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1

Changes associated with the aging population: immune system

Impaired T-cell response to antigen

Increase in function of autoimmune bodies

Increased susceptibility to infection and neoplasia 

Leukocytes unchanged, T lymphocytes reduced

Increased erythrocyte sedimentation (nonspecific) 

2

Changes associated with the aging population: integument system

Graying of hair results from decreased melanin production in hair follicles (by age 50, 50°/o of all persons male and female are at least 50°/o gray; pubic hair is last to turn gray) 

General wrinkling of skin Less active sweat glands

Decrease in melanin

Loss of subcutaneous fat

Nail growth slowed 

3

Changes associated with the aging population: musculoskeletal

Decrease in height because of shortening of spinal column (2-inch loss in both men and women from the second to the seventh decades) 

Reduction in lean muscle mass and muscle strength; deepening of thoracic cage 

Increase in body fat 

Elongation of nose and ears 

Loss of bone matrix, leading to osteoporosis 

Degeneration of joint surfaces may produce osteoarthritis 

Risk of hip fracture is 10°/o to 25°/o by age 90 

Continual closing of cranial sutures (parietomastoid suture does not attain complete closure until age 80) 

Men gain weight until about age 60, then lose; women gain weight until age 70, then lose 

4

Changes associated with the aging population: Genitourinary/Reproductive

Decreased glomerular filtration rate and renal blood flow

Decreased hardness of erection, diminished ejaculatory spurt

Decreased vaginal lubrication

Enlargement of prostate 

Incontinence 

5

Changes associated with the aging population: special senses

Thickening of optic lens, reduced peripheral vision 

Inability to accommodate (presbyopia)

High-frequency sound hearing loss (presbyacusis)-25°/o show loss by age 60, 65°/o by age 80 

Yellowing of optic lens

Reduced acuity of taste, smell, and touch

Decreased light-dark adaption 

6

Changes associated with the aging population: neuropsychiatric

Takes longer to learn new material, but complete learning still occurs 

Intelligence quotient (IQ) remains stable until age 80

Verbal ability maintained with age 

Psychomotor speed declines 

7

Changes associated with the aging population: memory

Tasks requiring shifting attentions performed with difficulty 

Encoding ability diminishes (transfer of short-term to long-term memory and vice versa) 

Recognition of right answer on multiple-choice tests remains intact 

Simple recall declines 

8

Changes associated with the aging population: cardiovascular

Increase in size and weight of heart (contains lipofuscin pigment derived from lipids) 

Decreased elasticity of heart valves

Increased collagen in blood vessels Increased susceptibility to arrhythmias 

Altered homeostasis of blood pressure 

Cardiac output maintained in absence of coronary heart disease 

9

Changes associated with the aging population: GI

At risk for atrophic gastritis, hiatal hernia, diverticulosis 

Decreased blood flow to gut, liver 

Diminished saliva flow 

Altered absorption from GI tract (at risk for malabsorption syndrome and avitaminosis) 

Constipation 

10

Changes associated with the aging population: Respiratory

Decreased vital capacity

Diminished cough reflex

Decreased bronchial epithelium ciliary action 

11

Elder abuse: physical

Physical force: Result in bodily injury, pain, or impairment

Acts of violence: striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, burning.

Inappropriate use: drugs, physical restraints, force feeding, and physical punishment of any kind.

Signs: bruises black eyes, welts, lacerations, rope marks, bone fractures, wounds: cut, punctures, various stages of healing, sprains, dislocations, internal injuries. Lab finding of medication overdose or under utilization, being hit slapped, kicked, mistreated.

Sudden change in behavior, care givers refusal to allow visitors to see an elder alone.

12

Elder abuse: sexual

Non-consensual sexual consent of any kind

Sexual contact w/ any person incapable of giving consent

Ex: unwanted touching, rape, sodomy, coerced, nudity, sexual explicit photographing

Signs: Bruises around breast or genital area, venereal disease or genital infection, vaginal or anal bleeding, torn stained bloody unclothing, report f being sexually assaulted or raped

13

Elder abuse: Emotional or Psychological

Infliction of anguish, pain, or distress through verbal non verbal acts

Verbal assaults, insults, threats, intimidation, humiliation, harassment

Isolating victims from their family, friends, regular activities.

Treating older person like an infant

Silent tx and enforced social isolation

Emotionally upset or agitated

Extremely withdrawn and non-communicative of non-responsive

Unusual behavior: sucking, biting, rocking

An elders report of being verbally or emotionally mistreated

14

Elder abuse: Abandonment

Desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder

Desertion of an elder at a hospital, nursing, facility or institution

Desertion of an elder at a shopping center or other public place

Elders report of being abandoned

15

Elder abuse: Financial or material exploitation

Illegal or improper use of elders funds, property, assets

Ex: cashing checks w/o auth or permission, forgiving a signature, misusing or stealing money

Sudden change in bank account/ banking practice

Unauth w/d of elders bank signature card,

Funds using an ATM card

Abrupt changes in a will

Disappearance of funds

Substandard care provided or bills unpaid despite the availability of financial resources

Discovery of an elders signature being forged

Relatives claiming their rights

Unexplained sudden transfer of assets

16

Elder abuse: Neglect

Behavior of an elderly person that threatens his/her own health safety

Manifested as refusal or failure to provide himself/herself with adequate food/water/clothing

Excludes: a situation in which a mental competent older person who understands consequences of their decisions and makes conscious decisions to engage in acts that threaten their health or safety as a matter of personal choice.

Dehydration, malnutrition, untreated medial conditions or poor hygiene

Hazardous unsafe living conditions/arrangements

No indoor plumbing/heat/running water

Unsanitary/unclean living quarters

Grossly inadequate housing/homeless

17

REM sleep

Rapid eye movement

Body paralysis

Mind very active

Vivid dreams

Problem-solving

18

NREM sleep

Slow eye movements

Lower physiological functions

Peaceful state relative to waking

HR, respiratory, and B/P is lower

Involuntary body movements

Unusual arousal characteristics

19

Insomnia

Difficulty initiation or maintaining sleep

Transient or persistent

Dissatisfaction with sleep quantity or quality associated with one or more:

Difficulty in initiating sleep

Difficulty in maintaining sleep w/ frequent awakenings

Problems returning to sleep

Early morning awakening w/ inability to return to sleep

20

Hypersomnolence Disorder

Excessive sleepiness

Life-threating noncommunicable conditions

Sleepiness can be a consequence of

Insufficient sleep

Basic neurologic dysfunction in brain systems regulating sleep

Disruptive sleep

A phase of an individual's circadian rhythm

21

Narcolepsy

A condition characterized by excessive sleepiness as well as auxiliary symptoms that represent the intrusion of an aspect of REM sleep into the waking states

Sleep attacks

Irresistible sleepiness, leading to 10-20 minutes of sleep

Can occur at inappropriate times: eating, driving, talking, during sex.

22

OSA

Repetitive collapse or partial collapse of the upper airway during sleep

As pt falls asleep, airway resistance increases

Decrease arterial oxygen saturation and transient arousal after which respiration resumes normally

23

Define parasomnias

Abnormal behavior or physiological events occurring in association with sleep specific sleep stages or sleep wake transitions

24

Sleepwalking

Repeated episodes of rising from bed during sleep and walking about

While sleepwalking the individual has a blank starting face, is relatively unresponsive to the efforts of others to communicate with him/her

Can be awakened only w/ great difficulties

NREM sleep

25

Sleep (Night) Terrors

Recurrent episodes of abrupt terror arousals from sleep

Usually beginning with a panicky scream,

There is intense fear and signs or autonomic arousal

Mydriasis tachy, rapid breathing, sweating.

There is relative unresponsiveness to efforts of others to comfort the individual during these episodes

NREM sleep

26

Nightmares

Frightening or terrifying dreams

Produce sympathetic activation and ultimately awaken the dreamer

Occur during the REM sleep

27

Isolated sleep paralysis

Inability to make voluntary movements during sleep

Induvial is partially conscious and aware of their surrounding

REM sleep