Jen ch 14 Flashcards
gerontology
Study of all aspects of the aging process and its consequences
ageism
discrimination against people because of increasing age
Stochastic theory
Biological theory of aging: view aging as the result of random cellular damage that occurs over time. The accumulated damage leads to the physical changes that are recognized as characteristic of the aging process
nonstochastic theory
Biological theory of aging: Nonstochastic theories view aging as the result of genetically programmed physiological mechanisms within the body that control the process of aging
Disengagement theory
psychosocial theory of aging: the oldest psychosocial theory, states that aging individuals withdraw from customary roles and engage in more introspective, self-focused activities
activity theory
psychosocial theory of aging: unlike the disengagement theory, considers the continuation of activities performed during middle age as necessary for successful aging
Continuity theory, or developmental theories,
suggests that personality remains stable and behavior becomes more predictable as people age
gerotranscendence theory
proposes that the older adult experiences a shift in perspective with age. The person moves from a materialistic and national view of the world to a more cosmic and transcendent one, causing an increase in overall life satisfaction
older adult integumentary changes
Loss of skin elasticity with fat loss in extremities, pigmentation changes, glandular atrophy (oil, moisture, sweat glands), thinning hair, with hair turning gray-white (facial hair: decreased in men, increased in women), slower nail growth, atrophy of epidermal arterioles
older adult respiratory changes
Decreased cough reflex; decreased cilia; increased anterior-posterior chest diameter; increased chest wall rigidity; fewer alveoli, increased airway resistance; increased risk of respiratory infections
older adult cardiovascular changes
Thickening of blood vessel walls; narrowing of vessel lumen; loss of vessel elasticity; lower cardiac output; decreased number of heart muscle fibers; decreased elasticity and calcification of heart valves; decreased baroreceptor sensitivity; decreased efficiency of venous valves; increased pulmonary vascular tension; increased systolic blood pressure; decreased peripheral circulation
older adult gastrointestinal changes
Periodontal disease; decrease in saliva, gastric secretions, and pancreatic enzymes; smooth muscle changes with decreased esophageal peristalsis and small intestinal motility; gastric atrophy, decreased production of intrinsic factor, increased stomach pH, loss of smooth muscle in the stomach, hemorrhoids, anal fissures; rectal prolapse and impaired rectal sensation
older adult Musculoskeletal changes
Decreased muscle mass and strength, decalcification of bones, degenerative joint changes, dehydration of intervertebral disks
older adult neurological changes
Degeneration of nerve cells, decrease in neurotransmitters, decrease in rate of conduction of impulses
older adult eyes changes
Decreased accommodation to near/far vision (presbyopia), difficulty adjusting to changes from light to dark, yellowing of the lens, altered color perception, increased sensitivity to glare, smaller pupils
older adult ears changes
Loss of acuity for high-frequency tones (presbycusis), thickening of tympanic membrane, sclerosis of inner ear, buildup of earwax (cerumen)
older adult taste changes
Often diminished; often fewer taste buds
older adult smell changes
Often diminished
older adult touch changes
Decreased skin receptors
older adult proprioception changes
Decreased awareness of bdy positioning in space
older adult genitourinary changes
Fewer nephrons, 50% decrease in renal blood flow by age 80, decreased bladder capacity
older adult reproductive changes
Male—enlargement of prostate
Female—reduced sphincter tone
Male—sperm count diminishes, smaller testes, erections less firm and slow to develop
Female—decreased estrogen production, degeneration of ovaries, atrophy of vagina, uterus, breasts
older adult endocrine changes
General—alterations in hormone production with decreased ability to respond to stress
Thyroid—decreased secretions
Cortisol, glucocorticoids—increased antiinflammatory hormone
Pancreas—increased fibrosis, decreased secretion of enzymes and hormones
older adult Immune system changes
Thymus involution
T-cell function decreases
three common conditions that affect cognition
delirium, dementia, and depression
delirium
Delirium, or acute confusional state, is potentially a reversible cognitive impairment that often has a physiological cause - often the presenting symptom for pneumonia or urinary tract infection
Dementia
Dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. It is an umbrella term that includes Alzheimer’s disease, Lewy body disease, frontal-temporal dementia, and vascular dementia
Depression
(1) Reduction in happiness and well-being that contributes to physical and social limitations and complicates the treatment of concomitant medical conditions. It is usually reversible with treatment. (2) Fourth stage of Kübler-Ross’s stages of grief and dying. In this stage the person realizes the full impact and significance of the loss - Depression is the most common, yet most undetected and untreated, impairment in older adulthood
Psychosocial changes
Life transitions, of which loss is a major component, include retirement and the associated financial changes, changes in roles and relationships, alterations in health and functional ability, changes in one’s social network, and relocation. But the universal loss for older adults usually revolves around the loss of relationships through death
General preventive measures for you to recommend to older adults include:
- Participation in screening activities (e.g., blood pressure, mammography, Pap smears, depression, vision and hearing testing, colonoscopy)
- Regular exercise
- Weight reduction if overweight
- Eating a low-fat, well-balanced diet
- Moderate alcohol use
- Regular dental visits
- Smoking cessation
- Immunization for seasonal influenza, tetanus, diphtheria and pertussis, shingles, and pneumococcal disease
Physiological concerns
Heart disease (leading cause of death in older adults), Cancer (second most common), stroke (third), alcohol abuse, nutrition, dental problems, exercise
Risk factors for falls in older adults (Intrinsic and Extrinsic)
Intrinsic Factors
• History of a previous fall
• Impaired vision
• Postural hypotension or syncope
• Conditions affecting mobility such as arthritis, muscle weakness, peripheral neuropathy, foot problems
• Conditions affecting balance and gait
• Alterations in bladder function such as frequency or urge incontinence and nocturia
• Cognitive impairment, agitation, and confusion
• Adverse medication reactions (sedatives, hypnotics, anticonvulsants, opioids)
• Slowed reaction times
• Deconditioning
Extrinsic Factors
• Environmental hazards outside and within the home such as poor lighting, slippery or wet flooring, items on floor that are easy to trip over, furniture placement and other obstacles to ambulation, and sidewalks and stairs in poor repair
• Inappropriate footwear
• Unfamiliar environment of a hospital room that contains barriers to movement (e.g., clutter, equipment, poor lighting at night)
• Improper use of assistive devices (e.g., canes, walkers, crutches)
pain
a symptom and a sensation of distress, alerting the person that something is wrong. It is prevalent in the older-adult population; it may be acute or chronic. The consequences of persistent pain include depression, loss of appetite, sleep difficulties, changes in gait and mobility, and decreased socialization
reality orientation
a communication technique that makes an older adult more aware of time, place, and person - The key elements of reality orientation include frequent reminders of person, time, and place; the use of environmental aids such as clocks, calendars, and personal belongings; and stability of environment, routine, and staff
validation therapy
an alternative approach to communication with a confused older adult. Whereas reality orientation insists that the confused older adult agree with our statements of time, place, and person, validation therapy accepts the description of time and place as stated by the confused older adult
reminiscence
recalling the past - During the assessment process use reminiscence to assess self-esteem, cognitive function, emotional stability, unresolved conflicts, coping ability, and expectations for the future
Acute care setting risks
poses increased risk for adverse events such as delirium, dehydration, malnutrition, health care–associated infections (HAIs), urinary incontinence, and falls
Restorative care
refers to two types of ongoing care: the continuation of the recovery from acute illness or surgery that began in the acute care setting and support of chronic conditions that affect day-to-day functioning. Both types of restorative care take place in private homes and long-term care settings
