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Elders Exam 1

The aging population: gerontological nursing as a specialty elders comprise majority of hospital admits; many nurses no formal training about how elders' s/s et response to care differ from those of younger adults
The aging population: Who are the old? Almost old (baby boomers); young old (65-74); old (75-84); old-old (85-99); centenarians (100+)
The aging population: demographics 12.8% age 65+; life expectancy 78.1 (@ birth 2006); 80% 1 chronic disease et 50% have 2; dec independence -> psych. consequences; 4.5% in nursing homes; 85+ >18.2% need LTC
chronological age length of time that has passed since birth (social organizations usually)
functional age physiologic health, psychological well-being, socioeconomic factors, et the ability to function et participate in desirable activities
perceived age how old someone looks
age identity how one feels; "I'm 50 but I still feel 30"; can shift within person
ageism the prejudices et stereotypes applied to older people on basis of their age
gerontophobia unreasonable fear et/or hating older people
aging anxiety concerns/fears about getting older
implicit ageism thoughts, feelings, behaviors not consciously aware of
Life expectancy predictable length of time expected to live from birth
Active life expectancy measured on continuum, indicator QOL (ability to perform ADLs <--------> inability to perform ADLs)
lifespan max survival potential of a species (human ~116yrs)
senescence actual cause of death
weak links inc vulnerability to pathology (component failure) causes death
vanquished sickness is pathologic et to be accepted if you're old ("untreatable") (sickness is expected)
integrated personality adjusted well to aging
armored personality defended; held to patterns of middle age or closed self off
passive personality dependent; rocking chair, apathy
unintegrated personality psychological problems/doesn't cope with ADLs
reminiscence et life review closely related processes used to promote psychosocial health of elders
reminiscence prevent/dec depression; inc life satisfaction; help deal c crises or losses; improve self-esteem; dec social isolation; improve cognitive function; recalling remote past; may not cover life span
life review reviewing, organizing, evaluating picture of one's life to achieve integrity; covers life span, examines actions @ certain time/place/event, evaluation is teh key, acceptance brings integrity
The Aging Brain - Age Related Changes Brain atrophy, begin to lose ~0.4% of brain annually beginning in mid-30s; loss of neurons et shrinkage of neurons; loss of synapses; diminished cerebral blood flow; accumulation of lipofuscin (aging pigment) in nerve cells
The Aging Brain - Age Related Cognitive Functions c dec in synapses, info processing is lower, word finding more difficult, slight dec in abstraction, calculation; dec neurotransmitters or their binding sites; changes don't appreciatively interfere c everyday activities
Alzheimer's Disease: Genetics - Early onset familial mutations on 1 of these chromosomes (1, 14, 21) associated c onset before age 65
Alzheimer's Disease: Genetics - Late Onset Apolipoprotein (APOE) gene has alleles (e2, e3, e4 on chromosome 19. e4-increased risk
Alzheimer's defining characteristics - look at table 14-2 higher density of PLAQUES & TANGLES in neocortex et hippocampus; onset insidious, gradual & progressive; loss/egeneration of neurons/synapses in these areas; marked reduction in brain weight
Vascular dementia defining characteristics - look at table 14-2 onset may be more abrupt et stepwise; stepwise progression not always noted bc VD may occur in combo c other types of dementia; additional cognitive losses occur c new vascular insults; s/s vary r/t area of brain affected; many also have alzheimers
Lewy Body dementia defining characteristics - look at table 14-2 abnormal spherical structure formed by a protein-alphasynuclein; many also have alzheimer's; 40% c Parkinson's have LB et Alzheimer's plaques
Frontal-temporal defining characteristics - look at table 14-2 strophy of frontal & temporal regions c accumulation of abnormal forms of tau protein. pick bodies-swollen cells in areas of atrophy. onset may be earlier; linked to chromosome 17 abnormalities
Dementia S/S cog impairment (memory dec, aphasia, apraxia, agnosia, abulia, dec in executive funct)psych (depression, delusions, hallucinations, apathy, anxiety); behavioral (wandering, agitation, catastrophic reaxtions, disinhibition, intrusiveness, resistiveness)
Dementia management on going assessments; understanding of individual hx; hydration/nutrition; relax music, photo albums, pets, quiet time; environments (stimuli, pictures rather than signs, calendars/seasonal decorations, color coding); structure (age, group/individual)
Meds for tx of dementia complementary meds (gingko biloba, omega 3, estrogen, vit e, etc); cholinesterase inhibitors; aricept; exelon; razadyne; cognex; NMDA drugs (namenda)
action of meds used to delay progression of dementia cholinesterase inhib. (inc Ach, help deliver messages b/w cells, Ach breaks down - slows the break down); NMDA (regulate glutamate - glutamate triggers NMDA receptors to let controlled Ca amt into cells allows info storage, excess glutamate -> cell death)
antipsychotic meds used to tx behavioral s/s assoc. c dementia et delirium Risperdal, Zyprexa, Seroquel, antidepressants et mood stabilizers (depakote, carbamazepine, klonopin)
Mini-cog may be more sensitive for dementia than MMSE; test with 3 unrelated words et drawing of clock
MMSE Score of <24 suggests cog impairment; limitations (relies on verbal response, ability to read et write, english proficiency, level of education); use more than 1 test to assess cog function
Confusion Assessment Method (CAM) assessing et manageing delirium in older adults c dementia; 1 features acute onset et fluctuating course, 2 inattention, 3 disorganized thinking, 4 altered LOC; 1 et 2 c 3 or 4 = delirium
Identifying delirium (assessment) hx (question fam et staff); physical assessment; med review; lab et other dx studies; depression screening; CAM; MMSE; routine et periodic observation (LOC, behavior, mood, affect, verbalizations, motor)
Subtypes of Delirium (clinical presentation) hyperactive (inc motor, rapid speech, irritable, restless); hypoactive (lethargic, slowed speech, apathy, dec LOC); mixed (shifts b/w hypo et hyper)
Risk factors for delirium sensory impairment, dehydration, infection, substance dependence, urinary retention, hypoxia, pain, chronic disease exacerbation, pre-existing cog impairment, hx delirium, fecal impaction, inc age, Pepcid
Delirium management supportive environment, family, dec sensory losses, nightlight, night time sleep, avoid restraints, reorient, cog enhancing strategies, sense of control, ambulate/ROM/exercise, dec immobilizing, pharm intervention
S/S of depression in older adults violent, apathetic, withdrawal/social isolation, change in appetite, pessimism, anergia, dec wt, sleep disturbance, flat affect, somatic complaints, won't answer questions, means of suicide attempt
S/S of depression in younger adults withdrawal/distancing self, emotional sx complaints, fatigue, change in appetite, pessimism, jealousy, insomnia, mood changes (irritability), change in job/school performance, more verbal about suicide, more successful suicide attempts
Elder suicide assessment Level 1 (life is not worth living/escaping from probs?); level 2 (harming self/taking own life?); level 3 (pain present/what would you do to take your life?); level 4 (started to act on a plan to harm self/circumstances act on plan?)
Elder suicide prevalence rates highest for any age group esp >75y.o.; 15.6/100,000; depression most common risk factor; high incidence elder white males; more likely to have seen HCP short time prior to attempt; fewer than 5% express suicidal ideation
stochastic biological theory of aging RANDOM events cause cellular damage that accumulates over time
Nonstochastic biological theory of aging series of PREDETERMINED genetic or biological clock PROGRAMMED event happening to all organisms
Free radical stochastic biological theory of aging FRs from (norm metabolism, rxn to radiation, chain rxn c other FRs, oxidation of pollutants); inc age FR formation inc or protective mechanism dec; aging occurs when cumulative cell damage interferes c function
Wear et Tear stochastic biological theory of aging body wears out like a machine; aged cells lose ability to counteract mechanical, inflammatory, et other injuries; physical activity may not be good d/t eventual microscopic tears in major muscles et organs
Cross-Linkage stochastic biological theory of aging proteins, DNA, et other molecules develop inappropriate attachment-"cross links"; "cross links" inhibit activity of proteases; damaged proteins stay et cause problems->increasing age weakens natural defenses, process leads to irreparable damage; mutations
Gene/biological clock Nonstochastic biological theory of aging each cell or whole organism has aging code stored in DNA; longer life expectancy->more cell divisions possible
Programmed (Hayflick) Nonstochastic biological theory of aging aging of cells d/t shortening telomere; cells divide until no longer able->cell death; some divide d/t telomerase (adds DNA back; Cancer); norm cells don't have telomerase
Human Genome project Nonstochastic biological theory of aging ID'd location each human gene that influences biological aging et age-related diseases; ID of genetic variation taht alter risk of late-life disorders
Immunity/Autoimmune theory Nonstochastic biological theory of aging Progressive dec in immune funct; primary organs (thymus, bone marrow) of immunity affected by aging; inc autoimmune response; more prone to infection, autoimmune diseases
Neuroendocrine Nonstochastic biological theory of aging changes in brain, nervous system, et endocrine glands cause aging; may cause age-related changes in organ function; imbalance in neurotransmitters in brain interferes with cell division
Apoptosis Nonstochastic biological theory of aging mechanism of cell death; non-inflammatory, gene driven process, occurs throughout life; cells shrink; membranes intact; interplay b/w genes promoting cell survival et cell elimination; dysregulation promotes disability et degeneration assoc c aging
subculture sociological theory elders have their own norms et subcultures r/t loss of status in society; status comes from health et mobility not from wealth, education, or occupation; extreme age creates status
age stratification sociological theory society divided into strata according to age et roles; people pass through society in COHORTS; new cohorts continually being born; aging occurs in cohorts; cohorts have similar experiences, values, expectations, attitudes
Disengagement sociological theory society et elders mutually withdraw from each other; norm mutually satisfying process; unclear who starts 1st elder or society; theory doesn't account for differences in culture et environment
activity sociological theory society expects elders to contribute; social role participation important for pos adjustment to aging; self-concept reinforced through activities assoc. c various roles; quality of activities > quantity
person-environment fit sociological theory competence involves biological health, motor skills, cog et sensori-perceptual capacity, ego-->funct. ability; environment possibly results in behavioral response; level of competence r/t level of environmental demand
Gerotranscendence psychological theory dec concern c body et material things; dec self-centered; dec fear of death; connect past et future generations; inc meditation et solitude; ability to balance losses et focus on what's important in life
continuity psychological theory coping strategies set before old age; personality stable over time c some changes in middle et later life; changes may reflect generational trends or socialization of cohorts; 4 personality patterns in older adults (see above)
Life course (lifespan development) psychological theory life occurs in stages that are structured according to 1's roles, relationships, values, goals; must adapt to changing relationships et roles that occur throughout life et may need to revise beliefs to be consistent c society; successful aging
successful aging r/t Life course (lifespan development) psychological theory engaging in life tasks that are important despite reduced energy
Human needs (maslow's hierarchy) psychological theory attaining lower level needs takes priority; success @ meeting lower level needs->success @ meeting higher level needs; self-actualized (autonomous, creative, pos interpersonal relationships, independence)
individualism (Jung) psychological theory view life from personal (introverted) or external (extroverted) perspective; "inner search" to critique beliefs et accomplishments; successful aging
successful aging r/t individualism (Jung) psychological theory accept past + cope c losses et dec in function
erikson's stages (8) psychological theory last stage ego integrity vs despair; task: evaluate life accomplishments; struggles: letting go, accepting care, detachment, physical et mental decline
Gender et Aging psychological theory roles evolve from being narrowly defined in adolescence et young adult yrs; older men et women have more choices about roles/relationships but influenced by outdated age et gender norms
functional consequences nursing theory age-related changes alone don't causes consequences but elders can be made more vulnerable to the effects of risk factors; emphasizes those that nurses can address through health promotion
positive consequences r/t functional consequences nursing theory facilitates highest level of functions, least dependency, best QOL
Negative consequences r/t functional consequences nursing theory interferes c functioning et QOL
theory of thriving nursing theory based on failure to thrive; thriving when harmony b/w person, environment, et relationships; nursing interventions focus on factors that impede thriving
Created by: kdrummond08
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