1. By Abby Horning
2. Respiratory System
2.1. Age related changes
2.1.1. Connective tissue changes in the nose causing the tip of the nose to rotate downward
2.1.1.1. Causes mouth breathing - contributing to snoring and sleep apnea
2.1.2. Decrease in submucosal gland secretions
2.1.2.1. Making secretions thicker and more difficult to expel
2.1.3. Calcification of costal cartilage
2.1.3.1. Makes trachea and rib cage more rigid
2.1.4. Anterior-posterior chest diameter increases causing kyphosis
2.1.5. Thoracic inspiration and expiratory muscles are weaker
2.1.5.1. Lungs exhale less effectively - increasing residue volume
2.1.6. Reduced cilia number and hypertrophy of the bronchial mucous gland
2.1.6.1. Decreases ability to expel mucus and debris
2.1.7. Alveoli reduce in number and stretch due to loss of elasticity
2.1.7.1. Decreases lung expansion
2.2. Pathological changes
2.2.1. Emphysema
2.2.1.1. Pathology
2.2.1.1.1. Caused by chronic bronchitis, chronic irritation from from air pollutants, and morphological changes in the lungs
2.2.1.1.2. Cigarette smoking increases the risk for getting emphysema
2.2.1.1.3. Can cause recurrent respiratory infections, malnutrition, congestive heart failure, and cardiac arrhythmias
2.2.1.2. Signs and symptoms - Increased dyspnea, chronic cough, hypoxia, fatigue, anorexia, weight loss
2.2.1.3. Treatment
2.2.1.3.1. Postural drainage
2.2.1.3.2. Bronchodilators
2.2.1.3.3. Breathing exercises
2.2.1.3.4. Stop cigarette smoking
2.2.1.3.5. Oxygen may be used
2.2.2. Influenza
2.2.2.1. Pathology
2.2.2.1.1. Impaired immune response make older adults more susceptible to influenza
2.2.2.1.2. Destroys ciliated epithelial cells and depresses mucociliary clearance in the respiratory tract
2.2.2.1.3. Pts with chronic respiratory, cardiac, or metabolic disease are at risk for developing secondary bacterial pneumonia
2.2.2.1.4. Two types - influenza A (more deadly) and influenza B
2.2.2.2. Signs and symptoms - fever, myalgia, sore throat, nonproductive cough
2.2.2.3. Treatment
2.2.2.3.1. Can be prevented by making sure older adults get annual flu vaccines
2.2.2.3.2. Anti-inflammatory pain relievers can reduce symptoms
2.2.2.3.3. Increased fluids and rest
2.2.2.3.4. Antivirals
3. Cardiovascular System
3.1. Age related changes
3.1.1. Slight left ventricular hypertrophy
3.1.2. May have incomplete valve closure leading to murmurs
3.1.3. Heart muscle loses efficiency and contractile strength
3.1.3.1. Results in reduced cardiac output
3.1.4. Pacemaker cells decrease in number
3.1.5. Contraction and relaxation phase are prolonged
3.1.6. Periods of tachycardia may last longer
3.1.6.1. Stroke volume increases to compensate
3.1.6.2. Increased stroke volume may increase blood pressure
3.2. Pathological changes
3.2.1. Enlarged hearts are associated with cardiac disease - not age related changes
3.2.2. Hypertension
3.2.2.1. Pathology
3.2.2.1.1. Can be caused by vasoconstriction associated with aging, hyperthyroidism, Parkinsonism, paget’s disease, anemia, and thiamine deficiency
3.2.2.1.2. Systolic pressure >140 and diastolic pressure >90
3.2.2.2. Signs and symptoms - awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor
3.2.2.3. Treatment
3.2.2.3.1. Rest
3.2.2.3.2. Reduce sodium intake
3.2.2.3.3. Reduce weight - if it is a contributing factor
3.2.2.3.4. Antihypertensive drugs - beta blockers, calcium channel blockers, ACE inhibitors, diuretics
3.2.2.3.5. DASH diet
3.2.3. Myocardial infarction
3.2.3.1. Pathology
3.2.3.1.1. Seen in older people with a history of hypertension and arteriosclerosis
3.2.3.2. Signs and symptoms - pain radiating to the left arm, chest, neck, jaw and abdomen, numbness is arms, neck or back, confusion, moist pale skin, decreased blood pressure, syncope, shortness of breath, cough, low grade fever
3.2.3.3. Treatment
3.2.3.3.1. Rest
3.2.3.3.2. Early ambulatory post MI
3.2.3.3.3. Thrombolytic therapy
3.2.3.3.4. Fitness programs
4. Gastrointestinal System
4.1. Age related changes
4.1.1. Tooth enamel becomes harder and more brittle
4.1.1.1. Brittleness increases risk of fragments breaking off and causing aspiration of these fragments
4.1.2. Dentin becomes more fibrous and it’s production is decreased
4.1.3. Nerve chambers in the tooth become narrower and shorter and teeth are less sensitive to stimuli
4.1.4. The root pulp undergoes shrinkage and fibrosis, the gingiva retracts, and bone density in the alveolar ridge is lost
4.1.5. Flattening of the chewing cusps
4.1.6. Taste sensations become less acute with age due to atrophy of the tongue
4.1.6.1. Excessive seasonings may be used to compensate and could lead to additional health problems
4.1.7. Decreased salvia production which interferes with breakdown of starches
4.1.8. Esophagus becomes dilated and esophageal emptying is slower
4.1.8.1. Causes a risk for aspiration
4.1.9. Decreased stomach motility causing decreased hunger
4.1.10. Hydrochloric acid and pepsin decrease causing a higher stomach pH and gastric irritation
4.1.11. Fewer cells are present on the absorbing surface of the intestines
4.1.12. Fat absorption is slower
4.1.13. Dextrose and xylose are more difficult to absorb
4.1.14. Absorption of vitamin B, B12, and D, calcium and iron is decreaseds
4.1.15. Slower transmission of neural impulses to the lower bowel reduces awareness of the need to evacuate the bowels
4.2. Pathological changes
4.2.1. Tooth loss can occur with poor dental care, diet, and environmental influences
4.2.1.1. After 30 years of age - periodontal disease is the main cause of tooth loss
4.2.2. Chronic irritation from pipe smoking can reduce taste efficiency more than the effect of age related changes alone
4.2.3. Dysphagia
4.2.3.1. Pathology
4.2.3.1.1. Swallowing difficulty
4.2.3.1.2. Can be due to cranial nerve issues and the muscles of the mouth, pharynx, and esophagus
4.2.3.1.3. GERD, stroke and structural disorders can cause this
4.2.3.1.4. Can be triggered by certain foods
4.2.3.2. Signs and symptoms - can vary from occasional swallowing difficulty to complete inability to swallow, can be accompanied with chest pain, nausea or coughing
4.2.3.3. Treatment
4.2.3.3.1. Observing food intake can help find proper treatment
4.2.3.3.2. Speech language pathologist will determine care
4.2.3.3.3. Soft diet and thickening of liquids
4.2.3.3.4. Eat in upright position
4.2.3.3.5. Easily accessible suction near pt when eating
4.2.4. Chronic constipation
4.2.4.1. Pathology
4.2.4.1.1. Due to inactive lifestyle, low fiber and fluid intake, depression, laxative abuse, medications, decreased sensation for bowel elimination
4.2.4.2. Signs and symptoms
4.2.4.2.1. Inability to eliminate bowels, abdominal pain and cramping
4.2.4.3. Treatment
4.2.4.3.1. Foods that promote bowel elimination include raisins, prunes, dates, and curants
4.2.4.3.2. Increase fiber and fluids
4.2.4.3.3. Increased activity
4.2.4.3.4. Constipation requiring medication may have an underlying cause that should be treated to help with constipation
5. Urinary System
5.1. Age related changes
5.1.1. Reduced renal blood flow and glomerular filtration rate
5.1.2. Tubular function decreases - less efficient tubular exchange of substances, conservation of water and sodium, and suppression of ADH secretion in the presence of hypo-osmolarity
5.1.3. Decreased reabsorption of glucose from the filtrate
5.1.4. Urinary frequency, urgency, and nocturnal are common with increasing age
5.1.5. Bladder muscles weaken and bladder capacity decreases
5.1.6. Micturition reflex is delayed
5.2. Pathological changes
5.2.1. Urinary tract infection
5.2.1.1. Pathology
5.2.1.1.1. Most common infection in older adults
5.2.1.1.2. Usually caused by Escherichia coli or Proteus species
5.2.1.1.3. Caused by the presence of any foreign body in the urinary tract or anything that slows down the flow of urine
5.2.1.1.4. Can result from poor hygienic practice, improper cleansing, low fluid intake/excess fluid loss, hormonal changes
5.2.1.2. Signs and symptoms - burning, urgency, fever, incontinence, delirium
5.2.1.3. Treatment
5.2.1.3.1. Antibiotics
5.2.1.3.2. Monitoring fluid intake and output
5.2.1.3.3. Urinalysis
5.2.2. Urinary incontinence
5.2.2.1. Pathology
5.2.2.1.1. Transient incontinence - acute and reversible, caused by infections, delirium, medication reaction, excessive urine production, decal impaction, mood disorders
5.2.2.1.2. Established incontinence - chronic and persistent
5.2.2.2. Signs and symptoms
5.2.2.2.1. Involuntary loss of urine
5.2.2.3. Treatment
5.2.2.3.1. Identify the underlying cause
5.2.2.3.2. Kegel exercises
5.2.2.3.3. Biofeedback
5.2.2.3.4. Use of a pessary or medication
5.2.2.3.5. Surgery if an obstruction is the cause
5.2.2.3.6. Toilet schedules
6. Reproductive System
6.1. Age related changes
6.1.1. Male
6.1.1.1. Seminal vesicles - smoothing of the mucosa, thinning of the epithelium, replacement of muscle tissue with connective tissue, and reduction of fluid-retaining capacity
6.1.1.2. Seminiferous tubules - increased fibrosis, thinning of the epithelium, thickening of the basement membrane, and narrowing of the lumen
6.1.1.3. Increases in follicle-stimulating and luteinizing hormone levels
6.1.1.4. Decreases in serum and bioavailable testosterone levels
6.1.1.5. Corpus spongiosum experiences venous and arterial sclerosis and fibroelastosis
6.1.1.6. Orgasm and ejaculation tend to be less intense
6.1.1.7. Atrophy of the testes
6.1.1.8. Prostatic enlargement is common
6.1.2. Female
6.1.2.1. Atrophy of the vulva from hormonal changes
6.1.2.2. Loss of subcutaneous fat and hair and a flattening of the labia
6.1.2.3. Loss of elastic tissue and rugae causing the appearance to be pink and dry with a smooth shiny canal v
6.1.2.4. Vaginal epithelium becomes thin and avascular
6.1.2.5. Vaginal environment is more alkaline and secretions are reduced
6.1.2.6. Cervix atrophies and becomes smaller, endocervical epithelium also atrophies
6.1.2.7. The uterus shrinks and the endometrium atrophies - the endometrium still responds to hormonal stimulation which can cause postmenopausal bleeding with women on estrogen therapy
6.1.2.8. Fallopian tubes atrophy and shorten
6.1.2.9. Ovaries atrophy and become thicker and smaller
6.1.2.10. Estrogen depletion causes pelvic floor muscles to weaken which can cause involuntary release of urine
6.2. Pathological changes
6.2.1. Erectile dysfunction
6.2.1.1. Pathology
6.2.1.1.1. Due to alcoholism, diabetes, dyslipidemia, hypertension, hypogonadism, multiple sclerosis, renal failure, spinal cord injury, thyroid conditions, psychological factors
6.2.1.2. Signs and symptoms - inability to achieve and sustain an erection
6.2.1.3. Treatment
6.2.1.3.1. Oral erectile agents
6.2.1.3.2. Drugs injected into the penis
6.2.1.3.3. Penile implants
6.2.1.3.4. Vacuum pump devices
6.2.2. Benign prostatic hyperplasia
6.2.2.1. Pathology
6.2.2.1.1. Prostate gland enlargement
6.2.2.2. Signs and symptoms - dysuria, hesitancy, decreased force of stream, frequency, nocturia, dribbling, poor control, overflow incontinence, bleeding
6.2.2.3. Treatment
6.2.2.3.1. Prostatic massage
6.2.2.3.2. Use of urinary antiseptics
6.2.2.3.3. Avoidance of diuretics, anticholinergics, and anti-arrhythmic agents
6.2.2.3.4. Surgery
6.2.3. Vaginitis
6.2.3.1. Pathology
6.2.3.1.1. Age related changes cause the vagina to be more fragile and easily irritated
6.2.3.2. Signs and symptoms - soreness, pruritis, burning, redness, foul smelling discharge
6.2.3.3. Treatment
6.2.3.3.1. Local estrogens in suppository cream form
6.2.3.3.2. Boric acid, zinc, lysine or gentian violet douches
6.2.3.3.3. Wear cotton underweark
6.2.3.3.4. Keep the genital area clean and dry
6.2.3.3.5. Use of lubricants during intercourse
7. Musculoskeletal System
7.1. Age related changes
7.1.1. Muscle fibers atrophy and decrease in number and are replaced with fibrous tissue
7.1.2. Overall muscle strength, mass, and movements are decreased
7.1.3. Tendons shrink and harden
7.1.4. Reflexes are decreased in the arms, lost in the abdomen, but unchanged in the knee
7.1.5. Bone mineral and mass are reduced causing brittle bones
7.1.6. Diminished calcium absorption, a gradual resorption of the interior surfaces of the long bones, and a slower production of new bone on the outside surface
7.1.6.1. This is why fractures are a greater risk to older adults
7.1.7. Thinning disks and shortening vertebrae reduce the length of the spinal column and overall height
7.1.8. Kyphosis - backward tilting of the head and some flexion at the hips and knees
7.1.9. Joint motion may be limited due to deterioration of cartilage and formation of points and spurs
7.2. Pathological changes
7.2.1. Sarcopenia - the loss of muscle mass, strength, and function
7.2.1.1. Seen mostly in inactive people
7.2.1.2. Exercise is important to minimize this
7.2.2. Osteoarthritis
7.2.2.1. Pathology
7.2.2.1.1. Progressive degeneration and abrasion of joint cartilage with the formation of new bone at the joint surfaces
7.2.2.1.2. Caused by excessive use, trauma, obesity, low vitamin D and C levels, and genetics
7.2.2.2. Signs and symptoms - pain in the hands, hips, knees, lower back or neck, stiffness, swelling, tenderness, crepitus, joint deformity, limping
7.2.2.3. Treatment
7.2.2.3.1. Analgesics
7.2.2.3.2. Rest
7.2.2.3.3. Heat or ice
7.2.2.3.4. Aqua therapy
7.2.2.3.5. Massage
7.2.2.3.6. Acupuncture
7.2.2.3.7. Splints, braces, and canes
7.2.2.3.8. Occupational or physical therapy
7.2.2.3.9. Arthroplasty
7.2.3. Osteoporosis
7.2.3.1. Pathology
7.2.3.1.1. Demineralization of the bone
7.2.3.1.2. Decrease in the mass and density of the bone
7.2.3.1.3. Risk factors include advanced age, calcium deficiency, vitamin d deficiency, small framed thin women, history of early menopause, estrogen deficiency, history of multiple pregnancies, smoking, alcoholism, prolonged immobility, diseases or chronic drug use that increases bone loss, family history of osteoporosis
7.2.3.2. Signs and symptoms - kyphosis, reduction in height, spinal pain, bones that fracture easily
7.2.3.3. Treatment
7.2.3.3.1. DEXA scan
7.2.3.3.2. Calcium or vitamin D supplements
7.2.3.3.3. Selective estrogen receptor modulators
7.2.3.3.4. Hormone therapy
7.2.3.3.5. Diet rich in protein and calcium
7.2.3.3.6. Braces to provide support and reduce spasms
7.2.3.3.7. Regular exercise
8. Nervous System
8.1. Age related changes
8.1.1. The nervous system effects often depend on the functional ability of other body systems
8.1.2. Cardiovascular problems can reduce blood flow to the brain and cause cerebral dysfunction
8.1.3. Declining nervous system function may go unnoticed because progression is slow and symptoms are not usually specific
8.1.4. Reduction in neurons, nerve fibers, cerebral blood flow and metabolism
8.1.5. Reduced glucose utilization and metabolic rate of oxygen in the brain
8.1.6. Nerve conduction velocity is lower - causing slower reflexes and delayed response to multiple stimuli
8.1.7. Slower response to changes in balance
8.1.8. Decrease in new axon growth and nerve reinnervation of injured peripheral nerves - causes slower recognition and response to stimuli
8.1.9. Hypothalamus regulates temperature less effectively
8.1.10. Circadian and homeostatic factors of sleep regulation are altered - causes changes in sleep pattern, stages III and IV are less prominent, frequent awakening is common
8.2. Pathological changes
8.2.1. Parkinson’s disease
8.2.1.1. Pathology
8.2.1.1.1. Impaired function of basal ganglia in the midbrain affecting the ability to control body movements
8.2.1.1.2. Neurons that produce dopamine die or become impaired - dopamine is necessary for smooth motor movement and emotions
8.2.1.2. Signs and symptoms - tremor, muscle rigidity, weakness, drooling, difficulty in swallowing, slow speech, bradykinesia, poor balance, emotional instability
8.2.1.3. Treatment
8.2.1.3.1. Carbidopa/levodopa
8.2.1.3.2. Dopamine agonists
8.2.1.3.3. Anticholinergics
8.2.1.3.4. Deep brain stimulation
8.2.1.3.5. Drug infusion systems
8.2.1.3.6. Gene therapy
8.2.2. Transient ischemic attacks
8.2.2.1. Pathology
8.2.2.1.1. An event that reduces cerebral circulation
8.2.2.1.2. Can be due to low blood pressure from anemia or certain drugs, smoking, sudden standing from a prone position
8.2.2.2. Signs and symptoms - hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, dysphagia
8.2.2.3. Treatment
8.2.2.3.1. Correction of the underlying cause
8.2.2.3.2. Anticoagulant therapy
8.2.2.3.3. Vascular reconstruction
9. Sensory Organs
9.1. Age related changes
9.1.1. Vision
9.1.1.1. Presbyopia - inability to focus or accommodate due to reduced elasticity of the lens
9.1.1.2. Field vision narrows making peripheral vision more difficult
9.1.1.3. Vision in dim areas is more difficult - older adults require more light
9.1.1.4. Macular degeneration can occur causing a loss in central vision due to alteration in blood supply to the retina
9.1.1.5. Opacification of the lens leads to cataracts - this increases sensitivity to glare, blurs vision, and interferes with night vision
9.1.1.6. Depth perception becomes distorted due to stereopsis
9.1.1.6.1. Causes safety issues with correctly judging heights of steps and curbs
9.1.1.7. Reduced lacrimal secretions cause the eyes to look dry and dull
9.1.1.8. Corneal sensitivity decreases which increases risk of injury to the eye
9.1.2. Hearing
9.1.2.1. Presbycusis - progressive hearing loss due to loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph
9.1.2.2. High frequency sounds are lost first - middle and low frequency may be lost as with progression
9.1.2.3. Speech may be distorted due to loss of hearing
9.1.2.4. Equilibrium can be altered due to degeneration of the vestibular structures and atrophy of the cochlea, organ of corti, and stria vascularis
9.1.3. Taste and smell
9.1.3.1. Sense of smell decreases due to decrease in the number of sensory cells in the nasal lining and fewer cells in the olfactory bulb of the brain - men experience a greater loss in smell than women
9.1.3.2. Taste decreases due to loss of smell and atrophy of the tongue, and reduced saliva production
9.1.3.2.1. Poor oral hygiene, medications, and contributing medical conditions can decrease taste further
9.1.4. Touch
9.1.4.1. Tactile sensation is reduced which reducing ability to sense pressure, pain and temperatures
10. Endocrine System
10.1. Age related changes
10.1.1. Decreased thyroid gland activity causes a lower basal metabolic rate, reduced radioactive iodine uptake, and less thyrotropin secretion and release
10.1.2. Total serum iodide is decreased
10.1.3. Thyroid gland progressively atrophies
10.1.4. ACTH secretion decreases with age decreasing secretory activity of the adrenal gland
10.1.5. Decreased secretion of glucocorticoids, 17-ketosteroids, progesterone, androgen, and estrogen due to adrenal gland
10.1.6. Decreased levels of ACTH, TSH, follicle-stimulating hormone, luteinizing hormone, luteotropic hormone
10.1.7. Gonadal secretion decreases
10.1.8. Insufficient release of insulin by the beta cells of the pancreas
10.1.9. Ability to metabolize glucose is reduced so high concentrations of glucose will cause longer hyperglycemia levels
10.2. Pathological changes
10.2.1. Hypothyroidism
10.2.1.1. Pathology
10.2.1.1.1. Subnormal concentration of thyroid hormone in the tissues
10.2.1.1.2. Primary - resulting from a disease process that destroys the thyroid gland
10.2.1.1.3. Secondary - caused by insufficient pituitary secretion of thyroid stimulating hormone
10.2.1.2. Signs and symptoms - fatigue, depression, anorexia, weight gain, puffy face, impaired hearing, periorbital or peripheral edema, constipation, cold intolerance, myalgia, paresthesia, ataxia, dry skin and coarse hair
10.2.1.3. Treatment
10.2.1.3.1. Replacement of thyroid hormone using synthetic T4
10.2.1.3.2. Treat symptoms as needed
10.2.2. Hyperthyroidism
10.2.2.1. Pathology
10.2.2.1.1. Thyroid gland secretes excess amounts of thyroid hormones
10.2.2.1.2. Amiodarone can cause this
10.2.2.2. Signs and symptoms - diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, insomnia, nervousness, confusion, heat intolerance, increased hunger, hypereflexia
10.2.2.3. Treatment
10.2.2.3.1. Anti thyroid medications
10.2.2.3.2. Radioactive iodine
10.2.2.3.3. Surgery
10.2.3. Diabetes mellitus
10.2.3.1. Pathology
10.2.3.1.1. The body does not produce enough insulin for the body’s needs
10.2.3.2. Signs and symptoms - increased thirst, frequent urination, extreme hunger, unexplained weight loss, ketones in the urine, fatigue, irritability
10.2.3.3. Treatment
10.2.3.3.1. Glucose monitoring
10.2.3.3.2. Diet changes
10.2.3.3.3. Exercises
10.2.3.3.4. Medications - insulin or oral agents
11. Integumentary System
11.1. Age related changes
11.1.1. Flattening of the dermal-epidermal junction
11.1.2. Reduced thickness and vascularity of the dermis
11.1.3. Slowing of epidermal proliferation
11.1.4. Increased quantity and degeneration of elastin fibers
11.1.5. Dermis becomes more avascular and thinner
11.1.6. Reduction in melanocytes
11.1.7. Hair thins and grays due to loss of pigment cells and atrophy and fibrosis of hair bulbs
11.1.8. Sweating is reduced due to decreased function and number of sweat glands
11.2. Pathological changes
11.2.1. Pressure injury
11.2.1.1. Pathology
11.2.1.1.1. Tissue anoxia and ischemia resulting from pressure causing necrosis, sloughing, and ulceration of tissue
11.2.1.1.2. Most common at the sacrum, greater trochanter, and ischial tuberosities
11.2.1.1.3. Older adults are risk because of their thin skin, poor nutrition, reduced sensations, and immobility
11.2.1.2. Signs and symptoms - redness, blister, open skin, undermining of tissue, nonblanchable redness
11.2.1.3. Treatment
11.2.1.3.1. Encourage activity and turning
11.2.1.3.2. High protein vitamin rich diet
11.2.1.3.3. Apply barriers to protect skin from pressure injury
11.2.1.3.4. Apply dressings and antibiotics to injury
11.2.1.3.5. Use the braden scale to assess for risk
12. Immune System
12.1. Age related changes
12.1.1. Immunosenescence - a depressed immune response due to aging
12.1.2. Thymic hormones decrease
12.1.3. T-cell activity declines
12.1.4. Decline in cell mediated immunity
12.1.5. T lymphocytes are less able to proliferate in response to mitogens
12.1.6. Concentration of IgM is lower, but IgA and IgG are higher
12.2. Pathological changes
12.2.1. Stress can effect the immune system function
12.2.1.1. Elevated cortisol levels lead to breakdown in lymphoid tissue, inhibition of the production of natural killer cells, increases in T suppressor cells, and reductions in the levels of T-helper cells and virus fighting interferon
12.2.2. Factors that positively effect immunity
12.2.2.1. Milk, yogurt, nonfat cottage cheese, eggs, fresh fruits and vegetables, nuts, garlic, onion, sprouts, pure, honey, unsulfured molasses
12.2.2.2. A daily multivitamin and mineral supplement
12.2.2.3. Regular physical activity