Lecture 15: Ageing Flashcards
1
Q
Why treat older adults separately?
A
- Anticipated response to interventions cannot be assumed to be the same as younger adults (efficacy for children treated separately)
- The higher prevalence of organic disorders
2
Q
When is old age?
A
The four ages of ageing:
1) Childhood & adolescence
2) Independence, earning & saving
3) Personal fulfilment (50-74)
4) Dependence, decrepitude & death (74+)
3
Q
Demographics
A
- For first time, more people in Britain over 45 than under 45
- NZ >65:1951=9%, 2001=12%, 2051=26%
- 98% aged 65-74 live independently, 70% aged 85+ live independently
4
Q
NZ life expectancy (2014 data)
A
- L.E at birth is 83.2 for females & 79.5 for males
- Gap between Maori and non-Maori L.E at birth has reduced to 7.1 years
- L.E at birth is 77.1 for Maori females & 73.0 for maori males, compared to 83.9 for non-maori females & 80.3 for non-maori males
5
Q
An Ageing World
A
- Older people now outnumber children <5 for first time
- > 1 billion >65 by 2040
- Projected that a 1/3 of people born now, in wealthy nations, could live to 100
6
Q
Challenges of Ageing Population
A
Human organisation:
- Structure of family
- Patterns of work + retirement
- Social services
- Health sector
- Pensions
7
Q
Theories of ageing
A
Erickson’s theory:
- Trust vs. mistrust = hope (0-2)
- Autonomy vs. doubt = will (2-4)
- Initiative vs. guilt = purpose (4-5)
- Industry vs. inferiority = competence (5-12)
- Identity vs. role diffusion = fidelity (13-19)
- Intimacy vs. isolation = love (20-39)
- Generativist vs. self absorption = care (40-64)
- Integrity vs. despair = wisdom (65-death)
- Transcendence = faith humility
8
Q
Successful ageing
A
- Contradiction in terms success & ageing
- Criteria for success? = length of life, biological health, mental health, cognitive efficacy, social competence & productivity, personal control, life satisfaction
- Subjective vs. objective indicators
9
Q
What is successful ageing
A
- R.J.Havighurst (1961) coined the phrase
- Rowe & Khan (1998) = avoidance of disease & disability
= maintenance of cognitive + physical functioning
= sustained engagement with life - Usual vs. successful ageing (R&K, 1987) = extrinsic vs. intrinsic factors
= example of diet
10
Q
How do we know what makes up successful ageing?
A
- Cross-sectional vs. longitudinal
- Large scale longitudinal studies = MacArthur Study
= Harvard Study - Examining groups that have lived to >100 - Blue Zones
11
Q
Blue Study Results
A
1) Move naturally
2) Purpose - “why i wake up”
3) Down shift - stress reducing techniques
4) 80% Rule
5) Plant Slant
6) Wine@5 = 1-2 glasses
7) Belong - faithbased
8) Loved ones first = families first
9) Right Tribe = groups that support healthy behaviours
= 5 friends
12
Q
Critique of successful ageing
A
- ‘Success’ based on scientific ideas by theorists yet to reach old age, rather than real life experiences of elderly
- Praises fortunate & privileged elders and labels others as ‘unsuccessful’
- Fits into neo-liberal ideology-individual responsibility vs. social collective
- Promotes white middle class values
- Does not accommodate losses that are part of ageing
- A health promotion model that does not speak to older adults
- Fits a political system that is trying to make the aged less a social responsibility
- Possibility that old age is a time of reflection?
13
Q
Older adults concept of successful ageing
A
- Respect
- Worth
- Wellbeing
- Via: reciprocal roles with children, social support, social engagement, spirituality, independence
14
Q
Physically successful ageing
A
Playgrounds for elderly
15
Q
Psychological elements of successful ageing
A
- Attitude = internalised (attitudes)
= self stereotypes
= determinants of longevity -> genes, will to live, +7.6yrs median with +ve ageing population
-> factors in order: selfperception, gender, loneliness, functional health, SES
16
Q
‘Only as Old as you feel’
A
- Yannick Stephan (2015)
- Younger subjective age related to risk of death, health, lower depression, increased wellbeing
- Continuing to engage actively with life
- Sexual identity
17
Q
Social elements contributing to successful ageing
A
- Productivity
- Strong interpersonal relationships
- Social support
- Marriage
- Socio-economic
18
Q
Kaumatua & Kuia
A
- Leadership
- Storehouse, transmission & imparting knowledge
- Guardians of Tikanga
- Nurterers of mokopuna
- Dispute resolution
19
Q
Ageing in NZ
A
- Life and Living in Advanced Age Cohort Study in NZ (LiLACS NZ)
- Prof Ngaire Kerse examining how Maori & non >80 are ageing
20
Q
Functional disorders in old age
A
- a general decrease in vulnerability to functional disorders while organic disorders means prevalence rates overall remains similar
- Low rate seeking help, many mental illness goes undiagnosed & untreated
21
Q
Depression
A
- Often under reported as seen as ‘normal’ part of ageing or illness
- prevalence = 1.1% of those >65
- Symptomology different to adults = loss of memory, changes in sleep + appetite
- Complications in diagnosis: cross-over with dementia, physical illnesses, polypharmacy
22
Q
Late life depression
A
- First episode past 60
- Symptoms = cognitive dysfunction, increased co-morbidity, high rates of lethargy & fatigue, less likely to have a family history of depression, chronic & more resistant to treatment, possible different biological pathway, possible prodrome to dementia, suicide
23
Q
Anxiety
A
- More common than depression in later life
- Underreporting = mimic physical health issues
= mimic side effects of medication
= mimic some signs of dementia
= institution
24
Q
Prevalence of anxiety
A
- 4.5% of older adults >65
- Phobias & GAD most common
- OCD & PTSD least common
- Most common females & with co-morbid medical disorder
- Older adults symptoms are centred on: sleep + appetite, memory + attention, agitation
25
Q
Psychometrics
A
- GAI, GDS, HONOS 65+, MMSE, Addenbrookes ACE-R, CAMCOG, MOCA, Clock drawing task
26
Q
Depression
A
- Mental decline rapid
- Knows time, date, where they are
- difficulty concentrating
- Language + motor skills slow but normal
- Notices memory problems
27
Q
Dementia
A
- Mental decline slowly
- Confused + disoriented
- Difficulty with ST memory
- Writing, speaking + motor skills impaired
- Doesn’t notice memory problems
28
Q
Delirium
A
- Acute onset
- Chest infection/UTI
- Bloods/MSU
29
Q
Organic disorders of old age
A
memory and dementia
30
Q
Changes in cognitive processes with age
A
- Complex attention decreases
- ‘Lapses’ in memory
- Semantic memory intact
- Episodic memory impacted
- Language intact
- Wisdom increases
31
Q
Ageing & memory
A
- Takes longer to recall
- More difficulty recalling names
- Putting a time to a memory
- Age Associated Memory Impairment (AAMI)
32
Q
Dementia
A
- Symptoms that occur when brain is affected by specific conditions
- Syndrome
33
Q
Types of dementia
A
- Alzheimer’s disease = 50-70%
- Vascular dementia = 20%
- Dementia with Lewy bodies = 10%
- Mixed/other account for large proportions of cases
34
Q
Prevalence of dementia
A
- 65-69 = 1.4%, 70-74 = 2.8%, 75-79 = 5.6%, 80-84 = 11.1%, 85+ = 23.6%
- Rates double every 5 years
- Women more likely Alzheimer’s and men vascular
- Other factors = genetic, cardiovascular, env.
35
Q
Treatments of dementia
A
- Lifestyle = exercise, stop smoking, diet, cognitive stimulation/socialisation
- Medication = aspirin, aricept, exelon, reminyl
36
Q
Functional & cognitive changes with dementia
A
- Forgetfulness, MCI, Early Dementia, Mild, Moderate, Severe, ‘Treatments in each area build on not move on’
37
Q
Working with memory problems
A
- treatments = physical-body, social-the carer, env., psychological, medication
38
Q
Approaches to dementia care
A
- Reality Orientation, reminiscence, validation therapy, stimulation (Snoozleen), person-centred care, working with care givers, reliance on care env. most important - env. driven behaviours, behaviour modification-ABC
39
Q
Approaches to dementia care - life story format
A
E.g. family, your friends, jobs…
40
Q
Approaches to dementia care - personhood theory
A
- Stresses importance of a humanising person-centred approach in care of PWD
- This conflicts with societal views of ageing which values youth, beauty, intelligence
- Tom Kitwood (early 1990s)
- Personhood is a ‘status that is bestowed on a human being by others in context of relationship + social being’
41
Q
Person-centred care
A
- View dementia as a disability not a disease
- Promoting positive wellbeing
- Importance of life history + identity
- Working with abilities
- Recognising quality of carers…
42
Q
Five part model
A
- Behaviour (centre)
- Env
- Person
- Biology
- The Carer
