Geriatrics Flashcards

Flashcards on Geriatrics, covering developmental theories, physiological changes, health maintenance, adjustments with aging, delirium, dementia, depression, and Alzheimer's.

Gerontology

The study of the normal effects of aging and age-related diseases on the human body.

Young Old

65 to 74 years old

Old

75 to 90 years old

Very Old

90+ years old

Eric Erickson's Theory

Each stage is marked by a conflict, for which successful resolution will result in a favorable outcome, sometimes known as virtues.

Trust vs. Mistrust Favorable Outcome

Faith in the environment and future events

Trust vs. Mistrust Unfavorable Outcome

Suspicion, fear of future events

Autonomy vs. Doubt Favorable Outcome

A sense of self-control and adequacy

Autonomy vs. Doubt Unfavorable Outcome

Feelings of shame and self-doubt

Initiative vs. Guilt Favorable Outcome

Ability to be a self-starter to initiate one's own activities

Initiative vs. Guilt Unfavorable Outcome

A sense of guilt and inadequacy to be on one's own

Industry vs. Inferiority Favorable Outcome

Ability to learn how things work to understand and organize

Industry vs. Inferiority Unfavorable Outcome

A sense of inferiority at understanding and organizing

Identity vs. Confusion Favorable Outcome

Seeing oneself as a unique and integrated person

Identity vs. Confusion Unfavorable Outcome

Confusion over who and what one really is

Intimacy vs. Isolation Favorable Outcome

Ability to make commitments to others, to love

Intimacy vs. Isolation Unfavorable Outcome

Inability to form affectionate relationships

Generativity vs. Self-Absorption Favorable Outcome

Concern for family and society in general

Generativity vs. Self-Absorption Unfavorable Outcome

Concern only for self-one's own well-being and prosperity

Integrity vs. Despair Favorable Outcome

A sense of integrity and fulfillment; willingness to face death

Integrity vs. Despair Unfavorable Outcome

Dissatisfaction with life; despair over prospect of death

Robert J. Havighurst's Most Famous Book

Human Development and Education

Three Sources for Developmental Tasks

Tasks that arise from physical maturation, tasks that arise from personal values, and tasks that have their source in the pressures of society

Six Major Stages in Human Life

Infancy & Early Childhood (birth till 6 years old), Middle Childhood (6 – 12 years old), Adolescence (13 – 18 years old), Early Adulthood (19 – 29 years old), Middle Age (30 – 59 years old), Later Maturity (60 years old and over)

Havighurst's Developmental Tasks of Later Life

Adjusting to decreased physical strength and health; Adjusting to retirement and reduced income; Establishing an explicit affiliation with one’s age group; Adjusting to the death of a spouse; Adopting and adapting social roles in a flexible way; Establishing satisfactory physical living arrangements

Clockwork Theory or Programmed Aging Theory

Connective tissues have an internal clock that genetically program the length of one's life

Free-Radical Theory or Somatic Mutation Theory

Free radicals in the atmosphere cause breakdown in the aging process

Wear-and-Tear (stress theory & cross-linkage or collagen theory)

After repeated injury cells wear out and cease to function

Immune-System Failure Theory

A decline in the immune functions of the body causes the body to slow

Autoimmune Theory

Results from the weakening of the immune system not recognizing the body’s own tissues and destroying itself

Disengagement Theory

Individual and society gradually withdraw from each other

Activity Theory

Age-related changes which decrease activity must be replaced

Continuity-Developmental Theory

Personality and coping remain constant with aging. Aging is seen as a part of the life cycle, not as a separate terminal stage.

Physical Changes with Aging - Height and Weight

Adults lose 1 cm per decade in height after the age of 30, decrease in shoulder width due to muscle mass loss, head circumference decreases and the nose and ears lengthen, body weight decreases slowly after age 55

Musculoskeletal System Changes with Aging

Loss of bone mass, postural changes, decreased height, decreased muscle mass and strength, ligaments and tendons are less elastic, pronounced stiffness and diminished range of motion following periods of disuse

Cardiovascular System Changes with Aging

Cardiac output decreases - 1% per year between ages 20 and 80 from loss of cardiac muscle strength, slower heart rate, heart valves become thicker and more rigid, vessels lose elasticity

Respiratory System Changes with Aging

Pulmonary elasticity and ciliary action decrease, alveoli decrease in number and increase in size, increased rigidity of chest wall, decreased cough efficiency

Gastrointestinal System Changes with Aging

Saliva decreases, diminished gag reflex, decreased peristalsis, decreased gastric secretions

Genitourinary System Changes - Women

After menopause the ovaries, uterus, and fallopian tubes atrophy, vaginal walls become thin and less elastic, lubrication and vaginal secretions decrease

Genitourinary System Changes - Men

Gradual decline in testicular mass, longer time achieving an erection, less semen is released at ejaculation

Integumentary System Changes with Aging

Loss of skin elasticity, skin becomes thinner, drier, and more fragile, circulatory changes delay wound healing, decrease in the number and function of the sweat glands

Nail and Hair Changes with Aging

Nail growth slows and nails become brittle, dull and yellow. Toenails become thicker. Hair grey

Neurological System Changes with Aging

Neurons decrease, brain weight peaks at age 2-25, decreased cerebral blood flow, slowed motor response, slowed reaction time

Sensory System Changes with Aging

All senses become less effective as we age

Presbyopia

a natural age-related decline in the eye's ability to focus sharply on close objects.

Cataracts

opacity (clouding) of the lens

Presbycusis

age-related hearing loss

Normal Aging of Dentition

Natural signs of wear and tear, loss of enamel , lengthening of the tooth, decreased ability to cut and chew efficiently

Endocrine System Changes with Aging

Secretory cells are replaced with connective tissue, decreasing hormone levels

Health Maintenance Concerns for the Elderly

Regular checkups and screenings should be maintained even more as we age to ensure homeostasis.

Physical Exams

Every 3 years to age 40, every year from age 40, or as instructed by your pcp

Breast Cancer Screening (Women)

Yearly mammogram at 40

Cervical Cancer Screening (Women)

Pelvic exam with a PAP every 3 years

Prostate Screening (Men)

PSA test yearly, Digital rectal exam early (begin at age 45 if African- American or family hx of prostate cancer)

Colorectal Cancer Screening (Men and Women)

Fecal occult blood test yearly, Sigmoidoscopy or colonoscopy every 3-5 years

Bone Density Screening

Those at risk: postmenopausal women, maternal hx of hip fx, fx after age 50, tall height at age 25. Begin usual testing at age 65

Vision Screening

Yearly exam with glaucoma screening

TD Immunization

booster every 10 years, 5-7 years if injured should have had ONE booster of Tdap

Influenza Immunization

1 dose yearly “high dose vaccine”(contains 4x the antigen as the regular flu shot), results in a higher immune response

Pneumococcal Polysaccharide Vaccine (PPV)

1 dose

Zoster Immunization

Recommends two doses of Shingrix separated by 2 to 6 months for immunocompetent adults age 50 years and older. Whether or not they report a prior dose of Zostavax

Prevention in the Elderly

Factors that may affect or influence an older person’s health may include: Lifestyle; Changes in body composition; Inflation and fixed incomes; Social Situations (living alone or with others)

Reducing Risk for Osteoporosis

Avoid tobacco, regular exercise, avoid caffeine, limit alcohol, HRT (estrogen), increase Ca intake (with D), maintain a safe environment

Encouraging Exercise for Elderly

What was once accepted as the normal deterioration of old age is now considered disuse

Hygiene for Elderly

Adaptations need to be made to accommodate the aging body.

Aging Changes Affecting Nutrition

Less aware of thirst sensation, increased threshold for sugar and salt, decreased number of taste buds, decreased ability to discern salty, sweet, bitter, decreased peristalsis, gastric secretions, saliva production

Aging changes in Immunity

The thymus begins to shrink after adolescence (the site T cells mature), T cells do not decrease with age. T cell function decreases.

Elderly Response to Infection

Diagnosing the elderly with an infection can be difficult. Classic symptoms such as fever, chills, and vomiting are less likely.

Two Types of Sleep

REM and NREM

Sleep and Rest for Elderly

As one ages, one tends to sleep less than 8 hours per night.

Meet the Individual's Comfort Needs

Warm drinks (milk), Back rubs, Maintain their Routine, Environmental concerns such as room temperature, noise, and lighting, Tend to toileting needs, Reposition, Pain needs

Adjustments Associated With Aging - Work and Leisure

Many older adults continue to work to postpone retirement because the discontinuation of the work role causes a change in lifelong habits.

Adjustments Associated With Aging - Loss of Friends

Older individuals may lose friends because of death while others may find it necessary to move to a new community, giving up old friends and neighbors.

Dementia, Delirium & Depression

Clarification of the differences between dementia, delirium and depression can provide guidance for effective interventions.

Dementia Definition

Dementia refers to the loss of cognitive abilities. Memory loss, disorientation and confusion may be caused by over 70 different diseases.

Delirium Definition

An acute problem which usually inhibits one’s ability to recall where he or she is, time of day or even their name. Short term memory may or may not be intact. Hallucinations or delusions may be present.

Depression Definition

A prolonged feeling of profound sadness and worthlessness.

Differentiating Between Dementia and Delirium

How long has this been going on?, How abruptly did it start?

Nursing Care of the Delirium

Determine the cause, Treat the cause, The sooner this is done the sooner delirium is resolved.

Nursing Care of the Depressed Patient

Therapy, Exercise, Exposure to the sunlight, Improving the diet, Medications

Alzheimer's

Alzheimer's is classified as either early onset and genetically linked or the most common type of Alzheimer's which is not considered genetic.

Signs of Alzheimer's

Poor judgment and decision making, inability to manage a budget, tracking of the date or the season, difficulty having a conversation

Stage 1: Early Alzheimer's

Forgetfulness, often subtle and masked by the client. Indecisiveness, increasing self-centeredness; decreased interest in others, environment, social activities

Stage 2: Middle Alzheimer's

Progressing forgetfulness, inability to remember names of family members or close friends, tendency to lose things, confusion, fearfulness

Stage 3: Late Alzheimer's

Inability to communicate, inability to eat, incontinence (urine and feces), inability to recognize family or friends