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Older Adult - Coggle Diagram
Older Adult
Changes to Gastrointestinal System
Tongue atrophies, affecting taste buds and decreasing taste sensations
xerostomia = dry mouth
can affect taste sensations
saliva production decreases and swallowing becomes more difficult
thinning of oral mucosa
weakening of muscles involved in mastication
presbyesophagus = weaker esophageal contractions and weakness of sphincter
esophageal and stomach motility decrease
food can remain in upper GI for longer period of time
risk of indigestion and aspiration
decreased elasticity of stomach
reduces amount of food stomach can hold at one time
stomach as higher pH
declines in hydrochloric acid and pepsin
increased incidence of gastric irritation late in life
reduced pepsin interferes with absorption of protein
interference in absorption of calcium, iron, folic acid, and vitamin B12
fewer cells on absorbing surface of intestinal wall affecting absorption of dextrose, xylose, calcium, iron, vitamins B, B12, and D
high incidence of constipation in older adults
slower peristalsis
inactivity
reduced food and fluid intake
drugs
diet low in fiber
decreased enzyme production in liver
affects drug metabolism and detoxification
decreased sensory perception may cause the signal for bowel elimination to go unnoticed which can promote constipation
tendency toward incomplete emptying of bowel with one bowel movement
structure of gallbladder and bile ducts unchanged with age
bile salt synthesis decreases
risk of gallstone development
affects digestion of fat
pancreases experiences fibrosis, atrophy, and fatty deposits
contribute to intolerance for fatty foods
dental caries occur more frequently in older people
incidence of dysphagia increases with age
incidence of hiatal hernia increases with age
sliding/rolling hiatal hernia
Cancer at any site along large intestine is common with advanced age
fecal incontinence most often associated with fecal impaction in older adults who are institutionalized or physically or cognitively impaired
severe pain that occurs in younger persons with appendicitis may be absent in older adults
Changes to Integumentary System
thin skin that provides a less effective barrier
decreased ability to detect and regulate temperature
dry skin from decrease in endocrine secretion
loss of elastin
increase in vascular fragility
keritinocytes become smaller and regeneration slows
hair loss occurs; women have increased facial hair
increased appearance of age spots and raised lesions (seborrheic keratosis)
dark, wart-like projection on the skin
tend to increase in size and number with age
nails become brittle and thick
graying hair
flattening of the dermal-epidermal junction
reduced thickness and vascularity of the dermis
increased coarseness of collagen
reduction in melanocytes
heightened risk for skin tears, bruising, pressure injury, and skin infections
pruritis
itching
precipitated by any circumstance that dries the persons skin such as excessive bathing and dry heat
diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia, and psychiatric problems can contribute to pruritis
Keratosis
small, light-colored lesions, usually gray or brown, on exposed areas of the skin
Skin Cancer
basal cell carcinoma
squamous cell carcinoma
can develop in scar tissue is is also associated with suppression of the immune system
melanoma
tends to metastasize, or spread more easily than other forms of skin cancer
risk factors - advanced age and exposure to the sun, UV radiation, and therapeutic radiation
growths tend to small, dome-shaped elevations covered by small blood vessels
age related changes can weaken the walls of the veins and reduce veins ability to respond to increased venous pressure
stasis ulcers
pressure injury - tissue anoxia and ischemia resulting from pressure can cause necrosis, sloughing, and ulceration of tissue
most common sites are sacrum, greater trochanter, and ischeial tuberosities
Changes to Cardiovascular System
Heart valves become thick and rigid
Diastolic murmurs in 50% of older adults
Aorta becomes dilated (ventricular hypertrophy/thickening of left ventricular wall)
Myocardial muscle less efficient
decreased contractile strength & prolonged cardiac cycle
Calcification and reduced elasticity of vessels
Dysrhythmias become more common with aging
Increased peripheral resistance
Arteriosclerosis can cause vascular problems
PVD
Edema
CAD
Medication side effects can alter tissue perfusion
Incidence and prevalence of hypertension increases with age
Prevalence of CAD/Atherosclerosis increases with age
Angina often has atypical presentation
vague discomfort under sternum
indigestion, coughing, syncope, sweating, and confusion
Myocardial infarction may have atypical presentation
confusion
decreased blood pressure
SOB
elevated temperature
Increased risk for orthostatic hypotension
postural and postprandial hypotension due to increased intake of vasoactive medications and baroreceptor sensitivity
Incidence for Congestive Heart Failure increases with age
CHF is a complication of arterioslcerotic heart disease, followed by hypertension, diabetes, dyslipidemia, cardiomyopathy, CKD, sedentary lifestyle, etc.
Incidence of pulmonary embolism is high
Risk factors are fractures, CHF, arrhythmias, history of thrombosis, and immbolization
S&S of confusion, apprehension, SOB, temperature elevation, pneumonitis
Risk of coronary artery disease with elevated total cholesterol (hyperlipidemia)
Arrhythmias in older adults caused by digitalis toxicity, hypokalemia, acute infections, hemorrhage, anginal syndrome, coronary insufficiency
older adults with diabetes have high risk for peripheral vascular problems such as arterial insufficiency
advanced arteriosclerosis aids in development of aneurysms
Changes to Respiratory System
Lungs lose elastic recoil
nose experiences connective tissue changes that interfere with air passage
trachea stiffens due to calcification of the cartilate
reduced secretions from submucosal gland
Alveoli are less elastic
loss of skeletal muscle strength in the thorax and diaphragm
reduction in vital capacity and increase in residual volume
increased dead space in lungs
decreased reaction of peripheral & central chemoreceptors to hypoxia and hypercapinia
Coughing is reduced due to blunting of the laryngeal and coughing reflexes
Immune response issues
decreased cilia
decreased ability to clear mucous secretion
decreased immune respons e
asthma - intermittent disease with reversible airflow obstruction and wheezing due to a variety of stimulants
higher risk for developing complications such as bronchitis and cardiac problems
Chronic Bronchitis - causes persistent productive cough, wheezing, recurrent respiratory infections and SOB
experience more frequent respiratory infections
results from recurrent inflammation and mucous production in the bronchial tubes
as disease progresses, emphysema may develop, and death may occur from obstruction
Emphysema has increasing incidence in older adults
causes of emphysema - chronic bronchitis, chronic irritation from dusts or certain air pollutants, and morphologic changes in lungs
cigarette smoking plays major role in development
symptoms are slow in onset
gradually, increased dyspnea which is not relieved by sitting upright
chronic cough develops
fatigue anorexia, weight loss, and weakness are demonstrated as hypoxia
older adults at high risk for pneumonia
immunosuppressed, hospitalized client, depressed gag or cough, immobile, cigarette smokers
pneumonia - inflammation of lower respiratory tract
causes - aspiration, inhalation, or hematogenous spread
signs and symptoms may be altered in older persons
pleuritic chest pain may not be as severe as described in younger patients
changes in body temperature may cause minimal or no fever
symptoms may include slight cough, fatigue, rapid respiration, confusion, restlessness, and behavioral changes
risk factors - debilitated by accumulated lung secretions, smokers, immobile, immunosuppressed, depressed cough or gag, sedated, NG, hospitalized
lung cancer - most lung cancer now occurs in patients older than 65 years
symptoms - dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and recurrent upper respiratory infections
lung abscess
causes - pneumonia, tuberculosis, a malignancy, or trauma to the lungs
symptoms - anorexia, weight loss, fatigue, temperature elevation, and chronic cough
Changes to Nervous System
loss of nerve cell mass causes some atrophy of brain and spinal cord
brain weight decreases
number of cells declines
each cell has fewer dendrites, and some demyelization of cells occurs
response and reaction times are slow; reflexes become weaker
plaques, tangles, and atrophy occur in brain in varying degrees
free radicals accumulate with age and have toxic effect on certain nerve cells
cerebral blood flow decreases about 20%
brains ability to compensate after injury declines with age
intellectual performance tends to maintained until at least 80
slowing in central processing delays the the time required to perform tasks
verbal skills are well maintained until age 70
the general lack of replacement of neurons affects the sensory organ's function
number of sensitivity of sensory receptors, dermatomes, and neurons decrease
dulling of tactile sensation
decline in function of cranial nerves mediating taste and smell
cerebrovascular accident
stroke, interruption in blood supply to the brain
risk factors - hypertension, severe arteriosclerosis, diabetes, gout, anemia, hypothyroidism, silent myocardial infarction, TIAs, dehydration, smokers
two major types of CVA
ischemic - usually results from a thrombus of embolus
hemorrhagic - can occur from ruptured cerebral blood vessel
major signs tend to include hemiplegia and hemianopsia
a drop attack is a fall caused by a complete muscular flaccidity in the legs but with no alteration in LOC
3rd leading cause of death in older adults
warning signs - light-headedness, dizziness, headache, drop attack, and memory and behavioral changes
Parkinson's disease
progressive degeneration of neurons in the basal ganglia resulting in the reduced production of dopamine
affects the ability of the CNS to control body movements
more common in men
death of substania nigra
faint tremor in hand or feet that progresses over a long time, may be first clue of Parkinson's disease
tremor is reduced when patients attempts purposeful movement
muscle rigidity and weakness develop, evidenced by drooling, difficulty swallowing, slow speech and monotone voice
patients face assumes masklike appearance and skin is moist
bradykinesia - slow movement and poor balance occur
characteristic sign is shuffling gait while leaning forward at trunk
treat with carbidopa and levodopa
TIA
temporary or intermittent reduction in cerebral perfusion
reduced blood pressure will decrease cerebral circulation, as will sudden standing from a prone position
hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, and dysphagia are manifestations of TIA
these signs can last from minutes to hours, and complete recovery is usual within days
increases patient risk of sustaining a cerebrovascular accident
Changes to Endocrine System
decreased thyroid gland activity
lower basal metabolic rate
increased iodine uptake
less thyrotropin secretion and release
thyroid gland progressively atrophies
loss of adrenal function can further decrease thyroid activity
ACTH secretion decreases
secretory activity of adrenal gland also decreases
less aldosterone is produced and excreted in urine
pituitary gland decreases in volume
gonadal secretion declines with age
decrease in testosterone, estrogen, and progesterone
ability to metabolize glucose is reduce
may detect higher blood glucose levels in non-diabetic older persons
insufficient release of insulin by B cells in the pancreases and reduced sensitivity to circulating insulin
somatotropic growth hormone blood levels may be reduced
glucose intolerance common among older adults
nonspecific/absent symptoms of diabetes in older adults
older adults can become hyperglycemic without evidence of glycosuria
older adults have greater risk for developing diabetes complications
atypical symptoms of hypoglycemia in older adults
behavior disorders, convulsions, confusion, disorientation, poor sleep patterns, nocturnal headache
peripheral vascular disease is a common complication in older adults who have diabetes
Amioderone induced thyroid dysfunction is prevalent
Changes to Urinary System
urinary frequency
caused by hypertrophy of the bladder muscle and thickening of bladder (decreases the ability of the bladder to expand and reduces storage capacity)
frequency during daytime and, nighttime urinary frequency (nocturia) can be a problem
age-related changes in cortical control of micturition also contribute to nocturia
urinary incontinence is not a normal change of aging
inefficient neurologic control of bladder emptying and weaker bladder muscles can promote the retention of large volumes of urine
in women the most common cause of urinary retention is fecal impaction,
prostatic hypertrophy is primary cause in men
symptoms include urinary frequency, straining, dribbling, palpable bladder, and sensation that the bladder has not been emptied
urinary retention can predispose older individuals to the development of UTIs
filtration efficiency of kidneys decreases with age, affecting body's ability to eliminate drugs
higher BUN levels may occur due to reduced renal function
decreased reabsorption from the filtrate makes proteinuria more common
increase in renal threshold for glucose is a serious concern for older adults
can be hyperglycemic without evidence of glycosuria
inability to control the elimination of urine is not a normal occurrence of advanced age
UTIs are the most common infection of older adults and increases in prevalence in age
organisms primarily responsible for UTIs are E coli in women and Proteus species in men
the presence of a foreign body in the urinary tract or anything that obstructs flow predisposes the individual to these infections
persons in a debilitated state or who have neurogenic bladders, arteriosclerosis, or diabetes also have a high risk of developing UTIs
Urinary Incontinence
urinary incontinence is present in more than half of institutionalized older population
incontinence can be transient or established
Stress incontinence - weak supporting pelvic muscles
urgency incontinence - caused by UTI, enlargement of prostate, pelvic or bladder tumors
overflow incontinence - associated with bladder neck obstructions and medications
neurogenic incontinence - arising from cerebral cortex lesions, MS, and other disturbances along the neural pathway
Functional incontinence - caused by dementia, disabilities that prevent independent toileting, sedation, inaccessible bathroom, medications
Mixed incontinence - can be due to a combination of factors
Bladder Cancer
incidence increases with age
chronic irritation of the bladder, exposure to dyes, and cigarette smoking are among risk factors
symptoms resemble those of bladder infection, such as frequency, urgency, and dysuria
painless hematuria is the primary sign and characterizes cancer of the bladder
Glomerulonephritis
clinical manifestations - fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, elevated blood pressure, and increased sedimentation rate
oliguria may occur, as can moderate proteinuria and hematuria
Changes to Musculoskeletal System
decline in the number and size of muscle fibers
reduction in muscle mass decreases the body strength, grip strength endurance declines
connective tissue changes reduce the flexibility of joints and muscles
sarcopenia - decline in walking speed or grip strength
can be caused by disease, immobility, decreased caloric intake, poor blood flow to muscle, mitochondrial dysfunction, a decline in anabolic hormones
impaired capacity for muscle regeneration that occurs
activity can be impacted by psychosocial factors
retirement is often accompanied by reduced activity
fractures
trauma, cancer metastasis to bone, osteoporosis, and other skeletal disease contribute to fractures in older adults
neck of the femur is a common site for fractures in older
older adults are also at risk of compression fracture of the vertebrae, resulting from falls or lifting heavy objects
Osteoarthritis
progressive deterioration and abrasion of joint cartilage, with the formation of new bone at joint surfaces
crepitation on joint motion may be noted, and the distal joints may develop bony nodules
Rheumatoid Arthritis
synovium becomes hypertrophied and edematous with projections of synovial tissue protruding into the joint cavity
affected joints are extremely painful, stiff, swollen, red, and warm to touch
systemic symptoms include fatigue, malaise, weakness, weight loss, wasting, fever, and anemia
Gout
metabolic disorder in which excess uric acid accumulated in the blood
Changes to Cells
functional cell number decreases
lean body mass decreases
total body fat increases
extracellular fluid remains constant
intracellular fluid reduced
makes dehydration a significant risk to older adults
less total body fluid
total body fat proportion of the body's composition increases
cellular solids and bone mass are decreased
Changes to the Immune System
Immunosenescence - aging of the immune system
includes depressed immune response which can cause infections
T-cell activity declines
more immature T cells are present in thymus
decline in cell-mediated immunity
responses to influenza, parainfluenza, pneumococcus, and tetanus vaccines are less effective
inflammatory defenses decline
older adult often presents with atypical fever
low grade fever and minimal pain
increase in proinflammatory cytokines
stress can affect the function of the immune system
Delirium and Dementia
Dementia is irreversible, progressive impairment in cognitive function affecting memory, orientation, judgement, reasoning, attention, language, and problem-solving
dementia is caused by damage or injury to the brain
Alzheimer's disease is most common form of dementia
presence of neuritic plaques, which contain B-amyloid protein
neurofibrillary tangles in the cortex
tau protein is changed
degeneration of neurons and synapses especially in neocortex and hippocampus
reductions in serotonin receptor, production of acetylcholines in areas of the brain
Stages of Dementia
Stage 1 (normal adult) - no impairment
Stage 2 (normal older adult) - self-report of memory impairment; no objective cognitive impairments noted
Stage 3 (compatible with early AD) - cognitive impairments recognized by others; anxiety; impaired performance in demanding work and social settings
Stage 3 (compatible with early AD) - cognitive impairments recognized by others; anxiety; impaired performance in demanding work and social settings
Stage 4 (mild AD) - withdrawal, denial, depression; inability to perform ADLs and complex tasks, flattening of affect; cognitive impairment evident on exam
Stage 5 (moderate AD) – disoriented to time and place; needs assistance in clothing selection
Stage 6 (moderate severe AD) – forgets name of spouse and other family members; personality and emotional changes; inability to perform many ADLs; agitation
Stage 7 (severe AD) – loss of verbal and psychomotor skills; incontinence; needs total assistance
Delirium is acute confusion and is usually reversible
Symptoms of delirium - disturbed intellectual function, disorientation of time and place, but usually not identity, liable mood, poor judgement, worsened memory, altered attention span, altered LOC
Causes of Delirium
hypoxia, dehydration, fluid and electrolyte imbalance, medications, pain, cognitive impairment, infection
Changes to Thermoregulation
Normal body temperatures are lower later in life than in younger years
rectal and auditory temperatures more accurate in older adults
reduced ability to respond to cold temperatures
inefficient vasoconstriction
reduced peripheral circulation
decreased cardiac output
diminished shivering
reduced muscle mass
Response to heat is altered
older adults are more susceptible to heat stress
Risk for accidental hypothermia, heat exhaustion, and heat stroke
Changes to the Senses
Touch
Pressure not sensed as easily late in life
Decreased tactile sensation
Difficulty with discrimination of temperatures
Vision
Reduced elasticity and stiffening of muscle fibers of the lens
decreased ability to focus (presbyopia)
Reduced pupil size
Opacification of lens and vitreous
visual acuity declines
Loss of photoreceptor cells in the retina
Increased sensitivity to glare
arcus senilis
Distortion in depth perception
Peripheral vision reduced
Tear production decreases
Cataracts
clouding of the lens and loss of transparency
Risk factors: diabetes, cigarette smoking, high alcohol consumption, and eye injury
Symptoms: night vision is decreased, objects appear blurred
Glare from sun and bight lights is bothersome
Nuclear sclerosis develops, causing the lens of the eye to become yellow or yellow-brown
Glaucoma
A degenerative eye disease in which the optic nerve is damaged from above normal IOP
associated with increased size of lens, iritis, allergy, endocrine imbalance, emotional instability, and family history
drugs w/ anticholinergic properties exacerbate glaucoma
Acute glaucoma = closed-angle or narrow-angle glaucoma
Symptoms - eye pain, headache, nausea, vomiting
Chronic glaucoma = open-angle glaucoma
Symptoms: tired feeling in eyes, headaches, misty vision, or seeing halos
Macular Degeneration
damage or breakdown of the macula, which results in loss of central vision
can result from injury, infection, or exudative macular dengeneration
Detached Retina
forward displacement of retina from its normal position
Symptoms: blurred vision, flashes of light, feeling of coating over the eye
Corneal ulcer
inflammation of cornea, accompanied by a loss of substance
Hearing
Sensorineural hearing loss
High pitches are diminished and the ability to discriminate tones is lost
Impacted cerumen
recurrent otitis media and trauma can damage hearing
vascular problems, viral infection, and presbycusis often causes inner ear damage
Tinnitus (ringing in ear)
Infections in middle ear common in older adults
Taste/Smell
Number of functioning taste buds decreased
sweet and salty flavor detection limited
Loss of cells in the olfactory bulb of brain causing olfactory function loss
Changes to the Mind
Memory
retrieval of information from long-term memory can be slowed (particularly information not used or needed on daily basis)
working memory function is reduced
short-term memory declines
long-term memory stays the same
change in hippocampus
decline in hormones & proteins that protect the brain
Intelligence
basic intelligence is maintained
abilities for verbal comprehension and arithmetic operations are unchanges
crystallized intelligence (knowledge accumulated over lifetime) is maintained through the adult years
fluid intelligence (new information) from the non dominant hemisphere declines
some decline in intellectual function occurs in moments preceding death
high levels of chronic psychological stress have been found to associated with increased incidence of mild cognitive impairment
Personality
remains consistent with that of the earlier years
changes may occur due to:
disease, retirement, death of significant other, loss of independence, reduced income, and disability
Learning
learning ability is not usually changed
learning is best when new information relates to previous learned information