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Introduction (Geriatric Syndrome:
multifactorial, shared risk factors;…
Introduction
Geriatric Syndrome:
- multifactorial, shared risk factors; pattern of symptoms and signs may not be known; associated with substantial morbidity and poor outcomes; unique features of common health conditions in older people (ex. older age, cognitive impairment, functional impairment)
- shared risk factors --> geriatric syndromes --> weakness --> poor outcomes: disability
Hypothermia/Cold and Aging:
- Intrinsic Risk Factors: decreased thermogenesis, decreased vasoconstriction in response to cold, decrease in intensity of shaking
- Extrinsic Risk Factors: possibly medications, socio-economic (nutrition, heating etc), co-morbidities includes falls/immobility
Sight and Aging:
- Reduction of pupil size (slows adjustment to light changes)
- Corneal surface flattens (admitting less light into the eye)
- Reduced lens transparency (interferes with reception of colour wavelengths)
- Reduced blood supply (radiation damage to retinal area)
Visual Changes and Aging:
- Need longer to adjust to changes in lighting
- Need increased contrast to facilitate depth perception.
- Increased vulnerability to visual impairment from cataracts, macula degeneration and glaucoma
Neuromuscular Junction and Aging:
- reduction in the numbers of motor neurons
- increase in distance between the junctional axon and the motor end-plate
- folds of the motor end-plate are flattened
- reduction in concentration of ACh receptors at the motor end-plate
- reduction in amount and release of ACh in the junctional vesicles
Osteoporosis and Aging:
- normal process: loss of endocrine protection (menopause), reduced endogenous production of Vitamin D (skin)
- Life-Style Related: low dietary intake of Calcium; disuse/inactivity
- Disease Related: chronic Renal Disease, Rheumatoid Arthritis, Thyroid Disease; medications – Steroids, Thyroxine
Sarcopenia and Aging:
- Between ages 30 and 75:
- lean body mass will be decreased due to loss of skeletal muscle mass
- number and size of muscle fibers progressively will be decreased
Skin and Aging:
- drier, thinner, and wrinkled skin
- ease of tearing or breakdown because of decline in the vascular supply
- decline in the immune cells of the integument system
- decline in the activation of Vitamin D
Memory Changes and Age:
- Difficulty with processing and working memory
- Need more time to process information.
- Difficulty with retrieve names.
- Having much better semantic memory than young adults (perform better on tasks of vocabulary & world knowledge)
Gender Differences in Aging:
- more women than men reach the age of 100 years (because of lower mortality levels at all ages)
- women outlive men by ~4-10 years (74 vs 80 years life expectancy)
Hormonal Differences:
- estrogen --> thought to protect against heart disease by lowering LDL and increasing HDL (but serious in risk of breast cancer)
- heightened immune function --> women have greater and faster immune response, usually have more chronic illnesses and weakening rather than fatal (but problem is autoimmune disease are more prevalent)
Social Explanations:
- risk taking behaviur is higher in men
- smokiing behaviour is higher in men (gap grew during WWII)
- women tend to use the health care system more and go to the doctor more often then men (but women have more acute illnesses and nonfatal chronic diseases)
Life Expectancy:
- in Canada increasing steadily
- at birth is was 79.1 years for males and 83.4 years for females for 2009/2011 period
- over last decade the life expectancy for males has increased by ~4 months every year and for females only 2.4 months every year
- in 2036, the life expectancy for females could be 87.3 years and for males it could be 84.0 years
- for both males and females, BC shows highest life expectancy in Canada (80 for males and 84 for females)
Aboriginals:
- is aging (like the rest of Canadain population)
- declining fertility and increasing life expectancy
- proportion of persons aged 65 and over within Aboriginal identity population may nearly triple, from 5.9% in 2011 to 15.1 % in 2031
Aging:
- Process or group of processes occurring at the molecular, cellular and organ levels that with the passage of time lead to:
- loss of appropriate response to internal/external stressors
- functional impairment
- death
Types of Aging:
- Primary Aging (Aging Process)
- universal changes with age within a population that are independent of disease and environment
- get here by acceleration of basic aging processes
- Secondary Aging (Process of Aging)
- development of clinical symptoms due to environmental and disease influences (no exercise, smoking, illness)
- get here by increased vulnerability to environmental stresses and disease
- Chronological Age: how long you have lived; inappropriate measure due to the individual differences (lifestyle, disease)
- Biological Age: the process or group of processes that causes the eventual breakdown of homeostasis with the passage of time; rate of change in function or performance is related to passage of time, not disease processes
- Psychological Age: how old is your mind; reflects mental and cognitive funciton capability; may be biologically mediated
- Sociological Age: how old do people treat you; reflects societal influences on lifestyle choice; attitude is everything
Describing Age:
- Middle Age: 2nd half of person’s working life (45-64yrs old); major biological systems show 20%-30% loss of function relative to peak as young adult
- Young-Old: immediate post retirement period (65-74 yrs old); further loss of function, but no gross impairment of homeostasis
- Old: 75-84 yrs old; substantial impairment in function of daily activities is likely; can still live relatively independently though
- Old-Old Age: 85+ yrs old; institutional or nursing care needed
- Maximal Lifespan: survival potential of members of a population
- Average Lifespan: average age by which all but a small percentage of the members of a population are deceased
- Life Expectancy: average number of years of life for a given population
Gerontology: study of biological, psychological and social aspects of ageing
Components of Gerontology:
- Social Aspects: relationships that developed by an individual through interactions with other people in society (ex. relationships with family, friends, neighbours)
- Psychosocial Aspects: aspects that involve the changes in mental functions and behaviours (ex. perception, cognition, emotion, brain function, personality)
- Biological Aspects: concerned with the structure, function and growth of an organism (ex. hair begins to turn gray, bone and muscle loss occurs, vision and hearing decline)
Working-Age Persons (15-64) for Each Senior:
- ratio of the working-age population for each senior aged 65 and over could decline by about half in the next 50 years
- by the late 2050s, there could be just over two working-age persons for each person aged 65 and over
Theories of Aging:
- Genetic theories: genes are programed from birth to death for example for puberty and menopause; gene mutation accelerates errors and aging
- Gradual Imbalance Theories: gradual failure of neural, endocrine or immune systems (neurotransmitter imbalance, reduction in hormone levels, autoimmune dysfunction --> regulate and integrate cell function and organ systems which cause aging)
- Accumulation Theories: accumulation of certain elements like foreign elements, natural results of cell metabolism
- Wear and Tear Theories: internal and external sources of damage to body's molecular structure (sources of damage: physical, chemical, infectious, mechanical)
- Interaction of Aging Theories: ex. gene related to immune function becomes defective --> become more vulnerable t free radical attack --> disturbs neuroendocrine immunity balance)
Geriatric Assessment:
- broad term that described a clinical approach to older patients that goes beyond a traditional exam to include functional, social, and psychological domains that affect well-being and quality of life
- 4 key concepts inform approach:
- clinical site of care (ex. long term care may focus on basic ADLs whereas outpatients may focus on higher levels of functioning)
- prognosis (important in determining which interventions are likely to be beneficial or burdensome for that individual; when life expectancy is over 10 years the treatment is generally the same as for younger persons but if life expectancy is less than 10 years the choice of treatment is based on improving quality of life)
- patient goals (should make goals; older persons should complete advance directives for both health care and finances)
- functional status (can be viewed as a summary measure of the overall impact of health conditions in context of a patients physical and psychosocial environment; important for planning; should be done initially and then periodically)
- to make it more efficient try to use pre-visit screening questionnaires