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Flashcards in Normal Aging and Dementia Deck (47):
1

Overview of Normal Aging

- change comes with age and is influenced by genetic patterns of aging as well as lifestyle choices

- older adults are the most rapidly growing age group among Americans

- 12.5% of US population is 65+

- 1.2% of US population is 85+

- by 2050, 20.4% of US population is projected to 65+ and 4.8% is expected to 85+

2

Geriatric Terminology

- young-old (65-74 years)

- old-old (75-84 years)

- oldest-old (≥ 85 years)

- geriatrics: area of medicine that deals with the elderly

3

Specific issues when working with the geriatric population

- physiological differences

- higher frequency of multiple chronic illnesses

- greater number of sensory impairments

- increased chance of being on multiple potentially interacting medications

4

Normal Signs of Aging

1. Skin

2. Hair

3. Height

1. less elastic with more lines and wrinkles; fingernail growth slows as does oil production

2. will gradually thin; hair pigment cells will decline and gray hair growth increases

3. by age 80, it is common to have lost 2 inches; often related to normal changes in posture and compression of joints, spinal bones and spinal discs

5

Normal Signs of Aging

1. Hearing

2. Vision

3. Bones

1. changes in the ear make higher frequency sounds harder to hear and changes in tone and speech less clear; tends to accelerate post age 55

2. most people in their 40’s develop a need for reading glasses; normal for night vision and visual sharpness to decline while glare increasingly interferes with clear vision

3. gradually lose mineral content, become less dense and strong; in women bone loss increases after menopause; increased risk of osteoporosis

6

Normal Signs of Aging

1. Metabolism and Body Composition

2. CNS

3. Heart and Blood Circulation

1. over time the body requires less energy and so metabolism slows; hormone changes will facilitate a shift for the body to store more fat and less muscle mass

2. beginning in the third decade of life, the brain’s weight and size of its nerve network and blood flow decreases; brain adapts by forming new connections; memory changes are typical with less recall of recent memories and slower ability to remember names commonplace

3. heart becomes less efficient; works harder during activity than it once did; heart muscle will increase in overall mass; gradual decline in endurance

7

Normal Signs of Aging

1. Lungs

2. Kidneys

3. Urinary Incontinence

4. Sexual Function

1. in inactive people, lungs become less efficient over time, supplying the body with less oxygen

2. with age, decline in size and function; they do not clear wastes and some medicines from the blood as quickly and do not handle dehydration as well

3. should not occur but may happen due to immobility and side-effects of some medicines

4. Both men and women begin producing less hormones

8

Cognitive changes in normal aging

- normal part of life; will be variable

- general cognitive decline begins typically in the sixth decade

- verbal abilities are usually maintained until the eighth decade

- additional areas to show decline with aging include:

- memory

- abstraction

- language

- visuospatial abilities

- attention

9

Memory changes in aging

- several types of memory are affected in the normal aging process

- however, elderly are compromised little in everyday life

- memory is stored knowledge and the processes for making and manipulating it

- humans have many memory systems that can each be separately impaired by trauma or disease




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Declarative Memory

- Semantic (concepts)

- Episodic (events)

- Lexical (words)

11

Nondeclarative Memory

- Motor skills

- Cognitive skills

- Priming

- Conditioned Responses

- Reflexes

12

Memory Types

1. Sensory memory

2. Working memory

3. LTM

1. Sensory memory: brief registration of incoming sensations

2. Working memory: info in conscious awareness; active in the reception, encoding and retrieval of information; allows us to make quick decisions and plan actions

3. LTM: dichotomized as both declarative and nondeclarative

13

Memory Types

1. Declarative

2. Nondeclarative

1. declarative memory: all about facts; semantic, episodic, lexical

2. nondeclarative memory: all about motor and cognitive (skills), habits, priming, conditioned responses and reflexes (actions you don't have to think about)

- semantics: think concepts (letter B on lichteim’s diagram)

- lexical: words, spellings, etc

14

Vision and aging

- acuity change after the fourth decade; will most likely see a decrease in visual field

- light sensitivity requires 3x as much light as young after age 70

- dark adaptation or adjustment of vision when moving from bright to dim light

15

Vision and aging

- color sensitivity decreases w/age: change in blue color starts at 40-50y; change in green starts in the 60’s

- perception: more difficult w/figure-ground discriminations and visuospatial skills (size, distance and 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 and limit alcohol consumption

- maintain high levels of physical activity; EXERCISE

---- facilitates muscle flexibility, strength and mood

- routine medical care

- maintain cardiovascular health

- extensive social support network

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Frail Elderly

- frail elderly those most likely to be in need of age-specific, multidisciplinary approaches

- “frailty” suggests a diminished ability to carry out important practical and social aspects of daily living

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Common Problems in the elderly 1 (5)

- polypharmacy

- dementia

- delirium

- incontinence (both fecal and urinary)

- arthritis

19

Common Problems in the elderly 2 (5)

- visual and hearing deficits

- pressure ulcers

- malnutrition

- osteoporosis

- high risk of falls

20

Functional Status and ADLs

- functional status is commonly defined by a person’s ability to perform ADL’s

- to be able to live alone without help, a person must be able to perform ADL’s independently

- pt must be able to complete self-care, self-maintenance and physical activities independently

- common ADLs include: bathing, dressing, toileting, transferring, continence, and feeding

21

Functionality Assessment Tools

- Katz index of independence in activities of daily living “Katz ADLs”

- functional status questionnaire

- functional independence measure (FIM)

22

Polypharmacy

- refers to the tendency of many older persons to be on numerous medications

- some numbers suggest that the elderly are ~12% of the population, however receive 32% of prescriptions

- on average, an elderly individual may have 2-6 prescription drugs + 1-3.4 OTC medicines



23

ADRs 1

- adverse drug reactions

- every drug has side effects

- ibuprofen can cause:

--- gastric ulceration (sometimes w/bleeding)

--- kidney impairment

--- edema

--- liver enzyme elevation

--- drowsiness and dizziness, etc

24

ADRs 2

- researchers suggest that the potential for an ADR 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

- supporting the facts that ADRs are serious is the statistic that 20-25% of hospital admissions for persons 65+ is due to an ADR

25

Risk factors forr cognitive decline

- HTN, diabetes, poor nutrition and social isolation (primary factors)

- heart disease

- family history of dementia

- psychological factors such as stress and depression

26

Differential Diagnosis

- delirium

- dementia

- mild cognitive impairment

- confusion

27

Symptoms of confusion 1

- disorientation

- impaired attention span

- distractibility

- purposeless activity

- anxiety; apprehension

- fright; fear; agitation

- verbosity

- confabulations

- dependent behavior

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Symptoms of confusion 2

- attention seeking behaviors

- withdrawal

- belligerence

- combativeness

- statement of confusion

- memory loss

- personality change

- inability to complete ADLs

- change in person’s usual behaviors

29

Delirium

- sudden severe confusion with rapid changes in brain function

- a disturbance of consciousness accompanied by a change in cognition

30

Delirium Symptoms 1

- changes in alertness (usually more alert in the morning, less alert at night)

- changes in feeling (sensation) and 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

31

Delirium Symptoms 2

- decrease in STM and recall

- unable to remember events since delirium began

- unable to remember past events

- disrupted or wandering attention

- inability to think or behave with purpose

- problems concentrating

- disorganized thinking

- incoherent speech

32

Delirium Symptoms- emotional or personality changes

- anger

- anxiety

- apathy

- depression

- euphoria

- irritability

33

Etiologies of Delirium

- most often caused by physical or mental illness and is usually temporary and reversible

- drug abuse

- infections such as UTIs and pneumonia

- persons already with 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


34

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

35

Mild Cognitive Impairment

- MCI

- development of cognitive and memory issues that are not severe enough to be dx’d as dementia

- symptoms are more pronounced than the cognitive changes associated w/normal aging

- the more impaired a person is with MCI, the greater the likelihood he/she will develop dementia (perhaps AD)

- a dx of MCI does not imply that a person is not capable of functioning independently in most situations

36

Dementia

- dementia is a syndrome and not a disease

- a syndrome is defined as a constellation of signs and symptoms

- according to the APA (American Psychiatric Association) the necessary features for a true diagnosis of dementia include:

[1] erosion of recent and remote memory

[2] impairment of one or more of the following functions

- language (ex: aphasia)

- motor activity (apraxia) (although physical ability is intact)

- recognition (agnosia) (although sensory ability is intact)

- executive functions

- deficits must be sufficient enough to interfere w/functioning

- pts must have difficulty w/cognition, memory, language, visual-spatial skills, emotion, personality

- dementia is not a normal part of the aging process

37

Global Dementia Types

- there are reversible and irreversible dementia etiologies

- all possible etiologies for reversible dementia must be exhausted and ruled out prior to a pt being given a diagnosis of irreversible dementia

38

Reversible Causes of Dementia

- the reversible causes of dementia are treatable

- the reversible causes of dementias include:
infection, drug toxicity, vitamin deficiency, tumor, depression, normal pressure hydrocephalus, renal failure, CHF, thyroid disease, hypoglycemia, syphilis

39

Pseudodementia

- pseudodementia or geriatric depression is classified as a reversible dementia in some diagnostic models

- some suggest that ≤10% of dementias are reversible with more than 2/3’s of them resulting from drug toxicity, depression or metabolic disorder

- pts with pseudodementia present w/cognitive impairments, difficulty sleeping, appetite changes and decreased affect

- drug tx is generally successful in improving affect and cognitive symptoms

40

Irreversible causes of dementia

- alzheimer’s disease

- pick’s disease

- frontotemporal dementia or PPA

- creutzfeldt-jakob’s disease

- huntington’s disease

- multiple infarctions

- vascular disease

- wilson’s disease

- parkinson’s disease

- lewy body disease

- binswanger’s disease

- HIV

- PSP- Progressive Supernuclear Palsy

41

Dementia Classifications

- cortical dementias

- subcortical dementias

- progressive dementias

- primary dementia

- secondary dementia

42

Signs of Possible Dementia 1

- getting lost in familiar places

- repetitive questioning

- odd or inappropriate behaviors

- forgetfulness of recent events

- repeated falls or loss of balance

- personality changes

- decline in planning and organization

- changes in diet/eating habits

43

Signs of Possible Dementia 2

- changes in hygiene

- increased apathy

- changes in language abilities, including comprehension

- dx of dementia is not usually given if there is no impairment in social functioning and independent living

44

Communication Language Deterioration

- communication is the sharing of information by means of an arbitrary symbol system

- communication is a manifestation of cognition

- persons w/dementia have difficulty w/intentional communication because they have multiple cognitive deficits

- in pts w/dementia, the degree of language impairment is often proportionate to the deterioration of other mental functions




45

Early Stage Dementia

- sounds:
used correctly

- words:
may omit a meaningful word, usually a noun when talking in sentences; may report anomic issues; vocabulary is shrinking

- grammar:
generally correct

- content:
may drift from topic; reduced ability to generate series of meaningful sentences; difficulty comprehending new information; may be vague

- use:
knows when to talk but may talk too long on a subject; may be apathetic, failing to initiate conversation appropriately; difficulty w/humor, analogies, sarcasm and indirect/non-literal statements

46

Middle Stage Dementia

- sounds:
used correctly

- words:
difficulty w/thinking of words in a category; anomia in communication; difficulty naming objects; vocabulary is noticeably diminished

- grammar:
sentence fragments and deviation common; difficulty w/complex grammatical sentences;

- content:
frequently repeats ideas; forgets topic; talks about events of past; few ideas

- use:
knows when to talk; recognizes questions; may fail to greet; loss of sensitivity to communicative partners; rarely corrects mistakes

47

Late Stage Dementia

- sounds:
generally used correctly; errors are not uncommon

- words:
marked anomia; poor vocabulary; lack of word comprehension; neologisms; jargon

- grammar:
somewhat preserved; sentence fragments and deviations common; may lack comprehension of many grammatical forms

- content:
generally unable to produce sequence of related ideas; content is meaningless and bizarre; subject of most meaningful events is from the past; marked repetition of words and phrases

- use:
generally unaware of surrounding and context; little meaningful use of language; some pts will be mute; some pts will be echolalic