1. Demographics
1.1. Gender
1.1.1. Male
1.1.1.1. Typically shorter life expectancy
1.1.1.2. Decline in testosterone
1.1.2. Female
1.1.2.1. Typically longer life expectancy
1.1.2.2. Effects of Aging
1.1.2.2.1. Menopause beginning in 50s
1.2. Education
1.2.1. US Census 2010
1.2.1.1. Majority (36.4%) High school graduate
1.2.1.2. 20.6% Some college/Assoc. Degree
1.2.1.3. 22.5% Bachelor's or Higher Degree
1.2.1.4. 20.5% Incomplete High school (no diploma) or less education
1.2.2. Adapt education planning based on geriatric patient's baseline
1.3. Socialization
1.3.1. Isolation
1.3.1.1. Rapid decline in health
1.3.1.1.1. Depression
1.3.1.1.2. Loss of sense of well-being
1.3.1.1.3. Sedentary/inactive
1.3.1.2. Maybe be involuntary
1.3.1.2.1. Ageism
1.3.1.2.2. Loss of spouse, family & friends
1.3.1.2.3. Uneducated or unadapted on modern technology or ways of living
1.3.1.2.4. Hearing or vision declination
1.3.1.3. Risk for developing delirium
1.3.2. Strong family & friend circle
1.3.2.1. Thrive in environments
1.3.2.2. Increased sense of well-being
1.3.3. Role Changes
1.3.3.1. Grandparenting
1.3.3.1.1. Adapt to active lifestyles
1.3.3.2. Loss of spouse
1.3.3.2.1. Performing ADLs alone
1.3.3.2.2. Single income
1.3.3.2.3. Loss of intimacy
1.3.3.3. Retirement
1.3.3.3.1. Role in society
1.3.3.3.2. Sense of identity
1.4. Interests
1.4.1. Active lifestyle
1.4.1.1. Frequent exercise/activity
1.4.1.2. Weekly social groups
1.4.1.3. Frequent visits with friends and family
1.4.1.4. Maintain mental acuity
1.4.2. Inactive
1.4.2.1. 2 hrs complete bedrest = decline in body
1.4.2.1.1. Risk for impaired skin integrity
2. Sleep
2.1. Pattern
2.1.1. Circadian Rhythem
2.1.1.1. Cycle changes
2.1.1.1.1. Early to bed & early to rise
2.1.1.1.2. Less time in REM
3. Safety
3.1. Pharmaceutical
3.1.1. Manage Drugs & Interactions
3.1.1.1. Polypharmacy
3.1.1.1.1. Try to prevent w/ adaptations to lifestyle
3.2. Mobility
3.2.1. Limited activity
3.2.1.1. Decreased lean muscle
3.2.1.2. Limited mobility
3.2.1.3. Struggle with rapid movements & reactions
3.2.1.3.1. Increased fall risk
3.2.1.4. Increased risk for fractures
3.2.1.4.1. Common sites: Hips, Pelvis, Wrist, Radius
3.2.1.4.2. Increase calcium intake
4. Pharmaceutics
4.1. Polypharmacy
4.1.1. Patient taking more than 6 drugs at once
4.1.1.1. Increased risk for interactions & contraindications
4.2. Common drugs
4.2.1. Anti hypertensives
4.2.1.1. Beta blockers
4.2.1.2. Diuretics
4.2.1.3. ACE inhibitors
4.2.2. Antiinfectives
4.2.2.1. Penecillins
4.2.2.2. Vancomycin
4.2.3. Glucose control
4.2.3.1. Insulins
4.2.3.2. Oral glucose regulators
4.2.4. Supplements
4.2.4.1. Calcium, Potassium, Iron
5. Respiratory
5.1. Oxygen requirements do not change
5.1.1. Sedentary lifestyle = risk for respiratory depression
5.1.1.1. Increased risk for pneumonia
5.1.1.1.1. Penicillins
5.1.2. Increased residual capacity & reduced vital capacity
5.1.2.1. High risk for infection
5.2. Calcification of costal cartilage and trachea
5.2.1. rib cage more rigid
5.3. Reduction of cough and laryngeal reflexes
6. Lydia Miller
7. Cardiac & Circulatory
7.1. Decreased proficient circulation
7.1.1. Heart muscle loses efficiency & contractile strength
7.1.1.1. Reduced cardiac output w/ physiologic stress
7.1.1.1.1. Harder to maintain BP
7.1.1.2. Valves become thick and rigid
7.1.1.3. Blood vessels reduce elasticity
7.1.1.4. O2 used less efficiently
7.1.1.5. Baroreceptors less responsive
7.1.1.5.1. Reduced compensation during activity
7.2. Heart dimensions = unchanged
8. Gastrointestinal
8.1. Decreased proper processing of food
8.1.1. Decreased pepsin
8.1.2. Decreased peristalsis
8.1.3. Presbyesophagus
8.1.3.1. Increased risk for aspiration
8.1.4. Atrophy of small and large intestines
8.1.4.1. Decreased proper nutrient uptake
8.1.4.1.1. Need for diet changes to include lacking nutrients
8.1.4.1.2. Take oral supplements
8.1.4.1.3. Indigestion & constipation
9. Cellular
9.1. Body composition
9.1.1. Less lean muscle mass
9.1.2. Increased subcutaneous fat
9.1.3. Loss of tissue elasticity
9.2. Immunosenescence
9.2.1. Presbycusis
9.2.2. Presbyesophagus
9.2.3. Presbyopia
9.3. Functional cell number decreases
9.4. Fluid Composition
9.4.1. Extracellular fluid remains constant
9.4.2. Intracellular fluid reduces
9.4.2.1. Easily dehydrated
9.4.2.1.1. Increased risk for Delirium
9.4.2.2. Create electrolyte imbalances
9.5. Lose ability for cell mediated defense
9.5.1. Increased risk for infection
10. Nero
10.1. Changes
10.1.1. Demylenization
10.1.2. Lacking exercise = increased free radicals
10.1.3. Slowing of central processing
10.1.4. Reduction in neurons, nerve fibers and cerebral blood flow
10.1.4.1. Slower response to change in balance
10.1.5. Hypothalamus less effective in temperature regulation
10.1.6. Changes in sleep pattern w/ waking often
10.2. Decline in weight and blood flow to brain
10.2.1. Maintain mental acuity
10.2.1.1. Until around 80s
10.2.1.2. Verbal skills intact
10.2.1.3. Intelligence
10.2.1.3.1. Crystallized
10.2.1.3.2. Fluid
11. Endocrine
11.1. Decreased parathyroid secretions
11.1.1. Reduced calcium production
11.2. Decreased ACTH
11.2.1. Decreased BP
11.3. Thyroid gland atrophies
11.3.1. Basal Metabolic Rate lowers
11.3.1.1. Gain weight easier
11.3.1.2. Cannot thermoregulate as well
11.3.1.2.1. Tend to be colder
11.3.1.2.2. Cannot withstand drastic temperature changes
11.4. Beta cells in pancreas become less effective in secreting insulin
11.4.1. Decrease sensitivity to insulin & glucose
11.4.1.1. Cannot deliver glucose successfully to cells
11.4.1.1.1. Possibly lead to Type 2 Diabetes
11.4.1.1.2. Inability to sustain homeostasis of glucose
12. Musculoskeletal
12.1. Loss of lean body mass (Sarcopenia)
12.1.1. Increased risk for fragility
12.1.1.1. Combat with regular aerobic and resistance/low weight workouts
12.2. Increase in subcutaneous fat
12.3. Shift in distribution of weight
12.3.1. Become more top-heavy
12.3.1.1. Increased instability
12.3.1.1.1. Increased risk of falls
12.4. Decrease flexibility
12.5. Thinning disks & shortened vertebrae
12.6. Decreased bone and mineral mass
12.6.1. Diminished calcium absorption
12.6.1.1. Increased risk of fractures
12.6.1.2. Increase diet or supplementation of calcium
13. Reproductive
13.1. Male
13.1.1. BPH develops in about half of aging men
13.1.1.1. Harms sexual activity with vasoconstriction of vessels
13.1.2. Rate of sperm cell productive slows
13.2. Female
13.2.1. Decreased vaginal lubrication
13.2.2. pH of vagina becomes alkalotic
13.2.2.1. Increase risk of UTI
13.2.3. Vulva atrophies & labia flatten
14. Renal
14.1. Reduced renal blood flow & GFR
14.2. Reduced bladder capacity
14.2.1. Increased urgency & frequency
14.2.1.1. BPH compression increases urgency to urinate
14.2.2. Nocturia