1. Environmental Safety
1.1. Lighting
1.1.1. Fluorescent lights bothersome
1.1.1.1. Causing eye strain and glare
1.1.2. Soft red light in the bedroom at night can improve night vision
1.1.3. Exposure to natural light during normal 24 hour dark-light cycle to maintain body rhythms
1.1.3.1. Influences body temperature, sleep cycles, hormone production
1.2. Temperature
1.2.1. Recommended room temperature should not be lower than 75 degrees
1.2.1.1. If less than 70 degrees, can lead to hypothermia
1.2.2. Temperature greater than 106 degrees can lead to brain damage
1.3. Color
1.3.1. Wall colors like red, yellow, white are stimulating
1.3.1.1. Increases blood pressure, pulse and appetite
1.3.2. Wall colors like blue, brown, earth tones are relaxing
1.3.3. Orange stimulates appetite
1.3.4. Violet decreases appetite
1.3.5. Green is a healing color and allows for a sense of well being
1.3.6. Black and grey are depressing
1.4. Floor coverings
1.4.1. Carpeting can reduce fractures associated with falls
1.4.2. Plush carpeting difficult for wheelchair mobility
1.4.3. Carpeting can be applied to wall surfaces for a noise buffer
1.4.4. Cockroaches, moths, fleas can reside underneath carpet
2. Cardiovascular
2.1. Age Related Changes
2.1.1. Valves are thicker and more rigid
2.1.2. Decreased stroke volume
2.1.3. Less efficient use of O2
2.1.4. Decreased cardiac output
2.1.5. More prominent arteries in head, neck, extremities
2.1.6. Less elasticity of vessels
2.1.7. Aorta becomes dilated and elongated
2.1.8. Increase of blood pressure
2.2. Pathological Changes
2.2.1. Hyperlipidemia
2.2.1.1. Pathophysiology
2.2.1.1.1. In older adults, most likely caused from conditions the adult has
2.2.1.1.2. Elevated total levels of cholesterol
2.2.1.2. Diagnosis
2.2.1.2.1. Obtain full lipid profile
2.2.1.2.2. If secondary causes are ruled out, autosomal dominant trait
2.2.1.3. Treatment
2.2.1.3.1. Dietary changes and exercise
2.2.1.3.2. First drug of choice for elevated LDL is 3-hydroxy-3-methylglutaryl-coenzyme (HMG CoA) reductase inhibitor
2.2.1.3.3. Complementary therapies
2.2.2. Atrial Fibrillation
2.2.2.1. Pathophysiology
2.2.2.1.1. Common in older adults with structural defects and comorbidities
2.2.2.1.2. Degeneration of electrical impulses in the atria
2.2.2.2. Signs and Symptoms
2.2.2.2.1. Palpitations
2.2.2.2.2. Irregular pulse
2.2.2.2.3. SOB
2.2.2.2.4. Chest pain
2.2.2.2.5. Fatigue
2.2.2.2.6. Dizziness
2.2.2.2.7. Delirium
2.2.2.3. Diagnosis
2.2.2.3.1. Physical examination, pt history, ECG, electrophysiology studies, stress tests, echocardiograms
2.2.2.4. Treatment
2.2.2.4.1. Antiarrhythmics, electrical cardioversion are the first things done
2.2.2.4.2. If no response to previous treatments, catheter ablation and maze procedure is done
2.2.2.5. Nurses role
2.2.2.5.1. Educate pt of disease, treatment regimen, activity modifications
2.2.2.5.2. Have pt report symptoms
3. Urinary
3.1. Age Related Changes
3.1.1. Decreased size of renal mass
3.1.2. Decreased tubular function
3.1.3. Decreased bladder capacity
3.1.4. Decrease in amt of nephrons
3.1.5. Weaker bladder muscles
3.1.6. Renal blood flow decreases by 53%
3.1.7. Glomerular filtration rate decreases by 50%
3.2. Pathological Changes
3.2.1. Urinary Incontinence
3.2.1.1. Pathophysiology
3.2.1.1.1. Failure of storage function of the lower urinary tract
3.2.1.2. Types
3.2.1.2.1. Stress Incontinence
3.2.1.2.2. Urgency Incontinence
3.2.1.2.3. Overflow Incontinence
3.2.1.2.4. Neurogenic (reflex) Incontinence
3.2.1.2.5. Functional Incontinence
3.2.1.2.6. Mixed Incontinence
3.2.1.3. Treatment
3.2.1.3.1. Kegel exercises
3.2.1.3.2. Catheterization
3.2.2. Urinary tract infection
3.2.2.1. Pathophysiology
3.2.2.1.1. Inflammation of renal tract due to bacteria
3.2.2.2. Symptoms
3.2.2.2.1. Early indicators
3.2.2.2.2. Older adults can develop delirium and incontinence
3.2.2.2.3. Retention and hematuria can occur
3.2.2.3. Treatment
3.2.2.3.1. Antibiotics to control infection
4. Neurological
4.1. Age Related Changes
4.1.1. Decreased conduction velocity
4.1.2. Slower response and reaction time
4.1.3. Decreased brain weight
4.1.4. Reduced blood flow to brain
4.1.5. Changes in sleep pattern
4.2. Pathological Changes
4.2.1. Dementia
4.2.1.1. Pathophysiology
4.2.1.1.1. Damage to brain tissue due to degenerative tissue, circulatory problems, lack of oxygen, infection, trauma, hydrocephalus, tumor, alcoholism
4.2.1.2. Onset
4.2.1.2.1. Slow takes months to years before symptoms are evident
4.2.1.3. Behavior
4.2.1.3.1. Inappropriate
4.2.1.3.2. May be unsteady on feet
4.2.1.3.3. Have difficulty with coordinated movements
4.2.1.4. Recovery
4.2.1.4.1. Progression can be slowed but cannot be reversed
4.2.1.4.2. Continues to worsen
4.2.2. Delirium
4.2.2.1. Pathophysiology
4.2.2.1.1. Disruption in brain function d/t medication side effect, circulatory disturbance, dehydration, low of high BP, low or high thyroid activity, low or high blood glucose, surgery, stress
4.2.2.2. Symptoms
4.2.2.2.1. Altered attention span
4.2.2.2.2. Worsened memory
4.2.2.2.3. Poor judgement
4.2.2.2.4. Altered LOC
4.2.2.2.5. Hyper vigilance
4.2.2.2.6. Mild drowsiness
4.2.2.2.7. Semicomatose status
4.2.2.3. Onset
4.2.2.3.1. Rapid
4.2.2.3.2. Change is noted within days
4.2.2.4. Mental status
4.2.2.4.1. Short term memory impaired
4.2.2.4.2. Disoriented and confused
4.2.2.4.3. Incoherent speech
4.2.2.4.4. Hallucinations
4.2.2.4.5. Exaggeration of personality features
4.2.2.5. Behavior
4.2.2.5.1. Hyperactive
4.2.2.5.2. Less active than normal
4.2.2.6. Recovery
4.2.2.6.1. Can be reversed and normal mental status can return if cause is treated promptly
5. Integumentary
5.1. Age Related Changes
5.1.1. Thicker hair in ears and nose
5.1.2. Darkening and wrinkling of skin around orbits
5.1.3. Growth of facial hair in women
5.1.4. Ectropion of eyelids
5.2. Pathological Changes
5.2.1. Skin cancer
5.2.1.1. Pathophysiology
5.2.1.2. Types
5.2.1.2.1. Basal cell carcinoma
5.2.1.2.2. Squamous cell carcinoma
5.2.1.2.3. Melanoma
5.2.2. Pressure Injury
5.2.2.1. Pathophysiology
5.2.2.1.1. Tissue anoxia and ischemia from pressure can result in necrosis, sloughing, and ulceration of the tissue
5.2.2.2. Stages
5.2.2.2.1. Stage 1
5.2.2.2.2. Stage 2
5.2.2.2.3. Stage 3
5.2.2.2.4. Stage 4
5.2.2.2.5. Unstageable
5.2.2.3. Nursing interventions
5.2.2.3.1. Encourage activity
5.2.2.3.2. Turn pt
5.2.2.3.3. Avoid shearing forces by not elevating the HOB greater than 30 degrees
5.2.2.3.4. Use pillows, flotation devices, alternating pressure mattresses, or water beds
5.2.2.3.5. Keep sheets wrinkle free
5.2.2.3.6. High protein, vitamin rich diet
5.2.2.3.7. Good skin care
6. Musculoskeletal
6.1. Age Related Changes
6.1.1. Shortening vertebrae
6.1.2. High decreases by approx 2 inches
6.1.3. Bones are more brittle
6.1.4. Slight knee flexion
6.1.5. Decrease in bone mass and bone material
6.1.6. Slight kyphosis
6.1.7. Slight hip flexion
6.1.8. Slight wrist flexion
6.1.9. Impaired flexion and extension movements
6.2. Pathological Changes
6.2.1. Osteoporosis
6.2.1.1. Pathophysiology
6.2.1.1.1. Metabolic disease of the bone
6.2.1.1.2. Demineralization of the bone
6.2.1.1.3. Decrease in mass and density of the bones
6.2.1.2. Symptoms
6.2.1.2.1. Inactivity or immobility
6.2.1.2.2. Diseases
6.2.1.2.3. Reduction in anabolic sex hormones
6.2.1.2.4. Diet
6.2.1.2.5. Drugs
6.2.1.3. Treatment
6.2.1.3.1. Calcium or vitamin D supplements
6.2.1.3.2. Selective estrogen receptor modulators (SERMs)
6.2.1.3.3. Hormone therapy
6.2.1.3.4. Biphosphonates
6.2.1.3.5. Diet rich in protein and calcium
6.2.1.3.6. Braces can be used to prevent spasms
6.2.1.3.7. Avoid heavy lifting, jumping, or other activities that can result in fracture
6.2.2. Gout
6.2.2.1. Pathophysiology
6.2.2.1.1. Metabolic disorder excess uric acid accumulates in blood
6.2.2.2. Symptoms
6.2.2.2.1. Severe pain
6.2.2.2.2. Tenderness of joint
6.2.2.2.3. Warmth, redness, swelling of tissue surrounding joint
6.2.2.3. Treatment
6.2.2.3.1. Aimed to reduce sodium urate through a low-purine diet
6.2.2.3.2. Alcohol and drugs should be avoided
6.2.2.3.3. Colchicine or phenylbutazone manage acute attacks
6.2.2.3.4. Long term management
6.2.2.4. Nurses role
6.2.2.4.1. Monitor pain
6.2.2.4.2. Encourage good fluid intake to prevent formation of renal stones
7. Sensory
7.1. Safety
7.1.1. Reduced peripheral vision
7.1.1.1. Approach individuals from the back or side
7.1.2. Altered depth perception
7.1.2.1. Reduce the ability to detect changes in levels
7.1.2.1.1. Alleviated by good lighting, no clutter on staircase, use contrasting colors on stairs
7.1.3. Hearing deficits
7.1.3.1. Hearing impaired individuals should live near people with adequate hearing
7.1.3.1.1. Can be alerted about fire alarms or other warnings
7.1.3.2. Trained dogs for people with hearing deficits
7.2. Age Related Changes
7.2.1. Sight
7.2.1.1. More opaque lens
7.2.1.2. Decreased pupil size
7.2.1.3. More spherical cornea
7.2.2. Smell
7.2.2.1. Impaired ability to identify and discriminate among odors
7.2.3. Taste
7.2.3.1. High prevalence of taste impairment
7.2.4. Touch
7.2.4.1. Reduction in tactile sensation
7.2.5. Hearing
7.2.5.1. Atrophy of hair cells of organ of Corti
7.2.5.2. Tympanic membrane sclerosis and atrophy
7.2.5.3. Increased cerumen and concentration of keratin
7.3. Pathological Changes
7.3.1. Cataracts
7.3.1.1. Pathophysiology
7.3.1.1.1. Clouding of the lens or its capsule that causes the lens to lose its transparency
7.3.1.2. Symptoms
7.3.1.2.1. No discomfort or pain
7.3.1.2.2. Vision distorted
7.3.1.2.3. Night vision decreased
7.3.1.2.4. Nuclear sclerosis develops
7.3.1.3. Treatment
7.3.1.3.1. Only cure - surgical removal of lens
7.3.1.3.2. Only affects one eye
8. Endocrine
8.1. Age Related Changes
8.1.1. Decrease thyroid gland activity
8.1.1.1. Lower basal metabolic rate
8.1.1.2. Reduced radioactive iodine uptake
8.1.1.3. Less thyrotropin secretion and release
8.1.2. ACTH secretion decreases
8.1.2.1. Secretory activity of adrenal gland also decreases
8.1.3. Pituitary gland decreases in volume by 20%
8.1.4. Decrease TSH, follicle-stimulating hormone, LH, luteotropic hormone
8.1.5. Delay and insufficient release of beta cells by pancreas
8.1.6. Ability to metabolize glucose reduced
8.1.6.1. Higher concentrations of glucose and more prolonged hyperglycemia levels
8.2. Pathological Changes
8.2.1. Hypothyroidism
8.2.1.1. Pathophysiology
8.2.1.1.1. Decreased levels of thyroxine (T4) and triiodothyronine (T3) that are produced by the thyroid gland
8.2.1.2. Symptoms
8.2.1.2.1. Fatigue, weakness, lethargy
8.2.1.2.2. Depression
8.2.1.2.3. Anorexia
8.2.1.2.4. Weight gain and puffy face
8.2.1.2.5. Impaired hearing
8.2.1.2.6. Periorbital or peripheral edema
8.2.1.2.7. Constipation
8.2.1.2.8. Cold intolerance
8.2.1.2.9. Myalgia, parenthesia, ataxia
8.2.1.2.10. Dry skin, coarse harir
8.2.1.3. Treatment
8.2.1.3.1. Replacement of thyroid hormone using synthetic T4
8.2.1.4. Nursing interventions
8.2.1.4.1. Help pt with management of other symptoms
8.2.1.4.2. Help pt understand that they will need thyroid replacement therapy for the rest of their life
8.2.2. Hyperthyroidism
8.2.2.1. Pathophysiology
8.2.2.1.1. Thyroid gland excretes excess amounts of thyroid hormones
8.2.2.2. Symptoms
8.2.2.2.1. Diaphoresis
8.2.2.2.2. Tachycardia
8.2.2.2.3. Palpitations
8.2.2.2.4. HTN
8.2.2.2.5. Tremor
8.2.2.2.6. Diarrhea
8.2.2.2.7. Stare
8.2.2.2.8. Lid lag
8.2.2.2.9. Insomnia
8.2.2.2.10. Nervousness
8.2.2.2.11. Confusion
8.2.2.2.12. Heat intolerance
8.2.2.2.13. Increased hunger
8.2.2.2.14. Proximal muscle weakness
8.2.2.2.15. Hyperreflexia
8.2.2.3. Treatment
8.2.2.3.1. Graves’ disease
8.2.2.3.2. Goiter
8.2.3. Diabetes Mellitus
8.2.3.1. Pathophysiology
8.2.3.1.1. Glucose intolerance
8.2.3.1.2. Increased amount of fat tissue in older adults who are obese and inactive
8.2.3.2. Diagnosis
8.2.3.2.1. Fasting blood sugar every 3 years if over 45 years of age
8.2.3.2.2. Glucose tolerance test
8.2.3.2.3. Diagnosis is established if one of these exist
8.2.3.2.4. Results are confirmed by repeat testing on another day
8.2.3.3. Patient education
8.2.3.3.1. Barriers
8.2.3.3.2. Provide reassurance, support, and information to reduce barriers
8.2.3.4. Drug Therapy
8.2.3.4.1. Metformin
8.2.3.4.2. Sulfonylurea
8.2.3.4.3. Acarbose
8.2.3.5. Patient self care and monitoring
8.2.3.5.1. Observe patients ability to handle a syringe and a vial of insulin
8.2.3.5.2. Observe the patient performing the finger-prick technique
8.2.3.5.3. Monitor triglycerides due to the development of metabolic syndrome
8.2.3.6. Exercise and nutrition
8.2.3.6.1. Regular exercise is very important!
8.2.3.6.2. Maintain consistent daily food intake
8.2.3.6.3. Nutritional supplements can reduce the complications
8.2.3.7. Symptoms of hypoglycemia in the older adult
8.2.3.7.1. Confusion
8.2.3.7.2. Abnormal behavior
8.2.3.7.3. Altered sleep patterns
8.2.3.7.4. Nocturnal headache
8.2.3.7.5. Slurred speech
9. Respiratory
9.1. Age Related Changes
9.1.1. Decreased ciliary action
9.1.2. Forced expiratory volume reduced
9.1.3. Loss of elasticity
9.1.4. increased rigidity
9.1.5. PO2 reduced by 15%
9.1.6. Blunting of cough and laryngeal reflexes
9.1.7. Alveoli fewer in number and larger in size
9.1.8. Thoracic muscles more rigid
9.1.9. Reduced basilar inflation
9.1.10. Increase in residual capacity by about 50% by age 90
9.2. Pathological Changes
9.2.1. Pneumonia
9.2.1.1. Pathophysiology
9.2.1.1.1. Infection of the lungs caused by bacteria, virus, or fungi
9.2.1.1.2. Alveoli become inflammed and fill with pus and/or fluid
9.2.1.2. Signs & Symptoms
9.2.1.2.1. Pleuratic pain
9.2.1.2.2. Minimal or no fever
9.2.1.2.3. Cough, fatigue, rapid respirations
9.2.1.2.4. Confusion, restlessness, behavioral changes
9.2.1.3. Treatment
9.2.1.3.1. Mobility
9.2.1.3.2. Pneumococcal vaccine
9.2.2. Lung cancer
9.2.2.1. Pathophysiology
9.2.2.1.1. Genetic factors
9.2.2.1.2. Exposure to environmental pollutants and carcinogens
9.2.2.2. At Risk
9.2.2.2.1. Cigarette smoker or exposure to cigarettes
9.2.2.2.2. Abestos
9.2.2.2.3. Coal and radon gas
9.2.2.2.4. Air pollutants
9.2.2.2.5. Highest African American males, white American Indian/Alaska native, Asian/Pacific Islander, Hispanic Men
9.2.2.3. Signs & Symptoms
9.2.2.3.1. Dyspneac
9.2.2.3.2. Cough
9.2.2.3.3. Chest pain
9.2.2.3.4. Fatigue
9.2.2.3.5. Anorexia
9.2.2.3.6. Wheezing
9.2.2.3.7. Recurrent upper respiratory tract infections
9.2.2.4. Treatment
9.2.2.4.1. Diagnosis
9.2.2.4.2. Surgery
9.2.2.4.3. Chemotherapy
9.2.2.4.4. Radiotherapy
9.2.3. Influenza
9.2.3.1. Pathophysiology
9.2.3.1.1. Virus enters the respiratory tract
9.2.3.2. Signs & Symptoms
9.2.3.2.1. Fever (not as high compared to young adults)
9.2.3.2.2. Myalgia
9.2.3.2.3. Sore throat
9.2.3.2.4. Nonproductive cough
9.2.3.3. Treatment
9.2.3.3.1. Influenza vaccine annually
10. GI
10.1. Age Related Changes
10.1.1. Decreased taste sensation
10.1.2. Esophagus more dilated
10.1.3. Reduced saliva
10.1.4. Smaller liver
10.1.5. Reduced intestinal blood flow
10.1.6. Slower peristalsis
10.1.7. Fewer cells on absorbing surface of intestines
10.1.8. Atrophy of gastric mucosa
10.1.9. Decreased esophageal motility
10.1.10. Decreased stomach motility
10.1.11. Decreased hunger contractions
10.1.12. Decreased emptying time
10.1.13. Less production of HCl acid, pepsin, lipase, pancreatic enzymes
10.2. Pathological Changes
10.2.1. Dysphagia
10.2.1.1. Pathophysiology
10.2.1.1.1. Lesions on upper digestive tract
10.2.1.1.2. Obstruction of upper digestive tract
10.2.1.1.3. Alterations in the nervous or muscular control of swallowing
10.2.1.2. Assessment
10.2.1.2.1. When did the problem begin?
10.2.1.2.2. Any other symptoms?
10.2.1.2.3. Do certain foods trigger the symptoms? Solids or liquids?
10.2.1.2.4. Does it occur with every meal?
10.2.1.2.5. Observe intake of food
10.2.1.2.6. Refer to speech language pathologist
10.2.1.2.7. Monitor I&O’s and weight
10.2.1.3. Treatment
10.2.1.3.1. Goal: adequate nutritional status and prevent aspiration
10.2.1.3.2. Soft diet
10.2.1.3.3. Thickening of liquids
10.2.1.3.4. Eat sitting in an upright position
10.2.2. Hiatal Hernia
10.2.2.1. Pathophysiology
10.2.2.1.1. Displacement of the gastroesophageal junction
10.2.2.1.2. More common in older women
10.2.2.1.3. Low fiber diet can contribute to this condition
10.2.2.2. Types
10.2.2.2.1. Sliding (axial)
10.2.2.2.2. Rolling (paraesophageal)
10.2.2.3. Symptoms
10.2.2.3.1. Heartburn
10.2.2.3.2. Dysphagia
10.2.2.3.3. Belching
10.2.2.3.4. Vomiting
10.2.2.3.5. Regurgitation
10.2.2.4. Diagnosis
10.2.2.4.1. Barium swallow
10.2.2.4.2. Esophagoscopy
10.2.2.5. Treatment
10.2.2.5.1. Weight loss if pt is obese
10.2.2.5.2. Bland diet
10.2.2.5.3. Milk and antacids for symptomatic relief
10.2.2.5.4. Multiple small meals a dayd
10.2.2.5.5. Do not eat before bed
10.2.2.5.6. H2 blockers (ranitidine, cimetidine, or nizatidine)
10.2.2.5.7. proton pump inhibitors (lansoprazole or omeprazole)
10.2.3. Diverticulitis
10.2.3.1. Pathophysiology
10.2.3.1.1. Multiple pouches of intestinal mucosa in the weakened muscular wall of the large bowel
10.2.3.2. Symptoms
10.2.3.2.1. Slight bleeding
10.2.3.2.2. Changes in bowel habits
10.2.3.2.3. Overeating, straining during a bowel movement, alcohol, irritating foods may contribute
10.2.3.2.4. Abrupt onset of pain in LLQ
10.2.3.2.5. n/v
10.2.3.2.6. Blood or mucus in stool
10.2.3.2.7. Low grade fever
10.2.3.3. Treatment
10.2.3.3.1. Reducing infection, provide nutrition, relieve discomfort, promote rest
10.2.3.3.2. IV therapy
10.2.3.3.3. Acute attack; consume low residue diet
10.2.3.3.4. Surgery may be performed
11. Reproductive
11.1. Male
11.1.1. Pathological Changes
11.1.1.1. Erectile Dysfunction
11.1.1.1.1. Pathophysiology
11.1.1.1.2. Causes
11.1.1.1.3. Treatment
11.1.1.2. BPH
11.1.1.2.1. Pathophysiology
11.1.1.2.2. Symptoms
11.1.1.2.3. Treatment
11.1.2. Age Related Changes
11.1.2.1. Prostate enlarges
11.1.2.2. Venous and arterial sclerosis of penis
11.1.2.3. Reduction in sperm count
11.1.2.4. Fluid-retaining capacity of seminal vesicles reduces
11.2. Female
11.2.1. Age Related Changes
11.2.1.1. Fallopian tubes atrophy and shorten
11.2.1.2. Ovaries become thicker and smaller
11.2.1.3. Cervix becomes smaller
11.2.1.4. Drier, less elastic vaginal canal
11.2.1.5. Flattening of the labia
11.2.1.6. Endocervical epithelium atrophies
11.2.1.7. Uterus becomes smaller in size
11.2.1.8. Endometrium atrophies
11.2.1.9. More alkaline vaginal environment
11.2.1.10. Loss of vulvar subcutaneous fat and hair
11.2.2. Pathological Changes
11.2.2.1. Perineal Herniation
11.2.2.1.1. Pathophysiology
11.2.2.1.2. Types
11.2.2.1.3. Symptoms
11.2.2.1.4. Treatment
11.2.2.2. Cervical Cancer
11.2.2.2.1. Pathophysiology
11.2.2.2.2. Symptoms
11.2.2.2.3. Treatment
11.2.2.2.4. Most prevalent among Hispanic women, then black women, white Native American/Alaskan Native, Asian Pacific women
12. Immune System
12.1. Age Related Changes
12.1.1. Immunosenescence
12.1.1.1. Increase in the amount of infections
12.1.1.2. Decline in T cell activity
12.1.1.2.1. More immature T cells
12.1.1.3. Decline in cell mediated immunity
12.1.1.4. T lymphocytes are not able to proliferate as well in response to mitogens
12.1.1.5. IgM lower
12.1.1.6. IgA and IgG higher
12.1.1.7. Responses to certain vaccines are less effective
12.1.1.7.1. Influenza
12.1.1.7.2. Parainfluenza
12.1.1.7.3. Pneumococcal
12.1.1.7.4. Tetanus
12.1.1.8. Decline in inflammatory responses
12.1.1.9. Inflammation presents atypically in older adults
12.1.1.9.1. Low grade fever
12.1.1.9.2. Minimal pain
12.1.1.10. Increase in proinflammatory cytokines
12.1.1.10.1. Associated with atherosclerosis, diabetes, osteoporosis