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

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