Gern 401 Final Exam

Classification of pain

Acute pain - associated with physiological responses to actual tissue damage and is rapid onset - when tissue heals the acute pain decreases or disappears within weeks or days - can be treated quite well with medications or surgery persistent pain - pain that persists beyond the time expected for an injury to heal or pain associated with a chronic pathological condition causing continuing pain for months or years - aka chronic pain

Congenital vs. Acquired disability

Congenital - refers to when someone is born with the disability or it developed t a young age - accessibility of physical environments are more limiting than the disability itself. - people with lifelong disability have never experienced life without the presence of their particular particular disability; it is difficult for them to imagine life without their disability - majority are well-adjusted to the limitations their disability presents Acquired - usually gain disability later in life - adapting can be more of a challenge - have to adjust to a permanent reduction in their functional abilities - both psychological and physical change - mourn the loss of their independence but find alternative ways of completing tasks

Intrinsic and extrinsic fall factors

Intrinsic 1. sensory impairments 2. central nervous system disorders 3. cognitive changes 4. musculoskeletal changes 5. drugs Extrinsic 1. activity 2. specific environmental factors

Age related disorders of the gastrointestinal system

Mouth - Xerostomia (dry mouth) - Dysphasgia (difficulty swallowing) - dental caries - periodontal disease - oral cancer Esophagus - cancer of the esophagus - gastroesophageal reflux disease (GERD) - Hiatal Hernia Stomach - Gastritis (inflammation of the stomach) - Gastric (peptic) ulcer - cancer of the stomach Large intestine - appendicitis - diarrhea - constipation - Diverticulosis and Diverticulitis - cancer of the colon and rectum - hemorrhoids

Age related cardiovascular changes

Structural changes - increase in fatty tissues in the outermost layer of heart muscle - some increase in the thickness of the left ventricular wall - increase in collagen and decreased elastin tissues in the heart and arteries, which causes the vessels to become more rigid and thick - decreased efficiency in contractile strength of the heart muscle and decreased maximum heart rate, stroke volume, cardiac output, ejection fraction, and oxygen uptake - accumulation of lipofuscin - thickening and sclerosis (hardening) of the valve flaps - decreased number of peacemaker cells - loss of muscle cells - increased elastic collagen-type tissue - thickened and stretched veins and less efficiently functioning calves in the veins - less elastic coronary arteries Functional changes - Longer recovery - Slight arrhythmias - decline in cardiac output - increase in atrial fibrillation - changes in arteries and veins - blood components

Components and functions of the grastrointestinal system

The alimentary canal (the GI tract) consists of: a.) mouth b.) pharynx c.) esophagus d.) stomach e.) small intestine (duodenum, jejunum, ileum) f.) large intestine (cecum, appendix, colon, rectum, anal canal Digestive organs and Digestive glands a.) organs (teeth, tongue, gallbladder) b.) glands (liver, pancreas) c.) salivary glands (parotoid, submandibular, tubuloalveolar)

apoptosis theory

studies cell death as a noninflammatory gene-driven process occurring normally in the body - when regulated properly it is beneficial to the body, but dysregulation may cause aging

Neuroendocrine theory

suggests that aging is due to a programmed decline in nervous, immune, and endocrine system functioning

musculoskeletal system

system consisting of: - bones - cartilage - joints - muscles - tendons - ligaments - bursae

Stochastic Theories

view aging as caused by a series of adverse changes in the cells that lead to replicative errors; occur randomly and over time Theories include: - Wear-and-tear theory - error theory - cross-linking or connective tissue theory - free radical theory

Physical effects of alcohol abuse in older adults

■​Central nervous system: slurred speech, visual impairments, body instability with the likelihood of falls, confusion, memory impairment, increased depression, and impaired thinking and problem-solving. ■​Cardiovascular: increased blood pressure, irregular heartbeat, enlarged heart; alcohol also contributes to coronary artery disease and increases the risk of heart attack. ■​Gastrointestinal: contributes to malnutrition and gastritis (may lead to serious anemia); nausea and vomiting may lead to dangerous electrolyte imbalances. ■​Metabolic effects: may lead to hypoglycemia (low blood sugar) or to acidosis (excessive acidity of the body fluids); chronic alcohol intake may result in osteomalacia if vitamin D is not metabolized normally, and fractures are then likely. Liver toxicity is a well-known complication of chronic alcohol abuse and often leads to cirrhosis, a serious liver disease. - 100 of the most often prescribed medication interact negatively with alcohol

Age related changes in the foot

■​Fat pads shrink and degenerate on the sole of the foot, reducing the cushioning effect. ■​Skin may become more dry, inelastic, and cool. ■​Subcutaneous tissue on the bottom and sides of the foot thins. ■​Toenails are more brittle; they tend to thicken and are more likely to develop fungal infections. ■​Foot range of motion may diminish because of degenerative joint diseases.

Primary dementia's

- Alzheimer's disease - Frontotemporal Lobar Degeneration - Dementia Associated with Huntington's Disease - Dementia with lewy bodies and Parkinson's disease dementia - Creutzfeldt-Jakob disease - Vascular dementia - Mixed dementias

Age related disorder of the cardiovascular system

- Arteriosclerosis and Atherosclerosis - hypertension - Postural hypotension - Acute coronary syndrome - Angina Pectoris - Myocardial Infarction - congestive heart failure - Heart valve disease - cardiac arrhythmias and conduction disorders - transient ischemic attack - cerebrovascular accident Vascular disorders - aneurysm - arterial occlusion - varicose veins - phlenitis and deep vein thrombosis

Age relates disorders of the visual system

- Cataract - Glaucoma - Diabetic Retinopathy - Age-related macular degeneration

Secondary dementias

- Dementia associated with Parkinson's disease and other movement disorders - HIV-associated dementia - Reversible dementias -- Normal pressure hydrocephalus -- Substance/ medication-induced dementia -- dementia caused by major depressive disorder -- dementia caused by metabolic disturbances -- dementia caused by space-occupying lesions -- Cardiovascular-anoxic dementia

Programmed aging theory

- Hayflick and Moorehead raised the possibility that a biological or genetic clock may determine the aging process - life expectancy is thought to be preprogrammed in a species-specific range

Age related changes in the immune system

- Immunosenescence refers to age related changes that occure in the immune system and result in decrease in immune functioning -changes in skin and mucous membranes reduce the first line of defense - thymus gland decreases in size and activity and is eventually unable to supply enough T cells - reduction of immune responsiveness in both innate and acquired immunity - decline in T-cell function - increase in autoimmunity Age-related disorders in the immune system - HIV/AIDS in older adults

Types of exercise

- Isometric -- very specific muscles are contracted for a short time without joint movement - Isotonic -- produces muscle contraction and movement at adjacent joints but the activity is not maintained consistently enough for cardio or respiratory conditioning - Aerobic --requires the body to use oxygen to produce the energy needed to carry out the activity; involves rhythmic or repetitive activity using several large muscle groups for 20 to 30 minutes of sustained exercise - Strength training - endurance exercises - flexibility/stretching exercises

Lymphatic system

- Lymph nodes -- small nodes which destroy invading cells and debris - Spleen -- largest lymph organ -- provide for the immune response, cleanse the blood of toxins, debris, bacteria, viruses, and defective blood cells, story red blood cell and release into blood - Thymus gland -- produce hormones causing t lymphocytes to become effective against specific pathogens - tonsils -- remove many pathogens from entering the body through food or inhaled air - peyer's patches -- destroy bacteria before they enter the intestinal tract - appendix -- destroy bacteria before they reach the actual intestinal wall and can also produce lymphocytes for long term immunity

Age-related disorders in muscles

- Muscle cramps - Myasthenia Gravis - Polymyalgia Rheumatica - Bursitis

Age-related skeletal system disorders

- Osteoporosis -- treatments include: regular exercise and drug therapy - Arthritis -- osteoarthritis -- Rheumatoid Arthritis -- Gout (gouty Arthritis) - Osteomalacia - Lyme Disease - Paget's Disease

Disease prevention

- Primary prevention -- identifying and targeting risk factors in individuals and preventing disease before it starts such as eating a diet with lower levels of fat and salt to reduce the incidence of cardiovascular disease or getting recommended immunizations - Secondary prevention -- preventing disease while still asymptomatic or unreported and identifying unrecognized health problems in the early stages by screening and assessment - Tertiary prevention -- minimizing the overall effects of an established disease by accurate diagnosis, appropriate treatments, and rehab that aims to prevent the progression of symptoms and complications - Quaternary prevention -- reducing the disability resulting from chronic symptoms while attempting to maintain the attained level of functioning

What is gerontology?

- The broad study of the aging process, and geriatrics, a specialty concentrating on medical problems associated with growing older. - it incorporates multidisciplinary concepts and approaches in an attempt to understand all aspects of the complex aging process - includes biological, psychological, and social aspects of aging

Age-related nervous system disorders

- Tremor -- at-rest tremor -- postural temor (action tremor) -- intention tremor - Parkinson's disease (a form of parkinsonism) - Tardive Dyskinesia - Brain Tumors - Stroke - Dimentia - Sleep disorders -- Insomnia -- sleep apnea -- Restless leg syndrome and nocturnal myoclonus -- psychophysiological problems -- disorders of excessive sleepiness -- disrupted sleep-wake cycle

Age-related disorders of the skin

- Xerosis - Rashes - Senile Purpura - Pruritus (severe itching) - Solar Elastosis (skin aging caused by sun exposure) - Keratosis (horny growth) - Psoriasis - Skin tags - Herpes Zoster (shingles) - Pressure Ulcers (Decubitus Ulcers) - Venous and Arterial Stasis Ulcers Skin Cancer - Basal cell cancer - Squamous Cell Cancer - Malignant Melanoma

Concepts in physical aging

- aging is not synonymous with illness or disease - numerous physical changes historically attributed to aging are now recognized as more likely to be caused by lifestyle variables - "use it or lose it" is common in gerontology and applies to physical, psychological, and social aging - skills and abilities that we continue to use will be maintained well into older age - some factors associated with aging are non-modifiable (genetics, gender, and age), but others can be modified by lifestyle such as exercise, adequate nutrition, no smoking, and stress management - Three lifestyle factors that have a major impact on the manner in which we age are regular exercise, proper nutrition, and stress management.

Implications of age-related hearing impairments

- are not life threatening but disabling because they can disrupt the quality of life - usually occur gradually affecting the ability to respond appropriately to auditory signals of danger and impairing the ability to understand what is said and to communicate - those with presbycusis hear part of a word or sentence and either have to ask to have it repeated or guess what was said - those with hearing impairments are treated as though they are mentally incompetent or in the early stages of dementia

Caloric restriction theory

- based on earlier research indicating that caloric restriction in diet increases life span, slows metabolism, and at least delays the onset of a number of age-related diseases

wear-and-tear theory

- based on the assumption that continued use leads to worn-out or defective parts of the body - this perspective ignores the various repair mechanisms available in the body and the fact that, in some cases (the muscles for example) use contributes to increased strength and improved functioning - changes at the molecular level, especially the activity of the reactive oxygen species (ROS) can cause damage that is random and unpredictable

Brain Structure

- brain can be subdivided into four sections: - cerebrum (two cerebral hemispheres) -diencephalon (thalamus, hypothalamus, and epithalamus) - brainstem (midbrain, pons, medulla, and cerebellum)

Age related changes in hearing

- changes in hearing usually begin in the 40s and progress with age - the pinna loses some flexibility and becomes a bit longer and wider, hairs become stiffer, cerumen produced in the later years is thicker in consistency (dryer) and is not always easily removed and can lead to substantial amount of conductive hearing impairment - aging changes in the middle ear involve lessened flexibility of the tympanic membrane, the oval window membrane, and the round window membrane; stiffness of ossicles, lessened efficiency of the acoustic reflex - age-related changes in the inner ear are primarily presbycusis, auditory loss generally affects perception of high frequencies first

Age-related changes in skin senses

- changes take place gradually involving some loss of receptors with age and higher threshold of stimulation in those remaining

Age related disorders of te respiratory system

- chronic obstructive pulmonary disease - chronic bronchitis - emphysema - pulmonary tuberculosis - pneumonia - lung cancer

Age-related changes in vision

- cornea becomes thicker and less curved with age; affects its refractive ability and causes older adults to be more prone to astigmatism; gray ring (arcus senilus) forms around the outer edge of cornea - the anterior chamber decreases in size, the growth of the lens puts pressure on the canal of Schlemm at the junction of the iris and the cornea; an increase in pressure can lead to glaucoma - With age, eye color (iris) fades and they may not appear as lustrous as those who are younger - Pupil diameter decreases and the amount of light reaching the visual receptors by age 70 may be only a third of the amount reaching a younger person's eye; decrease in ability to dilate - lens becomes thicker, denser and less elastic, becomes more yellow, lens can become increasingly cloudy or opaque which can result in cataracts -- yellowing produces changes in color vision - vitreous humor becomes less gel-like and becomes more liquid like leading to less distinct more blurred vision. this can also lead to floaters - retina changes include blood vessels and capillaries narrow and may atrophy; some loss of rods and cones; light and dark adaptation processes decrease

Barriers to health promotion

- cost of preventive health services may be prohibitive for those already on a fixed income - Difficulty in obtaining adequate treatment for existing illnesses results in a sense of futility about seeking additional services for health promotion and disease prevention - Ethnic and cultural influences regarding health-seeking behavior vary greatly and are complex. diversity has not always been considered or even recognized by many healthy care policy makers or providers - transportation is costly or not available

Immunological theory or immunity theory

- deals with the immune system of the human body, which is composed of a series of responses by the body to protect itself against invasion of foreign materials, viruses, and bacteria - with age, the immune system becomes less effective in warding off these invading substances, a process called immunosenescene - it loses the ability to distinguish between its own tissue and the invading materials and begins to attack and destroy its own tiess.

Erikson's stage theory of development

- describes developmental crises across life span Middle age generativity vs. Ego stagnation - altering ones perspective of time in which individuals become more aware of the finiteness of life - failure to resolve earlier psychosocial demands may result in increasing preoccupation with self and rigid adherence to the familiar Late adulthood: ego integrity vs. despair - the major developmental task is to review one's life, reconcile successes and failures, and put it all into perspective - is life is viewed as a series of failure experiences the individual feels they were inadequate in meeting most of lifes demands despair may well follow

cross-linking theory

- elastin and collagen tissues change with age from molecules that are loosely associated with each other to molecules that become more closely associated or cross-linked (making the tissues less flexible and more rigid) - Cross-linking not only lessens the flexibility of these tissues but also affects the accessibility of white blood cells to fight infection, decreases access to nutrition, inhibits cell growth, and reduces ability to eliminate toxins that are by-products of metabolism.

Abuse and neglect

- elder abuse is a single or repeated act or lack or approximate action occurring within any relationship where there is an expectation of trust or dependence which causes harm or distress to an older person seven types of elder abuse 1. neglect 2. self-neglect 3. emotional or psychologica; 4. sexual abuse 5. financial or material exploitation 6. abandonment 7. physical abuse

Structure of the endocrine system

- endocrine system functions through ductless glands that secrete chemicals called hormones directly into the blood or lymph Major glands: - Pituitary Gland -- produces growth hormone, thyroid-stimulating hormone (TSH), ACTH, FSH & LH, prolactine; posterior: oxytocin, vasopressin, ADH - Thyroid -- Thyroid Hormone (TH) and Calcitonin - Parathyroid -- parathyroid hormone (PTH) - Adrenal -- aka suprarenal -- homrones produced by the adrenal cortex are called corticosteroids -- glucocorticoids, mineralocorticoids, and androgens -- adrenal medulla: catecholamines, epinephrine, norepinephrine - Pineal -- in the diencephalon, secretes melatonin - Thymus -- development of the immune system - also include pancreas, ovaries, and testes

Modifiable risk factors

- factors that are changeable - lifestyle - exercise - adequate nutrition - no smoking - stress management

non-modifiable risk factors

- factors that cant be changes - genetics - gender - age - family history

Health promotion

- focuses on assisting individuals to achieve maximum health status is closely linked to successful aging Significant areas of health promotion for older adults - control of smoking - mind-body health - maximal nutritional status - weight control - social health - self-care, medically - spiritual healthcare - health, environmental

Type 1 diabetes

- formerly called insulin-dependent or juvenile diabetes - a multi-system disease involving beta cell destruction causing absolute insulin deficiency or pancreatic destruction from viral infection such as mumps, measles, encephalitis, or influenza - usually in people under 30 - considered an autoimmune disorder - symptoms are weight loss, excessive thirst, frequent urination, and excessive hunger - if insulin is not taken the individual will develop diabetic ketoacidosis (DKA)

Type 2 diabetes

- formerly knows as non-insulin dependent or adult-onset diabetes - more common, involved hyperglycemia caused by insulin resistance (cells do not respond to insulin due to unresponsive insulin receptors) - diminished ability for the pancreas to produce insulin - the liver is not appropriately producing glucose - there is modified production or hormones cytokines by adipose tissue - genetics, lifestyle (obesity and lack of exercise), ethnicity, and age related changes - medications: insuline and oral antidiabetic drugs

Free radical theory

- free radicals are chemical by-products of normal cell metabolism involving oxygen - with age, the body's ability to neutralize free radicals decreases, which can lead to damaging cell membranes, altering normal cell activity, and ultimately causing cell death

Age-related changes in the skeletal system

- gradual loss of calcium from bone -- factors influencing bone loss include genetics, smoking, excess consumption of alcohol, and hormonal factor - osteoporosis: loss of bone mass causes fractures, unremitting pain, or immobility - bone strength declines - cartilage surfaces become rougher, reduces flexibility and cushioning effect of normal cartilage so bones rub together - decreased hydration or water content in cartilage with age - cartilage of the intervertebral discs change with age by losing fluid and becoming stiffer or less compressible restricting body flexibility - loss of height - strength of tendons and ligaments decreases with age and shows some decrease in water content - proprioception (awareness of self in space) may change and influence balance and cause unsteadiness.

Aging and the adrenal gland

- gradual reduction in adrenal secretions occurs with age as the adrenal glands experience structural changes - two diseases of the adrenal gland occur among older adults which are Addison's disease and coshing's syndrome - Addison's Disease -- caused by deficiency of hormones -- characterized by muscle weakness, lack of appetite, weight loss, hypotension, fatigue, dark pigmentation, gastrointestinal symptoms, low blood glucose, low serum sodium, and high serum potassium - Cushing's Syndrome -- reflects excessive activity of the adrenal cortex with increased levels of corticosteroids - characteristic symptoms are fatty deposits around the face and trunk with thin arms and legs, weakness, sleep disturbances, weight gain, and retention of sodium and water

Age-related changes in hair

- graying of the hair -- begins around age 40 and is caused by sex-linked, genetic, and racial factors - hair loss - baldness -- for men usually begins with a receding hairline, but women too have thinner finer hair with aging - men have increased hair growth in the ears, nostrils, and eyebrows - women tend to have more hair growth on the chin and around the lips - in both men and women there is some loss of body hair with age

Age-related changes in smell

- higher threshold of smell sensitivity with age, suggesting that odor identification seems to be less efficient and that odors need to be stronger and more intense intense to be perceived and differentiated by older adults - changes have behavioral implications for the proper ingestion of food, for safety, and for personal hygiene

Age-related changes in the skin

- intrinsic aging: based on genetic makeup and normal aging - extrinsic factors: smoking exposure to UV light, and environmental pollutants - skin exposed to YV rays over time assumes a leathery wrinkled appearance, is fragile, and has impaired healing abilities - smoking has been lined to increased wrinkling of the skin grayish skin coloring, and a lessened ability of the skin to protect itself from UV rays. - epidermal thickness decreases - cells of the epidermis have decreased moisture which contributes to dry, itchy, and rough skin - the dermis loses about 20% of its thickness in older age causing skin to appear paper think and transparent, collagen decreases and elastin fibers thicken and fragment. - the layer of fat cells in the hypodermis becomes thinner with age which reduces both protection from trauma and the insulation that prevents loss of body heat; especially noticeable in the face legs and hands - less accumulation of fat in the abdominal areas of men and the thighs of women - loss of feet padding which leads to caluses, corns, foot pain, and ulcerations

Falls

- leading cause of both morbidity and mortality in those older than age 65 and is a major health problem - one out of three adults 65 and older fall each year and are the leading cause of both fatal and nonfatal injuries - older people who fall have a 50% change of dying within a year =- fractures are the most serious consequence of falls and at least 95% of all fractures in older people are from falling - most common fractures are hip, leg, ankle, and forearm, upper arm, hand, and pelvis

Lungs and their functions

- located in the thoracic cavity and are somewhat coned shape - left lung is divided into two lobes because the heart is located on the left side whereas the right lung has three lobes - lungs expand and recoil as the size of the chest cavity increases and decreases - pressure in the lung increases and air is forced out - breathing is not only a function of the lungs alone but is also due to the action of diaphragm and ribcage muscle - the lungs act more like balloons subject to pressure differences between the lung cavity in the body and atmospheric pressures outside the body

Preventive care of respiratory system

- maintain good health by drink 1.5 to 2 quarts of fluid each day and eating a well-balanced diet - annual physical exams - stop smoking - avoiding respiratory infections is especially important for those with respiratory disease - pneumonia vaccine is recommended - influenza vaccine is recommended - regular exercise regimen will help maintain and improve lung functioning

Age related changes in the nails

- nails grow more slowly often becoming lackluster, hard, thick, brittle, and develop a gray or yellowish appearance - longitudinal ridges and striations may cause the nails to split - toenails become thicker with and and more difficult to cut - Vision, musculoskeletal flexibility, and eye-hand coordination problems all make toenail care challenging or impossible.

Maslow's hierarchy of basic human needs

- need that motivate human behavior - as the needs of one level are met, the individual strives to meet the needs of the next level. 1. Psychological or survival needs 2. Safety and security needs 3. Belonging and affiliation needs 4. esteem needs 5. Self-actualization

Aging with cerebral palsy

- nonprogressive neurological disorder that affects movement and posture - occurs as a result of damage in areas of the brain that control motor function (motor cortex, basal ganglia, cerebellum) - people with CP can have difficulties with mobility, posture, balance, eating, controlling body movements, and purposeful movement

evaluation and prevention of falls

- not all older people define falls in the same ways so you must assess slips, tripping, and near falls. - Morse Fall Scale and Hendrick II scale are used to asses falls - Fall diaries are helpful Prevention: - modify environment to be safer - exercise especially balance, gait training, and muscle-strengthening exercises - medication management - environmental modifications - multidimensional programs

Age-related changes in taste

- older persons may notice a decrease in the sense of taste around age 60, and especially after age 70 - changes occur gradually, may not be consciously aware of changes in taste - there may be changes in taste receptors - dry mouth occurs more often in older adults bc of the reduction in saliva and can also result in changes in the perception of taste

Peck's tasks of middle and old age

- peck proposed dour specific tasks for middle age and three for older age; tasks for each age may be dealt with simultaneously rather than in a specific order Tasks for middle age: 1. Valuing wisdom, vs. physical powers 2. Socializing vs. sexualizing 3. Cathetic flexibility vs. cathetic impoverishment 4. Mental flexibility vs. mental rigidity Tasks for old age: 1. Ego differentiation vs work role preoccupation 2. Body transcendence vs. body preoccupation 3. Ego transcendence vs. ego preoccupation

Age related changes in the gastrointestoinal system

- process of digestion slows with age and may become somewhat less efficient Mouth - tooth enamel and dentin gradually wear down making teeth susceptible to cavities - dentures create discomfort - decrease in saliva - neuromuscular changes can affect chewing and swallowing and both tend to slow with age tastebuds decrease in numbers Esophagus - weaker smooth muscle and lessened sphincter motility cause delayed emptying of food into stomach, GERD Stomach - decreased hydrochloric acid, less elastic which effects gastric emptying Small intestine - decrease in digestive enzyme secretion affects absorption of nutrients; decreased muscle tone slower peristalsis Large intestine - weak spots in the wall of the color - liver decreases in size and weight, bloodflow declines

Homeostatic Equilibrium

- refers to a dynamic equilibrium that must be maintained in the body's internal environment - becomes more precarious as reserve capacity decreases with age - with age and a lessened reserve capacity it is easier for homeostatic balance to be disrupted and it is difficult to restore, so they are more vulnerable to illness, disease, and accidents - biological aging is sometimes considered to be a decline in the ability to maintain homeostatic equilibrium leading to impaired functioning and ultimately to death

Demographics

- statistical data relating to the population and particular groups within it. - changes in the united states have long indicated that we are an aging society - the fastest growing segment of the older population are the centenarians, those over age 100, while the second fastest growing numbers of people are those over age 85 - many gerontologists agree that it is necessary to differentiate between those who are "young-old" (65-74), those who are "middle old" (75-84), and those who are "old-old" (85+)

Delirium

- the NCD of delirium disrupts brain function and usually has multiple causes - major behavioral changes not explained by a preexisting dementia - inability to shift or maintain attention to external stimuli, disorganized thinking, perceptual disturbances (hallucinations, disturbances in sleep wake cycle, increased or decreased psychomotor activity, reduced level of consciousness, disorientation, and memory impairment - There are numerous possible causes of delirium in older adults, including infections, dementia and other cognitive impairments, immobilization, dehydration, malnutrition, electrolyte disorders, coexisting medical problems, surgery, sensory deprivation, and medications.

Obesity and health promotion in adults with intellectual disability

- the increasing rates of obesity is much worse in the ID population; children with ID have a prevalence rate of 28.9% compared with 15.5% of children without ID - attention needs to be directed at education about healthy living practices - conditions like cardiovascular disease, diabetes, are associated with obesity and risk becomes more commonplace if wellness programs to improve general fitness are not effectively implemented - healthcare professionals should promote health and wellness programs to adults aging with IDs and should note that this segment of the population is expected to derive great benefit from such programs

Mechanisms of the heart

- the pump of the blood-vascular system - hollow organ with highly muscular walls, situated within the thorax between the lungs in the space that separates the left pleural cavities - has four chambers: two atria and two ventricles; septum separates the left and right side of the heart - atria and ventricles are separated by atrioventricular (A-V) valves that control the location and the amount of blood in each of the four chambers of the heart - coronary circulation: involves specific coronary arteries branching from the base of the aorta and distributing blood to the heart muscle -- veins collect the blood to be returned to the right atrium through a large vein called the coronary sinus

error theory

- this theory is primarily concerned with cumulative mistakes that occur in DNA and RNA with age - if random errors occur in the copying functions of RNA, inaccurate genetic information is copied and transmitted thus impairing cell functions - aging and death are presumed to be the result of errors that occur and are transmitted at the cellular level

Age related disorders of hearing

- tinnitus -- 85% of those who have hearing or ear problems experience tinnitus and it is more common in older adults -- may be caused by medications, infections, neurological problems, and other disorders related to hearing -- may also be caused by blood flow in the ear, spastic muscles in the ear, or vibrations of the hair cells

Aging with down syndrome

- trisomy 21 - people with DS are likely to retain a reduced life expectancy compared with both the ID population and general population - general characteristics of a person with DS -- hypotonia -- hyperextensive joints -- small stature - flattened occiput -- poorly develped bridge of nose -- small mouth -- high arched palate -- recurrent conjunctivitis -- blepharitis - very prone to developing sensory problems; greater risk of hearing loss

Age-related disorders in taste and smell

- upper respiratory infection, head traumas, and nasal/sinus disease - olfactory distortions or losses have also been associated with alzheimer's disease, parkinson's disease, and huntington's disease

complexity of aging with disabilities

- very complex matter that often depends on the type of disability - if they already have impairments, age-related changes wont affect them as much as they have already adjusted - those who have hearing impairments than have age-related visual loss will be affected more

non-stochastic theories

- view aging as caused by replicated errors in cells that are intrinsic and predetermined or programmed Theories include: - Programmed aging theory - immunological or immunity theory

Aging changes and alcohol

- with age tolerance for alcohol usually decreases - lessened reserve capacity in all organ systems of the body which lessens the ability to deal appropriately with alcohol effects - body's composition changes so there is less lean body mass and an increase in fatty tissue accompanied by less total water - one drink produces higher blood and alcohol concentrations that it would in a younger person and the effects will last longer - may be more serious in women

Age-related changes modified by exercise

1, Aerobic capacity and cardiovascular-pulmonary functioning 2. muscle strength 3. flexibility and balance 4. bone mass 5. metabolic functioning 6. blood pressure 7. psychological benefits

Age-related changes in the respiratory system

1. calcification of the laryngeal and tracheal cartilage occurs resulting in a stiffening of those structures 2. the actual number of alveoli does mot change significantly with age, but their structure is altered; decrease in the surface area available for oxygen-carbon dioxide exchange 3. presbylaryngis refers to aging changes in voice pitch caused by thinning or aging of the vocal cords 4. Skeletal changes such as calcification of the costal (rib) cartilages, osteoporosis, and weakened respiratory muscles all affect respiratory functioning. 5. The skeletal muscles of the thorax and diaphragm responsible for inhalation and exhalation lose strength and endurance as a part of the aging process, there is increased stiffness 6. The lungs decrease in size, become flabbier, and decrease in weight 7. increased levels of carbon dioxide and decreased levels of oxygen in the blood predisposing them to to a lower oxygen supply available to vital organs in acute respiratory conditions and perhaps also to increased incidence of sleep disorders

Specific implications of age-related visual changes

1. decreased visual acuity 2. light and dark adaptation 3. visual threshold 4. increased sensitivity to glare 5. peripheral vision General implications: - primarily associated with older adults' decreasing efficiency in responding to the visual world and with accident prevention - moving from light to darker areas in the home increase the possibility of accidents

tips to protect/maintain healthy skin

1. drink at least 2 quarts of water daily 2. maintain a well-balanced diet with ample fruits, vegetables, and protein 3. at least twice daily, use skin creams and lubricants that moisturize the skin 4. use mild or superfatted non-perfumed soaps 5. bathe in warm water and rinse the skin well before drying thoroughly 6. keep air in home humidified 7. when outside use suncreen that blocks both UVA and UVB rays with an SPF of 30 or higher and a lip balm with sunscreen even on cloudy days 8. when in the sun wear cotton clothing that covers the body 9. limit time in the sun and exposure to cold and wind 10. full body bathe only 2-3 times a week 11.​If incontinent, make sure the skin is washed well and dried thoroughly and an emollient applied. 12.​Avoid rough, irritating clothing, or laundering clothes with harsh soaps, bleach, or starch.

Patterns of disease and chronological aging

1. many older persons have several health problems that need to be treated at the same time 2. the symptoms older persons describe may not be the classic symptoms characteristic of younger individuals 3. older adults tend to expect pain and discomfort as they age and may not report symptoms until a medical problem is far advanced

General recommendations for exercise programs for older adults

1. physical exam is recommended before embarking on an exercise program as well as lab and stress tests 2. Learn how to monitor heart rate; use their perceived level of exertion 3. teaching guidelines for self-pacing during exercise; they are working at a comfortable rate if they can talk when exercising; being aware of how they feel is important 4. programs should include: a warm up periods, an aerobic component, and a cool-down period 5. walking in the right manner 6. walking might include a mind-body aspect using chi walking

Age related changes in the vestibular system

1. sensory receptors (hair cells) decrease in number and peripheral neural fibers are reduced 2. increased difficulty walking or standing on uneven or soft surfaces in dark or poorly lit environments; body sway increases and may be partially responsible for general postural unsteadiness; equilibrium and balance become impaired

Age-related changes in the nervous system

1. some loss of neurons with age; decrease in brain weight and size 2. non-nervous or supporting tissue in the nervous system increases with age 3. highly selective atrophy with age 4. Lipofuscin accumulates in the nerve cells, cardiac muscle, skeletal muscle, smooth muscle, thymus gland, pancreas, adrenals, liver, spleen, and parts of sperm duct. 5. increase in neuritic plaques and neurofibrillary tangles -these are characteristic of the brains of those with Alzheimer's disease 6. aging initiates changes in transmission efficiency 7. changes in brain waver patters which reflect the electrical activity of the brain. - older persons EEG patterns are likely to be slower and may resemble the EEG pattern of a child 8. Sleep patterns change with age; total sleep time is reduced compared with younger years; daytime naps increase with age 9. Changes in the Autonomic Nervous System result in slower functioning and prolonged recovery time

Proper foot care

1.​ Maintain a well-balanced diet. 2.​ Wash the feet daily in warm water using mild soap. Dry well, especially between the toes, and apply an emollient such as Vaseline. Care should be taken, however, to avoid falling. 3.​ Inspect the feet daily for dry skin, toenail problems, sores, blisters, cracks, changes in skin temperature indicating possible circulatory impairment, changes in color or sensation, thickened toenails, reddened areas, swelling, pain, ulcers, drainage (indicative of infection), and odor. A family member may need to do these inspections if an older person has visual or manipulative difficulties. 4. ​Cut nails straight across to avoid skin punctures and ingrown toenails. 5.​Wear shoes that fit. Those with diabetes or circulatory problems should be especially careful to wear enclosed leather shoes that still allow the feet to breathe. 6.​Never go barefoot because of the danger of injury and consequent infection. 7.​ Have corns and calluses cut and treated by a podiatrist. 8.​Use range-of-motion exercises for the feet to preserve mobility. 9.​Maintain adequate circulation of blood to the feet by walking, stretching, or doing specific exercises. A foot massage or a warm foot bath also promotes circulation.

Strategies for change

1.​Increase the proportion of older adults with physical or cognitive health problems who get physical activity. 2.​Reduce the rate of pressure ulcer-related hospital admissions among older adults. 3.​Reduce the rate of hospital admissions for diabetes among older adults. 4.​Increase the proportion of older adults with diagnosed Alzheimer's disease and other dementias, or their caregiver, who are aware of the diagnosis. 5.​Reduce the proportion of preventable hospitalizations in older adults with dementia. 6.​Increase the proportion of adults with subjective cognitive decline who have discussed their symptoms with a provider. 7.​Reduce infections caused by Listeria. 8.​Reduce the rate of hospital admissions for urinary tract infections among older adults. 9.​Reduce fall-related deaths among older adults. 10.​Reduce the proportion of older adults who use inappropriate medications. 11.​Reduce the rate of emergency department visits due to falls among older adults. 12.​Reduce the proportion of older adults with untreated root surface decay. 13.​Reduce the proportion of adults aged 45 years and over who have lost all their teeth. 14.​Reduce the proportion of adults aged 45 years and over with moderate and severe periodontitis. 15.​Reduce hip fractures among older adults. 16.​Increase the proportion of older adults who get screened for osteoporosis. 17.​Increase the proportion of older adults who get treated for osteoporosis after a fracture. 18.​Reduce the rate of hospital admissions for pneumonia among older adults. 19.​Reduce hospitalizations for asthma in adults aged 65 years and over. 20.​Reduce vision loss from age-related macular degeneration.

Age related changes in muscles

1.​Muscle strength tends to decline with age, partially as a result of loss of motor units and muscle fibers. However, a large body of evidence indicates regular appropriate exercise can slow loss of muscle strength and also increase strength, even in very old age. 2.​There is some muscle atrophy with age, although how much is caused by the aging process and how much by disuse is not clear. 3.​The decrease in muscle mass and in contractile force or weakness often noted in older adults is called sarcopenia. Sarcopenia increases fatigue, frailty, and disabilities; is a major risk factor for falling; and makes daily activities more difficult, therefore compromising independence in many older adults

age-related disorders of the vestibular system

4 types of complaints 1. disequilibrium or imbalance 2. Faintness or a feeling of impending loss of consciousness 3. vague, nonspecific light headedness 4. vertigo Disorders - Meinieres disease/vestibular neuritis -