1. Intelligence
1.1. Age related changes
1.1.1. Crystallized intelligence maintained
1.1.2. Fluid intelligence decreases
1.1.3. Basic intelligence is maintained
2. Thermoregulation
2.1. Age related changes
2.1.1. Impaired sweating mechanism
2.1.1.1. More susceptible to heat stress
2.1.2. Reduced ability to respond to cold temperatures
2.1.3. Lower temperature
3. Endocrine system
3.1. Age related changes
3.1.1. Pancreases
3.1.1.1. Delayed and insufficient release of insulin
3.1.1.2. Reduced ability to metabolize glucose
3.1.2. Pituitary gland
3.1.2.1. Decreases in volume by 20%
3.1.2.2. Gonadal secretions decrease
3.1.3. Adrenal cortex
3.1.3.1. ACTH secretion decreases
3.1.3.2. Secretion of glucocorticoids is reduced
3.1.4. Thyroid gland
3.1.4.1. Fibrosis
3.1.4.2. Cellular infiltration
3.1.4.3. Lower BMI
3.1.4.4. Reduced radioactive iodine uptake
3.2. Pathologies
3.2.1. Hypothyroidism
3.2.1.1. Condition increases in prevalence with age
3.2.1.2. S/S: fatigue, weakness, disinterest in activities, anorexia, weight gain and puffy face, impaired hearing, peri orbital edema, constipation, cold intolerance, ataxia, paresthesia, dry skin, and coarse hair
3.2.1.3. Diagnostics: blood test TSH, T4 levels
3.2.1.4. Nursing Interventions: synthetic T4 replacement, treat and prevent signs and symptoms ( constipation, wear extra clothes if cold intolerant)
4. Integumentary system
4.1. Age related changes
4.1.1. Reduced melanocytes
4.1.2. Lines, wrinkles, sagging
4.1.3. Collagen fibers coarse and more random, reducing elasticity of the skin
4.1.4. Increased quantity and degeneration of elastin fibers
4.1.5. Reduced thickness and vascularity of the dermis
4.1.6. Flattening of dermal-epidural junction
4.2. Pathologies
4.2.1. Pruritus
4.2.1.1. Most common skin disease among older adults
4.2.1.2. Risk factors: diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia
4.2.1.3. S/S: uncomfortable, irritating sensation that makes you want to scratch
4.2.1.4. Nursing interventions: bath oils, moisturizing lotions, massage, vitamin supplements and diet high in vitamins, zinc oxide
4.2.1.4.1. Medications: antihistamines and topical steroids
5. Immune system
5.1. Age related changes
5.1.1. Inflammatory response declines
5.1.2. IgM concentration lower, IgA and IgG are higher
5.1.3. Large decline in cell-mediated immunity
5.1.4. T-cell activity declines and more immature T cells are present in the thymus
5.1.5. Immunosenescence- depressed immune response
5.1.5.1. Increases risk for infection
6. Sensory organs
6.1. Age related changes
6.1.1. Vision
6.1.1.1. Presbyopia
6.1.1.2. Stiffening of muscle fibers of lens
6.1.1.3. Visual field narrows
6.1.1.4. Pupillary sphincter hardens
6.1.1.5. Light perception threshold increases
6.1.2. Hearing
6.1.2.1. Atrophy of hair cells of organ of corti
6.1.2.2. Tympanic membrane sclerosis and atrophy
6.1.2.3. Increased cerumen and concentration of keratin
6.1.3. Taste and smell
6.1.3.1. High prevalence of taste impairment
6.1.3.2. Impaired ability to identify and discriminate among odors
6.1.4. Touch
6.1.4.1. Reduced tactile sensation
6.2. Pathologies
6.2.1. Cataracts
6.2.1.1. Clouding of the lens or its capsule causes the lens to lose its transparency
6.2.1.2. Common among older people
6.2.1.3. Risk factors: UV B rays exposure, diabetes, cigarette smoking, high alcohol consumption
6.2.1.4. S/S: no discomfort or pain, vision distorted, decreased night vision, blurred objects, feel like there is a film over eye, lens is yellow or yellow-brown, improvement in ability to see small print and objects
6.2.1.5. Treatment: surgery to remove lens, if only one eye effected then focus on strengthening vision that exists, sunglasses, shear curtains over windows, multiple soft lights instead of one bright one
7. Nervous system
7.1. Age related changes
7.1.1. Changes in sleep pattern
7.1.2. Reduced blood flow to the brain
7.1.3. Decreased brain weight
7.1.4. Decreased conduction velocity
7.1.5. Slower response and reaction time
7.2. Pathologies
7.2.1. Cerebrovascular accidents
7.2.1.1. Third leading cause of death and disability in older people
7.2.1.2. Risk factors: hypertension, obesity, diabetes, severe arteriosclerosis, gout, anemia, hypothyroidism, TIAs, dehydration
7.2.1.3. S/S: light-headedness, dizziness, headache, drop attack, memory and behavioral changes, hemiplegia, aphasia, hemianopsia
7.2.1.4. Nursing interventions: maintain a patent airway, provide adequate nutrition and hydration, monitor neurologic and vital signs, prevent complications associated with immobility, frequent skin care, frequent turns
8. Musculoskeletal system
8.1. Age related changes
8.1.1. Impaired flexion and extension movements
8.1.2. Slight wrist flexion
8.1.3. Slight kyphosis
8.1.4. Shortening of vertebrae
8.1.5. Between ages 20 and 70, height decreases approximately 2 inches
8.1.6. Bones more brittle
8.1.7. Slight knee flexion
8.1.8. Decrease in bone mass and bone mineral
8.2. Pathologies
8.2.1. Osteoarthritis
8.2.1.1. Progressive degeneration and abrasion of joint cartilage, with 5e formation of new bone at the joint surface
8.2.1.2. Effects most people over 55 to some extent
8.2.1.3. Risk factor: disequilibrium between destructive and synthetic elements leads to a lack of homeostasis necessary to maintain cartilage, causing joint changes. Excessive use of joint, trauma, obesity, low vitamin d and c, genetic factors, acromegaly,
8.2.1.4. S/S: crepitus of the joints, discomfort at the joint with extended use
8.2.1.5. Nursing interventions: rest, heat/ice, t’ai chi, aqua therapy, gentle massage, splints, braces, canes, weight reduction, occupational and physical therapy, arthroplasty-joint replacement
8.2.1.5.1. Medications: analgesics to control pain
8.2.1.5.2. Diet: abundance of cold water fish and other foods high in essential fatty acids, vitamin a, b, b6, c, and e. Zinc, selenium, niacin-amide, calcium, magnesium
9. Reproductive system
9.1. Age related changes
9.1.1. Male
9.1.1.1. Possible reduction in sperm count
9.1.1.2. Fluid-retaining capacity of seminal vesicles reduces
9.1.1.3. Venous and arterial sclerosis of the penis
9.1.1.4. Prostate enlarges in most men
9.1.2. Female
9.1.2.1. Flattening of labia
9.1.2.2. Drier, less elastic vaginal canal
9.1.2.3. Cervix becomes smaller
9.1.2.4. Ovaries become thicker and smaller
9.1.2.5. Fallopian tube atrophy and shortens
9.1.2.6. Endocervical epithelium atrophies
9.1.2.7. Uterus becomes smaller in size
9.1.2.8. Endometrium atrophies
9.1.2.9. More alkaline vaginal environment
9.1.2.10. Loss of vulvar subcutaneous fat and hair
9.1.2.11. Diseases related to body system
9.2. Pathologies
9.2.1. Female
9.2.1.1. Perineal herniation
9.2.1.1.1. Result of stretching and tearing of muscles during childbirth, common among older women
9.2.1.1.2. S/S: lower back pain, pelvic heaviness, pulling sensation, urinary and fecal incontinence, retention, constipation
9.2.1.1.3. Nursing interventions: educate on how intercourse can be painful, preparing and informing about surgical repair treatment
9.2.2. Male
9.2.2.1. Benign prostatic hyperplasia
9.2.2.1.1. Most older men have to some degree
9.2.2.1.2. S/S: hesitancy, frequency, nocturia, dribbling, bleeding
9.2.2.1.3. Nursing intervention: prostatic massage, urinary antiseptics, prostatectomy-educate on surgery
10. Urinary system
10.1. Age related changes
10.1.1. Decreased bladder capacity
10.1.2. Decreased size of renal mass
10.1.3. Decreased tubular function
10.1.4. Decrease in nephrons
10.1.5. Between ages 20 and 90 renal blood flow decreases 53%, and glomerular filtration rate decreases 50%
10.1.6. Weaker bladder muscles
10.2. Pathologies
10.2.1. Urinary tract infection
10.2.1.1. Most common infection of older adults
10.2.1.2. Risk factors:
10.2.1.2.1. Poor hygiene, improper cleaning after bowel elimination, low fluid intake, excessive fluid loss, hormonal changes, catheter
10.2.1.2.2. Escherichia coli (women), proteus (men)
10.2.1.3. S/S: burning, urgency, fever, retention, incontinence, hematuria
10.2.1.4. Diagnostic: Bacteriuria- >105
10.2.1.5. Nursing interventions: adequate urinary drainage, I&O’s, fluids, cranberry juice, avoid urinary catheter
10.2.2. Urinary incontinence
10.2.2.1. Common and bothersome disorder of older adults, in more than half of institutionalized older population
10.2.2.2. Risk factors: delirium, dementia, cerebrovascular accident, diabetes mellitus, congestive heart failure, UTI
10.2.2.2.1. medications that can affect continence: diuretics, antianxiety agents, antipsychotics, antidepressants, sedatives, narcotics, antiparkinson agents, antispomodics, antihistamine, calcium channel blockers, alpha-blockers, alpha-stimulants
10.2.2.3. Symptoms: urgency, burning, vaginal itching, pain, pressure in bladder area, fever
10.2.2.4. Nursing interventions: refer patient for a comprehensive medical evaluation, assess activities of daily living, note degree of dependency
11. Gastrointestinal system
11.1. Age related changes
11.1.1. Slower peristalsis
11.1.2. Fewer cells on absorbing surface of intestines
11.1.3. Less production of HCL, pepsin, lipase, and pancreatic enzymes
11.1.4. Decreased stomach motility and hunger contractions, and emptying time
11.1.5. Atrophy of gastric mucosa
11.1.6. Decrease esophageal motility
11.1.7. Decreased taste sensation
11.1.8. Esophagus more dilated
11.1.9. Reduced saliva and salivary ptyalin
11.1.10. Liver smaller in size
11.1.11. Reduced intestinal blood flow
11.2. Pathologies
11.2.1. Hiatal hernia
11.2.1.1. Affects about half of the people in the US over age of 50, more common in women
11.2.1.2. Risk factors: low-fiber diet, GERD, obesity
11.2.1.3. S/S: heartburn, dysphagia, belching, vomiting, regurgitation, pain, and bleeding
11.2.1.4. Diagnostics: barium swallow and esophagoscopy
11.2.1.5. Nursing interventions: weight reduction, bland diet, milk, several small meals, avoid eating before bedtime, sleep in slight recombinant position
11.2.1.5.1. Medications: antacids, H2 blockers, proton pump inhibitor
11.2.2. Colorectal cancer
11.2.2.1. Cancer along large intestine is common with advancing age
11.2.2.2. Diagnostics: colonoscopy with biopsy and CT colonoscopy, fecal occult blood testing
11.2.2.3. S/S: rectal bleeding, bloody stools, change in bowel pattern, feeling of incomplete emptying of bowel, anorexia, nausea, abdominal discomfort, pain over affected region, weakness, fatigue, unexplained weight loss, anemia
11.2.2.4. Nursing interventions: preparation for surgery, have regular meals, restrict tea and coffee, reduce alcohol and carbonated drinks, eat something solid with each meal
11.2.2.4.1. Radiotherapy: can downstage tumor to aid complete excision
11.2.2.4.2. Surgical resection
11.2.2.4.3. Chemotherapy: with high-risk Dukes B or Dukes C tumors with nodal disease to reduce recurrence
12. Cardiovascular system
12.1. Age related changes
12.1.1. Less elasticity of vessels
12.1.2. Blood pressure increases
12.1.3. Resistance to peripheral blood flow increases slightly each year
12.1.4. Cardiac output decreases
12.1.5. Aorta becomes dilated and elongated
12.1.6. More prominent arteries in head, neck, and extremities
12.1.7. Valves become thicker and more rigid
12.1.8. Stroke volume decreases
12.1.9. Heart pigmented with lipofuscin granules
12.1.10. Less efficient O2 utilization
12.2. Pathologies
12.2.1. Hypertension
12.2.1.1. Most prevalent CV disease among older adults
12.2.1.2. Causes: vasoconstriction, peripheral resistance, hyperthyroidism, Parkinson disease, Paget’s disease, anemia, thiamine deficiency
12.2.1.3. S/S: high blood pressure, awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, and a slow tremor
12.2.1.4. Diagnostics: systolic bp >140 and diastolic bp > 90
12.2.1.5. Nursing interventions: rest, reduce sodium intake, reduce weight,
12.2.1.5.1. Nonpharmocologic measures advised: biofeedback, yoga, meditation, relaxation exercises, fish oil supplements, garlic, hawthorn berries, Rauwolfia, periwinkle, increase whole grain in diet
12.2.1.5.2. DASH Diet: rich in fruits, veggies, whole grain, low-fat dairy foods
12.2.1.5.3. Medications:
12.2.2. Congestive heart failure
12.2.2.1. Leading cause of hospitalization of older adults
12.2.2.2. Causes: arteriosclerotic heart disease, coronary artery disease, hypertension, diabetes mellitus, dyslipidemia, sleep-disordered breathing, albuminuria, Anemia, chronic kidney disease, illicit drug use, sedentary lifestyle, psychological stress
12.2.2.3. S/S: dyspnea on exertion, confusion, insomnia, wandering during the night, agitation, depression, anorexia, nausea, weakness, shortness of breath, wheezing, weight gain, bilateral ankle edema, moist crackles on auscultation
12.2.2.4. Nursing interventions: bedrest (not complete), reduce sodium intake, skin care, frequent repositioning, emotional support
12.2.2.4.1. Medication: ACE inhibitor, beta blocker, digitalis, diuretics
13. Respiratory system
13.1. Age related changes
13.1.1. Thoracic muscles more rigid
13.1.2. Reduced basilar inflation
13.1.3. Alveoli fewer in number and larger in size
13.1.4. By age 90 years, approximately 50% increase in residual capacity
13.1.5. Blunting of cough and laryngeal reflexes
13.1.6. PO2 reduced as much as 15% between ages 20 and 80
13.1.7. Loss of elasticity and increased rigidity
13.1.8. Decreased ciliary action
13.1.9. Forced expiratory volume reduced
13.2. Pathologies
13.2.1. Pneumonia
13.2.1.1. Common among older adults, one of the leading causes of death in age group
13.2.1.2. Risk factors: shallow breathing, poor chest expansion, high prevalence of respiratory diseases, lowered resistance to infection, reduced sensitivity of pharyngeal reflexes
13.2.1.3. Causes: Streptococcus pneumonia, gram negative bacilli, anaerobic bacteria, and influenza
13.2.1.4. S/S: pleuritic pain, minimal fever, slight cough, fatigue, rapid respirations, confusion, restlessness
13.2.1.5. Diagnostics: chest x-ray, chest auscultation, ABG levels
13.2.1.6. Nursing interventions: pneumonococcal vaccine, hydration-IV fluids, higher calorie intake, monitor oxygen saturation, oxygen therapy if needed, rest to conserve energy
14. Cells
14.1. Age related changes
14.1.1. Intracellular fluid is decreased
14.1.1.1. Leads to less total body fluid
14.1.1.1.1. Risk for dehydration
14.1.2. Bone mass decreases
14.1.3. Fat tissue increases until sixth decade of life
14.1.4. Lean body mass reduced
14.1.5. Fewer functional cells in the body
14.1.6. Number of cells gradually reduced
15. Changes to the mind
15.1. Age related changes
15.1.1. Learning
15.1.1.1. Motivation changes
15.1.1.2. Delayed transmitting of information to the brain
15.1.2. Memory
15.1.2.1. Retrieval of information from long-term memory can be slowed
15.1.2.2. Sensory only lasts a few seconds
15.1.2.3. Working memory function is reduced
15.1.3. Personality
15.1.3.1. Consistent with how it was in earlier years
15.2. Pathologies
15.2.1. Dementia
15.2.1.1. Irreversible, progressive impairment of cognitive function affecting memory, orientation, judgment, reasoning, attention, language and problem solving
15.2.1.2. Alzheimer’s Disease
15.2.1.2.1. Most common form of dementia
15.2.1.2.2. Neurotic plaque with deposits of beta-amyloid protein, when clumping it impairs the function of nerve cells in the brain
15.2.1.2.3. Neurofibrillary tangles in the cortex, microtubules disintegrate and collapse the neuron transport system
15.2.1.2.4. Risk factors: Down syndrome, environmental and genetic factors, lipidemia, hypertension, smoking, head injury, mental and physical inactivity
15.2.1.2.5. S/S: changes in intellectual ability, anxious or depressed, language disturbances, visual disturbances, feeling of not being able to control limbs
15.2.1.2.6. Diagnostics: brain scan that reveals changes in brain structure, neurophysiology testing to evaluate cognition
15.2.1.2.7. Nursing interventions: estrogens role in prevention is being researched more, antioxidants, anti-inflammatory agents, folic acid/b12/b6 supplements, gene therapy to add nerve growth factor, medication to break down acetylcholine (donepezil, rivastigmine, galantamine)
16. Physical Appearance
16.1. Age related changes
16.1.1. Narrowing gait in women and wider gait in men
16.1.2. Deepening of hollows of axillae and intercostal and supraclavicular spaces
16.1.3. Darkening and wrinkling of skin around orbits
16.1.4. Thicker hair in ears and nose
16.1.5. Graying and thinning of hair
16.1.6. Ectropion of eyelids
16.1.7. Elongated ears
16.1.8. Arcus senilis
16.1.9. Growth of facial hair in women
16.1.10. Diminished muscle mass and skinfold thickness
16.1.11. Decreased height