Gero Older Adult
RESPIRATORY
CARDIOVASCULAR
ENDOCRINE
SENSORY
NERVOUS SYSTEM
GI SYSTEM
REPRODUCTIVE ORGANS
REST AND SLEEP
NORMAL AGING:
All senses are less proficient
Touch is effected because of the reduced tactile sensation and ability to feel pressure or pain and even temperature changes.
Vision is effected by presbyopia or the inability to focus on near objects and pupils are less reactive to light
Hearing is progressively lost which is known as presbycusis. Normal changes also includes problems hearing high-pitched sounds.
PATHOLOGIES NOT NORMAL TO AGING:
NORMAL AGING:
Dysrhythmias are a common result of aging
AGE- RELATED CHANGES IN SLEEP
Altered Circadian sleep-wake cycles
Phase advance is more common in older adults which is falling asleep earlier in the day and waking up earlier in the morning.
Other common changes in sleep of the older adult is sleep latency which is the delay in onset of sleep and older adults also sleep less soundly.
The older adult spends more time in stages I and II and not as much time in stages III and IV.
Isolated systolic hypertension from arterial walls thickening and decreased compliance
Decreased cardiac reserve which when the older adult is under stress this can result in fatigue, SOB, and slower recovery.
Increased peripheral resistance
This creates risk of arrhythmia, postural and diuretic induced hypotension and may cause syncope.
Inflamed varicosities
AGE-ASSOCIATED CHANGES
-Decreased respiratory muscle strength
Also common in the older adult is diminished ciliary and macrophage function which in return causes drier mucous membranes and a lessened cough reflex.
Older adults have a decreased natural response to hypoxia and hypercapnia.
Reduced pulmonary functional reserve
This leads to dyspnea with exertion and decreased exercise tolerance.
RENAL SYSTEM
MUSCULOSKELETAL SYSTEM
NORMAL AGING:
Decrease in neurons and neurotransmitters
Changes in cerebral dendrites, synapses, and glial support cells
Deficient thermoregulation
This leads to lower temperature sensitivity and changed or absent fever response.
AGE-RELATED CHANGES:
Older adults are still interested in their sexual life and are still capable of having sex.
General pattern of older adults sexual behavior remains consistent or the same throughout their life.
Effects of aging in females include vulva atrophying, flattening of the labia, and loss of subcutaneous fat and hair from hormonal changes and related to full body loss of subcutaneous fat.
Other female reproductive changes are reduction in collagen and less lubrication.
Can lead to discomfort during intercourse.
An older adult female's uterus and ovaries decrease in size and fallopian tubes become shorter and straighter as well as the endometrium continues to respond to hormonal stimulation.
Changes for the older adult men include seminal vesicles develop thinner epithelium, ejaculation fluid contains less live sperm, and there is more time required to achieve erection.
Other male effects are enlargement of the prostate gland and muscle tissue is replaced with connective tissue.
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PATHOLOGIES
Cancer of the Endometrium and Ovaries have increased incidence with age and cancer of the ovaries is the leading death when it comes to gynecologic cancers.
Erectile dysfunction is not a normal part of aging for older adults but this affects half of men around 70 years and older.
NORMAL AGING
Decreased in mass of kidneys and blood flow. Also lowered GFR which can cause problems with polypharmacy and drug clearance and side effects of pharmacology in older adults.
Lowered bladder elasticity and overall capacity and muscle strength.
Prostate enlargement in males
Higher postvoid residual and more nocturnal urine production.
Decreased sensitivity to the baroreceptor regulation of BP.
PATHOLOGIES
Hypertension -prevalence increases with age and can present with impaired memory, confusion, and dull headache. Wide range of treatment available.
Heart Failure- Heart loses ability to pump adequate blood for the demand of the body. Left sided failure causes pulmonary problems and crackles where right sided causes peripheral edema and weight gain among other things.
Pulmonary Emboli- A clot that moves to lung and risks include fractures, CHF, and immobilization which can happen frequently in older adults. S+S include SOB, temperature elevation, and higher sedimentation rate.
Cataracts- a clouding on the lens which leads to loss of transparency. This is one of the main causes of low vision in older adults.
Glaucoma-caused from damage to optic nerve from abnormally higher intraocular pressure. There is closes/narrowed angle glaucoma and chronic or open angle which is most common form.
Hearing deficits- can be caused by vascular disorders or viral infections and can lead to the older adult needing hearing aids.
PATHOLOGIES
Sleep Apnea-Patient has cessation of breathing during sleep lasting around 10 seconds for multiple episodes. CPAP is prescribed for this significant disorder that causes deficient sleep.
Arterial Vascular Disease- Causes smooth shiny skin and thickened nails. Also the pulse will be decreased or absent and causes ulcers in circular shape that can cause many additional problems for the older adult.
Restless leg syndrome- neurological problem that causes urge to move legs and can be associated with iron deficiency anemia diabetes, and rheumatoid arthritis.
PATHOLOGIES
Asthma-Intermittent disease that has reversible airflow and obstruction caused by a multitude of stimulants.In older adults with asthma you want to ensure proper aerosol nebulizer use and administer and bronchodilators prescribed.
Chronic Bronchitis- This pathology is chronic sputum and cough production for at least 3 months and results in chronic hypoxia. For this you want to have lowest FiO2 possible to prevent CO2 retention. Patient would present as "Blue Bloater" or general cyanosis.
Emphysema - Reduced gas exchange surface area which causes more air trapping and lowered capillary network. Patient would present with barrel chest and as "pink puffer" and wheezing.
Lung Cancer- leading cause of cancer-related death and is at increased incidence in older adults. Symptoms include coughing, chest pain, wheezing, and dyspnea. Treatment varies.
NORMAL AGING:
Lowered gastric and esophageal motility and delayed emptying
Atrophy of tongue that results in altered taste and lowers sensation of taste.
Lowered saliva production
This can cause older adults not to eat as much and easily lead to malnutrition
Less sleep can cause older adults at risk for many other pathologies including cardiac problems from worsened overall health.
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Presbyesophagus can cause weakened contractions of esophageal and lost strength of the sphincter
Makes it harder to swallow
Stomach is at a higher pH resulting from decreased hydrochloric acid and pepsin
Can create risk of aspiration and indigestion
Integumentary
NORMAL CHANGES RELATED TO AGING
Thyroid gland atrophies and has decreased activity which can lead to slower metabolism and weight gain.
Adrenal function is diminished and the volume of pituitary gland is lowered.
Insulin is released insufficiently and the older adult will also have a reduced tissue sensitivity to circulating insulin. Older adults can exercise to help cells respond to insulin.
Adrenocorticotropic hormone otherwise known as ACTH has a decrease in the overall secretion. As ACTH decreases the secretory activity of the adrenal gland also decreases.
The older adult may have reduced radioactive iodine uptake and less thyrotropin secretion and release.
PATHOLOGIES
Diabetes Mellitus - Type 1- The older adult does not produce insulin and most times is diagnosed earlier. Type 2 diabetes is when the patient does not respond to insulin as well as they used and sometimes leads to not making enough insulin. This can be diagnosed by blood glucose levels and A1C levels. Diabetes is managed with insulin and proficient lifestyle.
Hypothyroidism- low levels of thyroid hormone diagnosed with low T3, Also there is primary and secondary hypothyroidism meaning this pathology is caused by something else.