1. Frailty
1.1. Low physical activity
1.2. muscle weakness
1.3. slowed performance
1.3.1. keeping the mind active is necessary being an older adult
1.3.1.1. Sudoko and puzzles as well as mind games are important (crosswords, etc)
1.4. fatigue or poor endurance
1.5. unintentional weight loss
1.6. Maintaining good nutrition
2. Respiratory
2.1. Calcification of costal cartilage
2.2. Trachea and ribcage more rigid
2.3. Decreased cough and laryngeal reflexes
2.4. Increased residual capacity
2.5. Decreased vital capacity
2.6. Increased risk for respiratory infection
2.7. Yoga can aid in respiration
2.8. Nurses can teach all older adults to do deep breathing exercises several times daily
2.9. COPD
2.9.1. Asthma
2.9.1.1. Nebulizers create risk of cardiac arrhythmia
2.9.1.2. Higher rates of mortality and cardiac problems
2.9.2. Chronic bronchitis
2.9.2.1. productive cough, wheezing, SOB
2.9.2.2. Goal is to remove bronchial secretions
2.9.3. Emphysema
2.9.3.1. stop smoking
2.9.3.2. Treatment: postural drainage, bronchodilators, breathing exercises
2.10. Pnuemonia
2.10.1. Pneumococcal vaccine available for over 65
2.10.2. s&s : minimal/no fever or pleuritic pain- confusion, restlessness, cough, fatigue, rapid respiration
3. Cellular changes & Cancer
3.1. Decreased number of cells and lean mode mass
3.2. Increased body fat
3.3. Decreased intracellular fluid and less total body fluid
3.4. DNA condenses which causes less synthesis of RNA
3.5. Increase in lipids inside the cell
3.6. C
3.6.1. Change in bowel or bladder habits
3.7. A
3.7.1. A sore that does not heal
3.8. U
3.8.1. Unusual bleeding or drainage
3.9. T
3.9.1. Thickening or lump in the breast or elsewhere
3.10. I
3.10.1. Indigestion or swallowing difficulty
3.11. O
3.11.1. Obvious change in a wart or mole
3.12. N
3.12.1. Nagging persistent cough or hoarseness
3.13. Treatment
3.13.1. Surgery, radiation, chemotherapy, and CAM
3.14. THE OLDER POPULATION'S #2 LEADING CAUSE OF DEATH
3.15. Thymus decreases in size
3.16. T cells decline
3.17. Two theories
3.17.1. Biological age-related changes that impair the ability to resist diseases
3.17.2. Prolonged exposure to carcinogens over the years
4. Gastrointestinal
4.1. Decreased taste sensations
4.2. Decreased esophageal motility
4.3. Atrophy of small and large intestines
4.4. Increased risk of aspiration, indigestion, and constipation.
4.5. Esophageal and stomach motility decreased and elasticity of stomach is reduced
4.6. Stomach is more alkaline as a result of decline in hydrochloride acid and pepsin
4.7. Slower peristalsis, inactivity, reduced food/ fluid intake, drugs, and low-fiber diet (increased risk of constipation
4.8. Pancreas changes and affects digestion of fats
4.9. Atrophy of the tongue- affects taste buds
4.10. Esophageal and stomach motility decreased and elasticity of stomach is reduced
4.11. Stomach is more alkaline as a result of decline in hydrochloride acid and pepsin
4.12. Slower peristalsis, inactivity, reduced food/ fluid intake, drugs, and low-fiber diet (increased risk of constipation
4.13. Pancreas changes and affects digestion of fats
4.14. Atrophy of the tongue- affects taste buds
4.15. Diverticulitis
4.15.1. Bowel contents can accumulate in the diverticula and decompose, causing inflammation and infection
4.15.2. Surgery performed medical management is unsuccessful or if serious complications occur, may consist of a resection or temporary colostomy
4.16. Colorectal Cancer
4.16.1. cancer at any site along the large intestine is common with advancing age. The sigmoid colon and rectum tend to be frequent sites for carcinomas; in fact, colorectal cancer is second leading cause
4.16.2. S&S: rectal bleeding, bloody stools, change in bowel pattern, anorexia, nausea, weakness, anemia
5. Musculoskeletal
5.1. Pain
5.1.1. 3 in 5 patients 65 or older experience pain for 1 year or more
5.1.2. Severe joint pain increases with age
5.1.3. Persistent pain is chronic pain present 3 months or longer.
5.1.4. Nociceptive pain arises from mechanical, thermal, or chemical noxious stimuli (somatic or visceral.
5.1.5. Arthritis
5.2. Sarcopenia
5.2.1. Due to protein not being synthesized
5.2.2. Decline in size and number of muscle fibers
5.2.3. Reduction in muscle mass
5.2.4. Decreased body strength
5.2.5. Endurance declines
5.2.6. Reduced flexibility of joints and muscles
5.3. Exercise
5.3.1. All exercise programs should address:
5.3.2. Cardiovascular endurance
5.3.3. Flexibility
5.3.4. Strength training
5.4. Fractures
5.4.1. The absence of typical signs of fracture does not guarantee no fracture present
5.4.2. Osteoarthritis
5.4.2.1. Progressive deterioration of joint cartilage with the formation of new bone at joint surface
5.4.2.2. Cause: flaw in the production that produces cartilage
5.4.2.3. Risk factor: genetics and obesity
5.4.2.4. Crepitus occurs often with these patients
5.4.2.5. Therapy must relieve joints
5.4.2.6. Therapeutic hot/cold compress
5.4.2.7. Stem cells is a new treatment needed if joint has not fully deteriorated
5.4.3. Brittle bones fracture more easily and heal at slower rate
5.4.4. Most common sites: hips, forearm
5.4.5. Oftentimes different signs and symptoms than younger adults- such as less pain
5.4.6. Rheumatoid Arthritis
5.4.6.1. Inflammation
5.4.6.2. Deformities and disability can begin at an early age and peak during middle age
5.4.6.3. Females are more common
5.4.7. Osteoporosis
5.4.7.1. Pathology, not age related changes
5.4.7.2. Prevention: dietary in early adulthood- calcium intake
5.4.7.3. Inactivity is a huge risk factor
5.4.7.4. Kyphosis, spinal pain, and fractures
5.4.7.5. Diagnosis: bone density
5.4.7.6. Often asymptomatic until the patient falls and fractures something
5.4.8. Gout
5.4.8.1. More MEN have this
5.4.8.2. Metabolic disorder in which excess Uris acid accumulates in the blood
5.4.8.3. Occurs 1st in the toes- red and inflamed
5.4.8.4. Beer and high protein foods exasterbate symptoms
5.4.8.5. Symptoms: extreme pain
5.5. Pediatric Conditions
5.5.1. Plantar fasciitis
5.5.2. Onychomycosis: nail fungus
5.5.3. Calluses
5.5.4. Corns
6. Integumentary
6.1. Dry and fragile skin, less elasticity
6.2. Decreased subcutaneous fat and sweat gland activity
6.3. Increased benign and malignant skin neoplasms
6.4. Thinner skin and paler and translucent
6.5. Age spots and pigments
6.6. Changes in connective tissue
6.7. Keratosis- small light- colored benign lesions on epidermis
6.8. Melanocytes- epidermal cells that give skin its color
6.9. Monogolian spots- dark irregular areas that look like bruises and may be found on the buttocks, lower back, and to a lesser extent on the arms, abdomen, and thighs
6.9.1. These are more prevalent in African, Asian, or Native American background.
6.10. Photoaging is caused by exposure to ultraviolet rays that damage the skin: the condition is called solar elastosis
6.11. Stasis Ulcers
6.11.1. Control infections, remove necrotic tissue to facilitate healing
6.11.2. Leg ulcers from stasis dermatitis
6.11.3. Good nutrition and high vitamins
6.11.4. Promote venous return by elevating legs and wearing elastic stockings
6.12. Pruritus
6.12.1. RF: Diabetes, arteriosclerosis, hyperthyroidism, liver disease, cancer, excessive bathing
6.12.2. Prompt recognition to treat dry skin or underlying problem
6.12.3. Vitamin supplements and vitamin rich diets are encouraged
6.12.4. Meds: topical zinc oxide, antihistamines, topical steroids
7. Sleep
7.1. Increased severity. With age of restless leg syndrome.
7.2. Sleep apnea is 3x as likely in men and increased in obese and overweight patients.
7.3. Insomnia is more present with daytime sleepiness and napping
7.4. Circadian sleep-wake cycles: phase advance is common where older adults go to bed earlier and wake up earlier.
7.5. Sleep latency- delay in the onset of sleep.
7.6. Insomnia is more present with daytime sleepiness and napping
7.7. Sleep apnea
7.7.1. Snoring accompanies this
7.7.2. Sleep disorder clinics and treatment includes weight reduction, medications, continue Luis positive airway pressure, surgery
7.7.3. Can be caused by defect in CNS, blockage in upper airway, or mixed
7.7.4. At least 5 episodes of cessation of breathing, Lawton at least 10 seconds, occur per hour of sleep, accompanied by day time sleepiness
7.8. Circadian sleep-wake cycles: phase advance is common where older adults go to bed earlier and wake up earlier.
7.9. Restless leg syndrome
7.9.1. Uncontrollale urge to move the legs
7.9.2. Uncomfortable, electrical, itching, pins and needles, pulling, painful
7.9.3. Causes: iron deficiency anemia, uremia, Parkinson's disease
7.9.4. Treatment: dopaminergic drugs, bezos, opioids, anticonvulsants, adrenergic, iron supplements
8. Immunity
8.1. Cancer
8.1.1. Additional screening with increased age
8.1.2. Conventional treatment: surgery, radiation, chemotherapy, biological therapy
8.1.3. Complementary therapy: special diets, psychotherapy, spiritual practices, vitamin supplements, herbal remedies
8.1.4. Prolonged closure to carcinogens
8.1.5. Changes in immune system impair body's ability to recognize cancerous calls and destroy them
8.2. Decreased t-call activity and cell-mediated immunity
8.3. Decreased inflammatory defenses and cytotoxic response
8.4. Increased inflammation
8.5. Decreased normal body temperature
8.6. Vaccinations aren’t quite as effective
8.6.1. Still needs flu shots hearly
9. Sexuality
9.1. Andropause in men where testosterone declines which effects muscle mass, energy, strength, and stamina
9.2. Menopause in women and estrogen reduction which effects how they feel. Hormone therapy is an individual persons decision
9.3. BPH
9.3.1. Benign Prostatic Hypertrophy is an enlarged prostate
9.3.2. Very common in men as they age
9.3.3. Warning signs with aging: pain with urination, erectile dysfunction, hematuria
9.3.4. Men are reluctant or embarrassed to seek medical treatment oftentimes
9.3.4.1. Kidney damage can result
9.4. TURP
9.4.1. Transurethral resection of the prostate is surgery used to treat urinary problems for an enlarged prostate.
9.4.2. Removal of excess prostate tissue
9.4.3. Normal PSA level: 4.0-10.0
9.5. Erectile Dysfunction
9.5.1. Effects most men over 70 years old
9.5.2. Not normal aging
9.5.3. Can be treated
9.5.3.1. Viagra most common med along with Cialis
9.5.4. Atherosclerosis and diabetes are most common causes
9.6. Health Promotion
9.6.1. Annual gynecologic exam with Pap smear
9.6.2. Breast self- examination
9.6.3. Men with prostatic hypertrophy examined every 6 months
9.6.4. Testicular self- examination
9.6.5. Complete history and physical exam
9.7. HIV
9.7.1. Incidence increasing twice as quickly in patients over 50
9.7.2. 44% are among gay/bisexual men
9.7.3. Less use of condoms because no risk of becoming pregnant
9.7.4. Many embarrassed to seek treatment, symptoms may not be recognized as HIV because of common aging problems
10. Cardiovascular
10.1. Heart muscle loses efficiency and contractile strength
10.2. Decreased cardiac output with physiologic stress
10.3. Valves thicken and become more rigid
10.4. Decreased elasticity in blood vessels
10.5. Decreased efficient oxygen usage
10.6. Increased systolic BP and baroreceptors don’t respond as well
10.7. Stroke volume decreases
10.8. Aorta becomes dilated
10.9. Myocardial muscle use is less efficient- with decreased contractile strength and decreased CO when demands increase.
10.10. Less sensitive to baroreceptor regulation of BP
10.11. Aorta becomes dilated
10.12. Myocardial muscle use is less efficient- with decreased contractile strength and decreased CO when demands increase.
10.13. Less sensitive to baroreceptor regulation of BP
10.14. CHF
10.14.1. Leading cause of hospitalization in older adults
10.14.2. CAD and HTN are major causes
10.14.3. SX: dyspnea on exertion, confusion insomnia, wandering during night, aviation, SOB, weakness
10.14.4. Moist crackles heard ok auscultation
10.14.5. Treatment is bed rest, medications, reduce sodium intake
10.15. CAD
10.15.1. Myocardial Infarction can be delayed or missed in older adults because of atypical SX and less severe pain
10.15.2. Encourage early ambulation after MI prevents immobility complications and better for heart workload
10.15.3. Close observations for signs of bleeding, edema or CHF
10.15.4. Angina: pain may be diffuse and less sever than younger adults
10.15.5. Nitroglycerin is effective- watch for orthostatic hypotension
11. Nervous
11.1. Decrease in weight and blood flow to the brain
11.2. Decreased neurons and nerve fibers as well as cerebral blood flow
11.3. Decreased response to change in balance
11.4. Decreased temperature regulation from the hypothalamus
11.5. Sleep pattern changes with frequent awakening and less time in REM sleep
12. Reproductive
12.1. Vaginal canal shortens and narrows
12.2. Reduction in collagen and adipose tissue
12.3. Less lubrication
12.4. More alkaline vaginal pH as result of lower estrogen
12.5. Uterus and ovaries decrease in size
12.6. Breasts sag and are less firm
12.7. Some retraction of nipples related to shrinkage and fibrotic changes
12.8. Fallopian tubes become shorter and straighter
12.9. Seminal vesicles develop thinner epithelium in males
12.10. Decreased capacity to retain fluids
12.11. Enlarged prostate gland
12.12. Atrophy of testes and reduction in testicular mass
12.12.1. Ejactulation fluid contains less live sperm
12.13. more time required to achieve an erection
12.13.1. testosterone slightly decreases
13. Endocrine
13.1. Decreased thyroid gland activity and ACTH secretion
13.2. Increased adipose and look glucose in nondiabetic patients.
13.3. Decreased basal metabolic rate
13.4. Decreased adrenal function
13.5. Thyroid gland atrophies and activity decreases
13.6. Decreased volume of pituitary gland and delayed insulin release due to beta cells
13.6.1. reduced sensitivity of circulating insulin
13.7. Decreased ability to metabolize glucose
13.8. Hormones are broken down slower
13.8.1. Testosterone levels decrease in males
13.9. 2 classes
13.9.1. steroids
13.9.2. thyronines
13.10. Diabetes Mellitus
13.10.1. 7th leading cause of death among older adults
13.10.2. effects 20 % of the older population and high prevelance among African Americans and people 65-74 years old
13.10.3. Glucose tolerance test is most effective, however multiple tests need to be done
13.10.4. 20-33% of all older adults have insulin issues
13.10.5. stress causes glucose levels to rise
13.10.6. False positive test results are common
13.10.7. Complications
13.10.7.1. PVD, diabetic retinopathy, CAD, frequent UTIs, cancer and cardiovascular mortality, polypharmacy, falls, fractures, blindness, cognitive impairment, neuropathies.
13.10.8. Glucose level below 90 is more detrimental to cardiovascular health than 130
13.10.8.1. Hypoglycemia is a greater threat than ketoacidosis
13.10.9. Criteria for diagnosis: must have 1 of 3
13.10.9.1. symptoms and random blood glucose concentration > 200 mg/dL
13.10.9.2. Fasting blood glucose concentration > 126 mg/dL
13.10.9.3. Blood glucose concentrations 2 hours after oral glucose intake > 200 mg/dL
13.10.10. Insulin
13.10.10.1. Rapid-acting
13.10.10.1.1. Lispro/ aspart
13.10.10.2. Short-acting
13.10.10.2.1. inject 30 minutes before meal
13.10.10.3. Intermediate acting
13.10.10.3.1. old-school
13.10.10.4. Long-acting
13.10.10.4.1. glargine
13.11. Hypothyroidism
13.11.1. meds are permanant
13.11.2. types
13.11.2.1. primary- low T4, high TSH
13.11.2.2. secondary- low T4, low TSH
13.11.3. signs- everything slows down: fatigue, depression, weight gain, constipation, dry skin, coarse hair, anorexia, pt. complains of being cold
13.12. Hyperthyroidism
13.12.1. signs- everything speeds up: diaphoresis, hypertention, diarrhea, insomnia
13.12.2. Graves- autoimmune antibody that attacks TSH
13.12.2.1. treat with radioactive iodine
13.12.3. Goiter- toxic mutinodular dysfunction of nodular gland
13.12.3.1. surgical removal is necessary
14. Vision and Hearing
14.1. Presbycusis- progressive hearing loss that occurs due to age-related changes of the inner ear
14.2. Ear lobes sag and enlarge
14.3. High pitched noises are harder to hear
14.3.1. Lip reading may be necessary for older people to learn what others are saying without hearing aids
14.4. Inner ear changes cause presbycusis to be the most common
14.5. Preventing hearing loss is most important in younger ears by using ear plugs when you can
14.6. Hearing aids or cochlear implants may be necessary depending on hearing loss
14.6.1. HEARING LOSS
14.7. Education is necessary so that hearing tests are done at yearly physical appointment
14.8. Increased cerumen and concentration of keratin
14.9. Ears
14.9.1. exposure to noise, recurrent otitis media, certain drugs can all impair hearing
14.10. Cataracts
14.10.1. clouding of crystalline lens of eye
14.10.2. blue eyes are more prone
14.10.3. symptoms: no discomfort or pain is associated, vision distorted, night vision decreased, objects appear blurred, feels like they have a film over their eye while driving, halo effect
14.10.4. treatment: surgery to remove the lens is the only cure for a cataract unless that patient has another eye that can see and doesn't want surgery.
14.11. Glaucoma
14.11.1. eye disease involving increased intra-ocular pressure
14.11.2. Atenolol and drops can help
14.11.3. By watching the pressure and catch early, you can sometimes treat
14.11.4. Normal eye pressure= under 20
14.11.5. Chronically untreated can cause all vision loss
14.11.6. Acute glaucoma- sudden intra-ocular pressure
14.11.6.1. must check within a day or permanent blindness can occur
14.11.7. Retinal detachment- floating in front of eyes *THIS IS A MEDICAL EMERGENCY*
14.11.8. Diabetic retinopathy- effects blood vessels in the back of the eyes
14.11.8.1. this is a late stage finding
14.12. Presbyopia is an age- related decrease in eye's ability to change the shape of lens to focus on near objects
14.13. Macular degeneration is the loss of central vision due to the development of drusen deposits in the retinal pigmented epithelium
14.13.1. Pathology most common for blindness
14.14. Education
14.14.1. Nurses should stress the importance of annual eye exams for older adults because the earlier they detect an issue, the more treatable it will be.
14.14.2. Taking Vitamin A maintains healthy rods and cones in the retina
14.14.3. Zinc promotes normal visual capacity and adaptation to dark
14.14.3.1. Deficiency in this can facilitate cataract development
14.14.4. Vitamin C promotes normal vision; supplementation may reduce risk of cataracts
14.14.5. Vitamin E may aid in preventing cataracts and supplementation in large doses can prevent macular degeneration
14.14.6. Selenium may aid in preventing cataracts
15. Neuro
15.1. Acutely ill patients
15.2. This effects all aspects of ADLs
15.3. Loss of nerve cell mass
15.4. Atrophy of the brain and spinal cord
15.5. Demyelinization
15.5.1. Slows reaction time and reflexes are weaker
15.6. Decreased cerebral blood flow
15.6.1. Exercise can help with this
15.7. Free radicals accumulate
15.8. Intellectual performance maintained until at least 80 years of age
15.9. Verbal skills maintained until age 70
15.10. Number of sensitivity of sensory receptors, dermatomes, and neurons decrease
15.11. Decline in function of cranial nerves affecting taste and smell
15.12. Delay in time required to perform tasks
15.13. Health promotion
15.13.1. Detect measures and subtle indications
15.13.2. An early morning headache or wakes you up at night
15.13.3. Ringing in the ears, tingling, vision changes
15.14. Parkinson’s disease
15.14.1. Role of dopamine
15.14.2. More common in males
15.14.3. Cause is unknown
15.14.3.1. Environmental exposures such as farming causes an increased risk factor
15.14.4. Signs and symptoms: tremors, mask face, shuffling gate, muscles rigidity
15.14.4.1. Falls can be unaccounted for in the beginning which is a sign
15.14.5. Symptom management
15.14.5.1. Anticholinergic meds
15.14.6. Hallucinations can often occur, but not always
15.15. TIA
15.15.1. Temporary or intermittent reduction in cerebral perfusion
15.15.2. Vision changes can occur
15.15.3. Recovery in a day
15.15.4. Precursor for cerebral attack
15.15.5. Third leading cause of death in older adults
15.15.6. Ischemic or hemmorrhagic
15.15.7. Warning sign of stroke: Face, Arms, Smile, and talk or check time
15.15.7.1. F.A.S.T.
15.15.8. Early rehabilitations
15.16. Nursing Considerations
15.16.1. Assistive devices
15.16.2. Periodic home visits
15.16.3. Regular contact with family and friends
15.16.4. Promoting self- care
15.16.5. Promoting INDEPENDENCE- personality problems may occur
15.16.6. Depression is often commo
15.16.7. Displaced reactions
15.16.7.1. Stroke patient that yells at the nurse
15.16.8. Loss of former roles and identities