Older Adult

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Older Adult by Mind Map: Older Adult

1. Cardiovascular

1.1. Left ventricular hypertrophy

1.2. Heart muscle loses its efficiency and contractile strength

1.2.1. Decreased cardiac output under conditions of physiologic stress

1.3. Isometric contraction and relaxation phase of the left ventricle are prolonged

1.3.1. The cycle of diastolic filling and systolic emptying require more time to be completed

1.4. Aorta enlarges and elongates

1.5. gradual increase in blood pressure is common in U.S.

1.6. Increased irritability of the myocardium

1.6.1. Results in extra sinus bradycardia and sinus arrhythmia

1.7. Reduced baroreceptor sensitivity

1.7.1. Can lead to a rise in systolic BP

1.7.2. Can cause postural hypotension and postprandial hypotension

1.8. Tachycardia in older persons will last for a longer time

1.8.1. Stroke volume may increase to compensate. This results in higher BP

1.9. Atrioventricular valves become thick and rigid

1.9.1. Caused by sclerosis and fibrosis

1.10. Tunica Adventitia is not affected by the aging process

1.11. Tunica Media thins and calcifies elastin fibers and increase in collagen

1.11.1. Causes a stiffening in vessels

1.12. Tunica intima undergoes fibrosis due to calcium/lipid accumulation and cellular proliferation

1.12.1. Leads to the development of atherosclerosis

1.13. Pacemaker cells become increasingly irregular and decrease in number

1.13.1. The shell around the sinus node thickens

1.14. Decreased elasticity of the arteries and vessels

1.14.1. Vessels in head, neck, and extremities become more prominent

2. Musculoskeletal

2.1. Tendons shrink and harden. Tendon jerks decrease

2.2. Fibrous tissue gradually replaces muscle tissue

2.3. Sarcopenia is mostly seen in inactive persons

2.4. Muscle mass, strength, and movements decrease

2.5. Muscle tremors due to degeneration of extrapyramidal system

2.6. Bone mineral and mass decreases

2.6.1. Older women experience an accelerated loss of bone mass after menopause

2.6.2. Bone density decreases at a rate of 0.5% every year after the third decade of life

2.7. Reflexes are lessened in the arms, near totally lost in the abdomen, but maintained at the knees

2.7.1. Cramping frequently occurs

2.8. Kyphosis is the backwards tilting of the head and occurs in some older adults

3. Reproductive

3.1. Seminal vesicles have smoothing of the mucosa, thinning of the epithelium, and replacement muscle tissue with connective tissue

3.1.1. Reduction of fluid-retaining capacity

3.2. Seminiferous tubules experience fibrosis, thinning of the epithelium, thickening of the basement membrane, and narrowing of the lumen

3.2.1. Causes a decrease in sperm count

3.3. Increases in FSH and LH. Decrease in testosterone

3.4. Atrophy of the vulva from hormonal changes and loss of subcutaneous fat and hair and flattening of the labia

3.5. Vagina is pink and dry with a smooth, shiny canal because of the loss of elastic tissue and rugae

3.5.1. Epithelium is thin and avascular, more alkaline, and a change in the type of flora and reduction in secretions

3.6. Prostatic enlargement is usual

3.6.1. Causes problems with urinary frequency

3.6.2. 3/4 of men 65 and older have some degree of prostatism

3.7. Atrophy of the testes

3.8. Fibroelastosis of the corpus spongiosum

3.8.1. The older man does not lose the physical capacity to achieve an erection or ejaculation but they tend to be less intense

3.9. The uterus shrinks and the endometrium atrophies

3.9.1. Endometrium continues to respond to hormones that is why post-menopausal women on estrogen therapy experience bleeding

3.10. Older woman does not lose the ability to engage in sexual pleasure

3.11. Ovaries become smaller and thicker. Harder to palpate upon exam. The uterus tilts backwards and is also harder to palpate upon examination

4. Urinary

4.1. Stress incontinence occurs due to the weakening of the pelvic diaphragm

4.1.1. Most common in multiparous women

4.2. Tissue growth declines and atherosclerosis may promote atrophy of the kidney

4.3. Renal mass becomes smaller

4.3.1. Attributed to a cortical loss rather than medullary

4.4. Less ability to conserve sodium in response to sodium restriction

4.5. The renal blood flow and GFR is reduced by one half between ages of 20 and 90

4.6. Less efficient tubular exchange of substances, conversion of water and sodium, and suppression of ADH secretion in the presence of hypo-osmolarity

4.6.1. Decreased reabsorption of glcose from filtrate which can cause 1+ proteinurias and glycosurias not to be of diagnostic significance

4.7. Micturition reflex is delayed

4.8. Bladder weakens and capacity decreases

4.8.1. Retention of large volumes may result due to difficulties emptying the bladder

5. Endocrine

5.1. Delayed/insufficient release of insulin

5.1.1. Causes higher and prolonged periods of hyperglycemia

5.2. ACTH secretion decreases

5.2.1. Less aldosterone is produced as well as glucocorticoids, progesterone, estrogen, etc.

5.3. Pituitary gland decreases by 20%

5.4. Gonadal secretions decrease

5.5. Thyroid gland undergoes fibrosis, cellular infiltration, and increased nodularity

5.5.1. Causes lower BMR, reduced radioactive iodine intake, and less thyrotropin release

5.5.2. Protein bound iodine levels do not change even though serum levels decrease

5.5.3. TSH and T4 do not change by T3 has a significant reduction

6. Integumentary

6.1. Skin elasticity is reduced

6.2. Skin becomes irritated and breaks down more frequently

6.3. Reduction in melanocytes

6.4. Perspiration is reduced

7. Immune

7.1. Changes in the T-cell contribute to the reactivation of Varicella zoster and Tuberculosis

7.2. T-cell activity declines and more immature T-cells are present in the thymus

7.3. Responses to influenza vaccines are less effective

7.4. Inflammation presents with a low grade fever and minimal pain

7.5. Increase in proinflammatory cytokines occurs with age and is believed to be linked to atherosclerosis, diabetes, osteoporosis, etc.

8. Gastrointestinal

8.1. Fat Absorption is slower and xylose and dextrose are more difficult to absorb

8.2. Absorption of vitamin B, B12, D, Calcium, and Iron are faulty

8.3. Slower transmissions of neural impulses to the lower bowel reduces awareness of the need to evacuate the bowels

8.4. The older adult's liver is less able to regenerate damaged cells

8.5. Less efficient cholesterol stabilization an absorption cause an increased incidence of gallstones

8.6. HCl and pepsin decline

8.6.1. Higher pH of the stomach lead to increased incidence of gastric irritation

8.7. Chronic irritation can reduce taste efficiency

8.7.1. Commonly the cause of smoking

8.8. Teeth are less sensitive to stimuli

8.9. Dentin becomes fibrous and less is produced

8.10. Tooth enamel becomes harder and more brittle

8.10.1. Increased risk for aspiration

8.11. Esophagus becomes dilated and esophageal emptying is slower

8.11.1. Food sits in the esophagus for longer and causes discomfort and aspiration

8.11.2. Swallowing can take twice as long

8.12. Ptyalin is decreased

8.12.1. Impairs the breakdown of starches

8.13. Increased rate of root cavities around existing dental work

8.14. Taste sensations are less acute because the tongue atrophies

8.14.1. Loss of papillae and sublingual varicosities

8.14.2. Loss of sweet sensations on the tip of the tongue

8.15. Older adults only produce about 1/3rd the amount of normal saliva

9. Spirituality

9.1. Asking about spiritual needs fosters holistic care

9.1.1. Some examples include: loge, meaning, purpose, hope, dignity, forgiveness, gratitude, transcendence, and expression of faith

9.2. Be available to the older adult when discussing spiritual needs and honor their beliefs and practices

9.3. Nurses can contact clergy as needed to facilitate religious practices

9.4. The older adult may increase their interest in spirituality such as participating in prayer more often

10. Sexuality

10.1. Sexual desires do not diminish with old age. They usually stay about the same throughout an older adult's lifetime

10.2. Sexuality includes love, warmth, caring, and sharing between people and identification with a sexual role

10.3. Some older adults gain a new interest in sex

10.3.1. Possibly due to no longer having a fear of unwanted pregnancy. Also having their children grown and gone

11. Sleep

11.1. Some common sleep disorders include: insomnia, restless leg syndrome, sleep apnea, etc.

11.2. Try to avoid having an apartment or home on a busy street, excessively warm rooms, and bright hallway lights

11.3. Older adult falls asleep earlier in the evening and wake earlier in the morning

11.4. Advise older adult to limit caffeine and alcohol throughout the day to ensure a better sleep

11.5. Older adult spends more time in stages I and II of sleep rather than stages III and IV

11.5.1. Leads to a less sound sleep and a delay in onset of sleep

12. Nutrition

12.1. Older adults have a reduced need for calories

12.1.1. Less lean body mass, BMR rate declines, lower activity level

12.2. Calcium absorption decreases with age

12.2.1. Encourage older adult to eat leafy green vegetables

12.3. 1,500 mL minimal fluid intake per day

12.4. Increase in intake of soluble fiber

12.4.1. Soluble fiber lowers serum cholesterol and improves glucose tolerance

12.5. Constipation is more common in older adults

12.5.1. Due to slower peristalsis, inactivity, medication side effects, and decreased intake of fiber and fluids

12.6. Reduce the intake of carbohydrates

12.7. Dysphagia is a common problem in older adults

12.7.1. Could be caused by GERD. Increases the older adults risk for aspiration

13. Nervous

13.1. Beta-Amyloid and neurofibrillary tangles are associated with Alzheimer's disease but can be present in older adults with normal function

13.2. Reduction in neurons, nerve fibers, cerebral blood flow, and metabolism

13.2.1. Reduced glucose utilization and metabolic rate of oxygen in the brain

13.3. Decline in brain weight and a reduction of blood flow in the brain

13.3.1. These changes do not affect behavior

13.4. Decrease in brain size and weight particularly after 55 years of age

13.5. Slower reflexes and delayed response to multiple stimuli

13.5.1. Leads to an increased risk for falls

13.6. Decline of the nervouse system may be unnoticed because changes are often nonspecific and slowly progressing

13.7. Hypothalamus regulates temperature less effectively

13.8. Sleep regulation is altered with aging

13.8.1. Changes in stages III and IV of sleep becoming less prominent

13.8.2. Frequent awakening during sleep

14. Respiratory

14.1. Changes in connective tissue

14.2. Alveoli reduce in number and stretch due to a progressive loss of elasticity

14.2.1. Tip of the nose rotates downward

14.3. Lungs exhale less effectively

14.3.1. Increases residual volume and decrease vital capacity

14.4. Submucosal glands decrease secretions

14.4.1. Thicker secretions, sensation of nasal stuffiness

14.5. Calcification of costal cartilage

14.5.1. Trachea and rib cage are rigid

14.6. Septal deviations are common

14.7. Mouth breathing while sleeping

14.7.1. Obstructive sleep apnea, snoring

14.8. Thoracic inspiratory and expiratory muscles are weaker

14.9. Fewer cilia and hypertrophy of bronchial mucous glands

14.9.1. Impairs ability to clear mucus and ebris

14.10. Less effective gas exchange and lack of basilar function

14.10.1. Puts older adult at high risk for respiratory infections (ex: pneumonia)

15. Sensory

15.1. Hearing

15.1.1. Presbycusis causes speech to sound distorted and consonants are less able to be discerned

15.1.2. Accumulation of cerumen in the middle ear due to a high keratin content

15.2. Taste and Smell

15.2.1. Reduction in saliva production, poor oral hygiene, medications, and sinusitis can affect taste

15.2.2. Decrease in the number of sensory cells in the nasal lining and fewer cells in the olfactory bulb

15.2.3. Men tend to have a greater loss of sense of smell than women

15.2.4. Reduction in sense of smell leads to altered taste

15.3. Vision

15.3.1. Pupillary sphincter hardens, pupil size decreases, rhodopsin decreases Vision in dim areas or at night is difficult Light perception threshold increases

15.3.2. Visual field narrows, making peripheral vision more difficult

15.3.3. Opacification of the lens leads to cataracts

15.3.4. Yellowing of the lens makes older people less able to differentiate the low tone colors of the blues, greens, and violets

15.3.5. Less efficient resbsorption of the intraocular fluid increases the risk for glaucoma

15.3.6. Depth perception becomes distorted

15.3.7. Reduced lacrimal secretions

15.3.8. Accumulation of lipid deposits in the cornea cause scattering of light rays which blurs the vision

15.4. Touch

15.4.1. Tactile sensation is reduced Reduced ability to sense pressure and pain to detect different temperatures