1. Frailty
1.1. Weakness Weight loss: 10% a year Muscle wasting Exercise intolerance Decrease in Grip Strength Frequent falls Immobility Instability of chronic diseases
1.2. Preclinical Signs Sarcopenia Osteopenia Nonspecific balance disorders Nutritional problems Deconditioning Possible Causes Hormonal dysregulation Immuno-aging Pro-coagulation Pro-inflammatory status
1.2.1. Osteoporosis
1.2.1.1. Reduced bone density
1.2.1.2. Less vitamin D
1.2.2. Sarcopenia
1.2.2.1. Loss of muscle mass
1.2.2.2. Often a component of cache is as well
2. Sleep and sexual intimacy
2.1. Andopaus
2.1.1. Testosterone levels decline in men Does not occur in all men Low testosterone levels in older men can result in reduced muscle mass, energy, strength, and stamina Other changes: erectile dysfunction, breast enlargement, osteopenia, osteoporosis, and shrinkage of testes
2.2. Menopause
2.2.1. permanent cessation of menses
2.3. More time in stages I and II, less time in stages III and IV Less sound sleep, delay in onset of sleep
3. Cardiovascular
3.1. Heart dimensions are unchanged Heart muscle loses efficiency and contractile strength + reduced cardiac output with physiologic stress Valves become thick and rigid Blood vessels reduce elasticity Oxygen used less efficiently
3.1.1. Hypertension
3.1.1.1. Incidence and prevalence increases with age Evaluation of blood pressure Systolic blood pressure 140 mm Hg Diastolic blood pressure 90 mm Hg Factors to consider when monitoring blood pressure: anxiety, stress, and activity before assessment Symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor Wide range of treatment
3.1.2. Hypotension
3.1.2.1. Decline in systolic blood pressure of 20 mm Hg or more after changing positions Postural and postprandial hypotension due to increased intake of vasoactive medications and baroreceptor sensitivity Consequences: falls, stroke, syncope, other coronary complications
4. Integumentary
4.1. Flattening of the dermal‒epidermal junction Reduced thickness and vascularity of the dermis Reduction of epidermal turnover Degeneration of elastic fibers Increased coarseness of collagen Reduction in melanocytes and atrophy of hair bulbs and decline in the rate of hair and nail growth Increased fragility of the skin Changes potentially affecting body image, self-concept, reactions from others, socialization, and other psychosocial factors
4.1.1. Seborrheic keratosis
4.1.1.1. Description of appearance Increase in size and number with age Body locations Benign lesion Medical evaluation to differentiate from precancerous lesions
4.1.2. Squamous cell carcinoma:
4.1.3. Contributing factors Sun exposure Other factors that facilitate growth Common locations Description of appearance
4.1.4. Pressure ulcers
4.1.4.1. Tissue anoxia and ischemia result in necrosis, sloughing, and tissue ulceration Common sites Predisposing factors Longer healing periods Stages: STAGE I A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved. STAGE II A partial thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister, or shallow crater. “STAGE III A full thickness of skin is lost extending through the epidermis and exposing the subcutaneous tissues; presents as a deep crater with or without undermining adjacent tissue” STAGE IV A full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone, or both; presents as a deep crater that may include necrotic tissue, exudate, sinus tract formation, and infection.
5. Immune
5.1. Overview of immune function Thymus gland declines in size Increased number of immature T cells T-cell function declines Reduced response to foreign antigens Decrease in cell-mediated and humoral immunity Decreased number of Langerhans cells in the skin Reduced thickness of the skin Decreased circulation of the skin Reduced antibody response
5.1.1. Age-related decline in immune function Increases bodies susceptibility to infection Decreased strength of the immune response High prevalence of chronic conditions increases the risk of infection Increased risk of exposure to pathogens with hospitalization and institutionalization
5.1.1.1. Pneumonia
5.1.1.1.1. HAI
5.1.1.1.2. Risk increased due to decreased immune function
5.1.1.1.3. Incentive spirometer can help prevent this complication
5.1.1.1.4. Build up and stasis of body secretions in lungs increases risk
5.1.1.1.5. Vaccines need to be taken
5.1.2. Flu
5.1.2.1. Viral infection
5.1.2.2. Can cause death
5.1.2.3. Vaccine should be given
5.1.2.4. Spread by body fluids so droplet precautions should be implemented
6. Reproductive
6.1. New node
6.1.1. Erectile Dysfunction
6.1.1.1. Can not maintain erection long enough for intercours
6.1.2. Male
6.1.2.1. Seminal vesicles develop thinner epithelium Muscle tissue replaced with connective tissue Decreased capacity to retain fluids Seminiferous tubule changes Increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen Atrophy of the testes and reduction in testicular mass Ejaculation fluid contains less live sperm Testosterone stays the same or decreases slightly More time required to achieve an erection Enlargement of the prostate gland
6.2. Female
6.2.1. Hormonal changes Vulva atrophies Flattening of the labia Loss of subcutaneous fat and hair Vaginal epithelium thins Cervix, uterus, and fallopian tubes atrophy Vaginal canal changes Reduction in collagen and adipose tissue Shortening and narrowing of the canal Less lubrication May lead to discomfort with intercourse More alkaline vaginal pH as a result of lower estrogen changes “Uterus and ovaries decrease in size Endometrium continues to respond to hormonal stimulation Fallopian tubes become shorter and straighter Breasts sag and are less firm Some retraction of nipples related to shrinkage and fibrotic changes
6.3. Dyspareunia
6.3.1. Common problem that accompanies hormonal changes Not a normal consequence of aging More frequent in nulliparous women Many gynecologic problems contribute Thorough gynecologic exam Goal: achieve a satisfactory sexual life
6.4. Breast Cancer
6.4.1. Second leading cause of cancer deaths Risk increases with age Encourage regular breast examinations Older women less likely to receive yearly mammograms and breast examinations by a health care professional Diagnosis: breast examination Treatment: chemo, surgical interventions
7. Sensory
7.1. All senses are less proficient with advanced age: vision, hearing, taste, smell, and touch Decreased efficiency of the senses can affect well-being, activities of daily living, safety and health
7.1.1. Glaucoma
7.1.1.1. Acute (closed or narrow angle) Severe eye pain, headache, nausea, and vomiting Rapid increase in tension and edema Need for early treatment to prevent blindness Diagnosis with tonometry to measure IOP “Chronic (open angle) Most common form Need for early prevention to prevent blindness Vision loss due to glaucoma cannot be restored Care and prevention of complications Avoiding situations or activities that increase IOP Avoid emotional stress Carry card or wear bracelet Avoid abuse and overuse of the eyes Patient compliance can be challenging
7.1.2. Macular degenration
7.1.2.1. Most common cause of blindness in adults over the age of 65 Damage or breakdown of the macula leading to loss of central vision Treatment can include: laser eye surgery, medication, or corrective lenses
8. Urinary
8.1. Decline of renal blood flow and glomerular filtration by approximately 50% by age 90. Reduced bladder capacity Urinary frequency, urgency, and nocturia are common in older adults Incontinence is NOT a normal part of aging Affects the ability to eliminate drugs Potential for adverse drug reactions Reduced renal function High blood urea nitrogen levels
8.1.1. Decreased tubular function Concentration of urine changes in response to water and/or sodium excess/depletion Increase in renal threshold for glucose False-negative results for glucose in the urine without symptoms
8.1.2. Nocturia
8.1.2.1. Night time urination
8.2. Urinary incomtinence
8.2.1. Common embarrassing and bothersome symptom/issue for older adults Incidence/prevalence Not normal aging Age-related changes increase the risk Can be transient or established
9. Respiratory
9.1. Calcification of costal cartilage+trachea and rib cage more rigid Reduction of cough and laryngeal reflexes Increased residual capacity and reduced vital capacity High risk for respiratory infection
9.1.1. Asthma
9.1.1.1. Can develop in older years High risk of complications of bronchiectasis, cardiac problems High rates of mortality Assess for causative factors and educate patient Evaluate aerosol nebulizers’ use Precaution: avoid adverse drug effects
9.1.2. Lung cancer
9.1.2.1. Increasing incidence in 65 years and older Higher incidence in men than in women Incidence and mortality rate varies in ethnic groups Incidence in smokers twice as nonsmokers Symptoms: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections Treatment: surgery, chemotherapy, and radiotherapy
10. Safety
10.1. Monitor body temperature Prevent infection Suggest sensible clothing Use medications cautiously Avoid crime Promote safe driving Promote early detection of problems Address risks associated with functional impairment
10.1.1. Reduce falls with night lights
10.1.2. Fractures
10.1.2.1. More common in the aging population causing an increased mobility risk
10.1.2.2. Can be linked to physical falls or pathological fractures linked to other disease processes
10.1.3. Annual vaccinations
10.1.4. Preventative screenings
10.1.5. Orthostatic hypotension
10.1.5.1. Drop in blood pressure upon shifts in posture
10.1.5.2. Can be helped with waiting periods after standing
10.1.5.3. Drink plenty of fluids
11. Musculoskeletal
11.1. Thinning disks and shortened vertebrae Reduced muscle mass, strength and movement Decreased bone mineral and mass Diminished Calcium absorption Increased risk of fractures
11.1.1. Osteoarthritis
11.1.1.1. Degeneration of joint tissue
11.1.1.2. Reduces flexibility
11.1.1.3. Pain and discomfort in joint affected
11.1.1.4. Bone spurs
11.1.2. Rheumatoid arthritis
11.1.2.1. Chronic inflammation of joints
11.1.2.2. Common in hand when disease is present
11.1.2.3. Cases stiffness, redness, swelling, and can induce a slight fever
12. Nervous
12.1. Decline in weight and blood flow to the brain Does not affect thinking and behavior Reduction in neurons, nerve fibers and cerebral blood flow Slower response to change in balance Hypothalamus less effective in temperature regulation Changes in sleep patterns with frequent awakening
12.1.1. Transient ischemic attacks
12.1.1.1. Temporary or intermittent reduction in cerebral perfusion Causes: emboli, cardiovascular complications Signs and symptoms: weakness, numbing, tingling, slurred speech Minutes to hours Recovery is usually within 1 day Treatment/management of underlying cause Increased risk of cerebrovascular accident
12.1.2. Parkinson’s disease
12.1.2.1. New node
12.1.2.1.1. “Affects ability of the central nervous system (CNS) to control body movements Role of dopamine Incidence/prevalence Exact cause unknown; some theories Signs and symptoms Secondary symptoms Treatment/management Anticholinergic medications Technologies to control symptoms Nursing interventions Education Psychosocial Physical Goal: maximum level of independence preserved”
12.1.2.2. Affects ability of the central nervous system (CNS) to control body movements Role of dopamine Incidence/prevalence Exact cause unknown; some theories Signs and symptoms: tremor, shuffled gait Secondary symptoms Treatment/management Anticholinergic medications Technologies to control symptoms Nursing interventions Education on safety and promoting safe outcomes Psychosocial relationships need to be considered Physical environment Goal: maximum level of independence preserved
12.2. Dementia
12.2.1. Irreversible Progressive Impairment in cognitive function affects Memory, orientation, reasoning, attention, language, and problem solving Caused by damage or injury to the brain 4.5 million older adults are affected
12.2.2. Alzheimer’s Disease
12.2.2.1. Most common form of dementia Incidence/prevalence Changes in the brain: Neuritic plaques containing beta-amyloid protein Neurofibrillary tangles in the cortex Loss or degeneration of neurons and synapses Changes in neurotransmitter systems
12.2.3. Other forms
12.2.3.1. Vascular dementia Frontotemporal dementia Lewy body dementia Creutzfeldt-Jakob disease Wernicke encephalopathy Parkinson’s disease AIDS Trauma and toxins
12.2.3.1.1. All can lead to Dementia
12.2.4. Caring for pt with Dementia: “Ensuring patient safety Problems related to poor judgment and misperceptions Consistent, structured environment Items to trigger memory Controlled environment Wandering behavior Prevention of abuse
12.3. Memory/intelligence
12.3.1. Basic intelligence is upheld Crystallized intelligence is maintained Fluid intelligence may decline Chronic psychological stress associated with increased incidence of mild cognitive impairment
12.4. Delirium
12.4.1. Causes: infection, hypoxia Rapid; altered level of consciousness Prompt treatment may reverse condition and prevent permanent damage Treatment/management: determination of etiology, prevention of infection or hypoxia Depends on the cause
13. Endocrine
13.1. Thyroid gland activity decreases ACTH secretion decreases Pituitary gland decreases Insulin release by beta cells is delayed and insufficient Ability to metabolize glucose is reduced Higher blood glucose in nondiabetic patients
13.1.1. Hypothyroidism
13.1.1.1. Effects of aging on the thyroid gland Subnormal concentration of thyroid hormone Prevalence Primary versus secondary hypothyroidism Signs and symptoms: fatigue, cold sensitivity, constipation, dry skin, and unexplained weight gain Treatment/management: medication(levothyroxine)
13.1.2. Hyperthyroidism
13.1.2.1. Secretion of excess amounts of thyroid hormone Incidence/prevalence Causes: cancer, hyperactive thyroid Signs and symptoms: unexpected weight loss, rapid or irregular heartbeat, sweating, and irritability, the elderly experience less or no symptoms Diagnosis: biopsy, labs Treatment/management: medication or surgical intervention
14. Gi
14.1. Atrophy of the tongue affects taste buds and decreases taste sensation Saliva production decreases Swallowing may be difficult Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter “Esophageal and stomach motility decreases Risk for aspiration and indigestion Decreased elasticity of the stomach Reduces the amount of food accommodation at one time Stomach has higher pH as a result of decline in hydrochloric acid and pepsin “Decline in hydrochloric acid Increase in incidence of gastric irritation Interferes with absorption of calcium, iron, folic acid, and vitamin B12 Decline in pepsin Interferes with absorption of protein Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D Sensory perception decreases May lead to constipation or incomplete emptying of the bowel Bile salt synthesis decreases Increase in the risk of gallstone development Pancreas changes Affects digestion of fats Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet Increase in the risk of constipation
14.1.1. Dry Mouth (Xerostomia)
14.1.1.1. Results from: Decreased saliva, some medications, Sjögren’s syndrome, mouth breathing, and altered cognition Consequences of decreased saliva production in the older adult population Interventions Saliva substitutes, sipping water, sugarless candy and gum
14.1.2. Dysphagia
14.1.2.1. Incidence of swallowing difficulties increases with age Causes Gastroesophageal reflux disease (GERD), stroke, and structural disorders Nursing assessment Goals of care and interventions: Prevention of aspiration Promotion of adequate nutritional status
15. Thermoregulation
15.1. Normal body temperatures are lowered in older age; Mean body temperature can range from 96.9 F. to 98.3 F Ability to respond to cold temperatures is reduced Response to heat is altered
15.1.1. Increases workload on the heart and the changes of the patients vasculature
15.1.1.1. Increased risk for hyperthermia
15.1.1.1.1. Weakness
15.1.1.1.2. Nausea
15.1.1.1.3. Vomiting
15.1.1.1.4. Headaches
15.1.1.1.5. Muscle cramps
15.1.1.2. Increased risk for hypothermia
15.1.1.2.1. Slurred speach
15.1.1.2.2. Weak pulse
15.1.1.2.3. Decreased respirations
15.1.1.2.4. Decreased memory function
15.1.1.2.5. Red cold skin