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images The Older Adult, Skin provides a less effective barrier
Decreased…
The Older Adult
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- Skin provides a less effective barrier
- Decreased thermoregulation
- Decreased endocrine secretions cause dry skin
- Loss of elastin
- Increase in vascular fragility
- Hair loss occurs
- Female facial hair is more common
- Increased appearance of age spots and raised lesions
- Nail beds become brittle & thick
- Elongated ears, baggy eyelids, double chin
- Graying hair
- Flattening of the dermal-epidermal junction
- Decreased epidermal turnover
- Increased coarseness of collagen
- Reduction in melanocytes
- Heightened risks for tears, bruising, pressure injuries, skin infections
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- Decline of renal blood flow and glomerular filtration rate
- Urinary frequency
- Urinary urgency
- Nocturia
- Hypertrophy of bladder muscle
- Thickening of the bladder
- Reduces storage capacity
- Fecal impaction and prismatic hypertrophy can lead to urinary issues
- Kidney decline affects drug elimination
- higher BUN levels
- Proteinuria more common
- Heart dimensions unchanged
- Heart muscle loses efficiency and contractile strength
- Reduced cardiac output with physiological stress
- Valves become thick and rigid
- Diastolic murmur
- Blood vessels reduce elasticity
- Oxygen used less efficiently
- Aorta becomes dilated
- Slight ventricular hypertrophy
- Thickening of left ventricular wall
- Prolonged cardiac cycle
- Calcification and reduced elasticity of vessels
- Less sensitive to baroreceptor regulation of blood pressure
- Dysrhythmias more common
- Bradycardia, tachycardia, atrial fibrillation, heart block
- Increased peripheral resistance
- Decreased thirst perception
- Decreased glomerular filtration
- Decrease urine concentrating ability
- Hormone changes
- Decreased aldosterone
Increased atrial natriuretic peptide
- Thyroid gland atrophies and activity decreases
- Decreased metabolism
- Weight gain
- Diminished adrenal function
- ACTH secretion decreases
- Diminished cortisol, TSH, GH < LH, FSH, prolactin
- Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
- Decline in weight and blood flow to the brain
- Reduction in neurons, nerve fibers, and cerebral blood flow
- Slower response to change in balance
- Hypothalamus less effective in temperature regulation
- Changes in sleep patterns with frequent waking
- Fluid intelligence may decline
- Short-term memory decline
- Age related forgetfulness
- All senses are less proficient
- reduced ability to sense pressure, discomfort, change in temp
- Presbyopia
- Narrowed peripheral vision
- Pupil size reduction and less reactive
- Distorted depth perception
- Decline in visual acuity
- Presbycusis
- Distortion of high pitch sounds
- Alteration in equilibrium
- Sense of smell altered
- Atrophy of tongue
- Decreased saliva
- Altered circadian sleep-wake cycles
- Phase advance is common
- Calcification of costal cartilage and trachea
- More rigid rib cage
- Reduction of cough and laryngeal reflexes
- Pneumonia is more deadly
- Increased residual capacity and reduced vital capacity
- High risk for respiratory infection
- Lungs lose elastic recoil
- Declining muscle strength
- Lungs reduce in size and weight
- Increased dead space in the lungs
- Decrease in alveolar surface area
- Loose or brittle teeth can be aspired
- Decreased cilia
- Decreased ability to clear musus, cough and deep breath, immune response
- Less acute taste sensations
- Decreased esophageal motility
- Atrophy of the small and large intestines
- Increased risk of aspiration, indigestions, and constipation
- Atrophy of the tongue affects taste buds and decreases taste sensation
- Saliva production decreases
- Presbyesophagus results in weaker esophageal contraction and weakness of sphincter
- Esophageal and stomach motility decreases
- Higher risks for aspiration and indigestion
- Decreased stomach elasticity
- Stomach has a higher pH as a result of decline in hydrochloric acid and pepsin
- Decline in hydrochloric acid
- Increase in incidence of gastric irritation
- Interferes with absorption of calcium, iron, folic acid, and vitamin B12
- Decline in pepsin with absorption of protien
- Fewer cells on absorbing surface of intestinal wall impact absorption of dextrose, xylose, and calcium
- Decreased enzyme production in the liver which affects drug metabolism and detoxification processes
- Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low fiber diet
- Increased risk for constipation
- Sensory perception decreases
- May lead to incomplete emptying of the bowel
- Bile salt synthesis decreases
- Increase in the risk of gallstone development
- Thinning disks and shortened vertebrae
- Reduce muscle mass, strength, and movement
- Decreased bone mineral and mass
- Diminished calcium absorption
- Increased risk of fractures
- Ability to respond to cold temperatures is reduced due to subcutaneous tissue loss
- Decline in number and size of muscle fibers
- Reduce body strength
- Impaired capacity for muscle regeneration
- Grip strength endurance decreases
- Connective tissue changes reduce flexibility of joints and muscles
- Depressed immune response
- T cell activity declines
- Cell mediated immunity declined
- Risk for infection increases
- Inflammatory defenses decline
- Inflammation presents atypically
- Thymic mass decreases
- More immature T cells are present in the thymus
- IgM decrease
- IgA & IgG are higher
- Vaccine response is lesser
- Increase in proinflammatory cytokines
- Menopause in women
- Andropause in men
- Hormonal changes in women
- Vulva atrophies
- Flattening of labia
- Loss of subcutaneous fat and hair
- Vaginal epithelium thins
- Cervix, uterus and fallopian tubes atrophy
- Vaginal canal changes
- Reduction in collagen and adipose tissue
- Shortening and narrowing of canal
- less lubrication
- More alkaline vaginal pH due to estrogen changes
- Breasts sag and are less firm
- Some retraction of nipples related to shrinkage and fibrotic changes
- Changes in Males
- seminal vesicles develop thinner epithelium
- Muscle tissue replaces with connective tissue
- Decreased capacity to retain fluids
- Semonoferous tubule changes
- Increased fibrosis, epithelium thinning, thickening of the basement membrane, narrowing of lumen
- Atrophy of the testes and reduction in testicular mass
- Ejaculation fluid contains less live sperm
- More time to achieve erection
- Prostate enlargement
- Hypertension
- Incidence & prevalence increases with age
- Blood pressure on at least two occassions of: systolic pressure > 140 ordiastolic > 90
- Symptoms: dull headache, impaired memory, disorientation, confusion, slow tremor
- Often no symptoms
- Treatments: antihypertensives, diuretics, fluid management
- Can lead to orthostatic hypotension: systolic decline of 20 mmHg or more after changing positions
- Can cause: falls, syncope, stroke, coronary complications
- Venous Thromboembolism
- Increased incidence with age
- High risk: restricted to bed rest, recent surgery, fractures
- S/S: edema, warmth over affected areas, pain in foot, cyanosis, aching, engorgement of superficial veins
- Prevention in the best way to stop complications
- Treatment: anticoagulants, surgery, elastic stockings, elevation of extremities
- Hyperthyroidism
- Secretion of excess amounts of thyroid hormone
- Less prevalent than hypothyroidism
- Causes: benign or cancerous growth on thyroid
- S/S: accelerated processes, tachycardia, anxiety, high T3/T4, enlarged thyroid, exophthalmos, accelerated appetite, diarrhea, palpitations, insomnia, heat intolerance
- Treatment: thyroid ablation, radioactive iodine therapy, thyroidectomy, hormone replacement
- Hypothyroidism
- Hypofunction of the thyroid gland with resulting insufficiency of thyroid hormone
- More common
- Diagnostics: low T3/T4
- S/S: fatigue, weakness, lethargy, anorexia, weight gain, puffy face, impaired hearing, periorbital or peripheral edema, myalgia, ataxia, dry skin, dry hair, husky voice, slow speech
- Treatment: replacement of thyroid hormone, routine labs, symptoms relief
- Bronchitis
- Blue bloater
- Causes persistent, productive cough, wheezing, respiratory infections, shortness of breath
- Chronic sputum with cough daily for minimum of 3 months in each of 2 consecutive years
- Chronic hypozia
- Increase in mucus and bronchial wall thicness
- Management: remove secretions, prevent airway obstruction, maintain adequate fluid intake
- Less than 2 Liters of oxygen at all times
- S/S: cough, dyspnea on exertion, hypercapnia, hypoxemia, mild cyanosis
- Emphysema
- Causes: chronic bronchitis, chronic irritation, morphologic changes in lungs
- Cigarette smoking major role in development
- S/S; develop slowly, white/tenacoius/cloudy sputum, barrel-chest, dyspnea, prolonged expiration, breathes through pursed lips, tripod positioning
- Pink puffer
- Treatment: postural drainage, bronchodilators, avoid stress, breathing exercises
- Colorectal Cancer
- 2nd leading cause of cancer death
- S/S: change in bowel habits, sense of incomplete evacuation, abdominal pain, nausea, vomiting, weight loss, cachexia, abdominal distention, family hx, hx of polyps
- Profilactic colonoscopies
- Avoid processed diets
- Polyps change to cancer in a span of 10 yrs
- Diagnostics: fecal occult blood test, CBC, colonoscopy
- Treatment: colon resection
- 90-95% chance of survival if caught early
- Diverticular Disease
- Outpouching of the colon
- Often asymptomatic and found during other procedures
- Diverticulitis or Diverticulosis
- 50% of older adults have this
- Causes: chronic constipation, obesity, atrophy of the intestinal wall muscles
- S/S: left lower quadrant pain, increased flatus, rectal bleeding, fever, anorexia, distention of abdomen, constipation and alternating diarrhea
- Treatment: diagnostic colonoscopy or barium enema, NPO diet for acute phases, low fiber/non-irritating foods in recovery phase, avoid small poorly digested foods
- Parkinson Disease
- Affects ability of the central nervous system to control body movements
- S/S: chronic, progressive, debilitating neurologic disease of the basal ganglia and substantial Niagara, affecting motor ability and characterized by tremor at rest, increased muscle rigidity, bradykinesia, postural instability, mask like facial expression, difficult chewing/swallowing/speaking, drooling, shuffling gait, pill-rolling movements
- Caused by imbalances of dopamine
- Treatment: anticholinergic medications, regular timing of meds, technologies to control symptoms
- Interventions: schedule activities with ample time, encourage activity and exercise, eliminate environmental noise, soft diet, medication management
- Dementia
- Cognitive impairments characterized by gradual progressive onset
- Irreversible and affects judgement, memory, abstract thinking, and social behavior
- S/S: personality changes, confusion, disorientation, deterioration of intellectual functioning, loss of memory, decline in judgement and ADLs, difficulty performing familiar tasks, changes in mood or behavior
- Management basis, no cure
- Glomerulonephritis
- Early S/S: blood ro protein in the urine, high blood pressure, edema
- S/S of late stage kidney failure: lack of appetite, nausea and vomiting, tiredness, difficulty sleeping, dry and itchy skin, muscle cramping, cerebral edema
- Treatment: antibiotics, restricted sodium and protein diet, intake and output monitoring
- Urinary Tract Infection
- Most common infection in older adults
- infection or inflammation at any site in the urinary traact
- Mostly E. coli
- High risk: diabetes, pregnancy, prostatic hypertrophy, immunosuppressed, catheterized, urinary retention, older women with bladder prolapse
- S/S: fever, chills, confusion, urinary frequency, uurinary urgency, dysuria, hematuria, positive nitrite test, elevated WBC, disorientation
- Treatment: antibiotics specific to infectious agent, encourage fluids, I & O monitoring, analgesics, perineal care
- Erectile Dysfunction
- Unable to attain or maintain erection of penis for sexual disfunction
- Causes: atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, abnormalities, medications, psychological factors
- Physical exam is needed
- Often side effect of medicaiton
- Treatment: medications
- Affects half of men over 70 yrs
- Breast Cancer
- Second leading cause of cancer deaths
- Risk increases with age
- Encourage self breast exams
- Diagnosed with 3D ultrasounds, lumpectomy, mastectomy
- Treatment chemotherapy or radiation
- S/S: lump in breast, lymph node involvement, can be asymptomatic
- Pruritis
- Most common dermatologic problem among older adults
- Causes: excessive heat, bathing, diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia, and psychiatric diseases
- Can lead to traumatizing scratching, breakage of skin, infection
- Correct underlying prblem
- Treatment: vitamin rich diet, topical applications of zinc oxide, antihistamines, or topical steroids
- Seborrheic Keratosis
- Dark, wart-like projections on the skin
- Small or pinheaded to as large as a quarter
- Increase in age and number with aging
- Benign but require medical evaluation and assessment to differentiate from precancerous growths
- Removal may also bring cosmetic and confidence benefits
- Gout
- Metabolic disorder in which excess uric acid accumulates in the blood
- Uric acid crystals deposit in and around joints
- Causes: warmth, redness, swelling around tissue, sometimes severe pain
- Can have acute attacks with remission
- Treatment: reduce sodium urate through low-purine diet, reduce alcohol consumption, Colchicine or phenylbutazone can be used for acute attacks
- Dietary supplements and pain management are important
- Fractures
- Trauma, cancer metastasis to bone, osteoporosis, and other skeletal diseases contribute
- Prevention is the best method to prevent complications
- Bones are more brittle
- More common in women
- Fall prevention is a big priority
- Dietary changes are important
- Mobility is important
- Healing is delayed so prevention is highly important
- Cancer
- Complexities are greater due to immune system decline
- Often late stage before diagnosis
- Many may be prevented by healthy lifestyle and risk factor reduction
- Risk factors: tobacco use, sun exposure, poor diet, obesity, carcinogen exposure, alcoholism
- Treatment: surgery, radiation, chemotherapy, biologic therapy
- Complementary and alternative medicine approaches may be used
- Patient education and support is very important
- Harder recovery because of immune depression
Cross-Link * Nutritional deficits
- GI: decreased esophageal motility, atrophy of intestine, higher risks of aspiration and indigestion, bowel emptying complications
- Respiratory: aspiration pneumonia is a higher risk
- Immune: depressed immune system increases risk for illness which could lead to anorexia
- Musculoskeletal: reduce subcutaneous fat and muscle could be worsened by poor nutrition
- Urinary: fecal impaction and constipation could lead to feelings of fullness and food avoidance
- Endocrine: decreased senses, thirst perception
- Nervous: age related forgetfulness added to decreased senses
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Cross Link * Sleep Disturbance
- Urinary: urgency, nocturia
- GI: increased risk for indigestion or constipation
- Endocrine & Nervous: different sleep/wake cycles that may be hard to maintain in a shared home with younger generations
- Cardiovascular & Repiratory: oxygen used less efficiently may be worsened in certain lying positions
- Musculoskeletal: easier fractures and loss of subcutaneous fat may make certain positions more uncomfortable for sleep
- GI: decreased intestinal and esophageal motility, higher risk for aspiration, atrophy of taste sensation all can lead to ineffective management of nutrition
- Respiratory: increased residual capacity and decreased vital capacity may make physical activities more difficult
- Immune: risk for infections may cause social avoidance
- Musculoskeletal: reduced muscle mass, strength, and movement can increase difficulty of ADLs
- Urinary: frequency or urgency may make completing tasks more difficult
- Integumentary: physical appearance changes may cause self-esteem issues and social avoidance
- Endocrine: decreased sense may not alert older persons to bodily needs
- Nervous: age related forgetfulness and decreased senses may cause ADLs to not be completed
- Cardiovascular: extra work on the heart to complete ADLs may cause discomfort
- Reproductive: hormonal and bodily changes may increase the patients hesitance to complete social tasks
- Financial issues can cause problems related to all body systems. Patients may struggle to: afford proper nutrition, obtain medications or healthcare due to prices, enlist needed home help, or even maintain a home on their own.
- All of these financially dependent activities can be altered leading to health concerns and potential loss of independence.