Aging with Disabilities Flashcards
What is Ageism? 3 myths that go along with it:
“Ageism”-negatively biased perceptions of older people by younger population in today’s youth-oriented society
Many myths surround aging
“Getting older means being ill”
“Older people are less physically and mentally active”
“Older people have a poorer quality of life”
Epidemiology of aging:
- at turn of century 1 of every ____ individuals was 65 years or older
- By 1994, this increased to 1 out of _____ americans
- Current projections indicate what for 2030?
At the turn of the century 1 of every 25 individuals (4%) was 65 years of age or older
By 1994, this had increased to 1 out of 8 Americans (12.6% or 33.2 million)
Current projections indicate that 80 million or 1 out of 5 Americans will be 65 years or older by 2030 with most growth between 2010 and 2030 creating the “elder boom
Distribution of the elderly is uneven across the US with 50% living in 9 states:
- ____ has greatest number of people older than 65.
- _____ has largest proportion of elderly
- Estimated ethnic trends by 2050?
Distribution of the elderly is uneven across the US with 50% living in nine states
California has the greatest number of people older than 65 but Florida has the largest proportion of elderly (18.6%)
Estimated ethnic trends by 2050 with decrease of whites to 67% with increase of older Hispanic (16%) and African Americans (10%)
The rate of growth of elderly appears to be greatest in developing countries
Longevity continues to improve with average age of ____ years for Americans. Why?
Longevity continues to improve with average age of 78.7 years for Americans
Delayed occurrence of death due to delay in onset and reduced lethality of diseases such as stroke, cancer, and MI
More individuals surviving with larger number of people living with disabilities
What is primary and secodary aging
Primary aging
Universal changes with aging independent of disease and environmental effects
Secondary aging
Includes lifestyle and environmental consequences and disease as part of the aging syndrome
7 “general” changes in physiology of aging
- Decreased reserve capacity of organ systems, which is apparent only during periods of exertion or stress
- Decreased internal homeostatic control (blunting of the thermoregulatory systems, decline in baroreceptor sensitivity)
- Decreased ability to adapt in response to different environments (hypo or hyperthermia)
- Decreased capacity to respond to stress (exertion, fever, anemia)
- Variation between healthy people of the same age is far greater than the variation that is due to aging alone
- Difficult to determine if age decrements are linear over the entire age span or whether the rate of decline accelerates in later years
- There is variation in the rate of decline of the various organ systems
Hematologic physiology of aging:
- It is NOT normal for:
- Most common causes for anemia in the elderly
- Discuss Sed Rate/CRP:
- Functional changes related to anemia include: (3)
- Medication issues:
Hematologic System
1. It is NOT normal consequence of aging to have a Hgb
Physiology of normal aging: GI
- ____ may occur.
- Increased risk of (4)
- Decreased ____ contraction
GI system
Presbyesophagus may occur
Increased risk of hemorrhoids
Increased risk of gallstones
Increased risk of aspiration due to less coordinated swallowing
Decreased smooth muscle contraction which may lead to constipation and retained stool in the rectum
Fecal incontinence usually seen as a result of bowel impaction
Increased risk of colon CA
Normal physiology of aging: Renal: 1. 3 changes occur over time 2. Can lead to (2) 3. \_\_\_\_ may occur leading to hypernatremia 4. \_\_\_\_ also poorly tolerated: sequelae
Renal System
Decrease in renal mass, number and functioning of glomeruli and tubules, renal blood flow and GFR which have major implications for drug excretion with prolonged half lives of many meds
Can lead to electrolyte imbalances and fluid balance and caution must be taken with rehydration as to not cause large volume expansion leading to CHF
Caution must be used in the use of contrast dyes due to risk of kidney injury
Blunted thirst mechanism is often times seen in the elderly which may lead to hypernatremia
Hyponatremia also poorly tolerated with noted confusion, lethargy, anorexia and weakness
Physiology of normal aging: Pulm
- _(3_declines with age even without pathology
- Progressive _____ imbalance. due to:
- Discuss pO2 in different positions
- Max ____ consumption decreases with age: why
- increased risk of:
Pulmonary System
In absence of pulmonary d/o, pulmonary capacity declines without major functional limitations at rest
Progressive decrease of VC, expiratory flow rate and FEV noted
Progressive ventilation-perfusion imbalance with aging due to the collapse of the small airways which results in linear decline in pO2
Due to altered thoracic mechanics, pO2 is lower in supine than in sitting or standing, no change is seen in pH or pCO2
Maximal oxygen consumption decrease with age but most likely due to underlying cardiac complications more so than pulmonary dysfunction
Increased risk of pneumonia noted as related to poor cough, decreased chest wall compliance and decreased mucociliary function
Phys of normal aging: CV
- # 1 cause of:
- HD worsened by (5) factors
- Discuss changes in HR as we age (BOARD QUESTION)
- discuss changes with contractility.
- Increased risk of _____ with age
Cardiovascular System
Heart disease remains the #1 cause of death for adults older than 65
Heart disease worsened by secondary factors such as smoking, stress, uncontrolled hypertension, obesity and lack of exercise
No change in resting HR but decreased maximal HR with exercise related to decreased chronotropic responses to adrenergic stimuli
Decreased inonotropic responses to adrenergic stimulus results in decrease myocardial contractility, and EF and increased risk of CHF
Cardiovascular system
Decrease in rate of early diastolic filling with greater dependency on filling thru atrial contraction thus most elderly more susceptible to effects of Afib or atrial tachycardia
Decreased baroreceptor sensitivity with increased incidence of orthostatic hypotension
Immunology: phys of normal aging (5)
Immunologic System
1Marked decline in immunocompetence
2Decline in lymphocyte proliferation in response to antigen stimulation
3Increase in circulatory antibodies and immune complexes with decreased antibody production as seen with attenuated responses to immunizations
4Increased susceptibility to infection related to above and co-morbidities
5Less active leukocytosis and often absent or only low grade fever in case of infection
Endocrine: phys of normal aging (4)
Endocrine System Decreased glucose tolerance Changes in thyroid function Decreased cortisol production Decrease in serum testosterone and estrogen levels
Thermoregulatory system: phys of normal aging (3)
Thermoregulatory System
Impaired temperature regulation due to combination of diminished sensitivity to temperature change and abnormal autonomic vasomotor control
Diminished sweating which can lead to heat exhaustion and heat stroke
Hypohidrosis may be aggravated by anticholinergic medications
Sensory system: vision: phys of normal aging 4
Sensory system-Vision
Deterioration of vision with presbyopia and physiologic miosis
Cataract formation, glaucoma, macular degeneration, diabetic retinopathy all commonly seen
Visual changes lead to many falls, especially at night
Routine eye exams recommended
sensory system: hearing - phys of normal aging (3)
Sensory System-Hearing
Gradual decline in hearing acuity/presbycusis
Most consistent with conductive hearing loss
Important to try to correct as can lead to social isolation, paranoid ideations or at times psychiatric reactions
neurologic system: phys of normal aging (5)
Neurologic System
Decrease in STM especially episodic memory and incidental learning
Loss of speed of motor activities
Decrease in the rate of central information processing
Impairments in stature, proprioception and gait
Decline in sensory nerve conduction velocity and rate of muscle contraction
MSK: phys of normal aging:
- Progressive loss of muscle strength of about ___% per decade for LE muscles and ____% for UE muscles.
- Tendons and ligaments are more prone to ____
- What programs help with muscle strength? why
- Contribution of what factors (3) impact strength
- High prevalence of what two diseases (2)
Musculoskeletal System
Progressive loss of muscle strength of about 14-16% per decade for LE muscles and 2-12% per decade for UE muscles related to overall decrease in muscle cross-sectional area and mass with age
Tendons & ligaments more prone to bruising or tearing with longer recovery time
Significant contribution of cellular, neural and metabolic factors that also can impact strength
Improvement of muscle strength noted in older individuals involved in structured high intensity resistance exercise program
High prevalence of osteoporosis and DJD
Increase risk of fractures, dislocations and loss of function
GU system: Phys of normal aging:
- BPH occurs universally in men over:
- be wary of _____ as presence of underlying disease
- 4 changes in GU system
- sexually? 3
GU System
1. BPH occurs universally in men over age 40
2. If incontinence present this should be regarded as a symptom of an underlying disease
Decrease in bladder capacity, inability to postpone voiding, detrusor contractility and urinary flow rate
Most retain sexual interest and desire and to a variable extent capability
More incidence of ED with need for medictions
Women may experience fragility and dryness of the vaginal wall and labia
Integumentary system (6) changes in normal aging
Normal Aging Process Loss of skin elasticity Loss of subcutaneous supporting and adipose (fat) tissue Loss of underlying muscle mass and bulk Easy skin tears and bruising More prone to development of PU Delayed skin healing
Psychosocial aging process (3)
Normal Aging Process
Increased risk of depression due to feelings of hopelessness, helplessness combined with underlying medical issues and loss of independence
Increased risk of suicide
Need to be cautious of alcohol usage and interactions with medications
5 effects of acute hospitalization
Disorientation/delirium
Atypical routines that may cause or worsen insomnia
Adverse side effect of medications
Adverse events
Loss of function and confidence complicated by limited or no family support upon return to home
Functional impact of aging: 1. most experience \_\_\_\_ decline 2. what is "frailty" 3 Physically impaired older patients tend to become \_\_\_\_ 4. further loss associated with (4)
- Some experience a sudden change in function but most gradually decline over time
- “Frailty”-a concept of more than the functional losses of older individuals but also represents a state of vulnerability resulting from the balance and interplay of medical and social factors
3 Physically impaired older patients tend to become socially isolated with can lead to exacerbation of medical problems, functional deficits and mental health issues - Further loss worsened by stress of multiple losses to include friends and family, malnutrition, pain, and adverse drug effect
function loss in elderly:
- worsened by _____
- What is “right of dependency”
- Worsened by devaluing of the disabled elderly by themselves or others, lack of interest by their health care professionals and limited opportunity for rehabilitation services
2Attitudinal obstacles such as “right of dependency” perceived as an earned virtue of longevity and the “apathy and fatigue” both mental and physical associated with multiple medical complications and hospitalizations
Classification of Physical Functioning in older adults 75-12
(5)
Classification of Physical Functioning in older adults 75-12
Physically elite-high risk and power sports
Physically fit-moderate physical and endurance sports, most hobbies
Physically independent-Light physical work, low demand activities, golf, driving, All IADLs
Physically frail-light housekeeping, some IADLs, may be homebound
Physically dependent-no or only some ADLs, needs home based or institutional care
*Spirduso, W. Physical dimensions of aging. 1995
