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Older Adults, Lifestyle Changes, Physical Appearance, Thought Processes…
Older Adults
Nervous System
Hypothalamus is less effective in temperature regulation
Decline in blood flow to brain
Fluid Intelligence may decline
Crystallized intelligence is maintained
Normal body temp is lower in adults
Response to cold temperatures is reduced
Sleep
Insomnia
Chronic
Transient
Altered Circadian Sleep-Wake Cycle
Less time in REM sleep
Delay in the onset of sleep
Sleep is less sound
Number and sensitivity of sensory receptors, dermatomes, and neurons decrease
DULLING of tactile sensation
May have less pain sensation
Decline in function of cranial nerves affecting taste and smell
Verbal skills are maintained until age 70
Slowing in central processing
Delay in time required to perform tasks
Loss of nerve cell mass
Atrophy of the brain and spinal cord
Brain weight decreases
Number of dendrites declines
Demyelination
Slower nerve conduction
Response and reaction times are slower
Reflexes become weaker
Accumulation of free radicals
Fatty deposits accumulate in blood vessels
Transient ischemic attacks
Ability to compensate declines with age
Intellectual performance maintained until AT LEAST 80 years of age
INDICATIONS OF NEUROLOGICAL PROBLEMS
New headaches that occur in the early morning or interrupt sleep
Change in vision
Decreased acuity
Double vision
Blindness in portion of visual field
Sudden deafness OR ringing in ears
Mood OR personality changes
Altered cognition OR level of consciousness
Clumsiness, unsteady gait
Numbness, tingling of extremities
Unusual sensation or pain over nerve
Parkinson's Disease (PD)
Disease of the basal ganglia and substantia nigra
Decreased production of dopamine
Affects motor ability
Tremor at rest
increased muscle rigidity
Bradykinesia
Postural instability
Treatments:
Anticholinergic medications
Technologies to control symptoms
Manifestations:
Rigidity of extremities
Masklike facial expressions
Difficulty in chewing, swallowing, and speaking
Stooped posture
Increased tremors with stress or anxiety
Dementia
Cognitive impairments
Gradual progressive onset
Irreversible
Affects judgement, memory, abstract thinking, and social behavior
Decline in ADLs
Confusion, disorientation, and loss of memory
Gastrointestinal System
Atrophy of the small and large intestine
Decreased esophageal and stomach motility
Upper GI Changes
Atrophy of the tongue
Affects taste buds --> decreased taste sensation
Saliva production decreases
Dysphagia
Increased incidence with age
Weaker esophageal contractions and weakness of the sphincter
Decreased elasticity of the stomach
Stomach has a higher pH
Results from the decline in hydrochloric acid and pepsin
Fewer cells on absorbing surface of the intestinal wall
Affects absorption of vitamins and nutrients, like dextrose
Decreased enzyme production in the liver
Slowed peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet
Bile salt synthesis decreases
Increased risk of gallstone development
Affects digestion of fats
Hiatal Hernia
Hernia of the esophagogastric junction and a portion of the stomach is in the chest
Causes
Obesity
Large volumes of food
S/S
Heartburn
Belching
Abdominal Discomfort
Treatments
Small meals
Avoid meals at bedtime
Bland diet
Sleeping in partial recumbent position
Urinary System
Decline of renal blood flow and glomerular filtration
Size and weight of the kidney decreases
Hypertrophy and thickening of the bladder muscle
Reduced bladder capacity
Changes in cortical control of mictruition
Inefficient neurological control of bladder emptying and weaker bladder muscle
Increased risk for reflux of urine into the ureters
Retention of large volumes of urine
Female: fecal impaction
Male: prostatic hypertrophy
GFR decreases due to decreased renal blood flow
Decreased numbers of functioning glomeruli
Reduced tubular function
Higher BUN levels
Proteinuria is common in adults over 80
Decreased tubular function
Increase in renal threshold for glucose
Urinary Tract Infections
Infection or inflammation at any site in the urinary tract
Most common infectious agent is E. Coli
High risk individuals
Diabetes
Pregnancy
BPH
Immunosuppressed persons
Catheterized clients
Urinary retention
Older women with bladder prolapse
Cardiovascular System
Reduced cardiac output BUT increased peripheral resistance
Heart muscles loses efficiency & contractile strength
Valves become thick and rigid.
Aorta becomes dilated
slight ventricular hypertrophy
thickening of ventricular wall
Dysrhythmias become more common
Bradycardia, tachycardia, atrial fibrillation, heart block
Syncope, Falls, TIAs
MUCH heart disease is preventable
Prevalence of CVD increases with age
Coronary Artery Disease
Increases risk of MI
Atypical presentation of confusion, decreased blood pressure, shortness of breath, elevated temperature, and sedimentation rate.
Angina
Nitroglycerin may be used
Chest pain
Atypical presentation: vague discomfort under the sternum, indigestion, coughing, syncope, sweating, and confusion
Congestive Heart Failure
Leading cause of hospitalization
Complication of arteriosclerotic heart disease, followed by hypertension, diabetes, dyslipidemia, cardiomyopathy, sleep apnea, CKD, illicit drugs, sedentary lifestyle, and psychological stress
Coronary artery disease is responsible for most cases in older adults
Endocrine System
Thyroid gland atrophies and activity decreases
Hypothyroidism
Diminished adrenal function
ACTH secretion decreases
Volume of pituitary gland decreases
Insufficient release of insulin
Reduced tissue sensitivity to insulin secretions
Increased risk of developing Diabetes Mellitus
Hyperthyroidism
Increased secretion of thyroid hormone
Hypothyroidism
Hypofunction of the thyroid gland
Insufficient secretion of thyroid hormone
Respiratory System
Calcification of costal cartilage, trachea, and rib cage stiffen
Breathing Mechanics
Lungs lose elastic recoil
Declining muscle strength
Reduced cough reflex
Lung size and weight reduction
Oxygenation
Increased ventilation and perfusion are imbalanced
Increased dead space in the lungs
Decrease in alveolar surface area
Increased residual capacity
Reduced vital capacity
Ventilation Control
Decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia
Chronic Bronchitis
Increase in mucus, cilia projection
Increase in bronchial wall thickens
Emphysema
Reduced gas exchange surface area
Increased air trapping
Decreased capillary network
Increased CO2 consumption
Reproductive System
Osteoporosis & osteopenia
Sexual pattern remains consistent through older adult life
Female Reproductive Changes
Vaginal epithelium thins
Hormonal Changes
Loss of subcutaneous fat & hair
Vulva atrophies
Flattening of the labia
Cervix, uterus, and fallopian tubes atrophy
Vaginal Canal Changes
Less lubrication
Reduction in collagen and adipose tissue
Shortening and narrowing of the canal
More alkaline vaginal pH
Fallopian tubes become shorter and straighter
Breasts sag and are less firm
Retraction of nipples
Due to shrinkage and fibrotic changes
Increased risk of reproductive organ cancers
Atrophic Vaginitis
Occurs in postmenopausal women
Increased vaginal fragility
Increases the risk of irritation
Male Reproductive Changes
Erectile dysfunction
Testosterone levels decrease in men
Reduced strength, stamina, muscle mass, and energy
Small testes
Breast enlargement
Seminal vesicles develop thinner epithelium
Seminiferous tubule changes
Ejaculation fluid contains less live sperm
Enlargement of the prostate gland
Benign Prostatic Hyperplasia
Increased incidence of prostate cancer with age
Erectile Dysfunction
Unable to attain or maintain erection of the penis
Causes
Atherosclerosis
Diabetes
HTN
Thyroid dysfunction
Renal failure
Sensory Changes
Hearing
Distortion of high-pitched sounds
Sensorineural hearing loss
Impacted cerumen
Taste & Smell
Decrease in saliva production
Atrophy of the tongue
Decreased number of functioning taste buds
Touch
Decrease in the ability to sense pressure, discomfort, and change in temperature
Vision
Narrowing of the vision field
Depth perception distortion
Pupil size REDUCTION
Reduced elasticity and stiffening of the muscle fibers of the lens
Decreased ability to focus
Visual acuity declines
Loss of photoreceptor cells in the retina
Light perception threshold decreases
Dark and light adaptation takes longer
Difficulty with vision at night
Increased sensitivity to glare
Tear production decreases
Immune System
T-cell activity declines
Inflammation defenses decline
Immune Response Issues in the Respiratory System
Decrease in cilia
Decreased ability to cough and deep breathe
Decreased ability to clear mucus secretions
Decreased immune response
Lifestyle Changes
Adequate exercise
Stress management
Proper nutrition
Physical Appearance
Loss of Subcutaneous Tissue
Loss of tissue elasticity
Thinning of vertebrae; diminished stature
Thought Processes and Insecurities
Dental Problems
Impact on socialization
Impact on feelings towards appearance
Intimacy problems
Fear of losing sexual abilities
Concerns about body image
Negative attitudes from society
good cardio health = good neuro health