Aging Flashcards
What are some musculoskeletal age related changed?
- Sarcopenia
- Decreased velocity of muscular contraction
- Decrease in strength
- Decreased cross sectional area of muscle fibers
- Collagen stiffness
In aging population do men or women have a greater loss in bone mass
Women - Women experienced greater loss of bone mass following menopause
What percentage of strength is lost per decade in the aging population?
10%
What are some cardio/pulmonary age related changes?
- Increased calcification of valves
- Decreased arterial elasticity
- Decreased muscle strength
- Decreased forced expiratory volume (FEV)
- Increased residual volume following max expiration
What are some neuro age related changes?
- Decreased brain weight & volume
- Increased ventricular size
- Decreased nerve speed & conduction
- Decreased reaction speed
What are some integumentary age related changes?
- Decreased sensory perception
- More prone to hypo/hyper-themia
- Impaired thermoregulation (decreased sweat glands)
- Decreased elasticity & thickness of dermis
What are some metabolic & endocrine age related changes?
- Decreased sensitivity to insulin
- Metabolism decreases
What some gastrointestinal age related changes?
- Decreased energy/drug metabolism
- Increased risk of adverse side effect
- Decreased bowl motility
- Decreased gastric acid production
What are some genitourinary age related changes?
- Increased size of the prostate
- Increased incontinence
- Decreased kidney functioning including filtration rate
- Decreased bladder capacity
What is most common cognitive impairment associated with aging?
Memory loss
Which type of memory is most affected in older adults?
Short term - Older adults have difficulty recalling information they learned recently
What is semantic memory?
Facts, knowledge of specific information
What is procedural memory?
Performance of a specific procedure or skills
What is working memory?
Use of relevant information during a task
What is episodic memory?
Lived experience, personally experienced
While both working and short term memory decreases, which decrease more?
Short term
Of episodic, semantic and procedural which memory is affected the most?
episodic
Does sustained and selective attention show a decline in age?
No, not in comparison to divided attention
What is sustained attention?
Maintaining attention over a long period of time
What is selective attention?
Ability to selective disregard items that are relevant to that specific task
What is divided attention?
Ability to process two more sources of information at the same time
Which type of attention declines the most?
Divided
Deficits in divided attention leads to what risk?
Increased fall risk (generally prioritize motor tasks)
Which type of intelligence is know to decline with age? (General, Crystallized or Fluid)
Fluid intelligence
What is general intelligence?
Broad mental capacity-performance on cognitive ability measure
What is crystallized intelligence?
Accumulation of knowledge and skills
What is fluid intelligence?
Speed & ability to problem solve
When does general intelligence begin to decline?
Sometime between 50s & 70s
What is presbycusis?
Progressive loss of hearing
What is tinnitus?
Experience ringing; common hearing impairment associated with aging
When does a progressive loss of hearing begin? (Presbycusis)
Typically begins in patients 40’s and accelerates overtime
Individuals can differentiate (lower or higher) frequencies better than (lower or higher)
Individual can differentiate lower frequency better than high frequencies
What are some things that you should keep in mind when working with individuals with hearing defects?
- Reduce background noice/audio
- Speak loudly
- Speak slowly
- Pronounce carefully
- Attempt to use lower frequency range
Vision deficits (increase or decrease) with age
Increase
At what age will visual impairments increase?
75 years and older
What can visual deficits lead to?
- Falls
- Depression
- Decline
What happens to the pupils as people age?
They become smaller & less responsive which leads to more difficulty to see in the dark
As people age they have an (Increased or decreased) time to accommodate to bright or dark environments
Increase time
What are some common diseases of the eye?
- Cataracts
- Glaucoma
- Macular degeneration
- Diabetic retinopathy
Why does the aging population have impaired depth perception?
Loss of contrast
Name some visual impairment interventions
- Environmental & behavioral modifications can decrease the risk of injury
- Contrasting colors to highlight barriers, edge of steps, threshold, and transitions
- Remove throw rugs & uneven surfaces that are not secured to the floor safely
- Use night lights or motion sensor lights
- Allow for extra time when transitioning between light & dark areas
- Maintain clear steps, hallways, & floors
- Add handrails & grab bars to assist
With increased age, the size & number of taste buds (increase or decrease) which leads to (increased or decreased) sensitivity to tastes
Decrease and decrease
T/F: Saliva production increases leading to increased taste sensitivity in aging population
False- Saliva production decreases leading to a dry mouth and decreased taste sensitivity
T/F: Decreased ability to smell and detect odors, and decreases taste sensitivity occurs with aging
True
Decreased taste sensitivity leads to decreased desire to eat what can cause what to happen?
- Negatively affect their nutrition as a whole
- Patients may add more salt for flavor which can negatively impact them
As patients age they have an (increased or decreased) sensation to touch, pain, vibration, pressure, proprioception & temperature
Decreased
Impairments with vision, touch and somatosensation lead to what?
- Increased fall risk and decreased balance
T/F: As patients age they are at a decreased risk for injuries including burns & pressure ulcers
False - Increase
What are some geriatric issues with pharmacology?
- Larger quantity of medications
- Larger quantity of diagnoses or impairments being treated
- Altered response to medications
- Side effects
- Adverse effects
What is polypharmacy?
taking multiple medications, often defined as 5 or more medications
What is rational polypharmacy?
Multiple medications to treat multiple medical issues or to treat a single medical issue where each drug works together to control symptoms
What is irrational polypharmacy?
Excessive, duplicate or contradicted medications are prescribed to treat the same condition
What are the 4 categories of pharmacokinetics?
- Absorption (movement of drug into blood stream)
- Distribution (Transport of drug to various tissues)
- Metabolism (drug clearance primarily from liver)
- Excretion (Primary completed by renal system)
What is pharmacokinetics?
Study of what happens to the drug once it is in the human body
Name some reasons that pharmacokinetics change as we age
- Decreased absorption through GI tract
- Decreased total body water
- Decreased total body mass
- Decreased plasma protein concentrations
- Increased fat affects lipid and water soluble medications
- Reduced ability for kidneys to excrete drugs
What two things does changes in pharmacokinetics cause?
- Changes cause increased time period for medication half life
- Increased incidence of adverse drug effects
Name some common adverse drug reactions in seniors
- GI symptoms
- Sedation
- Confusion
- Depression
- Orthostatic hypotension
- Fatigue & weakness
What are 3 strategies to coordinate PT with drug treatment in the elderly?
- Distinguish drug effects from symptoms
- Schedule sessions around dose
- Educate & facilitate compliance with drug therapy
When scheduling sessions around dosage of medication what should you keep in mind?
- pain medications (important to be proactive rather than reactive)
- Avoid rollercoaster of pain management
- Parkinson’s disease (mindful of timing of levodopa)
What are some common problems when it comes to nutrition for older adults?
- Changes to taste/smell
- Meds may reduce appetite
- Decreased sense of thirst
- Intolerance and GI distress
- Difficulty chewing
- Financial concerns
Why may older adults be vulnerable to malnutrition?
- Decrease energy requirements
- Decrease lean body mass
- Decrease metabolic rate
- Need for certain nutrients
How is frailty defined?
Clinically recognizable state of increased vulnerability resulting from aging-association decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised
Frailty is defined as meeting 3/5 of what characteristics?
- Low grip strength
- Low energy
- Slowed walking speed
- Low physical activity
- Unintentional weight loss
What are 4 challenges when it comes to frailty in adults?
- More infections & diseases
- Their injuries take longer to heal
- Surgery is more risky
- Hospital stays are longer & more money
Name some recommendations to improve nutrition
- Drink more liquids
- Portion control
- Plan healthy meals
- Softer food
- Use herbs & spices
- Eat socially
- Eat safe
- Read labels
- Speak with mD
Name 3 reasons for dehydration in older adults
- Decreased thirst
- Dilute urine
- Medications
Name some symptoms of dehydration in older adults
- Confusion
- Lethargy
- Rapid weight loss
- Functional decline
- Decreased skin turgor
- Decreased BP (critical)
- Orthostatic hypotension (critical)
- Tachycardia (Critical)
Name some symptoms of UTI
- Pain with urination
- Increased frequency
- Persistent urge to urinate
- Hematuria
- Foul smell
- Cloudy urine
What is stress incontinence?
Urine leaks out when you jump, cough, laugh or strain
What is overactive bladder (urge) Incontinence?
Strong urge to urinate even when your bladder isn’t full
What is mixed incontinence?
symptoms of both stress and overactive incontinence
What is overflow incontinence?
Bladder never completely empties, urine leakage, with or without feeling a need to go
What is functional incontinence?
Your urinary tract is functioning properly but other illnesses or disabilities prevent you from staying dry
What is osteoporosis?
- Metabolic conditions that presents with a decrease in bone mass that increases risk of fracture
- Decrease in osteoblast function with less calcium & phosphate salts will cause bones to become brittle
What is osteopenia?
- Low bone mass but not low enough to classify as osteoporosis
- Individual may not have actual bone loss but lower bone density than norms naturally
What are signs and symptoms of osteoporosis?
- Compression & other bone fx
- Low back pain
- Thoracic pain
- Decreased lumbar lordosis
- Kyphosis
- Decreased height
What are the most common bones affected by osteoporosis?
- Primarily affects trabecular bone in postmenopausal women but seen in trabecular and cortical bone in geriatric population
- Vertebrae, distal radius/ulna, and femoral neck
What can cause secondary osteoporosis?
Prolonged drug therapies like heparin, corticosteroids
What are some rehabilitation principle for patients with osteoporosis?
- Decrease risk of falls (mobility training & AD)
- Exercise
- Trunk orthoses (Short term pain relief & long term weakness and deconditioning)
What should be avoided during the rehabilitation of patients with osteoporosis?
- Excessive forward bending
- Exercising trunk in flexion
- Trunk flexion with rotation
- Prolonged immobilazation
What exercise should be done for rehabilitating patients with osteoporosis?
- WB aerobic exercises
- Postural training
- Progressive resistance training
- Gentle stretching
- Balance training
What is dementia?
- Global decline in cognitive capacity in clear consciousness
- Impaired ability to complete ADL’s
What are some common symptoms of dementia?
- Difficulty with comprehension of language
- Decreased ability to problem solve
- Behavioral disturbances
- Memory deficits
- Increases with age
- Normal speech in early stages
What is delirium?
- Transient state of fluctuating cognitive abilities
- Memory, orientation, & arousal may be impacted
- Cognitive status may fluctuate day to fay
- Can occur after a hospitalization, surgery, or side effect of new medications
What are some risk factors for delirium?
- Age > 70
- Decreased cognitive staus
- Depression
- Alcohol abuse
What is the difference between dementia and delirium?
- Dementia: slow gradual onset of diminished ability to reason and make sound judgements, loss of social skills and develop of regressed or antisocial behavior
- Delirium: Transient mental disorder with relatively rapid onset, fluctuates typically and brief duration of hours to 4 weeks. Reduced ability to pay attention to external stimuli and to shift attention to new stimuli
What is Alzheimer’s Disease?
Progressive disease process typically causing dementia
What is Alzheimer’s Disease characterized by?
- Memory
- Language
- Visuospatial skills
- Personality
- Cognition
What motor changes occur in patients with Alzheimer’s Disease?
- Slow movements
- Halting gait
- Generalized weakness
- Increased risk of falls (decrease postural reflexes, awareness of self & environment, ability to navigate obstacles)
What are the primary goals for treatment of Alzheimer disease?
- Improve quality of life
- Maximize functional performance
- Foster a safe and secure environment
- Decrease risk for fall & re-hospitalization
- Caregiver training
What communication techniques should one employ interacting with a person with Alzheimer’s Disease?
- Speak clearly in a calm tone
- Introduce yourself everytime
- Be aware of body language
- Use visual cues
- Use patients name
- Eliminate distraction
- Single Step commands
- Break tasks into parts
- Avoid confrontation
- Maintain a routine
What is a geriatric syndrome?
- Non-disease clinical condition of older persons characterized by multiple causes determining a unified manifestation
- Encompasses a group of signs and symptoms variably occurring together and characterizing a particular abnormality
Name some signs of caregiver stress
- Lack energy
- Overwhelming fatigue
- Sleep problems
- Changes in eating
- WIthdrawing
- Feeling overwhelmed
- Anxiety
- Depression
- Mood swings
- Becoming unusually impatient, irritable or argumentative
- Anxiety about future
- Difficulty coping with everyday things
- Lowered resistance to illness
What is ageism?
Form of discrimination based on stereotypes of age
What is physical abuse?
Causing bodily harm by hitting, pushing or slapping. This may include restraint an older adult against their will
What is emotional abuse?
A caregiver saying hurtful words, yelling, threatening or repeatedly ignoring the older adult. Keeping that person from seeing close friends & relatives
What is neglect?
- When caregiver does not respond to older adults needs
- May include physical, emotional, & social needs or withholding food, medication or access to health care
What is abandonment?
Leaving an older adult who needs help alone without planning for their care
What is sexual abuse?
Caregiver forcing an older adult to watch or be part of sexual acts
What is financial abuse?
- Happens when money or belongings are stolen or social security benefits or using a person’s credit cards & bank account without their permission
- Includes changing names on a will, bank account, life insurance policy or title to a house without permission
Name some signs of elder abuse
- Unexplained injuries
- Annoyance/avoidance of personal questions
- Malnutrition/ Dehydration
- Poor hygiene
- Soiled or inappropriate clothing
- weight loss
- Trouble sleeping
- bed sores or preventable conditions
- Seems depressed, confused or withdrawn
