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Elders Exam 1
| Question | Answer |
|---|---|
| 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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