Please enable JavaScript.
Coggle requires JavaScript to display documents.
Biology of Aging/Atypical Presentation of Disease - Coggle Diagram
Biology of Aging/Atypical Presentation of Disease
Alterations of Various Organ Systems
Thermoregulation changes
Lower basal body temperatures
Decrease in release of endogenous pyrogens
Decrease hypthalamic sensitivity to pyrogens
Failure to elicit responses that increase body temp during febrile response
Impact
Older patients will run one degree below younger paitents for fevers
Immune regulation changes
Neutrophils
Intract
Migration
Impaired
Tissue penetration, phagocytosis, rescue from apoptosis
Impaired killing
Monocytes
Intact
Phagocytosis
Impaired
Decreased killing and production of cytokines
B and T Cells
B-cell
Cell mediated antibody response
T-Cell
T cell proliferation, decreased expression of co-stimualtory molecules
Impact of changes
Impaired response to antigens
Immunologic depression that favors inflammation
Increase in incidence and severity of infections
Higher vaccination rates
CV system changes
More/earlier: CHF, pulmonary edema, hypotension, impaired CO, Impaired response to stress
Ischemia presents more often as dyspnea
Volume regulation changes
Decreased % body water
Thin skin
Decreased CNS thirst drive
Decreased ADH response to hypovolemia
Renal Dysfunction
Max urine osmolarity decreased and slower to achieve
RAAS responsiveness is decreased
ANP responsiveness is impaired
Impact
Older patients take less water in, have less reserves, and less able to retain
Earlier and faster dehydration than younger paitents
CNS changes
Aging Brain
Brain atrophy, neuronla loss, loss of axons and dendrites, increased plaques and tangles, selective and reigonal decrease in neurotransmitters, regional declien in blood flow
Normal aging is typically associated with a mild decline in cogntiive functiinos
Impacts
Decrease in homeostatic reserve
Decrease in capacity to oppose damaging effects of strong, excessive stressors
More likely to display more cortical brain effects
Causes of Atypical Presentation
When do they occur?
Oldest of the old
Patients with many multiple chronic illnesses
Patients on multiple medications
Patients with cognitive defects
Factors leading
Age-related physiologic changes
Cognitive deficits
Insidious nature of many conditions
Complex Interactions of many chronic conditions + Acute conditions
Specific Conditions
Sespsis
Atypical symptoms
Changes in mental status, functional status, anorexia, falls, blood sugar changes
Cardiac Ischemia
Less frequent symptoms
Chest pain, ST elevation, LBBB, smaller enzymatic evidence
Possible presentation
Vague Symptoms of fatigue, nausea, decrease in functional status, heart failure, tachycardia
Hyperthyroidism
Less Frequent Symptoms
Fine tremor, increased perspiration, opthalmopathy, heat intolernace, tachycarida, anxiety, irritability
More likely symptoms
Anorexia, Weight loss, muscle wasting, fatigue/lethargy, depression/apathy/placid facies, atrial arrhythias, new or worsening CHF
Hypothyroidism
Calssfical presentation
Fatigue + Weight Gain
Older adults
Confusion, agitation, depression, apathy, fatigue, lethargy
Actue abdomen
Less common
Acute pain, fever, tachycardia, pain, leukocytosis
More common presentation
Mild discomofrt, constipation, tachypnea, change in mental status, vague resp symptoms
Depression
More common presentations
Apathy, cognitive changes, increase anxiety/irritability
Fatigue, vague GI symptoms
Atypical Aging
Non-specific symptoms occuring outside normal rubric of traditional signs and symptoms which may signify an impending acute illness
Implications
Delay in diagnostic, adverse hospital outcomes such as increased length of stay/admissions, Increased use of restraints, Increased morbidity/mortality