The Older Adult Client

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

1. Integumentary System

1.1. skin less elastic, dry and fragile

1.2. decreased subcutaneous fat

1.3. increased benign and malignant skin neoplasms

1.4. thinning, graying of hair

1.5. reduced sweat gland activity

1.6. pathologies:

1.6.1. eczema

1.6.1.1. 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

1.6.2. psoriasis

1.6.2.1. 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

1.6.3. bacterial infections

1.6.3.1. acne rosacea, acne vulgaris, boils, folliculitis, impetigo

1.6.4. viral infections

1.6.4.1. herpes simplex, herpes zoster verrucas, warts

1.6.5. fungal infections

1.6.5.1. tinea corporis, tinea pedis

1.6.6. moles

1.6.6.1. 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)

2. Musculoskeletal System

2.1. thinning disks and shortened vertebrae

2.2. reduced muscle mass, strength and movement

2.3. decreased bone mineral and mass

2.4. diminished calcium absorption

2.5. increased risk of fractures

2.6. pathologies:

2.6.1. osteoarthritis

2.6.1.1. 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

2.6.1.2. men are affected more than women

2.6.1.3. -cartilage becomes soft and damaged -osteophytes form -subchondral bone thickens -synovitis is mild to moderate

2.6.2. rheumatoid arthritis

2.6.2.1. 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

2.6.2.2. women are affected 3x more than men

2.6.2.3. -thickening of synovial membrane in affected joints -colonization of lymphocytes which synthesize the rheumatoid factor -subsequent erosion of cartilage and supporting structures

3. Circulatory System

3.1. heart dimensions are unchanged

3.1.1. slight left ventricle hypertrophy

3.1.2. aorta becomes dilated and elongated

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

3.3. valves become thick and rigid

3.4. blood vessels reduce elasticity

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

3.5. oxygen used less efficiently

3.6. pathologies:

3.6.1. coronary heart disease (CAD)

3.6.1.1. clogging of the vessels that nourish the heart muscle

3.6.2. blood vessels affected

3.6.2.1. tunica intima

3.6.2.1.1. fibrosis, calcium and lipid accumulation, and cellular proliferation

3.6.2.2. tunica media

3.6.2.2.1. thinning and calcification of elastin fibers and an increase in collagen - stiffening of the vessels

3.6.2.2.2. impaired baroreceptor function and increased peripheral resistance occur

3.6.2.3. tunica adventia

3.6.2.3.1. not affected

4. Nervous System

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

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

4.3. slower response to change in balance

4.4. hypothalamus less effective in temperature regulation

4.5. changes in sleep patterns with frequent awakening

4.6. pathologies:

4.6.1. Alzheimer disease

4.6.1.1. chronic progressive dementia caused by the atrophy of the brain tissue

4.6.1.2. one in nine people age 65 and older, which is about 11 percent, have Alzheimer’s disease

4.6.1.3. Involves progressive disorientation, apathy, speech and gait disturbances, personality changes, and loss of memory

4.6.2. vision disturbances

4.6.2.1. presbyopia

4.6.2.1.1. inability to focus or accommodate properly due to reduced elasticity of the lens

4.6.2.1.2. visual field narrows, making peripheral vision more difficult

4.6.3. hearing disturbances

4.6.3.1. presbycusis

4.6.3.1.1. 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

4.6.3.1.2. high frequency sounds of 2,000 Hz and above are lost first

4.6.4. taste and smell disturbances

4.6.4.1. loss of smell

4.6.4.1.1. 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

4.6.4.2. loss of taste

4.6.4.2.1. reduction in the sense of smell alters the sense of taste

4.6.4.2.2. atrophy of the tongue can also diminish taste sensations

4.6.4.2.3. reduced saliva production, poor oral hygiene, medications and conditions such as sinusitis can affect taste

4.6.5. touch disturbances

4.6.5.1. a reduction in the number of and changes in the structural integrity of touch receptors occurs with age

4.6.5.2. tactile sensation is reduced

4.6.5.2.1. can cause misperceptions of the environment, resulting in a safety risk

5. Respiratory System

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

5.2. reduction of cough and laryngeal reflexes

5.3. increased residual capacity and reduced vital capacity

5.4. high risk for respiratory infection

5.5. pathologies:

5.5.1. chronic obstructive pulmonary disease (COPD)

5.5.1.1. most common forms are chronic bronchitis and emphysema

5.5.1.1.1. irreversible

5.5.1.2. chronic condition of persistent obstruction of air flow through bronchial tubes and lungs

5.5.1.3. caused by smoking, air pollution, chronic infection, and, in a minority of cases, asthma.

5.5.2. pneumonia

5.5.2.1. acute inflammation and infection of alveoli, which fill with pus or products of the inflammatory reaction

5.5.2.1.1. having a chronic respiratory disease increases the risk of developing this disease

6. Endocrine System

6.1. thyroid gland activity decreases

6.2. ACTH secretion decreases

6.3. pituitary gland decreases

6.4. insulin release by beta cells is delayed and insufficient

6.5. ability to metabolize glucose is reduced

6.6. higher blood glucose in nondiabetic patients

6.7. pathologies:

6.7.1. hormonal decreases

6.7.1.1. estrogen (women)

6.7.1.1.1. menopause

6.7.1.2. testosterone (men)

6.7.1.2.1. gradual decrease

6.7.1.3. growth hormone

6.7.1.3.1. decreased muscle mass and strength

6.7.1.4. melatonin

6.7.1.4.1. melatonin levels may play an important role in the loss of normal sleep-wake cycles (circadian rhythms)

6.7.2. hypopituitarism

6.7.2.1. GnRH deficiency:

6.7.2.1.1. women - amenorrhea and infertility

6.7.2.1.2. men - decreased libido, impotence, loss of pubic and axillary hair

6.7.2.2. causes

6.7.2.2.1. nonfunctional pituitary adenomas, ischemic injury, surgery or radiation, inflammatory reactions

7. Digestive System

7.1. Diagnosis

7.2. Diseases

7.3. less acute taste and sensations

7.4. decreased esophageal motility

7.5. atrophy of the small and large intestines

7.6. increased risk of aspiration, indigestion, and constipation

7.7. pathologies:

7.7.1. gastroesophageal reflux disease (GERD)

7.7.1.1. backward flow of stomach contents into the esophagus

7.7.1.1.1. causes esophagitis

7.7.1.2. caused by: frequent reflux delayed gastric emptying, hyperacidity, reduced tone of LES, and hiatal hernias

7.7.2. peptic ulcer disease (PUD)

7.7.2.1. results when gastric mucosal defenses become impaired and can no longer protect the epithelium from the effects of acid and pepsin

7.7.2.2. a peptic ulcer is an excavated lesion of the mucosal wall of the esophagus, stomach, phylorus, or duodenum

7.7.2.3. occurs especially in people who use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)

8. Urinary System

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

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

8.3. incontinence is NOT a normal part of aging

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

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

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

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

8.7. tubular function decreases

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

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

8.9. pathologies:

8.9.1. kidney stones

8.9.1.1. kidney stones can form when mineral and acid salts in the urine crystallize and stick together.

8.9.1.2. small ones are easily passed, larger ones may get stuck in the urinary tract and can cause pain and back flow of urine

8.9.2. urinary incontinence

8.9.2.1. the sphincter muscles of the urethra are too weak or too active.

8.9.2.1.1. too weak = a cough or sneeze can cause urination

8.9.2.1.2. too active = sudden, strong urge to urinate with little urine in the bladder

9. Reproductive System

9.1. female

9.1.1. hormonal changes

9.1.1.1. vulva atrophies

9.1.1.2. flattening of the labia

9.1.1.3. loss of subcutaneous fat and hair

9.1.2. vaginal epithelium thins

9.1.3. cervix, uterus and fallopian tubes atrphy

9.1.4. vaginal canal changes

9.1.4.1. reduction in collagen, and adipose tissue

9.1.4.2. shortening and narrowing of the canal

9.1.4.3. less lubrication - may lead to discomfort with intercourse

9.1.4.4. more alkaline vaginal pH as a result of lower estrogen changes

9.1.5. uterus and ovaries decrease in size

9.1.6. endometrium continues to respond to hormonal stimulation

9.1.7. breasts sag and are less firm

9.2. male

9.2.1. seminal vesicles develop thinner epithelium

9.2.2. muscle tissue replaces with connective tissue

9.2.3. decreased capacity to retain fluids

9.2.4. seminiferous tubule changes

9.2.4.1. increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen

9.2.5. atrophy of the testes and reduction in testicular mass

9.2.6. testosterone stays the same or decreases slightly

9.2.7. more time required to achieve an erection

9.2.8. enlargement of the prostate gland

9.3. diseases and pathologies:

9.3.1. infections of the vuvla

9.3.2. tumors of the vulva

9.3.3. atrophic vaginitis

9.3.4. cancer of the vagina

9.3.5. problems of the cervix

9.3.6. cancer of the cervix

9.3.7. cancer of the endometrium

9.3.8. cancer of the overies

9.3.9. perineal herniation

9.3.10. dyspareunia

9.3.11. cancer of the breast

9.3.12. erectile dysfunction

9.3.13. benign prostatic hyperplasia

9.3.14. cancer of the prostate

9.3.15. tumors of the penis and testes

9.3.16. tumors of the scrotum

10. Human Needs

10.1. Spirituality

10.1.1. comfort in knowing connection greater than self

10.1.2. positive relationship with God or higher power

10.1.3. spirituality core of being

10.1.4. spirituality differs from religion

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

10.1.6. strong spiritual beliefs facilitate health and healing

10.2. Nutrition

10.2.1. required amount of specific nutrients vary over lifetime

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

10.2.3. quantity and quality of caloric intake must be monitored

10.2.4. nutritional needs

10.2.4.1. dietary fat intake: < 30% of calories

10.2.4.2. soluble fiber: lowers serum cholesterol and improves glucose tolerance

10.2.4.3. carbohydrates: reduction of intake

10.2.4.4. protein: 10% to 20% of calories

10.2.4.5. calcium: absorption ability decreases with age

10.2.4.6. fruits and vegetables: at least five servings daily

10.2.4.7. modified MyPyramid for people over age 70

10.2.5. 1,500 mL minimal required fluid intake

10.2.6. threats to good nutrition include:

10.2.6.1. indigestion and food intolerance

10.2.6.1.1. decreased stomach motility, less gastric secretion, and slower emptying time

10.2.6.2. anorexia

10.2.6.2.1. related to a variety of conditions, need to identify cause

10.2.6.3. dysphagia

10.2.6.3.1. GERD, incidence increases with age

10.2.6.4. constipation

10.2.6.4.1. common problem, slower peristalsis, inactivity, medication side effects, and decreased fiber and fluids

10.2.6.5. malnutrition

10.2.6.5.1. contributing factors, signs of clinical malnutrition

10.3. Sexuality

10.3.1. older adults can and do enjoy sex

10.3.2. general pattern of sexual behavior remains consistent throughout life

10.3.3. sexuality encompasses more than just physical acts

10.3.3.1. love, warmth, caring and sharing

10.3.3.2. intimate exchange of words and touch

10.3.3.3. feeling important and wanted by another perosn

10.3.3.4. multiple losses have significant effect on intimacy

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

10.3.5. barriers to sexuality

10.3.5.1. unavailability of a partner

10.3.5.2. negative attitudes from society

10.3.5.3. fear of losing sexual abilities

10.3.5.4. concerns about body image

10.3.5.5. relationship issues

10.3.5.6. misconception by older adults

10.3.5.7. medical conditions

10.3.5.8. medication adverse effects

10.3.5.9. cognitive impairment

10.4. Sleep

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

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

10.4.3. less sound sleep, delay in onset of sleep

10.4.4. disturbances include:

10.4.4.1. insomnia

10.4.4.1.1. difficulty in falling or staying asleep or prematurely awakening

10.4.4.2. leg movements

10.4.4.2.1. nocturnal myoclonus

10.4.4.2.2. restless leg syndrome

10.4.4.3. sleep apnea

10.4.4.3.1. five episodes of cessation of breathing, lasting 10 seconds

10.4.4.4. medical conditions

10.4.4.4.1. chronic diseases, cardiovascular or respiratory problems, diabetes, GERD, musculoskeletal conditions, dementia, depression

10.4.4.5. medications

10.4.4.5.1. anticholinergics, antidepressants, antihypertensives, benzodiazepines, beta-blockers, diuretics, levodopa, steroids, theophylline, thyroid preparations, caffeine, alcohol

10.4.4.6. environmental factors

10.4.4.6.1. apartment on busy street, snoring spouse, excessively warm room, bright hallway lights

10.4.4.7. pain