AOP Older Adults I: Midterm Exam

demographics of aging

population of older adults is increasing rapidly around the world

reductions in infant mortality

reductions in death from infectious disease

improved healthcare

definitions of old age and the experience of aging have changed over time as societies have changed

defining old age

defined in the context of life expectancy

in modern times, life expectancy has increased to late 70s/early 80s

positive aging

incorporates ideas of successful aging, aging well, and optimal aging

includes both objective (ability to complete ADLs and number of chronic conditions) and subjective (satisfaction with current activities and sense of social support) factors

important population trends for older adults

the absolute number and percentage of elders worldwide is increasing

the change in demographic structure will result in a more "rectangular" population structure

social and behavioral determinants of health in aging

low education

poverty (socioeconomic status)

food insecurity

depression

tobacco/alcohol use

low physical activity

lack of social connection

genetics

personality traits

coping skills

beliefs and expectations

adaptability/emotional regulation

impact of gender on aging

differences in life expectancy (women live longer)

differential rates of disease/disability (women more likely to be frail)

differences in career/work trajectories (women more likely to live in poverty)

differences in roles and expectations (men more likely to struggle with absence of work role)

place of residence impact on aging

aging in place

migration

homelessness

institutionalization

characteristics of neighborhood impact on aging

transportation

safety

rural community impact on aging

social support

difficult access to services

urban community impact on aging

tend to be lower SES but closer to resources and transportation

suburban community impact on aging

higher SES but some difficulty with transportation

sociocultural environment impact on aging

societal beliefs

cultural beliefs and aging

public policy (financial supports, access to care, and financing care)

8 dimensions of wellness

physical

intellectual

emotional

social

spiritual

vocational

financial

environmental

physical dimension of wellness

caring for your body to stay healthy now and in the future

intellectual dimension of wellness

maintaining curiosity about all there is to learn, valuing lifelong learning, and responding positively to intellectual changes

expanding knowledge and skills while discovering the potential for sharing your gifts with others

emotional dimension of wellness

understanding and respecting your feelings, values, and attitudes

appreciating the feelings of others

managing your emotions in a constructive way

feeling positive and enthusiastic about your life

social dimension of wellness

maintaining healthy relationships, enjoying being with others, developing friendships, and intimate relations

caring about others and letting others care about you

contributing to your community

spiritual dimension of wellness

finding purpose, value, and meaning in your life with or without organized religion

participating in activities that are consistent with your values and beliefs

vocational dimension of wellness

preparing for and participating in work that provides personal satisfaction and life enrichment that is consistent with your values, goals, and lifestyle

contributing your unique gifts, skills, and talents to work that is personally meaningful and rewarding

financial dimension of wellness

managing your resources to live within your means, making informed financial decisions and investment, setting realistic goals, and preparing for short-term and long-term needs or emergencies

being aware that everyone's financial values, needs, and circumstances are unique

environmental dimension of wellness

understanding how your social, natural, and built environments affect your health and wellbeing

demonstrating commitment to a healthy planet

being aware of the unable state of the earth and the effects of your daily habits on the physical environment

stochastic theories

explains aging as a result from the accumulation of "insults" from the environment which eventually reach a level incompatible with life

defect in protein synthesis mechanism, leads to error in proteins

genetic theories

propose that the process of aging is continuous with and probably operating through the same mechanisms as development and hence, is genetically controlled

evolutionary theories

attempt to explain the origin of aging as well as the divergence of species' life span

psychological theories

life-span development

selective optimization with compensation

socioemotional selectivity

cognition and aging

personality and aging

neuropsychological theories of typical age-related change

based on the principle that neural structures and related abilities laid down last should be the most vulnerable to processes of aging

neuropsychological theories of neurodegenerative change

age-linked neuropathological changes of the brain that produce observable degenerative deficits in cognitive functioning

life-span development theory

conceptualizes ontogenetic development as biologically and socially constituted and as manifesting both developmental universals and interindividual variability

three principles regulating the dynamics between biology and culture across the ontogenetic life span

evolutionary selection benefits decrease with age

the need for culture increases with age

the efficacy of culture decreases

socioemotional selectivity theory

combines insight from developmental psychology particularly the selective optimization with compensation mode

chosen interactions reflect the levels of reward these exchanges of emotional support achieve

individuals reduce interactions with some people as they age and increase emotional closeness with significant others

selective optimization with compensation (SOC)

selection refers to the increasing restriction of an individual's life to fewer domains of functioning because of age-related loss in the range of adaptive potential

optimization reflects the idea that people engage in behaviors that augment or enrich their general reserves and maximize their chosen life courses

compensations result from restriction of the range of adaptive potential and becomes operative when specific behavioral capacities are lost or are reduced

systems theory of motor control

motor movement can only be understood as an interaction of internal and external forces acting on the body

ICF domains

body function

body structures

abnormalities of function

activity

participation

loneliness

a subjective feeling of being isolated

social isolation

the objective state of having few social relationships or infrequent social contact with others

informed consent

respect for a client's autonomy by allowing the client to be the master of their own course of intervention and provides control in what the client may experience as an upsetting out of control situation

considerations: health literacy and cognition

standard of care

acceptable and appropriate care that an occupational therapist provides for a client's condition

medicare

largest single payer of health care services in the US

eligibility: 65, U.S citizen or permanent resident for 10 years, paid medicare taxes for at least 40 years or permanently disabled

medicare part A

hospitalization

skilled nursing home care

home health care

hospice

medicare part B

physician and other health provider

medicare part C

medicare advantage plans

medicare part D

prescription medication

Medicare part A coverage

hospital benefits cover acute illnesses, diseases, or surgical care typically for just a few days

hospital and SNF benefits include room and board and medically necessary professional services such as therapy services

SNF covered for up to 100 days for rehab

hospice care covered completely

co-pays and other out of pocket expenses are part of the plan

Medicare part B coverage

diagnostic, therapeutic, and preventive medical services; health related professional services, DME, prosthetics, and orthotics

beneficiaries pay roughly 25% of cost

covers the cost of independent OTs

Medicaid

joint federal-state program

individuals need to satisfy federal and state requirements regarding residency, immigration status, or U.S citizenship

long-term coverage is available only to those who have no financial resource

Jimmo vs Sebelius (2013)

changed eligibility for Medicare services

previously, progress/improvement was required for SNF and home health

findings in this action changes this so that functional maintenance and delayed decline as outcomes are covered

Older Americans Act (1965)

covers a variety of community services for older adults

established Area Agencies on Aging, senior meals programs, and others

must be reauthorized every 5 years

The Age Discrimination in Employment Act (ADEA)

1967

prohibits discrimination against people 40 years and older by labor organizations, employers with at least 20 employees, the federal government, and employment agencies

The Age Discrimination Act of 1975

prohibits age discrimination in programs receiving federal assistance and applies to all ages

advocacy strategies

engaging and mobilizing the public

coalition building

engaging decision makers

information campaigns

reform efforts

policy monitoring

meaningful occupations for older adults

associated with better physical and emotional health, greater life satisfaction, subjective well-being, longer life, positive aging

a challenge in later life because of reduction in expected roles

OT interventions to emphasize meaning

wellness

meaningful occupation

reminiscence

life review

spirituality

promote mental health, social function, functional status, and physical functioning support meaning

factors influencing aging

genetics

environmental factors and exposure

injuries

personalities and attitudes

lifestyle

advances in medicine

central nervous system changes

cerebral atrophy

reduced cerebral blood flow

plaque deposits and neurofibrillary tangles

peripheral nervous system changes

changes in peripheral receptors

slower nerve conduction and velocities

musculoskeletal changes

decrease in strength and mass of muscles

loss of skeletal mass in bones

joints are more prone to injury

integumentary system changes

skin thinning, atrophy, wrinkling, and age spots

glands decrease in number and sebaceous and sweat glands

nails thicken

hair graying, thinning, and loss

cardiovascular changes

structural changes to the heart

changes in electrical conduction system

decrease in maximal heart rate

changes in blood vessels

vascular system changes

vessels thicken and become less elastic

atherosclerotic narrowing, reduced blood flow, and arterial occlusion

respiratory system changes

pulmonary functioning decline

less efficient breathing

problems with ventilation and gas exchange

decreased capacity to cough

digestive systems changes

oral structural changes

changes in ability to break down substances

endocrine system changes

thyroid function changes

male sexual function changes

testosterone level decrease

prostate enlargement

decreased sperm production and ejaculatory force

female sexual function changes

vaginal dryness

changes in shape and muscle tone

thinning of vaginal wall

reduce size of clitoris

attention changes

may be more distractable

complex attention tasks more difficult

language changes

word finding problems common

executive function changes

decreased processing speed

some increased difficulty with complex multi-step tasks

memory changes

semantic, procedural, long term memory intact

changes in short term memory (decrease over time)

prospective decreased but often compensate

somatosensory changes

decline in sensitivity to tactile stimuli

temperature sensitivity

alterations in kinesthetic sensitivity

alterations in peripheral nervous system

increase risk of injury and diminished fine motor skills

visual changes

reduced visual acuity

decreased ability to accommodate/focus

decreased ability to adjust to changes in illumination

decreased resistance to glare

changes in color sensitivity

presbyopia

decreased tissue elasticity and tone in the eye

trouble focusing on near objects

presbycusis

age-related hearing loss

hearing loss

difficulty hearing high frequencies

diminished ability for pitch/tone threshold

most age-related hearing loss is sensorineural

interferes with ability to interact with environment (diminished speech reception, discrimination, and understanding)

vestibular system changes

loss of receptor organs and structures

increased postural sway, wide based gait

unsteadiness in standing/walking

alterations in righting and equilibrium

presbyastatis

age related disequilibrium

taste changes

overall decrease in taste perception

decreased sensitivity to sweet substances

atrophy of neurons in taste centers

mild dysguesia

decreased saliva flow

due to medication, dental problems and conditions

decreased number of papillae and taste buds on tongue

olfactory system changes

decline in threshold sensitivity for odors

due to changes in CNS ability to detect smell, nerve damage, and changes in nasal passages and membranes

geriatric syndrome

used to capture conditions in older adults that do not fit into discrete disease categories

impact quality of life

multiple underlying factors including multiple organ systems contribute to syndrome

risk factors for geriatric syndromes

frailty

incontinence

falls

dementia

malnutrition

functional decline

need for assessment in later life

changes in health status

increasing prevalence of chronic conditions

may lead to increasing difficulties in performing the daily activities of self-care, household maintenance, community activities, voluntary/work pursuits, and recreation

purpose of screening

identify older adults who may need further evaluation, intervention, or both

important that these are easy to do, take little time, and accurately identify those who require further evaluation for intervention

descriptive evaluation

focus on gathering information to describe characteristics of individuals and enable differentiation between persons on the specific characteristic that is being measured

identify issues that merit intervention; to determine specific problems in the areas of impairment, activity limitation, and participation restriction; and to help determine the need for therapeutic services

predictive assessment

include items related to a specific

characteristic in order to forecast another trait.

items on a predictive measure are included if they describe the characteristic of interest and

predict the trait or criterion of interest now or in the future

outcome evaluation

to ascertain how a particular intervention has affected the individual

considerations for choosing assessment tools

reliability

validity

responsiveness

performance based vs patient reported outcomes

standardized vs functional

complex vs simple

global vs multidimensional

generic vs diagnosis specific

time to implement

training and certification

cost

computer admin vs paper-pencil

fixed versus computer adaptive testing

important areas of functional performance that should be assessed in older adults

exercise capacity and tolerance

functional mobility

a person's usual or actual performance of mobility

overall functioning and disability

performance difficulties in self-care, productivity, and leisure areas

roles that are important sources of activity for older adults

ADL and IADL

home safety

cognition

multiple domains of physical function using observed performance of tasks

factors, specifically related to older adults, that affect functional performance and need to be considered in assessment

sensory changes

fatigue

cognition

education

caregiver support

cultural congruence

risk factors for falls

intrinsic (internal to the older adults such as medical conditions)

extrinsic (external, such as the environment and would include slippery floors)

modifiable or nonmodifiable

age-related/biological

behavioral/cognitive

environmental

community and policy

definition of a fall

a subject unintentionally coming to rest on the ground or on some other lower level, not as a result of major intrinsic event such as a stroke, syncope, or overwhelming hazard that would result in a fall by most young healthy persons

effects of a fall

1/4 of falls result in injury

many people never fully recover premorbid functional status

morbidity and mortality

bruises, confusions, lacerations

sprains

fractures

poorer overall functioning and early admission to long-term care facilities

fear of falling relevance

results in anxiety and restricted activity, poor quality of life

can result in deconditioning and increased fall risk

can occur in people who have fallen, but also those who have not

primary risk factors for falling

balance abnormalities

visual disorders

cardiovascular disease

cognitive impairment

muscular weakness

gait abnormalities

osteoporosis

alcohol

environmental hazards

precautions when assessing older adults

caution regarding osteoporosis and potential for fracture

concern about standing endurance/balance

avoid valsalva maneuver because of possible cardiovascular problems

extrinsic fall prevention strategies

optimize illumination/lighting

floor surfaces (non-trip, slip, and glare)

circulation pathways (adequate space for assistive devices)

furnishings/cabinets (height, need for step stool, and rearrange cabinets)

ambulatory aide transportation

phone access

toilet/commode/urinal access

stairways (railings/treads)

exterior surfaces

environmental interventions to prevent falls

assess community risks (uneven sidewalks)

work to remediate these risks

contingency strategies for falls

instruct in falling and rising

wear hip protectors

wear alarm device/alert pendant or carry cell phone

fear of falling interventions

improve balance

improve muscle strength

eliminate environmental hazards using a room-by-room checklist

education and counseling

behavioral modification

support systems

encourage assertiveness

teach client to problem solve

create emergency plan

intrinsic strategies for fall prevention

address medical conditions

restore/remediate (strength, flexibility, and balance)

modify (footwear and ambulatory devices)

promote (metacognition to decrease risk and address falling fear)