The Older Adult

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The Older Adult by Mind Map: The Older Adult

1. Musculoskeletal

1.1. Decline in size and number of muscle fibers, and reduction in muscle mass

1.1.1. Decreased body strength

1.1.2. Endurance declines

1.2. Connective tissue changes

1.2.1. Reduced flexibility of joints and muscles

1.3. Loss of bone mineral and bone mass diminished calcium absorption

1.4. New node

1.5. Selected Problems

1.5.1. Fractures Common sites: neck of femur, Colles' fracture, compression fractures for vertebrae Brittle bones allow them to fracture more easily and heal at a slower rate Interventions are aimed at prevention Should be suspected when an older adult falls or has trauma The absence of atypical signs does not guarantee no fracture

1.5.2. Osteoarthritis Progressive deterioration of joint cartilage with the formation of new bone at joint surface Affects several joints rather than a single one Weight-bearing joints: hips, knees, vertebrae, fingers Leading cause of physical disability in older people Treatment: physical therapy, analgesics, surgery

2. Endocrine

2.1. Thyroid gland atrophies and decreased activity

2.2. Diminished adrenal function

2.3. ACTH secretion decreases

2.4. Volume of pituitary gland decreases

2.5. Insufficient release of insulin

2.5.1. Diabetes Mellitus 7th leading cause of death among older adults Glucose intolerance Glucose tolerance test is most effective for diagnosis Classic nonspecific symptoms may be absent

2.6. Reduced tissue sensitivity to circulating insulin

2.7. New node

2.8. Selected Problems

2.8.1. Hypothyroidism Effects of aging on the thyroid gland Subnormal concentration of thyroid hormone Increases in prevalence with age, more common in women Primary or Secondary hypothyroidism S/S: fatigue, constipation, cold sensitivity, unexplained weight gain Treatment: Synthroid, Thyroxine

2.8.2. Hyperthyroidism Excess amounts of thyroid hormone secreted Less prevelant in older adults than hypothyroidism S/S: unexpected weight loss, sweating, irritability, rapid HR- elderly can have atypical symptoms Treatment: depends on the cause Surgery, radioactive iodine, anti thyroid meds

3. Integumentary

3.1. Flattening of dermal-epidermal junction

3.2. Reduction of thickness and vascular its of the dermis

3.3. Degeneration of elastic fibers

3.4. Increased coarseness of collagen

3.5. Reduction in melanocytes

3.6. Atrophy of hair bulbs and decline in rate of hair and nail growth

3.7. Increased fragility of skin Changes can potentially affect self-image, body image, socialization, etc.

3.8. New node

3.9. Selected Problems

3.9.1. Pruitis Most common problem amount older adults Excessive itching can lead to breakage and infection of skin

3.9.2. Pressure Ulcers Tissue anoxia and ischemia resulting from pressure can cause necrosis, sloughing, and ulceration Stages: 1) Persistent area of skin redness, no break in skin, does not disappear with pressure relief 2) Partial-thickness loss of skin layers (epidermis), intact or opened blister 3) Full thickness of skin (epidermis and Subcutaneous tissue) deep crater, with or without tunneling 4) Full thickness of skin and subcutaneous tissue is loss, exposing muscle, bone. Deep crater that may include necrotic tissue, slough, or eschar Common sites: sacrum, greater trochanter, ischial tuberosities High risk: poor nutrition, immobility, reduced sensation of pressure and pain Longer healing periods

3.9.3. Seborrheic Keratosis Dark, wart like projections on the skin Common on various parts of the body Increase in size and number as one ages Benign lesions Important to be evaluated to differentiate from precancerous lesions

4. Nervous System

4.1. Loss of nerve cell mass

4.1.1. Atrophy of brain and spinal cord

4.1.2. Brain weight decreases

4.2. Number of dendrites decrease

4.3. Demyelination

4.3.1. Slower nerve conductionr

4.3.2. Response and reaction times are slowed

4.3.3. Reflexes weaker

4.4. Decrease in cerebral blood flow

4.5. Ability to compensate declines with age

4.6. Intellectual performance is maintained until at least 80 years old

4.7. Decline in the function of cranial nerves affecting taste and smell

4.8. Verbal skills maintained until age 70

4.9. New node

4.10. Selected Problems

4.10.1. Parkinson's disease Affects ability of CNS to control body movements due to decreased levels of dopamine More common in men, incidence rises with age S/S: faint tremor in hands or feet, muscle rigidity and weakness, (drooling, slow speech), shuffling gait Treatment: anticholinergics, active and passive ROM

4.10.2. Transient Ischemic Attacks Temporary or intermittent reduction in cerebral perfusion Causes: emboli, cardiovascular complications S/S: weakness, numbing, tingling, slurred speech Recovery is usually within one day Treatment and management of underlying cause Increases risk for cerebrovascular accident

5. Reproductive

5.1. Males

5.1.1. Seminal vesicles develop thinner epithelium

5.1.2. Muscle tissue replaced with connective tissue

5.1.3. Decreased capacity to retain fluids

5.1.4. Atrophy of testes and reduction of testicular mass

5.1.5. Ejaculation fluid contains less sperme

5.1.6. Enlargement of prostate gland

5.1.7. New node

5.1.8. Select Problems Erectile Dysfunction Most men over 70 years of age NOT a normal change in aging Causes: alcoholism, DM, Dyslipidemia, HTN, Renal failure, Thyroid, Medications Treatment: Viagra, Levitra, Penile implants, Vacuum pump devices BPH Most older men have some degree of it S/S: decreased urinary stream, bleeding, urinary retention Treatment: urinary antiseptics, prostatic massage, avoidance of diuretics, anticholinergics, and antiarrhythmics a Andropause Testosterone levels decline in mend Does NOT occur in all men Can result in decreased muscle mass, energy, strength, and stamina

5.2. Females

5.2.1. Hormonal Changes Vulva atrophies Flattening of the labia Loss of subcutaneous fat and hair

5.2.2. Vaginal epithelium thins

5.2.3. Cervix, uterus, and Fallopian tubes atrophy

5.2.4. Vaginal canal changes Reduction in collagen and adipose tissue Shortening and narrowing of canal Less lubrication More alkaline vaginal pH

5.2.5. Uterus and ovaries decrease in size

5.2.6. Breasts sag and less firm

5.2.7. Retraction of nipples

5.2.8. New node

5.2.9. Selected Problems Breast Cancer Second leading cause of cancer deaths Risk increases with age Encourage regular breast exams Cancer of Ovaries Increased incidence with age Leading cause of death from gynecological malignancies S/S: Bleeding, as cites, and multiple masses Early S/S can be confused with GI discomfort Menopause Permanent cessation of menses for at least 1 year Important transition in a woman's life Nurse plays key role in guiding women through changes in menopause

5.3. Sexuality

5.3.1. Older adults can and do enjoy sex

5.3.2. Patterns of sexual behaviors remain consistent throughout life

5.3.3. Nurses need to recognize and respect sex-specific roles for elder identity

5.3.4. Provide basic information in understanding effects of aging process on sexuality

6. Gastrointestinal

6.1. Atrophy of tongue affects taste buds and decreases taste sensation

6.2. Saliva production decreases

6.2.1. Dry Mouth

6.3. Esophageal and stomach motility decreases

6.3.1. Risk for aspiration and indigestion Dysphasia

6.4. Decreased elasticity of stomach

6.4.1. Reduce amount of food accommodation at one time

6.5. Decline in hydrochloride acid

6.5.1. Increase in gastric irritation

6.5.2. Interferes with absorption of calcium, iron, folic acid, and vitamin B

6.6. Decline in pepsin

6.6.1. Interferes with absorption of protein

6.7. Slower peristalsis, inactivity, drugs, low fiber diet

6.7.1. Constipation

6.8. New node

6.9. Conditions

6.9.1. Hiatal Hernia S/S: heartburn, dysphasia, vomiting, bleeding Treatment: bland diet, weight loss, several small meals a day

6.9.2. Colorectal Cancer 2nd most common malignancy S/S: rectal bleeding, change in bowel patterns, anorexia, nausea, abdominal discomfort Colostomy considerations: separates them from society and dependence on others for help

6.9.3. Chronic Constipation Treatment: activity, high fiber, and fluid Rocking trunk from side to side on toilet Elimination chart

6.9.4. Fecal Obstruction S/S: distended rectum, oozing of fecal material around impaction, palpable mass, fever Treatment: enema, manual with finger, 50mL of hydrogen peroxide .

7. Urinary

7.1. Hypertrophy and thickening of bladder

7.1.1. Decreases bladders ability to expand

7.1.2. Results in reduced storage

7.2. Retention of large volumes of urine

7.2.1. Women: fecal impaction

7.2.2. Male: BPH

7.3. Decreased renal function

7.3.1. Affects ability to eliminate drugs

7.3.2. High BUN levels

7.4. New node

7.5. Urinary incontinence is NOT a normal change in aging

7.5.1. Treatment: identify cause and fix the underlying cause

7.5.2. Transient: acute and reversible Causes: infections, delirium, fecal impaction, mood disorders, inability to reach commode

7.5.3. Established: chronic and persistent Many types: Stress, Urgency Overflow, etc. Initial goal is to identify cause

7.6. Bladder Cancer

7.6.1. S/S: similar to bladder infection, hematuria is primary sign*

7.6.2. Risks: chronic irritation, smoking, dyes

7.7. Glomerulonephritis

7.7.1. S/s: fever, fatigue, NV, anemia, edema, high BP, oliguria

7.7.2. Treatment: antibiotics, restricted sodium and protein diet, monitor I and Os

8. Respiratory

8.1. Reduction in vital capacity, increase in residual volume

8.2. Alveoli less elastic

8.3. Calcification of costal cartilage and trachea

8.4. Higher risk for respiratory infection

8.5. Lungs reduce in size and weight

8.6. Respiratory problems are easy to develop and difficult to manage

8.7. Respiratory Conditions

8.7.1. New node

8.8. COPD

8.8.1. Asthma Can develop in older years High rates of mortality High risks of complications: bronchiectasis and cardiac problems Assess for causative factors and educate the patient Avoid adverse drug affects. Overuse of bronchodilators can create risk for arrhythmias which can lead to sudden death. Careful Assessment of the patient's use of aerosol nebulizer: a spacer or holding chamber may be advised to make it easier for administration

8.8.2. Chronic Bronchitis S/S: persistent, productive cough, wheezing, recurrent respiratory infections, SOB Management is aimed at removing bronchial secretions, preventing an obstruction of airway, and maintaining adequate fluid intake

8.8.3. Emphysema Increasing incidence in older adults Causes: Chronic Bronchitis, chronic irritation, morphological changes in the lung Smoking plays a major role in development Symptoms develop slowly, which delays diagnosis and treatment Life Threatening Complications: CHF, hypoxia, respiratory infections Treatment: postural drainage, bronchodilators, avoid stress, breathing exercises Education: pace activities, avoid cold weather, dietary support, O2 monitor

8.9. Other Conditions

8.9.1. Pneumonia One of the leading cause of death in this age group At risk due to weakened immune system and their less efficient respiratory system. S/S can be altered some exhibiting no symptoms at all. S/S: slight cough, fatigue, rapid respiration, minimal or no fever, pleuritic pain may not be severe, confusion- hypoxia Vaccines recommended for people over 65 years old

8.9.2. Lung Cancer Increased incidence in ages 65 and older, men, however varies with ethnic groups S/S: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections Treatment: surgery, chemo, and radiation

8.9.3. Lung Abcess Causes: pneumonia, TB, malignancy, trauma, aspiration, decreased pharyngeal reflexes S/S: anorexia, weight loss, elevated temperature, chronic cough Treatment: postural drainage, high protein and calorie diet

9. Cardiovascular

9.1. Heart muscle loses efficiency and contractile strength

9.2. Valves become thick and rigid

9.3. Blood vessels reduce elasticity

9.4. Decreased cardiac output with increased demands--> STRESS

9.5. Oxygen used less efficiently

9.6. New node

9.7. Selected Conditions

9.7.1. Blood Pressure Hypertension Both incidence and Prevelance increase with age Systolic: 140 mm Hg, Diastolic: 90 mm Hg When monitoring BP a nurse must consider: anxiety, stress, and Anya crucify before assessment S/S: impaired memory, dull headache, confusion, epistaxis, and slow tremor Treatment: wide range Hypotension Decline in systolic BP of 20 mm Hg or more after rising Postprandial and postural is due to increased intake of vasoactive meds and decrease in physiologic function Serious Consequences: falls, stroke, syncope, and coronary complications

9.7.2. Congestive Heart Failure Incidence increases with age Leading cause of hospitalization CAD is responsible for most cases S/S: SOB, dyspnea on exertion, confusion, insomnia, agitation, depression, weight gain, edema New node

10. Immune

10.1. Thymus gland decreases in size

10.2. Increased number of immature T cells

10.3. T-cell function declines

10.4. Reduced response to foreign antigens

10.5. Decrease in cell-mediated and humoral immunity

10.6. Reduced thickness of skin

10.7. Decreased circulation of skin Reduced antibody response

10.8. Inflammatory responses decline and present atypically

10.9. High prevelant even of chronic conditions increase the risk for infection

10.10. Increased risk of exposure to pathogens when hospitalized