1. Thermoregulation
1.1. Body temperature lower in later life than younger years
1.2. Reduced ability to respond to colder temperatures
1.2.1. Due to: inefficient vasoconstriction, reduced peripheral circulation, decreased cardiac output, diminished shivering, reduce muscle mass and subcutaneous tissue
1.3. Impaired responses to heat
1.3.1. Due to : impaired sweating mechanisms and decreases cardiac output
1.4. More susceptible to heat stress
2. Cell
2.1. Number of cells reduced
2.2. Lean body mass decreased
2.3. Fat tissue increases until 6th decade of life
2.4. Total body fat increases
2.5. Bone mass decreases
2.6. Extracellular fluid remains constant
2.7. Intracellular fluid decreased
2.7.1. Prone to dehydration
2.7.2. Fluid electrolyte imbalance
3. Immune system
3.1. Depressed immune response
3.2. Thymus mass decreases steadily
3.3. T cell activity declines and more immature T cells present in thymus
3.4. Inflammatory defense declines
3.5. Increase in proinflammatory cytokines
4. Physical
4.1. Graying and thinning of hair
4.2. Ectropion of eyelids
4.3. Elongated ears
4.4. Acrus senilis
4.5. Growth of facial hair in women
4.6. Diminished muscle mass and skin fold thickness
4.7. Thicker hair in ears and nose
4.8. Darkening and wrinkling of skin around orbits
4.9. Narrower gait in women, wider gait in men
4.10. Stature decreases
4.10.1. 2 in lost by age 80
4.10.2. Loss of cartilage and thinning of vertebrae
4.11. Changes are Gradual and subtle
5. Reproductive System
5.1. Age Related Changes
5.1.1. Male
5.1.1.1. Fluid training capacity of seminal vesicles reduced
5.1.1.2. Possible reduction in sperm count
5.1.1.3. Venous arterial sclerosis of penis
5.1.1.4. Prostate enlarges in most men
5.1.2. Female
5.1.2.1. Fallopian tubes atrophy and shorten
5.1.2.2. Ovaries become smaller and thicker
5.1.2.3. Cervix becomes smaller
5.1.2.4. Drier, less elastic vaginal canal
5.1.2.5. Flattening of labia
5.1.2.6. Endocervical epithelium atrophied
5.1.2.7. Uterus becomes smaller
5.1.2.8. Endometrium atrophied
5.1.2.9. Alkaline vaginal environment
5.1.2.10. Loss of vulvar subcutaneous fat and hair
5.2. Male
5.2.1. Health promotion
5.2.1.1. Men with prostatic hypertrophy be examined every 6 months
5.2.1.2. Routine prostate specific antigen testing in men with no hx of prostate cancer is not recommended
5.2.1.3. Complete history and physical exam
5.2.2. Prostatitis
5.2.2.1. patho: swelling of the prostate caused by UTI
5.2.2.2. Signs and Symptoms: fever, chills, lower stomach tenderness, body aches, flushing of skin
5.2.2.3. Treatment
5.2.2.3.1. antibiotics
5.2.3. Erectile Dysfunction
5.2.3.1. cannot keep erection or firm during sex
5.2.3.2. may be from medications or illness
5.3. Female
5.3.1. Health promotion
5.3.1.1. Annual gynecological exam
5.3.1.1.1. Pap smear
5.3.1.1.2. Knowledgeable about self breast examination
5.3.1.2. Complete history and physical exam
5.3.2. Reproductive conditions
5.3.2.1. Vaginitis
5.3.2.1.1. Increased fragility of vagina in post menopausal women cause it to be more easily irritated
5.3.2.1.2. s/s: soreness, pruritus, burning, reddened vagina accompanied by foul smelling vaginal discharge
5.3.2.1.3. Tx: local estrogens in suppository or cream form
5.3.2.1.4. Advise to avoid douching and perfumed soaps and sprays on genitalia
5.3.2.2. Cancer of the cervix
5.3.2.2.1. Signs: cervical bleeding and luekorrhea
5.3.2.2.2. Can develop urinary retention, incontinence (urine and fecal), uremia
5.3.2.2.3. Tx: radium or surgery
5.3.2.2.4. 65 and older can stop cervical cancer screening as long as it was done regularly past 10 years and no serious precancers
5.3.2.3. Menopause
5.3.2.3.1. permanent cessation of menses
5.3.2.3.2. awakening of body, mind and spirit
6. Respiratory
6.1. Emphysema
6.1.1. Patho
6.1.1.1. Abnormal permanent enlargement of air spaces distal to the terminal bronchioles with destruction of alveolar walls.
6.1.2. Signs and symptoms: slow onset, increased dyspnea, chronic cough, hypoxia, fatigue, weight loss
6.1.3. Treatment
6.1.3.1. Postural drainage
6.1.3.2. Bronchodilators
6.1.3.3. Avoidance of stressful situations
6.1.3.4. Breathing exercises
6.1.3.5. Cessation of smoking cigarettes
6.2. Pneumonia
6.2.1. Leading cause of death
6.2.2. 2 types
6.2.2.1. Pneumococcal pneumonia
6.2.2.2. Gram-negative bacilli causing
6.2.3. Patho
6.2.3.1. Patient inhales or aspirates a pathogen, such as bacteria or a virus. Lungs' defense mechanisms are impaired
6.2.4. Signs and symptoms: pleuritic pain (amy not be as severe as youth), temperature (minimal or no fever), slight cough, fatigue, rapid respiration
6.3. Influenza
6.3.1. Patho
6.3.1.1. Destroys ciliated epithelial cells of respiratory tract and depresses mucociliary clearance. Acquired through inhalation of infected droplets
6.3.2. Signs and symptoms: fever, myalgia, sore throat, nonproductive cough
6.3.3. Prevention
6.3.3.1. Annual influenza vaccine
6.4. Age Related Changes
6.4.1. PO2 reduced as much as 15% between ages 20 and 80
6.4.2. Loss of elasticity and increased rigidity
6.4.3. Decreased ciliary action
6.4.3.1. Complicates ability to expel mucous and debris
6.4.4. Forced expirations volume reduce
6.4.5. Blunting of cough and laryngeal reflexes
6.4.6. By 90 years old, approximately 50% increase in residual capacity
6.4.7. Alveoli fewer in number and larger in size
6.4.8. Thoracic muscles more rigid
6.4.9. Reduced basilar inflation
6.4.10. Residual volume increases, vital capacity is reduced
6.4.11. Connective tissue changes
7. Cardiac
7.1. Age Related Changes
7.1.1. More prominent arteries in head, neck, extremities
7.1.2. Valves become thicker and more rigid
7.1.2.1. Result of sclerosis and fibrosis
7.1.3. Stroke volume decreases by 1% per year
7.1.4. Heart pigmented with lip furs in granules
7.1.5. Less efficient O2 utilization
7.1.6. Aorta becomes dilated and elongated
7.1.7. Cardiac output decreases
7.1.8. Resistance to peripheral blood flow increases by 1% per year
7.1.9. Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output
7.1.10. Less elasticity of vessels
7.1.11. Diastolic filling and systolic emptying requires more time to be completed
7.1.12. Blood vessels
7.1.12.1. Tunica intima
7.1.12.1.1. Most direct changes
7.1.12.2. Tunica media
7.1.12.2.1. Thinning and calcification of elastin fibers
7.1.12.2.2. Increase in collagen
7.1.12.2.3. Impaired baroreceptor function
7.1.12.2.4. Peripheral resistance
7.1.12.3. Tunica adventitia
7.1.12.3.1. Not affected by aging process
7.2. Hypertension
7.2.1. Most prevalent cardiac disease in older adults
7.2.2. Patho: high blood pressure due to the amount of resistance to flow in your arteries
7.2.3. Signs and symptoms: awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor
7.2.4. Treatment
7.2.4.1. Reduce sodium intake
7.2.4.2. Reduce weight if necessary
7.2.4.3. Antihypertensive drugs
7.2.4.3.1. Thiazide diuretics
7.2.4.4. Non-pharmacological methods
7.2.4.4.1. Biofeedback
7.2.4.4.2. yoga
7.2.4.4.3. Meditation
7.2.4.4.4. Relaxation exercises
7.2.4.5. Diet rich in fruits, vegetables, whole grain, and low-fat in dairy foods
7.3. Congestive Heart Failure
7.3.1. Leading cause of hospitalization in older adults
7.3.2. Patho: heart muscle does not pump blood as well as it should
7.3.3. signs and symptoms: dyspnea on exertion, confusion, insomnia, wandering during the night, agitation, depression, weakness, SOB, bilateral ankle edema
7.3.4. Treatment
7.3.4.1. Bed rest
7.3.4.2. ACE inhibitors
7.3.4.3. Beta-blockers
7.3.4.4. Digitalis
7.3.4.5. Diuretics
7.3.4.6. Reduction in sodium intake
7.4. Coronary Heart Disease
7.4.1. Myocardial infarction
7.4.1.1. Patho: caused by blockage or clot forming in the coronary arteries that occludes the blood flow causing lack of oxygen
7.4.1.2. signs and symptoms: pain radiating to left arm, entire chest neck, jaw, abdomen; numbness in arms, neck or back; confusion; moist, pale skin; decreased BP; syncope; decreased BP
7.4.1.3. Treatment
7.4.1.4. Treatment
7.4.1.4.1. Reduce amount of time in which patient is limited to bed rest to allowing to sit up in chair next to bed.
7.4.1.4.2. Early ambulation following MI
7.4.1.4.3. Thrombolytic therapy
7.4.1.4.4. Fitness programs
7.5. Peripheral Vascular Disease
7.5.1. Arteriosclerosis
7.5.1.1. Patho: hardening of the arteries
7.5.1.2. Signs and symptoms: chest pain or angina, pain in leg, SOB, fatigue
7.5.1.3. Treatment
7.5.1.3.1. Bed rest
7.5.1.3.2. Warmth
7.5.1.3.3. Buerger-Allen exercises
7.5.1.3.4. Vasodilator
7.5.2. Venous thromboembolism
7.5.2.1. signs and symptoms: edema, warmth over affected area, pain in sole of foot
7.5.2.2. Treatment
7.5.2.2.1. Location determines the treatment
7.5.2.2.2. Elastic stockings, or bandages
7.5.2.2.3. Rest
7.5.2.2.4. elevation of affect limb may promote venous return
7.5.2.2.5. analgesics to relieve pain
7.5.2.2.6. Anticoagulants
7.5.2.2.7. Surgery
8. GI
8.1. Peptic ulcer
8.1.1. Patho: imbalance between factors that can damage the gastroduodenal mucosal lining and defense mechanisms that normally limit injury
8.1.2. Signs and symptoms: pain, bleeding, obstruction, perforation
8.1.3. Treatment
8.2. Dysphagia
8.2.1. Patho
8.2.1.1. Anything that impacts several cranial nerves or muscles of face, mouth, pharynx, esophagus causes dysphagia
8.2.2. Signs and symptoms: occasional difficulties swallowing certain types of food, complete inability to swallow
8.2.3. Treatment
8.2.3.1. Referral to speech language pathologist
8.2.3.2. Soft diet and thickening of liquids
8.2.3.3. eat in upright position
8.2.3.4. Ingest small bites in a non-hurried manner
8.3. Hiatal Hernia
8.3.1. Patho: displacement of the gastroesophageal junction above the diaphragm decreases the lower esophageal sphincter
8.3.2. signs and symptoms: heartburn, dysphagia, belching, vomiting, regurgitation
8.3.3. Treatment
8.3.3.1. Managed medically
8.3.3.2. If obese, lose weight
8.3.3.3. Bland diet
8.3.3.4. Milk and antacids for symptom relief
8.3.3.5. several small meals a day
8.3.3.6. H2 blockers
8.3.3.6.1. Ranitidine, cimetidine, nizatine
8.3.3.7. proton pump inhibitors
8.3.3.7.1. Lansoprazole, omeprazole
8.4. Colorectal Cancer
8.4.1. Cancer at any site along the large intestine
8.4.2. Signs and symptoms: rectal bleeding, bloody stools, change in bowel pattern, anorexia, nausea, anemia, abdominal discomfort, pain over affected region
8.4.3. Treatment
8.4.3.1. surgery to remove the cancer
8.4.3.2. chemotherapy
8.4.3.3. radiation
8.5. Age Related Changes
8.5.1. Decreased taste sensation
8.5.2. Esophagus more dilated
8.5.3. Reduced saliva and salivary ptyalin
8.5.4. Liver smaller in size
8.5.5. Reduced intestinal blood flow
8.5.6. Decreased esophageal motility
8.5.7. Atrophy of gastric mucosa
8.5.8. Decreased stomach motility, hunger contraction, emptying time
8.5.9. Less production of hydrochloric acid, Pepsin, lipase, and pancreatic enzymes
8.5.10. Fewer cells on absorbing surface of intestine
8.5.11. Slower peristalsis
9. Urinary elimination
9.1. Urinary tract infection
9.1.1. Patho
9.1.1.1. Caused by organism Escherichia coli in women and Proteus species in men
9.1.2. Signs and symptoms: burning, urgency, fever
9.1.3. Treatment
9.1.3.1. Aims to establish adequate urinary draining and control of infection through antibiotic therapy
9.1.3.2. Forcing fluids is advisable
9.1.3.3. cranberry juice promotes reduction of UTIs
9.2. Bladder cancer
9.2.1. Patho: malignancy of the urothiel cells
9.2.2. Signs and symptoms: frequency, urgency, dysuria, painless hematuria
9.2.3. treatment
9.2.3.1. Surgery
9.2.3.2. radiation
9.2.3.3. Immunotherapy
9.2.3.4. Chemotherapy
9.3. Renal calculi
9.3.1. patho: small hard deposit that forms in the kidney due to excessive calcium or uric acid
9.3.2. Signs and symptoms: pain, hematuria, symptoms of UTI, GI upset
9.3.3. treatment
9.4. Glomerulonephritis
9.4.1. Patho: inflammation of the glomerulus
9.4.2. Signs and symptoms
9.4.2.1. Subtle and nonspecific, initially go unnoticed
9.4.2.2. Clinical manifestations: fever, fatigue, nausea, vomiting, abdominal pain, increased sedimentation rate
9.4.3. Treatment
9.4.3.1. Antibiotics
9.4.3.2. Restriction in sodium and protein diet
9.4.3.3. Close attention to fluid intake and output
9.4.3.4. If older adults are receiving digitalis, diuretics, antihypertensives then close observation for cumulative toxic effects from compromised kidney function must be maintained
9.5. Urinary system: Age Related Changes
9.5.1. Decreased size of renal mass
9.5.2. Decreased tubular function
9.5.3. Decreased bladder capacity
9.5.4. Decreased nephrons
9.5.5. Renal blood flow decreases
9.5.6. Globular filtration rate decreases
9.5.7. Weaker bladder muscles
10. Mobility (Musculoskeletal)
10.1. Osteoarthritis
10.1.1. Patho: progressive deterioration of the joint cartilage with the formation of new bone at the joint surface.
10.1.2. Signs and symptoms: Crepitation on joint motion may be noted, Joints more uncomfortable during damp weather and extended use
10.1.2.1. Systemic symptoms not present
10.1.3. Treatment
10.1.3.1. Analgesics to control pain
10.1.3.2. Acetaminophen first drug of choice
10.1.3.3. Rest
10.1.3.3.1. Splints, braces, canes
10.1.3.4. Heat or Ice
10.1.3.5. T’ai chi
10.1.3.6. Aqua therapy
10.1.3.7. Gentle massage
10.1.3.8. Acupuncture
10.1.3.9. Diet high in cold water fish. Vitamins A,B,B6,C and E, zinc, selenium, niacinamide, calcium, magnesium help in controlling symptoms
10.1.3.10. Weight reduction
10.1.3.11. If treatments fail: arthoplasty
10.2. Rheumatoid Arthritis
10.2.1. Patho
10.2.1.1. Synovium becomes hypertrophied and edematous with projections of synovial tissue protruding into the joint cavity
10.2.2. Signs and symptoms: joint pain (during rest and activity, fatigue, malaise, weakness, weight loss, wasting, fever, anemia
10.2.3. Treatment
10.2.3.1. Rest and support to effected limbs
10.2.3.2. Range of motion exercises
10.2.3.3. Anti-inflammatory agents
10.2.3.4. Disease-modifying antirheumatic drugs (methotrexate)
10.2.3.5. Corticosteroids
10.2.3.6. Immunosuppressive
10.2.3.7. Surgery if significantly impaired, pain severe
10.2.3.7.1. Joint replacement surgery
10.3. Osteoporosis
10.3.1. Patho: asymptomatic decrease in bone density due to inactivity, diseases, reduction in sex hormones, diet and drugs
10.3.2. Signs and symptoms
10.3.2.1. Usually asymptomatic until detected by radiology
10.3.3. Treatment
10.3.3.1. Depends on cause of disease
10.3.3.2. Calcium, vitamin D supplements
10.3.3.3. Estrogen receptor modulators
10.3.3.4. Hormone therapy
10.3.3.5. Synthetic form of calcitonin
10.3.3.6. Bisphosphonates
10.3.3.7. Diet rich in protein and calcium
10.3.3.8. Regular exercise
10.4. Gout
10.4.1. Patho
10.4.1.1. Metabolic disorder in which excess Uris acid accumulates in the blood. Crystallization of Uris acid deposited around joints causing pain.
10.4.2. Signs and symptoms: severe pain, tenderness of joint, warmth of joint, redness, swelling of surrounding tissues
10.4.3. Treatment
10.4.3.1. Low-purine diet: Avoid bacon, turkey, veal, liver, kidney, anchovies, salmon, sardines, legumes, alcohol
10.4.3.2. Colchicine or phenylbutazone for acute attacks
10.4.3.3. Colchicine, allopurinol, probenecid, or indomethacin for long term
10.4.3.4. Avoid thiazide dietetics
10.4.3.5. Vitamin E, folic acid, eicosapentaenoic useful dietary supplements
10.5. Age Related Changes
10.5.1. Shortening of vertebrae
10.5.2. Height decreases 2in from age 20-70
10.5.3. Bones more brittle
10.5.4. Slight knee flexion
10.5.5. Decrease in bone mass and bone mineral
10.5.6. Slight kyphosis
10.5.7. Slight hip flexion
10.5.8. Slight wrist flexion
10.5.9. Impaired flexion and extension movements
11. Neurology
11.1. Parkinson’s Disease
11.1.1. Patho
11.1.1.1. Affects ability of CNS to control body movements as a result of Impaired function of basal ganglia in the midbrain. Neurons that produce dopamine in substantial nigra die or become impaired
11.1.2. Signs and Symptoms: fair tremor in hands or feet that progresses over time, muscle rigidity and weakness, drooling, difficulty swallowing, slow speech, monotone voice, face is a mask like appearance, bradykinesia and poor balance, appetite increases, shuffling gait
11.1.3. Treatment
11.1.3.1. Carbidopa/levodopa in forms of sinemet
11.1.3.2. Dopamine agonists
11.1.3.3. Anricholinergics
11.1.3.4. Amantadine, mono oxidase inhibitors, catechol-O-methyltransferase
11.1.3.5. Active and passive ROM exercises
11.1.3.6. Psychological support
11.2. Transient Ischemic Attacks
11.2.1. Patho
11.2.1.1. Temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation
11.2.2. Signs and symptoms: hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, N/V, dysphagia
11.2.3. Treatment
11.2.3.1. Correction of underlying cause
11.2.3.2. Anticoagulant therapy
11.2.3.3. Vascular reconstruction
11.3. Cerebrovascular Accidents
11.3.1. Patho: Can be ischemic or hemmorhagic causing compromise and damage to the brain. Need to stabilize patient and focus on rehabilitation
11.3.2. Signs and symptoms: light-headedness, dizziness, headache, drop attack, memory and behavioral changes.
11.4. Age Related Changes
11.4.1. Decreased conduction velocity
11.4.2. Slower response and reaction time
11.4.3. Decreased brain weight
11.4.4. Reduced blood flow to brain
11.4.5. Changes in sleep pattern
11.5. Changes to the mind: Age Related
11.5.1. Personality
11.5.1.1. Drastic changes don’t occur with age. Consistent with earlier years
11.5.2. Memory
11.5.2.1. Retrieval from long term memory slowed
11.5.2.2. Working memory function reduced
11.5.3. Intelligence
11.5.3.1. Basic intelligence maintained
11.5.3.2. Crystallized intelligence maintained
11.5.3.3. Fluid intelligence declines
11.5.4. Learning
11.5.4.1. Not seriously altered. Other factors interfere with ability to learn: motivation, attention span, delayed transmission of information to the brain, perceptual deficits, illness
12. Vision
12.1. Visual deficits
12.1.1. Cataracts
12.1.1.1. Patho
12.1.1.1.1. Clouding of Lens or its capsule that causes the lens to lose transparency
12.1.1.2. Signs and symptoms: vision is distorted, night vision decreased, objects appeared blurred, glare from sunlight and bright lights is bothersome, nuclear sclerosis develops
12.1.1.3. Treatment
12.1.1.3.1. Surgery
12.1.2. Glaucoma
12.1.2.1. Patho
12.1.2.1.1. Degenerative eye disease in which the optic nerve is damaged from an above normal intraoculat pressure
12.1.2.2. Signs and symptoms
12.1.2.2.1. Acute glaucoma: severe eye pain, headache, nausea, vomiting
12.1.2.2.2. Chronic: peripheral vision slowly becomes impaired, tired feeling in their eyes, headaches, misty vision, seeing halos around lights, symptoms more pronounced in mornings
12.1.2.3. Treatment
12.1.2.3.1. Acute glaucoma
12.1.2.3.2. Chronic
12.1.3. Detached retina
12.1.3.1. Patho
12.1.3.1.1. Forward displacement of the retina from its normal position against the choroid
12.1.3.2. Signs and symptoms: reception of spots moving across the eye, blurred vision, flashed of light, feeling that a coating is developing over the eye
12.1.3.3. Treatment
12.1.3.3.1. Prompt treatment
12.1.3.3.2. Bed red
12.1.3.3.3. Use of bilateral patches
12.1.3.3.4. Surgery
12.2. Age Related Changes: Sensory organs
12.2.1. Vision
12.2.1.1. More opaque lens
12.2.1.2. Decreased pupil size
12.2.1.3. More spherical cornea
12.2.2. Smell
12.2.2.1. Impaired ability to identify and discriminate among odors
12.2.3. Taste
12.2.3.1. High prevalence of taste impairment
12.2.4. Hearing
12.2.4.1. Atrophy of hair cells of organ of corti
12.2.4.2. Tympanic membrane sclerosis and atrophy
12.2.4.3. Increased crewmen and concentration of keratin
13. Endocrine
13.1. Diabetes mellitus
13.1.1. Patho: group of diseases that affect how your body uses glucose
13.1.2. Signs and symptoms: may be absent, orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, confusion, dupuytren's contracture
13.1.3. Treatment
13.1.3.1. Drug therapy
13.1.3.1.1. Metformin: Oral, first line treatment
13.1.3.1.2. Sulfonylurea drugs (glibenclamide)
13.1.3.1.3. Acarbose
13.1.3.1.4. Rosiglitazone and pioglitazone
13.2. Hypothyroidism
13.2.1. Patho: thyroid does not produce enough of the thyroid gland
13.2.2. Signs and symptoms: fatigue, weakness, lethargy, depression, anorexia, weight gain and puffy face, impaired hearing, periorbital or peripheral edema, dry skin, coarse hair
13.2.3. Treatment
13.2.3.1. Replacement of thyroid hormones using a synthetic T4 (synthroid and thyroxine)
13.3. Hyperthyroidism
13.3.1. Patho: loss of normal regulatory control of thyroid hormone secretion
13.3.2. Symptoms: diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, lid lag, increased hunger
13.3.3. Treatment
13.3.3.1. Depends on cause
13.3.3.2. Anti thyroid medications or radioactive iodine
13.3.3.3. Surgery
13.4. Endocrine System
13.4.1. Thyroid gland under goes fibrosis, cellular infiltration, and increased nodularity
13.4.1.1. Decreased metabolic rate
13.4.1.2. Reduce radioactive iodine uptake
13.4.1.3. Less thyrotropin secretion and release
13.4.2. Release for thyroid iodine decreases
13.4.3. Excretion of 17-ketosteriods declines
13.4.4. Reduction in triiodothyronine (T3)
13.4.5. TSH and T4 stay the same
13.4.6. ACTH secretion decrease
13.4.7. Secretory activity of adrenal gland decreases
13.4.7.1. Decrease of glucocorticoids, 17-ketosteroids, progesterone, androgen, estrogen
13.4.8. Pituitary gland decreases in volume
13.4.9. Gonadal secretion declines
13.4.10. delayed and insufficient resales of insulin by the beta cells of the pancreas
13.4.10.1. Reduce ability to metabolize glucose
14. Integumentary
14.1. Pruritus
14.1.1. Patho: itchy skin due to drones
14.1.2. Excessive itching can cause infection and skin breakdown
14.1.3. Treatment
14.1.3.1. Bath oils
14.1.3.2. Moisturizing lotions
14.1.3.3. Massage
14.1.3.4. Zinc oxide
14.1.3.5. Antihistamines and topical steroids
14.1.3.6. Vitamin supplements and high quality, rich vitamin diet
14.2. Pressure injury
14.2.1. Patho: injuries to the skin resulting from prolonged pressure on the skin
14.2.2. Signs and symptoms: swelling, unusual skin color or texture, redness, heat, pus drainage
14.2.3. Treatment
14.2.3.1. High protein, vitamin rich diet
14.2.3.2. Good skin care
14.2.3.3. Depends on state of injury
14.2.3.3.1. Hyperemia
14.2.3.3.2. Ischemia
14.2.3.3.3. Necrosis
14.2.3.3.4. Deep tissue damage
14.3. Age Related Changes
14.3.1. Flattening of the dermal-epidermal junction
14.3.2. Reduced thickness and vascularity of dermis
14.3.3. Slowing of epidermal proliferation
14.3.4. Increased quantity and degeneration of elastin fibers occur
14.3.5. Collagen fibers become more coarser and random
14.3.5.1. Reduce skin elasticity
14.3.6. Irritated and breaks down more easily
14.3.7. Dermis more avascular and thinner
14.3.8. Reduction in number of melanocytes by 10-20% each decade of life stating with third decade
14.3.8.1. Tan more slowly and less deeply
14.3.9. Skin immune response declines
14.3.9.1. More prone to skin inflections
14.3.10. Benign and malignant skin neoplasms
14.3.11. Growth rate of scalp, pubic, and axillary hair declines
14.3.12. Fingernails grow more slowly, brittle, develop longitudinal striations, decrease in lungless size
15. Psychosocial
15.1. Depression
15.1.1. Signs and symptoms: Vegetative symptoms: insomnia, fatigue, anorexia, weight loss, constipation, decreased interest in sex; Express self-depreciation, guilt, apathy, remorse, hopelessness, and helplessness; Changes in sleep and psychomotor activity pattern
15.1.2. Treatment
15.1.2.1. Psychotherapy
15.1.2.2. Antidepressants
15.1.2.3. Electroconvulsive therapy
15.1.2.4. Acupressure, acupuncture, guided imagery and light therapy
15.1.2.5. Good health practices: proper nutrition, regular exercise
15.2. Anxiety
15.2.1. Signs and symptoms: somatic complaints, rigidity in thinking and behavior, insomnia, fantasizing, hostility, restlessness, increase in pulse, BP, respirations, psychomotor activity and frequency
15.2.2. Treatment
15.2.2.1. Depends on cause
15.2.2.2. Medications
15.2.2.3. Biofeedback, guided imagery, relaxation therapy
15.2.2.4. Control environmental stimuli
15.3. social changes
15.3.1. shrinking social world
15.3.2. loss of spouse
15.3.3. retirement
15.4. Dementia
15.4.1. Irreversible, progressive impairment in cognitive functions affecting memory, orientation, judgement, reasoning, attention, language, and problem solving.
15.4.1.1. Alzheimer’s disease
15.4.1.1.1. Patho: intracellular neurofibrillary tangles and extracellular amyloidal protein deposits contributing to senile plaques
15.4.1.1.2. Signs and symptoms
15.4.1.1.3. Treatment
15.5. Delirium
15.5.1. Signs and symptoms
15.5.1.1. Disorientation to place and time but usually not identity
15.5.1.2. Altered attention span
15.5.1.3. Meaningless chatter
15.5.1.4. Poor judgement
15.5.1.5. Altered level of. Consciousness; hypervigilance, mild drowsiness, semicomatose state
15.5.1.6. Hallucinations
15.5.1.7. Disturbances in sleep wake cycle
15.5.1.8. May be suspicious, personality changes, experience delusions
15.5.1.9. Physical signs; SOB, fatigue, slower psychomotor activities
15.5.2. Treatment
15.5.2.1. Depends on cause
15.5.2.1.1. Stabilize glucose, correcting dehydration, discontinuing a medication
15.5.2.2. Reversible in most circumstances, prompt care and treat as medical emergency
16. Safety
16.1. Pharmacology
16.1.1. Most commonly used drugs
16.1.1.1. Cardiovascular agents, antihypertensive, analgesics, antiarthritic agents, sedatives, tranquilizers, laxatives, antacids
16.1.1.1.1. Can cause confusion, dizziness, falls, and fluid and electrolyte imbalance which effects quality of life.
16.1.2. Taking more then one drug can cause risk of drug- food interactions
16.1.3. Altered pharmacokinetics
16.1.3.1. Absorption
16.1.3.1.1. IM, subcutaneous, oral and rectal are not absorbed as efficiently as inhaled, applied topically, or instilled IV
16.1.3.1.2. Highly soluble and high concentrations are absorbed at greater speed
16.1.3.1.3. Decreased intracellular fluid, increased gastric PH, decreased gastric blood flow and motility, reduced CO and circulation, and slower metabolism can slow absorption
16.1.3.1.4. Exercise stimulates circulation and aids in absorption
16.1.3.2. Distribution
16.1.3.2.1. Hard to predict
16.1.3.2.2. Dehydration and hypoalbuminemia decrease distribution
16.1.3.3. Metabolism, detoxification, and excretion
16.1.3.3.1. Dehydration, hyperthermia, immobility and liver disease decrease metabolism of drug
16.1.3.3.2. Extended biological half life
16.1.3.3.3. Detoxification and conjugation of drugs reduced
16.1.3.3.4. Renal system excretes drugs; implications of reduced kidney efficiency important
16.1.3.3.5. Liver influences drug detoxification and excretion
16.1.4. Increased risk of adverse reactions
16.1.4.1. S/s of an adverse reaction in an older person can differ from given drug
16.1.4.2. Adverse reaction may take longer to become apparent
16.1.4.3. Adverse effect may occur after drug is discontinued
16.1.4.4. Can develop suddenly
16.1.4.5. Mental dysfunction one of the early symptoms of adverse reaction
16.1.5. Promoting safe use
16.1.5.1. Beers Criteria
16.1.5.1.1. Include drugs that are inappropriate to use in presence of specific conditions and in general. (Anticholinergics, tricyclics antidepressants, antipsychotics, barbiturates, and benzodiazepines)
16.1.5.2. Ensure drugs are used selectively and cautiously
16.1.5.2.1. Why is the drug ordered?
16.1.5.2.2. Is the smallest possible disaster ordered?
16.1.5.2.3. Is the patient allergic to the drug?
16.1.5.2.4. Can this drug interact with others being used?
16.1.5.2.5. are there special instructions for administration?
16.1.6. Promoting safe and effective administration
16.1.6.1. Most common route to administer drugs is orally
16.1.6.1.1. This can interfere with process (EX: dry mucous membranes and not being able to swallow)
16.1.6.2. Suppository: may take longe to melt due to lower body temperature
16.1.6.3. IM and subcutaneous administration: immobile limb will reduce rate of absorption
16.1.6.4. monitor for complications when giving IV
16.1.7. Patient education
16.1.7.1. Functional limitations
16.1.7.1.1. Impaired ADLs can decrease ability to administer meds
16.1.7.2. Cognitive limitations
16.1.7.2.1. Impairments that prevent them from remembering to take medications, may retake meds because forgot they already took, confuse medication schedule and dosage.
16.1.7.3. Educational limitations
16.1.7.3.1. Difficult reading labels, and instructions from being adequately seen
16.1.7.4. Sensory limitations
16.1.7.4.1. Hearing deficits can cause instructions to be missed or misunderstood. Poor vision can effect reading labels and instructions
16.1.7.5. Financial limitations
16.1.7.5.1. Limited funds could cause the older person to not fill prescription, skip dosage or use an old prescription
16.1.7.6. Choice
16.1.7.6.1. Some may choose not to take medications due to effect, lack of motivation, denial of condition or prefer to use funds elsewhere
16.2. Environmental
16.2.1. Lighting
16.2.1.1. Function: more mobile and participate in more activities in bright lit area
16.2.1.2. Orientation: lose perception of tine in a room that is constantly lit or darkened
16.2.1.3. Mood and behavior: blinking psychedelic lights cause a different reaction from candlelight.
16.2.1.4. Several diffuse lighting sources are best
16.2.1.5. Nightlights help facilitate orientation during the night and visibility to locate light switches
16.2.1.6. exposure to natural light during normal 24 hour dark-light cycle helps maintain body rhythms
16.2.2. Temperature
16.2.2.1. Maintain adequate environmental temperature is significant
16.2.2.2. Room temperature should no be lower than 75 degree Fahrenheit
16.2.2.3. brain damage can occur if the temperature is over 106 degrees Fahrenheit
16.2.3. Colors
16.2.3.1. red, yellow, white
16.2.3.1.1. stimulatng, increase pulse and BP
16.2.3.2. blue, brown, earth tones
16.2.3.2.1. relaxing
16.2.3.3. orange
16.2.3.3.1. stimulating
16.2.3.4. Violet
16.2.3.4.1. decreases appetite
16.2.3.5. green
16.2.3.5.1. sense of well being