Secretion of TSH and the serum concentration of T4 do not change

The secretion of glucocorticoids, 17-ketosteroids, progesterone, androgen, and estrogen decreases

Somatotropic growth hormone remains present in similar amounts

Decreases are seen in ACTH, TSH, FSH, LH, and luteotropic hormone

Delayed and insufficient release of insulin by beta cells

Decreased tissue sensitivity to circulating insulin

Dentin, the layer beneath the enamel, becomes more fibrous and its production is decreased

The number of root cavities and cavities around existing dental work increase

Chronic irritation (as from pipe smoking) can reduce taste efficiency to a greater degree

Sweet sensations on the tip of the tongue tend to suffer a greater loss than the sensations for sour, salt, and bitter flavors

Saliva is often diminished in quantity and is of increased viscosity

Fewer cells are present on the absorbing surface of intestinal walls

Absorption of vitamin B, vitamin B12, vitamin D, calcium, and iron is faulty

Large intestine has reductions in mucous secretions and elasticity of the rectal wall

The pancreatic ducts become dilated and distended, and often the entire gland prolapses

Sarcopenia, the age-related loss of muscle mass, strength, and function, is mostly seen in inactive persons

Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee

Bone density decreases at a rate of 0.5% each year after the third decade of life

The eye's ability to change the shape of the lens to focus on near objects is decreased

There is difficulty maintaining convergence and gazing upward

Older people less able to differentiate the low-tone colors of the blues, greens, and violets

Depth perception becomes distorted, causing problems in correctly judging the height of curbs and steps

Dark and light adaptation takes longer, as does the processing of visual information

The ciliary muscle gradually atrophies and is replaced with connective tissue

Reduced lacrimal secretions can cause the eyes to look dry and dull

Fat deposits can cause a partial or complete glossy white circle to develop around the periphery of the cornea (arcus senilis)

The accumulation of lipid deposits in the cornea can cause a scattering of light rays, which blurs vision

In the posterior cavity, bits of debris and condensation become visible and may float across the visual field; commonly called floaters

Speech sounds distorted as some of the high-pitched sounds (s, sh, f, ph, and ch) are filtered from normal speech and consonants are less able to be discerned

Weakening and stiffening of the middle ear muscles and ligaments

A reduction in the number of and changes in the structural integrity of touch receptors occurs

Men tend to experience a greater loss in the ability to detect odors

Reduced saliva production, poor oral hygiene, medications, and conditions such as sinusitis can also affect taste

Causes: any circumstance that dries the person's skin, such as excessive bathing and dry heat; diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia, and certain psychiatric problems

Treatment/prevention: bath oils, moisturizing lotions, massage, vitamin supplements, and a high-quality, vitamin-rich diet; antihistamines and topical steroids may also be prescribed for relief

Older adults are at high risk for pressure ulcers because they have skin that is fragile and damages easily; are often in a poor nutritional state; have reduced sensation of pressure and pain; are more frequently affected by immobile and edematous conditions, which contribute to skin breakdown

Common sites: sacrum, greater trochanter, and ischial tuberosities

Tissue anoxia and ischemia resulting from pressure can cause necrosis, sloughing, and ulceration of tissue

Prevention: encouraging activity; turning the patient who cannot move independently; not allowing patients to slide in bed; lifting instead of pulling patients when moving them; use of pillows, floatation pads, alternating pressure mattresses, and water beds; high-protein, vitamin-rich diet; good skin care; bath oils and lotions; massage of bony prominences; range-of-motion exercises

Tends to metastasize, or spread, more easily than the other forms of skin cancer, making it more deadly if not caught early

Treatment: melanomas are excised with removal of some of the surrounding tissue and subcutaneous fat; some physicians recommend removal of all palpably enlarged lymph nodes

Asymmetry- if a mole is not round or symmetrical, or one half of the mole is not similar to the other half, it could be a sign of melanoma

Border Irregularity- cancerous moles have irregular borders that may be uneven, ragged, notched, or blurred

Color- a mole that has changed color over time or is varied in a shade of brown, tan, and black may be cancerous; if melanoma has progressed, the mole may become red, blue, or white

Diameter- cancerous moles can be more than 6 mm in diameter

Some indications of diabetes in older persons include orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathy, confusion, glaucoma, Dupuytren contracture, and infection

Symptoms of diabetes and a random blood glucose concentration > or equal to 200 mg/dL

Blood glucose concentrations 2 hours after an oral glucose intake > or equal to 200 mg/dL during an oral glucose tolerance test

Sulfonylurea drugs, such as glibenclamide stimulate insulin secretion; however, the use of this drug in older persons carries a risk of severe hypoglycemia

Glipizide and gliclazide, which have shorter half lives and few or no active metabolites, are preferred sulfonylurea agents in older persons with diabetes

Glimepiride appears to be more selective than the earlier agents and carries a lower risk for causing vasoconstriction of small vessels

Sulfonylurea drugs should be started at a low dose, about half of the usual adult dosage

Contraindications: renal insufficiency, hepatic disease, alcoholism, severe congestive cardiac failure, severe peripheral vascular disease, and severe COPD

For persons with diabetes, the goal is Hemoglobin A1c below 7%

Begins to work about 15 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours

Usually reaches the bloodstream within 30 minutes after injection, peaks 2-3 hours after injection, and is effective for approximately 3-6 hours

Generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours

Reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period

Regular exercise is important for older diabetic patients and attempts should be made to maintain a consistent daily food intake

Classic S/S such as tachycardia, restlessness, perspiration, and anxiety may be totally absent in the older individual; instead, any of the following may be the first indication of the problem: behavior disorders, convulsions, somnolence, confusion, disorientation, poor sleep patterns, nocturnal headache, slurred speech, and unconsciousness

S/S: fatigue, weakness, and lethargy; depression and disinterest in activities; anorexia; weight gain and puffy face; impaired hearing; periorbital or peripheral edema; constipation; cold intolerance; myalgia, paresthesia, and ataxia; dry skin and coarse hair

The thyroid gland secretes excess amounts of thyroid hormones

Cause: iodine-induced, often related to the use of amiodarone

S/S: diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, stare, lid lag, insomnia, nervousness, confusion, heat intolerance, increased hunger, proximal muscle weakness, and hyperreflexia

Causes: exact cause is unknown; associated with a history of exposure to toxins, encephalitis, and cerebrovascular disease, especially arteriosclerosis

S/S: a faint tremor in the hands or feet that progresses over a long time; muscle rigidity and weakness develop, evidenced by drooling, difficulty in swallowing, slow speech, and a monotone voice; the patient's face assumes a mask-like appearance, and the skin is moist; bradykinesia and poor balance occur; appetite frequently increases; the person may demonstrate emotional instability; shuffling gait while leaning forward at the trunk

Secondary symptoms include: depression, sleep disturbances, dementia, forced eyelid closure, drooling, dysphagia, constipation, shortness of breath, urinary hesitancy, urgency, and reduced interest in sex

Management of disease: anticholinergics; carbidopa-levodopa; pulse generators that send electrical impulses that block tremor-causing brain signals; drug infusion systems; gene therapy; active and passive range-of-motion exercises; warm baths and massage

Risk factors: smoking, hypertension, severe arteriosclerosis, diabetes, gout, anemia, hypothyroidism, silent MI, TIAs and dehydration

Major types: ischemic (usually resulting from a thrombus or embolus) and hemorrhagic (which can occur from a ruptured cerebral blood vessel)

Warning signs: light-headedness, dizziness, headache, drop attack, and memory and behavioral changes

In the acute phase, nursing efforts have the following aims: maintain a patent airway, provide adequate nutrition and hydration, monitor neurologic and vital signs, and prevent complications associated with immobility

Irreversible, progressive impairment in cognitive function affecting memory, orientation, judgment, reasoning, attention, language, and problem solving

Characterized by: presence of neuritic plaques, which contain deposits of beta-amyloid protein; the beta-amyloid fragments clump together into plaques that impair the function of nerve cells in the brain; the second characteristic brain change is neurofibrillary tangles in the cortex

Possible causes: genetic factors; chromosomal abnormalities (especially on chromosome 21, 14, and 1); free radicals

Early in the disease, the patient may be aware of changes in intellectual ability and become depressed or anxious or attempt to compensate by writing down information, structuring routines, and simplifying responsibilities

S/S tend to be rapid and can include disturbed intellectual function; disorientation of time and place but usually not of identity; altered attention span; worsened memory; labile mood; meaningless chatter; poor judgment; and altered level of consciousness; significant perceptual changes, such as hallucinations and delusions

Treatment depends on cause (e.g., stabilizing blood glucose, correcting dehydration, and discontinuing a medication)

Some potential causes: fluid and electrolyte imbalances, medications, hyperglycemia/hypoglycemia, emotional stress, pain, dehydration, infection, hypoxia, hypotension, etc.

The sliding type is the most common and occurs when a part of the stomach and the junction of the stomach and esophagus slide through the diaphragm

Symptoms include: heartburn, dysphagia, belching, vomiting, and regurgitation

Management/treatment: weight reduction (if patient is obese); bland diet; use of milk and antacids; several small meals each day; H2 blockers; proton pump inhibitors

Common types: squamous cell carcinoma and adenocarcinoma

Risk factors: male gender, African American race, smoking, alcoholism, poor oral hygiene, Barrett's esophagus

S/S: dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia, and chronic bleeding

Treatment: surgical resection, radiation, chemotherapy, laser therapy, and photodynamic therapy

Common symptoms: bloody stools, change in bowel pattern, anorexia, nausea, pain over affected region, anemia

Treatment: surgical resection with anastomosis, formation of a colostomy

Causes: inactive lifestyle; low-fiber and low-fluid intake; depression; laxative abuse; certain medications, such as opiates, sedatives, and aluminum hydroxide gels; dulled sensations that cause the signal for bowel elimination to be missed

Ways to promote bowel elimination: a diet high in fluids and fiber; regular activity; providing a regular time for bowel elimination; rocking the trunk from side to side and back and forth while sitting on the toilet

Cholelithiasis- the formation or presence of gallstones in the gallbladder

Treatment: nonsurgical therapies- rotary lithotrite treatment and extracorporeal shock wave lithotripsy; and surgical procedures

Obstruction, inflammation, and infection are potential outcomes of gallstones

Progressive deterioration and abrasion of joint cartilage, with the formation of new bone at the joint surfaces

Risk factors: excessive use of the joint, trauma, obesity, low vitamin D and C levels, and genetic factors

Most common joints affected: knees, hips, vertebrae, and fingers

S/S: crepitation on joint motion, bony nodules on distal joints

Treatment: analgesics; rest, heat, or ice; aquatherapy; ultrasound; gentle massage; splints, braces, and canes provide support and rest to the joints; weight reduction (for obese individuals); joint replacement

The deformities and disability primarily begin during early adulthood and peak during middle age; in old age, greater systemic involvement occurs

The synovium becomes hypertrophied and edematous with projections of synovial tissue protruding into the joint cavity

Systemic symptoms include: fatigue, malaise, weakness, weight loss, wasting, fever, and anemia; the affected joints are extremely painful, stiff, swollen, red, and warm to the touch; subcutaneous nodules over bony prominences and bursae may be present, as may deforming flexion contractures

Management: encouraging patients to rest, providing support to the affected limbs; range-of-motion exercises; heat; gentle massage; analgesics; anti-inflammatory agents; corticosteroids; antimalarial agents; gold salts; immunosuppressive drugs

Causes: any health problem associated with inadequate calcium intake, excessive calcium loss, or poor calcium absorption; inactivity or immobility; Cushing syndrome, hyperthyroidism, diverticulitis; reduction in anabolic sex hormones; heparin, furosemide, thyroid supplements, corticosteroids, tetracycline

Treatment: calcium supplements, vitamin D supplements, progesterone, estrogen, anabolic agents, fluoride, phosphate; a diet rich in protein and calcium; braces; range-of-motion exercises