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