1. Hormonal Changes
1.1. Vulva atrophies
1.2. Flattening of the labia
1.3. Loss of subcutaneous fat and hair
2. Neuro
2.1. Normal Age Related Changes
2.1.1. Loss of nerve cell mass
2.1.1.1. Atrophy of the brain and spinal cord
2.1.1.2. Brain weight decreases
2.1.2. Number of dendrites declines
2.1.3. Demyelinization
2.1.3.1. Slower nerve conduction
2.1.3.2. Response and reaction times are slower
2.1.3.3. Reflexes become weaker
2.1.4. Plaques, tangles, atrophy of the brain
2.1.5. Free radicals accumulate
2.1.6. Decrease in cerebral blood flow
2.1.7. Fatty deposits accumulate in blood vessels
2.1.8. Ability to compensate declines with age
2.1.9. Intellectual performance maintained until at least 80 years of age
2.1.10. Slowing in central processing
2.1.10.1. Delay in time required to perform tasks
2.1.11. Verbal skills maintained until age 70
2.1.12. Number and sensitivity of sensory receptors, dermatomes, and neurons decrease
2.1.12.1. Dulling of tactile sensation
2.1.13. Decline in the function of cranial nerves affecting taste and smell
2.2. Parkinson's Disease
2.2.1. Affects ability of the CNS to control body movements
2.2.2. Role of dopamine
2.2.3. Exact cause unknown
2.2.4. Tremors and shuffling gait are characteristic
2.2.5. Treatment/management
2.2.5.1. Anticholinergic medications
2.2.5.2. Technologies to control symptoms
2.2.6. Nursing Interventions
2.2.6.1. Education
2.2.6.2. Psychosocial
2.2.6.3. Physical
2.2.6.4. Goal: maximum level of independence preserved
2.3. Cerebrovascular Accident
2.3.1. Third leading cause of death in older adults
2.3.2. Types
2.3.2.1. Ischemic
2.3.2.2. Hemorrhagic
2.3.3. Risk factors
2.3.3.1. Obesity
2.3.3.2. Hyperlipidemia
2.3.4. Warning signs
2.3.4.1. Face
2.3.4.2. Arms
2.3.4.3. Slurred speech
2.3.4.4. Time
2.3.5. Drop attack
2.3.6. Signs and symptoms
2.3.6.1. Variable
2.3.6.2. Depend on the area of brain affected
2.3.7. Nursing care during the acute phase; after patient stabilization, focus is on rehabilitation
3. Integumentary
3.1. Normal Age Related Changes
3.1.1. Flattening of the dermal-epidermal junction
3.1.2. Reduced thickness and vascularity of the dermis
3.1.3. Reduction of epidermal turnover
3.1.4. Degeneration of elastic fibers
3.1.5. Increased coarseness of collagen
3.1.6. Reduced in melanocytes
3.1.7. Atrophy of hair bulbs and decline in the rate of hair and nail growth
3.1.8. Increased fragility of the skin
3.2. Pruritus
3.2.1. Most common dermatologic problem among older adults
3.2.2. Causes
3.2.2.1. Hair regrowth
3.2.2.2. Insect bites
3.2.2.3. Sunburn
3.2.2.4. Dry skin
3.2.3. Potential for skin breakdown and infection
3.2.4. Prompt recognition
3.2.5. Treatment
3.2.5.1. Topical cannabinoid cream
3.3. Skin cancer
3.3.1. Basal cell carcinoma
3.3.1.1. Most common form
3.3.1.2. Grows slowly
3.3.1.3. Rarely metastasized
3.3.1.4. Slightly transparent bump on skin
3.3.1.5. Usually develops on the sun-exposed parts of the body
3.3.1.6. Electrodesiccation and curettage
3.3.2. Squamous cell carcinoma
3.3.2.1. Contributing factors
3.3.2.1.1. Sun exposure
3.3.2.1.2. Other factors that facilitate growth
3.3.2.2. Uncontrolled growth of abnormal squamous cells
3.3.2.3. Second most common form
3.3.2.4. Firm red nodule
3.3.2.5. Electrodesiccation and curettage
3.3.3. Melanoma
3.3.3.1. Tends to more easily metastasize
3.3.3.2. Rising incidence in the United States
3.3.3.3. Pigment-producing cells that give color to the skin become cancerous.
3.3.3.4. A new unusual growth or mole or a change in an existing mole
3.3.3.5. Surgery, radiation, medications
4. Reproductive
4.1. Normal Age Related Changes-Female
4.1.1. Vaginal epithelium thins
4.1.2. Cervix, uterus, and fallopian tubes atrophy
4.1.3. Vaginal canal changes
4.1.3.1. Reduction in collagen and adipose tissue
4.1.3.2. Shortening and narrowing of the canal
4.1.3.3. Less lubrication
4.1.3.3.1. May lead to discomfort with intercourse
4.1.3.4. More alkaline vaginal pH as a result of lower estrogen changes
4.1.4. Uterus and ovaries decrease in size
4.1.5. Fallopian tubes become shorter and straighter
4.1.6. Breasts sag and are less firm
4.2. Vaginitis
4.2.1. The increased fragility of the fragile vagina in postmenopausal women causes it to be more easily irritated, which heightens the risk of vaginitis
4.2.2. Symptoms
4.2.2.1. Soreness
4.2.2.2. Pruritus
4.2.2.3. Burning
4.2.2.4. Reddened vagina
4.2.2.5. Foul-smelling vaginal discharge is clear, brown, or white; could progress and cause bleeding and adhesions
4.2.3. Treatment
4.2.3.1. Local estrogens in suppository or cream form
4.2.3.2. Boric acid, zinc, lysine, or gentian violet douches may also be prescribed
4.2.3.3. Good hygienic practices help treat and prevent
4.3. Cervical Cancer
4.3.1. Median age when diagnosed is 49 years old
4.3.2. Although less than 20% of all diagnosed cases are in older women, about 1/3 of cervical cancer deaths occur among this group
4.3.3. Signs
4.3.3.1. Vaginal bleeding
4.3.3.2. Leukorrhea
4.3.3.3. Urinary retention
4.3.3.4. Fecal incocontinence
4.3.3.5. Uremia
4.3.4. Treatment
4.3.4.1. Radium
4.3.4.2. Surgery
4.4. Normal Age Related Changes-Male
4.4.1. Seminal vesicles develop thinner epithelium
4.4.2. Muscle tissue replaced with connective tissue
4.4.3. Decreased capacity to retain fluids
4.4.4. Seminiferous tubule changes
4.4.4.1. Increase fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen
4.4.5. Atrophy of the testes and reduction in testicular mass
4.4.6. Ejaculation fluid contains less live sperm
4.4.7. More time required to achieve an erection
4.4.8. Enlargement of the prostate gland
4.5. Erectile Dysfunction
4.5.1. Inability to achieve and sustain an erection for intercouse
4.5.2. Nearly half of the men over 70 years of age are affected
4.5.3. Caused by alcoholism, diabetes, dyslipidemia, HTN, hypogonadism, multiple sclerosis, renal failure, spinal cord injury, thyroid conditions, psychological factors, and certain medications.
4.5.4. Treatments
4.5.4.1. Oral erectile agents
4.5.4.1.1. Viagra
4.5.4.1.2. Levitra
4.5.4.1.3. Cialis
4.5.4.2. Drugs injected into the penis
4.5.4.3. Penis implants
4.5.4.4. Vacuum pump devices
4.6. Benign Prostatic Hyperplasia
4.6.1. Symptoms
4.6.1.1. Hesitancy
4.6.1.2. Decreased force of urinary stream
4.6.1.3. Frequency
4.6.1.4. Nocturia
4.6.2. Prostate enlarges putting pressure on the urethra
4.6.3. As the hyperplasia progresses, the bladder wall loses its elasticity and becomes thinner, leading to urinary retention and an increased risk of urinary infection
4.6.4. May develop kidney damage if left untreated
4.6.5. Treatment
4.6.5.1. Prostatic massage
4.6.5.2. Urinary antiseptics
4.6.5.3. The avoidance of diuretics, anticholinergics, and antiarrhythmics
4.6.5.4. Transurethral surgery
4.7. Prostate Cancer
4.7.1. More than half of men over 70 have evidence of prostate cancer; only a small percentage will die from it
4.7.2. Often asymptomatic
4.7.2.1. Symptoms such as back pain, anemia, weakness, and weight loss can develop as a result of metastasis
4.7.3. Detected by digital rectal examination
4.7.3.1. PSA test assists with diagnosis, confirmed through biopsy
4.7.4. Treatment
4.7.4.1. Monitoring, irradiation, or a radical prostatectomy if metastasis has not occurred
4.7.4.2. Hormones may be used to prevent tumor dissemination
4.7.4.3. Palliative treatment is used if metastasis has occurred; includes irradiation, transurethral surgery, chemotherapy, orchiectomy, and hormone therapy
5. Musculoskeletal
5.1. Normal Age Related Changes
5.1.1. Shortening of vertebrae
5.1.1.1. Height decreases approximately 2 inches
5.1.2. Slight knee, hip, and wrist flexion
5.1.3. Decrease in bone mass and bone mineral
5.1.3.1. Bones more brittle
5.1.4. Slight kyphosis
5.1.5. Decline in size and number of muscle fibers, and reduction in muscle mass
5.1.5.1. Decreased body strength
5.1.5.2. Endurance declines
5.1.6. Connective tissue changes
5.1.6.1. Reduced flexibility of joints and muscles
5.1.7. Sarcopenia
5.1.7.1. Age-related reduction of muscle mass or function resulting from a reduction in protein synthesis and an increase in muscle protein degeneration
5.1.7.1.1. Can lead to disability
5.2. Fractures
5.2.1. Risk Factors
5.2.1.1. Posture
5.2.1.2. Decreased calcium intake while 20-30 years old
5.2.1.3. Slow reaction time
5.2.1.4. Brittle bone
5.2.1.5. Malnutrition
5.2.2. Common sites
5.2.2.1. Hips
5.2.2.2. Wrist
5.2.3. Brittle bones fracture more easily and heal at a slower rate
5.2.3.1. Potential for complications associated with immobility
5.2.4. Interventions aimed at prevention
5.2.5. Immobility of the injured site
5.3. Osteoporosis
5.3.1. Most prevalent metabolic disease of the bone
5.3.2. Risk factors
5.3.2.1. Inactivity or immobility
5.3.2.2. Diseases
5.3.2.3. Reduction in anabolic sex hormones
5.3.2.4. Diet
5.3.2.5. Drugs
5.3.3. May cause kyphosis, spinal pain, and fractures
5.3.4. Often asymptomatic
5.3.5. Diagnosis
5.3.5.1. Bone density
5.4. Gout
5.4.1. Metabolic disorder in which excess uric acid accumulates in the blood
5.4.2. Excruciating pain
5.4.3. Exacerbations and remissions
5.4.4. Managing diet- decrease red meats and beer
6. Genitourinary
6.1. Normal Age Related Changes
6.1.1. Hypertrophy and thickening of the bladder muscle
6.1.1.1. Decreases bladder ability to expand
6.1.1.2. Reduces storage capacity
6.1.1.2.1. Daytime urinary frequency
6.1.1.2.2. Nocturia
6.1.2. Changes in cortical control of micturition
6.1.2.1. Nocturia
6.1.3. Inefficient neurological control of bladder emptying and weaker bladder muscle
6.1.3.1. Retention of large volumes of urine
6.1.3.1.1. Female: fecal impaction
6.1.3.1.2. Male: prostatic hypertrophy
6.1.4. Kidney filtration ability decreases
6.1.4.1. Affects the ability to eliminate drugs
6.1.4.1.1. Potential for adverse drug reactions
6.1.5. Reduced renal function
6.1.5.1. High blood urea nitrogen levels
6.1.6. Decreased tubular function
6.1.6.1. Concentration of urine changes in response to water and/or sodium excess/depletion
6.2. Bladder cancer
6.2.1. Incidence increases with age
6.2.2. Risk factors
6.2.2.1. Chronic irritation of the bladder
6.2.2.2. Exposure to dyes
6.2.2.3. Cigarette smoking
6.2.3. Symptoms
6.2.3.1. Frequency
6.2.3.2. Urgency
6.2.3.3. Dysuria
6.2.4. Treatment
6.2.4.1. Sugery
6.2.4.2. Radiation
6.2.4.3. Immunotherapy
6.2.4.4. Chemotherapy
6.3. Glomerulonephritis
6.3.1. Symptoms
6.3.1.1. Usually subtle and nonspecific
6.3.2. Clinical manifestations
6.3.2.1. Fever
6.3.2.2. Fatigue
6.3.2.3. N/V
6.3.2.4. Anorexia
6.3.2.5. Abdominal pain
6.3.3. Diagnosis/Treatemtn
6.3.3.1. Differ significantly from those used for the young
6.3.3.2. Antibiotics, a restricted sodium and protein diet, and pay attention to I & O's.
7. Safe Medication Use
7.1. Increased Risk of Adverse Reactions
7.1.1. Related to altered pharmacokinetics and pharmacodynamics
7.1.2. Mental dysfunction is often an early sign of adverse reaction to many medications
7.2. Age-related changes affect
7.2.1. Pharmacokinetics
7.2.1.1. Absorption
7.2.1.1.1. Factors altering absorption
7.2.1.2. Distribution
7.2.1.2.1. Difficult to predict drug distribution
7.2.1.2.2. Considerations with the older adult
7.2.1.2.3. Dehyrdration and hypoalbuminemia decrease drug distribution
7.2.1.3. Metabolism
7.2.1.3.1. Conditions decreasing metabolism of drugs
7.2.1.4. Excretion
7.2.1.4.1. Extended biological half-life: close evaluation of drug clearance
7.2.1.4.2. Renal system excretes drugs; implications of reduced kidney efficiency important
7.2.1.4.3. Liver influences drug excretion
7.2.2. Pharmacodynamics
7.2.2.1. Increased myocardial sensitivity to anesthesia
7.3. Polypharmacy
7.3.1. High prevalence of health conditions, large use of medications
7.3.2. Taking more than one drug increases the risk of drug-food interactions
7.3.3. Most older adults use at least one medication regularly; many use several medications daily
7.4. Factors interference with safe administration
7.4.1. Functional limitations
7.4.2. Cognitive limitations
8. Cardiacvascular
8.1. Normal Age Related Changes
8.1.1. Heart valves become thicker and rigid
8.1.2. Aorta becomes dilated
8.1.2.1. Slight ventricular hypertrophy
8.1.2.2. Thickening of left ventricular wall
8.1.3. Myocardial muscle less efficient
8.1.3.1. Decreased contractile strength
8.1.3.2. Decreased cardiac output when demands increased
8.1.4. Calcification, reduced elasticity of vessels
8.1.5. Less sensitive to baroreceptor regulation of blood pressure
8.1.6. Conditions altering tissue perfusion
8.1.6.1. Cardiovascular diseses
8.1.6.2. Diabetes, cancer, renal failure
8.1.6.3. Blood dycrasias
8.1.6.4. Hypotension
8.1.6.5. Medication side effects
8.2. Hypertension
8.2.1. Incidence and prevalence increases with age
8.2.2. Evaluation of blood pressure
8.2.2.1. Systolic BP > 140 mm Hg
8.2.2.2. Diastolic BP > 90 mm Hg
8.2.2.3. Factors to consider when monitoring BP
8.2.2.3.1. Anxiety
8.2.2.3.2. Stress
8.2.2.3.3. Activity before assessment
8.2.3. Symptoms
8.2.3.1. Dull headache
8.2.3.2. Impaired memory
8.2.3.3. Disorientation
8.2.3.4. Confusion
8.2.3.5. Epistaxis
8.2.3.6. Slow tremor
8.2.3.7. Treatment
8.2.3.7.1. Exercise
8.2.3.7.2. Antihypertensive medication
8.2.3.7.3. Low sodium diet
8.2.3.7.4. Quit smoking
8.3. Congestive Heart Failure
8.3.1. Incidence increases with age
8.3.2. Leading cause of hospitalization
8.3.3. Chronic condition where the heart doesn't pump as much blood as it should
8.3.4. Complication of arteriosclerotic heart disease
8.3.5. Coronary artery disease responsible for most cases
8.3.6. Symptoms
8.3.6.1. Shortness of breath
8.3.6.2. Dyspnea on exertion
8.3.6.3. Confusion
8.3.6.4. Agitation
8.3.6.5. Depression
8.3.6.6. Insomnia
8.3.6.7. Weight gain
8.4. Coronary Artery Disease
8.4.1. ischemic heart disease
8.4.2. Prevalence increase with age
8.4.3. Angina
8.4.3.1. Atypical presentation
8.4.3.1.1. Coughing
8.4.3.1.2. Syncope
8.4.3.1.3. Sweating
8.4.3.1.4. Confusion
8.4.3.2. Nitroglycerin effective
8.4.4. Myocardial infaction
8.4.4.1. Atypical presentation: confusion, decreased BP, SOB, elevated temperature, and sedimentation rate
9. Respiratory
9.1. Normal Age Related Changes
9.1.1. Changes occur in upper paths, nose, and trachea
9.1.2. Reduce cough
9.1.3. Lungs reduce in size and weight
9.1.4. Decreased elastic recoil
9.1.5. Alveoli less elastic
9.1.6. Reduction in vital capacity; increase residual volume
9.1.7. Loose or brittle teeth can be aspired
9.2. Asthma
9.2.1. Can develop in older years
9.2.2. High risk of complications of bronchiectasis, cardiac problems
9.2.3. High rates of mortality
9.2.4. Assess for causative factors and educate patient
9.2.5. Evaluate aerosol nebulizers' use
9.2.6. Precaution: avoid adverse drug effects
9.3. Chronic bronchitis
9.3.1. Causes persistent, productive cough; wheezing; recurrent respiratory infections; shortness of breath
9.3.2. Management of chronic bronchitis
9.3.2.1. Remove bronchial secretions
9.3.2.2. Prevent obstruction of airway
9.3.2.3. Maintain adequate fluid intake
9.4. Emphysema
9.4.1. Increasing incidence in older adults
9.4.2. Causes
9.4.2.1. Chronic bronchitis
9.4.2.2. Chronic irritation
9.4.2.3. Morphologic changes in the lung
9.4.3. Cigarette smoking major role in development
9.4.4. Symptoms develop slowly; can delay diagnosis, treatment
9.4.5. Treatment
9.4.5.1. Postural drainage
9.4.5.2. Bronchodilators
9.4.5.3. Avoid stress
9.4.5.4. Breathing exercises
10. Gastrointestinal
10.1. Normal Age Related Changes
10.1.1. Atrophy of the tongue affects taste buds and decrease taste sensation
10.1.2. Saliva production decreases
10.1.2.1. Swallowing may be difficult
10.1.3. Presbyesophagus results in weaker esophageal contractions and weakness sphincter
10.1.4. Esophageal and stomach motility decreases
10.1.4.1. Risk for aspiration and indigestion
10.1.5. Decreased elasticity of the stomach
10.1.5.1. Reduces the amount of food accommodation at one time
10.1.6. Stomach has higher pH as a result of decline in HCL
10.1.6.1. Interferes in incidence of gastric irritation
10.1.6.2. Interferes with absorption of calcium, iron, folic acid, and vitamin B12
10.1.7. Decline in pepsin
10.1.7.1. Interferes with absorption of protein
10.1.8. Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D
10.2. Xerostomia
10.2.1. Caused by decreased saliva, some medications, Sjogren's syndrome, mouth breathing, and altered congnition
10.2.2. Consequences of decreased saliva production in the older adult population
10.2.3. Interventions
10.2.3.1. Saliva substitutes
10.2.3.2. Sipping water
10.2.3.3. Sugarless candy and gum
10.3. Dysphagia
10.3.1. Incidence of swallowing difficulties increases with age
10.3.2. Causes
10.3.2.1. GERD
10.3.2.2. Stroke
10.3.2.3. Structural disorders
10.3.3. Goals of care and interventions
10.3.3.1. Prevention of aspiration
10.3.3.2. Promotion of adequate nutritional status
11. Endocrine
11.1. Normal Age Related Changes
11.1.1. Thyroid gland atrophies and activity decreases
11.1.2. Diminished adrenal function
11.1.3. Adrenocorticotropic hormone secretion decreases
11.1.3.1. Causes BP to increase
11.1.4. Volume of pituitary gland decreases
11.1.5. Insufficient release of insulin and reduced tissue insensitivity to circulating insulin
11.2. Type 2 Diabetes
11.2.1. Glucose intolerance
11.2.2. Incidence
11.2.2.1. 25-33% of older adults have diabetes
11.2.3. Classic nonspecific symptoms may be absent
11.2.4. Screening
11.2.4.1. Glucose tolerance test is the most effective test
11.2.4.2. Fasting blood sugar recommended every 3 years for persons over 45 years of age
11.2.4.2.1. Multiple tests should be performed to avoid false-positive results
11.2.5. Diagnosis
11.2.5.1. Symptoms and a random blood glucose concentration >200 mg/dl
11.2.5.2. Fasting blood glucose concentration >126 mg/dl
11.2.5.3. Blood glucose concentrations 2 hours after oral glucose intake >200 mg/dl
11.2.6. Medication
11.2.6.1. Metformin
11.2.6.1.1. Increase insulin sensitivity
11.2.6.1.2. Decrease glucose
11.2.6.2. Glyburide
11.3. Hypothyroidism
11.3.1. Subnormal concentration of thyroid hormone
11.3.2. Primary hypothyroidism
11.3.2.1. Low T4 and high TSH
11.3.3. Secondary hypothyroidism
11.3.3.1. Low T4 and low TSH
11.3.4. Signs/Symptoms
11.3.4.1. Fatigue
11.3.4.2. Depression
11.3.4.3. Disinterest in life
11.3.4.4. Anorexia
11.3.4.5. Constipation
11.3.4.6. Weight gain
11.3.4.7. Myalgia or parathesia
11.3.5. Treatment
11.3.5.1. Requires medication replacement
11.4. Hyperthyroidism
11.4.1. Secretion of excess amounts of thyroid hormone
11.4.2. Signs/Symptoms
11.4.2.1. Diaphoresis
11.4.2.2. Tachycardia
11.4.2.3. HTN
11.4.2.4. Tremor
11.4.2.5. Palpitations
11.4.2.6. Diarrhea
11.4.2.7. Lid Lag
11.4.3. Diagnosis
11.4.3.1. Graves' Disease
11.4.3.1.1. Autoimmune antibody to TSH
11.4.3.1.2. Antithyroid medication or radioactive iodine
11.4.3.2. Goiter
11.4.3.2.1. Toxic multi nodular condition
11.4.3.2.2. Surgically remove
12. Sensation
12.1. Vision
12.1.1. Normal Age Related Changes
12.1.1.1. Reduced elasticity and stiffening of the muscle fibers of the lens
12.1.1.1.1. Decreased ability to focus (presbyopia)
12.1.1.2. Reduced pupil size
12.1.1.3. Opacification of the lens and vitreous
12.1.1.3.1. Visual acuity declines
12.1.1.4. Loss of photoreceptor cells in the retina
12.1.1.4.1. Light perception threshold decreases
12.1.1.4.2. Dark and light adaptation takes longer
12.1.1.4.3. Difficult with vision at night
12.1.1.5. Increased sensitivity to glare
12.1.1.6. Distortion in depth perception
12.1.1.7. Peripheral vision reduced
12.1.2. Cataracts
12.1.2.1. Clouding of the lens and loss of transparency
12.1.2.2. Leading cause of low vision in older adults
12.1.2.3. Risk Factors
12.1.2.3.1. Increasing age; smoking; diabetes; high blood pressure
12.1.2.4. Blurred vision
12.1.2.5. Treatment/management
12.1.2.5.1. Need for surgery must be evaluated on an individual basis
12.1.3. Glaucoma
12.1.3.1. Damage to the optic nerve from an above normal intraocular pressure
12.1.3.2. 2nd leading cause of blindness in older adults
12.1.3.3. Acute
12.1.3.3.1. Closed or narrow angle
12.1.3.3.2. Severe eye pain, headache, N/V
12.1.3.3.3. Rapid increase in tension and edema
12.1.3.3.4. Need for early treatment to prevent blindness
12.1.3.3.5. Diagnosis with tonometry to measure IOP
12.1.3.4. Chronic
12.1.3.4.1. Open angle
12.1.3.4.2. Most common form
12.1.3.4.3. Need for early prevention to prevent blindness
12.1.3.4.4. Vision loss due to glaucoma cannot be restored
12.1.3.4.5. Avoid situations that increase IOP
12.1.3.4.6. Avoid abuse and overuse of the eyes
12.2. Hearing
12.2.1. Normal Age Related Changes
12.2.1.1. Changes may negatively impact communication
12.2.1.2. Sensorineural hearing loss (presbycusis)
12.2.1.3. Impacted cerumen
12.2.1.4. Self-conscious of limitation and avoid interactions
12.2.1.5. Underlying cause determined by professional
12.3. Others
12.3.1. Number of functioning taste buds decrease
12.3.1.1. Sweet and salty flavors
12.3.2. Pressure not sensed as easily in later life
12.3.2.1. Decreased tactile sensation
12.3.2.2. Difficulty discriminating b/t temperatures
12.3.3. Some olfactory function loss
13. Safety
13.1. Risks are compounded by:
13.1.1. Age-related factors reducing their capacity to protect themselves
13.1.2. Increased vulnerability to safety hazards
13.2. Nursing assessment includes a review of risks to safety
13.3. Interventions necessary to address threats to safety, life, well-being
13.3.1. Lighting
13.3.1.1. Light profound effect on visibility
13.3.1.1.1. Function
13.3.1.1.2. Orientation
13.3.1.1.3. Mood and behavior
13.3.1.2. Diffuse lighting better than bright light
13.3.1.3. Nightlights: soft red light in bedroom
13.3.2. Temperature
13.3.2.1. Older adults have lower than normal body temperatures
13.3.2.1.1. Decreased natural insulation
13.3.2.2. Maintaining adequate environmental temperature is significnat
13.3.2.3. Recommended room temperature is 75 degree F: lower temperature leads to hypothermia
13.3.3. Floor coverings
13.3.3.1. Carpeting: sound absorber but can cause problems
13.3.3.1.1. Static electricity and cling
13.3.3.1.2. Difficult wheelchair mobility
13.3.3.1.3. Cleaning
13.3.3.1.4. Odors
13.3.3.1.5. Pests
13.3.3.2. Scattered rugs or area rugs can cause falls
13.3.4. Furniture
13.3.4.1. Appealing
13.3.4.2. Functional
13.3.4.3. Comfortable
13.3.4.4. Tables and bookcases should be sturdy
13.4. Accidents rank sixth leading cause o fdeath
13.5. Falls leading cause of injury-related death
13.6. Environment
13.6.1. Microenvironment: immediate surrounding
13.6.2. Macroenvironment: elements in larger world