Older Adult Patient

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Older Adult Patient by Mind Map: Older Adult Patient

1. Environmental Safety

1.1. Lighting

1.1.1. Fluorescent lights bothersome

1.1.1.1. Causing eye strain and glare

1.1.2. Soft red light in the bedroom at night can improve night vision

1.1.3. Exposure to natural light during normal 24 hour dark-light cycle to maintain body rhythms

1.1.3.1. Influences body temperature, sleep cycles, hormone production

1.2. Temperature

1.2.1. Recommended room temperature should not be lower than 75 degrees

1.2.1.1. If less than 70 degrees, can lead to hypothermia

1.2.2. Temperature greater than 106 degrees can lead to brain damage

1.3. Color

1.3.1. Wall colors like red, yellow, white are stimulating

1.3.1.1. Increases blood pressure, pulse and appetite

1.3.2. Wall colors like blue, brown, earth tones are relaxing

1.3.3. Orange stimulates appetite

1.3.4. Violet decreases appetite

1.3.5. Green is a healing color and allows for a sense of well being

1.3.6. Black and grey are depressing

1.4. Floor coverings

1.4.1. Carpeting can reduce fractures associated with falls

1.4.2. Plush carpeting difficult for wheelchair mobility

1.4.3. Carpeting can be applied to wall surfaces for a noise buffer

1.4.4. Cockroaches, moths, fleas can reside underneath carpet

2. Cardiovascular

2.1. Age Related Changes

2.1.1. Valves are thicker and more rigid

2.1.2. Decreased stroke volume

2.1.3. Less efficient use of O2

2.1.4. Decreased cardiac output

2.1.5. More prominent arteries in head, neck, extremities

2.1.6. Less elasticity of vessels

2.1.7. Aorta becomes dilated and elongated

2.1.8. Increase of blood pressure

2.2. Pathological Changes

2.2.1. Hyperlipidemia

2.2.1.1. Pathophysiology

2.2.1.1.1. In older adults, most likely caused from conditions the adult has

2.2.1.1.2. Elevated total levels of cholesterol

2.2.1.2. Diagnosis

2.2.1.2.1. Obtain full lipid profile

2.2.1.2.2. If secondary causes are ruled out, autosomal dominant trait

2.2.1.3. Treatment

2.2.1.3.1. Dietary changes and exercise

2.2.1.3.2. First drug of choice for elevated LDL is 3-hydroxy-3-methylglutaryl-coenzyme (HMG CoA) reductase inhibitor

2.2.1.3.3. Complementary therapies

2.2.2. Atrial Fibrillation

2.2.2.1. Pathophysiology

2.2.2.1.1. Common in older adults with structural defects and comorbidities

2.2.2.1.2. Degeneration of electrical impulses in the atria

2.2.2.2. Signs and Symptoms

2.2.2.2.1. Palpitations

2.2.2.2.2. Irregular pulse

2.2.2.2.3. SOB

2.2.2.2.4. Chest pain

2.2.2.2.5. Fatigue

2.2.2.2.6. Dizziness

2.2.2.2.7. Delirium

2.2.2.3. Diagnosis

2.2.2.3.1. Physical examination, pt history, ECG, electrophysiology studies, stress tests, echocardiograms

2.2.2.4. Treatment

2.2.2.4.1. Antiarrhythmics, electrical cardioversion are the first things done

2.2.2.4.2. If no response to previous treatments, catheter ablation and maze procedure is done

2.2.2.5. Nurses role

2.2.2.5.1. Educate pt of disease, treatment regimen, activity modifications

2.2.2.5.2. Have pt report symptoms

3. Urinary

3.1. Age Related Changes

3.1.1. Decreased size of renal mass

3.1.2. Decreased tubular function

3.1.3. Decreased bladder capacity

3.1.4. Decrease in amt of nephrons

3.1.5. Weaker bladder muscles

3.1.6. Renal blood flow decreases by 53%

3.1.7. Glomerular filtration rate decreases by 50%

3.2. Pathological Changes

3.2.1. Urinary Incontinence

3.2.1.1. Pathophysiology

3.2.1.1.1. Failure of storage function of the lower urinary tract

3.2.1.2. Types

3.2.1.2.1. Stress Incontinence

3.2.1.2.2. Urgency Incontinence

3.2.1.2.3. Overflow Incontinence

3.2.1.2.4. Neurogenic (reflex) Incontinence

3.2.1.2.5. Functional Incontinence

3.2.1.2.6. Mixed Incontinence

3.2.1.3. Treatment

3.2.1.3.1. Kegel exercises

3.2.1.3.2. Catheterization

3.2.2. Urinary tract infection

3.2.2.1. Pathophysiology

3.2.2.1.1. Inflammation of renal tract due to bacteria

3.2.2.2. Symptoms

3.2.2.2.1. Early indicators

3.2.2.2.2. Older adults can develop delirium and incontinence

3.2.2.2.3. Retention and hematuria can occur

3.2.2.3. Treatment

3.2.2.3.1. Antibiotics to control infection

4. Respiratory

4.1. Age Related Changes

4.1.1. Decreased ciliary action

4.1.2. Forced expiratory volume reduced

4.1.3. Loss of elasticity

4.1.4. increased rigidity

4.1.5. PO2 reduced by 15%

4.1.6. Blunting of cough and laryngeal reflexes

4.1.7. Alveoli fewer in number and larger in size

4.1.8. Thoracic muscles more rigid

4.1.9. Reduced basilar inflation

4.1.10. Increase in residual capacity by about 50% by age 90

4.2. Pathological Changes

4.2.1. Pneumonia

4.2.1.1. Pathophysiology

4.2.1.1.1. Infection of the lungs caused by bacteria, virus, or fungi

4.2.1.1.2. Alveoli become inflammed and fill with pus and/or fluid

4.2.1.2. Signs & Symptoms

4.2.1.2.1. Pleuratic pain

4.2.1.2.2. Minimal or no fever

4.2.1.2.3. Cough, fatigue, rapid respirations

4.2.1.2.4. Confusion, restlessness, behavioral changes

4.2.1.3. Treatment

4.2.1.3.1. Mobility

4.2.1.3.2. Pneumococcal vaccine

4.2.2. Lung cancer

4.2.2.1. Pathophysiology

4.2.2.1.1. Genetic factors

4.2.2.1.2. Exposure to environmental pollutants and carcinogens

4.2.2.2. At Risk

4.2.2.2.1. Cigarette smoker or exposure to cigarettes

4.2.2.2.2. Abestos

4.2.2.2.3. Coal and radon gas

4.2.2.2.4. Air pollutants

4.2.2.2.5. Highest African American males, white American Indian/Alaska native, Asian/Pacific Islander, Hispanic Men

4.2.2.3. Signs & Symptoms

4.2.2.3.1. Dyspneac

4.2.2.3.2. Cough

4.2.2.3.3. Chest pain

4.2.2.3.4. Fatigue

4.2.2.3.5. Anorexia

4.2.2.3.6. Wheezing

4.2.2.3.7. Recurrent upper respiratory tract infections

4.2.2.4. Treatment

4.2.2.4.1. Diagnosis

4.2.2.4.2. Surgery

4.2.2.4.3. Chemotherapy

4.2.2.4.4. Radiotherapy

4.2.3. Influenza

4.2.3.1. Pathophysiology

4.2.3.1.1. Virus enters the respiratory tract

4.2.3.2. Signs & Symptoms

4.2.3.2.1. Fever (not as high compared to young adults)

4.2.3.2.2. Myalgia

4.2.3.2.3. Sore throat

4.2.3.2.4. Nonproductive cough

4.2.3.3. Treatment

4.2.3.3.1. Influenza vaccine annually

5. Neurological

5.1. Age Related Changes

5.1.1. Decreased conduction velocity

5.1.2. Slower response and reaction time

5.1.3. Decreased brain weight

5.1.4. Reduced blood flow to brain

5.1.5. Changes in sleep pattern

5.2. Pathological Changes

5.2.1. Dementia

5.2.1.1. Pathophysiology

5.2.1.1.1. Damage to brain tissue due to degenerative tissue, circulatory problems, lack of oxygen, infection, trauma, hydrocephalus, tumor, alcoholism

5.2.1.2. Onset

5.2.1.2.1. Slow takes months to years before symptoms are evident

5.2.1.3. Behavior

5.2.1.3.1. Inappropriate

5.2.1.3.2. May be unsteady on feet

5.2.1.3.3. Have difficulty with coordinated movements

5.2.1.4. Recovery

5.2.1.4.1. Progression can be slowed but cannot be reversed

5.2.1.4.2. Continues to worsen

5.2.2. Delirium

5.2.2.1. Pathophysiology

5.2.2.1.1. Disruption in brain function d/t medication side effect, circulatory disturbance, dehydration, low of high BP, low or high thyroid activity, low or high blood glucose, surgery, stress

5.2.2.2. Symptoms

5.2.2.2.1. Altered attention span

5.2.2.2.2. Worsened memory

5.2.2.2.3. Poor judgement

5.2.2.2.4. Altered LOC

5.2.2.2.5. Hyper vigilance

5.2.2.2.6. Mild drowsiness

5.2.2.2.7. Semicomatose status

5.2.2.3. Onset

5.2.2.3.1. Rapid

5.2.2.3.2. Change is noted within days

5.2.2.4. Mental status

5.2.2.4.1. Short term memory impaired

5.2.2.4.2. Disoriented and confused

5.2.2.4.3. Incoherent speech

5.2.2.4.4. Hallucinations

5.2.2.4.5. Exaggeration of personality features

5.2.2.5. Behavior

5.2.2.5.1. Hyperactive

5.2.2.5.2. Less active than normal

5.2.2.6. Recovery

5.2.2.6.1. Can be reversed and normal mental status can return if cause is treated promptly

6. GI

6.1. Age Related Changes

6.1.1. Decreased taste sensation

6.1.2. Esophagus more dilated

6.1.3. Reduced saliva

6.1.4. Smaller liver

6.1.5. Reduced intestinal blood flow

6.1.6. Slower peristalsis

6.1.7. Fewer cells on absorbing surface of intestines

6.1.8. Atrophy of gastric mucosa

6.1.9. Decreased esophageal motility

6.1.10. Decreased stomach motility

6.1.11. Decreased hunger contractions

6.1.12. Decreased emptying time

6.1.13. Less production of HCl acid, pepsin, lipase, pancreatic enzymes

6.2. Pathological Changes

6.2.1. Dysphagia

6.2.1.1. Pathophysiology

6.2.1.1.1. Lesions on upper digestive tract

6.2.1.1.2. Obstruction of upper digestive tract

6.2.1.1.3. Alterations in the nervous or muscular control of swallowing

6.2.1.2. Assessment

6.2.1.2.1. When did the problem begin?

6.2.1.2.2. Any other symptoms?

6.2.1.2.3. Do certain foods trigger the symptoms? Solids or liquids?

6.2.1.2.4. Does it occur with every meal?

6.2.1.2.5. Observe intake of food

6.2.1.2.6. Refer to speech language pathologist

6.2.1.2.7. Monitor I&O’s and weight

6.2.1.3. Treatment

6.2.1.3.1. Goal: adequate nutritional status and prevent aspiration

6.2.1.3.2. Soft diet

6.2.1.3.3. Thickening of liquids

6.2.1.3.4. Eat sitting in an upright position

6.2.2. Hiatal Hernia

6.2.2.1. Pathophysiology

6.2.2.1.1. Displacement of the gastroesophageal junction

6.2.2.1.2. More common in older women

6.2.2.1.3. Low fiber diet can contribute to this condition

6.2.2.2. Types

6.2.2.2.1. Sliding (axial)

6.2.2.2.2. Rolling (paraesophageal)

6.2.2.3. Symptoms

6.2.2.3.1. Heartburn

6.2.2.3.2. Dysphagia

6.2.2.3.3. Belching

6.2.2.3.4. Vomiting

6.2.2.3.5. Regurgitation

6.2.2.4. Diagnosis

6.2.2.4.1. Barium swallow

6.2.2.4.2. Esophagoscopy

6.2.2.5. Treatment

6.2.2.5.1. Weight loss if pt is obese

6.2.2.5.2. Bland diet

6.2.2.5.3. Milk and antacids for symptomatic relief

6.2.2.5.4. Multiple small meals a dayd

6.2.2.5.5. Do not eat before bed

6.2.2.5.6. H2 blockers (ranitidine, cimetidine, or nizatidine)

6.2.2.5.7. proton pump inhibitors (lansoprazole or omeprazole)

6.2.3. Diverticulitis

6.2.3.1. Pathophysiology

6.2.3.1.1. Multiple pouches of intestinal mucosa in the weakened muscular wall of the large bowel

6.2.3.2. Symptoms

6.2.3.2.1. Slight bleeding

6.2.3.2.2. Changes in bowel habits

6.2.3.2.3. Overeating, straining during a bowel movement, alcohol, irritating foods may contribute

6.2.3.2.4. Abrupt onset of pain in LLQ

6.2.3.2.5. n/v

6.2.3.2.6. Blood or mucus in stool

6.2.3.2.7. Low grade fever

6.2.3.3. Treatment

6.2.3.3.1. Reducing infection, provide nutrition, relieve discomfort, promote rest

6.2.3.3.2. IV therapy

6.2.3.3.3. Acute attack; consume low residue diet

6.2.3.3.4. Surgery may be performed

7. Integumentary

7.1. Age Related Changes

7.1.1. Thicker hair in ears and nose

7.1.2. Darkening and wrinkling of skin around orbits

7.1.3. Growth of facial hair in women

7.1.4. Ectropion of eyelids

7.2. Pathological Changes

7.2.1. Skin cancer

7.2.1.1. Pathophysiology

7.2.1.2. Types

7.2.1.2.1. Basal cell carcinoma

7.2.1.2.2. Squamous cell carcinoma

7.2.1.2.3. Melanoma

7.2.2. Pressure Injury

7.2.2.1. Pathophysiology

7.2.2.1.1. Tissue anoxia and ischemia from pressure can result in necrosis, sloughing, and ulceration of the tissue

7.2.2.2. Stages

7.2.2.2.1. Stage 1

7.2.2.2.2. Stage 2

7.2.2.2.3. Stage 3

7.2.2.2.4. Stage 4

7.2.2.2.5. Unstageable

7.2.2.3. Nursing interventions

7.2.2.3.1. Encourage activity

7.2.2.3.2. Turn pt

7.2.2.3.3. Avoid shearing forces by not elevating the HOB greater than 30 degrees

7.2.2.3.4. Use pillows, flotation devices, alternating pressure mattresses, or water beds

7.2.2.3.5. Keep sheets wrinkle free

7.2.2.3.6. High protein, vitamin rich diet

7.2.2.3.7. Good skin care

8. Reproductive

8.1. Male

8.1.1. Pathological Changes

8.1.1.1. Erectile Dysfunction

8.1.1.1.1. Pathophysiology

8.1.1.1.2. Causes

8.1.1.1.3. Treatment

8.1.1.2. BPH

8.1.1.2.1. Pathophysiology

8.1.1.2.2. Symptoms

8.1.1.2.3. Treatment

8.1.2. Age Related Changes

8.1.2.1. Prostate enlarges

8.1.2.2. Venous and arterial sclerosis of penis

8.1.2.3. Reduction in sperm count

8.1.2.4. Fluid-retaining capacity of seminal vesicles reduces

8.2. Female

8.2.1. Age Related Changes

8.2.1.1. Fallopian tubes atrophy and shorten

8.2.1.2. Ovaries become thicker and smaller

8.2.1.3. Cervix becomes smaller

8.2.1.4. Drier, less elastic vaginal canal

8.2.1.5. Flattening of the labia

8.2.1.6. Endocervical epithelium atrophies

8.2.1.7. Uterus becomes smaller in size

8.2.1.8. Endometrium atrophies

8.2.1.9. More alkaline vaginal environment

8.2.1.10. Loss of vulvar subcutaneous fat and hair

8.2.2. Pathological Changes

8.2.2.1. Perineal Herniation

8.2.2.1.1. Pathophysiology

8.2.2.1.2. Types

8.2.2.1.3. Symptoms

8.2.2.1.4. Treatment

8.2.2.2. Cervical Cancer

8.2.2.2.1. Pathophysiology

8.2.2.2.2. Symptoms

8.2.2.2.3. Treatment

8.2.2.2.4. Most prevalent among Hispanic women, then black women, white Native American/Alaskan Native, Asian Pacific women

9. Musculoskeletal

9.1. Age Related Changes

9.1.1. Shortening vertebrae

9.1.2. High decreases by approx 2 inches

9.1.3. Bones are more brittle

9.1.4. Slight knee flexion

9.1.5. Decrease in bone mass and bone material

9.1.6. Slight kyphosis

9.1.7. Slight hip flexion

9.1.8. Slight wrist flexion

9.1.9. Impaired flexion and extension movements

9.2. Pathological Changes

9.2.1. Osteoporosis

9.2.1.1. Pathophysiology

9.2.1.1.1. Metabolic disease of the bone

9.2.1.1.2. Demineralization of the bone

9.2.1.1.3. Decrease in mass and density of the bones

9.2.1.2. Symptoms

9.2.1.2.1. Inactivity or immobility

9.2.1.2.2. Diseases

9.2.1.2.3. Reduction in anabolic sex hormones

9.2.1.2.4. Diet

9.2.1.2.5. Drugs

9.2.1.3. Treatment

9.2.1.3.1. Calcium or vitamin D supplements

9.2.1.3.2. Selective estrogen receptor modulators (SERMs)

9.2.1.3.3. Hormone therapy

9.2.1.3.4. Biphosphonates

9.2.1.3.5. Diet rich in protein and calcium

9.2.1.3.6. Braces can be used to prevent spasms

9.2.1.3.7. Avoid heavy lifting, jumping, or other activities that can result in fracture

9.2.2. Gout

9.2.2.1. Pathophysiology

9.2.2.1.1. Metabolic disorder excess uric acid accumulates in blood

9.2.2.2. Symptoms

9.2.2.2.1. Severe pain

9.2.2.2.2. Tenderness of joint

9.2.2.2.3. Warmth, redness, swelling of tissue surrounding joint

9.2.2.3. Treatment

9.2.2.3.1. Aimed to reduce sodium urate through a low-purine diet

9.2.2.3.2. Alcohol and drugs should be avoided

9.2.2.3.3. Colchicine or phenylbutazone manage acute attacks

9.2.2.3.4. Long term management

9.2.2.4. Nurses role

9.2.2.4.1. Monitor pain

9.2.2.4.2. Encourage good fluid intake to prevent formation of renal stones

10. Sensory

10.1. Safety

10.1.1. Reduced peripheral vision

10.1.1.1. Approach individuals from the back or side

10.1.2. Altered depth perception

10.1.2.1. Reduce the ability to detect changes in levels

10.1.2.1.1. Alleviated by good lighting, no clutter on staircase, use contrasting colors on stairs

10.1.3. Hearing deficits

10.1.3.1. Hearing impaired individuals should live near people with adequate hearing

10.1.3.1.1. Can be alerted about fire alarms or other warnings

10.1.3.2. Trained dogs for people with hearing deficits

10.2. Age Related Changes

10.2.1. Sight

10.2.1.1. More opaque lens

10.2.1.2. Decreased pupil size

10.2.1.3. More spherical cornea

10.2.2. Smell

10.2.2.1. Impaired ability to identify and discriminate among odors

10.2.3. Taste

10.2.3.1. High prevalence of taste impairment

10.2.4. Touch

10.2.4.1. Reduction in tactile sensation

10.2.5. Hearing

10.2.5.1. Atrophy of hair cells of organ of Corti

10.2.5.2. Tympanic membrane sclerosis and atrophy

10.2.5.3. Increased cerumen and concentration of keratin

10.3. Pathological Changes

10.3.1. Cataracts

10.3.1.1. Pathophysiology

10.3.1.1.1. Clouding of the lens or its capsule that causes the lens to lose its transparency

10.3.1.2. Symptoms

10.3.1.2.1. No discomfort or pain

10.3.1.2.2. Vision distorted

10.3.1.2.3. Night vision decreased

10.3.1.2.4. Nuclear sclerosis develops

10.3.1.3. Treatment

10.3.1.3.1. Only cure - surgical removal of lens

10.3.1.3.2. Only affects one eye

11. Endocrine

11.1. Age Related Changes

11.1.1. Decrease thyroid gland activity

11.1.1.1. Lower basal metabolic rate

11.1.1.2. Reduced radioactive iodine uptake

11.1.1.3. Less thyrotropin secretion and release

11.1.2. ACTH secretion decreases

11.1.2.1. Secretory activity of adrenal gland also decreases

11.1.3. Pituitary gland decreases in volume by 20%

11.1.4. Decrease TSH, follicle-stimulating hormone, LH, luteotropic hormone

11.1.5. Delay and insufficient release of beta cells by pancreas

11.1.6. Ability to metabolize glucose reduced

11.1.6.1. Higher concentrations of glucose and more prolonged hyperglycemia levels

11.2. Pathological Changes

11.2.1. Hypothyroidism

11.2.1.1. Pathophysiology

11.2.1.1.1. Decreased levels of thyroxine (T4) and triiodothyronine (T3) that are produced by the thyroid gland

11.2.1.2. Symptoms

11.2.1.2.1. Fatigue, weakness, lethargy

11.2.1.2.2. Depression

11.2.1.2.3. Anorexia

11.2.1.2.4. Weight gain and puffy face

11.2.1.2.5. Impaired hearing

11.2.1.2.6. Periorbital or peripheral edema

11.2.1.2.7. Constipation

11.2.1.2.8. Cold intolerance

11.2.1.2.9. Myalgia, parenthesia, ataxia

11.2.1.2.10. Dry skin, coarse harir

11.2.1.3. Treatment

11.2.1.3.1. Replacement of thyroid hormone using synthetic T4

11.2.1.4. Nursing interventions

11.2.1.4.1. Help pt with management of other symptoms

11.2.1.4.2. Help pt understand that they will need thyroid replacement therapy for the rest of their life

11.2.2. Hyperthyroidism

11.2.2.1. Pathophysiology

11.2.2.1.1. Thyroid gland excretes excess amounts of thyroid hormones

11.2.2.2. Symptoms

11.2.2.2.1. Diaphoresis

11.2.2.2.2. Tachycardia

11.2.2.2.3. Palpitations

11.2.2.2.4. HTN

11.2.2.2.5. Tremor

11.2.2.2.6. Diarrhea

11.2.2.2.7. Stare

11.2.2.2.8. Lid lag

11.2.2.2.9. Insomnia

11.2.2.2.10. Nervousness

11.2.2.2.11. Confusion

11.2.2.2.12. Heat intolerance

11.2.2.2.13. Increased hunger

11.2.2.2.14. Proximal muscle weakness

11.2.2.2.15. Hyperreflexia

11.2.2.3. Treatment

11.2.2.3.1. Graves’ disease

11.2.2.3.2. Goiter

11.2.3. Diabetes Mellitus

11.2.3.1. Pathophysiology

11.2.3.1.1. Glucose intolerance

11.2.3.1.2. Increased amount of fat tissue in older adults who are obese and inactive

11.2.3.2. Diagnosis

11.2.3.2.1. Fasting blood sugar every 3 years if over 45 years of age

11.2.3.2.2. Glucose tolerance test

11.2.3.2.3. Diagnosis is established if one of these exist

11.2.3.2.4. Results are confirmed by repeat testing on another day

11.2.3.3. Patient education

11.2.3.3.1. Barriers

11.2.3.3.2. Provide reassurance, support, and information to reduce barriers

11.2.3.4. Drug Therapy

11.2.3.4.1. Metformin

11.2.3.4.2. Sulfonylurea

11.2.3.4.3. Acarbose

11.2.3.5. Patient self care and monitoring

11.2.3.5.1. Observe patients ability to handle a syringe and a vial of insulin

11.2.3.5.2. Observe the patient performing the finger-prick technique

11.2.3.5.3. Monitor triglycerides due to the development of metabolic syndrome

11.2.3.6. Exercise and nutrition

11.2.3.6.1. Regular exercise is very important!

11.2.3.6.2. Maintain consistent daily food intake

11.2.3.6.3. Nutritional supplements can reduce the complications

11.2.3.7. Symptoms of hypoglycemia in the older adult

11.2.3.7.1. Confusion

11.2.3.7.2. Abnormal behavior

11.2.3.7.3. Altered sleep patterns

11.2.3.7.4. Nocturnal headache

11.2.3.7.5. Slurred speech

12. Immune System

12.1. Age Related Changes

12.1.1. Immunosenescence

12.1.1.1. Increase in the amount of infections

12.1.1.2. Decline in T cell activity

12.1.1.2.1. More immature T cells

12.1.1.3. Decline in cell mediated immunity

12.1.1.4. T lymphocytes are not able to proliferate as well in response to mitogens

12.1.1.5. IgM lower

12.1.1.6. IgA and IgG higher

12.1.1.7. Responses to certain vaccines are less effective

12.1.1.7.1. Influenza

12.1.1.7.2. Parainfluenza

12.1.1.7.3. Pneumococcal

12.1.1.7.4. Tetanus

12.1.1.8. Decline in inflammatory responses

12.1.1.9. Inflammation presents atypically in older adults

12.1.1.9.1. Low grade fever

12.1.1.9.2. Minimal pain

12.1.1.10. Increase in proinflammatory cytokines

12.1.1.10.1. Associated with atherosclerosis, diabetes, osteoporosis

13. Eliopoulos, C. (2018). Gerontological nursing. Philadelphia: Wolters Kluwer.