All Flashcards
What is the hospitalization rate for 65+,85+?
3x, 6.9x
Most common chronic condition
Hypertension, arthritis, heart disease, cancer, diabetes, asthma, COPD
What percent of doctors are geriatricians?
3-6%
What is the need for geriatricians?
Currently have 8,000, need 14,000, in future we will need 36,000
Assessment of the elderly patient
Medical, cognitive, affective-mood, functional (physical, social), economic, caregiver, environmental, quality of life/well being, advance directives - what do they want to do at the end of their lives, spirituality
ADL
Bathing, dressing, continence, feeding
Intermediate Activities of Daily Living
Using telephone, preparing meals, shopping, housekeeping, doing laundry, taking medicine, handling finances
Advanced activities of daily living
Recreational, occupational, community service
Life space diary
As you get older, your range of life gets smaller, first you can’t go outside the county and then later outside of your home
What 5 aspects define frailty?
3/5 must be met: SWULC Unintended weight loss Weak grip strength Slow waking speed Low physical activity Chronic exhaustion
Do more males or females over 65 show problems with ADL or IADL
half as many males show problems than females
Leading cause of injury and injury related death
FALLS, 30% experience a fall in a given year
What are risk for falls?
sarcopenia, arthritis, impaired gait, use of 4+ meds which can affect blood pressure and balance, drugs for anxiety,depression or pain, visual impairment
Unlike other health problems fall related deaths have increased since 1990
normal eye changes
Cornea protects eye from dust and gets thicker thus reducing pupil size, vitreous fluid in the eye can get cloudy, can’t focus of adjust from light to dark as easily, decreased depth perception, impaired night vision because of small pupil, glare as cornea thickens, presbyopia
Lens
Focuses light to the optic nerve, major changes occur here, oldest cells in the body, collagen becomes less elastic, muscles that stretch the lens deteriorate
Accommodation
Changing lens to see far and near
Retina
Center is macula
Cones- color and detail
Rods - general shape
Presbyopia
Far sided, can’t see things near normal part of aging
cataracts
Leading cause of reversible blindness, collagen becomes cloudy and old, most commonly paid for Medicare surgery - lens removed and replaced with artificial lens
glaucoma
tunnel vision, fluid buildup causes pressure on optic nerve, leading cause of irreversible blindness in US, fluid can’t drain from canal of Schlemm
macular degeneration
can only see the sides not the middle, no cure but can slow progression
dry macular degeneration
Changes in cells that should transmit nutrient to macula, more common
wet macular degeneration
blood vessels begin to form near the macula which interfere with nutrition
Hearing loss
Presbycusis- normal aging, 33% have hearing loss, men at more risk than women, fluid in cochlea also affects balance
Anosmia
olfactory bulb closes to hippocampus early sign of AD, normal aging
Eating and age
lower muscle tone in pharynx causes difficultly in swallowing, constipation, lower mobility makes it harder to cook and buy food
Gut microbiome
over 160 species of bacteria in gut, as we age there is variability in the number of them in the gut, they boost immunity and help breaks down food
Touch
decrease in touch receptors, decrease in pressure receptors, decrease in ability to manipulate small objects
balance and equilibrium
vestibular, peripheral, visual
Tai chi
augments immunity
sensation
process of taking in info through the sense organs
perception
info is processed in the brain
sensory threshold
minimum intensity of a stimulus for an individual to detect a stimulus
Recognition threshold
intensity of a stimulus needed for an individual to recognize it
sensory discrimination
min difference necessary between one or more stimuli in order for a person to distinguish between them
Cornea eye changes
first to be affected, surface thickens, blood vessels become more prominent, rounded surface becomes flatter
Arcus senilis
fatty yellow ring forming around cornea but had no impact or indication of vision loss
Pupil
pupil opening decreases 2/3 in size, doesn’t seem to contract more in bright light and becoming bigger in low light
Retina
Slower shift between rods and cones, older adults show slower adjusting to changes in light
Lens
GREATEST Changes, mainly made of oldest cells of protein of collagen which hardens and becomes less flexible making accommodation hard, become more opaque.
What percent of people are 65+ in Florida?
18%
Age related macular degeneration
Elevator muscles that move the eyeball up and down and ciliary muscles which change lens shape deteriorate with age, gene affected is hemicentlin 1
cochlea
Hair cells that vibrate to move sounds waves, vibration causes frequency or pitch, and intensity causes loudness
osteosclerosis in the ear
stapes becomes fixed and cannot vibrate
tinnitus
High pitched ringing
Olfactory hedonic experiences
odor stimuli evaluated emotionally rather than analytically
Robust vs non robust older adults
- Productive involvement (1500+ hours com service, home maintenance)
- No depressive symptoms
- High physical functioning
- No cognitive impairment
What qualities predict positive aging?
- Long term relationships in which older adults help others and accept help
- Supportive marriage or partnership
- Continued involvement in life, making new friends, accepting inevitability of death
- Mature defense mechanisms and coping response rather than passive acceptance when dealing with crises in health or relationships
Spirituality
Transcnedning body space ego and time, giving and receding support, intuitive understanding of how to cope with life
Volunteerism rates highest in
Middle age 34-44
Political participation
Voting difference greater within than between age groups
Wheel of civic engagement
Deliberative dialogue, service learning, internships, community service, volunteerism, community partnership, community based research, get out the vote initiatives, activism
Nine categories of civic health index
connecting to civic and religious groups, trusting other people, connecting to others through family and friends, giving and volunteering, staying informed, understanding civic and politics, participating in politics, trusting and feeling connected to major institutions, expressing political views
Civic engagement over time
Decline in civic engagement over time since 1960s
Demographic changes affecting civic engagement
Urban sprawl commuting reduces involvement, fewer marriages, more divorces, fewer children, lower wages
Charitable giving
Has remained fairly constant
Volunteering
To increase among this generation
Robert Puttnam on diversity
Diversity is good and bad Good for long term Why good? Religion, army Why bad? People feel more inclined to volunteer for shared racial identity
Leading cause of death for all ages
Heart disease
Leading cause of death in the US for 15-24, also 1-44 age group
Unintentional injuries
Most potential years of life lost before 65
Due to unintentional injury
Leading causes of injury death
#1 poisoning/overdose #2 motor vehicle crash #3 falls
Ecologic model
helps to contextualize both risk factors and interventions
Individual –> relationship –> community –> societal
Mvc preventative strategies
Graduated listening, insurance rates, max speed limits, seat belt laws, child safety Seats, cell phone/texting bans
Environmental/structural
Air bags, crash barrels, speed trailers, runaway lanes
Most effective fall prevention
Comprehensive clinical assessment combined with individuals risk reduction and patient follow up
Public Health Approach of Injury
- Define the problem through surveillance
- Identify risk and protective factors
- Develop test prevention strategies
- Assure widespread adoption of effective injury prevention principles and strategies (i.e.: minimum age drinking laws)
Healthy People 2010
set of disease prevention and health promotion objectives for the nation to achieve in the first decade to eliminate health disparities
Motor vehicle related injury
Twice in men than in women older adults
Older adults drivers
Less likely to be involved in crash that kills so
KATZ scale and Burge Balance scale
Study
Brain health is…
Involves thinking, attention, memory, relaxation, mood, physical activity
Anti inflammatory lifestyle strategies
Good night sleep, eating omega 3 fatty acids, physical exercise
AD
Amyloid plaques and tau tangles that were later found to be the same plaques that cause senility, age is the single greatest risk factor, sensory motor and visual cortex spared or damage so ppl can sense and see things but cannot interpret them
apolipoprotein E-4
Common allele in 20% of population that increased risk but some with it never get AD, some without it get AD So not a good predictor
Other genes that indicate AD
Presenilin genes and APP gene
Functional mri scans of AD patients
Show more functioning in patients at risk for AD because they are overcompensating
Memory
Learning, recall
Cognition
Memory, attention, visual/spatial skills, reasoning
Dementia
Memory loss + another impairment
Cognitive disorders in older adults
Alzheimer’s, vascular disease, lest body disease, Parkinson’s, hunting tons, frontal dementia, head injury, nutritional, medications, alcohol/toxins, infectious, depression, neoplasms, autoimmune disorders
Non genetic risk factors of dementia
Physical conditioning, mental stimulation, stress management, nutrition
Hippocampus growth
Exercise grows the hippocampus
Obesity and memory
Obesity increase memory loss and weight loss decrease memory loss
Brain protective drinks
Red wine (reservatrol), caffeine, any alcohol in consideration, pomegranate, turmeric
AD prevention strategies
Physical exercise and healthy diet
Cognitive functioning
Intelligence, learning, memory
Tests of multidimensional structure of intelligence - primary mental abilities
Mathematical reasoning, word fluency-use of appropriate words to describe the world, spatial relations, inductive reasoning - generalize facts to concepts/logic, verbal memory - retain/recall words from reading, perceptual speed, verbal meaning - vocabulary
Fluid intelligence
Biologically determined, independent of experience, "native intelligence" Spatial orientation Abstract reasoning Word fluency Inductive reasoning
crystallized intelligence
acquired through education and experience, social judgement, Word association Social judgement Number skills Verbal meaning
Most widely used intelligence test
WAIS - wechsler adult intelligence scale
6 verbal scales - crystallized Intel
5 performance scales - fluid Intel
Classical aging pattern
Decline with age in performance scales (fluid) stable with age in verbal scales (crystallized)
Problems in cognition functioning tests
Cross sectional studies, cohort being more important than age difference, subject attrition, selective attrition producing skewed studies
Gender differences
Men slow down in areas of spatial awareness first and women slow down in word fluency first women have a late Peale performance
Terminal decline hypothesis
Rapid decline in Intel in the last 5 years of life
Proximity to death is more indicative of intellectual decline than age
executive function
Ability to organize ones learning and plan and make decisions and to shift attention to modify cognitive and spatial sets as new info is received
Leads to decline in IADLS
Three components of attention
Selective attention - learner must be able to reject irrelevant information
vigilance - requires to look out for a signal or specific stimuli
attentional control - individuals ability to determine how much attention should be given to a stimuli in conditions of divided attention
General slowing hypothesis
processing of info slows down in the nervous system with age
recall
process of searching through vast store of secondary info perhaps without an orienting question (free response answer)
recognition
requires less search, matching with orienting question (MC)
Decrement model
Memory networks deteriorate with age
Incremental knowledge gain
all the knowledge and vocab gathered by older adults can cause more names in secondary meme key to interfere with the name to be recalled
Memory mediators
Use of Visual and verbal links between info to be encoded and that in secondary memory
Visual mediators
Associating word with locations
Look snap connect
Look
Cognitive plasticity
Ability to accomplish three mechanisms which are selection optimization and compensation
Neural plasticity
Changes in brain structure and function that result from new neuron and synaptic connections
Dementia
Loss of:
Coherent speech
Recognizing or identifying objects
Executing and comprehending motor tasks
Thinking abstractly and performing executing functions
Change in ability to recall events in current memory
Disorientation in time place and person
Beginning stage of a AD
First affected area is the hippocampus which aids in learning new info and retrieving old info
Intermediate stage of AD
Once neocortex is affected more complex thinking like linking old info with new info are affected
Advanced age of AD
Neurons affected in motor cortex
Tests for AD
Mini cog - shorter
Mini mental status exam, dementia rating scale
Global deterioration scale
- No cog/functional decrements
- Complaints of mild forgetfulness
- Mild cog impairment, concentration problems, difficulty traveling alone
- Confusional stage, planning, handling finances
- Poor recall of events, need to be reminded of ADL
- Advanced memory decline, need assistance with ADL, personality changes
- Loss of verbal abilities, incontinence, can’t walk, may become comatose
Five outcome areas of service learning
Attitudes toward self, attitudes toward learning, civic engagement, social skills, academic performance (most salient)
K-12 service learning standards what 4 recommend practices studied
Linking progress to academic and program objective and curriculum,
Incorporating youth voice, involving community partners, providing opportunities for reflection
Results of service learning meta analysis
Programs that used recommended practices yielded twice the positive effect of programs that didn’t use recommended practices, outcome comparable regardless of age, number of recommendations didn’t really Matter
How many people on LA city council? Asians? Women? County board of supervisors?
15,1,1, 5
The third LA
1st - 1880s to before WW2, lots of growth but walkable downtown streetcar system
2nd - WW2 to turn of the millennium, freeways, suburbs
3RD - Profound reinvention - no more room to sprawl, dense housing, mass transit
Good deserts
Lots of LA areas don’t have grocery stores
Gerotechnology
Technology to help older people to engineering to make assistive technology
Universal design
Signing the environment to accommodate both young and old health and disabled
Telemedicine
Providing care from a distance, transmission of data to improve healthcare
Most common chronic conditions in older adults
Hypertension, arthritis, heart disease
