Aging Demographics and Immune System

delirium

abrupt change in mental status, attention, global awareness

elder abuse

physical, emotional, neglect, or financial abuse

helper, cytotoxic, regulatory

name the 3 types of T cells

phagocytes

type of cell (such as a neutrophil) that ingests and kills invading organisms

thymus size

less than 5% that of a newborns size

innate immunity

physical barriers and bloodborne phagocytes, neutrophils

born with this system

first barrier

mucous membranes, cornea, urinary sphincter

antigens

bacteria, fungi, cancer cells, parasites, transplanted organs

HLA/MHC

plays a role in organ transplantation

depression

“common cold” of elderly

senescence of immune system

correlates closely with development of disease

suboptimal, weaker, slower

vaccination response in elderly

zinc

this mineral supports cytokine production and regulates helper T cell activity

seems to boost immune system function

vitamin E

antioxidant which protects lymphocytes against destructive free radicals

seems to boost immune system function

interleukin 2

induces cell proliferation and supports long term growth of T cells

CLL, TB, shingles

increased disease process in elderly leads to

autoantibodies

react against “self” antigens

second barrier

phagocytes and inflammation mediated responses

naive T cells

cell more prevalent in the young than in the elderly, has not been changed into a memory cell

we lose these more as we age

calcium

what element/mineral is neccessary for signal transduction for extracellular antibody reaction and other chemical processes such as enzyme stimulation

CD69

antigen on cell surface which helps in activation of T lymphocytes

IgM

first antibody in response to initial exposure to antigen

anti-idiotypic

antibodies which attack other antibodies

interleukin 10

stimulates production of autobodies in patients with autoimmune disease

ageism

negative bias or stereotypic attitude towards the aged

health literacy

newest vital sign, the ability to understand and use health information

typical vital signs

heart rate, respiratory rate, pulse ox, temp, and BP are all what

gait speed

vital sign proposed by APTA home health and geriatric sections

factor contributing to ageism

fear of death, emphasis on youth, emphasis on productivity in American culture, manner in which this was originally researched

usual aging

common mode of aging with significant physiological losses, substantial loss of reserve capacity

optimal aging

aging well, elite aging, effective aging, successful aging, robust aging

aging sterotypes

“past their sell by date”, helpless, senile, don’t deserve healthcare, older women less valuable than younger women, etc

messenger cell (cytokine) secreted by some WBCs affecting other WBCs

2 and 4

what is an interleukin and which ones are important for T cell development

calcium deficiency

what happens to calcium in older adults

most important cell in the immune system

how many systems make up the immune system

2 (nonspecific: first and second; specific: third)

how many barriers make up the immune system

first (mechanical/physical barriers), second (innate immunity), third (quired immunity)

name the lines of defense that make up the immune system

1. recognition: distinguish self from non self

2. activation and mobilization: WBCs, T cells, B cells

3. regulation: to prevent excessive damage to body, suppressor T cells secrete cytokines to control and mitigate immune response (central and peripheral tolerance)

4. resolution: confine and eliminate the antigen

what are 4 components of the immune systems plan of action

thymus

what organ produces and differentiates T cells

because we are less able to distinguish self from non self

why do we develop increased autoimmune antibodies as we age

antibody (they also have 5 classes: IgM, IgA, IgE, IgD, IgG)

immunoglobin is another name for what

diminished response for fighting infection

what happens to IgM as we age

decrease in T cells which means fewer antibodies produced, less able to remember antigens, etc

what component of the immune system decreases due to aging of the thymus

they respond more slowly

what happens to the number of memory T cells as one ages

disease

as the immune system ages, one becomes increasingly susceptible to _____?

sense of feeling unwell, change in mentation, fatigue, decreased appetite

what are frequent early warning signs of illness in the elderly

fever and chills

what usual hallmarks of infection may be absent in the elderly

CD28

aged cells do not display what

IL2 and IL4; IL6 and IL10

as we age we have decrease ____ production and increased ____ production which contributes to disability

decreased lymphoid tissue

happens to the lymph as we age

keeps them “quiescent” and this decreased T cell also means decreased B cell activation and cell mediated cytotoxicity

as we age we get decreased Ca, what does this do to T cells

slower

as we age we have _____ clearance of antigens from the body

20%

what percentage of the population is over 65 from year 2030-2050

telomere theory of aging

theory that states there are random repeats of DNA located at ends of chromosomes and that the length of these ends limits the total number of attainable cell generations or replications

so the total length decreases with each cell generation or replication,,, then when these are exhausted the cell dies

basically: length of telomeres is predictive of lifespan for that cell and ultimately for that organism

free radical theory of aging

theory that states highly charged, highly reactive unpaired electrons in the outer orbit damages the cell membrane, lysosomes, mitochondria, and the nuclear membrane. this increase damage then leads to increased lipofuscin in tissues which is the best indicator of true physiological age (independent of chronological age)

this yellowish brown pigment accumulates at poles of nuclei

caloric restriction theory of aging

high nutrient, low calorie diet is optimal for decreasing effects of aging

genetics, lifestyle, nutrition, medical care

what 4 factors influence aging

verbal skills

what cognitive skill generally remains intact well into our 80s

annual wellness visit discusses improving health now and in the future and includes

• screenings

• preventative measures for maintaining health

• risk factor discussion for chronic disease

• current problems assessment

• vaccinations recommended

• counseling on weight loss, PA, smoking, fall prevention, nutrition

what is the AWV visit and what occurs during it

integrity vs despair

Erikson’s stage of personality and ego development for late life

reversible cause of sudden dementia

adult child of the older adult

who is most likely to be an elder abuser

4-5+ medications

how many medications makes one a victim of polypharmacy

multifactorial health conditions

___________ occur when accumulated effects of impairments in multiple systems render an older person vulnerable to situational challenges

• unintentional weight loss

• self reported exhaustion

• weakness in grip strength

• slow walking speed

• low PA

what are hte criteria you must meet 3 of for a diagnosis of frailty

• Matters most (to patient)

• Mentation (dementia, depression, delirium, anxiety)

• Medication (side effects on function

• Multicomplexities/Multiple comorbidity

• Mobility

5 M’s of geriatric assessment and rehabilitation