTI
6.11.1.1. Most common infection of older adults
6.11.1.2. Asymptomatic bacteriuria
6.11.1.3. Urosepsis
6.11.2. Pneumonia
6.11.2.1. One of he leading causes of death in older adults
6.11.2.2. Need to have close observation for subtle changes
6.11.2.3. Pneumococcal vaccine
6.11.3. Influenza
6.11.3.1. Serious infection in older adults
6.11.3.2. Two types: A and B
6.11.3.3. Age related changes leading to high susceptibility
6.11.3.4. Secondary bacterial infections and other complications increase the risk of death
6.11.3.5. Prevention measures are annual influenza vaccination
6.11.4. TB
6.11.4.1. Reactivation of a previous infection
6.11.4.2. Potential for delayed diagnosis
6.11.4.3. Screening is a two step Mantoux test
6.11.4.4. Treatment includes rest, good nutrition, meds
7. Cardiovascular
7.1. More prominent arteries
7.1.1. Head
7.1.2. Neck
7.1.3. Extremities
7.2. Valves become thicker more rigid
7.2.1. Result from sclerosis and fibrosis
7.3. Stroke volume decreases
7.3.1. 1% per year
7.4. Heart pigmented with lipofuscin granules
7.5. Less efficient O2 utilization
7.6. Aorta dilated and elongated
7.7. Cardiac output decreased
7.8. Resistance to peripheral blood flow increases
7.8.1. 1% per year
7.9. BP increases
7.9.1. Compensates for increased peripheral resistance and decreased cardiac output
7.10. Decreased elasticity of arteries
7.10.1. Responsible for vascular changes to the heart, kidney, and pituitary gland
7.11. Slight left ventricular hypertrophy
7.12. Heart muscle losses it's efficiency and contractile strength
7.12.1. Resulting in reduced cardiac output
7.13. Pacemaker cells increasingly irregular and decreased in number
7.13.1. She'll surround sinus ode thickens
7.14. Isometric contraction phase and relaxation time of ventricles is prolonged
7.14.1. Cycle of filling and emptying takes more time to complete
7.15. Changes are most apparent when unusual demands are placed on the heart
7.16. Tachycardia will last longer
7.16.1. Stroke volume may increase to compensate
7.16.1.1. Results in elevated BP
7.17. Tunica intima
7.17.1. Innermost layer with the most changes
7.17.2. Calcium and lipid accumulation
7.17.3. Fibrosis
7.17.4. Cellular proliferation
7.17.5. Contribute to development of atherosclerosis
7.18. Tunica media
7.18.1. Middle layer
7.18.2. Thinning and calcification of elastin fibers
7.18.3. Increase in collagen
7.18.3.1. Causes stiffening of vessels
7.18.4. Impaired baroreceptors function and increased peripheral resistance
7.18.4.1. Leads to a rise in systolic BP
7.19. Tunica adventitia
7.19.1. Outermost layer
7.19.2. Not affected by the aging process
7.20. Decreased elasticity of vessels, thinner skin, and less subcutaneous fat
7.20.1. Causes more prominent vessels
7.21. Reduced sensitivity of blood pressure-regulating baroreceptors
7.21.1. Increased risk for postural hypotension and postprandial hypotension
7.22. Prevalent conditions
7.22.1. CHF
7.22.1.1. Increase incidence with age
7.22.1.2. Complication of arteriosclerosis heart disease
7.22.1.3. Coronary artery disease responsible for most cases
7.22.1.4. Symptoms include SOB, dyspnea, confusion, insomnia, agitation, depression, Orthopnea, wheezing, weight gain, edema
7.22.2. CAD
7.22.2.1. Ischemic heart disease
7.22.2.2. Prevelance increases with age
7.22.2.3. Angina
7.22.2.3.1. Typical presentation includes coughing, syncope, sweating, and confusion
7.22.2.3.2. Nitroglycerin ismeffective
7.22.2.4. MI
7.22.2.4.1. Atypical presentation includes confusion, decreased BP, SOB, increased temp, and sedimentation rate
7.22.3. Arrhythmias
7.22.3.1. Causes are digitalis toxicity, hypokalemia, acute infection, hemorrhage, angina, syndrome, and coronary insufficiency
7.22.3.2. Sy,proms include weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, and syncope
7.22.3.3. Treat is antiarrhythmic drugs, digitalis, potassium supplements and cardioversion
7.22.3.4. Educate on modifying diet, stop smoking, increase activity, and decrease alcohol
8. Sensory
8.1. Sight
8.1.1. More opaque lens
8.1.2. Decreased pupil size and less reactive to light
8.1.3. More spherical cornea
8.1.4. Presbyopia
8.1.4.1. Inability to focus on close objects clearly
8.1.5. Narrowing of the visual field
8.1.5.1. Decreased peripheral vision
8.1.6. Depth perception distorted
8.1.7. Decline in visual acuity
8.1.8. Prevalent conditions
8.1.8.1. Cataracts
8.1.8.1.1. Clouding of the lens
8.1.8.1.2. Loss of transparency
8.1.8.1.3. Leading cause of low vision in older adults
8.1.8.1.4. Treatment includes possible surgery
8.1.8.2. Glaucome
8.1.8.2.1. Damage to the optic nerve from an above normal intraoculae pressure
8.1.8.2.2. Second leading cause of blindness in older adults
8.1.8.2.3. Acute (narrow angle or closed)
8.1.8.2.4. Chronic (open angle)
8.1.8.3. Macular degeneration
8.1.8.3.1. Most common cause of blindness in adults over 65
8.1.8.3.2. Damage or breakdown the macula leading to loss of central vision
8.1.8.4. Detached retina
8.1.8.4.1. Forward displacement of the retina
8.1.8.4.2. Promote treatment to prevent continued damage and eventual blindness
8.2. Smell
8.2.1. Impaired ability to identify and discriminate odors
8.3. Taste
8.3.1. High prevalence of taste impairment
8.3.1.1. Most likely due to factors other than aging
8.3.2. Taste acuity is dependent on smell
8.3.2.1. Sense of smell altered with age
8.3.3. Atrophy of the tongue
8.3.4. Decreased saliva, poor oral hygiene and medications all affect taste sensation
8.4. Touch
8.4.1. Reduction in tactile sensation
8.4.2. Reduced ability to sense pressure, discomfort, change in temperature
8.5. Hearing
8.5.1. Atrophy of hair cells in organ of Corti
8.5.2. Tympanic membrane sclerosis and atrophy
8.5.3. Alteration in equilibrium
8.5.4. Cerium increases which affects hearing
8.5.5. Prevalent conditions
8.5.5.1. Inner ear problems
8.5.5.1.1. Due to vascular disorders and viral infections
8.5.5.2. Presbycusis
8.5.5.2.1. Progressive loss of hearing with older age
8.5.5.3. Tinnitus
8.5.5.3.1. Raining in the ears
8.5.5.4. Otosclerosis
8.5.5.4.1. Hearing loss due to the ears inability to amplify sound
8.6. All senses are less proficient and have a decreased efficiency
8.6.1. This can affect well-being, ADL's, safety and health
9. Thermoregulation
9.1. Normal body temperatures are lower
9.1.1. Oral mean body temperature 96.9-98.3 degrees Fahrenheit
9.1.2. Rectal mean body temperature 98-99 degrees Fahrenheit
9.2. Rectal and auditory temperatures are most accurate and reliable
9.3. Reduced ability to respond to cold temperatures
9.3.1. Inefficient vasoconstriction
9.3.2. Decreased cardiac output
9.3.3. Diminished shivering
9.3.4. Reduced muscle mass and subcutaneous tissue
9.3.5. Impaired sweating mechanisms
9.3.6. Decreases cardiac output
9.4. Maintaining adequate environmental temperature is significant
9.4.1. Room temperature should be 75 degrees
9.4.1.1. If it is lower than that, there is risk for hypothermia
10. Reproductive
10.1. Prevalent conditions in men
10.1.1. Andropause
10.1.1.1. Testosterone levels decline
10.1.1.2. Doesn't occur in all men
10.1.1.3. Low testosterone levels can result in reduced muscle mass, energy, strength, and stamina
10.1.2. Erectile dysfunction
10.1.2.1. Unable to attain or maintain erection of penis for sexual intercourse
10.1.2.2. Causes
10.1.2.2.1. Atherosclerosis
10.1.2.2.2. Diabetes
10.1.2.2.3. Hypertension
10.1.2.2.4. MS
10.1.2.2.5. Thyroid dysfunction
10.1.2.2.6. Renal failure
10.1.2.2.7. Other: alcoholism, structure abnormalities, meds, psychological factors
10.1.3. BPH
10.1.3.1. Common with increased aged men
10.1.3.2. Signs are dysuria, hesitancy, decreased force, frequency, nocturia, dribbling, poor control, imcomtinece, and bleeding
10.1.3.3. Treatment is most often a TURP procedure
10.1.4. Scrotum Tumors
10.1.4.1. Usually benign
10.1.5. Cancers
10.1.5.1. Penis
10.1.5.1.1. Rare
10.1.5.1.2. Signs are painless lesion/ wort on prepuce or glands
10.1.5.2. Testicular
10.1.5.2.1. Uncommon in older men
10.1.5.2.2. Signs are testicular enlargement, pain, and enlarges breasts
10.1.5.3. Prostate
10.1.5.3.1. Increased incidence with older age
10.1.5.3.2. A symptomatic until later disease progression
10.1.5.3.3. Signs are benign hypertrophy, back pain, anemia, and weakness
10.1.5.3.4. Diagnose with DRE, confirm with PSA test and biopsy
10.1.5.3.5. Treat by monitoring BPH and use estrogen
10.2. Male
10.2.1. Changes in seminal vessels
10.2.1.1. Smoothing of the mucosa
10.2.1.2. Thinning of the epithelium
10.2.1.3. Replacement of muscle tissue with connective tissue
10.2.1.4. Reduction of fluid-retaining capacity
10.2.2. Reduced sperm count
10.2.2.1. Result of structural changes
10.2.3. Venous & arterial sclerosis and fibroelastosis of the corpus spongiosum can affect the penis
10.2.4. Prostate enlarges
10.2.4.1. 3/4 of men over 65 have some degree of prostatism
10.2.4.1.1. Causes problems with urinary frequency
10.2.4.2. Most are benign but it does pose a greater risk for malignancy
10.2.4.2.1. Need regular evaluation
10.2.5. Changes in seminiferous tubules
10.2.5.1. Increased fibrosis
10.2.5.2. Thinning of the epithelium
10.2.5.3. Thickening of the basement membrane
10.2.5.4. Narrowing of the lumen
10.2.6. Increase in FSH and LH levels
10.2.7. Decrease in serum and bioavailable testosterone levels
10.2.8. Don't fully loose the ability to achieve erection or ejaculation
10.2.8.1. These do become less intense with age
10.2.8.2. More time required to achieve an erection
10.2.8.3. Ejaculation fluid contains less live sperm
10.2.9. Decreased capacity to retain fluids
10.2.10. Testosterone levels stay the same or decrease slightly
10.3. Females
10.3.1. Fallopian tubes atrophy and shorten
10.3.1.1. Become more straight
10.3.2. Ovaries atrophy, thicken and become smaller
10.3.2.1. Can shrink to the point that they aren't palpable during an exam
10.3.3. Cervix atrophies and becomes smaller
10.3.3.1. Endocervical epithelium also atrophies
10.3.4. Stier, less elastic vagina canal
10.3.5. Uterus becomes smaller and shrink
10.3.5.1. Ligaments supporting the uterus weaken and cause backward tilting of the uterus
10.3.5.1.1. These two things combined make it difficult to palate the uterus during an exam
10.3.6. Endometrium atrophies
10.3.6.1. Continues to respond to hormonal stimulation
10.3.6.1.1. Can be responsible for incidents of postmenopausal bleeding in older women on estrogen therapy
10.3.7. Atrophy of the vulva
10.3.7.1. From hormonal changes
10.3.7.2. Accompanied by the loss of subcutaneous fat and hair and flattening of the labia
10.3.8. Vagina changes
10.3.8.1. Pink and dry with smooth shinny canal
10.3.8.1.1. Due to loss of elasticity and rugae
10.3.8.2. Vaginal epithelium thin and avascular
10.3.8.3. Vaginal environment more alkaline
10.3.8.3.1. Accompanied by change in type of flora and a reduction in secretions
10.3.8.3.2. Result of lower estrogen changes
10.3.9. Breast sag and are less firm
10.3.9.1. Some retraction of nipples related to shrinkage and fibrotic changes
10.4. Prevalent conditions in women
10.4.1. Infections of the vulva
10.4.1.1. Vulva becomes more fragile and more susceptible to irritation and infection
10.4.1.2. Senile vulvitis
10.4.1.2.1. Hypertrophy or atrophy
10.4.1.2.2. Incontinence and poor hygiene lead to it
10.4.1.2.3. #1 sign is pruritus
10.4.1.2.4. Treat the underlying cause, Sitt baths, steroid creams, good nutrition
10.4.2. Tumors of the vulva
10.4.2.1. Gynecological malignancy
10.4.2.2. Large painful foul-smelling ulcerative tumor
10.4.2.3. The clitoris is the number one site for this
10.4.2.4. Treat with radical vulvectomy or radiation
10.4.3. Atrophic vaginitis
10.4.3.1. In postmenopausal women
10.4.3.2. Increase vaginal fragility which increases risk of irritation
10.4.3.3. Signs are itching, foul-smelling, discharge
10.4.3.4. Treat with topical estrogen creams and estrogen replacement therapy
10.4.4. Problems of the cervix
10.4.4.1. Endocervical glands seal over leading to form nabothiancysis
10.4.4.1.1. Secretions can increase and a palpable tender mass is present
10.4.4.2. Smaller cervix, endocervical epithelium atrophies
10.4.5. Perineal herniation
10.4.5.1. Stretch/ tear muscles during birth
10.4.5.2. Signs are lower back pain, pelvic heaviness, pulling sensation, and incontinence
10.4.5.3. Treat with surgery
10.4.5.4. Makes sex very painful and uncomfortable
10.4.6. Dyspareunia
10.4.6.1. Accompanies hormonal changes
10.4.6.2. Increases in nullparus women
10.4.6.3. Not a normal part of aging
10.4.7. Cancers
10.4.7.1. Vagina
10.4.7.1.1. Decreased risk in older adults
10.4.7.2. Cervix
10.4.7.3. Endometrium
10.4.7.3.1. Most common in increased age
10.4.7.3.2. Number one sign in postmenopausal bleeding
10.4.7.4. Ovarian
10.4.7.4.1. Increases with age
10.4.7.5. Breast
10.4.7.5.1. Need yearly mammogram at 40
11. Physical appearance
11.1. Gray/ thin hair
11.2. Ectropion of eyelids
11.3. Loss of tissue elasticity
11.3.1. Elongated ears
11.3.2. Double chin
11.3.3. Baggy eyelids
11.4. Arcus senilis
11.5. Decreased heights
11.5.1. 2 inches by 80 years of age
11.5.2. Due to reduced hydration, loss of cartilage, and thinning vertebrae
11.5.3. Curvature is the spine, hips, and knees can cause decreased height
11.6. Thicker ear and nose hair
11.7. Darkening/ wrinkling skin around orbits
11.8. Diminished muscle mass and skin fold thickness
11.8.1. Back of the hands and forearm
11.8.2. Responsible for a decline in body's natural insulation
11.8.2.1. More sensitive to cold temperatures
11.9. Most appear around the fourth decade of life
11.10. Body fat atrophies
11.10.1. Bony appearance
11.10.2. Deepening the hollows of intercostal and supraclavicular spaces
11.10.2.1. Orbits
11.10.2.2. Axillae
12. Gastrointestinal
12.1. Decreased taste sensation
12.1.1. Nerve chambers become narrow and shorter in teeth
12.1.2. Tongue atrophies
12.1.2.1. Affecting the taste buds
12.1.3. Chronic irritation
12.1.3.1. Such as smoking
12.1.4. Sweet sensations suffer the greatest loss
12.1.4.1. On the tip of the tongue
12.1.4.2. Excessive seasoning of foods is often done to compensate for this loss
12.1.4.2.1. This can lead to more health problems
12.2. Reduced saliva & salivary ptyalin
12.2.1. Increased in viscosity from certain meds to treat gastric conditions
12.2.2. Decreased salivary ptyalin interferes with the breakdown of starches
12.3. Liver smaller in size
12.3.1. Reduced weight and volume
12.3.2. Less able to regenerate damaged cells
12.3.3. Less efficient cholesterol stabilization and absorption
12.3.3.1. Results in an increased incidence of gallstones
12.3.4. Pancreatic ducts more dilated and distended
12.3.4.1. Often the entire glam prolapses
12.4. Reduced intestinal blood flow
12.5. Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes
12.5.1. Higher pH of the stomach contributes to an increased incidence of gastric irritation
12.6. Fewer cells of absorbing surface of intestine
12.6.1. Atrophy throughout the small and large intestines
12.6.1.1. Gradual reduction in weight of small intestine
12.6.1.2. Shortening and widening of villi
12.6.1.2.1. Causing them to develop in parallel ridges shape instead of finger-like projections
12.7. Slower peristalsis
12.8. Tooth enamel becomes harder and more brittle
12.8.1. Dentin becomes more fibrous and decreased in production
12.9. Bones supporting teeth decrease in density and height
12.9.1. Contributing to tooth loss
12.9.1.1. Tooth loss is not a normal consequence of older age
12.10. Periodontal disease
12.10.1. After 30 is the major cause of tooth loss
12.10.2. Teeth in port condition
12.10.2.1. Fracture easily
12.10.2.2. Have flatter surfaces and stains
12.10.2.3. Varying degrees of erosion and abrasion of the crown and root structure
12.11. Tooth brittleness could lead to aspiration of tooth fragments
12.12. Presbyesophagus occurs
12.12.1. Decreased intensity of propulsive waves and an increased frequency of non-propulsive waves in the esophagus
12.12.2. Decreased esophageal motility
12.13. Esophagus slightly dilated
12.13.1. Slower emptying
12.13.1.1. Causing discomfort due to food remaining in the esophagus for a longer time
12.14. Relaxation of the lower esophageal sphincter
12.14.1. Combine this with a weaker gag reflex and delayed esophageal emptying causes a risk for aspiration
12.15. Decreased stomach motility
12.15.1. Decreased hunger contractions
12.16. Absorption of vitamin B, B12, D, calcium, and iron is less effective
12.17. Large intestine has reduced mucous secretions and elasticity of the recital wall
12.17.1. Normal gaining doesn't interfere with the mobility of feces through the bowel
12.17.2. Loss of time of the internal sphincter can affect bowel elimination
12.18. Prevalent conditions
12.18.1. Dysphasia
12.18.1.1. Swallowing difficulties
12.18.1.2. Caused by GERD, stroke, structural disorders
12.18.1.3. Prevent aspiration and promote adequate nutritional status
12.18.2. Cancers
12.18.2.1. Esophageal
12.18.2.1.1. Cause is Barrers esophagus
12.18.2.2. Stomach
12.18.2.2.1. Adenocarcinomas
12.18.2.3. Colorectal
12.18.2.3.1. Along the large intestine sigmoid colon and rectum
12.18.2.4. Pancreatic
12.18.2.4.1. Difficult to detect
12.18.2.4.2. Diagnosed at an advanced stage
12.18.2.5. Gallbladder
12.18.2.5.1. Rare but poor prognosis
12.18.3. Cholelithiasis
12.18.3.1. Gallstones that increase with age and in women
12.18.3.2. Pain is the number one sign
12.18.3.3. Treat with shock treatment or surgery
13. Integumentary
13.1. Flattening of the dermal-epidermal junction
13.2. Reduced thickness and vascularity of dermis
13.3. Slowing of epidermal proliferation
13.4. Increased quantity and degeneration of elastin fibers
13.5. Collagen fibers become coarser and more random
13.5.1. Reduced skin elasticity, more dry and fragile
13.5.1.1. Lines, wrinkles, and sagging becomes evident
13.6. Dermis becomes more avascular and thinner
13.7. Skin becomes irritated and breaks down more easily
13.8. Reduced number of melanocytes
13.8.1. 10-20% each decade beginning in the third decade
13.8.2. Melanocytes cluster
13.8.2.1. Causes skin pigmentation
13.8.2.1.1. AKA age spots
13.8.2.2. More prevalent in areas of the body exposed to sun
13.8.3. Causes older adults to tan more slowly and less deeply
13.9. Skin immune response declines
13.9.1. More prone to skin infections
13.9.2. Benign and malignant skin neoplasms occur more often
13.10. Scalp, pubic, and axillary hair thins and grays
13.10.1. From progressive loss of pigment cells
13.10.2. From atrophy and fibrosis of hair bulbs
13.10.3. By 50 mout white men have some degree of baldness and half have gray hair
13.10.4. Growth rate of hair declines
13.10.5. Facial hair in women may occur
13.10.6. Increased eyebrow, ear, and nostril hair in men
13.11. Nose and ear hair becomes thicker
13.12. Fingernails grow more slowly
13.12.1. More fragile and brittle
13.12.2. Develop longitudinal stristions
13.12.3. Experience a decrease in lunula size
13.13. Perspiration is slightly reduced
13.13.1. Due to number and function of sweat glands are lessened
13.14. Prevalent conditions
13.14.1. Pruritus
13.14.1.1. Most common dermatological problem with older age
13.14.1.2. Potential for skin breakdown and infection
13.14.1.3. Prompt recognition
13.14.2. Keratosis
13.14.2.1. Referred to as actinic or solar keratosis
13.14.2.2. A rough scaly patch on the skin caused by years of sun exposure
13.14.2.3. Treated by removing patch to be cautious as some could be cancerous
13.14.3. Skin cancer
13.14.3.1. Basal cell carcinoma
13.14.3.2. Squamous cell carcinoma
13.14.3.2.1. Due to sun exposure and other factors that facilitate growth
13.14.3.3. Melanoma
13.14.3.3.1. Tends to be more easily metastasize
13.14.3.3.2. Rising incidence in the US
13.14.4. Vascular lesions
13.14.4.1. Age-related changes of weakened vein walls
13.14.4.1.1. Reduce ability of veins to respond to increased venous pressure
13.14.4.1.2. Obesity and hereditary factors compound problems
13.14.4.2. Patho
13.14.4.2.1. Varicose veins
13.14.4.2.2. Lower extremity edema
13.14.4.2.3. Pigmented appearance