1. Reproductive
1.1. Seminal vesicles have smoothing of the mucosa, thinning of the epithelium, and replacement muscle tissue with connective tissue
1.1.1. Reduction of fluid-retaining capacity
1.2. Seminiferous tubules experience fibrosis, thinning of the epithelium, thickening of the basement membrane, and narrowing of the lumen
1.2.1. Causes a decrease in sperm count
1.3. Increases in FSH and LH. Decrease in testosterone
1.4. Atrophy of the vulva from hormonal changes and loss of subcutaneous fat and hair and flattening of the labia
1.5. Vagina is pink and dry with a smooth, shiny canal because of the loss of elastic tissue and rugae
1.5.1. Epithelium is thin and avascular, more alkaline, and a change in the type of flora and reduction in secretions
1.6. Prostatic enlargement is usual
1.6.1. Causes problems with urinary frequency
1.6.2. 3/4 of men 65 and older have some degree of prostatism
1.7. Atrophy of the testes
1.8. Fibroelastosis of the corpus spongiosum
1.8.1. The older man does not lose the physical capacity to achieve an erection or ejaculation but they tend to be less intense
1.9. The uterus shrinks and the endometrium atrophies
1.9.1. Endometrium continues to respond to hormones that is why post-menopausal women on estrogen therapy experience bleeding
1.10. Older woman does not lose the ability to engage in sexual pleasure
1.11. Ovaries become smaller and thicker. Harder to palpate upon exam. The uterus tilts backwards and is also harder to palpate upon examination
2. Urinary
2.1. Stress incontinence occurs due to the weakening of the pelvic diaphragm
2.1.1. Most common in multiparous women
2.2. Tissue growth declines and atherosclerosis may promote atrophy of the kidney
2.3. Renal mass becomes smaller
2.3.1. Attributed to a cortical loss rather than medullary
2.4. Less ability to conserve sodium in response to sodium restriction
2.5. The renal blood flow and GFR is reduced by one half between ages of 20 and 90
2.6. Less efficient tubular exchange of substances, conversion of water and sodium, and suppression of ADH secretion in the presence of hypo-osmolarity
2.6.1. Decreased reabsorption of glcose from filtrate which can cause 1+ proteinurias and glycosurias not to be of diagnostic significance
2.7. Micturition reflex is delayed
2.8. Bladder weakens and capacity decreases
2.8.1. Retention of large volumes may result due to difficulties emptying the bladder
3. Endocrine
3.1. Delayed/insufficient release of insulin
3.1.1. Causes higher and prolonged periods of hyperglycemia
3.2. ACTH secretion decreases
3.2.1. Less aldosterone is produced as well as glucocorticoids, progesterone, estrogen, etc.
3.3. Pituitary gland decreases by 20%
3.4. Gonadal secretions decrease
3.5. Thyroid gland undergoes fibrosis, cellular infiltration, and increased nodularity
3.5.1. Causes lower BMR, reduced radioactive iodine intake, and less thyrotropin release
3.5.2. Protein bound iodine levels do not change even though serum levels decrease
3.5.3. TSH and T4 do not change by T3 has a significant reduction
4. Immune
4.1. Changes in the T-cell contribute to the reactivation of Varicella zoster and Tuberculosis
4.2. T-cell activity declines and more immature T-cells are present in the thymus
4.3. Responses to influenza vaccines are less effective
4.4. Inflammation presents with a low grade fever and minimal pain
4.5. Increase in proinflammatory cytokines occurs with age and is believed to be linked to atherosclerosis, diabetes, osteoporosis, etc.
5. Spirituality
5.1. Asking about spiritual needs fosters holistic care
5.1.1. Some examples include: loge, meaning, purpose, hope, dignity, forgiveness, gratitude, transcendence, and expression of faith
5.2. Be available to the older adult when discussing spiritual needs and honor their beliefs and practices
5.3. Nurses can contact clergy as needed to facilitate religious practices
5.4. The older adult may increase their interest in spirituality such as participating in prayer more often
6. Sexuality
6.1. Sexual desires do not diminish with old age. They usually stay about the same throughout an older adult's lifetime
6.2. Sexuality includes love, warmth, caring, and sharing between people and identification with a sexual role
6.3. Some older adults gain a new interest in sex
6.3.1. Possibly due to no longer having a fear of unwanted pregnancy. Also having their children grown and gone
7. Sleep
7.1. Some common sleep disorders include: insomnia, restless leg syndrome, sleep apnea, etc.
7.2. Try to avoid having an apartment or home on a busy street, excessively warm rooms, and bright hallway lights
7.3. Older adult falls asleep earlier in the evening and wake earlier in the morning
7.4. Advise older adult to limit caffeine and alcohol throughout the day to ensure a better sleep
7.5. Older adult spends more time in stages I and II of sleep rather than stages III and IV
7.5.1. Leads to a less sound sleep and a delay in onset of sleep
8. Nervous
8.1. Beta-Amyloid and neurofibrillary tangles are associated with Alzheimer's disease but can be present in older adults with normal function
8.2. Reduction in neurons, nerve fibers, cerebral blood flow, and metabolism
8.2.1. Reduced glucose utilization and metabolic rate of oxygen in the brain
8.3. Decline in brain weight and a reduction of blood flow in the brain
8.3.1. These changes do not affect behavior
8.4. Decrease in brain size and weight particularly after 55 years of age
8.5. Slower reflexes and delayed response to multiple stimuli
8.5.1. Leads to an increased risk for falls
8.6. Decline of the nervouse system may be unnoticed because changes are often nonspecific and slowly progressing
8.7. Hypothalamus regulates temperature less effectively
8.8. Sleep regulation is altered with aging
8.8.1. Changes in stages III and IV of sleep becoming less prominent
8.8.2. Frequent awakening during sleep
9. Sensory
9.1. Hearing
9.1.1. Presbycusis causes speech to sound distorted and consonants are less able to be discerned
9.1.2. Accumulation of cerumen in the middle ear due to a high keratin content
9.2. Taste and Smell
9.2.1. Reduction in saliva production, poor oral hygiene, medications, and sinusitis can affect taste
9.2.2. Decrease in the number of sensory cells in the nasal lining and fewer cells in the olfactory bulb
9.2.3. Men tend to have a greater loss of sense of smell than women
9.2.4. Reduction in sense of smell leads to altered taste
9.3. Vision
9.3.1. Pupillary sphincter hardens, pupil size decreases, rhodopsin decreases
9.3.1.1. Vision in dim areas or at night is difficult
9.3.1.2. Light perception threshold increases
9.3.2. Visual field narrows, making peripheral vision more difficult
9.3.3. Opacification of the lens leads to cataracts
9.3.4. Yellowing of the lens makes older people less able to differentiate the low tone colors of the blues, greens, and violets
9.3.5. Less efficient resbsorption of the intraocular fluid increases the risk for glaucoma
9.3.6. Depth perception becomes distorted
9.3.7. Reduced lacrimal secretions
9.3.8. Accumulation of lipid deposits in the cornea cause scattering of light rays which blurs the vision
9.4. Touch
9.4.1. Tactile sensation is reduced
9.4.1.1. Reduced ability to sense pressure and pain to detect different temperatures
10. Cardiovascular
10.1. Left ventricular hypertrophy
10.2. Heart muscle loses its efficiency and contractile strength
10.2.1. Decreased cardiac output under conditions of physiologic stress
10.3. Isometric contraction and relaxation phase of the left ventricle are prolonged
10.3.1. The cycle of diastolic filling and systolic emptying require more time to be completed
10.4. Aorta enlarges and elongates
10.5. gradual increase in blood pressure is common in U.S.
10.6. Increased irritability of the myocardium
10.6.1. Results in extra sinus bradycardia and sinus arrhythmia
10.7. Reduced baroreceptor sensitivity
10.7.1. Can lead to a rise in systolic BP
10.7.2. Can cause postural hypotension and postprandial hypotension
10.8. Tachycardia in older persons will last for a longer time
10.8.1. Stroke volume may increase to compensate. This results in higher BP
10.9. Atrioventricular valves become thick and rigid
10.9.1. Caused by sclerosis and fibrosis
10.10. Tunica Adventitia is not affected by the aging process
10.11. Tunica Media thins and calcifies elastin fibers and increase in collagen
10.11.1. Causes a stiffening in vessels
10.12. Tunica intima undergoes fibrosis due to calcium/lipid accumulation and cellular proliferation
10.12.1. Leads to the development of atherosclerosis
10.13. Pacemaker cells become increasingly irregular and decrease in number
10.13.1. The shell around the sinus node thickens
10.14. Decreased elasticity of the arteries and vessels
10.14.1. Vessels in head, neck, and extremities become more prominent
11. Musculoskeletal
11.1. Tendons shrink and harden. Tendon jerks decrease
11.2. Fibrous tissue gradually replaces muscle tissue
11.3. Sarcopenia is mostly seen in inactive persons
11.4. Muscle mass, strength, and movements decrease
11.5. Muscle tremors due to degeneration of extrapyramidal system
11.6. Bone mineral and mass decreases
11.6.1. Older women experience an accelerated loss of bone mass after menopause
11.6.2. Bone density decreases at a rate of 0.5% every year after the third decade of life
11.7. Reflexes are lessened in the arms, near totally lost in the abdomen, but maintained at the knees
11.7.1. Cramping frequently occurs
11.8. Kyphosis is the backwards tilting of the head and occurs in some older adults
12. Integumentary
12.1. Skin elasticity is reduced
12.2. Skin becomes irritated and breaks down more frequently
12.3. Reduction in melanocytes
12.4. Perspiration is reduced
13. Gastrointestinal
13.1. Fat Absorption is slower and xylose and dextrose are more difficult to absorb
13.2. Absorption of vitamin B, B12, D, Calcium, and Iron are faulty
13.3. Slower transmissions of neural impulses to the lower bowel reduces awareness of the need to evacuate the bowels
13.4. The older adult's liver is less able to regenerate damaged cells
13.5. Less efficient cholesterol stabilization an absorption cause an increased incidence of gallstones
13.6. HCl and pepsin decline
13.6.1. Higher pH of the stomach lead to increased incidence of gastric irritation
13.7. Chronic irritation can reduce taste efficiency
13.7.1. Commonly the cause of smoking
13.8. Teeth are less sensitive to stimuli
13.9. Dentin becomes fibrous and less is produced
13.10. Tooth enamel becomes harder and more brittle
13.10.1. Increased risk for aspiration
13.11. Esophagus becomes dilated and esophageal emptying is slower
13.11.1. Food sits in the esophagus for longer and causes discomfort and aspiration
13.11.2. Swallowing can take twice as long
13.12. Ptyalin is decreased
13.12.1. Impairs the breakdown of starches
13.13. Increased rate of root cavities around existing dental work
13.14. Taste sensations are less acute because the tongue atrophies
13.14.1. Loss of papillae and sublingual varicosities
13.14.2. Loss of sweet sensations on the tip of the tongue
13.15. Older adults only produce about 1/3rd the amount of normal saliva
14. Nutrition
14.1. Older adults have a reduced need for calories
14.1.1. Less lean body mass, BMR rate declines, lower activity level
14.2. Calcium absorption decreases with age
14.2.1. Encourage older adult to eat leafy green vegetables
14.3. 1,500 mL minimal fluid intake per day
14.4. Increase in intake of soluble fiber
14.4.1. Soluble fiber lowers serum cholesterol and improves glucose tolerance
14.5. Constipation is more common in older adults
14.5.1. Due to slower peristalsis, inactivity, medication side effects, and decreased intake of fiber and fluids
14.6. Reduce the intake of carbohydrates
14.7. Dysphagia is a common problem in older adults
14.7.1. Could be caused by GERD. Increases the older adults risk for aspiration
15. Respiratory
15.1. Changes in connective tissue
15.2. Alveoli reduce in number and stretch due to a progressive loss of elasticity
15.2.1. Tip of the nose rotates downward
15.3. Lungs exhale less effectively
15.3.1. Increases residual volume and decrease vital capacity
15.4. Submucosal glands decrease secretions
15.4.1. Thicker secretions, sensation of nasal stuffiness
15.5. Calcification of costal cartilage
15.5.1. Trachea and rib cage are rigid
15.6. Septal deviations are common
15.7. Mouth breathing while sleeping
15.7.1. Obstructive sleep apnea, snoring
15.8. Thoracic inspiratory and expiratory muscles are weaker
15.9. Fewer cilia and hypertrophy of bronchial mucous glands
15.9.1. Impairs ability to clear mucus and ebris
15.10. Less effective gas exchange and lack of basilar function
15.10.1. Puts older adult at high risk for respiratory infections (ex: pneumonia)