Chapter 19: Geriatrics!

  • Geriatricians: physicians who specialize in the care of elderly people.

  • Gerontologists: professionals who study the aging process.

  • Social workers, nutritionists, and physical and occupational therapists.

Section 19.1 Aging and Senescence

Aging

  • Aging: gradual, spontaneous changes resulting in maturation through childhood, adolescence, young adulthood and then the progressive decline in function in later adulthood and old age.

  • Senile: Term used to express characteristics of older age; Senility is the general term for conditions (specifically mental) occurring in older age.

  • Gerontology: Study of social, mental, and physical aspects of aging.

Profile of Older Americans

  • Population aged >=65 is 52.4 million and is projected to reach 94.7 million by 2060.

  • About one/seven people are 65 years or older.

  • Average life expectancy is an addition 19.4 years after hitting 65.

  • Woman live longer than men.

  • Most frequent occurring conditions amongst elderly are:

    • Arthritis (54%)

    • Hypertension (67% of men.. and 79% of women)

    • All types of heart disease (28%)

    • Any cancer (19%)

    • Diabetes (28%)

Senescence of Organ Systems

  • Organ systems exhibit difference signs of senescence at very different ages and do not degenerate at same speeds.

  • Peak performance of all organs is during a person’s twenties.

  • Autopsies (postmortems) in children strangely show atherosclerosis in arteries, indicating that the aging process can begin much earlier than previously understood.

    • Pathologist 

  • Integumentary system changes during forties: Melanocytes die, hair becomes gray and thinner; Skin becomes paper thin, loses elasticity, and wrinkles appear.

    • Senile lentigines: Flat brown-black spots that appear on back of hands and areas exposed to sunlight.

  • Special senses start to decline in twenties. Visual acuity declines and by forties, presbyopia begins.. later becoming cataracts later in life. Hearing loss occurs as ossicles become stiffer and cochlear hair cells declines, same with olfactory bubls.

  • Skeletal system: Changes appear in a person’s thirties. Osteoblasts become less active than osteoclasts, causing osteopenia, which leads into osteoporosis. Synovial fluid and articular cartilage also declines.

  • Muscular System: Muscle mass is lost (sarcopenia) and replaced with fat with age.

  • Nervous system: Changes begin around age 30. Motor coordination, intellectual function, and short-term memory decline more quickly than long-term memory and language skills.

  • Cardiovascular System: With age, myocardial cells die, resulting in weaker cardiac output. Allows atherosclerotic plaques to build up easily. Vein valves also become weaker, causing pooling.. which leads to poor venous return and possible heart failure.

  • Respiratory System: Changes occur in thirties. Pulmonary ventilation declines.. resulting in poor stamina, rib cage becomes less flexible, lunges become less elastic and alveoli count decreases. Hypoxic degenerative changes occur as a result in other organ systems.

  • Urinary System: Changes begin in person’s twenties. Count of nephrons start to die and glomeruli start becoming atherosclerotic. Glomerular filtration rate (GFR) decreases, resulting less efficient kidneys. 

  • Immune System: Lymphatic tissue and red bone marrow decreases with age.. meaning, the body's ability to respond to infections and heal wounds becomes less effective over time.

Theories of Senescence

Causes of senescence are unknown. Heredity does play a interesting role.. theories:

  • Protein abnormalities: One quart of the body’s protein is collagen. With age, collagen and other proteins exhibit increasing abnormal structures, leading to a decline in tissue repair and regeneration, which may contribute to the overall aging process.

  • Free Radicals:  Chemical particles with an extra electron. If an oxygen molecule for instance, gets one of these extra electrons, it becomes a free radical itself, which can then react with other molecules, causing them to become free radicals and creating a chain reaction of damage. They can be neutralized by antioxidants.

  • Autoimmune-altered molecules: Recognized as foreign antigens, and an immune response may be generated against body’s own tissue. Rheumatoid arthritis supports this theory.

Complex Effects of Aging

  • Decline in physiologic reserve: Can produce complications from mild problems.. appearance of aging depends on what organ systems are healthy.

  • Vague and nonspecific symptoms require a long time to discover and care for. Something as simple as constipation.. can end up causing delirium in elderly.

  • polypharmacy can result in adverse drug interactions. 

Disorders of Aging

Geriatric Giants

  • Immobility: the inability to move or transfer oneself can lead to complications such as pressure sores, deep vein thrombosis, and muscle atrophy.

    • Iatrogenic: something accidently induced by a pharma

  • Instability: a condition characterized by an increased risk of falls, which can result in fractures, hospitalization, and a decline in overall functional status.

  • Incontinence: Inability to prevent discharge of urine or feces.

    • Urge incontinence: Loss of urine before one can get to toilet.

    • Stress incontinence: Weak bladder muscles. Sneezing, coughing, climbing can make you leak.

    • Overflow incontinence: Rare condition where the bladder doesn't empty completely, leading to frequent dribbling of urine.

    • Functional incontinence: Inability to reach toilet in time.. due to arthritis, stroke or dementia.

    • Mixed incontinent: A combination of stress and urge incontinence, often seen in older adults, where both involuntary leakage during physical activity and a sudden, overwhelming need to urinate occur.

    • Fecal incontinence: occurs in about 1/3 of elderly in institutional care, and is second most common reason for committing elderly to nursing home.

  • Impaired intellect/Memory: If it last for six months it is classified as dementia. Cognitive functionality is clearly impaired, and higher think abilities are muffled.

Dementia

  • Treatment options: no cure. Maximizing patient’s QOL and ability to communication is key. Environmental modifications such as reducing visual and auditory clutter, providing cues, and other shit.

  • Reminiscence therapy (RT): photography, familiar items, past activities and experiences to improve patient’s memory t reinforce understanding and awareness of the environment. 

  • Medications: Don’t stop dementia from progressing. Cholinesterase inhibitors and memantine have been approved to help.

Section 19.3 Dying and Death

Death 

  • Life expectancy has rise from 47 to 84.

  • Dying is inevitable. 

Legal Issues in Dying and Death

  • Advance medical directive: 

    • Medical (durable) power of attorney: This document allows an individual to appoint someone else to make healthcare decisions on their behalf if they become unable to do so.

    • Living Will: Set of instructions written by someone which lays out what treatment you wish to undergo. Things like do not resuscitate (DNR), hospice care can be listed in here.

Legal Definition of Death

  • Brain death (BD): no cerebral or brainstem activity and electroencephalogram (EEG) is flat for a while. This is the standard for Death in most states.

  • Persistent vegetative state (PVS): a condition in which a person loses consciousness of surroundings but automatic functions such as breathing and circulation remain intact; this condition is often confused with coma and can lead to ethical dilemmas regarding end-of-life care.

  • Minimally conscious state (MCS): condition of severely altered consciousness in which minimal evidence of awareness of self for surroundings is demonstrated. 

Word Bank!

Prefixes

  • In - not

  • Bi two

  • dis apart, away from

  • cata down

  • para abnormal, beside

  • anti against

  • de take away

  • pre before

  • poly many

Combining/Root

  • Behav - mental activity

  • hom/I - man

  • -san- sound, healthy

  • psych/o- mind

  • -analysis process to define

  • analyst one who defines

  • -therapist: professional who provides mental health care and support

  • pol pole

  • order arrange

  • depress press down

  • acr/o peak, highest point

  • agor/a marketplace

  • claustr/o confined space

  • compuls drive, compel

  • somn sleep

  • obsess besieged with thoughts

  • traumat wound

  • somat/o body

  • ton pressure, tension

  • delus decieve

  • hallucin imagination

  • mut silent

  • noia to think

  • noid abnormal thinking

  • soci partner, ally, community

  • person person

  • narciss self-love

  • bio life

  • feed to nourish

  • congru come together, agree

  • ger old age

  • iatr medical treatment

  • longev long life

  • senesc growing

  • sen old age

  • senil characteristic of old age

  • geront/o process of aging

  • oxid oxidize

  • scribe write

  • pharmacy drug

  • deliril confusion, disorientation

Suffix

  • -al pertaining to

  • -ior- pertaining to

  • -cide to kill

  • -cidal pertaining to killing

  • -ity condition

  • -iatry treatment

  • -ic pertaining to

  • iatrist one who treats, practioner

  • logy study of

  • logist specialist

  • therapy treatment

  • ion condition or process

  • -ar pertaining to

  • phobia fear

  • ive nature of, quality of

  • form appearance of

  • istic pertaining to

  • back back, return

  • ent end result, state of

  • ics knowledge of

  • ant forming