Gerontology Module 2
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| What 3 things does aging biologically lead to? | Reduced tissue and physiological function, increased susceptibility to disease and decreased resistance to stress
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| What happens to cells as we age? | tissues age at different rates and degrees - total number of cells in body decreases
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| What do morphological studies demonstrated about age? | It is difficult to predict chronological age
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| What happened to mitochondria as we age? | Decreased ability to survive hypoxic insult - esp around 50 y.o.
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| 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
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| What 2 things are musculoskeletal changes with age? | Sarcopenia (loss of muscle mass) and Dynapenia (loss of strength and power)
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| How much does strength decline with age? | 10-15% per decade - Decrease in strength does not become apparent until after age 60
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| 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)
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| What accounts for age related drops in VO2 max? | deterioration of oxygen-carrying capacity - affects functional capacity and ability to perform ADLs
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| What is the best indicator of fitness? | VO2 max - declines 10% per decade from age 20
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| 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
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| 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
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| 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
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| 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
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| 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”
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| What can cause cartilage to create turn over and new cartilage? | Slough off in cartilage horizontally - vertical damage is worse
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| 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
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| What properties of tendons and ligaments are altered with age? | – Decrease plasticity and water content
– Decrease ability to recover original length when injured

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| 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
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| 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
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| 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
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| How do baroreceptors change with age? | they become less sensitive to BP fluctuations
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| How does stroke volume and cardiac output change with age? | Decrease in both stroke volume and cardiac output
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| 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
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| What can cause heart murmurs and left ventricular hypertrophy? | • ↑ valve stiffness = heart murmur
• ↓ blood vessel diameter = ↑ left ventricle hypertrophy
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| What can affect exercise response and increase in peripheral resistance? | • ↓ contractility, ↓ HRmax = Exercise response • ↓ vascular elasticity = ↑ in peripheral resistance
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| Which vessel is affected most with increased calcification/thickening of vessel walls? | Thoracic aorta most affected
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| How is alveolar gas exchange altered with age? | – ↓ oxygenation of blood, ↓ O2 utilization
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| How does vital capacity decrease with age? | • ↑ resistance to air flow + ↑ residual volumes = ↓ lung volume capacity – ↑ effort when breathing (dyspnea)
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| 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
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| 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
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| 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
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| 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
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| What occurs to the vestibular system with age? | • Vestibular Degeneration– Sensory receptors in the otoliths and semicircular canals
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| 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
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| 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
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| 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
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| 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
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| 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
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| What happens to taste and smell with age? | – decreased saliva – decreased cells in olfactory bulb – Chemosensory decrements
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| 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
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| 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
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| What occurs to your urine output with age? | Urinary Increased in residual urine – Increased reflux into ureters - decreased absorption of calcium and B12
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| 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
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| 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
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| What is the minimum requirement for community dwelling older adults? | Walking min of 1200 ft while carrying 8lbs and perform postural transitions
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| 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
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| 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
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| What are the 2 basic principles for effective exercise prescription? | Overload and specificity
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| 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
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| What can happen with emphasizing motor learning? | • Emphasizing motor learning does not reverse muscle atrophy and often creates regression towards initial baseline limitation
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| 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
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| 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
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| How often should 1RM be re-evaluated for optimal results? | Every 2 weeks
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| What characteristics are required for strength gains? | sufficient overload includes intensity, duration, frequency, speed of movement and difficulty or complexity of exercise movement
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| 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
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| How long should you rest for type II fibers? | 3-5 min to let them repolarize
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| What should you include to provide adequate muscle rest in an exercise prescription? | motor learning activities and aerobic activity
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| What are initial strength gains due to? | motor learning and neural adaptaiton
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| 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
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| 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
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| How can power be increased in older adults? | training by overloading rapid movements - max muscle fiber recruitment - 3-5 reps of 3-5 sets
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| 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
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| What are basic aerobic exercise prescriptions? | 30 min of walking at 50-70% HRRmax (can do 3 walks of 10 min)
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| 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%
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| 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
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| 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
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| When does Erikson's stage of older adulthood begin? | with retirement and continues throughout life
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| Which of Peck's psychosocial tasks of later adulthood involves looking for new meaning beyond previous roles? | Ego differentiation vs work-role preoccupation
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| Which of Peck's psychosocial tasks of later adulthood involves learning new ways to transcend physical discomfort? | – Body Transcendence vs. Body Preoccupation
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| Which of Peck's psychosocial tasks of later adulthood involves leaving an enduring legacy | – Ego Transcendence vs. Ego Preoccupation
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| 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
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| What part of the Engagement (Havinghurst) activity theory involves a high degree of competence in daily activities and complex inner life? | Integrated
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| What part of the Engagement (Havinghurst) activity theory involves seeking others to satisfy emotional needs? | passive dependent
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| What are the parts of the Engagement (Havinghurst) activity theory? | Integrated, Passive dependent, Armored, and Unintegrated
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| What part of the Engagement (Havinghurst) activity theory involves attempting to control environment and impulses? | Armored
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| What part of the Engagement (Havinghurst) activity theory involves showing poor emotional control and intellectual competency? | Unintegrated
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| 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
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| 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
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| What domains experience losses with cognitive age changes? | Speed, reasoning, and memory
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| Which type of intelligence depends on sociocultural influence? | Crystallized intel
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| Which type of intelligence depends on the genetic and neuropsychological? | Fluid intel
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| 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
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| When do psychomotor skills and information processing decline? | begins in 50s
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| When does problem solving decline? | in the late 60s
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| When do verbal skills decline? | may declines after 80
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| Does intelligence decline more than verbal? | Yes - but there is little or no decline in memory (abstract reasoning declines as well)
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| 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
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| What are 3 depression symptoms? | (1) Cognitive (poor concentration), (2) Somatic (fatigue, heart palpitations), (3) Affective (sadness, anxiety)
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| What does widowhood, urban crowing, rural lifestyle or institutionalization result in? | geographic isolation
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| What are 3 types of isolation? | 1. presentation isolation - disfigurement from physical disabilities 2. Behavioral Isolation: inappropriate behaviors 3. Attitudinal Isolation: Ageism
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| What is a nonspecificmanifestationofan underlying physical, mental, or psychosocial condition? | failure to thrive
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| 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
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| 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)
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| 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
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| What are the 4 common causes of chronic disease? | 1. Inactivity
2. Poor Nutrition
3. Tobacco use
4. Excessive alcohol consumption
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| 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
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| What does JAMCO stand for? | Used to recognize cognitive decline - Judgment, Affect, Memory, Cognition, Orientation
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| 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
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| What does chronic dementia cause a progressive loss of? | – Cognitive abilities
– Psychomotor skills
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| 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
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| Which stage of Alzheimer's may last several years with an increase in symptoms? | Second stage
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| 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
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| What is a form of discrimination and prejudice, that is particularly experienced by seniors? | Ageism
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| 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
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| What is intentionally inflicting, or allowing someone else to inflict, bodily injury or pain? | Abuse
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| What is a Failure to provide goods, services or care necessary to maintain health? | Neglect
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| What is Taking advantage of an older adult for monetary gain? | Exploitation
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| What is verbal harassment, intimidation, denigration and isolation? | Psychological abuse
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| What does supportive services include? | – Information, referral, outreach, case management, escort, transportation; In-home services; Community services; Caregiver services
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