1. Respiratory
1.1. Loss of elasticity and increased rigidity of lung tissue
1.2. Forced expiratory volume reduced
1.3. Blunting of cough and laryngeal reflexes
1.4. Increase in residual capacity
1.5. Alveoli fewer in number and size
1.6. Thoracic muscles more rigid
1.7. Pathology
1.7.1. COPD
1.7.1.1. Asthma
1.7.1.1.1. Higher rates of mortality and cardiac problems
1.7.1.1.2. Nebulizers create risk of cardiac arrhythmia as
1.7.1.2. Chronic bronchitis
1.7.1.2.1. productive cough, wheezing, SOB
1.7.1.2.2. Goal is to remove bronchial secretions
1.7.1.3. Emphysema
1.7.1.3.1. From chronic bronchitis and respiratory irritation
1.7.1.3.2. Tx: postural drainage, bronchodilators, breathing exercises
1.7.1.3.3. Stop smoking
1.7.2. Pneumonia
1.7.2.1. S&S:minimal/no fever or pleuritic pain- confusion, restlessness, cough, fatigue, rapid respiration
1.7.2.2. Pneumococcal vaccine available for over 65
2. Endocrine
2.1. Thyroid gland undergoesfibrosis
2.2. Lower basal metabolic rate
2.3. Reduction in triiodothyronine (T3)
2.4. ACTH Secretion decreases
2.5. Pituitary gland decreases in volume
2.6. Delayed and insufficient release of insulin by beta cells
2.7. PATHOLOGY
2.7.1. Diabetes mellitus
2.7.1.1. Affects 20% of older population
2.7.1.2. Diagnosis: fasting blood glucose >126, random blood glucose >200, HbA1c>6.5%
2.7.1.3. Patient education is critical in treatment
2.7.1.4. Drug therapy includes oral anti diabetics (metformin, sulfonylurea, acarbose,
2.7.1.5. Can lead to: PVD, retinopathy to blindness
2.7.2. Hypothyroidism
2.7.2.1. Primary: low T4, high TSH, secondary: low T4, low TSH
2.7.2.2. More common than hyper, more common in women
2.7.2.3. SX: fatigue/weakness, depression, Anorexia, weight gain, impaired hearing, edema, constipation, cold intolerance
2.7.2.4. TX: replacement of thyroid hormone (low dose initially to higher dose)
3. Urinary
3.1. Decreased size of renal mass
3.2. Decreased tubular function
3.3. Decreased bladder capacity
3.4. Decrease in nephrons
3.5. GFR decreases
3.6. Weaker bladder muscles
3.7. PATHOLOGY
3.7.1. urinary tract infections
3.7.1.1. Most common infection of older adults
3.7.1.2. Result from poor hygiene, prostate problems, catheterization, dehydration, diabetes, arteriosclerosis, neurogenic bladders
3.7.1.3. SX: burning, urgency, fever, incontinence, delirium
3.7.1.4. Carefully watch intake and output!
3.7.1.5. Severe UTIs can lead to septicemia and prostatitis (men)
3.7.1.6. Avoid catheterization at all costs
3.7.2. Incontinence
3.7.2.1. Stress
3.7.2.1.1. Weak support in pelvic muscles
3.7.2.2. Urgency
3.7.2.2.1. Spasms of bladder
3.7.2.3. Overflow
3.7.2.3.1. Bladder neck obstructions or meds
3.7.2.4. Neurogenic
3.7.2.4.1. Reflex, problem with neural pathway
3.7.2.5. Functional
3.7.2.5.1. Inability to reach bathroom
3.7.2.6. Mixed
3.7.2.6.1. Combination
4. Nervous
4.1. Decreased conduction velocity
4.2. Decreased brain weight
4.3. Reduced blood flow to brain
4.4. Changes in sleep pattern
4.5. Slower response and reaction time
4.6. PATHOLOGY
4.6.1. Parkinson’s disease
4.6.1.1. Impaired function of basal ganglia, imbalance of dopamine and acetylcholine cause problems with motor control
4.6.1.2. More common in men, most frequently after 5th decade
4.6.1.3. Faint tremor is first sign, followed by muscle rigidity and weakness
4.6.1.4. Bradykinesia and poor balance, shuffling gait is key sign
4.6.1.5. Meds: carbidopa/levodopa, dopamine agonists, anticholinergics
4.6.1.6. Active/passive ROM, warm baths, massages all help with muscle rigid diet and prevention of contracture
4.6.2. Cerebrovascular accident
4.6.2.1. Third leading cause of death, major cause of disability
4.6.2.2. RF: HTN, severe arteriosclerosis, diabetes, gout, anemia, hypothyroidism, TIAs, smokers
4.6.2.3. Ischemic (thrombus/embolus) more common, also hemorrhagic from ruptured cerebral blood vessel
4.6.2.4. SX: hemiplegia, hemianopsia, aphasia, dizziness, headache, drop attack
4.6.2.5. Recovery: after acute care, physical/speech therapy
5. Sensory
5.1. Eyes
5.1.1. More opaque lens
5.1.2. Decreased pupil size
5.1.3. More spherical cornea
5.1.4. PATHOLOGY
5.1.4.1. Cataracts
5.1.4.1.1. Clouding of lens
5.1.4.1.2. Leading cause of low vision
5.1.4.1.3. Proper use of sunglasses helps to prevent cataracts
5.1.4.1.4. SX: night vision decreased, feeling of film over eye, glare from sunlight/bright lights, eventually pupil turns from black to cloudy white
5.1.4.2. Glaucoma
5.1.4.2.1. Acute (closed angle)
5.1.4.2.2. Chronic (open angle)
5.2. Smell
5.2.1. Impaired ability to identify and discriminate among odors
5.3. Taste
5.3.1. Taste impairment
5.3.2. Usually from reasons other than normal aging
5.4. Touch
5.4.1. Reduction in tactile sensation
5.5. Ears
5.5.1. Atrophy of hair cells of organ of Corti
5.5.2. Tympanic membrane sclerosis and atrophy
5.5.3. Increased cerumen and concentration of keratin
5.5.4. PATHOLOGY
5.5.4.1. Hearing loss
5.5.4.1.1. Exposure to noise, recurrent otitis media, certain drugs can all impair hearing
5.5.4.1.2. Vascular probs, viral infections, presbycusis affect inner ear
5.5.4.1.3. Encourage audio metric examination
5.5.4.1.4. Hearing aids: come in variety of forms, help with issue do not completely solve it
6. Sexuality
6.1. Menopause
6.2. Andropause
6.3. Decrease in sexual responsiveness and a reduction in the frequency of orgasm
6.4. Older men are slower to erect, mount, and ejaculate
6.5. Older women may experience dyspareunia (painful intercourse) as a result of less lubrication
6.6. Many older women gain a new interest in sex
6.7. PATHOLOGY
6.7.1. HIV
6.7.1.1. Incidence increasing twice as quickly in patients over 50
6.7.1.2. 44% are among gay/bisexual men
6.7.1.3. Less use of condoms because no risk of becoming pregnant
6.7.1.4. Many embarrassed to seek treatment, symptoms may not be recognized as HIV because of common aging problems
7. Immunity
7.1. Decline in immune function
7.1.1. Reduced antibody response
7.2. High prevalence of chronic conditions
7.3. Thymus gland decreases in size
7.4. T-cell function declines
7.5. Reduced thickness of skin, decreased circulation of skin
7.6. PATHOLOGY
7.6.1. Cancer
7.6.1.1. Changes in immune system impair body’s ability to recognize cancerous cells and destroy them
7.6.1.2. Prolonged closure to carcinogens
7.6.1.3. Additional screening with increased age
7.6.1.4. Conventional treatment: surgery, radiation, chemotherapy, biological therapy
7.6.1.5. Complementary therapy: special diets, psychotherapy, spiritual practices, vitamin supplements, herbal remedies
8. Cardiovascular
8.1. Aorta becomes dilated and elongated
8.2. Cardiac output decreases
8.3. Resistance to peripheral blood flow increases
8.4. Less elasticity of vessels
8.5. Valves become thicker and more rigid
8.6. Stroke volume decreases
8.7. Less efficient oxygen utilization
8.8. Pathology
8.8.1. Hypertension
8.8.1.1. SX: Dull headache, impaired memory, disorientation, confusion, epitaxis, slow tremor
8.8.1.2. Reduce sodium intake, possibly reduce weight as well (DASH diet)
8.8.1.3. Medical Tx: antihypertensives, diuretics
8.8.1.4. Nonpharmacologic tx: meditation, yoga, exercise, relaxation fish oil supplements, diet
8.8.2. Coronary Artery Disease
8.8.2.1. Angina: pain may be diffuse and less severe than younger adults
8.8.2.2. SX: vague pain under sternum, coughing, syncope, sweating, episodes of confusion
8.8.2.3. Nitroglycerin is effective- watch for orthostatic hypotension
8.8.2.4. Myocardial Infarction: can be delayed or missed in older adults because of atypical SX and less severe pain
8.8.2.5. SX: pain radiating to left arm, entire chest, neck, jaw and abdomen. Confusion, pale skin, decreased BP
8.8.2.6. Encourage early ambulation after MI- prevents immobility complications and better for heart workload
8.8.2.7. Close observations for signs of bleeding, edema or CHF
8.8.3. CHF
8.8.3.1. Leading cause of hospitalization in older adults
8.8.3.2. CAD and HTN are major causes
8.8.3.3. SX: dyspnea on exertion, confusion insomnia, wandering during night, aviation, SOB, weakness
8.8.3.4. Moist crackles heard ok auscultation
8.8.3.5. TX: bed rest, medications, reduce sodium intake, (encourage pt to sit in chair instead of bed)
9. Integumentary
9.1. Reduced thickness and vascularity of dermis
9.2. Collagen fibers become coarser
9.3. Reduced skin elasticity
9.4. Lines, wrinkles, sagging become evident
9.5. Increased presence of age spots due to clustering of melanocytes
9.6. Hair thins and grays due to loss of pigment cells
9.7. PATHOLOGY
9.7.1. Pruritus
9.7.1.1. RF: diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia, excessive bathing
9.7.1.2. Prompt recognition to treat dry skin or underlying problem
9.7.1.3. Vitamin supplements and vitamin rich diets are encouraged
9.7.1.4. Meds: topical zinc oxide, antihistamines, topical steroids
9.7.2. Vascular lesions
9.7.2.1. Stasis ulcers
9.7.2.1.1. Control infections, remove necrotic tissue to facilitate healing
9.7.2.1.2. Leg ulcers from stasis dermatitis
9.7.2.1.3. Good nutrition and high vitamins
9.7.2.1.4. Promote venous return by elevating legs and wearing elastic stockings
9.7.2.2. Pressure injury (ulcer)
9.7.2.2.1. Pressure leads to tissue anoxia and ischemia resulting in necrosis, sloughing and ulceration of tissue
9.7.2.2.2. RF: fragile skin that damages easily, poor nutrition, reduced sensation and pain, typically more immobile
9.7.2.2.3. Require longer to heal than younger persons— PREVENT
9.7.2.2.4. Sometimes need more frequent movement than turning every 2 hours, avoid shearing forces, use pillows/water beds/pads,
9.7.2.2.5. Sheets should be wrinkle free and free of foreign bodies
9.7.2.2.6. High protein, vitamin rich diet, skin clean and dry
10. Reproductive
10.1. M: reduction in sperm count
10.2. M: prostate enlarges
10.2.1. Leads to BPH
10.3. M: venous/arterial sclerosis of penis
10.4. F: fallopian tunes and uterus atrophy
10.5. F: Ovaries become thicker and smaller
10.6. F: Cervix and uterus become smaller
10.7. F: Drier, less elastic vaginal canal
10.8. PATHOLOGY: female
10.8.1. Vaginitis
10.8.1.1. SX: soreness, pruritus, burning, reddened vagina, foul smelling vaginal discharge
10.8.1.2. TX: estrogens in suppository creams, avoid douches, perfumed soaps
10.8.2. Cancer of cervix
10.8.2.1. SX: vaginal bleeding and leukorrhea, pain is not a SX, can develop urinary retention and incontinence, fecal incontinence
10.8.2.2. TX: radium or surgery
10.8.2.3. Women over 65 years should have regular screening
10.8.3. Cancer of breast
10.8.3.1. Second leading cause of cancer deaths for women
10.8.3.2. Regular breast exams and self exams
10.9. PATHOLOGY: male
10.9.1. Erectile dysfunction
10.9.1.1. Causes: alcoholism, diabetes, dyslipidemia, hypertension,hypogonadism, multiple sclerosis, renal failure, thyroid conditions
10.9.1.2. TX: oral agents (sildenafil, vardenafil, tadalafil), drugs injected into penis, penile implants, vacuum pump devices
10.9.2. Benign prostatic hyperplasia
10.9.2.1. SX: hesitancy, decreased force ofurinary stream, frequency, and nocturia, dribbling may occur, overflow incontinence, bleeding
10.9.2.2. TX: prostatic massage, urinary antiseptics, urethral surgery,
11. Gastrointestinal
11.1. Decreased taste sensation
11.2. Esophagus more dilated
11.3. Reduced saliva and salivary ptyalin
11.4. Liver smaller
11.5. Reduced intestinal blood flow
11.6. Decreased esophageal motility
11.7. Less production of HCl, pepsin, lipase, and pancreatic enzymes
11.8. Fewer cells on absorbing surface of intestines
11.9. PATHOLOGY
11.9.1. Periodontal disease
11.9.1.1. Predispose older adults to systemic infection
11.9.2. Dysphagia
11.9.2.1. GERD is major cause
11.9.2.2. Prevention of aspiration and promotion of adequate nutritional status are major goals
11.9.2.3. Soft diet, thickened liquids recommended, eat in upright position, small bites
11.9.2.4. Have suction available in case of choking!!
11.9.3. Diverticular disease
11.9.3.1. Multiple pouches of intestinal mucosa of large bowel
11.9.3.1.1. Inflammation and infection lead to diverticulitis
11.9.3.2. SX: slight bleeding, constipation/diarrhea, tenderness of LLQ
11.9.3.3. Common problem in western societies from low fiber/residue diets
12. Musculoskeletal
12.1. Shortening of vertebrae
12.2. Bones more brittle
12.2.1. Increased risk for injury
12.3. Slight knee, hip, and wrist flexion
12.4. Slight kyphosis
12.5. PATHOLOGY
12.5.1. Fractures
12.5.1.1. Trauma, cancer metastasis to bone, osteoporosis contribute to fractures
12.5.1.2. Neck of femur and distal radius are common fractures
12.5.1.3. Heal at slower rates and lead to immobility
12.5.1.4. Avoid risky activities, prevent orthostatic hypotension, proper shoe wear, safety supports in home
12.5.1.5. SX: pain, change in shape/length of limb, restricted motion of limb, edema, discoloration
12.5.2. Osteoarthritis
12.5.2.1. Progressive deterioration of joint cartilage
12.5.2.2. Leading cause of disability in older adults
12.5.2.3. No inflammation (unlike rheumatoid arthritis)
12.5.2.4. Excessive use of joint, trauma, obesity, low vitamin D levels, and genetic factors can predispose
12.5.2.5. SX: crepitus, bony nodules, more uncomfortable during damp weather and with extended use,
12.5.2.6. Acetaminophen is first drug choice
12.5.2.7. Rest, heat/ice, tai chi, aqua therapy, acupuncture
12.5.2.8. Arthroplasty may be recommended if other treatments do not work
12.5.3. Rheumatoid arthritis
12.5.3.1. Most develop earlier in life, before 65
12.5.3.2. Inflammation of synovial fluid causing pain and edema
12.5.3.3. SX: pain during rest and activity, swollen, red, warm, fatigue, malaise, weakness, weight loss, fever, anemia
12.5.3.4. Anti-inflammatory meds, corticosteroids, immunosuppressive drugs,
12.5.3.5. Foods to avoid: potatoes, peppers, eggplants, tomatoes
12.5.3.6. Herbs to improve SX: green tea and ginger
13. Sleep
13.1. Insomnia
13.1.1. Difficulty falling asleep or staying asleep
13.2. Phase advance
13.3. More time in stage 1-2, less time in REM (stage 3-4)
13.4. Sleep latency
13.4.1. Delay in onset of sleep, more sensitive to noises while sleeping
13.4.2. Nurses should be aware and limit noisy activities at night
13.5. PATHOLOGY
13.5.1. Restless leg syndrome
13.5.1.1. Uncontrollable urge to move the legs
13.5.1.2. Uncomfortable, electrical, itching, pins and needles, pulling, painful
13.5.1.3. Causes: iron deficiency anemia, uremia, Parkinson’s disease, rheumatoid arthritis, diabetes, neurological lesions
13.5.1.4. TX: dopaminergic drugs, benzodiazepines, opioids, anticonvulsants, adrenergic, iron supplements
13.5.2. Sleep apnea
13.5.2.1. At least 5 episodes of cessation of breathing, Lawton at least 10 seconds, occur per hour of sleep, accompanied by day time sleepiness
13.5.2.2. Snoring accompanies this
13.5.2.3. Sleep disorder clinics and TX: weight reduction, medications, continue Luis positive airway pressure, surgery
13.5.2.4. Can be caused by defect in CNS, blockage in upper airway, or mixed