Lifespan Flashcards
Gerontology
Study of normal aging process
Geriatrics
Branch of medicine concerned with the illnesses of old age
Categories of elderly
Young elderly_____
Old elderly_____
Old, old elderly
YE: 65-74 yo
OE: 75-84 yo
OOE: 85+
Leading causes of death in elderly (in order)
CHD (31%) CA (20%) CVD COPD Pneumonia/flu
Leading causes of disability in elderly
Arthritis (49%)
HTN (37%)
Hearing impairment (32%)
Heart impairment (30%)
Genetic theory of aging
Aging is intrinsic.
No one gene is responsible
Premature aging syndromes are examples of faulty genetic programming
Hutchinson-Gilford Syndrome
Progeria (premature aging) in childhood
Werner’s Syndrome
Progeria of young adults
Doubling/biological clock theory of aging
Hayflick’s limit theory
Limited number of genetically planned cell replications
Free radical theory of aging
Free radicals damage cell membrane and DNA.
results in decreased O2 delivery and tissue death
Can lead to atherosclerosis, cell mutation, CA
Cell mutation theory of aging
errors in synthesis of DNA/RNA lead to aging changes
Hormonal theory of aging
Impaired hormonal functions lead to aging
Which 3 glands have the biggest impact on aging
Hypothalamus, pituitary, adrenal
Thyroxine (T4)
master hormone of the body.
controls protein synthesis
Increase of ______ hormones can damage the brain, including the memory center, the _____
stress (cortisol)
Hippocampus
Immune cells also affected
Immunity theory of aging
thymus size decreases, bone marrow efficiency decreases
These lead to impaired immune response
Environmental theory of aging
Aging is caused by accumulation of toxins such as UV light, saturated fats, heavy metals, etc
Impairs DNA synthesis
In the elderly, there is a selective loss of type (I/II) fibers
II
this leads to an increased proportion of type I (slow twtich) fibers, limiting power
Aging’s effect on collagen
Denser
More irregular
Lower water content
Lower elasticity
Can strength training positively impact older adults strength levels and fitness
You betcha
Which has been shown to produce quicker results in the elderly, moderate intensity or high intensity
High intensity (70-80% 1RM)
Common postural changes in the elderly
Forward head kyphotic T spine
Flat lumbar spine
hip/knee flexion contractures
What are lipofuscins?
finely granular yellow-brown pigment granules composed of lipid-containing residues of lysosomal digestion
increase with aging, and can cause detrimental aging effects
Age-related tremors (essential tremors)
Often in hands, head, or voice
Benign and slowly progressive
Often postural or kinetic
Rarely resting
Presbyopia
Age related visual loss
poor focus and blurry images
Due to loss of accomodation and decreased elasticity of lens
Cataracts
Opaque lens due to change in proteins
Central vision loss first
Glaucoma
Increased intraocular pressure, degneration of optic disc
loss of peripheral vision first, can progress to total blindness
Macular degeneration
loss of central vision
may progress to total blindness, or pt may retain peripheral vision
Diabetic retinopathy
Damage to retinal capillaries
Central vision impairment, complete blindness rare
Homonymous Hemianopsia
loss of half of visual field of each eye
cannot see one total half of the visual field (R/L)
Conductive hearing loss
mechanical
Damage to middle ear ossicles or exterior structures
All frequencies affected
Tinnitus may be present
Sensorineural hearing loss
Central/neural
Meniere’s disease
Episodic attacks of tinnitus and dizziness (pt may feel pressure in ears)
sensorineural hearing loss possible
BPPV
Brief episodes (less than 1 min) associated with position change
Terminal drop
The most significant loss of cognitive function, generally occurs in years immediately proceeding death
Aging effects on pulmonary function
Decreased total lung capacity
Increased residual volume
Decreased vital capacity
Osteoporosis
BMD at hip/spine that is 2.5 SD or more below mean
Osteopenia
BMD at hip/spine that is 1-2.5 SD below mean
Diseases impacting bone health
Hyperthyroid DM Hyperparathyroid SLE Celiac disease gastric bypass pancreatic disease MM sickle cell ESRD Paget's CA
Medications affecting bone loss
Corticosteroids Chemo Thyroid hormone estrogen antagonists anticonvulsents
Risk factors for low BMD
Family history White/Asian Early menopause Smoking Small frame
Common locations of osteoporotic fx’s
Vertebrae
Femoral neck
Radius
Humerus
Medicine options for low BMD
Bisphosphonates
Calcitonin
Estrogens
Calcium and Vitamin D recommendations
Ages of 50:
Calcium: 1200 mg
Vit D: 800-1000 IU
Verbal ability peaks at____ but is well maintained until____
30, 60’s
Numeric abilities peak _____ and are well maintained till _____
mid 40’s, 60’s
Intellect changes do not typically show until___. but declines are not significant in every day life until____
60’s, 80’s
Interventions for low BMD
weight bearing exercises postural corrections functional balance tai chi gait training education-fall risk, fracture prevention
Hip fracture mortality rate in the elderly
20%
What percent of elderly with hip fracture do not reach premorbid functional level
50%
vertebral fractures are often caused by (trauma, routine activity)
routine activity
Interventions for OA
ROM Strengthen support joints, limit imbalances Aerobic conditioning Aquatics Education AD training
What is the most common cause of adult disability in the US
Stroke
What percentage of stroke patients will die during acute phase?
30%, another 30-40% will have severe disability
Delerium
Acute, potentially reversible confusion and loss of mental function
can be from drug toxicity, systemic illness, O2 deprivation, sensory deprivation
alertness may be high or low
Dementia
Loss of intellect/memory
Alertness usually normal
Reversible Dementia
10-20% of dementias
d/t drugs, nutrition disorders, psychiatric disorders, or toxins
Primary degenerative dementia, Alzheimer’s type
50-70% of dementias
leading cause of institutionalization-up to 50% of nursing home.
Generalized atrophy of brain with decreased neurotransmitters
Types of Alzheimer’s dementia
Senile: over 60 yo at onset
presinle: 40-60 at onset
Multi-infarct dementias
20-25% of dementias
Sudden onset
Patchy distribution of deficits
Emotional lability
often have hx of stroke
Dementia and Parkinsons
dementia can be seen in late stages of PD
MMSE
lower than 24/30 is indicative of mental decline/dementia
Geriatric Depression Scale
30 item yes/no. greater than 8=depression
Angina in elderly
anginal pain may not be best indicator of ischemia: shortness of breath and ST segment depression may be more reliable
Acute MI in elderly
may present with sudden dyspnea, acute confusion, syncope
Maturationist Hierarchical theory of development
- Genetically and biologically dertermined
- Aspects of behavior are inate
Empiricist theory of development
Source of behavior is the environment
Behaviorist theory of development
Environment reinforces cognitive and motor behavior
Used in behavior modification
1 month development
Head turned to side
Hands fisted with indwelling thumb
2 months development
astasia/abasis
prone on elbows
3 months development
prone on elbows, wt on forearms
coos and chuckles
optical and labyrinthine head righting
4 months development
no head lag in pull to sit
unsupported sit
roll to sidelying
ulnar palmar grasp
5 months development
rolls prone to supine
weight shift in prone
6 months development
rolls supine to prone
7 months development
trunk rotation in sitting
pivot prone
8-9 months development
belly crawl
transfer objects hand to hand
cruises sideways
unsupported stand
10-15 months development
unassisted walk
creeps up/down stairs
self feeding
20 months
step to pattern for stairs
2 years
runs well
reciprocal stair pattern
Piagetian theory of development
interaction of environment and neural maturation
spiraling of development
Neuromaturation theory of motor development
CNS control
Dynamic Systems theory of motor control
varying control centers depending on task
cocontraction decreases with maturation
Principles of motor development
- cephalocaudal, proximal to distal
- unrefinded to refined
- stability to controlled mobility
- periods of equilibrium/disequilibrium
Normal gestation period
38-42 weeks
Gestational age
age of fetus/newborn from first day of mothers last normal menstrual period
TIMP
used for 32 weeks post conceptual age to 3.5 months postterm
spontaneous and evoked movement
APGAR
Appearance Pulse Grimace Activity Respiration
checked at 1, 5, 10 and every 5 minutes after if having difficulty
7 or higher is considered good
Galant
stroke along paravertebrals causes lateral flexion toward
0-2 months
Moro
sudden extension of neck=flexion and ABD of shoulder, extension of elbows, followed by shoulder ADD and elbow flexion
0-4 mo
Neonatal neck righting
neck on body-turn neck, body follows
0-6 months
Rooting
0-3 mo
Sucking
0-6 mo
TLR
Prone=flexor tone, supine=extensor tone
0-6 mo
STNR
neck extension=UE extension, LE flexion
neck flexion=UE flexion, LE extension
6-8 mo
Denver Developmental Screening Test II
birth to 6 yrs
Screens for social, fine motor, gross motor, language
AIMS
observational gross motor milestones
birth-walking independently
Movement Assessment of Infants
birth-1 year
PDMS
birth-42 months
GMFM
measure change in gross motor in CP, also used with Downs
All items can be accomplished by typical 5yo
BOT2
4.5-21 yo
gross/fine motor
Sensory integration and praxis test
sensorimotor
4-9 yo with mild/mod learning impairment
Bayley
motor/mental scores birth-42 months
Early intervention programs
0-3 years old
NDT utilizes what as primary intervention strategy?
therapeutic handling
Is advanced didactic and clinical experience required to work with premature infants
yup
Meconium Aspiration syndrome
near term or term infant inhales bowel movement.
can cause respiratory distress
20% present with developmental delays up until age 3
Respiratory distress syndrome
aka hyaline membrane disease
d/t atelectasis
may lead to bronchopulmonary dysplasia
may require O2 supplementation and surfactant administration
Bronchopulmonary dysplasia
Chronic
Predisposes child to frequent respiratory infections
Periventricular leukomalacia
necrosis of white matter
may result in CP
Periventricualar-intraventricular hemorrhage
graded I-IV
Grades II-IV may result in CP
Retinopathy of prematurity
combination of low birthweight and high O2 levels
Can range from insignificance to blindness
Necrotizing enterocolitis
ischemia results in inflammatory, infected bowel
Patent ductus arteriosis
Temporary vessel b/w aorta and pulmonary artery fails to close
nonO2 blood is circulated
Intervention guidelines for peds
supervised SL and tummy time
sleep in supine to avoid SIDS
avoid activities that may increase extensor tone (infant jumpers/walkers
CP
group of disorders
non-progressive encephalopathy
associated with pre-term birth
Spastic CP
increased tone-lesion of motor cortex or projections from
mass flexion/extension patterns
imbalance of tone may cause contractures (hip FADIR, knee flexion, PF)
Crouched gait
athetosis
Lesion of basal ganglia, writhing movements with fluctuating tone
generalized low tone
poor visual tracking
ATNR
Ataxia
lesion of cerebellum
ataxia follows initial hypotonia
dystonia
involuntary movements
Gross motor classification for CP
1: walk without restriction
2: walk without AD
3: walk with AD
4: use power chair outdoors
5: mobility severely limited
