1. Cardiovascular System
1.1. Age-Related Changes
1.1.1. Heart dimensions unchanged
1.1.2. Lost efficiency and contractile strength
1.1.3. Reduced cardiac output with physiologic stress
1.1.4. Valves become thick and rigid
1.1.5. Reduced elasticity in blood vessels
1.1.6. Oxygen used less efficiently
1.1.7. Increased blood pressure
1.2. Abnormal Processes
1.2.1. Congestive Heart Failure
1.2.1.1. Description
1.2.1.1.1. Due to a number of combined factors, the heart muscle begins to fail/cannot keep up with the workload demanded by the body
1.2.1.1.2. Leading cause of hospitalization in older adults
1.2.1.2. Pathophysiology
1.2.1.2.1. Commonly a complication of arteriosclerotic heart disease
1.2.1.2.2. Coronary artery disease is responsible for most cases
1.2.1.2.3. Reduced elasticity and lumen size of vessels + rises in blood pressure interfere with blood supply to heart muscle
1.2.1.3. Signs/Symptoms
1.2.1.3.1. Shortness of breath
1.2.1.3.2. Dyspnea on exertion
1.2.1.3.3. Confusion
1.2.1.3.4. Insomnia
1.2.1.3.5. Agitation
1.2.1.3.6. Orthopnea
1.2.1.3.7. Wheezing
1.2.1.3.8. Weight gain
1.2.1.3.9. Edema
1.2.1.4. Nursing Interventions
1.2.1.4.1. Assess ability to perform ADLs
1.2.1.4.2. Administer oxygen as prescribed
1.2.1.4.3. Educate importance of exercise as tolerated
1.2.1.4.4. Smoking
1.2.1.4.5. Review symptoms which must be reported
2. Gastrointestinal System
2.1. Age-Related Changes
2.1.1. Taste sensations are less acute
2.1.2. Decreased esophageal motility
2.1.3. Atrophy of the small and large intestines
2.1.4. Increased risk of aspiration, indigestion, and constipation
2.1.5. Impaired absorption of certain vitamins and nutrients
2.2. Abnormal Processes
2.2.1. Hiatal Hernia
2.2.1.1. Description
2.2.1.1.1. Sliding (Axial)
2.2.1.1.2. Rolling (Paraesophageal)
2.2.1.2. Pathophysiology
2.2.1.2.1. Weakness in the diaphragm allows for the opening to stretch, allowing parts of the stomach/esophagus to advance upwards
2.2.1.2.2. Often leads to a reflux of stomach acid into the esophagus, and trapping since it cannot move back down into the stomach
2.2.1.3. Signs/Symptoms
2.2.1.3.1. Heartburn
2.2.1.3.2. Dysphagia
2.2.1.3.3. Belching
2.2.1.3.4. Vomiting/regurgitation
2.2.1.3.5. Pain
2.2.1.3.6. Bleeding
2.2.1.4. Treatment/Management
2.2.1.4.1. Barium swallow and esophagoscopy confirm diagnoses
2.2.1.4.2. Weight reduction can minimize problem in overweight patients
2.2.1.4.3. Bland diet recommended
2.2.1.4.4. Antacids and H2 blockers can be helpful for symptom relief
2.2.1.5. Nursing Interventions
2.2.1.5.1. Educate regarding diet
2.2.1.5.2. Instruct pt to eat slowly and sit upright during/1 hr post-meal
2.2.1.5.3. Avoid heavy lifting, bending, wearing girdles or tight pants, coughing/sneezing strenuously
3. Urinary System
3.1. Age-Related Changes
3.1.1. Decline of renal blood flow
3.1.1.1. Glomerular filtration by approximately 50% by age 90
3.1.1.1.1. Affects ability to eliminate drugs
3.1.1.2. High BUN levels
3.1.2. Reduced bladder capacity
3.1.2.1. Urinary frequency
3.1.2.2. Urinary urgency
3.1.2.3. Nocturia
3.1.3. Inefficient neurological control of bladder emptying and weaker bladder muscle
3.1.3.1. Retention of large volumes of urine could be caused by:
3.1.3.1.1. Female: fecal impaction
3.1.3.1.2. Male: prostatic hypertrophy
3.2. Abnormal Processes
3.2.1. Incontinence - not a normal part of aging
3.2.1.1. Stress
3.2.1.1.1. Caused by weak supporting pelvic muscles
3.2.1.1.2. Laughing, sneezing, coughing, etc. can cause involuntary loss of urine
3.2.1.1.3. Obesity contributes to this problem
3.2.1.1.4. Treatment/Interventions
3.2.1.2. Urgency
3.2.1.2.1. Caused by UTI, enlarged prostate, diverticulitis, pelvic/bladder tumors
3.2.1.2.2. Irritation or spasms of the bladder wall cause sudden loss of urine
3.2.1.2.3. Treatment/Interventions
3.2.1.3. Overflow
3.2.1.3.1. Caused by bladder neck obstructions, certain medications
3.2.1.3.2. Treatment/Interventions
3.2.1.4. Neurogenic/Reflex
3.2.1.4.1. Caused by cerebral cortex lesions, MS, or other neural pathway disturbances
3.2.1.4.2. Treatment/Interventions
3.2.1.5. Functional
3.2.1.5.1. Caused by a functional inability to reach the bathroom
3.2.1.5.2. Treatment/Interventions
3.2.1.6. General Incontinence
3.2.1.6.1. Important Factors to Assess
3.2.1.6.2. Positive reinforcement and encouragement are extremely beneficial
4. Nervous System
4.1. Age-Related Changes
4.1.1. Decline in weight and blood flow to the brain
4.1.1.1. This does not affect thinking/behavior
4.1.2. Reduction in neurons, nerve fibers, and cerebral blood flow
4.1.3. Hypothalamus less effective in temperature regulation
4.1.3.1. Lower body temperature is the norm
4.1.4. Changes in sleep patterns
4.1.4.1. More time spent in stages I and II of sleep, less time in stages III and IV
4.1.5. Slowing in central processing
4.1.5.1. Delay in time required to perform tasks
4.1.6. Number/sensitivity of sensory receptors, dermatomes, and neurons decrease
4.1.6.1. This dulls tactile sensation
4.1.7. Decline in function of cranial nerves affecting taste and smell
4.2. Abnormal Processes
4.2.1. Parkinson's Disease
4.2.1.1. Description
4.2.1.1.1. Affects the ability of the central nervous system to control body movements
4.2.1.2. Pathophysiology
4.2.1.2.1. Exact cause is not understood
4.2.1.2.2. Dopamine receptors in the brain are no longer properly stimulated; dopamine is not conserved properly
4.2.1.3. Signs/Symptoms
4.2.1.3.1. Bradykinesia: slowing of movements
4.2.1.3.2. Tremors at rest
4.2.1.3.3. Rigidity due to an involuntary increase in muscle tone
4.2.1.3.4. Loss of balance
4.2.1.3.5. Shuffling gait
4.2.1.3.6. Hallucinations
4.2.1.4. Treatment/Management
4.2.1.4.1. Anticholinergic medications
4.2.1.4.2. Dopamine simulators
4.2.1.4.3. Technology to control symptoms
4.2.1.5. Nursing Interventions
4.2.1.5.1. Goal: preserve patient's independence as much as possible
4.2.1.5.2. Education
4.2.1.5.3. Allow for extra time to complete tasks or answer questions
5. Endocrine System
5.1. Age-Related Changes
5.1.1. Thyroid gland atrophies, leading to decrease of activity
5.1.2. ACTH secretion decreases
5.1.2.1. This leads to an increase in blood pressure
5.1.3. Pituitary gland activity decreases
5.1.4. Insulin release by beta cells is delayed and can be insufficient
5.1.4.1. Reduced tissue sensitivity to circulating insulin
5.1.4.1.1. Higher blood glucose in non diabetic patients
5.1.5. Ability to metabolize glucose is reduced
5.2. Abnormal Processes
5.2.1. Hypothyroidism
5.2.1.1. Description
5.2.1.1.1. A pathologic reduction in serum levels of hormones T3 and T4
5.2.1.2. Pathophysiology
5.2.1.2.1. Primary
5.2.1.2.2. Secondary
5.2.1.3. Signs/Symptoms
5.2.1.3.1. Fatigue, weakness, lethargy
5.2.1.3.2. Depression and disinterest in activities
5.2.1.3.3. Anorexia
5.2.1.3.4. Weight gain and puffy face
5.2.1.3.5. Impaired hearing
5.2.1.3.6. Periorbital or peripheral edema
5.2.1.3.7. Constipation
5.2.1.3.8. Cold intolerance
5.2.1.3.9. Myalgia, paresthesia, and ataxia
5.2.1.3.10. Dry skin and coarse hair
5.2.1.4. Treatment/Management
5.2.1.4.1. Replacement of thyroid hormone using synthetic T4
5.2.1.5. Nursing Interventions
5.2.1.5.1. Regular monitoring of symptoms
5.2.1.5.2. Education
5.2.1.5.3. Assist with symptom management
6. Integumentary System
6.1. Age-Related Changes
6.1.1. Hair loss/graying
6.1.2. Loss of tissue elasticity
6.1.2.1. Elongated ears
6.1.2.2. Baggy eyelids
6.1.2.3. Double chin
6.1.3. Wrinkles
6.1.4. Loss of subcutaneous fat
6.2. Abnormal Processes
6.2.1. Pressure (Decubitus) Ulcers
6.2.1.1. Description
6.2.1.1.1. Stage I: persistent area of unblancheable red skin; no break in skin
6.2.1.1.2. Stage II: Partial thickness loss of skin layers; involves the epidermis
6.2.1.1.3. Stage III: Full thickness of skin is lost; extends through the epidermis, exposing subcutaneous tissues
6.2.1.1.4. Stage IV: Full thickness of skin and subcutaneous tissue lost; exposed muscle, bone, or both presenting as a deep crater than may include necrotic tissue or educate
6.2.1.2. Pathophysiology
6.2.1.2.1. When the skin/flesh over a bony prominence undergoes continuous pressure or shearing, this can result in tissue anoxia/ischemia
6.2.1.2.2. Common at sacrum, coccyx, ischium, knees, elbows, heels, occiput
6.2.1.3. Nursing Interventions
6.2.1.3.1. PRIORITY: prevention
6.2.1.3.2. Avoid unrelieved pressure
7. Respiratory System
7.1. Age-Related Changes
7.1.1. Calcification of costal cartilage and trachea
7.1.1.1. Rib cage becomes more rigid
7.1.1.1.1. Increased residual capacity
7.1.1.1.2. Reduced vital capacity
7.1.2. Reduction of cough and laryngeal reflexes
7.1.3. High risk for respiratory infections
7.2. Abnormal Processes
7.2.1. Pneumonia
7.2.1.1. Higher risk due to age-related changes; not a normal process
7.2.1.1.1. Pathophysiology
7.2.1.1.2. Signs/Symptoms
7.2.1.1.3. Treatment/Management
7.2.1.1.4. Nursing Interventions
8. Musculoskeletal System
8.1. Age-Related Changes
8.1.1. Thinning disks and shortened vertebrae
8.1.1.1. Loss of height
8.1.2. Reduced muscle mass, strength, and movement
8.1.3. Decreased bone mineral and mass
8.1.4. Diminished calcium absorption
8.1.5. Increased risk of fractures
8.2. Abnormal Processes
8.2.1. Osteoporosis
8.2.1.1. Risk Factors
8.2.1.1.1. Advanced age
8.2.1.1.2. Ethnicity - white women with a northwestern European or British Isles background, Asian women
8.2.1.1.3. Calcium deficiency
8.2.1.1.4. Vitamin D deficiency
8.2.1.1.5. Small-framed, thin women
8.2.1.1.6. Hx of early menopause
8.2.1.1.7. Estrogen deficiency
8.2.1.1.8. Cigarette smoking
8.2.1.1.9. High alcohol consumption
8.2.1.1.10. Prolonged immobility
8.2.1.1.11. Family hx of osteoporosis
8.2.1.2. Pathophysiology
8.2.1.2.1. Any health problem associated with inadequate calcium intake, excessive calcium loss, or poor calcium absorption can cause osteoporosis
8.2.1.3. Signs/Symptoms
8.2.1.3.1. May cause kyphosis
8.2.1.3.2. May cause a reduction in height
8.2.1.3.3. Spinal pain, especially in lumbar region
8.2.1.3.4. Bones tend to fracture more easily
8.2.1.3.5. Often asymptomatic, pts can be unaware of the problem until detected by radiography
8.2.1.4. Treatment/Management
8.2.1.4.1. Depends on underlying cause of disease
8.2.1.4.2. Calcium supplements
8.2.1.4.3. Vitamin D supplements
8.2.1.4.4. Selective estrogen receptor modulators
8.2.1.4.5. Hormone therapy
8.2.1.4.6. Diet rich in calcium and protein
8.2.1.5. Nursing Interventions
8.2.1.5.1. Advise the patient to avoid heavy lifting, jumping, and other activities with risk for fracture
8.2.1.5.2. Be gentle when providing care for these patients; moving, exercising, or lifting them can cause fractures
8.2.1.5.3. Range-of-motion exercises and ambulation are important to maintain function and prevent greater damage
9. Sensory Changes
9.1. Vision
9.1.1. Age-Related Changes
9.1.1.1. Presbyopia (far-sightedness)
9.1.1.2. Narrowing of the visual field leads to decreased peripheral vision
9.1.1.3. Pupil size reduction and less reaction to light
9.1.1.4. Depth perception distortion
9.1.1.5. Decline in visual acuity
9.1.2. Abnormal Processes
9.1.2.1. Chronic Glaucoma
9.1.2.1.1. Description
9.1.2.1.2. Pathophysiology
9.1.2.1.3. Signs/Symptoms
9.1.2.1.4. Treatment/Management
9.1.2.1.5. Nursing Interventions
9.2. Hearing
9.2.1. Age-Related Changes
9.2.1.1. Presbycusis = progressive loss of hearing
9.2.1.2. Distortion of high-pitched sounds
9.2.1.3. Cerumen increases: affecting hearing
9.2.1.4. Alteration in equilibrium
9.2.2. Abnormal Processes
9.2.2.1. Impaired hearing should not be assumed a normal process of aging; requires attention and audiometric examination
9.2.2.2. Pathophysiology
9.2.2.2.1. Impacted cerumen
9.2.2.2.2. Cysts
9.2.2.2.3. Vascular problems inside of the ear
9.2.2.2.4. Viral infections
9.2.2.2.5. Otitis media
9.2.2.2.6. Tinnitus: ringing in the ears
9.2.2.3. Signs/Symptoms
9.2.2.3.1. Pt reports difficulty in understanding
9.2.2.3.2. Volume on devices is consistently turned up higher than necessary for those with appropriate hearing
9.2.2.3.3. These may vary based on the cause of hearing loss
9.2.2.4. Treatment/Management
9.2.2.4.1. Depending on the cause, treatments can vary
9.2.2.4.2. Hearing Aids
9.2.2.5. Nursing Interventions
9.2.2.5.1. Provide education through visual and tactile aids as well
9.2.2.5.2. Speak more slowly and clearly, ensure lips are visible for those who lip-read
9.2.2.5.3. Practice patience while teaching
9.3. Taste and Smell
9.3.1. Age-Related Changes
9.3.1.1. Taste acuity is dependent on smell
9.3.1.2. Atrophy of the tongue
9.3.1.3. Decreased saliva
9.3.1.4. Poor oral hygiene
9.3.1.5. Certain medications
9.3.1.6. Sense of smell altered with age
9.4. Touch
9.4.1. Age-Related Changes
9.4.1.1. Reduction of tactile sensation
9.4.1.2. Reduced ability to sense pressure, discomfort, change in temperature
10. Immune System
10.1. Age-Related Changes
10.1.1. Depressed immune response
10.1.1.1. T-cell activity declines
10.1.1.1.1. Reduced response to foreign antigens
10.1.1.2. Thymus gland decreases in size
10.1.1.2.1. Increased number of immature T-cells
10.1.1.3. Cell-mediated immunity declines
10.1.1.4. Inflammatory defenses decline; inflammation presents atypically
10.1.1.5. Reduced antibody response
10.1.1.6. Decreased number of Langerhans cells in the skin
10.1.1.7. Reduced thickness of skin
10.1.1.8. Decreased circulation in skin
10.1.2. Risk for infection becomes significant