The Older Adult Client

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The Older Adult Client by Mind Map: The Older Adult Client

1. Nervous System

1.1. decline in weight and blood flow to the brain - does not affect thinking and behavior

1.2. reduction in neurons, nerve fibers and cerebral blood flow

1.3. slower response to change in balance

1.4. hypothalamus less effective in temperature regulation

1.5. changes in sleep patterns with frequent awakening

1.6. pathologies:

1.6.1. Alzheimer disease chronic progressive dementia caused by the atrophy of the brain tissue one in nine people age 65 and older, which is about 11 percent, have Alzheimer’s disease Involves progressive disorientation, apathy, speech and gait disturbances, personality changes, and loss of memory

1.6.2. vision disturbances presbyopia inability to focus or accommodate properly due to reduced elasticity of the lens visual field narrows, making peripheral vision more difficult

1.6.3. hearing disturbances presbycusis progressive hearing loss that occurs as a result of age-related changes to the inner ear, including loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, and reduced production of endolymph high frequency sounds of 2,000 Hz and above are lost first

1.6.4. taste and smell disturbances loss 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 of the brain loss of taste reduction in the sense of smell alters the sense of taste atrophy of the tongue can also diminish taste sensations reduced saliva production, poor oral hygiene, medications and conditions such as sinusitis can affect taste

1.6.5. touch disturbances a reduction in the number of and changes in the structural integrity of touch receptors occurs with age tactile sensation is reduced can cause misperceptions of the environment, resulting in a safety risk

2. Urinary System

2.1. decline of renal blood flow and glomerular filtration by approximately 50% by age 90

2.2. reduced bladder capacity - urinary frequency, urgency, and nocturia are common

2.3. incontinence is NOT a normal part of aging

2.3.1. some stress incontinence may occur because of a weakening of the pelvic diaphragm, particularly in multiparous women

2.4. affected by changes in the kidneys, ureters, and bladder

2.5. renal mass becomes smaller with age, which is attributable to a cortical loss rather than a loss of the renal medulla

2.6. renal tissue growth declines and atherosclerosis may promote atrophy of the kidney

2.7. tubular function decreases

2.7.1. less efficient tubular exchange of substances, conservation of water and sodium, and suppression of antidiuretic hormone secretion in the presence of hypo-osmolality

2.8. less ability to conserve sodium in response to sodium restriction

2.9. pathologies:

2.9.1. kidney stones kidney stones can form when mineral and acid salts in the urine crystallize and stick together. small ones are easily passed, larger ones may get stuck in the urinary tract and can cause pain and back flow of urine

2.9.2. urinary incontinence the sphincter muscles of the urethra are too weak or too active. too weak = a cough or sneeze can cause urination too active = sudden, strong urge to urinate with little urine in the bladder

3. Reproductive System

3.1. female

3.1.1. hormonal changes vulva atrophies flattening of the labia loss of subcutaneous fat and hair

3.1.2. vaginal epithelium thins

3.1.3. cervix, uterus and fallopian tubes atrphy

3.1.4. vaginal canal changes reduction in collagen, and adipose tissue shortening and narrowing of the canal less lubrication - may lead to discomfort with intercourse more alkaline vaginal pH as a result of lower estrogen changes

3.1.5. uterus and ovaries decrease in size

3.1.6. endometrium continues to respond to hormonal stimulation

3.1.7. breasts sag and are less firm

3.2. male

3.2.1. seminal vesicles develop thinner epithelium

3.2.2. muscle tissue replaces with connective tissue

3.2.3. decreased capacity to retain fluids

3.2.4. seminiferous tubule changes increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen

3.2.5. atrophy of the testes and reduction in testicular mass

3.2.6. testosterone stays the same or decreases slightly

3.2.7. more time required to achieve an erection

3.2.8. enlargement of the prostate gland

3.3. diseases and pathologies:

3.3.1. infections of the vuvla

3.3.2. tumors of the vulva

3.3.3. atrophic vaginitis

3.3.4. cancer of the vagina

3.3.5. problems of the cervix

3.3.6. cancer of the cervix

3.3.7. cancer of the endometrium

3.3.8. cancer of the overies

3.3.9. perineal herniation

3.3.10. dyspareunia

3.3.11. cancer of the breast

3.3.12. erectile dysfunction

3.3.13. benign prostatic hyperplasia

3.3.14. cancer of the prostate

3.3.15. tumors of the penis and testes

3.3.16. tumors of the scrotum

4. Human Needs

4.1. Spirituality

4.1.1. comfort in knowing connection greater than self

4.1.2. positive relationship with God or higher power

4.1.3. spirituality core of being

4.1.4. spirituality differs from religion

4.1.5. spiritual needs: love, meaning and purpose, hope, dignity, forgiveness, gratitude, transcendence, expression of faith

4.1.6. strong spiritual beliefs facilitate health and healing

4.2. Nutrition

4.2.1. required amount of specific nutrients vary over lifetime

4.2.2. older adults have reduced need for calories: less lean body mass, basal metabolic rate declines, activity level lowered

4.2.3. quantity and quality of caloric intake must be monitored

4.2.4. nutritional needs dietary fat intake: < 30% of calories soluble fiber: lowers serum cholesterol and improves glucose tolerance carbohydrates: reduction of intake protein: 10% to 20% of calories calcium: absorption ability decreases with age fruits and vegetables: at least five servings daily modified MyPyramid for people over age 70

4.2.5. 1,500 mL minimal required fluid intake

4.2.6. threats to good nutrition include: indigestion and food intolerance decreased stomach motility, less gastric secretion, and slower emptying time anorexia related to a variety of conditions, need to identify cause dysphagia GERD, incidence increases with age constipation common problem, slower peristalsis, inactivity, medication side effects, and decreased fiber and fluids malnutrition contributing factors, signs of clinical malnutrition

4.3. Sexuality

4.3.1. older adults can and do enjoy sex

4.3.2. general pattern of sexual behavior remains consistent throughout life

4.3.3. sexuality encompasses more than just physical acts love, warmth, caring and sharing intimate exchange of words and touch feeling important and wanted by another perosn multiple losses have significant effect on intimacy

4.3.4. regular sexual expression for both sexes is important in promoting sexual capacity

4.3.5. barriers to sexuality unavailability of a partner negative attitudes from society fear of losing sexual abilities concerns about body image relationship issues misconception by older adults medical conditions medication adverse effects cognitive impairment

4.4. Sleep

4.4.1. Circadian sleep-wake cycles: phase advance is common

4.4.2. more time in stages I and II, less time in stages III and IV

4.4.3. less sound sleep, delay in onset of sleep

4.4.4. disturbances include: insomnia difficulty in falling or staying asleep or prematurely awakening leg movements nocturnal myoclonus restless leg syndrome sleep apnea five episodes of cessation of breathing, lasting 10 seconds medical conditions chronic diseases, cardiovascular or respiratory problems, diabetes, GERD, musculoskeletal conditions, dementia, depression medications anticholinergics, antidepressants, antihypertensives, benzodiazepines, beta-blockers, diuretics, levodopa, steroids, theophylline, thyroid preparations, caffeine, alcohol environmental factors apartment on busy street, snoring spouse, excessively warm room, bright hallway lights pain

5. Integumentary System

5.1. skin less elastic, dry and fragile

5.2. decreased subcutaneous fat

5.3. increased benign and malignant skin neoplasms

5.4. thinning, graying of hair

5.5. reduced sweat gland activity

5.6. pathologies:

5.6.1. eczema itchy skin disease characterised by redding and vesicle formation (may lead to weeping and crusting), outside agents don't play a role, found all over the body but most commonly on the inside of knee and elbow joints and on face hands and scalp, it is not contagious, if massaging use a hypoallergenic cream and if in acute stage it's better not to massage

5.6.2. psoriasis chronic skin disease with no known cause, scaly pink patches covered in silvery scales form on the elbows knees and scalp, it is not infectious, local-contraindication

5.6.3. bacterial infections acne rosacea, acne vulgaris, boils, folliculitis, impetigo

5.6.4. viral infections herpes simplex, herpes zoster verrucas, warts

5.6.5. fungal infections tinea corporis, tinea pedis

5.6.6. moles non-malignant collection of pigmented cells in the skin, common occurence on face and body, vary in size, colour and vascular appearence (if mole changes size or is darker than normal, reccomend a visit to the GP)

6. Musculoskeletal System

6.1. thinning disks and shortened vertebrae

6.2. reduced muscle mass, strength and movement

6.3. decreased bone mineral and mass

6.4. diminished calcium absorption

6.5. increased risk of fractures

6.6. pathologies:

6.6.1. osteoarthritis chronic disease that primarily involves the weight bearing joints. OA causes a degeneration of articular cartilage. Subsequent deformity and thickening of subchondral bone occurs with an outcome of impaired functional status men are affected more than women -cartilage becomes soft and damaged -osteophytes form -subchondral bone thickens -synovitis is mild to moderate

6.6.2. rheumatoid arthritis systemic autoimmune disorder or unknown etiology. the disease presents with a chronic inflammatory reaction in the synovial tissues of a join that results in erosion of cartilage and supporting structures within the capsule women are affected 3x more than men -thickening of synovial membrane in affected joints -colonization of lymphocytes which synthesize the rheumatoid factor -subsequent erosion of cartilage and supporting structures

7. Circulatory System

7.1. heart dimensions are unchanged

7.1.1. slight left ventricle hypertrophy

7.1.2. aorta becomes dilated and elongated

7.2. heart muscle loses efficiency and contractile strength + reduced cardiac output with physiologic stress

7.3. valves become thick and rigid

7.4. blood vessels reduce elasticity

7.4.1. responsible for vascular changes to the heart, kidney and pituitary gland

7.5. oxygen used less efficiently

7.6. pathologies:

7.6.1. coronary heart disease (CAD) clogging of the vessels that nourish the heart muscle

7.6.2. blood vessels affected tunica intima fibrosis, calcium and lipid accumulation, and cellular proliferation tunica media thinning and calcification of elastin fibers and an increase in collagen - stiffening of the vessels impaired baroreceptor function and increased peripheral resistance occur tunica adventia not affected

8. Respiratory System

8.1. calcification of costal cartilage + trachea and rib cage more rigid

8.2. reduction of cough and laryngeal reflexes

8.3. increased residual capacity and reduced vital capacity

8.4. high risk for respiratory infection

8.5. pathologies:

8.5.1. chronic obstructive pulmonary disease (COPD) most common forms are chronic bronchitis and emphysema irreversible chronic condition of persistent obstruction of air flow through bronchial tubes and lungs caused by smoking, air pollution, chronic infection, and, in a minority of cases, asthma.

8.5.2. pneumonia acute inflammation and infection of alveoli, which fill with pus or products of the inflammatory reaction having a chronic respiratory disease increases the risk of developing this disease

9. Endocrine System

9.1. thyroid gland activity decreases

9.2. ACTH secretion decreases

9.3. pituitary gland decreases

9.4. insulin release by beta cells is delayed and insufficient

9.5. ability to metabolize glucose is reduced

9.6. higher blood glucose in nondiabetic patients

9.7. pathologies:

9.7.1. hormonal decreases estrogen (women) menopause testosterone (men) gradual decrease growth hormone decreased muscle mass and strength melatonin melatonin levels may play an important role in the loss of normal sleep-wake cycles (circadian rhythms)

9.7.2. hypopituitarism GnRH deficiency: women - amenorrhea and infertility men - decreased libido, impotence, loss of pubic and axillary hair causes nonfunctional pituitary adenomas, ischemic injury, surgery or radiation, inflammatory reactions

10. Digestive System

10.1. Diagnosis

10.2. Diseases

10.3. less acute taste and sensations

10.4. decreased esophageal motility

10.5. atrophy of the small and large intestines

10.6. increased risk of aspiration, indigestion, and constipation

10.7. pathologies:

10.7.1. gastroesophageal reflux disease (GERD) backward flow of stomach contents into the esophagus causes esophagitis caused by: frequent reflux delayed gastric emptying, hyperacidity, reduced tone of LES, and hiatal hernias

10.7.2. peptic ulcer disease (PUD) results when gastric mucosal defenses become impaired and can no longer protect the epithelium from the effects of acid and pepsin a peptic ulcer is an excavated lesion of the mucosal wall of the esophagus, stomach, phylorus, or duodenum occurs especially in people who use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)