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Age Related Changes Rachel Gessler 002 - Coggle Diagram
Age Related Changes
Rachel Gessler 002
Cardiovascular System
Blood vessels have a reduction in elasticity and oxygen is used less efficiently
Heart muscle loses efficiency and contractile strength and reduced cardiac output with physiologic stress
NORMAL CHANGES RELATED TO AGING:
Pathologies
Hypertension (HTN)
HTN is defined as a systolic BP > 140 mmHg and a diastolic BP >90 mmHg
Incidence and prevalence increases with age
Many modifiable and non-modifiable risk factors: stress, weight, race (African American individuals have a higher predisposition to high BP), level of physical activity, genetic predispositions, gender, age
Usually no symptoms and a wide range of treatments
Coronary Artery Disease (CAD)
Angina
Chest pain that often presents as vague discomfort under the sternum
Nitroglycerine and pt education
Myocardial Infarction (MI)
Presentation: confusion, decreased BP, SOB, increase in body temp
Prevalence increases with aging; Some form is present after 70 years of age
Hyperlipidemia
Elevated cholesterol levels; HDL to LDL ratios; importance of dietary changes
Orthostatic Hypotension
Can be due to increased intake of vasoactive meds and baroreceptor sensitivity
At risk for falls, stroke, syncope
Decline in systolic BP of 20 mmHg when changing positions
Education: instruct pts move slowly when changing positions
Heart Failure (HF)
Right sided HF
The number one cause: L sided HF
Causes peripheral edema --> results in peripheral congestion due to R ventricles inability to pump blood out to lungs
Symptoms: weight gain, hepatomegaly, ascites, distended neck veins, weakness
Left sided HF
Causes pulmonary edema --> resulting in pulmonary congestion related to L ventricles inability to pump blood to the periphery
The number one cause: HTN
Symptoms: dyspnea, crackles, cough, restlessness, tachycardia
Congestive HF
Incidence increases with age; Leading cause of hospitalization
a complication of arteriosclerotic heart disease, followed by hypertension, diabetes, dyslipidemia, cardiomyopathy, sleep apnea, chronic kidney disease, illicit drugs, sedentary lifestyle, and psychological stress.
Symptoms: crackles on auscultation, SOB, dyspnea on exertion, cough, fatigue, restlessness, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, and bilateral ankle edema
Tx: monitor weight, avoid salt, monitor pulse for tachycardia, assess for changes in mental status, and frequent repositioning
Deep Vein Thrombus (DVT)
Virchow's Triad: stasis, vessel damage, and hypercoagability
Risk for a pulmonary embolism (PE), a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow. VERY dangerous
Blood clot forms in a deep vein, such as in the lower leg or thigh
Arythmias
Can be due to digitalis toxicity, hypokalemia, acute infections, and coronary insufficiency
-Symptoms: weakness, fatigue, palpitations, hypotension, bradycardia
Tx: antiarrhythmic drugs, modify diet, smoking cession and decrease alcohol intake
Peripheral Vascular Disease (PVD)
Circulatory problems; arteriosclerosis & atherosclerosis
-Affects smallest vessels furthest from heart
Arterial Vascular Disease
-Smooth shiny skin
-Loss of hair
-Thickened nails
-Dry, pale skin
-Cool
-Pulse decreased or absent
-Circular ulcers
-Sharp pain & claudication
Venous Vascular Disease
-Brown pigmented around ankles
-Warm
-Painful --> aching, dull
-Nocturnal cramps
-Superficial ulcers
-Normal pulse
Special Problems w/ Diabetic Adults
High risk for peripheral vascular issues
Arterial insufficiency: resting pain, arterial pulses, skin discoloration (ulcers, gangrene)
Importance of proper foot care --> clean and inspect feet often, avoid injury, watch for lesions, potential for fungal issues
Relationship that displays one of the many complications that can arise from the progression of diabetes, especially one that is poorly controlled
Varicose Veins
Common problems for older adults
Dilated, tortuous veins that can cause dull pain
Tx: sclerotherapy, which involves injection of a solution directly into the vein. This then causes the vein to scar and forces blood to reroute through healthier veins. The collapsed vein is then reabsorbed into local tissue and eventually fades
Heart valves become thick and rigid --> diastolic murmurs occur in 50% of older adults
Less sensitive to baroreceptor regulation of blood pressure
The aorta becomes more dilated --> slight ventricular hypertrophy & thickening of left ventricular wall
Urinary System
Decrease of renal blood flow as well as glomerular filtration by about 50% at the age of 90
Reduced bladder capacity (by about 1/2)
NORMAL CHANGES RELATED TO AGING:
Size and weight of kidney decreases
Hypertrophy and thickening of bladder muscle
Decrease ability of bladder to expand
Changes in cortical control of micturition (nocturia)
Inefficeient neurological control of bladder emptying and weaker bladder muscle
-female: feccal impaction
-male: prostatic hypertrophy
Reduced kidney tubular function --> which can lead to high BUN and proteinuria
Increase in renal threshold for glucose
Pathologies
Urinary Incontinence
Different types: -stress (involuntary leakage on effort or exertion, or on sneezing or coughing) -urgency (involuntary leakage accompanied by or immediately preceded by strong urgency)
-overflow (unexpected leakage of small amounts of urine because of an overfilled bladder) -neurogenic [reflex] (bladder dysfunction caused by nerve, brain, or spinal cord)
-functional (untimely urination b/c of disability, external obstacles, or problems that prevent from reaching toilet)
-mixed (involuntary leakage associated w/ urgency and also with exertion effort, coughing, or sneezing)
Bladder cancer
: cancer that begins in bladder; risk factors: irritation, smoking, clothing dye; most common symptom is blood in urine; observe for signs of metastasis; treatments include surgery, biological therapy, and chemotherapy
Renal Calculi:
hard deposits of minerals and acid salts that stick together in concentrated urine. They can be painful when passing through the urinary tract, but usually don't cause permanent damage. Possible causes for renal stones include dehydration, obesity, and eating foods too high in sugar or salt.
The most common symptom is severe pain, usually in the side of the abdomen, that's often associated with nausea.
Treatment includes pain relievers and drinking lots of water to help pass the stone. Medical procedures may be needed to remove or break up larger stones.
Glomerulonephritis:
damage to the tiny filters inside the kidneys
-acute: develops suddenly; may get after throat or skin infection; early symptoms include puffiness of face, blood in urine, and urinating less than normal
-chronic: may develop over several years, often w/o symptoms; often leads to complete kidney failure; early s/s include blood or protein in urine, edema, high BP, and nocturia
UTI:
An infection in any part of the urinary system, the kidneys, bladder, or urethra.
Urinary tract infections are more common in women. They usually occur in the bladder or urethra, but more serious infections involve the kidney.
A bladder infection may cause pelvic pain, increased urge to urinate, pain with urination, and blood in the urine. A kidney infection may cause back pain, nausea, vomiting, and fever.
Common treatment is with antibiotics.
Gastrointestinal System
Less acute taste sensations
Atrophy of both small and large intestines
NORMAL CHANGES RELATED TO AGING:
Decreases esophageal mobility; presbyesophagus
Atrophy of tongue -- affects taste buds & decreases taste sensation
Decrease in saliva production -- could cause swallowing difficulties
Decreased elasticity of stomach
Stomach has higher pH as a result of decline in hydrochloric acid and pepsin
Decline in hydrochloric acid and pepsin (protein breakdown)
Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D
Decreased enzyme production in liver -- affects metabolism and detoxification
Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet-- Increase risk of constipation
Decreased sensory preception and bile salt production
Pathologies
Dysphasia: incidence of swallowing difficulty; Causes: GERD, stroke, structural disorders
Hiatal hernia: Herniation of the esophagogastric junction & a portion of the stomach is in the chest; causes include: obesity & large volume of food -s/s: heartburn, belching, abdominal discomfort -tx: small meals, avoiding meals at bedtime, bland diet, sleeping in a partial recumbent position
Two types:
sliding/ axia
(your stomach and the lower part of your esophagus slide up into your chest through the diaphragm) and
rolling/ paraesophagea
l (a part of the stomach protrudes up through the hole in the diaphragm next to the oesophagus)
Esophageal Cancer: greater incidence with age; contributed to smoking and alcohol
-types: squamous cell & adenocarcinoma
-causes: poor oral hygiene and irritation
-s/s: dysphagia, weight loss, and excessive saliva
-diagnosis with barium swallow and esophagoscopy and biopsy
-Tx: surgery, radiation, chemotherpay, laster therapy
Stomach cancer: a cancer that occurs in the stomach; risk factors include alcohol and a diet high in processed/salty foods
-s/s: anorexia, epigastric pain, weight loss, indigestion
-diagnosis: gastroscopy, barium swallow
-Tx: surgical-partial gastrectomy
-prevention: a diet low in red meet and high in antioxidants
Diverticular disease:
Includes diverticulosis and diverticulitis; present in 50% of older adults
-causes: chronic constipation, obesity, atrophy of intestinal wall muscles
-s/s: Diverticulitis: left lower quadrant pain, increased flatus, rectal bleeding; Obstruction: fever, anorexia, abdominal distention, constipation alternating with diarrhea
-Tx: Dx colonoscopy or barium enema
Maintenance measures (nutrition): Acute phase-NPO, Recovery phase-no fiber or foods that irritate the bowel, Maintenance phase: high-fiber diet with bulk-forming laxatives to prevent pooling of foods. Avoid small poorly digested food such as popcorn, nuts, seeds
Colorectal cancer: second leading cause of cancer death
-s/s: change in bowel habits, sense of incomplete evacuation, abdominal pain, nausea and vomiting, weight loss, cachexia, abdominal distention, polyp
-Diagnosis and diagnostic tests: fecal occult blood test, CBC, colonoscopy
-Tx: colon resection
-10 years from time polyp in colon forms to getting colon cancer ; VERY IMPORTANT to get colonoscopy done
Intestinal obstruction: can be caused by tumor, intersession, stool impaction
-partial or complete obstruction; large intestine= cancer, small intestine= adhesions and hernia
-s/s vary depending on site and cause
Tx: medical and surgical management
Bowel incontinence relates to involuntary delectation & the inability to control passage of stool
-often associated w/ fecal impaction
Acute appendicitis: a sudden and severe inflammation of appendix-- fills w/ pus
-Atypical presentation in older adults, most often experience pain all over and not just the typical RLQ pain
-Tx: surgery, antibiotics (to help cool inflammation of appendix)
Pancreatic cancer: difficult to detect, often diagnosed at advanced state; generally poor prognosis;
-typically no symptoms in early stages
-Tx: surgery, radiation, chemotherapy
Biliary Tract Disease:
-
Cholelithiasis (gallstones)
has an increased incidence w/ age; Gallstones are hardened deposits of digestive fluid and can vary in size and number; may or may not cause symptoms.
People who experience symptoms usually require gallbladder removal surgery
-
Cancer of the gallbladder
: poor prognosis, easier for the cancer to grow undetected due to gallbladders size and location;
-S/s: sometimes no symptoms, but may include abdominal pain, bloating, itchiness, and fever.
-Tx: surgery, chemotherapy, and radiation.
Integumentary System
Less effective skin barrier
Increase in vascular fragility
NORMAL CHANGES RELATED TO AGING:
Decreased ability to detect and regulate body temperature
Drier skin and loss of elastin
Pathologies
Seborrheic Keratosis:
common noncancerous growth; appears as a waxy brown, black, or tan growth
-Often appears on chest, face, shoulders, or back
-No tx is necessary; can be removed by doctor if irritation is experienced
Skin cancer
Squamous cell carcinoma:
second most common form of skin cancer characterized by uncontrolled growth of abnormal squamous cells ; usually is not life-threatening but can be aggressive
Melanoma:
aggressive form of skin cancer that develops when melanocytes start to grow out of control
-New, unusual growth or change in existing mole is common to see; can occur anywhere on the body
-Tx: surgery, radiation, medications, chemotherapy
-ABCDE rule: asymmetry, border irregularity, color, diameter (>6mm), and evolving
Basal Cell Carcinoma:
begins in basal cells of skin; limiting sun exposure can help prevent from becoming cancerous
-Appears as a waxy lump or brown scaly patch on sun-exposed areas (such as face and neck)
-often benign
Pressure injuries
Stage I:
intact skin with non-blanchable redness
Stage II:
partial thickness, loss of dermis, redness
Stage III:
full thickness loss, subcutaneous fat may be visible
Stage IV:
full thickness tissue loss with exposed tendon or muscle; slough or eschar may be present
Suspected Deep Tissue Injury:
purple or maroon localized area of discoloration of intact skin
Unstageable:
full thickness, but base is covered with dead tissue and makes it unable to stage
Sores (ulcers)
that develop on areas under pressure, especially bony prominences (such as the heels)
-often occur from immobility, such as from laying in a bed or sitting in a wheelchair
-different stages of classification:
Hair loss and graying
Brittle, thick nails
Wrinkled skin
Subcutaneous fat loss, decreased natural inhalation
Respiratory system
Higher risk of respiratory infections
NORMAL CHANGES RELATED TO AGING:
Calcification of costal cartilage, trachea, and rib cage-- causing rigidity
Decreased laryngeal reflexes and reduction in cough
Increased residual capacity and decreased vital capacity
Pathologies
Chronic obstructive pulmonary disease (COPD)
Group of diseases including asthma, chronic bronchitis, emphysema
Leading cause of respiratory disability
Asthma: intermittent disease with reversible airflow obstruction and wheezing due to a variety of stimulants
-Can develop over years
-nursing interventions include administering bronchodilators, fluids, and humidification
Chronic Bronchitis: Chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years
-Causes persistent, productive cough; wheezing; recurrent respiratory infections; shortness of breath-Increase in mucus, cilia projection
-Increase in bronchial wall thickness
-"Blue Bloater"
-Nursing interventions include lowest FiO2 possible to prevent CO2 retention and watching for signs of fluid overload
Emphysema: reduced gas exchange surface area, decreased capillary network, and increased air trapping
-Assess for barrel chest, "Pink Puffer"
-Cigarette smoking is major cause
-Symptoms develop slowly
Tx: postural drainage, bronchodilators, breathing exercises
Pneumonia: inflammation of lower respiratory tract -Causative agents: bacterial (gram pos and gram neg), viral, fungal, chemical
-community- acquired or medical-care associated
-Older adults present: confusion, lethargy, anorexia, rapid respiration rate, and tachypnea
-Prevent with annual flu and pneumococcal vaccines
Lung abscess: a type of necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection
-Causes: pneumonia, TB, malignancy, and aspiration
-s/s: anorexia, weight loss, elevated temperature, and chronic cough
-Tx: postural drainage & high protein, high calorie diet
Lung cancer: leading cause of cancer-related death
-Increasing incidence in 65 years and older
-Higher incidence n men than women
-Incidence: 80 to 80% were smokers
-s/s: dyspnea, coughing, chest pain, wheezing, fatigue, anorexia, and respiratory infections
-Tx: surgery, chemotherapy, radiotherapy
COVID 19: caused by SARA-CoV-2 respiratory virus -s/s: cold symptoms, red watery eyes, persistent cough, heart palpitations, extreme fatigue, loss of taste & smell
-statistics: 80% get mild symptoms, 14% severe symptoms w/ infection of lungs, and 5% are critical and lead to damage of air sacs
-Tx: stay away from others, get rest & hydrate, monitor symptoms carefully, hospitalization may be needed
Lung loses elastic recoil
Decreased reaction of peripheral & central chemoreceptors to hypoxia and hypercapnia
Decrease in lung size and weight
Endocrine System
Hormone receptors become less sensitive
Level of most hormones decrease with aging
NORMAL CHANGES RELATED TO AGING:
Thyroid gland atrophies and activity decreases
Diminished adrenal function
Adrenocorticotropic hormone (ACTH) secretion decreases
Volume of pituitary gland decreases
Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Pathologies
Diabetes Mellitus
-Seventh leading cause of death in older adults
-Glucose intolerance
-Diagnosis of diabetes in the older adult
-Classic nonspecific symptoms may be absent
-Condition that can lead to attack almost every organ system
Criteria for diagnosis(generally established if one of three exists):
-Symptoms and a random blood glucose concentration > 200 mg/dL
-Fasting blood glucose concentration > 126 mg/dL
-Blood glucose concentrations 2 hours after oral glucose intake >200 mg/dL
High risk of hypoglycemia--> very dangerous in older adults
Complications: Neuropathies; Retinopathy leading to blindness; Cognitive impairment; Coronary artery disease; Cerebral arteriosclerosis; Urinary tract infections; Higher risk of developing problems in every body system
Hypothyroidism
Hypofunction of the thyroid gland with resulting insufficiency of thyroid hormone
Diagnostics: Low T3 (<70), Low T4 (<5), Presence of T4 antibody
S/S: Fatigue, Weakness, Lethargy, Anorexia, Weight gain or a Puffy Face, Impaired hearing, Periorbital or peripheral edema, Myalgia, paresthesia, ataxia, Dry skin and dry hair, Husky voice, slow speech
Hyperthyroidism
Secretion of excess amounts of thyroid hormone
Diagnosis: T3 level > 220ng/dL, T4 level >12 mcg/dL
S/S: Enlarged thyroid, Exophthalmos, Acceleration of body processes (increased appetite, tachycardia, ect.)
Observe for thyroid storm
Musculoskeletal System
Reduced muscle mass, strength, and movement
Diminished calcium absorption
Thinning of disks and shortening of vertebrae, which can result in height reduction
Increased risk of fractures
NORMAL CHANGES RELATED TO AGING:
Sarcopenia (age related, involuntary loss of skeletal muscle mass and strength) and Osteopenia (a condition that occurs when the body doesn't make new bone as quickly as it reabsorbs old bone due to age related hormone changes)
Pathologies
Falls
Risks for falls: improper use of mobility aids, medications, postural hypotension, environmental hazard, health conditions, and caregiver-related factors
1/3 of adults over the age of 75 fall each year
20% of hospital and 40% of nursing home admissions related to falls
Prevention of falls: change positions slowly to avoid orthostasis, proper use of cane and walker, use of prescribed eyeglasses, adequate lighting, and review of regular medications
Arthritis
Osteoarthritis:
occurs when flexible tissue at the ends of bones wears down.
The wearing down cartilage occurs gradually and worsens over time.
Joint pain in the hands, neck, lower back, knees, or hips is the most common symptom.
Medications, physical therapy, and sometimes surgery can help reduce pain and maintain joint movement.
Rheumatoid arthritis
: an autoimmune disease that can cause joint pain and damage throughout your body. The joint damage that RA causes usually happens on both sides of the body. s/s: tender, warm swollen joints and joint stiffness. There is no cure for rheumatoid arthritis, however physiotherapy and medication can help slow the disease's progression. Most cases can be managed with a class of medications called anti-rheumatic drugs (DMARDS)
Psoriatic arthritis:
a form of arthritis that affects some people who have the skin condition psoriasis.
Psoriatic arthritis is a type of inflammatory arthritis.
Symptoms include joint pain, stiffness, and swelling, which may flare and subside. Many people with the condition are affected by morning stiffness. Even mild skin psoriasis can have a significant degree of arthritis.
Treatment may include medication to reduce inflammation, steroid injections, or joint replacement surgery.
Osteoporosis:
bones become weak and brittle; often no symptoms; risks: women over age of 65, men over age of 80. Treatment includes medications, healthy diet, and weight-bearing exercise to help prevent bone loss or strengthen already weak bones
Nervous System
NORMAL CHANGES RELATED TO AGING
Neurons being to reduce, as well as nerve fibers and cerebral blood flow
Decline in weight and blood flow to the brain
Slower response to balance changes
The hypothalamus is less effective in regulating body temperature
Changes in sleep patterns (frequent awakenings throughout night); Altered Circadian Rhythm --> Phase advance (go to sleep and wake up at earlier time)
Pathologies
Sleep Disturbances
Nocturnal Myoclonus and Restless Leg Syndrome=
-Nocturnal myoclonus: five leg jerks or movements per hour during sleep
-Restless leg syndrome: neurological condition of urge to move leg
Sleep Apnea=five episodes of cessation of breathing, lasting 10 seconds
-Disorder in central nervous system affecting diaphragm
(central sleep apnea)
Insomnia= difficulty falling or staying asleep; short-term or chronic
Drugs that affect sleep include: Anticholinergics, Antidepressants, Diuretics, Antihypertensives, Beta-Blockers, ect.
Cataracts:Clouding of the lens and loss of transparency; Leading cause of low vision in older adults
Glaucoma: Damage to the optic nerve from an above normal intraocular pressure (IOP);Second leading cause of blindness in older adults
Acute (closed or narrow angle): Severe eye pain, headache, nausea, and vomiting; Rapid increase in tension and edema; Need for early treatment to prevent blindness; Diagnosis with tonometry to measure IOP
Chronic: Most common form; Need for early prevention to prevent blindness; Vision loss due to glaucoma cannot be restored
Macular Degeneration: Most common cause of blindness in adults over the age of 65; Damage or breakdown of the macula leading to loss of central vision
Detached Retina: Forward displacement of the retina; Signs and symptoms= Gradual or sudden; Prompt treatment to prevent continued damage and eventual blindness
Corneal Ulcer:Inflammation of the cornea accompanied by a loss of substance
Otosclerosis: A condition in which there's abnormal bone growth inside the ear; an inherited disorder that causes hearing loss due to the ear's inability to amplify sound
Tinnitus:Ringing or buzzing noise in one or both ears that may be constant or come and go, often associated with hearing loss
Dementia
Irreversible and progressive
Impairment in cognitive function affects: Memory, orientation, reasoning, attention, language, and problem solving
Caused by damage or injury to the brain; 4.5 million older adults are affected
Alzheimer's Disease
Most common form of dementia
Changes in the brain: Neuritic plaques containing beta-amyloid protein, Neurofibrillary tangles in the cortex, Loss or degeneration of neurons and synapses, Changes in neurotransmitter systems”
Possible causes: Genetics, Environmental factors, Chromosomal abnormalities, Free radicals, Levels of aluminum and mercury in brain, Slow-acting virus
Symptoms develop gradually and progress at different rates among individuals; staging
No current treatment to prevent/cure AD
However, there are clinical trials in place to help slow progression of disease and improve function; medications to slow acetylcholinesterase; Other: Antioxidants, anti-inflammatory agents, folic acid, vitamins B6 and B12, and gene therapy
Other dementias: Vascular dementia, Frontotemporal dementia, Lewy body dementia, Creutzfeldt-Jakob disease, Wernicke encephalopathy, Parkinson’s disease, AIDS, Trauma and toxins
Possible causes: genetics, environmental factors, chromosomal abnormalities, free radicals, level of aluminum and mercury in the brain, slow-acting virus, and inactivity
CAM therapies (including nutrition supplements-- vitamins, minerals, herbs), therapeutic exercise (Qigong-- which includes breathing techniques, meditation, guided imagery), and occupational and expressive therapy
Dementia is an example of a condition that can affect cognitive impairment and therefore lead to inappropriate sexual behaviors
Delirium
Rapid, altered level of consiouness
Related to acute condition-- infection, hypoxia, dehydration, hyper/ hyponatremia, new medications, pain, and cognitive impairment
Consider the coexisting factors
Results in confused thinking and reduced awareness of surroundings; NOT the same as dementia
Mental Health
Anxiety Disorder
: unrealistic, excessive, or persistent (lasting 6 months or longer) anxiety and worry about two or more life circumstances. Previously learned coping mechanisms are inadequate to deal with this level of anxiety; 30% of older adults present with generalized anxiety disorder
Substance abuse disorder
: Habitual use of psychoactive substances that is not socially acceptable or a medical necessity. The substance is purposely used to alter the individual’s emotion, mood, or state of consciousness;
The most commonly used illicit psychoactive substance is marijuana.
Behavior problems
: Actions that are disruptive, harmful or deviate from the normal and tend to be recurrent in nature, such as physical or verbal abuse, resistance to care, repetitive actions, wandering, restlessness, suspiciousness or inappropriateness; These problems can occur in persons with altered cognitive status who are unable to think rationally and make good judgements.
Depression
, a type of mood disorder, is the most prevalent mental health problem among older adults. It is associated with distress and suffering; adult males over the age of 85 have the highest rate of suicide; S/s: changes in appetite, feelings of hopelessness, and lack of energy; Tx: good health practices (proper nutrition and regular exercise) and anti-depressants
Parkinson's Disease (PD)
PD affects the ability of the central nervous system (CNS) to control body movements. The disease is a chronic, progressive, debilitating neurologic disease of the basal ganglia and substantia nigra that affects motor ability
Parkinson disease involves and imbalance between acetylcholine and dopamine. Symptoms can be controlled by a dopamine precursor (levodopa)
S/s: tremors at rest (pill-rolling tremor), mask-like expression, stooped posture, shuffling gait, and drooling
Anticholinergic and Antiparkinson's meds
Progression of PD can be one of the many reasons that a patient can be susceptible to falls due to mobility limitations
Pain
: can be acute or chronic; Three of five patients aged 65+ experience
pain lasting for 1 year or more, lower back pain is most common in older adults
-Pain is classified according to pathophysiological mechanism
-Nociceptive: mechanical, thermal, and chemical
-Somatic pain: bone and soft tissue. Localized and described as throbbing or aching
-Visceral pain: disorders that cause generalized or referred pain deep and aching
-Neuropathic: abnormal processing of sensory stimuli by central or peripheral
nervous systems
-Abnormal processing of sensory stimuli by central or peripheral nervous system
Ex. Diabetic neuropathies, post-therpetic neuralgias
-Pain is sharp, stabbing, tingling, or burning with sudden onset of high intensity
Important for nurse to assess pt pain and help find relief methods
Vision changes: presbyopia
Hearing changes: presbycusis
Taste bud atrophy: decreased taste sensation for sweet and salty
Reproductive system
Normal Changes related to Aging
Physically able to remain sexually active
Female Reproductive Changes:
-Hormonal changes: Vulva atrophies, Flattening of the 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 the canal, Less lubrication (May lead to discomfort with intercourse), More alkaline vaginal pH as a result of lower estrogen changes
-Uterus and ovaries decrease in size
-Breast sag and are less firm
Menopause & Andropause
-decreased levels of estrogen and testosterone
Male Reproductive Changes:
-Seminal vesicles develop thinner epithelium
-Muscle tissue replaced w/ connective tissue
-Seminiferous tubule changes
-Increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen
-Atrophy of the testes and reduction in testicular mass
-Ejaculation fluid contains less live sperm
-Testosterone stays the same or decreases slightly
-More time required to achieve an erection
-Enlargement of prostate gland
Pathologies
Erectile disfunction:
unable to attain or maintain erection of penis for sexual intercourse
Multiple causes: atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medications, and psychological factors
Cognitive impairment can affect sexual behavior
Issues w/ inappropriate touching and endearing statements
Dyspareunia: painful sex
Atrophic vaginitis: Occurs in postmenopausal women; Increased vaginal fragility increases the risk of irritation leading to vaginitis
Cancer
Cancer of Endometrium: Begins in lining of uterus; most cases occur in women after the age of 55; key sign= abnormal vaginal bleeding
Cancer of Ovaries: often goes undetected until it has spread within the pelvis and belly; often has no symptoms in the early stages. Later stages are associated with symptoms, but they can be non-specific, such as loss of appetite and weight loss;
Surgery and chemotherapy are generally used to treat ovarian cancer.
Cancer of the Breast: forms in cells of breast; can occur in women & men; Symptoms of breast cancer include a lump in the breast, bloody discharge from the nipple, and changes in the shape or texture of the nipple or breast;
Treatment depends on the stage of cancer. It may consist of chemotherapy, radiation, and surgery.
Cancer of the Prostate: Symptoms include difficulty with urination, but sometimes there are no symptoms at all;
Some types of prostate cancer grow slowly, but other types are aggressive and require radiation, surgery, hormone therapy, chemotherapy, or other treatments
Benign Prostatic Hyperplasia (BPH):
An enlarged prostate gland that can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems
Perineal Herniation: results from a weakening of the muscles that support the rectum (pelvic diaphragm). These hernias begin to bulge when they fill with fat, abdominal tissue, or the urinary bladder, or when part of the rectum slides into the pocket.
Lymphatic System
NORMAL CHANGES OF AGING
Lymphedema is a common condition in the elderly, excess fluid builds up in the interstitial space
Pathologies
Lymphedema
: Swelling in an arm or leg caused by a lymphatic system blockage.
The condition is caused by a blockage in the lymphatic system, part of the immune and circulatory systems. Lymphedema is most commonly caused by lymph node removal or damage due to cancer treatment.
The main symptom is swelling in an arm or leg that may be accompanied by pain or discomfort.
Tx: Exercise, wrapping, massage, and compression
Hodgkin's Lymphoma:
Cancer of the part of the immune system called the lymphatic system.
As the cancer progresses, it limits the body's ability to fight infection.
Lymph nodes in the neck, armpits, or groin may swell. Fatigue, fever, and chills are some symptoms.
Tx: chemotherapy, radiation, and in rare cases stem-cell transplant.
Vessels may become leaky because cell-to-cell gap junctions become looser
Lymphatic collector function generally declines with aging (for example= decreased contractile pressure and frequency
Immune system decreases in ability to fight off infections
Reduced B and T cell production
