Advanced Old Age Slides

Advanced Old Age – Definition

• Early-old: 60 to 75
• Middle-old: 76 to 90
• Late-old: 90 and older
• Advanced old age: over 75 years
• In 2010, 1.9 million Americans were over age 90

Geriatrics

• The study of biological, psychological, physiological, and sociological aspects of aging
• Goal: maximize ability to function and live independently, shorten period of illness and disability
• Activities of Daily Living (ADL): Ability to independently eat, dress, wash, toilet, and communicate

Physical Transitions – Aging Types

• PRIMARY AGING: Universal & irreversible changes that, due to genetic programming, occur as people get older
• SECONDARY AGING: Changes in physical and cognitive functioning due to illness, health habits, or other individual differences; not inevitable with age
• Effects of secondary aging can be prevented or decreased by exercising, eating healthy, avoiding smoking and drugs, and limiting alcohol consumption

Theories of the Aging Process

• Cellular Changes
• Free Radicals
• Biological Clock (Programmed Cell Death)
• Wear-and-Tear Theory
• Immune Theory

Free Radicals

• Ions break off and become unpaired, forming free radicals
• Unstable; seek other molecules to bond
• Oxidative stress begins and damages cells, DNA, and mitochondria
• Oxygen bonds to other molecules, creating reactive oxygen species (ROS)
• Free radicals increase with age

Biological Clock (Programmed Cell Death)

• Apoptosis: Cell membrane breaks down
• Debris is phagocytized (eaten) by other cell material

Wear-and-Tear Theory

• Can be equated to a machine: just as machine parts wear out, so does the human body

Immune Theory

• Aging reduces the body’s ability to distinguish healthy from defective cells
• Immune response becomes impaired
• Increases susceptibility to illnesses, infections, and immune cells attacking normal body cells

Physiological Changes – Bones and Cartilage

• Loss of body water and bone mass = decrease in height
• Decrease in muscle mass; increase in fat deposits
• Osteoporosis: Loss of bone mass and thinning of bones; encourage high calcium diet, regular aerobic & weight-bearing exercise to strengthen bones and prevent fractures

Physiological Changes – Blood Vessels

• Heart muscle becomes less elastic
• Oxygen exchange slows

Physiological Changes – Lungs

• Ribs and cartilage become rigid; respiratory muscles work harder
• Lung tissue loses elasticity

Physiological Changes – Kidneys & Bladder

• Decreased blood flow and scarring slow kidney filtration, causing accumulation of medications & waste products
• Bladder capacity decreases, causing urinary frequency & incontinence

Physiological Changes – Metabolism

• Retention of glucose and lipids increases risk of cardiovascular disease and diabetes

Physiological Changes – Digestion, Taste, and Smell

• Decreased GI motility (peristalsis) leads to constipation & gas
• Declining perception of salt, increased detection of bitter, decreased appetite, reduced gag reflex, increasing risk of choking

Physiological Changes – Teeth and Skin

• Jawbone shrinks; circulation to gums decreases, resulting in tooth loss
• Skin thinner; poor elasticity (turgor)
• Decreased sense of touch

Physiological Changes – Eyes

• Cataracts: Lens of the eye becomes progressively opaque (cloudy), causing blurred vision
• Glaucoma: Leading cause of blindness; atrophy of optic nerve and increased intraocular pressure; advancing age & diabetes are risk factors
• Macular Degeneration: Retinal degeneration causing loss of central vision
• Tear production decreases, leading to eye irritation

Physiological Changes – Ears

• Decrease in hearing ability
• Loss of hair cells in inner ear; difficulty hearing certain frequencies
• When teaching geriatric adults, ask them to repeat what they heard because of possible hearing deficits

Physiological Changes – Nervous System

• Neuron atrophy (neurons decrease in size)
• Brain volume shrinks ~5% per decade over 40
• Blood flow to brain slows
• Delayed motor responses and longer reaction time to stimuli

Physical Activity

• “Use it or lose it”
• Regular exercise promotes mental and physical health
• Examples: Walking, swimming, dancing, Tai Chi
• Benefits:
 • Improves balance
 • Decreases risk of hypertension
 • Improves physical/muscle strength
 • Improves hand-eye coordination
 • Increases blood circulation
 • Improves sleep quality
 • Improves cognitive function and memory
 • Reduces depression and anxiety

Sexuality

• Continue to have sexual feelings
• Most common cause of sexual inactivity is loss of a partner

Psychological Changes

• Negative self-image may affect ability to function
• Aging is gradual, allowing coping and adaptation to physical changes
• Role adjustments require adaptation and acceptance

Developmental Tasks

• Immortality versus extinction: Reflecting on accomplishments & legacies brings integrity & satisfaction; implies successful mastery of prior developmental stages
• Adjusting to retirement
• Adjusting/accepting frailties of aging and accompanying physical/lifestyle changes
• Reminiscing about positive life experiences is therapeutic and brings achievement and satisfaction

Healthy People 2030 Goals – Occupational Activities

• Finding fulfillment outside employment
• Volunteer activities, hobbies, travel

Healthy People 2030 Goals – Nutrition

• Maintain adequate nutritional intake
• Challenges: dental issues, slowed digestion, constipation

Healthy People 2030 Goals – Prevention of Illness

• Regular checkups; follow up for abnormal symptoms
• Immunizations
• Polypharmacy and medication errors: Decreased organ function delays drug excretion

Healthy People 2030 Goals – Placement Alternatives

• Aging in place: Ability to live safely, independently, and comfortably at home regardless of age, income, or ability level
• Long-term residential care (Assisted Living)
• Nursing home

Healthy People 2030 Goals – Mental Health

• Late-life depression
• Social isolation
• Suicide

Healthy People 2030 Goals – Environmental Controls

• Reduce risk of falls
• Elder Abuse: Intentional infliction of mental, sexual, emotional, or physical pain or failure to provide necessary care
• Illinois abuse or neglect hotlines: https://www.dhs.state.il.us/page.aspx?item=32675

Principles of Elder Care

• Minor environmental changes can enhance ability to function
• Observe family interaction
• Encourage confidence; raise self-image
• Provide empowerment; assist in setting personal goals
• Demonstrate kind, caring manner; actively listen
• Identify family and social-support systems
• Integrate spirituality, hope, and faith
• Monitor exercise and nutrition; follow up on health concerns
• Ageism: Prejudicial attitude & discriminatory practices against older people