Exam 1 Flashcards
Instrumental activities of daily living – summarize an individual’s ability to perform more complex multidimensional activities and interact effectively with environment
Managing money, meal preparation, grocery shopping (most common), phone calls
Disability
Impairments in ability to complete multiple tasks
Health status
Presence/absence of disease and degree of disability in an individual’s level of functioning
Activities of daily living – measure functional health, summarize an individual’s ability to perform basic personal care tasks
Eating, bathing, dressing, walking (most common)
Frailty
Unintended weight loss, slow walking speed, low physical activity levels, chronic exhaustion, weak grip strength
Leading cause of injuries and injury related deaths for 65+ group
Falls (Account for 95% of all hip fractures)
Over 1/3 of those 65+ fall every year
9th leading cause of death among seniors
Most effective fall intervention is comprehensive clinical assessment combined with individualized fall risk reduction and patients follow up
Most common chronic condition affecting older people
Hypertension, Arthritis, Heart disease
Advanced activities of daily living
Patient specific functional activities like recreational, occupational, community service
Geriatrics vs gerontology
Geriatrics is the clinicals study of treatment of older people and the diseases that affect them (medical specialty)
Gerontology focuses on understanding the biological psychological social and political factors that influence people’s lives (interdisciplinary study)
Good health
More than absence of disease or disability – complete mental, physical, and social state of well-being
Risk factors for falls include all of the following except: a) Being overweight B) multiple diseases C) unfamiliar environments D) fear of falling
A) being overweight
Risk factors for falls
Lack of balance control, impaired gait, arthritis, cognitive impairment, increased age, use of 4+ medications that cause blood pressure to drop/affect balance, use of multiple drugs that affect CNS, visual impairment, sarcopenia
Sensory threshold
Minimum intensity of a stimulus that is required to detect the stimulus
Recognition threshold
Intensity of a stimulus needed for an individual to identify it
Sensory discrimination
Difference between two or more stimuli necessary in order for a person to distinguish between them
Sensation
Taking in information through the sense organs
Perception
Higher function in which information received through senses is processed in the brain
Changes in cornea
Cornea protects from dust and infection
Usually first affected is the cornea – surface of cornea thickens and smooth/rounded surface becomes flatter and less smooth
Changes in pupil
Pupil is the opening where light comes in then travels to the back of the eye
Pupil becomes two thirds smaller and more fixed in size thus less able to dilate/contract as necessary and slow response to light changes
Changes in rods and cones
Cones-color (more detailed)
Rods-general shapes
Part of retina
Slower shift from rods to cones in low light situations and affects ability to read small text
Changes in lens
Helps focus light which is connected to the optic nerve to be perceived in brain
Lens is a simple structure biochemically - all cells are of same type and composed of proteins (collagen). Collagen thickens and hardens with age making it less elastic + muscles that help stretch lens deteriorate–> less able to alter its shape when accomodating.
When collagen hardens there’s differential hardening (some surfaces let in more light than others) and this leads to uneven refraction of light onto the retina
When combined with poor refraction of light through uneven, flattened cornea surface, glare sensitivity results
Lens becomes more yellow and leads to reduced color sensitivity
Accommodation
Focusing from near to far
Deteriorates w age
Glaucoma
Aqueous humour fills front portion of eye and vitreous humour is in posterior chamber. Aqueous humour drains through Schlemm canal
Drainage is less efficient in glaucoma leading to pressure on optic nerve and resulting in tunnel vision
Treatment: medication to eliminate fluid backup
Leading cause of IRREVERSIBLE blindness in elders in US, 2nd leading cause of blindness in US, primary cause of blindness among blacks
Age related cataract
Lens becomes more opaque and less light passes through with age
Age-related cataract is severe opacification to the point that the lens prevent like from entering
associated with lack of antioxidants and alcohol consumption
Treatment: cataract surgery - extract lens and implant new lens, most frequent outpatient surgical procedure on 65+ group
Like looking through a waterfall, leading cause of REVERSIBLE blindness in US and primary cause of blindness worldwide (more than half of people 60+ have cataracts)
Other vision changes
Depth and distance perception deteriorate, narrower peripheral vision, reduced tear secretion
Elevator muscles (which move eyeball up and down within socket) and ciliary muscle (aid lens in changing shape) deteriorate
Macular degeneration
Loss of central vision (macula is in center of retina with sharpest vision)
leading cause of blindness in US adults
WET (blood vessels form and block nutrition) or DRY (changes in cells that transmit nutrients to the macula, more common)
Smoking, Long term UV exposure, lack of antioxidants
Laser treatment or light activated drug treatment
Anatomy of ear
Outer ear- pinna (outside of the ear) and consists of auditory canal.
Tympanic membrane (eardrum) separates outer ear from middle ear
Middle ear consists of 3 small bones aka ossicles (malleus, incus, stapes) that transfer sounds to inner ear
Inner ear is the cochlea - snail shaped, fluid filled chamber with vibrating hair cells that perceive frequency and intensity of sound
(sounds are Converted to nerve impulses in cochlea and sent through internal auditory canal and cochlear nerve to brain)
Hearing age related changes
Supporting walls of external auditory canals deteriorate, arthritic conditions affect joints between malleus and stapes, stiffening eardrum as it thins
Declines in middle ear affect ability to detect and localize sound
hearing loss at lower volume and high frequency range (more common among smokers, hypertension, diabetes)
Presbycusis
Sensorineural loss that accompanies aging in the cochlea
Leading cause of hearing loss in elders
Otosclerosis
Condition in which stapes can’t vibrate and becomes fixed
Tinnitus
High pitched ringing related to occupations noise
Speech comprehension can be first sign of hearing loss
Low frequency hearing loss has minimal impact on speech comprehension, high frequency sounds can be heard by raising intensity
Changes in taste/smell
Changes in taste acuity are minimal but older people have more difficulty discriminating between different intensities of flavor
perceive airborne stimuli as less intense and do less well on odor identification
Iris
Gives eye color, controls size of pupil
eye health care professionals
Ophthalmologist (M.D.)
optometrist (checks vision)
optician (sells glasses)
Presbyopia
Can’t focus on near objects (farsightedness) due to decreased lens elasticity
What percent of hearing impaired use hearing aids?
20-25%
Stigma, expensive, uncomfortable, background noise also raised
3 systems of sensation responsible for sense of balance
Peripheral, vestibular, visual
Gut microbiome
Over 1000 bacterial species live in gut, about 160 diff species in avg person
They help break down food and boost immunity, driven by diet
Later in life, Number of bacterial species in the gut varies tremendously
What are some Strategies to deal w declines?
Use nonverbal cues use external devices stand closer to hear and see better reduce level of excessive stimulation in environment face and make eye contact Avoid noisy and move to quieter
Successful aging
Combination of physical and functional health, high cognitive functioning, active involvement in society
Resilience
Ability to thrive under adverse conditions, turning adversity into a catalyst for growth
Productivity
Any paid or unpaid activity that produces goods and services for the benefit of society, reciprocally benefiting both elders and society
Most salient social factor that shapes what is possible in old age
Social class
Leisure
Any activity characterized by the absence of obligation
Leisure disagreement
Leisure cannot substitute for employment because it is not legitimated by social norms versus leisure can provide personal satisfaction and activities to challenge abilities
Most common choice for elders for organize participation
Religious affiliation
Religion
Narrower than religiosity, and refers to an organized system of spiritual beliefs values and behaviors shared by community and transmitted over time
Religiosity
Encompasses trust and faith in a power greater than oneself
Spirituality
Belief in a relationship with a higher power – broader than religion or religiosity, provides framework for individuals to make sense of the world: who they are and how they should live, emphasis on personal experience
An ageless self
Someone who is not discouraged by their aging and has an identity that maintains continuity and is on a spiritual journey in time
Civic engagement
Process in which individuals actively participate in the life of the communities through individual and collective activities such as voting, joining community groups and service volunteering
Those with college experience have greater civic engagement
Different views on civic engagement: conservatives, progressives, social constructionists
Conservatives: favor voluntary involvement to fill gaps created by budgetary cuts in social service programs
Progressives: advocate for elders to be politically active to ensure that public policies safeguard their rights
Social constructionists: Focus on civic engagement may devalue those who can’t be engaged
Volunteer work
Distinguished by choosing to serve others rather than by it’s unpaid nature or by formal activity
Depression era elders actively engaged in community service the baby boomers are less engaged
volunteerism is highest among adults at midlife (but elders spend more time volunteering )
higher rates of volunteerism in employed than unemployed
elders participate more in informal volunteering
2 benefits of volunteering
Provide individuals with meaningful social roles and give organizations reliable workers w no cost
Generativity
Focus on caring and doing for others and guiding the next generation
Experience corps
Older adults help high need elementary kids, benefitting both elders and children
Civic health index 9 categories
Connecting to civic and religious groups trusting other people connecting to others through family/friends giving and volunteering staying informed understanding Civics and politics participating in politics trusting major institutions expressing political views
Social capital
Collective value of all social networks as a force to create change
Urban sprawl
Migration of population from populated cities to more rural land
Each additional 10 min of commuting reduces involvement in community activities by 10%
The Greatest Generation (born before 1930) compared to grandchildren were:
Twice as trusting
75% more likely to vote
Twice as likely to participate in community projects
Graph that is steady over past 40 years
Charitable giving and volunteering
In graphs, there was a decline in civic engagement after:
1960s
But some signs of hope w our generation
Repotting hypothesis
Putnam, frequent changes of residence prevent people from planting deep enough roots in communities to nurture civic engagement (potting of plants damages roots)
Robert Putnam interview
In the short-term diversity results in decreased civic engagement but in the long term diversity is good
Civic engagement/volunteering at macro level vs micro level
Macro level: addresses social needs, supports economic growth, improves social capital (and states with high social capital, kids are better off, violent crime rarer, better health, economic equality)
Micro: health and longevity
Leading cause of death for Americans age 1–44
Unintentional injury
Public health approach to injury prevention
Define problem, identify riskand protective factors, develop and test prevention strategies, assure widespread adoption of effective injury prevention principles and strategies
Infants and toddlers (1-3)
Leading cause of Injury death
Leading cause of death
2nd leading cause of injury death
Unintentional suffocation
Motor vehicle crashes
Drowning
Children (4-11)
Leading cause of death
Cause of injury related death
4th leading cause
Motor vehicle crashes
Drowning
Homicide
Adolescents(12-19)
Leading cause of death
2nd leading cause of death
3rd leading cause of death
Motor vehicle injuries
Homicide
Suicide
Risk is higher among 16–19-year-olds than in any other age group (4times more likely than older drivers to crash)
Adults (20-49)
Leading cause of death
4th leading cause of death
5th leading cause of death
Motor vehicle injuries
Suicide
Homicide
Older adults (50+)
Leading cause of injury death
Leading cause of death
Falls
Heart disease
Drivers have higher crash death rates per mile driven than all BUT TEENS
1 leading cause of death in US (all age groups taken together)
Heart disease
Not cancer, injuries, stroke, or diabetes
1 leading cause of death in US (15-24 years old)
Unintentional injuries
Not suicide, homicide, heart disease, or diabetes
Leading cause of death age 1-44
Unintentional injuries
Unintentional injuries have more years of potential life lost before age 65 than any other cause of death
YPLLs describe how much impact a cause of death has on a lifespan
If someone dies at 15, compare it to 65 and they’ve lost 50 years of potential life
Leading cause of injury death out of all age groups
Unintentional poisoning
Motor vehicle crashes: prevention strategies and environmental/structural strategies
Prevention strategies: graduated licensing, Insurance rates, maximum speed limit, seatbelt laws, child safety seats, texting bans
environmental/structural strategies: speed bumps, stop signs, red light cameras, airbags, crash barrels and guard rails, speed trailers, runaway lanes
Among older drivers the most commonly cited reason for no longer driving is
Poor vision
Not loss of hearing, longer reaction time, slower reflexes, or fear of being involved in a crash
Driving prevention strategies for elders
Increased vision and driving testing condition specific limits on driving on drivers license graduated licensing for elders more frequent renewals roundabouts
Reducing fall risk
Education, environmental interventions, tai chi, preventative meds, informal social support, assessment tools
Universal design
Designing the environment to accommodate both young and old, healthy and disabled
Removing stairs, widening doors for wheelchairs, elevator, replacing door knobs with easier to use levers
Gerotechnology
Field where engineers and gerontologists work together to create assistive technology
Assistive technology
Electronics that allow elders to perform ADLs and to remain independent longer
Med dispenser, cameras to sense falls and sense alerts, granny pods, monitor when they pick up pill bottle
Telemedicine
Providing care from far away
Transmission of data to improve healthcare
Pros: increases compliance w meds, reduced hospitalization
Cons: expensive, can’t replace love, caregivers don’t trust it
Cognitive functioning
Intelligence, memory, learning
Intelligence
Theoretical limit of an individual’s performance
consists of three major sets of abilities: problem-solving, verbal, and social competence
IQ
Individuals relative abilities compared to others of the same chronological age
Fluid intelligence
Skills that are biologically determined, independent of experience/learning, requires flexibility in thinking
Spatial orientation, abstract reasoning, word fluency, inductive reasoning
Crystallized intelligence
Knowledge and abilities that the individual acquires through education and lifelong experiences, includes social judgment and ability to understand subtle meanings in the verbal communication
Verbal meaning, word association, social judgement, # skills
Classic aging pattern
Consistent pattern of WAIS scores – people over 65 perform worse on fluid intelligence test but their scores for crystallized tests remain stable
Most significant declines occur in intellectual abilities that are:
Less practiced and require speed
Terminal drop aka terminal decline hypothesis
Those who declined more sharply are found to die sooner than good performers therefore age is not as significant in intellectual decline as proximity to death
Executive function
Ability to organize ones learning
Includes planning, decision making, avoiding distraction, ability to shift attention
Selective attention
Selecting important information while ignoring irrelevant information
Vigilance/sustained attention
Requires individual to look out for specific stimulus overtime
attentional control under conditions of divided attention
Ability to determine how much attention should be directed at specific stimuli and when to shift focus to other stimuli
Under conditions of divided attention, the individual must try to perform multiple tasks at same time
General slowing hypothesis
Processing of information slows down in the nervous system with aging
Recall
Process of searching through vast store of information in secondary memory, perhaps for a cue or specific question
Recognition
Information in secondary memory must be matched with stimulus information in environment
Cue overload
Same cues that were once helpful in remembering info are also used to recall recent events so Cues strongly associated with older life experiences make newer information harder to retrieve
Disuse theory
Information can fade unless exercised
Interference theory
New info interferes with material that’s been stored over many years
Decrement model
Suggests memory networks w aging and TOTs are a manifestation of these impaired networks
Incremental knowledge gain
Cumulative knowledge and vocab of elders can cause more names in secondary memory to interfere with the name to be recalled
Positivity effect
Elders recall twice as much info with positive emotional content than negative/neutral info and respond faster
Cognitive retraining
Teaching research participants to use various techniques to keep mind active and maintain good memory skills
Mediators
Use of visual and verbal links between info to be encoded and info that’s already in secondary memory
Look, snap and connect- practical method for retaining info efficiently to recall it
Look- actively focus on what you want to learn and record info from multiple senses
Snap- mental snapshot
Connect- visualize a link between images created through mental snapshots
Selection, Optimization, and Compensation (SOC)- focuses on adapting and regulating individual resources
Selection - selecting specific cognitive domains in which to adapt
Optimization- maximizing abilities in selected areas
Compensation- loss in some areas require enhancement of skills in other areas
Cognitive plasticity
Ability to accomplish three mechanisms of SOC and to recognize where one must compensate for these deficits in cognitive abilities
Neural plasticity
Changes in brain structure and function that occur as a result of the addition of new neurons and synaptic connections between neurons, activating specific regions of the brain
Dementia
Includes conditions caused by damage of brain tissue, resulting in impaired memory and at least one of:
Coherent speech/understanding language
Recognizing objects
Thinking abstractly and performing executive functions
All dementias have these characteristics
Change in ability to recall recent events, problems with comprehension/attention span/judgment, disorientation to time place and person
Reversible dementia
Cognitive decline that may be caused by drug toxicity, hormonal or nutritional disorders, and other reversible diseases
Irreversible dementia
No discernible environmental cause with no cure
Alzheimer’s, vascular dementia, (small strokes), Lewy body (protein deposits inside nerve cells called Lewy bodies), huntingtons, picks disease, creuzfeldt-Jacob, kuru, korsakoff
Delirium
Reversible dementia that has more rapid onset
Abrupt behavior changes, irrational speech, disturbed sleep
Alzheimer’s
Most common irreversible dementia (60-80% of all dementias)
Familial Alzheimer’s disease- rare early onset in multiple generations of same family
Alzheimer’s risk factors
Major: Obesity, hypertension, diabetes, low education, smoking, physical inactivity, depression
stroke, slow walking pace, severe head injury, stress
Reduced # of cholinergic nerve cells reduces acetylcholine available to transfer info from one cell to another, beta amyloid protein –>death of brain cells, mutations of APOE-E4
Hippocampus
Region in limbic system in the brain involved in learning new info and retrieving old info, first region where plaques and tangles occur
Stages of AD
1-no cognitive decrements
2-mild forgetfulness
3-mild cognitive impairment, concentration probs, some work difficulty
4-late confusional stage, increased financial probs, denial/withdrawal
5-poor recall of recent, remind about clothing/bathing
6-need assistance of ADLS and personality changes
7-late dementia, loss of verbal abilities, incontinence, no walking, maybe coma
Greatest risk factor for AD
Age
Inflammation
Normal information protects from infection
brain inflammation associated with memory loss
Decreasing inflammation protect brain health
Antiinflammatory lifestyle strategies: sleep, omega 3 fatty acids, exercise
Dementia risk factors
Major: Depression/stress, obesity, hypertension, diabetes, smoking, physical inactivity, patient/cognitive inactivity
Genetics
Five benefits of service learning
Attitude toward self, attitude toward school, academic performance, civic engagement, social skills
Service learning recommended practices
Linking programs to academic objectives, incorporating use voice, involving community partners, reflection opportunities
How many people live in City of LA?
4 million
LA
2nd largest school system, 2nd largest port, most museums, most homeless people, 2nd worst traffic IN COUNTRY
How many people live in LA County?
10 million
Environmental justice movement in LA
Boyle Heights was industrialize and polluted, environmental justice movement was born, used to be 100% Jewish but now mostly Latino
Most common nutrition disorder in elders
Obesity
Two age groups in order of severity that have highest crash death rate per mile
Teens and 85+
Antioxidant compound found in wine that in some studies has been found to have positive effects on brain health
Resveratrol
Water tanks and guard rails are two types of
Environmental/structural intervention
Leading cause of death for 65+ group
Heart disease
Dementia and incontinence are two examples of this category of disease
Geriatric syndromes
Onset of this type of sensory loss as a predictor of early onset of Alzheimer’s
Smell (anosmia)
Normal parts of aging
Presbycusis, presbyopia, anosmia
Abnormal parts of aging
Tinnitus, glaucoma, cataracts, macular degeneration
Predenentia state which can potentially lead to Alzheimer’s
Mild cognitive impairment
Disorder appeared to be linked to repeated head impacts in athletes
Chronic traumatic encephalopathy
Condition when older adults develop problems from multiple meds
Polypharmacy
2 proteinaceous structures seen in brain with advancing Alzheimer’s
Amyloid beta plaques and tau tangles
Activity that increases economic growth while addressing particular societal needs in the process
Volunteering
Leading cause of death for college student age group
Unintentional injury
Most common unintentional injury
Motor vehicle crashes
Why is civic engagement declining?
Increase of woman in labor force, too busy lack of free time, repotting hypothesis, urban sprawl, technological transformation of leisure
Leading cause of death among teens 15-24
2nd leading cause
Motor vehicle accidents
Suicide
Best way to prevent falls among elders in homes
Physical modifications to home
Short term, mid range and long term issues
Short- present through 1 yr, to restore patient to previous health an reduce future fall risk
Mid range- 1-5 yrs, to provide preventative care
Long- beyond 5 yrs, plan for eventual decline
Examples of civic engagement wheel
Deliberative dialogue, service learning, internships, community service, community based research, community partnership, volunteerism, get out the vote initiatives, activism
1st, 2nd and 3rd LA
1st-1880s to eve of WW2 - growth, walkable downtown, streetcar system
2nd-WW2 to turn of millennium, era of suburbs, built freeways and no streetcars
3rd- profound reinvention, no room to sprawl, dense housing, public mass transit, environmental improvements
A dementia evaluation should always include
MRI or CT scan
Reducing fall risk
Education, environmental intervention, tai chi, assessment tools, meds, informal social support
