Changes in Aging

1. Cardiovascular

1.1. Effects of Aging

1.1.1. Heart dimensions are unchanged

1.1.2. heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress

1.1.3. Valves become thick and rigid

1.1.4. blood vessels reduce elasticity

1.1.5. oxygen use less efficiently

1.1.6. Aorta becomes dilated

1.1.6.1. slight ventricular hypertrophy

1.1.6.2. thickening on ventricular wall

1.1.7. less sensitive to baroreceptor regulation of blood pressure

1.2. Health Promotion

1.2.1. alterations modified by lifestyle and diet

1.2.2. Identify and lower risks through education

1.2.3. proper nutrition

1.2.3.1. control of cholesterol

1.2.4. adequate exercise

1.2.4.1. enhance circulation with aerobic exercise, yoga, strengthening exercises, balance exercises

1.2.5. Cigarette smoking cessation

1.2.6. Stress management

1.2.7. proactive interventions

1.2.7.1. low-dose aspirin daily; preventive measure

1.2.7.2. nutritional supplements

1.3. Hypertension

1.3.1. incidence and prevalence increases with age

1.3.2. evaluation of blood pressure

1.3.2.1. systolic >140

1.3.2.2. diastolic >90

1.3.3. symptoms

1.3.3.1. dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor

1.3.4. Treatment

1.3.4.1. thiazide diuretics

1.3.4.1.1. watch for electrolyte imbalances

1.3.4.2. beta blockers

1.3.4.3. calcium channel blockers

1.3.4.4. ACE

1.3.4.5. nonpharmacologic measures taken first due to increased risk of adverse effects of medications in older adults

1.3.4.5.1. diet, exercise, stress management

1.3.5. Causes Related to Aging

1.3.5.1. oxygen use less efficiently

1.3.5.2. heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress

1.3.5.3. Blood vessels lose elasticity

1.3.5.4. Less sensitive to baroreceptor regulation

1.4. Hypotension

1.4.1. Decline in systolic blood pressure of 20 mmHg or more after changing positions

1.4.2. postural and postprandial hypotension due to increased intake of vasoactive medications and baroreceptor sensitivity

1.4.3. Consequences

1.4.3.1. falls, stroke, syncope, other coronary complications

1.5. Congestive Heart Failure

1.5.1. Incidence increases with age

1.5.2. Leading cause of hospitalization

1.5.3. complication of arteriosclerotic heart disease

1.5.4. symptoms

1.5.4.1. shortness of breath, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight, gain

1.5.5. treatment

1.5.5.1. ACE inhibitors

1.5.5.2. beta-blockers

1.5.5.3. digitalis

1.5.5.4. diuretics

1.5.5.5. reduction in sodium intake

1.6. Coronary Artery Disease

1.6.1. Ischemic heart disease

1.6.2. prevalence increases with age

1.6.3. angina

1.6.3.1. atypical presentation

1.6.3.1.1. coughing, syncope, sweating and confusion

1.6.3.2. Nitroglycerin is effective

1.6.3.2.1. more likely to experience orthostatic hypotension

1.6.3.3. Education

1.6.3.3.1. avoid aggravating factors

1.6.3.3.2. Nitroglycerin administration education

1.6.3.4. Causes related to Aging

1.6.3.4.1. oxygen use less efficiently

1.6.3.4.2. Valves more rigid

1.6.3.4.3. blood vessels lose elasticity

1.6.4. Myocardial Infarction

1.6.4.1. atypical presentation

1.6.4.1.1. confusion, decreased blood pressure, shortness of breath, elevated temperature, and sedimentation rate

1.6.4.2. Treatment

1.6.4.2.1. bed rest with minimal exertion

1.6.4.2.2. early ambulation

1.6.4.2.3. Thrombolytic therapy

1.6.4.2.4. Fitness programs

1.7. Arrhythmias

1.7.1. Causes

1.7.1.1. digitalis toxicity, hypokalemia, acute infections, hemorrhage, anginal syndrome and coronary insufficiency

1.7.2. Symptoms

1.7.2.1. weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, syncope

1.7.3. Treatment

1.7.3.1. anti-arrhythmic drugs, digitalis, potassium supplements, cardioversion

1.8. Venous Thromboembolism

1.8.1. High Risk persons

1.8.1.1. restricted to bed rest

1.8.1.2. recent surgery

1.8.1.3. fractures

1.8.2. Signs and symptoms

1.8.2.1. edema, warmth over affected area, pain in foot, cyanosis, aching, and engorgement of superficial veins

1.8.3. Treatment

1.8.3.1. Anticoagulants, surgery, elastic stockings, bandages, and elevation of extremities

2. Respiratory

2.1. Effects of Aging

2.1.1. Calcification of costal cartilage, trachea and rib cage more rigid

2.1.2. Decreased elastic recoil

2.1.3. increased residual capacity and reduced vital capacity

2.1.4. high risk for respiratory infection and more difficult to manage

2.1.5. reduction of cough and laryngeal reflexes

2.1.6. alveoli less elastic

2.2. Health Promotion

2.2.1. Prevention of Infection

2.2.2. Smoking cessation

2.2.3. influenza and pneumonia vaccines important

2.2.4. avoiding exposure to people with respiratory infections

2.2.5. deep-breathing exercises

2.2.6. immobility is a major threat

2.2.7. caution with self-treatment of respiratory issues

2.3. Pneumonia

2.3.1. One of the leading causes of death in the elderly population

2.3.2. Causes related to aging

2.3.2.1. Poor chest expansion

2.3.2.2. Lowered resitance to infection

2.3.2.3. reduced pharyngeal reflexes

2.3.2.3.1. promotes aspiration of foreign material

2.3.2.4. immobility and inactivity

2.3.3. Signs and symptoms

2.3.3.1. cough, fatigue, confusion, restlessness, usually no change in temperature

2.3.4. Treatment

2.3.4.1. Antibiotics

2.3.4.2. Vaccine and booster after 5 years

2.3.4.3. watch for adverse effects

2.3.4.3.1. increased risk in elderly population

2.3.4.4. pain management

2.3.4.5. consult dietician for nutrition assessment

2.4. Asthma

2.4.1. Can develop in later years

2.4.2. Causes related to aging

2.4.2.1. alveoli less elastic

2.4.2.2. more exposure to irritants as we age

2.4.3. high risk of complication of bronchiectasis and cardiac problems

2.4.4. high rates of mortality

2.4.5. Assess for the use of aerosol nebulizers'

2.4.6. education

2.4.6.1. avoid environmental irritants

2.4.6.2. safe medication use

2.5. Chronic Bronchitis

2.5.1. causes persistent, productive cough, wheezing, recurrent respiratory infections, shortness of breath

2.5.2. Causes related to aging

2.5.2.1. reduction in vital capacity

2.5.2.1.1. less air leaving and more fluids remain

2.5.2.2. Reduced cough reflex

2.5.2.3. Loss of muscle strength in diaphragm

2.5.2.4. alveloi less elastic

2.5.3. Management

2.5.3.1. remove bronchial secretions

2.5.3.2. prevent obstruction of airway

2.5.3.3. maintain adequate fluid intake

2.6. Emphysema

2.6.1. Increasing incidence in older adults

2.6.2. Causes

2.6.2.1. Chronic bronchitis, chronic irritation, and morphologic changes in the lung

2.6.2.2. Cigarette smoking is major role in development

2.6.3. Symptoms develop slowly; can delay diagnosis and treatment

2.6.4. Treatment

2.6.4.1. postural drainage

2.6.4.2. bronchodilators

2.6.4.3. avoid stress

2.6.4.4. breathing exercises

3. GI

3.1. Effects of Aging

3.1.1. Atrophy of the tongue and taste buds

3.1.1.1. Less acute taste sensation

3.1.2. decreased esophageal motility

3.1.3. atrophy of the small and large intestines

3.1.4. increased risk of aspiration, digestion and constipation

3.1.5. Decreased elasticity of the stomach

3.1.5.1. reduces the amount of food accommodation at one time

3.1.6. Stomach has a higher pH

3.1.6.1. decline in hydrochloric acid and pepsin

3.1.6.1.1. Interferes with absorption of calcium, iron, folic acid, vitamin b12 and protein

3.1.7. Slower peristalsis, inactivity, reduced food intake, drugs and low fiber diet

3.1.7.1. increase risk of constipation

3.2. Health Promotion

3.2.1. good dental hygiene and regular dental visits can prevent disorders that threaten nutritional intake

3.2.2. proper nutrition enhances general health and minimizes the risk of indigestion and constipation

3.2.3. utilization of natural means to promote bowel elimination

3.2.3.1. fiber, fluids, activity

3.3. Dysphagia

3.3.1. Difficulty swallowing

3.3.2. Causes related to aging

3.3.2.1. Atrophy of tongue

3.3.2.2. decreased esophageal motility

3.3.2.3. reduced stimulation of cranial nerves

3.3.3. Consequences

3.3.3.1. GERD

3.3.3.2. Aspiration

3.3.3.2.1. pneumonia

3.3.4. Treatment

3.3.4.1. Observe food intake

3.3.4.2. promotion of adequate nutrition

3.3.4.3. Speech therapy

3.3.4.4. Eat in an upright position

3.3.4.4.1. small bites

3.3.4.5. accessible suction

3.4. Chronic Constipation

3.4.1. Infrequent, hard and dry stools that are difficult to pass

3.4.2. Causes related to aging

3.4.2.1. atrophy of the small and large intestine

3.4.2.2. decrease in peristalsis

3.4.2.3. inactivity and immobility

3.4.2.4. reduced fiber intake

3.4.3. Treatment

3.4.3.1. increased dietary fiber

3.4.3.1.1. prunes, raisins, dates

3.4.3.2. increased fluids

3.4.3.3. increased physical activity

3.4.3.4. safe use of laxatives and enemas

3.4.3.5. review of medications

3.4.3.5.1. antibiotics, antacids, calcium and narcotics

3.4.3.6. monitor for fecal impaction

3.5. Xerostomia

3.5.1. "dry mouth"

3.5.2. results from decreased saliva production, medication, mouth breathing and altered cognition

3.5.3. treatment

3.5.3.1. saliva substitutes, increased fluid, sugarless candy and gum

4. Renal

4.1. Effects of Aging

4.1.1. Decline of renal blood flow and glomerular filtration by approximately 50% by age 90

4.1.1.1. high blood urea nitrogen level

4.1.1.2. affects the ability to eliminate drugs

4.1.1.2.1. potential for adverse drug reactions

4.1.1.3. concentration of urine changes in response to eater and/or sodium excess

4.1.2. Hypertrophy and thickening of the bladder muscle

4.1.2.1. reduced bladder capacity

4.1.2.1.1. daytime urinary frequency

4.1.2.1.2. nocturia

4.1.3. inefficient neurological control of bladder emptying and weaker bladder muscle

4.1.3.1. male

4.1.3.1.1. prostatic hypertrophy

4.1.3.2. female

4.1.3.2.1. fecal impaction

4.1.4. increase in renal threshold for glucose

4.1.4.1. false-negative results in glucose in the urine without symptoms

4.2. Incontinence is NOT a normal change in aging

4.2.1. Factors to assess for urinary incontinence

4.2.1.1. cognition

4.2.1.2. urinary control and retention

4.2.1.3. elimination pattern

4.2.1.4. fecal impaction

4.2.1.5. diet (amount)

4.2.2. Types

4.2.2.1. Stress

4.2.2.1.1. weak supporting pelvic muscles

4.2.2.2. Urgency

4.2.2.2.1. UTI, enlargement of prostate

4.2.2.2.2. irritation or spasms of bladder

4.2.2.3. overflow

4.2.2.3.1. bladder neck obstruction and medications

4.2.2.3.2. fail to contract and relax appropriately

4.2.2.4. Neurogenic

4.2.2.4.1. inability to sense the urge

4.2.2.5. Functional

4.2.2.5.1. dementia

4.2.2.6. Mixed

4.3. Health Promotion

4.3.1. adequate fluid intake

4.3.2. maintenance of acidic urine

4.3.3. avoidance of catheterization

4.3.4. appropriate level of activity

4.3.5. frequent toileting

4.3.6. interventions and education to enhance voiding and prevent retention

4.4. Renal Calculi

4.4.1. Painful formation of stones

4.4.2. Causes related to aging

4.4.2.1. immobility

4.4.2.2. misuse of calcium

4.4.2.3. changes of pH in urine

4.4.2.4. excessive elimination of uric acid

4.4.3. Symptoms

4.4.3.1. Pain

4.4.3.2. hematuria

4.4.3.3. UTI like symptoms

4.5. Nursing Consideration for Urinary Conditions

4.5.1. Consider fear and anxiety toward urinary incontinence

4.5.2. provide education and realistic expectations

4.5.3. maintain dignity

5. Sleep and Comfort

5.1. Pain

5.1.1. Predominat in older population

5.1.2. One in four suffer day-long bouts of pain

5.1.3. three of five patients aged 65+ experience pain lasting for 1 year or more

5.1.4. lower back pain is most common

5.1.5. severe joint pain increased with age

5.1.6. Experience of pain is complicated by chronic disease in many older adults

5.1.7. Management

5.1.7.1. Medication

5.1.7.1.1. trial non-opioids prior to opioids

5.1.7.1.2. acetaminophen is most commonly used

5.1.7.1.3. NSAIDS

5.1.7.1.4. Propoxyphene and pentazocine contraindicated with older adults

5.1.7.2. Complementary Therapy

5.1.7.2.1. exercise, acupuncture, yoga, herbal, heat and cold

5.1.7.3. Dietary changes

5.1.7.3.1. avoid: high fat foods, high sugar foods and animal products

5.1.8. Complications of unresolved pain

5.1.8.1. Limited mobility

5.1.8.2. develop pressure ulcers

5.1.8.3. pneumonia

5.1.8.4. constipation

5.1.8.5. poor appetite

5.1.8.6. depression, hopelessness

5.1.8.7. spiritual distress

5.1.9. Types

5.1.9.1. Nociceptive

5.1.9.2. Neuropathic

5.1.9.3. changes in neurotransmitter systems

6. Sexuality/Reproductive

6.1. Women

6.1.1. Menopause: permanent cessation of menses

6.1.1.1. Important transition in a woman's life

6.1.1.2. More than a physiological experience

6.1.1.3. awakening of body, mind and spirit

6.1.1.4. physical beauty of youth versus inner beauty of age

6.1.1.5. Hormone Therapy

6.1.1.5.1. age at the start of hormone replacement therapy alters risk (young the better)

6.1.1.5.2. Estrogen and progestin increased heart risks

6.1.1.5.3. Estrogen alone less risky

6.1.2. Effects of Aging:

6.1.2.1. Hormonal Changes

6.1.2.1.1. vulva atrophies

6.1.2.1.2. flattening of the labia

6.1.2.1.3. loss of subcutaneous fat

6.1.2.2. vaginal epithelium thins

6.1.2.3. cervix, uterus and fallopian tubes atrophy

6.1.2.4. vaginal canal changes

6.1.2.4.1. reduction in collagen and adipose tissue

6.1.2.4.2. shortening and narrowing of the canal

6.1.2.4.3. less lubrication

6.1.2.4.4. more alkaline vaginal pH as a result of lower estrogen changes

6.1.2.5. Uterus and ovaries decrease in size

6.1.2.6. endometrium continues to respond to hormnal stimulation

6.1.2.7. fallopian tubes become shorter and straighter

6.1.2.8. breast sag and are less firm

6.1.2.9. some retraction of nipples related to shrinkage and fibrotic changes

6.1.3. Health Promotion

6.1.3.1. Annual gynecologic exam with pap smear

6.1.3.2. breast self examination

6.1.4. Infections of the Vulva

6.1.4.1. Age related changes cause the vulva to be more fragile and more susceptible to irritation and infection

6.1.5. Problems of the Cervix

6.1.5.1. Age changes:

6.1.5.1.1. cervix becomes smaller

6.1.5.1.2. endo-cervical epithelium atrophies

6.1.5.2. Endo-cervical glands can seal over leading to formation of nabothian cysts

6.1.5.2.1. Secretions can accumulate and a palpable tender mass may be evident

6.1.5.3. regular gynecologic examinations to check cervix patency are very important

6.1.6. Dyspareunia (painful intercourse)

6.1.6.1. Not a normal consequence of aging

6.1.6.2. more frequent in nulliparous women

6.1.6.3. thorough gynecologic exam and sexual history

6.1.6.4. goal: achieve a satisfactory sexual life

6.2. Men

6.2.1. Andropause: testosterone levels decline in men (does not occur in all men)

6.2.1.1. can result in reduced muscle mass, energy, strength and stamina

6.2.1.2. other changes: erectile dysfunction, breast enlargement, osteopenia, osteoporosis and shrinkage of testes

6.2.2. Effects of Aging:

6.2.2.1. Seminal vesicles develop thinner epithelium

6.2.2.2. muslce tissue replaced with connective tissue

6.2.2.3. decreased capacity to retain fluids

6.2.2.4. seminiferous tubule changes

6.2.2.4.1. increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen

6.2.2.5. Atrophy of the testes and reduction in testicular mass

6.2.2.6. ejaculation fluid contains less sperm

6.2.2.7. testosterone stays the same or decreases slightly

6.2.2.8. more time required to achieve an erection

6.2.2.9. enlargement of the prostate gland

6.2.3. Erectile Dysfunction

6.2.3.1. Unable to attain or maintain erection of penis for sexual intercourse

6.2.3.2. Multiple Causes:

6.2.3.2.1. Atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medication

6.2.3.2.2. antihypertensives, anticholinergics, digoxin and antidepressants

6.2.3.3. Age Changes

6.2.3.3.1. testosterone decreases

6.2.3.3.2. more time required to achieve erection

6.2.3.3.3. enlargement of prostate

6.2.3.4. Treatments

6.2.3.4.1. oral erectile agents

6.2.3.4.2. vacuum pump machines

6.2.4. Benign Prostatic Hyperplasia

6.2.4.1. most older men have some degree of benign prostatic hyperplasia

6.2.4.2. men reluctant to receive treatment

6.2.4.2.1. delay of treatment can cause kidney damage

6.3. Barriers to sexual activity

6.3.1. physical

6.3.1.1. unavailability of partner

6.3.1.1.1. particularly for older women

6.3.2. Emotional

6.3.2.1. negative attitudes from society

6.3.2.2. fear of losing sexual abilities

6.3.2.3. concerns about body image

6.3.2.4. relationship issues

6.3.3. Social

6.4. Promoting Healthy Sexual Function

6.4.1. Basic education

6.4.2. openly discuss sex and desires

6.4.3. masturbation beneficial

6.4.4. holding, caressing and exchanging loving words as means for sexual satisfaction

6.5. Health Promotion

6.5.1. testicular self-examination

6.5.2. men with prostatic hypertrophy examined every 6 months

7. Dementia and Delirium

7.1. Fear of loss of normal cognition

7.2. losses that result from impaired cognition

7.3. With aging there is an increased risk

7.4. Dementia

7.4.1. Irreversible

7.4.2. Progressive

7.4.3. Impairment in cognitive function affects

7.4.3.1. memory, orientation, reasoning, attention, language, and problem solving

7.4.4. Caused by damage or injury to the brain

7.4.5. 4.5 million adults are affected

7.4.6. Alzheimer's Disease

7.4.6.1. Most common form of dementia

7.4.6.2. Changes in the brain

7.4.6.2.1. neuritic plaques containing beta-amyloid protein

7.4.6.2.2. neurofibrillary tangles in the cortex

7.4.6.2.3. loss or degeneration of neuron and synapses

7.4.6.2.4. Symptoms develop gradually and progress at different rates among individuals

7.4.6.2.5. Staging

7.4.6.2.6. Treatment

7.4.7. Caring for Persons with Dementia

7.4.7.1. Ensure safety

7.4.7.2. Providing Physical Care

7.4.7.2.1. Close observation and attention to physical needs

7.4.7.2.2. eating and drinking, bathing and skin care, consider inability to communicate needs and discomforts

7.4.7.3. Promoting therapy and activity

7.4.7.4. Support the patient and the patient's family

7.4.8. Assessment

7.4.8.1. Mini-Cog

7.5. Delirium

7.5.1. Rapid onset; altered level of consciouness

7.5.2. prompt treatment may reverse condition and prevent permanent damage

7.5.3. Causes

7.5.3.1. Hypoxia

7.5.3.2. Infections

7.5.3.2.1. urinary tract

7.5.3.2.2. respiratory

7.5.3.2.3. cellulitis

7.5.3.2.4. mouth

7.5.3.2.5. feet

7.5.3.3. Dehydration

7.5.3.4. Hypernatremia

7.5.3.5. Hyponatremia

7.5.3.6. Pain

7.5.3.7. Medications

7.5.4. Interventions

7.5.4.1. Establish medical stability

7.5.4.2. minimizing stimulation

7.5.4.3. consistency in care

7.5.4.4. prevention of harm to self and others

7.5.4.5. support and realistic expectations

8. Neuro

8.1. Effects of Aging

8.1.1. Decline in weight and blood flow to the brain

8.1.1.1. Loss of nerve cell mass

8.1.1.1.1. atrophy of the brain and spinal cord

8.1.2. reduction in neurons, nerve fibers and cerebral blood flow

8.1.3. slower response to change in balance

8.1.3.1. demyelinization

8.1.4. hypothalamus less effective in temperature regulation

8.1.5. changes in sleep patterns with frequent awakeneing

8.1.6. Number and sensitivity of sensory receptors, dermatomes and neurons decrease

8.1.6.1. affecting taste, smell and tactile sensation

8.2. Subtle Indications of Neurologic Problems

8.2.1. New headaches that occur in the early morning and/or interrupt sleep

8.2.2. changes in vision

8.2.3. sudden deafness, ringing in ears

8.2.4. mood, personality changes

8.2.5. clumsiness, unsteady gait

8.2.6. numbness, tingling of extremity

8.2.7. unusual sensation or pain over nerve

8.3. Cerebrovascular Accidents

8.3.1. third leading cause of death in elderly patients

8.3.2. Symptoms

8.3.2.1. light headedness, dizzy, aphasia, drop attack, headache

8.3.3. High Risk patients

8.3.3.1. hypertension, gout, diabetes, MI, dehydration and those who smoke

8.3.4. Causes related to Aging

8.3.4.1. decline in weight and blood flow to the brain

8.3.4.2. blood vessels less elastic

8.3.4.3. heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress

8.3.5. Nursing Interventions

8.3.5.1. Maintain patient airway

8.3.5.2. provide adequate nutrition and hydration

8.3.5.3. monitor vital signs and neurologic symptoms

8.3.5.4. prevent complications associated with immobility

8.3.5.4.1. infections

8.3.5.4.2. atrophy of muscles

8.3.5.4.3. loss of independence

8.3.5.5. Assist with ADLs

8.3.5.6. Reorient patient

8.4. Parkinson's Disease

8.4.1. Affects ability of the central nervous system to control body movements

8.4.2. Lack of dopamine

8.4.3. Exact cause is unknown

8.4.4. Signs and Symptoms

8.4.4.1. Tremor

8.4.4.2. slow movement

8.4.4.2.1. shuffling unsteady gait

8.4.4.3. rigid movements

8.4.4.4. loss of muscle tone

8.4.4.5. impaired balance and posture

8.4.5. Treatments

8.4.5.1. Anticholinergic medications

8.4.5.2. Physical therapy

8.4.6. Goal

8.4.6.1. Maximum level of independence is preserved

8.5. Nursing Considerations for Neurologic Conditions

8.5.1. Promoting Independence

8.5.1.1. Assistive devices

8.5.1.2. Periodic home visits

8.5.1.3. Regular contact with family and friends

8.5.1.4. promoting self care

8.5.1.5. patience, reassurance and encouragement

8.5.1.6. Need to educate family members and friends

8.5.2. Prevent Injury

8.5.2.1. high risk of accidents

8.5.2.2. avoid hazards

9. Endocrine

9.1. Effects of Aging

9.1.1. ability to metabolize glucose is reduced

9.1.2. higher blood glucose in nondiabetic patients

9.1.3. Thyroid gland activity decreases

9.1.4. pituitary gland decreases

9.1.5. ACTH secretion decreases

9.1.6. insulin released by beta cells is delayed and insufficient

9.2. Diabetes Mellitus

9.2.1. Type 2

9.2.1.1. seventh leading cause of death in older adults

9.2.1.2. Glucose intolerance due to the insulin being released by beta cells is delayed and insufficient

9.2.1.3. classic nonspecific symptoms may be absent

9.2.1.4. Screening

9.2.1.4.1. Fasting blood glucose recommended every 3 years for persons over the age of 45

9.2.1.4.2. glucose tolerance test is the most effective test

9.2.1.5. Causes related to aging

9.2.1.5.1. reduced ability to metabolize glucose

9.2.1.5.2. insulin released by beta cells of pancreas is delayed and insufficent

9.2.1.6. Diagnosis

9.2.1.6.1. symptoms and a random blood glucose concentration of >200

9.2.1.6.2. Fasting blood glucose concentration >126

9.2.1.6.3. blood glucose concentrations 2 hours after oral glucose intake >200

9.2.1.7. Management

9.2.1.7.1. Education

9.2.1.7.2. Drug Therapy

9.2.1.7.3. Hygiene

9.2.1.7.4. Exercise

9.2.1.8. Complications

9.2.1.8.1. Hypoglycemia

9.2.1.8.2. Peripheral Vascular Disease

9.2.1.8.3. Diabetic retinopathy

9.2.1.8.4. drug interaction

9.2.1.8.5. Urinary tract infections

9.2.1.8.6. cognitive impairment

9.2.1.8.7. Metabolic syndrome

9.3. Hypothyroidism

9.3.1. Primary

9.3.1.1. results from a disease process that destroys part of the thyroid gland

9.3.2. Secondary

9.3.2.1. insufficient pituitary secretion of TSH

9.3.3. Symptoms

9.3.3.1. fatigue, weakness, depression, disinterest in activities, anorexia, weight gain, puffy eyes, impaired hearing, constipation, cold intolerance, dry skin

9.3.4. Treatment

9.3.4.1. replacement of hormone

9.3.4.2. Management of symptoms

9.4. Hyperthyroidism

9.4.1. less prevalent than hypo

9.4.2. more common in women

9.4.3. a frequent cause is the use of aminodarone

9.4.4. Diagnosis

9.4.4.1. T3 not always telling

9.4.4.2. Must look at T4, free T4 and TSH

9.4.5. Symptoms

9.4.5.1. diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, stare, lid lag, insomnia, confusion, nervousness, muscle weakness

9.4.6. Treatment

9.4.6.1. Depends on cause, treat underlying disease

9.4.6.2. surgery

9.4.6.3. Radioactive iodine therapy

10. Immune

10.1. Effects of Aging

10.1.1. Decreased immune response

10.1.2. inflammatory defenses decline; inflammation present atypically

10.1.3. risk for infection becomes significant

10.1.4. T-cell activity declines

10.1.5. cell-mediated immunity declines

10.1.6. Thymus gland declines in size

10.1.7. reduced number of langerhans cells in the skin

10.1.8. reduced thickness of skin

10.1.9. decreased circulation of the skin

10.2. Health Promotion

10.2.1. Diet

10.2.1.1. foods affect immunity both positively and negatively

10.2.1.2. protein, magnesium, vitamins A E B C, manganese, folic acid, selenium, pantothenic acid, zinc, iron

10.2.2. Exercise

10.2.2.1. regular physical activity enhances immune function

10.2.2.2. low impact

10.2.2.2.1. yoga, t'ai chi

10.2.3. immunizations

10.2.3.1. pneumococcal polysaccharide

10.2.3.1.1. booster every 5 years

10.2.3.2. influenza

10.2.3.2.1. every year before flu season

10.2.3.3. zoster

10.2.3.4. hepatitis A and B

10.2.4. Stress Management

10.2.5. Careful use of antibiotics

10.2.5.1. can develop resistance

10.2.5.2. side effects and adverse reactions increased in older adults

11. Sensory

11.1. all senses are less proficient with advanced age: vision, hearing, taste, smell and touch

11.2. decreased efficiency of the senses can affect well-being, activities of daily living, safety and health

11.3. Changes in Aging

11.3.1. presbyopia

11.3.1.1. inability to focus on close objects clearly

11.3.2. narrowing of the visual field-decreased peripheral vision

11.3.3. pupil size reduction and less reactive to light

11.3.4. depth perception distortion

11.3.5. decline in visual activity

11.3.6. Loss of photoreceptor cells in the retina

11.3.6.1. light perception threshold decreases

11.3.6.2. dark and light adaption takes longer

11.3.6.3. difficulty with vision at night

11.4. Vision

11.4.1. Glaucoma

11.4.1.1. damage to the optic nerve from an above normal intra-ocular pressure

11.4.1.2. second leading cause of blindness in older adults

11.4.1.3. Causes related to aging

11.4.1.3.1. changes in lens

11.4.1.3.2. decline in visual activity

11.4.1.4. Causes

11.4.1.4.1. iritis

11.4.1.4.2. allergies

11.4.1.4.3. endocrine imbalances

11.4.1.4.4. family history

11.4.1.4.5. drugs with anticholinergic properties may exacerbate

11.4.1.5. Acute (closed or narrow angle)

11.4.1.5.1. severe eye pain, headache, nausea and vomiting

11.4.1.5.2. rapid increase in tension and edema

11.4.1.5.3. need for early treatment to prevent blindness

11.4.1.5.4. diagnosis with tonometry to measure IOP

11.4.1.5.5. If pressure doesn't decrease in 24 hours surgery is necessary

11.4.1.6. Chronic (open angle)

11.4.1.6.1. most common form

11.4.1.6.2. need for early treatment to prevent blindness

11.4.1.6.3. blindness from glaucoma cannot be restored

11.4.1.6.4. peripheral vision becomes slowly impaired but may not realize what is happening

11.4.2. Cataracts

11.4.2.1. clouding of the lens and loss of transparency

11.4.2.2. leading cause of low vision in older adults

11.4.2.3. older women with blue eyes at most risk

11.4.2.4. treatment

11.4.2.4.1. surgery is only treatment

11.4.2.4.2. not preformed until vision is completely lost

11.5. Hearing

11.5.1. Care of the Person with a hearing deficit

11.5.1.1. encourage testing

11.5.1.2. patience

11.5.1.3. safety considerations

11.5.1.4. Hearing aids should only be bought with correct prescription

11.5.2. Changes in Aging

11.5.2.1. Presbycusis

11.5.2.1.1. progressive loss of hearing

11.5.2.2. distortion of high-pitched sounds

11.5.2.3. alteration in equilibrium

11.5.2.4. cerumen increases

11.5.3. Causes of hearing loss

11.5.3.1. exposure to loud machinery

11.5.3.2. loud music

11.5.3.3. certain drugs are ototoixc

11.5.3.3.1. aspirin, -mycins,

11.6. Taste and Smell

11.6.1. Changes of Aging

11.6.1.1. taste acuity dependent on smell

11.6.1.2. sense of smell altered with age

11.6.1.3. decreased saliva and poor oral hygiene

11.6.1.4. atrophy of tongue

11.7. Touch

11.7.1. reduction of tactile sensation

11.7.2. reduced ability to sense pressure, discomfort, change in temperautre

11.7.2.1. Normal body temperature are lowered in older adults (96.9-98.3)

11.8. Health Promotion

11.8.1. Vision

11.8.1.1. Routine eye exams

11.8.1.2. Incorporate Zinc, Selenium, Vitamin A and C into diet

11.8.2. Hearing

11.8.2.1. Take good care of ears throughout years

11.8.2.2. prompt treatment of infections

11.8.2.3. Education

11.8.2.3.1. reduce environmental noise, trauma and regular examinations

12. Musculoskeletal

12.1. Effects of Aging

12.1.1. Thinning disks and shortened vertebra

12.1.2. reduced muscle mass, strength and movement

12.1.3. decreased bone mineral and mass

12.1.4. diminished calcium absorption

12.1.5. increased risk of fractures

12.2. Osteoporosis

12.2.1. Most prevalent metabolic disease of the bone

12.2.2. Risk Factors

12.2.2.1. advanced age

12.2.2.2. sex (female)

12.2.2.3. small-frame

12.2.2.4. history of early menopause

12.2.2.5. cigarette smoking and alcohol consumption

12.2.2.6. family history

12.2.3. Causes Related to aging

12.2.3.1. Immobility and Inactivity

12.2.3.2. Diminished Calcium absorption

12.2.3.3. reduced muscle mass, strength and movement

12.2.3.4. Poor Nutrition

12.2.3.4.1. related to decreased access, loss of teeth, difficulty swallowing

12.2.3.5. Reduction in sex hormones

12.2.3.5.1. Estrogen has protective effect

12.2.4. Diagnosis

12.2.4.1. Bone mass Density tests

12.2.4.1.1. DEXA scan

12.2.4.1.2. DPA

12.2.5. Treatment

12.2.5.1. treat underlying cause

12.2.5.1.1. disease

12.2.5.2. calcium supplements

12.2.5.3. a diet rich in protein

12.2.5.4. regular exercise

12.3. Health Promotion

12.3.1. Management of Pain

12.3.2. Preventing Injury

12.3.3. Promoting Independence

13. Cancer

13.1. Second leading cause of death in person over the age of 65

13.2. Probability of cancer increases with age

13.3. Aging and Cancer

13.3.1. Advanced stage when initially diagnosed

13.3.2. increased risk of complications, disability and death

13.3.3. biological age-related changes that impair the ability to resist disease

13.3.4. prolonged exposure to carcinogens

13.4. Prevention

13.4.1. healthy lifestyle

13.4.1.1. avoid use of tobacco and alcohol

13.4.1.2. limit exposure to sun

13.4.1.3. eat a diet rich in fiber, fruits and vegetables

13.4.1.4. maintain weight in an ideal weight range

13.4.1.5. protect against known carcinogens

13.4.2. Screening

13.4.2.1. Women

13.4.2.1.1. mammograms

13.4.2.1.2. papsmears

13.4.2.2. Men

13.4.2.2.1. colonoscopy

13.4.3. Education

13.4.3.1. CAUTION

13.4.3.1.1. change in bowel habits

13.4.3.1.2. a sore that does not heal

13.4.3.1.3. unusual bleeding or drainage

13.4.3.1.4. thickening or lump in the breast

13.4.3.1.5. Indigestion or swallowing difficulties

13.4.3.1.6. Obvious change in a wart or mole

13.4.3.1.7. nagging persistent cough

13.5. Treatment

13.5.1. Conventional

13.5.1.1. Depends on type of cancer

13.5.1.2. surgery, radiation, chemotherapy, and biologic therpapy

13.5.1.3. with age comes advanced risks for complications

13.5.2. Complementary and Alternative medicine

13.5.2.1. special diets, psychotherapy, spiritual practices, vitamin regimes, herbal remedies

13.5.2.2. Relationship-centered care

13.5.2.3. Support

13.5.2.4. Healing Partnerships

13.5.2.5. Comfort

13.5.2.6. Hope

14. Integumentary

14.1. Effects of aging

14.1.1. Skin is less elastic, dry and fragile

14.1.2. thinning, graying of hair

14.1.3. increased benign and malignant skin neoplasms

14.1.4. reduced sweat gland activity

14.1.5. decreased subcutaneous fat

14.2. Health Promotion

14.2.1. Avoid agents irritating to the skin

14.2.2. good skin nutrition

14.2.3. promote activity

14.2.4. hydration using bath oils, lotions

14.2.5. avoid excessive bathing

14.2.6. skin inspection

14.2.6.1. A: asymmetry

14.2.6.2. B: border irregularity

14.2.6.3. C: color

14.2.6.4. D: diameter

14.3. Pressure Ulcers

14.3.1. Tissue anoxia and ischemia result in necrosis, sloughing and tissue ulceration

14.3.2. Common sites

14.3.2.1. Sacrum, head of femur, ankles, elbows

14.3.3. Predisposing factors

14.3.4. Longer healing periods needed for older adults

14.3.5. Causes related to aging

14.3.5.1. skin is less elastic, dry and fragile

14.3.5.2. decreased subcutaneous fat

14.3.5.3. Decreased nutrition

14.3.5.4. immobility and inactivity

14.3.6. Stages

14.3.6.1. 1

14.3.6.1.1. Persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved

14.3.6.2. 2

14.3.6.2.1. a partial thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister or shallow crater

14.3.6.3. 3

14.3.6.3.1. a full thickness of skin is lost extending through the epidermis and exposing the subcutaneous tissues; presents as a deep crater with or without undermining adjacent tissue

14.3.6.4. 4

14.3.6.4.1. a full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone or both; presents as a deep crater that may include necrotic tissue, exudate, sinus tract formation and infection

14.3.6.5. unstagable

14.3.7. Treatment

14.3.7.1. encourage activity and turning

14.3.7.2. use of pillows, alternating pressure mattresses

14.3.7.3. high protein, vitamin rich diet

14.3.7.4. skin should be kept dry and clean

14.3.7.4.1. incontinent patients should be checked frequently

14.4. Pruritus

14.4.1. An uncomfortable itching sensation

14.4.2. most common dermatologic problem among older adults

14.4.3. Potential for skin breakdown and infection

14.4.4. Need for prompt recognition and correct the underlying cause

14.4.5. Treatment

14.4.5.1. topical application of zinc ointment

14.4.5.2. vitamin rich diet

14.4.5.3. antihistamines and topical steroids

14.5. Skin Cancer

14.5.1. Basal Cell Carcinoma

14.5.1.1. most common form

14.5.1.2. grows slowly

14.5.1.3. rarely metastasized

14.5.1.4. Causes

14.5.1.5. Risk factors

14.5.1.5.1. advanced age

14.5.1.5.2. ultraviolet radiation

14.5.1.5.3. exposure to sun

14.5.1.5.4. therapeutic radiation

14.5.1.6. Appearance

14.5.1.6.1. small, dome shaped elevations

14.5.1.6.2. flesh colored with pearly appearnace