Older Adult Concept Map

Neurological

Respiratory

Endocrine

Cardiology

Sensory

Reproductive

Digestive

Changes with age

intervention recommendations

-Heart valve becomes thick and more rigid
-Diastolic murmurs occur in 50% of older adults
-Aorta is dilated
-Thickening of left ventricular wall
-Decreased contractile strength and prolonged cardiac cycle
-Reduced elasticity and calcification of vessels
-Increased peripheral resistance

-control cholesterol intake
-proper diet and weight
-DASH diet
-adequate exercise like yoga, strengthening, balance
-stress management

pathologies

Congestive Heart Failure- complication of arterioscleriotic heart disease. coronary artery disease responsible for most cases in the older adult. The heart cannot pump blood as efficiently as it should. Blood can back up and fluid may build up in the lungs or arms and legs. symptoms; crackles on auscultation, shortness of breath, cough, fatigue, confusion. Monitor weight, avoid salt, check for skin breakdown, monitor pulse. Arrhythmias- rhythm disturbances causes; hypokalemia, infection, hemorrhage, coronary insufficiency. symptoms; weakness, palpitations, dizziness, hypotension, syncope. treatment; antiarrhythmic drugs, potassium, cardioversion. education; modify diet, smoking cessation, decrease alcohol, activity.

Pulmonary emboli- clots may dislodge and travel to pulmonary arteries. risk factors; congestive heart failure, arrhythmias, history of thrombosis. symptoms; confusion, shortness of breath, temperature elevation, pneumonitis

pathologies

-thyroid gland atrophies and activity decreases
-diminished adrenal function
-decreased ACTH secretion
-pituitary gland volume decreases
-insufficient release of insulin

teach medication regimen
-effects and side effects
-ongoing follow-up for serum hormone levels
-bowel elimination plan

type 2 diabetes- glucose intolerance. nonspecific symptoms in older adults. fasting blood sugar every 3 years. glucose tolerance is the most effective test. 1st line is Metformin. ability to handle syringe, promote exercise and nutrition
hypothyroidism- hypofunction of the thyroid gland. weakness, lethargy, anorexia, impaired hearing, periorbital edema. synthroid and thyroxine.
hyperthyroidism- excess thyroid hormone. exophthalmos, radioactive iodine uptake, increased appetite, tachycardia. thyroid ablation, thyroidectomy

-reduced elasticity and stiffening of the muscle fibers of the lens
-decreased ability to focus (presbyopia)
-reduced pupil size
-distortion in depth perception
-presbycusis
-impacted cerumen
-decreased taste buds
-loss of olfactory bulb cells

-encourage social interaction
-safe environment
-lower the tone of voice with hearing impaired
-frequent touch to compensate for visual and auditory loss

pathologies

cataracts- clouding of the lens and loss of transparency, leading cause of low vision in older adults.
acute glaucoma- severe eye pain, headache, nausea, and vomiting. rapid increase in tension and edema. early treatment to prevent blindness. diagnosis with tonometry
chronic glaucoma- most common form, vision loss due to glaucoma cannot be restored

-lungs lose elastic recoil
-reduced cough reflex
-lung size and weight reduction
-increased dead space in the lungs
-decreased alveolar surface area
-decreased ability to clear mucus secretions
-decrease in cilia

-atypical presentation, no chest pain, lower body temperature.
-monitor closely to minimize disability and prevent mortalty
-perform postural drainage
-promote productive cough
-promote self care
-proper use of ventilators

emphysema- reduced gas exchange, increased air trapping, decreased capillary network. barrel chest, pink puffer, wheezes. causes; chronic bronchitis, chronic irritation, cigarette smoking. treatment; postural drainage, bronchodilators, breathing exercises.
lung cancer; leading cause of cancer-related death. 80-90% were smokers. symptoms; dyspnea, coughing, chest pain, fatigue, wheezing, and respiratory infections. treatment; surgery, chemotherapy, and radiotherapy
asthma- intermittent disease with reversible airflow obstruction and wheezing due to stimulants. assess for causative factors. administer bronchodilators

-atrophy of the tongue decreased taste sensation
-saliva production decreases
-difficulty swallowing
-weaker esophageal contractions
-stomach motility decreased
-increased risk for aspiration and indigestion
-decreased elasticity of the stomach
-decline in absorption of proetin
-slower peristalsis, reduced food/fluid intake, drugs, and low-fiber diet
-bile salt synthesis decreases
-decreased enzyme production in the liver affecting drug metabolism

-good dental hygiene and regular dental visits can prevent disorders that prevent disorders that threaten nutritional intake
-proper nutrition
-kniwledge of the impact of medications on GI health
-utilization of fiber, fluids, and timing to promote bowel elimination

dysphagia- swallowing difficulties increases with age. causes; GERD, stroke, and structural disorders. prevent aspiration, promote adequate nutritional status
-hiatal hernia; herniation of the esophagogastric junction and a portion of the stomach is in the chest. causes; obesity, large volumes of food. heart burn, belching, abdominal discomfort. treatment; small meals, avoid meals at bedtime, bland diet, sleeping in a partial recumbent position
-esophageal cancer; greater with increased age. caused by poor oral hygiene, irritation. signs and symptoms; dysphagia, weight loss,, thirst, hiccups. diagnosis; barium swallow, esophagoscopy, biopsy. treatment; surgical resection, radiation, chemotherapy

-intelligence remains constant
-delay in time required to perform tasks
-dulling of tactile sensation -atrophy of the brain and spinal cord
-brain weight decreases
-number of dendrites decline
-demyelination
-reflexes become weaker
-response and reaction times slower -free radicals accumulate -decrease in cerebral blood flow
-fatty deposits accumulate in blood vessels
-ability to compensate declines with age

-perform mental status exam
-screen for depression
-screen for cognitive impairment
-provide assistive devices as needed for ambulation
-encourage walking, ROM, and balance exercises
-teach stress management and adaptive self-care management
-monitor for fatigue, confusion, and disorientation

pathologies

Parkinson Disease- affects ability of CNS to control body movements. Bradykinesia, rigidity, postural instability, mask like expression, drooling, stooped posture, shuffling gait, tremors, pill-rolling. encourage activities and exercise, a walker may be needed. soft diet easy to swallow. Levodopa is the drug of choice.
Dementia- cognitive impairment, gradual and progressive. irreversible and effects judgement, memory, and social behavior. may experience anxiety and depression, sleep deprivation, incontinence, and constipation. maintain a safe environment, set a routine,, and use simple, direct statements.
Transient Ischemic Attacks- temporary reduction in cerebral perfusion. recovery is usually within 1 day. Lasts minutes to hours.

Female:
-vulva atrophies
-flattening of labia
-vaginal epithelium thins
-cervix, uterus, and fallopian tubes atrophy
-less lubrication
-more alkaline vaginal pH as a result of less estrogen
-uterus and ovaries decrease in size
-breasts sag
-retraction of nipples
Males:
-seminiferous tubule changes
-seminal vesicles develop thinner epithelium
-atrophy of testes and reduction of testicular mass
-ejaulation fluid contains less live sperm
-testosterone decreases slightly
-enlargement of prostate gland

-annual gynecologic exam with Pap smear
-breast self-exam
-men with prostatic hypertrophy examined every 6 months
-testicular self-examination
-complete history and physical examination

pathologies

benign prostatic hyperplasia- Prostate gland is enlarged. symptoms progress slowly but continuously, decreased force of urinary stream, nocturia. frequent urge to urinate, inability to completely empty the bladder, and weak urine stream. treatment is alpha blockers to relax the muscles of the prostate.
atrophic vaginitis- occurs in postmenopausal women, increased vaginal fragility and the risk of irritation leading to vaginitis. treatment includes lubricants and vaginal moisturizers.
perineal herniation- organs or tissue push through pelvic floor muscles into abdominal cavity. it is common in older women. symptoms are difficulty peeing or pooping, pulling sensation when standing, and swelling in one buttcheek. treatment is surgery.

Renal

Changes with age

intervention recommendation

pathologies

-size and weight of kidney decreases
-hypertrophy and thickening of bladder muscle
-bladder decreases capacity
-daytime urinary frequency
-inefficient neurological control of bladder emptying and weaker bladder muscle
-glomerular filtration rate decreases
-reduced tubular function

-initiate a bladder-training program
-encourage older women to void at first urge
-provide methods of dealing with incontinence. kegel exercises
-avoid caffeine because it promotes diuresis
-avoid catheterization
-promote fluid intake
-appropriate level of activity

urinary tract infection- inflammation at any site in the urinary tract, most common infectious agent is E. coli. high risk if immunocompromised, diabetes, older women. assess for elevated serum WBC and dysuria. encourage 3000ml of fluid a day check I & Os.
bladder cancer- risk factor; irritation. symptoms; dysuria, frequency, urency, blood. cystoscopy. observe for metastasis
glomerulonephritis- inflammation of filters in the kidneys. blood or protein in the urine, high blood pressure, swelling in ankles. treat sodium and low protein diets

Older adults are at risk for congestive heart failure. Blood cannot be pumped effectively through the heart, and a cause for that could be due to the heart valves being thick and rigid, which is a change with aging. Another changing with age is reduced elasticity of the vessels which would also have an effective of the heart not being able to pump blood as efficiently. Chronic heart failure is the leading cause of hospitalization for people over the age of 65.

Older adults are at risk for dysphagia due to the changes of aging of decreased saliva production and weaker esophageal contractions. If the esophagus has weak contractions and saliva is not being produced to lubricate the esophagus, it causes difficulty with swallowing, and may cause aspiration.

Older adult males are at risk for benign prostate hyperplasia due to the changes of aging of the enlargement of the prostate gland. The amount of testosterone in the blood declines and may trigger prostate cell growth. Systemic inflammation and oxidative stress caused by diabetes can cause prostatic hyperplasia.

Older adults are at risk for COPD. COPD is when the airways in the lungs become inflamed and thicken, the tissue where oxygen is exchanged is destroyed. The flow of air in and out of the lungs decreases. The reason older adults may be at risk for COPD is due to increased dead space in the lungs, decreased cilia, and the loss of elastic recoil. Any comorbidities older adults have play a role in COPD as well.

TIAs are commonly seen in patients over 65, though there are no direct causes from changes of aging neurologically. It is often due to high blood pressure, physical inactivity, diabetes, heart disease, and other comorbidities that are commonly seen in older adults.

Older adults are at risk for cataracts due to the proteins in the lens starting to break down and clump together. This makes the lens appear cloudy, causing low vision. Treatment of cataracts is surgery, which is replacement with an artificial lens. Hypertension and diabetes can also be a causative factor.

Older adults are at risk for UTIs due to a weaker muscles in the bladder or pelvic floor, and when urine stays in the urinary tract there is a potential for bacteria like E. coli to build. Older women are more prone to UTIs than men because after menopause they produce less estrogen, which creates an imbalance of good and bad bacteria in the vagina which can lead to an infection. UTIs in older adults can also lead to delirium, a sudden change in behavior, and this can become permanent if not treated quickly.

Older adults are at risk for diabetes due to the aging process of insufficient release of insulin and impaired pancreatic islet function. Diabetes can also lead to other pathologies common in older adults such as cataracts, congestive heart failure, and glaucoma. Treating and controlling diabetes will lead to a better overall health for many systems.