1. Sleep and sexual intimacy
1.1. Andopaus
1.1.1. Testosterone levels decline in men Does not occur in all men Low testosterone levels in older men can result in reduced muscle mass, energy, strength, and stamina Other changes: erectile dysfunction, breast enlargement, osteopenia, osteoporosis, and shrinkage of testes
1.1.2. hormone therapy can be indicated
1.2. Menopause
1.2.1. permanent cessation of menses
1.2.2. hormone therapy can be indicated for condition
1.3. More time in stages I and II, less time in stages III and IV Less sound sleep, delay in onset of sleep
2. Integumentary
2.1. Flattening of the dermal‒epidermal junction Reduced thickness and vascularity of the dermis Reduction of epidermal turnover Degeneration of elastic fibers Increased coarseness of collagen Reduction in melanocytes and atrophy of hair bulbs and decline in the rate of hair and nail growth Increased fragility of the skin Changes potentially affecting body image, self-concept, reactions from others, socialization, and other psychosocial factors
2.1.1. Seborrheic keratosis
2.1.1.1. Description of appearance Increase in size and number with age Body locations Benign lesion Medical evaluation to differentiate from precancerous lesions
2.1.1.1.1. Scrapping, laser removal and freezing can be used to remove condition
2.1.2. Squamous cell carcinoma:
2.1.2.1. Contributing factors Sun exposure Other factors that facilitate growth Common locations Description of appearance
2.1.2.1.1. proper use of sunscreen, treatment of burns, and education on the effects of the sun can reduce risks of squamous cell carcinoma
2.1.3. Pressure ulcers
2.1.3.1. Tissue anoxia and ischemia result in necrosis, sloughing, and tissue ulceration Common sites Predisposing factors Longer healing periods Stages: STAGE I A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved. STAGE II A partial thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister, or shallow crater. “STAGE III A full thickness of skin is lost extending through the epidermis and exposing the subcutaneous tissues; presents as a deep crater with or without undermining adjacent tissue” STAGE IV A full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone, or both; presents as a deep crater that may include necrotic tissue, exudate, sinus tract formation, and infection.
2.1.3.2. Q2 turns, proper assessment, proper hygiene and cleaning of patients can all reduce the risk of pressure ulcers
2.1.3.3. mepilex can be used to reduce friction and shear when a patient has or is at risk for pressure ulcers
3. Reproductive
3.1. New node
3.1.1. Erectile Dysfunction
3.1.1.1. Can not maintain erection long enough for intercours
3.1.1.2. treatment can include violators or behavioral modifications related to the patients habits for example drinking less
3.1.2. Male
3.1.2.1. Seminal vesicles develop thinner epithelium Muscle tissue replaced with connective tissue Decreased capacity to retain fluids Seminiferous tubule changes Increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen Atrophy of the testes and reduction in testicular mass Ejaculation fluid contains less live sperm Testosterone stays the same or decreases slightly More time required to achieve an erection Enlargement of the prostate gland
3.2. Female
3.2.1. Hormonal changes Vulva atrophies Flattening of the labia Loss of subcutaneous fat and hair Vaginal epithelium thins Cervix, uterus, and fallopian tubes atrophy Vaginal canal changes Reduction in collagen and adipose tissue Shortening and narrowing of the canal Less lubrication May lead to discomfort with intercourse More alkaline vaginal pH as a result of lower estrogen changes “Uterus and ovaries decrease in size Endometrium continues to respond to hormonal stimulation Fallopian tubes become shorter and straighter Breasts sag and are less firm Some retraction of nipples related to shrinkage and fibrotic changes
3.3. Dyspareunia
3.3.1. Common problem that accompanies hormonal changes Not a normal consequence of aging More frequent in nulliparous women Many gynecologic problems contribute Thorough gynecologic exam Goal: achieve a satisfactory sexual life
3.3.2. topical ointment can be given to facilitate a less painful experience as well as lubrication
3.4. Breast Cancer
3.4.1. Second leading cause of cancer deaths Risk increases with age Encourage regular breast examinations Older women less likely to receive yearly mammograms and breast examinations by a health care professional Diagnosis: breast examination Treatment: chemo, surgical interventions
3.4.2. treatments can include surgery, radiation, hormone therapy, chemo, and biological therapy
3.4.3. promoting proper diet, exercise, avoidance of smoking and alcohol all can help reduce risks of breast cancer
4. Immune
4.1. Overview of immune function Thymus gland declines in size Increased number of immature T cells T-cell function declines Reduced response to foreign antigens Decrease in cell-mediated and humoral immunity Decreased number of Langerhans cells in the skin Reduced thickness of the skin Decreased circulation of the skin Reduced antibody response
4.1.1. Age-related decline in immune function Increases bodies susceptibility to infection Decreased strength of the immune response High prevalence of chronic conditions increases the risk of infection Increased risk of exposure to pathogens with hospitalization and institutionalization
4.1.1.1. Pneumonia
4.1.1.1.1. HAI
4.1.1.1.2. Risk increased due to decreased immune function
4.1.1.1.3. Incentive spirometer can help prevent this complication
4.1.1.1.4. Build up and stasis of body secretions in lungs increases risk
4.1.1.1.5. Vaccines need to be taken every year
4.1.2. Flu
4.1.2.1. Viral infection
4.1.2.2. Can cause death
4.1.2.3. Vaccine should be given every year
4.1.2.4. Spread by body fluids so droplet precautions should be implemented
5. Sensory
5.1. All senses are less proficient with advanced age: vision, hearing, taste, smell, and touch Decreased efficiency of the senses can affect well-being, activities of daily living, safety and health
5.1.1. Glaucoma
5.1.1.1. Acute (closed or narrow angle) Severe eye pain, headache, nausea, and vomiting Rapid increase in tension and edema Need for early treatment to prevent blindness Diagnosis with tonometry to measure IOP Chronic (open angle) Most common form Need for early prevention to prevent blindness Vision loss due to glaucoma cannot be restored Care and prevention of complications Avoiding situations or activities that increase IOP Avoid emotional stress Carry card or wear bracelet Avoid abuse and overuse of the eyes Patient compliance can be challenging
5.1.1.1.1. sleeping, limiting caffeine, and proper sleep can all promote a more level intra ocular pressure for reduced glaucoma risk
5.1.2. Macular degenration
5.1.2.1. Most common cause of blindness in adults over the age of 65 Damage or breakdown of the macula leading to loss of central vision Treatment can include: laser eye surgery, medication, or corrective lenses
5.1.2.1.1. education on the increased risks of smoking, obesity, and unchecked cardiovascular health has on Macular degeneration
6. Frailty
6.1. Weakness Weight loss: 10% a year Muscle wasting Exercise intolerance Decrease in Grip Strength Frequent falls Immobility Instability of chronic diseases
6.2. Preclinical Signs Sarcopenia Osteopenia Nonspecific balance disorders Nutritional problems Deconditioning Possible Causes Hormonal dysregulation Immuno-aging Pro-coagulation Pro-inflammatory status
6.2.1. Osteoporosis
6.2.1.1. Reduced bone density
6.2.1.2. Less vitamin D
6.2.1.3. increase vitamin D and calcium intake
6.2.2. Sarcopenia
6.2.2.1. Loss of muscle mass
6.2.2.2. Often a component of cache is as well
6.2.2.3. exercising to reduce muscle loss and proper protein intake
7. Cardiovascular
7.1. Heart dimensions are unchanged Heart muscle loses efficiency and contractile strength + reduced cardiac output with physiologic stress Valves become thick and rigid Blood vessels reduce elasticity Oxygen used less efficiently
7.1.1. Hypertension
7.1.1.1. Incidence and prevalence increases with age Evaluation of blood pressure Systolic blood pressure 140 mm Hg Diastolic blood pressure 90 mm Hg Factors to consider when monitoring blood pressure: anxiety, stress, and activity before assessment Symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor Wide range of treatment
7.1.1.2. education on proper low sodium diet, stress management, and proper medication administration will help facilitate a lower blood pressure
7.1.2. Hypotension
7.1.2.1. Decline in systolic blood pressure of 20 mm Hg or more after changing positions Postural and postprandial hypotension due to increased intake of vasoactive medications and baroreceptor sensitivity Consequences: falls, stroke, syncope, other coronary complications
7.1.2.2. if correlated with postural hypo-tension education can promote less risk of falls
7.1.2.3. drink more fluids and eat more salt in diet to raise blood pressure
8. Urinary
8.1. Decline of renal blood flow and glomerular filtration by approximately 50% by age 90. Reduced bladder capacity Urinary frequency, urgency, and nocturia are common in older adults Incontinence is NOT a normal part of aging Affects the ability to eliminate drugs Potential for adverse drug reactions Reduced renal function High blood urea nitrogen levels
8.1.1. Decreased tubular function Concentration of urine changes in response to water and/or sodium excess/depletion Increase in renal threshold for glucose False-negative results for glucose in the urine without symptoms
8.1.2. Nocturia
8.1.2.1. Night time urination
8.1.2.2. medication regimen modification can be warranted as well as changes in bowel habits. going to the restroom right before bed can help prevent nocturia
8.2. Urinary incontinence
8.2.1. Common embarrassing and bothersome symptom/issue for older adults Incidence/prevalence Not normal aging Age-related changes increase the risk Can be transient or established
8.2.2. treatment is linked to the cause of the disease process
8.2.3. increased risk of pressure ulcers due to moisture and skin irritation of fecal matter if not properly cleaned
9. Nervous
9.1. Decline in weight and blood flow to the brain Does not affect thinking and behavior Reduction in neurons, nerve fibers and cerebral blood flow Slower response to change in balance Hypothalamus less effective in temperature regulation Changes in sleep patterns with frequent awakening
9.1.1. Transient ischemic attacks
9.1.1.1. Temporary or intermittent reduction in cerebral perfusion Causes: emboli, cardiovascular complications Signs and symptoms: weakness, numbing, tingling, slurred speech Minutes to hours Recovery is usually within 1 day Treatment/management of underlying cause Increased risk of cerebrovascular accident
9.1.2. Parkinson’s disease
9.1.2.1. Affects ability of the central nervous system (CNS) to control body movements Role of dopamine Incidence/prevalence Exact cause unknown; some theories Signs and symptoms: tremor, shuffled gait Secondary symptoms Treatment/management Anticholinergic medications Technologies to control symptoms Nursing interventions Education on safety and promoting safe outcomes Psychosocial relationships need to be considered Physical environment Goal: maximum level of independence preserved
9.2. Dementia
9.2.1. Irreversible Progressive Impairment in cognitive function affects Memory, orientation, reasoning, attention, language, and problem solving Caused by damage or injury to the brain 4.5 million older adults are affected
9.2.2. Alzheimer’s Disease
9.2.2.1. Most common form of dementia Incidence/prevalence Changes in the brain: Neuritic plaques containing beta-amyloid protein Neurofibrillary tangles in the cortex Loss or degeneration of neurons and synapses Changes in neurotransmitter systems
9.2.3. Other forms
9.2.3.1. Vascular dementia Frontotemporal dementia Lewy body dementia Creutzfeldt-Jakob disease Wernicke encephalopathy Parkinson’s disease AIDS Trauma and toxins
9.2.3.1.1. All can lead to Dementia
9.2.4. Caring for pt with Dementia: “Ensuring patient safety Problems related to poor judgment and misperceptions Consistent, structured environment Items to trigger memory Controlled environment Wandering behavior Prevention of abuse
9.3. Memory/intelligence
9.3.1. Basic intelligence is upheld Crystallized intelligence is maintained Fluid intelligence may decline Chronic psychological stress associated with increased incidence of mild cognitive impairment
9.4. Delirium
9.4.1. Causes: infection, hypoxia Rapid; altered level of consciousness Prompt treatment may reverse condition and prevent permanent damage Treatment/management: determination of etiology, prevention of infection or hypoxia Depends on the cause
10. Safety
10.1. Monitor body temperature Prevent infection Suggest sensible clothing Use medications cautiously Avoid crime Promote safe driving Promote early detection of problems Address risks associated with functional impairment
10.1.1. Reduce falls with night lights
10.1.2. Fractures
10.1.2.1. More common in the aging population causing an increased mobility risk
10.1.2.2. Can be linked to physical falls or pathological fractures linked to other disease processes
10.1.2.3. reduce risk of falls by proactive toileting, proper lighting, removing skid rug use and proper use of bed alarms
10.1.3. Annual vaccinations
10.1.4. Preventative screenings
10.1.5. Orthostatic hypotension
10.1.5.1. Drop in blood pressure upon shifts in posture
10.1.5.2. Can be helped with waiting periods after standing
10.1.5.3. Drink plenty of fluids
11. Musculoskeletal
11.1. Thinning disks and shortened vertebrae Reduced muscle mass, strength and movement Decreased bone mineral and mass Diminished Calcium absorption Increased risk of fractures
11.1.1. Osteoarthritis
11.1.1.1. Degeneration of joint tissue
11.1.1.2. Reduces flexibility
11.1.1.3. Pain and discomfort in joint affected
11.1.1.4. Bone spurs
11.1.1.5. increase vitamin D and Calcium intake
11.1.2. Rheumatoid arthritis
11.1.2.1. Chronic inflammation of joints
11.1.2.2. Common in hand when disease is present
11.1.2.3. Cases stiffness, redness, swelling, and can induce a slight fever
11.1.2.4. use heating pads for pain
11.1.2.5. use anti-inflammatory agents to reduce inflammation and pain
12. Gi
12.1. Atrophy of the tongue affects taste buds and decreases taste sensation Saliva production decreases Swallowing may be difficult Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter “Esophageal and stomach motility decreases Risk for aspiration and indigestion Decreased elasticity of the stomach Reduces the amount of food accommodation at one time Stomach has higher pH as a result of decline in hydrochloric acid and pepsin “Decline in hydrochloric acid Increase in incidence of gastric irritation Interferes with absorption of calcium, iron, folic acid, and vitamin B12 Decline in pepsin Interferes with absorption of protein Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D Sensory perception decreases May lead to constipation or incomplete emptying of the bowel Bile salt synthesis decreases Increase in the risk of gallstone development Pancreas changes Affects digestion of fats Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet Increase in the risk of constipation
12.1.1. Dry Mouth (Xerostomia)
12.1.1.1. Results from: Decreased saliva, some medications, Sjögren’s syndrome, mouth breathing, and altered cognition Consequences of decreased saliva production in the older adult population Interventions Saliva substitutes, sipping water, sugarless candy and gum
12.1.1.2. use of mouth swabs and oral moisturizing agents to prevent potentiate of Xerostomia
12.1.2. Dysphagia
12.1.2.1. Incidence of swallowing difficulties increases with age Causes Gastroesophageal reflux disease (GERD), stroke, and structural disorders Nursing assessment Goals of care and interventions: Prevention of aspiration Promotion of adequate nutritional status
12.1.2.2. use of thickening solutions such as thick it to provide for a consistency of drink to facilitate proper swallowing
12.1.2.3. can consult a speech pathologist for more education and facilitation of patient specific needs
13. Thermoregulation
13.1. Normal body temperatures are lowered in older age; Mean body teperature can range from 96.9 F. to 98.3 F Ability to respond to cold temperatures is reduced Response to heat is altered
13.1.1. Increases workload on the heart and the changes of the patients vasculature
13.1.1.1. Increased risk for hyperthermia
13.1.1.1.1. Weakness
13.1.1.1.2. Nausea
13.1.1.1.3. Vomiting
13.1.1.1.4. Headaches
13.1.1.1.5. Muscle cramps
13.1.1.1.6. monitor body temperature and present a safe environment to reduce risks of hypothermia such as space heaters and heating appliances
13.1.1.2. Increased risk for hypothermia
13.1.1.2.1. Slurred speach
13.1.1.2.2. Weak pulse
13.1.1.2.3. Decreased respirations
13.1.1.2.4. Decreased memory function
13.1.1.2.5. Red cold skin
13.1.1.2.6. monitor body temperature to facilitate proper body temperature and help consider patient needs by having access to more blankets
14. Endocrine
14.1. Thyroid gland activity decreases ACTH secretion decreases Pituitary gland decreases Insulin release by beta cells is delayed and insufficient Ability to metabolize glucose is reduced Higher blood glucose in nondiabetic patients
14.1.1. Hypothyroidism
14.1.1.1. Effects of aging on the thyroid gland Subnormal concentration of thyroid hormone Prevalence Primary versus secondary hypothyroidism Signs and symptoms: fatigue, cold sensitivity, constipation, dry skin, and unexplained weight gain Treatment/management: medication(levothyroxine)
14.1.1.2. provide medications indicated such as levothyroxine to promote disease process healing
14.1.1.3. provide patient with motility drugs and promote warm environment due to cold sensitivity
14.1.2. Hyperthyroidism
14.1.2.1. Secretion of excess amounts of thyroid hormone Incidence/prevalence Causes: cancer, hyperactive thyroid Signs and symptoms: unexpected weight loss, rapid or irregular heartbeat, sweating, and irritability, the elderly experience less or no symptoms Diagnosis: biopsy, labs Treatment/management: medication or surgical intervention
14.1.2.2. monitor patients response to treatment of medications such as methimazole and the cardiac side effects of the disease process
15. Respiratory
15.1. Calcification of costal cartilage+trachea and rib cage more rigid Reduction of cough and laryngeal reflexes Increased residual capacity and reduced vital capacity High risk for respiratory infection
15.1.1. Asthma
15.1.1.1. Can develop in older years High risk of complications of bronchiectasis, cardiac problems High rates of mortality Assess for causative factors and educate patient Evaluate aerosol nebulizers’ use Precaution: avoid adverse drug effects
15.1.1.2. elevate head of bed to facilitate breathing
15.1.1.3. provide proper medications indicated for stage of asthma along with education on slow and deep breathing exercises
15.1.2. Lung cancer
15.1.2.1. Increasing incidence in 65 years and older Higher incidence in men than in women Incidence and mortality rate varies in ethnic groups Incidence in smokers twice as nonsmokers Symptoms: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections Treatment: surgery, chemotherapy, and radiotherapy
15.1.2.2. if correlated with COPD teach patient about pursed lips breathing and tripod position to facilitate breaths
15.1.2.3. provide education on smoking cessation if warranted