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