1. Reproductive- Women
1.1. Vulva atrophy
1.1.1. Senile Vulvitis
1.2. Flattening labia
1.3. vaginal epithelium thins
1.3.1. less lubrication
1.3.1.1. May lead to painful intercourse
1.4. Cervix, uterus, ovaries and Fallopian tubes atrophy
1.4.1. Increased risk for cervical cancer
1.5. decreased estrogen production
1.5.1. more alkaline pH
1.6. Breast cancer risk increases
2. Reproductive- Men
2.1. seminal vesicles develop thinner epithelium
2.1.1. less live sperm in ejaculation
2.2. Muscle tissue replaced with connective tissue
2.3. Testicle atrophy
2.4. Prostate enlargement
2.4.1. BPH
2.4.1.1. hard time initiating flow of urine
2.4.1.2. Increased risk for prostate cancer
2.4.1.2.1. Frequent digital rectal exams
3. Circulation
3.1. Valves become thick and rigid
3.2. Aorta dilation
3.2.1. Ventricular hypertrophy
3.3. Myocardial tissue less effective
3.3.1. Decreased cardiac output
3.4. decreased baroreceptor sensitivity
3.4.1. blood pressure less regulated
3.4.1.1. Hypertension
3.4.1.1.1. Older adults have a higher risk for adverse effects from antihypertensives
3.4.1.2. Hypotension
3.4.1.2.1. can increase risk of falls
3.5. Congestive Heart Failure
3.5.1. related to coronary artery disease
3.5.2. Contributing factors: diabetes, dyslipidemia, albuminuria, anemia, chronic kidney disease, substance abuse, stress and sedentary lifestyle
3.5.3. other causes: decreased elasticity of vessels, and increase in BP
3.6. Hyperlipidemia
3.6.1. can contribute to plaque build up in the heart
3.6.1.1. dietary factors
3.6.2. Diabetes, hypothyroid, uremia, nephrotic syndrome can contribute
3.7. Arrhythmias
3.7.1. can be caused by low potassium, infection, hemorrhage, and coronary insufficiency
3.7.2. Atrial Fibrilation
3.8. Peripheral vascular disease
3.8.1. Diabetics most affected
3.8.1.1. Affects small vessels furthest from heart
3.8.1.1.1. Daily foot inspection
3.9. Pulmonary embolism
3.9.1. Risk with fractured hip, CHF, arrhythmias, hx of thrombosis,immobilization, and malnutrition
3.10. Coronary artery disease
3.10.1. Angina
3.10.2. Myocardial infarction
3.10.2.1. hx of hypertension and arteriosclerosis
4. Urinary Elimination
4.1. hypertrophy of bladder muscle
4.1.1. increase in frequency
4.2. Urinary retention
4.2.1. prostatic hypertrophy in men
4.3. Insufficient neurological control of bladder
4.4. Filtration efficiency of kidneys decreases
4.4.1. hard to eliminate drugs
4.4.1.1. Increased risk for toxic levels of medications
4.5. Reduced ability to concentrate and dilute urine
4.6. UTIs
4.6.1. risk factors: neurogenic bladders, arteriosclerosis, diabetes
4.6.1.1. Foley catheters increase risk
4.7. Incontinence
4.7.1. Stress
4.7.1.1. weak pelvic muscles, obesity
4.7.2. Urgency
4.7.2.1. UTI, BPH, diverticulitis, irritation or spasm
4.7.3. Overflow
4.7.3.1. Bladder neck obstruction, medications
4.7.4. Neurogenic
4.7.4.1. cerebral cortex lesions, MS
4.7.5. Functional
4.7.5.1. Dementia, or disability
4.7.6. Mixed
4.8. Bladder cancer
4.8.1. Chronic irritation, exposure to dyes, and cigarettes
4.9. Renal Calculi
4.9.1. Immobilization, infection, change in pH, diarrhea, dehydration, hypercalcemia
5. Neuro
5.1. Loss of nerve cell mass
5.1.1. atrophy of brain and spinal cord
5.2. number of nerve cells decline
5.2.1. slower nerve conduction
5.2.1.1. response time decreases
5.3. free radicals accumulate
5.4. cerebral BF decreases
5.4.1. increase risk for stroke
5.4.1.1. Increased risk with diabetes and HTN
5.5. Ability to come back after injury decreases
5.5.1. making brain or spinal injuries hard to come back from
5.6. number and sensitivity of sensory receptors, dermatomee and neurons decrease
5.6.1. Decreased sensation
5.7. Decline in function of cranial nerves
5.7.1. Affects taste and smell perception
5.8. Neurovascular disease
5.8.1. RF: diabetes, hypertension, smoking, obesity, high stress, high cholesterol
5.9. Parkinson’s
5.9.1. cause: Impaired basal ganglia
5.9.1.1. Dopamine producing neurons die or are impaired
5.9.1.1.1. more common in men
5.9.2. RF: exposure to toxins, encephalitis, cerebrovascular disease, and arteriosclerosis
5.10. Transient Ischemic Attacks
5.10.1. hyperextension and flexion of head
5.10.2. Impaired cerebral BF
5.10.3. reduced blood pressure
5.10.4. anemia
5.10.5. some medications
5.10.6. Cigarette smoking
5.11. Cerebrovascular Accidents
5.11.1. RF: HTN, arteriosclerosis, diabetes, gout, anemia, hypothyroidism, silent myocardial infarction, TIAs, dehydration and cigarette smoking
5.11.2. Ischemic
5.11.2.1. from a thrombus
5.11.3. hemorrhagic
5.11.3.1. ruptured cerebral blood vessels
6. Vision and hearing
6.1. Reduced elasticity, stiffening of muscle fibers of lens
6.1.1. Inability to focus
6.1.1.1. Begins in fourth decade
6.1.1.1.1. Need for corrective lenses
6.2. Decrease pupil size, loss of photoreceptors cells
6.2.1. Visual acuity declines
6.3. light perception decreases
6.3.1. Difficulty seeing at night
6.4. Sensitivity to glare
6.4.1. Cataract formation
6.4.1.1. Clouding of lens
6.4.1.2. Causes: exposure to UV rays, diabetes, smoking, alcohol, eye injury
6.4.1.2.1. Importance of wearing sunglasses
6.5. inaccurate depth perception
6.5.1. Increased risk for injuries/falls
6.6. Decreased peripheral vision
6.7. Eyes produce fewer tears
6.7.1. Dry eyes
6.8. Arteriosclerosis, and diabetes can damage the retina
6.9. Glaucoma
6.9.1. Optic nerve damage
6.9.1.1. results from increased intraocular pressure
6.9.2. Occurs in fourth decade
6.9.2.1. Women more affected
6.9.3. assoc. with: increased lens size, iritis, allergy, endocrine imbalance, emotional instability and family hx
6.9.4. Acute
6.9.4.1. Closed angle/ Narrow angle
6.9.4.1.1. Medical emergency
6.9.5. Chronic
6.9.5.1. Open angle
6.9.5.1.1. Gradual
6.10. Macular degeneration
6.10.1. Most common cause of blindness over 65
6.10.1.1. damage of macula
6.10.1.1.1. loss of central vision
6.11. Detached retina
6.11.1. Prompt treatment required
6.12. Corneal ulcer
6.12.1. RF: fever, irritation, nutrition deficiency, and stroke
6.13. Hearing loss
6.13.1. long time exposure to loud noises: music, jets, machinery, etc.
6.13.2. Ototxic drugs
6.13.3. Recurrent infection/irritation
6.13.4. diabetes, tumors of nasopharyngeal, hypothyroidism, and syphillis
6.14. Inner ear damage
6.14.1. Vascular problems, viral infections, presbycusis
6.15. Otosclerosis
6.15.1. Middle ear problem
6.15.1.1. Affects more women
6.15.1.1.1. Osseous growth
6.16. Tinnitus
6.16.1. Ringing in ears
6.16.1.1. Hearing loss, ear injury, medication, cardiovascular disease
7. Skin
7.1. long term exposure to UV rays
7.1.1. Skin cancer
7.1.2. Photoaging
7.1.3. Skin spots
7.2. increased fragility of skin
7.2.1. increased risk for pressure injuries, infection, tears
7.3. Reduced thickness and vascularity
7.3.1. Vascular lesions
7.3.2. Varicose veins
7.3.3. Stasis dermatitis
7.3.4. Stasis ulcers
7.4. Increased coarseness of collagen
7.5. Decreased epidermal turnover
7.5.1. Delayed wound healing
8. Sleep
8.1. Phase advance
8.1.1. less REM sleep
8.2. Nocturnal myoclonus
8.2.1. related to use of anti depressants & renal failure
8.3. Restless leg syndrome
8.3.1. related to iron deficiency anemia, uremia, Parkinson’s, rheumatoid arthritis, diabetes, neuro lesions
8.4. Sleep Apnea
8.4.1. can be caused by COPD
9. Sexuality
9.1. Adropause
9.1.1. Decline in testosterone
9.1.1.1. Can lead to erectile dysfunction, decrease in muscle mass, osteoporosis
9.2. Menopause
9.2.1. Cessation of menses
9.3. Erectile dysfunction
9.3.1. can be caused by diabetes, hypertension, MS, thyroid dysfunction, alcoholism, renal failure
10. Respiratory
10.1. Decrease in lung size
10.2. Decreased elastic recoil
10.3. Decrease in vital capacity
10.4. COPD
10.4.1. Asthma
10.4.1.1. overuse of bronchodilator nebulizers increase risk for arrhythmias
10.4.2. Chronic bronchitis
10.4.2.1. Scarring that restricts air flow
10.4.2.1.1. Recurrent inflammation and mucus production
10.4.2.2. Emphysema may develop
10.4.3. Emphysema
10.4.3.1. Long term exposure to smoke, chronic bronchitis, chronic irritation, dissension of alveolar sacs
10.4.4. Lung cancer
10.4.4.1. related to smoking
10.4.4.2. Chronic exposure to coal gas, radioactive dusts, and chromates
10.4.5. Lung abscess
10.4.5.1. Can be caused by pneumonia, TB, malignancy,, trauma and aspiration
10.5. reduced submucosal gland secretion
10.5.1. mucus is thicker and harder to expel
10.6. Trachea calcifies
10.7. Coughing reduced
10.8. Gag reflex becomes weaker
10.8.1. At risk for aspiration
10.9. Loss of skeletal muscle strength in thorax
10.9.1. Kyphosis
10.9.2. Barrel chest
10.10. Pneumonia
10.10.1. poor chest expansion
10.10.2. decreased immune function
10.10.3. reduced sensitivity of pharyngeal reflexes
10.10.4. Important to get pneumococcal vaccine recommended every 5 years
10.11. Influenza
10.11.1. recommended to go the flu shot, annually
11. Digestion and Bowel Elimination
11.1. Tongue atrophy
11.1.1. affects taste sensation
11.1.1.1. dry mouth
11.2. Saliva production decreases
11.3. Presbyesophagus
11.3.1. Increased aspiration risk
11.4. Increased stomach pH
11.4.1. increase in gastric irritation
11.4.2. decrease in hydrochloride acid and pepsin
11.4.2.1. decrease absorption in Ca, Iron, folic acid, B12
11.5. Increased constipation
11.5.1. decreased peristalsis, inactivity, decreased intake, drugs, low fiber diet
11.6. pancreases atrophies
11.6.1. Affects fat digestion
11.7. Hiatal hernia
11.7.1. Low fiber diet
11.8. Esophageal Cancer
11.8.1. Exposure to smoke, alcohol, poor oral hygiene contribute
11.9. Peptic Ulcers
11.9.1. Risk factors: smoking, alcohol, stress, H. Pylori infection
11.10. Diverticular disease
11.10.1. Diverticulitis
11.10.1.1. overeating, straining with a BM, alcohol and irritating food
11.10.2. Chronic constipation, obesity, hernia, atrophy of intestinal walls, and low fiber diet
11.11. Colorectal Cancer
11.11.1. annual stool occult blood and digital rectal exams
11.12. Chronic constipation
11.12.1. Inactive, low fiber, low fluid, depression, laxative use, dulled sensations, incomplete bowel emptying
11.13. Intestinal obstruction
11.13.1. caused by diverticulitis, ulcerative colitis, hypokalemia, vascular problems, and paralytic ileus
12. Endocrine
12.1. thyroid gland atrophy
12.1.1. Decreased basal metabolic rate
12.1.1.1. less secretion and release of thyrotropin
12.2. Adrenocorticotropic hormone decreases
12.2.1. Decreases activity of adrenal gland
12.2.1.1. Decreases secretion of estrogen, progesterone, androgen, ketosteroids, and glucocorticoids
12.3. Pituitary gland decreases
12.4. Insufficient insulin release
12.4.1. Reduced tissue sensitivity to insulin
12.4.1.1. Reduced ability to metabolize glucose
12.5. Diabetes
12.5.1. increased incidence between 65-74
12.5.2. Glucose intolerance
12.5.3. RF: obesity, inactivity, family hx
12.5.4. Fasting blood sugar screenings every 3 years over 45
12.5.5. Thyroid gland atrophies, fibrosis, increased colloid nodules, and lymphocytic infiltration
12.5.6. Renal threshold for glucose increases
12.5.6.1. older adults hyperglycemia without symptoms
12.5.7. Risk for metabolic syndrome with diabetes
12.5.8. Hypoglycemia risk to older adults
12.5.8.1. Uncorrected can cause tachycardia, arrhythmias, MIs, cerebrovascular accident, death
12.5.9. PVD common complication
12.5.9.1. Retinopathy
12.5.9.1.1. Cognitive impairment
12.6. Hypothyroid
12.6.1. production of T4 declines
12.6.2. More common in women
12.6.3. Primary
12.6.3.1. Disease process that destroys gland
12.6.3.2. Low T4, elevated TSH
12.6.4. Secondary
12.6.4.1. Insufficient secretion of TSH
12.6.4.2. low T4
12.7. Hyperthyroid
12.7.1. thyroid gland secretes excessive thyroid hormone
12.7.2. affects women more
12.7.3. Use of amiodarone potential cause
12.7.4. Goiter
12.7.5. Graves’ disease
12.7.5.1. autoimmune
12.7.6. Risk for thyroid storm
13. Immunity
13.1. Decreased immune response
13.2. Thymus gland decreases
13.2.1. T cell function declines
13.2.1.1. Less able to fight infection and illness