Normal Aging and Dementia Flashcards
1
Q
Overview of Normal Aging
A
- change comes with age and is influenced by genetic patterns of aging as well as lifestyle choices
- older adults are the most rapidly growing age group among Americans
- 12.5% of US population is 65+
- 1.2% of US population is 85+
- by 2050, 20.4% of US population is projected to 65+ and 4.8% is expected to 85+
2
Q
Geriatric Terminology
A
- young-old (65-74 years)
- old-old (75-84 years)
- oldest-old (≥ 85 years)
- geriatrics: area of medicine that deals with the elderly
3
Q
Specific issues when working with the geriatric population
A
- physiological differences
- higher frequency of multiple chronic illnesses
- greater number of sensory impairments
- increased chance of being on multiple potentially interacting medications
4
Q
Normal Signs of Aging
- Skin
- Hair
- Height
A
- less elastic with more lines and wrinkles; fingernail growth slows as does oil production
- will gradually thin; hair pigment cells will decline and gray hair growth increases
- by age 80, it is common to have lost 2 inches; often related to normal changes in posture and compression of joints, spinal bones and spinal discs
5
Q
Normal Signs of Aging
- Hearing
- Vision
- Bones
A
- changes in the ear make higher frequency sounds harder to hear and changes in tone and speech less clear; tends to accelerate post age 55
- most people in their 40’s develop a need for reading glasses; normal for night vision and visual sharpness to decline while glare increasingly interferes with clear vision
- gradually lose mineral content, become less dense and strong; in women bone loss increases after menopause; increased risk of osteoporosis
6
Q
Normal Signs of Aging
- Metabolism and Body Composition
- CNS
- Heart and Blood Circulation
A
- over time the body requires less energy and so metabolism slows; hormone changes will facilitate a shift for the body to store more fat and less muscle mass
- beginning in the third decade of life, the brain’s weight and size of its nerve network and blood flow decreases; brain adapts by forming new connections; memory changes are typical with less recall of recent memories and slower ability to remember names commonplace
- heart becomes less efficient; works harder during activity than it once did; heart muscle will increase in overall mass; gradual decline in endurance
7
Q
Normal Signs of Aging
- Lungs
- Kidneys
- Urinary Incontinence
- Sexual Function
A
- in inactive people, lungs become less efficient over time, supplying the body with less oxygen
- with age, decline in size and function; they do not clear wastes and some medicines from the blood as quickly and do not handle dehydration as well
- should not occur but may happen due to immobility and side-effects of some medicines
- Both men and women begin producing less hormones
8
Q
Cognitive changes in normal aging
A
- normal part of life; will be variable
- general cognitive decline begins typically in the sixth decade
- verbal abilities are usually maintained until the eighth decade
- additional areas to show decline with aging include:
- memory
- abstraction
- language
- visuospatial abilities
- attention
9
Q
Memory changes in aging
A
- several types of memory are affected in the normal aging process
- however, elderly are compromised little in everyday life
- memory is stored knowledge and the processes for making and manipulating it
- humans have many memory systems that can each be separately impaired by trauma or disease
10
Q
Declarative Memory
A
- Semantic (concepts)
- Episodic (events)
- Lexical (words)
11
Q
Nondeclarative Memory
A
- Motor skills
- Cognitive skills
- Priming
- Conditioned Responses
- Reflexes
12
Q
Memory Types
- Sensory memory
- Working memory
- LTM
A
- Sensory memory: brief registration of incoming sensations
- Working memory: info in conscious awareness; active in the reception, encoding and retrieval of information; allows us to make quick decisions and plan actions
- LTM: dichotomized as both declarative and nondeclarative
13
Q
Memory Types
- Declarative
- Nondeclarative
A
- declarative memory: all about facts; semantic, episodic, lexical
- nondeclarative memory: all about motor and cognitive (skills), habits, priming, conditioned responses and reflexes (actions you don’t have to think about)
- semantics: think concepts (letter B on lichteim’s diagram)
- lexical: words, spellings, etc
14
Q
Vision and aging
A
- acuity change after the fourth decade; will most likely see a decrease in visual field
- light sensitivity requires 3x as much light as young after age 70
- dark adaptation or adjustment of vision when moving from bright to dim light
15
Q
Vision and aging
A
- color sensitivity decreases w/age: change in blue color starts at 40-50y; change in green starts in the 60’s
- perception: more difficult w/figure-ground discriminations and visuospatial skills (size, distance and position)
- visual memory (more effective at all ages than auditory memory)
- light on dark for testing/reading; focus on high contrast vs. low contrast
16
Q
Slowing down the aging process
A
- stay away from smoking and limit alcohol consumption
- maintain high levels of physical activity; EXERCISE
—- facilitates muscle flexibility, strength and mood
- routine medical care
- maintain cardiovascular health
- extensive social support network
17
Q
Frail Elderly
A
- frail elderly those most likely to be in need of age-specific, multidisciplinary approaches
- “frailty” suggests a diminished ability to carry out important practical and social aspects of daily living
18
Q
Common Problems in the elderly 1 (5)
A
- polypharmacy
- dementia
- delirium
- incontinence (both fecal and urinary)
- arthritis
19
Q
Common Problems in the elderly 2 (5)
A
- visual and hearing deficits
- pressure ulcers
- malnutrition
- osteoporosis
- high risk of falls
20
Q
Functional Status and ADLs
A
- functional status is commonly defined by a person’s ability to perform ADL’s
- to be able to live alone without help, a person must be able to perform ADL’s independently
- pt must be able to complete self-care, self-maintenance and physical activities independently
- common ADLs include: bathing, dressing, toileting, transferring, continence, and feeding
21
Q
Functionality Assessment Tools
A
- Katz index of independence in activities of daily living “Katz ADLs”
- functional status questionnaire
- functional independence measure (FIM)
22
Q
Polypharmacy
A
- refers to the tendency of many older persons to be on numerous medications
- some numbers suggest that the elderly are ~12% of the population, however receive 32% of prescriptions
- on average, an elderly individual may have 2-6 prescription drugs + 1-3.4 OTC medicines
23
Q
ADRs 1
A
- adverse drug reactions
- every drug has side effects
- ibuprofen can cause:
— gastric ulceration (sometimes w/bleeding)
— kidney impairment
— edema
— liver enzyme elevation
— drowsiness and dizziness, etc
24
Q
ADRs 2
A
- researchers suggest that the potential for an ADR is:
- 6% when the pt is taking 2 medications
- 50% when the pt is taking 5 medications
- 100% when the pt is taking 8+ medications
- supporting the facts that ADRs are serious is the statistic that 20-25% of hospital admissions for persons 65+ is due to an ADR
25
Risk factors forr cognitive decline
- HTN, diabetes, poor nutrition and social isolation (primary factors)
- heart disease
- family history of dementia
- psychological factors such as stress and depression
26
Differential Diagnosis
- delirium
- dementia
- mild cognitive impairment
- confusion
27
Symptoms of confusion 1
- disorientation
- impaired attention span
- distractibility
- purposeless activity
- anxiety; apprehension
- fright; fear; agitation
- verbosity
- confabulations
- dependent behavior
28
Symptoms of confusion 2
- attention seeking behaviors
- withdrawal
- belligerence
- combativeness
- statement of confusion
- memory loss
- personality change
- inability to complete ADLs
- change in person’s usual behaviors
29
Delirium
- sudden severe confusion with rapid changes in brain function
- a disturbance of consciousness accompanied by a change in cognition
30
Delirium Symptoms 1
- changes in alertness (usually more alert in the morning, less alert at night)
- changes in feeling (sensation) and perception
- changes in level of consciousness or awareness
- changes in movement (may be inactive or slow moving)
- changes in sleep patterns, drowsiness
confusion (disorientation) about time or place
31
Delirium Symptoms 2
- decrease in STM and recall
- unable to remember events since delirium began
- unable to remember past events
- disrupted or wandering attention
- inability to think or behave with purpose
- problems concentrating
- disorganized thinking
- incoherent speech
32
Delirium Symptoms- emotional or personality changes
- anger
- anxiety
- apathy
- depression
- euphoria
- irritability
33
Etiologies of Delirium
- most often caused by physical or mental illness and is usually temporary and reversible
- drug abuse
- infections such as UTIs and pneumonia
- persons already with CVA or dementia
- poisons
- fluid/electrolyte or acid/base disturbances
- pts w/more severe brain injuries are more likely to get delirium from another illness
34
Complications of Delirium
- loss of ability to function or care for self
- loss of ability to interact
- progression to stupor or coma
- side effects of medications used to treat the disorder
35
Mild Cognitive Impairment
- MCI
- development of cognitive and memory issues that are not severe enough to be dx’d as dementia
- symptoms are more pronounced than the cognitive changes associated w/normal aging
- the more impaired a person is with MCI, the greater the likelihood he/she will develop dementia (perhaps AD)
- a dx of MCI does not imply that a person is not capable of functioning independently in most situations
36
Dementia
- dementia is a syndrome and not a disease
- a syndrome is defined as a constellation of signs and symptoms
- according to the APA (American Psychiatric Association) the necessary features for a true diagnosis of dementia include:
[1] erosion of recent and remote memory
[2] impairment of one or more of the following functions
- language (ex: aphasia)
- motor activity (apraxia) (although physical ability is intact)
- recognition (agnosia) (although sensory ability is intact)
- executive functions
- deficits must be sufficient enough to interfere w/functioning
- pts must have difficulty w/cognition, memory, language, visual-spatial skills, emotion, personality
- dementia is not a normal part of the aging process
37
Global Dementia Types
- there are reversible and irreversible dementia etiologies
- all possible etiologies for reversible dementia must be exhausted and ruled out prior to a pt being given a diagnosis of irreversible dementia
38
Reversible Causes of Dementia
- the reversible causes of dementia are treatable
- the reversible causes of dementias include:
infection, drug toxicity, vitamin deficiency, tumor, depression, normal pressure hydrocephalus, renal failure, CHF, thyroid disease, hypoglycemia, syphilis
39
Pseudodementia
- pseudodementia or geriatric depression is classified as a reversible dementia in some diagnostic models
- some suggest that ≤10% of dementias are reversible with more than 2/3’s of them resulting from drug toxicity, depression or metabolic disorder
- pts with pseudodementia present w/cognitive impairments, difficulty sleeping, appetite changes and decreased affect
- drug tx is generally successful in improving affect and cognitive symptoms
40
Irreversible causes of dementia
- alzheimer’s disease
- pick’s disease
- frontotemporal dementia or PPA
- creutzfeldt-jakob’s disease
- huntington’s disease
- multiple infarctions
- vascular disease
- wilson’s disease
- parkinson’s disease
- lewy body disease
- binswanger’s disease
- HIV
- PSP- Progressive Supernuclear Palsy
41
Dementia Classifications
- cortical dementias
- subcortical dementias
- progressive dementias
- primary dementia
- secondary dementia
42
Signs of Possible Dementia 1
- getting lost in familiar places
- repetitive questioning
- odd or inappropriate behaviors
- forgetfulness of recent events
- repeated falls or loss of balance
- personality changes
- decline in planning and organization
- changes in diet/eating habits
43
Signs of Possible Dementia 2
- changes in hygiene
- increased apathy
- changes in language abilities, including comprehension
- dx of dementia is not usually given if there is no impairment in social functioning and independent living
44
Communication Language Deterioration
- communication is the sharing of information by means of an arbitrary symbol system
- communication is a manifestation of cognition
- persons w/dementia have difficulty w/intentional communication because they have multiple cognitive deficits
- in pts w/dementia, the degree of language impairment is often proportionate to the deterioration of other mental functions
45
Early Stage Dementia
- sounds:
used correctly
- words:
may omit a meaningful word, usually a noun when talking in sentences; may report anomic issues; vocabulary is shrinking
- grammar:
generally correct
- content:
may drift from topic; reduced ability to generate series of meaningful sentences; difficulty comprehending new information; may be vague
- use:
knows when to talk but may talk too long on a subject; may be apathetic, failing to initiate conversation appropriately; difficulty w/humor, analogies, sarcasm and indirect/non-literal statements
46
Middle Stage Dementia
- sounds:
used correctly
- words:
difficulty w/thinking of words in a category; anomia in communication; difficulty naming objects; vocabulary is noticeably diminished
- grammar:
sentence fragments and deviation common; difficulty w/complex grammatical sentences;
- content:
frequently repeats ideas; forgets topic; talks about events of past; few ideas
- use:
knows when to talk; recognizes questions; may fail to greet; loss of sensitivity to communicative partners; rarely corrects mistakes
47
Late Stage Dementia
- sounds:
generally used correctly; errors are not uncommon
- words:
marked anomia; poor vocabulary; lack of word comprehension; neologisms; jargon
- grammar:
somewhat preserved; sentence fragments and deviations common; may lack comprehension of many grammatical forms
- content:
generally unable to produce sequence of related ideas; content is meaningless and bizarre; subject of most meaningful events is from the past; marked repetition of words and phrases
- use:
generally unaware of surrounding and context; little meaningful use of language; some pts will be mute; some pts will be echolalic
