Sub groups of the elderly
Young old equals 65 to 74 years. Metal old equals 75 to 84 years. Old old is 85 plus years
Gerontology
A discipline that studies aging and the aged from biologic, psychological, and sociological perspectives.
Goals of gerontology
To explore the dynamic processes of complex physical changes, adjustments and psychological functioning, and alterations in social identities. To maximize functional ability and prevent or minimize illness and disability.
Elderly population statistics
1. Most lived in family settings with a spouse or relative.
2. 24% live alone and only 4.5% over 65 reside in nursing homes.
Older adults are the largest consumers of health care
Almost half of all adult hospital beds are filled with patients 65 years of age and older
Common health problems in the elderly
Arthritis, hypertension, heart disease, hearing impairment, orthopedic impairments, cataracts, sinusitis, diabetes.
Assets of the elderly population
Poverty is common among the elderly population . 9.9% live below the poverty line. 6.1 percent were classified as near poor. 22.7 of elderly African-Americans and 20.4% of Hispanics and 8.3% of Caucasians were at the poverty level.
Elderly population income
1. 90% Social Security
2. 62% income from assets.
3. 43% from pensions.
4. 21% from earnings
Issues faced by the elderly
Retirement, changes in lifestyle, loss of significant others, decline in physical functioning.
Positive aspects of the aging process
The elderly tend to be wiser, Palmer, confident, more independent , have a clear sense of priority, have greater freedom.
Developmental /genetic series
Changes that occur with aging are genetically programmed
Stochastic Theories
Changes that occur with aging result from an accumulation of random offense or damage from environmental factors.
Physiological changes in elderly skin
Becomes dry, wrinkled and an even pigmentation. Dermis thickness decreases by 20%. Decrease in skin strength and elasticity. Sebum secretion decreases. Vascular fragility occurs leading to senile pursuers.
Elderly skin changes continued
Fingernails and toenails become dull brittle and thick. Changes occur in hair color and growth. Skin disorders are common.
Muscular changes in aging
Reduction in muscle size and strength due to loss of muscle fibers and reduction in size of existing fibers. Decrease in type to muscle fibers type one fiber stay constant . Progress can be slowed with exercise
Skeletal changes in aging
Decreased bone mass and bone renewal. Weakness in trabecular bone- head of the femur and radius and vertebral body. Joint degeneration, osteoarthritis and synovial joints.
Cardiovascular function in the elderly
Cardiovascular disease is the leading cause of morbidity and mortality. 40% of older adults have hypertension. Aorta and arteries become stiffer and less distensible . cardiovascular function at rest is adequate to meet needs
Respiratory function in the elderly
Decline in maximal oxygen consumption. Loss of elastic recoil in long. Calcification of soft tissues of the chest wall= increases workload of respiratory muscles.
Alveolar function in the elderly
Loss of alveolar structure that decreases surface areas of gas exchange. Increase in residual lung volume and functional reserve capacity. Decline and vital capacity
Neurologic function and the elderly
Brain weight decreases. Loss of neurons and brain and spinal cord. Change in neurons and supporting cells and and paired synaptic connections. Diminished electrochemical reactions, narrow dysfunction sensorimotor changes. Cognitive abilities remain intact
Special senses in the elderly
Visual acuity and color discrimination decline. Ophthalmologic diseases are more common. Hearing acuity decreases, presbycusis, Cerumen occurs in the EAC. Taste and smell decline.
Immune function in the elderly
An increased risk for infections such as UTI, respiratory tract infection, wound infections and nosocomial infections. Early detection of infections becomes more difficult .
Gastrointestinal function in elderly
Let's age associated changes than any other organ. Toothloss, but is not normal. Changes in esophageal function . Atrophic gastritis and decrease secretions of intrinsic factor are common . diverticula of the colon are more common. Achorhydria.
Achorhydria
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Renal function and the elderly
Decreased reserve capacity , decline in kidney mass , steady decline in total renal bloodflow , decrease in renal tubular function, decreased creatinine in urine not indicated of renal disease. Capable of maintaining fluid and electrolyte balance
Genitourinary function in the elderly
Changes in the bladder , atrophy of the perineal structures in women, benign prostatic hyperplasia in men.
Functional assessment of the elderly
ADL- titties of daily living : basic self-care tasks such as bathing, dressing, grooming, and ambulating etc.
IADL- an instrumental activities of daily living: more complex tasks necessary to function in society for example writing, reading, cooking, clea
Transient urinary incontinence
Not established . Can be caused by medication , possible infection, or stress
Chronic urinary incontinence
Established. Failure of the bladder to store or Indique urine - urge incontinence. - Stress incontinence - neurogenic incontinence
Fall risk and elderly
Accidents and environmental hazards, age-related function changes, cardiovascular changes , G.I. or GU disorders , medication , musculoskeletal and neurological disorders , bed rest, sensory or respiratory disorders .
Depression and the elderly
Depressed mood, irritable, loss of interest, appetite and weight changes , sleep disturbance, psychomotor agitation, fatigue or loss of energy, worthlessness, excessive guilt, diminished ability to think, suicidal ideation.
Criteria for selection of screening tools to measure function in the elderly
Purpose of data collection . Individual or target population to be assessed . Availability and applicability of instruments. Reliability and validity of screening tools. Setting or environment
Mini-mental state examination as a measure of cognitive function
Assesses memory - orientation - attention - constructional ability
Dementia characteristics
Insidious onset . Symptoms present for a long duration. An accurate answering of orientation questions . May try to conceal deficits. . . Mood and behavior are labile . Neurologic symptoms .
Characteristics of pseudo-dementia of depression
Rapid onset. Symptoms present for a short time. Lack of interest and answering questions. May emphasize deficits. Marked variability in performing tasks of similar difficulty. Mood consistently depressed. Neurologic symptoms are not present .
Delirium
Acute confusional state - 6% to 56% of hospitalized older adults. Present with other underlying disorders such as MI, pneumonia, cancer, hyperthyroidism, drug toxicity
Drug therapy in the older adult population
Start low and go slow. Due to increased likelihood of toxic and adverse reactions. Avoid centrally acting drugs and drugs with long half lives . Education about drug use is key to compliance and accurate administration .
Adverse effects of drugs and the elderly
Noncompliance. Errors result from poor manual dexterity, failing eyesight, lack of understanding, attitudes and beliefs about medication use, mistrust of healthcare providers, forgetfulness or confusion.
Intrinsic/ Nonstochastic theories of aging
Propose that the changes that occur with aging are genetically programmed.
Somatic mutation theory of aging.
States that the longevity and function of cells in various tissues of the body are determined by the double stranded DNA molecule and it's specific repair enzymes
Havelock limit
Human cells have a limited ability to replicate approximately 50 population doublings, and then die . Approaching the limit they slow the rate of division and manifest identifiable and predictable morphologic changes characteristic of senescent cells.
Telomerase
An enzyme believed to govern chromosomal aging through its action on telomeres, the outermost extremities of the chromosome arms. It is believed cancer cells maintain telomere link thereby enhancing cell replication.
Bone loss in aging
The process of bone formation/renewal is slowed in relation to bone resorption resulting in a loss of bone mass and weekend bone structure especially in post menopausal women
Common changes in BP regulation
SBP progressively increases , D be T plateaus or declines after age 50, hypertension is a consequence of arterial stiffness. Orthostatic hypotension is more common due to delayed or insufficient compensatory mechanisms.
Changes in G.I. tract
Xerostomia-dry mouth due to decreased salivary secretions. Presbyesophagus decrease in esophageal motility and an adequate relaxation of the lower esophageal sphincter.
GI changes in older adults continued
Achlorydria- decrease in hydrochloric acid secretion due to a loss of parietal cells Helicobacter pylori infestation. Diverticula , constipation due to low fiber.
Significance of decreased lean body mass on interpretation of the GFR are using serum creatinine levels
Decrease in GF R is not accompanied by an increase in serum creatinine secondary to reduced creatinine production as a result of decreased muscle mass.
Risk factors for falls in older adults
Environmental hazards . Slips, trips . Decreased muscle strength , slow reaction time , altered gait, impaired vision/hearing , medication , pain , neurological disorders
Symptoms of depression in older adults
Depressed or irritable mood, loss of interest , decreased appetite , weight changes, sleep disturbance , fatigue/loss of energy, feelings of worthlessness suicidal , guilt.
Cognitive assessment tool for older adults
Mini-Mental State Examination.
Characterize drug therapy in the older population
Complex phenomenon influenced by numerous biopsychosocial factors. Start low and go slow. Build trust and educate to improve compliance.
Five factors that contribute to adverse drug reactions in the older adult
Lack of understanding about treatment, miss trust of healthcare providers , forgetfulness or confusion, attitudes about medication use, failing eyesight, or manual dexterity
Cautions for prescribing meds in the older adult
Physiologic changes, lean body mass , water versus fat soluble meds , require smaller doses and slower titrations. Polypharmacy increased risk of drug interactions . Centrally acting drugs with long half-lives should be avoided.