Nur 1390 final exam (goodluck :p !)

Stereotypes

Stereotypes

Life expectancy

Average(the age most people die),

Useful( how useful can you be while living),

Maximum (years you can live),

Factors: Genetic, environmental, ethnic, gender

Senescence

Period in adult life when aging starts

Young old: 65-75

Old: 76-84

Old-old: 85-99

Elite-old: 100 yrs+

Geriatrics: the study of old age

Erikson Integrity vs Despair

Psychosocial stage where people reflect on life
Life review
Adjusting to retirement
Begins when an individual experiences a sense of mortality( retirement, death)
Adjusting to and accepting the frailties of aging and changes in physical appearance and lifestyles
Healthy children won't fear life if adults have enough integrity to not fear death

Despairty

The negative resolution is a fear of death " Life is too short"

Wisdom

Informed, detached concern with life

CDC Longevity Factors

Genetics, healthcare, environment, lifestyle impact on lifespan
19% genetics
10% access to high-quality healthcare
20% environmental factors
51% on lifestyle factors

Biological Theories of Aging

Genetic, wear and tear, neuroendocrine, free radical theories

Genetic

programmed to age by the biological clock

wear and tear

cells are damaged by overuse and abuse over time

Neuroendocrine

the most important factor in aging due to the drop in hormone levels causes a decline in the ability to repair and regulate itself

Free radical

people age because when cells metabolize. Causes damage to the body. Ex: Memory loss, Cataracts, Alzheimer's, Cancer, Parkinson's, Side effects of medicine

Nervous System Changes

Neurons atrophy
Transmission sluggish
Blood flow slows due to fatty deposits within blood vessels
Motor responses and reaction time to stimuli is delayed
Maintaining environmental safety necessary
Decrease in Gabba

Dementia

Is an "umbrella term" referring to many different types of dementia
Most common type is Alzheimer's Disease
Gradual loss of cognitive functioning can also incorporate losses of motor, emotional, and social functioning.
Unable to care for oneself

Early stage of dementia

Forgetfulness to confusion to disorientation
Check problem-solving judgment, decision-making, orientation personality changes

Risk factors of Alzheimer's

Family History- a clear inherited pattern exists in approximately 10% of cases
Down's syndrome- nearly 100% of people who live into their 40's
Chronic Hypertension- Treatment reduces the risk
Head Injuries- Three times more likely to develop AD
Gender-inclusive data. Some studies show a greater risk for females while others show an increased risk for males

MMSE

Mini-Mental State Exam for cognitive assessment

Any person over the age of 65 should be tested on this

Orientation( what year? Country you're on?),

Registration( naming 3 objects, repeat after 1 second, rename), Attention and Calculation( serial 7’s, spell “world” backwards), Recall and Language( name pencil and watch, repeat, copy design)

Cardiovascular Changes

Arterial walls thicken with fatty deposits and connective tissue
Heart muscles are less elastic
BP rises to compensate for lowered O2
Takes longer for the heart to respond to activity or stress

Respiratory System Changes

Ribs and cartilage become more rigid
Lung tissue loses elasticity
More vulnerable to respiratory infections

Urinary Tract Changes

The rate that the kidneys filter the blood slows so medication and other substances take longer to leave the body
Bladder capacity decreases
Dripping urine
Women's tube shortens, and the lining becomes thinner so more risk of urinary tract infections
The prostate enlarges, have bladder issues

Digestive Changes

Decreased motility results in slower emptying of the stomach
Decreased digestive enzymes- poor appetite and digestive disturbances
Slowed gag reflex
Slowed peristalsis

Aging and the Skin

Takes longer to repair and replace skin cells
Thinner with poor turgor
More vulnerable to skin injury, and slower wound healing
Decrease in the number and function of sweat glands
Decrease ability to perceive cold and hold
Age spots

Eyes Changes

Loss of cells in the optic nerve makes it difficult to see details
Pupils open and close more slowly so need to adapt to their surroundings
Cataracts develop
Dry eyes
Colors are less bright
Things start to look more grey
Eye color changes to blue or grey
Floaters

Ears Changes

Degenerative changes in the bones of the middle ear result in a decrease in hearing ability
Difficult to locate sound
Repeat words to ensure clear communication
A man's voice is easier to hear than the higher pitches than the higher pitches of a woman's voice

Sexuality Factors

Factors that influence sexuality:

Attitude/Interest

Body image perception

Mental function

Social contact

Environment/Privacy

Sexual Health

Urinary function

Mobility

ED/menopause

Illness

Medication

Health Maintenance

Physical exercise
Occupational activities
Nutrition
Challenged by dental loss, denture adaption, slowed digestion, constipation and decline in ability to cook

Mental Health

Depression (high)
Suicide
Must be realistic, use strengths, and coping strategies to deal with physiologic changes, and set positive goals and attainable

Environmental Controls

Illuminate stairways and provide light switches at both the top and button of stairs
Avoid high-gloss floor finishes
Nightlights
Handrails
Tack down carpeting, non-skid treads
No area rugs
Grab bars on bathroom walls and nonskid mats in tubs

Elder Abuse

Mistreatment of older adults

Polypharmacy

Use of multiple medications simultaneously

Spirituality

Exploring the meaning of life, self-expression through various mediums, and connecting with others on personal and universal levels

Religion

Affiliation with a faith community sharing beliefs, rituals, morals, and often centered on a higher power like god

Spiritual Needs

Include acceptance, personal worth, forgiveness, hope, love, humor, faith, worship, and practices like meditation and prayer

FICA spiritual assessment

F: Faith and beliefs

What are your spiritual or religious beliefs?

I: Importance and Influence

Is it important in your life?

C: Community

Are you part of a spiritual or religious community?

A: Address

How would you like me to address these issues in your treatment?

Young Adult

Individual aged 18 to 40, preparing for adult responsibilities

Erikson's Intimacy vs Isolation

Body and ego must be masters of organ modes and of others nuclear conflicts
Struggle between forming close relationships and feeling isolated

Erikson's definition of love

Being able to put aside differences through a mutual devotion to each other
Can be found in the love of one's neighbor, coworker
Must be reciprocal

Genital Utopia

Mutual orgasm with a loved partner of the opposite sex

Friendships in Adulthood: Gender Differences

Female:confide in one another about feelings,problems, and interpersonal relationships
Male:minimize discussions about relationships & hang out more

Piaget's Post Formal Operational Thought (adulthood)

Integrating viewpoints for knowledge and problem-solving

Cognitive Development (adulthood)

Reflective, relativistic thinking with decreased idealism

Maturity and Adulthood

Achieving balance in physiological, psychosocial, and cognitive growth

Physiological Changes ( adulthood )

Few changes, less severe illness, physical changes in middle age

Health Risks (adulthood)

Include violence, substance abuse, STDs, and occupational risks

Lifestyle Concerns (adulthood)

Involving smoking, stress, exercise, hygiene, and family history

Health perception- maintenance pattern

-Preventive care
--Maximize health status, detect problems
early, appropriate intervention
-Age 18: full health appraisal
Repeat history/physical every 2 years
Screenings: BSE, testicular exam, PAP smear
--P.E. includes, height, weight, BMI, blood pressure, blood
tests, counseling on avoidance of inactivity and obesity
-Over age 25: focus on coronary risk factors
--Cholesterol, diabetes, smoking, hypertension,
metabolic syndrome, heart disease, chest pain
- No known risk factors: screen every five years at
age 35 for men and 45 for women

Metabolic Syndrome

Cardiovascular risk factors linked to overweight and obesity

Blood Pressure Risks

Hypertension- increase in cardiac output or increases in peripheral resistance or a combination of both and 3rd cause of death worldwide

Goal BP of 120/80, risks increase with age and lifestyle factors

Brain Growth in Adulthood

Continued growth with senses at peak, vision decline in 40s

Advantages of Regular Exercise

Improves fitness, lung capacity, muscle strength, and mental health

Leading Causes of Death (adulthood)

Accidents, AIDS, cancer, heart disease, suicide

Cognitive-Perceptual Patterns (adulthood)

Visual acuity peaks at 20, declines at 40; hearing best at 20

Stress

Body's reaction to threatening or challenging events

Stages of Stress Response

Mobilization: Stage One. All bodily activity is increased in response to a stressor; hr increases, rapid breathing, sweating

Exhaustion or consuming energy: Stage Two Body begins to release stored sugars and fats using up bodily resources; tiredness, fatigue, anxiety, acute illness, cold/flu

Draining energy stores: Stage Three. If a stressful situation isn't resolved, may become chronically stressed. The body's energy resources exceed its ability to produce them; heart disease, ulcers, mental illness, insomnia

Reducing Stress/ Preventing stress

Through breathing exercises, stretching, walking, and sleep (reducing)
Make decisions, avoid procrastination, delegate tasks (preventing)

Task-oriented Stress Management

Dealing directly with stressful situations through actions

Emotion-oriented Stress Management

Dealing with feelings and seeking social support

Distraction-oriented Stress Management

Using activities to divert attention from stressors

3 stages of sleep disorders

Lack of sleep, disturbed sleep and too much sleep

The 5 Sleep Stages

Stage 1: Light sleep, muscles begin to relax and a person can easily be awakened
Stage 2: Brain activity slowing slows down & and eye movement stops
Stages 3 & 4: Deep sleep, all eye movement end, and muscle movement ceases
Stage 5: REM dreaming, when people dream

Secondary sexual characteristics

Nonreproductive traits
such as breast and hips in girls
Facial hair and deepening of voice in boys
Pubic hair and hair in armpits for boys and girls

Estrogen effect on a woman's body

Heart protection, cholesterol reduction, ovary production, uterus preparation, brain adjustments, breast growth, skin youthfulness, and bone strengthening

Changes in girls during puberty

Widening of hips and thighs, pubic hair growth, visual sexual maturity indicators, pheromone secretion, and breast development

Tanner Staging

Assessment of pubic hair growth and breast development in females, and hormone effects on males
The pituitary gland increases FH and LH to increase sperm production

Testosterone effects

Muscle strength increase, liver protein synthesis, fat mass decrease, bone growth stimulation, brain functions, skin changes, and male sexual organ development

Physical development during puberty ( both genders)

Height and weight gains, secondary sex characteristics development, and ongoing brain growth

Physical development (adolescence)

Rapid gains in height and weight
Development of secondary sex characteristics
Continued brain development

Physical Growth by age 18

Height spurt lasting 24-36 months, completion at 16-17 for girls and 18-20 for boys, adult-like vital signs

Neurologic system changes

Brain restructuring with neuron proliferation, gray matter increase, synapse formation, and myelin coat accumulation

White matter in the brain

Increases up to age 40, enhances information processing speed and problem-solving abilities (not uniformly)

Midbrain reward systems

Influence of romantic love, addictive substances, hypersensitivity to new experiences, brain maturation until age 24

Pruning starts at the back of the brain and moves to the front

Physical coordination→motivation→emotion→judgment

Implications for arrested development

Physical vs. cognitive development disparities leading to behavior consequences like risk-taking and impulsivity

Musculoskeletal system changes

45% skeletal growth increase, disproportionate hands and feet growth, muscle group development, posture and coordination issues

System Report

Overview of vital signs, organ systems, and health considerations for adolescents

How do these changes affect teens?

Sleep longer

More clumsy because of growth spurts

Overly sensitive about weight

Develop at different rates

Feel awkward about demonstrating affection to the opposite-sex parent

Ask more direct questions about sex

Freud- Genital Stage

Focus on genitals during 7-year period from 11 to 18 years old

Erikson- Identity vs. Role Confusion

Psychosocial stage questioning identity, future, peer influence, and key developmental issues

Five Psychosocial Issues (Erikson)

Establishing an identity

Establishing autonomy

Establishing intimacy

Becoming comfortable with one’s sexuality

Achievement

Teenage behavioral issues

Rebellion, privacy needs, dishonesty, responsibility, curfews, peer influence, and parental interactions

How do these changes affect teens?

Spend more time with friends than family

More questions about sexuality

Begin to keep a journal

Lock bedroom doors

Become involved in hobbies or clubs

Become argumentative

May not want to be seen with their parents in public

Begin to interact with parents as people

What can you do?

Encourage involvement in multiple groups or activities

Praise teens for their efforts as well as abilities

Help explore career goals and options

Let them establish guidelines and consequences

Establish rituals for making significant passages

Know peer group

Structured environment

Piaget- Formal operations (adolescence)

Abstract, logical thinking independent of immediate circumstances, hallmark (logical and systematic hypothesis testing), and hypothesis testing

Cognitive Development for Teens

Advanced reasoning, abstract thinking, metacognition(ability to think about thinking), and self-consciousness

How do these changes affect teens?

Heightened level of self-consciousness

Tend to believe that no one else has ever experienced similar feelings and emotions

Personal fable beliefs

Very cause-oriented

Exhibit justice orientation

What can you do?

Don't take it personally when teens discount your experience

Get teen involved in discussing their behavioral rules and consequences

Provide opportunities to participate in controlled risky behavior

Opportunities for community service

Talk about their views and be open to discussing your own

Build a genuine relationship with teen

Nutritional problems

Undernutrition, deficiencies in iron, iodine, vitamin A, calcium, and obesity

Common health problems

Acne, STDs, HIV, unwanted pregnancy, chronic diseases, and behavioral disorders

Take home for parents

P= promote activities that capitalize on strengths of the developing brain
A= assist your child with challenges that require planning
R= reinforce their seeking advice from you and other adults
E= educate about risking taking and negative consequences
N= never underestimate alcohol's effects on the developing brain
T= tolerate the "oops" behavior due to an immature brain

Latency (childhood)

Freud's stage where sexual drive is dormant

Industry vs Inferiority (childhood)

Erikson's stage focusing on achievement and avoiding comparisons
"I am what I can achieve"

Cognitive Development ( childhood)

Cognitive actions that can be performed on objects or ideas that consistently yield

Beginnings of Adult Logic

Begin to understand events interpreted in different ways

Developed reversibility and flexibility in thinking

Less egocentrism

Engaging in decentration

Understanding conversation, transitivity, class inclusion

Concrete Operations

Development of mental operations on objects or ideas

Selective Attention

Ability to focus on important information and ignore irrelevant

Organization

grouping of items to be remembered into groups or clusters of information

Memory

to pay attention to a task and build to remember that memory

Metamemory

Intuitive understanding of how memory works

Metalinguistic Awareness

Ability to think about language itself

Understanding metaphors

Not every word is absolute in its meaning

Communicative competence

the ability to think about what one is being told and judge whether the message is clear

Humor

Play on words, puns, jokes that have double meanings

Syntax

Grammar rules and word connections understanding

Growth Patterns

Body weight doubles
Spends much energy on physical activity and play
Eat much more than preschoolers
2-2.5 in year
4-7 pounds per year
Lean, with narrow hips and shoulders
Decrease in baby fat
Males- more muscle
Females-more adipose
Growing pains

Gross Motor Skills

By 6: hopping, jumping
6-7: climbing, pedaling, balancing on a bike
8-10: better balance, coordination and strength

Fine Motor Skills

By 6-7: tie shoes, hold a pencil as adults, fasten buttons, brush teeth, wash themselves, coordinate a knife and fork, skill at using chopsticks improves

Neuromuscular Development

Brain activity, glucose metabolism, brain size changes

Hemispheric Specialization

Efficiency in language, logic, memory, and spatial knowledge
Makes brain more efficient

Prefrontal Cortex

Improved emotional control and routine response