GI, urinary, endocrine aging
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each of the black spaces below before clicking
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| GI Aging: teeth & gums | - Denture problems
- Reduced chewing
- Teeth lose masticating enameled area
- Denture misfit, weak masticators
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| GI Aging: jaw atrophy | teeth closer &/or farther apart
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| GI Aging: saliva | - Dehydration →Reduced quantity
- Swallowing difficulty
- Dry mouth
- Oral ms weakness: drool
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| GI aging: esophagus | less mobile
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| GI aging: upper esophageal sphincter | Takes longer to relax = feel full
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| GI aging: lower esophageal sphincter | weaker
- gastric reflux
- heartburn
- hiatal hernia
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| Intestinal aging | - Malabsorption → malnutrition
- Weaker peristalsis
- Less lactase → more intestinal gas & diarrhea
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| Constipation | - Insufficient fluid &/or fiber intake
- Reduced blood supply → decr motility
- Depression, confusion
- Weakness
- Inaccessible toilet
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| Constipation: colonic obstruction | - fecal impaction
- diverticulosis
- tumor
- radiation
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| Constipation: neurogenic | - Parkinson’s
- CVA
- dementia
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| Constipation: endocrine | - Hypothyroid
- Hyperparathyroid
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| Constipation: drugs | - Antidepressants
- relaxants
- Ca, iron
- opiates
- diuretics
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| Hepatic aging | Decline/reduction:
- Liver mass & blood perfusion
- Protein binding
- Drug metabolism
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| Aging renal anatomy: Decr... (4) | - Kidney mass & wt
- Nephrons: 30-40% fewer
- Glomeruli # & size
- Ms tone
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| Aging renal anatomy: Incr... (1) | Arterial tortuosity
(conn tissue condition, elongation & twisting of arteries)
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| Urinary aging: DIAPERS | - Delirium
- Infection
- Atrophic urethritis/vaginitis
- Pharmaceuticals
- Psychosis
- Excess urine output
- Restricted mobility
- Stool impaction
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| Aging renal physiology: Decline | - Renal perfusion 50%
- GFR
- Renal tubules excretory & reabsorptive capacities
- Metabolizing incr acids & bases
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| Aging renal physiology: Reduction | - Blood filtered -> less blood in kidney: narrow vessels
- Ability to reabsorb water & solutes from plasma
- Ability to prevent water loss in dehydrated pt
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| Aging renal pathology | - Too much/too little fluid
- Too much/too little sodium
- Too much potassium
- Drug intoxication
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| Excessive K+: Young vs Old | Young:
- K exchanged for Na
- K excreted, Na retained
Old: Less K excreted -> More extracellular K -> Cardiac arrhythmia
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| Na/Water imbalance: Less able to excrete leads to (2) | - Very dilute urine
- Water
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| Na/Water imbalance: Diluted serum Na → (4) | - Fatigue
- Lethargy
- Weakness
- Confusion
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| Dehydration | - Less able to conserve water
- Loss of thirst mechanism
- Mental changes
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| Dehydration: Na retention -> water retention | More extracellular fluid:
- CHF
- Edema
- HTN
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| Kidney changes: drugs | - Lower clearance rate
- Drugs retained longer
- Younger adult dosage may be toxic
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| Bladder | - Incr # of uninhibited contractions
- Incr residual urine
- Reduced capacity
- Reduced ms tone
- Reflux into ureters: risk infection
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| Incontinence: Urge | - Need to empty, but insufficient time
- Overactive bladder detrusor ms
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| Incontinence: Stress | - Cough, strain, laugh, sneeze, sit-stand
- Small void volume
- Small post void residual volume
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| Incontinence: Overflow | - Bladder distended: outlet obstruction, atony
- Bladder pressure > urethral pressure
- Weak sphincter
- Small void volume
- Large post void residual volume
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| Cholecystic aging | Biliary stones more likely:
Chol stabilization less efficient
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| Endocrine Aging: Incr (3) | - Atrial Na peptide: diuretic -> nocturia
- NE: BP by vasoconstriction
- Parathormone: blood Ca & bone resorption
- Insulin: need wt loss, exercise
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| Endocrine Aging: Decr (1) | Corticotropin: stress response
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| Endocrine Aging: Women | Incr: Testosterone
Decr: Estrogen, progesterone
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| Endocrine Aging: Men | Incr: Estrogen
Decr: Testosterone
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| Thyroid: Thyroxin | Controls: metabolism & temp
Regulates:
- protein, fat, carb catabolism
- cardiac rate
- force & output ms tone
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| Thyroid: Calcitonin | - reduces serum Ca
- inhibits bone resorption
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| Hypothyroidism: Signs & Symptoms | - Dry skin
- Jt pain
- Lethargy
- Confusion, depression
- Wt gain
- Edema
- Cold intolerance
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| Thyroid: Circulating levels unchanged | Decr production but decr degradation
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| Parathyroid | - Stimulates Ca absorption from intestine & bone
***PTH incr with age
Maintains Ca balance for:
- nm irritability
- blood clotting
- cell membrane permeability
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| Pituitary | - Incr resorption of water from kidney -> Incr BP
Influences:
- growth
- thyroid
- adrenocortex
- melanocytes
- vasopressin antidiuretic
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| Pituitary release stimulated by | - Decr fluid volume
- Incr osmolarity
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| Hypopituitary: 3 signs | Lethargy, confusion, seizures
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| Insulin | - Produced in pancreas, bc of incr blood glucose
- Regulates metabolism of glucose, fat, carbs, proteins
- Promotes entry of glucose into ms cells
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| Glucose intolerance | ***Incr 25% by age 80
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| Diabetes Pathophysiology: Insulin | - Healthy body adjusts glucose production by liver & uptake by mms
- Tissue takes glucose from blood
- suppresses hepatic glucose production
- lowers plasma glucose
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| Diabetes Pathophysiology: Amylin | - peptide co-secreted with insulin from pancreatic B cells
- Modulates rate of nutrient delivery
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| Type 1 DM | Autoimmune destruction of pancreatic B cells = deficient insulin
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| Type 2 DM | - Liver produces excessive glucose
- Insulin resistance in ms & adipose tissue
Declined production of:
- Pancreatic insulin
- GI incretins (hormones)- facilitate response of pancreas & liver to plasma glucose fluctuations
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| Type 2 DM: Signs & Symptoms | - Polyuria, polydipsia
- Unexplained wt loss
- Neuropathy
- Nephropathy
- Retinopathy
- Accelerated atherosclerosis
- Skin ulcers
- Bacterial & fungal infections
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| Diabetes: Aggravating factors | -Repetitive stress
-Decr tactile sensation/proprio
-Charcot neuropathic jts: Fragmentation & sublux
-Autonomic neuropathy: decr sweating, dry skin -> fissures, callus
-Infection
-Deformities: weak intrinsic ms, pes planus
-Plantar fat pad atrophy
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| Diabetes: Macrovascular disease | - Stroke
- MI: clots caused by platelet abnormalities
- PAD: may have intermittent claudication
- Lipid disorders
- Thrombosis
- HTN
- Protein glycation: Glucose bonds to protein molecule
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| Diabetes: Microvascular disease | - Abnormal vasoreactivity
“ angiogenesis
“ vasodilation & detoxification
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| Diabetes foot inspection & care: DO NOTs (8) | - Smoke
- Use chemical removers
- Expose feet to high heat
- Walk barefooted
- Wear shoes without socks
- Wear mended, holed, elastic top socks
- Wear circular undies?
- Wear thong sandals
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| Diabetes foot inspection & care: DOs (7) | - Inspect feet daily, using mirror
- Check b/w toes
- Wash feet in warm water
- Dry feet, esp b/w toes
- Lubricate skin
- Trim nails straight across
- Check shoes for wrinkles, debris
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| Diabetic shoe | - High, wide toe box
- Resilient inner sole
- High traction rocker outer sole
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Created by:
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