1. Pulmonary
1.1. Decreased respiratory muscle strength
1.2. Stiffer chest wall with reduced compliance
1.3. Diminished ciiliary and macrophage activity
1.4. Dry mucus membranes
1.5. Decreased cough reflex
1.6. Decreased response to hypoxia and hypercapnia
1.7. Reduced pulmonary functional reserve
1.8. With exertion: dyspnea, decreased exersice tolerance
1.9. Decreased respiratory excursion and chest/lung expansion with less effective exhalation
1.10. Decreased foreign matter clearance
1.11. Increased risk of infection and bronchospasm with airway obstruction
1.12. Common problems
1.12.1. COPD
1.12.2. Emphysema
1.12.3. Chronic bronchitis
1.12.4. Pneumonia
2. Gastrointestinal
2.1. Decreases in strength of muscle of mastication, taste and thirst perception
2.2. Decreased gastric motility with delayed emptying
2.3. Atrophy of protective mucosa
2.4. Malabsorption of carbohydrates, vitamin B12 and D, folic acid and calcium
2.5. Impaired sensation of defecate
2.6. Reduced hepatic reserve
2.7. Decreased metabolism of drugs
2.8. Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition
2.9. Gastric changes: altered drug absorption, increased risk of GERD, maldigestion, NSAID-induced ulcers
2.10. Constipation not a normal finding
2.11. Risk for fecal incontinence
2.12. Stable liver function tests. Risk of adverse drug reactions
2.13. Common problems
2.13.1. Diverticular disease
2.13.2. Ulcers
2.13.3. Constipation
2.13.4. GERD
2.13.5. Polyps
2.13.6. Xerostomia
2.13.7. Dysphagia
2.13.8. Hiatal hernias
2.13.9. Esophageal cancer
2.13.10. PUD
2.13.11. Cancer of the stomach
2.13.12. Colorectal cancer
2.13.13. Intestinal obstruction
2.13.14. Fecal impaction
2.13.15. Incontinence
2.13.16. Pancreatic cancer
2.14. Atrophy of the tongue affects taste buds and decreases taste sensation
2.15. Saliva production decreases
2.16. Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter
2.17. Esophageal and stomach motility decreases
2.17.1. Risk for aspiration and indigestion
2.18. Decreased elasticity of the stomach
2.18.1. Reduces the amount of food accommodation at one time
2.19. Stomach has high pH as a result of decline in hydrochloric acid and pepsin
2.20. Decline in pepsin
2.20.1. Interferes with absorption of protein
2.21. Bile salt synthesis decreases
2.21.1. Increase in the risk of gallstone development
2.22. Pancreas changes
2.22.1. Affects digestion of fats
3. Musculoskeletal
3.1. Sarcopenia with increased weakness and poor exercise tolerance
3.2. Lean body mass replaced by fat with redistribution of fat
3.3. Risk of osteopenia and osteoporosis
3.4. Bone loss in women and men after peak mass at 30 to 35 years
3.5. Decreased ligament and tendon strength
3.6. Intervertebral disc degeneration
3.7. Articular cartilage erosion
3.8. Changes in stature with kyphosis, height reduction
3.9. Sarcopenia
3.9.1. Increased risk of disability, falls and unstable gait
3.10. Limited ROM, joint instability
3.11. Common problems
3.11.1. Arthritis
3.11.2. Osteoarthritis
3.11.3. Rheumatoid arthritis
3.11.4. Osteoporosis
3.11.5. Gout
4. Urinary
4.1. Hypertrophy and thickening of the bladder muscle
4.1.1. Decreases bladder ability to expand
4.1.2. Reduces storage capacity
4.1.2.1. Daytime urinary frequency
4.1.2.2. Nocturia
4.2. Changes in cortical control of micturition
4.3. Inefficient neurological control of bladder emptying and weaker bladder muscle
4.3.1. Retention of large volumes of urine
4.4. Kidney filtration ability decreases
4.4.1. Affects the ability to eliminate drugs
4.4.1.1. Potential for adverse reactions
4.5. Reduced renal function
4.5.1. High blood urea nitrogen levels
4.6. Decreased tubular function
4.6.1. Concentration of urine changes in response to water and-or sodium excess/depletion
4.7. Increase in renal threshold for glucose
4.8. Common problems
4.8.1. Urinary incontinence
4.8.2. Bladder cancer
4.8.3. Renal calculi
4.8.4. Glomerulonephritis
5. Integumentary
5.1. Epidermal cells grow slower
5.2. Skin becomes thinner and more translucent
5.3. The speed of skin healing slows down
5.4. The ability to lose heat decreases
5.5. Reduction of sweat gland activity
5.6. Melanocyte activity decreases
5.7. Sebaceous gland activity declines as does sebum production
5.7.1. Causing dry, scaly skin
5.8. Loss of fat and collagen
5.8.1. Producing skin sagging and wrinkles
5.9. Dermis becomes thinner and less elastic
5.10. Vascularity and circulation also decrease in the subcutaneous tissues, causing drugs that are administered in this manner to be absorbed more slowly
5.11. Common problems
5.11.1. Xeroxes
5.11.2. Pruritus
5.11.3. Eczema
5.11.4. Purpura
5.11.5. Chronic venous insufficiency
5.11.6. Skin tears
5.11.7. Pressure injuries
6. Reproductive
6.1. Male
6.1.1. Testicular tissue mass decreases
6.1.2. Testosterone decreases
6.1.3. Erectile dysfunction
6.1.4. Sclerosis
6.1.5. Rate of sperm cell production slows
6.1.6. Epididymis, seminal vesicles, and prostate gland lose some of their surface cells
6.1.7. Volume of fluid ejaculated usually remains the same, but there are fewer living sperm
6.1.8. Decrease in sex drive
6.1.9. Seminal vesicles develop thinner epithelium
6.1.10. Muscle tissue replaced with connective tissue
6.1.11. Decreased capacity to retain fluids
6.1.12. Seminiferous tubule changes
6.1.12.1. Increased fibrosis
6.1.12.2. Epithelium changes
6.1.12.3. Thickening of the basement membrane
6.1.12.4. Narrowing of the lumen
6.1.13. BPH
6.2. Common problems
6.2.1. Erectile dysfunction
6.2.2. BPH
6.2.3. Prostate cancer
6.2.4. Endometriosis
6.2.5. Uterine fibroids
6.2.6. Gynecologic cancer
6.2.6.1. Cervical cancer
6.2.6.2. Ovarian cancer
6.2.6.3. Uterine cancer
6.2.6.4. Vaginal and vulvar cancer
6.2.7. Atrophic vaginitis
6.2.8. Perineal herniation
6.2.9. Dysparenuia
6.2.10. Cancers for males
6.2.10.1. Prostate cancer
6.2.10.2. Penis and testicular cancer
6.2.10.3. Tumors of the scrotum
6.3. Female
6.3.1. Menopause
6.3.1.1. Periods will become much less frequent, until they completely stop
6.3.2. Ovaries stop making the hormones estrogen and progesterone
6.3.3. Ovaries stop releasing eggs
6.3.4. Vagina walls become thinner, dryer, less elastic and irritated
6.3.5. Sex can become painful
6.3.6. Increase risk of yeast infection
6.3.7. Decrease in breast tissue
6.3.8. Lower sex drive
6.3.9. Loss of tine in the pubic muscles,
6.3.9.1. Resulting in the vagina, uterus, or urinary bladder prolapse
6.3.10. Vulva atrophies, labia flattens, loss of subcutaneous fat and hair
6.3.11. Vaginal canal changes
6.3.11.1. Reduction in collagen and adipose tissue
6.3.11.2. Shortening and narrowing of the canal
6.3.11.3. Less lubrication
6.3.11.4. More alkaline vaginal pH
6.3.12. Uterus and ovaries decrease in size
6.3.13. Fallopian tubes become shorter and straighter
6.3.14. Breast sag and become less firm
6.3.15. Some retraction of nipples
7. Cardiovascular
7.1. Arterial wall thickening and stiffening, decreased compliance
7.2. Left ventricular and atrial hypertrophy
7.3. Sclerosis of atrial and mitral valves
7.4. Strong arterial pulses, diminished peripheral pulses, cool extremities
7.5. Decreased cardiac reserve
7.6. Decreased maximal heart rate and cardiac output
7.6.1. Results in fatigue, shortness of breath, slow recovery from tachycardia
7.7. Risk of isolated systolic hypertension; inflamed varicosities
7.8. Risk of arrhythmias, postural and diuretic-induced hypotension
7.9. Common problems
7.9.1. Coronary artery disease
7.9.2. Congestive heart failure
7.9.3. Arteriosclerosis
7.9.4. HTN
7.9.5. Orthostatic hypotension
7.9.6. Pulmonary emboli
7.9.7. Hyperlipidemia
7.9.8. Arrhythmias
7.9.9. Peripheral vascular disease
7.9.10. Aneurysms
7.9.11. Varicose veins
7.10. Heart valves become thicker and rigid
7.11. Aorta becomes dilated
7.11.1. Slight ventricular hypertrophy
7.11.2. Thickening of L ventricular wall
7.12. Myocardial muscle less efficient
7.12.1. Decreased contractile strength
7.12.2. Decreased cardiac output when demands increased
7.13. Calcification, reduced elasticity of vessels
7.14. Less sensitive to baroreceptor regulation of BP
8. Neurological
8.1. Decrease in neurons and neurotransmitters
8.2. Modifications in cerebral dendrites, glial support cells, synapses
8.3. Compromised thermoregulation
8.4. Impairments in general muscle strength; deep tendon reflexes; nerve conduction velocity
8.5. Slower motor skills and potential deficits in balance and coordination
8.6. Decreased temperature sensitivity
8.7. Blunted or absent fever response
8.8. Slowed speed of cognitive processing
8.9. Some cognitive decline is common but not universal
8.10. Most memory functions adequate for normal life
8.11. Increased risk of sleep disorders, delirium, neurodegenerative diseases
8.12. Common problems
8.12.1. Dementia
8.12.2. Alzeimer disease
8.12.3. Delirium
8.12.4. Parkinson's disease
8.12.5. Stroke
8.12.6. Muscular dystrophy
9. Immune
9.1. Immune response dysfunction with increased susceptibility to infection
9.1.1. Reduced efficiency of vaccination
9.1.2. Chronic inflammatory state
9.2. Diseases especially immunization recommendations for pneumococcal infections, seasonal, influenza, zoster,tetanus, hepatitis for the older adult
9.3. Symptoms/signs often subtle include nonspecific declines in function or mental status, decreased appetite, incontinence, falls, fatigue, exacerbation of chronic illness
9.4. Fever blunter or absent in very old, frail or malnourished adults
9.5. Baseline oral temperature in older adults is 97.4 degrees F versus 98.6 degrees F in younger adults
10. Endocrine
10.1. Diminished adrenal function
10.2. ACTH secretion decreases
10.3. Insufficient insulin release
10.3.1. Reduced sensitivity to insulin
10.3.1.1. Type 2 DM
10.4. Volume of pituitary gland decreases
10.5. Thyroid gland atrophy
10.5.1. Decreased function
10.5.1.1. Primary hypothyroidism
10.5.1.1.1. Secondary hypothyroidism
10.6. Common disease
10.6.1. Diabetes
10.6.2. Hypothyroidism