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Age-related Changes in Older Adults (Integumentary (Fingernails (Grow more…
Age-related Changes in Older Adults
Respiratory
Relaxation of the tissue at the lower edge of the septum
Reduced support
The tip of the nose rotates downward (slightly)
Mouth breathing (during the night) becomes more common
Snoring
Obstructive apnea
Submucosal glands have decreased secretions
The ability to dilute mucus secretions is reduced
Secretions thicken
The ability to expel mucus and debris is more complicated
Cough and laryngeal reflexes become weaker
Cilia reduce in number
The bronchial mucous gland hypertrophies
Reduction in body fluid/Reduced fluid intake
Drier mucous membranes
Older persons have a sensation of nasal stuffiness
Calcification of costal cartilage
Trachea and rib cage become more rigid
Kyphosis and an increase in anterior-posterior chest diameter r/t...
The loss of skeletal muscle strength in the thorax and diaphragm
The loss of resilient force that holds the thorax in a slightly contracted position
Thoracic inspiratory and expiratory muscles become weaker
Less lung expansion
Insufficient basilar inflation
Risk for respiratory infections increases
Lungs exhale less effectively
Residual volume increases
Vital capacity decreases
Maximum breathing capacity decreases
Alveoli lose elasticity
Alveoli reduce in number and stretch
The lungs become...
Smaller
Less firm
Lighter
More rigid (less recoil)
COPD
Chronic Bronchitis
S/S may develop gradually and include: persistent, productive cough; wheezing; recurrent respiratory infections; and shortness of breath
Cause: recurrent inflammation and mucus production in the bronchial tubes, which, over time, produce blockage and scarring that restricts airflow
Management of chronic bronchitis is aimed at removing bronchial secretions and preventing obstruction of the airway; older patients may need special encouragement to maintain good fluid intake and to expectorate secretions
Emphysema
Causes: cigarette smoking; chronic bronchitis; chronic irritation from dusts or certain air pollutants; and morphologic changes in the lungs, which include distention of the alveolar sacs, rupture of the alveolar walls, and destruction of the alveolar capillary bed
S/S are slow in onset and initially may resemble age-related changes in the respiratory system. S/S include: dyspnea, chronic cough, fatigue, anorexia, weight loss, weakness, recurrent respiratory infections, malnutrition, CHF, and cardiac arrhythmias
Treatment includes postural drainage, bronchodilators, the avoidance of stressful situations, breathing exercises, cigarette smoking cessation
Lung Cancer
Causes: smoking; and exposure to asbestos, coal gas, radioactive dusts, and chromates
S/S include: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and recurrent upper respiratory infections
Treatment may consist of surgery, chemotherapy, or radiotherapy
Endocrine
Thyroid gland
Fibrosis
Cellular infiltration
Increased nodularity
Decreased activity
Lower basal metabolic rate
Reduced radioactive iodine uptake
Thyrotropin secretion and release is decreased
Secretion of TSH and the serum concentration of T4 do not change
There is a significant reduction in T3
Reduced conversion of T4 to T3
Total serum iodide is reduced
Progressive atrophy
ACTH secretion decreases
Secretory activity of the adrenal gland decreases
The secretion of glucocorticoids, 17-ketosteroids, progesterone, androgen, and estrogen decreases
Pituitary gland
Decreases in volume by approximately 20%
Somatotropic growth hormone remains present in similar amounts
Decreases are seen in ACTH, TSH, FSH, LH, and luteotropic hormone
Gonadal secretion declines
Gradual decreases in...
Testosterone
Progesterone
Estrogen
Higher blood glucose levels in non-diabetic older persons
Ability to metabolize glucose is reduced
Delayed and insufficient release of insulin by beta cells
Decreased tissue sensitivity to circulating insulin
Diabetes Mellitus
Some indications of diabetes in older persons include orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathy, confusion, glaucoma, Dupuytren contracture, and infection
Diagnostic Criteria
Symptoms of diabetes and a random blood glucose concentration > or equal to 200 mg/dL
Fasting blood glucose concentration > or equal to 126 mg/dL
Blood glucose concentrations 2 hours after an oral glucose intake > or equal to 200 mg/dL during an oral glucose tolerance test
Drug Therapy
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
Metformin
Contraindications: renal insufficiency, hepatic disease, alcoholism, severe congestive cardiac failure, severe peripheral vascular disease, and severe COPD
This drug should be administered immediately after meals
Start with small doses
Insulin
Rapid-acting
Humalog; NovoLog
Begins to work about 15 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours
Short-acting
Humulin R; Novolin R
Usually reaches the bloodstream within 30 minutes after injection, peaks 2-3 hours after injection, and is effective for approximately 3-6 hours
Intermediate-acting
NPH
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
Long-acting
Levemir; Lantus
Reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period
For persons with diabetes, the goal is Hemoglobin A1c below 7%
Regular exercise is important for older diabetic patients and attempts should be made to maintain a consistent daily food intake
Complications
Hypoglycemia
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
Peripheral Vascular Disease
Retinopathy and consequent blindness
Peripheral Neuropathy
Hypothyroidism
A decreased concentration of thyroid hormone in the tissues
Hypothyroidism can be either primary, resulting from a disease process that destroys the thyroid gland, or secondary, caused by insufficient pituitary secretion of TSH
Primary is characterized by low T4 with an elevated TSH level
Secondary is characterized by low T4 and low TSH
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
Treatment: replacement of thyroid hormone
Hyperthyroidism
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
Treatment depends on the cause
Grave's Disease: antithyroid medications or radioactive iodine
Toxic multinodular goiter: surgery
Gastrointestinal
Teeth
Tooth enamel becomes harder and more brittle
The possibility of aspirating tooth fragments is increased
Dentin, the layer beneath the enamel, becomes more fibrous and its production is decreased
The nerve chambers become narrower and shorter
Teeth are less sensitive to stimuli
The number of root cavities and cavities around existing dental work increase
Tooth loss
Bones that support the teeth decrease in density and height
Poor dental care
Diet
Environmental influences
Taste sensations become less acute
Tongue atrophies
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
Diminished muscle strength and tongue pressure can interfere with mastication and swallowing
Swallowing can take twice as long
Esophagus
Decreased esophageal motility
Esophageal emptying is slower
Food remains in the esophagus for a longer time
Increased risk of aspiration
Relaxation of the lower esophageal sphincter may occur
Increased risk of aspiration
Weaker gag reflex
Increased risk of aspiration
Stomach
Reduced motility
Hunger contractions decrease
Gastric mucosa atrophies
Hydrochloric acid and pepsin decline
Higher pH
Increased incidence of gastric irritation
Small/Large Intestine
Some atrophy occurs (in both)
Fewer cells are present on the absorbing surface of intestinal walls
Fat absorption is slower
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
Loss of tone of the internal sphincter
Bowel elimination is affected
Slower transmission of neural impulses to the lower bowel
Awareness of the need to evacuate the bowels is reduced
Liver
Reduced weight and volume
The older liver is less able to regenerate damaged cells
Less efficient cholesterol stabilization and absorption
Increased incidence of gallstones
The pancreatic ducts become dilated and distended, and often the entire gland prolapses
Hiatal Hernia
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
Esophageal Cancer
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
Colorectal Cancer
Common symptoms: bloody stools, change in bowel pattern, anorexia, nausea, pain over affected region, anemia
Treatment: surgical resection with anastomosis, formation of a colostomy
Constipation
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
Prevention of constipation aids in avoiding
fecal impaction
Biliary Tract Disease
Cholelithiasis- the formation or presence of gallstones in the gallbladder
Pain is the primary symptom
Treatment: nonsurgical therapies- rotary lithotrite treatment and extracorporeal shock wave lithotripsy; and surgical procedures
Obstruction, inflammation, and infection are potential outcomes of gallstones
Urinary
Renal blood flow and the glomerular filtration rate are reduced
Renal mass becomes smaller
Renal tissue growth declines
Atherosclerosis may promotes atrophy of the kidney
Tubular function decreases
There is less efficient tubular exchange of substances, conservation of water and sodium, and suppression of ADH secretion in the presence of hypo-osmolality
Older kidneys have less ability to conserve sodium in response to sodium restriction
These changes can contribute to hyponatremia and nocturia
Reabsorption of glucose from the filtrate is reduced
Urinary frequency, urgency, and nocturia are increased
Bladder muscles weaken
Bladder capacity decreases
The micturition reflex is delayed
Emptying of the bladder becomes more difficult
Retention of large volumes of urine may result
Some stress incontinence may occur r/t...
Weakening of the pelvic diaphragm
Bladder Cancer
Risk factors: chronic irritation of the bladder, exposure to dyes, cigarette smoking
S/S resemble those of a bladder infection: frequency, urgency, and dysuria; painless hematuria is the primary sign
Treatment: surgery, radiation, immunotherapy, chemotherapy
Renal calculi
Causes: immobilization, infection, changes in the pH or concentration of urine, chronic diarrhea, dehydration, excessive elimination of uric acid, and hypercalcemia
S/S are similar to those of a UTI; pain, hematuria, and GI upset are also common
Kidney stone
Glomerulonephritis
Clinical manifestations include fever, fatigue, N/V, anorexia, abdominal pain, anemia, edema, arthralgias, elevated blood pressure, and an increased sedimentation rate; oliguria may occur, as can moderate proteinuria and hematuria
Headache, convulsions, paralysis, aphasia, coma, and an altered mental status may be consequences of cerebral edema
Treatment: antibiotics, a restricted sodium and protein diet, and close attention to fluid intake and output
Glomerulonephritis is inflammation of the glomeruli, which are structures in the kidneys that are made up of tiny blood vessels. These knots of vessels help filter blood and remove excess fluids. If the glomeruli are damaged, the kidneys will stop working properly, and the risk for kidney failure increases
Integumentary
Collagen fibers become coarser and more random
Skin elasticity is reduced
Lines, wrinkles, and sagging become evident
The dermis becomes more avascular and thinner
The skin becomes more dry and fragile
Lines, wrinkles, and sagging become evident
Reduction of subcutaneous fat
Lines, wrinkles, and sagging become evident
Skin becomes irritated and breaks down more easily
Reduction in the number of melanocytes by 10-20% each decade (starting in the 3rd decade of life)
Melanocytes cluster
Skin pigmentation (age spots)
Skin immune response declines
More prone to skin infections
Benign and malignant skin neoplasms occur more
Scalp, pubic, and axillary hair thins and grays due to...
Progressive loss of pigment cells
Atrophy and fibrosis of hair bulbs
Hair in the nose and ears becomes thicker
Fingernails
Grow more slowly
Become fragile and brittle
Develop longitudinal striations
Experience a decrease in lunula size
Number and function of sweat glands are lessened
Perspiration is slightly reduced
Pruritus
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
Skin Cancer
Melanoma
Tends to metastasize, or spread, more easily than the other forms of skin cancer, making it more deadly if not caught early
Risk factors: sun exposure, fair skin, and older age
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
Inspection for abnormal moles using the A, B, C, and Ds
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
Pressure Ulcers
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
Cardiovascular
Sclerosis and fibrosis of heart valves
Heart valves increase in thickness and rigidity
Aorta dilates
Slight ventricular hypertrophy develops
Left ventricular wall thickens
Myocardial muscle becomes less efficient and some of its contractile strength is lost
Cardiac output is reduced with physiologic stress
Oxygen utilization becomes less efficient
Calcification and reduced elasticity of vessels occur
Peripheral resistance increases
Systolic blood pressure increases
Older hearts are less sensitive to baroreceptor regulation of blood pressure
Postural hypotension
Postprandial hypotension
Congestive Heart Failure
Causes: arteriosclerotic heart disease; coronary artery disease; hypertension; diabetes mellitus; dyslipidemia; sleep-disordered breathing; albuminuria; anemia; chronic kidney disease; use of illicit drugs; sedentary lifestyle; psychological stress
Age-related changes, such as reduced elasticity and lumen size of vessels and rises in blood pressure that interfere with the blood supply to the heart muscle contribute to this problem
S/S include: dyspnea on exertion; confusion; insomnia; wandering during the night; agitation; depression; anorexia; nausea; weakness; shortness of breath; orthopnea; wheezing; weight gain; and bilateral ankle edema
Management includes: partial bed rest (complete bed rest is discouraged), ACE inhibitors, beta-blockers, digitalis, diuretics, and a reduction in sodium intake
Coronary Artery Disease
Angina
Myocardial ischemia
Presents in an atypical pattern in older adults, making detection difficult
S/S: pain may be diffuse and of a less severe nature than described by younger adults; first indication of this problem may be a vague discomfort under the sternum, frequently after exertion or a large meal; patient may experience precordial pain radiating down the left arm
Prevention and treatment: nitroglycerin (lower doses may be indicated); avoidance of factors that may aggravate this problem, which include: cold wind, emotional stress, strenuous activity, anemia, tachycardia, arrhythmias, and hyperthyroidism
Myocardial Infarction
Causes: hypertension; arteriosclerosis
S/S: pain radiating to the left arm, the entire chest, the neck, jaw, and abdomen; numbness in arms, neck, or back; confusion; moist, pale skin; decreased blood pressure; syncope; shortness of breath; cough; low-grade fever; and an elevated sedimentation rate
Treatment: replacement of complete bed rest with armchair treatment, early ambulation, thrombolytic therapy, fitness programs, walking, swimming, and bicycling
Peripheral Vascular Disease
Arteriosclerosis
Mostly affects the smaller vessels farthest from the heart
Treatment includes: bedrest, warmth, Buerger-Allen exercises, and vasodilators
Advanced arteriosclerosis is usually responsible for the development of
aneurysms
A pulsating mass, sometimes painful, in the umbilical region is an indication of an abdominal aortic aneurysm
Aneurysms of the abdominal aorta most frequently occur in older people
Causes: arteriosclerotic lesions, angina pectoris, MI, and CHF
Prompt correction is essential to prevent rupture
Venous Thromboembolism
Risk factors: bed rest, recent surgery, or fractures of a lower extremity
S/S: edema, warmth over the affected area, and pain in the sole of the foot
Edema may be the primary indication of thromboembolism in the veins of the calf muscle
Treatment: elastic stockings or bandages; rest; elevation of the affected limb; anticoagulants
Hypertension
Causes: vasoconstriction associated with aging; hyperthyroidism; parkinsonism; Paget's disease; anemia; and thiamine deficiency
Criteria for hypertension: systolic blood pressure > or equal to 140; diastolic blood pressure > or equal to 90
S/S include: awakening with a dull headache; impaired memory; disorientation; confusion; epistaxis; and a slow tremor
Hypertensive older patients are advised to rest, reduce their sodium intake, and, if necessary, reduce their weight
Drugs that can be used to treat HTN include: diuretics, beta-blockers, calcium channel blockers, and ACE inhibitors
Older individuals are at a higher risk of adverse reactions from antihypertensive drugs; therefore, non-pharmacologic measures to reduce blood pressure should be used and include: biofeedback, yoga, meditation, and relaxation exercises
Musculoskeletal
Muscle fibers atrophy and decrease in number
Fibrous tissue gradually replaces muscle tissue
Overall muscle mass, muscle strength, and muscle movements are decreased
Sarcopenia, the age-related loss of muscle mass, strength, and function, is mostly seen in inactive persons
Muscle tremors may be present r/t...
Degeneration of the extrapyramidal system
Decreased tendon jerks
Tendons shrink and harden
Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee
Muscle cramping frequently occurs
Bone
Bone mineral and bone mass are reduced
This contributes to the brittleness of the bones of older people
Bone density decreases at a rate of 0.5% each year after the third decade of life
Fractures
become a serious risk to older adults
Diminished calcium absorption
Gradual resorption of the interior surface of long bones
Slower production of new bone on the outside surface
The length of the spinal column (height) is reduced
Thinning disks
Shortening vertebrae
Varying degrees of kyphosis, a backward tilting of the head
Flexion at the hips and knees
Joint activity and motion may be limited
The cartilage surface of joints deteriorates
Points and spurs form
Osteoarthritis
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
Rheumatoid Arthritis
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
Osteoporosis
Demineralization of bone
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
Manifestations: kyphosis, spinal pain, fractures
Treatment: calcium supplements, vitamin D supplements, progesterone, estrogen, anabolic agents, fluoride, phosphate; a diet rich in protein and calcium; braces; range-of-motion exercises
Nervous
Decline in brain weight
Thinking and behavior is not affected
Reduction in blood flow to the brain
Thinking and behavior is not affected
Reduction in...
Cerebral blood flow
Reduction in glucose utilization
Reduction in metabolic rate of oxygen in the brain
Neurons
Nerve fibers
Metabolism
The nerve conduction velocity is lower
Slower reflexes
Delayed responses to multiple stimuli
Kinesthetic sense lessens
Slower responses to changes in balance
Increased risk of falls
Slower recognition and response to stimuli
Decrease in new axon growth
Nerve rein-nervation of injured peripheral nerves
Hypothalamus regulates temperature less effectively
Changes in sleep pattern occur
Stages III and IV of sleep become less prominent
Frequent awakening
Parkinson's Disease
Occurs when neurons that produce dopamine in the substantia nigra die or become impaired
Dopamine is significantly reduced
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
Stroke
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
Sensory
Vision
Presbyopia
Reduced elasticity of the lens
The eye's ability to change the shape of the lens to focus on near objects is decreased
The ability to adapt to light is decreased
The visual field narrows
Peripheral vision becomes more difficult
There is difficulty maintaining convergence and gazing upward
The pupil is less responsive to light
The pupillary sphincter hardens
The pupil size decreases
Rhodopsin content in the rods decreases
The light perception threshold increases
Vision in dim areas or at night is difficult
Alterations in the blood supply of the retina and retinal pigmented epithelium causes...
Macular Degeneration
Loss in central vision
The density and size of the lens increase
The lens becomes stiffer and more opaque
Opacification of the lens leads to the development of
cataracts
Increases sensitivity to glare
Blurs vision
Interferes with night vision
Yellowing of the lens and alterations in the retina that affect color perception
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
Vitreous decreases and the proportion of liquid increases
The vitreous body pulls away from the retina, which causes...
Blurred vision
Distorted images
Floaters
Visual acuity progressively declines with age
Decreased pupil size
Scatter in the cornea and lens
Opacification of the lens and vitreous
Loss of photoreceptor cells in the retina
Hearing
Presbycusis
Progressive hearing loss
Loss of hair cells
Decreased blood supply
Reduced flexibility of basilar membrane
Degeneration of spiral ganglion cells
Reduced production of endolymph
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
Gradual and subtle
Hearing can be further jeopardized by an accumulation of cerumen in the middle ear
Higher keratin content of cerumen contributes to this problem
The acoustic reflex, which protects the inner ear and filters auditory distractions from sounds made by one's own body and voice, is diminished due to...
Weakening and stiffening of the middle ear muscles and ligaments
Equilibrium may be altered
Degeneration of the vestibular structures
Atrophy of the cochlea, organ of Corti, and stria vascularis
Taste and Smell
The sense of smell is reduced
Decreased number of sensory cells in the nasal lining
Fewer cells in the olfactory bulb of the brain
Men tend to experience a greater loss in the ability to detect odors
Reduction in the sense of smell alters the sense of taste
The tongue atrophies
Taste sensations diminished
Reduced saliva production, poor oral hygiene, medications, and conditions such as sinusitis can also affect taste
Touch
A reduction in the number of and changes in the structural integrity of touch receptors occurs
Tactile sensation is reduced
Dementia
Irreversible, progressive impairment in cognitive function affecting memory, orientation, judgment, reasoning, attention, language, and problem solving
Alzheimer's Disease
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
Delirium
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
Reversible
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.
Immune
Thymic mass decreases steadily
Serum activity of thymic hormones is almost undetectable
T-cell activity declines and more immature T cells are present in the thymus
A significant decline in cell-mediated and humoral immunity occurs
Changes in the T cells contribute to the reactivation of...
Varicella Zoster
Mycobacterium Tuberculosis
The concentration of IgM is lower, whereas the concentrations of IgA and IgG are higher
Responses to influenza, parainfluenza, pneumococcus, and tetanus vaccines are less effective (although still recommended)
Inflammatory defenses decline and inflammation often presents atypically (low-grade fever and minimal pain)
Proinflammatory cytokines increase
Atherosclerosis
Diabetes
Osteoporosis
Local defenses against infections are weakened
The skin loses macrophages
Thickness and circulation to the skin is reduced
Common Infections
Urinary Tract Infection
Organisms responsible for UTIs are
Escherichia coli
in women and and
Proteus
species in men
Causes: the presence of any foreign body in the urinary tract or anything that slows or obstructs the flow of urine (immobilization, urethral strictures, neoplasms, or a clogged indwelling catheter); poor hygienic practices; improper cleansing after bowel elimination; low fluid intake and excessive fluid loss; hormonal changes; persons in a debilitated state or who have neurogenic bladders, arteriosclerosis, or diabetes
S/S: burning, urgency, and fever are early indicators; incontinence, delirium, retention, and hematuria may occur as a UTI progresses
Treatment aims to establish adequate urinary drainage and control the infection through antibiotic therapy; forcing fluids is advisable, provided that the patient's cardiac status does not contraindicate this action
Prevention: daily inclusion of cranberry juice and avoidance of indwelling urinary catheters
Pneumonia
Causes: poor chest expansion and more shallow breathing due to age-related changes to the respiratory system; high prevalence of respiratory diseases that promote mucus formation and bronchial obstruction; lowered resistance to infection; reduced sensitivity of pharyngeal reflexes that promotes aspiration of foreign material; high incidence of conditions that cause reduced mobility and debilitation; greater likelihood for older adults to be hospitalized or institutionalized and develop nosocomial pneumonia than younger persons
Streptococcus pneumoniae
S/S may be altered in older persons- pleuritic pain may not be as severe as that described by younger patients and differences in body temperature may cause minimal or no fever; symptoms may include: slight cough, fatigue, and rapid respiration; confusion, restlessness, and behavioral changes may occur as a result of cerebral hypoxia
Prevention: pneumococcal vaccination
Influenza
Influenza A is the most frequent cause of serious illness
Age-related changes, including an impaired immune response to the virus, cause older persons to be highly susceptible to influenza
S/S: typically influenza causes fever (although not as high as in younger adults), myalgia, sore throat, and nonproductive cough
Once it attacks, influenza destroys ciliated epithelial cells of the respiratory tract and depresses mucociliary clearance
Secondary bacterial infections and other complications increase the risk of older adults dying as a result of influenza
Patients with chronic respiratory, cardiac, or metabolic disease are at particularly high risk for developing secondary bacterial pneumonia
Prevention: reducing contact with persons with known or suspected influenza; annual influenza vaccination
Reproductive
Men
Seminal vesicles
Mucosa becomes smoother
Epithelium thins
Muscle tissue is replaced with connective tissue
Fluid-retaining capacity is reduced
Seminiferous tubules
Increased fibrosis
Epithelium thins
The basement membrane thickens
Lumen narrows
Some men experience a reduction in sperm count
FSH and LH increase
Both serum and bioavailable testosterone levels decrease
Venous and arterial sclerosis of penis
Orgasm and ejaculation tend to be less intense
Some atrophy of the testes occurs
Prostatic enlargement occurs in most older men
Erectile Dysfunction
Causes: alcoholism, diabetes, dyslipidemia, hypertension, hypogonadism, MS, renal failure, spinal cord injury, thyroid conditions, and psychological factors
Other causes: medications such as anticholinergics, antidepressants, antihypertensives, digoxin, sedatives, and tranquilizers
Treatments: oral erectile agents, drugs injected into the penis, penile implants, and vacuum pump devices
The inability to achieve and sustain an erection for intercourse
Benign Prostatic Hyperplasia
S/S: hesitancy, decreased force of urinary stream, frequency, nocturia; dribbling, poor control, overflow incontinence, and bleeding may occur
Obstruction of the vesical neck and compression of urethra
Hypertrophy of detrusor muscle
Outlet obstruction
As the hyperplasia progresses, the bladder wall loses its elasticity and becomes thinner, leading to urinary retention and an increased risk of urinary infection
Treatment: prostatic massage; the use of urinary antiseptics; the avoidance of diuretics, anticholinergics, and antiarrhythmic drugs; transurethral surgery
Prostate Cancer
Often, this disease can be asymptomatic
Risk factors: benign hypertrophy
Symptoms such as back pain, anemia, weakness, and weight loss can develop as a result of metastasis
Treatment: monitoring, irradiation, or a radical prostatectomy
PSA tests assist with the diagnosis
Women
Vulva atrophies
Loss of vulvar subcutaneous fat and hair
Labia flattens
The vagina of the older woman appears pink and dry with a smooth, shiny canal because of the loss of elastic tissue and rugae
Vaginal epithelium becomes thin and avascular
The vaginal environment
More alkaline
Changes in the type of flora occur
Reduction in secretions
The cervix atrophies
The endocervical epithelium atrophies
Uterus
The ligaments supporting the uterus weaken
Can cause a backward tilting of the uterus
Shrinks
The endometrium atrophies
Continues to respond to hormonal stimulation
May lead to postmenopausal bleeding (in older women on estrogen therapy)
The fallopian tubes atrophy and shorten
The ovaries atrophy and become thicker and smaller
Estrogen depletion causes a weakening of pelvic floor muscles
Involuntary release of urine when there is an increase in intra-abdominal pressure
Breast Cancer
Causes: decreased fat tissue and atrophy in older women's breasts
Second leading cause of cancer deaths for women
Prevention: regular breast examinations; annual mammograms (starting at age 40, and then at age 75, every 2-3 years)
Perineal Herniation
Causes: stretching and tearing of muscles during childbirth; muscle weakness associated with advanced age
Cystocele, rectocele, and prolapse of the uterus are the types most likely to occur
Associated with this problem are lower back pain, pelvic heaviness, and a pulling sensation; urinary and fecal incontinence, retention, and constipation may also occur
Treatment: surgical repair
Ovarian Cancer
Leading cause of death from gynecologic malignancies
Early symptoms are nonspecific and can be confused with GI discomfort; as the disease progresses, clinical manifestations include: bleeding, ascites, and the presence of multiple masses
Treatment: surgery, irradiation
Cervical Cancer
Although less than 25% of all diagnosed cases of cervical cancer are in older women, over 40% of cervical cancer deaths occur among this group
S/S: vaginal bleeding and leukorrhea; as the disease progresses, the patient can develop urinary retention or incontinence, fecal incontinence, and uremia
Treatment: radium, surgery
Prevention: annual Pap tests until age 70; for women over 70 who have had at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years, Pap smears can be done every 2-3 years