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421 Comm & The Aged > 421 > Flashcards

421 Flashcards

1
Q

Selective attention

A

maintain focus in the face of distraction
ability to discriminate between relevant and irrelevant information and focus only on the relevant stimuli

ex: being able to have a conversation with loud music on

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2
Q

Alternating attention

A

ability to shift attention/perspective and move between tasks having different stimuli

ex: reading a recipe and making it

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3
Q

sustained attention

A

vigilance (seconds to minutes)
ability to maintain a consistent response during a continuous and repetitive stimulus

ex: reading a newspaper article

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4
Q

divided attention

A

respond simultaneously to multiple tasks or multiple task demands

ability to process two or more pieces of information

(ex: driving)

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5
Q

How is attention affected by aging?

A

attention can decrease with increased complexity, increased time demands, and when the talk is not personally relevant

If overwhelmed with demands, it can lead to limited social engagement.

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6
Q

Communication Accommodation Theory

A

A model for explaining the processes behind communicative interaction—based on premise that speakers and listeners accommodate to each other’s communication patterns (appropriate vs inappropriate)

Appropriate Vs. inapproprate accommodations- under and overaccommodation

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7
Q

Accommodations for Communication in Clinical Interactions

A

g

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8
Q

Primary Aging Changes: Eyes/Vision

A
  • Presbyopia (loss of near vision)
  • reduced tearing
  • reduced pupil size
  • poorer night vision
  • more “floaters”
  • lens enlargement, less transparency
  • decrease in color vision
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9
Q

Secondary Aging Changes: Eyes/Vision

A
  • Cataracts
  • Glaucoma
  • Macular degeneration
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10
Q

Somesthetic Primary Aging Changes

A

Increase in pain/temperature/touch thresholds

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11
Q

Primary Aging: Skin

A
  • Loss of elasticity
  • wrinkling
  • reduced moisture
  • hair thinning
  • facial hair (females)
  • reduction of subcutaneous fat
  • reduction in swear glands
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12
Q

Secondary Aging: Skin

A
  • Bedsores
  • Skin shearing
  • Bruising
  • Shingles
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13
Q

Primary Aging: Respiratory

A
  • reduced vital capacity
  • increased residual volume
  • loss of elasticity of lung tissue
  • reduction in cilia
  • reduction in alveoli
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14
Q

Secondary Aging: Respiratory

A
  • Chronic obstructive pulmonary disease (COPD)

- Pneumonia

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15
Q

Primary Aging: Cardiovascular

A
  • Loss of cardiac muscle bulk and elasticity
  • Decreased heart rate
  • increased stroke volume
  • increased systolic pressure
  • heart valves more sclerotic
  • stiffening and narrowing of arteries
  • decline in barorecepter reflex
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16
Q

Secondary Aging: Cardiovascular

A
  • congestive heart failure
  • coronary artery disease
  • stroke
  • heart attack
  • hypertension
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17
Q

Primary Aging: Gastrointestinal

A
  • reduced motility
  • reduction of secretions
  • reduction of metabolism in liver
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18
Q

Secondary Aging: Gastrointestinal

A
  • cancer (colon)
  • diverticula
  • fecal impaction
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19
Q

Primary Aging: Neurological

A
  • loss of neurons
  • slower transmission
  • poorer regulation of temperature
  • reduction in REM sleep
  • decline in balance
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20
Q

Secondary Aging: Neurological

A
  • Parkinson’s Disease
  • Alzheimer’s Disease
  • balance disorders
  • Dementia
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21
Q

Primary Aging: Muscular/skeletal

A
  • loss of muscle
  • loss of bone minerals
  • decreased weight (due to muscle mass)
  • loss of elasticity of muscles
  • loss of joint flexibility
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22
Q

Secondary Aging: Muscular/skeletal

A
  • arthritis
  • fractures, dislocations
  • Bursitis
  • osteoporosis
  • Tendonitis
  • spinal stenosis
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23
Q

Self-Actualization

A

the highest level that can be reached in Maslow’s hierarchy of human needs

Experiencing heightened aesthetic, creative, problem-solving, philosophical, moral understanding

older adults benefit from a wealth of personal experiences and knowledge that can only be acquired over a lifetime.

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24
Q

Self-Actualization–Artists, philosophers, sages

A

Artists- feel the need to express their talents. Renewed inspiration. Increased sense of urgency with regard to their work associated with the perception that time, energy, and strength is decreasing

Philosophers- may experience a fundamental shift in how they view the world. Look back on time spent (Life review). Integrity versus despair. Increased introspection.

Stages- Increased wisdom is a positive consequence of growing older. Insight into human condition.

   - Practical Wisdom- reflects expert knowledge, superior judgement, exceptional insight with regard to the fundamental pragmatics of life
   - Philosophical Wisdom- reflects an understanding of the abstract relationship that exists between one's self and the rest of humankind.
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25
Q

5 Subsystems of Speech

A
  1. Respiration
  2. Phonation
  3. Resonation
  4. Articulation
  5. Prosody
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26
Q

Respiration

A
  • Lung volumes reduced as an effect of primary aging
  • Healthy elders adjust naturally–may produce fewer syllables per breath
  • *Assess: max phonation, speech syllables per breath in oral reading or convo**
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27
Q

Phonation

A

(Pitch, loudness, quality of voice)

  • Age related voice changes between 7th and 9th decade of life
  • Pitch drops in women, men have rise in pitch
  • vocal roughness increases
  • varies greatly in people–some maintain young voice into 80s
  • Assess: pitch, loudness, roughness, hoarseness, breathiness, strain, effort*
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28
Q

Resonation

A
  • shapes the sound (phonation) as it travels through the vocal tract
  • Physical changes with aging: lengthening of vocal tract, atrophy of tongue and pharyngeal muscle, decline in sensory-motor function
  • Assess: nasality characteristics*
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29
Q

Articulation

A

Production of speech phonemes (manner, place, voicing, vowels)

  • Articulatory precision is slightly reduced
  • Assess: standard articulation test, intelligibility test*
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30
Q

Prosody

A

Rate, intonation, inflectional characteristics of speech

  • Older individuals tend to show increased intonation in conversational speech
  • reduced speech rate
  • rate, rhythm, intonation, stress patterns*
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31
Q

Working Memory

A

most affected by aging
difficulty focusing & switching attention
dynamic, short-term, can actively manipulate the information in order to store/keep it.
-limited capacity, decays in a few seconds, unless rehearsed
Central Executive- allows info to be held in short term storage
Phonological Loop- repeating it
Visuospatial sketchpad- object shapes, colors, route in a building
Episodic buffer- connects across domains.

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32
Q

Why do communication disorder professionals need to understand physical aging?

A

Without a clear understanding of the nature of physical changes, professionals might misinterpret assessment findings as pathological (secondary) instead of normal consequences of primary physical aging.

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33
Q

common causes of dysphasia:

Category & example

A

Cancer: surgical effects, radiation effects, chemotherapy
Neurological disorders: stroke, Parkinson’s, Alzheimers, Dementia
Gastroesophogeal Disorders: Barrett’s esophogus
Dental Conditions: Dentures, Periodontal diseas
Chronic Conditions: diabetes, chronic obstructive pulmonary disease, thyroid disease, kidney disease

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34
Q

Primary Aging

A

Normal process of aging
Does not interfere in a huge way with activities

Greying hair, loss of skin elasticity, hair thinnning, presbyopia (loss of near vision), poorer night vision, decreased heart rate, loss of muscle

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35
Q

Secondary Aging

A

Pathological Aging. Changes occurring due to an age-related disease

Cataracts, glaucoma, bedsores, bruising, pneumonia, congestive heart failure, stroke, heart attack, hypertension, cancer, alzheimer’s, dementia, balance disorders, Parkinson’s, arthritis, osteoporosis, malnutrition

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36
Q

Tertiary Aging

A

Aging factors that are the result of social, psychosocial, and environmental changes

Reduction in social support (retirement, children moving, death), reduction of financial resources, quality of life

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37
Q

Discuss the vocal quality changes associated with age and laryngeal function

A

-Voice gets deeper in women
-men’s voice gets higher
-decrease in lung volume–less syllables per breath
-increased degrees of coarseness, pitch change, -tremulousness, breathiness
-Laryngeal cartilage ossification- begins in middle decades
diminished range of motion (breathiness)
-Atrophy of vocalis and other intrinsic laryngeal muscles (due to social isolation, diminished vocal cord bulk and altered shape)…degree of closure altered (breathiness)

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38
Q

Executive Function

A

Doing what must be done to solve a problem or achieve one’s goals

  • command center
  • regulates who we are
  • goal directed behavior
  • modifying behavior
  • awareness of behavior
  • self-monitoring
  • self-regulation
  • initiating intentional behavior
  • planning behavioral routines to accomplish intentions
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39
Q

Executive Function and Aging

A

More concrete in their thinking

  • increased rigidity
  • decreased flexibility

Cognitive processing strategies & goals shift
Degraded processing speed
degraded working memory
difficulties witching or preparing attention to deal with uncertain events

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40
Q

Fluid Intelligence

A

Includes abstract reasoning and problem solving; is independent of acquired knowledge, eduction, and acculturation

  • skills support an individual’s ability to think and act quickly, solve novel problems and encode short-term memories
  • peaks in adolescence and then declines
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41
Q

Crystallized Intelligence

A

Learning from past experience, acculturation, and acquired knowledge, supports activities such as test-taking, language use, and acquired skills

Continues to grow throughout adulthood

  • greatly influenced by personality and motivation, educational and cultural opportunities
  • indirectly affected by physiological changes that strongly influence fluid intelligence
  • supports higher level reasoning
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42
Q

Cognitive Components that are most resilient and most vulnerable in aging:

A

Most Resilient: Crystallized Intelligence

  • cumulative end product of information acquired over a lifetime
  • demonstrated on tests of vocabulary, general information
  • increases until 6th and 7th decade
  • may only decrease in late old age

Most Vulnerable: Information Processing Speed

  • may be the “bottleneck” that causes other deficits in cognitive function
  • Medications can exacerbate it.
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43
Q

Declarative Memory

A

(knowing that) FACTS
-Requires conscious thought and effort to recall target information

  1. Episodic- specific to time and place. Autobiographical. Catalogs personal experiences (where were you on 9/11?)
  2. Semantic- factual or textbook learning about the world. Not related to a place.
  3. Lexical- specialized word knowledge.
44
Q

Nondeclarative Memory

A

(knowing how) to do things
unconscious and difficult to verbalize

  1. Procedural Memory- applied automatically. Allows us to perform common tasks without the need for conscious recall of how to do it (driving)
  2. Priming- memory that is established and triggered by experience. Greater familiarity with info increases neural pathways to info (important in naming).
  3. Conditioned- behaviors automatically produced with a stimuli (Pavlov’s dog)
45
Q

Vocal Hygiene

A

Voice Care:

  1. Laryngeal hydration- 64oz/day
  2. Avoid excessive throat clearing (teach less traumatic technique. Treat contributing factors)
  3. Avoid vocal strain (avoid forceful vocalization or whispering. Address hearing loss)
  4. Minimize tobacco smoke exposure
  5. Minimize laryngeal reflux (meals two hours before bed, raise head of bed)
  6. Avoid prolonged exposure to polluted air (face mask around dust)
46
Q

Treatment and devices that can assist an older person to improve hearing and communication and quality of life

A

Protection against trauma, modification of listening techniques, assistive listening devices, hearing aids, cochlear implants

Prevention= decrease noise exposure
Behavioral/Listening modifications= face each other, glasses etc.
Hearing aids:
BTE: behind the ear
ITE: in the ear
ITC: in the canal
CIC: completely in the canal
Assistive Listening Device: hearing aid with microphone and transmitter
Cochlear Implants: electrical signals to the auditory nerve

47
Q

Information Processing Model

A
  1. External info (stimulus) enters sensory store (sight, sound, smell)
  2. Attended to or ignored—> forgotten
  3. Working memory
  4. Forgotten, repeated, elaborated, encoded
  5. Long-Term Memory- info is permanently stored or moved to working memory

*How brain receives (input), analyzes, and overtly or covertly responds (output) to information from the environment

48
Q

How is perceptual processing affected with aging?

A

Processing Speed!
accounts for 71-79% of variance between young and old

Recognizing is better than recall
working memory is most affected
in LTM— episodic is most affected

  • Takes longer to process information
  • speed and efficiency most affected
  • Brain volume decreases
  • neuron shrinkage
  • smaller dendrites
  • atrophy- brain weight declines
49
Q

Cognitive maintenance and Loss Prevention:

Ways to exercise your brain:

A

Cognitive losses can be reduced through mental exercises “use it or lose it”

  • test your recall (memorize list, recall later)
  • draw a map from memory (when visit a new place)
  • do math in your head
  • take a cooking class. Learn new ways to cook
  • refine hand-eye coordination by learning a new skill (crocheting, painting, puzzle)
  • learn a new sport
  • learn a foreign language
50
Q

Schaie’s Life-Span Model of Postformal Cognitive Development

A
  1. Acquisitive Stage (childhood–adolescence)
    • play, exploring, not working towards goals
  2. Achieving stage (late teens–early 30s)
    • skills are used to attain goals
  3. Responsible stage (late 30s–early 60s)
    • doing things for others
  4. Executive Stage (30s–middle age)
    • can overlap with 2 previous. Responsible for complicated relationships.
  5. Reorganizational Stage (late middle age–late adulthood)
    • Retirees. Looking @ meaningful pursuits
  6. Reintegrative Stage (late adulthood–postformal thought_
    • most meaningful things, don’t bother with the rest
  7. Legacy-creating Stage (Advanced old age–postformal thought)
    • preparing for death

no time frame, not everyone hits every stage
Remaining active physically, mentally & socially will help them progress at a different rate

51
Q

Strategies for caregivers when working with elderly with dysphagia

Prefeeding
Mealtime
Post-feeding

A

Prefeeding: small frequent meals & snacks at same time each day, allow sufficient time for each meal, don’t plan meals right after physical exercise, provide max calories for “most alert” meal, encourage self feeding (meals without utensils), enhance sensory characteristics of food, plan meals that avoid mucous binders (if needed). Make sure they have glasses, dentures, hearing aids. Gone to bathroom, washed hands

Mealtime: Reduce distractions, provide comfortable room, provide utensils, seat them in appropriate position, allow pauses, start slow, offer food within 5-10minutes of sitting, provide physical or verbal cues, provide encouragement

Post-Feeding: Clean patient’s mouth after eating to remove residue, check for pockets of food, ensure patient maintains an upright position for 30 mins, have patient sleep with head elevated

52
Q

Presbyphagia

A

Age-related changes in the oropharyngeal and esophageal swallowing of healthy adults.

good health is maintained in the presence of disease-free presbyphagia

15-40% of individuals over 60yrs

53
Q

Laryngectomy

A

removal of the larynx and separation of the airway from the mouth, nose and esophagus (usually due to cancer)

54
Q

Biological Age

A

Physical

55
Q

Chronological Age

A

of years

56
Q

Most elderly have at least one…

A

chronic health condition

57
Q

Relocation

A

50% of relocated elderly experience health declines

58
Q

Nursing Homes

A 
house 5% of elderly- mostly women
50% will spend some time in an ECF
Most residents have @least 4 chronic disorders
   62% memory/orientation
   33% are incontinent
59
Q

Ageism

A

thinking of all elderly as alike

60
Q

Communication Predicament & Aging Model

A

Communication based on stereotypes of aging can impact the communication success

61
Q

Communication Enhancement & Aging Model

A

Shows how the negative cycle of ageism can be broken. Accommodation results in respect and increased empowerment

62
Q

Models of Practice in Management of Older People

A

Medical Model -focus on impairment
Rehabilitation Model -focus on activity
Social Model -focus on participation

63
Q

Failure to Thrive

A

Refuse to eat or interact socially.

Limited function, depression, end-stage dementia

64
Q

Presbyopia

A

inability of the eye to accomidate to close detail

65
Q

Arcus senilis

A

Primary: faint whitish ring inside the iris—doesn’t impair vision

66
Q

Ptosis

A 
Primary
Drooping eyelid (not a medical condition for insurance typically)
67
Q

Cataracts

A

Primary
Clouding of the lens that affects vision. Most are related to age. By 80yrs 1/2 Americans have had one. Develop slowly. Don’t spread from one eye to another

68
Q

Glaucoma

A

Damage to the eye’s optic nerve

One of the main causes of blindness in US

69
Q

Anatomy: Outer Ear

A

Pinna
External Auditory Meatus
Cerumen (ear wax)

70
Q

Anatomy: Middle Ear

A

Tympanic Membrane
Ossicular Chain: malleus, incus, stapes
Eustachian Tube

71
Q

Anatomy: Inner Ear

A

Cochlea: organ of hearing

Semicircular Canals

72
Q

Presbycusis

A

Age-related hearing loss
Natural
Often accompanied with Tinnitus (ringing in the ears)
medically irreversible

73
Q

4 Types of Presbycusis

A

Sensory
Neural
Metabolic
Mechanical

74
Q

Sociocusis

A

hearing loss due to social environment, noise, and medications

75
Q

Age Related Changes in the Ear

A

Outer Ear: Increase cerumen, hair growth, changes in cartilaginous structure of the pinna.

Middle Ear: Muscle action is reduced

Inner Ear: Cells may be susceptible to biological aging

76
Q

Secondary Changes in the Ear

A

Conductive and Mixed hearing loss
Sudden sensorineural Hearing Loss (SSNHL)
Assymmetric or Unilateral Sensorineural Hearing Loss
Diabetes
Medications
Tennitus

77
Q

Tertiary Aging with Hearing Loss

A

anxiety, low self-esteem, frustration, embarrassment, social isolation

challenges understanding speech, most people adapt well with mild hearing loss

78
Q

Components of a Hearing Aid

A

Microphone
Battery
Amplifier
Receiver

79
Q

Abduction

A

VF open

80
Q

Adduction

A

VF closed

81
Q

Stroboscopy

A

Video stroboscopy of the vocal folds

allows clinician to gather information about the vibratory nature of vocal cords

gives the perception that it’s slowed down so we can see how the vocal folds interact

82
Q

Indirect Laryngoscopy

A

long mirror

83
Q

Flexible laryngoscopy

A

through the nose

84
Q

Rigid laryngoscopy

A

through the mouth

85
Q

Management of presbyphonia and other vocal disorders

A

vocal hygiene, speech/voice therapy, medical therapy, surgery

86
Q

symptoms of vocal irritation

A 
hoarseness
raspiness
severe dryness of throat
fullness of "lump" in throat
excess of thick mucus in throat
voice fatigue
throat irritation
loss of vocal range
coughing up blood
difficulty swallowing
87
Q

Causes of Vocal Irritation

A 
Dehydration
Laryngopharyngeal Reflux
Throat Clearing
Voice Strain
Smoking
Drinking
Medications
Polluted Air
Infection
88
Q

Dysphagia

A

disordered swallowing

Causes: neurologic, cancer, pharyngeal, gastroesophageal, dental, chronic conditions

89
Q

Oral transit and pharyngeal transit…

A

slow down with age

90
Q

Videofluoroscopy types of liquid/solids

A 
thin-liquid---watered down liquid barium
thick-liquid---apricot nectar
Puree---apple sauce/pudding
Mixed solid---cereal, fruit cocktail, soup
Solid---sandwich, crackers
91
Q

Apraxia of speech

A

problems between voiced and voice-less phonemes

92
Q

Speech in Parkinson’s

A

Prosody is very flat, monotone, interjections, word pauses in older adults occur with their language not because of speech in normal aging

93
Q

Presbyphonia

A

Aged Voice
Primary age
Breathiness is due to VF not fully coming together as one ages

94
Q

Changes in Speech

A

slower, longer pauses between words, articulatory movements reduced, longer phoneme duration

95
Q

Aspiration

A

passage of food and/or liquid into the larynx through the vocal folds (below vocal folds)

96
Q

Laryngeal Penetration

A

food/liquids enter the laryngeal vestibule but does not pass through the vocal folds (not below vocal folds)

97
Q

Oropharyngeal Changes (normal)

A 
timing of the swallow
safety of the swallow
tooth loss
reabsorption of bone
muscle mass thinning
dry mouth
reduced strength and tension in tongue, mandible, pharynx
longer oral and pharyngeal transit time
2-3% more residue
98
Q

Secondary Aging: Swallow

A

Pneumonia, dehydration, malnutrition, weight loss

99
Q

Bedside swallow evaluation

A

trail different consistencies to see if instrumental exam is needed
say “ahhh”…dry? wet?
check for excess food

100
Q

Dysphagia Assessment

A 
assess anatomy and physiology
conduct thorough interview
chart review (history & physical)
bedside swallow evaluation
modified barium swallow 
Fiberoptic Endoscopic Evaluation of Swallow
101
Q

Videofluoroscopic Swallow Study

aka Modified Barium Swallow

A

radiation (x-ray)–can’t do this for very long

able to see the barium as it moves through

102
Q

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

A

through the nose

scope can be in for much longer

103
Q

Cognition

A

knowledge of self and the world

104
Q

Normal Aging in the Brain

A

symmetrical, no significant atrophy, a little gap between skull and brain

105
Q

Types of Declarative Memory

A

Episodic
Semantic
Lexical

106
Q

Types of Non-declarative memory

A

Procedural
Priming
Conditioned

421 Comm & The Aged (1 decks)

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