The Older Adult Age Related Changes

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The Older Adult Age Related Changes by Mind Map: The Older Adult Age Related Changes

1. Reproductive System

1.1. Age Related Changes

1.1.1. Male Fluid training capacity of seminal vesicles reduced Possible reduction in sperm count Venous arterial sclerosis of penis Prostate enlarges in most men

1.1.2. Female Fallopian tubes atrophy and shorten Ovaries become smaller and thicker Cervix becomes smaller Drier, less elastic vaginal canal Flattening of labia Endocervical epithelium atrophied Uterus becomes smaller Endometrium atrophied Alkaline vaginal environment Loss of vulvar subcutaneous fat and hair

1.2. Male

1.2.1. Health promotion Men with prostatic hypertrophy be examined every 6 months Routine prostate specific antigen testing in men with no hx of prostate cancer is not recommended Complete history and physical exam

1.2.2. Prostatitis patho: swelling of the prostate caused by UTI Signs and Symptoms: fever, chills, lower stomach tenderness, body aches, flushing of skin Treatment antibiotics

1.2.3. Erectile Dysfunction cannot keep erection or firm during sex may be from medications or illness

1.3. Female

1.3.1. Health promotion Annual gynecological exam Pap smear Knowledgeable about self breast examination Complete history and physical exam

1.3.2. Reproductive conditions Vaginitis Increased fragility of vagina in post menopausal women cause it to be more easily irritated s/s: soreness, pruritus, burning, reddened vagina accompanied by foul smelling vaginal discharge Tx: local estrogens in suppository or cream form Advise to avoid douching and perfumed soaps and sprays on genitalia Cancer of the cervix Signs: cervical bleeding and luekorrhea Can develop urinary retention, incontinence (urine and fecal), uremia Tx: radium or surgery 65 and older can stop cervical cancer screening as long as it was done regularly past 10 years and no serious precancers Menopause permanent cessation of menses awakening of body, mind and spirit

2. Respiratory

2.1. Emphysema

2.1.1. Patho Abnormal permanent enlargement of air spaces distal to the terminal bronchioles with destruction of alveolar walls.

2.1.2. Signs and symptoms: slow onset, increased dyspnea, chronic cough, hypoxia, fatigue, weight loss

2.1.3. Treatment Postural drainage Bronchodilators Avoidance of stressful situations Breathing exercises Cessation of smoking cigarettes

2.2. Pneumonia

2.2.1. Leading cause of death

2.2.2. 2 types Pneumococcal pneumonia Gram-negative bacilli causing

2.2.3. Patho Patient inhales or aspirates a pathogen, such as bacteria or a virus. Lungs' defense mechanisms are impaired

2.2.4. Signs and symptoms: pleuritic pain (amy not be as severe as youth), temperature (minimal or no fever), slight cough, fatigue, rapid respiration

2.3. Influenza

2.3.1. Patho Destroys ciliated epithelial cells of respiratory tract and depresses mucociliary clearance. Acquired through inhalation of infected droplets

2.3.2. Signs and symptoms: fever, myalgia, sore throat, nonproductive cough

2.3.3. Prevention Annual influenza vaccine

2.4. Age Related Changes

2.4.1. PO2 reduced as much as 15% between ages 20 and 80

2.4.2. Loss of elasticity and increased rigidity

2.4.3. Decreased ciliary action Complicates ability to expel mucous and debris

2.4.4. Forced expirations volume reduce

2.4.5. Blunting of cough and laryngeal reflexes

2.4.6. By 90 years old, approximately 50% increase in residual capacity

2.4.7. Alveoli fewer in number and larger in size

2.4.8. Thoracic muscles more rigid

2.4.9. Reduced basilar inflation

2.4.10. Residual volume increases, vital capacity is reduced

2.4.11. Connective tissue changes

3. GI

3.1. Peptic ulcer

3.1.1. Patho: imbalance between factors that can damage the gastroduodenal mucosal lining and defense mechanisms that normally limit injury

3.1.2. Signs and symptoms: pain, bleeding, obstruction, perforation

3.1.3. Treatment

3.2. Dysphagia

3.2.1. Patho Anything that impacts several cranial nerves or muscles of face, mouth, pharynx, esophagus causes dysphagia

3.2.2. Signs and symptoms: occasional difficulties swallowing certain types of food, complete inability to swallow

3.2.3. Treatment Referral to speech language pathologist Soft diet and thickening of liquids eat in upright position Ingest small bites in a non-hurried manner

3.3. Hiatal Hernia

3.3.1. Patho: displacement of the gastroesophageal junction above the diaphragm decreases the lower esophageal sphincter

3.3.2. signs and symptoms: heartburn, dysphagia, belching, vomiting, regurgitation

3.3.3. Treatment Managed medically If obese, lose weight Bland diet Milk and antacids for symptom relief several small meals a day H2 blockers Ranitidine, cimetidine, nizatine proton pump inhibitors Lansoprazole, omeprazole

3.4. Colorectal Cancer

3.4.1. Cancer at any site along the large intestine

3.4.2. Signs and symptoms: rectal bleeding, bloody stools, change in bowel pattern, anorexia, nausea, anemia, abdominal discomfort, pain over affected region

3.4.3. Treatment surgery to remove the cancer chemotherapy radiation

3.5. Age Related Changes

3.5.1. Decreased taste sensation

3.5.2. Esophagus more dilated

3.5.3. Reduced saliva and salivary ptyalin

3.5.4. Liver smaller in size

3.5.5. Reduced intestinal blood flow

3.5.6. Decreased esophageal motility

3.5.7. Atrophy of gastric mucosa

3.5.8. Decreased stomach motility, hunger contraction, emptying time

3.5.9. Less production of hydrochloric acid, Pepsin, lipase, and pancreatic enzymes

3.5.10. Fewer cells on absorbing surface of intestine

3.5.11. Slower peristalsis

4. Mobility (Musculoskeletal)

4.1. Osteoarthritis

4.1.1. Patho: progressive deterioration of the joint cartilage with the formation of new bone at the joint surface.

4.1.2. Signs and symptoms: Crepitation on joint motion may be noted, Joints more uncomfortable during damp weather and extended use Systemic symptoms not present

4.1.3. Treatment Analgesics to control pain Acetaminophen first drug of choice Rest Splints, braces, canes Heat or Ice T’ai chi Aqua therapy Gentle massage Acupuncture Diet high in cold water fish. Vitamins A,B,B6,C and E, zinc, selenium, niacinamide, calcium, magnesium help in controlling symptoms Weight reduction If treatments fail: arthoplasty

4.2. Rheumatoid Arthritis

4.2.1. Patho Synovium becomes hypertrophied and edematous with projections of synovial tissue protruding into the joint cavity

4.2.2. Signs and symptoms: joint pain (during rest and activity, fatigue, malaise, weakness, weight loss, wasting, fever, anemia

4.2.3. Treatment Rest and support to effected limbs Range of motion exercises Anti-inflammatory agents Disease-modifying antirheumatic drugs (methotrexate) Corticosteroids Immunosuppressive Surgery if significantly impaired, pain severe Joint replacement surgery

4.3. Osteoporosis

4.3.1. Patho: asymptomatic decrease in bone density due to inactivity, diseases, reduction in sex hormones, diet and drugs

4.3.2. Signs and symptoms Usually asymptomatic until detected by radiology

4.3.3. Treatment Depends on cause of disease Calcium, vitamin D supplements Estrogen receptor modulators Hormone therapy Synthetic form of calcitonin Bisphosphonates Diet rich in protein and calcium Regular exercise

4.4. Gout

4.4.1. Patho Metabolic disorder in which excess Uris acid accumulates in the blood. Crystallization of Uris acid deposited around joints causing pain.

4.4.2. Signs and symptoms: severe pain, tenderness of joint, warmth of joint, redness, swelling of surrounding tissues

4.4.3. Treatment Low-purine diet: Avoid bacon, turkey, veal, liver, kidney, anchovies, salmon, sardines, legumes, alcohol Colchicine or phenylbutazone for acute attacks Colchicine, allopurinol, probenecid, or indomethacin for long term Avoid thiazide dietetics Vitamin E, folic acid, eicosapentaenoic useful dietary supplements

4.5. Age Related Changes

4.5.1. Shortening of vertebrae

4.5.2. Height decreases 2in from age 20-70

4.5.3. Bones more brittle

4.5.4. Slight knee flexion

4.5.5. Decrease in bone mass and bone mineral

4.5.6. Slight kyphosis

4.5.7. Slight hip flexion

4.5.8. Slight wrist flexion

4.5.9. Impaired flexion and extension movements

5. Vision

5.1. Visual deficits

5.1.1. Cataracts Patho Clouding of Lens or its capsule that causes the lens to lose transparency Signs and symptoms: vision is distorted, night vision decreased, objects appeared blurred, glare from sunlight and bright lights is bothersome, nuclear sclerosis develops Treatment Surgery

5.1.2. Glaucoma Patho Degenerative eye disease in which the optic nerve is damaged from an above normal intraoculat pressure Signs and symptoms Acute glaucoma: severe eye pain, headache, nausea, vomiting Chronic: peripheral vision slowly becomes impaired, tired feeling in their eyes, headaches, misty vision, seeing halos around lights, symptoms more pronounced in mornings Treatment Acute glaucoma Chronic

5.1.3. Detached retina Patho Forward displacement of the retina from its normal position against the choroid Signs and symptoms: reception of spots moving across the eye, blurred vision, flashed of light, feeling that a coating is developing over the eye Treatment Prompt treatment Bed red Use of bilateral patches Surgery

5.2. Age Related Changes: Sensory organs

5.2.1. Vision More opaque lens Decreased pupil size More spherical cornea

5.2.2. Smell Impaired ability to identify and discriminate among odors

5.2.3. Taste High prevalence of taste impairment

5.2.4. Hearing Atrophy of hair cells of organ of corti Tympanic membrane sclerosis and atrophy Increased crewmen and concentration of keratin

6. Integumentary

6.1. Pruritus

6.1.1. Patho: itchy skin due to drones

6.1.2. Excessive itching can cause infection and skin breakdown

6.1.3. Treatment Bath oils Moisturizing lotions Massage Zinc oxide Antihistamines and topical steroids Vitamin supplements and high quality, rich vitamin diet

6.2. Pressure injury

6.2.1. Patho: injuries to the skin resulting from prolonged pressure on the skin

6.2.2. Signs and symptoms: swelling, unusual skin color or texture, redness, heat, pus drainage

6.2.3. Treatment High protein, vitamin rich diet Good skin care Depends on state of injury Hyperemia Ischemia Necrosis Deep tissue damage

6.3. Age Related Changes

6.3.1. Flattening of the dermal-epidermal junction

6.3.2. Reduced thickness and vascularity of dermis

6.3.3. Slowing of epidermal proliferation

6.3.4. Increased quantity and degeneration of elastin fibers occur

6.3.5. Collagen fibers become more coarser and random Reduce skin elasticity

6.3.6. Irritated and breaks down more easily

6.3.7. Dermis more avascular and thinner

6.3.8. Reduction in number of melanocytes by 10-20% each decade of life stating with third decade Tan more slowly and less deeply

6.3.9. Skin immune response declines More prone to skin inflections

6.3.10. Benign and malignant skin neoplasms

6.3.11. Growth rate of scalp, pubic, and axillary hair declines

6.3.12. Fingernails grow more slowly, brittle, develop longitudinal striations, decrease in lungless size

7. Safety

7.1. Pharmacology

7.1.1. Most commonly used drugs Cardiovascular agents, antihypertensive, analgesics, antiarthritic agents, sedatives, tranquilizers, laxatives, antacids Can cause confusion, dizziness, falls, and fluid and electrolyte imbalance which effects quality of life.

7.1.2. Taking more then one drug can cause risk of drug- food interactions

7.1.3. Altered pharmacokinetics Absorption IM, subcutaneous, oral and rectal are not absorbed as efficiently as inhaled, applied topically, or instilled IV Highly soluble and high concentrations are absorbed at greater speed Decreased intracellular fluid, increased gastric PH, decreased gastric blood flow and motility, reduced CO and circulation, and slower metabolism can slow absorption Exercise stimulates circulation and aids in absorption Distribution Hard to predict Dehydration and hypoalbuminemia decrease distribution Metabolism, detoxification, and excretion Dehydration, hyperthermia, immobility and liver disease decrease metabolism of drug Extended biological half life Detoxification and conjugation of drugs reduced Renal system excretes drugs; implications of reduced kidney efficiency important Liver influences drug detoxification and excretion

7.1.4. Increased risk of adverse reactions S/s of an adverse reaction in an older person can differ from given drug Adverse reaction may take longer to become apparent Adverse effect may occur after drug is discontinued Can develop suddenly Mental dysfunction one of the early symptoms of adverse reaction

7.1.5. Promoting safe use Beers Criteria Include drugs that are inappropriate to use in presence of specific conditions and in general. (Anticholinergics, tricyclics antidepressants, antipsychotics, barbiturates, and benzodiazepines) Ensure drugs are used selectively and cautiously Why is the drug ordered? Is the smallest possible disaster ordered? Is the patient allergic to the drug? Can this drug interact with others being used? are there special instructions for administration?

7.1.6. Promoting safe and effective administration Most common route to administer drugs is orally This can interfere with process (EX: dry mucous membranes and not being able to swallow) Suppository: may take longe to melt due to lower body temperature IM and subcutaneous administration: immobile limb will reduce rate of absorption monitor for complications when giving IV

7.1.7. Patient education Functional limitations Impaired ADLs can decrease ability to administer meds Cognitive limitations Impairments that prevent them from remembering to take medications, may retake meds because forgot they already took, confuse medication schedule and dosage. Educational limitations Difficult reading labels, and instructions from being adequately seen Sensory limitations Hearing deficits can cause instructions to be missed or misunderstood. Poor vision can effect reading labels and instructions Financial limitations Limited funds could cause the older person to not fill prescription, skip dosage or use an old prescription Choice Some may choose not to take medications due to effect, lack of motivation, denial of condition or prefer to use funds elsewhere

7.2. Environmental

7.2.1. Lighting Function: more mobile and participate in more activities in bright lit area Orientation: lose perception of tine in a room that is constantly lit or darkened Mood and behavior: blinking psychedelic lights cause a different reaction from candlelight. Several diffuse lighting sources are best Nightlights help facilitate orientation during the night and visibility to locate light switches exposure to natural light during normal 24 hour dark-light cycle helps maintain body rhythms

7.2.2. Temperature Maintain adequate environmental temperature is significant Room temperature should no be lower than 75 degree Fahrenheit brain damage can occur if the temperature is over 106 degrees Fahrenheit

7.2.3. Colors red, yellow, white stimulatng, increase pulse and BP blue, brown, earth tones relaxing orange stimulating Violet decreases appetite green sense of well being

8. Thermoregulation

8.1. Body temperature lower in later life than younger years

8.2. Reduced ability to respond to colder temperatures

8.2.1. Due to: inefficient vasoconstriction, reduced peripheral circulation, decreased cardiac output, diminished shivering, reduce muscle mass and subcutaneous tissue

8.3. Impaired responses to heat

8.3.1. Due to : impaired sweating mechanisms and decreases cardiac output

8.4. More susceptible to heat stress

9. Cell

9.1. Number of cells reduced

9.2. Lean body mass decreased

9.3. Fat tissue increases until 6th decade of life

9.4. Total body fat increases

9.5. Bone mass decreases

9.6. Extracellular fluid remains constant

9.7. Intracellular fluid decreased

9.7.1. Prone to dehydration

9.7.2. Fluid electrolyte imbalance

10. Immune system

10.1. Depressed immune response

10.2. Thymus mass decreases steadily

10.3. T cell activity declines and more immature T cells present in thymus

10.4. Inflammatory defense declines

10.5. Increase in proinflammatory cytokines

11. Physical

11.1. Graying and thinning of hair

11.2. Ectropion of eyelids

11.3. Elongated ears

11.4. Acrus senilis

11.5. Growth of facial hair in women

11.6. Diminished muscle mass and skin fold thickness

11.7. Thicker hair in ears and nose

11.8. Darkening and wrinkling of skin around orbits

11.9. Narrower gait in women, wider gait in men

11.10. Stature decreases

11.10.1. 2 in lost by age 80

11.10.2. Loss of cartilage and thinning of vertebrae

11.11. Changes are Gradual and subtle

12. Cardiac

12.1. Age Related Changes

12.1.1. More prominent arteries in head, neck, extremities

12.1.2. Valves become thicker and more rigid Result of sclerosis and fibrosis

12.1.3. Stroke volume decreases by 1% per year

12.1.4. Heart pigmented with lip furs in granules

12.1.5. Less efficient O2 utilization

12.1.6. Aorta becomes dilated and elongated

12.1.7. Cardiac output decreases

12.1.8. Resistance to peripheral blood flow increases by 1% per year

12.1.9. Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output

12.1.10. Less elasticity of vessels

12.1.11. Diastolic filling and systolic emptying requires more time to be completed

12.1.12. Blood vessels Tunica intima Most direct changes Tunica media Thinning and calcification of elastin fibers Increase in collagen Impaired baroreceptor function Peripheral resistance Tunica adventitia Not affected by aging process

12.2. Hypertension

12.2.1. Most prevalent cardiac disease in older adults

12.2.2. Patho: high blood pressure due to the amount of resistance to flow in your arteries

12.2.3. Signs and symptoms: awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor

12.2.4. Treatment Reduce sodium intake Reduce weight if necessary Antihypertensive drugs Thiazide diuretics Non-pharmacological methods Biofeedback yoga Meditation Relaxation exercises Diet rich in fruits, vegetables, whole grain, and low-fat in dairy foods

12.3. Congestive Heart Failure

12.3.1. Leading cause of hospitalization in older adults

12.3.2. Patho: heart muscle does not pump blood as well as it should

12.3.3. signs and symptoms: dyspnea on exertion, confusion, insomnia, wandering during the night, agitation, depression, weakness, SOB, bilateral ankle edema

12.3.4. Treatment Bed rest ACE inhibitors Beta-blockers Digitalis Diuretics Reduction in sodium intake

12.4. Coronary Heart Disease

12.4.1. Myocardial infarction Patho: caused by blockage or clot forming in the coronary arteries that occludes the blood flow causing lack of oxygen 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 Treatment Treatment Reduce amount of time in which patient is limited to bed rest to allowing to sit up in chair next to bed. Early ambulation following MI Thrombolytic therapy Fitness programs

12.5. Peripheral Vascular Disease

12.5.1. Arteriosclerosis Patho: hardening of the arteries Signs and symptoms: chest pain or angina, pain in leg, SOB, fatigue Treatment Bed rest Warmth Buerger-Allen exercises Vasodilator

12.5.2. Venous thromboembolism signs and symptoms: edema, warmth over affected area, pain in sole of foot Treatment Location determines the treatment Elastic stockings, or bandages Rest elevation of affect limb may promote venous return analgesics to relieve pain Anticoagulants Surgery

13. Urinary elimination

13.1. Urinary tract infection

13.1.1. Patho Caused by organism Escherichia coli in women and Proteus species in men

13.1.2. Signs and symptoms: burning, urgency, fever

13.1.3. Treatment Aims to establish adequate urinary draining and control of infection through antibiotic therapy Forcing fluids is advisable cranberry juice promotes reduction of UTIs

13.2. Bladder cancer

13.2.1. Patho: malignancy of the urothiel cells

13.2.2. Signs and symptoms: frequency, urgency, dysuria, painless hematuria

13.2.3. treatment Surgery radiation Immunotherapy Chemotherapy

13.3. Renal calculi

13.3.1. patho: small hard deposit that forms in the kidney due to excessive calcium or uric acid

13.3.2. Signs and symptoms: pain, hematuria, symptoms of UTI, GI upset

13.3.3. treatment

13.4. Glomerulonephritis

13.4.1. Patho: inflammation of the glomerulus

13.4.2. Signs and symptoms Subtle and nonspecific, initially go unnoticed Clinical manifestations: fever, fatigue, nausea, vomiting, abdominal pain, increased sedimentation rate

13.4.3. Treatment Antibiotics Restriction in sodium and protein diet Close attention to fluid intake and output If older adults are receiving digitalis, diuretics, antihypertensives then close observation for cumulative toxic effects from compromised kidney function must be maintained

13.5. Urinary system: Age Related Changes

13.5.1. Decreased size of renal mass

13.5.2. Decreased tubular function

13.5.3. Decreased bladder capacity

13.5.4. Decreased nephrons

13.5.5. Renal blood flow decreases

13.5.6. Globular filtration rate decreases

13.5.7. Weaker bladder muscles

14. Neurology

14.1. Parkinson’s Disease

14.1.1. Patho 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

14.1.2. 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

14.1.3. Treatment Carbidopa/levodopa in forms of sinemet Dopamine agonists Anricholinergics Amantadine, mono oxidase inhibitors, catechol-O-methyltransferase Active and passive ROM exercises Psychological support

14.2. Transient Ischemic Attacks

14.2.1. Patho Temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation

14.2.2. Signs and symptoms: hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, N/V, dysphagia

14.2.3. Treatment Correction of underlying cause Anticoagulant therapy Vascular reconstruction

14.3. Cerebrovascular Accidents

14.3.1. Patho: Can be ischemic or hemmorhagic causing compromise and damage to the brain. Need to stabilize patient and focus on rehabilitation

14.3.2. Signs and symptoms: light-headedness, dizziness, headache, drop attack, memory and behavioral changes.

14.4. Age Related Changes

14.4.1. Decreased conduction velocity

14.4.2. Slower response and reaction time

14.4.3. Decreased brain weight

14.4.4. Reduced blood flow to brain

14.4.5. Changes in sleep pattern

14.5. Changes to the mind: Age Related

14.5.1. Personality Drastic changes don’t occur with age. Consistent with earlier years

14.5.2. Memory Retrieval from long term memory slowed Working memory function reduced

14.5.3. Intelligence Basic intelligence maintained Crystallized intelligence maintained Fluid intelligence declines

14.5.4. Learning Not seriously altered. Other factors interfere with ability to learn: motivation, attention span, delayed transmission of information to the brain, perceptual deficits, illness

15. Endocrine

15.1. Diabetes mellitus

15.1.1. Patho: group of diseases that affect how your body uses glucose

15.1.2. Signs and symptoms: may be absent, orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, confusion, dupuytren's contracture

15.1.3. Treatment Drug therapy Metformin: Oral, first line treatment Sulfonylurea drugs (glibenclamide) Acarbose Rosiglitazone and pioglitazone

15.2. Hypothyroidism

15.2.1. Patho: thyroid does not produce enough of the thyroid gland

15.2.2. Signs and symptoms: fatigue, weakness, lethargy, depression, anorexia, weight gain and puffy face, impaired hearing, periorbital or peripheral edema, dry skin, coarse hair

15.2.3. Treatment Replacement of thyroid hormones using a synthetic T4 (synthroid and thyroxine)

15.3. Hyperthyroidism

15.3.1. Patho: loss of normal regulatory control of thyroid hormone secretion

15.3.2. Symptoms: diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, lid lag, increased hunger

15.3.3. Treatment Depends on cause Anti thyroid medications or radioactive iodine Surgery

15.4. Endocrine System

15.4.1. Thyroid gland under goes fibrosis, cellular infiltration, and increased nodularity Decreased metabolic rate Reduce radioactive iodine uptake Less thyrotropin secretion and release

15.4.2. Release for thyroid iodine decreases

15.4.3. Excretion of 17-ketosteriods declines

15.4.4. Reduction in triiodothyronine (T3)

15.4.5. TSH and T4 stay the same

15.4.6. ACTH secretion decrease

15.4.7. Secretory activity of adrenal gland decreases Decrease of glucocorticoids, 17-ketosteroids, progesterone, androgen, estrogen

15.4.8. Pituitary gland decreases in volume

15.4.9. Gonadal secretion declines

15.4.10. delayed and insufficient resales of insulin by the beta cells of the pancreas Reduce ability to metabolize glucose

16. Psychosocial

16.1. Depression

16.1.1. 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

16.1.2. Treatment Psychotherapy Antidepressants Electroconvulsive therapy Acupressure, acupuncture, guided imagery and light therapy Good health practices: proper nutrition, regular exercise

16.2. Anxiety

16.2.1. Signs and symptoms: somatic complaints, rigidity in thinking and behavior, insomnia, fantasizing, hostility, restlessness, increase in pulse, BP, respirations, psychomotor activity and frequency

16.2.2. Treatment Depends on cause Medications Biofeedback, guided imagery, relaxation therapy Control environmental stimuli

16.3. social changes

16.3.1. shrinking social world

16.3.2. loss of spouse

16.3.3. retirement

16.4. Dementia

16.4.1. Irreversible, progressive impairment in cognitive functions affecting memory, orientation, judgement, reasoning, attention, language, and problem solving. Alzheimer’s disease Patho: intracellular neurofibrillary tangles and extracellular amyloidal protein deposits contributing to senile plaques Signs and symptoms Treatment

16.5. Delirium

16.5.1. Signs and symptoms Disorientation to place and time but usually not identity Altered attention span Meaningless chatter Poor judgement Altered level of. Consciousness; hypervigilance, mild drowsiness, semicomatose state Hallucinations Disturbances in sleep wake cycle May be suspicious, personality changes, experience delusions Physical signs; SOB, fatigue, slower psychomotor activities

16.5.2. Treatment Depends on cause Stabilize glucose, correcting dehydration, discontinuing a medication Reversible in most circumstances, prompt care and treat as medical emergency