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Older Adult by Mind Map: Older Adult

1. Circulatory

1.1. Normal Age Related Changes

1.1.1. Aorta becomes dilated and enlongated

1.1.2. More prominent arteries in head, neck, and extremities

1.1.3. Valves become thicker and more rigid

1.1.4. Cardiac output decreases

1.1.5. Stroke volume decreases by 1% every year

1.1.6. Heart pigmented with lipofuscin granules

1.1.7. Less efficient O2 utilization

1.1.8. Resistance to peripheral blood flow increases by 1% each year

1.1.9. Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output

1.1.10. Less elasticity of valves

1.1.11. Thermoregulation alteration Decrease CO Vasoconstriction Reduced peripheral circulation

1.2. Selected Conditions

1.2.1. Hypertension Vasoconstriction Hyperthyroidism, Parkinson's, Paget's, anemia, and thiamine deficiency Atherosclerosis and plaques Fatty diet and increased cholesterol Increased sodium consumption

1.2.2. Hypotension Decrease in baroreceptor sensitivity intake of vasoactive medications Blunting of baroreflex mediated heart rate

1.2.3. Congestive Heart Failure Arteriosclerotic heart disease MI treatment thrombolytic agents Deprived of O2 cause tissue damage Coronary artery disease Hypertension Overstretched muscles decreased cardiac output overloading of ventricles reduced ability of cross action of myosin and actin fibers Increased volume remaining in ventricles after contraction Hypertrophy of myocardial muscle Atrophy of skeletal muscles decreased tissue perfusion

1.2.4. Pulmonary Emboli Immobilization Malnourishment Altered pain sensation may delay diagnosis

1.2.5. Angina Myocardial ishemia MI Plaques and atheriosclerosis CAD Decreased perfusion Increased resistance Resistance to bloodflow Atypical pain presentation

1.2.6. Myocardial Infaction Atypical pain sensation no pain may be present Myocardial ischemia hypertension CAD Atherosclerosis

1.2.7. Hyperlipidemia Lipoprotein disorders uncontrolled diabetes hypothyroidism uremia nephrotic syndrome corticosteroid use thiazide diuretics Increase in LDL Decreased activity tolerance Decreased exercising leads to accumulation of LDL

1.2.8. Atrial Fibrillation Structural defects Congenital abnormalities Comorbidities HTN Ischemic heart disease hyperlipidemia CHF Anemia Arthritis DM CKD

1.2.9. Arteriosclerosis Reduced elasticity of smaller vessels Vasoconstriction Decreased tissue perfusion Increased activity intolerance DM

1.2.10. Aneurysms Advanced arteriosclerosis Infection Trauma Syphilis Abdominal aneurysm pulsating mass could develop a thrombus

1.2.11. Varicose Veins Incompetent valves Lack of exercise Venous stasis and blood pooling Jobs that require long periods of standing Decreased elasticity and strength

2. Respiratory

2.1. Normal Age Related Changes

2.1.1. PO2 reduced as much as 15% between ages 20-80

2.1.2. Loss of elasticity and increased rigidity

2.1.3. Decreased ciliary action

2.1.4. Forced expiratory volume reduced

2.1.5. Blunting of cough and laryngeal reflexes

2.1.6. By age 90, 50% increase in residual capacity

2.1.7. Alveoli fewer in number and larger in size

2.1.8. Thoracic muscles more rigid

2.1.9. Reduced basilar inflation

2.2. Selected Conditions

2.2.1. COPD Asthma Places added stress on heart Bronchiectasis Higher mortality rate Chronic Bronchitis Persistent, productive cough Wheezing Recurrent Respiratory infections SOB Increased WOB d/t cold Recurrent inflammation and mucus production in broncial tubes Emphysema distension of alveolar sacs rupture of alveolar walls destruction of alveolar capillary bed Increased SOB not relieved with sitting up Chronic cough Anorexia and weight loss CHF, malnutrition, and recurrent infections

2.2.2. Pneumonia Causes Poor chest expansion High prevalence of respiratory illness Lowered infection resistance Reduced pharyngeal relfexes Greater incidence of hospitilization

2.2.3. Lung Abscess May result from pneumonia, TB, malignancy, or lung trauma Aspiration of foreign material

3. Digestive

3.1. Normal Age Related Changes

3.1.1. Decreased taste sensation

3.1.2. Esophagus more dilated

3.1.3. Decreased esophageal motility

3.1.4. Reduced saliva and salivary ptyalin

3.1.5. Atrophy of gastric mucosa

3.1.6. Decreased stomach motility, hunger contractions, and emptying time

3.1.7. Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes

3.1.8. Fewer cells on absorbing surface of intestines

3.1.9. Reduced intestinal blood flow

3.1.10. Slower peristalisis

3.1.11. Liver decreased in size

3.2. Selected Conditions

3.2.1. Dry Mouth/Xerostomia medication use for other comorbidities Diuretics HTN anti-inflammatories antidipressants Sjogren's Disease Mouth breathing Altered cognition

3.2.2. Dental Problems Complicatoins Poor PO intake Constipation Malnourishment Socialization Periodontal Disease Predispose to systemic infection Altered taste sensation Poor Diet Low Carbohydrate Excessive sweet consumption Cancer White spots in the mouth damages soft tissue surrounding teeth and supporting bones

3.2.3. Dysphagia Impacts on esophagus Deteriorated esophageal reflex Widening of esophagus Reduced muscle function Impacts on nerves Anything that inhibits innervation from cranial nerves GERD Stroke

3.2.4. Hiatal Hernia Low fiber diet Separation of muscles Stomach or esophagus can slide through diaphragm muscles

3.2.5. Peptic Ulcer Stress Genetics Diet Complication of COPD Decreased gastric mucosa Increased consumption of irritants Drugs Decreased gastric emptying time

3.2.6. Cancer Esophageal Cancer Decreased esophageal protection Smoking Dip use Barret's Esohpagus Alcoholism Dysphagia GERD Stomach Cancer Cigarette smoking Alcoholism Poor socioeconomic groups Decreased gastric emptying time Decreased stomach mucosa Enlarged liver and bleeding may occur Colorectal Cancer Increased risk with red meat consumption Polyps and increased cell proliferation Pancreatic Cancer DNA changes in pancreatic cells Weakening and slowing of pancreas

3.2.7. Diverticulitis Constipation Decreased peristalisis Chronic inflammation and irritation Decreased blood perfusion to bowel low fiber and low residue diets atrophy of intestinal wall muscles

3.2.8. Fecal Incontinence Cognition alterations Innervation and decreased sensory alterations Reduced muscle strength Impaired automacity of rectal sphincters

4. Endocrine

4.1. Normal Age Related Changes

4.1.1. Thyroid gland undergoes fibrosis, cell infiltration, and increased nodularity lower BMR Reduced radioactive iodine uptake less thyrotropin secretion

4.1.2. Total serum iodine decreased

4.1.3. Loss of adrenal function

4.1.4. ACTH decreases

4.1.5. Aldosterone decreases

4.1.6. Pituitary gland decreases in size by 20%

4.1.7. Gonadal secretion declines

4.1.8. Decrease in FSH, TSH, luteinizing homrone, luteotropic hormone

4.1.9. Pancreas Beta cells delayed and insufficient release of insulin Decreased tissue sensitivity to insulin Decreased ability to metabolize glucose

4.2. Selected Conditions

4.2.1. Diabetes Mellitus Glucose intolerance Pancreatic decrease of insulin Increased insulin resistance Poor glucose metabolism Orthostatic Hypotension periodontal disease stroke gastric hypotony impotence neruopathy confusion glaucoma Dupuytren's Contracture infection

4.2.2. Hypothyroidism Primary Decreased T3/T4 and elevated TSH Secondary Decreased T3/T4 and decreased TSH Depression Periorbital edema Cold intolerance Coarse hair Dry skin Constipation Puffy face

4.2.3. Hyperthyroidism Primary Elevated T3/T4 and decreased TSH Secondary Elevated T3/T4 and elevated TSH Amiodarone Cardiac drug that deposits iodine into tissue Affects thyroid function Diaphoresis Heat intolerance Diarrhea Tachycardia Palpitations HTN Hyperreflexia

5. Integumentary

5.1. Normal Age Related Changes

5.1.1. Flattening of dermal-epidermal junction

5.1.2. reduced thickness and vasularity of dermis

5.1.3. Slower epidermal proliferation

5.1.4. increased degeneration of elastin fibers

5.1.5. collagen fibers become coarser and more random

5.1.6. dermis avascular thinner

5.1.7. Appearance skin fine lines wrinkles sagging easier breakdown Hair grays and thins thicker ear and nose hair facial hair may occur in women slower growth rate Nails slower fingernail growth more brittle decreased lunula size Perspiration decreases decreased sweat glands

5.1.8. Melanocytes reduced by 10-20% each decade after 30 years cluster and cause pigmentation or "age spots"

5.1.9. Skin immune response more susceptible to infections Decreases

5.1.10. Thermoregulation Decreased subcutaneous tissue Decreased apocrine glands

5.2. Selected Conditions

5.2.1. Pruritis atrophic changes dry skin excessive bathing dry heat Comorbidities DM Arteriosclerosis Hyperthyroidism Ureia Liver disease cancer pernicious anemia psychiatric problems

5.2.2. Keratosis small, light colored lesions gray or brown Keratin accumulation Precancerous lesion

5.2.3. Seborrheic Keratosis dark wart projections Oily skin, sebaceous secretions

5.2.4. Skin Cancer Basal Cell carcinoma advanced age sun exposure UV radiation Therapeutic radiation commonly on the face flesh colored moles with a pearly surface Squamous Cell carcinoma occurs on squamous cells sun exposure hydrocarbons arsenic radiation Suppression of the immune system Firm, skin colored or red nodules Melanoma tends to metastasize Lentigo maligna melanoma Superficial spreading melanoma Nodular melanoma

5.2.5. Vascular lesions Weakened walls of veins Reduced ability of veins to respond to increased venous pressure Obesity and genetics Varicose veins poor venous return congestion Stasis dermatitis scratching irritation trauma leads to formation of leg ulcers

5.2.6. Pressure injuries skin breakdown bony prominences decreased subcutaenous fat decreased skin elasticity poor nutrition reduced sensation and mobility

6. Immune

6.1. Normal Age Related Changes

6.1.1. Immunosenescence depressed immune response significant infection risk Decreased response to vaccines

6.1.2. Thymic mass declines serum levels almost undetectable Decreased cell mediated immunity T cell changes T cell activity declines More immature T cells present Reactivation of the Herpes Zoster virus Reactivation of mycobacterium tuberculosis

6.1.3. Atypical inflammation presentation low grade fever minimal pain

6.1.4. Increase in proinflammatory cytokines

6.2. Selected Conditions

6.2.1. Rheumatoid Arthritis synovium becomes hypertrophied projections of synovial tissue into joint cavity Painful, stiff, swollen joints Subcut nodules over bony prominences Deforming flexion contractures

7. Musculoskeletal

7.1. Normal Age Related Changes

7.1.1. Muscular Slight hip flexion Impaired flexion and extension movements Slight wrist flexion Slight knee flexion Decreases muscle mass and strength Muscle tremors Degeneration of extrapyramidal system Tendons shrink and harden Reflexes lessened in arms

7.1.2. Skeletal Shortening of vertebrae Slight kyphosis Decrease in bone mass and bone mineral Bones more brittle Height decreases by 2 inches by 70 years

7.1.3. Thermoregulation decreased shivering reduced muscle mass

7.2. Selected Conditions

7.2.1. Osteoarthritis deterioration and abrasion of joint cartilage bone spurs cartilage changes disequilibrium between destructive and synthetic elements decreases homeostasis Excessive use of joint Lack of vitamin D and C genetic facotrs Acromegaly

7.2.2. Osteoporosis metabolic disease of bone demineralization of bone decrease in mass and density inadequate calcium intake poor calcium absorption inactivity or immobility Cushing's syndrome reduced anabolic sex hormones Drugs heparin furosemide corticosteroids tetracycline

7.2.3. Gout uric acid accumulates in blood uric acid crystals deposit around joints severe pain tenderness warmth redness swelling

8. Renal

8.1. Normal Age Related Changes

8.1.1. Decreased size of renal mass

8.1.2. Decreased tubular function

8.1.3. Decreased bladder capacity

8.1.4. Decreased in nephrons

8.1.5. GFR decreases by 50% by age 90

8.1.6. Renal blood flow decreases 53% by age 90

8.1.7. Weaker bladder muscles

8.2. Selected Conditions

8.2.1. UTI Increased sexual intercourse in women Increased urinary obstruction in men BPH Disease/Process that blocks urine flow Urine stasis Decreased sensation Altered cognition Decreased sensation Decreased hygiene practices

8.2.2. Urinary Incontinence Transient incontinence From infections Delirium Medication reactions Excessive urine production Fecal impaction Mood disorders Impaired mobility Established Incontinence Stress incontinence Urgency incontinence Overflow incontinence Neurogenic Reflex Incontinence Functional incontinence Mixed incontinence

8.2.3. Bladder cancer Chronic bladder irritation Cigarette smoking Bladder infections

8.2.4. Renal Caliculi immobilization infection pH or concentration changes of urine chronic diarrhea dehydration dehydration excessive elimination of uric acid hypercalcemia

8.2.5. Glomerulonephritis infection oliguria proteinuria hematuria causes cerebral edema HA HTN convulsions coma aphasia altered mental status

9. Reproductive

9.1. Normal Age Related Changes

9.1.1. Male Fluid retaining capacity of seminal vesicles reduces Possible reduction in sperm count Venous and arterial sclerosis of penis Prostate enlarges in most men

9.1.2. Female Fallopian tubes atrophy and shorten Ovaries become smaller and thicker Cervix becomes smaller Drier, less elastic vagina Flattening of labia Endocervial epithelium atrophies Uterus becomes smaller in size Endometrium atrophies More alkaline vaginal environment Loss of vulvar subcutaneous fat and hair

9.2. Selected Conditions

9.2.1. Female Vaginitis reduction in collagen reduction in adipose tissue shortening and narrowing of vaginal canal decreased elasticity decreased vaginal secretion more alkaline vaginal pH lower estrogen levels increased fragility Vaginal Cancer Chronic irritation wear a pessary Cervical problems Nabothian cysts Cancer Infections and tumors of the vulva more fragile more susceptible to irritation and infection Could be a sign of Senile vulvitis Incontinence Poor hygiene practices Dyspareunia accompanies hormonal changes nulliparous women vulvitis, vaginitis increase risk Breast cancer decreased fat tissue atrophy of breast tissue genetic link

9.2.2. Male Erectile Dysfunction alcoholism diabetes dyslipidemia HTN hypogonadism MS renal failure spinal cord injury thyroid conditions medications BPH nocturia bladder continence issues kidney damage hypertrophy of prostate gland bladder wall loses elasticity Cancer from altered DNA in cells

10. Nervous

10.1. Normal Age Related Changes

10.1.1. Decreased brain weight

10.1.2. Decreased conduction velocity

10.1.3. Reduced blood flow to brain

10.1.4. Changes in sleep pattern

10.1.5. Slower response and reaction time

10.1.6. Sensory changes Vision More opaque lens Decreased pupil size More spherical cornea Presbyopia Narrowed visual field Rhodopsin content in rods decrease Decreased tear formation Taste Atrophy of tongue Reduced saliva production Salt detection most affected Smell Decrease sensory cells in nasal lining Fewer cells in olfactory bulb Hearing Atrophy of hair cells of organ of corti Tympanic membrane sclerosis and atrophy Increased cerumen and concentration of keratin Presbycusis Equilibrium alteration Touch Reduction in tactile sensation Reduced ability to sense pressure Reduced ability to detect pain Reduced discrimination of temperature

10.2. Selected Conditions

10.2.1. Parkinson's Disease alteration in CNS impaired function of basal ganglia decreased dopamine levels from death of substantia nigra impairs smooth motor movement causes exposures to toxins encephalitis cerbrovascular disease tremors and appearance of lewy bodies tremor decreased with purposeful movement muscle rigidity and weakness drooling dysphagia slow speech monotone foice mask like appearance bradykinesia emotional instability depression anxiety increased appetite Sleep disturbances

10.2.2. TIA Cause Hyperextension or flexion of head Drugs cigarette smoking Hemiparesis Hemianesthesia Aphasia unilateral loss of vision vertigo diplopia dysphagia

10.2.3. Vision Cataracts Cloudy lens Loses transparency exposure to Ultraviolet B Diabetes Smoking Alcohol consumption Eye injury Glaucoma Increased IOP Damages optic nerve Increased size of lens Iritis Allergy Endocrine imbalance emotional instability Family hx Macular Degeneration injury Infection Central vision loss Most of the age related changes affect this disease Detached Retina forward displacement of retina Perception of spots blurred vision flashing of light feeling that a coating is developing over the eye progresses to complete loss of vision Corneal Ulcer inflammation of the cornea loss of substance CVA

10.2.4. CVA Risks DM Arteriosclerosis HTN Gout anemia TIAs MI dehydration smokers Ischemic From disrupted blood flow Hemorrhagic ruptured cerebral blood vessel Drop Attack Memory and behavioral changes Hemiplegia Aphasia Hemianopsia