Test 2: Older Adults Flashcards
what is geriatrics
subdivision of medicine and healthcare concerned with old age and disease
medical treatment is considered to start at 65
what is gerontology
study of aging
younger adults vs middle older adults vs oldest older adults
younger = 65-69
middle = 70-79
oldest = 80+
describe the programmed theory of aging and the key components
programmed longevity- due to switching on and off of certain genes
endocrine - biological clock/hormones; aging hormonally regulated
immunological
- immune system programmed to decline with time
- peaks at puberty and gradually declines from there
- antibodies lose effectiveness with age
- dysregulated immune response has been linked to CVD, inflammation, ALZ< and cancer
describe the damage or error theory of aging and the subcomponents/theories
wear and tear
- cells and tissues have vital parts that wear out
rate of living
- greater rate of O2 basal metabolism, shorter life span
cross linking
- accumulation of cross linked proteins damages cells and tissues; slows down body processes
free radicals
- damage to macromolecular components of cells; accumulated damage which eventually causes cells and organs to stop functioning
somatic DNA damage
- DNA damage occurs continuously; genetic mutations occur and accumulate with increased age
optimal vs successful aging
optimal = ability to function across many domains (physical, cognitive, social, emotional, etc) to ones satisfaction in spite of medical conditions
successful = absence of disease and physical functioning, high cognitive and physical function, and active engagement with life
4 distinctive levels of the “slippery slope of aging”
Fun = physiological state that allows for unrestricted activities in work, home, and recreation
function = physiologically can accomplish work and home tasks but may need modification but will restrict leisure activities secondary to declining physiological function
frailty = managing basic ADLs is difficult; very limited with community activities and may require outside assistance for home activities
failure = person needs assistance with all ADLs and may be completely bedridden
MSK changes with aging
reduction of size of Type I and II mm fibers
decreased firing rate of mixed and myosin protein synthesis
dcreased mm protein metabolism
decreased mm power
reduced elasticity
decreased vertebral disc height
decreased glycogen storage capacity
increased osteoclast activity (decreased bone mineral density)
increased mm and connective tissue fat (decreased mm mass, strength, power, and endurance
ROM/joint mobility changes with aging
both AROM and PROM decline but active more
cervical - ext and lat flex decline most; upper cervical most affected
lumbar/thoracic = ext declines most
LE - hip ext and ankle DF decline most
UEs less affected, but shoudler flex and ER most affected
results in posture changes
factors that result in decreased mm performance with aging
by 75 25% reduction in mm mass (loss is 2x greater in men)
mm replaced with fat
mm fibers regroup = fiber necrosis
slowed contractile properties = decreased force
what is sarcopenia
age related mm loss
loss of strength, power, functional quality
deficits in mobility and functional ability
reduced demand of protein synthesis
how is a pt diagnosed with sarcopenia
have low mass
AND
low mm strength OR low physical performance
causes of sarcopenia
physical inactivity
loss of alpha motor neuron input to mm
decline in testosterone
decline in growth hormone
protein deficiency
what all decreases with neurological changes
nn cells in brain
brain weight
motor coordination
nn conduction velocity
acuity of sensory neurons
cognitive speed/accuracy/processing
temp regulation
dopamine levels
nervous system response to stress INCREASES
ear changes neurological with age
ability to hear high pitch sounds
sound localization is less consistent
eye neurological changes with age
less elastic
decreased number of rods
pupul reactivity and size reduces
weakness of ocular mm
more likely to have cataracts, glaucoma, macular degeneration, and diabetic neuropathy
neurological sensory changes that happen with age
reduce pain and tactile receptors
decreases smell and odor perception
reduction number of taste buds and perception
decreased somatosensation
decreaed vestibular function
cognitive changes with age
some parts of memory, language, and social cognition remain stable with age
implicit (unconscious) memory remains stable/only slight decline
mild decline visual confirmation (naming) and word generation to a category; all other language aspects remain stable
reductions
- processing speed
- explicit memory
- short term memory
- executive function
- learning ability
- retrieval of verbal/nonverbal info
- cognitive flexibility
- selective/divided attention
gait changes
changes in sensory systems = predictable changes in gait
arthrokinematic changes and alignment changes affect gait
older adults struggle to generate power from distal mm and rely on hip to achieve greater gait speed
decrease with age:
- self selected gait speed
- step and stride length
- excursion of movement
- reliance on ankle kinetics/power
- upright posture
increase with age:
- stance time
- double limb support
- step width
- variability of gait
decreases that occur with the CV system with age
max aerobic capacity
max HR
max cardiac output, stroke volume, peak HR, max O2 consumption
endothelial reactivity
capillary densoty
vascular insulin sensitivity
heart size
end diastolic filling
release of catecholomines
pace maker cells
sensitivity to baroreceptors
speed of red blood cell production
HDL
CV increases with age
resistance to blood flow
epicardial fat
thickening of vascular structures
HR and BP response to submax ex
vascular resistance
total cholesterol
LDL cholesterol
pulmonary system decreases
vital capacity
tital volume
insulin sensitivity
flow rates
respiratory mm strength
max O2 uptake
alveolar vasculaity
pulmonary system increases
stiffness in chest wall
number of cells that produce mucous
residual volume
respiratory rate
vulnerability to respiratory infections
integ changes with age
epidermal layer things
langerhan cells decrease; body is less able to prevent infection/dehydration
dermis thins; fewer blood vessels and nerves; more prone to hemorrhage
nn ending un dermis degenerates and contributes rto reduced perception of light touch and pressure
subcutaneous layer also thins which causes reduced mechanical protection and thermal insulation
integ decreases with age
hair and nail growth
number melanocytes
mast cells
sweat glands
vascularity
subcutaneous fat
epidermal/dermal layer
elastin and collagen in dermis
pain perception
langerhan cells
thymocyte activating factor which enhances T cells and decreases immunity
wound healing
integ increases with age
fibrosis
atrophy
tendency to bruise
tendency to get skin tears
urinary/hormonal changes men vs women
women = estrogen declines causing urethra shortening with thinning of lining
men = rate of urine flow through urethra and bladder slows; worse with enlarged prostate
both
- amount of urine that bladder can hold reduces and ability to hold urine post urge reduces
- increase in residual urine
- reduced tight closure of urethra
hormonal changes related to urinary system
women = estrogen and progesterone decrease
men = testosterone decreases
both
- glucose tolerance decreases along with growth hormone
- increase in insulin concentration and hormonal response to stress
changes to pharm response in older adults
more likely to have adverse reactions
more severe reactions
older adults are often suffering from polypharmacy; drugs used to treat drug side effects; it is a cycle
changes in drug reaction with age are influenced by
pattern of drug use that occurs
altered response to drug therapy
multiple disease states
lack of proper testing
drug edu and compliance
reasons drug absorption is impaired with older adults
decreased:
- gastric acid
- stomach emptying
- absorbing area
- motility
reasons drug distribution is altered in older adults
decreased water
increased body fat
decreased lean body mass
decreased plasma proteins
reasons metabolism is altered in older adults
decreased liver mass
decreased liver blood flow
decreased enzyme activity
reasons renal excretion decreases in older adults
decreased kidney mass
decreased kidney blood flow
decreased tubular function
common adverse drug reactions
GI symptoms
confusion
depression
OH
fatigue and weakness
dizziness and falls
anticholinergic
extrapyramidal
extrapyramidal symptoms
tardive dyskinesia
dystonia
pseudoparkinsonism
what is a fall
leading cause of death from injury and hospitalization in older adults
unintentional loss of balance that leads to postural instability and unexpected change in position
what defines a recurrent faller
2 or more falls in 6-12 months
number 1 predictor of falls
confidence
posture control depends on
sensory system
CNS
neuromuscular system
how does central processing work to maintain posture/prevent falls
recieves info from sensory systems to send to NM system for execution
involves thalamus, cortex, basal ganglia, vestibular nucleus, and cerebellum
what are the response strategies to postural perturbations
ankle strategy - 1st response and activation around ankle; distal to proximal mm sequence
hip - activation of mm around hip as a result of medium perturbation, proximal to distal mm sequence\
stepping - fwd or bwd step to regain balance and COG placed beyond LOS
reaching - moving arm to grasp/touch an object; reaction to large perturbation
suspensory - bending knees or ambulation to maintain stability
neuromuscular system is dependent on
mm strength
mm endurance
mm latency
mm torque
power
flexibility
ROM
postural alignment
most of these decrease with age
extrinsic/modifiable factors that play into falls
ground surface types and changes, outside/weather
light
doorways
stairs
clutter
non slip mats, grab bars, HRs
predictors of falls over 80
hx fall
hx dizziness
gender
reduced health related QOL
IADL dependency
reduced grip strength
fear of falling
fatigue
feeling nervous
predictors of falls under 80
higher age
female
nervous feeling
reduced grip strength
fear of fall
dizziness
fatigue/sleep
poor appetite
vision impaired
reduced QOL
benzodiazepines
