Extra

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1 in 10 people over 65 who are senile (impaired memory)

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1- an adequate income in retirement in accordance with the American standard of living

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2- the best possible physical and mental health which science can make available without regard to economic status

○

8- efficient community services, including access to low-cost transportation, which provide a choice in supported living arrangements and social assistance in a coordinated manner and which are readily available when needed, with emphasis on maintaining a continuum of care for vulnerable older individuals

Assent

:A term that arose to cover situations when a person is not in a position for their consent to be legally honored but puts burden on the caregiver to try and discern what the people want in regards to decisions profoundly affecting their life. This situation is usually found with children and adults with impaired decision-making capacity.

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A more humanistic approach to the environment and operations of a nursing facility

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Abnormal motor behavior and/or catatonia

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Acceptance (Ok)

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Accident rate per driver over age 65 is lower than for those under 65

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Adults reformulate their life stories throughout adulthood. Life stories are internalized narratives with a beginning, middle, and end. The goal is to create a life story that is coherent, credible, open to new possibilities within one's sociocultural context. Essential to Generativity.

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Measure the dependent variable (DV)

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Move it or lose it - your cognition, that is!

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Muscle and glandular tone diminish - less elasticity

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Mutations in SNCA, LRRK2, Parkin, PINK1 and DH-1

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NMS of PD significantly impact quality of life

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Negative symptoms

○ Nationalerontologists- Association for Professional Gerontologists-

Networks Gerontologists and related professionals to bridge research and practice.

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Nursing services

○

Nutrition

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Nutrition counseling, fitness, education, health screenings

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One elder suicide every 80 minutes

○

Others....

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Our attitudes towards people or things in terms of liking or disliking them

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Our sense of self mastery and self efficacy are important to this effort, as is receiving positive feedback

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Ovaries and uterus decreased in size and weight

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Over ⅓ of average 85 year old's expenditure lies in that person's future

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Overall improvements since OBRA 87

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PD is now conceptualized as a neurodegenerative disorder characterized by progressing decline in both motor and nonmotor (NMS) functions

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PD progresses from onset to death in 10-20 years

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Participate in resident and family groups

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Pensions are disappearing in favor of defined contributions

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People are ambivalent about retirement - a day without urgency is a day lost; stress of work is gone but also is the opportunity for achievement; freedom of retirement can lead to social isolation; couples must recalibrate; even financially secure face uncertainty about future

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Person centered care

6.

Personal growth

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Plateau - Can be maintained longer

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Plateau - May require more stimulation to become aroused

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Predict what may happen

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Preferences can be influenced by emotional reactions, memory or framing effects

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Prevalence is 2-6% of US adults

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Prevalence ranges between 18 to 418 per 100,000 (Zhang & Roman, 1993)

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Prima Facie Duties: Duties or rights that allow you to make choices among conflicting principles.

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Privacy

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Productive aging

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Promote prevention and disease

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Provide more information to consumers: ACA requires more transparency (ex: ownership)

Culture and ethnic:

Provide status social settings living conditions and personal experiences for people of all ages

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Provides for sanctions (plans of correction, civil monetary penalties, appoints of a receiver, etc.)

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Provides science-based, 10 year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:

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Published October 4, 2016

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Quantitative Scales

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RSVP

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Race: Minorities = 19.9% (20%)

Auxiliary Grant Rate

Rate assisted living facilities agree to charge to individuals who are eligible for auxiliary grant assistance.

○

Receive training and subsidized employment opportunities through these programs

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Recognizes that the special needs of the elders are best addressed within their cultural environment as well as recognizing their autonomy of the groups

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Reconsider care options

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Refers to a long-term reduction in a person's ability to do his or her usual activities;

Bereavement

Refers to both the situation and the process of adjusting to a loss of someone to whom we feel close. There are physical, emotional, intellectual, and spiritual aspects.

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Rehabilitation services

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Resolution - Longer refractory period

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Results are mixed: generally fitness interventions had both broad and specific beneficial cognitive effects, most notably on executive control functions

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Retirement of the baby boom generation

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Risky use

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Rule Utilitarianism: Thought of as a hybrid of deontologic and utilitarian approaches. Holds that you will always bring about more good consequences by following certain "rules" or duties.

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SCORE

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Salience - how relevant does the stereotype seem to the individual?

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Section 2176 of the Omnibus Reconciliation Act of 1987 permits states to offer, under a waiver, a wide array of home and community-based services that an individual may need to avoid institutionalization

1.

Self acceptance

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Self-regulation, executive control and capacity for self-initiated processing (front lobe strategic processes)

Conflict of Interest

Situation that occurs for professionals when they incur interest that significantly threaten their professional duties and commitments.

○

Sleep Disorders

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Social Security constituted 90% of the income for 35% of beneficiaries. (2009)

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Social Support System - network of friends and family

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Social engagement

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Social problems

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Social services

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Some promising findings about transferability and duration of effects

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Stresses:

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Successful aging

●

Successful aging occurs as people are less preoccupied with body and more on the meaning of life and spending time with close family and friends.

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Suicide

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System 1: Affective: thoughts, feelings, unconscious, spontaneous, fast

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System 2: Deliberative: verbal reason, conscious, deliberate, slow

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Systematic Analysis and Systematic Action

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The Broader Aging Network may be viewed as agencies that are not a part of the formal aging network that serve older adults, such as Department of Social Services, or, the Alzheimer's Association for example.

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The Disability Insurance (DI) Trust Fund pays disability benefits. (The two trust funds are often considered on a combined basis designated OASDI).

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The Eden Alternative is an international not-for-profit organization dedicated to transforming care environments into habitats for human beings that promote quality of life for all involved. The Eden Alternative's principle-based philosophy empowers care partners to transform institutional approaches to care into the creation of a community where life is worth living.

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The Nursing Home Reform Act established the following rights for nursing home residents:

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The Supplemental Medical Insurance (SMI) Trust Fund comprises two separate accounts: Part B, which pays for physician and outpatient services, and Part D, which covers the prescription drug benefit.

Aging Network

The constellation of government and private health and social services providers who serve older person, specifically over the age of 60.

3.

The crystallized intelligence parallel: wisdom develops over time

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The maintenance of good cognition and maintenance of ADLs which are necessary for high levels of social interaction and productive behavior. This theory explores how individuals optimize psychosocial continuity despite physical loss.

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The majority of older couples continue to enjoy sexual relations

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The organization of work has changed

Apoptosis

The organized, genetically process of pre-programmed cell death that occurs in multicellular organisms. Is part of the maturation of the species. In contrast to necrosis, which is a form of traumatic cell death that results from acute cellular injury. For example, in vitro we have webbed fingers but those cells die before we are born.

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The poverty rate among older people is lower than among persons under 65

2.

The program's design

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Theory that analyzes a person's life as they move through, taking on socially defined roles and responsibilities with expectations for successive life stages. If an individual does not follow the normal life course, the deviation is still defined in terms of the expected life course.

Cellular Theory: (non-stochastic)

Theory that argues that aging ultimately results from the progressive weakening of capacity for cell division, perhaps through exhaustion of the genetic material. The Hayflick Limit (Leonard Hayflick) is the finite number of cell divisions that normal human cells in tissue culture go through (50 +\- 10).

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Theory that as the individual ages they experience stress through the problems and hardships that threaten their well being and they use personal resources to adapt to those stresses.

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Theory that claims as we age elastin and collagen tissues change from molecules that are loosely associated with each other (making the tissues flexible) to molecules that become more closely associated with each other or cross-linking (making the tissues less flexible and more rigid). Also affects the accessibility of white blood cells to fight infections.

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Theory that suggests individuals will limit efforts to areas of top priority, working to optimize performance in those areas and use external aids to compensate for losses.

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Theory that telomeres (a series of repetitive DNA sequences and specialized proteins that cap the ends of chromosomes) become shorter with each cell division. When the telomeres become too short to divide, the cells reach a critical level where the it can no longer function and it dies. Cancers, negative lifestyle choices, and cell mutations can speed up telomere shortening.

Autoimmune Theory: (non-stochastic)

Theory that the system may eventually become defective and no longer distinguish the body's own tissues from foreign tissues. The body may then begin to attack itself, as suggested by the increase in autoimmune diseases such as rheumatoid arthritis.

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Theory that there is a social exchange that is governed by the relationship between individual's costs and rewards (the greater the costs, the greater the rewards).

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This psychological adaptation theory states that older adults focus on the positive and select those activities that bring rewards and do not expend energy on the negative. They optimize existing abilities and compensate for losses finding other ways to accomplish a task.

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This results in a more sudden buildup of fluid. Less common.

Assimilative and Accommodative Coping Theory: Brandstadter & Renner (1990)

This theory addresses coping strategies for maintaining a sense of continuity and efficiency in the face of resource loss. In this case assimilation refers to the tenacious goal pursuit and accommodation refers to the flexible goal adjustment. People usually try assimilation first and if they are unsuccessful then they accommodate by adjusting their goals.

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Three major components (1) The State Long-term care Ombudsman Program (2) Programs for the Prevention of Elder Abuse (3) State Legal Assistance Development

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Title VII: Vulnerable Elder Rights Protection Activities

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To "ensure that individuals receiving services through HCBS program have full access to the benefits of community living"

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Type A: "you cannot do what you know is right". The morally right course of action leading to the desired outcome is blocked by policies and practices. The moral distress comes precisely because of the repercussions the professionals believe they may have to endure.

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Under recognized and under diagnosed

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Vitreous humor - becomes less gel-like and more liquid, less transparent causing light rays to scatter

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Voice grievances without discrimination or reprisal

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WHO: the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age allowing people to realize their potential for physical, social and mental well-being throughout the life course.

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When to retire

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Whether to move into a retirement community

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a superannuation pension paid to a retired person.

Biological age

biological age refers to changes in the body that commonly occur as people age

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the process of superannuating an employee.

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to receive OAA funding states must designate a State Unit on Aging (SUA) and Area Agencies on Aging (AAAs) to provide services in each state

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Social Security expenditures exceeded the program's non-interest income in 2010 for the first time since 1983

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Sociocultural - interpersonal, societal and cultural factors

ADEA:

(Age Discrimination in Employment Act 1967), the primary federal statute that protects employees and applicants from being treated less favorably because of their age (40 years or older).

Adult Attachment Theory:

(Bowlby 1907-1990): Stresses the primacy of unconscious motivations and early childhood experiences in determining adult personality

CNA

(Certified Nursing Assistant), Provides personal care to residents or patients, such as bathing, dressing, transporting, and other essential activities. CNAs are trained, tested, and certified and work under the supervision of a registered nurse (RN) or licensed practical nurse (LPN).

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(ex. Red =1, Yellow = 2, Blue = 3, white = 4)

Accumulative Waste Theory:

(stochastic) - organisms age due to an evolutionary trade-off between growth, reproduction, and DNA repair maintenance

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***Nursing Facility/Institutions: 5%

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10 types in all: paranoid, schizoid, schizotypal, antisocial, borderline, avoidant, dependent, obsessive compulsive, narcissistic, histrionic

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4- full restorative services for those who require institutional care, and a comprehensive array of community-based, long-term care services adequate to appropriately sustain older people in their communities and in their homes, including support to family members and other persons providing voluntary care to older individuals in need of long-term care services

-

5% of people over 65 are in long-stay institutions

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5- opportunity for employment with no discriminatory personnel practices because of age

○

545 million worldwide population of 65 and older

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60% report no disability

○

9- immediate benefits from proven research knowledge which can sustain and improve health and happiness

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91% do not have a severe disability

Aging in Place

: The process of remaining in an existing residence as one ages. Significant because communities need to prepare for adaptations to allow for aging in place.

Capitalist System

:devalues labor: seeks cheaper and cheaper labor (NAFTA opposition); created new global markets; new products (some are improvements, but we end up controlled as consumers (new drugs to control diabetes without exercise and diet)

Richmond Age Wave

A collaboration of public and private organizations, businesses, and individuals including older adults working to prepare for the opportunities and challenges of our region's growing aging population. Together, we are working hard to implement, monitor, and evaluate the Greater Richmond Regional Plan for Age Wave Readiness—a shared blueprint that prioritizes targeted actions to improve our well-being in the counties of Charles City, Chesterfield, Goochland, Hanover, Henrico, New Kent and Powhatan, and the City of Richmond.

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A multidimensional concept that includes domains related to physical, mental, emotional and social functioning

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A progression of adaptation to loss as it occurs; threshold refers to the point at which an age related change is perceived as important by the individual; identity, coping processes, adaptation outcomes, and age-related control behaviors all play a role. An adaptation theory of psychology of aging. Recognition of aging occurs in a stepwise process. Each new age-related change brings with it the potential for another threshold to be crossed. Age-related changes affect identity, coping processes and control behaviors. The areas of greatest significance to one's identity are observed with great care or vigilance others may be ignored completely.

Alzheimer's disease (AD)

A progressive and irreversible organic disease, typically occurring in the elderly and characterized by degeneration of the brain cells leading to dementia of which Alzheimers is the most common cause. Progresses from forgetfulness to severe memory loss and disorientation, loss of orientation, loss of ability to calculate numbers, and finally to increased severity of all symptoms and significant personality changes.

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A related concept of HRQoL is well begin, which assesses the positive aspects of a person's life, such as positive emotions and life satisfaction

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After 2022, trust fund assets will be redeemed in amounts that exceed interest earnings until trust fund reserves are exhausted in 2036, one year earlier than was projected last year.

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After 2036 and beyond, tax income would be sufficient to pay only about ¾ of scheduled benefits through 2085.

Normative

Aging in a continuing, normal process

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Also known as the "Nursing Home Reform Act

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Closed Angle

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Cluster A: Odd/eccentric (suspicious)

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Cluster B: Dramatic/emotional

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Complex medical decisions

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DSM-5 diagnostic criteria

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Design and Scope

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Economic recession of 2008

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Ensure that services follow an individualized and person-centered plan of care

4.

Environmental mastery

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Epidemiology: environmental risk factors - exposure to MPTP, herbicides, mangense, iron, and drinking well water (Hubble et al)

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Example: a 38 year old would be twice as likely to die ad a 30 year old.

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Family Caregiver Services

Congregate Meal

Free or low-cost, nutritionally sound meals served five days a week in easily accessible locations. Meal programs also provide daily activities and socialization for participants.

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Frontal-subcortical patterns of dysfunction

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Future: increasingly moving away from institutionalized settings toward home and community setting

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Gain cumulative understanding and avoid reinventing the wheel in research

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General public anxiety and then obtain more authority of extreme action

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Grief and bereavement

○

Hispanic Origin = 7.0%

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Home Delivered Meal Programs

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Integrate knowledge from a range of disciplines

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Landmark legislation that changed the focus on regulation; established new standards, including a Residents' Bill of Rights; revamped the inspection and enforcement process

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Laser - stops leakage - done in the office in 1 session.

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Medical treatment -

○

Mixed results executive function does not appear to improve as a result of these interventions

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Omnibus Budget Reconciliation Act of 1987

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Orgasm - Could be less intense due to fewer muscle contractions

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Orgasm - Pressure of ejaculation decreases

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Policymaking - policies at the state and federal level affect individual and population health (increasing taxes on tobacco sales, seat belts)

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Procedural Justice: The process employed to resolve conflict or divide benefits or burdens. Idea that the person with top priority should be able to remain in place.

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Reimbursement: pay for performance, more money for more difficult cases (ambulatory v dementia with behaviours)

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Related to OCD

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Reset public mindsets about the elderly

○

Resident rights, including care plans, notices and safety;

○

Respiratory Symptoms

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Retirement as a role of consumerism: The third age - we have more choice, more autonomy, can express ourselves more, can seek pleasure, complacency or volunteer; self indulgent or committed caregiver

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Risk factors: being male, especially widowed, prior attempts, substance abuse, depression, physical illness and pain, especially w/poor prognosis, family discord, social isolation/loneliness, institutionalization

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Social Model: Focus on the social and medical services to treat disease and its attendant influences with the patient within a collaborative, inter-professional experience.

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Social Support- different people within your life help to get you through

❖

Social justice (health as a social good)

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Societies inevitably minimize the contributions of older adults in order to avoid the social disruption that would occur because death is more prevalent among older people.

Attrition

Some persons relocate, dropout due to personal health, or die. Happens during research studies but often during longitudinal studies.

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Specifically authorized through NFCP

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Spiritual forces - meaning making, connectedness

•Metabolism

The body using the drug and giving off a byproduct

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The employee can move the account to a new job or take it out lump sum when they move jobs.

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The labor market for older persons

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The quality of pensions

-

Thinning and graying of pubic hair

-

Thinning of vaginal walls

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This is increasingly preferred and used by those needing access Medicaid funding for LTC/LTSS

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When to stop driving

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"We lack a compelling vision for later life" - Freedman

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Retina - blood vessels and capillaries narrow, loss of rods and cones, light dark adaptation decreases

○

12.9% of US population is over 65

○

20-40% prevalence rates of dementia

○

23 million older women to 17 million older men

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Accommodation of medical, physical, psychological and social needs

5.

Act

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Admission, transfer and discharge rights

Chronological Age

Age in years or numbers, the number of calendar years a person is. Based solely on the passage of time.

Biopsychosocialspiritual Framework (BPSS)

Aging is due to multiple forces

○

Aging population will double by 2030.

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Almost 60% - $188,658 - of total lifetime cost of survivors is spent after age 65

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Anterior chamber - as lens thickens, anterior chamber decreases is size

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Attrition: (selective drop out) loss of participants over the course of the study

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Autonomic changes

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Be treated with dignity

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Bulk of expenditures in the aging population

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Can be exacerbated by other mental illness

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Cognitive changes

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Conscientiousness: organized, responsible and hard working

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Create send of "need to do something" (prepare for sacrifice)

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Decision is a choice between two or more alternatives

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Depression (major depressive disorder (DD), persistent DD (aka dysthymia); substance induced DD; unspecified DD

○

Depression in later life depends on prior history of depression, symptom presentation, setting, medical illnesses, medications, ageism

■

Designed to foster health in older adults

Durable Power of Attorney:

Durable Power of Attorney: a legal document that gives someone you choose the power to act in your place. In case you ever become mentally incapacitated

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Emile Durkheim, a French sociologist, is credited with introducing the theory of social integration in the late 19th century. Social integration is the means through which people interact, connect and validate each other within a community. The theory proposes that people experience mental, emotional and physical benefits when they believe they are a contributing, accepted part of a collective. According to Durkheim, improper social integration was linked to the health risks of prolonged isolation, including mental or physical illness and suicide

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Emotional changes

○

Emotional problems including depression, apathy, and anziety

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Empower individuals toward making informed health decisions

-

Excitement - Less lubrication

○

Fastest growing over the age of 85

○

Funds senior employment programs for low-income older adults and is administered by the Department of Labor. Senior Community Service Employment Program (SCSEP)

○

Heart disease, cancer and stroke alone cause more than 50% of all deaths each year

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High prevalence, nearly 100%

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Higher completion rates

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Higher hospitalization rates

❖

In association with Classical Ethical Theory - a physician is duty bound to do whatever is necessary to restore a patient's health; an individual is responsible for paying the physician for services; the poor can be served by charity; ignores the societal good and people's responsibility to the community at large

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Increase disability levels

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Laser surgery can be successful some require long term medications

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Lifestyle factors more to blame than age (poor diet, lack of adequate fluid intake, lack of bulk in diet, excessive straining when defacting, lack of exercise)

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Limitations: 27.3% have problems with IADLs.

○

Nominal: Assignment to qualitatively distinct categories w/o quantitative significance. "naming" or classification (gender, ethnicity, personality type)

-

Partial correlation: to "hold aside" certain a variable so that it's not a factor when assessing the relationship.

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Pathology

●

Performance Improvement Projects (PIPs)

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Periodic assessments for each resident

●

Phased in implementation over 3 years

○

Physical fitness

●

Physically and mentally unhealthy days measure the number of days in the past 30 days that individuals rated their physical or mental health as not good

●

Population: 39.6 million over 65. (13%)

●

Possible ways to improve care:

●

Poverty Rate: 9%

●

Senior Companion

●

Sensory processing

5.

Purpose in life

●

QAPI: Quality Assurance and Program Improvement

●

Qualitative scales

○

African-American = 8.3%

●

After 2014, cash deficits have grown rapidly as the number of beneficiaries continues to grow at a substantially faster rate than the number of covered workers.

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Age in place

■

Ambient Strains- interactions with community/neighbors

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Analyze data

3.

Analyze the Problem Using Ethical Theories and Approaches (principles and theories)

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Anger (It's not fair!)

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Reactivity: unintended effects of the experimental arrangement on responses

●

Reduce behaviours and environmental factors that contribute to premature death and disability

●

Reduced life expectancy

●

Reduced quality of life

●

Refers to the connection between depression, alcohol, and suicide in older adults. According to Osgood, ⅓ of all suicides are alcoholics. Many of the factors which lead to depression also lead to alcoholism and suicide such as loss, loneliness, stress, helplessness, and low self-esteem. Family, caregivers, and health care practitioners need to be aware of the deadly relationship between the three.

●

Regulations to implement the act lise the following services as community and home based services which may be offered under the waiver program: case management, homemaker, home health aide, personal care, adult day health care, habilitation, respite care and other services

○

Asian/Pacific Islander = about 3.4%

●

Assign participants to treatment groups

●

Attention control

●

Bargaining (Just let me finish...)

-

Blood glucose control

○

Breavement: loss of someone close

Cardiovascular Disease

Cardiovascular disease refers to any disease that affects the cardiovascular system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease. The causes of cardiovascular disease are diverse but atherosclerosis and/or hypertension are the most common. Additionally, with aging come a number of physiological and morphological changes that alter cardiovascular function and lead to subsequently increased risk of cardiovascular disease, even in healthy asymptomatic individuals.

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Caregiver burden

Baby Boomers

Cohort born between 1946 and 1964. Baby boomers began turning 65 in 2011 and hence the first of their cohort to collect Social. Security . This cohort is significant because they are the largest number of older adults in history.

ANOVA (analysis of variance)

Comparison among more than two groups.

●

Complaint or targeted surveys when appropriate

■

Congregate Meal Programs

○

Coping skills

○

Coping:

●

Deficiency Report: Form 2567

●

Define the population

●

Define the problem - state hypothesis

●

Depression (Let me be...)

-

Depression is more frequent among adults under 65

●

Diagnostic issues

●

Encourage collaborations across communities and sectors

●

Explain phenomena - how people change, develop, grow and adapt later in life

○

External continuity: living in familiar environments and interacting with familiar people. Continuity does not mean that nothing changes it means that new life experiences occur against a solid backdrop of familiar and relatively persistent attributes and processes for both the self and the environment.

-

Extraversion - excitability, sociability, talkativeness, assertiveness, high amounts of emotional expressiveness

●

Extroversion: outgoing, friendly, lively, active and talkative

-

Financial Security

●

Firearms, substance abuse

○

Focus on longevity, independence, and health

●

Forms of memory

●

Foster Grandparents

●

Gender alters the experience of aging from different lifelong access to key resources in that women experience aging differently than men do. This theory is a spin-off of the Political Economy Theory posed by Estes et al.

-

Hearing - starts in 40's, 40-50% of those 75+. Men earlier than women. High frequencies go first.

●

Impaired control

●

Impairments

●

Improve the health and wellbeing of older adults

Caregever stats

In 1996 22 million US households contained informal caregivers

●

In 2006, 32.6% of noninstitutionalized adults age 65+ had a limitation of activity

●

In 2006, 5.5% of adults ages 18-44 had a limitation of activity

●

Income:

○

Legal vs illidal drugs

-

Lens - Yellowing produces changes to color vision. Cloudy or opaque can lead to cataract

●

Long life illnesses - schizophrenia, bipolar disorder, schizo-affective distorder; borderline personality disorder, panic disorder, OCT, PTSC

Non normative aging

aging-related diseases

●

"To be a tool to assist states with adhering to the Olmstead mandate and the requireents of the ADA" (rule's Preamble)

APS

(Adult Protective Services), investigates reports of abuse, neglect and exploitation of adults aged 60 and older and incapacitated adults 18 years of age and older. APS provides or purchases services when persons are found to be in need of protective services. Strive to insure the safety and well-being of elders and adults with disabilities who are in danger of being mistreated or neglected, are unable to take care of themselves or protect themselves from harm, and have no one to assist them. In most states, APS caseworkers are the first responders to reports of abuse, neglect, and exploitation of vulnerable adults.

ARMD

(Age Related Macular Degeneration) A degenerative disorder of the central area of the retina, the macula. Causes severe central vision impairment. Leading cause of vision loss in developed world. Increased Risk from: aging, genetic predisposition, gender (more in females) race (whites more) smoking, Cardiovascular disease. Long term sunlight exposure.

POA

(Power of Attorney), Advanced directives that enable a patient to specify a surrogate or proxy decision maker who they want to make treatment decisions when they are no longer able to make them. The POA directive can be tailored to be as broad or specific as the patient wishes it to be and can authorize such legal actions as signing checks, making healthcare decisions, selling property, or depositing/withdrawing funds.

ADL:

(activities of daily living), physical functions that an independent person performs each day including bathing, dressing, eating, toileting, walking/wheeling, and transferring into and out of bed. The ability to perform ADL's are used as a checklist to evaluate needs.

Civic Engagement: (as per the Older Americans Act) "An individual or collective action designed to address a public concern or an unmet human, educational, health care, environmental, or public safety need." Potential benefits to older person's: wellbeing, life satisfaction; self esteem; sense of control; physical health; depression; longevity.

(as per the Older Americans Act) "An individual or collective action designed to address a public concern or an unmet human, educational, health care, environmental, or public safety need." Potential benefits to older person's: wellbeing, life satisfaction; self esteem; sense of control; physical health; depression; longevity.

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(failure to thrive), Has long been associated with infants who do not gain weight. In frail older people it is a syndrome defined as a gradual decline in physical and /or mental functioning along with weight loss, decreased appetite, and withdrawal from social interactions in absence of an explanation for these symptoms. Also has been used an an admission criteria for nursing homes and hospitals.

•Excretion

- Getting rid of the byproduct

○

10- freedom, independence, and the free exercise of individual initiative in planning and maintaining their own lives, full participation in the planning and operation of community-based services and programs provided for their benefit, and protection against abuse, neglect, and exploitation

-

13% of U.S. population now age 65 or over

○

3.3% of US population is over 80.

○

6- retirement in health, honor, and dignity- after years of contribution to the economy

○

7- participating and contributing to meaningful activity within the widest range of civic, cultural, educational training, and recreational opportunities

Aging Issues:

: Creation of an age-defined end to employability (retirement) along with separation of home from workplace under capitalism were central forces in devaluing old age. (Retirement can be good, but in a society that values highly paid contribution and productivity, status of retiree is less; when goods produced in the home, individual has control - when goods are produced in a factory, own has control; food industry comodifies eating by pushing prepared meals - gain convenience but lose control of quality and ownership.

Aging

: The life-long process of growing older; not just a later life experience. A series of time-dependent anatomical and physiological changes that reduce physiological reserve and functional capacity. Age can be defined from multiple perspectives and human behavior is ffunctional capacity. Age can be defined from multiple perspectives and human behavior is time-dependent anatomical and physiological changes that reduce physiological reserve andtime-dependent anatomical and physiological changes that reduce physiological reserve and affected by experiences that occur with the passage of time rather than time itself.

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A US federal retirement system that provides benefits to retirees, persons with disabilities, and families that have lost a wage earner. To qualify a person must have worked at least 40 quarters during with Social Security taxes were deducted. Social security is funded through payroll taxes. Excess taxes collected are put in a fund to pay future retirees. SS retirement can be accessed at 62 (partial benefits) and full benefits at 66-67. The average monthly benefit amount is $1177. For 40% of older persons SS makes up 80% of their income.

Arthritis: A chronic disease that causes joint inflammation or degenerative changes in body joints and it's consequences of pain and inflammation. A common complaint of older adults.

A chronic disease that causes joint inflammation or degenerative changes in body joints and it's consequences of pain and inflammation. A common complaint of older adults.

Cataracts: A condition in which affects the ocular lens of the eye causing a cloudy or opaque lens that impairs vision by interfering with light rays passing through the lens. Most common age related disorder affects 70% of those 70 ++. Risk Factors: age, gender (females more), elevated BMI, diabetes, nutrition, smoking, alcohol consumption, hypertension. Symptoms: blurred vision, depth perception, Difficulty seeing when moving from brightly lit to dimly lit settings; alterations in color perception especially yellows, Halo's

A condition in which affects the ocular lens of the eye causing a cloudy or opaque lens that impairs vision by interfering with light rays passing through the lens. Most common age related disorder affects 70% of those 70 ++. Risk Factors: age, gender (females more), elevated BMI, diabetes, nutrition, smoking, alcohol consumption, hypertension. Symptoms: blurred vision, depth perception, Difficulty seeing when moving from brightly lit to dimly lit settings; alterations in color perception especially yellows, Halo's

○ SGS- Southern Gerontological Society

A network of the South's most respected gerontology professionals. Southern Gerontological Society (SGS) members are educators, aging network personnel, researchers, health professionals, and policy makers. SGS provides the bridge between research and practice, translating and applying knowledge in the field of aging.

Caregiver: A person, either paid or voluntary, who helps and provides an older adult with their ADLs, healthcare, finances, companionships, and social interaction. This is usually a female (wife or daughter), family member, or friend. They help to provide ongoing assistance with a wide variety of functions ranging from periodic chores, housework, and transportation to 24-hour monitoring and help with ambulation and eating."

A person, either paid or voluntary, who helps and provides an older adult with their ADLs, healthcare, finances, companionships, and social interaction. This is usually a female (wife or daughter), family member, or friend. They help to provide ongoing assistance with a wide variety of functions ranging from periodic chores, housework, and transportation to 24-hour monitoring and help with ambulation and eating."

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A roadmap to "successful aging" which includes cosmic, individual, and social dimensions. Key areas would be focusing on being less self-centered, less preoccupied with body, reflecting and reminiscing on the purpose of your life, seeing your life as a continuum, spending more time with those you care about, appreciating small wonders, and seeing more issues as gray rather than black and white.

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About 11% of older Medicare enrollees receive personal care from paid or unpaid source (1999)

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Absolute Duties: Are binding under all circumstances, they can never give way to another compelling duty or right.

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Access Services (information and referral services-I&R-, care management, and transportation)

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Activities of Daily Living - bathing, showering, dressing, eating, getting in and out of bed, walking, using the toilet)

Biological Aging: Aging is a complex biological process with changes occurring at the molecular, cellular, and systems/ organ level causing increasing difficulty in the body's ability to respond to internal /and/or external stressors. Biological aging is the process of cells dying faster than they can be replaced.

Aging is a complex biological process with changes occurring at the molecular, cellular, and systems/ organ level causing increasing difficulty in the body's ability to respond to internal /and/or external stressors. Biological aging is the process of cells dying faster than they can be replaced.

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Agreeableness: helpful, warm, caring, softhearted and sympathetic

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An approach that emphasizes how the forces of globalization affect policies and programs for older adults and the daily lives of older people. On the cusp of social sciences and humanities, this theory (Minkler) looks at social behavior as grounded in the structure of society.

Conservator: An individual appointed by a court of law to manage a mentally incapable individual's financial and related concerns. This is a protective arrangement to the benefit of the incapable individual.

An individual appointed by a court of law to manage a mentally incapable individual's financial and related concerns. This is a protective arrangement to the benefit of the incapable individual.

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Any other activity that they cannot do because of limitations caused by physical mental or emotional problems

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AoA is under the supervision of the Assistant Secretary for Aging

Area Agencies on Aging

Area Agencies on Aging-the local level that provide home and community-based services.

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As the individual ages she experiences stress through the problems and hardships that threatens her well-being. Coping involves the persons use of personal resources to adapt to. As people age, they become more selective about peripheral relationships in favor of spending more time with close friends. The idea of time left to live vs time lived and a preference for emotional quality. tresses. (Behavioral, social, and self-efficacy) 3 types of stress - ambient - interactions with community; role strains - in the family; quotidian - logistical problems with ADL's IADL's.

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As we grow older our neural functions and neural structures start to deteriorate so in order to compensate for that our brains develop what are called neural scaffolds to adjust to the changes. neural scaffolds that serve as supportive structures that preserve cognitive function

○ ASA - American Society on Aging

Association of diverse individuals bound by a common goal: to support the commitment and enhance the knowledge and skills of those who seek to improve the quality of life of older adults and their families. The membership of ASA is multidisciplinary and inclusive of professionals who are concerned with the physical, emotional, social, economic and spiritual aspects of aging.

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Authorizes funds for Native American tribes/Native Hawaiian organizations to develop social and nutritional services for the aged

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Avoidance of chronic disease, maintenance of high cognitive and physical health, and an engagement in life. Terms - elderhood; aging well; optimal aging; successful frailty; productive aging.

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Biology and genetics - "older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging - how much from again, how much from a poor lifestyle? Age/ Sex? Family history?

Beneficence: (principle)

Bringing about good, acting to benefit another. Can be seen along a continuum of : do no harm, prevent harm, remove harm when it is being inflicted, and bring about positive good.

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Can affect mouth, esophagus, stomach, small intestine, large intesting

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Change assumptions about the financial impact of ageing on healthcare - growth in older population has less impact than believed

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Change organizational culture (Eden Alternative)

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Changes made to:

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Cluster C: anxious/fearful

Aging of Dermis - Collagen and elastin changes result in wrinkling, especially in sun exposed areas, loss of fat also related to wrinkles, nose and ears don't change but may look different due to loss of subcutaneous fat, body odor is because of decreased sweat gland production

Collagen and elastin changes result in wrinkling, especially in sun exposed areas, loss of fat also related to wrinkles, nose and ears don't change but may look different due to loss of subcutaneous fat, body odor is because of decreased sweat gland production

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Collect data

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Comparability of services: lets states make waiver services available only to certain groups of people who are at risk of institutionalization (states can use this authority to target services to the elderly, technology-dependent children, people with behavioral conditions, or people with intellectual disabilities. States might also target services on the basis of disease or condition (AIDS).

Between-subjects design: Compare different groups in order to address your research question (ex. with vs. without dementia). This minimizes the demands on each participant because there are more participants involved but also increases the chances for selection bias. This may also be likened to "cross-sectional" designs.

Compare different groups in order to address your research question (ex. with vs. without dementia). This minimizes the demands on each participant because there are more participants involved but also increases the chances for selection bias. This may also be likened to "cross-sectional" designs.

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Compensatory Justice: Requires an assumption of deep interdependence of people in society. For example, compensatory justice cannot be discussed apart from also determining who in the population should bear the burden of costs incurred as a result of policies based on compensatory reasoning.

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Conductive Hearing loss - interference with transmission

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Conscientiousness - high levels of thoughtfulness, good impulse control, goal-directed behavior, organized, mindful of details, planful

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Consequences: brain changes, financial deficits, homeless/substance abuse, poor physical health outcomes, lack of social supporters, inability to negotiatiate the health care system

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Consequences: misattribution of symptoms, diagnosis difficulties, medical model of long-term care can create care barriers, bifurcation of mental and physical health, fear of stigma

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Constitutional Duties: Commitments that come into being only after certain conditions are met. For example, the Americans with Disabilities Act outlines certain duties and rights that apply solely to individuals who have disabilities.

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Cornea - becomes thicker and less curved which affects refractive ability

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Create uncertainty

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Delirium: disrupts brain function and usually has multiple causes. Includes major behavior changes not explained by a pre-existing dementia. Inability to shift or maintain attention to external stimuli, disorganized thinking and hallucinations - Change in consciousness or cognitive ability with an acute onset.

CCRC Without Walls: Delivers the benefits of a CCRC to people in their own homes; lower entry fees and monthly fees than traditional CCRC; very new concept, no set package, but services typically include care coordination, home inspections, wellness programs (focus on prevention), activities. The goal is to keep people at home. Pros: the benefits of a CCRC while staying at home; entrance fee and monthly fee lower than traditional CCRC; more accessible to people on middle incomes. Cons: very strict admission criteria - must be healthy and active to qualify; new concept, still kinks to work out; there are not many available.

Delivers the benefits of a CCRC to people in their own homes; lower entry fees and monthly fees than traditional CCRC; very new concept, no set package, but services typically include care coordination, home inspections, wellness programs (focus on prevention), activities. The goal is to keep people at home. Pros: the benefits of a CCRC while staying at home; entrance fee and monthly fee lower than traditional CCRC; more accessible to people on middle incomes. Cons: very strict admission criteria - must be healthy and active to qualify; new concept, still kinks to work out; there are not many available.

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Dementia: The loss of cognitive or intellectual function, including memory loss,and loss of physical coordination that interfere with daily activities. The symptoms can be brought on by degenerative diseases including Alzheimer's. Onset is gradual and is irreversible and progressive deterioration of functioning

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Demonstrate that providing waiver services won't cost more than providing these services in an institution

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Determine how to help

Beers List/Criteria

Developed by an expert panel in 1991, the list initially provided guidance on what drugs should be avoided for older adults living in a nursing home. In the next decade however, the list was expanded to cover older adults in all settings. Not only does it guide doctors, pharmacists, and practitioners on what drugs and drug categories to avoid, but it rates severity of the drug and its potential harm on older adults. It should not be used solely by itself, but rather in conjunction with a patient and family history, evaluation, and expert opinions regarding each individual.

Life-cycle:

Differences in how the same event or combination of BPSS forces affect people at different points in life

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Different paths: community vs. "institutional" care

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Differentiation from other mental disorders

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Difficulty is due to perceived need to keep items

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Digestion slows, is less efficient as we age

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Disease Prevention and Health Promotion Services

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Disorders: Chronic obstructive pulmonary disease (COPD), Chronic bronchitis, Emphysema, Pulmonary tuberculosis, Pneumonia, Lung cancer

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Disorganized thinking/speech

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Disparities - race and ethnicity; gender; secual identitiy and orientation; disability status or special health care needs; geographic location (rural or urban)

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Distinguishing personality traits from disorders

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Draw conclusions

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Early onset (typically 20's) - cumulative biopsychosicial deficits; more males; potential for symptom stabilization in aging; neurological side effects of long term drug use

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Educational programming to support family caregivers, respite services, and adult day services

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Elderly white men at highest risk: 51 of every 100,000 (vs. 12.6 for all ages; 21 for men only)

○ AGHE- Association for Gerontology in Higher Education.

Established in 1974, is a membership organization of colleges and universities that offer education, training, and research programs in the field of aging. The purpose of AGHE is to foster the commitment of higher education to the field of aging through education, research, and public service.

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Examples of crises: tax rate too high; tax cuts to wealthy would benefit all; states should have most power; deficit too high and social programs should be cute; market is king; individual should be responsible for health

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Expected years of life free of selected chronic disease

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Expected years of life in good or better health

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Explain eight stages through which a healthily developing human should pass from infancy to late adulthood. In each stage, the person confronts, and hopefully masters, new challenges.

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Factors that affect the amount needed include: lower estimates for death rates at advanced ages; a slower economic recovery; living longer than previous generations; having produced fewer children than did their own parents; immigration, legal and otherwise.

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Fewer sperm produced and decreased motility

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For Medicare, the Hospital Insurance (HI) Trust Fund pays for inpatient hospital and related care;

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For Social Security, the Old-Age and Survivors Insurance (OASI) Trust Fund pays for retirement and survivors benefits;

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Freedom from abuse and neglect

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Freedom from abuse, neglect and exploitation

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Freedom from physical restraints

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Good Physical and Mental Health

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Hallucinations

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Happiness among old people is about as common as among younger people

Arteriosclerosis

Hardening of the arteries. Most common disease of the arteries. Lessened elasticity and thickening of walls causes high blood pressure. Pathology of the blood vessels.

Ageism.

Having a negative bias towards people due to their age. Within gerontology, this is discrimination against older people simply because of their age. Example of negative ageism words are: dependent, elderly, frail, geezer, greedy, helpless/victims, ineffectual, incapable, neglected, lonely, isolated, old, poor, senile, and weak. Ageism was coined in 1969 by Robert Butler. A form of prejudice in which people are categorized and judged solely on the basis of their chronological age, considers people as part of a category and not as individuals (gerontophobia). Personal ageism vs institutional ageism.

Activity Theory

Havinghurst & Roscow in the early 1960's in part, as a response to Disengagement theory. Successful aging includes remaining engaged and active in social roles and interactions.

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Health services - barriers to accessing health services such as lack of availability; high cost; lack of insurance coverage; limited language access; barriers lead to unmet health needs, delays in receiving appropriate care; inability to get preventive services; hospitalizations that could have been prevented

Code of Ethics: Highlights that you are in a special type of group that is given societal privileges, but with these privileges come the responsibility to conduct yourself in ways that are acceptable not only to members of your own group but also to the larger society. An example would be the Hippocratic Oath taken by health professionals.

Highlights that you are in a special type of group that is given societal privileges, but with these privileges come the responsibility to conduct yourself in ways that are acceptable not only to members of your own group but also to the larger society. An example would be the Hippocratic Oath taken by health professionals.

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History: important events that occur could affect IV

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Hoarding causes life impairments

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Holistic Model: Focus on health rather than disease including emphasis on prevention and collaboration between self and professionals

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Home and Community Based Services (HCBS) Waivers

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Home-and Community-Based Services (chore services, personal care services, adult day services)

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However, there are still instances of poor quality

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Identify the Type of Ethical Problem (such as moral distress, ethical dilemma, locus of authority)

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If the facility has more than 120 beds, the services of a full-time social worker

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In 1900 life expectancy was 47.3 years in 2000 it was 76.9 years. For those that reach 65 today they have an average life expectancy of an additional 18.8 years - 20 for females; 17.5 for males (82.9)

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In 2008, 107 million Americans (1 out of every 2 adults 18 years+) had at least 1 of 6 reported chronic illnesses (cardiovascular disease, arthritis, diabetes, asthma, cancer, COPD)

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In 2008, individuals in the US reported on average 3.6 physically unhealthy days and 3.4 mentally unhealthy days in the past 30 days

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In association with Libertarianism - equity is achieved when resources are distributed according to merits; health care distributed according to minimal standards and financed through willingness to pay; health care is not a central priority (Shi & Sing, 2015)

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In closed-angle glaucoma, the colored part of the eye (iris) and the lens block the movement of fluid between the chambers of the eye. The blockage of fluid causes pressure to build up and makes the iris press on the eye's drainage system (trabecular meshwork). The increased pressure can cause damage to the optic nerve, leading to vision loss and possible blindness. Closed-angle glaucoma is also sometimes referred to as primary angle-closure glaucoma (PACG).

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Income and resource rules applicable in the community - Lets states provide Medicaid to people who would otherwise be eligible on in an institutional setting, often due to the income and resources of a spouse or parent. States can also use spousal impoverishment rules to determine financial eligibility for waiver services.

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Increase in the size of the prostate gland

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Increased medical comortalities due to lifestyle/health behaviors or antipsychotics

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Increased risk of chronic conditions

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Increased suicide risk

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Individual behaviour such as diet, physical activity, alcohol, cigarette and other drug use; hand washing

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Informal Caregiver: Provide extraordinary, uncompensated care predominantly in the home setting involving significant amounts of time and energy over months and years. Informal caregivers may experience physical, emotional, and social and financial stress due to their caregiving role.

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Inspections of Medicare-certified facilities by a multidisciplinary team of surveyors

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Instrumental activities of daily living - using the phone, light housework, heavy housework, preparing meals, shopping for personal items, managing money

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Internal continuity: the persistence of a personal structure of ideas based on memory.

Psychological forces:

Internal perceptual, cognitive, emotional and personality

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Interval Scale: Placement along a quantitative dimension w/ equal intervals. Where the points on the scale are not only ordered but also equidistant . (however, not true zero). (ex. 40*F vs. 30*F)

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Iris - eye color may fade due to de-pigmentation

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Is the finite number of cell divisions that normal human cells in tissue culture go through (50 +\- 10).

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Late onset (over 40) - approximately 20% of cases; more women, more paranoia, negative symptoms less pronounced; fewer cognitive deficits; risk: sensory deficits

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Later onset illness: depression, dementia/cognitive impairment, anxiety, alcohol and substance abuse, sexual and sleep disorder, adjustment disorders, complicated grief

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Less than ¼ of old people are socially isolated

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Life Expectancy at 65: 17.2 for males (82.2) 19.9 for females (84.9)

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Life Satisfaction - rewarding, few regrets, positive attitude about past and future

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Life satisfaction is probably the most often indicator of effective adaptation to aging. If older people are satisfied with their present and past lives then they are seen as having adapted to aging. There are five components to life satisfaction: zest, resolution & fortitude, completion, self-esteem, and outlook.

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Lifespan Theory-what motivates human behavior? As one need is met, the individual strives to meet the need at the next level. From physiological survival to self-actualization

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Major sources of income for older adults is Social Security (87%) income from assets(53%) private pensions (28%), government pensions (14%) and earnings (26%)

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Make geriatric care a bigger part of medical training

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Make inferences

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Make treatments more appropriate to older populations

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Market justice (health as an economic good) CURRENTLY WINNING

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Mean age of onset is 58-62, age -specific prevalence increases until 9th decade

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Measure the impact of prevention activities

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Measures for HRQoL - would you say that in general your health is excellent, very good, good fair or poor? How many days during the past 30 days was your physical health not good? Mental health (stress, depression, emotional issues - how many days in the past 30 were not good? In past 30 days, how many were you in poor physical or mental health that kept you from doing your usual activities?

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Median Income: $25,877 for males $15,282 for females

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Medicaid and Medicare rationalized medical care through cost-based payments

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Medical Model: Focus on the treatment of disease and injury with physicians in charge of care.

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Medical or Health Care Power of Attorney (POA): The medical POA is a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you're unable to do so. However, it is different from a power of attorney authorizing someone to make financial transactions for you.

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Medical practitioners tend to give older patients lower priority than younger patients

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Mentally unhealthy days decreased with age in the older groups. In 2008, adults ages 18 to 24 reported an average of 4.0 mentally unhealthy days in the past 30 days, while adults age 75 and older reported 2.0 days.

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Morals are beliefs based on practices or teachings regarding how people conduct themselves in personal relationships and in society, while ethics refers to a set or system of principles, or how the tool we use to evaluate our morals

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More older women are working, creating more dual earner households; and more joint planning of retirement needed

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More than ¾ of people over 65 are able to do their normal activities

Atherosclerosis: Most prevalent type of arteriosclerosis. Fatty lesions and scar tissue and blood clot formation cause hypertension. White patches that are plaques that are building up in the arteries.

Most prevalent type of arteriosclerosis. Fatty lesions and scar tissue and blood clot formation cause hypertension. White patches that are plaques that are building up in the arteries.

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Most workers over 65 work as effectively as younger workers

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Motor signs first appear when about 50-60-70% of substantia nigra (SN) dopamine neurons are lost

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Neuropsychiatric symptoms include depression, cognitive deficits and dementia (Chaudhuri et al, 2006)

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Neuroticism - emotional instability, anxiety, moodiness, irritability, sadness

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Non-declarative - do not require conscious access, repetition, procedural learning, classical conditioning, habituation - only mild decline over the lifespan

Assisted Living: Non-medical residential settings that provide or coordinate personal and health care services, 24-hour supervision, and assistance for the care of four or more adults who are aged, infirm, or disabled. These facilities offer congregate dining and activity programs. Regulated by states; no single model. Private pay (also long-term care insurance); 24/7 services (scheduled and unscheduled). Pros: consumer directed, social model; homelike environment; safety and peace of mind; reduces risk of social isolation. Cons: expensive, tieres of increasing cost; acuity is high (7 in 10 have dementia); staff training and pay are low, hence quality can suffer; for-profit may be linked to poorer quality).

Non-medical residential settings that provide or coordinate personal and health care services, 24-hour supervision, and assistance for the care of four or more adults who are aged, infirm, or disabled. These facilities offer congregate dining and activity programs. Regulated by states; no single model. Private pay (also long-term care insurance); 24/7 services (scheduled and unscheduled). Pros: consumer directed, social model; homelike environment; safety and peace of mind; reduces risk of social isolation. Cons: expensive, tieres of increasing cost; acuity is high (7 in 10 have dementia); staff training and pay are low, hence quality can suffer; for-profit may be linked to poorer quality).

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Non-motor symptoms of PD

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Non-motor vs. motor symptoms (fluctuate together, NMS rates as more disabling (Chaudhuri et al, 2005), impact QOL and increase risk of institutionalization at advanced stage of the disease Barone et al, 2009

Adult Day Care Center

Non-residential facilities that provide a variety of health, social, and related support services in a protective setting during part of the day to four or more aged,

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Normal aging does not equal depression: media depict as sad and lonely, less prevalent among older cohorts, myths created barriers to treatment seeking, diagnosis, effective treatments

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Not due to another medical condition

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Openness to experience - imagination and insight, broad range of interests

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Openness: creative, imaginative, intelligent and adventurous

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Ordinal: Ordering in terms of magnitude along a quantitative dimension. "ordering" (ex. 1= passive, 2= moderately aggressive, 3= aggressive, 4= very aggressive). Yet, one does not know the size of the difference.

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Participate in the review of one's care plan, and to be fully informed in advance about any changes in care, treatment, or change of status in facility; and

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Persistent difficulty parting with possessions

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Personal Control Over One's Life - Independence, dignity, and self-worth

Construct Validity

Pertains to the accuracy of the theoretical interpretations of the conclusions of the findings, have we arrived at the correct explanation for any cause-&-effect relations? Not only is Internal validity obtained, but now it is whether we know why the results have occurred.

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Physically unhealthy days increased with age. In 2008, adults ages 18 to 24 reported an average of 2.1 physically unhealthy days, while adults age 75 and older reported 6.0 days

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Positive relations with others

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Preferences are malleable

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Primary aging - normal, disease-free development during adulthood

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Primary funding mechanism for grants that have supported research about the development of the aging network and the needs of older adults as well as funding to try new approaches to service delivery and training

Cognitive Psychology: Processing capacity, memory, knowledge. Motivation and emotion affect cognitive performance (Reha, Hasher, Colcombe 2001)

Processing capacity, memory, knowledge. Motivation and emotion affect cognitive performance (Reha, Hasher, Colcombe 2001)

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Programmatic Grants: in general, a project grant is given to support a specific, connected set of activities, with a beginning and an end, explicit objectives and a predetermined cost. When a funder gives a grant for a specific project, it is generally a restricted grant and must be used for that project.

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Psychosocial - internal perceptual, cognitive, emotional and personality factors

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Pupil - Diameter decreases and amount of light reaching visual receptors is decreased

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Qualitative scales: includes nominal (naming or classification, gender, ethnicity) and ordinal (ranking or rating such as shirt size, where exact quantity is not known) scales of measurement.

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Ratio scales: Placement along a dimension w/ equal intervals and a true zero point (ex. weight)

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Recent identification of risk genes (SNC, LRRK2) which contribute to overall changes of developing PD

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Recently- HR 3590 Elder Justice Act - increases funding for research, ombudsman programs, and APS

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Reciprocity and Beneficency are the concepts people use to maximize their rewards and minimize their costs.

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Requirements: a high-quality education, nutritious food, decent and safe housing, affordable, reliable public transportation; culturally sensitive health care providers; health insurance, clean water and unpolluted air

Belmont Report: 3 fundamental ethical principles used for any human subject research

Respect for persons: Protecting autonomy treating with respect and common courtesy. Beneficence: Philosophy of "do no harm" and maximize benefits. Justice: Fair distribution of costs and benefits (selection consent, informed consent and assessment of risks and benefits)

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Role Strains- institutionalized role, especially with/within family (changing role within the family)

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Selection bias: nonequivalent participants selected

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Self Stereotyping - unconscious assimilation to behaviors consistent with the stereotype of one's group

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Self-Efficacy Belief- belief that you have some power to affect the situation

Commodification of Old Age: "Taking a good or service that has been produced and used, but not bought and sold, and turning it into an item exchanged for money". Good or service becomes part of a monetary exchange; emphasize a for-profit or for-profit clones (non-profit sector looks more and more like for-profit); IADL and ADL care - medical care gatekeepers decide if we need help with these.

Shift on the mode of production of medical goods and services from an orientation of fulfilling human needs to a mode of medical production oriented towards monetary exchange for the created of provide profit and increasingly enormous private wealth. Commodification diminishes the consideration of social needs and the right of the elderly to health and health care. Medical providers serve as gatekeepers.

○ GSA - Gerontological Society of America

Since 1945, advancing Gerontology profession and the study of aging, the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society is to advance the study of aging and disseminate information among scientists, decision makers, and the general public

Biomedicalization of Aging: So as we have controlled the public health and environmental factors that lead to acute care diseases: life expectancy has increased; more people are living into old age; there are more years to have chronic disease occur. As a result, the medical establishment began to exert more and more control over the response to chronic disease.

So as we have controlled the public health and environmental factors that lead to acute care diseases: life expectancy has increased; more people are living into old age; there are more years to have chronic disease occur. As a result, the medical establishment began to exert more and more control over the response to chronic disease. Biomedical model assumes: "Medicine has become one of the most important and powerful forces in the 20th century". Biomedical model leads to: The social construct of aging as a medical problem, disease and the practice of aging as a medical problem; "insitutionalized thought structure" (Berger and Luckman) - we all send up thinking the same way.

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Social factors - availability of resources to meet daily needs, such as educational and job opportunities, living wages or healthful foods; social norms and attitudes, such as discrimination; exposure to crime, violence and social disorder, such as the presence of trash; social support and social interactions; exposure to mass media and emerging technologies, such as the internet or cell phones; socioeconomic conditions, such as concentrated poverty; quality schools; transportation options; public safety; residential segregation

Sun exposure - called photoaging - depends on persons skin color and history of intense sun exposure because of repeated UV exposure breaks down collagen and impairs the synthesis of new collagen. The sun also attacks the elastin. Facial expressions are also repetitive movements lead to fine lines and wrinkles and the grooves become permanently etched. Gravity is a culprit and causes the nose to droop, ears to elongate, eyelids to fall, upper lip to disappear while lower lip is more pronounced.

Sun exposure - called photoaging - depends on persons skin color and history of intense sun exposure because of repeated UV exposure breaks down collagen and impairs the synthesis of new collagen. The sun also attacks the elastin. Facial expressions are also repetitive movements lead to fine lines and wrinkles and the grooves become permanently etched. Gravity is a culprit and causes the nose to droop, ears to elongate, eyelids to fall, upper lip to disappear while lower lip is more pronounced.

Auxiliary Grant

Supplement to income for recipients of Supplemental Security Income (SSI) and certain other aged, blind, or disabled individuals residing in assisted living facilities or adult foster care to help them afford the cost of their care.

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Symptoms include depressed mood/irritable; decreased interest or pleasure; significant change in weight/appetite, sleep changes, fatigue/low energy, guilt/worthlessness, diminished concentration, suicidality

Autonomy: (principle)

The capacity to have the say-so about your own well-being, it is the capacity to act on your own decisions freely and independently. Have professional, patient, and self autonomy. This principle is emphasized in patient/person-centered care.

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The employer and the employee both make contributions to the account which is managed by a professional financial investment firm. Some employers will make a standard contribution but others will only contribute if the employee does as well. The value of this fund is determined by the amount of retirement funds available when the employee retires, and can fluxuate with the market with is a threat to the DC plan.

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The employer commits to providing a specific benefit to the workers at retirement, it can be a lump sum or a benefit amount given over a period of time with benefits based on age, years of service, and salary. They make up about 20% of the income of older persons and are received mostly by persons in the upper two income quintiles of the population.

2.

The fluid intelligence parallel: wisdom peaks early then declines

4.

The fluid/crystallized intelligence parallel: wisdom increases to a point then decreases

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The immune system theory of aging is that the rate of aging is largely controlled by the immune system. As we age, the numbers of critical cells in the immune system decrease and become less functional. The body has a series of responses to protect against foreign materials, viruses, and bacteria (bone marrow, spleen, lymph nodes, thymus gland). With age, the immune system decreases in functioning (immunosenescence) and may also no longer recognize itself and attack its own tissues (autoimmune response).

Durable Power of Attorney:

The medical POA is a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you're unable to do so. However, it is different from a power of attorney authorizing someone to make financial transactions for you.

•Distribution

The movement of a drug once it is in the bloodstream

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The nature of work has changed - less physical but more stressful

1.

The need for a program

AAA: (Area Agencies on Aging),

The public or private nonprofit agency created pursuant to the federal Older Americans Act of 1965, system of services for older persons administered by the State Units on Aging serving the local areas. In many cases, AAAs subcontract with other organizations to facilitate the provision of a full range of services for older people.

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The threat to DB pensions is underfunded pensions in which the company goes bankrupt and can no longer afford to pay their retirees or current employees pensions. The Pension Benefit Guaranty Corporation (PBGC) helps to maintain pension commitments by bankrupt corporations.

Continuity Theory: Atchley (1989)

Theory that adaptation to aging comes from personal framework and internal and external resources developed over time, as a person ages they adapt by preserving a continuity with their past experiences. Basic personality, attitudes, and behaviors remain constant throughout the lifespan.

Aging Clock Theory: (non-stochastic)

Theory that claims that aging is programmed into our bodies like a clock ticking away from conception. Our cells are pre programmed from conception to divide a certain number of times before deteriorating. Example: fetal fibroblastic cells were able to divide 50 times before deteriorating, proves programmed aging at a cellular level.

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Theory that older adults are more likely to lose roles rather than acquire new ones and that these losses are largely irreversible. These losses may lead to the erosion of social identity and a decline in self-esteem.

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Theory that older adults withdraw their commitments to society and social roles as they age, they disengage from their roles and activities as they get older. This was the first social theory on aging but was not supported by empirical studies.

Age Stratification Theory: Riley at al. (1971)

Theory that society and its institutions are organized into strata based on age and social class. They are further centered on norms, roles, and privileges for each age and experience of a cohort. A sub-theory looks at structural lag, how societal institutions do not keep up with changing cohorts of older persons.

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Theory that states as the economy became more industrial, the status (power, influence, wisdom) of older adults declined and that older adults had a lack of applicable knowledge to the new environment (technology).

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Theory that states that over time cummulative mistakes in the RNA and DNA will result in random errors of the "copying " functions of the genetic coding. These inacurate genetic copies will result in transmitting faulty cell functions throughout the body. Therefore aging and death are presumed to be a result of errors at occur and are transmitted at the cellular level. This theory has stimulated a lot of research but has not resulted in a lot of concrete evidence.

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This theory is based on the assumption that continued use leads to worn out or defective parts of the body and sees aging as the result of chance. This wearing out is further affected by the accumulation of by products in cell/tissues that are detrimental to normal functioning. This theory dates back to Aristotle and can be related to the damage of joints and bones from much use over time.

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This theory states that organisms age because cells accumulate free radical damage over time. Free-radical disruption of cell metabolism is part of what ages our cells; it may also create mutant cells leading ultimately to cancer and death. A free radical is any atom or molecule that has a single unpaired electron in an outer shell. The free radical seeks to gain a matching electron from any possible molecule and creates cell death to achieve this goal.

Living Will

This written, legal document that lets people state their wishes for end-of-life medical care, in case they become unable to communicate their decisions. It has no power after death.

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Through 2022, annual cash deficits will be made up by redeeming trust fund assets from the General Fund of the Treasury. Redemptions will be less than interest earnings, so the trust fund balances will continue to grow.

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Title I: Objectives of the Older Americans Act

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Title II: -sets out the language to establish the AoA

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Title III: Grants for State and Community Programs on Aging

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Title IV: Research, Development, and Training

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Title V: Community Service Senior Employment Programs

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Title VI: Grants for Native Americans

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To "further expand the opportunities for meaningful community integration in support of the goals of the Americans with Disabilities Act and the Supreme Court's decision in Olmstead v. L.C."

Compression of Morbidity: Fries, James (1980)

To squeeze or compress the time horizon between the onset of chronic illness or disability and the time in which a person dies (FRIES)

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Treatment: medications, psychotherapies, combined treatments, brain stimulation therapies (electroconvulsive therapy (ECT), repetitive transcranial magentic stimulation (rTMS), lifestyle behaviors (exercise, socialize), clinical trials

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Triggered by health crises

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Type B: "you know something is wrong but are not sure what". You may question how to arrive at a morally correct course of action or how to work toward a specific outcome that is consistent with your professional goal of achieving a caring response. The ethical challenge is to remove the barrier of doubt or uncertainty as much as possible.

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Unannounced surveys at least every 15 months

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Up to 10 million individual worldwide (vs 350 million individuals in the world with diabetes)

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Use technology to deliver key skills remotely and enable home-based care

Board and Care

Usually small residences that provide meals, light housekeeping, and social care but have only state regulations.

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Utilitarianism: As a moral agent you must consider what several different courses of action could accomplish. An act is right if it helps to bring about the best balance of benefits over burdens, what the best "utility" or consequence is overall. Emerged in response to some of the criticisms of deontology.

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Vestibular - The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. With aging, we may experience increased difficulty walking or standing, increased body sway, dizziness or vertigo or difficulty with equilibrium or balance.

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Visuospatial deficits

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Vitrecotomy - removes blood from the center of the eye - the vitreous and scar tissue tugging on the retina

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What is the medical Industrial Complex: Hospitals, drug companies, insurers and suppliers. Policy supports health spending through tax deductions for medical insurance, for medical expenses; by publicly funded training of doctors and other health care workers; tax exemptions to nonprofit health care entities; the National Institute of Health's research helps drug company/medical company pipeline by doing the early work on innovation

Blinding: Withholding potentially biasing information to ensure the researcher doesn't know which person(s) is/are the object of observation in a setting.

Withholding potentially biasing information to ensure the researcher doesn't know which person(s) is/are the object of observation in a setting.

Consumer Price Index (CPI)

a measure of the overall cost of the goods and services bought by a typical consumer

Alcohol-Induced Dementia: (Korsakoff's syndrome) caused by many years of heavy drinking and malnutrition. <5% of all dementias. Severe memory loss, loss of motor control, inventing false memories, reduced speech and coordination. Can be partially reversed with the abstinence from alcohol and high doses of thiamine.

caused by many years of heavy drinking and malnutrition. <5% of all dementias. Severe memory loss, loss of motor control, inventing false memories, reduced speech and coordination. Can be partially reversed with the abstinence from alcohol and high doses of thiamine.

Could be voluntary or strategic or an involuntary from job displacement, need for

income

Advance Directives

legal documents that convey your decisions about end-of-life care ahead of time, should you become unable to due to incompetence or illness. Some types include a living will and a durable power of attorney.

Congestive Heart Failure: occurs when heart is not able to pump adequate blood and oxygen to the body tissues - shortness of breath, wheezing, 2/3 people with CHF are over 65.

occurs when heart is not able to pump adequate blood and oxygen to the body tissues - shortness of breath, wheezing, 2/3 people with CHF are over 65.

■Structural Lag Theory: Riley, Kahn, & Foner (1994)

social structures/institutions do not keep up with the changing cohorts of older adults and lag behind the realities of a healthy and capable older population.

Comprehensive Geriatric Assessment: SOAP - subjective, objective, assessment, plan. Includes information on diagnosis, medications, nutrition, continence, defecation, cognitions, emotion, mobility, cooperation with care plan. Interdisciplinary approach.

subjective, objective, assessment, plan. Includes information on diagnosis, medications, nutrition, continence, defecation, cognitions, emotion, mobility, cooperation with care plan. Interdisciplinary approach.

ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly)

the ACTIVE study proves that healthy older adults can make significant cognitive improvements with appropriate cognitive training and practice.

Administration on Aging-

the Federal agency responsible for coordinating care to older persons.

Comparative Anatomy

the study of the structure of different species, helps us understand the differences in aging and lifespan across species.

Age-blaming - when an individual draws attention to, acknowledges, apologizes or jokes about a perceived deficit related to aging

when an individual draws attention to, acknowledges, apologizes or jokes about a perceived deficit related to aging

Age-shaming

when an individual uses language to describe age or an age-related trait or behavior as shameful

Psychological age

where a person is in terms of the abilities people use to adapt to changing environmental demands (coping)

Sociological age

where a person is in terms of the specific set of roles adopted in relations to other members of the society or culture

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Special Focus Facilities: receive visits twice as often

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Special programs for family caregivers, care

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State Wideness - lets states target waivers to areas of the state where the need is greatest, or where certain types of providers are available

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State survey agency

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Stereotype Threat - when situational factors explicitly activate group stereotypes in members of low status groups who them confirm the behavior

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Supportive Services

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Testing: effects of taking a test on test performance later

Cognitive Reserve

The brain's ability to cope with pathology. Has been suggested as a mechanism for the link between educational experiences and risk of dementia and cognitive decline.

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The lifespan perspective is an adult developmental theory or framework for understanding approach to aging proposed in 1987 by Baltes. The key elements of this perspective include the idea that aging is

Classical Conditioning

The most basic behavior process by which humans and animals learn psychological or emotional reactions. Involves involuntary responses. A stimulus that automatically evokes a particular emotion physiological reaction occurs in conjunction with a neutral stimulus

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The most promising approaches are nestled into a coordinated enhancement of:

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The positivity effect comes into focus, or how they are more concerned with a preference for positive over negative experiences.

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Typical American spends $300,000+ over a lifetime

5.

Wisdom continually deteriorates with age.

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also- nutrition counseling and education

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contains 7 titles (or sections)

AARP

formerly the American Association of Retired Persons, is a United States-based non-governmental organization and interest group, based in Washington, D.C. it is "a nonprofit, nonpartisan membership organization for people age 50 and over ... dedicated to enhancing quality of life for all as we age," which "provides a wide range of unique benefits, special products, and services for our members."

Sociocultural forces:

interpersonal, societal, cultural, and ethnic factors that affect development

Age-Related Cardiovascular Changes:

•Increase in fatty tissues in outermost heart Thickening if left ventricular wall Increase in collagen and elastin tissue Accumulation of lipfuscin Thickening of sclerosis of heart valve flaps Decrease in pacemaker cells Loss of muscle cells

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2nd most common neurodegenerative disease

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3- obtaining and maintaining suitable housing, independently selected, designed, located with reference to special needs and available at costs to which senior citizens can afford

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Aging with a personality disorder:

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American Indian/Native Alaskan = <1%

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Average deficiencies per survey: 6-7

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Beginning in early adulthood people become more socially selective, reducing peripheral social contact in favor of close friends. Older adults are still interested in meeting new people and doing new things but are more interested in the immediate pleasure of the experience than the overall goal attainment behind it.

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Beware of diagnostic overshadowing

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Biological - genetic and health related factors; epigenetic factors

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Cessation of menstrual flow

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Chronic diseases are the leading cause of death and disability in the United States. They cause 7 out of 10 deaths each year.

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Communicate freely

Comorbidity

Concurrent health conditions. Occurs when an individual is affected by several diseases simultaneously.

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Delusions

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Dietary services

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Distributive Justice: Purports that humans have the capacity to make non-arbitrary, reasonable based for distributing goods and services that are in at least moderately scarce supply but desired by many.

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Do video games training improve performance on un-trained tasks?

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Don't assume everything is a delusion, especially abuse

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Effective treatments available

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Ejaculatory force is diminished

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Elders = 14% of population, 16.4% of suicides

Caring Response

Entails responsibilities that have clinical, ethical, and legal dimensions. It is highly individualized through the idea of person-centered care. A caring response includes: navigation between friendly and professional conduct, caring expressed through technical competence, and having care as a part of the professional responsibility (professional responsibility is comprised of accountability and responsiveness).

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Episodic memory - specific events in time and place and retrieval of context in experienced events.

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Erections are less firm

6.

Evaluate the Process & Outcome (reflection)

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Example: African-American woman with low income and elderly

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Example: godparents

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Feedback, Data Systems, and Monitoring

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Functional limitations

1.

Gathering Relevant Information (get the story straight)

Biological forces:

Genetic and health

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Genetics: complex genetic mutation interactions, rather than rare clear sutosomal recessive and dominant gene patterns; however, relative risk of developing PD is 3x more likely when first-degree relative has sporadic PD

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Hallmark symptoms of the disease include resting tremor, rigidity, bradykinesia (slowness of movement), postural instability

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Intellectual stimulation

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It goes beyond direct measures of population health, life expectancy and causes of death, and focuses on the impact health status has on quality of life

5.

Its efficiency

4.

Its impact or outcomes

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Provide adequate and reasonable provider standards to meet the needs of the target population

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Quotidian Strains- logistical problems with ADLs/IADLs

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State Unit on Aging-administer funds and coordinate care in each state in association with 629 AAA's

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Symptoms misattributed to effects of aging

1.

The "received" view: wisdom develops in old age after an awakening

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The experience of retirement

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Urinary symptoms

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Working memory

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Working memory- Prospective memory; mechanisms

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also- immunizations

Chronological age

based solely on the passage of time

Affordable Care Act (2010)

provides Americans with better health security by putting in place comprehensive health insurance reforms that will: expand coverage, hold insurance companies accountable, lower health care costs, guarantee more choice and enhance the quality of care for all Americans

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A comprehensive care plan for each resident

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Active aging

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Agreeableness - trust, altruism, kindness, affection, and other prosocial behaviors

3.

Autonomy

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Behavioral Strategies- exercise, eating, drinking, music, etc

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Changing in coping levels - may be influenced by changes in support system

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Current treatments extend life expectancy so that the terminal phases are posponed for 13-14 years after appearance of the first symptoms (Cummings, 1992)

DNR

DNR: Do Not Resuscitate: A legal order written either in the hospital or on a legal form to respect the wishes of a patient or resident to not undergo cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. The DNR is usually made by the patient/resident or Power of Attorney and allows the medical teams taking care of them to respect their wishes.

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Death rates for contemporary humans double every eight years.Additionally men are twice as likely to die than women.

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Declarative memory - conscious access to episodic information about events, accumulated knowledge of the world; shows decline over lifespan

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Decrease in testosterone level

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Decreased estrogen

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Denial (No!)

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Disability

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Drug effects (tolerance, withdrawal)

And old old - 80 - death??

Ego Integrity vs. Despair Reflection on Life Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.

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Eligible if unemployed, 55+, low-income (125% of federal poverty line)

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Ensure the protection of people's health and welfare

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Environmental factors - natural environment, such as plants, weather or climate change; built environment, such as buildings or transportation; worksites, schools, and recreational settings; housing, homes and neighborhoods; exposure to toxic substances and other physical hazards; physical barriers, especially for people with disabilities; aesthetic elements, such as good lighting, trees or benches

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Error theory that cells can be damaged by radiation and as a result mutate or experience genetic mutations. There is little scientific evidence to support this more modern and sophisticated version of the wear-and-tear theory.

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Errors in RNA transmission produce a protein or enzyme that is not an exact copy of the original, thus it cannot carry out its function in maintaining life. As a result, cells grow older and die, and so do we. Errors are likely because RNA molecules are relatively unstable and formed continuously, whereas DNA molecules are highly stable and maintained throughout the lifespan of a cell

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Example: On a farm the jobs could be done on a continuum until old age and death but an industrialized world and on an assembly line this was not applicable.

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Example: a concert pianist who knows 100 pieces but 20 very well so to optimize his performance will practice those 20 pieces but will compensate by using his experience and by practicing for long hours.

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Excitement - with aging this phase is longer (longer to achieve erection

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Exercise self-determination

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Expected years of life fee of limitation of activity

4.

Explore the Practical Alternatives

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Gastrointestinal symptoms

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Governance and Leadership

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Greater prevalence in males than females

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How to manage retirement

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How were doctors paid before BCBS, Medicare and Medicaid? Paid in kind, with chickens, home improvements, whatever the patient had to offer

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Issues that become salient and must be grappled with at each of the life stages from infancy to late adulthood. Within the scope of gerontology, older adults deal with Generativity vs Stagnation (the concern in establishing the next generation) and Integrity vs Despair (accepting and balancing one's life in order to accept death). Reminiscence and Life Review stem from these stages in which an individual processes the balance of their stages.

3.

Its implementation and service delivery

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Judgement is an integration of different kinds of information (e.g. about a person, ojbect or situation) to arrive at an overall evaluation

sociocultural forces

Meaning making, connectedness

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Neuroticism: moody worrying and nervous

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Positive aging

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Resolution - Return to unaroused state faster

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The form and timing of retirement -

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Theory that economic class conflict is the root of political processes and exacerbates the effects of age, gender, and race. The major social institutions (governments and corporations) create structured dependency for older adults.