1. Gastrointestinal
1.1. Age related changes
1.1.1. Teeth
1.1.1.1. Dentin production decreases and it become more fibrous.
1.1.1.1.1. This causes teeth to become more fibrous.
1.1.1.2. Nerve chamber become more narrow
1.1.1.2.1. Causes less sensation in the teeth.
1.1.1.3. Bone density lessens
1.1.1.3.1. Increases the number of cavities on the teeth
1.1.1.4. Gingiva retract
1.1.1.5. Tooth loss is typical of aging
1.1.2. Tounge
1.1.2.1. Taste sensation is decreases
1.1.2.1.1. Sweet sensation is lost more so than sour, salty, and bitter sensations.
1.1.3. Saliva
1.1.3.1. 1/3 the production amount t compared to young adults.
1.1.4. Jaw
1.1.4.1. Mastication becomes harder as the muscles in the jaw become weaker
1.1.5. Esophagus
1.1.5.1. Delayed esophageal emptying and dilation occur
1.1.5.1.1. Discomfort can result as food stays in the esophagus longer
1.1.5.2. Decreased gag reflex
1.1.6. Stomach
1.1.6.1. Decreases motility
1.1.6.2. Decrease in pepsin and hydrochloric acid production result in poorly digested food and indigestion
1.1.7. Small intestine
1.1.7.1. Fat absorption is slower
1.1.7.2. Vitamin B, B12, D, calcium, iron, dextrose, and xylose absorption are decreased
1.1.8. Large intestine
1.1.8.1. Decrease in mucus production
1.1.8.1.1. Makes it more difficult for stool to pass through the intestinal walls
1.1.8.2. Loss of sensation in the internal sphincter, and fewer nerve impulses to the lower bowel
1.1.8.2.1. Makes it more difficult for an older adult to know when they need to evacuate their bowels.
1.1.9. Liver
1.1.9.1. Decreased ability to stabilize cholesterol
1.1.9.1.1. Causes increased incidence of gallstones
1.1.10. Pancreas
1.1.10.1. Ducts become dilated, and the entire organ prolapses eventually
1.2. Human needs changes
1.2.1. Eat 5-6 small meals rather than 3 large ones, this will decrease esophageal discomfort
1.2.2. Season foods carefully, to ensure a safe amount of sodium and other herbs are being consumed
1.2.3. Flossing daily can decrease tooth decay and cavity formation
1.3. Pathophysiology
1.3.1. Diverticular disease
1.3.1.1. Multiple ouches of intestinal mucosa in the weakened muscular wall of the large intestine
1.3.1.2. Contributing factors
1.3.1.2.1. Chronic constipation
1.3.1.2.2. Obesity
1.3.1.2.3. Hiatal hernia
1.3.1.2.4. Atrophy of intestinal wall
1.3.1.3. Common in western civilization due to low fiber diets
1.3.1.4. Symptoms
1.3.1.4.1. slight bleeding
1.3.1.4.2. Change in bowel habbits
1.3.1.4.3. tenderness in left lower quadrant
1.3.1.4.4. Inflammation and infection
1.3.1.5. Treatment
1.3.1.5.1. Focus on reducing the infection, providing nutrition, receiving discomfort, and promoting rest
1.3.1.5.2. Consume low residue diet
1.3.1.5.3. Resection surgery for severe cases
1.3.2. Colorectal cancer
1.3.3. Chronic constipation
1.3.4. Dysphagia
1.3.5. Dry mouth
1.3.6. Hiatal Hernia
1.3.7. Flatulence
1.3.8. Intestinal Obstruction
1.3.9. Fecal Impaction
2. Urinary
2.1. Age related changes
2.1.1. Kidneys
2.1.1.1. Renal tissue growth declines
2.1.1.2. Atherosclerosis contributes to renal tissue atrophy
2.1.1.3. 50% loss of renal function between ages 20 and 90
2.1.2. Tubules
2.1.2.1. Less efficient in retaining water and salt, along with other substances normally reabsorbed
2.1.2.1.1. Leads to dehydration and low sodium levels
2.1.3. Bladder
2.1.3.1. Increase in frequency, urgency, and nocturia.
2.1.3.2. Bladder muscles weaken, and bladder capacity decreases
2.1.3.3. Urine retention increases due to the bladder becoming more difficult to empty
2.2. Human needs changes
2.2.1. Ensure age adjusted drug doses to compensate for the decreased ability of the kidneys to filter and reabsorb certain substances
2.2.2. Assist older adult with need for more frequent urination
2.2.3. make sure their room is well lit with dim light at night to lower the risk of falls when they have nocturia
2.2.4. Older adult needs to have his prostate examined annually to keep track of prostatism
2.3. Pathophysiology
2.3.1. Renal calculi
2.3.1.1. Kidney stones
2.3.2. Glomerulonephritis
3. Reproductive
3.1. Age related changes
3.1.1. Men
3.1.1.1. Seminal vessels effected by thinned epithelium, reduced fluid capacity, replacement of muscle with connective tissue, narrowed lumen.
3.1.1.1.1. May result in lower sperm count
3.1.1.2. Increase in follicle stimulation hormone and luteinizing hormone
3.1.1.3. Decrease in testosterone
3.1.1.3.1. This is known as andropause
3.1.1.4. Orgasm and ejaculation less intense
3.1.1.5. Some atrophy to testes
3.1.1.6. Prostatic enlargement
3.1.1.6.1. Causes problems with urinary frequency
3.1.2. Women
3.1.2.1. Atrophy of vulva
3.1.2.2. Loss of Sub-Q fat and hair on the labia
3.1.2.3. Vagina appears pink, dry, and smooth with a shiny canal due to the loss of elastic tissue.
3.1.2.4. Vaginal environment more alkaline, and has fewer secretions
3.1.2.5. Cervix atrophies
3.1.2.6. Uterus shrinks and the endometrium atrophies but still responds to homronal stimuli
3.1.2.6.1. Older women can experience bleeding when on estrogen therapy
3.2. Human needs changes
3.2.1. Men
3.2.2. Women
3.2.2.1. Safe use of lubricants during sex due to decreased amount of natural lubricating secretions
3.3. Pathophysiology
3.3.1. Men
3.3.1.1. Erectile dysfunction
3.3.1.2. Benign prostatic hyperplasia
3.3.1.2.1. Enlargement of the prostate
3.3.1.2.2. Symptoms: Frequency, overflow incontinence, nocturia, bleeding
3.3.1.2.3. As the obstruction form the enlarged prostate increases, the bladder wall loses elasticity and thins
3.3.1.2.4. Treatment may include prostatic massage, or prostatectomy
3.3.2. Women
3.3.2.1. Atrophic vaginitis
3.3.2.1.1. Vaginal infection secondary to this
3.3.2.1.2. Can be treated with estrogen creams or estrogen hormone replacement therapy
3.3.2.2. Cancer of the Vagina
3.3.2.2.1. Usually a different cancer that metastasizes to the vagina
3.3.2.2.2. Treatment may include radiation, chemo, or surgery, depending on how far along the cancer is
3.3.2.3. Cancer of the cervix
3.3.2.4. Dyspareunia
3.3.2.5. Breast cancer
3.3.2.5.1. Decrease in fat tissue can lead to tumor development
3.3.2.5.2. Attend routine mammograms to detect breast cancer early
4. Musculoskeletal
4.1. Age related changes
4.1.1. Muscle tissue atrophies and is replaced with connective tissue eventually
4.1.1.1. leads to muscle flabbiness, weakness, and decreases in movement.
4.1.2. Tendons shrink and harden
4.1.2.1. Causes decrease in tendon jerks.
4.1.3. Reflexes lessenes in the arms, absent in the abdomen, but maintained int he knee
4.1.4. Bone minerals and mass are reduces
4.1.4.1. Leads to fractures and brittleness.
4.1.4.1.1. Women experience the loss of bone mass after menopause.
4.1.5. Diminished calcium reabsorption
4.1.6. Deterioration of cartilage in joints results in limited joint movement
4.1.7. Discs become thinner, resulting in shorter vertebral column, and shortening the stature of older adults
4.1.8. Decreased muscle mass
4.1.8.1. Contributes to inability to regulate temperature.
4.2. Human needs changes
4.2.1. Daily exercise important in maintaining strength, and flexibility, but avoid straining muscles
4.3. Pathophysiology
4.3.1. Osteoporosis
4.3.2. Osteoarthritis
4.3.3. Rheumatoid arthritis
4.3.4. Gout
4.3.4.1. Metabolic disorder in which uric acid accumulates in the blood.
4.3.4.1.1. The uric acid forms crystals that are deposited on the joints of the body
4.3.4.2. Treatment
4.3.4.2.1. Low purine (meat) diet
4.3.4.2.2. Avoid alcohol
4.3.4.2.3. Medications
4.3.5. Podiatric conditions
4.3.5.1. Calluses
4.3.5.2. Corns
4.3.5.2.1. con shaped layers of thick, dry skin that forms over bony prominence.
4.3.5.3. Bunions
4.3.5.4. hammer toe
5. Nervous system
5.1. Age related changes
5.1.1. Brain
5.1.1.1. Reduction in neurons, nerve fibers, cerebral blood flow, and metabolism.
5.1.1.2. Less prominent stage 3 and 4 sleep stages, frequent awakening can occur
5.1.2. Nerves
5.1.2.1. Nerve conduction velocity is lower
5.1.2.1.1. Slower reflexes, delayed response to multiple stimuli
5.1.2.2. Slower response to change in balance
5.1.2.2.1. Results in more frequent falls
5.1.3. Hypothalamus
5.1.3.1. Less effective temperature regulation
5.1.3.1.1. Lower body temperatures
5.2. Human needs changes
5.2.1. Try to eliminate any nightly interruptions as they reduce the already lowered amount of sleep an older adult receives
5.2.2. Allow older adult more time to process stimuli and respond in conversations
5.3. Pathophysiology
5.3.1. Insomnia
5.3.2. Restless leg syndrome
5.3.2.1. Uncontrollable urge to move the legs, which increases in severity with age
5.3.2.2. Sensations such as burning, itching, uncomfortable, painful, and pulling are relieved by leg movements but interfere with sleep
5.3.2.2.1. Dehydration worsens the symptoms
5.3.2.3. Caused by iron deficiency anemia, uremia, parkinson's disease, arthritis, diabetes, or neurologic lesions
5.3.2.4. Treated with benzodiazepines, opioids, anticonvulsants, adrenergic, and iron supplements
5.3.3. Sleep Apnea
6. Eyes
6.1. Age related changes
6.1.1. Lens
6.1.1.1. Presbyopia: Inability to focus or accommodate properly due to reduced elasticity of the lens.
6.1.1.1.1. Begins in the 4th decade
6.1.1.2. Stiffening of the muscles that effect the ability of the lens to focus causes a decreased ability to focus and adjust to light
6.1.1.2.1. Causes low light vision difficulty
6.1.1.3. Thickening of the lens results in increased opacification.
6.1.1.3.1. Cataracts. begins int he 5th decade
6.1.1.3.2. Exposure to the sound (UV rays) increases the rate at which cataracts develop.
6.1.2. Retina
6.1.2.1. Decreased blood flow to the retina
6.1.2.1.1. Causes macular degeneration
6.1.2.2. Decreased ability to differentiate between cool colors like blue and green
6.1.2.3. Decreased amount of photoreceptor cells
6.1.3. Connection between the eyes
6.1.3.1. Depth perception decreases as the connection between the eyes and the retinal pictures received by the brain become less connected
6.1.3.2. Ciliary muscle is replaced by connective tissue.
6.1.4. Cornea
6.1.4.1. sensitivity is decreased
6.1.4.1.1. Increased risk for corneal injury
6.1.4.2. Lipid deposits in the cornea can cause scattering of light rays which blurs vision
6.2. Human needs changes
6.2.1. Avoid using blues and greens together, as they can be confuse for the same color
6.2.2. Use eye protection in the sun to reduce corneal damage
7. Ears
7.1. Age related changes
7.1.1. Inner Ear
7.1.1.1. presbycusis
7.1.1.1.1. Progressive hearing loss that occurs due to loss of heat cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph
7.1.1.2. Increase in amount of cerumen in the middle ear
7.1.1.2.1. Decreases hearing ability
7.1.1.3. Acoustic reflex
7.1.1.3.1. The buffering of noise made by ones own voice is reduced
8. Respiratory
8.1. Age related changes
8.1.1. Costal cartilage
8.1.1.1. Calcification of costal cartilage makes trach and rib cage rigid.
8.1.2. Cough and laryngeal reflexes
8.1.2.1. Decreased.
8.1.3. Chest diameter
8.1.3.1. Increases
8.1.4. Mouth
8.1.4.1. Mouth breathing more common, leads to snoring & obstructive apnea
8.1.5. Nose
8.1.5.1. Connective tissue loosens, causing tip of nose to rotate down.
8.1.6. Submucosal glands
8.1.6.1. Less liquid secretions means they are harder to remove, causing stuffiness.
8.1.6.2. # of cilia decrease, increasing the difficulty of removing secretions.
8.1.6.3. Bronchial mucous gland hypertrophy causes difficulty in expelling mucus.
8.1.7. Alveoli
8.1.7.1. 6th Decade of life
8.1.7.1.1. Decrease in number
8.1.7.1.2. Decrease in elasticity
8.1.8. Lungs
8.1.8.1. Smaller
8.1.8.1.1. Less lung expansion
8.1.8.2. Increased rigidity
8.1.8.2.1. Insufficient basilar inflation
8.1.8.2.2. Decreased ability to expel foreign matter
8.1.8.3. Exhale less effectively
8.1.8.3.1. Increased residual volume
8.1.8.3.2. Decreased vital capacity
8.1.8.3.3. Decreased maximum capacity
8.2. Human needs changes
8.2.1. Respiratory activity important in increasing lung capacity
8.3. Pathophysiology
8.3.1. COPD
8.3.2. Asthma
8.3.3. Chronic Bronchitis
8.3.4. Emphysema
8.3.4.1. Chronic cough
8.3.4.2. Not corrected by sitting up
8.3.4.3. Contributing factors: Inhaling pollutants form the environment, chronic bronchitis, and the normal lung changes from aging
8.3.5. Lung Cancer
9. Cardiovascular
9.1. Age related changes
9.1.1. Physical changes of the heart
9.1.1.1. Left ventricular hypertrophy
9.1.1.2. Aorta dilated and elongated
9.1.1.3. Atrioventricular valves become thick and rigid.
9.1.1.3.1. Incomplete valve closure (murmurs)
9.1.2. Heart muscle
9.1.2.1. Loss of contractile strength
9.1.2.1.1. Reduced cardiac output
9.1.3. Pacemaker cells
9.1.3.1. Decrease in number and regularity
9.1.3.1.1. Leads to irregular contractions
9.1.3.2. Contraction and relaxation of left ventricle require more time
9.1.3.2.1. Increases amount of time needed for filling and emptying leads to more time per contraction.
9.1.4. Blood vessels
9.1.4.1. Tunica intima
9.1.4.1.1. Fibrosis, and accumulation of calcium, cells, and lipids.
9.1.4.2. Tunica media
9.1.4.2.1. Thinning, and clarification of elastin fibers
9.1.4.3. Inefficient ability to vasoconstrict
9.1.4.3.1. Contributes to inability to regulate body temperature (cooler body temp)
9.1.5. Baroreceptors
9.1.5.1. Decreased sensitivity to blood pressure changes
9.1.5.1.1. Causes problems with regulating blood pressure
9.1.6. Blood pressure
9.1.6.1. Increases gradually with age.
9.1.6.1.1. Occurs more frequently in older adults who live in more industrialized areas.
9.2. Human needs changes
9.2.1. Low sodium diet can aid in high blood pressure
9.2.2. limiting fats and foods high in cholesterol and help prevent atherosclerosis
9.2.3. Remaining active through old age maintains cardiovascular strength
9.3. Pathophysiology
9.3.1. Hypertension
9.3.2. Orthostatic hypotension
9.3.2.1. Commonly caused by medications (polypharmacy)
9.3.2.1.1. Can contribute to falls
9.3.3. Congestive heart failure
9.3.3.1. Leading cause of hospitalizations in older adults
9.3.3.2. Hypertension and coronary artery disease are leading contributing factors
9.3.4. Pulmonary embolism
9.3.5. CAD
9.3.5.1. Coronary artery disease
9.3.5.1.1. Ischemic heard disease
9.3.6. Hyperlipidemia
9.3.6.1. Contributes to atherosclerosis
9.3.7. Arrhythmias
9.3.7.1. Caused by dig toxicity, hypokalemia, acute infections, hemorrhage, coronary insufficiency.
9.3.8. Peripheral vascular disease
10. Nose
10.1. Age related changes
10.1.1. Reduced sense of smell due to decreased number of sensory cells in the nasal lining and in the olfactory portion of the brain
10.1.1.1. Detection of scent by age 80 is half of what it was at its peak
10.1.2. Men experience greater loss in smell than women
10.1.3. Taste is dependent on smell, so taste is decrease as well
11. Endocrine
11.1. Age related changes
11.1.1. Thyroid
11.1.1.1. Fibrosis, cellular infiltration, increased nodularity.
11.1.1.2. Lower activity
11.1.1.2.1. causes a decreases metabolic rate
11.1.2. Pituitary Glands
11.1.2.1. ACTH production reduced
11.1.2.1.1. Causes decreased secretion from the adrenal glands
11.1.3. Pancreas
11.1.3.1. Delayed production of insulin
11.1.3.1.1. Ability to metabolize glucose is decreasd
11.2. Human needs changes
11.2.1. Reduce the amount of calories consumed as the body uses less of them
11.2.2. Avoid high intake of carbohydrates as the glucose levels of older adults is already high
11.3. Pathophysiology
11.3.1. Diabetes Mellitus
11.3.2. Hypothyroidism
11.3.3. Hyperthyroidism
12. Integumentary
12.1. Age related changes
12.1.1. Skin
12.1.1.1. Callogen fibers become more random, causing decreases skin elasticity
12.1.1.2. Dermis thins
12.1.1.3. The sum of all integumentary changes result in lines, wrinkles, and sagging of skin
12.1.1.4. Becomes drier
12.1.2. Hair
12.1.2.1. Scalp, pubic, and axillary hair thins and becomes more grey due to loss of pigment cells and atrophy of hair bulbs
12.1.2.2. Growth of facial hair in women may occur
12.1.2.3. Increase in eyebrow, ear, and nostril hair increase in men
12.1.3. FIngernails
12.1.3.1. Growth slows
12.1.3.2. Become more brittle
12.2. Human needs changes
12.2.1. Faith less frequently to conserve the natural oils that hydrate the skin
12.3. Pathophysiology
12.3.1. Pruitis
12.3.1.1. Most common dermatologic problem among older adults
12.3.1.2. Excessive itching from this condition can cause infection and skin breakage
12.3.2. Keratosis
12.3.3. Seborrhec Keratisis
12.3.4. Pressure ulcers
13. Spirituality
13.1. Human needs changes
13.1.1. Love
13.1.1.1. Need for unconditional, unselfish, spiritual love
13.1.1.2. The type of love that God has for people is what the older adult seeks, they need to feel loved regardless of physical, mental, social, or material positions
13.1.2. Meaning and purpose
13.1.2.1. Healthy aging requires a sense of integrity which is supported by life experiences.
13.1.2.2. Some believe their actions and experiences are weight in the eyes of God
13.1.3. Hope
13.1.3.1. Expectation for something in the future
13.1.3.2. Some look forward to the wonders of tomorrow
13.1.3.3. Hope gets some through their suffering because they know better things lie at the end
13.1.4. Dignity
13.1.4.1. Since worth in most of the world is determined by appearance, and status, older adults look toward their relationship with God for dignity and worth
13.1.5. Foregiveness
13.1.5.1. Forgiving others and allowing others to forgive you is an important part of aging, as it mends relationships that are important in the later years
13.1.6. Gratitude
13.1.6.1. Losses are typically great in old age, and being grateful for what a person had, or hat they still have is helpful in combating the negative emotions of loss
13.1.7. Transcendence
13.1.7.1. This allows older adults to feel they are part of something greater, which makes dealing with difficult situations easier
13.1.8. Expression of faith
13.1.8.1. Prayer, scripture reading, rituals, all help a person to become more in tune with their faith and they are important practices as older adults
13.1.8.2. Spiritual distress can make it seem like God has abandoned a person, or they are not worthy. This can have detrimental effects on a persons mind and health, and they need to be consoled.
14. Nutrition
14.1. Human needs changes
14.1.1. Fiber
14.1.1.1. Soluble fibers decrease cholesterol, improve glucose control in diabetics, and prevents obesity.
14.1.1.2. Increased fiber reduces risk of colon cancer
14.1.2. Carbohydrates
14.1.2.1. Reduce carb intake!
14.1.2.1.1. Increased intake of carbs can cause unusually high release of insulin, causing hypoglycemia
14.1.3. Protein
14.1.3.1. At least 1g per day for older adults
14.1.4. Calcium and Vitamin D
14.1.4.1. Calcium is needed for the maintence of bone, which is especially important in older adults
14.1.4.2. Vitamin D is needed for the absorption of calcium
14.1.5. Fruits and veggies
14.1.5.1. Older adults should get at least 5-6 servings of fruits and veggies per day
14.1.6. Hydration
14.1.6.1. Intracellular fluid is decreased with age, which means less fluid in the body
14.1.6.2. Lessened thirst reflex means an older adult has trouble knowing when they are dehydrated and may need a schedule or help identifying the signs of dehydration.