Exam 1 Flashcards
(85 cards)
1
Q
Gerontology
A
The scientific study of the effects of time on human development, specifically the study of older people
2
Q
Social age
A
Measured by age-graded behaviors, carrying expected status and role within a particular culture or society
3
Q
Biological aging
A
Expression of declining functional capacity of most basic structures in cells, which in turn affects functioning of organism
4
Q
Cellular functioning (theory of aging)
A
- Changes to cell that decrease ability to replicate attributed to aging
- if reproduction was always perfect then we would never age
5
Q
Stochastic (error) theories of aging
A
- Propose that changes at cellular level are random and unpredictable
- include wear and tear theory, cross linkage theory and free radical theory
6
Q
Wear-and-tear theory of aging
A
The repeated use and injury of the body over time as it performs its specialized functions causes aging
- wearing out over time because of continued use
- is accelerated by harmful effects of internal (free radicals) and external (pollutants) stressors
- teaching: engage in exercise and muscle training
7
Q
Cross-linkage theory of aging
A
Cellular division is threatened as a result of radiation or a chemical reaction
- accumulated damage from errors associated with cross-linked proteins
- teaching: avoid skin dryness and joint stiffening; watch for research related to effects of unsaturated fats and heavy metals on cell health
8
Q
Free radical theory of aging
A
Free radical and antioxidants are affected
- accumulation of damage from free radicals occurs faster then the cells can repair the damage
- teaching: avoid environmental pollutants and unnecessary radiation; watch for research on use and presence of antioxidants; avoid stress
9
Q
Programmed theory of aging
A
“Biological clock”
- each cell has a preprogrammed life span (the # of replications it is limited to)
- people inherit a genetic program that determines their life expectancy
10
Q
Immunity theory of aging
A
The primary organs of the immune system (thymus and bone marrow) are affected by the aging process
- damage is the result of oxidative stress and the ability of lymphocytes to widthstand this stress
- teaching: avoid situations that decrease immune functioning (stress, malnutrition, excessive exercise)
11
Q
Autoimmune reactions in aging
A
Cells undergo changes with age -> body perceives these cells as foreign substances -> antibodies are formed to attack and rid body of foreign substances -> cells die
12
Q
Biological theories of aging
A
- Cellular functioning
- Stochastic theories: wear and tear, cross lonckage, free radical
- nonsotchastic: programmed aging, gene, immunity
13
Q
Sociological theories of aging
A
- role theory
- activity theory
- disengagement theory
- continuity theory
- age stratification theory
- social exchange theory
- modernization theory
14
Q
Role theory of aging
A
Age norms
- based on the assumption that chronological age implies roles
- socially and culturally constructed expectations of behavior at times in ones life and in pre-establishes roles
15
Q
Activity theory of aging
A
- aging is based o the individuals ability to maintain an active lifestyle
- looked at ones level of activity and productivity
16
Q
Disengagement theory of aging
A
- widthdrawal of elders from their roles and activities earlier in life that were necessary to allow transfer of power to younger adults
- viewed as necessary for the maintenance of social equilibrium
- widthdrawal was seen as successful aging (nowadays not so much)
17
Q
Continuity theory of aging
A
Ones ability to maintain and continue previous behaviors roles or to find suitable replacements
18
Q
age- stratification theory of aging
A
goes beyond the individual to age structure of society
- “ cohort effects”
19
Q
social exchange theory of aging
A
based on consideration of cost-benefit of social participation
- as one ages they have fewer and fewer economic resources to contribute to society -> results in loss of social status, self-esteem and political power
20
Q
modernization theory of aging
A
status and value of elders were lost when their labors are no longer considered useful, their knowledge is no longer pertinent to society and they are no longer accepted because of their age
- non material aspects of exchange
21
Q
psychological theories of aging
A
- jung’s theories of personality
- developmental theories ( erikson, peck)
- maslows hierarchy of human needs
22
Q
jung’s theories of personality theory of aging
A
personality is either extroverted (orientated toward external world) or introverted (oriented to subjective inner world of individual)
- aging is a movement from extroversion to introversion
- person is able to move from a focus on outward achievement to one of acceptance to the self.
23
Q
developmental theories of aging
A
Erickson: predetermined order of development and specific tasks associated with specific periods in ones life course; one must overcome each age specific task to move onto the next stage
Peck: expanded erikson’s work; achievement results in ego integrity
24
Q
maslow’s hierarchy of human needs theory of aging
A
combines bio-psych-social needs of individual
- top of the pyramid is self-actualization, bottom is basic needs (food and shelter)
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healthy aging
is multidemential and is uniquely defined by each individual
| - wellness is a concept, not a condition
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Steps for health behavior change
1. precontemplation- what pt thinks of making the potential change
2. contemplation- has ideas of change, considers the positives and the negatives, may take a long time
3. preparation- intention to change unites with plan of action, concrete steps to be taken within 1 month
4. action- actual steps taken to modify behavior, person feels empowered and in control of life, takes one day at a time
5. maintenance- becomes 6 months after action, prevention of relapse
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tai chi training
- positive impact on BMI, systolic blood pressure and heart rate
- fall occurrences reduced
- improved cardiovascular performance, decreased falls and increased functional ability
-
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biofeedback
feedback from body's internal processes
- by observing monitoring devices, a person can learn to influence HR, circulation and muscle tension
- explores mind-body connection
- learned skill in stress control
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autogenic training
total body biofeedback or self regulation without machinery
| -combination of yoga and autosuggestion
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general changes in the older adult
- # of cells is gradually reduced
- total body fat increases
- lean body mass is reduced
- bone mass decreases
- intracellular fluid is decreased resulting in less total body fluid (ECF remains constant)
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effects of aging on the SKIN
-hair loss, grey hair, wrinkles
- deepening hollows around eyes, armpit, intercostal and subclavian spaces
- elongated ears, double chin, baggy eyelids
-reduced sweat gland activity
-loose 20% of thickness
-liver spots on skin
- diffuse alopecia occurs in both genders
- nails become more britle, flat and concave; cuticle becomes less thick and wide
ABNORMAL: pressure ulcers and cancer
32
effects of aging on the CARDIOVASCULAR system
- decrease in SA cells(gest replaced by fatty cells that cause an increased risk for arrhythmias)
- Av node and bungle of his lose conductive cells
- murmurs due to weakened valves
- thickened and more rigid heart valves and walls
- increase in BP ( systolic rises, need more pressure to push blood through heart due to more rigid valves)
- size of heart is unchanged!
- increase in peripheral resistance
- reduced elasticity and lumen
- have no cardiac reserve (fight or flight responses take longer to get back to normal)
ABNORMAL: heart disease, murmur, hypertension, hypotension, CHF, Atherosclerosis, Dysrhythmias, Thrombosis
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how the aging heart responds to stress
- tachycardia in the elderly will last for a longer time
- stroke volume may increase which elevates BP
- resting HR is unchanged
34
effects of aging on RESPIRATORY system
- increase in dead space and residual capacity
- decrease in tidal volume, CO and vital capacity
- ribs and cartilage become stiffer, limits chest expansion
- loss in elastic recoil
- inefficient gas exchange
- increased resistance to air flow
- decreased muscle strength, cilia and cough reflex
- nose elongates downward and can restrict airflow
- stiffening of larynx and tracheal cartilage (mens voice increases, womens voice decreases)
-PO2 declines
- chemoreceptor function altered or blunted
ABNORMAL: COPD, asthma, emphysema, loss of alveoli function, lung cancer
35
effects of aging on GI system
-teeth lose enamel and dentin and become more vulnerable to cavities
- gums more susceptible to disease
- taste buds decline
- less salvia; dry mouth
- slower absorption of nutrients
- decreased gastric mobility, volume and gastric mucous secretions
- contractions of GI increase in frequency but are more disordered with less effective propulsion (leads to discomfort)
- increased risk for constipation because things slow down
- liver decreases in weight and mass, the incidence of gallstones increases
ABNORMAL: Chronic constipation, Chronic inflammation of intestinal lining, gastric ulcers, cancer, hernias, gall bladder problems, dysphagia, loosing teeth
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auscultating GI system
- if no bowel sounds there is an obstruction
- needs to listen in the order the food would follow
- RLQ-> RUQ-> LUQ-> LLQ
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effects of aging on the URINARY system
- capacity of bladder decreases by half
- tone an elasticity is lost
- renal blood flow decreases by 50%
- increased risk of infections due to weakened contractions during emptying
- GFR may be reduced by 50%
- decreased size and function of kidneys
ABNORMAL: incontinence, renal failure
38
effects of again on the REPRODUCTIVE system
- prostatic enlargement
- menopause
-vaginal dryness
-slowed sexual response
- erectile changes
- decreased fertility ( not a decrease in the amount of sperm but an increase in structural abnormalities)
ABNORMAL: Uterine prolapse, Erectile dysfunction, Lack of sex drive
39
effects of again on MUSCULOSKELETAL systems
- vertebral disk become thin; shortening of trunk
- stooped, slightly forward bent posture
- increased risk of fractures
- disequilibrium in bone maintenance develops when resorption is more rapid than the deposition of new minerals
- tendons may shorten and move from usual positions
-decreased flexibility
- increased muscle spasms
- muscle tissue mass decreases while adipose tissue increases
ABNORMAL: muscular dystrophy, multiple sclerosis
40
effects of aging on NERVOUS system
- reduction in nerve cells in size and number
- decreased cerebral blood flow
- slower reflexes delayed responses and changes in balance
- health of this system is affected by status of other systems
- stage 3 & 4 of sleep are less prominent
- decrease in myelin and number of spines on dendrites
- decrease in proprioception
- decreased memory of things newly learned
ABNORMAL: Alzheimers, dementia, Parkinson's, stroke, Decreased brain cells due to injury, infection, or environmental factors, substance abuse
41
effects of again on the EYES
- narrowing of visual fields
- presbyopia (cant focus on nearby objects)
- hardening of pupil
- reduced pupil size
- eyelids start drooping
- yellowing of the lens, less pupil response to light
- decreased ability to read small print
ABNORMAL: cataracts, glaucoma, diabetic retinopathy
42
effects of aging on HEARING
- Increased production of ear wax
- Decreased ability to hear high-pitched sounds
ABNORMAL: Hearing loss related to injury, infection, or environmental causes.
43
effects of aging on TOUCH, TASTE and SMELL
- decreased sensitivity to odors, tactile sensitivity
| ABNORMAL: Loss of sensation due to stroke or other neurological problems
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effects of aging on ENDOCRINE system
- decreased thyroid gland activity and secretion of hormones
- altered release of insulin
- decreased ATCH secretion
- decreased sensitivity to insulin
- reduced ability to metabolize glucose
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effects of aging on IMMUNE system
- skin is thinner and less resistant to bacterial invasion
- reduced number of cilia in lungs-> increased risk for pneumonia
- friability of urethra increases risk for UTI
- reduced immunity at cellular level
- decreased antibodies
- slower healing
ABNORMAL: Thrombocytosis, Agranulocytosis
46
changes in the mind due to aging
- basic personality does not change
- retrieval of long term memory information can be slower
- basic intelligence is maintained
- older adults are more easily distracted
47
gait changes due to aging
- speed of walking remains constant until 70
- older men walk with their legs rotated laterally
- older women walk with a narrower stance
- walk with greater downward pelvic rotation and increased lumbar lordosis
48
changes in thermoregulation due to aging
- normal body temperature is lower
| - ability to respond to cold temperature is reduced
49
hematological testing
includes blood and lymph ( RBC, WBC, platelets)
50
red blood count
-normal: 4.2-6.1 million
(if decreased RBS= anemic or GI bleed)
-hemoglobin normal value: 12-18
-hematocrit normal value: 37%-52%
51
whats produced in the bone marrow?
- WBC: high infection by phagocytosis, protect body from foreign invaders
- RBC: transport hemoglobin and carry oxygen, last 120 days
- Platelets: control clotting
52
white blood cell count
- normal: 5,000-10,000
(if decreased anemia, sickle cell, fracture, slow GI bleed)
(in increased infection)
- neutrophils normal value: 55%-70%
- lymphocytes normal value: 20%-40%
- platelets normal value: 150,000-400,000
- number of WBC is regulated by endocrine system
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functions of WBC
- neutrophils: stimulated by pyogenic (bacterial) infections
- monocytes: become macrophages
- eosinophils: increase with allergies
- basophils: transport histamine and play a role in allergic reaction, increase with allergies
- lymphocytes: stimulated by the presence of viral infections
- platelets: help trigger clotting (count doesn't change with age)
54
erythrocyte sedimentation rate
the rate at which a RBC falls to the bottom of a sline solution; helpful in determining degree of inflammation, infection, necrosis
55
B vitamins
- folic acid: for normal functioning of RBC and WBC and DNA synthesis, doesnt decline with aging
B12: for normal development of RBC, neurological function and DNA synthesis, deficiency is fatal if untreated
56
hypothryoidism
common in older adults but not a common sign of aging
57
electrolytes
- control nerve impulses and maintain homeostasis inside and outside the cell
- potassium decreases with aging
- glucose fasting levels are higher and take longer to return to normal
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hypokalemia
- decrease in potassium
- generalized muscle weakness
- fatigue, muscle cramps
- constipation
- ileus ( intestine doesn't contract normally to move waste out)
- tetany
- hyporeflexia: slow or absent reflexes
- hypercapnia: rapid and deep breathing
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hyperkalemia
- increase in potassium
- impaired muscle activity
- weakness
- muscle pain/cramps
- increased GI motility
- bradycardia
- cardiac arrest (causes arrhythmias)
60
measuring acute cardiac events
- creatine kinase: rises 3-6 hours after AMI, peaks as 12-24 hours, returns to normal 12-48 hours
- troponin: gold standard for diagnosis of heart injury, increases 3 hours after and remains elevated 7-10 days for troponin I and 10-14 days for troponin T
61
brain natriuretic peptide
- indentifies congestive heart failure by responding to excessive stretching
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serum albumin
measures nutritional status
| - most useful indicator of severity of illness and risk of mortality
63
blood urea nitrogen
- measurement of the nitrogen portion of urea
- used as gross measurement of renal functioning and level of hydration
- if increased there is dehydration OR renal failure (if creatinine is increased as well
64
creatinine
- most accurate reflection of renal health
- key aspect in determining the GFR
- if increased there is renal failure
65
blood clots
- pulmonary embolism= lungs
- thrombosis= veins and arteries
- deep vein thrombosis= lower extremeties
- stroke= brain
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prothrombin time
the most sensitive measure of deficiencies in clotting factors
- affected by warfarin use
67
international normalized ratio
- if increased it could cause life-threatening bleeding
| - if decreased it could suggest a hypercoagulation state
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digoxin
- used to control ventricular response to chronic afib.
- initiated slowly to prevent to rapid of a reduction in HR
- May cause anorexia
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urine studies
- specific gravity (measures hydration)
- pH ( more acidic with UTI or bacteria)
- protein (dont want)
- glucose ( will see if diabetic)
- ketones ( will see if someone is breaking down fats; sign of starvation or hypoglycemic)
- blood (dont want)
- bilirubin, nitrates, leukocytes (dont want, sign of infections)
70
physical assessment for older people
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FANCAPES
fluids (state of hydration)
aeration (pulmonary and cardio function)
nutrition
communication (impairment)
activity (activity abilities)
pain
elimination (bowel and bladder functioning)
social skills (ability to negotiate society)
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assessment of social support
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APGAR
adaptation
partnership
growth
affection
resolution
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pharmacokinetics
- the movement of medication in the body
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transdermal systems
- very slow absorption but extremely useful for those who require small doses of medication
- overcomes any first pass problems
- if rash (most common side effect) is acquired it is usually from the adhesive and not the medication
- do not reapply to same area for at least 7 days
74
pharmacodynamics
- effects of the drugs actions
| - the older the person gets, the more likely they will have an alteration of unreliable response to a drug
75
polypharmacy
- taking multiple medications at one
| - increased risk for drug interactions and adverse events
76
Drug-herbal interactions
Number of herbs have a direct effect on coagulability
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Drug-food interactions
Food many bind to medications decreasing their absorption which can have an increased, decreased, or variable effect
78
Drug-drug interactions
Some will compete for binging sites or bind to one another forming a non absorbable compound or can inactivate both drugs
- common cause of ADE in elderly
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Absorption of drugs
- begins in small intestine
- no difference in absorption rates from aging
- first pass metabolism is extremely variable based on the individual older adults degree or decline in hepatic blood flow
80
Distribution of drugs
- once drug is absorbed,it must be distributed or transported to receptor site on target organ to have therapeutic effect
- effected by peripheral vascular disease
- organs of higher blood flow (brain, kidneys,lungs,liver) receive highest concentration
- fat soluble drugs can accumulate to an excess because of increase in body fat in older adults
81
Metabolism of drugs
Liver is primary site of metabolism
82
Excretion of drugs
- drugs get excreted primarily through kidneys but also through sweat and saliva
- GFR will also decline with aging because so does kidney function which will effect amount of drug excreted through kidneys
83
Antipsychotics (neuroleptic)
- block dopamine receptors in the brain
- cause movement disorders:
- acute dystonia: involuntary slow and continuous movement of the mouth, jaw, face and neck
- akathisia: extreme sense of restlessness
- tardive dyskinesia: irreversible movement disorders starts with worm like movement of the tongue; slow movements of the limbs, trunk, eyes,face and neck
84
Conditions that decrease metabolism of drugs
Dehydration
Hyperthermia
Immobility
Liver disease
85
Influences on drug absorption
Age related changes
Route of administration
Concentration and solubility of drug
Diseases and symptoms
