aging & health - exam 1

Evolutionary theories of aging

the “why” of aging

Mutation accumulation theory

• aging is a non-adaptive trait

  • A by-product and inevitable result of the declining force of natural selection with age

Antagonistic pleiotherapy theory

• Aging is an adaptive trait

  • Genes that influence several traits are selected and affect individual fitness in antagonistic ways at different stages of life

Biological theories (molecular, cellular, and organ system changes associated with aging)

the “what” and “where” of aging

Genetic (programmed) theories

• Aging is genetically determined and organisms have an an internal clock that programs longevity

  • Genes contribute about 20-30% of aging

Damage (stochastic) theories

Propose that chance error and the accumulation of damage over time cause aging

Free radical theory of aging (FRTA)

• One of the most popular aging theories and forms the basis for many antiaging products and strategies

• Free radicals (FRs) react with molecules in a destructive way 

• Aging is due to the accumulation of oxidative damage to lipids, DNA, proteins, and tissue by free radicals

Cross-linking theory of aging

• Aging results from glucose binding to proteins which impairs their biological functions that cause connective tissue hardening, cardiac enlargement, and renal disorders, malformed cells, and an increased risk of cancer

• Diabetes is viewed as an accelerated aging process

Psychosocial theories of aging

the “who” of aging

Activity theory

Life satisfaction in old age depends upon social participation, hobbies, and enjoyable endeavors

Disengagement theory

Gradual withdrawal from previously held roles can be beneficial for both the older adult and society

Continuity theory

People do not change dramatically with regard to their behavioral preferences as they age, but rather substitute new roles for those they may have lost, adapting to age-related changes as they occur

Life course perspective

A framework that recognizes the social, cultural, and structural contexts of a person’s lifelong development

Four key principles that guide the life course perspective:

• Historical time and place

• Timing of events in live

• Linked lives

  • Human agency to make decisions

What is aging?

• Aging is characterized by a progressive loss of function and an organism’s increased vulnerability to disease and the environment

• Eliminates older members of a population so that they no longer compete with younger generations for resources, paving the way for younger members to survive and reproduce

What are the causes of aging?

• Genetic (programmed) theory

• Damage (stochastic) theory

• Free radical theory of aging (FRTA)

• Cross-linking theory of aging

Men vs. women’s perspectives

• Women live longer than men

  • However they are frailer and have worse health at the end of life

  • Men still perform better in physical function examinations, but don’t live as long

Social determinants of health (SDOH)

• “Gender gap”

  • Still persists despite improved healthcare systems, public health initiatives, and increased health awareness

  • Women face different socio-economic circumstances

Lifespan

life expectancy, the amount of time a person is alive from birth to death

Healthspan

number of years a person has lived a healthy, active, and disease-free life

Recent statistics show that…

lifespan has recently been increasing while healthspan remains stagnant

Ageism

• Refers to the stereotypes (how we think), prejudice (how we feel), discrimination (how we act) towards others or oneself based on age

• Can be deliberate or non-deliberate

• Can affect anyone

4Ms Framework

• What matters

• Medication

• Mentation

• Mobility

What matters (4Ms framework)

Know and align care with each older adult’s specific health outcome goals and care preferences including end-of-life care, and cross settings of care

Medication (4Ms Framework)

Use age-friendly medication that does not interfere with What Matters to the adult, Mentation, or Mobility across settings of care

Mentation (4Ms Framework)

Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care

Mobility (4Ms Framework)

Ensure that older adults move safely every day in order to maintain function and do What Matters

What physiologic change happen to an older adult’s body systems when assessing their health

Decline in cognitive, intelligence, cardiovascular, respiratory, renal, musculoskeletal, hepatic, vision, immune system, etc.

How should elders be spoken to?

• Address them as they would prefer

• Do not call them pet names or make up names for them

  • No calling them “cute”

What are the ethical principles?

• Respect for autonomy

• Beneficence

• Nonmaleficence

• Justice

Respect for autonomy

• Emphasizing the right of patients to make their own health decisions

  • The right to say “yes” or “no”

  • Must get full disclosure

  • Capacity is determined in the clinical setting

    • 4 Criteria for Capacity

      • Understanding

      • Expressing a choice

      • Appreciation

        • Reasoning

Beneficence

Duty of healthcare professionals to promote the well-being of patients

Nonmaleficence

Obligation to do no harm to patientsJus

Justice

Fair and equitable treatment of all patients regardless of personal characteristics

DNR (Do-not-resuscitate)

• Different types (ex: DNI - do not intubate)

• A type of directive that is typically respected and can be persuasive in a judicial decision about withholding life-sustaining treatment

• A patient on DNR won't be put on life support but they must stay on comfort measures such as feeding and pain medicine

Advance directives

Include the living will in it 

POLST/MOLST

Consolidated sets of medical orders specifically for patients with a life limiting illness

POLST

practitioner/physician order for life sustaining treatment

MOLST

medical orders for life sustaining treatment

Healthcare proxy / Power of Attorney (POA)

• A document that enables a capacitated individual to legally appoint another person to make medical decisions on his/her behalf after capacity has been lost

• Have the legal designation of a healthcare agent with the same decision making authority as the patient had the patient be incapable of deciding 

Hospice care

• For patients that are no longer on life sustaining measures; they have a prognosis of 6 months or less

• To better quality of life rather than a curative treatment 

• Can be covered by medicare and medicaid or commercial insurance 

Informed consent

• Requirements for informed consent include capacity, full disclosure, understanding, voluntariness, consent/refusal 

• Very specific, informed consent for one procedure is not transferrable to another procedure 

Decision-making capacity

• Must be assessed, can be done through: 

  • MMSE (mini mental state exam) or the ACED Assessment of capacity for everyday decision making; but there is not one standardized assessment tool, varies upon patient

  • Supported Decision-Making: For patients with fluctuating capacity, supported decision-making arrangements can help maintain their involvement in healthcare decisions

  • Risk based scale: The level of capacity required for a decision correlates with the risk involved; higher risk decisions demand higher levels of understanding and reasoning

Palliative care

• Can be concurrent with life sustaining measures and is focused on comfort and quality of life 

• Provided for persons of all ages with a serious (not terminal) medical condition that will predictably reduce life expectancy 

• Delivery of person-centred and family-focused palliative care 

• There are different palliative care models (don't have to know the individual models just know there are different models)

Family caregiving

• Tend to be underprepared and unpaid

• Takes on a mental toll