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1. Cardiovascular System

1.1. myocardial muscle less efficient

1.1.1. decreased contractile strength

1.1.2. decreased cardiac output when demands increased

1.2. heart valves become thicker and rigid

1.3. Aorta becomes dilated

1.3.1. slight ventricular hypertrophy

1.3.2. thickening of left ventricular wall

1.4. blood vessels reduce elasticity

1.4.1. risk for hypertension

1.4.2. less sensitive to baroreceptor regulation of blood pressure

1.5. oxygen used less efficiently

2. Gastrointestinal System

2.1. atrophy of tongue affects

2.1.1. taste buds

2.1.2. decreases taste sensation

2.2. decreased esophageal motility

2.3. atrophy of the small and large intestines

2.4. increased risk of aspiration, indigestion, and constipation

2.4.1. increased risk for dysphagia

2.4.2. increased risk for fecal impaction

2.5. Prebyesophagus

2.5.1. results in weaker esophageal contractions and weakness of the sphincter

2.6. higher stomach pH

2.6.1. as a result of a decline in hydrochloric acid increases in incidence of gastric irritation interferes with absorption of calcium, iron, folic acid, and vitamin B12

2.6.2. and a decline in pepsin interferes with absorption of protein

2.7. fewer cells on absorbing surface of intestinal wall

2.7.1. impacts the absorption of dextrose, xylose, and vitamin B and D

2.8. bile salt synthesis decreases

2.8.1. increase risk of gallstone development

2.9. Pancreas changes

2.9.1. affects digestion of fats

3. Genitourinary System

3.1. decline in renal blood flow

3.2. kidney filtration ability decreases

3.2.1. affects the ability to eliminate drugs

3.2.2. potential for adverse drug reactions

3.3. hypertrophy and thickening of the bladder muscle

3.3.1. decreases bladder ability to expand

3.3.2. reduces storage capacity daytime urinary frequency nocturia

3.4. inefficient neurological control of bladder emptying and weaker bladder muscle

3.4.1. retention of large volumes of urine risk for UTIs females: risk for fecal impaction males: risks for prostatic hypertrophy

3.5. reduced renal function

3.5.1. high blood urea nitrogen levels

3.6. increase in renal threshold for glucose

3.6.1. false-negative results for glucose in the urine without symptoms

4. Musculoskeletal System

4.1. decline in size and number of muscle fibers, and reduction in muscle mass

4.1.1. decrease body strength

4.1.2. endurance declines

4.1.3. increase risk for Sarcopenia results from a reduction in protein synthesis and an increase in muscle protein degeneration

4.2. thinning disks are shortened vertebrae

4.3. decreased bone mineral and mass

4.4. diminished calcium absorption

4.5. increased risk of fractures

4.5.1. osteoporosis

4.6. connective tissue changes

4.6.1. reduced flexibility of joints and muscles

5. Nervous System

5.1. loss of nerve cell mass

5.1.1. atrophy of the brain and spinal cord

5.1.2. brain weight decreases

5.2. reduction in neurons, nerve fibers and cerebral blood flow

5.3. slower response to change in balance

5.4. hypothalamus less effective in temperature regulation

5.5. changes in sleep patterns with frequent awakening

5.6. number of dendrites declines

5.7. demyelinization

5.7.1. slower nerve conduction

5.7.2. response and reaction times are slower

5.7.3. reflexes become weaker

5.8. ability to compensate declines

5.9. slowing in central processing

5.9.1. delay in time required to perform tasks

5.10. number and sensitivity of sensory receptors, dermatomes, and neurons decrease

5.10.1. dulling of tactile sensation

5.11. decline in function of cranial nerves

5.11.1. affecting taste and smell

6. Sensory Changes

6.1. Vision

6.1.1. Presbyopia inability to focus on close objects clearly

6.1.2. narrowing of the visual field leads to decreased peripheral vision depth perception distortion

6.1.3. loss of photoreceptor cells in retina light perception threshold decreases dark and light adaptation takes longer difficulty with vision at night

6.1.4. decline in visual acuity

6.1.5. communication problematic facial expressions and gestures may be missed or misinterpreted limitation of lip reading and written communication

6.2. Hearing

6.2.1. Presbycusis progressive loss of hearing

6.2.2. distortion of high-pitched sounds

6.2.3. cerumen increases decreases hearing

6.2.4. alteration in equilibrium

6.3. Taste and Smell

6.3.1. taste acuity is dependent on smell

6.3.2. atrophy of the tongue

6.3.3. decreased saliva risk for Xerostomia

6.3.4. poor oral hygiene loose or brittle teeth can be aspirated can restrict food intake and lead to constipation and malnourishment

6.4. Touch

6.4.1. reduction of tactile sensation

6.4.2. reduced ability to sense pressure, discomfort, and change in temperature

6.5. All senses are less proficient

6.5.1. decreased efficiency of the senses can affect well-being, activities of daily living, safety and health

6.5.2. may lead to constipation or incomplete emptying of bowel

7. Endocrine System

7.1. thyroid gland atrophies activity decreases

7.2. ACTH secretion decreases

7.2.1. changes in blood pressure

7.3. volume of pituitary gland decreases

7.4. Insulin release by beta cells is delayed and insufficient

7.4.1. reduced tissue sensitivity to circulating insulin

7.4.2. risk for Diabetes Mellitus

7.5. ability to metabolize glucose is reduced

7.6. high blood glucose in non-diabetic patients

7.7. diminished adrenal function

8. Integumentary System

8.1. skin less elastic, dry and fragile

8.2. decreased subcutaneous fat

8.3. increased benign and malignant skin neoplasms

8.3.1. encourage self- inspection of entire body on a regular basis

8.4. thinning, graying of hair

8.4.1. atrophy of hair bulbs

8.5. reduced sweat gland activity

8.6. flattening of the dermal- epidermal junction

8.7. increased fragility of the skin

8.8. reduction of epidermal turnover

8.9. reduction in melanocytes

9. Immune System

9.1. depressed immune response

9.2. T cell function declines

9.2.1. reduced response to foreign antigens

9.2.2. decrease in cell-mediated and humoral immunity

9.3. increased number of immature T cells

9.4. cell mediated immunity declines

9.5. risk for infection becomes significant

9.6. inflammatory defenses decline

9.6.1. inflammation presents atypically

9.7. thymus gland declines in size

10. Physical Appearance

10.1. hair loss and graying

10.2. wrinkles

10.3. loss of tissue elasticity

10.3.1. elongated ears

10.3.2. baggy eyelids

10.3.3. double chin

10.4. loss of subcutaneous fat

10.5. diminished stature related to

10.5.1. reduced hydration

10.5.2. loss of cartilage

10.5.3. thinning vertebrae

11. Respiratory System

11.1. calcification of costal cartilage

11.1.1. trachea and rib cage more rigid

11.2. reduction of cough and laryngeal reflexes

11.3. increased residual capacity

11.4. reduced vital capacity

11.5. high risk for respiratory infection

11.5.1. promote productive cough important in removal of secretions

11.6. lungs reduce in size and weight