Geriatrics-Week 1

successful aging involves both subjective and ______________ factors

objective

successful aging involves ___________ aspects and ________________ factors

biomedical, psychosocial

successful aging biomedical aspects (3)

1. health and ADL

2. Physical function

3. cognitive function

successful aging psychosocial factors (2)

psychologically well adapted, actively engaged in life

true or false: healthy aging, active aging, and productive aging are all factors in aging well

true

true or false: between 2014 and 2060 the number of americans 65 years and older is increasing from 15% to 24% of population

true

Hayflick limit theory

limited cell population doubling, average being 50 per life cycle

evoluntionary theory

each successive generation is more resistant to mutations

stress theory

resistance to stress by the genes

neuroendocrine and hormonal theory

neurons and associated hormones central to aging

theory of intrinsic mutagenesis

specific characteristics of genes that regulate rate of errors

immunological theory

immune system declines w age

free radical theory

damage caused by free radicals

caloric restriction theory

high-nutrient and low-calorie diet is beneficial

error theory

error in making proteins causes multiple effects

redundant DNA theory

errors accumulating in genes

somatic mutation theory

mutations or genetic damage from RADIATION

transcription theory

aging exists in nuclear chromatin theory

cross-linkage theory

large reaction proteins, cross link, responsible for aging

stochastic theories

view aging as the result of random cellular damage that occurs over time (error theory, transcription theory etc. )

sleep and aging theory

prolonged sleep loss affects homeostasis

growth hormone theory

too much GH and not enough insulin

dehydroepiandrosterone theory

failure at adrenal gland exacerbates aging associated loss of neuronal synapses and plasticity

telomere theory

length of telomere is predictive of life span

progress of cell culture theory

dysregulation of nontraumatic and noninflammatory cell death more prevalent in older persons

the genome project

strong relationship between genetic influences and longevity

Werner syndrome

this syndrome causes premature aging, variants of gene influence life span

what are the effects on aging from physical activity

chronic disease prevention, functional status improvement, social outcomes, psychological well being

true or false: our ability to adapt to physiological stressors influence illness and injury

true

physical stress theory (Mueller and Maluf)

changes in the relative level of physical stress cause a predictable adaptive response in biological tissue

CV changes with age what decreases?

decrease max HR, decrease diastolic filling rate, decreased ventricular compliance

CV changes with age what increases?

peripheral resistance

pulmonary changes with age what decreases?

chest wall compliance, elastic recoil, muscle strength, VC, max voluntary ventilation, RV

lung cilia with age

less strong (weaker if you will)

pulmonary changes with age what increases?

calcification of ribs and kyphosis

cartilage with age

deteriorates, decreases hydration, reduced elasticity, increased fibrous growth around bony prominences

muscle changes with age

atrophy of fibers (type 2 especially), decline in alpha motor neurons, decreased max strength, decreased muscle mass

bones: decreased _____________, decreased circulating levels of vitamin ____, decreased bone _____________, and decreased reserve to accelerate production of RBC

calcium, D, strength

true or false: brain mass decreases w age

true

CNS: decline in number/efficiency of ______________, slower ______________ ______________, decreased _____________

neurons, conduction velocity, neurotransmitters

PNS: decreased __________ cells, decreased __________ to nerves

nerve, blood

intersystem homeostasis: hypothalamic thermostat

declines

intersystem homeostasis: BMR

decreases

intersystem homeostasis: reactivity of _________________ system declines

autonomic NS

intersystem homeostasis: vasomotor system less responsive to ______________ and _______________

warming and cooling

intersystem homeostasis: decreased _________________ balance and decreased blood flow to brain

hormonal

true or false: touch receptors and nerve fibers decline w age

true

skin changes with aging (3)

1. dermal thinning

2. decreased elasticity

3. vascularity

sweat glands with age?

number and size of these glands diminish

vision changes with aging

pupil smaller, increase density of lens, diminished tear production, loss of receptors, decrease in muscle tone

hearing: sclerotic changes in ______________ membrane

tympanic

hearing: cochlear _______________

osteosclerosis

hearing: decrease receptors in the _______________

Corti

hearing: degeneration of the _______________ nerve

auditory

true or false: proprioception and kinesthesia are enhanced with age, so Berg will just keeping getting better and better

false

vestibular system: degeneration in the sensory receptors in the _____________ and ______________

otoliths, SCC

______% of taste bud atrophy

80

decreased ______________ production (harder to digest food and taste)

saliva

true or false: decreased cells in olfactory bulb may be a reason behind older adults not knowing if food has gone bad

true

motility of esophagus with age?

decreases

motility in stomach and intestines

decreases

blood supply to the gut?

decreased w age

renal changes with age

decrease mass and weight, protein binding of medications is decreased

true or false: there are prolonged drug effects in the older adult

true

hepatic changes with age

liver mass and perfusion decline, decreases urine-concentrating abilities, decline in extretory/reabsoprtive capacities

urinary changes w age

increase in residual urine, increased reflux into ureters

5 Ms of Geriatrics

1. mind/mentation

2. mobility

3. medication

4. multicomplexity

5. matters most

Mind

communication strategies, seek input from care partners, respect, motivational interviewing, assess barriers to learning

what patient education techniques should you use?

teach back, show me

Mobility

use EBP, fall risk, mental health, geriatric syndromes, appropriate dosing, prevention strategies, screening, annual wellness visits

Medications

consider effects of pharm profile, fall risk, adverse drug reactions

Multicomplexity

osteoporosis, fracture risk, consider effects of organ system changes with age, home body systems influence function, CPGs

Multicomplexity: screen older adults for

cognitive change, functional decline, fall risk, depression, frailty, delirium, polypharmacy, elder abuse

matters most: restraints?

promote restraint-free environment, find alternatives

matters most:

advocate during care transitions, referrals, resources, recommendations, community resources

community resources/programs for:

nutrition, food security, care partner support, social needs

matters most: explain how ageism can negatively affect what 4 things?

mental health, physical health, emotional health, lifespan

Terms central to psychology of patient care

motivation, compliance, engagement, empowerment

visual field accomodation

lower height

visual acuity accomodation

visual aids

vision: glare accomodation

lamp shades, curtains, blinds, non-glare wax, carpeting

vision: dark adaptation

nightlights, pocket flashlight, light switches

vision: color accomodations

bright, warm colors

vision: contrast accomodations

bright detail on dark background

vision: depth perception accomodations

contrasting colors, avoid patterned floors

hearing accomodations

hearing aids, pocket amplifiers, acoustically absorbent window sheers

taste and smell accomodations

spices, check dates on food, adapt smoke detectors, safety spring caps

true or false: when communicating with your patient you should face them, make eye contact, start with name, talk clearly, normal pace, project voice, use visual aids, avoid chewing gum or covering mouth

true!