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Older Adult - Coggle Diagram
Older Adult
Renal
Changes of Aging
Decreased size of renal mass
Decreased bladder capacity
Decreased tubular function
Decrease in nephrons
Weaker bladder muscles
Renal blood flow and glomerular filtration rate decrease
Common Renal Issues/Diseases in the Older Adult
Urinary Tract Infection
Bladder Cancer
Renal Calculi
Glomerulonephritis
Fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, arthralgias, hypertension, increased sedimentation rate, oliguria, proteinuria, hematuria
Characterized by varying degrees of glomerular scarring that is always accompanied by tubular atrophy, interstitial fibrosis, and interstitial infiltration by chronic inflammatory cells
Reduction in glomerular filtration rate (GFR) and reduced tubular function
Cardiovascular
Changes of Aging
Cardiac output decreases
Less elasticity of vessels
Less efficient O2 utilization
Valves become thicker and more rigid
More prominent arteries in head, neck, and extremities
Aorta becomes dilated and elongated
Increased blood pressure
Stroke volume decreases by 1% per year
Common Cardiovascular Conditions
Hypertension
Hypotension
Congestive Heart Failure (CHF)
Leading cause of hospitalization in older adults
Coronary Artery disease is responsible for most cases of CHF
Risk factors include diabetes mellitus, dyslipidemia, sleep-disordered breathing, albuminuria, anemia, chronic kidney disease, use of illicit drugs, sedentary lifestyle, psychological stress
This problem is common in older adults because of the reduced elasticity and lumen size of vessel and rises in blood pressure that interfere with the blood supply to the heart
Dyspnea on exertion, confusion, insomnia, wandering during the night, agitation, depression, anorexia, nausea, weakness, shortness of breath, orthopnea, wheezing, weight gain, and bilateral ankle edema
Happens when the heart does not pump blood as well as it should
Pulmonary Emboli
Coronary Artery Disease
Peripheral Vascular Disease
Respiratory
Changes of Aging
Calcification of costal cartilage making rib cage and trachea more rigid
Reduced basilar inflation
Forced expiratory volume reduced
Decreased ciliary action
Loss of elasticity
Alveoli fewer in number and larger in size
Blunting of cough and laryngeal reflexes
Increase residual capacity
Increase of anterior-posterior chest diameter
Lungs become smaller, less firm, lighter, more rigid, less recoil
Common Respiratory Diseases
Pneumonia
Influenza
Lung Cancer
Lung Abscess
Chronic Obstructive Pulmonary Disease (group of diseases including asthma, chronic bronchitis, emphysema. COPD is a cause of increased anterior-posterior chest diameter
Asthma
Airway inflammation, bronchial hyperresponsiveness, intermittent airflow obstruction
High risk for older patients to develop bronchiestasis and cardiac problems
Chronic Bronchitis (Blue Bloater)
Persistent productive cough, wheezing, recurrent respiratory infections, and shortness of breath
Airways irritated and inflamed
Increased swelling and mucus production in the airway
Emphysema (Pink Puffer)
Increased dyspnea, chronic cough, fatigue, anorexia, weight loss, weakness
Enlargement of airspaces distal to the terminal bronchioles resulting in reduced alveolar surface area, leading to reduced gas exchange
Neurological
Changes of Aging
Decreased brain weight
Reduced blood flow to brain
Changes in sleep pattern
Decreased conduction velocity
Slower response and reaction time
Hypothalamus regulates temperature less effectively
Slower reflexes
Slower response to changes in balance
Common Neurological Conditions
Parkinson's Disease
Affects ability of central nervous system to control body movements as a result of impaired function of basal ganglia in the midbrain
It occurs when neurons that produce dopamine in the substantia nigra die or become impaired (dopamine deficiency)
Tremors, shuffling gait, muscle rigidity, mask like appearance of face, bradykinesia
Transient Ischemic Attacks (TIAs)
Cerebrovascular Accidents
Musculoskeletal
Changes of Aging
Decrease in bone mass and bone mineral
Impaired flexion and extension movements
Slight wrist flexion
Slight hip flexion
Slight kyphosis
Bones more brittle
Slight knee flexion
Shortening of vertebrae
Height can decrease by approximately 2 inches
Common Musculoskeletal Conditions
Osteoarthritis
Progressive deterioration and abrasion of joint cartilage, with the formation of new bone at the joint surfaces
Disequilibrium between destructive and synthetic elements leads to a lack of homeostasis necessary to maintain cartilage, causing joint changes
Risk factors are excessive use of the joint, trauma, obesity, low vitamin D and C levels
Those with acromegaly have a high incidence of osteoarthritis
Weight bearing joints are most affected with the common sites being the knees, hips, vertebrae, and fingers
Creptiation on joint motion may be noted and the distal joints may develop bony nodules known as Heberden nodes
Decrease in bone mass and bone mineral can play a role in this along with the bones being more brittle
Rheumatoid Arthritis
Osteoporosis
Gout
Gastrointestinal
Changes of Aging
Slower peristalsis
Reduced intestinal blood flow
Liver smaller in size
Reduced saliva
Esophagus more dilated
Decreased taste sensation
Decreased esophageal motility
Atrophy of gastric mucosa
Decreased stomach motility
Fewer cells on absorbing surface of intestines
Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes
Common Gastrointestinal Issues
Dysphagia
Hiatal Hernia
Esophageal Cancer
Peptic Ulcer
Stomach Cancer
Diverticular Disease
Colorectal Cancer
Pancreatic Cancer
Acute Appendicitis
Biliary Tract Disease
Chronic Constipation
Infrequent passage of dry, hard stools
A causative factors can be age-related decrease in peristalsis
Important to have a high fiber diet, increase in fluids, and regular activity to promote bowel elimination
Fecal Impaction
Endocrine
Changes of Aging
Decreased thyroid gland activity causing lower basal metabolic rate
Thyroid gland atrophies
Significant reduction in T3 hormone
ACTH secretion decreases
Pituitary gland decreases in volume
Decreases in testosterone, progesterone, and estrogen
Delayed and insufficient release of insulin
Decreased tissue sensitivity to circulating insulin
Ability to metabolize glucose is reduced
Common Endocrine Conditions
Diabetes Mellitus
Hypothyroidism
Thyroid does not produce and release enough thyroid hormone (T3 and T4)
Metabolism slows down
Weight gain, cold intolerance, depression, fatigue, dry skin, coarse hair
Hyperthyroidism
Sensory
Changes of Aging
Vision
More opaque lens
Decreased pupil size
More spherical cornea
Inability to focus or accommodate properly due to reduced elasticity of the lens
Peripheral vision reduced
Decreased ability to adapt to light
Reduced lacrimal secretions
Common Optic Diseases
Macular Degeneration
Glaucoma
Cataracts
It is a clouding of the lens or its capsule that causes the lens to lose its transparency
Leading cause of low vision in older adults
Diabetic Retinopathy
Hearing
Increased cerumen and concentration of keratin
Atrophy of hair cells of Organ of Corti
Tympanic membrane sclerosis and atrophy
Common Auditory Diseases
Presbycusis also known as hearing loss
Smell
Decrease in number of sensory cells in the nasal lining and olfactory bulb of the brain, reducing the sense of smell
Taste
Number of functioning taste buds reduces with age
Tactile
Reduction in tactile sensation
Reproductive
Changes of Aging
Male
Venous and arterial sclerosis of penis
Prostate enlarges in most men
Fluid-retaining capacity of seminal vesicles reduces
Possible reduction in sperm count
Common Male Reproductive Conditions
Erectile Dysfunction
Benign Prostatic Hyperplasia (BPH)
Enlarging of prostate puts pressure on the urethra
Urinary hesitancy, decreased force of urinary stream, urinary frequency, and nocturia as a result of obstruction of vesical neck and compression of urethra that causes a compensatory hypertrophy of the detrusor muscle and subsequent outlet obstruction
Dribbling of urine, poor control, overflow incontinence, and bleeding
As the hyperplasia progresses, the bladder wall loses its elasticity and becomes thinner, leading to urinary retention and increased risk of urinary infection
Prostate Cancer
Tumors of Penis, Testes, and Scrotum
Female
Fallopian tubes atrophy and shorten
Ovaries become thicker and smaller
Cervix becomes smaller
Drier, less elastic vaginal canal
Flattening of labia
Endocervical epithelium atrophies
Uterus becomes smaller in size
Endometrium atrophies
More alkaline vaginal environment
Loss of vulvar subcutaneous fat and hair
Common Female Reproductive Conditions
Infections and Tumors of the Vulva
Vaginitis
Vaginal Cancer
Cervical Cancer
Vaginal bleeding, leukorrhea, pain does not usually occur
Can develop urinary retention or incontinence, fecal incontinence, and uremia
Usually a squamous cell carcinoma caused by human papillomavirus infection (HPV)
Endometrium Cancer
Ovarian Cancer
Dyspareunia
Breast Cancer
Integumentary
Changes of Aging
Thin skin providing 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
Common Integumentary Conditions
Pruritus
Most common dermatologic problem in older adults
Can be precipitated by any circumstance that dries the person's skin such as excessive bathing and dry heat
Diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia, and certain psychiatric problems can also contribute to pruritus
If not corrected then the itching may cause traumatizing scratching, leading to breakage and infection of the skin
Dry skin from a decrease in endocrine secretion contributes to pruritus
Keratosis
Seborrheic Keratosis
Skin Cancer
Vascular Lesions
Pressure Injury
Personality
Changes of Aging
Remains constant with that of earlier years
No personality type labels all older adults
Changes may occur due to disease, retirement, death of significant other, loss of independence, reduced income, and disability
Thermoregulation
Changes of Aging
Ability to respond to cold temperatures is reduced
Response to heat is altered
Normal body temperatures are lowered in older age; Mean body temperature can range from 96.9 F to 98.3 F
Common Thermoregulation Conditions
Hypothermia
When body loses heat faster than it can produce it
Immune System
Changes of Aging
T-Cell activity declines
Cell-mediated immunity declines
Risk for infection becomes significant
Inflammatory defenses decline
Inflammation presents atypically
Common Immune System Conditions
COVID-19
Characterized by a massive proinflammatory response to cytokine storm that results in ARDS and multi-organ dysfunction
Aging is associated with increasing proinflammatory cytokines that govern neutrophil functions and have been correlated with the severity of ARDS
Signs and symptoms are fever/chills, cough, fatigue, headache, shortness of breath, congestion, diarrhea, nausea/vomiting, loss of taste and smell
Older adults do not have strong immunity and their risk for infection increases therefore with this highly contagious disease, they are more susceptible
Nervous System
Changes of Aging
Decline in weight and blood flow to the brain
Reudction in neurons, nerve fibers, and cerebral blood flow
Slower response to change in balance
Hypothalamus less effective in temperature regulation
Changes in sleep patterns with frequent awakening
Common Nervous System Conditions
Alzheimer's Disease
Cerebrovascular Accidents
3rd leading cause of death and major cause of disability in older adults
RIsk factors include those with hypertension, severe arteriosclerosis, diabetes, gout, anemia, hypothyroidism, silent myocardial infarctions, TIAs, and dehydration
Most CVAs in older adults are ischemic caused by partial or complete cerebral thrombosis
Warning signs include light headedness, dizziness, headache, drop attack, memory changes, behavioral changes
Neuropathy
Cellular Level
Changes of Aging
Functional cell number decreases
Lean body mass decreases
Total body fat increases
Extracellular fluid remains constant
Intracellular fluid reduced
Less total body fluid