Advanced Old Age: Over 75

Advanced Age

People over the age of 75.

Senescence

Early-Old

Middle-Old

Late-Old

Early-Old

60 to 75

Middle-Old

76 to 90

Late-Old

90+

What is senescence?

A period in an older adult's life in which the body begins to age and weaken.

What does senescence signal in terms of lifespan?

It is considered a signal of the final stage or end of the lifespan.

Is senescence a gradual process?

Yes, senescence is a gradual process.

Do people age at the same rate during senescence?

No, people age in different ways and at different rates.

What do older adults seek to achieve for a sense of integrity beyond their death?

Immortality through legacy, family, spirituality, or accomplishments.

What can failure to achieve a sense of immortality lead to in older adults?

Despair and fear of extinction.

What practices can promote ego integrity in older adults?

Supporting life review, legacy building, and meaning.

What is the wear-and-tear theory of aging?

Aging results from accumulated damage to cells/tissues due to use, environmental assaults, and mechanical wear, reducing organism function over time.

Wear and Tear Theory (Biological/Cellular)

Deterioration over time due to continued use.

Human body wears down

Immune Theory (Biological)

Aging is a programmed accumulation of damage and decline in immune function

What is the immune theory of aging

Age-related decline in immune function reduces ability to detect/destroy abnormal cells and pathogens; increased infections, cancers, and autoimmune responses result.

Free Radical Theory or Oxidative Stress (Biological/Cellular)

Errors are a result of random damage from free radicals; they are unpaired unstable ions

What is the free radical theory of aging?

Free radicals (unstable oxygen molecules) produced in metabolism damage DNA/proteins/membranes over time; cumulative oxidative damage contributes to aging and disease. (Slides/text list free radical theory among biologic theories).

Healthy People 2030 Goals

Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death.

Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

Create social, physical, and economic environments that promote attaining full potential for health and well-being for all.

Promote healthy development, healthy behaviors and well-being across all life stages.

Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.

What Healthy People 2030 goals relate to older adults?

Increase healthy lifespan and quality of life; focus on illness prevention, early diagnosis/management of dementia, promoting mobility and independence, increase physical activity among those with physical/cognitive problems, reduce hip fractures and pressure ulcer-related admissions, and reduce hospitalizations for diabetes.

Physiological Changes

Bones and cartilage

Height

Blood vessels

Lungs

Kidneys and bladder

Metabolism

Nervous system

Digestion

Senses

Teeth

Skin

Eyes

Ears

Bones and Cartilage

Loses density

Greater risk for fractures

Cartilage wears down

Joint stiffness common

Osteoporosis risk increases with age

Decreased bone mass

Height

Decreases due to vertebral compression and postural changes.

Blood Vessels

Loses elasticity.

Increased peripheral resistance

Blood pressure rises with age.

Lungs

Decreased expansion

Decreased vital capacity

Reduced efficiency of gas exchange

Kidneys and Bladder

Kidneys decrease in size.

Reduced renal blood flow.

Decreased filtration rate.

Bladder capacity decreases.

More frequent urination.

Metabolism

Slows with age

Decreased caloric needs

Nervous system

Forgetfulness

Inattentiveness

Disorganized thinking

Altered level of consciousness

Perceptual disturbances

Psychomotor disturbances

Sleep-wake disorder

Digestion/GI System

Saliva production decreases → difficulty swallowing dry foods.

Decreased digestive secretions.

Constipation is common.

Vision

Decreased tear production

Decreased visual acuity, color discrimination, pupil size

Safety concerns—driving (esp night)

Annual eye examinations needed

Presbyopia

age-related loss of accommodation—need for reading glasses almost universal

Glaucoma

intraocular pressure

Cataracts

opacity and yellowing of lens

What is inner-ear atrophy?

A condition characterized by the degeneration of cells in the inner ear.

What causes loss of hearing hair cells?

Damage or degeneration of the hair cells in the inner ear.

Why is annual audiology testing important?

To monitor hearing loss and detect changes in hearing ability.

What is tympanic membrane atrophy/sclerosis?

A condition where the eardrum becomes thin or hard, affecting hearing.

What is presbycusis?

Progressive sensorineural hearing loss associated with aging.

How does hearing loss affect quality of life?

It can lead to miscommunication, loss of self-esteem, depression, falls, safety risks, and cognitive decline.

Skin

Becomes more thinner, wrinkled, and fragile

Safety issues from decreased sensation: burns from cooking, bathing; motor skill consideration

Decreased function of sweat glands: Difficulty with temperature regulation

Skin with age comes with risk of decubitus Ulcer

localized tissue necrosis (from compression against bone)

Hazard of chronic disease esp CVA• Proper nutrition will help prevent

Taste/Smell

Loss of taste buds

Changes result in large amount of salt/sugar in food

Dental health important—semiannual dental visits

Loss of teeth, caries, periodontitis, gingivitis

Decreased acuity of olfactory nerve

Food safety issues with loss of smell

Concerns related to living arrangements include:

Safety

Accessibility

Social isolation

Health-care access

Financial considerations

Living Modifications

Majority of older people prefer to stay in their own home, best to alter:

•Widened doorways

•Door levers

•Ramps

•Lighting

•Smart home devices

•Bathtub with walk-in shower or bathtub w/bench or bath chair & safety bars

Concerns Related to Living Arrangements

Access to health care and assessment

Individual's perception of move as "dumping" or as assistance

Control of patient's finances

Personal space allowed

Accommodation of special needs

Privacy or shared room

Providing pet care, allowing plants in room

Peer-group activity

Rehabilitation and therapies available

Living Placements

Assisted living in a residential setting - Adult needs minimal or moderatesupervision & careNursing home or long-term care facility - Higher level of care

Assisted living in a residential setting

Adult needs minimal or moderate supervision & care

Nursing home or long-term care facility

Higher level of care

High Prevalence of Sleep Disorders

Decrease in total hours required

Increase in nocturnal awakenings, shorter periods of sleep, decrease in slow-wave activity

Nursing Interventions for Sleep

• Teach re: normal changes in sleep

• Encourage sleep routine

• Increase daytime physical activity

• Pain management

• Environmental adjustments(lights/sound)

• Sleep medications: short-term use

Sleep-related issues are listed as symptoms within cognitive decline and dementia:

Sleep-wake disorder

Sleep-wake disturbance

Sleep promotion strategies

Maintain routines and structure

Address causes contributing to sleep changes (e.g., medication effects, environmental factors)

Monitor sleep as part of dementia management

Dementia Definition

An abnormal condition marked by multiple cognitive defects that include memory impairment.

2 Types of Dementia

Multi-infarct Dementia

Alzhemier's Disease

Dementia

Not inevitable outcome of aging

Multi-Infarct Dementia

Death of brain tissue

Treatment for Dementia

Medications, encourage self-care, routines, and stimulation, safety interventions (falls, wandering)

Alzheimer's Disease

Most common form of dementia

Causes not fully understood

No cure

Symptoms of Alzheimer's Disease

Forgetfulness

Inattentiveness

Disorganized thinking

Altered level of consciousness

Perceptual disturbances

Sleep-wake disorders

Psychomotor disturbances

Disorientation

Treatment for Alzheimer's

"No cure."

Medications for memory, behaviors, sleep

Nonpharmacologic:

Routine

Structure

Safety modifications

Encourage self-care

Nursing role in Alzheimer's

Provide structure

Environmental safety

Support for family/caregivers

Monitor reversible causes of cognitive decline

Who is at the highest risk for depression?

Older adults

What are some factors that contribute to depression?

Isolation, loss, change in environment, low self-esteem, medical conditions, medications

Chronic illness

Social isolation

Hearing loss (linked in sensory loss slide)

Cognitive decline

What are common treatments for depression?

Counseling, social support, pleasurable activities

Which age group has the highest rate of suicide?

Elderly

What are some factors contributing to suicide in the elderly?

Serious illnesses, social isolation, alcohol abuse, bereavement

What is physician-assisted suicide also known as?

Euthanasia

What is a challenge related to suicide prevention?

Promote value in life and alleviate suffering

Memory Change Warning Signs:

Memory loss that affects job functioning

Difficulty performing familiar tasks

Disorientation

Losing track of time/place/date

Decreased abstract thinking

Personality, mood, or language changes

Reversible / Preventable Causes of Memory Issues:

Drug toxicity

Depression

Metabolic problems (kidney or liver dysfunction, hypoglycemia)

Sensory problems (hearing, vision)

Nutritional deficiencies (Dehydration, B12 deficiency, Iron deficiency)

Illnesses

Pneumonia

Infections

What is a key aspect of coping with immortality versus extinction?

Reminiscing about the past; focus on activities that bring pleasure.

What should individuals identify to adjust to retirement?

Hobbies and activities that bring fulfillment.

What is important for adjusting to aging?

Accepting the frailties of aging and changes in physical appearance and lifestyles.