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Older Adult
Body Systems
Cardiovascular
Age related changes
thickened heart valves
dilated aorta
Decreased contractile strength and prolonged cardiac cycle
calcification and reduced elasticity of vessels
increased peripheral resistance
thickening of left ventricular wall
slight ventricular hypertrophy
Diseases/conditions
hypertension
systolic greater than or equal to 140, diastolic greater than or equal to 90
symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor
Coronary artery disease
Angina, MI, atherosclerosis
orthostatic hypotension
decline in systolic BP of 20 mm Hg or more after changing positions
can result in falls, stroke, syncope
CHF
S/S: crackles on auscultation, SOB, dyspnea on exertion, cough, fatigue, depression, wheezing
monitor weight and salt intake, light activity, monitor pulse, assess for altered mental status
pulmonary emboli
high incidence
risks: CHF, immobility, history of thrombosis, arrhythmias
S/S: confusion, apprehension, SOB, elevated temperature, pneumonitis, elevated sedimentation rate
Integumentary
Age related changes
thin skin that provides a less effective barrier
decreased ability to detect and relate temp
dry skin from decrease in endocrine secretion
loss of elastin
increase in vascular fragility
keratinocytes become smaller and regeration shows
hair loss occurs
nails become brittle and thick
increased appearance of age spots and raised lesions
Pathologies
Pruritis
seborrheic keratosis
cancers
basal cell carcinoma
squamous cell carcinoma
melanoma
pressure injuries
Interventions
avoid overexposure to sunlight
encourage balanced nutrition and fluid intake
avoid extreme temperatures
observe for signs of pressure
encourage use of oils
GI
Age related changes
atrophy of the tongue affects taste buds and decreases taste sensation
saliva production decreases
difficulty swallowing
weaker esophageal contractions and weakness of the sphincter
esophageal and stomach motility decreases
decreased elasticity of the stomach
stomach has a higher pH as a result of decline in hydrochloric acid and pepsin
fewer cells on the absorbing surface of intestinal wall
decreased enzyme production
slower peristalsis, inactivity, reduced food intake, drugs, and low fiber diet
sensory perception decreases
bile salt synthesis decreases
Pathologies
Dysphagia
Caused by GERD, stroke, and structural disorders
can result in aspiration
incidence of swallowing difficulties increases with age
Hiatal Hernia
herniation of the esophagogastric junction and a portion of the stomach is in the chest
caused by obesity, large volumes of food
S/S: heartburn, belching, abdominal discomfort
Treatment: small meals, avoid eating at bedtime, bland diet, sleeping in partial recumbent position
Cancers
Esophageal
Squamous cell or adenocarcinoma
caused by poor oral hygiene, irritation
S/S: dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia
Stomach
S/S: anorexia, epigastric pain, weight loss, indigestion, anemia
Diagnosis: gastroscopy and barium swallow
Prevention: diet low in red meats and high in antioxidants
Colorectal
second leading cause of cancer death and 4th most common malignancy in the US
S/S: change in bowel habits, sense of incomplete evacuation, abdominal pain, nausea, vomiting, weight loss, cachexia, abdominal distention, family hx, hx of polyps
fecal occult blood test, cologuard, CBC, colonoscopy
Pancreatic
Diccifult to detect, diagnosed at an advanced stage
Diverticular disease
present in 50% of older adults
caused by chronic constipation, obesity, atrophy of the intestinal wall muscles
S/S: left lower quadrant pain, increased flatus, rectal bleeding
Urinary
Age related changes
decline of renal blood flow and glomerular filtration by approximately 50% by age 90
reduced bladder capacity: decrease in the ability to expand
urinary frequency, urgency, nocturia
size and weight of the kidney decreases
hypertrophy and thickening of the bladder muscle
changes in cortical control of micturition
inefficient neurological control of bladder emptying and weaker bladder muscle
increased risk for reflux of urine into the ureters
urine retention
can cause fecal impaction in females and prostatic hypertrophy in males
higher blood urea nitrogen levels
decreased tubular function
increase in renal glucose threshold
Education
adequate fluid intake
maintenance of acidic urine
ensure appropriate activity levels
Pathologies
Urinary incontinence
identify cause
assess for urinary control, elimination pattern, diet, fecal impaction
question about UTI, med history, meds, cognition, neuromuscular function
UTI
inflammation/infection in urinary tract
usually caused by E. coli
individuals with comorbidities are at a higher risk
assess for signs of infection, hematuria, disorientation, elevated WBC
don't keep catheter in for too long, administer mild analgesics, encourage hydration, monitor I&O, antibiotics
Bladder cancer
S/S: dysuria, frequency, urgency, blood
Renal calculi
Glomerulonephritis
early s/s: blood or protein in urine, high blood pressure, edema
S/S of late stage: lack of appetite, nausea/vomiting, fatigue, insomnia, dry skin, muscle cramps
Musculoskeletal
Age related changes
Thinning disks and shortened vertebrae
reduced muscle mass, strength, and movement
decreased bone mineral and mass
diminished calcium absorption
increased risk of fractures
Nervous
Age related changes
Intelligence is constant
slowing in central processing
decrease in number and sensitivity of sensory receptors, dermatomes, and neurons
dulling of tactile sensation
decline in number of dendrites
decline in the function of cranial nerves for taste and smell
loss of nerve cell mass
atrophy of brain and spinal cord
brain weight decreases
demyelination
slower nerve conduction
response and reaction times are slower
weaker reflexes
plaques, tangles, and atrophy of the brain
accumulation of free radicals
decrease in cerebral blood flow
fatty deposits accumulate in blood vessels
ability to compensate declines with age
Pathologies
Parkinsons
Chronic, progressive, debilitation neurologic disease of basal ganglia and substantial nigra
affects motor ability and characterized by tremor at rest, increased muscle rigidity
bradykinesia, difficulty with gait and balance
rigidity of extremities, mask like facial expression, drooling stooped poster and shuffling gait, tremors at rest, "pill rolling" movement, emotional liability
Dementia
cognitive impairments characterized by gradual progressive onset. Irreversible and affects judgement, memory, abstract thinking, and social behavior
personality changes, confusion, disorientation, deterioration of intellectual functioning, loss of memory, decline of appropriate judgement, difficulty performing familiar tasks, changes in mood or behavior
Transient ischemic attacks
increased risk of CVA
temporary or intermittent reduction in cerebral perfusion
Stroke
third leading cause of death in older adults
ischemic and hemorrhagic
care in the acute phase, later focus on rehabilitation
Delirium
rapid onset, altered level of consciousness
most common causes are urinary tract, respiratory, cellulitis, hypoxia, dehydration, hyper/hypo natremia, new medications, pain, cognitive impairment
consider coexisting factors; establish medical stability, minimize stimulation, consistency in care, prevention of self harm
Respiratory
Age related changes
lungs lose elastic recoil
lung size and weight reduction
increased ventilation and perfusion are imbalanced
decrease in alveolar surface area
decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia
decrease in cilia, decreased ability to clear mucus secretions, decreased ability to cough and deep breathe, decreased immune response
changes in upper airway paths, nose, and trachea
Pathologies
Asthma
intermittent disease with reversible airflow obstruction and wheezing
administer bronchodilators, fluids and humidification, C-pap/bi-pap
Chronic bronchitis
chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years
chronic hypoxemia, increase in mucus, increase in bronchial wall thickness
assess for cyanosis, R heart failure, distended jugular veins, SOB, productive cough, recurrent respiratory infections
Emphysema
reduced gas exchange surface area, increased air trapping, decreased capillary network
assess for barrel chest, distant quiet breath sounds, wheezes, pulmonary blebs
Lung Cancer
leading cause of cancer related death
S/S: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections
higher incidence in men, 80 to 90% were smokers
Covid 19
Caused by SARS-CoV-2 virus
S/S: cold symptoms, red watery eyes, persistent cough, heart palpitations, extreme fatigue, loss of smell or taste
80% get mild to moderate symptoms. 14% are severe with lung infection, 5% are critical and lead to damage to the lining and walls of air sacs
Interventions
turn cough and deep breathe
incentive spirometer
pursed lip breathing
elevate HOB
Endocrine
Age related changes
atrophy and activity of thyroid decreases
diminished adrenal function
ACTH secretion decreases
volume of pituitary decreases
insufficient release of insulin/reduced tissue sensitivity to circulating insulin
Pathologies
Diabetes Mellitus
type 2 is the 7th leading cause of death in older adults
Educate patient on: disease process, proper nutrition, enough activity and exercise, medication regimen, recognition of S/S, what potential complications to be aware of
Assess patient's ability to monitor blood glucose, self-administer insulin, and ensure proper self care
can lead to hypoglycemia, peripheral vascular disease, diabetic retinopathy, drug interactions, UTIs, CAD, problems in every body system
Hypothyroidism
subnormal concentration of thyroid hormone
S/S: fatigue, weakness, lethargy, anorexia, weight gain, impaired hearing, peripheral edema, ataxia, dry skin
thyroid replacement, 3L fluid a day, high fiber diet, increased activity, avoid laxatives
Hyperthyroidism
excess thyroid hormone
enlarged thyroid, exophthalmos, radioactive iodine uptake, increased appetite, diarrhea, tachycardia, diaphoresis, insomnia, heat intolerance
Tx: thyroid ablation, radioactive iodine therapy, thyroidectomy
observe for thyroid storm, teach daily hormone replacement, wear med alert, high calorie, high protein, low caffeine low fiber
Immune
Age related changes
decreased immune response
decline in T-cell activity
cell mediated immunity declines
risk for infection becomes significant
inflammatory defenses decline
inflammation presents atypically
Reproductive
Age related changes
Females
vulva atrophies, labia flatten, loss of subcutaneous fat and hair
thinning of vaginal epithelium
cervix, uterus, and Fallopian tubes atrophy
changes in vaginal canal
reduction in collagen and adipose tissue
shortening and narrowing of the canal
less lubrication
vaginal pH becomes more alkaline
uterus and ovaries decrease in size
endometrium continues to respond to hormonal stimulation
Fallopian tubes become shorter and straighter
breasts sag and are less firm
retraction of nipples
Males
seminal vesicles develop thinner epithelium
muscle tissue replaced by 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 slighty
enlargement of the prostate gland
Pathologies
Cancers
endometrial
S/S: postmenopausal bleeding
ovarian
leading cause of death from gynecologic malignancies
Prostate
increased incidence with age
enlarged prostate, excessive need to urinate worsens at night
Breast
second leading cause of cancer deaths
regular breast exams
BPH
S/S: hesitancy, decreased force of urinary stream, nocturne
Erectile dysfunction
affects half of men over 70
not normal aging