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1. Frailty

1.1. Low physical activity

1.2. muscle weakness

1.3. slowed performance

1.3.1. keeping the mind active is necessary being an older adult Sudoko and puzzles as well as mind games are important (crosswords, etc)

1.4. fatigue or poor endurance

1.5. unintentional weight loss

1.6. Maintaining good nutrition

2. Sexuality

2.1. Andropause in men where testosterone declines which effects muscle mass, energy, strength, and stamina

2.2. Menopause in women and estrogen reduction which effects how they feel. Hormone therapy is an individual persons decision

2.3. BPH

2.3.1. Benign Prostatic Hypertrophy is an enlarged prostate

2.3.2. Very common in men as they age

2.3.3. Warning signs with aging: pain with urination, erectile dysfunction, hematuria

2.3.4. Men are reluctant or embarrassed to seek medical treatment oftentimes Kidney damage can result

2.4. TURP

2.4.1. Transurethral resection of the prostate is surgery used to treat urinary problems for an enlarged prostate.

2.4.2. Removal of excess prostate tissue

2.4.3. Normal PSA level: 4.0-10.0

2.5. Erectile Dysfunction

2.5.1. Effects most men over 70 years old

2.5.2. Not normal aging

2.5.3. Can be treated Viagra most common med along with Cialis

2.5.4. Atherosclerosis and diabetes are most common causes

2.6. Health Promotion

2.6.1. Annual gynecologic exam with Pap smear

2.6.2. Breast self- examination

2.6.3. Men with prostatic hypertrophy examined every 6 months

2.6.4. Testicular self- examination

2.6.5. Complete history and physical exam

2.7. HIV

2.7.1. Incidence increasing twice as quickly in patients over 50

2.7.2. 44% are among gay/bisexual men

2.7.3. Less use of condoms because no risk of becoming pregnant

2.7.4. Many embarrassed to seek treatment, symptoms may not be recognized as HIV because of common aging problems

3. Respiratory

3.1. Calcification of costal cartilage

3.2. Trachea and ribcage more rigid

3.3. Decreased cough and laryngeal reflexes

3.4. Increased residual capacity

3.5. Decreased vital capacity

3.6. Increased risk for respiratory infection

3.7. Yoga can aid in respiration

3.8. Nurses can teach all older adults to do deep breathing exercises several times daily

3.9. COPD

3.9.1. Asthma Nebulizers create risk of cardiac arrhythmia Higher rates of mortality and cardiac problems

3.9.2. Chronic bronchitis productive cough, wheezing, SOB Goal is to remove bronchial secretions

3.9.3. Emphysema stop smoking Treatment: postural drainage, bronchodilators, breathing exercises

3.10. Pnuemonia

3.10.1. Pneumococcal vaccine available for over 65

3.10.2. s&s : minimal/no fever or pleuritic pain- confusion, restlessness, cough, fatigue, rapid respiration

4. Cellular changes & Cancer

4.1. Decreased number of cells and lean mode mass

4.2. Increased body fat

4.3. Decreased intracellular fluid and less total body fluid

4.4. DNA condenses which causes less synthesis of RNA

4.5. Increase in lipids inside the cell

4.6. C

4.6.1. Change in bowel or bladder habits

4.7. A

4.7.1. A sore that does not heal

4.8. U

4.8.1. Unusual bleeding or drainage

4.9. T

4.9.1. Thickening or lump in the breast or elsewhere

4.10. I

4.10.1. Indigestion or swallowing difficulty

4.11. O

4.11.1. Obvious change in a wart or mole

4.12. N

4.12.1. Nagging persistent cough or hoarseness

4.13. Treatment

4.13.1. Surgery, radiation, chemotherapy, and CAM


4.15. Thymus decreases in size

4.16. T cells decline

4.17. Two theories

4.17.1. Biological age-related changes that impair the ability to resist diseases

4.17.2. Prolonged exposure to carcinogens over the years

5. Cardiovascular

5.1. Heart muscle loses efficiency and contractile strength

5.2. Decreased cardiac output with physiologic stress

5.3. Valves thicken and become more rigid

5.4. Decreased elasticity in blood vessels

5.5. Decreased efficient oxygen usage

5.6. Increased systolic BP and baroreceptors don’t respond as well

5.7. Stroke volume decreases

5.8. Aorta becomes dilated

5.9. Myocardial muscle use is less efficient- with decreased contractile strength and decreased CO when demands increase.

5.10. Less sensitive to baroreceptor regulation of BP

5.11. Aorta becomes dilated

5.12. Myocardial muscle use is less efficient- with decreased contractile strength and decreased CO when demands increase.

5.13. Less sensitive to baroreceptor regulation of BP

5.14. CHF

5.14.1. Leading cause of hospitalization in older adults

5.14.2. CAD and HTN are major causes

5.14.3. SX: dyspnea on exertion, confusion insomnia, wandering during night, aviation, SOB, weakness

5.14.4. Moist crackles heard ok auscultation

5.14.5. Treatment is bed rest, medications, reduce sodium intake

5.15. CAD

5.15.1. Myocardial Infarction can be delayed or missed in older adults because of atypical SX and less severe pain

5.15.2. Encourage early ambulation after MI prevents immobility complications and better for heart workload

5.15.3. Close observations for signs of bleeding, edema or CHF

5.15.4. Angina: pain may be diffuse and less sever than younger adults

5.15.5. Nitroglycerin is effective- watch for orthostatic hypotension

6. Gastrointestinal

6.1. Decreased taste sensations

6.2. Decreased esophageal motility

6.3. Atrophy of small and large intestines

6.4. Increased risk of aspiration, indigestion, and constipation.

6.5. Esophageal and stomach motility decreased and elasticity of stomach is reduced

6.6. Stomach is more alkaline as a result of decline in hydrochloride acid and pepsin

6.7. Slower peristalsis, inactivity, reduced food/ fluid intake, drugs, and low-fiber diet (increased risk of constipation

6.8. Pancreas changes and affects digestion of fats

6.9. Atrophy of the tongue- affects taste buds

6.10. Esophageal and stomach motility decreased and elasticity of stomach is reduced

6.11. Stomach is more alkaline as a result of decline in hydrochloride acid and pepsin

6.12. Slower peristalsis, inactivity, reduced food/ fluid intake, drugs, and low-fiber diet (increased risk of constipation

6.13. Pancreas changes and affects digestion of fats

6.14. Atrophy of the tongue- affects taste buds

6.15. Diverticulitis

6.15.1. Bowel contents can accumulate in the diverticula and decompose, causing inflammation and infection

6.15.2. Surgery performed medical management is unsuccessful or if serious complications occur, may consist of a resection or temporary colostomy

6.16. Colorectal Cancer

6.16.1. cancer at any site along the large intestine is common with advancing age. The sigmoid colon and rectum tend to be frequent sites for carcinomas; in fact, colorectal cancer is second leading cause

6.16.2. S&S: rectal bleeding, bloody stools, change in bowel pattern, anorexia, nausea, weakness, anemia

7. Musculoskeletal

7.1. Pain

7.1.1. 3 in 5 patients 65 or older experience pain for 1 year or more

7.1.2. Severe joint pain increases with age

7.1.3. Persistent pain is chronic pain present 3 months or longer.

7.1.4. Nociceptive pain arises from mechanical, thermal, or chemical noxious stimuli (somatic or visceral.

7.1.5. Arthritis

7.2. Sarcopenia

7.2.1. Due to protein not being synthesized

7.2.2. Decline in size and number of muscle fibers

7.2.3. Reduction in muscle mass

7.2.4. Decreased body strength

7.2.5. Endurance declines

7.2.6. Reduced flexibility of joints and muscles

7.3. Exercise

7.3.1. All exercise programs should address:

7.3.2. Cardiovascular endurance

7.3.3. Flexibility

7.3.4. Strength training

7.4. Fractures

7.4.1. The absence of typical signs of fracture does not guarantee no fracture present

7.4.2. Osteoarthritis Progressive deterioration of joint cartilage with the formation of new bone at joint surface Cause: flaw in the production that produces cartilage Risk factor: genetics and obesity Crepitus occurs often with these patients Therapy must relieve joints Therapeutic hot/cold compress Stem cells is a new treatment needed if joint has not fully deteriorated

7.4.3. Brittle bones fracture more easily and heal at slower rate

7.4.4. Most common sites: hips, forearm

7.4.5. Oftentimes different signs and symptoms than younger adults- such as less pain

7.4.6. Rheumatoid Arthritis Inflammation Deformities and disability can begin at an early age and peak during middle age Females are more common

7.4.7. Osteoporosis Pathology, not age related changes Prevention: dietary in early adulthood- calcium intake Inactivity is a huge risk factor Kyphosis, spinal pain, and fractures Diagnosis: bone density Often asymptomatic until the patient falls and fractures something

7.4.8. Gout More MEN have this Metabolic disorder in which excess Uris acid accumulates in the blood Occurs 1st in the toes- red and inflamed Beer and high protein foods exasterbate symptoms Symptoms: extreme pain

7.5. Pediatric Conditions

7.5.1. Plantar fasciitis

7.5.2. Onychomycosis: nail fungus

7.5.3. Calluses

7.5.4. Corns

8. Nervous

8.1. Decrease in weight and blood flow to the brain

8.2. Decreased neurons and nerve fibers as well as cerebral blood flow

8.3. Decreased response to change in balance

8.4. Decreased temperature regulation from the hypothalamus

8.5. Sleep pattern changes with frequent awakening and less time in REM sleep

9. Reproductive

9.1. Vaginal canal shortens and narrows

9.2. Reduction in collagen and adipose tissue

9.3. Less lubrication

9.4. More alkaline vaginal pH as result of lower estrogen

9.5. Uterus and ovaries decrease in size

9.6. Breasts sag and are less firm

9.7. Some retraction of nipples related to shrinkage and fibrotic changes

9.8. Fallopian tubes become shorter and straighter

9.9. Seminal vesicles develop thinner epithelium in males

9.10. Decreased capacity to retain fluids

9.11. Enlarged prostate gland

9.12. Atrophy of testes and reduction in testicular mass

9.12.1. Ejactulation fluid contains less live sperm

9.13. more time required to achieve an erection

9.13.1. testosterone slightly decreases

10. Endocrine

10.1. Decreased thyroid gland activity and ACTH secretion

10.2. Increased adipose and look glucose in nondiabetic patients.

10.3. Decreased basal metabolic rate

10.4. Decreased adrenal function

10.5. Thyroid gland atrophies and activity decreases

10.6. Decreased volume of pituitary gland and delayed insulin release due to beta cells

10.6.1. reduced sensitivity of circulating insulin

10.7. Decreased ability to metabolize glucose

10.8. Hormones are broken down slower

10.8.1. Testosterone levels decrease in males

10.9. 2 classes

10.9.1. steroids

10.9.2. thyronines

10.10. Diabetes Mellitus

10.10.1. 7th leading cause of death among older adults

10.10.2. effects 20 % of the older population and high prevelance among African Americans and people 65-74 years old

10.10.3. Glucose tolerance test is most effective, however multiple tests need to be done

10.10.4. 20-33% of all older adults have insulin issues

10.10.5. stress causes glucose levels to rise

10.10.6. False positive test results are common

10.10.7. Complications PVD, diabetic retinopathy, CAD, frequent UTIs, cancer and cardiovascular mortality, polypharmacy, falls, fractures, blindness, cognitive impairment, neuropathies.

10.10.8. Glucose level below 90 is more detrimental to cardiovascular health than 130 Hypoglycemia is a greater threat than ketoacidosis

10.10.9. Criteria for diagnosis: must have 1 of 3 symptoms and random blood glucose concentration > 200 mg/dL Fasting blood glucose concentration > 126 mg/dL Blood glucose concentrations 2 hours after oral glucose intake > 200 mg/dL

10.10.10. Insulin Rapid-acting Lispro/ aspart Short-acting inject 30 minutes before meal Intermediate acting old-school Long-acting glargine

10.11. Hypothyroidism

10.11.1. meds are permanant

10.11.2. types primary- low T4, high TSH secondary- low T4, low TSH

10.11.3. signs- everything slows down: fatigue, depression, weight gain, constipation, dry skin, coarse hair, anorexia, pt. complains of being cold

10.12. Hyperthyroidism

10.12.1. signs- everything speeds up: diaphoresis, hypertention, diarrhea, insomnia

10.12.2. Graves- autoimmune antibody that attacks TSH treat with radioactive iodine

10.12.3. Goiter- toxic mutinodular dysfunction of nodular gland surgical removal is necessary

11. Integumentary

11.1. Dry and fragile skin, less elasticity

11.2. Decreased subcutaneous fat and sweat gland activity

11.3. Increased benign and malignant skin neoplasms

11.4. Thinner skin and paler and translucent

11.5. Age spots and pigments

11.6. Changes in connective tissue

11.7. Keratosis- small light- colored benign lesions on epidermis

11.8. Melanocytes- epidermal cells that give skin its color

11.9. Monogolian spots- dark irregular areas that look like bruises and may be found on the buttocks, lower back, and to a lesser extent on the arms, abdomen, and thighs

11.9.1. These are more prevalent in African, Asian, or Native American background.

11.10. Photoaging is caused by exposure to ultraviolet rays that damage the skin: the condition is called solar elastosis

11.11. Stasis Ulcers

11.11.1. Control infections, remove necrotic tissue to facilitate healing

11.11.2. Leg ulcers from stasis dermatitis

11.11.3. Good nutrition and high vitamins

11.11.4. Promote venous return by elevating legs and wearing elastic stockings

11.12. Pruritus

11.12.1. RF: Diabetes, arteriosclerosis, hyperthyroidism, liver disease, cancer, excessive bathing

11.12.2. Prompt recognition to treat dry skin or underlying problem

11.12.3. Vitamin supplements and vitamin rich diets are encouraged

11.12.4. Meds: topical zinc oxide, antihistamines, topical steroids

12. Vision and Hearing

12.1. Presbycusis- progressive hearing loss that occurs due to age-related changes of the inner ear

12.2. Ear lobes sag and enlarge

12.3. High pitched noises are harder to hear

12.3.1. Lip reading may be necessary for older people to learn what others are saying without hearing aids

12.4. Inner ear changes cause presbycusis to be the most common

12.5. Preventing hearing loss is most important in younger ears by using ear plugs when you can

12.6. Hearing aids or cochlear implants may be necessary depending on hearing loss


12.7. Education is necessary so that hearing tests are done at yearly physical appointment

12.8. Increased cerumen and concentration of keratin

12.9. Ears

12.9.1. exposure to noise, recurrent otitis media, certain drugs can all impair hearing

12.10. Cataracts

12.10.1. clouding of crystalline lens of eye

12.10.2. blue eyes are more prone

12.10.3. symptoms: no discomfort or pain is associated, vision distorted, night vision decreased, objects appear blurred, feels like they have a film over their eye while driving, halo effect

12.10.4. treatment: surgery to remove the lens is the only cure for a cataract unless that patient has another eye that can see and doesn't want surgery.

12.11. Glaucoma

12.11.1. eye disease involving increased intra-ocular pressure

12.11.2. Atenolol and drops can help

12.11.3. By watching the pressure and catch early, you can sometimes treat

12.11.4. Normal eye pressure= under 20

12.11.5. Chronically untreated can cause all vision loss

12.11.6. Acute glaucoma- sudden intra-ocular pressure must check within a day or permanent blindness can occur

12.11.7. Retinal detachment- floating in front of eyes *THIS IS A MEDICAL EMERGENCY*

12.11.8. Diabetic retinopathy- effects blood vessels in the back of the eyes this is a late stage finding

12.12. Presbyopia is an age- related decrease in eye's ability to change the shape of lens to focus on near objects

12.13. Macular degeneration is the loss of central vision due to the development of drusen deposits in the retinal pigmented epithelium

12.13.1. Pathology most common for blindness

12.14. Education

12.14.1. Nurses should stress the importance of annual eye exams for older adults because the earlier they detect an issue, the more treatable it will be.

12.14.2. Taking Vitamin A maintains healthy rods and cones in the retina

12.14.3. Zinc promotes normal visual capacity and adaptation to dark Deficiency in this can facilitate cataract development

12.14.4. Vitamin C promotes normal vision; supplementation may reduce risk of cataracts

12.14.5. Vitamin E may aid in preventing cataracts and supplementation in large doses can prevent macular degeneration

12.14.6. Selenium may aid in preventing cataracts

13. Sleep

13.1. Increased severity. With age of restless leg syndrome.

13.2. Sleep apnea is 3x as likely in men and increased in obese and overweight patients.

13.3. Insomnia is more present with daytime sleepiness and napping

13.4. Circadian sleep-wake cycles: phase advance is common where older adults go to bed earlier and wake up earlier.

13.5. Sleep latency- delay in the onset of sleep.

13.6. Insomnia is more present with daytime sleepiness and napping

13.7. Sleep apnea

13.7.1. Snoring accompanies this

13.7.2. Sleep disorder clinics and treatment includes weight reduction, medications, continue Luis positive airway pressure, surgery

13.7.3. Can be caused by defect in CNS, blockage in upper airway, or mixed

13.7.4. At least 5 episodes of cessation of breathing, Lawton at least 10 seconds, occur per hour of sleep, accompanied by day time sleepiness

13.8. Circadian sleep-wake cycles: phase advance is common where older adults go to bed earlier and wake up earlier.

13.9. Restless leg syndrome

13.9.1. Uncontrollale urge to move the legs

13.9.2. Uncomfortable, electrical, itching, pins and needles, pulling, painful

13.9.3. Causes: iron deficiency anemia, uremia, Parkinson's disease

13.9.4. Treatment: dopaminergic drugs, bezos, opioids, anticonvulsants, adrenergic, iron supplements

14. Immunity

14.1. Cancer

14.1.1. Additional screening with increased age

14.1.2. Conventional treatment: surgery, radiation, chemotherapy, biological therapy

14.1.3. Complementary therapy: special diets, psychotherapy, spiritual practices, vitamin supplements, herbal remedies

14.1.4. Prolonged closure to carcinogens

14.1.5. Changes in immune system impair body's ability to recognize cancerous calls and destroy them

14.2. Decreased t-call activity and cell-mediated immunity

14.3. Decreased inflammatory defenses and cytotoxic response

14.4. Increased inflammation

14.5. Decreased normal body temperature

14.6. Vaccinations aren’t quite as effective

14.6.1. Still needs flu shots hearly

15. Neuro

15.1. Acutely ill patients

15.2. This effects all aspects of ADLs

15.3. Loss of nerve cell mass

15.4. Atrophy of the brain and spinal cord

15.5. Demyelinization

15.5.1. Slows reaction time and reflexes are weaker

15.6. Decreased cerebral blood flow

15.6.1. Exercise can help with this

15.7. Free radicals accumulate

15.8. Intellectual performance maintained until at least 80 years of age

15.9. Verbal skills maintained until age 70

15.10. Number of sensitivity of sensory receptors, dermatomes, and neurons decrease

15.11. Decline in function of cranial nerves affecting taste and smell

15.12. Delay in time required to perform tasks

15.13. Health promotion

15.13.1. Detect measures and subtle indications

15.13.2. An early morning headache or wakes you up at night

15.13.3. Ringing in the ears, tingling, vision changes

15.14. Parkinson’s disease

15.14.1. Role of dopamine

15.14.2. More common in males

15.14.3. Cause is unknown Environmental exposures such as farming causes an increased risk factor

15.14.4. Signs and symptoms: tremors, mask face, shuffling gate, muscles rigidity Falls can be unaccounted for in the beginning which is a sign

15.14.5. Symptom management Anticholinergic meds

15.14.6. Hallucinations can often occur, but not always

15.15. TIA

15.15.1. Temporary or intermittent reduction in cerebral perfusion

15.15.2. Vision changes can occur

15.15.3. Recovery in a day

15.15.4. Precursor for cerebral attack

15.15.5. Third leading cause of death in older adults

15.15.6. Ischemic or hemmorrhagic

15.15.7. Warning sign of stroke: Face, Arms, Smile, and talk or check time F.A.S.T.

15.15.8. Early rehabilitations

15.16. Nursing Considerations

15.16.1. Assistive devices

15.16.2. Periodic home visits

15.16.3. Regular contact with family and friends

15.16.4. Promoting self- care

15.16.5. Promoting INDEPENDENCE- personality problems may occur

15.16.6. Depression is often commo

15.16.7. Displaced reactions Stroke patient that yells at the nurse

15.16.8. Loss of former roles and identities