Older Adult

Circulatory system

Respiratory system

Digestive System

Sensory system

Changes of aging

Heart valves become thick and more rigid

Aorta becomes dilated

Myocardial muscle is less efficient

Calcification & reduced elasticity of vessels

Less sensitive to baroreceptor regulation of blood pressure

Changes of Aging

Atrophy of the tongue affecting taste buds and causing taste sensations

Saliva production decreases causing swallowing to be more difficult

Esophageal and stomach motility decreases

Decreased elasticity of the stomach

Changes of aging

Breathing mechanics

Changes occur in upper airway paths, nose and trachea

Declining muscle strength causing decreased cough reflex

Lung size and weight reduction

Oxygenation

increased ventilation and perfusion are imbalanced

decreased alveolar surface area

Ventilation Control

decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia

increased need for an older adult to eat smaller meals

Higher risk for aspiration and indigestion

Decline in hydrochloric acid

increase in incidence of gastric irritation

Interferes with absorption of calcium, iron, folic acid and B12

Decline in pepsin

Interferes with absorption of protein

changes of aging

Hearing changes

Impacted cerumen

High pitches are diminished and the ability to discriminate tones is lost

Vision changes

Loss of photoreceptor cells in the retina

difficulty with vision at night

dark and light adaption takes longer

Light perception threshold decreases

opacification of the lens and viterous

Visual acuity declines

reduced pupil size

Decreased ability to focus

reduced elasticity and stiffening of the muscle fibers of the lens

Abnormal changes

Glaucoma

Damage to the optic nerve from an above normal intraocular pressure

Second leading cause of blindness in older adults

Lungs lose elastic recoil

Diastolic murmurs occur in 50% of older adults

Slight ventricular hypertrophy

Thickening of left ventricular wall

Decreased contractile strength and prolonged cardiac cycle

unable to meet the demands of increased activity

Endocrine System

Neurological System

Thyroid gland atrophies and acitivty decreases

decreased production fo thyroid hormone, which drives metabolism leading to weight gain

Diminished adrenal function

Stabilization of mineral within body compensation is more fragile

Adrenocorticotropic hormone (ACTH) secretion decreases

Affects BP regulation

Volume of pituitary gland decreases

TSH, growth hormone, oxytocin, prolactin, luteinizing hormones, FSH hormones affected

Insufficient release of insulin and reduced tissue sensitivity to circulating insulin

Leads to diabetes mellitus

Urinary/Renal System

Changes of aging- urinary elimination

Size and weight of the kidney decreases

Hypertrophy and thickening of the bladder muscle

Decreases bladder ability to expand

reduces stroage capacity

daytime urinary frequency

Nocturia

Changes in cortical control of micturition

nocturia

Ineffecient neurological control of bladder emptying and weakened bladder muscles

Retention of large volumes

GFR decreases due to decreased renal blood flow and decreased numbers of functioning glomeruli

Affects the abilty to eliminate drugs

Slowed organ function

Reduced tubular function

Bladder capacity decreases by one-half

Weakening of the bladder and perineal muscles and decrease in sensation of urge to void

Integumentary System

Changes of Aging

Slowing in central processing

Delay in time required to perform tasks

Number and sensitivity of sensory receptors, dermatomes and neurons decrease

Dull in tactile sensation

Decline in the function of cranial nerves affecting taste and smell

Loss of nerve cell mass

atrophy of the brain and spinal cord

brain weight decreases

Demyelination

slower nerve conduction

response and reaction times are slower

reflexes become weaker

decrease in cerebral blood flow

Fatty deposits accumulate in blood vessels

Parkinson disease

Affects ability of the CNS to control body movements

Chronic, progressive, debilitating neurologic disease of the basal ganglia and substantia nigra, affecting motor ability and characterized by tremor at rest, increases muscle rigidity. Slowness in the initiation and execution of movement and postural instability

Unknown cause

Dopamine uptake plays a major role

Treatment

Anticholinergic medications

Technologies to control symptoms

Signs and Symptoms

Rigid extremities

Masklike facial expressions

Drooling

Stooped posture and slow, shuffling gait

Tremors at rest, pill-rolling movement

Bronchitis

Chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years

chronic hypoxemia

Increase in mucus, cilia projection

Increase in bronchial wall thickness

Signs and symptoms

cyanosis, "blue bloater"

R heart failure

Distended JV

chronic, productive cough

wheezing, SOB

Interventions

maintain lowest FiO2 possible to prevent CO2 retention and decreased drive to breathe

watch for s/s of fluid overload

Urinary tract infection

Infection or inflammation at any site in the urinary tract

Most common infectious agent is E.coli

Signs and symptoms

fever and chills

urinary frequency, urgency and dysuria

Hematuria

Evaluated WBC

Disorientation and confusion

Treatment

Administer antibiotics specific to infectious agent

encourage fluids of 3000 mL per day

Encourage frequent voiding and proper perineal care

Hyperthyroidism

An excess secretion of thyroid hormone

signs and symptoms

enlarged thyroid

exophthalmos

increase appetite

tachycardia, palpitations, increased systolic BP

Heat intolerance

Treatment

thyroid ablation

radioactive iodine therapy

thyroidectomy

Observe for thyroid storm

Signs and symptoms

severe eye pain

headache

nausea/vomiting

rapid increase in tension and edema

need for early treatment to prevent blindness

beta blockers

laser eye surgery

Interventions

avoid situations or activities that increase IOP

avoid emotional stress

avoid abuse or overuse of eyes

Esophageal cancer

Types

signs and symptoms

causes

poor oral hygiene

irritation

squamous cell

adenocarcinoma

dysphagia

weight loss

excessive salivation

thirst

hiccups

treatment

surgical resection

radiation

chemotherapy

laser therapy

photodynamic therapy

changes of aging

thin skin that provides a less effective barrier

decreased ability to detect and regulate temperature

dry skin from decrease in endocrine secretions

loss of elastin

increase in vascular fragility

decrease in size of keratinocytes

hair loss, women increase facial hair

increased appearance of age spots and raised lesions such as seborrheic keratosis

nails become thick and brittle

skin cancer

basal cell carcinoma

squamous cell carcinoma

melanoma

most aggressive

black to brown irregular surface

less aggressive

appears like a papule and has a pearlescent look to it

more aggressive than basal cell but less then melanoma

Congestive heart failure

complication of arteriosclerotic heart disease

leading cause of hospitalization in older adults

Coronary artery disease responsible for most cases in the older adult

signs and symptoms

crackles on auscultation

SOB, dyspnea on exertion

cough

confusion, wandering at night

weight gain, ankle edema

classes of CHF

class 1: cardiac disease without physical limitation

Class 2: symptoms experienced with ordinary physical activity, slight limitations

Class 3: symptoms experienced with less than ordinary activities, physical activity significantly limited

Class 4: symptoms experienced with any activity and during rest

Interventions

monitor weight

avoid salt

plan activities spaced apart and include lots of rest

monitor pulse for tachycardia and dysrhythmias

Renal Calculi

Formed by a buildup of calcium and oxalate in the kidneys

Signs and symptoms

unbearable pain

blood in the urine

Diagnosis

ultrasound

treatment

lithotripsy or bursting the stones

internal procedure to remove the stones

Nursing interventions

push fluids

no caffeine

avoid urinary irritants

Immune system

Changes of aging

Depressed immune response

T-cell activity declines

Cell-mediated immunity declines

Risk for infection increases significantly

Inflammatory defense declines

Inflammation presents atypically

Fever not as prevent of a sign of infection

Musculoskeletal system

Changes of aging

thinning disks and shortened vertebrae

reduced muscle mass, strength and movement- physical exercise can help to gain or maintain

Decreased bone mineral and mass

Diminished calcium absorption

Critical for bone health

Associated with Vit. D levels

Increased risk for fractures

Osteoarthritis

Causes

Signs and symptoms

Treatment

Breakdown of cartilage

NSAIDs

Analgesics

Dietary calcium and vit. d

Exercise

Physical therapy

Pain in the joints, hands, hips, knees, lower back and/or neck

pain during colder months

Joint stiffness, crackling, swelling and/or tenderness

Systemic lupus erythematosus

Causes

Signs and symptoms

Treatment

Auto attacking of the bodies immune system

Pain in the muscles and joints

Anemia

Fatigue

Hair loss

Rash

Immunosuppressive drugs

Steriods

Keratinocytes become smaller and regeneration slows

Increased peripheral resistance

Dysrhythmias become more common

Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter

Stomach has higher pH as a result of decline in hydrochloric acid and pepsin

Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D

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

Increase in the risk of constipation

Increased sensitivity to glare

A partial or complete white ring encircles the periphery of the cornea (arcus senilis)

Distortion in depth perception

Peripheral vision reduced

Tear production decreased

Sensorineural hearing loss (presbycusis)

Potential for adverse drug reactions

Higher blood urea nitrogen levels

Proteinuria is common in adults over 80

Increase in renal threshold for glucose

False-negative results for glucose in the urine without symptoms

Decrease in the filtration efficiency has grave implications for clients on medications, esp. penicillin, tetracycline, and digoxin

Changes of aging- bladder

Emptying the bladder may become difficult because of a weakening of the bladder and perineal muscles and decrease in sensation of urge to void

Increased frequency and dribbling may occur because of a weakened bladder and enlarged prostate

Increased dead space in the lungs

Decreased immune response

decrease in cilia

Decrease ability to clear mucus secretions

Decreased ability to cough and deep breathe

Intelligence remains constant in the healthy older adult

Number of dendrites declines

Plaques, tangles, atrophy of the brain

Free radicals accumulate

Reproductive system

Changes of aging on the female reproductive system

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 chnages

Reduction in collagen and adipose tissue

Shortening and narrowing of the canal

Less lubrication

More alkaline vaginal pH as a result of lower estrogen

Uterus and ovaries decrease in size

Endometrium continues to respond to hormonal stimulation

Fallopian tubes become shorter and straighter

Breasts sag and become less firm

Some retraction of nipples related to shrinkage and fibrotic chnages

Changes of aging on the male reproductive system

Seminal vesicles develop thinner epithelium

Muscle tissue replaced with CT

Decreased capacity to retain fluids

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 the prostate gland

Atrophic Vaginitis

Caused by...

Increased vaginal fragility increases the risk of irritation leading to vaginitis

Occurs in postmenopausal women

Signs and symptoms

Treatment

These 4 changes in the vaginal canal leading to dryness, and wall layers/wall thickness lead to atrophic vaginitis

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Vaginal dryness

Vaginal burning

Vaginal discharge

Burning with urination

Topical vaginal estrogen

Oral estrogen

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Leads to stomach having a higher pH

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Diminished calcium leads to bone fractures and bone pain

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Decreased immune response due to respiratory issues/changes can lead to more immune system attacks

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Severe infections can lead to alterations in mental status and orientation