Cognitive Lecture 4 Normal Aging Flashcards
(85 cards)
1
Q
Change comes with age & is influenced by…
A
Genetic patterns of aging & lifestyle choices
2
Q
Most rapidly growing age group among Americans
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Older adults
3
Q
% of population 65yo+
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12.5
4
Q
% of population 85yo+
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1.2
5
Q
by 2050, ___% of US population is projected to be 65+ and ___% is expected to 85+
A
20.4; 4.8
6
Q
Young-old age range:
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65-74 years old
7
Q
Old-old age range:
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75-84 years old
8
Q
Oldest-old age range:
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85+ years old
9
Q
Geriatrics definition
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area of medicine that deals with the elderly
10
Q
Specific issues when working with geriatric population:
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Physiological differences (changes in how the body itself works) Higher frequency of multiple chronic illnesses Greater # of sensory impairments (changes in taste, smell, hearing, sight, etc) Increased chance of being on multiple potentially interacting medications
11
Q
Normal Signs of Aging: Skin
A
Less elastic with more lines & wrinkles; fingernail growth slows as does oil production
Epidermal layer of skin thins out and skin is more susceptible to tears; common to see in nursing homes; more susceptible to bruises too
12
Q
Normal Signs of Aging: Hair
A
Will gradually thin; pigment cells will decline & gray growth increases
13
Q
Normal Signs of Aging: Height
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By age 80, it is common to have lost 2” often related to normal changes in posture & compression of joints, spinal bones, spinal discs
14
Q
Normal Signs of Aging: Hearing
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Changes in the ear make higher frequency sounds sounds harder to hear & changes in tone & speech less clear; tend to accelerate post age 55; presbycusis
15
Q
Normal Signs of Aging: Vision
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Most people in their 40s develop a need for reading glasses; normal for night vision & visual sharpness to decline while glare increasingly interferes with clear vision; presbyopia
16
Q
Normal Signs of Aging: Bones
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Gradually lose mineral content, become less dense & strong; in women bone loss increases after menopause; increased risk of osteoporosis (calcium supplements)
17
Q
Normal Signs of Aging: Metabolism & Body Composition
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Over time, body requires less energy so metabolism slows; hormone changes will facilitate a shift for the body to store more fat & less muscle mass
18
Q
Normal Signs of Aging: CNS
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Beginning in the 3rd decade of life, the brain’s weight & size of its nerve network & blood flow decreases; brain adapts by forming new connections; memory changes are typical with less recall of recent memories & slower ability to remember names commonplace
19
Q
Normal Signs of Aging: Heart & Blood Circulation
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Heart becomes less efficient; works harder during activity than it once did; heart muscle will increase in overall mass; gradual decline in endurance
20
Q
Normal Signs of Aging: Lungs
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In inactive people, become less efficient overtime, supplying body with less oxygen
21
Q
Normal Signs of Aging: Kidneys
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With age, decline in size & function; do not clear waste & some medicines from the blood as quickly & do not handle dehydration as well
22
Q
Normal Signs of Aging: Urinary Incontinence
A
Should not occur but may happen due to immobility & side-effects of some medicines
(maybe b/c women are pregnant, men’s muscles may relax, etc.)
23
Q
Normal Signs of Aging: Sexual Function
A
Both men & women begin producing less hormones
24
Q
Cognitive Changes in Normal Aging
A
Normal part of life; will be variable
General decline begins typically in 6th decade
Verbal abilities usually maintained until 8th decade
“Not as sharp as you used to be”
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Additional Cognitive Areas to Show Decline with Aging:
Memory, Abstraction, Language, Visuospatial abilities, Attention
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Memory Changes in Aging
Several types of memory are affected in the normal aging process; however, elderly are compromised little in everyday life
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Memory is...
Stored knowledge & the processes for making & manipulating it
Humans have many memory systems that can each be separately impaired by trauma or disease
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Sensory memory
Brief registration of incoming sensations
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Working memory
Info in conscious awareness; active in the reception, encoding, & retrieval of info; allows us to make quick decisions & plan actions
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Long-term memory (LTM)
dichotomized as both declarative & nondeclarative
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Declarative memory
All about facts; semantic (concepts), episodic, lexical (words, spellings, etc)
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Nondeclarative memory
All about motor & cognitive (skills), habits, priming, conditioned responses, & reflexes
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Vision Acuity Changes
After the 4th decade; will most likely see a decrease in visual field
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Light Sensitivity Requires...
3 times as much light after as young after age 70
| Dark adaptation or adjustment of vision when moving from bright to dim light
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Color sensitivity...
Decreases with age; Change in blue color at 40-50 years; change in green starts in the 60s
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Vision Perception:
More difficult with figure-ground discriminations & visuospatial skills (size, distance, position)
Visual memory (more effective at all ages than auditory memory)
Light on dark for testing/reading; focus on high contrast vs. low contrast
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Slowing Down the Aging Process
Stay away from smoking & limit alcohol consumption
Maintain high levels of physical activity; Exercise; facilitates muscle flexibility, strength, mood
Routine medical care
Maintain cardiovascular health (tied into exercise)
Extensive social network support (both friends & family)
PREVENTION
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Frail Elderly
Those most likely to be in need of age-specific, multidisciplinary approaches
"frailty" suggests a diminished ability to carry out important practical & social aspects of daily living
Ties back to skin tears, etc., chronically ill, chronically sick, not good support networks, etc.
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Common Problems Related to Aging
Polypharmacy (multiple medications), dementia, delirium, incontinence (both bowel & urinary), arthritis, visual & hearing deficits, pressure ulcers (skin breakdowns from lack of movements; diabetics less likely to heal from them), malnutrition, osteoporosis (brittle bones), high risk of falls (decreased balance)
40
Functional Status
Defined by a person's ability to perform ADL's (activities of daily living)
To be able to live alone w/o help, person must be able to perform ADLs independently; must be able to complete self-care, self-maintenance, & physical activities independently
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Common ADLs
bathing, dressing, toileting, transferring, continence, feeding
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Functionality Assessment Tools
Katz index of independence in ADLs ("Katz ADLs")
Functional Status Questionnaire
Functional Independence Measure (FIM)-required by Medicare at admission, discharge (& follow-up) to see that stay was helpful
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Polypharmacy
Tendency of many older persons to be on numerous medications
Some #s suggest that the elderly are ~12% of the population, but receive 32% of prescriptions
On avg, an elderly individual may have 2-6 prescriptions +1-3.4 OTC medicines
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ADRs
Adverse Drug Reactions
| Every drug has side effects
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Ibuprofen can cause:
```
Gastric ulceration (sometimes w/ bleeding)
Kidney impairment
Edema
Liver enzyme elevation
Drowsiness & dizziness, etc.
```
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Research suggests that the potential for ADRs is:
6% when the pt. is taking 2 medications
50% when the pt. is taking 5 medications
100% when the pt. is taking 8+ medications
20-25% of hospital admissions for persons 65+ is due to an ADR
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Primary Risk Factors for Cognitive Decline
Hypertension
Diabetes
Poor nutrition
Social isolation
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Other Risk Factors for Cognitive Decline
Heart disease
Family history of dementia
Psychological factors such as stress & dementia
(hyperlipidemia-high cholesterol)
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Eustress vs. distress
eustress is good; distress is bad
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Differential Diagnosis
Delirium vs. dementia vs. MCI vs. confusion
| May be involved in diagnosis, but will not solely make diagnosis
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Symptoms of Confusion
Can come & go; Can be an indication of things to come; (a sign of stroke in some pts
Disorientation, impaired attention span, distractability, purposeless activity, anxiety, apprehension, fright, fear, agitation, verbosity, confabulations, dependent behavior, attention seeking behaviors, withdrawal, belligerence, combativeness, statement of confusion, memory loss, personality change, inability to complete ADLs, change in person's usual behaviors
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Delirium
Sudden severe confusion with rapid changes in brain function
A disturbance in consciousness accompanied by a change in cognition (can be altered consciousness, not necessarily unconsciousness)
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Delirium Symptoms
Let dr. make this call; Let somebody know if you see change in state
Changes in alertness (usu. more alert in morning, less alert @ night)
Changes in feeling (sensation) & perception
Changes in level of consciousness or awareness
Changes in movement (may be inactive or slow moving)
Changes in sleep patterns, drowsiness
Confusion (disorientation) about time or place
Decrease in STM & recall (unable to remember events since delirium began; unable to remember past events)
Disrupted or wandering attention (inability to think or behave w/ purpose; problems concentrating)
Disorganized thinking
Incoherent speech
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Emotional or Personality Changes Associated with Delirium Symptoms
Anger, anxiety, apathy, depression, euphoria, irritability
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Etiologies of Delirium
Most often caused by physical or mental illness & is usually temporary & reversible
Drug abuse
Infections such as UTIs & pneumonia
Persons already w/ CVA or dementia
Poisons
Fluid/electrolyte or acid/base disturbances
Pts w/ more severe brain injuries are more likely to get delirium from another illness
Can be related to confusion & dementia as well
UTIs can make elderly look like dementia or delirious state
Some are temporary and reversible and some are irreversible
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Complications of Delirium
Loss of ability to function or care for self
Loss of ability to interact
Progression to stupor or coma
Side effects of medications used to treat the disorder
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Mild Cognitive Impairment (MCI)
Development of cognitive & memory issues that are not severe enough to be dx'd as dementia; sx's are more pronounced than the cognitive changes associated w/ normal aging
More impaired a person is, the greater the likelihood of developing dementia (perhaps AD)
Dx does not imply that a person is not capable of functioning independently in most situations (most of the time they can)
Pre-dementia state
AD isn’t a diagnosis that can be made definitively while living (DAT—dementia of alzheimer’s type)
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Dementia
SYNDROME; not a disease
Necessary features for a true dx according to APA are: 1)erosion of recent & remote memory; 2)impairment of 1 or more of the following functions: language (ex. aphasia), motor activity (apraxia; although physical ability intact), recognition (agnosia, although sensory ability intact), executive functions
Deficits must be sufficient enough to interfere with functioning
Pts must have difficulty w/ cognition, memory, language, visual-spatial, emotion, personality
NOT a normal part of aging process
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Syndrome
Constellation of signs and symptoms
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Global Dementia Types
there are irreversible & reversible etiologies
| all possible reversible etiologies must be exhausted & ruled out prior to a pt being given a dx of irreversible etiology
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Reversible Causes of Dementia
Treatable
Infection, drug toxicity, vitamin deficiency, tumor, depression, normal pressure hydrocephalus, renal failure, CHF, thyroid disease, hypoglycemia, syphilis
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Normal pressure hydrocephalus
violation of Monroe-Kellie hypothesis that doesn’t show up on scans
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Pseudodementia
Geriatric depression; classified as a reversible dementia in some diagnostic models
False dementia
Hopefully if you get rid of depression, dementia will improve
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Some suggest that _____ are reversible with more than ____ resulting from drug toxicity, depression, or metabolic disorder
≤10%; 2/3
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Patients with pseudodementia present with...
cognitive impairments, difficulty sleeping, appetite changes, & decreased affect
Drug tx is generally successful in improving affect & cognitive sx's
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Irreversible Causes of Dementia
Alzheimer's disease, Pick's disease, Frontotemporal dementia (PPA), creutzfeldt-jakob’s disease, huntington's disease, multiple infarctions, vascular disease, Wilson's disease, PD, Lewy body disease, Binswanger's disease, HIV, PSP
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Dementia Classifications
```
Cortical Dementias
Subcortical Dementias
Progressive Dementias
Primary Dementia
Secondary Dementia
```
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Signs of Possible Dementia
Getting lost in familiar places, repetitive questioning, odd/inappropriate behaviors, forgetfulness of recent events, repeated falls or loss of balance, personality changes, decline in planning & organization, changes in diet/eating habits, changes in hygiene, increased apathy, changes in language abilities (including comprehension)
Dx not usually given if there is no impairment in social functioning & independent living
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Communication
The sharing of info by means of an arbitrary symbol system; a manifestation of cognition
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Communication Language Deterioration
Persons w/ dementia have difficulty w/ intentional communication b/c they have multiple cognitive deficits
In pts w/ dementia, the degree of language impairment is often proportionate to the deterioration of other mental functions
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Early Stage Dementia: Sounds
Used correctly
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Early Stage Dementia: Words
May omit a meaningful word, usually a noun when talking in sentences; may report anomic issues; vocabulary is shrinking
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Early Stage Dementia: Grammar
Generally correct
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Early Stage Dementia: Content
May drift from topic; reduced ability to generate series of meaningful sentences; difficulty comprehending new info; may be vague
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Early Stage Dementia: Use
Knows when to talk but may talk too long on a subject; May be apathetic, failing to initiate conversation appropriately; difficulty with humor, analogies, sarcasm, & indirect/ non-literal statements
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Middle Stage Dementia: Sounds
Used correctly
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Middle Stage Dementia: Words
Difficulty with thinking of words in a category; anomia in communication; difficulty naming objects; vocabulary noticeably diminished
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Middle Stage Dementia: Grammar
Sentence fragments & deviation common; difficulty with complex grammatical sentences
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Middle Stage Dementia: Content
Frequently repeats ideas; forgets topic; talks about events of past; few ideas
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Middle Stage Dementia: Use
Knows when to talk; recognizes questions; may fail to greet; loss of sensitivity to communicative partners; rarely corrects mistakes
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Late Stage Dementia: Sounds
Generally used correctly; errors not uncommon
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Late Stage Dementia: Words
Marked anomia; poor vocabulary; lack of word comprehension; neologisms; jargon
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Late Stage Dementia: Grammar
Somewhat preserved; sentence fragments & deviations common; may lack comprehension of many grammatical forms
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Late Stage Dementia: Content
Generally unable to produce sequence of related ideas; content is meaningless & bizarre; subject of most meaningful events is from the past; marked repetition of words & phrases
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Late Stage Dementia: Use
Generally unaware of surrounding & context; little meaningful use of language; some pts will be mute; some pts will be echolalic
