1. Gastrointestinal System
1.1. Decrease in strength of muscles of mastication, taste and thirst perception
1.1.1. Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition.
1.2. Decreased gastric motility with delayed emptying
1.3. Atrophy of protective mucosa
1.3.1. Aaltered drug absorption, increased risk of GERD, maldigestion, NSAID-induced ulcers.
1.4. Malabsorption of carbohydrates, vitamin B12, vitamin D, folic acid and calcium
1.5. Impaired sensation to defecate
1.5.1. Constipation and risk of fecal incontinence
1.6. Reduced hepatic reserve and decreased metabolism of drugs
1.7. PATHOLOGIES
1.7.1. GERD
1.7.1.1. Severe heartburn
1.7.2. Jaundice
1.7.3. Diverticulitis
1.7.3.1. Small pouches may form along the walls of the large intestine (nuts and seeds may get caught in them)
1.7.4. Cirrhosis
1.7.5. Dysphagia
1.7.5.1. Difficulty swallowing
1.7.6. Crohn's disease
1.7.6.1. Chronic inflammatory disease of the bowel
1.8. NUTRITION
1.8.1. Required amount of nutrients vary over lifetime
1.8.1.1. Soluble fiber, reduction of carbohydrate intake, 10-20% protein, calcium absorption decreases with age, 5 servings of fruits and vegetables daily
1.8.2. Reduced need for calories
1.8.3. Less lean body mass
1.8.4. Basal metabolic rate declines
1.8.5. Activity level lowered
2. Musculoskeletal System
2.1. Sarcopenia with increased weakness and poor exercise tolerance
2.1.1. Increased risk of disability, falls, unstable gait
2.2. Lean body mass replaced by fat with redistribution of fat
2.3. Bone loss in women and men after peak mass at 30-35 years
2.3.1. Risk of osteopenia and osteoporosis
2.4. Decreased ligament and tendon strength, intervertebral disc degeneration
2.4.1. Limited ROM, joint instability, risk of osteoarthritis
2.5. Articular cartilage erosion and changes in stature with kyphosis and height reduction
2.6. PATHOLOGIES
2.6.1. Muscular dystrophy
2.6.1.1. Damage of muscle fiber
2.6.2. Myasthenia gravis
2.6.2.1. Autoimmune, muscle weakness and fatigue
2.6.3. Compartment syndrome
2.6.3.1. Blood vessels, muscles and nerves get compressed
2.6.4. Muscle cramps
2.6.5. Tendonitis
3. Nervous System
3.1. Decreased conduction velocity
3.2. Slower response and reaction time
3.2.1. Impairments in general muscle strength; deep-tendon reflexes; nerve conduction velocity. Slowed motor skills and potential deficits in balance and coordination
3.3. Decreased brain weight
3.4. Reduced blood flow to the brain
3.4.1. Slowed speed of cognitive processing. Some cognitive decline is common
3.5. Changes in sleep pattern
3.5.1. Increased risk of sleep disorders, delirium, neurodegenerative diseases
3.6. PATHOLOGIES
3.6.1. Stroke
3.6.2. TIA
3.6.3. Hematoma
3.6.3.1. Solid swelling of clotted blood
3.6.4. Meningitis
3.6.5. Encephalitis
3.6.5.1. Inflammation of the brain
3.6.6. Polio
3.6.6.1. Paralysis
3.7. SLEEP
3.7.1. Circadian sleep wake cycles
3.7.2. More time in stages 1 and 2
3.7.3. Less sound sleep
3.7.4. Insomnia, leg movements, sleep apnea, medical conditions, medications
3.7.5. Apartment on busy street, snoring spouse, excessively warm room, bright hallway lights, caffeine, alcohol and pain
4. Immune System
4.1. Diseases especially infections may manifest with atypical symptoms in older adults
4.1.1. Sign/symptoms often include nonspecific declines in function or mental status, decreased appetite, incontinence, falls, fatigue and exacerbations of chronic diseases
4.2. Fever blunted or absent in very old, frail, malnourished adults
4.3. Baseline oral temperature in older adults is 97.4 degrees fahrenheit
4.4. T Cell activity declines
4.4.1. Changes in T cells contribute to the reactivation of varicella zoster and tuberculosis
4.5. PATHOLOGIES
4.5.1. Eczema
4.5.2. Allergic rhinitis
4.5.2.1. Sneezing, runny nose
4.5.3. Type 1 diabetes
4.5.4. Rheumatoid arthritis
4.5.4.1. Swelling and deformities of joints
4.5.5. Lupus
4.5.5.1. Attacks body tissues like lungs, kidneys and skin
5. Sensory System
5.1. VISION: Presbyopia is the inability to focus or accommodate properly due to reduced elasticity of the lens, begins in the fourth decade of life.
5.1.1. Depth perception is distorted causing problems judging the height of curbs and steps, risk of falls
5.2. HEARING: Presbycusis is the progressive hearing loss that occurs as a result of changes to the inner ear including loss of hair cells, decreased blood supply and reduced production of endolymph.
5.2.1. Equilibrium can be altered because of degeneration of the vestibular structures and atrophy of the cochlea, risk of falls
5.3. TASTE AND SMELL: The sense of smell reduces with age because of a decrease in the number of sensory cells in the nasal lining and fewer cells in the olfactory bulb. Atrophy of the tongue with age can diminish taste sensations.
5.4. TOUCH: A reduction in the number of and changes in the structural integrity of touch receptors occurs with age, tactile sensation is reduced
5.4.1. May cause misperceptions of the environment which may cause profound safety risks.
5.5. PATHOLOGIES
5.5.1. Tinnitus
5.5.1.1. Ringing
5.5.2. Astigmatism
5.5.2.1. Abnormal reaction to light
5.5.3. Otitis Interna
5.5.3.1. Produces vertigo
5.5.4. Conjunctivitis
5.5.5. Strabismus
5.5.5.1. Deviation of the eyes
5.6. SPIRITUALITY
5.6.1. Love
5.6.2. Meaning and purpose
5.6.3. Hope and dignity
5.6.4. Forgiveness and gratitude
5.6.5. Transcendence and expression of faith
6. Reproductive System
6.1. SEXUALITY
6.1.1. Older adults can and do enjoy sex
6.1.2. Sexual behavior remains consistent throughout life
6.1.3. Nurses should recognize and respect sex specific roles of older adults identity
6.1.4. More than just physical acts- love, intimate words and touch, feeling wanted, caring and sharing
6.2. MALE: Possible reduction in sperm count, venous and arterial sclerosis of penis, prostate enlarges and fluid retaining capacity of seminal vesicles reduce
6.2.1. Older men do not lose the physical capacity to achieve erections or ejaculate
6.3. FEMALE: Fallopian tube atrophy and shortening, ovaries become thicker and smaller, drier less elastic vaginal canal, uterus becomes smaller in size and labia flattens
6.3.1. Involuntary release of urine when there is an increase in intra-abdominal pressure
6.4. PATHOLOGIES
6.4.1. Prostate cancer
6.4.2. Breast cancer
6.4.3. Pelvic inflammatory disease (PID)
6.4.4. Hydrocele
6.4.4.1. Fluid filled sac surrounding the testes
6.4.5. Benign Prostatic hypertrophy
6.4.5.1. Difficulty urinating, dribbling and nocturia
6.4.6. Erectile dysfuntion
7. Integumentary System
7.1. The dermal and epidermal junction flatten, reduced thickness and vascularity of the dermis, slowing of epidermal proliferation and an increased quantity and degenertation of elastin fibers occur
7.1.1. Skin immune response declines causing older adults to be more prone to skin infections
7.2. Collagen fibers become coarser which reduces skin elasticity
7.2.1. Reduction of melanocytes causes older adults to tan more slowly
7.3. Dermis becomes more avascular and thinner. The skin becomes less elastic and more dry and fragile, subcutaneous fat is lost, lines, wrinkles and sagging become more evident
7.4. Scalp, pubic, and axillary hair thins and grays due to a progressive loss of pigment cells and atrophy and fibrosis of hair bulbs, but hair in the ear and nose become thicker
7.4.1. By age 50 some men have baldness and some women may have facial hair
7.5. PATHOLOGIES
7.5.1. Scabies
7.5.1.1. Mites that burrow in the skin
7.5.2. Rosacea
7.5.2.1. Persistent blushing
7.5.3. Melanoma
7.5.3.1. Symptoms are any changes in a mole's appearance
7.5.4. Acne
7.5.5. Psoriasis
7.5.5.1. White, scaley
8. Renal and Genitourinary System
8.1. Decrease in kidney mass, blood flow and GFR (10% decrement after age 30) and decreased drug clearance
8.1.1. Reduced renal functional reserve; risk of renal complications in illness.
8.2. Reduced bladder elasticity and muscle tone and capacit
8.2.1. Risk of nephrotoxic injury and adverse reactions from drugs
8.3. Increased postvoid residual and nocturnal urine production
8.3.1. Risk of volume overload, dehydration, hyponatremia, hypernatremia, hyperkalemia
8.4. In males, prostate enlargement with risk of BPH
8.4.1. Increased risk of urinary urgency, incontinence, urinary tract infection, nocturnal polyuria
8.5. Decreased tubular function
8.6. PATHOLOGIES
8.6.1. UTI
8.6.2. Kidney stones
8.6.2.1. Solid deposit that occurs in urinary system, drink more water
8.6.3. Prostatitis
8.6.3.1. Inflammation of prostate
8.6.4. Kidney failure
8.6.4.1. No longer able to remove waste from blood
9. Endocrine System
9.1. The thyroid gland undergoes fibrosis, cellular infiltration and increased nodularity
9.1.1. Thyroid gland progressively atrophies and the loss of adrenal function can decrease thyroid activity
9.2. ACTH secretion decreases with age as well as secretory activity of the adrenal gland
9.2.1. Pituitary hormone
9.3. The pituitary gland decreases in volume by approximately 20%
9.4. Decreases in ACTH, TSH, follicle-stimulating hormone, luteinizing hormone and luteotropic hormone are seen
9.5. Delayed and insufficient release of insulin by the beta cells of the pancreas and decreased tissue sensitivity to circulating insulin
9.5.1. Metabolizing glucose is reduced
9.6. PATHOLOGIES
9.6.1. Hypothyroidism
9.6.1.1. Too little thyroid hormone
9.6.2. Hyperthyroidism
9.6.2.1. Too much thyroid hormone
9.6.3. Hypoglycemia
9.6.3.1. Low glucose
9.6.4. Hyperglycemia
9.6.4.1. High glucose
9.6.5. Menopause
9.6.5.1. Ovarian reproductive function ends
10. Cardiovascular System
10.1. Arterial wall thickening and stiffening
10.2. Left ventricular and atrial hypertrophy, Sclerosis of atrial and mitral valves
10.3. Strong arterial pulses, diminshed peripheral pulses and cool extremitites
10.4. Stroke volume decreases by 1% per year
10.5. Less efficient 02 utilization
10.5.1. Fatigue, SOB, slow recovery time from tachycardia
10.6. Cardiac output decreases
10.6.1. At rest no change in heart rate or cardiac output
10.7. PATHOLOGIES
10.7.1. Coronary artery disease
10.7.1.1. narrowing
10.7.2. Heart attack
10.7.3. Heart failure
10.7.3.1. Heart doesnt pump as well as it should
10.7.4. Pericarditis
10.7.4.1. Lining around heart inflammed
10.7.5. Atherosclerosis
10.7.5.1. Build up of fats and cholesterol in artery walls
11. Respiratory System
11.1. PO2 reduced as much as 15% between ages 20-80
11.1.1. Decreased respiratory excursion and chest and lung expansion with less effective exhalation
11.2. Loss of elasticity and increased rigidity
11.3. Decreased ciliary action
11.3.1. Decreased cough and mucus clearance
11.4. Forced expiratory volume reduced
11.5. Blunting of cough and laryngeal reflexes
11.6. Alveoli fewer in number and larger in size
11.6.1. Increased risk of infection and bronchospasm with airway obstruction
11.7. PATHOLOGIES
11.7.1. Asthma
11.7.2. Chronic bronchitis
11.7.2.1. Causes persistent, productive cough (wheezing, SOB)
11.7.3. Emphysema
11.7.4. Lung Cancer
11.7.5. Lung Abscess
11.7.5.1. Pneumonia, tuberculosis, malignancy, trauma and aspiration