HLTB01 Chapter Notes.docx

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University of Toronto St. George
Trinity College Courses
Michelle Silver

The Aging of the Population.  There has been a dramatic change in population demographics in the last century that continues to provide ongoing challenges for health care providers to provide adequate services to the increasing number of older adults in the world.  Population Aging in the United States:  In 1905, children and young people represented a large segment of the population with only a small percentage of individuals of 65 years of age and older.  In 1900, there were only approximately 100,000 people who were over the age of 85 in the United States. The probability of reaching 100 years of age improved during the 20 th century. In 1879, a person had a 1/400 chance of living to be 100 years old, but as of 1980, there was a 1/87 chance to living to 100. Definitions:  Total Dependency Ratio (TDR) – compares the number of economically non-productive citizens (below age 18 and age 65 and older) with the number of working-aged adults. The age dependency ratio is a rough estimate of the number of people who need to be supported by workers. The equation is: TDR = (a+c)/b where a = Children <18, b = adults 18-65, and c = adults 65 and older.  Life Expectancy – is the average number of years a person in a particular cohort can expect to live.  Fries and Crapo (1981) noted that survival tables showed an increased squaring of the curve, with larger numbers of people surviving until late life. Demographic trends suggested that the onset of major chronic disabling illness had been delayed. He proposed a fairly rosy scenario, that people would remain healthy longer, until a few months before their maximum life span (about 85) and would then die after a relatively short period of disability.  Socioeconomic Status (SES):  SES has highly significant effects on morbidity and mortality. Although most older people in the United States have adequate incomes, there are others who live in poverty or near the poverty line at a time when there is little possibility of economic growth. Furthermore, health care, and transportation costs are often greater in later life.  International Aging: 1  Worldwide, there were approximately 420 million people 65 years of age or over in 2000. Demographically, the European countries and Japan have the greatest percentage of older adults in their populations; Italy is first in this respect.  Most nations have increasing numbers of older adults in their populations.  Demographic Transition:  Demographic Factors and Rate of Aging:  Demographic predictors of longevity include gender, marital status, ethnicity, and socioeconomic status. Chapter 2 Total dependency ratio (TDR) – (a+c)/b The leading cause of death used to be infectious disease but has changed dramatically. Compression of morbidity – people would remain healthy longer, until a few months before their maximum life span and would then die after a relatively short period of disability. Others have said that extension of morbidity – people living longer with disabilities. Whether there is a maximum life span in humans has not been resolved Half the world‟s population of older adults live in developed countries and the other half in developing countries but this will change where by 2030, more than twice as many older people will be in developing countries. Demographic transition is used to describe the process by which a society or nation moves from one of high birthrate and high mortality to one of low birthrate and low mortality. Demographic Factors and Rate Of Aging Gender – men and women used to have similar life expectancies largely due to infectious disease. Now, women live longer than me – expectancy increased for both genders but more for women. Reasons – reduced pregnancy and childbirth mortality rates that started in the late 1800s and early 1900s. More males are conceived and born than females, but male death rates exceed female death rates at every age of life. Males are more likely to have prenatal and neonatal problems and are more susceptible. In adulthood, men develop heart disease earlier than women, typically beginning in midlife. Despite the longeiveity, women typically report poorer health than men. They also have higher rates of disability. Why are men likely to die more than women if they are sicker? Because women often report more illnesses that are nonfatal while men suffer more fatal ones. In very late life, there are indeed „two girls for every boy‟. Marital Status – marriage appears to provide the greatest health benefits, divorce the most difficult problems, and widowhood mixed results. Men are much more likely to be married than women. Married people often have better health behaviour habits, more likely to have better diets and exercise regularly, have higher incomes and thus higher socioeconomic status, also the social integration that accompanies marriage is important for health. Both men and women appear to suffer from mental health problems after being widowed, although it may be more prominent among men than women. 2 Ethnicity – asian and pacific islanders had the greatest life expectancy at birth, followed by European Americans, American Indians, and African Americans. Immigrants tend to be healthier. There seems to be a crossover of age age-specific life expectancy in later life. Socioeconomic Status (SES) – tweeners – they make too much money to receive most federal and state services such as Medicaid or SSI, but too little to have financial security. They myth persists that older people need less money, and poverty levels are set accordingly. Therefore, a younger person making a certain amount of money would be considered living in poverty while a older person would not. Older women are among the poorest people in the country, especially if they are widowed and live alone – factors include inadequate education, resulting in low paying jobs. The longer a person lives, the greater the risk of poverty. The effect of SES on longevity may decrease as a person gets older. Chapter 3 – Theories of Aging Two reasons why there is a lack of integration in theories of gerontology. First, there are three different aspects of age on which theories can focus: characteristic of the aging population, the developmental or aging process, and the way in which the age is incorporated into the social structure. Second, gerontology has historically been a bottom up discipline; it starts from facts that may be grouped loosely into models and only rarely become theories. Maruyama‟s deviation amplification model – most systems have deviation-countering mechanisms to maintain homeostasis. Systems can change over time. Once a system is jarred out of homeostasis, then deviation amplification mechanisms can take over, accelerating the change or imbalance. Chaos theory shows how initially small changes can result in very large differences between systems or individuals. Biological Theories of Aging Genetic Theories: Programmed Cell Death (Apoptosis) – existence of a death gene- a gene that regulates sudden cell death. There may be a positive correlation between the life span of a species and the number of times a cell will replicate. The number of times a cell will replicate is partially regulated by the length of telomeres. The absence of these processes could well shorten life, as apoptosis and senescence may be one way of getting rid of damaged and cancerous cells. senescence is the major protection against cancer and is a form of antagonistic pleiotropy – a process that is helpful and promotes reproduction in early life but may have harmful effects in later life. Stochastic Processes – there may be a limited number of times that a cell can replicate without error. DNA in the mitochondria may be particularly susceptible to damage and is because of the close proximity of mitochondrial DNA to reactive oxygen. DNA repair mechanisms – base excision repair, nucleotide excision repair, mismatch repair, and repair of strand breaks. Sometimes the errors don‟t get detected and other times it could be tolerated and the cell uses replication bybass. 3 Molecular/Cellular Theories of Aging: Oxidation – free radicals or reactive oxygen species (ROS) are molecules that are generated during the oxidation process. ROS is chemically unstable and can interfere with the functions of other molecules. Superoxide dismutase (SOD) are cells that produce antioxidant factors. The concentration of free radicals increases with age, because more free radicals are generated in aging cells, there appears to be a decrease in the ability of the cell to generate antioxidants, and cellular repair mechanisms become less efficient. Lipofuscin - aging cells accumulate waste matter called lipfuscin. Heat Shock Proteins – play a major role in protecting cells from nearly every kind of stressor, from radiation to infection to oxidation. They are found in every living organism. These are also called „molecular chaperones‟ because they assist in protein synthesis and repair. They also control inflammation. Apoptosis – a cell systematically dismantles and repackages itself. Necrosis – the cell ruptures and spews toxic chemicals and distress signals. System Level theories: Homeostasis – as we age, it becomes harder to maintain homeostasis. Three factors: there may be a decline in the production of hormones (estrogen), the target organs becomes less responsive either due to fewer receptors or degradation in the functioning of receptor sites, and third the target organ may synthesize less than optimal amounts of its product. Wear and Tear Theories – with continual use, our organs and joints simply wear out. For most organ systems, this does not hold. The one exception to this is the skeletal joints. Stress – a modern reincarnation of the wear and tear theories. Hormesis – moderate exposure to toxins or stressors may promote future resistance to stress and enhance longevity. Interrelationships Among Levels of Analysis – these are all linked. Psychosocial Theories of Aging Classical Theories Ontogenetic Models – posit that development stems from internal forces and consists of stages that are universal, sequential, and irreversible. Erickson‟s eight stages that all are dialectical is a prime example of ontogenetic. Sociogenic Models – ontogenetic theories were strongly criticized for positing one primary goal or developmental pathway and ignoring differences in life courses due to gender, social class, and cohort. Sociogenic focuses on changes in adulthood that varies as a function of social roles and historical contexts. Transitions that follow social norms are said to be on time and those that occur earlier or later are said to be off time. Disengagement theory – a mutual withdrawal between the individual and society as one ages. Activity theory – the more active the older person is, the greater the life satisfaction. The moderating factor is personal desire: The activity level preferred by older adults. 4 Current Theories Life Course Theory – examines the ways in which cohort and historical periods affect the life course structure of individuals. Development is seen as a series of transitions and choice points that are influenced by both immediate social context and the larger sociohistorical period, as well as gender and social roles. Goal Orientated Models – development in adult hood as a balance between gains and losses, with relatively more gains in early adulthood and more losses later. Like Erickson, Baltes proposed life span (as opposed to life course) theory, and the dialectical approach is seen here in positive and negative outcomes. Baltes did not propose a series of stages but instead used a process approach that describes adaptation to aging. Successful aging is characterized by the selection, optimization, and compensation model (think about the pianist that was older and practiced less songs to know them well). Brandtstadter‟s self development model – early adulthood is to achieve the ideal self which is mostly culturally determined, and in later life, the goal becomes to maintain the self as much as possible. Postformal Operations – emphasizes relativistic and dialectical reasoning. Relativistic reaonsing says that there are very few absolutes; instead, complex thinkers understand that the context modifies decisions and thought processes. Dialectical reasoning, it may be understood that there are often opposing but equally valid stances (thesis and counterthesis). Conscious Development – growing sense that adult development is something that individuals do , and not something that simply occurs. Mindfullness as three characteristics: the continuous creation of new categories, openness to new information, and an implicit awareness of more than one perspective. Liberative Model of adult development that defined adult development as increasing freedom from social and biological conditioning. In the liberative model, the method of development is based on self-observation. Loss can also play a central role to adult development, as it can force individuals to examine their own assumptions and develop new and more mindful ways of being. Interrelations Among Theories – early theories of adult development tended to focus on one aspect whereas contemporary theories tend to focus on multiple influences. Most current models emphasize some sort of agency, or conscious choice, in developmental processes. Psychosocial factors and aging There is fairly good presumptive evidence to argue that psychosocial factors and physical health are more tightly entwined in late life. Social breakdown Theory – relatively trivial events may snowball into serious problems for older adults because psychological, social, and physical health are so tightly intertwined. Others have shown that older adults are less vulnerable to psychosocial factors and even others have found no differential age vulnerability. Thus, the findings on relative vulnerability (or resilience) of older adults to the effects of psychosocial risk factors on health are mixed and likely vary by type of factor, health outcome, and age of the sample. Chapter 5 – Aging of the skin and musculoskeletal system 5 -The skin provides the covering for the body and is the first line of defense against bacteria, viruses and other type of environmental damage. -The bones,ligaments,tendons and muscles that make up the musculoskeletal system provide shape and support for the body,make movement and adjustments in position possible and protect the internal vital organs from external trauma. -The skin and musculoskeletal system provide the most obvious external signs of aging. Skin Basic Anatomy and physiology -The skin(integumentary system) is an important part of your immunologic and endocrine systems. Aging of the skin is one of the most obvious clues to an individual‟s age. Largest and most visible organ in the body. -The skin is the largest and most visible organ of the body. -The outermost layer of the skin is called the epidermis, and the second layer is called the dermis. -Below the epidermis and dermis is a layer of subcutaneous fat. -Keratinocytes: Cell that protect the skin from outside harm and help the skin to heal. -Epidermis has 90% of keratinocytes. [email protected] Young cells, keratinocytes are found deep, as the skin start to age, it goes up. -melanocytes, make up 2% of the cells in epidermis, produce melanin for kearinocytes and give skin color. -Langerhan, 1% of the cells in epidermis, important part of immune system. -The dermis consists largely of collegen and elastic tissue, which provides strength and elasticity to the skin. -Cells in dermis responsible for the skin‟s ability to respone to allergens. Age-related changes -As ppl get older, a decrease in the size and # of keratinocytes limits the skin‟s ability to help the body produce vitamin D. -Slower to heal -decrease in melanocytes affect the skin‟s ability to protect itself from the sun, also remaining melanocytes clump together, leaving blotchy uppigment area on the skin. -flattening of the juction between the epidermis and dermis. -The skin is much more likely to bruise and tear, less likely to heal. Disease-related processes Xerosis -most common dematological problem for older person - Red, scaly, and itchy skin on the legs, back and arms. -Cause in unknown, lack of vitamin A. -Treatment: Skin cream after bath. Seborrbeic Keratoses -Brown or black, have irregular edges, old age spots. - Occur in young adulthood, appear more frequently with age. -Sun exposure is a risk factor. Skin Cancer -Two common form of skin cancer; basal-cell and squamous-cell carcinomas. Basal cell Carcinoma -Appears as a small, fleshy bump or nodule, usually on the head or neck. 6 -Risk factor: exposure to the sun. -Slow growing Squamous-cell carcinomas: -Found on face or the back of the hand Appearance of a red, scaly and hard patch, become ulcerated and crusty with time. -Risk factor: Exposure to the sun, chronic irritation. Malignant melanomas: -Most dangerous -found in epidermis -red, white, blue or black growth with an irregular border. -Risk factor: Light skin, blond or red hair. -occur all ages. Pressure ulcers -occur in those who spend long period of time in wheelchairs or beds. -caused by pressure over a susceptible tissue. -very painful, hard to heal. - Begin when an area of skin damage, or breakdown of tissue over a bony prominence. Promoting Optimal Aging - The rate @ which skin ages is influenced by genetics, disease nutrition, smoking, social status, environmental conditions. - Skin is one of the first systems to be affected by poor nutritional intake - Element of a healthy skin included adequate food, fluid intake. - Lifetime exposure to sunlight and indement weather or pollutants has a major impact on the Skin. Musculoskeletal System Basic Anatomy and Physiology Bones -Provides structure and strength -The size and shape of the bones various -All bones are made up of trabecular or cortical tissue -Cortical bones are tightly packed, very strong, 75% of the body skeletal weight. - Trabecular bone, which accounts for the 25% of skeletal weight, such as ribs, the end of long bones. -old bones resorbed by osteoclasts and new bone generated by osteoblasts. Soft Tissues -The tendon attachs muscles to bones. -Ligaments bind bones to bones and other structures -These tissues work to stabilize the joints between bones. - cartilage, connective tissue, is found on the ends of bones and acts as a cushion to protect the joints of the body, such as the knee joint. - three type of muscles: skeletal muscles are striated (the tubes of muscle fibers lies in rows). Each bundle of muscle fiber has a plate to which a motor neuron is attached. Stimulation by the nervous system either contracts or extends the muscle fibers, which pull against the skeleton, resulting in movement. 40% of the body`s mass comes from skeletal muscles. Smooth muscles are not attached to the skeleton but are found in the walls of internal organs and are responsible for contraction in the respiratory system and the digestive and urinary tracts. The most complex 7 muscle is the cardiac muscle. These muscles contract 72 times a minute, 24 hours a day every day. Unlike other muscles of the body, cardiac muscle initiates its own beat, although the rate changes due to the enervation by the sympathetic and parasympathetic nervous system. Age-related change Bones -peak bone mass is achieved by age 30 and then decreases -decrease in calcium, and vitamin D intake. -Trabecular bone become thin, weakening – earliest and greatest bone loss -Cortical:Change later on , become thin and weaken. Women are at a greater risk for bone loss than men, particularly in the years during the immediately following menopause. Soft Tissues: -25% decrease in range of motion. - Cause stress on the bone -Muscle loss. Disease-Related Processes Osteoporosis -bone loss and deterioration so severe that bone can fracture - Called silent disease, no obvious symptom -increased porosity of the trabecular bone and thinning of the cortical bone -Risk factor: Weight loss, European, American, Asia American women, low calcium diet Osteoarthritis -fractures of the lower thoracic and upper lumbar areas of the vertebrae are fairly common -skeletal kyphosis (dowager`s hump) – severe and often painful condition of the spine that affects not only posture and height. -wrist fractures are more common among those aged 50 to 60 and hip fractures among those aged 75 and older and reasons for these differences are age-related changes in gait and a lack of balance. -this is one of the few skeletal disorders associated with significant mortality – 20% of people that have a hip fracture die within a year -treatments include: calcitonin – naturally occurring hormone that works directly on osteoclasts to prevent trabecular bone loss. Bisphosphonates are synthetic medications that have been used successfully to increase bone mass. Estrogen is also good for women that are older. Osteoarthritis -most common form of arthritis and not a single disease but a group of osteoarthritic disorders. In this disease, the protective cartilage thins or is damaged, allowing the bones of the joints to rub together, resulting in injury. Not clear whether the disease starts in the cartilage or the bone. -by the age of 55, most people will have some form of osteoarthritis but not every older person will have it and not every joint if affected in those who do have the disease. -osteoarthritis is not a result of normal aging process in the joints, as many of the changes found in the cartilage and bone in this disease are different from normal aging changes. -osteoarthritis thickens the bones while osteoporosis thins the bones and therefore it is rare to find these two diseases co-ocurring. -disease does not cost death but linked to high levels of disability -treatment is centered around maintenance of the joint function and pain relief. Bursitis, Tendinitis and Back Pain: 8 -bursitis is inflammation of the fluid-filled sacs that are found where muscles cross over bony prominences, such as shoulder -tendinitis is inflammation of a tendon -the two disorders above are usually due to an injury or years of overuse of the joint -back pain is probably the most common source of discomfort and limitation in older people, has causes from damage to the vertebrae due to degeneration of the disks and resulting compression of the nerves. -treatment: exercise and rest Promoting Optimal Aging -Maintenance of the musculoskeletal system into very later yrs is important. -exercising and adequate protein intake can decelerate the loss of muscle mass that occurs with aging. -maintenance of healthy bone tissue depends on factors such as adequate intake of calcium and vitamin D. -weight bearing exercise such as walking or lifting weights help to increase bone density and strength, as there is a direct positive relationship between bone volume and mechanical strain on a bone. -exercise stimulates the synovial tissue to produce synovial liquid, helping to lubricate joints and protect them against arthritis Chapter 6 Aging of the Internal Organ Systems 1. Cardiovascular System Basic Anatomy and Physiology  The cardiovascular system is the body’s main transportation system.  It sends supplies such as fluids, nutrients, hormones, oxygen, and antibodies to tissues in the body while at the same time removing waste products such as carbon dioxide and hydrogen ions.  The system is composed of the heart, blood vessels (arteries, arterioles, capillaries, veins and venules), and blood. In general, arteries carry blood away from the heart, and veins carry blood to the heart. Blood  Blood is a highly complex fluid composed of water, red and while blood cells, and platelets, as well as nutrients such as fat globules, carbohydrates, and proteins.  It is perfused by gases such as oxygen, carbon dioxide, and nitrogen.  Blood also carries electrolytes, to help maintain the acid/base balance, and a host of other chemicals, including hormones, neurotransmitters, and various other peptides necessary to regulate homeostasis, cognition, movement, and every other function of the body. 9 Heart  The heart is the centre of the circulatory system.  It is located behind the chest wall, in a slightly canted position, with the midsection somewhat to the left of the sternum, or breastbone.  It is enclosed in a fibrous sac called the pericardium.  The left and right sides of the heart each have two upper chambers (atria), which collect the blood, and two lower chambers (ventricles), which pump the blood to the lungs and the rest of the body. Anatomically, the atria are thin-walled; the walls of the ventricles are thicker and more muscular, as they do the long-distance pumping.  The right and left sides of the heart each serve as a pump. Blood Pathway  Oxygen-poor blood is collected in the right atrium from the large veins of the body, the superior and inferior vena cava.  From there it flows to the right ventricle and is pumped via the pulmonary arteries into the capillary system of the lungs for carbon dioxide and oxygen exchange.  Oxygen-rich blood is sent via the pulmonary veins to the left atrium, from there it flows to the left ventricle and is pumped out through the aorta.  The blood from the aorta flows into the large arteries and then to the smaller arteries, arterioles, and the capillaries.  The rate of blood flow is largely determined by physical demands on the body. Capillaries  Capillaries are very small- one cell wide- fluid, nutrients, electrolytes, hormones, and other substances are exchanged Venules  Collects blood from capillaries and move it into larger and larger veins (reaching superior/inferior vena cava)  64% blood volume is found in veins  Walls of veins and arteries: flexible smooth muscle, elastic fibers, and collagen Beat Sinoatrial node (pacemaker) upper part of right atrium ↓ Spreads down the heart through atrial myocardium to reach atrioventricular node ↓ conducted to atrioventricular bundle & purkinje fibers ↓ Sent to both ventricles ↓ Single moves down and contraction of cardiac/heart muscle begins 10 Systole- contraction of heart Diastole – relaxation of the heart Asystole- no heartbeat Lub – first/loudest sound of a heartbeat (valves b/w atria & ventricles close and ventricles contract) Dub- second/softer (closure of the valves b/w ventricles & large arteries (pulmonary & aorta) Carotid artery- neck Radia artery- outer edge of wrist Pedal pulse- top of foot Popliteal pulse- back of the knee Age-Related Changes  Enlargement of the heart with age- due to increase size in muscle cells & myocites  By age 75, 10% of pacemaker cells remain  Changes in the collagen in the middle layer of the large arteries of the body cause them to thicken and become stiff  Fat tissue surrounds the sinoatrial node, leads to abnormally slow pulse - bradycardia  Overall, heart function is less efficient with age  Most of the normal aging changes have little impact on the everyday functioning of an older person Disease-Related Processes Hypertension  Optimal blood pressure for adults over the age of 18 is 120/80 or lower. (The first number refers to the systolic and the second to the diastolic pressure.)  Blood pressure is still considered normal at a reading of 130/85, but at 140/90 or greater, it is classified as hypertension (although some have argued that 160/90 is normal for older adults).  Hypertension is one of the most prevalent problems in the older population. About a quarter of European Americans and a third of African Americans over the age of 65 suffer from hypertension.  Systolic hypertension (a high reading in the systolic pressure only) increases throughout life, whereas an elevation in diastolic pressure tends to level off in later years.  High blood pressure affects all the major arteries of the body and the organs and tissues that they serve.  Highly variable (or labile) blood pressure refers to rapid expansion and contraction of the arteries.  Both conditions damage the collagen in the arterial walls, making them stiffer. 11  It also damages the lining of the arteries, contributing the atherosclerosis, and increases the risk of heart and kidney disease, peripheral vascular disease, and cerebral vascular accidents (strokes), which can lead to dementia.  One of the dangers of hypertension is that damage from the disease occurs in the absence of symptoms.  Hypertension has a number of causes, including changes in kidney function, obesity, hormonal changes, increased sensitivity to sodium, and genetic propensities.  It also results from arthrosclerosis and atherosclerosis. Arteriosclerosis and Atherosclerosis  Arteriosclerosis refers to the thickening and loss of elasticity of arterial walls. Stiffened arteries tend to be slightly contracted, raising blood pressure and leading to hypertension, which can create further damage to the walls. Thus, high blood pressure both results from and is a cause of arteriosclerosis. One of the most common forms of arteriosclerosis is atherosclerosis, or the deposition of plaques inside the arterial wall. Atherosclerosis creates a disruption of blood supply to all systems of the body.  The disease can be caused by: o Traumas, toxins, viruses, cholesterol, low-density lipoproteins (LDL), triglycerides, dead blood cells  Risk factors: male, family history, smoking, diet high in saturated fat, diabetes, hypertension, obesity, sedentary lifestyle Peripheral Vascular Disease  Atherosclerosis can also damage peripheral blood vessels. In peripheral arterial occlusive disease (PAOD), arteries that carry blood to the legs and feet are partially or completely blocked due to arthrosclerosis, resulting in a decrease in the supply of oxygen and nutrients to these areas.  Symptoms of PAOD include pain, a pale or bluish colour to the skin of the feet and legs, and a lack of hair growth in these areas. Another symptom is a weak or nonexistent arterial pulse in the lower extremities, such as the popleteal and pedal pulses felt at the back of the knee and the top of the foot, respectively.  Causes: smoking (constriction of blood vessels), diabetes (impaired circulation), & physical inactivity. Coronary Heart Disease  Coronary heart disease (CHD) results from atherosclerosis of the coronary arteries of the heart.  It is the leading cause of disease in the older population and is a major cause of disability and death.  Among those over the age of 65, about 85% of deaths from heat disease are due to CHD. 12  Heart disease typically at an earlier age for men than for women, although after menopause, there is a rapid progression of the disease in women, probably due to a decrease in estrogen levels. In later years, the incidence of CHD for men and women is similar, although women are less likely to be diagnosed or treated fro the disease.  Risk Factors: smoking, high blood pressure, high cholesterol, being overweight, inactive lifestyle.  Angina pectoris is a common symptom of CHD. It develops when the demand for blood to the heart muscle is greater than what can be supplied.  It can be a temporary, although painful, condition that resolves when the person is resting or relaxed. On the other hand, angina pectoris is one of the symptoms of an impending heart attack, especially among older people.  Generally, angina is felt as pain that radiates to the left shoulder and down the left arm or to the jaw or back.  However, older people may also have dyspnea (difficulty breathing), coughing, or confusion.  Dyspnea- difficulty breathing, coughing, confusion  Myocardial infarction (MI)- heart attack (artery in the heart is blocked b/c of blood clot) Heart Failure  One definition of heart failure is the cessation of a heartbeat, with death imminent.  Another use of the term heart failure describes a heart that is no longer able to pump blood to meet the metabolic needs of the body‟s tissues.  This is the type of heart failure addressed in this section.  Unlike hypertension and coronary artery disease, which are found among younger people, heart failure is almost exclusively a disease of older people.  Left ventricle less able to pump blood  Kidneys are affected and restrict release of water and sodium, which leads to an excess of fluid in the body‟s venous system – increase in blood flow to heart and lungs – ventricles are slow at pumping blood.  Decrease in hypertension and CHD and increase in heart failture- 10% of over age 80 have heart failure. 2. Respiratory System Basic Anatomy and Physiology  The primary function of the respiratory system is to transfer oxygen from the air into the bloodstream and to remove carbon dioxide.  The breathing process is highly complex and involves not only the respiratory tract but also the muscles of the abdomen, chest, and diaphragm.  To breathe in, the diaphragm and intercostal (rib cage) muscles of the chest contract, causing the diaphragm to lower and the thoracic cavity to expand. 13  The decreasing pressure in the chest cavity creates a relative vacuum that forces the air to flow into the lungs.  With expiration (breathing out), the relaxing diaphragm bow upward and the intercostal muscles relax, allowing the air to leave the lungs. AIR MOVEMENT: Nasal Cavity → Nasopharynx → Trachea → Bronchi → Bronchioles → Alveoli (Each being smaller than the previous) Alveoli- perfused by capillaries – site where blood exchange occurs ( replenish oxygen and extract CO2 from blood) ** Lungs have most extensive network of capillaries than any organ in the body. Mast Cells- lines the respiratory tract, are immune systems first line of defence against airborne germs & viruses Ex. Sneezing & coughing clears upper/lower respiratory passages Cilia- clear mucus & other detritus from lungs in a sweeping motion Control Centre (brain)- controls rate & depth of breathing in medulla oblongata and pons [ balances intake and excretion of O2 and CO2) Lung volume- amount of air expired with each breath Tidal volume- person resting quietly Vidal capacity- tidal volume + extra amounts person can breathe in and out Residual volume- remaining air left after expiration of air Lung Capacity- vital capacity + residual volume Age-Related Changes  Intercostal & diaphragm muscles become weaker  Chest wall becomes stiffer (reduces ability of lungs to expand & contract)  Collagen & elastin becomes less elastic  Alveoli- enlarged & flattened  Bronchioles collapse –trapping air  Normal decrease in cough reflex (which fought infections)  Ciliary function- decreases with age plus decrease in T-cell immunity Disease-Related Changes Lung Cancer  Currently, lung cancer is the leading cause of cancer death in both men and women in the United States. The rate of death from lung cancer has changed in the last decade, but varies by ethnicity and age.  The two most common types of lung cancer are small-cell and non-small-cell cancer  Small cell lung cancer- grow rapidly, high rate of metastasize  Non-small cell lung cancer – slower growing, less likely to metastasize (older adults)  Unfortunately, lung cancer is often under diagnosed among older people. One reason is that many symptoms of the disease – such as persistent cough, shortness of breath, and weight loss – are common occurrences in late life, especially in 14 those who have other diseases. Therefore, careful screening of older persons who present with these symptoms is critical  Lung cancer is frequently under treated in older people, although they do well with current therapies. Surgical treatment of non-small-cell lung cancers was equally beneficial for the old as for the young.  As is true with all persons undergoing treatment for lung cancer, older adults and their families require extensive supportive care to maintain a reasonable quality of life. Pneumonia  Although infectious disthses are not the frequent cause of death that they were at the beginning of the 20 century, pneumonia is still a serious illness for a frail older person.  As might be expected, pneumonia is especially virulent among those over 80 and those who live in crowded places such as institutions.  Pneumonias found in nursing homes are often caused by unusual and more virulent organisms than those circulating in the community.  Spread quickly among nursing home patients  Frail older people are particularly vulnerable to pneumonia because of normal aging changes in the lungs, including: decreased lung capacity, inadequate cough reflex, and a decline in immune function.  Aspiration pneumonia- common among old, with difficulty in breathing, drinking, eating, or taking medications  Caused by intake of susbstances such as food, fluids, medications Diagnoses: Difficult to understand due to different among the young and the old with pneumonia Young people: fever, chills, cough Older people: confusion, poor appetite, or weakness and/or loss of ability Chronic Obstructive Pulmonary Disease  Chronic obstructive pulmonary disease (COPD) is a general term for several diseases of the respiratory tract, two of the most common of which are chronic bronchitis and emphysema.  The majority of people with chronic bronchitis also have emphysema.  COPD is a leading cause of both morbidity and morality among the older population, ranking as the fourth leading cause of death in those 65 years of age and older.  COPD Symptoms: shortness of breath, fatigue, coughing (strongly related to smoking; may happen due to exposure to asbestos, lead in paints) 1. Chronic bronchitis is the most common of the COPD disorders.  In chronic bronchitis, the cells of the respiratory tract are inflamed and secrete copious amounts of thickened mucus, making it difficult for the person to clear his or her respiratory tract. 2. Emphysema 15  Characterized by abnormal and permanent deterioration of tissue at the end of the respiratory tract, in the smallest bronchiole and alveoli.  With time, there is scarring on the surface of the alveoli and they become less elastic.  Over time, alveoli become flattened and unusable or are lost outright.  Thus, there is increasingly limited alveoli surface area for gas exchange, causing shortness of breath.  Furthermore, there is an excessive secretion of mucus, and the alveoli and bronchiole close prematurely with expiration.  The person with emphysema has to work hard to exhale and get rid of trapped air. In both illnesses- use the sternocleidomastoid muscles in the upper chest to aid in expanding the lungs Tuberculosis  Tuberculosis (TB) is a bacterial infection that can occur in several different organs but particularly affects the lungs.  Groups that show TB: homeless, prison populations, HIV patients, some immigrant groups  Bacteria may remain dormant for years (infection), and may become a disease in those with frail immunity  Symptoms: chronic fatigue, cognitive impairment, persistent low-grade fever ** Smoking: lowers good cholesterol levels, promotes atherosclerosis (increasing blood fibrinogen, & viscosity levels (leads to blood clots) ** Aerobic exercising: increases vital capacity, VO2 max ( max. volume of O2 that can be processed) 3. Gastrointestinal System Basic Anatomy and Physiology  The gastrointestinal (GI) system consists of the organs and glands needed for processing and absorption of fluids, electrolytes, and nutrients.  The digestive tract extends from the mouth to the anus and includes: the teeth and mouth, esophagus, stomach, and small and large intestines.  The large intestine includes the cecum; ascending, transverse, and descending colon’ the sigmoid colon; and the rectum.  Organs such as the liver, pancreas, and gall bladder also are part of the digestive system.  The digestive process includes the secretion of gastric acids and enzymes that break down nutrients into their component parts, which are then absorbed into the blood system for delivery throughout the body.  Carbohydrates get broken down into sugars such as glucose and glycogen for energy use or for conversion into fats for storage. 16  Proteins are broken down into their component amino acids that are used to construct the new proteins necessary for maintenance and growth of cells and every other body function.  Fats are converted into fatty acids and glycerol, used for building cell membranes, absorption of fat soluble vitamins, and energy.  The GI system also provides for the elimination of the body‟s waste products.  Gastroesophageal sphincter relaxes to allow food move into stomach  Contraction of esophagus & constriction of gastroesophageal sphincter prevents partially food from flowing back into esophagus  Stomach churns food & secretes powerful gastric acids & enzymes –begins digestion of carbohydrates & proteins Pyloric glands (duodenum)  secrete thin mucus that lubricates food & protects stomach from gastric juices Chyme = Processed food  moves by peristalsis through relaxed pyloric sphincter into small intestine Duodenum  enzymes secreted from intestinal mucosa to digest food Jejunum  9 ft and third part of ileum-13 ft long Villi  increases surface area ( absorption of water, electrolytes, & nutrients take place) Large Intestine  5ft long- extend to rectum ( no villa – secretes few enzymes; reabsorbs water & electrolytes) Bicarbonate ions  protect the walls of intestine from strong acids & help in forming fecal (waste) products Pancreas  tucked behind stomach – secretes enzyme necessary for digestion; sodium bicarbonate to neutralize gastric acids; insulin ( regulates blood glucose) Liver  right side of body beneath diaphragm – regulates metabolism of carbohydrates, fats, proteins & breaks down toxins (ex. Alcohol, medication)  converts highly toxic byproduct ammonia into urea  storage for iron & fat-soluble vitamins A, B, D, E, K.  manufaturs fibrinogen, prothrombin (for blood clotting)  Secretes bile- necessary for digestion/ absorption of fats & cholesterol Age-Related Processes  Vitamin B12 deficiency- cause of pernicious anemia, neurological deficits (gait problems & motor loss)  Vitamin A excess can cause toxicity –requirement decreases with aging  Lining of large intestine becomes thinner  Decrease in liver cells (hepatocytes) and weight of liver 17 Disease-Related Processes Periodontal Disease  Periodontal disease is a disease of the structures that support the teeth, including the bone that anchors the teeth.  Bacterial infections damage the gums (gingivitis) and eat away at the roots of teeth, creating severe damage.  Bacterial deposits form plaques at the junction of the gums and teeth, which can harden, causing periodontal disease.  It is not a normal consequence of aging but reflects inadequate care of the teeth, which should include brushing, flossing, and frequent dental check-ups.  Older adults in the current cohort have extensive loss of teeth, mostly due to less access to dental care, although utilization of dental services by older adults has improved over the past 30 years. Constipation  Constipation is medically defined as a bowel movement that is hard and dry. It is one of the most common gastrointestinal complaints of an older person.  Although some normal aging changes in the gastrointestinal system may contribute to problems of constipation, studies generally show little difference in colon activity between healthy older and younger people.  Common causes: diet low in fibre, inadequate fluid intake, inactivity, delayed defecation  Medications that causes: analgesics, sedatives, tranquilizers, anticholinergics, diuretics, iron & calcium  Health problems common with: parkinsons, depression, hypothyroidism, bedridden, lack of exercise Diverticular Disease  Diverticulosis, or the presence of diverticula in the colon, is a frequent gastrointestinal problem of older adults. In fact, from one third to two thirds of people over the age of 60 have some diverticulosis.  Diverticulosis becomes diverticulitis (inflammation of the diverticula) when stool becomes trapped in the diverticula. About 25% of people with diverticulosis develop diverticulitis.  Caused by: long-time lack of fibre. To prevent: high fibre, fruits, vegetables, whole grain fibers, fluids Gallbladder Disease  Another gastrointestinal disorder commonly found among older adults is gallbladder disease. About 30% to 50% of people over the age of 70 have gallstones.  Large gallstones can cause problems, however, when they move out of the gallbladder and become stuck in either the cystic or common bile duct. Injury to either of these ducts may occur. 18  In particular, problems can develop when the common bile duct is blocked and there is a backup of bilirubin in the system.  These conditions cause pain, nausea, vomiting, and problems with digestion. Treatment of these conditions includes chemicals to dissolve the stones or surgical removal of the stone and/or the gallbladder.  Risk factors: obesity, inactivity, a diet high in cholesterol and fat, high blood pressure, diabetes, being female, and the use of estrogen.  Prevention includes: a low-fat diet, exercise, and regulation of blood pressure and diabetes. Cancer  Colorectal cancer is the third leading cause of cancer death. Although this type of cancer is found among younger people, incidence of the disease increases with age, doubling every 5 years after the age of 40.  Colorectal cancer is usually asymptomatic in very early stages of the disease, and when overt symptoms finally appear they are often vague (e.g., weight loss or slight pains in the abdominal area).  Anemia is another symptom of colorectal cancer that may be overlooked, as there are numerous causes of anemia in the older person, for example, hemorrhoidial bleeding, a diet low in iron, and other disease processes.  Screening for colorectal cancer should begin at about 40, especially for those who have a family history of colorectal cancer or intestinal polyps.  Risk Factors: low diet in fibre, high diet in fat, family history (colorectal cancer or polyps), long standing colitis or polyps, women: history of breast, ovarian and/or endometrial cancer  Detection: o Sigmoidoscopy- examination of the descending colon o Colonoscopy- view ascending, transverse & descending colon Undernutrition  The older, isolated, and chronically ill person may be at risk of being undernourished, defined as having a diet low in calcium, protein, and calories, as well as an inadequate fluid intake.  Poor nutrition has serious consequences in the older population. It can impair immune system functioning, making older adults vulnerable to bacteria and viruses.  Dehydration causes: electrolyte imbalances, kidney/cardiac failure, impair cognition, confused states  Institutionalized older adults are also at risk of undernutrition. In-hospital mortality is often related to low serum levels of albumin, indicating an inadequate intake of protein or an increased need for protein for healing of tissue. Obesity  A major controversy in the field of gerontology is the relationship between weight and mortality BMI = (weight in pounds)/ (Height in inches)^2 x 703 19 BMI Index between 25-29 is overweight and 30 denotes obesity  Although some weight loss tends to occur after age 65, this loss does not necessarily represent good health, as lean muscle mass decreases with age, and the relative proportion of body fat increases. 4. Renal/Urinary System Basic Anatomy and Physiology  The urinary system serves to filter waste products from the blood, maintain fluids and electrolytes, and regulate osmotic pressure, acid/base balance, and blood pressure.  It also helps maintain appropriate concentrations of minerals and regulate oxygen levels. Components of this system include the right and left kidneys, a ureter leading from each kidney into the urinary bladder, and the urethra that empties the urine outside the body. Kidneys  Right kidney lower than left kidney; both are protected by abdominal muscles & rib cage  Each contains 1.2 million nephrons – producing urin  Each nephron consists of a glomerulus, tubules (proximal, distal, loop of Henle) and a collecting duct  Glomeruli- composed of capillaries though which blood filtered  Glomeruli + tubule structures = reabsorp water, solutes: electrolytes, glucose, amino acids  Remaining fluid reaches collecting duct → ureter → bladder → urethra  Metabolism of amino acid: urea, uric acid, ammonia (toxic) and metabolic byprodcuts: creatinine (breakdown of muscle cells + waste products of hormones)  Kidneys vital for maintaining osmotic, blood pressure by regulating fluids & electrolytes  If sodium intake is high → increase in extracellular fluid → increase blood pressure  If water intake is high → urine output will be greater  Maintains minerals for acid/base balance  Regulates: K, Mg, Ca, P and O levels  If O2 is low → secretes hormone erythropoietin (RBC production) Age-Related Processes  Arterial blood flow to kidneys begins to decrease  Renal mass, # of nephrons, glomeruli decreases as well  By age 70- 30%-50% of glomeruli are lost  Aging kidneys less able to concentrate urine to conserve water or to dilute urine to excrete excess water  Nocturia- nightime urination 20 Disease-Related Processes Urinary Incontinence  Urinary incontinence is one of the most embarrassing and annoying problems facing older adults.  It affects 5% to 30% of individuals over the age of 65 who live at home and almost 60% of those living in nursing homes.  It is also a primary risk factor for skilled nursing placement, as caring for a person who is incontinent can easily overload a caregiver.  Urinary incontinence is frequently under-diagnosed and often undertreated.  There are four major types of urinary incontinence: urge, functional, stress and overflow. Urge:  Inability to delay voiding after bladder fullness is felt  No warning sign of a need of urination [inability to stop involuntary bladder contractions]  Source: obstruction, neurogenic disorder, stroke, parkinsonism, spinal cord injury Functional incontinence  Inability to control urination due to cognitive or physical limitations  Neurological disorders, such as dementia, depression or hostility Stress incontinence  Common among older women; estrogen deficiency, previous vaginal childbirth, sphincter weakness Urinary incontinence  Great inconvenience to the older person, interfering with daily activities, limiting social interaction, decreasing satisfaction Benign Prostatic Hyperplasia  One of the major causes of incontinence is enlargement of the prostate, benign (nonmalignant) prostatic hypertrophy (BPH), an almost universal disorder in older men.  The prostate is found at the base of the bladder circling the urethra  Common signs: providing with voiding, nocturia, urgency, frequency, hesitancy, weak urine flow, interrupted stream  Risk factors for surgery: impotence, incontinence, bleeding and infection Prostate Cancer  Prostate cancer is second only to lung cancer as a cause of cancer death in men.  The primary risk factors for prostate cancer are age, heredity, and lifestyle, with age being the greatest risk. 21  Two methods of examination: digital exam of the prostate gland and blood test  Treatment: surgery, radiation, hormone therapy Chapter 7 Aging of the Regulatory Systems  In order for the organs to function properly, they must recognize changes in both the external and internal environment and be able to communicate with each other to maintain homeostasis, avert dangers, and manage growth.  The regulatory systems that manage this communication are the sensory, nervous, endocrine, and immune systems.  Disruption in the communication among these systems plays a major role in the development of disease and in the aging process itself.  Less is known about how to maintain optimal health in these systems. 1. Sensory Systems  The sensory system is composed of five senses: touch, smell, taste, hearing and vision.  Sensory organs allow the nervous system to gain information about the external environment.  In the interest of brevity, we focus primarily on changes in the senses due to aging and disease rather than describing the anatomy and physiology of these highly complex organs in depth. FIVE SENSES and DISEASE RELATED CHANGES Touch  Sense organ for touch  Changes to touch receptors (Meissner‟s corpuscles) and pressure receptors (Pacinian corpuscles)  With age- these receptors decrease with number and sensitivity, degradation of the sense touch, decreased ability to detect, locate, or identify objects Smell  Loss of sense of smell decreases by 10%  Decreases in numbers of sensory neurons in the nasal lining, and in the olfactory pathways to the brain  Food-borne illnesses are a risk for older adults who have lost their sense of smell, and they can‟t smell rotten eggs, milk or meat, as well as detecting leaking gases or bad body odours Taste  Test buds on the tongue can sense salt, sweet, sour, bitter, fat, and umami [glutamate – form of monosodium glutamate]  Gradual loss in taste, maybe due to smoking, periodontal diseases, or medication 22  Serious consequences leads to anorexia Hearing  Middle ear contains three ossicles (little bones) that pass vibrations to the oval window  Fluid in inner ear puts pressure on the cochlea  Vestibule, allows organisms to sense gravity and head rotation o Contains two small, geletin-filled sacks, with small mineral particles and hairlike sensors o These minerals press down on the sensors, transmitting info to the brain on position of the head-whether upright, down or tilted  Cells in the ear canal develop earwax, decreasing sensitivity to sound  Drugs, antibiotics, pain relievers, diuretics, and cancer drugs are toxic to the ear and its Corti  Structure of the inner ear senses gravity & head position can also degrade with time, leading to dizziness, and falls  Presbycusis- loss of hearing, most common hearing problem [men-90% and women - 30% by 90]  Hearing leads to older people becoming less attached to their environment, not being able to participate in conversations, hear others, listen to music or enjoy listening to nature  Tinnitus, ringing in the ears with no discernible cause [ear infections, high blood pressure, diabetes, tumors, atherosclerosis, malnutrition, medications, and toxin chemicals Vision  Cornea- through which light passes [transparent structure that protects the eye]  Iris [contracts & dilates]- regulates the amount of light enters the eyes  Retina- contains photoreceptors [rods & cones] – lens focuses on the image on the retina adjusting for the distance of the object  Cones- colour vision  Rods- black and white  Humor- gel-like substance protects the eye against shock  The liquidy (water) humor provides support and transports nutrients and wastes  Presbyopia- lens lose elasticity with age [difficult to focus on near objects]  Cornea becomes irregular- resulting in astigmatisms, distorts vision b doubling the edges of objects  Muscles in iris decrease in number & strength, collagen stiffens [reducing pupil ability to discharge]  Vitreous humor decreases in size, creates tension in retina, causing flashes – too much tension causes retina to detach- leading to blindness  Rods are more vulnerable to aging [become irregular, decrease ability to see dim light] Four Common Diseases 23 Cataracts  Cloudiness or opacity of the lens [ interferes with vision at night or bright light]  Risk factors: UV-B light, environmental toxins, topical or internal steroids, diabetes, smoking, dehydration, eye trauma, and low level of antioxidants such as vitamine A, C, E.  Leading cause of blindness among older people  Treatment: surgery, or contact lenses or eye glasses Macular degeneration  Deleterious retinal diseases  Accounts for about 40% of visual impairment in people over age of 80 [sever vision loss in 60+] o Wet (exudative)-onset sudden, precipitous visual decline [severe vision loss] o Dry (atrophic) – 9% of cases with a gradual onset  Risk factors: UV rays, smoking – also vegetable fats  Treatment: antioxidants (Vit E), laser therapy, and surgery Glaucoma  leading cause of blindness in adults over the age of 50  caused by increased build up of aqueous humor in the eye [increase in intraocular pressure & damage to the retina & optic nerve]  Risk factors: high blood pressure, diabetes, African Americans and family history  Treatment: Medication and laser therapy and early detection Diabetic retinopathy - discussed later 2.Nervous System Basic Anatomy and Physiology  The nervous system is the primary regulator of the body.  It monitors and provides communication between all the systems and regulates homeostasis.  It also permits voluntary movement and underlies all cognitive processes, including sensation, attention, language, memory, emotions, and problem solving.  The central nervous system (CNS) consists of the brain and the spinal cord; the peripheral nervous system (PNS) consists of sensory and motor neurons. 24  The autonomic nervous system (ANS) is responsible for all regulatory functions, including monitoring and controlling blood pressure, digestion, respiration, and temperature; it includes components of both the CNS and PNS.  The ANS is further subdivided into the sympathetic (SNS) and parasympathetic nervous systems, which act in consort to stimulate and inhibit their target organs in order to respond adequately to environmental challenges and then return to baseline functioning.  Neurons communicate across interneuronal junctions – synapses. Communication is unidirectional, and can be inhibitory and excitatory  Neurons release neurotransmitters- which can stimulate, inhibit or modulate the receiving nerve cell  Neuroglial cells- provide support for neurons and synthesize myelin sheath [insulating material]  Myelinated axons – white matter  Non-myelinated – nerve cell bodies- gray matter  Target cells – produce neurotrophic factor – nerve growth factor (NGF) and Brain derived neurotrophic factor (BDNF)- which protect neurons, regulate their function, growth and contribute to CNS plasticity by promoting dendrification.  Brain Stem –[Oldest part of the brain] regulates heart rate and respiration  Cerebellum- wrapped around the brain stem – controls balance, body position, and movement in space and may store certain types of procedural memory related to movement  Limbic System [wrapped around the thalamus- helps initiate consciousness] + regulates many functions:  homeostasis [regulated by hypothalamus & pituitary glad]  memory consolidation [ mediated by hippocampus]  Emotions [ mediated by the amygdale and pituitary]  Cerebrum – largest part of the brain and divided into two parts (hemispheres) connected by the corpus callosum  Cortex folded into ridges called gyri to increase surface area and increase in size  Sulci- spaces between gyri  Occipital Lobe-visual information  Pariental Lobe- processes somatosensory information  Frontal Lobe- control voluntary motor behaviour, language production, higher-order cognitive & emotional processing  Temporal Lobe- process hearing, recognition of faces, higher-order visual processing, maybe emotional control Age-Related Changes  MRI studies suggest 10-15% decrease in brain matter with age  Speed of action potentials decrease with age in the PNS and CNS [ due to poor vascular perfusion of the cell body and damage to myelin sheaths]  Decrease in acetylcholine, dopamine, motor neurons 25  Changes in the BBB ( Blood-brain barrier) – composed of Glial and other supporting cells that serves as a buffer between nerve cells in the brain & circulating blood, & protecting nerve cells from chemicals  With age, BBB becomes porous, and allows toxic chemicals to enter [medication, drugs, alcohol] Disease-Related Processes  CVAs result from the same ischemic problems as do myocardial infarctions or heart attacks, which is why they are also called brain attacks.  Hypertension, arteriosclerosis, and atherosclerosis cause damage not only to the coronary arteries but also to other arteries, arterioles, and capillaries in the brain.  Small, temporary ischemic blockages care called transitory ischemic attacks, or TIAs.  These “ministrokes” are surprisingly prevalent, especially among African Americans, are major risk factors for subsequent strokes.  CVAs result from more permanent blockages in the blood delivery system in the brain, which can cause the vessel to be blocked or, less frequently, to rupture.  Aneurisms (weakened areas of blood vessels) can also cause vessels to rupture and create serious damage.  These blockages or ruptures result in the death of nerve cells, and neuronal loss can have serious implications.  Ruptures in the occipital cortex can result in blindness  Damage to Broca‟s area- difficulty in producing speech, comprehension, reading & writing preserved  Damage to Wernick‟s area- able to produce speech, but unable to understand, comprehend  CVA‟s are accompanied by inflammation, cerebral edema (swelling) –[3 days after stroke]  Treatments: depends on blockage, or hemorrhage [anticoagulant –blood thinner- such as heparin is given to lower blood pressure  Tissue Plasminogen Activator (TPA)- given within 3 hours of the stroke, to dissolve the clot  Can improve functioning by 30%  If haemorrhaging- then antihypertensives are given  Massive bleeding- surgery  Others: speech, physical and occupational therapy Dementia  The incidence of dementia also increases with age, and there are many different types. 26  Relatively rare among the young-old, it increases rapidly in very late life, and nearly a third of people over the age of 85 suffer from some form of cognitive impairment.  Dementias may result from several different types of disease. Vascular dementia is caused by a series of TIAs.  Brain tumors in older adults may clinically present as dementia, and also appear to be increasing.  Pick‟s disease and Creuztfeldt-Jakob disease are particularly virulent dementias characterized by very rapid declines.  However, by far the most common of the dementias is Alzheimer‟s disease (AD).  AD is characterized by an increase in neuritic plaques and neurofibrillary tangles.  Neuritic plaques are composed of beta-amyloid proteins and dead neurons; neurofibrillary tangles consist of tau protein fibers twisted into a helix and lipoproteins called apolipoprotein E (APOE).  Neuritic plaques are formed outside neurons, whereas the tangles may exist inside neuronal cell bodies, axons, and dendrites.  It is currently a matter of debate whether the plaques and tangles cause massive neuronal death or are merely symptoms of an underlying process.  Formation of plaques and tangles beings in the hippocampus & the innermost regions of temporal lobes  Then spreads to posterior regions of cortex before infiltrating frontal lobes, eventually it infiltrates subcortical structures [brain stem]- making eating, swallowing & breathing impossible  Symptoms: memory impairment, difficulty in concentrating or confusional states  Initially- short term memory. Later affects- longer-term memory [failure to recognize family]  People become episodic [specific events], semantic[ world knowledge: words, objects, social customs] procedural forms [praxis-knowledge of how to do things] of long-term memory  Other Impairments: abstract thinking, judgement, problem concentrating, difficulty in finding/defining words or places [home], personality changes [aggression, inappropriate social behaviour]  Etiology: four types of alleles – individual with 2 copies of the fourth kind, APOE) are at increased risk of AD o Other causes: TIAs, strokes, co-occurrence of infarcts with plaques & tangles, heavy metals [lead] creates neurofibrillary tangles  Treatment: blocking the uptake of Acetylcholine (Ach). Clinical Treatments monoamine oxidase inhibitors, NSAIDS, antioxidants, estrogen Parkinson’s Disease  The third most common neurological disorder in older adults, Parkinson‟s disease, is characterized by a loss of cells in the substantia nigra, an area in the brainstem which regulates dopamine levels. 27  Loss of cells results in lower dopamine levels- movement is controlled by neurotransmitters [Ach – controls contractions] [Dopamin- Ach antagonist]  Too much Ach- over-contraction  Different kinds of Parkinsons- motor tremors of hands, legs, arms  Increased muscle stiffness & decrease in control of muscle contractions results in balance and gait problems & difficulty in completing voluntary tasks  Treatment: L-Dopa, mitigate effects of P. but does not slow its progess  Physical therapy, occupational therapy Pseudodementia and Delirium  Not all cognitive impairments in late life are due to dementias. Depression can be associated with memory problems and result in a pseudodementia.  Delirium is also characterized by cognitive impairments in memory and attention, but may include hallucinations and delusional states as well.  It can be caused by a variety of factors that interfere with normal brain functioning, including inadequate nutrition, medication side-effects, anesthesia, alcohol consumption, bladder infections, and so on.  Pseudodemtias and delirium may be reversible if adequately diagnosed, but unfortunately the tendency is to attribute all memory problems or confusional states to dementia. (Difficult to discern the cause of dementia, pseudo = similar)  Check for: dehydration, malnutrition, overmedication, & changes in living conditions - bereavement 3. Endocrine System Basic Anatomy and Physiology  The endocrine system is also a complex communication system that regulates growth, maturation, reproduction, metabolism, and body mass, as well as senescence.  Working together, the nervous and the endocrine systems integrate the organism‟s response to a changing environme
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