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Gerontology 2

Gerontology Module 2

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