Interprofessional work settings and aging

Etiologies: pathophysiology

• Acute onset

  • Focal (one area of the brain)

  • Diffuse (spread out in many parts of the brain)

• Progressive/degenerative

Etiologies: location

• Bilateral

• Left hemisphere (aphasia)

• Right hemisphere

• Subcortical

What are priorities in acute care? In order of most to least important?

• Medical stability

• Emotional support

• Physical limitations (e.g., swallowing and feeding)

• Communicative and cognitive limitations

• SLPs

  • Screening/bedside testing

  • Counseling and family education

What are priorities in in-patient and day rehabilitation? In order of most to least important?

• Communicative and cognitive limitations

• Physical limitations (e.g., with ADLs, accessibility)

• Functional independence

• Psychosocial and emotional support

What are priorities in skilled nursing? In order of most to least important?

• Medical status

• Physical limitations

• Communicative and cognitive limitations

• Functional independence

What are priorities in home and community re-entry? In order of most to least important?

• Psychosocial and emotional support

• Financial vocational issues

• Functional independence

• Communicative and cognitive limitations

Peripheral changes in aging

1. Hearing presbycusis (especailly in high frequencies)

2. Reading/vision presbyopia (also careracts, loss of peripheral vision

What did the Nun study find?

High idea density and grammatical complexity → lower risk of cognitive impairment

Components of a screener for healthy aging

• MOCA (used to be Mini-Mental State Exam, no longer)

• Delayed Word Recall (0-10 range)

• Basic activities of daily living (0-5 range, feeding, dressing, standing)

• Instrumental activities of daily living (e.g., 0-5 range, reading, using telephone, handling money)

• Self-rated function

Cognitive reserve

• The presence of brain pathology in good/very good levels of aging

• It is compensation for biological aging

• The brain’s ability to improvise, adapt and recruit alternative neural pathways to maintain function despite aging, stress, injury, or neurodegenerative disease

• Influenced by modifiable lifestyle factors and non-modifiable factors

What is word recognition in older adults impacted by?

• Hearing loss

• Reduced temporal processing ability (speaking rate, consonant transitions)

• Filter out background nouns in adverse listening conditions

What strategies to older adults have greater reliance on to counter peripheral difficulties?

Top-down strategies

What is happening with the myelin sheath with age?

Myelin sheath increases with age and completes in one’s late 20s, but then there is a decline causing reduced processing speed.

Lexical knowledge/vocabulary ___ with age

Increases

When do most changes in word retrieval occur?

Only after 70 years, subtle changes begin by 50 years

What is the decline of word retrieval per decade?

2% or 1.3 words per decade

What is tip of the tongue state (TOT)?

Semantic information is more accessible than phonological information, more common for proper names, words with low neighborhood frequency.

What are less common errors concerning word retrieval?

Slips of the tongue, circumlocutions

Processing speed versus verbal fluency in older adults

Processing speed slower, verbal fluency remains the same compared to younger adults

Overall comprehension of simple sentences with appropriate context is ____ to younger adults

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