Gerontological Concepts

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Gerontological Concepts by Mind Map: Gerontological Concepts

1. Sleep/Rest

1.1. Phase Advance

1.1.1. Fall asleep earlier in evening and wake earlier in morning

1.2. Reduction in NREM and REM sleep cycles

1.3. Less time in stage III and IV sleep

1.4. Sleep latency

1.4.1. Delay in onset of sleep

1.5. More sensitive to noise and light while sleeping

1.6. Insomnia

1.6.1. Difficulty falling asleep, staying asleep, and/or premature waking

1.7. Restless legs syndrome

1.8. Sleep apnea

1.9. Pharmacologic measures with older adults can change sleep cycle

2. Integumentary

2.1. Age-Related Changes

2.1.1. Flattening of dermal-epidermal junction

2.1.2. Reduced vascularity of dermis

2.1.3. Decreased rate of epidermal turnover

2.1.4. Degeneratoin of elastic fibers

2.1.5. Increased coarseness of collagen

2.1.6. Reduction in melanocytes

2.1.7. Increased fragility of skin

2.1.8. Increased risk for skin tears, bruising, pressure injuries, and infections

2.1.9. Lines and wrinkles, thicker nails, graying hair

2.2. Pathological Disorders

2.2.1. Seborrheic Keratosis Pathophysiology Clonal expansion of mutated epidermal keratinocyte Signs/Symptoms Waxy or wart-like growth Treatment Freezing with liquid nitrogen Scraping the skin's surface Burning with electric current Targeting growth with a laser

3. Reproductive

3.1. Age-Related Changes

3.1.1. Women Vulva atrophies Flattening of labia Loss of subcutaneous fat and hair Vaginal epithelium thin Environment more dry and alkaline Uterus and ovaries decrease in size Harder to palpate Fallopian tubes shorten and straighten Breasts sag and become less firm Cervix, uterus, fallopian tubes, and ovaries atrophy Increased risk of malignancy

3.1.2. Men Tthinning of seminal vesicle epithelium Reduction in sperm count Seminiferous tubules undergo fibrosis, thinning of epithelium, thickening of basement membrane, and narrowing of lime Atrophy of testes More time for erection to be achieved Enlargement of prostate as tissue is replaced with fibrotic tissue Increased risk of prostatic malignancy

3.2. Pathological Disorders

3.2.1. Breast Cancer Pathophysiology Arise from growth of epithelial tumors that develop from cells lining ducts or lobules in the breasts Signs/Symptoms Breast lump or thickening, change in size, shape, and appearance of breast, changes to skin over breast, newly inverted nipple, peeling, scaling, crusting around the nipple, redness or pitting on the skin of breast Treatment Lumpectomy Mastectomy Node biopsy Lymph node dissection Chemotherapy Radiation Hormone therapy

3.2.2. Benign Prostatic Hyperplasia Pathophysiology Stromal and epithelial elements of prostate arising in the gland cause hypertrophy Signs/Symptoms Hesitancy, decreased force of stream, frequency, nocturia, dribbling, poor control, overflow incontinence, bleeding Treatment Prostatic massage Urinary antiseptics Avoidance of diuretics, anticholinergics, and antiarrhythmic drugs Prostatectomy

4. Musculoskeletal

4.1. Age-Related Changes

4.1.1. Decrease in number of muscle fibers

4.1.2. Reduction in muscle mass

4.1.3. Grip strength endurance declines

4.1.4. Flexibility of joints and muscles decreases

4.1.5. Sarcopenia Decline in walking speed and grip strength

4.1.6. Demineralization of bone and deterioration of cartilage and surface joints

4.1.7. More brittle bones

4.2. Pathological Disorders

4.2.1. Osteoarthritis Pathophysiology Caused by factors that alter tissue homeostasis of articular cartilage causing predominance of destructive over productive processes Signs/Symptoms Pain, tenderness, stiffness, loss of flexibility, grating sensation, bone spurs Treatment Medication Therapy Joint replacement Injections Bone realignment

4.2.2. Osteoporosis Pathophysiology Reduction in skeletal mass caused by imbalance between bone resorption and formation Signs/Symptoms Back pain, loss of height, stooped posture, frequent bone fractures Treatment Medications Hormone replacement therapy Smoking cessation Safety measures to prevent falls

5. Neurologic

5.1. Age-Related Changes

5.1.1. Loss of nerve cell mass Atrophy of brain and spinal cord

5.1.2. Brain weight decreases

5.1.3. Number of nerve cells decline

5.1.4. Nerve cells have fewer dendrites with some demyelinization

5.1.5. Slower nerve conduction Reaction times slower Reflexes weaker

5.1.6. Cererbral blood flow decreases

5.1.7. Free radical accumulate and can have a toxic effect on nerve cells

5.1.8. Slowing in central processing

5.1.9. Gradual reduction in vocabulary

5.1.10. Number and sensitivity of sensory receptors decrease Dulling of tactile sensation

5.1.11. Decline in cranial nerve Affects taste and smell

5.2. Pathological Disorders

5.2.1. Parkinson's Disease Pathophysiology Neurons that produce dopamine in the substance nigra die or become impaired Signs/Symptoms Tremors, bradykinesia, rigid muscles, impaired posture or balance, loss of automatic movements, speech changes, writing changes Treatment Medications Surgery Safety precautions to prevent falls

5.2.2. Transient Ischemic Attacks Pathophysiology Reduction or cessation in cerebral blood flow as a result of partial or total occlusion of cerebral vessels Signs/Symptoms Weakness, numbness, or paralysis, slurred speech, blindness in one or both eyes, dizziness, loss of coordination or balance, sudden headache, nausea, vomiting, dysphagia Treatment Medications Surgery

6. Vision/Hearing

6.1. Reduced elasticity and stiffening of muscle fibers of lens of eyes

6.1.1. Presbyopia

6.2. Visual acuity declines

6.2.1. Reduced pupil size

6.2.2. Opacification of lens and vitreous

6.2.3. Loss of photoreceptor cells in retina

6.3. Light perception threshold decreases causing difficulty with night vision and in dim areas

6.4. Cataract formation

6.4.1. Causes sensitivity to glares

6.5. Depth perception distorted

6.5.1. Judging height and walking surfaces challenging

6.6. Visual fields become smaller reducing peripheral vision

6.7. Tear production decreases

6.8. Presbycusis

6.8.1. Sensorineural hearing loss Reduces ability to hear "s, sh, f, ph, and w"

7. Respiratory

7.1. Age-Related Changes

7.1.1. Nose has connective tissue changes to reduce support such as septal deviation that can interfere with passage of air Septal deviation Interefernce of air passage

7.1.2. Reduced secretions from submucosal glands Mucus thicker and harder to expel

7.1.3. Trachea stiffens due to calcification of its cartilage

7.1.4. Coughing reduced due to reduced laryngeal and cough reflexes

7.1.5. Reduced nerve endings in larynx Gag reflex weaker

7.1.6. Lungs smaller in size and weight

7.1.7. Connective tissues responsible for respiration and ventilation weaker

7.1.8. Elastic recoil decreased during expiration

7.1.9. Alveoli less elastic, develop fibrous tissue, and contain fewer functional capillaries

7.1.10. Kyphosis and barrel chest

7.1.11. Reduction in body fluid and reduced intake can cause mucus to be harder to expel

7.1.12. Loose or brittle tooth Risk for aspiration, lung abscesses, and infection

7.1.13. Increased rigidity of thoracic muscles and ribs

7.2. Pathological Disorders

7.2.1. Emphysema Pathophysiology Inner walls of air sacs weaken and rupture causing large spaces of air in the alveoli and loss of elasticity Signs/Symptoms Shortness of breath, dyspnea, frequent lung infections, mucus, wheezing, fatigue, cyanosis, morning headaches Treatment Supportive treatment

7.2.2. Pneumonia Pathophysiology Infection that invades air sacs of the lungs and causes inflammation Signs/Symptoms Chest pain when breathing or coughing, phlegm, fatigue, fever, sweating, chills, nausea, vomiting, diarrhea, shortness of breath Treatment Antibiotics Cough medicine Fever reducer/pain relievers

8. Cardiovascular

8.1. Age-Related Changes

8.1.1. Decreased elasticity of blood vessels

8.1.2. Increased resistance of peripheral vessels

8.1.3. Decreased coronary blood flow

8.1.4. Heart valves increase in thickness and rigidity due to sclerosis and fibrosis

8.1.5. Aorta becomes dilated

8.1.6. Slight ventricular hypertrophy and thickening of left ventricular wall

8.1.7. Myocardial muscle is less efficient and loses contractile strength

8.1.8. More time required for diastolic filling and systolic empyting

8.1.9. Heart less sensitive to baroreceptor regulation of blood pressure

8.1.10. Decreased cardiac output

8.2. Pathological Disorders

8.2.1. Coronary Artery Disease Pathophysiology Plaque develops and causes narrowing of coronary arteries which decreases blood flow to the heart that can cause angina, myocardial infarctions, or stroke Signs/Symptoms Chest pain, shortness of breath, heart attack, intermittent claudication, activity intolerance Treatment Lifestyle changes Drugs

8.2.2. Congestive Heart Failure Pathophysiology Heart muscle does not pump blood as well as it should due to conditions such as CAD and hypertension that leave the heart too weak and stiff to allow the heart to pump efficiently Signs/Symptoms Fatigue, weakness, peripheral edema, rapid/irregular heartbeat, exercise intolerance, wheezing, coughing, ascites, fluid retention, weight gain, nausea, shortness of breath, chest pain Treatment Medication Surgery

9. Gastrointestinal

9.1. Age-Related Changes

9.1.1. Tongue atrophies Decreased taste buds and taste sensations

9.1.2. Xerostomia Dry mouth

9.1.3. Saliva production decreases

9.1.4. Swallowing more difficult Dysphagia

9.1.5. Thinning of oral mucosa

9.1.6. Weakening of muscles involved with mastication Difficulty chewing

9.1.7. Presbyesophagus Weaker esophageal contractions and weakness of sphincter

9.1.8. Esophagus and stomach motility decrease

9.1.9. Decreased elasticity of stomach Reduces amount of food it can hold

9.1.10. Declines in HCl and pepsin Higher pH of stomach Increased stomach irritation

9.1.11. Interfered absoprtion of proteins, calcium, iron, solid acid, and vitamin B12, D, xylose, and dextrose

9.1.12. Increased chance of constipation

9.1.13. Bile salt synthesis decreases Gallstone formation

9.1.14. Pancreas experiences fibrosis, atrophy, fatty acid deposits, and reduction in secretions Affects digestion of fats Intolerance to fatty foods can develop

9.1.15. Liver size decreases with age and blood flow can be reduced

9.2. Pathological Disorders

9.2.1. Dysphagia Pathophysiology Difficulty swallowing related to neurologic conditions, muscular disorders, motility disorders, or mechanical obstruction that alters the function the esophagus muscles Signs/Symptoms Pain while swallowing, unable to swallow, drooling, hoarse voice, regurgitation, heartburn, weight loss, coughing or gagging, feeling of food getting stuck in throat Treatment Oropharyngeal Esophageal Thickened liquids, feeding tube, sitting upright after eating, pureed foods

9.2.2. Peptic Ulcer Pathophysiology Usually caused by an infection with Helicobacter pylori, long-term use of aspirin, and NSAIDs that break down the lining of the stomach Signs/Symptoms Burning stomach pain, feeling of fullness, bloating, belching, heartburn, nausea, fatty food intolerance, nausea/vomiting, weight loss, blood in vomit or stool Treatment Antibiotics to kill infection, Medications to block acid production Medications to reduce acid production Antacids to neutralize stomach acid Medications to protect lining of stomach and intestine

10. Genitourinary

10.1. Age-Related Changes

10.1.1. Decreased ability for bladder to expand and reduced storage capacity

10.1.2. Nocturia often a problem

10.1.3. Incontience NOT a normal part of aging

10.1.4. Most common cause of urinary retention Women Fecal impaction Men BPH

10.1.5. Filtration efficiency of kidneys decrease with age Affecting body's ability to eliminate drugs

10.1.6. Urinary retention can cause frequent UTIs

10.1.7. Reduced kidney function Increased BUN levels

10.1.8. Decreased tubular function Difficulty concentrating urine

10.1.9. Decreased reabsorption from filtrate makes proteinuria of 1.0 usually no diagnostic significance

10.1.10. Increase in renal threshold for glucose serious concern

10.1.11. Hypertrophy of the bladder muscle and thickening of the bladder Urinary frequency

10.2. Pathological Disorders

10.2.1. Renal Calculi Pathophysiology Form when urine contains more crystal-forming substances that fluid in the urine can dilute including calcium, oxalate, and uric acid Signs/Symptoms Flank pain, pain on urination, pink/red/brown urine, cloudy or foul smelling urine, nausea, vomiting, urinary frequency, fever, chills Treatment Drinking water and increasing fluids, and pain relievers Large stones

10.2.2. Glomerulonephritis Pathophysiology Immune mechanisms trigger inflammation and proliferation of the glomerular tissue that results in damage to endothelium and basement membranes Signs/Symptoms Hematuria, proteinuria, foamy urine, red or dark urine, hypertension, fluid retention, periorybital and peripheral edema, headache Treatment Diet Smoking cessation Medications Dialysis Transplant

11. Endocrine

11.1. Age-Related Changes

11.1.1. Thyroid atrophies and activity decreases Lower basal metabolic rate

11.1.2. Reduced radioactive iodine uptake

11.1.3. Less secretion of thyrotropin

11.1.4. Adrenocorticotropic hormone secretion decreases

11.1.5. Reduction of estrogen, progesterone, androgen, and glucocorticoid secretion

11.1.6. Volume of pituitary gland decreases

11.1.7. Insufficient release of insulin by beta cells in the pancreas and reduced sensitivity to circulating insulin

11.1.8. Reduced ability to metabolize glucose

11.2. Pathological Disorders

11.2.1. Hypothyroidism Pathophysiology Primary Secondary Signs/Symptoms Fatigue, weakness, depression, weight gain, impaired healing, edema, constipation, cold intolerance, dry skin, coarse hair, myalgia, ataxia Treatment Hormone replacement

11.2.2. Hyperthryoidism Pathophysiology Graves Disease Signs/Symptoms Diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, insomnia, heat intolerance, weakness, hyperreflexia, nervousness Treatment Removal of thyroid Antithyroid medication Radioactive iodine