Test 2: Older Adults Flashcards

1
Q

what is geriatrics

A

subdivision of medicine and healthcare concerned with old age and disease

medical treatment is considered to start at 65

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2
Q

what is gerontology

A

study of aging

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3
Q

younger adults vs middle older adults vs oldest older adults

A

younger = 65-69

middle = 70-79

oldest = 80+

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4
Q

describe the programmed theory of aging and the key components

A

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

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5
Q

describe the damage or error theory of aging and the subcomponents/theories

A

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

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6
Q

optimal vs successful aging

A

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

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7
Q

4 distinctive levels of the “slippery slope of aging”

A

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

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8
Q

MSK changes with aging

A

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

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9
Q

ROM/joint mobility changes with aging

A

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

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10
Q

factors that result in decreased mm performance with aging

A

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

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11
Q

what is sarcopenia

A

age related mm loss

loss of strength, power, functional quality

deficits in mobility and functional ability

reduced demand of protein synthesis

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12
Q

how is a pt diagnosed with sarcopenia

A

have low mass

AND

low mm strength OR low physical performance

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13
Q

causes of sarcopenia

A

physical inactivity
loss of alpha motor neuron input to mm
decline in testosterone
decline in growth hormone
protein deficiency

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14
Q

what all decreases with neurological changes

A

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

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15
Q

ear changes neurological with age

A

ability to hear high pitch sounds

sound localization is less consistent

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16
Q

eye neurological changes with age

A

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

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17
Q

neurological sensory changes that happen with age

A

reduce pain and tactile receptors

decreases smell and odor perception

reduction number of taste buds and perception

decreased somatosensation

decreaed vestibular function

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18
Q

cognitive changes with age

A

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

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19
Q

gait changes

A

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

20
Q

decreases that occur with the CV system with age

A

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

21
Q

CV increases with age

A

resistance to blood flow
epicardial fat
thickening of vascular structures
HR and BP response to submax ex
vascular resistance
total cholesterol
LDL cholesterol

22
Q

pulmonary system decreases

A

vital capacity
tital volume
insulin sensitivity
flow rates
respiratory mm strength
max O2 uptake
alveolar vasculaity

23
Q

pulmonary system increases

A

stiffness in chest wall
number of cells that produce mucous
residual volume
respiratory rate
vulnerability to respiratory infections

24
Q

integ changes with age

A

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

25
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
26
integ increases with age
fibrosis atrophy tendency to bruise tendency to get skin tears
27
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
28
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
29
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
30
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
31
reasons drug absorption is impaired with older adults
decreased: - gastric acid - stomach emptying - absorbing area - motility
32
reasons drug distribution is altered in older adults
decreased water increased body fat decreased lean body mass decreased plasma proteins
33
reasons metabolism is altered in older adults
decreased liver mass decreased liver blood flow decreased enzyme activity
34
reasons renal excretion decreases in older adults
decreased kidney mass decreased kidney blood flow decreased tubular function
35
common adverse drug reactions
GI symptoms confusion depression OH fatigue and weakness dizziness and falls anticholinergic extrapyramidal
36
extrapyramidal symptoms
tardive dyskinesia dystonia pseudoparkinsonism
37
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
38
what defines a recurrent faller
2 or more falls in 6-12 months
39
number 1 predictor of falls
confidence
40
posture control depends on
sensory system CNS neuromuscular system
41
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
42
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
43
neuromuscular system is dependent on
mm strength mm endurance mm latency mm torque power flexibility ROM postural alignment most of these decrease with age
44
extrinsic/modifiable factors that play into falls
ground surface types and changes, outside/weather light doorways stairs clutter non slip mats, grab bars, HRs
45
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
46
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
47