1. Nervous System
1.1. Changes in sleep patterns with frequent awakening
1.2. Hypothalamus less effective in temperature regulation
1.3. Slower response to change in balance
1.4. Reduction in neurons, nerve fibers and cerebral blood flow
1.4.1. Parkinson's Disease
1.4.1.1. A progressive nervous system disorder that affects movement
1.4.1.1.1. This affects the nerve cells in the brain that produce Dopamine. By the time of diagnosis, about 80% of dopamine cells have been destroyed
1.5. Decline in weight and blood flow to the brain
1.5.1. Subtle indications of neurologic problems could include new headaches that occur in the early morning or that interrupt sleep, changes in vision, sudden deafness, numbness or tingling in extremities, or unusual sensation or pain over a nerve
2. Musculoskeletal System
2.1. Lean body mass decreases
2.1.1. Promote physical exercise and education related to importance
2.1.1.1. All exercise programs should address cardiovascular endurance, flexibility and strength training
2.1.1.2. Exercise should match individuals' interests and needs, should pace exercise throughout the day, begin gradually and increase as tolerated, and ensure rest after activity
2.2. Total body fat increases
2.3. Loss of tissue elasticity, elongated ears, baggy eyelids, double chins
2.3.1. Weight-bearing exercises such as walking, dancing, or lifting weights can help maintain muscle mass, strength and balance
2.4. Loss of subcutaneous fat
2.5. Diminished calcium absorption
2.5.1. Increased risk of fractures
2.5.1.1. The absence of typical signs of fracture does not guarantee no fracture present in an older adult who falls or has trauma to their bones
2.5.2. Osteoporosis
2.5.2.1. This is the most common form of arthritis
2.5.2.1.1. Caused by protein makeup of cartilage degenerating
2.5.2.2. Most commonly affects joints in the hands, knees, hips and spine
2.5.2.2.1. While calcium intake does not directly associated with onset of osteoarthritis, a high calcium diet may decrease one's chance of getting arthritis
3. Physical Appearance
3.1. Hair loss, graying and wrinkles
3.1.1. People may become self-conscious and seek treatment to cover or disguise their graying or hair loss
3.2. Diminished stature related to reduced hydration, loss of cartilage, and thinning of vertebrae
3.2.1. We typically lose about one to two inches in height, and this begins in our 40's
3.2.2. Spinal Stenosis
3.2.2.1. Condition where your spinal canal starts to narrow, which can cause pain and other issues
3.2.2.1.1. Can be caused by herniated discs, injuries, tumors, Paget's disease, and arthritis
3.2.2.2. Usually results from changes because of arthritis. The spinal canal may narrow, the open spaces between the vertebrae may start to get smaller, the tightness can pinch the spinal cord or the nerves around it which can cause extreme pain
3.3. Small blood vessels break beneath the surface of the skin, and warts, skin tags and age spots may form on the body
3.3.1. Make sure that dry skin stays moisturized to prevent cuts, especially in the winter months
3.3.2. Skin Breakdown
3.3.2.1. Skin breakdown can be a problem in older adults that have incontinence issues or who are wheelchair or bed ridden
3.3.2.1.1. The skin becomes more fragile and paper like as we age, so keeping the skin moisturized but not wet is important in keeping the skin from breaking down or tearing
4. Intelligence
4.1. Basic intelligence is upheld
4.1.1. Alzheimer's disease
4.1.1.1. This is a type of dementia that causes problems with memory, thinking, and behavior
4.1.1.1.1. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks
4.1.1.1.2. Early symptoms can include: memory loss that disrupts daily life, challenges in planning or solving problems, difficulty completing familiar tasks, confusion with time or place, and new problems with words in speaking or writing
4.2. Crystallized intelligence is maintained
4.2.1. This is the accumulation of knowledge, facts, and skills that are acquired through life
4.3. Fluid intelligence may decline
4.3.1. This is the inherited ability to reason and think
4.3.2. Can also be considered inductive reasoning, and problem solving
5. Cellular Level
5.1. Functional cell number decreases
5.2. Extracellular fluid remains constant, intracellular fluid decreases
5.2.1. This can cause the elderly to be more likely to get dehydrated, so it is important to ensure that patients are drinking enough water during the day
6. Renal System
6.1. Reduced glomerular filtration rate
6.1.1. Affects ability to eliminate drugs, potential for adverse drug reactions
6.1.2. End-Stage Renal Disease
6.1.2.1. Disease in which the kidneys do not function properly, not an acute phase
6.1.2.2. Main risk factors would include diabetes type 1 and 2, high blood pressure, immune system diseases, and glomerulonephritis
6.1.2.2.1. Drugs and toxins can also cause permanent damage to the kidneys
6.2. Reduced bladder elasticity and capacity
6.2.1. Daytime urinary frequency and nocturia
6.2.1.1. Nursing interventions can include frequent toileting, avoidance of catheterization, adequate fluid intake, and encouraging appropriate level of activity
6.3. Inefficient neurological control of bladder emptying and weaker bladder muscle
6.3.1. Female: fecal impaction
6.3.2. Male: prostatic hypertrophy
6.3.2.1. Benign Prostatic Hyperplasia
6.3.2.1.1. Can cause uncomfortable urinary symptoms such as blocking the flow of urine out of th ebladder
6.3.2.2. Also called prostate gland enlargement
6.4. Decrease in kidney mass and blood flow
6.5. Decrease in tubular function
6.5.1. Concentration of urine changes in response to water and/or sodium excess/depletion
7. Gastrointestinal System
7.1. Decreased esophageal and stomach motility
7.1.1. Increases the risk for aspiration and indigestion
7.1.2. Gastroesophageal Reflex Disease (GERD)
7.1.2.1. This is the return of of the stomach's contents back up into the esophagus
7.1.2.1.1. The most common symptom is heartburn, or indigestion
7.1.2.2. This occurs when the lower esophageal sphincter is weak or relaxes inappropriately, causing the stomach's contents to flow up into the esophagus
7.1.2.2.1. Smoking is a big determinant, as it weakens the LES
7.2. Atrophy of the small and large intestines
7.2.1. Reduces the amount of food accommodation at one time
7.3. Stomach pH increases
7.3.1. Results from decline in hydrochloric acid and pepsin
7.3.1.1. Decline in pepsin interferes with absorption of protein
7.3.1.2. Decline in hydrochloric acid increases incidences of gastric irritation. It also interferes with the absorption of calcium, iron, folic acid, and vitamin B-12
7.4. Slower peristalsis, inactivity, reduced food/fluid intake, drugs and low-fiber diet
7.4.1. Increase in the risk of constipation
7.4.1.1. Encourage physical exercise and a higher consumption of fiber to promote gastric motility
7.4.2. Diverticulosis
7.4.2.1. This is the formation of numerous tiny pockets (diverticula) in the lining of the bowel
7.4.2.1.1. These are formed by increased pressure on the weakened spots of the intestinal wall by gas, waste, or liquid
7.4.2.1.2. These can form during straining with a bowel movement, such as constipation
7.5. Bile sale synthesis decreases
7.5.1. Increase in the risk of gallstone development
8. Cardiovascular System
8.1. Arterial Wall thickens and stiffens, decreasing compliance
8.1.1. Can be influenced by physical deconditioning, which is the decline in cardiovascular function due to physical inactivity
8.1.1.1. Health promotion can be improved through alterations modified by lifestyle and diet. Educate your patients!
8.2. Left ventricular and atrial hypertrophy
8.2.1. Heart Failure
8.2.1.1. This does not mean that the heart has stopped working, just that the heart works less efficiently than normal
8.2.1.1.1. Some symptoms of heart failure are congested lungs, fluid and water retention, dizziness, fatigue, weakness, and irregular or rapid heart beat
8.2.1.2. Blood moves through the heart and body at a slower rate, and the pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs
8.2.1.2.1. Some causes of heart failure can include: Coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart such as hypertension
8.3. Strong arterial pulses and diminished peripheral pulses
8.3.1. Promote circulation of blood through ambulation and movement as tolerated
8.3.2. Atrial Fibrillation
8.3.2.1. This is a fluttery heartbeat, or an arrhythmia
8.3.2.1.1. This increases your risk of stroke and heart disease
8.3.2.2. When the atria squeezes, the ventricles normally follow, and this is what moves blood. In atrial fibrillation, the electrical signals that control this are thrown off
8.3.2.2.1. Symptoms may include heart palpitations, confusion, pain and pressure in your chest, shortness of breath and feeling tired or weak
8.4. Decreased cardiac reserve
8.5. Cool extremities
9. Pulmonary System
9.1. Decreased respiratory muscle strength
9.2. Reduced chest wall compliance
9.2.1. COPD: group of diseases including asthma, chronic bronchitis and emphysema
9.2.1.1. Long-term exposure to things that irritate your lungs is the most common cause
9.2.1.1.1. SMOKING!
9.2.1.1.2. Symptoms include: a cough that doesn't go away, coughing up mucus, shortness of breath, wheezing, tightness in the chest, blue fingernails, and swollen ankles, feet, or legs
9.2.1.2. Although rare, you can also be predisposed to COPD through the alpha 1 antitrypsin gene
9.3. Decreased exercise tolerance
9.3.1. Asthma
9.3.1.1. Elderly asthamtics are more likely to be underdiagnosed and undertreated and at a higher risk for mortality
9.3.1.1.1. Some people with asthma are told that they have COPD
9.3.1.2. To treat asthma, an inhaled corticosteroid that inhibits the inflammation that causes asthma is prescribed
9.3.1.2.1. People also use a bronchodilator to expand bronchial air passages and to ease breathing
9.4. Decreased cough and matter clearance
9.4.1. Coughing is important in removal of secretions, use hard candy to increase secretions or teach breathing exercises for those who have the inability to promote productive cough
10. Changes in Sleep
10.1. Nocturnal Myoclonus: condition characterized by at least five leg jerks or movements per hour during sleep
10.1.1. This can lead to insomnia, which is difficulty falling asleep, staying asleep, or restless sleep
10.2. Phase advance: falling asleep earlier in the evening and awakening earlier in the morning
10.2.1. One may get sleepy around 7-9 pm and have early morning awakening
10.3. Restless leg syndrome: neurological disorder characterized by an uncontrollable urge to move the legs when one lies down
11. Endocrine Systen
11.1. Thyroid gland atrophies and activity decreeases
11.1.1. Hypothyroidism
11.1.1.1. Condition in which the thyroid gland is not able to produce enough thyroid hormone
11.1.1.2. This has symptoms that are associated with a slow metabolism
11.1.1.2.1. S&S: Fatigue, Increased sensitivity to cold, constipation, weight gain, puffy face, thinning hair, slowed heart rate
11.2. Diminished adrenal function
11.2.1. Results in decrease of Aldosterone, which can contribute to lightheadedness and a drop in blood pressure with sudden position changes
11.3. Adrenocorticotropic hormone (ACTH) secretion decreases
11.4. Volume of pituitary gland decreases
11.4.1. Pituitary gland usually reaches reaches its maximum size in middle age
11.5. Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
11.5.1. Average fasting glucose level rises 6 to 14 milligrams per deciliter every 10 years after age 50 as the cells become less sensitive to the effects of insulin
11.5.2. Diabetes Type 2
11.5.2.1. This stems from insulin resistance
11.5.2.1.1. Symptoms can include: being very thirsty, excessive urination, blurry vision, being cranky, tingling or numbness in hands or feet, and wounds that won't heal
11.5.2.2. Most common type of diabetes, affecting about 29 million people in the US
11.5.2.2.1. It is better for an elderly patient to have a higher blood glucose level than a lower if there was a choice, as if their blood sugar is too low they may pass out and fall and hurt themselves
11.6. In women, estrogen and prolactin levels often decrease significantly
11.6.1. Some hormones that may increase include FSH and LH
11.6.2. Testosterone levels usually decrease gradually in men