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Older Adults - Coggle Diagram

- - - - atrophy of thymus
      - decreased response to interleukin 2
      - decreased cell mediated cytotoxicity
      - T cells which "remember" antigens respond less quickly
      - Fewer WBC available - less intense reaction
      - Fewer antibodies produced, less able to attach the antigen
  - - - viral infection with symptoms of common cold affects aged population differently than the younger
      - decreased antigen response
      - decreased naive T cells available
      - slowed clearance of virus from the body
      - increased risk of secondary infections
      - child, adult, aged adult time frames
- - - - Types:
        
        Cross Linking Theories- chemical changes going on in the body
        Example: Collagen (Skin Changes)
        
        Free Radical- organisms change because cells accumulate free radical damage over time
        Example: oxidative stress
        
        Wear and Tear: "Once the body is wore out, there is no longer any use to it"
        Example: aligns with many stressors
    - - Disengagement Theory: Aging is a natural process that the older adult recognizes. During this time individuals may withdrawal or disengage for mutual benefits
        
        Activity Theories: The point of view that successful aging requires a high level of activity and be positive throughout these changes to maintain satisfaction
        
        Continuity Theory: While making choices, older adults attempt to maintain internal and external structures and use past experiences to engage themselves socially.
        THEORY RECOGNIZES: the unique features of older adults while the adapt into older adult changes
    - - Types:
        
        Apoptosis
        
        Programmed Theory of Aging- "Aging and death are naturally processes of evolution and not biology"
        
        Auto-immune reactions- Immune system can attack the body, example: Humoral immune response
        4.Neuro-endocrine- a decrease of brain and endocrine chemicals
    - - Erik Erikison Ego Integrity vs. Despair
        
        Ego Integrity: Adults who arrive at a sense of integrity feel whole, complete, and satisfied with their achievements.
        
        What is despair?
        
        Despair occurs when older adults feel they have made many wrong decisions, yet time is too short to find an alternate route to integrity.
        
        The despairing person finds it hard to accept that death is near and is overwhelmed with bitterness, defeat, and hopelessness
      - 1. Ego differentiation vs. work-role preoccupation: after retirement, people who have invested heavily in their careers must find other ways of affirming their self-worth.
        
        2. Body transcendence vs. body preoccupation: older adults must transcend physical limitations by emphasizing the compensating rewards of cognitive, emotional, and social power
        
        3. Ego transcendence vs. ego preoccupation
        a. 1. Elderly people must find a way to face the reality of death constructively, by investing in a future that goes beyond their own lifespan
        b. 2. Attaining ego integrity requires a continuing effort to make life more secure, meaningful, and gratifying for those who will go on after one dies.
      - Maslows Hierarchy
      - Gerotranscendence
        As aging occurs there is less emphasis on physical appearance, material possessions, meaningless relationships, and self interests
        More emphasis on living life with more significance and greater connection to others.
  - - - Grandparenting Roles
        
        Involved Grandparenting: took active role in rearing their grandchildren, frequently behaving more like their parents than their grandparents.
        
        grandparents who see their grandchildren infrequently and have a relationship that is mainly ritualistic and symbolic.
        
        Loss of a Spouse
        
        Adjustments to widowhood:
        
        • Task of living alone
        
        • Developing alternative roles
        
        • Issues with income
        
        • Loss of intimacy
        
        • Choosing a new lifestyle
        
        Retirement Phases
        
        Pre-retirement phase: when the reality of retirement is evident, preparation for leaving one's job begins, as does fantasy regarding the retirement role
        
        Retirement Phase: a "honeymoon period" in which the fantasies from the preretirement phase are tested. Retirees attempt to do everything they never had time for simultaneously.
        
        Disenchantment phase: As life begins to stabilize, a depression is experienced. The more unrealistic the preretirement fantasy, the greater the degree of disenchantment.
        
        Reorientation phase: When realistic choices and alternatives sources of satisfaction are considered. The retirees develop a lifestyle that provides some satisfaction.
        
        Retirement routine phase: An understanding of the retirement role is achieved, and this provides a framework for concern, involvement, and action in the older person's life. Some retirees reach this phase sooner, others never reach the phase
        
        Termination of retirement: The retirement role is lost as a result of either the resumption of a work role or dependency due to illness or disability
- - - - Hair loss (M)
      - Grey hair (M&F)
      - Wrinkles (M&F)
      - Bony appearance (M&F)
      - Double chins (M&F)
      - Baggy Eyelids (M&F)
      - Loss of tissue elasticity (M&F)
      - More sensitive to cold
      - --> less fat (M&F)
      - Stature decrease 2" by 80 yrs
      - --> spinal cord compresses (M&F)
      - Long bones appear disproportionate to rest of body (M&F
  - - - •Decrease in thirst perception
        
        •Decrease in glomerular filtration rate
        
        •Decrease urine concentrating ability
        
        •Limitations in excretion of water, sodium, potassium
        
        •Changes in Hormone Levels i.e. Increase Antidiuretic Hormone
        
        Increase Atrial Natriuretic Peptide
        
        Decrease Aldosterone
- - - - Main Importance: ADEQUATE Exercise
        
        Exercise is important for optimal health: it enhances circulation with aerobic exercise: YOGA, stretching, balancing excercises
      - Stress Management: Relaxation interventions, such as reading a book, listening to sedating music, mediatation
    - - Older Adults have a reduced need for calories due to
        
        Less lean body mass
        
        Basal metabolic rate
        
        Activity level lowered
      - Antioxidants: "Free radicals" are small, cell damaging molecules produced by the body waste products, antioxidants neutralize them
      - Monitoring the QUALITY AND QUANTITY for food intake is vital for the older adult diet
      - Monitoring the supplements and dosages for toxicity of food
      - WATER IS VITAL: Water is 60% of the total body weight, it regulates body temperature and protects your internal organs from damage
    - - Dietary fat intake: < 30% of calories
      - •Soluble fiber: lowers serum cholesterol and improves glucose
      - •Carbohydrates: reduction of intake
      - •Protein: 10% to 20% of calories
      - •Calcium: absorption ability decreases with age
      - •Fruits and vegetables: at least five servings daily
      - •Modified MyPyramid for people over age 70
      - REMEMBER: BRIGHT COLORS, RICH DIET, dark and intensely colored plant foods usually contain more chemically active antioxidant pigments
      - Hydration Needs: 1,500 minimal required fluid intake: DUE TO Intracellular fluid loss results in decreases total body fluid
  - - - Cardiovascular Diseases
        
        Atherosclerosis AND Coronary Artery Disease
        
        Pathophysiology
        
        Begins as soft deposits of fat that harden with age
        
        Coronary artery disease is a type of blood vessel disorder that is included in the general category of atherosclerosis.
        
        Atherosclerosis is a major cause of CAD
        
        Characterized by lipid deposits within intima of artery
        : Endothelial injury and inflammation play a major role in development
        
        Although this disease can occur in any artery in the body, the atheromas (fatty deposits) prefer the coronary arteries
        
        Heart Disease is the number one killer of men and women
        Starts with arteries, over time the soft fatty deposits harden, you lose elastin and less responsive to pressure
        
        Risk Factors for CAD
        
        Elevated serum lipids
        
        Cholesterol >200 mg/dL (5.2 mmol/L)
        
        Triglycerides >150 mg/dL (3.7 mmol/L)
        
        High-density lipoproteins (HDL)
        
        Higher the number the better; the good fats; don't have a tendency to go into intima
        
        Low-density lipoproteins (LDL)
        
        Bad fats; keep it as low as possible
        
        Try and get it down to 50
        
        Treatment according to guidelines based on 10-year and life time risk score
        
        Increased catecholamine release
        
        ↑ LDL, ↓ HDL, ↑oxygen radicals
        
        ↑ Carbon monoxide
        
        Second-hand smoke (exposed to it because around people that smoke all the time)
        
        -Third hand smoke (when it gets into furniture, bedding, pillows, etc.)
        
        Tobacco use (vasoconstriction!!! [already small from fatty plaque]; oxygen free radiacals which is an irritant that causes more damage; more lipids in and more fatty plaques)
        
        Angina association
        
        Atypical presentation: vague discomfort under the sternum
        
        indigestion, coughing, syncope, sweating, and confusion
        
        Treatment: Nitroglycerin may be used
        
        Nursing Interventions
        
        Health promotion
        
        Health history, including family history
        
        Presence of cardiovascular symptoms
        
        Environmental patterns: diet, activity
        
        Psychosocial history
        
        Values and beliefs about health and illness
        
        Managing Risk Factors
        
        Encourage lifestyle changes (stop adding salt; get up and walk around)
        
        Education
        
        Clarify personal values
        
        Set realistic goals
        
        Fitness Promotion
        
        30 minutes most days plus weight training 2 days a week
        
        Regular physical activity contributes to
        
        Weight reduction
        
        Reduction of >10% in systolic BP
        
        In some men more than women, increase in HDL cholesterol
        
        Nutritional Therapy
        
        ↓ Saturated fats and cholesterol
        
        ↑ Complex carbohydrates and fiber
        
        ↓ Red meat, egg yolks, whole milk
        
        ↑ Omega-3 fatty acids
        
        Medications and Treatment
        
        Statins (any drug ending in -statin; designed to lower lipids in the body; some may increase HDL and lower LDL; some may be combination drugs)
        Inhibit cholesterol synthesis, decrease LDL, increase HDL
        Monitor for liver damage and myopathy (muscle pain)
        
        A- antiplatelets, anticoagulation, antianginals, ACE, ARB's
        
        B- Beta blockers
        
        C- cholesterol management; smoking cessation; calcium channel blockers
        
        D- Diet, Diabetes management; depression screening
        
        E- education (yourself and patients); exercise [be role model]
        
        F- Flu vaccine [ increased risk of MI in first two months after you had the flu
        
        CHF: Congestive Heart Failure
        
        Incidence increases with age
        
        • Leading cause of hospitalization
        
        CHF is a complication of arteriosclerotic heart disease, followed by hypertension, diabetes, dyslipidemia, cardiomyopathy, sleep apnea, chronic kidney disease, illicit drugs, sedentary lifestyle, and psychological stress.
        
        Coronary artery disease responsible for most cases in the older adult
        
        Symptoms: crackles on auscultation, shortness of breath, dyspnea on exertion, cough, fatigue, restlessness, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, and bilateral ankle edema
        
        Classes of CHF
        
        Stage 1
        
        Cardiac Disease w/o physical limitations
        
        Stage 2
        
        Symptoms experienced with ordinary physical activity
        
        Stage 3
        
        Symptoms experienced with less than ordinary activities
        
        Stage 4
        
        Symptoms experienced with any activity and during rest
        
        Modifications and daily lifestyle changes
        
        Monitor Weight
        
        • Avoid Salt
        
        • Light activity
        
        • Plan activities to be spaced apart
        
        • Monitor pulse for tachycardia (fast heart rate) & dysrhythmia (irregular)
        
        • Assess for mental status changes
        
        • Frequent repositioning
        
        • Check for skin breakdown
        
        Hypertension
        
        Incidence and Prevalence increases with age
        
        Risk Factors
        
        Excessive alcohol intake is strongly associated with hypertension.
        • Moderate intake of alcohol has cardioprotective properties; males with hypertension should limit their daily intake of alcohol to 2 drinks per day, and 1 drink per day for females with hypertension.
        
        Tobacco use
        
        • Smoking tobacco greatly ↑ risk of cardiovascular disease.
        
        • People with hypertension who smoke tobacco are at even greater risk for cardiovascular disease
        
        Gender (males)
        
        • Family history
        
        • Obesity
        
        • Ethnicity (African American - 2X higher risk)
        
        • Sedentary lifestyle
        
        • Hypertension is more prevalent in lower socioeconomic groups and among the less educated.
        
        • Stress
        
        • People exposed to repeated stress may develop hypertension more frequently than others.
        
        • People who develop hypertension may respond differently to stress than those who do not develop hypertension
        
        Diagnosis: evaluation of blood pressure in two different occasions:
        Criteria:
        
        Systolic blood pressure ≥ 140 mm Hg
        
        Diastolic blood pressure ≥ 90 mm Hg
        
        Factors to consider when monitoring blood pressure: anxiety, stress, and activity before assessment
        
        Physiologic changes of Blood pressure mechanisms as we age
        
        Decreased compliance
        
        Decreased sensitivity of baroreceptors
        
        Heightened vasoconstriction, impaired vasodilation
        
        Changes in Kidney function (volume)
        
        Signs and Symptoms of Hypertension
        
        Usually no symptoms: if they do present: dull headache, impaired memory, disorientation,
        
        Ways to improve blood pressure with lifestyle changes in older adults
        
        Non-pharmcologic approach is ALWAYS the first choice. BUT VERY HARD TO DO in the OLDER ADULT
        
        weight reduction
        
        increased physical activity
        
        reduce stress
        
        reduce sodium intake
        
        increased potassium
        
        Medication Interventions in treating HBP in older adults
        
        1st choice drugs
        
        1)Low dose thiazide diuretic
        
        Side effects
        
        1 more item...
        
        Long acting calcium channel blocker
        
        Long acting its once a day, can be could for patients that are not adherent to meds
        
        Ace inhibitor
        
        Side effects
        
        4 more items...
        
        ARB
        
        For patients who cannot tolerate ACE
        
        Start with with half the recommended dose and monitor
        
        Orthostatic Hypotension
        
        •Decline in systolic blood pressure of 20 mm Hg or more after
        
        changing positions
        
        •Postural and postprandial hypotension due to increased intake of
        
        vasoactive medications and baroreceptor sensitivity
        
        •Consequences: falls, stroke, syncope, other coronary complications
        
        Primary Hypertension
        Defined as: essential or idiopathic hypertension
        
        90-95% of all cases
        
        • Elevated BP without an identified cause
        
        • Exact cause unknown but several contributing factors
        
        Secondary Hypertension
        
        • Elevated BP with a specific cause - 5-10% of adult cases
        
        EX. atherosclerosis
        
        • Clinical findings relate to underlying cause
        
        • Treatment aimed at removing or treating cause
        
        "high contributing factor to HTC - treat ASAP b/c they can stroke, MI, cardiac death
        
        Hyperlipidemia
        
        • Excess dietary sodium
        
        • increase blood volume - excess sodium reacts with hypertensive drugs (decreases effectiveness)
        
        • ↑ Levels of cholesterol and triglycerides are primary risk factors in atherosclerosis.
        
        • Hyperlipidemia is more common in people with hypertension.
        
        Evaluation
        
        • Evaluate full lipid profile, triglycerides, high-density lipoprotein, low-density lipoprotein
        
        Familial tendency
        
        Treatment:
        
        Dietary changes, medications, and alternative and
        
        complementary therapies
        
        • HDL to LDL Ratios
        
        Heart Faiilure: Inability of the heart to pump enough blood to meet circulation demands
        
        Left Sided:
        causes pulmonary edema-results in pulmonary congestion
        due to the inability of the left ventricle to pump blood to the periphery
        
        Symptoms: dyspnea, crackles, cough, tachycardia, fatigue, anxiety, restlessness,
        
        Right Sided:
        
        causes peripheral edema-results in peripheral congestion
        
        due to the inability of the right ventricle to pump blood out to the lungs this
        
        may occur because of left sided failure or pulmonary disease.
        
        Symptoms: peripheral edema, weight gain, distended neck veins, anorexia, weakness,
        hepatomegaly, ascites
    - - Cardiovascular Diseases increases with age: 70% of women one the age of 65 have a cardiovascular disease
      - After menopause, CAD risk= is that of men
      - Signs with these types of diseases are different in woman
- - - - Increased skin transparency and fragility
        
        Nursing Intervention: Handling patients carefully to minimize friction and shear
    - - Delayed wound healing
        
        Nursing Intervention: Avoid tape, assess for dryness/moisture, protect open areas and use moisture moisture-retentive dressings to promote wound healing
    - - Skin hyperplasia (hyperkeratoses and skin cancer)
        
        Nursing Intervention: Assess exposed skin areas for sun-induced changes
    - - Increased susceptibility to irritant reactions
        
        Nursing Intervention: Teach pts how to avoid exposure to skin irritants
    - - Decreased cutaneous inflammatory response
        
        Nursing Intervention: Do not rely on redness and swelling to indicate skin damage
    - - Increased sensitivity to sun exposure
        
        Nursing Intervention: Teach patients to wear hats and avoid sun between 10-4 and wear sunscreen
    - - Mottled hyperpigmentation and hypopigmentation (age spots)
        
        Nursing Intervention: Teach patients to track spots and differentiate between normal and malignancy
      - Flattening of the epidermal junction
        
        Increased susceptibility to shearing forces with resultant blisters, pupura, skin tears, and pressure-related skin problems
        
        Nursing Intervention: Avoid dragging/pulling. Assist bedridden pts to change positions Q2H, use care when removing adhesive dressings
    - - Increased susceptibility to osteomalacia
        
        Urge patients to take a multivitamin or calcium with vitamin D
    - - Increased susceptibility to dry skin (xerosis)
        
        Nursing Intervention: Apply moisturizers when skin is still moist
    - - Increased thermoregulatory alterations (heat stroke/hypothermia)
        
        Nursing Intervention: Dress for the environmental temperatures, do not rely on skin sensations to tell them if they are hot or cold
    - - Paper-thin, transparent skin susceptible to trauma
        
        Nursing Intervention: Use lift sheets, avoid tape and tight dressings
    - - Decreased tone and elasticity (wrinkles)
        
        Nursing Intervention :Use the forehead or chest to assess skin turgor
    - - Decreased rate of nail growth
        
        Increased susceptibility to fungal infections
      - Decreased blood flow beneath nail bed
        
        Longitudinal nail ridges
      - Thickening of the nail
        
        Toenail thicken and may overhang the toes
        *Use fingers to assess capillary refill, cut toenails straight across, do not use appearance alone to determine the presence of a fungal infection, assess skin in contact with nail for irritation
- - - - Alveolar surface area decreases.
      - Diffusion capacity decreases.
      - Elastic recoil decreases.
      - Bronchioles and alveolar ducts dilate.
      - Ability to cough decreases.
      - Airways close early.
    - - Residual volume increases.
      - Vital capacity decreases.
      - Efficiency of oxygen and carbon dioxide exchange decreases.
      - Elasticity decreases.
    - - Muscles atrophy.
      - Vocal cords become slack.
      - Laryngeal muscles lose elasticity, and airways lose cartilage.
    - - Vascular resistance to blood flow through pulmonary vascular system increases.
      - Pulmonary capillary blood volume decreases.
      - Risk for hypoxia increases.
    - - Excerise Tolerance: Body's response to hypoxia and hypercarbia decreases
        Nursing Intervention: Early assessment of subtle manifestations of hypoxia
      - Muscle Strength: Respiratory muscle strength, especially the diaphragm and the intercostals, decreases
        Nursing Intervention: Regular pulmonary hygiene and overall fitness help maintain maximal functioning of the respiratory system and prevent illness
      - Susceptibility to Infection: Effectiveness of cilia decreases, Immunglobulin decreases and alveolar macrophages are altered
        Nursing Intervention: Encourage pulmonary hygiene and help patient maintain health and fitness to help maintain maximal function of the respiratory system and precent illness
    - - Anteroposterior diameter increases.
      - Thorax becomes shorter.
      - Progressive kyphoscoliosis occurs.
      - Chest wall compliance (elasticity) decreases.
      - Mobility may decrease.
- - - - Age related changes in renal vasculature disturb glomerular hemodynamics reduce the GFR
      - Renal blood flow decreases due to decreased cardiac output and age related atherosclerotic changes
      - Tubular reabsorption and renal concentrating ability decline as the size and number of nephrons decrease
      - Bladder muscles weaken, possibly causing incomplete bladder emptying and chronic urine retention
      - Acute Realted Changes that effect health
        
        Decreased function in the kidneys
        
        Degenerative changes
        
        Decreased blood flow
        
        Decreased number of functioning nephrons
        
        Changes in the bladder and urinary tract
        
        Bladder/detrusor: volume 350 mL in older adults
        
        Changes in nervous system and other regulatory systems
        
        Thirst perception
        
        Impaired absorption of calcium, predisposition to hyponatremia and hyperkalemia, diminished ability to maintain fluid and electrolyte balance, and correct pH imbalances
        
        Diminished renal function contributes to increased incidence of drug interactions and adverse medication reactions
        
        Effects on voiding patterns
        
        Bladder capacity is smaller, empties incompletely and contracts during filling.
        
        May retain residual urine post voiding
    - - Diminished kidney size
      - Impaired renal clearance of drugs
      - Reduced bladder size and capacity
      - Decreased renal ability to respond to variations of sodium intake
      - BUN levels also rise
    - - Decrease elasticity in urinary tract muscles,
      - Degenerative changes in cerebral cortex,
      - Increase production of urine
    - - Due to urinary tract changes, older adults are at risk for Hyperkalemia and hyponatermia
        
        Hyponatremia, and hyperkalemia, less responsive to ADH, more prone to dehydration, urine less concentrated, pH imbalances, increase risk for Drug interactions
      - The bones do not absorb calcium as much
      - Increased: Chronic residual, nocturia
      - Cerebral cortex changes alters sensation of fullness and ability to empty
      - Decrease tone and strength of urogenital tissue causing leakage
    - - Dependency on others to do ADLs*
        Cognition, balance, mobility, coordination, visual function and manual dexterity. Accessibility and acceptance of toilet facilities. Time between perception to void and actual empty of bladder
      - Underlying Causes that cause incontinence
        
        Acute illness or sx, chronic illness, constipation/low stool freq, pelvic floor disorders, BPH, stroke, arthritis, depression, delirium, DM, Parkinsons, COPD, Fecal impactio
    - - Urinary tract infections (UTIs)
      - Common in long-term care settings
      - Incidence of UTIs
      - 12% to 29% in community settings
      - 44% to 58% in long-term care facilities. Urge urinary incontinence
      - Stress urinary incontinence
      - Detrusor overactivity incontinence
      - Urethral urinary incontinence
      - Mixed urinary incontinence
      - Potential for overactive bladder and urge-frequency syndrome
    - - Challenge myths regarding urinary incontinence.
      - Address attitudes of resignation.
      - Teach self-care interventions.
      - Teach about overall urinary wellness.
      - Interventions for urinary incontinence
      - Facilitate referrals.
      - Teach pelvic floor muscle exercise (PFME).Initiate continence training programs.
      - Suggest environmental modifications. Use appropriate continence aids.
      - Be knowledgeable about medications for urinary incontinence.
      - Medications that act on the autonomic nervous system are most often used for the control of incontinence.
      - a- Adrenergic agents control stress incontinence by increasing bladder outlet resistance through stimulating receptors at the trigone and internal sphincter.
      - a-Adrenergic blocking agents, (alone or in combination with cholinergic agents), treat incontinence by decreasing bladder outlet resistance.
      - Antimuscarinic agents: urge urinary incontinence and OAB; control the uninhibited or unstable bladder by blocking the transmission of nerve impulses.
    - - Bladder becomes more fibrous, with subsequent decreased capacity and increased postvoiding residuals
      - Autonomic innervation of the bladder decreases with age, affecting not only contraction of the detrusor muscle but also the external sphincter
      - The detrusor muscles (three layers of muscle the cover the bladder) become less contractile but also somewhat unstable
      - Weakening of the voluntary pelvic floor muscles that are important to controlling the release of urine from the urethra
      - Neurological changes in the areas of the brain that control the bladder indicating that there is a decreased activation in the brain in response to bladder fullness
      - Urethral changes in women are mostly related to loss of estrogen, following menopause. The external sphincter muscle becomes thinner and less able to resist the pressure of urine from the bladder
      - In men, there is no muscle thinning but and enlarged prostate may constrict the urethra
    - - Typical symptoms seen in younger adults (urgency and frequency) may not be seen in the older adult
        However, if the older adult presents with new symptoms of urinary urgency, a shortened period of time between the urge to void and actual urination, urinary frequency or more than seven voids per 24 hour period
        
        Treatment
        
        The pathogens have become increasingly resistant (E. coli) to the usual treatment of trimethoprim-sulfamethoxazole (Bactrim).
        
        Fluoroquinolones have been used in its place, raising concerns about diminishing their effectiveness as a broad-spectrum antibiotic.
        
        Nitrofurantoin 100 mg po twice a day for 5 days, has been recommended as an alternative that is effective and appropriate for uncomplicated UTI
        
        Men take longer to treat than women. When the bacteria reach the bladder the infection is considered complicated and requires longer course of treatment
        
        Types of Urinary Incontinence
        
        Stress
        
        Weakened external sphincter/pelvis floor, increased intra-abdominal pressure
        
        ie: small urine loss during sneezing, laughing, exercise
        
        Women under age 60 and men after prostate surgery are most affected
        
        Urge
        
        Detrusor instability, internal sphincter weakness
        
        ie: overactive bladder and losses or large amounts of urine
        
        Older adults of both sexes, older men somewhat more affected
        
        Overflow
        
        Bladder muscles overextended and have poor tone, overflow of retained urine
        
        ie: enlarge prostate causes obstruction of the urethra, urine backs up in bladder; diabetic nephropathy affects the contractility of the detrusor muscles. May present as "dribbling" or constant losses of small amounts of urine
        
        People with diabetes mellitus, men with enlarged prostates, people taking calcium channel blockers, anticholinergics, and adrenergics
        
        Functional
        
        hysical or psychological factors impair ability to get to the toilet
        
        ie: older adult unable to transfer from wheelchair to toilet is unable to obtain needed assistance and often voids large amounts of urine on the floor while walking to the bathroom
        
        Frail older adults, nursing home residents, people with dementias
- - - - Female Reproductive System
        
        Rapid change at menopause: average age is 52
        
        Normal Average age is 45-56
        
        Pituitary stops producing follicle stimulating hormone and lutenizing hormone
        
        Ovary stops responding to these hormones
        
        Follicle development and oogenesis stop
        
        Thus: No ovulation
        
        Ovary stops producing estrogen and progesterone
        
        Uterine cycle and menstruation stop
        
        Menopause Symptoms
        
        Early symptoms:
        
        Dizziness
        
        Numbness
        
        Muscle aches
        
        Dry mouth
        
        Dry vagina
        
        Later Symptoms:
        
        Labia, vagina, uterus, breast shrinks
        
        Weight gain
        
        Voice deepens
        
        Facial hair
        
        Osteoporosis
        
        The uterus and ovaries decrease in size; may not be palpable for physical examination
        
        The cervix, uterus and Fallopian tube and ovaries atrophy
        
        (2) thinning and grating of pubic hair
        
        (3) loss of subcutaneous fat and elastic tissue in external genitalia (slightly shrink in size)
        
        (4) vaginal walls: thinner, drier, less elastic, shrink
        
        (5) sexual intercourse can be uncomfortable (decrease in blood flow, decrease in amount of vaginal lubrication produced)
        
        (6) increase time of arousal
        
        (7) decrease secretion of estrogen-> ovaries and uterus decrease in size and weight (becomes more fibrous)
        
        contribute to bone weakening-> osteoporosis
        
        (8) ovulation gradually stops (no more production of egg)
        
        (9) loss of elasticity: ligaments supporting ovaries and uterus
        
        (10) muscle and gradual tone diminish
        
        (11) Skin: loses elasticity, amount of fat tissue in breasts decrease
        
        Vagina
        
        The vaginal environment is drier and more alkaline
        
        Hormonal Changes in the vulva atrophy
        
        Flattening of the labia and kiss if subcutaneous fat and hair
        
        Changes can cause intercourse to become uncomfortable
      - Male Reproductive System
        
        fewer viable sperm are produced and motility of sperm decreases
        
        amount and consistency of semen changes
        
        decreases in testosterone levels occur with age
        
        testes are less firm and smaller
        
        fertility still possible in older men
        
        may experience decreased libido
        
        erection less firm (need more stimulation)
        
        longer time to ejaculation
        
        difficult or delayed ejaculation
        
        ejaculatory force is diminished
        
        lengthening refractory period
        
        prostate enlargement
        
        Prostate Cancer
        
        very common in men in their 60-80's
        
        most frequently occurring cancer in men
        
        Risk factors
        
        age 50+
        
        family history of prostate cancer
        
        ethnicity (AA)
        
        diet (high-fat esp. from red meat)
        
        Testosterone
        
        produced by the testicles
        
        stimulates growth of normal prostate tissue and prostate cancer cells
        
        involved in development and growth of prostate cancer
        
        normally decreases with age
        
        ** in cancer testosterone increases
        
        no relationship between sexual activity and prostate cancer
        
        Early Stage and Late Stage
        
        (2) later stages- obstruction of the urethra
        
        discomfort in the perineal and rectal areas
        
        nausea
        
        weakness
        
        frequent urination, especially at night
        
        difficulty starting and stopping urination
        
        weak or interrupted urinary stream
        
        painful or burning sensation during urination or ejaculation
        
        blood in urine or semen
        
        (1) early stages- no symptoms usually
      - Hormones
        
        Estrogen
        
        Levels decrease with menopause
        Many women try to minimize symptoms of menopause by taking supplements
        
        Testosterone
        
        Levels remain relatively stable
      - Although degenerative changes occurring, sexual interest and arousal still occur
        Most couples remain sexually active well into old age and report continued satisfaction
- - - - Aging dehydrates cartilage to become stiffer and thins in weight bearing areas
      - Cartilage has no direct blood supply
      - Blood flow in adjacent bones and synovial fluid provide nutrients to the condroblasts.
      - Osmotic force created by glycoprotien secretions from condroblasts attracts water/gas/salts/organic material for metabolism
      - Concentration of glycoprotiens in the matrix determines the amount of fluid drawn into the cartilage
      - Normal aging has a reduction in chondrotin sulfate which decreases cartilage fluid
      - Nutrients enter the matrix of cartilage only when compressive forces are absent
      - In loaded or compressed state nutrients or fluid are squeezed out
      - Movement of substance in and out of cartilage occur with alternating compressive and unloading forces
      - Metabolites remain in cartilage in the absence of compression
      - With inactivity hyaline cartilage is converted to fibrocartilage
      - Prescience of metabolites reduces the oxygen content which decreases glycoprotien and increases procollagen
      - Synovial joint produce hyaluronic acid by condroblasts which lubricates the interface of cartilage
      - Hyaluronic acid molecules forma viscous layer over cartilage
      - Compression facilitates production of hyaluronic acid form the viscous layer covering the hylaine cartilage.
      - Hyaluronic acid decreases with aging reducing joint gliding
      - Degenerative changes in cartilage are not reversible
      - Weight bearing activities are essential for cartilage health
      - Cartilage thins with aging especially in weight bearing joints
      - Cartilage has no blood supply or nerves
      - Decreased hydration, reduced elasticity and increased fibrousous growth around bony contribute to increase stiffness and decrease function
      - Advanced stages of
    - - Loss of flexibility
        
        Increased stiffness in intramuscular connective tissue
        
        Intraarticular changes in joint structure
        
        Increased stiffness in joint periarticular connective tissue
        
        Decrease in physical activity
        
        Increased time spent sitting
        
        Tightness is often seen in the hip and knee flexors and hip rotators
        
        May be evident in gait pattern
        
        In Genders
        
        Women more likely to have deficits in ankle dorsiflexion, knee flexion, and shoulder elevation.
        
        Men more likely to have deficits in hip and trunk.
        
        Both sexes have deficits in the neck, hip extension and trunk rotation.
        
        Decrease in physical activity
        
        Increased time spent sitting
        
        Tightness is often seen in the hip and knee flexors and hip rotators
        
        May be evident in gait pattern
        
        Need extra strength to overcome tightness
      - Connective tissues changes
        
        Increased stiffness
        
        Reduced ability to absorb energy
        
        More brittle, more likely to be damaged
        
        Increased cross-links reduces ability of tissues to return to original shape after deformation
        
        Reduced fibroblast proliferation and altered control of apoptosis
        
        Reduced maintenance of tissue homeostasis
        
        Reduced response to circulating growth factors alters ability for repair and maintenance of connective tissue structures
        
        Less responsive to adaptations with loading
        
        In young individuals, loading stimulates tissue synthesis; in older adults, cyclic loading of articular cartilage depresses cartilage synthesis
        
        In Glycoconjugates
        
        Assist in:
        
        Cell-to-cell communication
        
        Cross-linkages between proteins
        
        Maintaining fluid content of tissue (water binds to it)
        
        Increased degradation, reduced synthesis of glycoconjugate as we age
        
        Reduced ability for connective tissue to retain water
      - Range of Motion Issues
        
        Joints of upper extremities tend to remain more flexible than joints of lower extremities.
        
        Cervical Spine: extension and lateral flexion
        
        Shoulder: flexion and external rotation
        
        Elbow/Wrist: no age-associated declines
        
        Thoracic Spine: extension
        
        Lumbar Spine: extension
        
        Hip: extension
        
        Knee: ROM remains relatively stable as we age
        
        Ankle: dorsiflexion
        
        Loss of PROM in older adults is often progressive and subtle.
        
        Occurs at extremes of joints' potential movement.
        
        Greatest joint mobility in the 20's, with gradual decline thereafter.
        
        Loss of ROM is highly variable across joint and subject, but universally related to aging.
        
        Joints of upper extremities tend to remain more flexible than joints of lower extremities.
        
        Exercise and flexibility
    - - Bone mass increases for men and women until about age 45, then declines with women losing 25% and men 12% over the next 25 years.
      - Loss of skeletal mass - universal accompaniment of aging regardless of race or sex.
      - Factors affecting bone remodeling:
      - Impact of mechanical forces
      - Circulating hormones include estrogen, testosterone, calcitonin, parathyroid hormone
    - - Bone health is dependent on
        
        Development of maximal peak bone mass in early adulthood
        
        Rate of bone loss in later years
        
        Genetics
        
        Mechanical loading
        
        Nutrition
        
        Hormones
      - Bone Remodeling
        
        Mechanical stress
        
        Calcium and phosphate levels
        
        Hormonal levels
        
        Aging affects both stiffness and strength of bone
        
        Reduced calcium levels with aging
      - Osteoporosis
        
        Metabolic bone disorder characterized by a gradual decline in absolute bone mass and microdeterioration of bony tissue with preservation of the skeletal mineralization, leading to enhanced bone fragility and a resultant increase in fracture risk.
        
        Often leads to pain, immobility and disability
        
        Osteoporosis occurs when bone reabsorption occurs too quickly and replacement occurs too slowly
        
        Causes:
        
        genetic factors
        
        Metabolic disorder
        
        Sedentary lifestyle
        
        Decreased hormonal levels
        
        Decreased circulation
        
        Warning Signs:
        
        A Broken Bone
        
        Back Pain or Spinal Deformities: Back pain that will not quit could be a sign that you have a spinal fracture.
        
        Loss of Height: A fractured bone in your spine could collapse onto itself causing you to shrin
        
        Age Related Changes
        
        inflammatory component to OA includes increased activity of cytokines and chemokines in joint tissues drive production of matrix degrading enzymes.
        
        Changes in the musculoskeletal system contribute to the development of OA by making the joint more susceptible to the effects of other OA risk factors that include
        
        abnormal biomechanics
        
        joint injury
        
        genetics
        
        obesity
        
        Age-related sarcopenia
        
        increased bone turnover
      - Pagets Disease
        
        Disorder of bone remodeling characterized by both increased bone resorption and increased formation
        
        results in abnormal and disorganized collagen deposits.
        
        Looks like "woven bone"
        
        Older adults, genetic link, European males > females
        
        Usually involves one bone, but can affect several
        
        Rapid remodeling of bone makes it weaker and misshapen and may lead to fractures or arthritic joints
        
        2nd most common
        
        Symptoms
        
        Bone pain in leg, pelvis or spine and is worse lying down
        
        Persistent joint pain
        
        Compressed nerves cause numbness and tingling
        
        Scoliosis
        
        Skull problems can lead to hearing loss, vertigo, headache and tinnitus
- - - - A slight decline in nerve conduction velocity (starts at 50 years old 10-20%)
      - Decrease in reaction time (1/3)
      - Decrease in mental processing time
      - Effects are minimal when speed is not a factor
      - Speech comprehension more susceptible to interference and speed
    - - Ability to sleep reduces; need for sleep does not
      - Reduction in total sleep time (1hr)
      - Time spent in REM decreases (50%)
      - Frequency of awakening increases
      - Delta wave sleep difficult (deepest sleep)
    - - part of brain shrinks (prefrontal and hippocampus)
      - these areas are important for learning/memory/ planning
      - communication between neurons and neurotransmitters much slower!
      - damage can be caused by free radicals
      - inflammation increases (Alzheimer is an inflammatory disease)
    - - increased elasticity of lens(harder to see)
      - increased fat (delays conduction to brain)
      - increase opacity (cataracts)
      - increased sclerosis of ciliary muscles (cant scan as much)
      - increased corneal degeneration
      - increased drooping of eyelids
      - decreased blood supply-->retinal atrophy
      - decreased tissue mass
      - decreased visual field (changes in lens)
      - decreased tear production (irritation and infection)
    - - sclerotic changes in tympanic membrane (hard to hear high frequency)
      - decreased discrimination
      - degeneration of auditory nerve (stimulus slower to brain)
      - communication problems(misunderstanding, failure to hear, failure to ask questions)
        social problems (withdrawal, isolation, confusion, paranoia)
      - Changes in Mouth and Taste
        
        Dry mouth-why elderly suck on candies, dont like to drink water because then have to use bathroom)
        
        speech difficulty
        
        swallowing difficulty (higher chance of aspiration)
        
        dental deterioration
        
        depressed appetite or engorgement with food
- - - - Menopause: decrease in estrogen (estradiol) around 50 years
      - Andropause: decrease in testosterone levels with age, but not at a set time as it is a gradual change
        
        -gradual decrease in testosterone
        
        -average decrease in free testosterone
        
        -decrease in early morning production
        
        -decrease # of testosterone receptors on most target cells
        
        -decrease LH effect on Leydig cells
        
        -increased affinity of testosterone binding to prostate
      - Adenopause: DHEA and DHEAS levels decrease with age
      - Somatopause: changes in GH levels with age
      - Neuroendocrine - Stress Theory of Aging; more stress as we age results in more hormones
      - Decrease in FSH, LH, ADH, and Norepinephrine
      - Hormones that remain slightly unchanged : T3 andT4, cortisol, insulin, epinephrine, parathyroid hormone, and 25-hydroxyvitamin D
      - GH and IGF-1
        
        mean levels during day unchanged
        
        -at night, decreased GH/IGF-1 rise during pulse
        
        -reduction starts at ~30 years old
        
        -total daily levels decrease with age
        
        -decreased LBM
        
        -increased fat mass
        
        -decreased bone mass
        
        -changes in sleep pattern
        
        -decreased immune function
      - Estrogen
        
        -shrinkage and decreased function of reproductive organs
        
        -increased LDL and decreased HDL
        
        -increased rate of bone loss
    - - Weight decreases
      - Cell number is decreasing
      - Cells are becoming more tightly packed
      - Abnormal mitochondria
      - Vacuole content in cells increases
      - Leads to non-functioning tissues developing where old cells were - more connective tissues and fibers - less output of some hormones (more of others)
      - Growth hormone production decreases after we reach maximum size
    - - Metabolism decreases with age - less T3 and T4 needed, concentration decreases a little with age
        
        Weight decreases
        
        Cell number decreases
        
        Cells become abnormal
        
        Connective tissue
        
        Decreases in calcitonin
    - - Same changes as parathyroid and thyroid (weight decreases, cells decrease, etc.)
      - Lipofuscin content in cortical cells increases with age
      - DHEA and DHEAS levels show true age associated changes, they decrease with age: which causes other hormone levels to decrease
      - Elderly have higher levels of epinephrine, norepinephrine, and dopamine due to some type of stress
      - Have fewer epinephrine and norepinephrine receptors
      - Elevated glucocorticoids due to age-related stress
    - - Beta degrade - levels of insulin decrease, endocrine functions decrease
        Results in higher levels of blood glucose, which lead to more AGE products