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Gerontology 2
Gerontology Module 2
| Question | Answer |
|---|---|
| What 3 things does aging biologically lead to? | Reduced tissue and physiological function, increased susceptibility to disease and decreased resistance to stress |
| What happens to cells as we age? | tissues age at different rates and degrees - total number of cells in body decreases |
| What do morphological studies demonstrated about age? | It is difficult to predict chronological age |
| What happened to mitochondria as we age? | Decreased ability to survive hypoxic insult - esp around 50 y.o. |
| What 3 things do senescent cells have a decreased capacity for? | Uptake of nutrients and repair of genetic damage, DNR/RNA synthesis declines, and Cells have morphological changes |
| What 2 things are musculoskeletal changes with age? | Sarcopenia (loss of muscle mass) and Dynapenia (loss of strength and power) |
| How much does strength decline with age? | 10-15% per decade - Decrease in strength does not become apparent until after age 60 |
| What musculoskeletal changes with age can result in weakness and limitations in mobility? | Muscles gradually decrease in volume; decrease # of motor units, decrease in type I and II muscle fibers; increase in collage content = decrease in muscle elasticity (muscle is replaced with fat and connective tissue) |
| What accounts for age related drops in VO2 max? | deterioration of oxygen-carrying capacity - affects functional capacity and ability to perform ADLs |
| What is the best indicator of fitness? | VO2 max - declines 10% per decade from age 20 |
| How does power decrease with age? | power decreases at a rate of 3-5% per year - affect function and ability to move and react quickly - leads to falls |
| When do neuromusculoskeletal and phsysiological systems peak? When is there a noticeable deline in function and what is the min required for basic existence? | Peak age at 30; Lose 30% of capacity = noticeable decline in function, and need at least lowest 30% for basic existence - ADLs may require increased effort and energy expenditure |
| A weakness in which muscle group has been implicated in development and progression of joint degeneration? | Quadriceps weakness - Health muscle absorbs 80% of joint kinetic forces - strongest predictor of pain and functional mobility in pts with knee OA |
| What is the strongest predictor for subsequent nursing home placement? | Loss of leg strength - exercise can mitigate effects of age on function and preserve functional reserve - Improving physiological reserves above minimum cutoff points may increase muscle strength needed to successfully perform ADLs |
| What occurs to cartilage with age? | Smooth surface of articular cartilage deteriorates – ↓ ability of cartilage chondrocytes to maintain homeostasis - Changes in weight bearing portions of cartilage – Loss of compression ability “sponginess” |
| What can cause cartilage to create turn over and new cartilage? | Slough off in cartilage horizontally - vertical damage is worse |
| How does weight bearing effect joints? | Moderate WB exercises will increase proteoglycan content in OA pts - proteoglycans are part of the extracellular matrix - which is part of lubricating the joint |
| What properties of tendons and ligaments are altered with age? | – Decrease plasticity and water content – Decrease ability to recover original length when injured  |
| How does bone change with age? And what are the rates for men and women? | Amount of bone formed during remodeling decreases with age in both sexes - more bone resorption than formation - rate of bone loss 1% per year - starts at 30-35 yo for women, and 50-55 yo for men |
| What are the physiological changes in bone structure? | Consisten decrease in wall thickness - Formation of osteoblasts decreases > bone density and strength decreases - changes result in osteoporosis and osteopenia |
| What vitamins and minerals decrease with age? | Decreased circulating levels of vitamin D3 (related to bone metabolism and homeostasis); skeletal decreased Calcium - decreased reserve to quickly accelerate the production of RBCs when needed |
| How do baroreceptors change with age? | they become less sensitive to BP fluctuations |
| How does stroke volume and cardiac output change with age? | Decrease in both stroke volume and cardiac output |
| What is responsible for dysrhythmias and what age is there a decline? | decreased pacemaker cells response = dysrhythmias; By age 60 pacemaker cells have marked decline; by age 75, 90% of pacemaker cells are gone |
| What can cause heart murmurs and left ventricular hypertrophy? | • ↑ valve stiffness = heart murmur • ↓ blood vessel diameter = ↑ left ventricle hypertrophy |
| What can affect exercise response and increase in peripheral resistance? | • ↓ contractility, ↓ HRmax = Exercise response • ↓ vascular elasticity = ↑ in peripheral resistance |
| Which vessel is affected most with increased calcification/thickening of vessel walls? | Thoracic aorta most affected |
| How is alveolar gas exchange altered with age? | – ↓ oxygenation of blood, ↓ O2 utilization |
| How does vital capacity decrease with age? | • ↑ resistance to air flow + ↑ residual volumes = ↓ lung volume capacity – ↑ effort when breathing (dyspnea) |
| What occurs to the chest wall and respiratory muscle strength with age? | • Chest wall is less compliant – kyphotic posture and chondral cartilage calcified • Decrease respiratory muscle strength – Older adult's diaphragm < 25% strength vs. young adult - 20% residual lung capacity in 20s, 35% by 60 |
| What neurological changes occur to the CNS and PNS with age? | – 37% ↓ no. of spinal cord axons – 10% ↓ nerve conduction velocity -Loss of motor units results in muscle atrophy and weakness |
| What occurs to the cerebellum and brain blood flow with age? | • Cerebral atrophy and decreased blood flow to the brain – Amyloid plaque and lipofuscin deposits |
| What occurs to your senses and motor learning with age? | • Sensory deficits: Proprioception / Kinesthesia – ↓ kinesthetic awareness and ↓ proprioception – increase latency response to stimuli • Motor learning is dependent on sensory information and feedback mechanisms |
| What occurs to the vestibular system with age? | • Vestibular Degeneration– Sensory receptors in the otoliths and semicircular canals |
| What occurs to temperature regulation with age? | • Intersystem Homeostasis Hypothalamic thermostat declines – Takes longer to accommodate to stabilizing the body temperature • due to changes in activity or ambient temperature |
| What occurs to the basal metabolic rate and ANS with age? | • Basal metabolic rate decreases • Reactivity of the ANS declines – Vasomotor system is less responsive to warming and cooling – Decreased hormonal balance |
| What changes to touch occur with age? | • Touch receptors and nerve fibers decline with age – Skin changes – Number and size of sweat glands are diminished |
| What occurs to vision over time? | • Vision decrease in muscle tone – Ocular pupil is smaller and focus declines (presbyopia) – Intraocular pressure – Increased density of lens – Loss of visual receptors in retina or macula |
| What occurs to hearing over time? | • Hearing sclerotic changes tympanic membrane – Cochlear oteosclerosis = ↓ ability to discriminate consonants – Decreased receptors in corti = difficulty hearing softer sounds – Degeneration of auditory nerve canals = difficulty localizing sound |
| What happens to taste and smell with age? | – decreased saliva – decreased cells in olfactory bulb – Chemosensory decrements |
| What happens to your GI system with age? | • Gastrointestinal Decreased motility of esophagus – Lower esophageal pressure and hesitance of the sphincter – Decreased motility in stomach and intestines – Decreased blood supply to the gut |
| What happens to your renal and hepatic systems with age? | • Renal Decreased mass and weight – Protein binding of medications is decreased • Hepatic Liver mass and blood perfusion decline – Decreased vascularity – Decline in excretory and re-absorptive capacities – Decreased urine concentrating abilities |
| What occurs to your urine output with age? | Urinary Increased in residual urine – Increased reflux into ureters - decreased absorption of calcium and B12 |
| What are some basic aging considerations? | • Slower healing times • Lower rates of recovery • Increase soreness with activity and exercise • Decreased gait speed • Decreased overall function • Greater challenges in our care planning • Greater number of comorbidities |
| What are the 6 impairments that can classify a frail adult? (need 3 or more of these) | 1. Strength = Weakness 2. Endurance = Fatigue 3. Balance = Increase susceptibility to falls 4. Slower gait speed (about 1mph, avg is 2.7mph) 5. Unintentional weight loss > 10 lbs. 6. Low physical activity and a loss of functional independence |
| What is the minimum requirement for community dwelling older adults? | Walking min of 1200 ft while carrying 8lbs and perform postural transitions |
| What are some things that community dwelling adults over 75 yo impaired with? | 16% unable to lift 10lbs 21% unable to climb 10 step 28% unable to stoop, crouch or kneel 29% unable to walk 1200 feet |
| What does the evidence say about benefits of physical activity? | regular physical activity contributes to prevention of a number of chronic diseases • Graded linear relation between the volume of physical activity and health status |
| What are the 2 basic principles for effective exercise prescription? | Overload and specificity |
| How do you increase strength? | adequate stimulus > 60% 1RM = 16-20 reps or 11 on Borg Scale • Loads < 60% of 1 RM do not cause muscle strength changes that affect function |
| What can happen with emphasizing motor learning? | • Emphasizing motor learning does not reverse muscle atrophy and often creates regression towards initial baseline limitation |
| How does high intensity training effect muscles? | • Higher intensity loads at or near maximal effort will produce a significantly greater effect • 80% of 1RM ~ 8 to 12 repetitions is most effective for increasing strength and preventing loss of Type II fibers |
| What is the most significant variable in exercise prescription? | • Intensitymaybethemostsignificantvariablein exercise prescription • No evidence to suggest a higher rate of injury at higher resistive loads or during 1RM testing • No adverse cardiac events in patients HIT program |
| How often should 1RM be re-evaluated for optimal results? | Every 2 weeks |
| What characteristics are required for strength gains? | sufficient overload includes intensity, duration, frequency, speed of movement and difficulty or complexity of exercise movement |
| How should you progress exercises? | Increase repetitions first then resistance, up to 12 repetitions – Additional sets vs. additional resistance - 8 reps min, 12 reps max |
| How long should you rest for type II fibers? | 3-5 min to let them repolarize |
| What should you include to provide adequate muscle rest in an exercise prescription? | motor learning activities and aerobic activity |
| What are initial strength gains due to? | motor learning and neural adaptaiton |
| How long do you need for long lasting and significant change in strength? And in muscle hypertrophy? | 12-16 weeks for strength changes, 8-12 weeks for hypertrophy |
| What is a better predictor of physical function than isometric or isotonic strength? | Power! – Functional activities require a quick muscle contraction – Falls and slower gait speeds |
| How can power be increased in older adults? | training by overloading rapid movements - max muscle fiber recruitment - 3-5 reps of 3-5 sets |
| How many exercises are best for increasing HEP compliance? | 2-3 exercises on written handouts with 14 point font and grade 4 reading skills; Face-to-face instruction of therapeutic exercises together with written HEP improved compliance |
| What are basic aerobic exercise prescriptions? | 30 min of walking at 50-70% HRRmax (can do 3 walks of 10 min) |
| What type of aerobic exercise has shown an increase in VO2 max in older adults? | • Fast walking at 60% to 70% HRRmax or RPE 12 to 13 up to 85% HRRmax or RPE 14 to 15 - increase VO2 max by 30% |
| What is a positive effect of the aerobic walking Rx? What is a disadvantage? | • Positive effect on pain and Self-reported disability • Walking alone does not address decline in musculoskeletal health |
| Who's stages of ego development involve integrity vs despair, where they review their life at the end? | Erikson - Final stage - active concern with life, even in face of death, learns to experience own wisdom – Accept life and history as it has unfolded – Assume responsibility for successes and failures or lapse into depression, despair, anger |
| When does Erikson's stage of older adulthood begin? | with retirement and continues throughout life |
| Which of Peck's psychosocial tasks of later adulthood involves looking for new meaning beyond previous roles? | Ego differentiation vs work-role preoccupation |
| Which of Peck's psychosocial tasks of later adulthood involves learning new ways to transcend physical discomfort? | – Body Transcendence vs. Body Preoccupation |
| Which of Peck's psychosocial tasks of later adulthood involves leaving an enduring legacy | – Ego Transcendence vs. Ego Preoccupation |
| Which late life theory includes older people and society mutually withdrawing, where the Withdrawal is characterized by a positive change in psychological well-being for the older person? | Disengagement theory |
| What part of the Engagement (Havinghurst) activity theory involves a high degree of competence in daily activities and complex inner life? | Integrated |
| What part of the Engagement (Havinghurst) activity theory involves seeking others to satisfy emotional needs? | passive dependent |
| What are the parts of the Engagement (Havinghurst) activity theory? | Integrated, Passive dependent, Armored, and Unintegrated |
| What part of the Engagement (Havinghurst) activity theory involves attempting to control environment and impulses? | Armored |
| What part of the Engagement (Havinghurst) activity theory involves showing poor emotional control and intellectual competency? | Unintegrated |
| What are the 4 parts of Neugarten's tasks of successful aging? | 1. Accepting imminence of death 2. Coping with physical illness 3. Coordinating dependence on support and accurately assessing independent choices 4. Giving and obtaining emotional gratification |
| How could you improve learning to accommodate for cognitive changes in life? | • Poor performance vs. poor learning • Emphasize new knowledge consistent with previous learning • Concentrate on one task at a time before proceeding • Reduce potential for distraction • Space learning experiences sufficiently |
| What domains experience losses with cognitive age changes? | Speed, reasoning, and memory |
| Which type of intelligence depends on sociocultural influence? | Crystallized intel |
| Which type of intelligence depends on the genetic and neuropsychological? | Fluid intel |
| What are techniques for supporting learning in late life? | • Allow for self-pacing • Assist in organizing information to be learned • Make learning experience concrete • Use supportive vs. neutral instruction • Use the senses to facilitate learning • Provide feedback |
| When do psychomotor skills and information processing decline? | begins in 50s |
| When does problem solving decline? | in the late 60s |
| When do verbal skills decline? | may declines after 80 |
| Does intelligence decline more than verbal? | Yes - but there is little or no decline in memory (abstract reasoning declines as well) |
| What is a chronic form of severe depression? And how could you treat it? | major depressive disorder - can be treated with resistive training and group ex |
| What are 3 depression symptoms? | (1) Cognitive (poor concentration), (2) Somatic (fatigue, heart palpitations), (3) Affective (sadness, anxiety) |
| What does widowhood, urban crowing, rural lifestyle or institutionalization result in? | geographic isolation |
| What are 3 types of isolation? | 1. presentation isolation - disfigurement from physical disabilities 2. Behavioral Isolation: inappropriate behaviors 3. Attitudinal Isolation: Ageism |
| What is a nonspecificmanifestationofan underlying physical, mental, or psychosocial condition? | failure to thrive |
| What are 5 aspects of total institution? | • Institutionalism:psychological state - 1. Hierarchical authority: Residents on lowest rung 2. Total institution: Control of personal habits 3. Humiliation 4. Setting: Insensitivity to resident 5. Status: Outside roles are rarely counted |
| What are 5 types of anxiety disorders? | • Obsessive-Compulsive Disorder (OCD) • Post-Traumatic Stress Disorder (PTSD) • Panic Disorder • Generalized Anxiety Disorder (GAD) • Phobic Disorders (Agrophobia – Social Phobia) |
| What is the leading cause of death and disability? | • Chronic diseases i.e. heart disease, Stroke, Cancer, Diabetes, arthritis – Leading Causes of Death and Disability • 7 out of 10 deaths among Americans each year are from chronic diseases |
| What are the 4 common causes of chronic disease? | 1. Inactivity 2. Poor Nutrition 3. Tobacco use 4. Excessive alcohol consumption |
| What are the phases of grief? | – Denial / isolation, anger, depression, acceptance -• Bereaved persons should be encouraged to discuss the deceased rather than the avoid the subject – HCP (healthcare provider) may end up allowing patient to release tears of grief |
| What does JAMCO stand for? | Used to recognize cognitive decline - Judgment, Affect, Memory, Cognition, Orientation |
| What condition has a Slow onset of progressive disorientation, shortened attention span, and loss of cognitive function? | Dementia - the result of many neurologic diseases,and may be caused by: – Alzheimer disease – Cerebrovascular accidents – Genetic factors |
| What does chronic dementia cause a progressive loss of? | – Cognitive abilities – Psychomotor skills |
| Which stage of Alzheimer's lasts 2-4 yrs and includes moodiness, poor judgment, helplessness and difficulty w/ social adaptation, may have catastrophic reactions stressful events? | First stage |
| Which stage of Alzheimer's may last several years with an increase in symptoms? | Second stage |
| Which stage of Alzheimer's has no time limit and includes irritability, seizures, disorientation, illogical communication, severe anorexia, rigid postures, and explosive sound/behaviors? | Third Stage |
| What is a form of discrimination and prejudice, that is particularly experienced by seniors? | Ageism |
| What do more than 50% of community dwelling adults (65-100 y.o.) feel are expected parts of aging? | depressed, more dependent, more aches and pains and less energy - those with low expectations were less likely to seek health care for age-associated conditions |
| What is intentionally inflicting, or allowing someone else to inflict, bodily injury or pain? | Abuse |
| What is a Failure to provide goods, services or care necessary to maintain health? | Neglect |
| What is Taking advantage of an older adult for monetary gain? | Exploitation |
| What is verbal harassment, intimidation, denigration and isolation? | Psychological abuse |
| What does supportive services include? | – Information, referral, outreach, case management, escort, transportation; In-home services; Community services; Caregiver services |
Created by:
rjchokito
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