Changes of Aging in the Older Adult

1. COPD (chronic obstructive pulmonary disease)

1.1. chronic bronchitis

1.1.1. younger age of onset

1.1.2. "blue bloater"

1.1.2.1. cyanosis

1.1.2.2. associated with obesity

1.1.2.3. crackles and wheezes

1.2. emphysema

1.2.1. older age of onset

1.2.2. "pink puffer"

1.2.2.1. barrel chest

1.2.2.2. diminished breath sounds

1.2.2.3. pink skin

1.3. treated with number of therapies including pharmacological and non pharmacological

1.3.1. bronchodilators

1.3.2. smoking cessation

1.3.3. pulmonary rehabilitation

2. Respiratory System

2.1. Normal Changes

2.1.1. connective tissue loses elasticity

2.1.1.1. increased rigidity of lung tissue and chest

2.1.2. decreased action of cilia

2.1.2.1. unwanted particles can enter lungs more easily

2.1.3. costal cartilage calcifies

2.1.3.1. anterior-posterior chest diameter increases

2.1.4. thoracic muscles become more rigid

2.1.4.1. inspiratory and expiratory capacity decreases

2.1.5. cough and laryngeal reflexes blunted

2.1.6. fewer alveoli, and alveoli decrease in size

2.1.6.1. PO2 reduces by as much as 15% between age 20 and 80

2.1.7. maximum breathing capacity reduces

2.2. Prevalent Pathologies

2.2.1. Pneumonia

2.2.1.1. can be related to reduced mobility, aspiration (with swallowing difficulties), and overall decreased breathing capacity

2.2.1.2. bacterial infection

2.2.1.2.1. treated with antibiotics, fluids, rest, etc.

2.2.1.3. viral infection

2.2.1.3.1. may be treated with antivirals, though rarely prescribed

2.2.1.3.2. rest, fluids, etc. may serve as treatment

2.2.1.4. may present with symptoms that are not typical

2.2.1.4.1. new onset confusion is sign of infection

2.2.1.4.2. fever may or may not be present

3. Cardiovascular System

3.1. Normal Changes

3.1.1. aorta becomes dilated and elongated

3.1.2. cardiac output decreases

3.1.2.1. blood pressure increases to conpensate

3.1.3. vessels lose elasticity

3.1.3.1. peripheral resistance increases by 1% a year

3.1.4. sclerosis and fibrosis of heart valves

3.1.4.1. incomplete valve closure may led to murmurs

3.1.5. oxygen use is less efficient

3.1.6. pacemaker cells decrease in number and elasticity

3.1.7. heart loses over contractile strength and efficiency

3.1.7.1. reduced tolerance fo exercise and activity

3.2. Prevalent Pathologies

3.2.1. heart failure

3.2.1.1. left-sided heart failure

3.2.1.1.1. pulmonary congestion

3.2.1.1.2. confusion and restlessness

3.2.1.1.3. cyanosis

3.2.1.1.4. dyspnea and orthopnea

3.2.1.2. right-sided heart failure

3.2.1.2.1. ascites

3.2.1.2.2. edema of lower legs

3.2.1.2.3. weight gain

3.2.1.2.4. fatigue

3.2.1.3. pharmacological treatments

3.2.1.3.1. diuretics

3.2.1.3.2. beta blockers

3.2.1.3.3. ACE inhibitors

3.2.1.4. affects almost 6 million American adults according to CDC

3.2.2. myocardial infarction

3.2.2.1. can result from atherosclerosis

3.2.2.2. can result from blood clot

3.2.2.3. coronary artery bypass graft may be needed after heart attack

3.2.2.4. symptoms

3.2.2.4.1. chest pain

3.2.2.4.2. radiating arm pain

3.2.2.4.3. gastrointestinal upset

3.2.2.4.4. shortness of breath

3.2.2.4.5. cold sweat

3.2.2.5. pharmacological treatment

3.2.2.5.1. nitroglycerin

3.2.2.5.2. aspirin

3.2.2.5.3. blood thinners, beta blockers, etc. to reduce change of having another MI

4. Gastrointestinal System

4.1. Normal Changes

4.1.1. decreased taste sensation

4.1.1.1. reduced nutritional intake

4.1.2. esophageal changes

4.1.2.1. dilates and has decreased motility

4.1.3. less production of digestive fluids

4.1.3.1. hydrochloric acid

4.1.3.2. pepsin

4.1.3.3. lipase

4.1.3.4. pancreatic enzymes

4.1.4. reduces blood flow intestines

4.1.5. number of intestinal absorption cells decreases

4.1.5.1. reduced nutrient absorption

4.1.6. peristalsis is slower

4.1.7. saliva production reduced

4.1.8. liver atrophies

4.1.9. tooth enamel becomes harder and more brittle

4.1.9.1. decreased chewing capabilities

4.2. Prevalent Pathologies

4.2.1. GERD (gastroesophageal reflux disease)

4.2.1.1. can result from hiatal hernia, weak esophageal sphincter, irritation of esophagus by alcohol, and other conditions

4.2.1.2. symptoms

4.2.1.2.1. heartburn after eating or when laying down

4.2.1.2.2. regurgitation of food or stomach acid

4.2.1.2.3. excessive burping

4.2.1.2.4. bitter taste in mouth

4.2.1.3. irritation of esophagus can cause cellular damage

4.2.1.3.1. Barrett's esophagus

4.2.1.3.2. esophageal cancer

4.2.1.4. treatments

4.2.1.4.1. weight loss

4.2.1.4.2. diet alterations

4.2.1.4.3. surgery if hiatal hernia present

4.2.1.4.4. pharmacological

4.2.2. dysphagia

4.2.2.1. swallowing difficulty

4.2.2.2. may result from stroke, MS, Parkinson's, dementia, or be unrelated to another disease

4.2.2.3. aspiration can lead to pneumonia

4.2.2.4. management

4.2.2.4.1. dietary changes

4.2.2.4.2. speech/swallowing therapy

4.2.2.4.3. alternative medication delivery

5. Urinary/Renal Systems

5.1. Normal Changes

5.1.1. bladder muscles weaken

5.1.2. bladder capacity reduces

5.1.2.1. increased frequency of urinattion

5.1.3. number of nephrons in the kidneys reduce

5.1.4. glomerular filtration rate reduces by 50% between age 20 and 90

5.1.5. renal blood flow reduces by 53% between age 20 and 90

5.1.6. size of kidneys decreases

5.1.7. pelvic diaphragm weakens

5.1.7.1. especially common in multiparous women

5.1.8. renal tubular function decreases

5.1.8.1. less efficient conservation of water

5.1.8.2. less efficient exchange of substances

5.2. Prevalent Pathologies

5.2.1. Urinary Tract Infection

5.2.1.1. infection of urethra, bladder, ureters, or kidneys

5.2.1.2. most common bacteria is E. coli from gastrointestinal tract

5.2.1.3. symptoms may be atypical in older adults

5.2.1.3.1. sudden onset of confusion

5.2.1.3.2. hallucinations

5.2.1.3.3. classic symptoms may also be present

5.2.1.4. first line of treatment is antibiotics

5.2.2. Chronic Kidney Disease

5.2.2.1. may result from diabetes and high blood pressure

5.2.2.2. can lead to kidney failure

5.2.2.2.1. may require dialysis or transplant

5.2.2.3. treatments

5.2.2.3.1. control of blood pressure

5.2.2.3.2. controlling blood sugar if diabetic

5.2.2.3.3. limit salt and fat in diet

5.2.2.3.4. some pharmacological therapies

5.2.2.4. symptoms may not be present until kidneys begin to fail

5.2.2.4.1. blood tests used to diagnose CKD

6. Reproductive System

6.1. Male Normal Changes

6.1.1. seminal vesicles

6.1.1.1. smoothing of mucosa

6.1.1.2. thinning of epithelium

6.1.1.3. muscles tissue replaced by connect tissue

6.1.1.4. reduction of fluid-retains capacity

6.1.2. seminiferous tubules

6.1.2.1. fibrosis

6.1.2.2. thinning of epithelium

6.1.2.3. can have reduced sperm count

6.1.3. testosterone level decreases

6.1.4. corpus spongiosum

6.1.4.1. venous and arterial sclerosis and fibroelastosis

6.1.4.2. erection can still be reached

6.1.5. mild atrophy of testes

6.1.6. orgasm and ejaculation less intense

6.1.7. prostate increases in size

6.1.7.1. may be benign (BPH) or cancerous

6.2. Female Normal Changes

6.2.1. vagina

6.2.1.1. pH becomes more alkaline

6.2.1.2. drier and less elastic

6.2.1.3. thin and avascular

6.2.1.4. tears may happen more easily

6.2.2. vulva and labia

6.2.2.1. loss of subcutaneous fat and hair

6.2.2.2. flattening due to hormonal changes

6.2.3. ovaries become thicker and smaller, while Fallopian tubes atrophy and shorten

6.2.4. endometrium atrophies

6.2.4.1. still responds to hormonal stimulation

6.2.5. pelvic floor muscles weaken due to estrogen depletion

6.2.6. estrogen level decreases

6.3. Prevalent Pathologies

6.3.1. prostate cancer (in males)

6.3.1.1. malignant growth of prostate

6.3.1.2. prostate specific antigen test used for diagnosis

6.3.1.3. can result in blockage of urethra (difficulty urinating) or loss of control of urination

6.3.1.4. treatments

6.3.1.4.1. chemotherapy

6.3.1.4.2. radiation

6.3.1.4.3. prostatectomy

6.3.1.4.4. supportive care

6.3.1.5. one of the most common cancers affecting adult males in the U.S.

6.3.2. breast cancer (99% occurs in women)

6.3.2.1. symptoms

6.3.2.1.1. lump in breast

6.3.2.1.2. discharge from nipple

6.3.2.1.3. swelling or soreness of breast

6.3.2.1.4. dimpling of breast skin

6.3.2.2. treatments

6.3.2.2.1. chemotherapy

6.3.2.2.2. radiation

6.3.2.2.3. mastectomy

6.3.2.3. screening/diagnosis

6.3.2.3.1. mammogram

6.3.2.3.2. breast exam

6.3.2.3.3. biopsy of lumps

6.3.2.4. 50% of new breast cancers occur in women over age 60

7. Musculoskeletal System

7.1. Normal Changes

7.1.1. posture become slightly kyphotic

7.1.2. joints become enlarged

7.1.3. height decreases

7.1.3.1. compression of vertebrae

7.1.3.2. kyphosis

7.1.4. muscle changes (sarcopenia)

7.1.4.1. decreased mass

7.1.4.2. decreased strength

7.1.4.3. decreased movement

7.1.5. tendons harden and decrease in size

7.1.6. muscular reflexes decrease

7.1.6.1. lessened in arms

7.1.6.2. nearly totally absent in abdomen

7.1.6.3. knee reflex remains

7.1.7. muscle cramps may occur

7.1.8. bones become brittle

7.1.8.1. minerals are reduced

7.1.8.2. especially in women after menopause

7.1.8.3. fractures more likely to occur

7.1.8.4. overall bone mass decreased

7.1.9. bone density decreases

7.1.9.1. 0.5% each year starting at age 40

7.1.9.2. may result in osteoporosis

7.1.10. calcium absorption decreases

7.1.11. slight flexion of joints

7.1.11.1. hip, wrist, and knee joints

7.2. Prevalent Pathologies

7.2.1. osteoporosis

7.2.1.1. especially common in older adult women

7.2.1.1.1. related to decrease of estrogen

7.2.1.2. bone becomes porous and decreasingly dense

7.2.1.3. often lacks symptoms

7.2.1.3.1. first fracture may be first sign

7.2.1.4. can be prevented with weight-bearing exercise

7.2.1.4.1. increases bone density

7.2.1.5. may be related to lack of calcium

7.2.1.5.1. vitamin D important for absorption

7.2.1.6. treatments

7.2.1.6.1. biphosphonate medications

7.2.1.6.2. estrogen replacement therapy

7.2.1.6.3. teriperatide

7.2.1.6.4. weight-bearing exercise

7.2.2. osteoarthritis

7.2.2.1. related to "wear and tear" of joints

7.2.2.2. joint cartilage wears down

7.2.2.2.1. hands, knees, hips, and spine are most common joints affected

7.2.2.3. symptoms

7.2.2.3.1. pain in joints

7.2.2.3.2. joint stiffness, swelling, or tenderness

7.2.2.3.3. deformity

7.2.2.4. treatments

7.2.2.4.1. pain relievers

7.2.2.4.2. self care

7.2.2.4.3. physical therapy

7.2.2.4.4. surgical joint replacement

8. Neurologic/Sensory Systems

8.1. Normal Changes

8.1.1. brain and nervous system

8.1.1.1. reduced number of neurons and nerve fibers

8.1.1.2. circadian rhythm and sleep is altered

8.1.1.2.1. sleep may be of lower quality

8.1.1.2.2. older adults often go to bed early and rise early

8.1.1.2.3. frequent awakening during sleep (may or may not be related to nocturia)

8.1.1.3. temperature regulation by hypothalamus decreases

8.1.1.3.1. normal body temperature is generally lower

8.1.1.4. slower response to balance changes

8.1.1.5. slower nerve conduction velocity

8.1.1.5.1. slower reflexes and delayed response to stimuli

8.1.1.6. reduced weight of brain

8.1.1.7. reduced cerebral blood flow

8.1.1.7.1. reduction in glucose utilization

8.1.1.7.2. reduced metabolism of oxygen by brain

8.1.1.8. slower retrieval of long term memory

8.1.1.9. altered response to painful stimuli

8.1.1.10. personality and intelligence remain intact as a person ages

8.1.2. sensory changes

8.1.2.1. hearing changes

8.1.2.1.1. presbycussis

8.1.2.1.2. reduced hearing of high frequency sounds

8.1.2.1.3. equilibrium and balance may be altered by inner ear problems

8.1.2.1.4. accumulation of cerumen

8.1.2.2. taste and smell changes

8.1.2.2.1. loss of smell sensation

8.1.2.2.2. taste sensation reduced

8.1.2.3. vision changes

8.1.2.3.1. presbyopia

8.1.2.3.2. peripheral vision decreases

8.1.2.3.3. reduced blood flow to retina

8.1.2.3.4. distorted depth perception

8.1.2.4. touch changes

8.1.2.4.1. touch receptors reduce in number and structural integrity

8.1.2.4.2. pressure and pain reception may be altered

8.1.2.4.3. can result in safety risk such as falls

8.2. Prevalent Pathologies

8.2.1. dementia

8.2.1.1. symptoms

8.2.1.1.1. confusion

8.2.1.1.2. memory loss

8.2.1.1.3. disorientation

8.2.1.1.4. irritability

8.2.1.1.5. jumbled speech

8.2.1.1.6. mood swings

8.2.1.1.7. anxiety

8.2.1.2. complications can include dysphagia and immobility

8.2.1.3. various types including Alzheimer's, vascular dementia, frontotemporal dementia, and others ,

8.2.1.4. management

8.2.1.4.1. occupational therapies

8.2.1.4.2. medications to improve cognition

8.2.1.4.3. supportive care

8.2.2. macular degerenation

8.2.2.1. reduced blood supply to retina and retinal pigmented epithelium

8.2.2.2. symptoms

8.2.2.2.1. blurred vision

8.2.2.2.2. affects center of visual field

8.2.2.2.3. reduced vision in dim light

8.2.2.3. treatment

8.2.2.3.1. laser surgery

8.2.2.3.2. corrective lenses

8.2.2.3.3. ranibizumab

8.2.2.4. vision loss can result in safety concerns including falls, unsafe driving, inability to manage medications, etc.

9. Endocrine System

9.1. Normal Changes

9.1.1. thyroid gland

9.1.1.1. fibrosis increases

9.1.1.2. decreased thyroid activity

9.1.1.3. metabolism is slowed

9.1.1.4. thyroid itself atrophies

9.1.2. adrenal glands

9.1.2.1. aldosterone production decreases

9.1.2.2. secretion of steroid hormones including glucocorticoids are reduced

9.1.3. pituitary gland

9.1.3.1. decreases in size by 20%

9.1.3.2. ACTH, TSH, FSH, LH, and luteotropic hormones decrease

9.1.4. gonads

9.1.4.1. estrogen and progesterone decrease

9.1.4.2. testosterone levels decrease

9.1.5. pancreas

9.1.5.1. insulin release is insufficient and delayed

9.1.5.2. sensitivity to insulin decreases

9.1.5.3. glucose metabolism is reduced

9.1.5.4. blood glucose may be higher even in non diabetic patients

9.1.6. overall, endocrine system loses ability to regulate body systems and processes with age

9.2. Prevalent Pathology

9.2.1. diabetes mellitus

9.2.1.1. type 2 diabetes results from insulin resistance

9.2.1.2. symptoms

9.2.1.2.1. increased thirst

9.2.1.2.2. increased urination

9.2.1.2.3. increased hunger

9.2.1.2.4. non healing wounds

9.2.1.2.5. blurred vision

9.2.1.2.6. headache

9.2.1.3. treatment

9.2.1.3.1. oral anti-diabetic medications

9.2.1.3.2. insulin replacement

9.2.1.3.3. diet changes

9.2.1.3.4. exercise

9.2.1.3.5. importance of preventing skin injuries

9.2.1.4. neuropathy and retinopathy can occur

10. Integumantry System

10.1. Normal Changes

10.1.1. flattening of dermal-epidermal junction

10.1.2. dermis thins and has decreased blood supply

10.1.3. epidermal proliferation slows

10.1.4. skin elasticity is reduced

10.1.4.1. collagen is coarse and random

10.1.5. melanocytes

10.1.5.1. decrease in number

10.1.5.1.1. tanning reduces

10.1.5.2. clustering results in "age spots"

10.1.6. hair becomes thinner and grays

10.1.7. male pattern baldness usually appears by age 50

10.1.8. axially and pubic hair decreases

10.1.9. fingernails are more brittle and grow more slowly

10.1.10. reduced perspiration

10.1.10.1. number and function of sweat glands reduced

10.1.11. reduced subcutaneous fat

10.2. Prevalent Pathologies

10.2.1. melanoma

10.2.1.1. type of skin cancer

10.2.1.2. mole with unusual characteristics

10.2.1.2.1. jagged border

10.2.1.2.2. increasing size

10.2.1.2.3. asymmetrical

10.2.1.2.4. various colors

10.2.1.3. very serious cancer

10.2.1.3.1. difficult to treat

10.2.1.3.2. fast-growing

10.2.1.3.3. metastatis to liver, lungs, bones, and brain

10.2.1.4. treatment

10.2.1.4.1. chemotherapy

10.2.1.4.2. radiation

10.2.1.4.3. excision of cancer

10.2.1.4.4. skin grafting

10.2.2. pressure injuries

10.2.2.1. can be related to a number of factors

10.2.2.1.1. immobility

10.2.2.1.2. friction and shear

10.2.2.1.3. loss of subcutaneous fat

10.2.2.1.4. incontinence

10.2.2.1.5. impaired sensation

10.2.2.1.6. cognitive problems like dementia

10.2.2.1.7. medical devices like oxygen tubing

10.2.2.2. most common sites

10.2.2.2.1. sacrum

10.2.2.2.2. hips

10.2.2.2.3. heels

10.2.2.2.4. back of head

10.2.2.2.5. shoulder blades

10.2.2.2.6. back of ears

10.2.2.3. treatment

10.2.2.3.1. wound care

10.2.2.3.2. blood sugar control

10.2.2.3.3. antibiotics if infection present

10.2.2.3.4. incontinence management

10.2.2.3.5. alternating pressure devices

11. Immune System

11.1. Normal Changes

11.1.1. thymus reduces dramatically in size and hormonal activity

11.1.1.1. results in immature T cells

11.1.1.2. inactive infections may reappear

11.1.2. serum IgM concentration decreases

11.1.3. response to vaccines is reduced

11.1.3.1. flu and pheumonia vaccines still reccomdned

11.1.4. inflammation response declines

11.1.4.1. minimal pain

11.1.4.2. low-grade fever

11.1.5. proinflammatory cytokines increase

11.1.5.1. may be linked to a number of diseases including arthritis and diabetes

11.1.6. physical activity and diet can enhance immune function

11.2. Prevalent Pathologies

11.2.1. Herpes zoster (Shingles)

11.2.1.1. reactivation of varicella virus due to changed in T cell function

11.2.1.2. causes blistering rash

11.2.1.3. extremely painful condition

11.2.1.4. post-herpetic neuralgia can result

11.2.1.5. treated with acyclovir

11.2.2. influenza

11.2.2.1. symptoms

11.2.2.1.1. aches and pains

11.2.2.1.2. respiratory symptoms

11.2.2.1.3. fever may be present

11.2.2.1.4. older adults may have GI disturbances

11.2.2.2. can be life-threatening to older adults especially

11.2.2.2.1. can lead to pneumonia

11.2.2.2.2. may cause dehydration

11.2.2.2.3. can worsen COPD and heart disease

11.2.2.3. treatment

11.2.2.3.1. antiviral medication (Tamiflu)

11.2.2.3.2. fluids

11.2.2.3.3. rest

11.2.2.4. older adults should get flu vaccine every year