1. Pulmonary system
1.1. decreased respiratory muscle strength
1.2. diminished ciliary & macrophage activity
1.2.1. decreased cough reflex
1.2.2. drier mucous membranes
1.3. decreased response to hypoxia & hypercapnia
1.4. problems easily develop
1.4.1. difficult to manage
1.5. lungs reduce in size and weight
1.6. decreased elastic recoil
1.7. alveoli less elastic
1.8. reduction in vital capcity
1.8.1. increase in residual volume
1.9. aspiration risk
1.9.1. loose or brittle teeth can be aspired
1.10. Emphysema
1.10.1. causes
1.10.1.1. chronic bronchitis
1.10.1.2. chronic irritation
1.10.1.3. morphologic changes in the lung
1.10.1.4. cigarette smoking
1.10.2. symptoms develop slowly
1.10.2.1. can delay diagnosis and treatment
1.10.3. Treatment
1.10.3.1. postural drainage
1.10.3.2. bronchodilators
1.10.3.3. avoid stress
1.10.3.4. breathing exercises
2. Cardiovascular system
2.1. Isolate systolic hypertension (systolic BP >140mmHg & diastolic <90mmHg
2.1.1. strong arterial pulses
2.1.2. cool extremities
2.1.3. diminished peripheral pulses
2.2. risk of arrhythmias, postural and diuretic-induced hypertension
2.3. heart valves become thicker and rigid
2.4. Aorta becomes dilated
2.4.1. slight ventricular hypertrophy
2.4.2. thickening of left ventricular wall
2.5. Myocardial muscle less efficient
2.5.1. decreased contractile strength
2.5.2. decreased cardiac output when demands increased
2.6. Calcification
2.6.1. reduced elasticity of vessels
2.7. less sensitive baroreceptor regulation of blood pressure
2.8. Conditions altering tissue perfusion
2.8.1. cardiovascular diseases
2.8.2. diabetes, cancer, renal failure
2.8.3. blood dyscrasias
2.8.4. hypotension
2.8.5. medication side effects
2.9. Hypertension
2.9.1. symptoms
2.9.1.1. dull headache
2.9.1.2. impaired memory
2.9.1.3. disorientation
2.9.1.4. confusion
2.9.1.5. epistaxis
2.9.1.6. slow tremor
2.9.2. factors to consider when monitoring BP
2.9.2.1. anxiety
2.9.2.2. stress
2.9.2.3. activity before assessment
2.10. Arrhythmias
2.10.1. causes
2.10.1.1. digitalis toxicity
2.10.1.2. hypokalemia
2.10.1.3. acute infections
2.10.1.4. hemorrhage
2.10.1.5. anginal syndrome
2.10.1.6. coronary insufficiency
2.10.2. symptoms
2.10.2.1. weakness
2.10.2.2. fatigue
2.10.2.3. palpitations
2.10.2.4. confusion
2.10.2.5. dizziness
2.10.2.6. hypotension
2.10.2.7. bradycardia
2.10.2.8. syncope
2.10.3. treatment
2.10.3.1. antiarrhythmic drugs
2.10.3.2. digitalis
2.10.3.3. potassium supplements
2.10.3.4. cardivoersion
2.10.4. education
2.10.4.1. modify diet
2.10.4.2. smoking cessation
2.10.4.3. decrease alcohol
3. Nervous System and Cognition
3.1. decrease in neurons and neurotransmitters
3.2. compromised thermoregulation
3.3. slowed speed of cognitive processing
3.4. increased sleep disorders, delirium, neurodegenerative diseases
3.5. slowed motor skills
3.6. loss of nerve cell mass
3.6.1. atrophy of the brain and spinal cord
3.7. number of dendrites declines
3.8. Demyelinization
3.8.1. slower nerve conduction
3.8.2. response and reaction times are slower
3.8.3. reflexes weaken
3.9. Verbal skills maintained until age 70
3.10. number of sensitivity or sensory receptors, dermatomes, and neurons decrease
3.10.1. leads to dulling of tactile sensation
3.11. decline in function of cranial nerves
3.11.1. affects taste and smell
3.12. plaques, tangles, atrophy of the brain
3.13. free radicals accumulate
3.14. decrease in cerebral blood flow
3.15. fatty deposits accumulate in blood vessels
3.16. ability to compensate declines with age
3.17. intellectual performance maintained until at least 80 years of age
4. Endocrine System
4.1. Thyroid gland atrophies and activity decreases
4.2. diminished adrenal function
4.3. ACTH secretion decreases
4.4. volume of pituitary gland decreases
4.5. insufficient release of insulin and reduced tissue sensitivity to circulating insulin
5. Justine Eversole
6. Renal and Genitourinary systems
6.1. decreased kidney mass, blood flow, GFR, and drug clearance
6.1.1. potential for adverse drug reactions
6.2. reduced bladder elasticity, muscle tone, capacity
6.3. males experience prostate enlargement
6.4. at risk for nephrotoxic injury and adverse drug reactions
6.5. reduced renal function
6.5.1. high blood urea nitrogen levels
6.6. decreased tubular function
6.6.1. concentration of urine changes in response to water and/or sodium excess/depletion
6.7. increase in renal threshold for glucose
6.7.1. false-negative results for glucose in the urine without symptoms
7. Oropharyngeal and Gastrointestinal Systems
7.1. risk of chewing impairment
7.2. fluid/electrolyte imbalances
7.3. poor nutrition
7.4. atrophy of the tongue
7.4.1. effects taste buds
7.4.2. decreases taste sensation
7.5. saliva production decreases
7.5.1. swallowing may be difficult
7.6. Presbyesophagus
7.6.1. results in weaker esophageal contractions and weakness of the sphincter
7.7. Esophageal and stomach motility decreases
7.7.1. risk for aspiration and indigestion
7.8. Decreased elasticity of the stomach
7.8.1. reduces amount of food accommodation at one time
7.9. Stomach has higher pH as a result of decline in hydrochloric acid and pepsin
7.9.1. decline in hydrochloric acid
7.9.1.1. increase in incidence of gastric irritation
7.9.1.2. interferes with absorption of calcium, iron, folic acid, and vitamin B12
7.9.2. decline in pepsin
7.9.2.1. interferes with absorption of protein
8. Musculoskeletal System
8.1. Sacropenia
8.1.1. increased risk of disability, falls, unstable gait
8.1.2. can lead to disability
8.2. decreased ligament and tendon strength
8.3. decline in size and number of muscle fibers, and reduction in muscle mass.
8.3.1. decreased body strength
8.3.2. endurance declines
8.4. Connective tissue changes
8.4.1. reduced flexibility of joints
9. Immune system
9.1. Increased susceptibility to infection
9.2. Reduced efficacy of vaccination
9.3. chronic inflammatory state
9.4. diseases manifest with atypical symptoms
9.4.1. declines in function or mental status
9.4.2. decreased appetite
9.4.3. incontinence
9.4.4. falls
9.4.5. fatigue
9.4.6. exacerbation of chronic illness
9.5. Thymus gland declines in size
9.6. increased number of immature T cells
9.7. T-cell function declines
9.7.1. reduced response to foreign antigens
9.7.2. decrease in cell-mediated and humoral immunity
9.8. Reduced antibody response
9.9. increased number of Langerhans cells in the skin
9.10. reduced thickness of the skin
9.10.1. reduced circulation of the skin
9.11. Cancer
9.11.1. advanced age = #1 risk factor
9.11.2. two theories on incidence of cases in older adults
9.11.2.1. biological age-related changes that impair the ability to resist diseases
9.11.2.2. prolonged exposure to carcinogens over the years
10. Patient A
10.1. Smoker of 44 years
10.2. Breast Cancer
10.2.1. Lumpectomy
10.2.2. remission for 1 year
10.3. received chemotherapy for 8 months
10.3.1. decreased appetite
10.3.1.1. difficulty swallowing
10.3.2. taste sensation decreased
10.3.2.1. number of taste buds decreased
10.3.2.1.1. lead to dry mouth
10.4. Broken ankle
10.4.1. recent injury
10.4.1.1. 3 weeks since initial injury
10.4.2. limited activity for 6-12 weeks
10.4.3. ankle brace/boot applied
10.5. depression
10.5.1. recent diagnosis
10.6. Lymphedema
10.6.1. bilateral
10.6.2. currently taking prescribed diuretic
10.6.2.1. furosemide
10.7. unintentional weightloss
10.7.1. >50lbs in 3 months
10.7.2. dehydration
10.8. arrhythmia
10.9. Hypertension
10.10. CKD
10.10.1. elevated Na and K+ levels
10.10.2. temporary dialysis for 3 weeks