Ch20: Gerontology Flashcards
age range: young old, old old, oldest old, elite old
young old: 65-74yo
old old: 75-84yo
oldest old: 85-100yo
elite old: >100yo
average life expectancy at:
- 65yo
- 75yo
- 85yo
- 90yo
- 100 yo
65yo + 18 75yo + 11 85yo + 6 90yo + 4 100yo + 2
the longer you live, the older you are expected to live
% of population over 65yo that is classified as poor or nearly poor
18%
single biggest source of income after 65yo
social security (42%)
limited contribution from pension, earnings, assets, and other sources
the majority of elders >85yo [do vs. do not] need assistance with instrumental ADLs
do not :)
77% do not need assistance
% of elderly who live alone
33%
majority live with a spouse or another relative
Erik Erickson psychosocial task/conflict of old age
ego integrity vs. despair
Butler psychosocial/ developmental theory of aging: retrospection and life review results in …. (3)
serenity, candor, wisdom
(3) conflicts in Peck psychosocial/developmental theory of aging
- ego differentiation vs. work role preoccupation
- body transcendence vs. body preoccupation
- ego transcendence vs. ego preoccupation (happy with what you’ve done, happy with what you’ve accomplished, rather than preoccupied with what you did not)
conflict of Levinson’s season on life psychosocial/developmental theory of aging
individual must ultimately come to terms with the inevitability of death
this theory focuses on relationship of physical changes to personality
physiologic theory of aging: gene theory
suggests that one or more latent, harmful genes become activated in late adulthood, and the individual cannot ultimately survive
suggests the killer gene was there all along, but remained latent
physiologic theory of aging: error theory
as a cell ages, proteins contain more and more errors and eventually a “killer” gene is produced
the more a cell ages and copies, will not work as well as before and more errors accumulate
suggests that errors create a killer gene
physiologic theory of aging: somatic mutation theory
there is an active destruction of a key gene that causes cells to stop dividing
longevity depends on how well the cell can repair DNA
suggests that there is a gene that promotes life, allowing cells to survive
physiologic theory of aging: programmed theory
a senescence factor (aging factor) accumulates in cells, and then finally begins to act in a dominant factor
the aging factor is dominant to young cells
physiologic theory of aging: immunologic theory
imbalance of T cells (cellular immune function),
cellular immune function decreases and auto-antibodies become responsible to the breakdown of the body
physiologic theory of aging: free-radical theory
free-radicals are unpaired electrons (circulate as super-oxide O3 and peroxide H2O2 and hydroxyl free radical)
- three forms of oxygen that are highly reactive or volatile
- aka, reactive oxygen species
- forms of oxygen with a loose electron (O2 is stable, but O3 is not. H0 is stable, H2O2 is not, etc.)
unpaired electrons are produced both intrinsically and externally -> altered biochemical reactions thus result in DNA damage and cell death
physiologic theory of aging: cross-link theory
collagen molecules cross-link in tissues producing stiffness and rigidity
stiff tissues don’t function very well and eventually die
physiologic theory of aging: stress-adaptation
age-related physical changes lead to a decrease in the ability to cope with stressors
related to hypothermia (metabolism slows down, and heat is a byproduct of metabolism), cardiac output decline, and vital capacity result in diminished ability to cope with stress
high degree of variability, which could explain why some people live so much longer than others
author of the transtheoretical model of change - e.g., precontemplation, contemplation, etc.
Prochaska
Prochaska’s stages of change in the transtheoretical model of change (5)
- precontemplation
- contemplation
- preparation
- action
- maintenance
what is competency?
the law presumes that all adults are competent to make decisions regarding their medical care
ONLY a COURT can declare a person incompetent and appoint a guardian to make decisions for them
Impaired judgement does not make a patient incompetent
what is the only entity that can declare a person incompetent?
a judge
Does impaired judgement make a patient incompetent?
no!
you can have transient delirium, or other acute conditions, rendering unable to provide informed consent but doesn’t make you permanently incompetent
who can determine whether a patient can provide informed consent?
providers
does not require a judge, like incompetency does
requirements for the ability to give informed consent (4)
- has knowledge of the diagnosis
- understands the nature and purpose of the procedure
- understands the benefits, risks, and side effects
- understands reasonable alternatives
% prevalence of elder abuse and neglect, current estimates
4-10% of elderly Americans
types of elder abuse (5)
- physical
- sexual
- psychological/ emotional
- financial
- neglect
theories of elder abuse (4)
- cycles of learned violence (we know that people who are abused may be more likely to become abusive; e.g., abused child taking care of abusive parent)
- caregiver stress (the greater the requirements on the caregiver, the greater risk this relationship could deteriorate)
- pathophysiology of abuser (?)
- physical/mental impairment of the elder (the more dependent the patient, the higher the risk)
suspicious indicators of elder abuse
- description of injury does not match physical findings
- history of similar injuries
- appears afraid or avoids eye contact
- flinches when you touch them
- bruises, burns scratches, lacerations in unusual places
- injuries in various stages of healing
- patterns of seeking different health care
- frequent emergency room use
- withdrawal from social activities
- significant changes in affect
- untreated malnutrition
- misuse of medications
- untreated medical needs
Omnibus Reconciliation Act of 1987 provides that every resident of long-term care has the right to be …
free from physical or chemical restraint imposed for the purpose of discipline or convenience, and not required to treat medical needs
when injury occurs to an unrestrained patient in long-term care, lawsuits are typically the result of…..
failure to meet reasonable standards of care e.g., negligent in duty to provide care for a wandering patient or alarm systems not working
NOT failure of the result to restrain (don’t restrain when not needed!)
methods of decision making for patients who cannot communicate wishes: appointed person
appointed person makes decisions based upon their understanding of the patient’s past wishes and values
methods of decision making for patients who cannot communicate wishes: rational approach
makes decisions based on what a “rational” person would do under the circumstances
Medicare wants providers to counsel whom about ACPs?
all folks 65yo and older
methods of decision making for patients who cannot communicate wishes: substituted judgement
attempts to determine what decision the patient would make if they were able
what is the single best method of decision making for patients who cannot communicate their wishes
advanced directives!
durable statements of intent based upon the patient’s last written wishes
a contract between the patient and HCP which specifies wishes for end-of-life care in terminal events
living will
a document that authorizes another person to make decisions regarding healthcare when the patient is no longer able to
durable power of attorney
are advanced directives legally binding?
no
and not all states recognize advanced directives legally
even states that do recognize them do so only when the patient is, in the opinion of the HCP, hopelessly and terminally ill
which elderly place requires functional ability (e.g., ability to go to bathroom on own?)
- senior care centers
NOT required in: - adult day care - home health care - life care communities ^^ all of these are built to help with folks losing their functional abilities
true or false: only a court can declare a person incompetent?
true
true or false: impaired judgement does not make a person incompetent?
true
true or false: living wills are generally only honored if a person is terminally ill
true
true or false: if a person is not declared incompetent, then they can give informed consent
false
these are separate considerations; there are some people who haven’t been declared incompetent by a judge who still cannot give consent to a particular situation (e.g., acute delirium)
true or false: most elderly live with a spouse or other family member
true
true or false: almost 25% of elderly over 85yo require assistance with IADLs
true
true or false; stereotypes about aging have resulted in fiscal policy benefits helpful to elders
true
true or false: the number of older men in the workforce has increased in recent years
false - percentage is decreasing, while percentage of women is increasing
which theory of aging suggests that vitamins might delay aging process?
free radical theory
reactive oxygen species destroy bonds and ultimately kill cells
in contrast, vitamin E is an example of an antioxidant that could theoretically neutralize free radicals and keep them from destroying cells
normal or pathophysiologic change in aging?
increased A:P chest diameter
normal change of aging
important to distinguish from COPD via typical history, symptoms, and diagnostic spirometry findings
normal or pathophysiologic change in aging?
corneal ring
normal change of aging
aka, senile arcus
important to distinguish from HLD, can draw lipid panel
normal or pathophysiologic change in aging?
decreased skin turgot
normal change of aging
important to distinguish from dehydration, can draw labs for BUN
(4) body systems MOST affected by the NORMAL changes of aging
- neurological
- cardiovascular
- musculoskeletal
- lower urinary
because of the weakness in those four organ systems, the strain of any illness tends to manifest in one of these four
predominant cluster of symptoms tends to occur for any illness, e.g., confusion
predominant symptom cluster of illness in the older adult (5)
- acute confusion
- depression
- falls
- incontinence
- syncope
when these occur, can mean anything
e.g., if they have acute onset confusion check for UTI and pneumonia, MI, not suspecting a neurological event first
as a consequence of normal age-related declines in compensatory mechanisms, a new illness/ disease may present itself [earlier vs. later]
earlier!
as a result, possibly easier to treat
in the elderly, heart failure might be precipitated by….
mild hypothyroidism
hypothyroidism decreases HR< and combined with age-related decline in cardiac output, cannot compensate as well and thus may present earlier
in the elderly, mild hyperparathyroidism may cause….
significant cognitive dysfunction via hypercalcemia
less efficient mechanisms for removing and using up calcium
3 (D)s that occur more commonly in elderly patients than younger adults
dementia, delirium, depression
syndrome characterized by deterioration of, or impairment in, behavioral or emotional function despite a state of clear consciousness. distinguished by its persistent, progressive nature.
dementia
most common dementia
Alzheimer’s dementia
% of folks at 75yo and 85yo with at least some degree of Alzheimer’s dementia
50% by 85yo
25% by 75yo
second most common form of dementia
vascular dementia
types:
- multi-infarct dementia (MID)
- vascular dementia (VaD)
- dementia with cerebrovascular disease (DCVD)
commonly comorbid with Alzheimer’s dementia
what is the cognitive behavioral syndrome of frontotemporal dementia called
Pick’s disease
Lewy body dementia is characterized by…
quick trajectory
neurofibrillary tangles are present in what type of dementia
Alzheimer’s dementia
confabulation typically occurs in which type of dementia
Alzheimer’s dementia
an acute event characterized by global cognitive impairment, alterations in the sleep-wake cycle, and alterations in psychomotor behavior. distinguished by its rapidly-fluctuating, acute nature. is a symptom, caused by something outside the CNS, not a disease
delirium
in the elderly population, causation of delirium is usually ….
an infection
Parkinson’s disease is a degenerative CNS disorder resulting from an imbalance between (2)
dopamine and acetylcholine
loss of dopaminergic neurons –> unchecked acetylcholine moving throughout CNS
NOT ENOUGH DOPAMINE
(3) classic characteristics of Parkinson’s disease
- resting tremor, e.g., pill-rolling and disappears with purposeful movement
- rigidity
- bradykinesia
can progress to impairment in swallowing, decreased automatic movement, and decreased blinking
the tremor of Parkinson’s disease would get better or worse with goal-directed movement?
better
gold standard drug for Parkinson’s disease
carbidopa-levodopa (Sinemet)
treats symptomatically, does not deter progression of the disease
average duration of response to Sinemet is….
5 years
all Parkinson’s drugs aim to increase….
dopamine availability
all Parkinson’s drugs aim to [relieve symptoms vs. stymie disease progression]
relieve symptoms
% of falls that lead to serious injury
11%
age-related risk factors for falls
- female
- chronic medical conditions
- cognitive impairment
- ADL dependence
- impaired vision or hearing
- polypharmacy
- environmental hazards
- gait and balance disorders
questions to ask after a fall
- what were you doing when you fell?
- was there an aura? warning or prodrome that this was going to happen?
- was there loss of vision? transient vision loss?
- did you experience vertigo?
- was there any loss of consciousness?
- did you break the fall with a hand or other body part?
- is this an isolated incident or are falls happening more often?
- what medications are you taking?
- do you ever drink alcohol?
(4) required components of physical exam after a fall
- vital signs, including orthostatic vitals
- cardiovascular exam
- sensory assessment
- gait/balance assessment
other systems as indicated
occurs when tissues are compressed or subject to pressure and vascular pressure is exceeded -> lose vascular supply aka ability to provide nutrition to and drain an area
pressure ulcer
significant contributing factors include friction, shear forces, and nutritional deficiencies
contributing factors to pressure ulcers
- friction
- shear forces
- nutritional deficiencies
- moisture
- advanced age
- low BP
- smoking
- elevated body temperature
- dehydration
all of these are things that contribute to decreased tissue perfusion or increased burden on the pressure externally
types of ulcers (6)
- pressure ulcer
- fungal or yeast infection
- venous insufficiency ulcer (chronic interstitial pressure)
- PAD ulcer (consequence of poor perfusion)
- neuropathic ulcer
- malignancy
(2) risk screening tools for ulcers you can use
both of these measure physical, mental, nutritional, mobility, and continence condition
- Braden Scale
- Norton Scale
priority intervention for pressure ulcer
- relief of pressure
otherwise, correct risk factors like improving BP, nutritional status, removing shear forces
stage 1 pressure ulcer
non-blanchable erythema … induration may be present, but NO OPEN AREAS
stage 2 pressure ulcer
minor epidermal or skin loss, may look like an intact blister
shiny, pink erosion
stage 3 pressure ulcer
full-thickness skin loss without undermining (not into the deeper structures)
stage 4 pressure ulcer
full-thickness skin and tissue loss through fascia, muscle, bone or supporting tissue visible
