After studying Module 6: Lecture Materials & Resources, discuss the following:

Describe major changes that occurs on the neurological system associated to age. Include changes on central nervous system and peripheral nervous system.
Define delirium and dementia, specified similarities and differences and describe causes for each one.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

 
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Meiner, S. E., & Yeager, J. J. (2019).

Chapter 21
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Chapter 22
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Chapter 23
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Chapter 24
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Chapter 25
Chapter_025.pptxChapter 25
Endocrine Function
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There is decreased estrogen production in women (menopause), decreased testosterone production in men (andropause), decreased adrenal function (adrenopause), and decreased growth hormone (GH)–insulin-like growth factor (IGF) (somatopause).
Neuroendocrine Aging
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2

Endocrine system uses a delicate balance of chemical messengers in the bloodstream to maintain homeostasis and regulate mood, growth, organ function, metabolism, nutrition, and sexual activity.
Clinical manifestations due to the imbalance include decreased bone remodeling, decreased lean muscle mass, increased adipose tissue, compromised skin integrity, impaired insulin signaling, and impaired immune response.
Endocrine Physiology in Older Adults
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3

Decline in biosynthesis and balance of sex hormones with aging
Both genders may experience hot flashes, night sweats, depression, and sexual dysfunction in response to declines in androgen or estrogen.
Laboratory values—luteinizing hormone and testosterone in men; follicle-stimulating hormone and estrogen in women determine endocrine decline.
Andropause and Menopause
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4

Menopausal and postmenopausal hormone replacement (HR) practices continue to change based on larger, more rigorous research studies.
Although many clinicians continue to prescribe hormone replacements, the benefit must outweigh the risks of developing adverse events.

Menopause
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5

Age-related decreases in mineralocorticoids, glucocorticoids, and androgenic hormones manifest changes in body composition, skeletal mass, muscle strength, body weight, and metabolism.
Age-related decreases in DHEA and norepinephrine can produce fluid and electrolyte imbalances; impair glucose, protein, and fat metabolisms; and impair immune and inflammatory responses.
Adrenopause
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6

Somatotropin (growth hormone), an anabolic protein, is secreted from the hypothalamus–pituitary axis and influences many age-related changes.
Somatopause
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7

Multifactorial syndrome of aging due to chronic low inflammation, and is characterized by central obesity, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, hypertension, and/or hyperglycemia
Primary risk factors for the syndrome are abdominal obesity, insulin resistance, physical inactivity, and hormonal imbalance.
Metabolic Syndrome–Diabetes Continuum Pathophysiology
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8

When three of the following five criteria are met:
Obesity (waist circumference >40 inches in men or >35 inches in women)
Blood pressure >130/85 mm Hg
Fasting plasma glucChapter 23
Musculoskeletal Function

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Diseases of musculoskeletal system are usually not fatal but can lead to chronic pain and disability.
May cause impairments in ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
When dependence occurs, can result in loss of self-esteem, perception of decreased quality of life, and depression
Introduction
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2

Muscle mass, tone, and strength decrease
Elasticity of ligaments, tendons, and cartilage decreases
Bone mass decreases
Intervertebral disks lose water, narrowing the vertebral space.
Posture and gait change leading to shift in center of gravity.
Age-Related Changes in Structure and Function
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3

Musculoskeletal system affected in numerous ways by aging process

3

All the changes may cause pain, impaired mobility, self-care deficits, and increased risk of falls for older adults.
One-third of people age 65 or older have falls each year.
Moderate to severe injuries included hip fractures, lacerations, and traumatic brain injury.
Falls are the most common cause of accidental death.
Fall experience causes a fear of falling.
Consequences of Changes in
Structure and Function
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4

Common problems and often result in loss of functional ability
May occur because of trauma to bone or joint, or may be the result of pathologic processes
Falls are a common cause.
Most common fractures are hip, the proximal femur, Colles (wrist), vertebral, and clavicular.
Fractures
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5

Most disabling type of fracture for older adults
25% patients with hip fractures die within 1 year after injury.
Complications of hip fractures generally related to immobility.
Classified by location: intracapsular, extracapsular
Affected extremity is externally rotated and shortened with tenderness and severe pain.
Hip Fracture
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6

Assess hips and lower extremities for evidence of fracture such as shortening of the extremity, and abnormal rotation.
Assess for presence of tenderness, swelling, or ecchymosis and pain with movement.
Obtain VS and level of consciousness.
Can you name six nursing diagnoses for hip fracture?

Hip Fracture: Assessment and Diagnosis
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7

Pain, resulting from the discomfort from the muscle and bone trauma
Decreased mobility, resulting from immobilization of the fracture and the healing process
Potential for reduced skin integrity, resulting from immobilization required for healing
Potential for infection, resulting from inadequate wound healing, compromised nutrition, and effects of immobility
Inadequate bathing/dressing/feeding/toileting self-care, resulting from discomforChapter 24
Cognitive and Neurologic Function
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Function of neurotransmitters is altered due to a decreased number of neurons in various areas of the brain.
Changes in neuron function are associated with accumulation of lipofuscin granules and neuritic plaques in the cell body of some neurons.
Physiologic changes in the CNS include sensory motor changes, the reticular activating system (RAS) and neuroendocrine system are altered.
Age-Related Cellular and Structural Changes of the Neurologic System (1 of 2)
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2

2

Hippocampus changes include: structural changes, synapse loss in the neurons, decreased microvascular integrity, reduction in glucose metabolism, and alterations in the neuroglia cells
Reduction in the turnover of cerebrospinal fluid (CSF)
Neurodegenerative and neurochemical changes in the cerebellum

Age-Related Cellular and Structural Changes of the Neurologic System (2 of 2)
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3

Sleep disorders (sleep-wake cycle)
Altered ability to learn new information quickly, memory storage, and memory retrieval
Altered vision, hearing loss, decreased taste and smell, vibratory sensations, and position sense
Balance issues and postural hypotension
Decreased ability to feel pain and cope with temperature changes
Changes may contribute to diseases causing cognitive decline.
How These Changes
Affect the Older Adult
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4

Mental status assessment: attention, memory, orientation, perceptions, thought processes, thought content, insight, judgment, affect, mood, language, and higher cognitive functions
Neurologic assessment: cranial nerves, gait, balance, distal deep tendon reflexes, plantar responses, primary sensory modalities in lower extremities, and cerebrovascular integrity
Include functional assessment

Assessment of Cognitive Function
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5

Dementia Severity Rating Scale (DSRS)
Covers the areas of memory, orientation, judgment, community affairs, home activities, personal care, speech and language recognition, feeding, incontinence, and mobility or walking
Normal score instrument is 4 or less; score increases as older person’s cognition decreases.
Cognitive Function Screening Instrument: Functional Assessment
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6

Montreal Cognitive Assessment (MoCA): a quick screening tool for mild cognitive impairment (MCI) and early Alzheimer’s dementia
Assesses the domains of attention and concentration, executive functions, memory, language, visuospatial abilities, conceptual thinking, calculations, and orientation
Mini cog—screens for cognitive impairment
Cognitive Function Screening Instrument: Mental Status Examination
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7

Geriatric Depression Scale (Chapter 22
Urinary Function
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Bladder capacity decreases, prevalence of involuntary bladder contractions increases, and more urine is produced at night.
Women: declining estrogen levels, thinning and increased friability of urethral mucosa, and altered pelvic floor muscle tone and function cause urgency and frequency
Men: prevalence of prostatic hypertrophy increases, resulting in incontinence or urinary retention

Age-Related Changes in Structure and Function
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2

2

UI is common in older adults and is associated with irritant dermatitis, pressure injuries, falls, significant sleep interruptions, and UTIs.
Many health care providers do not ask patients about incontinence, even when patients inform them about incontinence and therefore it is not diagnosed or treated.
Urinary Incontinence (UI)
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3

Acute incontinence: sudden onset, generally associated with some medical or surgical condition, generally resolves when underlying cause has been corrected
Drugs are a common cause.
Chronic incontinence: not related to an acute illness, continues over time, often becoming worse
Five major types include: urge, stress, overflow, functional, and mixed incontinence
Incontinence
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4

Most common type, may be associated with overactive bladder
Causes: urinary tract infection (UTI), medications, bladder irritants, bowel issues, dementia, stroke, Parkinson’s disease, and cancers of the uterus and urinary system
Involuntary urine loss after sudden urge to void
Can be precipitated by sound of running water, cold weather, or sight of toilet
Often accompanied by nocturia and complaints of frequency
Urge Incontinence
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5

Commonly seen in older women who involuntarily lose urine as result of sudden increase in intraabdominal pressure
Caused by lack of estrogen, obesity, previous vaginal deliveries, surgeries
Leak urine with physical exertion: coughing, sneezing, laughing, lifting, and exercise
Unusual in men, and mainly occurs after transurethral surgery or radiation therapy
Stress Incontinence
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6

Chronically full bladder increases bladder pressure to level higher than urethral resistance, causing the involuntary loss of urine
Common in men
Complain of constant dribbling
Causes: urethral blockage, weakened bladder muscles, nerve injury or damage, constipation, or drugs

Overflow Incontinence
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7

Caused by physical, mental, psychologic, or environmental factors interfering with the ability to make it to the toilet on time
Not recognizing the need, lack of motivation or physical barrier to the toilet
Functional incontinence should be a diagnosis of exclusion.
FunctionaChapter 21
Gastrointestinal Function
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1

Some changes in the gastrointestinal (GI) tract are due to normal aging; factors such as polypharmacy, stress, poor nutrition, multiple comorbidities, and poor hygiene may also contribute to alteration in GI function.
Many systemic changes in functions of digestion and absorption of nutrients result from changes in older patients’ cardiovascular and neurologic systems rather than GI systems.
Age-Related Changes in Structure and Function
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2

2

One fourth of those 65 or older are edentulous.
Taste buds may atrophy with age.
Changes in smooth muscle lining lower in the esophagus may contribute to a decrease in the strength of esophageal contractions and sphincter weakness.
Neurogenic, hormonal, and vascular changes may also contribute to decrease in esophageal motility.

Age-Related Changes in Oral Cavity, Pharynx, and Esophagus
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3

3

Decreased production of gastric acid, pepsin, bicarbonate, prostaglandins, and mucous
Gastric emptying time is increased secondary to decreased elasticity of the stomach wall.
Decreased stomach capacity
Age-Related Changes in Stomach
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4

Atrophy and broadening of the villi leading to a decrease in absorptive surface
Decrease in the production of lactase
Overpopulation of certain intestinal bacteria
Atrophy of the muscle layers and mucosa in colon
Decrease in contraction of the muscle wall when the rectum is filled with stool
Diverticuli are prevalent.

Age-Related Changes in
Small and Large Intestine
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5

Gallbladder and bile ducts are unaffected by aging.
Incidence of gallstones does increase with age.
Fibrosis, fatty acid deposits, and atrophy of pancreas
Volume of pancreatic secretions declines.
Decrease in enzyme activity which affects fat digestion
Increased incidence of pancreatic cancer and pancreatitis
Age-Related Changes in
Gallbladder and Pancreas
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6

Liver size decreases after age 50, but function remains WNL.
Decrease in hepatic blood flow affects drug metabolism.
Decreased ability to compensate for infectious, immunologic, and metabolic disorders
Age-Related Changes in Liver
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7

No clear-cut GI diseases can be attributed directly to aging process.
Older adults may complain of symptoms related to GI tract that have not been related to a specific diagnosis.
Any symptom reported by an older patient needs thorough assessment by the nurse.
Common Gastrointestinal Symptoms
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8

Nausea without vomiting originates in the brain, rather than GI track, and is usually a response to a metabolic disorder.
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