1. Musculoskeletal
1.1. Shortening of vertebrae
1.2. Between ages 20-70 height decreases by 2 inches
1.3. Bones are more brittle
1.4. Slight knee flexion
1.5. Decrease in bone mass and bone mineral
1.6. Slight kyphosis
1.7. Slight hip flexion
1.8. Slight wrist flexion
1.9. Osteoporosis
1.9.1. Bones become weak and brittle
1.9.2. S/S: back pain, loss of height, stooped posture, bone fractures
1.9.3. As people age bone mass is lost faster than its created. Risk factors: women, increased age, family history, and smaller frame size.
1.9.4. Reduction of estrogen and menopause is one of the strongest risk factors
2. Integumentary
2.1. Reduced sweat glands
2.2. Decreased subcutaneous fat
2.3. Reduced thickness and vascular it’s of the dremis
2.4. Slowing of epidermis proliferation
2.5. Collagen fibers become coarser and more random
2.6. Skin is more dry and fragile
2.7. Lines, wrinkles, and sagging become evident
2.8. Reduction in melanocytes by 10-20% each decade starting at age 30
2.9. Fingernails grow more slowly and are fragile and brittle
3. Gastrointestinal
3.1. Presbyesophagus: decreased intensity of propulsive and increase frequency of non-propulsive waves
3.2. Decreased taste sensation
3.3. Atrophy of intestines
3.4. Decreased hydrochloric acid
3.5. Potential for iron, B12, B vitamin deficiencies
3.6. Reduced saliva and salivary ptyalin
3.7. Liver smaller in size
3.8. Reduced intestinal blood flow
3.9. Irritable Bowel Syndrome
3.9.1. Affects the large intestines
3.9.2. S/S: abdomen pain, constipation, diarrhea, indigestion, nausea, gas, cramping
3.9.3. Causes: muscle contractions, nervous system abnormalities, inflammation, severe infection, changes in micro flora.
4. Nervous System
4.1. Age-related changes does NOT effect intelligence
4.2. Decreased number of neurons
4.3. Slower responses to change in balance
4.4. Personality does NOT change
4.5. Decreased conduction velocity
4.6. Slower response and reaction time
4.7. Changes in sleep pattern
4.8. Reduced blood flow to brain
4.9. Decreased brain weight
4.10. Dementia
4.10.1. Irreversible, progressive impairment interfering with daily functioning
4.10.2. Caused by damage or or injury to the brain
4.10.3. Alzheimer’s Disease- most common form of dementia
4.10.4. S/S: forgetfulness, limited social skills, impaired thinking, confusion, disorientation.
4.11. Delirium
4.11.1. Rapid onset, that may cause permanent damage
4.11.2. S/S: confusion, inability to stay focused, withdrawn, limited activity, disorientation, poor memory
4.11.3. Causes: hypoxia, infection*most common, dehydration, hypernatremia, hyponatremia, pain, drugs
5. Respiratory
5.1. Decreased cough/laryngeal reflexes: at risk for aspiration!
5.2. By age 90, approximately 50% Increase in residual capacity
5.3. Decreased vital capacity
5.4. Decrease of useful O2 with each breath
5.5. Decreased ciliary action
5.6. Alveoli fewer in number and larger in size
5.7. Reduced basilar inflation
5.8. Chronic Obstructive Pulmonary Disease
5.8.1. Chronic inflammatory lung disease causing obstructive airflow from the lungs: Emphysema and Chronic Bronchitis
5.8.2. S/S: dyspnea, sputum production, wheezing, chest tightness, chronic cough, fatigue
5.8.3. COPD risk factors include: tobacco smokers, irritants, emphysema, chronic bronchitis, asthma, & increased age
5.9. Sleep Apnea
5.9.1. Breathing repeatedly stops and starts during sleep
5.9.2. 5 episodes of breathing cessation per hour lasting at least 10 seconds
6. Sensory
6.1. Presbyopia: inability to focus/accommodate properly
6.2. Reduced elasticity lens of the eyes
6.3. Presbycusis: progressive hearing loss
6.4. Loss of high pitched tones
6.5. Reduction in tactile sensation
6.6. Impaired ability to identify and discriminate amount odors
6.7. More opaque lens of the eye
6.8. Decreased pupil size
6.9. Tympanic membrane sclerosis and atrophy
6.10. Increased cerumen and concentration of keratin
7. Physical Changes
7.1. Hair loss
7.2. Graying and thinning of hair
7.3. Elongated ears
7.4. Darkening and thickening of skin around orbits
7.5. Narrower gait in women; wider gait in men
7.6. Decreased height
7.7. Diminished muscle mass
7.8. More prominent arteries in head, neck, and extremities
8. Falls
8.1. More than 1/3 of older adults of 65 fall each year
8.1.1. 20% are in hospitals and 40% in nursing homes
8.2. Causes: unbalanced gait, sensory changes such as: vision and tactile. Bone density decreases, center of gravity changes, kyphosis, dementia, decreased flexibility.
8.3. Prevention of falls: diffuse lighting, removing scattered rugs, install side rails
9. Frailty
9.1. Increased vulnerability, impaired capability to withstand intrinsic and environmental stressors
9.2. Found in 20-30% of adults over the age of 75
9.3. Frailty is a syndrome with many different signs and symptoms
9.4. 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
9.5. Failure to Thrive
9.5.1. Common with 1 or more chronic illnesses, usually have 6 diagnoses
9.5.2. Average age: 79
9.5.3. S/S: malnourished, dehydrated, skin ulcers, falls
9.5.4. 16% die in the hospital
10. Immunity
10.1. Decreased T cells
10.2. Natural cytotoxic responses are diminished
10.3. Decreased immune response
10.4. Increase in immature T cells
10.5. Increase in proinflammatory cytokines
10.6. T lymphocytes are less able to proliferate in response to mitogens
10.7. Concentration of IgM is lower
10.8. Concentration of IgA and IgG are higher
10.9. Health Promotion for decreased Immunity
10.9.1. Diet! Food is Medicine
10.9.2. Multivitamins
10.9.3. 5 servings of fruits and veggies daily
10.9.4. Eat foods high in: protein, magnesium, manganese, vitamins A, B, C, E, folic acid, selenium, zinc, iron
10.9.5. Exercise regularly
10.9.6. Immunizations
10.9.7. Stress management
10.10. Cancer
10.10.1. 2nd leading cause of death in ages 65 and up
10.10.2. Chance of getting cancer increases with age
10.10.3. Advanced stage when initially diagnosed due to: atypical symptoms and not as proactive
10.10.4. 2 theories:
10.10.4.1. 1. Biological age-related changes that impair the ability to resist disease
10.10.4.1.1. 2. Prolonged exposure to carcinogens over the lifetime
10.10.5. Healthy Lifestyle practice: decrease tobacco and alcohol consumption, limit time in the sun, healthy dieting, and maintaining a healthy weight
10.10.6. CAUTION
10.10.6.1. Change in bowel/bladder habits
10.10.6.2. A sore that doesn’t heal
10.10.6.3. Unusual bleeding or discharge
10.10.6.4. Thickening or lump
10.10.6.5. Indigestion or dysphagia
10.10.6.6. Obvious change in mole or wart
10.10.6.7. Nagging cough or hoarseness
11. Cardiovascular
11.1. Heart dimensions stay the same
11.2. Valves become thicker
11.3. Blood vessels decrease in elasticity
11.4. O2 used less efficiently
11.5. Aorta becomes dilated and elongated
11.6. Cardiac output decreases
11.7. Stroke volume decreases by 1% each year
11.8. Congestive Heart Failure
11.8.1. The heart works less efficiently than normal
11.8.2. S/S: dyspnea, fatigue, edema in extremities, tachycardia, cough, wheezing, chest pain
11.8.3. CHF can be caused by thickening of chambers or valves, blockages, or strenuous activity which causes the heart to work harder
12. Endocrine
12.1. Thymus gland shrinks
12.2. Thyroid gland activity decreases
12.3. ACTH secretion decreases
12.4. Pituitary gland function decreases
12.5. Insulin release is delayed
12.6. Metabolization of glucose is decreased
12.7. Increased blood glucose
12.8. Diabetes
12.8.1. Too much sugar in the blood
12.8.2. S/S: increased thirst, urination, and hunger. Unexplained weight loss, fatigue, irritability, blurred vision, slow healing sores.
12.8.3. Risk factors: Women older then 25, family or personal history, overweight
12.9. Hypothyroidism
12.9.1. Primary: T4 decreases, TSH increases
12.9.2. Secondary: T4 decreases, TSH decreases
12.9.3. S/S: fatigue, depression, weight gain, anorexia, dry skin, constipation, cold
12.9.4. 6.9% in ages 55-64 years old
12.9.5. 8.9% in ages over 70 years old
12.10. Hyperthyroidism
12.10.1. Treatment: anti-thyroid meds, surgery
12.10.2. S/S: diaphoresis, HTN, tremors, diarrhea, tachycardia, insomnia
13. Urinary
13.1. Decreased GFR by 50% between ages 20-90
13.2. Decreased renal blood flow by 53% between ages 20-90
13.3. Decreased bladder capacity
13.4. Incontinence is NOT a normal Age-related change
13.5. Decrease in nephrons
13.6. Weaker bladder muscles
13.7. Decreased tubular function
13.8. Decreased size of renal mass
14. Reproductive-Male
14.1. Thinning of epithelium
14.2. Replacement of muscle tissue with connective tissue
14.3. Reduction of fluid-retaining capacity
14.4. Increased fibrous in seminiferous tubules
14.5. Prostate enlarges in most men
14.6. Possible reduction in sperm count
14.7. Venous and arterial sclerosis of penis
14.8. Benign Prostatic Hyperplasia
14.8.1. Age associated prostate gland enlargement
14.8.2. S/S: increased urgency, nocturia, increased frequency of urination, difficulty starting urination
14.8.3. BPH risk factors include: increased age, family history, diabetes, and obesity. 1/3 of men experience symptoms by age 60.
14.8.4. Get examined every 6 months
15. Sleep
15.1. Reduction of time in non-rapid eye movement stage
15.2. Reduction of time in REM sleep
15.3. Sleep less soundly
15.4. Shift in and out of stage I sleep more
15.5. Spend more time in stage I and II sleep
15.6. Decline in the amount of time spent in stage III and IV sleep
15.7. Drugs that affect sleep
15.7.1. Anticholenergics, antidepressants, antiHTN, benzos, beta-blockers, diuretics, levodopa, steroids, theophylline, caffeine, alcohol
16. Reproductive-Female
16.1. Fallopian tubes atrophy and shorten
16.2. Ovaries become thicker and smaller
16.3. Cervix becomes smaller
16.4. Drier, less elastic vaginal canal
16.5. Flattening of labia
16.6. Endocervical epithelium atrophies
16.7. Uterus becomes smaller in size
16.8. Endometrium atrophies
16.9. More alkaline vaginal environment
16.10. Menopause
16.10.1. A natural decline in reproductive hormones when a women reaches her fourth and fifth decade
16.10.2. S/S: irregular periods, vaginal dryness, hot flashes, chills, sleep problems, mood changes, joint pain
16.10.3. Complications: heart and blood vessel (cardiovascular) disease, osteoporosis, urinary incontinence