A&A Chapter 3 Notes.pptx

Chapter 3: The Aging Body and Age-Related Health Conditions Overview Age-related changes and common disorders for the following systems: Integumentary system Musculoskeletal system Nervous system Cardiovascular system Immune system Respiratory system En...

Chapter 3: The Aging Body and Age-Related Health Conditions Overview Age-related changes and common disorders for the following systems: Integumentary system Musculoskeletal system Nervous system Cardiovascular system Immune system Respiratory system Endocrine system Overview (cont’d)  Age-related changes and common disorders for the following systems: (cont’d) Urinary system Reproductive system Digestive system Important to distinguish between normal aging and age-related pathophysiology Do not want to over treat age-related changes or undertreat because the symptoms are dismissed as “old age” Overview (cont’d) 16% of people aged 65 to 79 and 31% of people aged 85 or older have at least four diagnosed chronic health conditions Integumentary System Structure Skin and its associated structures (hair, nails, sweat glands, and so forth) Skin has three layers: Epidermis, dermis, subcutis Age-related changes All three layers of skin get thinner Skin elasticity is reduced due to changes in the epidermis and dermis Tactile sensory perception is reduced Drier skin due to decrease in sebum production Integumentary System (cont’d) Age-related changes (cont’d) Skin is less able to react to temperature change. Overall, skin is more easily damaged and slower to heal. Some of these changes are determined by genetics, but environmental factors play a role too, especially chronic sun exposure. Integumentary System (cont’d) Common disorders of the integumentary system Dermatitis (eczema) and pruritis (skin itching): Not life- threatening but are physically uncomfortable and may have a negative psychosocial impact Shingles: Reactivation of the varicella-zoster virus that goes dormant after having chicken pox No cure though shingles vaccine may reduce the risk of both shingles and postherpetic neuralgia. Integumentary System (cont’d) Common disorders of the integumentary system (cont’d) Skin cancer Due to chronic sun exposure as well as the skin’s diminished resiliency and reduced ability to heal Most common types are basal cell carcinoma, squamous cell carcinoma, and melanoma. Melanoma is the most aggressive but also the least common. Tends to be more common among older adults due to the cumulative effect of UV sun exposure across their life span. Musculoskeletal System Structure Bones, muscles, joints, connective tissues (ligaments, tendons, cartilage) Age-related changes Changes begin in middle age: Decrease in total amount of calcium in the skeleton, leading to overall decrease in bone mass. Strength of bones is also reduced by microfractures that accumulate over time. Musculoskeletal System (cont’d) Age-related changes (cont’d) After age of 50, the body begins to lose muscle tissue as the amount and the size of the muscle fibers begin to decline at the rate of 1% to 2% a year. By age 75, a person’s muscle mass will be reduced by up to half and the amount of body fat will double. More fat, less muscle, and less water in the body increase sensitivity to alcohol, drugs, and other medications. Musculoskeletal System (cont’d) Age-related changes (cont’d) Joints composed of bones, muscles, ligaments, tendons, and cartilage With age, cartilage grows thinner, and ligaments and tendons become more rigid and brittle Overall effect is reducing the joint’s resiliency thereby making it more vulnerable to damage Musculoskeletal System (cont’d) Common disorders Osteoporosis Leading cause of disability among older adults Accounts for more than 70% of fractures experienced by older adults Most commonly in the hip, vertebrae, and wrist Osteoporosis more common in women due to smaller, thinner bones, and loss of estrogen at menopause Treatments focus on prevention: Exercise, hormone replacement therapy, medication, and a diet rich in calcium and Vitamin D Musculoskeletal System (cont’d) Common disorders (cont’d) Sarcopenia Loss of skeletal muscle mass and function Increases risk for falls and fractures Most commonly seen in older adults who are inactive Primary treatment is resistance exercise Musculoskeletal System (cont’d)  Common disorders (cont’d) Osteoarthritis Occurs when the cartilage inside a joint wears down Results in inflammation, pain, and eventual loss of cartilage in the affected joint Most common form of arthritis Treatment focuses on stretching, range of motion activities, weight management Nervous system Structure Central nervous system includes the brain and spinal cord. Peripheral nervous system includes all other nerves in the body. Further divided into voluntary (somatic) nervous system and involuntary (autonomic) nervous system. Involuntary system includes the sympathetic nervous system, the parasympathetic nervous system, and the enteric (i.e., gastrointestinal) nervous system Nervous system (cont’d) Age-related changes Fewer neurons in brain and spinal cord Reduced visual acuity Reduced hearing acuity, particularly higher frequencies Changes in smell Reduced number of taste receptors Reduced accuracy in touch sensitivity Reduced balance Overall brain atrophy and reduced volume Nervous system (cont’d) Common disorders Cataracts, macular degeneration, and glaucoma Cataract: Clouding of the eye resulting in visual impairment Very common among older adults—typically treated with surgery Macular degeneration: Vision loss resulting from deterioration of the macula Dry or wet type (dry type more common)—commonly due to smoking and age Glaucoma: Visual impairment or blindness due to damaged optic nerve Most common type is open-angle glaucoma Symptoms include peripheral vision loss (tunnel vision) Nervous system (cont’d) Common disorders (cont’d) Tinnitus and presbycusis Tinnitus: Persistent abnormal noise when no sound is present Can be caused by problems in any part of the ear, auditory nerve, or the auditory pathways in the brain. Treatment may be pharmacological or psychological. Presbycusis: Gradual loss of hearing that occurs with age Affects 30% to 35% of people aged 65 to 75 years and 40% to 50% of people older than 75. May be difficult to hear when background noise is high. Due to damage or impairment in the inner ear. Nervous system (cont’d) Common disorders (cont’d) Peripheral neuropathy The result of damage to the peripheral nervous system and includes symptoms such as burning, numbness, and tingling Commonly caused by physical trauma, disease, or toxic exposure Treat the underlying cause or manage symptoms Cardiovascular System Age-related changes Left ventricle of the heart loses efficiency Left ventricle wall becomes thicker, making the heart large and less capable of contracting This reduces diastolic functioning, meaning there is less blood exiting from the aorta with each contraction of the heart With age, the heart beats more slowly, tends to be more irregular, and does not react in the same way to changes in the environment. Cardiovascular System (cont’d) Common disorders Hypertension: The most prevalent vascular disease in older adults More than 90% of individuals who are free of hypertension at 65 years of age will develop hypertension during their remaining lifetime. No single underlying cause but rather a number of factors related to its occurrence. Major risk factor for cerebrovascular disease, coronary heart disease, congestive heart failure, stroke, among others. Cardiovascular System (cont’d) Common disorders (cont’d) Congestive heart failure: The heart is unable to pump enough blood to the body’s other organs. Blood moves through the heart more slowly, which results in greater pressure inside the heart. Eventually the tissues being supplied with blood from the heart become congested with fluid. This fluid often builds up in the arms, legs, ankles, feet, lungs, and other organs causing edema (i.e., swelling). Primarily a disease of old age. Cardiovascular System (cont’d) Common disorders (cont’d) Cerebral arteriosclerosis and strokes Hardening of the arteries within the brain, with onset typically in the mid-60s Thickening of the artery walls with advancing age, along with reductions in diameter of the vessels due to accumulation of fatty tissues and calcification, can lead to an interference in the blood circulation to the brain Increases the probability of blockage or a rupture of the vessels, which may result in a stroke Immune System Structure Protects the body from infection and disease. The lymphatic system is part of the body’s immune system and is made up of a network of vessels that consist of lymph, extracellular fluid, and lymphoid organs. Key cells involved in the lymphatic system are found in the bloodstream. Red blood cells, white blood cells, and platelets as well as plasma, which comprises about 55% of blood Immune System (cont’d) Age-related changes With advancing age, the immune system becomes less effective in fighting infection due to widespread changes throughout the system. Known as immunosenescence: Older adults are more susceptible to infections, those infections tend to be more severe, and vaccines are less effective. Increased autoimmune responses Immune system is less accurate in distinguishing foreign substances from itself. Immune System (cont’d) Common disorders Most common infections in older adults are respiratory infections, urinary tract infections, and sepsis. Older adults are more likely to contract an infection after hospitalization. Risk factors for infection include living in long-term care facility, chronic disease, malnutrition, polypharmacy, difficulty accessing medical care, and greater use of prosthetic devices and other medical instruments (e.g., catheters). Respiratory System Structure Group of tissues and organs that work together to facilitate breathing Main function of the respiratory system is to bring fresh air into the body (i.e., oxygen) and expel waste gases (i.e., carbon dioxide) Consists of the airway, lungs and muscles of respiration Respiratory System (cont’d) Age-related changes Lungs are exposed to an accumulation of environmental exposures due to direct contact with the atmosphere. Lungs experience a decrease in peak air flow and gas exchange as well as a decrease in vital capacity. Overall weakening of the respiratory muscles, which reduces both their strength and endurance. Respiratory System (cont’d) Common disorders Pneumonia: Second most common infection experienced by older adults Infection or inflammation in one or both lungs that causes alveoli to fill with pus and fluid. Long-term consequences of pneumonia include reduced exercise capacity, worsened cardiovascular disease, cognitive decline, and reduced quality of life. Respiratory System (cont’d) Common disorders (cont’d) Chronic obstructive pulmonary disease (COPD): Progressive restriction of airflow due to emphysema, chronic bronchitis, or both Third leading cause of death in the United States When a person has COPD, inflammation causes the lungs to thicken and destroys tissue that is responsible for the exchange of oxygen. Results in less oxygen transmitted to the blood and bodily tissues Leads to development of shortness of breath, wheezing, chest tightness, and productive cough Respiratory System (cont’d)  Common disorders (cont’d) Cigarette smoking causes up to 50% of COPD cases, followed by air pollution and occupational exposure to irritants like fumes and dust. Asthma: Chronic lung disease that causes inflammation and narrowing of the airways Approximately 10% of older adults experience asthma. Of those 10%, about half are acquired in late life. The most common causes of late onset asthma are respiratory infection or virus, exercise, allergens, and air pollution or irritants. Respiratory System (cont’d) Common disorders (cont’d) Lung cancer Two out of three new cases of lung cancer are diagnosed in persons aged 65 or older. Older adults often present with bony metastases. The main risk factor for the development of lung cancer is smoking, though 10% to 15% of nonsmokers also develop the disease. Endocrine System Structure Consists of the major endocrine glands, which are the hypothalamus, pituitary gland, thyroid gland, parathyroid gland, adrenal gland, pineal body, and hypothalamus as well as the reproductive organs (e.g., ovaries and testes) and the pancreas. Work together to regulate and control bodily functions through the production and secretion of hormones. Endocrine System (cont’d) Age-related changes With age, there are changes in the responsiveness of tissues, levels of hormone secretion, and hormone release rhythms. Hormone levels begin to decline around age 30 and continue to decline about 1% a year in subsequent years. Men and women have similar reductions in reproductive hormones as they grow older. Menopause happens around age 51, on average. Men experience a loss of total testosterone at a rate of 1% a year. Endocrine System (cont’d) Age-related changes (cont’d) As part of the aging process, the body can develop insulin resistance, which creates a situation in which the body is not able to use insulin effectively and, therefore, requires more insulin to maintain normal blood sugar levels. This requires the pancreas to produce more insulin to accommodate for the insulin resistance. Leads to glucose buildup in the blood and diabetes or prediabetes. Endocrine System (cont’d) Age-related changes (cont’d) Thyroid functioning also changes over the course of the normal aging process, which can lead to thyroid problems. Endocrine System (cont’d) Common disorders Diabetes Caused by either a lack of insulin production by the pancreas or a reduced ability to use insulin Results in high blood sugar levels Divided into type 1 (develops earlier in life) and type 2 (diabetes mellitus) Almost 30% of older adults are estimated to have diabetes (type 2), and 50% are estimated to have prediabetes, a state in which blood sugar levels are elevated above normal but below the range classified as diabetes. Thought to be related to the rise in rate of obesity Endocrine System (cont’d) Common disorders (cont’d) Diabetes (cont’d) Acute symptoms include increased urine production, excessive thirst, weight loss, and blurred vision. Diabetes slowly damages blood vessels and nerves due to prolonged high blood glucose levels. In the brain, damage to small blood vessels and fluctuating/high blood glucose levels can lead to cognitive decline and reduced neuronal connectivity. Modifiable risk factors include obesity, physical inactivity, high blood pressure (hypertension), and abnormal cholesterol levels (specifically, low high- density lipoprotein [HDL] and high triglycerides). Endocrine System (cont’d) Figure 3.1 Long-term problems associated with diabetes mellitus. Endocrine System (cont’d) Hyperthyroidism Condition where the thyroid synthesizes and secretes too much thyroid hormone Prevalence increases over the age of 60 There are fewer signs and symptoms in older adults compared to their younger counterparts, which may make it more difficult to detect If left untreated, hyperthyroidism can lead to cardiovascular complications, gastrointestinal symptoms (e.g., diarrhea or constipation), insulin resistance, osteoporosis, and neurological symptoms or cognitive impairment Endocrine System (cont’d) Hypothyroidism Condition when the thyroid underproduces thyroid hormones Typically treated with a synthetic thyroid hormone Thyroid cancer Rates of thyroid cancer have doubled over the past 30 years, and the risk of thyroid cancer increases significantly with age. May be due to better diagnosis and overdiagnosis Typically treated with radiation and thyroidectomy Urinary System Structure Includes the kidneys and urinary tract (ureters, bladder, urethra) Age-related changes Kidneys decrease in size Decline in the ability of nephrons to filter waste from the blood with age The wall of the bladder becomes more rigid causing the bladder to be less elastic, which limits the amount of urine it can store Urinary System (cont’d)  Age-related changes (cont’d) Sporadic contractions of the bladder result in urinary incontinence. Women experience increased risk for urinary incontinence. Men experience enlargement of prostate gland, which may block the urethra. Results in having the feeling to urinary without being able to void, which may lead to kidney damage Urinary System (cont’d) Common disorders Urinary tract infections Most common infection in long-term care facilities More common in older women Often presents with nonspecific symptoms; may be difficult for cognitively impaired older adults to communicate symptoms Treated with antibiotics Urinary System (cont’d) Common disorders (cont’d) Chronic kidney disease Includes any condition that damages the kidney and impairs their function Many do not recognize the symptoms until the kidneys are barely functioning The final stage is called end-stage renal disease Kidneys are no longer able to process waste and excess fluid. Two most common causes are diabetes and hypertension. Reproductive System Structure Females: Ovaries, fallopian tubes, uterus, cervix, vagina Males: Penis, scrotum, testes, epididymis, vas deferens, urethra, prostate, seminal vesicles Age-related changes For women: Body produces less estrogen Skin becomes thin, dry, vulnerable to injury Increased risk of osteoporosis Breast tissue changes with age Increased low density lipoprotein (LDL) cholesterol Reproductive System (cont’d) Age-related changes (cont’d) For men: Testosterone declines with age, which reduces libido Declines in frequency, duration, and rigidity of the erection Reduced sensitivity of penis, changes in orgasm and ejaculation Common disorders Higher rates of cancer in the reproductive system for both men and women Reproductive System (cont’d) Common disorders (cont’d) Uterine and ovarian cancer Uterine cancer is the most common type of gynecologic cancer. Median age of diagnosis is 60 years old. Uterine cancer has a higher survival rate than ovarian cancer. Prostate cancer Fourth most common disorder in men older than 65 and second most common cancer in men (skin cancer is first) Digestive System Structure Digestive tract: Mouth, throat and esophagus, stomach, small intestine, large intestine, rectum, and anus Also includes the liver, pancreas, and gallbladder Age-related changes Many of the changes in the digestive tract with age do not result in functional impairment. Digestive System (cont’d) Age-related changes (cont’d) Lining of the stomach is more susceptible to damage, which increases a person’s risk for peptic ulcers. Stomach becomes less elastic and therefore can accommodate less food. Changes in the intestine result in more vulnerability to lactose intolerance. Liver also becomes less able to metabolize substances and less resistant to the effects of stress while also recovering more slowly from damage. Digestive System (cont’d) Common disorders Constipation Common in older adults due to reduced physical activity, reduced fluid intake, dietary changes, reduced motility in the large intestine, and drug side effects Treat through increased fiber intake and physical activity Also can try over-the-counter medications Digestive System (cont’d)  Common disorders (cont’d) Gastritis When the lining of the stomach grows inflamed Due to thinning of stomach and reduce immune response, older adults have a higher risk for gastritis Older adults are also more likely to acquire the H. Pylori infection, and use pain relievers more frequently, all of which increase the risk of gastritis Treatments can include use of antacids Conclusions Older adults experience normal physiological changes in the reviewed systems. Pathophysiological changes are not considered part of the normal aging process. Although there are age-related changes in all of the systems, these do not necessarily lead to a disease or disorder. Prevention is key for stopping a normal age-related change from turning into a disorder or disease.