Adult Development and Aging (Chapter 5)

Aphasia

- loss of language ability

The two components of COPD are:

1. Chronic emphysema Loss of elasticity in the alveoli 2. Chronic bronchitis Bronchial tubes inflamed and irritated. Will result in shortness of breath and also coughing. They are susceptible to respiratory infections. - smoking is the main cause

Incidence of heart disease and stroke

A large cause of death across the lifespan in the US but becomes increasingly more common in older people. We do see differences in risk for mortality around the globe and a lot of that has to do with lifestyle and cultural factors. The Mediterranean diet seems to be protective against heart disease. We see the French paradox, they eat a lot of wine, cheese, and olive oil and it seems like they shouldn't be that healthy but really they are very healthy. Also, they exercise more and walk around and they eat their biggest meal earlier in the day rather than in America where we eat our largest meal at night. In 2010, heart disease accounted for 24% of all deaths in the US. Behavioral risk factors: smoking, sendentary lifestyle, unhealthy diet, alcohol( excessive)

Cerebrovascular accident

Artery leading to the brain bursts or is clogged by blood clot or other particle. This is a stroke. There can be residual damage overtime. The impairment can build up overtime so can be a debilitating condition.

Congestive heart failure

Chronic condition in which heart unable to pump adequate blood to meet needs of organs so there could be problems then with the organs. This could be because of the heart itself and problems with the arteries. It's a vicious cycle w=because when the arteries can carry it the heart tries to compensate and that damages the heart even more. People can live with it for a long time and people would feel tired and weak.

Hypertension

Chronically elevated blood pressure: Often these exist together: Increase heart attack and stroke, 120/80 ... but now they are lowering it, Systolic over diastolic. The higher number is when the arteries are open and when the heart contracts is the lower number

Incidence of Heart Disease and Stroke

Heart disease accounted for 24% of all deaths in US (2010). Heart and CVD accounted for 33% of all deaths among 65+ in US, 25% of all deaths around the world. Eastern European countries have highest rates - high cholesterol diets

Cancer treatment

Screening is the first line of treatment. Once cancer has been detected, alternatives are: Surgery, Radiation and Chemotherapy

Transient ischemic attack

Temporary blockage of artery. Blood flow is reduced or cut off for a short period of time. Mini stoke/TIA's.

Respiratory diseases

There are a number of common respiratory diseases in older people and they can affect different areas like the bronchi or the alveoli. They start to lose their structure and form which makes the air exchange more difficult. The two main components of COPD- chronic obstructive pulmonary disorder- which are conditions which makes it difficult to exchange air. 1) Chronic emphysema- alveoli lose their plasticity 2) Chronic bronchitis which is a chronic inflammation and irritation of the bronchial tubes. *COPD symptoms can include shortness of breath even from minimal exertion. They seem to be more susceptible to respiratory infections and it can be harder for them to fight off.

Arteriosclerosis

Thickening and hardening of arteries

Diabetes

Type 1 is early onset and is a disorder typically diagnosed in childhood, there is damage to the insulin producing cells. Type 2 is damage to insulin receptor cells so the body is not able to use insulin. - type 2 diabetes is associated with obesity so since we are seeing more obesity we are seeing more type 2 diabetes even in children. - There is some research that shows that depression and psychological stress may increase someone's risk of developing diabetes. - There are also sociocultural factors like eating patterns, lack of education, and low economic resources that probably work through interaction with other factors like behaviors. - Diabetes is on the rise in the US and in the rest of the world- so we see the power of the US's influence.

Primary Prevention

before illness develops (watching diet, prevent people from starting smoking and quitting smoking to prevent lung cancer, cervical cancer- HPV vaccine). Alter existing problem behaviors , Prevent development of poor health habits

subdural haematoma

can be caused by a head injury- its a blood clot that creates pressure on the brain tissue

"Teachable moment"

childhood (teaching child and parents. A lot of our health behaviors are established during childhood- like diet, brushing teeth), pregnancy (women who smoke might quit smoking while pregnant, newly diagnosed).

Atherosclerosis

condition in which plaque builds up in the arteries.

Reversible neurocognitive disorders

due to the presence of a medical condition that affects but does not destroy brain tissue

Secondary Prevention

early disease detection (eg, screening, blood tests, blood pressure, pap smear for cervical cancer)

frontotemporal neurocognitive disorder (FTD)

experiencing personality changes such as apathy, lack of inhibition, obsessiveness, addictive behaviors, and loss of judgement.

Cervical cancer

fairly common form that is potentially treatable if diagnosed early. The main risk factors are having sexual intercourse before age 18 or having many partners. It is detectable in a precancerous form in a pap smear so it is recommended that women get a gynocological exam every year even though the pap smear may not be recommended for every year. It can be deadly if the cancer spreads but if it is detected early it can generally be removed.

Skin cancer

has become the most common cancer in the US but not necessarily the most deadly. The rates have increased tremendously recently. Many skin cancers can be removed surgically without too much concern. There is a subtype called melanoma where the cancer grows inside the body as well and can be very deadly once it takes root. If it is caught early it can be treated as well. The increase in skin cancer is believed to be due to the wearing away of the ozone layer mak-ing the sun a more potent source of radiation. Nowadays sunscreen is recommended from 6 months and up. People have been increasing their use of sunscreen but we are also seeing an increased use of tanning beds which is putting people at increased risk for skin cancer.

normal pressure hydrocephalus

involves an obstruction in the flow of cerebrospinal fluid, which causes the fluid to accumulate in the brain

Pick's disease

involves severe atrophy of the frontal and temporal lobes

Dementia

its an umbrella term for a number of specific disorders that are degenerative brain conditions. - Alzheimers- half of dementia cases are alzheimers disease - Vascular- dementia due to stroke and TIA'a. disruption of blood flow to the brain. If someone has a major stroke the impairment can come on suddenly. With TIA'a we see deterioration come on more slowly. The damage can accumulate overtime. - Parkinsons- a neurologic disease where someon is not producing adequate amounts of dopamine- neurotransmitter that controlls locomotive. They would have difficulty walking, no affect, monotone voice, hand tremmors - HIV/AIDS - Wernikes dementia- caused by excessive alcohol consumption * U.S. Prevalence figures are higher than rest of the world Increases with age 11% of all 65+ or 5 million (80% of all dementias) WHO estimates 5-7% of all 60+, but this includes all dementias; 43% of cases are "pure" Alzheimer's Alzheimer's Association prevalence figures may be accurate for ALL forms of dementia, not Alzheimer's alone.

Apraxia

loss of ability to carry out coordinated movement

Disturbance in executive functioning

loss of ability to plan and organize

Health promotion

more successful and less costly than disease prevention

Agnosia

of ability to recognize familiar objects

pseudodementia

older adults who suffer from clinical depression may show cognitive changes that mimic those involved in Alzheimer's disease

vascular neurocognitive disorder

progressively lose cognitive functioning due to damage to the arteries supplying the brain- most common form is multi-infarct dementia (MID): caused by transient ischemic attacks.

Tertiary Prevention

reduce negative impact of disease (eg, palliative care, cervical cancer- chemo, surgery, working with people in ways to enhance mobility- walker) palliative care- provided to individuals when they have disease or illness that's not treatable and the care minimizes the effects of the illness without treating it.

Respiratory system cancers

risk factors are environmental toxins, things like asbestos.

Breast cancer

second behind lung cancer for women for most common. Potentially treatable if diagnosed early. Screening guidelines are in flux. The rates increase with age. Screening includes clinical breast exam and mammography. There is concern about the radiation from mammography so there is concern about doing the mammogram every year. There is also an issue of false positives that result in a lot of anxiety, diagnostic procedures, and expenses. If someone has a problematic screening mammogram, they then go for a diagnostic mammogram and usually a biopsy. More than 50% of abnormal mammograms really are false positives. There is also discussion about when to start getting mammograms. There are 2 genes that have been identified and a person can do genetic testing to see if they have the gene. If they do have the gene, their risk is much higher. One intervention approach if someone has the gene is a prophalactic mastec-tomy or someone can be placed in a high risk surveillance program.

Lung cancer (and mouth and esophogeal cancer)

smoking is the biggest risk factor. Second hand smoking is also a big risk factor. But there does seem to be a genetic contribu-tion sometimes because some people who never smoke will still get it. People who quit smoking seemingly decrease their risk for lung cancer as soon as they stop smoking. There is a tobacco type product called betel quid that people chew like they chew tobacco. This has also been found to be associated with lung cancer. Research found that 80% of adults in India actually use this product.

Metabolic syndrome

someone has issues with their metabolism. A lot of times these people will go on to develop diabetes. It is sometimes a warning sign. Need at least 3 of these to have diagnoses: 1)abdominal obesity (waist circumference or waist to hip ratio) 2) high triglycerides 3)low HDL 4)high bp. Systolic is when the heart is filling up/ diastolic when it is contracting 5)high fasting glucose.

Prostate cancer

testosterone is a risk factor. Only for males. The prostate is a gland that is part of the male reproductive tract, the ejaculatory duct runs through it. Its main purpose it to secrete a fluid that is part of semen, with time and age the prostate tends to get enlarged and when the prostate gets bigger it causes urinary frequency and possibly difficulty expelling all of the urine. This is why older men get up a lot to go to the bathroom. Prostate cancer is increasingly common in older men but it is a slow growing cancer. Treatment can result in bladder incontinence and impotence so people are very hesitant to get the treatment. The screening can include a digital prostate exam(through the rectum) and there is also a blood test to screen for PSA levels. There are a lot of false positives with this blood test. So now these recs are in question and PSA testing is not done as often as it had been. And there is question of if men reach a certain age if they should stop prostate screening in general be-cause since it is slow growing it is more likely they'll die from something else than the prostate cancer if they have it.

Uterine cancer

the biggest risk factor is a high BMI

Osteoarthritis

the most common condition in the elderly. More common in people who over-use the joints even at a young age. - Obesity is also a risk factors because it causes more wearing of the joints. - Joint injuries also make it more likely. The only way to truly treat an arthritic joint is to replace it. So now we are seeing more hip and knee replacements. The rehab after is pretty substantial. - There is also pain management which includes taking medication, which is something we need to be careful of with the elderly because of longer half lives of medications. - There is also rheumatoid arthritis which is an autoimmune disease and is not more common in the elderly. - Yoga is the best way to treat (and maybe prevent) osteoarthritis.

GI system cancers

this can be cancer or the stomach, colon, rectum. The risk factors are high BMI, high fat diet, and also eating a diet with a lot of food preserved by drying or salting. We also see higher rates of stomach cancer in countries like Japan where they eat a lot of grilled foods.

Behavioral risk factors for chronic disease in adulthood

tobacco smoking, physical inactivity, unhealthy diet, alcohol → high p, high blood sugar, high lipids, obesity → disease outcomes

polypharmacy

when an individual takes multiple drugs sometimes without the knowledge of the physician, can be particularly lethal.

Activities of daily living (ADL)

• Bathing • Dressing • Transferring (going from one position to another) • Using the toilet • Eating

Instrumental activities of daily living (IADL)

• Use the telephone • Go shopping • Prepare meals • Complete housekeeping tasks • Do the laundry • Use private or public transportation • Take medications (even the cognitive awareness of when and how to take the medication). • Handle finances