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Geriatric Patient, Link to Dyspareunia in pathologies, Link to…
Geriatric Patient
Endocrine
Age related changes
Thyroid gland atrophies and activity decreases
Diminished adrenal function
Adrenocorticotropic hormone (ACTH) secretion decreases
Volume of pituitary gland decreases
Insufficient release of insulin and reduced tissue sensitivity to
circulating insulin
Thyroid gland undergoes fibrosis, cellular infiltration, and increased nodularity
Total serum iodine is reduced
Pituitary gland decreases in volume by around 20%
Delayed and insufficient release of insulin
Reduced ability to metabolize glucose, causing a higher blood sugar
Reduction in TSH, FSH, and LH
Pathologies
Type 2 diabetes (T2DM)
Pathology
Body stops producing insulin for it's needs
Treatment
Glucose monitoring
Diet change
Exercise
Medication- insulin
Signs and symptoms
Polydipsia
Polyuria
Diaphoresis
Palpitations
Hypothyroidism
Hypofunction of the thyroid gland with resulting insufficiency of thyroid
hormone
Hyperthyroidism
Secretion of excess amounts of thyroid hormone
Pathology
Thyroid gland secretes excess amounts of thyroid hormones
Signs and symptoms
Heat intolerance
Diarrhea
Palpitations
HTN
Nervousness
Confusion
Treatment
anti thyroid medication
radioactive iodine
surgery
Type 1 Diabetes Mellitus
Nervous
Age related changes
Intelligence remains constant in the healthy older adult
Slowing in central processing
Delay in time required to perform tasks
Verbal skills maintained until age 70
Number and sensitivity of sensory receptors, dermatomes, and
neurons decrease
Dulling of tactile sensation
Decline in the function of cranial nerves affecting taste and smell
Loss of nerve cell mass
Atrophy of the brain and spinal cord
Brain weight decreases
Number of dendrites declines
Demyelination
Slower nerve conduction
Response and reaction times are
slowerReflexes become weaker
Reflexes become weaker
Plaques, tangles, atrophy of the brain
Free radicals accumulate
Decrease in cerebral blood flow
Fatty deposits accumulate in blood vesselsAbility to compensate declines with age
Ability to compensate declines with age
Intellectual performance maintained until at least 80 years of age
Reduction 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
Pathologies
Parkinson Disease
Tremors and shuffling gait are characteristic of Parkinson’s disease
Treatments
Carbidopa/Levodopa
Dopamine agonists
Deep brain stimulation
Anticholingerics
Pathology
Impaired function of basal ganglia in the midbrain affecting the ability to control body movements
Neurons producing dopamine die or become impaired
Tremor, rigidity, bradykinesia, or akinesia, and postural instability
Dementia
cognitive impairments characterized by gradual progressive onset. Irreversible & affects judgement, memory, abstract thinking, and social behavior.
TIACerebrovascular Accident
Cerebrovascular Accident
Seizures
Treatment
antiepileptic drugs (AED)
anticonvulsants
Ketogenic dietBalance diet, proper rest and stress reduction
Balance diet, proper rest and stress reduction
Ativan
Versed
Keppra
Pathology
Generalized
Partial
is abnormal sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness, motor, sensory and/or behavior
Gastrointestinal
Age related changes
Atrophy of the tongue affects taste
buds and decreases taste sensationSaliva production decreases
Saliva production decreases
Swallowing may be difficult
Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter
Esophageal and stomach motility decreases
Risk for aspiration and indigestion
Decreased elasticity of the stomach
Reduces the amount of food accommodation at one time
Stomach has higher pH as a result of decline in hydrochloric acid and pepsin
Decline in hydrochloric acid
Increase in incidence of gastric irritation
Interferes with absorption of calcium, iron, folic acid, and vitamin B12
Decline in pepsin
Interferes with absorption of protein
Fewer cells on absorbing surface of intestinal wall impact the
absorption of dextrose, xylose, and vitamins B and D
Decreased enzyme production in the liver which affects drug
metabolism and detoxification processes
Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and
low-fiber diet
Increase in the risk of constipation
Sensory perception decreases
May lead to constipation or incomplete emptying of the bowel
Bile salt synthesis decreases
Increase in the risk of gallstone development
Affects digestion of fats
Less acute taste sensationsDecreased esophageal motility
Atrophy of the small and large intestines
Increased risk of aspiration, indigestion and
constipation
Pathologies
Xerostomia
Dysphagia
Gastroesophageal reflux disease (GERDHiatal Hernia
Hiatal Hernia
Esophageal Cancer
Cancer of the Stomach
Diverticular Disease
Colorectal Cancer
Chronic Constipation
Intestinal Obstruction
Fecal Impaction
Bowel Incontinence
Acute Appendicitis
Cancer of the Pancreas
Biliary Tract Disease
Integumentary
Age related changes
wrinkles
Loss of subcutaneous fat
Loss of tissue elasticity
Reduction in Melanocytes
Reduced thickness and vascularity of dermis
Sweat reduction
Pathologies
Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma
Pressure ulcer
Pathology
Tissue anoxia and ischemia resulting from pressure causing necrosis, sloughing, and ulceration of tissue
Older adults are at higher risk because their thin skin, poor nutrition, reduced sensations, and immobility
Redness, blistering, non blanch-able, necrosis, tenderness
Treatments
Rotate and turn patient often
High protein and high vitamin diet
apply thick clothes to protect skin
Use braden scale
Sensory
Age related changes
Sight
More opaque lense
Decrease in pupil size
More spherical cornea
Presbyopia
Narrowing of the visual field-decreased peripheral vision
Pupil size reduction & less reactive to light
Depth perception distortion
Decline in visual acuity
Smell
Impaired ability to discriminate odors
Less sensory cells in nasal lining
Less olfactory bulb cells
Detection of scent is at 50% by age 80
Taste
Atrophy of tongue
High prevalence of taste impairment
Taste buds atrophy
Decreased saliva, poor oral hygiene,
and medications
Touch
Reduction in tactile sensation
Hearing
Presbycusis is a result from age related changes
Loss of hair cells
Lower blood supply
Lower flexibility of basilar membrane
Degeneration of spiral ganglion cells
Reduced production of endolymph
Pathologies
Cataracts
Muscoloskeletal
Age related changes
Diminished stature related to reduced hydration, loss of cartilage, and
thinning vertebrae
Thinning disks and shortened vertebrae
Reduced muscle mass, strength and movement
Decreased bone mineral and mass
Diminished calcium absorption
Increased risk of fractures
Slight knee flexion, slight hip flexion, slight wrist flexion
Bones become more brittle
Joint motion might become limited from deterioration of cartilage and formation of points and spurs
Pathologies
Osteoarthritis
Pathologies
Progressive degeneration and abrasion of joint cartilage with the formation of new bone at the joint surfaces
overuse, trauma, obesity, low vitamin D and C levels, and genetics
Symptoms
Pain in hands, hips, knees, lower back pain, crepitus
Treatment
Analgesics
Rest
Aqua therapy
Massage
acupuncture
Braces, canes
Osteoporosis
Demineralization of the bone
Decrease in the mass and density of the bone
Urinary
Age related changes
Size and weight of the kidney decreases
Hypertrophy and thickening of the
bladder muscle
Decrease in bladder’s ability to expand
Reduced storage capacity
Emptying the bladder may become more difficult
Daytime urinary frequency
Nocturia
Changes in cortical control of micturition
Inefficient neurological control of bladder emptying and weaker
bladder muscle
Glomerular filtration rate decreases due to decreased renal blood flow
and decreased numbers of functioning glomeruliReduced tubular function
Reduced tubular function
Higher blood urea nitrogen levels
Proteinuria is common in adults over 80
Decreased tubular function
Concentration of urine changes in response to water and/or sodium
excess/depletion
Increase in renal threshold for glucose
False-negative results for glucose in the urine without symptoms
Decrease in the filtration efficiency has grave implications for clients on medications, esp. penicillin, tetracycline, and digoxin
Bladder capacity decreases by one-half
Emptying the bladder may become difficult because of a weakening of the bladder and perineal muscles and decrease in sensation of urge to void
Increased frequency and dribbling may occur because of a weakened
bladder and enlarged prostate
Decline of renal blood flow and glomerular filtration by approximately 50% by age 90Reduced bladder capacity
Reduced bladder capacity
Urinary frequency, urgency, and
nocturia are common in older adults
Pathologies
Incontinence
Bladder Cancer
Renal CalculiGlomerulonephritis
Reproductive
Pathologies
Male
Dyspareunia
Erectile dysfunction
Unable to attain or maintain erection of
penis for sexual intercourse
Causes: atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medications, and psychological factors
Andropause
Low testosterone levels in older men can result in reduced muscle mass, energy, strength, and stamina. Erectile dysfunction, breast enlargement, osteopenia, osteoporosis and smaller testes
Benign Prostatic Hyperplasia
Prostate cancer
Tumors of the Scrotum
Causes: hydrocele, varicocele, inguinal hernia
Female
Dyspareunia
Common problem that accompanies hormonal chan
More frequent in nulliparous women
Atrophic vaginitis
Nabothian cysts
Cancer of the Endometrium
Cancer of the Ovaries
Perineal Herniation
Breast cancer
Both male and female
Cognitive Impairment
Dementia affects sexual behavior
Inappropriate behaviors can occur
Touching and endearing statements may be misinterpreted by cognitive impaired person as an invitation to become sexual
Age related changes
Female
Fallopian tubes atrophy and shorten
ovaries become smaller and thicker
Vaginal canal becomes drier and less elastic
Cervix becomes smaller
Labia flatten
Uterus becomes smaller in size
Endometrium atrophies
More alkaline vagina
Loss of vulvar subcutaneous fat and hair
Menopause
Perimenopause
Postmenopause
Vaginal canal changes
Reduction in collagen and adipose tissue
Shortening and narrowing of the canal
Less lubrication
May lead to discomfort with intercourse
lower estrogen changes
Endometrium continues to respond
to hormonal stimulation
Breasts sag and are less firm
Some retraction of nipples related to
shrinkage and fibrotic changes
Cervix becomes smaller; endocervical
epithelium atrophies
Male
Fluid-retaining capacity of seminal vesicles reduces
possible reduction in sperm amount
venous and arterial sclerosis of penis
Prostate enlargement
Seminal vesicles develop thinner epithelium
Muscle tissue replaced with connective tissue
Decreased capacity to retain fluids
Seminiferous tubule changes
Increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen
Atrophy of the testes and reduction in
testicular mass
Ejaculation fluid contains less live sperm
Testosterone stays the same or decreases
slightly
More time required to achieve an erection
Age-related changes have impact
on sexual function
Older adults are physically able to
remain sexually active
Regular sexual expression for both sexes is important in promoting a sense of well being and emotional connection
Respiratory
Age related changes
Lungs lose elastic recoil
Changes occur in upper airway paths, nose, and
trachea
Declining muscle strength-Reduced cough reflex
Lung size and weight reduction
Oxygenation
Increased ventilation and perfusion are imbalanced; increased dead space in the lungs
Decrease in alveolar surface area
Ventilation control
decreased reaction of peripheral & central chemoreceptors to hypoxia and hypercapnia
Decrease in cilia
Decreased ability to clear mucus secretions
Decreased ability to cough and deep breatheDecreased immune response
PO2 reduced as much as 15% between ages 20 and 80
Forced expiratory volume reduced
Reduced basilar inflation
Increased residual capacity and reduced vital capacity
Calcification of costal cartilage, trachea and ribcage more rigid
Reduction of cough and largyngeal reflexes
High risk for respiratory infection
Pathologies
Chronic obstructive pulmonary disease (COPD)
group of diseases
including asthma, chronic bronchitis, and emphysema
Kyphosis
curvature of the spine
Pneumonia
Inflammation of the lower respiratory tract
Caused by aspiration, inhalation, or hematogenous spread
Asthma
Emphysema
Lung Cancer
COVID 19
Pneumonia
Symptoms
Fever
Cough
Fatigue
Confusion
Rapid diaphoresis
Restlessness
Pathology
pnuemococcal pneumonia most common caused by streptococcus pneumoniae
Cardiovascular
Age related changes
Heart valves become thick and more rigid
Aorta becomes dilated
Thickening of left ventricular wall
Myocardial muscle less efficient
Decreased contractile strength & prolonged cardiac cycle
Calcification & reduced elasticity of vessels
Less sensitive to baroreceptor regulation of blood pressure
Increased peripheral resistance
periods of tachycardia may last longer
Pacemaker cells decrease in number
oxygen used less efficiently
Heart dimensions are unchanged
Valves become thick and rigid
Heart muscle loses efficiency and contractile strength and reduced cardiac output with physiologic stress
Blood vessels reduced elasticity
Pathologies
Diastolic murmers
Heart dysrhythmias
Arteriosclerosis
Peripheral Vascular Disease
Edema
Coronary artery disease
Acute coronary insufficiency,
myocardial infarction
Dysrhythmias
Heart failure
Peripheral Vascular Disease
Atrial Fibrillation
Heart Block
Transient Ischemic Attacks (TIA’s)
Falls
Congestive Heart Failure
Myocardial Infarction
Sleep
Age related changes
Altered Circadian sleep-wake cycles
Phase advance common
Sleep latency, or delay in the onset of sleep
Less sound sleep
More time in stages I and II, less time in stages III and IV
Pathologies
Insomnia
Sleep apnea
Nocturnal Myoclonus
Restless Leg
Syndrome
Link to Dyspareunia in pathologies
Link to osteoarthritis
Link to osteoarthritis
Link to cardiovascular
Link to musculoskeletal
Link to congestive HF
Link to pressure injury
Link to Nervous system
Link to nervous system
Link to GI