Older adult changes

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Older adult changes by Mind Map: Older adult changes

1. Hypothyroidism

1.1. Aging affects the thyroid gland by moderate atrophy, fibrosis, increasing colloid nodules, and some lymphocytic infiltration

1.2. It can either be primary, resulting from a disease process that destroys the thyroid gland

1.2.1. It can also be secondary hypothyroidism that is caused by insufficient pituitary secretion of thyroid stimulation hormone Secondary is due to low free T4 or free T4 index and low TSH

1.2.2. Primary hypothyroidism is characterized by low free T4 or free T4 index and low TSH

1.2.3. A subclinical hypothyroidism can exist in which the person is asymptomatic but has elevated TSH levels and normal T4

1.3. Symptoms

1.3.1. Fatigue, weakness, lethargy depression and disinterest in activities anorexia

2. Vision and hearing

2.1. The reduced elasticity and stiffening of the muscle fibers of the lens of the eye that begins in the fourth decade of life

2.2. Visual acuity progressively declines due to reduced pupil size, opacification of the lens and vitreous, and loss of photoreceptors cells in the retina

2.3. The light perception threshold decreases causing difficulty with vision at night and dimly lit areas

2.4. Dark and light adaptation takes longer

2.5. Sensitivity to glare increases due to cataract formation

2.6. Visual fields become smaller reducing peripheral vision

2.7. The eyes produce fewer tears are drier

2.8. Presbycusis

2.8.1. Age-related sensorineural hearing loss This reduces ability to hear s, sh, f, ph, and w sounds and may cause speech to be inaudible or distorted as can impacted cerumen

2.9. Visual changes cause depth perception to become distorted, this causes the judging of height of walking surfaces harder

2.10. Glaucoma

2.10.1. This a common disease among older adults It is a degenerative eye disease in which the optic nerve is damaged from an above-normal intraocular pressure The exact cause is unknown but it can be associated with and increased size of the lens, iritis, allergy, endocrine imbalance, emotional instability, and a family history

2.10.2. This is the second leading cause of blindness among people

2.10.3. There are two types of glaucoma Actute: which is also called closed-angled or narrow-angled The person experiences severe eye pain, headache, nausea, and vomiting Chronic: which is also called open-angled is the more common of the two This type occurs more gradually that affected people are unaware that they have visual problems

3. Musculoskeletal/mobility

3.1. Decline in size and number of muscle fibers

3.2. Reduction in muscle mass

3.2.1. Decreased body strength Endurance declines

3.3. Connective tissue changes

3.3.1. Reduction in flexibility of joints

3.4. Sarcopenia

3.4.1. Age related reduction of muscle mass or function resulting from a reduction of protein synthesis and increase in protein degeneration

3.4.2. Causes Disease, immobility, decreased caloric intake, poor blood flow to the muscles, mitochondrial dysfunction, a decline in anabolic hormones, and increase in pro inflammatory cytokines

3.4.3. When added to the impaired capacity for muscle regeneration that occurs in late life, this can lead to disability

3.4.4. Symptoms Weakness and loss of stamina This can interfere with physical activity

3.5. Osteoporosis

3.5.1. There is a reduction in skeletal mass This is caused by an imbalance between bone resorption and bone formation

3.5.2. Osteoporosis causes bones to become so weak and brittle that a fall or a mild stress to the bones can cause fractures This happens when the creation os new bone does not keep up with the removal of the old bone

3.5.3. This is a very common disease in older adults more so in older women

3.5.4. Symptoms Back pain that is caused by a fractures or collapsed vertebra Loss of height over time A stooped posture A bone fracture that occurs much more easily than it should be expected

4. Delirium/Dementia

4.1. Delirium,

4.1.1. The onset of symptoms tend to be rapid and can include disturbed intellectual function

4.1.2. Disorientation of time and place but usually not of identiy

4.1.3. Altered attention span Worsened memory labile mood

4.1.4. Hallucinations may occur They are usually visual

4.1.5. The reason delirium occurs is due to the disruption in brain function due to medications side effects, circulatory disturbances, dehydration, high blood pressure, low or high thyroid activity, high or low blood sugar, surgery, or stress

4.2. Dementia

4.2.1. The onset of symptoms are slow, it make take months to years for them to be noticed

4.2.2. There is poor short and long term memory disorientation Difficulty finding the proper word

4.2.3. The reason why Dementia occurs is from damage to brain tissue due to Alzheimer's or other degenerative diseases, circulatory problems, lack of oxygen, infection, trauma, alcoholism, hydrocephalus, or a tumor

5. Thermoregulation

5.1. Normal body temperature is lowered 96.9-98.3

5.2. Ability to responded to cold temperature is reduced

5.3. Having different norms of body temperatures can cause fevers to happen more often and can also cause for infections to occur in the older adult population

5.4. Room temperatures that are lower than 70 degrees can lead to hypothermia

5.5. Older adults must also be cautious the their bath temperature so they do not burn themselves

6. Integumentary

6.1. Sin less elastic and dry and fragile

6.2. Decreased subcutaneous fat

6.3. Increased benign and malignant skin neoplasms

6.4. Thing, graying of hair

6.5. Reduced sweat gland activity

6.6. Nails become thicker

6.7. Flattening of the dermal-epidermal junction

6.8. reduced thickness and vascularity of the dermis

6.9. Degeneration of elastic fibers

6.10. Increased coarseness of collagen

6.11. Reduction in melanocytes

6.12. Pruritus

6.12.1. This is a common dermatologic problem among older adults

6.12.2. It can be precipitated by any circumstance that dries the person's skin This could include diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia, and certain psychiatric problems

6.12.3. If Pruritus is not corrected properly it can cause traumatizing stratching this can lead to breakage in the skin which leads to infection

6.13. Pressure Ulcers

6.13.1. Tissue anoxia and ischemia resulting from pressure can cause necrosis, sloughing, and ulceration of the tissue of an older adult

6.13.2. Pressure ulcers are a common disorder that result from immobilization, improper skin care, improper turning in the hospital setting, and poor diet.

6.13.3. Pressure ulcers are very common in older adults due to these reason

6.13.4. Any part of the body can develop a pressure ulcer The most common areas are the sacrum, greater trochanter, and ischial tuberosities

6.13.5. Older adults that are at high risk for pressure ulcers because of: Skin that is fragile and damages easily Poor nutrition

7. Neurological

7.1. Loss of nerve call mass

7.1.1. Atrophy of the brain and spinal cord

7.1.2. Brain weight decreases

7.2. Number of dendrites declines

7.3. Demyelination occurs

7.3.1. Slower nerve conduction

7.3.2. Response and reaction times are slower

7.3.3. Reflexes become weaker

7.4. Plaques, tangles, and atrophy of the brain occur

7.5. Free radicals accumulate

7.6. Decrease in cerebral blood flow

7.7. Fatty deposits accumulate in blood vessels

7.8. Ability to compensate is decreased

7.9. intellectual performance is maintain until around age 80

7.10. Slowing in central processing

7.10.1. Delay in time required to perform tasks

7.10.2. Verbal skills are maintained until age 70

7.10.3. Number and sensitivity of sensory receptors, dermatomes, and neurons decrease Dulling of tactile sensation

7.11. Decline in the function of the cranial nerves affecting taste and smell

7.12. Parkinson’s Disease

7.12.1. This disease affects the ability of the central nervous system to control body movements as a result of impaired function of basal ganglia in the midbrain It occurs when neurons that produce dopamine in the substantial migration die or become impaired Dopamine is necessary for smooth motor movement and has a role in emotions

7.12.2. Parkinson’s is more common in men and occurs most often after the fifth decade in life The incidence also rises with age

7.12.3. The disease is associated with a history of an exposure to toxins, encephalitis, and cerebrovascular disease, especially arteriosclerosis

7.12.4. Symptoms of Parkinson’s disease A faint tremor of the hands or feet over a long period of time may be the first sign The tremor is reduced when the person is doing a purposeful movement Muscle rigidity Weakness Drooling Difficulty swallowing Slowed speech

7.13. Cerebrovascular accidents

7.13.1. CVA's are the third leading cause of death and a major cause of disability in older adults

7.13.2. Older adults with hypertension, severe arteriosclerosis, diabetes, gout, anemia, hypothyroidism, silent myocardial infarction, TIAs, and dehydration People that smoke are at the highest risk for CVA's

7.13.3. The major types of CVA are ischemic This results from a thrombus or embolus, and hemorrhagic which can occur from a ruptured cerebral blood vessel These are also caused by cerebral thrombosis

7.13.4. Most CVA's in older adults are ischemic

7.13.5. Symptoms Light-headedness, dizziness, headache, or a drop attack (feeling of being strongly and suddenly pulled to the ground), and memory and behavioral changes are common as well

8. Cardiac and Circulation

8.1. With age heart valves increase in thickness and rigidity due to sclerosis and fibrosis

8.2. The aorta becomes dilated, a slight ventricular hypertrophy develops, and there is a thickening of the let ventricular wall

8.3. Myocardial muscle is less efficient and loses some of its contractile strength, causing a reduction in cardiac output when the demands not he heart are increased

8.4. More time is required for the cycle of diastolic filling and systolic emptying to be completed

8.5. Calcification and reduced elasticity of vessels occur, and older hearts are less sensitive to baroreceptor regulation of blood pressure

8.6. The incidence of hypertension increases with advancing age and is the most prevalent cardiovascular disease of older adults

8.6.1. The reason for the increased risk for high blood pressure is related to the vasoconstriction associated with aging, which produces peripheral restate. Hyperthyroidism, parkinsonism, Paget's disuse, anemia, and thiamine deficinecy can also be responsible for hypertension in older adults Individuals with systolic pressure >140 and diastolic pressure >90 are considered to have hypertension

8.6.2. Symptoms may include awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, and a slow tremor

8.6.3. Hypertensive older adults are advised to rest, reduce their sodium intake, and if applicable reduced their weight

8.7. Congestive Heart Failure

8.7.1. The incidence of CHF increases with age and it is the leading cause of hospitalization of older adults CHF is a potential complication in older patients with arteriosclerotic heart disease

8.7.2. Coronary artery disease is responsible for most cases of CHF. Hypertension is also one of the main risk factors for developing CHF Some other risks factors associated with the development of CHF is diabetes mellitus, dyslipidemia, sleep-disordered breathing, albuminuria, anemia, chronic kidney disease, the use of illicit drugs, sedentary lifestyle, and psychological stress It is common in older adults because of age related changes such as reduced elasticity and lumen size of the vessels of the heart. Rises in the blood pressure that can also interfere with the blood supply to the heart muscle.

8.7.3. Symptoms Dyspnea on exertion, confusion, insomnia, wandering during the night, agitation, depression anorexia, nausea, weakness, shortness of breath, orthopnea, wheezing, weight gain, bilateral ankle edema On auscultation moist crackles are heard

9. Digestion and Bowel Elimination

9.1. A trophy of the tongue affects the taste buds and decreases taste sensation

9.2. Salvia production decreases

9.2.1. Swallowing may be difficult

9.3. Presbyesophagus results is weaker esophageal contractions and weakness

9.4. Esophageal and stomach motility decreases

9.4.1. Risk for aspiration and ingestion increases

9.5. Decreased elasticity of the stomach

9.5.1. Reduces the amount of food accommodation at one time

9.6. Stomach has a higher Ph

9.7. Decline in hydrochloride acid

9.7.1. Increase in incidence of gastric irritation Interferes with absorption of calcium, iron, folic acid, and vitamin B12

9.8. Decline in pepsin

9.8.1. This interferes with the absorption of protein

9.9. Slower peristalsis

9.9.1. Reduced food and fluid Increase risk of constipation

9.10. Decrease in sensory perception which can also lead to constipation

9.11. Dry mouth (Xerostomia)

9.11.1. Salvia is helpful in lubricating the soft tissues of the mouth, assisting in remineralizing the teeth, promoting taste sensations, and helping to control bacteria and fungus in the oral cavity. ACTH secretion decreases

9.11.2. Having a reduction of saliva can cause a lot of issues to an older adult

9.11.3. Dry mouth can result from a variety of factors and also due to the increase of age in older adults Many medications that older adults are taking such as diuretics, antihypertensives, anti-inflammatories, and antidepressants can affect salvia production Sjögren's syndrome that is a disease that affects the immune system can reduce salivary galen function and can also cause severe dryness of the mucous membrane

9.12. Dysphagia

9.12.1. The incidence of swallowing difficulties increases with age

9.12.2. Swallowing depends on complex mechanisms involving several cranial nerves and the muscles of the mouth, face, pharynx, and esophagus Having issues with anyone these mechanisms can cause dysphagia

9.12.3. Gastroesophagel reflect disease (GERD) is a common cause Strokes are also a common cause of dysphagia

9.12.4. Dysphagia can be oropharyngeal which is the difficulty transferring food bolus or liquid from the mouth into the pharynx and esophagus and more common in people with neurological damage

9.12.5. Dysphagia also can be esophageal which is involving difficulty with the transfer of food down the esophagus and sphincter abnormalities, or mechanical obstructions caused by structures

9.12.6. Symptoms of dysphagia can be mild such as difficulty swallowing food every once in a while It could also be as bad as not being able to swallow at all

10. Endocrine

10.1. Thyroid gland activity decreases

10.2. Pituitary gland volume decreases

10.3. Insulin release by beta cells is delayed

10.4. Ability to metabolize glucose is reduced

10.5. Decrease in activity of the adrenal glands results in reduced secretion of estrogen, progesterone, androgen, 17-ketosteroids, and glucocorticoids

10.6. Diabetes Mellitus

10.6.1. Glucose intolerance is a common occurrence among older adults It is thought that a physiologic deterioration of glucose tolerance occurred with increasing age Increased amounts of fat issue present in older persons who are obese and inactive is considered to be a huge contributor to type two diabetes

10.6.2. Symptoms excessive hunger, excessive thirst, or fatigue, weight gain or weight loss, frequent urination, blurred vision, or poor wounds healing

10.6.3. This is caused by the resistance associated with compensatory hyperinsuliemia followed by progressive beta-cell impairment that results in decreasing insulin secretion

11. Immune/cancer

11.1. Depressed immune response

11.2. T-cell activity declines

11.3. Cell-mediated immunity declines

11.4. Risk for infection is higher

11.5. Inflammatory defenses decline

11.6. More inflammation present

11.7. Older adults have the highest risk of cancer among any other age group

11.8. An older adults cancer is most likely in the late stages when first diagnosed

11.9. It is also common for an older adult to have multiple disease such as heart disease or diabetes

11.9.1. This would make the treatment of cancer more difficult

11.10. There are two theories as to why older adults are diagnosed with cancer more than any other age group

11.10.1. The first theory is that the older adult body simply can not fight off diseases due to the reduced T-cell activity. This might allow the cancer to spread due to the body not being able to recognize the cancer cells as forge in and destroy them

11.10.2. The other theory is that older adults throughout their lifetime have been exposed to carcinogens over the years which puts them at a higher incidence of cancer

12. Urinary Elimination

12.1. Urinary frequency is one of the most common older adults changes

12.1.1. This is caused by the hypertrophy of the bladder muscle and thickening of the bladder, which decreases the ability of the bladder to expand and reduces storage capacity

12.2. Nocturia is common also which is the frequency of urination at night

12.3. Inefficient neurologic control of bladder emptying and weaker bladder muscles can promote the retention of large volumes of urine

12.4. In women the most common reason for urinary retention is fecal impaction

12.5. The primary cause of urinary retention in men is due to prostatic hypertrophy

12.6. The filtration efficiency of the kidneys decreases with age

12.7. There is an increase in the renal threshold for glucose

12.8. Stress incontinence may be common in some women

12.9. Urinary tract infections

12.9.1. These are the most common infections of older adults and increase in prevalence with age

12.9.2. Organisms primarily responsible for the UTI's are Escherichia coli in women and Proteus in men The presence of any forgery body in the urinary tract or anything that slows or obstructs the flow of the urine can cause UTI's Examples of these would be immobilization, urethras strictures, neoplasms, or a clogs indwelling catherer

12.9.3. UTI's can also result from poor hygiene Such as improper cleansing after a bowel movement, a predisposition created by low fluid intake and excessive fluid loss, and hormonal changes, which reduce the body's resistance

12.9.4. Older adults that are in a debilitated state or who have neurogenic bladders, arteriosclerosis, or diabetes also have a high risk for developing UTI's

12.9.5. Catheter associated UTI's are the most common type of hospital acquired infections

12.9.6. Symptoms of UTI's Burning, urgency, and fever, some older adults experience deliruim

12.10. Renal Calculi

12.10.1. The formation of stones can result form immobilization, infection, changes in the pH or concentration of urine, chronic diarrhea, dehydration, excessive elimination of uric acid, and hypercalcemia

12.10.2. Symptoms Pain, hematuria, and the same symptoms of a UTI

13. Respiratory system

13.1. Changes in the respiratory system can be noted in upper airway passages

13.2. The nose has connective tissue changes that reduce support and can cause nasal septal deviations that interfere with the passage of air

13.3. Reduced secretions from the submucosal gland cause the mucus in the nasopharynx to become thicker and harder to expel

13.3.1. This could cause the sensation of a constant tickle in the throat

13.4. Due to the nostrils becoming thicker it makes it easier for more dirt particles to become inhaled on inspiration

13.5. The trachea stiffens due to calcification of its cartilage

13.6. Coughing is reduced due to a blunting of the laryngeal and coughing reflexes

13.7. The gag reflux is weaker due to a reduced number of nerve endings in the larynx

13.8. The lungs become smaller in size and weight with age

13.9. Various connective tissues responsible for respiration and ventilation are weaker

13.10. The elastic recoil of the lungs during expiration is decreased because of less elastic collagen and elastin

13.10.1. Expiration requires the active use of accessory muscles

13.11. Alveoli are less elastic

13.11.1. They develop fibrous tissues and contain fewer functional capillaries

13.12. The loss of skeletal muscle strength in the thorax and diaphragm, combined with the loss of resilient force that holds the thorax in a slightly contracted position

13.12.1. This contributes to the slight kyphosis and barrel chest seen in many older adults

13.13. There is reduction of vital capacity in the lungs

13.14. Increase in residual volume

13.14.1. There is less air exchange and more air and secretions remaining in the lungs

13.15. There is a reduction in body fluids and reduced fluid intake

13.15.1. This can cause drier mucous membranes This can lead to the development of mucous plugs and infection

13.16. Chronic Obstructive Pulmonary Disease (COPD)

13.16.1. This disease is common in older adults and it also represents a group of disease that are known as asthma, chronic bronchitis, and emphysema

13.16.2. This disease process is higher among women and smokers

13.16.3. This disease starts due to the damage of the air pathways from another disease such as asthma, chronic bronchitis, or emphysema As time goes on and the airways are damaged more and more

13.16.4. Emphysema (known as the pink puffers) This is a disease of the alveoli The fibers that make up the walls of the alveoli become damaged

13.16.5. Bronchitis (known as the blue bloaters) This a disease when the lung airways become inflammed This results in an increase of mucous production

13.16.6. Symptoms Coughing, shortness of breathe, wheezing, the build up of mucous and chest tightness

13.17. Influenza

13.17.1. Most deaths from influenza occur in older adults

13.17.2. There are two types of influenza type A & B

13.17.3. Type A is the most common among older adults

13.17.4. Age related changes that contribute to influenza are impaired immune system response to the virus

13.17.5. infulenza causes fever, myalgia, sore throat, and a nonproductive cough

13.17.6. It attacks by destroying the ciliated epithelial cells of the respiratory tract and depresses mucocillary clearance

14. Sleep and rest

14.1. Insomnia

14.2. Daytime sleepiness

14.3. Napping more often

14.4. These experiences are due to the age-realted changes in the circadian sleep-wake cycles, sleep architecture, sleep efficiency, and sleep quality

14.5. Older adults are more likely to fall asleep earlier in the evening and wake up in the morning before dawn

14.6. There is a reduction in non-rapid eye movement stage sleep and rapid eye movement (REM) sleep

14.7. Older adults sleep less soundly and shift in and out of stage 1 sleep to a greater degree than younger adults

14.8. A delay in the onset of sleep is more prevalent with older adults

14.9. Sleep apnea

14.9.1. This is a disorder in which there are five episodes of cessation of breathing, that lasts at least 19 seconds or longer. That occur per hour of sleep, accompanied by more day time sleepiness The prevalence is three times higher in men than women

14.9.2. Sleep apnea can be caused by a defect in the central nervous system that affects the diaphragm

14.9.3. It can also be cause by a blockage in the upper airway that interferes with normal air flow

14.10. Restless leg syndrome

14.10.1. This is a neurological condition characterized by an uncontrollable urge to move the legs

14.10.2. The incidence increases with age

14.10.3. Moving the legs can bring relief of the sensations that are being felt but also it interferes with sleep

14.10.4. This can be caused by Parkinson's disease, rheumatoid arthritis, diabetes, or neurological lesions

14.10.5. It is also associated with alterations in dopamine and iron metabolism Antidepressants, antihistamines, antipsychotics, alcohol, caffeine, hypoglycemia, and simple or refined carbs can contribute

15. Safety

15.1. Older adults are at a higher risk for falls and injuries

15.2. Older adults experience more than 2.3 million nonfatal injuries every year

15.3. There is an altered antigen-antibody response and the high prevalence of chronic disease caused older adults to be at a high risk for infections

15.4. Home safety risks

15.4.1. Due to many older adults having a shuffling gait and an incomplete tow lift during ambulation This could cause static electricity and cling to carpet that could cause a fall

15.4.2. Having carpet and using a wheelchair to make it hard to move the wheelchair or walker around the house

15.4.3. Spills are more difficult to clean on carpet causing an increased risk for a fall

15.4.4. Lighting sound be a dim lighting Older adults should also use dim nightlight in order to see when they are walking at night to prevent falls

15.4.5. Older adults patients should not have any loose rugs around the house this could also cause a fall

15.4.6. In case of a fire older adults should keep walkways clear of items and door clear of items as well to make it easier and safer to get out in case of an emergency

15.5. There are many potential disease processes that can impact the safety of older adults

15.5.1. Presnyopia This causes a decreased ability to focus and visualize near objects

15.5.2. Decreased opacity of sclera, which allows more light to come in and there is a yellowing of the lens of the eyes Colors are more washed out, more contrast is required

15.5.3. Senile cataracts cloud lens, macular degeneration, smile mitosis, pupil size is decreased, less hight reaches the retina There is a distorted color vision, particularly for browns, beiges, blues, greens, and violets, glare is more bothersome, vision is more difficult, more magnification is needed, slower slight-to-dark accommodation

15.5.4. Decreased vision field, presbycusis, dependency on hearing aids Peripheral vision narrower, distortion of normal sounds, amplification of all environmental sounds

15.5.5. Stiff joints and urinary frequency This can lead to having difficulty climbing stairs, or having a difficult time reaching a restroom in a safe manner.

15.5.6. The types and amounts of medications that older adults are on This may cause dizziness which can lead to falls and injuries

16. Sexuality, intimacy, and reproductive health

16.1. Older adults are physically able to be sexually active

16.2. Lack of partner causes issues with sexuality of older adults

16.3. By age 65 there is 7 men to every 10 women, by age 85, there is 1 man to every 5 women

16.4. Psychological barriers

16.4.1. Negative attitudes from society

16.4.2. Fear of losing sexual abilites

16.4.3. Concerns about body image

16.4.4. Relationship issues

16.4.5. Misconceptions by older adults

16.5. Erectile dysfunction

16.5.1. This is the inability to attain or maintain erection of the penis for sexual intercourse There are multiple causes to this disease These causes are known as: atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medications There is smooth muscle relaxation of the penile arteries and corpus cavernous which leads to an erection this action results from the parasympathetic system and without this action a man cannot hold and erection

16.6. Meopause

16.6.1. This is the permanent cessation of menses for at least a year This occurs for most women around the fifth decade of life

16.6.2. Symptoms Hot flashes fatigue

16.6.3. The ovaries no longer produce estradiol or inhibin, this causes FSH and LH hormones to no longer be produced causing the cessation of menses and a women's inability to conceive a child