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Changes in Aging, Linkages, Cross Link Between Pulmonary Embolism &…

- - - - Neuritic plaques occur in the brain alongside neurofibrillary tangles in the cortex to contribute to the deterioration of cognition in Alzheimer's
      - Neurons and synapses in the brain degenerate
      - Neurotransmitter function is altered so the disease impacts more than just the brain
  - - - Suicidal ideation grows more common after this occurs
      - Most older adults feel sad that their roles in life are changing or that they are losing mental and physical capabilities compared to their younger selves
    - - This can lead to confusion, irritation, and potential harm to the older adult
      - This could lead to hallucinations which could result in falls or harm to oneself or others
- - - - Mixed Incontinence
      - Neurogenic Incontinence
      - Nocturia
      - Overflow Incontinence
      - Stress Incontinence
      - Transient Incontinence
      - Urgency Incontinence
      - Urinary Incontinence
  - - - Decreased tubular function may result in an altered specific gravity
      - Decreased ability to eliminate drugs increases the older adult's risk of toxicity
      - Increased BUN levels occur
      - Decreased reabsorption makes proteinuria more common
  - - - Decreased sexual activity
      - E. coli
    - - Bladder outlet obstruction from BPH
      - Proteus
      - Prostatitis is the most common UTI in older men
- - - - This could be due to a variety of chronic conditions, instability, vertigo, etc.
    - - Sarcopenia is common in older adults
      - Improper inflammatory and immune responses to joint pain
      - Bones within the joint begin to come in direct contact with each other as cartilage is worn down
      - An edematous synovium leads to Rheumatoid Arthritis
      - Decreases range of motion in joints
      - Osteoarthritis is one of the leading causes of disability in older adults
    - - Incidences of pressure injuries increases
        
        Susceptibility to infection increases or potential for tissue loss occurs
      - Muscle wasting and atrophy occurs from disuse
      - Incidence of obesity increases as active lifestyles are more difficult to fulfill
  - - - This could lead to clot formation which could contribute to increased BP, PE, or DVT
      - Blood flow to site of injury is slow and insufficient
      - Preventative measures need to be taken to avoid injuries in older adults
  - - - Leads to decreased CO and potential for under-oxygenated tissues
- - - - Loss of subcutaneous fat also make older adults less adaptable to changes in temperature
      - Loss of subcutaneous fat causes more susceptibility to pressure ulcers as there is less cushion throughout the body
  - - - Leads to skin breakdown and susceptibility for infections
      - Could be caused by diabetes, hyperthyroidism, cancer, or anemia
      - Excessive bathing or use of sanitizer worsens this affect
- - - - Decrease in lunge size due to reduced elastic recoil
      - Ineffective breathing may occur
        
        COPD may occur
        
        Emphysema incidence can increase
        
        Causes distension of alveolar sacs or alveolar wall rupture which impairs gas exchange
        
        Chronic cough and dyspnea develops as the older adult's breathing becomes labored
        
        Malnutrition, cardiac arrhythmias, anorexia, and heart failure can result from extensive undersupply of oxygen to tissues
        
        Chronic Bronchitis cases become more prominent
        
        Leads to dyspnea, recurrent respiratory infections, and a productive cough
        
        Mucus obstructs airflow and hypoxia grows more common
        
        This can lead to emphysema or even death
        
        Asthma may develop in the bronchi of the lungs
        
        This places increased tension on the heart and leads to dyspnea
        
        Older adults have higher mortality rates from asthma
        
        Can lead to development of chronic bronchitis or extensive cardiac issues
        
        Decreased amounts of oxygen being obtained can lead to tissue necrosis
    - - Accessory muscles are used to breathe
      - Contributes to slight kyphosis or hunching
  - - - Dysphagia can impair nutritional intake and increase risk of aspiration
      - Occurs due to reduced number of nerve endings in the larynx
  - - - Older adults need to get annual influenza vaccines to reduce respiratory distress and frequent illness
      - Impaired immune responses makes it more difficult for the older adult to fight off infections
  - - - This may be due to cigarette use associated with lung cancers
      - Not enough oxygen is diffused into tissues and bloodstream, CO2 stays in the blood leading to respiratory acidosis
      - Decreased blood flow to the alveoli from CAD also leads to this
    - - These can reduce mobility and lead to debilitation
      - Muscle wasting and atrophy occurs with periods of immobility
      - Reduced capillary refill and increased pallor in fingers and toes
      - The older adult may require oxygen therapy or bronchodilators to increase airway effectiveness and bodily oxygenation
- - - - Less room within the vessels for blood to flow through
      - Peripheral pressure increases
    - - Diabetes Mellitus
      - Hyperthyroidism
      - Paget's Disease
      - Anemia
      - Parkinson's Disease
    - - Less elasticity to accompany larger volumes of blood
      - This can be due to long-term smoking
    - - DASH diet
        
        Increase in fruits, vegetables, and whole grains
        
        Switch to low-fat dairy products
        
        Decrease sodium intake
      - Antihypertensive medications
        
        May be a risk for polypharmacy or drug interactions
      - Increased physical activity within limits of the older adult
    - - After menopause, the risk for CAD in women is equivalent to that of men
      - Occurs in most older peoples age 70 or older
      - This can lead to acute coronary insufficiency, myocardial infarction, dysrhythmias, heart failure
        
        Arrhythmias can occur with MI and they have the potential to result in fibrillation, and in extreme cases, death
        
        Pain radiates to the chest, left arm, neck, abdomen, or the back
    - - Potential cause for Pulmonary Embolism and DVT
        
        This could lead to death if the embolus impairs lung functioning
        
        Older adults have a higher risk of developing these if they have arrhythmias, CHF, thrombosis, or recently had a major surgery
        
        PE can result in dyspnea, confusion, pneumonitis, and increased sedimentation rates
        
        Lower extremity edema and pain occurs in DVT
  - - - Decreased systolic pressure of 20mmHg or more when rising to a standing position
    - - Decreased systolic pressure of 20mmHg or more within 1 hour of eating
  - - - For the respiratory system, CHF causes dyspnea, orthopnea, wheezing, and moist crackles in the lungs
      - In the Neurologic system, CHF causes insomnia, agitation, and confusion
      - In the gastrointestinal system, CHF causes weight gain, nausea, and anorexia
      - Lower extremity edema is also common in CHF
    - - Diabetes Mellitus
      - Dyslipidemia
      - Anemia
      - Chronic Kidney Disease
      - Illicit Drug Use
    - - Left ventricle is unable to pump blood to the periphery
      - Causes pulmonary edema, which results in pulmonary congestion
      - Symptoms are: dyspnea, crackles, cough, tachycardia, fatigue, anxiety, restlessness, confusion
    - - Causes peripheral edema which results in peripheral congestion
      - Right ventricle is unable to pump blood out to the lungs this may occur because of left sided failure or pulmonary disease
      - Symptoms are: peripheral edema, weight gain, distended neck veins, anorexia, weakness, hepatomegaly, ascites
- - - - Cavities become more common
      - Teeth grow less sensitive to stimuli
      - Bone density in the teeth decreases, contributing to tooth loss
    - - Older adults need to utilize more seasonings besides just salt
      - Dietary changes may need to include more flavorful foods
    - - Leads to xerostomia and difficulty with the 1st stage of chemical breakdown of food
    - - Dysphagia develops as people age
      - Diet may need to be altered to accommodate altered chewing and swallowing
  - - - Gag reflex is weaker which can lead to GERD
      - Food may need to be pureed or liquids need to be thickened
      - Aspiration may occur
    - - Rolling and Sliding type
      - Exacerbates GERD symptoms
      - Several small meals instead of 3 big meals a day should be eaten
  - - - These impact appetite due to pain, obstruction, and bleeding
    - - More prevalent in men, smokers, and poor socioeconomic groups
      - Leads to anorexia, weight loss, epigastric pain, and potentially liver enlargement
      - Low red meat diet is needed
  - - - The absorptive surface on these organs decreases leading to less nutrients absorbed and slower fat absorption
      - The elasticity of the rectal wall is lost
      - Awareness of the need to empty the bowels is reduced
    - - Can be due to colon cancer, hernias, paralytic ileus, mechanical obstruction, etc
      - This alters bowel habits and frequency of bowel movements
        
        Fecal Impaction occurs
      - Chronic Constipation
        
        More common in older adults due to polypharmacy, inactive lifestyles, low fluid intake, and laxative abuse
        
        Increased fiber diet and fluid intake relieves this
        
        Regulating bathroom times may also relieve this
        
        Occurs due to long periods of immobility
    - - Leads to rectal bleeding, nausea, anorexia, anemia
      - Unexplained weight loss and abdominal pain
      - Fecal occult blood testing is needed to determine severity
- - - - Decreased T4 and T3 production
      - Elevated TSH
      - Cold intolerance, constipation, anorexia, depression, and other symptoms can impact patient's life
    - - Elevates T4 and T3 levels
      - Can cause tachycardia, hypertension, palpitations, heat intolerance, diarrhea, and other symptoms
  - - - Decrease in growth and slowed healing process
  - - - Can lead to cardiovascular complications like tachycardia, peripheral vascular disease, postural hypotension etc.
      - Retinopathy and blindness can occur
      - Cognitive impairment is possible
      - Neuropathies and associated pain can occur
      - Could lead to hypertension and peripheral edema
  - - - Reduced secretion of estrogen
      - Reduced secretion of progesterone
      - Reduced androgens
      - Reduced glucocorticoids
- - - - This impacts urinary function and can lead to decreased urine stream or painful urination
      - Urinary retention and increased risk for UTIs occur in Benign Prostatic Hyperplasia
      - Prostate cancer can occur if metastasis occurs
    - - Reduction in sperm count due to thinner epithelium of seminal vesicles
      - Increased fibrosis, thickening of the basement membrane, and narrowing of the lumen occurs
  - - - Vaginitis grows more prevalent as the vaginal canal is easily irritated due to lack of lubrication and alteration in the vaginal wall
      - Altered discharge coloration and patterns can occur
      - Chronic vaginal irritation can lead to cancer of the vagina
    - - Process of releasing eggs stops at menopause
      - Vulva atrophies, labia flattens, and hair on perineal area is lost
      - Ovaries, fallopian tubes, cervix, and uterus atrophy
- - - - As tissues began to die perfusion of gases across alveolar membranes would decrease, thus hypoxia would set in
        
        Lack of oxygenated blood flow to the lungs and other tissues starts to cause tissue necrosis and failure
        
        Leads to respiratory failure as the lungs collapse and are unable to perfuse gases into other tissues
    - - Crackles would be heard in the lung fields and breathing would become labored
        
        Fluid buildup in the lungs would restrict incoming O2 and result in reduced gas exchange so tissues wouldn't be getting sufficient O2 and would begin to die
- - - - This causes an increase in peripheral resistance, which in turn, causes the overall blood pressure to rise because BP=COxPR
        
        As hypertension occurs the body looks for a way to get rid of excess fluid volume in the blood, thus edema occurs in the lower extremities to help reduce the bod's blood pressure
        
        Peripheral edema is seen as a common symptom in those with Diabetes Mellitus as the body tries to rid itself of Hypertension
- - - - Due to lack of movement the bowels aren't stimulated as frequently as the body isn't requiring the breakdown of intestinal contents to use for energy
        
        Lack of bowel stimulation allows for the contents of the intestines to become sedentary within the gastrointestinal tract and they slowly buildup until the colon is full from wall to wall
        
        Thus, when the older adults attempts to defecate, they have to strain as the buildup of feces has compacted together and the abdominal muscles are not able to tense sufficiently to dispel the stool.
        
        The end result is chronic constipation that can be alleviated through physical activity, increased fiber and fluid intake, laxative use, or perhaps an enema
- - - - UTIs become more prevalent with an enlarged prostate since the perineal area is continuously moist or because the urine is not proceeding through the urethra killing microorganisms with its acidity as one urinates
        
        These increased UTIs can result in chronic kidney infections and serious complications if not properly treated