Older Adult

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Older Adult by Mind Map: Older Adult

1. Reproductive

1.1. Prevalent conditions in men

1.1.1. Andropause Testosterone levels decline Doesn't occur in all men Low testosterone levels can result in reduced muscle mass, energy, strength, and stamina

1.1.2. Erectile dysfunction Unable to attain or maintain erection of penis for sexual intercourse Causes Atherosclerosis Diabetes Hypertension MS Thyroid dysfunction Renal failure Other: alcoholism, structure abnormalities, meds, psychological factors

1.1.3. BPH Common with increased aged men Signs are dysuria, hesitancy, decreased force, frequency, nocturia, dribbling, poor control, imcomtinece, and bleeding Treatment is most often a TURP procedure

1.1.4. Scrotum Tumors Usually benign

1.1.5. Cancers Penis Rare Signs are painless lesion/ wort on prepuce or glands Testicular Uncommon in older men Signs are testicular enlargement, pain, and enlarges breasts Prostate Increased incidence with older age A symptomatic until later disease progression Signs are benign hypertrophy, back pain, anemia, and weakness Diagnose with DRE, confirm with PSA test and biopsy Treat by monitoring BPH and use estrogen

1.2. Male

1.2.1. Changes in seminal vessels Smoothing of the mucosa Thinning of the epithelium Replacement of muscle tissue with connective tissue Reduction of fluid-retaining capacity

1.2.2. Reduced sperm count 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 3/4 of men over 65 have some degree of prostatism Causes problems with urinary frequency Most are benign but it does pose a greater risk for malignancy Need regular evaluation

1.2.5. Changes in seminiferous tubules Increased fibrosis Thinning of the epithelium Thickening of the basement membrane 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 These do become less intense with age More time required to achieve an erection 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 Become more straight

1.3.2. Ovaries atrophy, thicken and become smaller Can shrink to the point that they aren't palpable during an exam

1.3.3. Cervix atrophies and becomes smaller Endocervical epithelium also atrophies

1.3.4. Stier, less elastic vagina canal

1.3.5. Uterus becomes smaller and shrink Ligaments supporting the uterus weaken and cause backward tilting of the uterus These two things combined make it difficult to palate the uterus during an exam

1.3.6. Endometrium atrophies Continues to respond to hormonal stimulation Can be responsible for incidents of postmenopausal bleeding in older women on estrogen therapy

1.3.7. Atrophy of the vulva From hormonal changes Accompanied by the loss of subcutaneous fat and hair and flattening of the labia

1.3.8. Vagina changes Pink and dry with smooth shinny canal Due to loss of elasticity and rugae Vaginal epithelium thin and avascular Vaginal environment more alkaline Accompanied by change in type of flora and a reduction in secretions Result of lower estrogen changes

1.3.9. Breast sag and are less firm Some retraction of nipples related to shrinkage and fibrotic changes

1.4. Prevalent conditions in women

1.4.1. Infections of the vulva Vulva becomes more fragile and more susceptible to irritation and infection Senile vulvitis Hypertrophy or atrophy Incontinence and poor hygiene lead to it #1 sign is pruritus Treat the underlying cause, Sitt baths, steroid creams, good nutrition

1.4.2. Tumors of the vulva Gynecological malignancy Large painful foul-smelling ulcerative tumor The clitoris is the number one site for this Treat with radical vulvectomy or radiation

1.4.3. Atrophic vaginitis In postmenopausal women Increase vaginal fragility which increases risk of irritation Signs are itching, foul-smelling, discharge Treat with topical estrogen creams and estrogen replacement therapy

1.4.4. Problems of the cervix Endocervical glands seal over leading to form nabothiancysis Secretions can increase and a palpable tender mass is present Smaller cervix, endocervical epithelium atrophies

1.4.5. Perineal herniation Stretch/ tear muscles during birth Signs are lower back pain, pelvic heaviness, pulling sensation, and incontinence Treat with surgery Makes sex very painful and uncomfortable

1.4.6. Dyspareunia Accompanies hormonal changes Increases in nullparus women Not a normal part of aging

1.4.7. Cancers Vagina Decreased risk in older adults Cervix Endometrium Most common in increased age Number one sign in postmenopausal bleeding Ovarian Increases with age Breast 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 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 Stretch due to progressive loss of elasticity 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 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 High risk for complications of bronchiectasis and cardiac problems High rates of mortality Assess for causative factors and educate patient

2.20.2. Chronic bronchitis Causes persistent productive cough, wheezing, recurrent respiratory infections, SOB Manage it by removing bronchial secretions, prevent obstruction of airway, and maintaining adequate fluid intake

2.20.3. Emphysema From chronic bronchitis, chronic irritation, and morphological changes in the lung Smoking has a major role in its development Symptoms develop slowly, delaying diagnosis and treatment Treatment is postural drainage, bronchodilators, avoid stress, and breathing exercises

2.20.4. Lung cancer Increase incidence in >65 Symptoms include dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections Treat with surgery, chemo, and radiotherapy

2.20.5. Lung abscess Causes are pneumonia, TB, malignancy, trauma, and aspiration Symptoms include anorexia, weight loss, increased temp, and chronic cough 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 Less ability to conserve sodium in response to sodium restriction Can contribute to hyponatremia and nocturnal Have no affect on specific gravity

3.2.2. Causes decreased reabsorption of glucose from the filtrate 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 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 Common in multiparous women

3.10. Prevalent conditions

3.10.1. Bladder cancer Increase indecency with age >55 and in men Chronic bladder irritation, exposure to dyes, smoking Signs include frequency, urgency, dysuria, and most commonly hematuria Assess for metastasis Pain back and pelvic pain

3.10.2. Renal calculus Due to immobility, infection, pH change, urine concentration, chronic diarrhea, dehydration, and hypercalcemia Signs include pain hematuria and UTI signs Treat with increased fluids UTI treatment, and prevent urinary stasis

3.10.3. Glomerulonephritis Chronic condition Subtle, nonspecific signs Signs include fever, fatigue, nausea, vomiting, anorexia, pain, anemia, edema, increased BP, oliguria, and hematuria 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 Insomnia Difficulty falling or staying asleep Prematurely waking Short-term causes Chronic causes (>3 weeks) Leg movements Nocturnal myoclonus Restless leg syndrome Sleep apnea Five episodes of cessation of breathing lasting 10 seconds 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 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 Irreversible and progressive Impairment in cognitive function affects memory, orientation, reasoning, attention, language, and problem solving Caused by damage to the brain Alzheimer's Others such as decreased oxygen, infection, trauma, hydrocephalus, tumor, alcohol, or circulatory problem Slow onset Level of consciousness is normal and alert

4.10.2. Delirium Acute confusion that is reversible Rapid onset Disrupted brain function from medication side effects, circulatory disturbances, dehydration, BP change, and blood glucose level changes Level of consciousness is changes Highly agitated or very dull 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 Lower basically metabolic rate Reduced radioactive iodine uptake 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 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 Higher blood glucose levels in non-diabetic older adults

5.11. Prevalent conditions

5.11.1. Diabetes Mellitus No glucose tolerance or glucose intolerance Screening with FBS eve very 3 years for people over 45 Diagnose with FBS >126, random blood glucose concentration >200 Need education on diet, exercise and monitoring

5.11.2. Hypothyroidism Effects of aging on the thyroid gland Subnormal concentration of thyroid hormone

5.11.3. Hyperthyroidism 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 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 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 Progressive deterioration of joint cartilage with the formation of new bone at joint surface No inflammation or deformities Affects several joints From wear and tear, obesity, genetics, and decreased vitamin D and C No systemic symptoms Treat with analgesics and arthroplasty

6.14.2. Rheumatoid arthritis Deformities and disability begin at an early age, peak during middle age, and increase systemic involvement in older age Red, swollen, warm, stiff, and painful Systemic signs Weak, decreased weight, fever, anemia, and wasting Take anti inflammatory meds like prostaglandins

6.14.3. Osteoporosis Most prevalent metabolic disease of the bone Risk factors Inactivity, disease, reduction in anabolic sex hormone, diet, and drugs Causes kyphosis, spinal pain, and increased risk for fractures Asymptomatic often Treat with calcium and vitaminD supplements, progesterone, estrogen, anabolic agents, or phosphate Diagnosis with bone density test

6.14.4. Frailty Impaired capacity to withstand intrinsic and environmental stressors Limited capacity to maintain physiological and psychological homeostasis Found in20-30% of elderly >75 Behavioral adaptation made in response to declining physiologic reserve and capacity with which to meet environmental challenges Causes are multifactorial Environmental challenges Intraindividual challenges Signs include weakness, weight loss,muscle wasting, exercise intolerance, decrease group strength, frequent falls, immobility, and instability of chronic disease Possible causes Hormonal dysregulation, immune-aging, pro-coagulation, pro-inflammatory status Failure to thrive Mean age 79 Average of 6 diagnosis Symptoms similar to clinical syndrome Malnourished, dehydrated, skin ulcers, falls, cognitive

7. Immune

7.1. Immunosenescence

7.1.1. Depressed immune response 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 Low grade fever 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 Most common infection of older adults Asymptomatic bacteriuria Urosepsis

7.11.2. Pneumonia One of he leading causes of death in older adults Need to have close observation for subtle changes Pneumococcal vaccine

7.11.3. Influenza Serious infection in older adults Two types: A and B Age related changes leading to high susceptibility Secondary bacterial infections and other complications increase the risk of death Prevention measures are annual influenza vaccination

7.11.4. TB Reactivation of a previous infection Potential for delayed diagnosis Screening is a two step Mantoux test 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 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 Causes stiffening of vessels

8.18.4. Impaired baroreceptors function and increased peripheral resistance 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 Increase incidence with age Complication of arteriosclerosis heart disease Coronary artery disease responsible for most cases Symptoms include SOB, dyspnea, confusion, insomnia, agitation, depression, Orthopnea, wheezing, weight gain, edema

8.22.2. CAD Ischemic heart disease Prevelance increases with age Angina Typical presentation includes coughing, syncope, sweating, and confusion Nitroglycerin ismeffective MI Atypical presentation includes confusion, decreased BP, SOB, increased temp, and sedimentation rate

8.22.3. Arrhythmias Causes are digitalis toxicity, hypokalemia, acute infection, hemorrhage, angina, syndrome, and coronary insufficiency Sy,proms include weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, and syncope Treat is antiarrhythmic drugs, digitalis, potassium supplements and cardioversion 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 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 Orbits Axillae

10. Gastrointestinal

10.1. Decreased taste sensation

10.1.1. Nerve chambers become narrow and shorter in teeth

10.1.2. Tongue atrophies Affecting the taste buds

10.1.3. Chronic irritation Such as smoking

10.1.4. Sweet sensations suffer the greatest loss On the tip of the tongue Excessive seasoning of foods is often done to compensate for this loss 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 Results in an increased incidence of gallstones

10.3.4. Pancreatic ducts more dilated and distended 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 Gradual reduction in weight of small intestine Shortening and widening of villi 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 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 Fracture easily Have flatter surfaces and stains 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 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 Swallowing difficulties Caused by GERD, stroke, structural disorders Prevent aspiration and promote adequate nutritional status

10.18.2. Cancers Esophageal Cause is Barrers esophagus Stomach Adenocarcinomas Colorectal Along the large intestine sigmoid colon and rectum Pancreatic Difficult to detect Diagnosed at an advanced stage Gallbladder Rare but poor prognosis

10.18.3. Cholelithiasis Gallstones that increase with age and in women Pain is the number one sign 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 Inability to focus on close objects clearly

11.1.5. Narrowing of the visual field Decreased peripheral vision

11.1.6. Depth perception distorted

11.1.7. Decline in visual acuity

11.1.8. Prevalent conditions Cataracts Clouding of the lens Loss of transparency Leading cause of low vision in older adults Treatment includes possible surgery Glaucome Damage to the optic nerve from an above normal intraoculae pressure Second leading cause of blindness in older adults Acute (narrow angle or closed) Chronic (open angle) Macular degeneration Most common cause of blindness in adults over 65 Damage or breakdown the macula leading to loss of central vision Detached retina Forward displacement of the retina 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 Most likely due to factors other than aging

11.3.2. Taste acuity is dependent on smell 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 Inner ear problems Due to vascular disorders and viral infections Presbycusis Progressive loss of hearing with older age Tinnitus Raining in the ears Otosclerosis 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 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 Causes skin pigmentation AKA age spots 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 Most common dermatological problem with older age Potential for skin breakdown and infection Prompt recognition

12.14.2. Keratosis Referred to as actinic or solar keratosis A rough scaly patch on the skin caused by years of sun exposure Treated by removing patch to be cautious as some could be cancerous

12.14.3. Skin cancer Basal cell carcinoma Squamous cell carcinoma Due to sun exposure and other factors that facilitate growth Melanoma Tends to be more easily metastasize Rising incidence in the US

12.14.4. Vascular lesions Age-related changes of weakened vein walls Reduce ability of veins to respond to increased venous pressure Obesity and hereditary factors compound problems Patho Varicose veins Lower extremity edema 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 If it is lower than that, there is risk for hypothermia