1. Neurological
1.1. Normal aging changes
1.1.1. Sleeping changes
1.1.1.1. Circadian sleep-wake cycles
1.1.1.1.1. Phase advance common among older adults
1.1.1.2. More sleep time spent in Stage 1 and 2 and less time spent in Stages 3 and 4
1.1.1.3. Less sound sleep, delay in onset of sleep - Reduction in NREM and REM sleep
1.1.1.3.1. Problems with sleep
1.1.2. Loss of nerve cell mass
1.1.2.1. Atrophy of the brain and spinal cord
1.1.3. Number of dendrites declines
1.1.4. Demyelinization - slower nerve conduction; response and reaction times are slower; reflexes become weaker
1.1.5. Plaques, tangles, atrophy of the brain
1.1.6. Free radicals accumulate
1.1.7. Fatty deposits accumulate in blood vessels
1.1.8. Slowing in central processing - delay in time required to perform tasks
1.1.9. Problems r/t aging
1.1.9.1. Parkinson's Disease - affects ability of the CNS to control body movements and muscles; role of dopamine is affected
1.1.9.2. Transient Ischemic Attacks - temporary or intermittment reduction in cerebral perfusion
1.1.9.3. Cerebrovascular accident
1.1.9.3.1. Ischemic
1.1.9.3.2. Hemorrhagic
1.1.9.3.3. Drop attack - fall caused by a complete muscular flaccidity in the legs, without an alteration in consciousness
2. Musculoskeletal
2.1. Normal effects of aging/ problems with aging
2.1.1. Decline in size and number of muscle fibers and reduction in muscle mass
2.1.1.1. Decreased body strength and endurance declines
2.1.2. Connective tissue changes - reduced flexibility of joints and muscles
2.1.3. Sarcopenia - age related reduction of muscle mass or function resulting from a reduction in protein synthesis and an increase in muscle protein degeneration
2.1.3.1. can lead to disability
2.1.4. Psychosocial factors impacting activity
3. Circulation
3.1. Normal effects of aging and problems with it
3.1.1. Heart declines
3.1.1.1. Problems
3.1.1.1.1. Arrhythmia - abnormal heart rate or rhythm
3.1.1.1.2. Atherosclerosis - hardening and narrowing of arteries due to plaque build up in vessel walls
3.1.1.1.3. Physical deconditioning - decline in cardiovascular function due to physical inability
3.1.1.1.4. Homan's sign - pain when the affected leg is dorsiflexed, usually associated with deep phlebitis of the leg
3.1.1.1.5. Hypertension - consistent BP+ 140-90
3.1.1.1.6. Postural hypotension - decline in systolic BP of 20+ after rising and standing for 1 min
3.1.1.1.7. Diseases
3.1.2. Heart valve becomes thicker and rigid
3.1.3. Aorta becomes dilated
3.1.3.1. Slight ventricular hypertrophy
3.1.4. Myocardial muscle less efficient
3.1.4.1. Decreased contractile strength
3.1.4.2. Decreased CO when demands increased
3.1.5. Calcification, reduced elasticity of vessels
3.1.6. Less sensitivity to baroreceptor regulation of BP
3.2. Regular exercise
3.2.1. Physical deconditioning can heighten many of the age-related functional declines
4. GU
4.1. Normal effects of aging
4.1.1. Hypertrophy and thickening of the bladder muscle
4.1.1.1. Decreases bladder ability to expand
4.1.1.2. Reduced storage capacity
4.1.1.2.1. Daytime urinary frequency and nocturia
4.1.2. Changes in cortical control of micturition
4.1.3. Inefficient neurological control of bladder emptying and weaker bladder muscle
4.1.3.1. Retention of large volumes of urine
4.1.4. Kidney filtration ability decreases
4.1.4.1. Effects ability to eliminate drugs
4.1.5. Reduced renal function - high blood urea nitrogen levels
4.1.6. Decreased tubular function - concentration of urine changes
4.1.7. Increased in renal threshold for glucose
4.1.8. Problems related to aging
4.1.8.1. Overflow incontinence
4.1.8.2. Bladder cancer
4.1.8.3. Renal calculi - causes of stone formation
4.1.8.4. Glomerulonephritis
5. Reproductive
5.1. Female
5.1.1. Effects of aging
5.1.1.1. Hormonal changes - vulva atrophies, flattening of the labia, loss of subQ fat and hair
5.1.1.2. Vaginal epithelium thins
5.1.1.3. Cervix, uterus, fallopian tubes atrophy
5.1.1.4. Vaginal canal changes - reduction in collagen and adipose tissue
5.1.1.5. More alkaline vaginal pH as a result of lower estrogen changes
5.1.1.6. Uterus and fallopian tubes smaller
5.1.1.7. Endometrium continues to respond to changes
5.1.1.8. Retraction of nipples
5.1.1.9. Problems with aging
5.1.1.9.1. Seinile vulvitis - hypertrophy or atrophy of vulva
5.1.1.9.2. Tumors of vulva
5.1.1.9.3. Atrophic vaginitis
5.1.1.9.4. Cervical, endometrium, ovaries cancer
5.1.1.9.5. Perineal herniation
5.1.1.9.6. Dyspareunia
5.1.1.9.7. Breast cancer
5.2. Male
5.2.1. Effects of aging
5.2.1.1. Seminal vesicles develop thinner epithelium
5.2.1.2. Muscle tissue replaced with connective tissue
5.2.1.3. Decreased capacity to retain fluids
5.2.1.4. Seminiferous tubule changes - increased fibrosis, epithelium thinning
5.2.1.5. Atrophy of testes
5.2.1.6. Ejaculation fluid less sperm
5.2.1.7. Testosterone same or decreased
5.2.1.8. Enlargement of prostate
5.2.1.9. Erection takes more time
5.2.1.10. Problems with aging
5.2.1.10.1. Erectile dysfunction
5.2.1.10.2. Benign Prostatic Hyperplasia - men experience dysuria
5.2.1.10.3. Cancer of prostate
5.2.1.10.4. Cancer of penis
5.2.1.10.5. Tumors of the scotum
6. Sensory
6.1. Vision
6.1.1. Normal effects on aging
6.1.1.1. Reduced elasticity and stiffening of the muscle fibers of the lens
6.1.1.1.1. Presbyopia = decreased ability to focus
6.1.1.2. Reduced pupil size
6.1.1.3. Opacification of the lens and vitreous humor declines
6.1.1.4. Loss of photoreceptor cells in the retina
6.1.1.4.1. Light perception threshold decreases
6.1.1.4.2. Dark and light adaptation takes longer
6.1.1.5. Increased sensitivity to glare
6.1.1.6. Distortion in depth perception
6.1.1.7. Peripheral vision reduced
6.1.2. Problems effecting aging
6.1.2.1. Cataracts - clouding of the lens and loss of transparency
6.1.2.2. Glaucoma - damage to the optic nerve from an above normal intraocular pressure
6.1.2.3. Macular degeneration - damage or breakdown of the macula leading to loss of central vision
6.1.2.4. Detached retina - like a curtain coming over the eyes
6.1.2.5. Diabetic Retinopathy
6.1.2.6. Corneal ulcer
6.2. Hearing
6.2.1. Normal effects/problems
6.2.1.1. Sensorineural hearing loss = presbycusis
6.2.1.1.1. loses high pitch hearing first
6.2.1.1.2. Can't differentiate between voices
6.2.1.2. Conductive hearing disorder - blockage of the sound waves
6.2.1.2.1. impacted cerumen = earwax
6.2.2. Problems with aging
6.2.2.1. Stroke causes hearing loss on affected side
6.2.2.2. Viral infections can cause deafness
6.2.2.3. Otosclerosis - the bone attachment is not shaking like it should
6.2.2.4. Minnears
6.2.2.4.1. Tinnitus - ringing in the ear
6.2.2.4.2. Vertigo
6.3. Other changes
6.3.1. Number of functioning taste buds decreased = sweet and salty flavors
6.3.2. Pressure not sensed as easily in late life
6.3.2.1. Decreased tactile sensation
6.3.2.2. Difficulty discriminating between temp
6.3.3. Some olfactory function loss
7. Endocrine
7.1. Normal and problem of aging changes
7.1.1. Thyroid gland atrophies and activity decreased - lower BMR, reduced radioactive iodine uptake, less secretion and release of thyrotropin
7.1.2. Diminished adrenal function
7.1.2.1. ACTH secretion decreases = effects blood pressure
7.1.3. Volume of pituitary gland decreases = GH, LG, FHS
7.1.4. Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
7.1.4.1. Type 2 DM
8. Respiratory
8.1. Normal Effects and problems of aging
8.1.1. Elastic recoil - lungs ability to expand and contract
8.1.1.1. Lung cancer - dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections
8.1.1.1.1. Treatment = surgery, chemo, radioteherapy
8.1.1.2. Lung abscess
8.1.1.2.1. Causes = pneumonia, TB, malignancy, trauma, aspiration
8.1.1.2.2. Symptoms = anorexia, weight loss, elevated temp, chronic cough
8.1.1.2.3. Treatment = postural drainage, high protein and high calorie diet
8.1.2. Total lung capacity decreased
8.1.3. Vital capacity decreased
8.1.3.1. COPD
8.1.3.1.1. Asthma
8.1.3.1.2. Chronic Bronchitis - causes persistent productive cough; wheezing; recurrent respiratory infection, SOB
8.1.3.1.3. Emphysema - causes are chronic bronchitis, chronic rritation
8.1.4. Increased residual volume - air and mucus staying in the lungs
8.1.4.1. Aspiration of foreign material
9. GI
9.1. Nutritional Needs
9.1.1. Reduced caloric needs r/t less lean body mass, BMR declines, activity lowered
9.1.2. Dietary fat intake <30% of calories
9.1.3. Increase soluble fiber - lowers serum cholesterol and improves glucose tolerance
9.1.4. Reduction of carb intake
9.1.5. Protein 10-20% of calories
9.1.6. Increase in calcium needs r/t absorption ability decreases with age
9.1.7. Should have at least 5 servings of fruits and veggies per day
9.1.8. Modified MyPyramid for people over the age of 70
9.2. Normal effects of aging
9.2.1. Indigestion and food intolerance
9.2.1.1. Decreased stomach motility- peristalsis
9.2.1.2. Less gastric secretion
9.2.1.3. Slower emptying time
9.2.2. Atrophy of the tongue affects taste buds and decreases taste sensation
9.2.3. Saliva production decreases = swallowing may be difficult
9.2.4. Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter
9.2.5. Esophageal and stomach motility decreases
9.2.6. Decreased elasticity of the stomach
9.2.7. Stomach has high pH as a result of decline in hydrochloric acid and pepsin
9.2.8. Problems associated with aging
9.2.8.1. Xerostomia - dry mouth
9.2.8.1.1. Decreased saliva, meds, mouth breathing, altered cognition
9.2.8.1.2. Relieved by sugarless candy/gum, sipping water, frequent oral hygiene
9.2.8.2. Dysphagia - caused by GERD, stroke
9.2.8.2.1. Prevent aspiration and promote adequate nutritional status
9.2.8.3. Hiatal hernia - sliding vs rolling
9.2.8.4. Esophageal cancer
9.2.8.5. Peptic ulcer disease
9.2.8.6. Diverticular disease - bowel contents can accumulate in the diverticula and decompose, causing inflammation and infection which is considered diverticulitis
9.2.8.7. Colorectal cancer - colostomy is treatment most often
9.2.8.8. Flatulence - discomfort may occur if there is an inability to expel flatus
9.2.8.9. Intestinal obstruction
10. Integumentary
10.1. Normal aging changes
10.1.1. Flattening of the dermal-epidermal junction
10.1.2. Reduced thickness and vascularity of the dermis
10.1.2.1. As the skin becomes more thin and fragile and subQ decreases results in wrinkles
10.1.3. Slowing of the epidermal proliferation
10.1.4. Increased quantity and degeneration of elastin fibers occur
10.1.4.1. Collage fibers become coarser and more random, reducing the skin elasticity
10.1.5. Age spots develop due to changes in melanocytes
10.1.6. Loss of pigment cells in hair allowing it to become gray and hair in the nose and ears become thicker
10.1.7. Fingernails grow more slowly, are fragile and brittle
10.1.8. Perspiration declines due to less sweat glands
10.1.9. Problems with aging
10.1.9.1. Pruritus - itching that can be attributed to any circumstance that dries out the skin (such as excessive bathing or meds)
10.1.9.2. Keratosis - small, light colored lesions causing the formation of a cutaneous horn with a slightly reddened and swollen base due to keratin being accumulated in these lesions
10.1.9.3. Skin cancer
10.1.9.3.1. Basal cell carcinoma
10.1.9.3.2. Melanoma
10.1.9.3.3. Squamous cell carcinoma
10.1.9.4. Vascular lesions - weakened vessel walls cause varicose veins
10.1.9.5. Pressure ulcers - tissue anoxia and ischemia resulting from pressure can cause the necrosis, sloughing, and ulceration of tissue
11. Immune
11.1. Normal aging changes
11.1.1. The aging is called immunosenescence
11.1.2. Depressed immune response
11.1.2.1. Problems with aging include higher risk for infection
11.1.3. Thymic mass decreases and seems to be undetectable later in life
11.1.4. T-cell activity declines and more immature T cells are present in the thymus
11.1.5. T lymphocytes are less able to proliferate in response to mitogens
11.1.5.1. Problems with aging include contributing to the reactivation of Varicella and Tb
11.1.6. Ig concentration did not change; IgM is lower, IgA/IgG are higher
11.1.7. Inflammatory defenses decline and inflammation presents atypically (low grade fever and minimal pain)
11.1.8. Increase in proinflammatory cytokines occurs with age which is thought to be linked with: atherosclerosis, diabetes, osteoporosis
11.2. Problems with aging
11.2.1. Higher risk for infection
11.2.2. Reactivation of infections like Varicella and Tuberculosis