Older Adult

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Older Adult by Mind Map: Older Adult

1. Cardiovascular

1.1. Common changes with aging

1.1.1. Less efficient O2 utilization

1.1.2. Heart muscle looses efficiency and contractile strength

1.1.3. Blood vessels loose elasticity which increases blood pressure

1.1.4. Reduced cardiac output with physiological stress

1.1.5. Heart dimensions are unchanged but the aorta is elongated and dilated

1.1.6. Valves become thick and rigid

1.1.7. More prominent arteries in head, neck and extremities

1.2. Pathology

1.2.1. Congestive heart failure Leading cause of hospitalization in older adults Coronary artery disease is responsible for most cases of CHF, followed by hypertension Symptoms can be dyspnea on exertion (most common finding), confusion, insomnia, wandering during the night, agitation, weakness, SOB, orthopnea, weight gain, and wheezing Management includes bed rest, ACE inhibitors, beta-blockers, digitalis, diuretics, and reduction of sodium intake

1.2.2. Hypertension Consistent blood pressure reading of >140 systolic and >90 diastolic Most prevalent cardiovascular disease of older adults May arise from vasoconstriction that occurs with advanced age which produces peripheral resistance Symptoms can include awakening with a dull headache, impaired memory, disorientation, confusion, and a slow tremor Patients should reduce sodium intake and and if necessary reduce their weight

1.2.3. Coronary artery disease Angina is a symptom of myocardial ischemia, it presents in an atypical pattern for older adults so detection is difficult Nitroglycerin is effective in the treatment of anginal attacks Myocardial infarction is frequently seen in older adults, especially in men with a history of hypertension and atherosclerosis Symptoms include pain radiating to the left arm and the entire chest, numbness in arms, moist pale skin, decreased blood pressure and SOB

2. Gastrointestinal

2.1. Common changes with aging

2.1.1. Decrease in hydrochloric acid so nutrients don’t absorb as well

2.1.2. Reduction in saliva and salivary ptyalin

2.1.3. Slower peristalsis, inactivity, reduced fluid intake, and a diet low in fiber leads to high rates of constipation

2.1.4. Increased risk of aspiration, indigestion and constipation

2.1.5. Atrophy of small and large intestines

2.1.6. Decreased esophageal motility

2.1.7. Less acute taste sensations

2.1.8. Bile salt synthesis decreases, contributing to the risk of gallstone development

2.2. Pathology

2.2.1. Hiatal hernia Portion of the stomach protrudes through an opening in the diaphragm Two types are sliding (axial) and rolling (paraesophageal), sliding is the most common Causes can include a history of GERD and a low fiber diet Symptoms include heartburn, dysphasia, belching, vomiting, and regurgitation

2.2.2. Esophageal cancer The most common types are squamous cell carcinoma and adenocarcinoma Poor oral hygiene, chronic irritation from tobacco, alcohol, and Barrett's esophagus can be causes Dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia, and chronic bleeding are symptoms Symptoms are often not recognized until the disease is advanced, contributing to a poor prognosis

2.2.3. Intestinal obstruction Partial or complete impairment of flow of intestinal contents in the large intestines usually occurs from cancer of the colon; adhesions and hernias are primary cause of obstruction in the small intestine Other causes include diverticulitis, ulcerative colitis, hypokalemia, and paralytic ileus Symptoms include abdominal pain, vomiting, abdominal distention, ,high-pitched bowel sounds or absent bowel sounds if it has persisted for a long time Timely intervention is essential to prevent serious complication

3. Urinary

3.1. Common changes with aging

3.1.1. Decrease in the number of nephrons

3.1.2. Weaker bladder muscles

3.1.3. Decreases in kidney mass, blood flow, GFR (10% decrement/decade after age 30). Decreased drug clearance

3.1.4. Reduced bladder elasticity, muscle tone, capacity

3.1.5. Increased postvoid residual, nocturnal urine production

3.2. Pathology

3.2.1. Urinary incontinence Involuntary loss of urine that can be caused by many different aspects 90% of nursing home residents experience urinary incontinence and 24% of people in the community There are different types that include stress, urgency, overflow, neurogenic, functional, and mixed incontinence The initial goal for incontinent individuals is to identify the cause of the incontinence Kegal exercises, biofeedback, and the use of a pessary and medications may be useful in the improvement of incontienence The nurse should thoroughly cleanse and dry a patient's skin after an inconteinent episode

3.2.2. Bladder cancer 90% of the cases of bladder cancer are in people over the age of 55, and is seen more frequently in older men Causes can include chronic irritation of the bladder, exposure to dyes, and cigarette smoking; which are all avoidable factors Symptoms can include urgency, frequency, dysuria and painless hematuria which is the primary sign Treatment can include surgery, radiation, immunotherapy or chemotherapy depending on the extent and location of the lesion

4. Reproductive

4.1. Common changes with aging

4.1.1. Women Fallopian tubes atrophy and shorten Ovaries become thicker and smaller Drier, less elastic vaginal canal Uterus and cervix get smaller Vulva atrophies and is more susceptible to infection Flattening of labia Loss of subcutaneous fat and hair More alkaline vaginal pH as a result of lower estrogen changes Breasts sag and are less first, some retraction of nipple related to shrinking

4.1.2. Men Seminal vesicles develop thinner epithelium Muscle tissue replaced with connective tissue Atrophy of testes and reduction in testicular mass Ejaculation fluid contains less live sperm Testosterone stays the same or decreases slightly Enlargement of prostate gland More time required to achieve an erection

4.2. Pathology

4.2.1. Infections of the vulva Age-related changes to the vulva cause it to be more fragile and more easily susceptible to irritation and infection Valvular problems in the older women may reflect serious disease processes such as diabetes, hepatitis, leukemia, and pernicious anemia Senile vulvitis is the term used to describe vulvular infection associated with hypertrophy and atrophy Incontinence and poor hygiene practices can also be an underlying cause of vulvitis Pruritus is the primary symptoms associated with vulvitis

4.2.2. Cancer of the ovaries Responsible for 5% of malignant disease in older women, and is the leading cause of death in gynecologic malignancies Early symptoms are nonspecific and can be confused with GI discomfort Symptoms include bleeding, ascites, and the presence of multiple masses Treatment may consist of surgery and irradiation

4.2.3. Benign prostatic hyperplasia Nonmalignant enlargement of the prostate gland Symptoms progress slowly but continuously can can include hesitancy, decreased force of urinary stream, frequency, and nocturia Unfortunately, some men are reluctant and embarrassed to seek treatment and may develop kidney damage as a result Treatment can include prostatic massage, the use or urinary antiseptics, avoidance of diuretics and anticholinergics The most common prostatectomy approach used for older men is a transurethral resection of the prostate

5. Immune

5.1. Common changes with aging

5.1.1. T cell activity decline

5.1.2. Cell mediated immunity declines

5.1.3. Inflammation presents atypically

5.1.4. Increased susceptibility to infection

5.2. Pathology

5.2.1. Cancer Second leading cause of death in persons age 65 and older Lowest rates of early detection is in older adults Reducing risk of cancer can include avoiding the use of tobacco products, limit exposure to the sun, eat a diet rich in fiber, fruits and veggies, maintain ideal weight, limit alcohol consumption, and avoid exposure to carcinogens Annual checkups that examine the oral cavity, thyroid, breasts, ovaries, testes and skin may help with prevention The plan of treatment depends on the specific cancer, most conventional forms of treatment include surgery, radiation, chemotherapy, and biologic therapy Complementary and alternative medicines such as special diets, psychotherapy, spiritual practices, vitamin supplements, and herbs remedies may also be helpful in treatment The nurse must ensure that patients understand the warning signs of chancer such as change in bowel or bladder habits, a sore that does not heal, unusual bleeding or drainage, thickening or lump in the breast or elsewhere, indigestion, obvious change in wart or mole, and nagging or persistent cough

6. Sexuality

6.1. Common changes with aging

6.1.1. Erectile dysfunction which results in the inability to attain and maintain an erection of the penis

6.1.2. Low testosterone in men can result in reduced muscle mass, energy, strength and stamina

6.1.3. Older women may experience dyspareunia or painful intercourse as a result of less lubrication, decreased distensibility, and thinning of vaginal walls

6.1.4. Menopause is a permanent cessation of menses and is a permanent transition in a women’s life

6.1.5. A drop abuse is testosterone level decrease in men but it does not occur in all men

6.1.6. Decrease in sexual responsiveness and a reduction in the frequency of orgasm

6.2. Pathology

6.2.1. HIV/AIDS The incidence of AIDS has increased more than twice as quickly in people over age 50 than in younger adults 44% of the new HIV infections from persons over age 55 are among gay or bisexual men Sexually active older adults who have sex with new are multiple partners may not consider using a condom because pregnancy is no longer a risk Some older adults who have contracted the disease are too embarrassed to seek medical attention Older adults must be educated about the risks and warning signs associated with HIV

7. Cellular Changes

7.1. Common changes with aging

7.1.1. Total body fat increases

7.1.2. Function cell number decreases

7.1.3. Intracellular fluid reduces which leads to less total body fluid

7.1.4. Lean body mass decreases

8. Symptoms include fatigue, weakness, depression, anorexia, weight gain, impaired hearing, peripheral edema, constipation, cold intolerance, ataxia, and dry skin

9. Respiratory

9.1. Common changes with aging

9.1.1. Calcification of costal cartilage which makes the rib cage more rigid

9.1.2. High risk of respiratory infection

9.1.3. Lungs become smaller, less firm, lighter and have less recoil

9.1.4. Decrease in secretions in mouth and thicker secretions

9.1.5. Reduction of cough and laryngeal reflexes

9.1.6. Increase in anterior-posterior chest diameter

9.1.7. Decreased respiratory muscle strength; stiffer chest wall with reduced compliance

9.1.8. Diminished ciliary & macrophage activity, drier mucus membranes. Decreased cough reflex

9.1.9. Decreased response to hypoxia and hypercapnia

9.2. Pathology

9.2.1. Chronic bronchitis Persistent, productive cough, wheezing, recurrent respiratory infections and shortness of breath are all caused by chronic bronchitis Symptoms may develop gradually, sometimes taking years to have full impact and for the disease to be noticed The condition results from recurrent inflammation and mucous production in the bronchial tubes, which over time, produce blockage and scarring that restrict airflow Management is acmes at removing bronchial secretions and preventing obstruction of the airway

9.2.2. Pneumonia Especially bronchopneumonia is one of the leading causes of death in the older adult population Can be caused by poor chest expansion and more shallow breathing due to bronchial obstruction, high prevalence of respiratory distress, lowered resistance for infection and immobility Pneumcoccal pneumonia caused by streptococcus pneumonia's the most common pneumonia in older adults Close observation for subtle changes is very important for older adults Pneumococcal vaccines are very recommended for adults over the age of 65

10. Musculoskeletal

10.1. Common changes with aging

10.1.1. Decrease bone mineral, bone mass, and calcium absorption

10.1.2. Reduced muscle mass, strength and movement

10.1.3. Thinning disks and shortened vertebrae

10.1.4. Increase risk of fractures

10.1.5. Sarcopenia with increased weakness and poor exercise tolerance

10.1.6. Bone loss in women and men after peak mass at 30 to 35 years

10.1.7. Decreased ligament and tendon strength. Intervertebral disc degeneration. Articular cartilage erosion. Changes in stature with kyphosis, height reduction

10.2. Pathology

10.2.1. Osteoporosis Bone condition characterized by low bone density and porous bones Osteoporosis affects men and women of all races, but white and Asian women especially and older women who are past menopause Symptoms include back pain, caused by a fractured or collapsed vertebra, loss of height over time, stooped posture, bone fracture that occurs much more easily than expected Risk factors include your gender, age, race, family history and body frame size

10.2.2. Osteoarthritis Progressive deterioration and abrasion of the joint cartilage, with formation of new bone at the joint surfaces Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury Unlike rheumatoid arthritis, it does not cause inflammation, deformity or crippling; Excessive use of the joint, obesity, trauma, low vitamin D and C levels, and genetic factors can be causes Usually, osteoarthritis affects several joint, instead of just one and weight bearing joints like the knees, hips and vertebrae are the most common sites Analgesics may be prescribed to control pain, acetaminophen is the first drug of choice followed by NSAIDs

11. Nervous

11.1. Common changes with aging

11.1.1. Each of 5 senses become less efficient

11.1.2. Slower response and reaction time

11.1.3. Hypothalamus less effective in temperature regulation

11.1.4. Decline in weight and blood flow to brain

11.1.5. Reduction in neurons, nerve fibers, and cerebral blood flow

11.1.6. Reduction in tactile sensation

11.1.7. Change in sleep patterns, frequent waking

11.1.8. Decreased temperature sensitivity. Blunted or absent fever response

11.1.9. Slowed speed of cognitive processing. Some cognitive decline is common but not universal. Most memory functions adequate for normal life

11.2. Pathology

11.2.1. Parkinson's disease Progressive degeneration of the neurons in the basal ganglia resulting in the reduced production of dopamine PD is more common in men and occurs most frequently in the 5th decade of life It's exact causes is unknown but the disease is thought to be associated with a history of exposure to toxins, encephalitis, and cerebrovascular disease Symptoms include tremors, muscle rigidity, weakness, drooling, dysphagia, monotone voice, bradykinesia, poor balance, shuffling gait, and a mask-like affect Carbidopa and Levodopa are two of the most widely used drugs for PD patients Active and passive ROM exercises maintain and improve joint mobility, warm baths and massages may relieve muscle spasms and muscle rigidity

11.2.2. Transient ischemic attack Temporary or intermittent neurological event that can result from any situation that reduces cerebral circulation Causes can include anemia, certain drugs like diuretics or antihypertensives, and cigarette smoking Symptoms include hemiparesis, hemianestheia, aphasia, unilateral vision loss, diplopia, vertigo, nausea, vomiting, and dysphagia These signs can last from minutes to hours, and complete recovery is usually within a day Treatment includes correction of the underlying cause, anticoagulant therapy, and vascular reconstruction

12. Endocrine

12.1. Common changes with aging

12.1.1. Delayed and insufficient insulin release

12.1.2. Thyroid gland decreases in function which leads to less T3 and a decrease in metabolism

12.1.3. Decrease in ACTH secretion which decreases glucose metabolism

12.1.4. Decrease in pituitary gland function and it's volume decreases

12.1.5. Adrenocorticotropic hormone secretion decreases, which reduces the secretion of estrogen, progesterone, androgens, and glucocorticoids

12.2. Pathology

12.2.1. Hypothyroidism A subnormal concentration of thyroid hormones in the tissues More common in women than men Can either be primary, resulting from a disease process that destroys the thyroid gland, or secondary caused by an insufficient pituitary secretion of TSH Treatment includes replacement of thyroid hormones using synthetic T4, initially a low dose is recommended

12.2.2. Hyperthyroidism The thyroid gland secretes excess amounts of thyroid hormones A potential cause in older patients that should be considered is related to the use of Amiodarone, a cardiac drug containing iodine Symptoms include diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, insomnia, confusion, heat intolerance and hyperreflexia Treatment depends on the cause. Surgery may be preferred Patients need special monitoring when experience an acute illness or trauma because it can lead to a thyroid storm

13. Integumentary

13.1. Common changes with aging

13.1.1. Reduced sweat gland activity

13.1.2. Les elastic , dry, and fragile skin

13.1.3. Decrease in subcutaneous fat

13.1.4. Lines and wrinkles in the skin

13.1.5. Flatenning of the dermal-epidermal junction

13.1.6. Reduced thickness, and vascularity of the dermis

13.1.7. Decreased rate of epidermal turnover

13.1.8. Degeneration of elastic fibers

13.1.9. Reduction on melanocytes

13.2. Pathology

13.2.1. Seborrheic keratosis Dark, wart-like projections on the skin They tend to increase in size and number with age Sometimes abrasive activity with a gauze pad containing oil will remove small seborrheic keratosis Larger raised lesions can be removed by freezing agents or by a curettage and cauterization procedure

13.2.2. Skin Cancer Basal cell carcinoma, squamous cell carcinoma, and melanoma are the three most common types of skin cancer later in life Basal cell carcinoma is the most common form of skin cancer, it grows slowly and rarely metastasizes Risk factors can include advanced age, exposure to the sun, exposure to ultraviolet radiation, and therapeutic radiation Suspicious lesions should be evaluated and biopsied The nurse should teach olde adults to inspect for melanomas, identify moles that demonstrate changes in pigmentation or size; early detection improves the prognosis

14. Hearing

14.1. Common changes with aging

14.1.1. Increase in cerumen, impacted cerumen

14.1.2. Presbycusis- progressive hearing loss

14.1.3. Distortion of high pitched sounds

14.2. Pathology

14.2.1. Hearing loss Exposure to noise from loud music, jets, traffic, heavy machinery, and guns are all causes of hearing loss Recurrent otitis media and trauma can also damage hearing Certain drugs may be ototoxic including aspirin, bumetanide, erthacrynic acid, furosemide, erythromycin and streptomycin Impaired hearing is associated with social isolation, depression, the risk of dementia, and higher mortality rate

15. Sleep

15.1. Common changes with aging

15.1.1. Insomnia, daytime sleepiness, and napping are all highly prevalent among older adults

15.1.2. Phase advance occurs when the older adult falls asleep earlier in the evening and awakes earlier in the morning

15.1.3. Chronic conditions can interfere with sleep by producing symptoms like nocturia, incontinence, pain, apnea, muscle cramps and tremors

15.2. Pathology

15.2.1. Restless legs syndrome neurological condition characterized by an uncontrollable urge to move the legs Patient's with this condition describe the sensations as "uncomfortable", "electrical", "pins and needles", and "painful" Moving the legs brings relief of the sensations but also interferes with sleep Causes can include iron deficiency anemia, diabetes, PD, RA, uremia or neurological lesions Most conditions are treated with dopaminergic drugs, benzodiazepines, opioids, anticonvulsants, adrenergic, and iron supplements