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The Older Adult, Respiratory, Cardiovascular, Gastrointestinal,…

- - - - Alveoli lose shape and become baggy, altering gas exchange
      - Muscles near airways weaken and lose ability to keep airways open
      - Lungs lose elastic recoil, causing airways to get smaller and lung size and weight to reduce
    - - Diminished immune responses make older adults susceptible to respiratory infections
      - Asthma: airway inflammation, epithelial sloughing, mucous hypersecretion, and bronchial hyperresponsiveness
      - COPD: airway and lung inflammation, airway narrowing, and parenchymal lung destruction
    - - Inspiratory and expiratory muscle weakness #
      - Functional residual capacity and residual volume increase, resulting in lower vital capacity
    - - Weakening of diaphragm and respiratory muscles
- - - - Stiffening of heart valves that control direction of blood flow
      - Higher stroke volume and mean arterial blood pressure
    - - Calcific deposits frequently present on aortic valve cusps
      - Thickening of basement membrane of capillary walls
      - Increase in connective tissue and calcium deposits cause valve stiffening and incompetency
    - - Decreased cardiac tolerance to stress and increased susceptibility to ischemia
      - Congestive heart failure: ventricular filling and ejection of blood into systemic circulation are impaired
    - - Atherosclerosis: tunic media smooth muscle cells and collagen fiber hyperplasia cause arterial stiffening
      - Mechanical and structural properties of vascular walls are altered
    - - Degeneration of elastic and collagen components
      - Aorta wall thickens
      - Arteriosclerosis: degeneration of collagen leads to the aorta being dilated, elongated, and becomes tortuous
- - - - Hypertrophy and thickening of the bladder muscle
      - Daytime urinary frequency and nocturia
      - Prostate enlargement
    - - Reduction in glomerular capillary plasma flow rate
      - Decreased numbers of functional glomeruli
      - CKD/ kidney failure: inability of kidneys to perform excretory function, resulting in buildup of nitrogenous waste products from the blood
    - - Higher BUN levels
      - Proteinuria
      - Decreased sodium reabsorption and potassium excretion
    - - Kidney atrophy: loss of nephrons and insufficient blood supply to the kidney results in organ size decrease
      - Arteries supplying the kidneys narrow, resulting in decrease in blood supply to kidneys
- - - - Esophagus becomes stiffer
      - Dysphagia: trouble swallowing
      - Risk for aspiration
      - Reduced primary and secondary peristalsis
    - - Nerve damage to stomach muscles
      - Constipation
      - Loss of cholinergic enteral neurons
    - - Malabsorption syndrome: small bowel ischemia and damage to small intestine mucous lining prevents proper absorption
      - Diverticulosis: thinning of large intestine walls result in outpockets from the wall
    - - Decrease in number of tase buds or shrinking of tase buds
      - Mouth produces less saliva
- - - - Pruritis
      - May result from diabetes, kidney disease, or medication #
      - Reduction in oil and sweat gland function
    - - Rosacea
      - Purpura: easy bruising
      - Epidermolysis bullosa
    - - Reduction of superficial skin blood flow
      - Reductions in thermoreceptor density
    - - Loss of elastin
      - Pressure injury
- - - - Decreased production of estrogen and progesterone
      - Pituitary gland tries to compensate by producing more FSH
      - Menopause: loss of ovarian sensitivity to gonadotropin stimulation; reduction in quality and quantity of follicles
    - - Reduction in testicular mass
      - Testicular volume reduction of 20% compared with baseline volume
      - Disappearance of tubular or germinal epithelium which is replaced by fibrosis
    - - Shortening and narrowing of vaginal canal
      - Less lubrication may lead to discomfort with intercourse
      - Reduction in collagen and adipose tissue
      - More alkaline pH resulting from lower estrogen changes
    - - Hormonal changes (increase in DHT) stimulates cell growth in the prostate gland
      - Benign prostatic hyperplasia: hyperplastic process resulting in growth of glandular-epithelial and stromal tissue in the prostate, leading to progressively obstructed urine outflow
- - - - Low concentration of hormones can cause sarcopenia
      - Reduction in nerve cells responsible for sending signals to start muscular movement
      - Muscle nuclei become centralized along muscle fiber and muscle plasma membrane becomes less excitable
    - - Degenerative disc disease: Lower oxygen pressure in the discs leads to accumulation of lactic acid, leading to inability of disc cells to synthesize extracellular matrix and cause degeneration
      - Disk degeneration: discs dry out and no longer cushion the bones, leading to pressure and pinching of the nerve roots or spinal cord
    - - Osteoporosis: osteoclastic bone resorption not compensated by osteoblastic bone formation, causing weak and fragile bones and increasing risk for fracture
      - Reabsorption of calcium and phosphate results in more bone being broken down (resorbed) than generated
      - Rapid cortical bone loss in older age and after menopause
- - - - Cells in the vestibular system die off
      - Blood flow to the inner ear is decreased
      - Dizziness and balance problems
    - - Changes in biophysical properties of paranodal and internodal membranes causes impaired transmission of impulses
      - Poor conduction of action potentials
      - Multiple sclerosis: multiple areas of myelin loss within the CNS called plaques or lesions combined with inflammation, axonal loss, and demyelination
    - - Insomnia
      - Lower levels of growth hormone results in decrease in slow wave/deep sleep
      - Decreased production of melatonin
    - - Vascular dementia: narrowing of small blood vessels deep in the brain damages and eventually kills brain cells
      - Increase in arterial stiffness decreases cerebral blood flow
- - - - Progressive thyroid gland fibrosis and atrophy lead to a reduction in thyroid volume
      - Subclinical hypothyroidism: normal FT4 levels and increased TSH levels resulting in thyroid failure
    - - Decrease in hypothalamic-pituitary-adrenal axis sensitivity to glucocorticoid feedback suppression
      - With aging, hormones are metabolized more slowly, leading to a decrease in secretion of them #
    - - Diabetes mellitus type 2: peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining pancreatic beta-cell function
      - Reduction in insulin-stimulated glycogen synthesis, resulting in reduced glucose transport