1. Immune
1.1. depressed immune response
1.1.1. t-cell activity declines
1.1.2. cell-mediated immunity declines
1.2. reduced antibody response
1.3. decreased number of Langerhans cells in the skin
1.4. reduced thickness of the skin
1.5. decreased circulation of the skin
2. Gastrointestinal
2.1. less acute taste sensations
2.2. decreased esophageal motility
2.3. atrophy of small and large intestines
2.3.1. fewer cells on walls impact absorption of dextrose, xylose, and vitamins B and D
2.4. increased risk for aspiration, indigestion and constipation
2.5. presbyesophagus
2.5.1. weaker esophageal contractions and weakness sphincter
2.6. decreased elasticity of stomach
2.6.1. reduces amount of food accommodation at one time
2.7. stomach has higher pH
2.7.1. decline in hydrochloric acid
2.7.1.1. increase in incidence of gastric irritation
2.7.1.2. interferes with absorption of calcium, iron, folic acid, and vitamin B12
2.7.2. deline in pepsin
2.7.2.1. interferes with absorption of protein
2.8. decreased peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet
2.8.1. increased in risk of constipation
2.9. bile salt synthesis decreases
2.9.1. increased risk of gallstones development
2.10. pancreases changes
2.10.1. affects digestion of fats
2.11. Ex: Xerostomia
2.11.1. results from
2.11.1.1. decreased saliva, some medications, mouth breathing and altered cognition
2.11.2. consequences of decreased saliva in the older population
2.11.3. interventions:
2.11.3.1. saliva substitutes, sipping water, sugarless candy or gum
2.12. Dysphasia
2.12.1. swallowing difficulties that increase with age
2.12.2. causes:
2.12.2.1. GERD, stroke, structural disorders
2.13. bowel incontinence
2.13.1. involuntary defecation
2.13.2. most often associated with fecal impaction
3. Safety
3.1. lighting
3.1.1. diffuse lighting better than bright light
3.1.2. night lights: soft red light in bedroom
3.2. temperature
3.2.1. older adults have lower than normal body temperatures
3.2.2. decreased natural insulation
3.3. floor coverings
3.3.1. carpeting: sound absorber but can cause problems
3.3.1.1. static electricity and cling
3.3.1.2. difficulty in wheelchair
3.3.1.3. cleaning
3.3.1.4. odors
3.3.1.5. pests
3.3.2. scattered rugs or area rugs can cause falls
3.4. furniture
3.4.1. chairs correct height with arm rests
3.4.2. tables and book cases should be sturdy
3.5. Fall precautions
4. Respiratory
4.1. Reduction of cough and laryngeal reflexes
4.2. increased residual capacity and reduced vital capacity
4.3. high risk for respiratory infection
4.4. lungs reduce in size and weight
4.5. decreased elastic recoil
4.6. alveoli less elastic
4.7. Ex: Asthma
4.7.1. can develop in older years
4.7.2. high risk of complications of bronchiectasis, cardiac problems
4.7.3. high rates of mortality
4.7.4. assess for causative factors and educate patient
4.7.5. evaluate aerosol nebulizer's use
5. Endocrine
5.1. thyroid gland activity decreases
5.2. ACTH secretion decreases
5.3. Pituitary gland decreases
5.4. insulin release by beta cells is delayed and insufficient
5.5. ability to metabolize glucose is reduced
5.6. higher blood glucose in non diabetic patients
6. Cancer
6.1. #1 predictor of developing cancer is age
7. Sleep
7.1. more time in stages I and II, less time in III and IV
7.2. less sound sleep, delay in onset of sleep
7.3. common disorders
7.3.1. insomnia
7.3.1.1. difficulty falling asleep or staying asleep
7.3.1.2. short term (transient)
7.3.1.2.1. change in environment, illness, anxiety, stress
7.3.1.3. Chronic (3 weeks or more)
7.3.1.3.1. physical or mental illness
7.3.1.3.2. environmental factors
7.3.1.3.3. substance abuse
7.3.1.3.4. medications
7.3.2. leg movements
7.3.3. sleep apnea
7.3.3.1. five episodes of cessation of breathing, lasting 10 seconds
7.3.3.2. evaluation of sleep disorder clinic for best treatment
7.3.3.3. supine position for sleep should be avoided
7.3.4. medical conditions
7.3.5. medications
7.4. chronic disorders affecting sleep
7.4.1. diabetes
7.4.2. musculoskeletal conditions
7.4.3. dementia
7.4.4. depression or other emotional problems
7.5. can be affected by
7.5.1. environmental factors
7.5.1.1. snoring spouse
7.5.1.2. loud street noises
7.5.1.3. bright hallway lights
7.5.2. caffeine and alcohol
7.5.3. pain
8. Cardiac
8.1. valves become thick and rigid
8.2. blood vessels reduce elasticity
8.3. oxygen used less efficiently
8.4. aorta becomes dilated
8.4.1. slight ventricular hypertrophy
8.4.2. thickening of left ventricular wall
8.5. myocardial muscle less effective
8.5.1. decreased contractile strength
8.5.2. decreased cardiac output when demands increase
8.6. calcification, reduced elasticity of vessels
8.7. less sensitive to baroreceptor regulation of blood pressure
8.8. conditions altering tissue perfusion
8.8.1. hypotension
8.8.2. blood dyscrasias
8.8.3. cardiovascular disease
8.9. Ex: Congestive Heart Failure
8.9.1. incidence increases with age
8.9.2. leading cause of hospitalization
8.9.3. complication of arteriosclerotic heart disease
8.9.4. coronary artery disease is responsible for most cases
8.9.5. symptoms: SOB, dyspnea, confusion, insomnia, orthopnea, wheezing, weight gain, edema
9. Integumentary
9.1. increased benign and malignant skin neoplasms
9.2. reduced sweat gland activity
10. Urinary
10.1. decline of renal blood flow and glomerular filtration
10.1.1. decrease by 50% by age 90
10.2. hypertrophy and thickening of the bladder muscle
10.2.1. decreases bladder's ability to expand
10.2.1.1. reduced bladder capacity
10.2.1.2. frequency, urgency and nocturne
10.3. changes in cortical control of micturition
10.3.1. nocturne
10.4. kidney filtration ability decreases
10.4.1. affects the ability to eliminate drugs
10.4.1.1. potential for adverse drug reactions
10.5. reduced renal function
10.5.1. high blood urea nitrogen levels
10.6. decreased tubular function
10.6.1. concentration of urine changes in response to water and/or sodium excess/depletion
10.7. increase in renal threshold for glucose
10.7.1. false-negative results for glucose in the urine without symptoms
11. Nervous
11.1. reduction in neurons, nerve fibers and cerebral blood flow
11.2. slower response to change in balance
11.3. hypothalamus less effective in temperature regulation
11.3.1. normal body temperature lowered
11.3.1.1. range 96.9-98.3 degrees F
11.3.2. response to heat is altered
11.3.3. ability to respond to cold temperatures is reduced
11.4. changes in sleep patterns with frequent awakening
11.5. loss of nerve cell mass
11.5.1. atrophy of the brain and spinal cord
11.5.2. brain weight decreases
11.6. number of dendrites declines
11.7. demyelinization
11.7.1. slower nerve conduction
11.7.2. response and reaction times are slower
11.7.3. reflexes become weaker
11.8. plaques, tangles, atrophy of the brain
11.9. free radicals accumulate
11.10. decrease in cerebral blood flow
11.11. fatty deposits accumulate in blood vessels
11.12. ability to compensate declines with age
11.13. intellectual performance maintained until at least 80 years old
11.14. slowing in central processing
11.15. Ex: Parkinsons
11.15.1. affects ability of the CNS to control body movement
11.15.2. dopamine
11.15.3. treatment:
11.15.3.1. anticholinergic medications
11.15.4. temors, shuffling gait, mask face expression
12. Sensory
12.1. presbycusis
12.1.1. distortion of high pitched sounds
12.1.2. cerumen increases
12.1.3. alteration in equilibrium
12.2. presbyopia
12.2.1. narrowing of visual field
12.2.2. pupil size reduction & less reactive
12.2.3. depth perception distorted
12.2.4. decline in visual acuity
12.3. decreases in all senses
12.3.1. taste & smell
12.3.1.1. taste acuity is dependent on smell
12.3.1.2. decreased saliva, poor oral hygiene and medications
12.3.1.3. atrophy of tongue
12.3.2. touch
12.3.2.1. reduction of tactile sensation
12.3.2.2. reduced ability to sense pressure, discomfort, change in temperature
12.3.3. can affect well-being, ADLs, and health
13. Cellular
13.1. functional cell number decreases
13.2. lean body mass decrease
13.3. today body fat increases
14. Physical Appearance
14.1. hair loss, greying, wrinkles
14.2. loss of tissue elasticity
14.2.1. elongated ears
14.2.2. baggy eyelids
14.2.3. double chin
14.3. loss of subcutaneous fat
15. musculoskeletal
15.1. thinning disks and shortened vertebrae
15.2. reduced muscle mass, strength and movement
15.3. decreased bone mineral and mass
15.4. diminished calcium absorption
15.5. increased risk of fractures
16. Reproductive
16.1. female
16.1.1. hormonal changes
16.1.1.1. vulva atrophy
16.1.1.2. flattening of the labia
16.1.1.3. loss of subcutaneous fat and fat
16.1.2. vaginal epithelium thins
16.1.3. cervix, uterus, and Fallopian tubes atrophy
16.1.4. vaginal canal changes
16.1.4.1. less lubrication
16.1.4.1.1. may lead to discomfort with intercourse
16.1.4.2. reduction in collagen and adipose tissue
16.1.5. more alkaline vaginal pH as a result of lower estrogen changes
16.1.6. uterus and ovaries decrease in size
16.1.7. endometrium continues to response to hormonal stimuli
16.1.8. breasts sag and become less firm
16.1.9. Ex: atrophic vaginitis
16.1.9.1. occurs in postmenopausal women
16.1.9.2. increased vaginal fragility increases the risk of irritation leading to vaginitis
16.2. male
16.2.1. seminal vesicles develop thinner epithelium
16.2.2. muscle tissue replaced with connective tissue
16.2.3. decreased capacity to retain fluids
16.2.4. seminiferous tubules changes
16.2.5. atrophy of the testes and reduction in testicular mass
16.2.6. ejaculation fluid contains less live sperm
16.2.7. testosterone stays the same or decreases slightly
16.2.8. more time requires to achieve an erection
16.2.9. enlargement of the prostate gland
16.2.10. Ex: Benign Prostatic Hyperplasia
16.2.10.1. most older men have some degree of BPH
16.2.10.2. men reluctant or embarrassed to seek medical treatment
16.2.10.2.1. may result in kidney damage