Copy of The Older Adult

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Copy of The Older Adult by Mind Map: Copy of The Older Adult

1. Immunity

1.1. Decreased T cells

1.2. Natural cytotoxic responses are diminished

1.3. Decreased immune response

1.4. Increase in immature T cells

1.5. Increase in proinflammatory cytokines

1.6. T lymphocytes are less able to proliferate in response to mitogens

1.7. Concentration of IgM is lower

1.8. Concentration of IgA and IgG are higher

1.9. Health Promotion for decreased Immunity

1.9.1. Diet! Food is Medicine

1.9.2. Multivitamins

1.9.3. 5 servings of fruits and veggies daily

1.9.4. Eat foods high in: protein, magnesium, manganese, vitamins A, B, C, E, folic acid, selenium, zinc, iron

1.9.5. Exercise regularly

1.9.6. Immunizations

1.9.7. Stress management

1.10. Cancer

1.10.1. 2nd leading cause of death in ages 65 and up

1.10.2. Chance of getting cancer increases with age

1.10.3. Advanced stage when initially diagnosed due to: atypical symptoms and not as proactive

1.10.4. 2 theories: 1. Biological age-related changes that impair the ability to resist disease 2. Prolonged exposure to carcinogens over the lifetime

1.10.5. Healthy Lifestyle practice: decrease tobacco and alcohol consumption, limit time in the sun, healthy dieting, and maintaining a healthy weight

1.10.6. CAUTION Change in bowel/bladder habits A sore that doesn’t heal Unusual bleeding or discharge Thickening or lump Indigestion or dysphagia Obvious change in mole or wart Nagging cough or hoarseness

2. Musculoskeletal

2.1. Shortening of vertebrae

2.2. Between ages 20-70 height decreases by 2 inches

2.3. Bones are more brittle

2.4. Slight knee flexion

2.5. Decrease in bone mass and bone mineral

2.6. Slight kyphosis

2.7. Slight hip flexion

2.8. Slight wrist flexion

2.9. Osteoporosis

2.9.1. Bones become weak and brittle

2.9.2. S/S: back pain, loss of height, stooped posture, bone fractures

2.9.3. As people age bone mass is lost faster than its created. Risk factors: women, increased age, family history, and smaller frame size.

2.9.4. Reduction of estrogen and menopause is one of the strongest risk factors

3. Cardiovascular

3.1. Heart dimensions stay the same

3.2. Valves become thicker

3.3. Blood vessels decrease in elasticity

3.4. O2 used less efficiently

3.5. Aorta becomes dilated and elongated

3.6. Cardiac output decreases

3.7. Stroke volume decreases by 1% each year

3.8. Congestive Heart Failure

3.8.1. The heart works less efficiently than normal

3.8.2. S/S: dyspnea, fatigue, edema in extremities, tachycardia, cough, wheezing, chest pain

3.8.3. CHF can be caused by thickening of chambers or valves, blockages, or strenuous activity which causes the heart to work harder

4. Integumentary

4.1. Reduced sweat glands

4.2. Decreased subcutaneous fat

4.3. Reduced thickness and vascular it’s of the dremis

4.4. Slowing of epidermis proliferation

4.5. Collagen fibers become coarser and more random

4.6. Skin is more dry and fragile

4.7. Lines, wrinkles, and sagging become evident

4.8. Reduction in melanocytes by 10-20% each decade starting at age 30

4.9. Fingernails grow more slowly and are fragile and brittle

5. Gastrointestinal

5.1. Presbyesophagus: decreased intensity of propulsive and increase frequency of non-propulsive waves

5.2. Decreased taste sensation

5.3. Atrophy of intestines

5.4. Decreased hydrochloric acid

5.5. Potential for iron, B12, B vitamin deficiencies

5.6. Reduced saliva and salivary ptyalin

5.7. Liver smaller in size

5.8. Reduced intestinal blood flow

5.9. Irritable Bowel Syndrome

5.9.1. Affects the large intestines

5.9.2. S/S: abdomen pain, constipation, diarrhea, indigestion, nausea, gas, cramping

5.9.3. Causes: muscle contractions, nervous system abnormalities, inflammation, severe infection, changes in micro flora.

6. Nervous System

6.1. Age-related changes does NOT effect intelligence

6.2. Decreased number of neurons

6.3. Slower responses to change in balance

6.4. Personality does NOT change

6.5. Decreased conduction velocity

6.6. Slower response and reaction time

6.7. Changes in sleep pattern

6.8. Reduced blood flow to brain

6.9. Decreased brain weight

6.10. Dementia

6.10.1. Irreversible, progressive impairment interfering with daily functioning

6.10.2. Caused by damage or or injury to the brain

6.10.3. Alzheimer’s Disease- most common form of dementia

6.10.4. S/S: forgetfulness, limited social skills, impaired thinking, confusion, disorientation.

6.11. Delirium

6.11.1. Rapid onset, that may cause permanent damage

6.11.2. S/S: confusion, inability to stay focused, withdrawn, limited activity, disorientation, poor memory

6.11.3. Causes: hypoxia, infection*most common, dehydration, hypernatremia, hyponatremia, pain, drugs

7. Endocrine

7.1. Thymus gland shrinks

7.2. Thyroid gland activity decreases

7.3. ACTH secretion decreases

7.4. Pituitary gland function decreases

7.5. Insulin release is delayed

7.6. Metabolization of glucose is decreased

7.7. Increased blood glucose

7.8. Diabetes

7.8.1. Too much sugar in the blood

7.8.2. S/S: increased thirst, urination, and hunger. Unexplained weight loss, fatigue, irritability, blurred vision, slow healing sores.

7.8.3. Risk factors: Women older then 25, family or personal history, overweight

7.9. Hypothyroidism

7.9.1. Primary: T4 decreases, TSH increases

7.9.2. Secondary: T4 decreases, TSH decreases

7.9.3. S/S: fatigue, depression, weight gain, anorexia, dry skin, constipation, cold

7.9.4. 6.9% in ages 55-64 years old

7.9.5. 8.9% in ages over 70 years old

7.10. Hyperthyroidism

7.10.1. Treatment: anti-thyroid meds, surgery

7.10.2. S/S: diaphoresis, HTN, tremors, diarrhea, tachycardia, insomnia

8. Respiratory

8.1. Decreased cough/laryngeal reflexes: at risk for aspiration!

8.2. By age 90, approximately 50% Increase in residual capacity

8.3. Decreased vital capacity

8.4. Decrease of useful O2 with each breath

8.5. Decreased ciliary action

8.6. Alveoli fewer in number and larger in size

8.7. Reduced basilar inflation

8.8. Chronic Obstructive Pulmonary Disease

8.8.1. Chronic inflammatory lung disease causing obstructive airflow from the lungs: Emphysema and Chronic Bronchitis

8.8.2. S/S: dyspnea, sputum production, wheezing, chest tightness, chronic cough, fatigue

8.8.3. COPD risk factors include: tobacco smokers, irritants, emphysema, chronic bronchitis, asthma, & increased age

8.9. Sleep Apnea

8.9.1. Breathing repeatedly stops and starts during sleep

8.9.2. 5 episodes of breathing cessation per hour lasting at least 10 seconds

9. Urinary

9.1. Decreased GFR by 50% between ages 20-90

9.2. Decreased renal blood flow by 53% between ages 20-90

9.3. Decreased bladder capacity

9.4. Incontinence is NOT a normal Age-related change

9.5. Decrease in nephrons

9.6. Weaker bladder muscles

9.7. Decreased tubular function

9.8. Decreased size of renal mass

10. Reproductive-Male

10.1. Thinning of epithelium

10.2. Replacement of muscle tissue with connective tissue

10.3. Reduction of fluid-retaining capacity

10.4. Increased fibrous in seminiferous tubules

10.5. Prostate enlarges in most men

10.6. Possible reduction in sperm count

10.7. Venous and arterial sclerosis of penis

10.8. Benign Prostatic Hyperplasia

10.8.1. Age associated prostate gland enlargement

10.8.2. S/S: increased urgency, nocturia, increased frequency of urination, difficulty starting urination

10.8.3. BPH risk factors include: increased age, family history, diabetes, and obesity. 1/3 of men experience symptoms by age 60.

10.8.4. Get examined every 6 months

11. Sleep

11.1. Reduction of time in non-rapid eye movement stage

11.2. Reduction of time in REM sleep

11.3. Sleep less soundly

11.4. Shift in and out of stage I sleep more

11.5. Spend more time in stage I and II sleep

11.6. Decline in the amount of time spent in stage III and IV sleep

11.7. Drugs that affect sleep

11.7.1. Anticholenergics, antidepressants, antiHTN, benzos, beta-blockers, diuretics, levodopa, steroids, theophylline, caffeine, alcohol

12. Sensory

12.1. Presbyopia: inability to focus/accommodate properly

12.2. Reduced elasticity lens of the eyes

12.3. Presbycusis: progressive hearing loss

12.4. Loss of high pitched tones

12.5. Reduction in tactile sensation

12.6. Impaired ability to identify and discriminate amount odors

12.7. More opaque lens of the eye

12.8. Decreased pupil size

12.9. Tympanic membrane sclerosis and atrophy

12.10. Increased cerumen and concentration of keratin

13. Physical Changes

13.1. Hair loss

13.2. Graying and thinning of hair

13.3. Elongated ears

13.4. Darkening and thickening of skin around orbits

13.5. Narrower gait in women; wider gait in men

13.6. Decreased height

13.7. Diminished muscle mass

13.8. More prominent arteries in head, neck, and extremities

14. Reproductive-Female

14.1. Fallopian tubes atrophy and shorten

14.2. Ovaries become thicker and smaller

14.3. Cervix becomes smaller

14.4. Drier, less elastic vaginal canal

14.5. Flattening of labia

14.6. Endocervical epithelium atrophies

14.7. Uterus becomes smaller in size

14.8. Endometrium atrophies

14.9. More alkaline vaginal environment

14.10. Menopause

14.10.1. A natural decline in reproductive hormones when a women reaches her fourth and fifth decade

14.10.2. S/S: irregular periods, vaginal dryness, hot flashes, chills, sleep problems, mood changes, joint pain

14.10.3. Complications: heart and blood vessel (cardiovascular) disease, osteoporosis, urinary incontinence

15. Falls

15.1. More than 1/3 of older adults of 65 fall each year

15.1.1. 20% are in hospitals and 40% in nursing homes

15.2. Causes: unbalanced gait, sensory changes such as: vision and tactile. Bone density decreases, center of gravity changes, kyphosis, dementia, decreased flexibility.

15.3. Prevention of falls: diffuse lighting, removing scattered rugs, install side rails

16. Frailty

16.1. Increased vulnerability, impaired capability to withstand intrinsic and environmental stressors

16.2. Found in 20-30% of adults over the age of 75

16.3. Frailty is a syndrome with many different signs and symptoms

16.4. S/S: weakness, weight loss of more than 10% in one year, muscle wasting, exercise intolerance, decreased in grip strength, frequent falls, immobility, instability of chronic diseases

16.5. Failure to Thrive

16.5.1. Common with 1 or more chronic illnesses, usually have 6 diagnoses

16.5.2. Average age: 79

16.5.3. S/S: malnourished, dehydrated, skin ulcers, falls

16.5.4. 16% die in the hospital