Sir M

midterm aging, chronic illness, gordon

The group of effects that lead to a decreasing expectation of life with increasing age

Senescence

all postmaturational changes and the increasing vulnerability individuals face as a result of these changes

Senescence

At age 75, the average person, compared to age 30:

l__% of brain weight

l__% of basal metabolism

l__% kidney filtration rate

l__% of maximul breathing capacity

92 brain

84 metabolism

70 kidney

43 breathing

ultimate indicator of age (Kart & Kinney)

skin

Loss of subcutaneous fat

Wrinkling

less _____ of body to cold (also affected by diminished blood flow to skin & extremities) & heat

insulation

remaining pigment cells enlarge

age spots

_____ & allied bone and muscular conditions are among the most common of all disorders afffecting people 65 years of age and over.

Arthritis

A generic term that refers to an inflammation or degenerative change in a joint

Occurs world wide & is one of the oldest known diseases

Arthritis

A gradual wearing away of joint cartilage that results in the exposure of rough underlying bone ends

“degenerative joint disease”

Osteoarthritis

–A chronic, systemic, inflammatory disease of connective tissue

–2-3 times more common among women than men

–“autoimmune disease”

–may occur at any age -- most common onset between 20 & 50

Rheumatoid Arthritis

Gradual loss of bone that reduces skeltal mass without disrupting the proportions of minerals & organic materials

bones involved: vertebra, wrist, hip

Osteopenia --> Osteoporosis

–Loss of muscle mass that occurs with aging

–Cause not completely understood

–Preventable/reversible with regular physical activity

Sarcopenia

The phenomenon of ____ is common in the GI

referral

–Systolic stabilizes at about age __

–Diastolic stabilizes at about __ then may gradually decline

systolic 75

diastolic 65

The bladder of an elderly person has a capacity of less than half _____ml

250ml

delayed-- usually activated when bladder is half full; in OAs, not until bladder is nearly  at capacity

Micturation reflex

Study of all aspects of aging and its consequences

Gerontology

when older adults are stereotyped

ageism

specialized nursing with knowledge of illness and health of the aging

Gerontologic nursing

•Young Old __-__

•Middle Old __-__

•Old Old __  & older

young 60-74

middle 75-84

old 85

life expectancy of women __

life expectancy of men __

women 81

men 75.2

Study of health among populations

epidemiology

•_____

–Health promotion

•_______

–Early diagnosis and prompt treatment

•_____

–Restoration and rehabilitation

primary

secondary

tertiary

Two of the three leading causes of death

heart disease & stroke

biological aging is the change in the biology of an organism as it ages after its maturity

Senescence

Modifiable changes that can be slowed

plastic

Progressive body system deterioration

Senescence

–Maintenance of body equilibrium

homeostasis

•refers to the body's ability to physiologically regulate its inner environment to ensure its stability in response to fluctuations in the outside environment and the weather

–Inability of body to restore homeostasis after environmental changes

Homeostenosis

§Hypothesize that the body’s genetic codes contain instructions for regulation of cellular reproduction and death

Programmed theories

§Hypothesize that environmental assaults and the body’s constant need to make energy and fuel metabolic activities cause toxic by- products

error theories

–Coping or adaptive strategies must occur for a person to age successfully.

Psychological aging theories

–Focus on roles and relationships that occur later in life

Sociological aging theories

Created by Congress in 1974

National Institute on Aging

study, diagnose, and treat disease

past focus

improvement of health holistically

current focus

Systolic/diastolic blood pressures tend to increase: 120/80mmHg -> _____mmHg

130/90mmHg

Systolic/diastolic blood pressures tend to increase: 120/80mmHg -> 130/90mmHg

Reduced maximum oxygen  consumption.

Decreases by __, __% reduction by 65 yrs

30,40%

Complex diseases with a common origin

Blood vessel disfunction

plaques, deposits on the inner surface of arteries.

Atherosclerosis

Injury to the endothelium is the primary event

Endothelial Dysfunction

Decrease in plasminogen activators, heparan sulphate, prostacyclin

Impair endothelial protection

•Caused by: aging changes of the vessels, atherosclerosis, arteriosclerosis, high sodium.

•Effects: heart attack, heart failure, kidney damage, blood vessel rupture (hemorrhage stroke).

hypertension

•Involved in disorders like Alzheimer’s, Huntington’s, Parkinson’s.

•Also involved in neuromuscular diseases like ALS or Lou Gehrig’s disease.

Neurodegeneration

Rate of conduction along axons declines, due to loss of myelin

Neuronal function decline

•Neurodegenerative disease causing progressive memory & language loss

•Associated with deposition of amyloid protein (APP) in CNS and neurofibrillary tangles (NFTs). NFTs associated with mutations to Tau proteins that stabilize microtubules.

•Mutations to PS-1 and PS-2 (presenelin genes) give rise to early onset disease.

•Mutation to apolipoprotein E gives rise to late onset.

Alzheimer’s Disease

§The first true geriatric nurse

§Nurse superintendent comparable to our current nursing homes

Florence Nightingale

1956 speech at the annual conference of the SNA in London

Doreen Norton

First geriatric textbook published

1950

First geriatric nursing study published

1952

ANA recommends specialty group for geriatric nurses

1961

Duke opens first Master’s CNS program

1966

ANA Standards or Practice

1970

First certification exam

1973

Journal of Gero Nursing by Slack, Inc.

1975

First national gero nursing conference

1979

ANA scope of practice

1981

NGNA established

(National Gerontological Nursing Association)

1984

First PhD program

1988

NICHE established at NYU

1992

John A. Harford Foundation Institute of Geriatric Nursing established at NYU

1996

ANA  certification available for APNs

1998

a formal process by which a certifying agency validates a nurse’s knowledge, skills, and competencies through a written exam in a specialty area of practice

Nurse certification

§5^th leading cause of death among black men

§4^th leading cause among Hispanic men

§4^th leading cause of death for Hispanic and black women 65 or older

§6^th among white men and men of Asian or Pacific Islander origin

§7^th leading cause of death for white women 65 or older

Diabetes

Military pensions were initiated by Teddy Roosevelt

1861

Franklin Roosevelt signed social security act that provided income assistance to elderly

1935

Medicare and Medicaid law signed by President Johnson

1965

describes how changing roles, relationships, and status within a culture or society impact the older adult’s ability to adapt

sociological

central theme that remaining active in old age is desirable

activity theory

characterized by gradual withdrawal from society and relationships

disengagement theory

aging caused by effects of free radicals

free radical theory

cumulative changes occurring in cells age and damage cellular metabolism

wear & tear theory

Data collected about the health status of the older adult are systematically and continuously. The data are accessible, communicated and recorded.

Standard I

Nursing diagnoses are derived from the identified normal responses of the individual to ageing and the data collected about the health status of the older adult.

Standard II

A plan of nursing care is developed in conjunction with the older adult and/or significant others, that includes goals derived from the nursing diagnosis.

Standard III

The plan of nursing care includes priorities and prescribed nursing approaches, and measures to achieve the goals derived from the nursing diagnosis.

Standard IV

The plan of care is implemented, using appropriate nursing actions.

Standard V

The older adult and/or significant other(s) participate in determining the process attained in the achievement of established goals.

Standard VI

The older adult and/or significant others participate in the ongoing process of assessment, the setting of new goals, the reordering of priorities, the revision of plans for nursing care, and the initiation of new nursing actions.

Standard VII

A long-lasting illness

chronic illness

•Principal cause of death among o.a.’s

•Accounts for significant morbidity, disablement & inactivity among o.a.’s

•Dominant factor--atherosclerosis (build-up of fatty deposits within arterial walls)

heart disease

denial of adequate blood supply

ischemia

persistence of deficient blood supply, tissue dies

myocardial infarction

persistence of deficient blood supply, tissue dies

cardiac arrest

•sudden blockage of coronary artery with a blood clot

coronary thrombosis

2nd leading cause of death in U.S

cancer

Main cause of stroke in o.a.’s

Occurs when a formed clot becomes lodges in an already narrowed artery

cerebral thrombosis

Warning signs of an impending stroke

“mini strokes”

transient ischemic attacks

•Thrombus forms elsewhere in the body and travels to obstruct a vessel supplying the brain

cerebral embolism

•Impaired ability to comprehend or express verbal language

aphasia

–A person understands what is said but cannot form the words or gestures to respond to stimuli

–May be incorrectly associated with mental deterioration

expressive aphasia

–difficulty in processing external stimuli; 

–may not understand other’s speech or what is read

–familiar objects may become unrecognizable

receptive aphasia

an assessment gives nurses insight into a patient's physical status through observation, the measurement of vital signs and self-reported symptoms.

•It includes a medical history, a general survey and a complete physical examination

comprehensive health assessment

an assessment collects relevant information pertaining to the current condition of the patient after a change or new symptom develops

focused assessment

This assessment is performed during transport on all patients

ongoing assessment

an assessment where a nurse is focused on rapidly identifying the root causes of concern for the patient and assessing the airway, breathing and circulation (ABCs) of the patient. Once the ABCs are stabilized, the emergency assessment may turn into an initial or focused assessment, depending on the situation

emergency assessment