Older Adults

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Older Adults by Mind Map: Older Adults

1. Musculoskeletal

1.1. Age-related changes

1.1.1. Decreased muscle mass, strength, and movement Weakness and activity intolerance Increased risk of falls and instability Lean body mass replaced with fat

1.1.2. Decreased bone mineralization and mass

1.1.3. Reduced calcium absorption

1.1.4. Thinning disks and shortened vertebrae Kyphosis and height reduction

1.2. Diseases

1.2.1. Osteoporosis Diagnostics: Radiography, bone density, DEXA Causes: immobility, diseases like diabetes, Cushing's syndrome, hyperthyroidism, Diet, menopause, medications like antacids Treatment: depends on cause: Ca and Vit. D supplements, SERMs, hormone therapy, protein and Ca rich diet, regular exercise

1.2.2. Rheumatoid arthritis S&S: painful, stiff, swollen, red and warm joints present during rest and activity, bony prominence and bursae, fatigue, malaise, weakness, wt loss, wasting, fever, anemia Treatment: rest, support limbs, splints, ROM exercises, heat application, massage, analgesics, anti-inflammatory meds, immunosuppressants

2. Nervous

2.1. Age-related changes

2.1.1. Reduced blood flow to the brain

2.1.2. Slower response to changes in balance

2.1.3. Reduction in neurons and nerve fibers Circadian rhythm effected

2.1.4. Less effective Hypothalamus Temperature regulation effected

2.2. Diseases

2.2.1. Parkinson's S&S: tremors, muscle rigidity, weakness, drooling, dysphagia, slow speech, monotone voice, bradykinesia, poor balance, increased appetite, SOB, depression, anxiety, urinary hesitancy/urgency, constipation Treatment: Carbidopa/levodopa, dopamine agonists, anticholinergics, deep brain stimulation, ROM exercises, Nursing considerations: monitor drug therapy, avoid foods with B6 with levodopa, education and support

3. Sensory

3.1. Vision

3.1.1. Age-related changes Presbyopia Decreased peripheral vision distorted depth perception Decreased reactivity to light

3.1.2. Diseases Glaucoma: degenerative eye disease with optic nerve damage from increased intraocular pressure Associated with increased size of lens, iritis, allergy, endocrine imbalances, family Hx

3.2. Hearing

3.2.1. Age-related changes Presbycusis Cerumen increase Altered equilibrium

3.3. Taste

3.3.1. Age-related changes Atrophy of the tongue Decreased taste acuity Decreased saliva, poor oral hygiene, medications

3.4. Smell

3.4.1. Age-related changes Some olfactory function loss

3.5. Touch

3.5.1. Age-related changes Reduced tactile sensation reduced ability to sense pressure and discomfort decreased ability to detect changes in temperature

4. Endocrine

4.1. Age-related changes

4.1.1. Decreased thyroid gland activity

4.1.2. Decreased pituitary gland Decreased ACTH secretion

4.1.3. Glucose regulation changes Higher blood glucose levels Decreased ability to metabolize glucose delayed and insufficient insulin release

4.2. Diseases

4.2.1. Diabetes Mellitus Diagnosis criteria: 1. symptoms of DM and random BG >= 200 mg/dL 2. HbA1c >= 6.5% 3. fasting BG >=126 mg/dL 4. BG 2 hours after oral glucose intake >= 200 mg/dL during an oral glucose intolerance test Management: Patient education, drug therapy, self-care and monitoring, exercise and nutrition Complications: hypoglycemia, peripheral vascular disease, retinopathy, drug interactions, cognitive impairment

5. Immune

5.1. Age-related changes

5.1.1. Decreased inflammatory responses

5.1.2. T-cell activity and cell mediation decrease Increased infection rates

5.1.3. Atypical presentation Decline in mental status, decreased appetite, incontinence, falls, fatigue, exacerbation of chronic illness

5.2. Diseases

5.2.1. Weakened immune function in the older adult population leads to many diseases and infections occurring in the other body systems

6. Reproductive

6.1. Age-related changes

6.1.1. Male thinner epithelium of seminal vesicles and seminiferous tubules Atrophy of testicles and reduced mass less live sperm in ejaculation fluid Enlargement of prostate gland

6.1.2. Female Menopause decreased estrogen levels Vulva, cervix, uterus, and fallopian tubes atrophy flattening labia, loss of subcutaneous fat and hair Vaginal epithelium thins, shortens and narrows, less lubricant, more alkaline pH Breast tissue sags and is less firm

6.2. Diseases

6.2.1. Male Erectile dysfunction: inability to get of maintain an erection Multiple causes: atherosclerosis, diabetes, hypertension, MS, thyroid dysfunction, alcoholism, renal failure, medications Treatment: oral erectile agents, penile implants. vacuum pumps Benign prostatic hyperplasia S&S: dysuria, dribbling, poor stream, overflow incontinence, bleeding Treatment: prostatectomy, prostate massage, avoid diuretics, anticholinergics, and antiarrhythmics

6.2.2. Female cancer of the ovaries S&S: early: nonspecific and confused with GI discomfort; late: bleeding, ascites, masses treatment: surgery and irradiation Perineal herniation S&S: lower back pain, pelvic heaviness, pulling sensation, urinary and fecal incontinence or retention, constipation, painful intercourse Treatment: surgical repair

7. Respiratory

7.1. Diseases

7.1.1. chronic bronchitis S&S: productive cough, wheezing, recurrent resp. infection, SOB, hypoxia, Treatment: removing bronchial secretions and prevent obstructions, Increase fluid intake, discourage risk factors like smoking

7.1.2. emphysema Risk factors: Chronic irritation from pollutants, alveolar changes in the lungs, smoking S&S: dyspnea, chronic cough, fatigue, anorexia, wt loss, weakness, recurrent resp. infections, malnutrition, CHF Treatment: postural drainage, avoid stress, breathing exercises, stop smoking, adequate nutrition and fluid intake, oxygen PRN, resp. infection prevention,

7.1.3. Pneumonia Risk factors: poor chest expansion, shallow breathing, low resistance to infection, reduced pharyngeal reflexes, immobility S&S: slight cough, fatigue, tachypnea, confusion, restlessness

7.2. Age-related changes

7.2.1. Reduction of cough and laryngeal reflexes decreased ability to clear secretions or foreign matter

7.2.2. Increased residual capacity

7.2.3. Decreased vital capacity With activity S+S: dyspnea and exercise intolerance

7.2.4. Decreased respiratory muscle strength with reduced chest wall compliance less effective exhalation

8. Cardiovascular

8.1. Age-related changes

8.1.1. Decreased efficiency and contractile strength Risk of ineffective circulation

8.1.2. Decreased cardiac output With activity S+S: fatigue, SOB, tachycardia

8.1.3. Thick and rigid heart valves

8.1.4. Reduced blood vessel elasticity

8.1.5. Strong arterial pulses with weak peripheral pulses

8.2. Diseases

8.2.1. Congestive heart failure Risk factors: HTN, coronary artery disease, DM, dyslipidemia, albuminuria, anemia, CKD, substance abuse, sedentary lifestyle, physiological stress S&S: dyspnea, confusion, insomnia, agitation, depression, anorexia, nausea, weakness, SOB, orthopnea, wheezing, wt gain, peripheral edema, and crackle lung sounds Categorized based on symptoms and physical limitations Treatment: bed rest, ACE inhibitors, beta-blockers, digitalis, diuretics, restricted Na+ diet, adequate support

8.2.2. Hypertension S&S: headache, impaired memory, disorientation, confusion, epistaxis, slow tremor Treatment: rest, restricted Na+ diet, reduce wt, thiazide diuretics, ACE inhibitors, beta-blockers, calcium channel blockers, DASH diet

9. Gastrointestinal

9.1. Age-related changes

9.1.1. Decreased esophageal motility and delayed emptying Risk of constipation Increased risk for aspiration altered drug absorption Fluid and electrolyte imbalances risk of dehydration

9.1.2. Atrophy of small and large intestines Malabsorption of carbohydrates, vitamins and minerals

9.1.3. Reduced hepatic reserve decreased metabolism of drugs

9.2. Diseases

9.2.1. Hiatal hernia S&S: heartburn, dysphagia, belching, vomiting, and regurgitation; Pain and bleeding more serious Treatment: Wt loss in obese pts, bland diet, small, frequent meals, H2 inhibitors and PPIs prescribed

9.2.2. Peptic ulcer disease S&S: pain, bleeding, obstruction, and perforations Causes: stress, diet, genetics, and COPD; medications that increase gastric secretions; smoking, alcohol consumption, caffeine, H. pylori infections Nursing considerations: identify risk factors, treatment side effects (diarrhea and constipation), and obstruction signs

10. Genitourinary

10.1. Age-related changes

10.1.1. Decreased kidney blood flow and glomerular filtration Decreased drug clearance Risks for fluid volume overload

10.1.2. Reduced bladder capacity Risk for incontinence and urgency

10.2. Diseases

10.2.1. Glomerulonephritis S&S: subtle and nonspecific: fever, fatigue, N&V, anorexia, abdominal pain, anemia, edema, elevated BP, and increased ESR Treatment: I&O monitoring, antibiotics, restricted Na+ and Protein diet D/T compromised kidney function, close monitoring of pts on digitalis, diuretics, or antiHTN

10.2.2. renal calculi Results from immobilization, infection, changes in urine pH or concentration, chronic diarrhea, dehydration, or hypercalcemia S&S: hematuria, pain, GI upset, and common UTI symptoms Treatment: Adequate fluid intake, treat UTI

11. Integumentary

11.1. Age-related changes

11.1.1. Less elastic

11.1.2. Decreased subcutaneous fat

11.1.3. Dry, fragile skin

11.1.4. Reduces sweat gland activity

11.2. Diseases

11.2.1. Pruritus Causes: dry heat, excessive bathing, diabetes, hyperthyroidism, cancer, pernicious anemia itching can lead to breaks in skin, increasing risk of infection Treatment: identify underlying cause, bath oils, moisturizers, massage, Vit. supplementation

12. References

12.1. Hartford Institute for Geriatric Nursing, & NYU Rory Meyers College of Nursing. (2012). ConsultGeri. Retrieved from ConsultGeri

12.2. Eliopoulos, C. (2018). Gerontological Nursing 9th Edition. Wolters Kluwer, Philadelphia