Changes in Aging

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Changes in Aging by Mind Map: Changes in Aging

1. GI

1.1. Effects of Aging

1.1.1. Atrophy of the tongue and taste buds Less acute taste sensation

1.1.2. decreased esophageal motility

1.1.3. atrophy of the small and large intestines

1.1.4. increased risk of aspiration, digestion and constipation

1.1.5. Decreased elasticity of the stomach reduces the amount of food accommodation at one time

1.1.6. Stomach has a higher pH decline in hydrochloric acid and pepsin Interferes with absorption of calcium, iron, folic acid, vitamin b12 and protein

1.1.7. Slower peristalsis, inactivity, reduced food intake, drugs and low fiber diet increase risk of constipation

1.2. Health Promotion

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

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

1.2.3. utilization of natural means to promote bowel elimination fiber, fluids, activity

1.3. Dysphagia

1.3.1. Difficulty swallowing

1.3.2. Causes related to aging Atrophy of tongue decreased esophageal motility reduced stimulation of cranial nerves

1.3.3. Consequences GERD Aspiration pneumonia

1.3.4. Treatment Observe food intake promotion of adequate nutrition Speech therapy Eat in an upright position small bites accessible suction

1.4. Chronic Constipation

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

1.4.2. Causes related to aging atrophy of the small and large intestine decrease in peristalsis inactivity and immobility reduced fiber intake

1.4.3. Treatment increased dietary fiber prunes, raisins, dates increased fluids increased physical activity safe use of laxatives and enemas review of medications antibiotics, antacids, calcium and narcotics monitor for fecal impaction

1.5. Xerostomia

1.5.1. "dry mouth"

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

1.5.3. treatment saliva substitutes, increased fluid, sugarless candy and gum

2. Renal

2.1. Effects of Aging

2.1.1. Decline of renal blood flow and glomerular filtration by approximately 50% by age 90 high blood urea nitrogen level affects the ability to eliminate drugs potential for adverse drug reactions concentration of urine changes in response to eater and/or sodium excess

2.1.2. Hypertrophy and thickening of the bladder muscle reduced bladder capacity daytime urinary frequency nocturia

2.1.3. inefficient neurological control of bladder emptying and weaker bladder muscle male prostatic hypertrophy female fecal impaction

2.1.4. increase in renal threshold for glucose false-negative results in glucose in the urine without symptoms

2.2. Incontinence is NOT a normal change in aging

2.2.1. Factors to assess for urinary incontinence cognition urinary control and retention elimination pattern fecal impaction diet (amount)

2.2.2. Types Stress weak supporting pelvic muscles Urgency UTI, enlargement of prostate irritation or spasms of bladder overflow bladder neck obstruction and medications fail to contract and relax appropriately Neurogenic inability to sense the urge Functional dementia Mixed

2.3. Health Promotion

2.3.1. adequate fluid intake

2.3.2. maintenance of acidic urine

2.3.3. avoidance of catheterization

2.3.4. appropriate level of activity

2.3.5. frequent toileting

2.3.6. interventions and education to enhance voiding and prevent retention

2.4. Renal Calculi

2.4.1. Painful formation of stones

2.4.2. Causes related to aging immobility misuse of calcium changes of pH in urine excessive elimination of uric acid

2.4.3. Symptoms Pain hematuria UTI like symptoms

2.5. Nursing Consideration for Urinary Conditions

2.5.1. Consider fear and anxiety toward urinary incontinence

2.5.2. provide education and realistic expectations

2.5.3. maintain dignity

3. Sleep and Comfort

3.1. Pain

3.1.1. Predominat in older population

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

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

3.1.4. lower back pain is most common

3.1.5. severe joint pain increased with age

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

3.1.7. Management Medication trial non-opioids prior to opioids acetaminophen is most commonly used NSAIDS Propoxyphene and pentazocine contraindicated with older adults Complementary Therapy exercise, acupuncture, yoga, herbal, heat and cold Dietary changes avoid: high fat foods, high sugar foods and animal products

3.1.8. Complications of unresolved pain Limited mobility develop pressure ulcers pneumonia constipation poor appetite depression, hopelessness spiritual distress

3.1.9. Types Nociceptive Neuropathic changes in neurotransmitter systems

4. Dementia and Delirium

4.1. Fear of loss of normal cognition

4.2. losses that result from impaired cognition

4.3. With aging there is an increased risk

4.4. Dementia

4.4.1. Irreversible

4.4.2. Progressive

4.4.3. Impairment in cognitive function affects memory, orientation, reasoning, attention, language, and problem solving

4.4.4. Caused by damage or injury to the brain

4.4.5. 4.5 million adults are affected

4.4.6. Alzheimer's Disease Most common form of dementia Changes in the brain neuritic plaques containing beta-amyloid protein neurofibrillary tangles in the cortex loss or degeneration of neuron and synapses Symptoms develop gradually and progress at different rates among individuals Staging Treatment

4.4.7. Caring for Persons with Dementia Ensure safety Providing Physical Care Close observation and attention to physical needs eating and drinking, bathing and skin care, consider inability to communicate needs and discomforts Promoting therapy and activity Support the patient and the patient's family

4.4.8. Assessment Mini-Cog

4.5. Delirium

4.5.1. Rapid onset; altered level of consciouness

4.5.2. prompt treatment may reverse condition and prevent permanent damage

4.5.3. Causes Hypoxia Infections urinary tract respiratory cellulitis mouth feet Dehydration Hypernatremia Hyponatremia Pain Medications

4.5.4. Interventions Establish medical stability minimizing stimulation consistency in care prevention of harm to self and others support and realistic expectations

5. Endocrine

5.1. Effects of Aging

5.1.1. ability to metabolize glucose is reduced

5.1.2. higher blood glucose in nondiabetic patients

5.1.3. Thyroid gland activity decreases

5.1.4. pituitary gland decreases

5.1.5. ACTH secretion decreases

5.1.6. insulin released by beta cells is delayed and insufficient

5.2. Diabetes Mellitus

5.2.1. Type 2 seventh leading cause of death in older adults Glucose intolerance due to the insulin being released by beta cells is delayed and insufficient classic nonspecific symptoms may be absent Screening Fasting blood glucose recommended every 3 years for persons over the age of 45 glucose tolerance test is the most effective test Causes related to aging reduced ability to metabolize glucose insulin released by beta cells of pancreas is delayed and insufficent Diagnosis symptoms and a random blood glucose concentration of >200 Fasting blood glucose concentration >126 blood glucose concentrations 2 hours after oral glucose intake >200 Management Education Drug Therapy Hygiene Exercise Complications Hypoglycemia Peripheral Vascular Disease Diabetic retinopathy drug interaction Urinary tract infections cognitive impairment Metabolic syndrome

5.3. Hypothyroidism

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

5.3.2. Secondary insufficient pituitary secretion of TSH

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

5.3.4. Treatment replacement of hormone Management of symptoms

5.4. Hyperthyroidism

5.4.1. less prevalent than hypo

5.4.2. more common in women

5.4.3. a frequent cause is the use of aminodarone

5.4.4. Diagnosis T3 not always telling Must look at T4, free T4 and TSH

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

5.4.6. Treatment Depends on cause, treat underlying disease surgery Radioactive iodine therapy

6. Sensory

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

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

6.3. Changes in Aging

6.3.1. presbyopia inability to focus on close objects clearly

6.3.2. narrowing of the visual field-decreased peripheral vision

6.3.3. pupil size reduction and less reactive to light

6.3.4. depth perception distortion

6.3.5. decline in visual activity

6.3.6. Loss of photoreceptor cells in the retina light perception threshold decreases dark and light adaption takes longer difficulty with vision at night

6.4. Vision

6.4.1. Glaucoma damage to the optic nerve from an above normal intra-ocular pressure second leading cause of blindness in older adults Causes related to aging changes in lens decline in visual activity Causes iritis allergies endocrine imbalances family history drugs with anticholinergic properties may exacerbate Acute (closed or narrow angle) severe eye pain, headache, nausea and vomiting rapid increase in tension and edema need for early treatment to prevent blindness diagnosis with tonometry to measure IOP If pressure doesn't decrease in 24 hours surgery is necessary Chronic (open angle) most common form need for early treatment to prevent blindness blindness from glaucoma cannot be restored peripheral vision becomes slowly impaired but may not realize what is happening

6.4.2. Cataracts clouding of the lens and loss of transparency leading cause of low vision in older adults older women with blue eyes at most risk treatment surgery is only treatment not preformed until vision is completely lost

6.5. Hearing

6.5.1. Care of the Person with a hearing deficit encourage testing patience safety considerations Hearing aids should only be bought with correct prescription

6.5.2. Changes in Aging Presbycusis progressive loss of hearing distortion of high-pitched sounds alteration in equilibrium cerumen increases

6.5.3. Causes of hearing loss exposure to loud machinery loud music certain drugs are ototoixc aspirin, -mycins,

6.6. Taste and Smell

6.6.1. Changes of Aging taste acuity dependent on smell sense of smell altered with age decreased saliva and poor oral hygiene atrophy of tongue

6.7. Touch

6.7.1. reduction of tactile sensation

6.7.2. reduced ability to sense pressure, discomfort, change in temperautre Normal body temperature are lowered in older adults (96.9-98.3)

6.8. Health Promotion

6.8.1. Vision Routine eye exams Incorporate Zinc, Selenium, Vitamin A and C into diet

6.8.2. Hearing Take good care of ears throughout years prompt treatment of infections Education reduce environmental noise, trauma and regular examinations

7. Musculoskeletal

7.1. Effects of Aging

7.1.1. Thinning disks and shortened vertebra

7.1.2. reduced muscle mass, strength and movement

7.1.3. decreased bone mineral and mass

7.1.4. diminished calcium absorption

7.1.5. increased risk of fractures

7.2. Osteoporosis

7.2.1. Most prevalent metabolic disease of the bone

7.2.2. Risk Factors advanced age sex (female) small-frame history of early menopause cigarette smoking and alcohol consumption family history

7.2.3. Causes Related to aging Immobility and Inactivity Diminished Calcium absorption reduced muscle mass, strength and movement Poor Nutrition related to decreased access, loss of teeth, difficulty swallowing Reduction in sex hormones Estrogen has protective effect

7.2.4. Diagnosis Bone mass Density tests DEXA scan DPA

7.2.5. Treatment treat underlying cause disease calcium supplements a diet rich in protein regular exercise

7.3. Health Promotion

7.3.1. Management of Pain

7.3.2. Preventing Injury

7.3.3. Promoting Independence

8. Cancer

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

8.2. Probability of cancer increases with age

8.3. Aging and Cancer

8.3.1. Advanced stage when initially diagnosed

8.3.2. increased risk of complications, disability and death

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

8.3.4. prolonged exposure to carcinogens

8.4. Prevention

8.4.1. healthy lifestyle avoid use of tobacco and alcohol limit exposure to sun eat a diet rich in fiber, fruits and vegetables maintain weight in an ideal weight range protect against known carcinogens

8.4.2. Screening Women mammograms papsmears Men colonoscopy

8.4.3. Education CAUTION change in bowel habits a sore that does not heal unusual bleeding or drainage thickening or lump in the breast Indigestion or swallowing difficulties Obvious change in a wart or mole nagging persistent cough

8.5. Treatment

8.5.1. Conventional Depends on type of cancer surgery, radiation, chemotherapy, and biologic therpapy with age comes advanced risks for complications

8.5.2. Complementary and Alternative medicine special diets, psychotherapy, spiritual practices, vitamin regimes, herbal remedies Relationship-centered care Support Healing Partnerships Comfort Hope

9. Cardiovascular

9.1. Effects of Aging

9.1.1. Heart dimensions are unchanged

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

9.1.3. Valves become thick and rigid

9.1.4. blood vessels reduce elasticity

9.1.5. oxygen use less efficiently

9.1.6. Aorta becomes dilated slight ventricular hypertrophy thickening on ventricular wall

9.1.7. less sensitive to baroreceptor regulation of blood pressure

9.2. Health Promotion

9.2.1. alterations modified by lifestyle and diet

9.2.2. Identify and lower risks through education

9.2.3. proper nutrition control of cholesterol

9.2.4. adequate exercise enhance circulation with aerobic exercise, yoga, strengthening exercises, balance exercises

9.2.5. Cigarette smoking cessation

9.2.6. Stress management

9.2.7. proactive interventions low-dose aspirin daily; preventive measure nutritional supplements

9.3. Hypertension

9.3.1. incidence and prevalence increases with age

9.3.2. evaluation of blood pressure systolic >140 diastolic >90

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

9.3.4. Treatment thiazide diuretics watch for electrolyte imbalances beta blockers calcium channel blockers ACE nonpharmacologic measures taken first due to increased risk of adverse effects of medications in older adults diet, exercise, stress management

9.3.5. Causes Related to Aging oxygen use less efficiently heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress Blood vessels lose elasticity Less sensitive to baroreceptor regulation

9.4. Hypotension

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

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

9.4.3. Consequences falls, stroke, syncope, other coronary complications

9.5. Congestive Heart Failure

9.5.1. Incidence increases with age

9.5.2. Leading cause of hospitalization

9.5.3. complication of arteriosclerotic heart disease

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

9.5.5. treatment ACE inhibitors beta-blockers digitalis diuretics reduction in sodium intake

9.6. Coronary Artery Disease

9.6.1. Ischemic heart disease

9.6.2. prevalence increases with age

9.6.3. angina atypical presentation coughing, syncope, sweating and confusion Nitroglycerin is effective more likely to experience orthostatic hypotension Education avoid aggravating factors Nitroglycerin administration education Causes related to Aging oxygen use less efficiently Valves more rigid blood vessels lose elasticity

9.6.4. Myocardial Infarction atypical presentation confusion, decreased blood pressure, shortness of breath, elevated temperature, and sedimentation rate Treatment bed rest with minimal exertion early ambulation Thrombolytic therapy Fitness programs

9.7. Arrhythmias

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

9.7.2. Symptoms weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, syncope

9.7.3. Treatment anti-arrhythmic drugs, digitalis, potassium supplements, cardioversion

9.8. Venous Thromboembolism

9.8.1. High Risk persons restricted to bed rest recent surgery fractures

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

9.8.3. Treatment Anticoagulants, surgery, elastic stockings, bandages, and elevation of extremities

10. Respiratory

10.1. Effects of Aging

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

10.1.2. Decreased elastic recoil

10.1.3. increased residual capacity and reduced vital capacity

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

10.1.5. reduction of cough and laryngeal reflexes

10.1.6. alveoli less elastic

10.2. Health Promotion

10.2.1. Prevention of Infection

10.2.2. Smoking cessation

10.2.3. influenza and pneumonia vaccines important

10.2.4. avoiding exposure to people with respiratory infections

10.2.5. deep-breathing exercises

10.2.6. immobility is a major threat

10.2.7. caution with self-treatment of respiratory issues

10.3. Pneumonia

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

10.3.2. Causes related to aging Poor chest expansion Lowered resitance to infection reduced pharyngeal reflexes promotes aspiration of foreign material immobility and inactivity

10.3.3. Signs and symptoms cough, fatigue, confusion, restlessness, usually no change in temperature

10.3.4. Treatment Antibiotics Vaccine and booster after 5 years watch for adverse effects increased risk in elderly population pain management consult dietician for nutrition assessment

10.4. Asthma

10.4.1. Can develop in later years

10.4.2. Causes related to aging alveoli less elastic more exposure to irritants as we age

10.4.3. high risk of complication of bronchiectasis and cardiac problems

10.4.4. high rates of mortality

10.4.5. Assess for the use of aerosol nebulizers'

10.4.6. education avoid environmental irritants safe medication use

10.5. Chronic Bronchitis

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

10.5.2. Causes related to aging reduction in vital capacity less air leaving and more fluids remain Reduced cough reflex Loss of muscle strength in diaphragm alveloi less elastic

10.5.3. Management remove bronchial secretions prevent obstruction of airway maintain adequate fluid intake

10.6. Emphysema

10.6.1. Increasing incidence in older adults

10.6.2. Causes Chronic bronchitis, chronic irritation, and morphologic changes in the lung Cigarette smoking is major role in development

10.6.3. Symptoms develop slowly; can delay diagnosis and treatment

10.6.4. Treatment postural drainage bronchodilators avoid stress breathing exercises

11. Sexuality/Reproductive

11.1. Women

11.1.1. Menopause: permanent cessation of menses Important transition in a woman's life More than a physiological experience awakening of body, mind and spirit physical beauty of youth versus inner beauty of age Hormone Therapy age at the start of hormone replacement therapy alters risk (young the better) Estrogen and progestin increased heart risks Estrogen alone less risky

11.1.2. Effects of Aging: Hormonal Changes vulva atrophies flattening of the labia loss of subcutaneous fat vaginal epithelium thins cervix, uterus and fallopian tubes atrophy vaginal canal changes reduction in collagen and adipose tissue shortening and narrowing of the canal less lubrication more alkaline vaginal pH as a result of lower estrogen changes Uterus and ovaries decrease in size endometrium continues to respond to hormnal stimulation fallopian tubes become shorter and straighter breast sag and are less firm some retraction of nipples related to shrinkage and fibrotic changes

11.1.3. Health Promotion Annual gynecologic exam with pap smear breast self examination

11.1.4. Infections of the Vulva Age related changes cause the vulva to be more fragile and more susceptible to irritation and infection

11.1.5. Problems of the Cervix Age changes: cervix becomes smaller endo-cervical epithelium atrophies Endo-cervical glands can seal over leading to formation of nabothian cysts Secretions can accumulate and a palpable tender mass may be evident regular gynecologic examinations to check cervix patency are very important

11.1.6. Dyspareunia (painful intercourse) Not a normal consequence of aging more frequent in nulliparous women thorough gynecologic exam and sexual history goal: achieve a satisfactory sexual life

11.2. Men

11.2.1. Andropause: testosterone levels decline in men (does not occur in all men) can result in reduced muscle mass, energy, strength and stamina other changes: erectile dysfunction, breast enlargement, osteopenia, osteoporosis and shrinkage of testes

11.2.2. Effects of Aging: Seminal vesicles develop thinner epithelium muslce tissue replaced with connective tissue decreased capacity to retain fluids seminiferous tubule changes increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen Atrophy of the testes and reduction in testicular mass ejaculation fluid contains less sperm testosterone stays the same or decreases slightly more time required to achieve an erection enlargement of the prostate gland

11.2.3. Erectile Dysfunction Unable to attain or maintain erection of penis for sexual intercourse Multiple Causes: Atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medication antihypertensives, anticholinergics, digoxin and antidepressants Age Changes testosterone decreases more time required to achieve erection enlargement of prostate Treatments oral erectile agents vacuum pump machines

11.2.4. Benign Prostatic Hyperplasia most older men have some degree of benign prostatic hyperplasia men reluctant to receive treatment delay of treatment can cause kidney damage

11.3. Barriers to sexual activity

11.3.1. physical unavailability of partner particularly for older women

11.3.2. Emotional negative attitudes from society fear of losing sexual abilities concerns about body image relationship issues

11.3.3. Social

11.4. Promoting Healthy Sexual Function

11.4.1. Basic education

11.4.2. openly discuss sex and desires

11.4.3. masturbation beneficial

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

11.5. Health Promotion

11.5.1. testicular self-examination

11.5.2. men with prostatic hypertrophy examined every 6 months

12. Neuro

12.1. Effects of Aging

12.1.1. Decline in weight and blood flow to the brain Loss of nerve cell mass atrophy of the brain and spinal cord

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

12.1.3. slower response to change in balance demyelinization

12.1.4. hypothalamus less effective in temperature regulation

12.1.5. changes in sleep patterns with frequent awakeneing

12.1.6. Number and sensitivity of sensory receptors, dermatomes and neurons decrease affecting taste, smell and tactile sensation

12.2. Subtle Indications of Neurologic Problems

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

12.2.2. changes in vision

12.2.3. sudden deafness, ringing in ears

12.2.4. mood, personality changes

12.2.5. clumsiness, unsteady gait

12.2.6. numbness, tingling of extremity

12.2.7. unusual sensation or pain over nerve

12.3. Cerebrovascular Accidents

12.3.1. third leading cause of death in elderly patients

12.3.2. Symptoms light headedness, dizzy, aphasia, drop attack, headache

12.3.3. High Risk patients hypertension, gout, diabetes, MI, dehydration and those who smoke

12.3.4. Causes related to Aging decline in weight and blood flow to the brain blood vessels less elastic heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress

12.3.5. Nursing Interventions Maintain patient airway provide adequate nutrition and hydration monitor vital signs and neurologic symptoms prevent complications associated with immobility infections atrophy of muscles loss of independence Assist with ADLs Reorient patient

12.4. Parkinson's Disease

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

12.4.2. Lack of dopamine

12.4.3. Exact cause is unknown

12.4.4. Signs and Symptoms Tremor slow movement shuffling unsteady gait rigid movements loss of muscle tone impaired balance and posture

12.4.5. Treatments Anticholinergic medications Physical therapy

12.4.6. Goal Maximum level of independence is preserved

12.5. Nursing Considerations for Neurologic Conditions

12.5.1. Promoting Independence Assistive devices Periodic home visits Regular contact with family and friends promoting self care patience, reassurance and encouragement Need to educate family members and friends

12.5.2. Prevent Injury high risk of accidents avoid hazards

13. Immune

13.1. Effects of Aging

13.1.1. Decreased immune response

13.1.2. inflammatory defenses decline; inflammation present atypically

13.1.3. risk for infection becomes significant

13.1.4. T-cell activity declines

13.1.5. cell-mediated immunity declines

13.1.6. Thymus gland declines in size

13.1.7. reduced number of langerhans cells in the skin

13.1.8. reduced thickness of skin

13.1.9. decreased circulation of the skin

13.2. Health Promotion

13.2.1. Diet foods affect immunity both positively and negatively protein, magnesium, vitamins A E B C, manganese, folic acid, selenium, pantothenic acid, zinc, iron

13.2.2. Exercise regular physical activity enhances immune function low impact yoga, t'ai chi

13.2.3. immunizations pneumococcal polysaccharide booster every 5 years influenza every year before flu season zoster hepatitis A and B

13.2.4. Stress Management

13.2.5. Careful use of antibiotics can develop resistance side effects and adverse reactions increased in older adults

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 A: asymmetry B: border irregularity C: color 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 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 skin is less elastic, dry and fragile decreased subcutaneous fat Decreased nutrition immobility and inactivity

14.3.6. Stages 1 Persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved 2 a partial thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister or shallow crater 3 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 4 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 unstagable

14.3.7. Treatment encourage activity and turning use of pillows, alternating pressure mattresses high protein, vitamin rich diet skin should be kept dry and clean 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 topical application of zinc ointment vitamin rich diet antihistamines and topical steroids

14.5. Skin Cancer

14.5.1. Basal Cell Carcinoma most common form grows slowly rarely metastasized Causes Risk factors advanced age ultraviolet radiation exposure to sun therapeutic radiation Appearance small, dome shaped elevations flesh colored with pearly appearnace