1. Gastrointestinal
1.1. Normal Changes of Aging
1.1.1. DECREASED:
1.1.1.1. Saliva production
1.1.1.2. Esophageal/Stomach motility (risk for aspiration and indigestion)
1.1.1.3. Elasticity of stomach (reduces amount of food accomodation/storage)
1.1.1.4. Production of hydrochloric acid (HCl) and pepsin
1.1.1.4.1. Increased gastric irritation
1.1.1.4.2. HCl: interferes w/ absorption of Ca, Fe, folic acid, Vit B12
1.1.1.4.3. Pepsin: interferes w/ absorption of protein
1.1.1.5. Cells on absorbing surface (ileum)
1.1.1.5.1. Interferes w/ absorption of sugars and Vit B & D
1.1.1.6. Peristalsis (lead to constipation)
1.1.1.7. Sensory perception (incomplete emptying of bowel)
1.1.1.8. Bile salt synthesis (gallstone development)
1.1.2. Atrophy of tongue: affects taste buds/decreases taste senstation
1.1.3. Presbyesophagus: weaker esophageal contractions/weakness of sphincter
1.1.4. Pancreas changes: impacts digestion of fats
1.2. Pathologies
1.2.1. Xerostomia (Dry Mouth)
1.2.1.1. Interventions: saliva substitutes, sipping water, sugarless candy/gum
1.2.2. Dysphagia (Swallowing Difficulties)
1.2.2.1. Cause: GERD, CVA, structural abnormalities
1.2.2.2. Interventions: thicken feeds, eat upright, tip chin down while swallowing
1.2.3. Hiatal Hernia (Sliding & Rolling)
1.2.3.1. Interventions: lose weight, small/frequent meals, sleep upright; PPIs (decrease Vit B12)
1.2.4. Cancer
1.2.4.1. Esophageal: men (smoking, ETOH, poor oral hygiene)
1.2.4.2. Stomach: not as common (smoking)
1.2.4.3. Colorectal
1.2.4.3.1. S/S: Ascending (R side) = anemia, SOB, abnormal CBC; Transverse/Sigmoid (L side) = changes in bowel patterns
1.2.4.3.2. 2nd most common malignancy in US but VERY preventable - takes 5 years for CA to develop after first polyp appears
1.2.4.3.3. Colonoscopy at age 50+
1.2.4.4. Pancreas
1.2.4.4.1. Very poor prognosis
1.2.4.5. Gallbladder
1.2.4.5.1. Poor prognosis
1.2.5. Diverticulitis (infection in diverticula)
1.2.6. Intestinal Obstruction
1.2.6.1. Large: cancer; feel heavy dullness
1.2.6.2. Small: adhesions, hernias, NE tumor; high acute pain
1.2.6.3. HIGH PITCHED, TYMPANIC BOWEL SOUNDS (severe = absent)
1.2.7. Bowel Incontinence
1.2.7.1. Usually d/t fecal impaction
1.2.7.2. Late stage dementia, paralysis
1.2.8. Cholelithiasis (gallstones)
2. Respiratory
2.1. Normal Changes of Aging
2.1.1. DECREASED:
2.1.1.1. Cough
2.1.1.2. Size/weight of lungs
2.1.1.3. Elastic recoil & elastcity of alveoli
2.1.1.4. Vital Capacity
2.1.2. INCREASED:
2.1.2.1. Residual volume
2.1.2.2. Risk for aspiration
2.2. Pathologies
2.2.1. Emphysema
2.2.1.1. Causes: chronic bronchitis, cigarette smoking
2.2.1.2. Treatment: postural drainage, bronchodilators, avoid stress, breathing exercises
2.2.2. Chronic bronchitis
2.2.2.1. Persistent, PRODUCTIVE cough; wheezing, recurrent respiratory infections
2.2.3. Lung cancer
2.2.3.1. More common in men 65+ and twice as common in smokers vs non-smokers
2.2.3.2. S/S: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections
2.2.4. Lung abscess
2.2.4.1. Cause: pneumonia, TB, malignancy, trauma, aspiration
2.2.4.2. Treatment: postural drainage, high-protein, high-calorie diet
3. Cardiovascular
3.1. Normal Changes of Aging
3.1.1. Heart valves: thicker/rigid
3.1.2. Aorta dilated
3.1.2.1. Slight ventricular hypertrophy
3.1.2.2. Thickening of L ventricular wall
3.1.3. Myocardial muscle less efficient
3.1.3.1. Decreased contractile strength
3.1.3.2. Decreased CO
3.1.4. Calcification & reduced elasticity of vessels
3.1.5. Less sensitive to baroreceptor regulation of BP (causes orthostatic hypotension)
3.2. Pathologies
3.2.1. Hypertension: BP > 140/90 on two occasions
3.2.1.1. S/S: dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor
3.2.1.2. Factors to consider while measuring: anxiety, stress, activity before assessment
3.2.2. Hypotension: decrease of systolic BP more than 20 mmHg after changing positions
3.2.3. Congestive Heart Failure (CHF)
3.2.3.1. Leading cause of hospitalization
3.2.3.2. Most common cause: CAD
3.2.3.3. S/S: SOB, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, edema
3.2.4. Pulmonary Emboli (PE)
3.2.4.1. Risk factors: Afib, fractures, immobilization, CHF
3.2.4.2. S/S: confusion, apprehension, SOB, temperature elevation, pneumonitis, elevated sedimentation rate
3.2.5. Coronary Artery Disease (CAD)
3.2.5.1. Angina
3.2.5.1.1. Atypical presentation: coughing, syncope, sweating, confusion
3.2.5.1.2. Nitroglycerine (don't take if on ED meds!)
3.2.5.2. Myocardial Infarction
3.2.5.2.1. Atypical presentation: confusion, decreased BP, SOB, elevated temperature
3.2.6. Varicose Veins
3.2.6.1. Dilated, tortuous nature of vein
3.2.6.2. Dull pain, cramping, can interfere with sleep
3.2.6.3. Susceptible to trauma & infection
4. Immune
4.1. Normal Changes of Aging
4.1.1. DECREASED:
4.1.1.1. Strength of immune/antibody response
4.1.1.2. Size of thymus gland
4.1.1.3. T-cell function
4.1.1.4. Thickness of skin
4.1.2. INCREASED:
4.1.2.1. Risk of infection d/t chronic conditions
4.1.2.2. Risk of exposure d/t hospitalizations and institutionalization
4.1.2.3. # of immature T-cells
5. Cellular
5.1. Normal Changes of Aging
5.1.1. DECREASED:
5.1.1.1. Functional cell number
5.1.1.2. Lean body mass
5.1.1.3. Intracellular fluid
5.1.2. INCREASED:
5.1.2.1. Total body fat
6. Endocrine
6.1. Normal Changes of Aging
6.1.1. DECREASED:
6.1.1.1. Thyroid gland activity
6.1.1.2. Adrenal function
6.1.1.3. Volume of pituitary gland
6.1.1.4. Release of insulin
6.2. Pathologies
6.2.1. Diabetes Mellitus
6.2.1.1. Glucose intolerance
6.2.1.2. Screening recommended every 3 years for people 45+ (glucose tolerance test - GTT)
6.2.1.3. Treatment goal varies for pt. but usually A1C < 6%
6.2.1.4. Interventions: exercise and nutrition, insulin education if needed
6.2.1.5. Complications (at higher risk than younger adult)
6.2.1.5.1. Hypoglycemia
6.2.1.5.2. Peripheral Vascular Disease, Atherosclerosis
6.2.1.5.3. Diabetic retinopathy, Neuropathies
6.2.1.5.4. Drug interactions
6.2.1.5.5. UTI
6.2.2. Hypothyroidism
6.2.2.1. S/S: dry skin, coarse hair, constipation, cold, periorbital edema, weight gain, impaired hearing, anorexia, depression
6.2.3. Hyperthyroidism
6.2.3.1. S/S: nodule goiters, anxious, weight loss, difficulties sleeping
6.2.3.2. Treatment: radioactive iodine, surgical removal
7. Changes to the Mind
7.1. Normal Changes of Aging
7.1.1. Learning
7.1.1.1. Motivation changes
7.1.1.2. Delayed transmission of information to brain
7.1.2. Memory
7.1.2.1. Retrieval of information from long-term memory can be slowed
7.1.2.2. Working memory function reduced
7.1.2.3. Short-term memory only lasts for a few seconds
7.1.3. Personality
7.1.3.1. Consistent with younger age
7.2. Pathologies
7.2.1. Dementia
7.2.1.1. Irreversible, progressive impairment in cognitive function
7.2.1.2. Caused by damage or injury to the brain
7.2.1.3. Alzheimer's Disease
7.2.1.3.1. Most common form of Dementia
7.2.1.3.2. Neurofibrillary tangles in cortex, neurtitic plaques containing beta-amyloid in the brain
7.2.1.3.3. Causes: genetics, environmental factors, free radicals, levels of aluminum and mercury in brain
7.2.1.3.4. Treatment: no current cure; clinical trials in place to improve function and slow disease progression
7.2.1.4. Other Types
7.2.1.4.1. Vascular (TIAs) - mood swings/memory loss not as profound
7.2.1.4.2. Frontotemporal: severe/radical personality changes
7.2.1.4.3. Lewy body: common in PD
7.2.1.5. Care: ensure patient safety and support family/caregiver
7.2.2. Delirium
7.2.2.1. Rapid, altered level of consciousness
7.2.2.2. Abrupt change in the brain that causes mental confusion
7.2.2.3. Cause: infection, brain tumor, medications, kidney/liver failure, alcohol withdrawal
8. Madison Balsinger (001)
9. Musculoskeletal
9.1. Normal Changes of Aging
9.1.1. DECREASED:
9.1.1.1. Size & # of muscle fibers
9.1.1.2. Muscle mass
9.1.1.3. Flexibility of joints d/t changes in connective tissue
9.1.2. Sarcopenia
9.2. Pathologies
9.2.1. Fractures
9.2.1.1. Brittle bones fracture more easily and heal at a slower rate
9.2.1.2. Common sites: radius, hip, compression fractures of vertebrae (falls)
9.2.2. Osteoarthritis: progressive deterioration of joint cartilage
9.2.2.1. S/S: grading crepitation, heavy aching pain in the joints
9.2.2.2. Common sites: hips, knees, vertebrae, fingers
9.2.2.3. Nursing interventions: apply ice, massage, use of splints/braces
9.2.2.4. Diet: cold water fish (high in fatty acids), Vitamins A, B, C, E; Zn, Se, Ca
9.2.3. Osteoporosis: porous bone
9.2.3.1. Risk factors: post-menopausal women, family history, Caucasian, Asian, long-term use of corticosteriods
9.2.3.2. Prevention: diet high in Ca and protein, adequate Vitamin D absorption, weight-bearing exercise, avoid smoking/drinking
9.2.4. Gout: metabolic disorder in which excess uric acid accumulates in blood
9.2.4.1. Hallmark sign = EXTREME pain
9.2.4.2. Low purine diet: no rich meats, alcohol, or seafood
9.2.4.3. Medications: allopurinol, indomethacin
10. Nervous
10.1. Normal Changes of Aging
10.1.1. DECREASED:
10.1.1.1. Nerve Cell Mass (atrophy of brain and spinal cord)
10.1.1.2. # of dendrites
10.1.1.3. Cerebral blood flow
10.1.1.4. Neurons/Neurotransmitters
10.1.1.5. Central processing (takes longer to perform tasks)
10.1.1.6. Function in cranial nerves affecting taste and smell
10.1.2. Comprised Thermoregulation
10.1.3. Demyelinization
10.1.3.1. Slower nerve conduction and raaction times
10.1.3.2. Weaker reflexes
10.1.4. Fatty deposits accumulate in blood vessels
10.2. Pathologies
10.2.1. Parkinson's Disease (PD)
10.2.1.1. 4 Cardinal Symptoms
10.2.1.1.1. Resting tremors
10.2.1.1.2. Muscle rigidity
10.2.1.1.3. Bradykinesia
10.2.1.1.4. Postural instability
10.2.1.2. 80% of dopamine neurons lost by diagnosis (responsible for emotions & smooth motor movement)
10.2.2. Transient Ischemic Attacks (TIA)
10.2.2.1. Temporary/intermittent reduction in cerebral perfusion
10.2.3. Cerebrovascular Accident (CVA)
10.2.3.1. Predisposing factors: HTN, gout, atherosclerosis, DM, anemia, hypothyroidism, hx of TIA/silent MI, smoker, dehydration
10.2.3.2. Common sequelae
10.2.3.2.1. Hemiparesis: weakness to one side of body
10.2.3.2.2. Homonymous hemianopia: condition where a person sees only one side of the visual field of each eye
10.2.3.2.3. Expressive aphasia (Broca's): partial loss of ability to produce language (comprehension remains intact)
11. Renal/Genitourinary
11.1. Normal Changes of Aging
11.1.1. DECREASED:
11.1.1.1. Kidney Filtration
11.1.1.1.1. Impacts ability to eliminate drugs
11.1.1.2. Renal function (High BUN)
11.1.1.3. Tubular function (concentration of urine changes in reponse to water and/or sodium excess/depletion)
11.1.2. Hypertrophy/thickening of bladder muscle
11.1.2.1. Decreases bladder ability to expand
11.1.2.2. Reduces storage capacity
11.1.3. Changes in cortical control of micturition
11.1.4. Inefficient neurological control
11.1.4.1. Unable to fully empty bladder
11.1.4.2. Retention of large volumes of urine
11.2. Pathologies
11.2.1. Urinary Incontinence
11.2.1.1. Stress: ability of pelvic floor muscles to hold urine
11.2.1.2. Urgency: bladder tumors, prostate enlargement
11.2.1.3. Overflow: drugs, bladder outlet issues
11.2.1.4. Neurogenic (reflex)
11.2.1.5. Functional: dementia, inability to get to toilet (ambulation)
11.2.2. Renal Calculi
11.2.2.1. Flank, severe pain
11.2.2.2. Stain stones to save for diagnosis; if stone is too large - lithotripsy
11.2.3. Glomerulonephritis
11.2.3.1. Kidney infection that can lead to kidney failure (ESRD)
12. Reproductive/Sexuality
12.1. Normal Changes of Aging
12.1.1. Sexuality
12.1.1.1. Menopause: permanent cessation of menses
12.1.1.1.1. Risks of hormone therapy: increased risk of cardiac problems and breast cancer
12.1.1.1.2. Manage symptoms: change in emotions, hot flashes
12.1.1.2. Older adults are able to be sexually active, although some age-related changes have impact on sexual function
12.1.1.3. Andropause: testosterone levels decline in men
12.1.1.3.1. Results in reduced muscle mass, energy, strength and stamina
12.1.1.3.2. Does not occur in all men
12.1.2. Women
12.1.2.1. Vaginal canal changes
12.1.2.1.1. Reduction in collagen and adipose tissue
12.1.2.1.2. Shortening/narrowing of canal
12.1.2.1.3. Less lubrication
12.1.2.1.4. More alkaline vaginal pH
12.1.2.2. Fallopian tubes become shorter and straighter
12.1.3. Male
12.1.3.1. Seminal vesicles develop thinner epithelium
12.1.3.2. Muscle tissue replaced with connective tissue
12.1.3.3. Ejaculation fluid contains less live sperm
12.2. Pathologies
12.2.1. Yeast Infection (vulva)
12.2.1.1. Vulva is more fragile and susceptible to irritation/infection
12.2.2. Erectile Dysfunction
12.2.2.1. Cause: diabetes (#1 cause), HTN, atherosclerosis, MS, thyroid dysfunction, alcoholism, renal failure, structure abnormalities
12.2.2.2. Medical treatments available: do NOT take nitroglycerine if on ED meds bc it will bottom out BP!
12.2.3. Benign Prostatic Hyperplasia (BPH)
12.2.3.1. Men are reluctant/embarrassed to seek treatment
12.2.3.2. May result in kidney damage
12.2.4. Prostate Cancer
12.2.4.1. Asymptomatic disease progression
12.2.4.2. Diagnosis: digital rectal examination and elevated PSA levels
12.2.4.3. BPH does NOT cause prostate cancer, but can hide cancerous nodules
13. Physical Appearance
13.1. Normal Changes of Aging
13.1.1. DECREASED:
13.1.1.1. Tissue elasticity
13.1.1.1.1. Elongated ears
13.1.1.1.2. Baggy eyelids
13.1.1.1.3. Double chin
13.1.1.2. Subcutaneous fat
13.1.1.3. Stature d/t loss of cartilage and thinning vertebrae
13.1.2. INCREASED:
13.1.2.1. Facial hair in women
13.1.2.2. Graying/thinning of hair on scalp
14. Integumentary
14.1. Normal Changes of Aging
14.1.1. DECREASED:
14.1.1.1. Thickness/vascularity of dermis
14.1.1.2. Melanocytes
14.1.1.3. Rate of hair/nail growth
14.1.2. Flattening of dermal-epidermal junction
14.1.3. INCREASED:
14.1.3.1. Coarseness of collagen
14.1.3.2. Fragility of skin
14.1.4. Atrophy of hair bulbs
14.2. Pathologies
14.2.1. Pruritus: itchiness
14.2.1.1. Most common dermatologic problem among older adults
14.2.1.2. Potential for skin breakdown/infection
14.2.2. Cancer
14.2.2.1. Basal Cell Carcinoma
14.2.2.1.1. Most common form
14.2.2.1.2. Grows slowly
14.2.2.1.3. Rarely metastasizes
14.2.2.2. Melanoma
14.2.2.2.1. Rising incidence in the US
14.2.2.2.2. Tends to more easily metastasize
14.2.3. Pressure Ulcers
14.2.3.1. Tissue anoxia/ischemia that results in necrosis, sloughing and tissue ulceration
14.2.3.2. Braden Scale used to grade: 1-4
14.2.3.3. Prevention: avoid unrelieved pressure
15. Sensory
15.1. Normal Changes of Aging
15.1.1. Vision
15.1.1.1. Presbyopia: decreased ability to focus d/t reduced elasticity of lens
15.1.1.2. Visual acuity declines: opacification of lens
15.1.1.3. Loss of photoreceptor cells in retina
15.1.1.3.1. Light perception threshold decreases
15.1.1.3.2. Dark/light adaptation takes longer
15.1.1.3.3. Difficulty with night vision
15.1.1.4. Increased sensitivity to glare
15.1.1.5. Distortion in depth perception
15.1.1.6. Peripheral vision reduced
15.1.2. Hearing
15.1.2.1. Presbycusis: sensorineural hearing loss
15.1.2.2. Impacted cerumen
15.1.3. Taste
15.1.3.1. Sweet/salty flavors impacted
15.1.4. Touch
15.1.4.1. Decreased tactile sensation
15.1.4.2. Difficulty discriminating between temperatures
15.2. Pathologies
15.2.1. Glaucoma
15.2.1.1. Damage to optic nerve from increased intraocular pressure (IOP)
15.2.1.2. Second leading cause of blindness in older adults
15.2.1.3. Acute (closed-angle) and Chronic (open angle)
15.2.2. Macular Degeneration
15.2.2.1. Most common cause of blindness in adults 65+
15.2.2.2. Damage/breakdown of macula leading to loss of central vision