HS 2711 Aging - Final Examination Notes

20 Pages
Unlock Document

Western University
Health Sciences
Health Sciences 2711A/B
Aleksandra Zecevic

Week 8 Lecture Notes:   -­‐  Topics:  Incontinence  and  intellectual  impairment  (Giants  of  Geriatrics)     Giants  of  G!     Geriatrics?  “Geriatrics  is  the  branch  of  internal  medicine  that  focuses  on  health  care   of  the  elderly.  It  aims  to  promote  health  and  to  prevent  and  treat  diseases  and   disabilities  in  older  adults.”     • Clusters  of  chronic  diseases  with  diminished  possibility  for  recovery,   afflicting  mostly  old  people   1. Immobility   2. Instability   3. Incontinence   4. Intellectual  impairment   • Why  are  they  “Giants”?   o #  of  afflicted  people  (high)   o dependence  on  others  for  care   o they  can  interconnect  (lead  to  another:  immobility  à  instability)     Definitions:     Immobility   Level  of  activity  less  than  optimal  mobility   Mobility  is  movement  that  gives  freedom  and  independence   Instability   Inability  of  correct  body  position  in  space  and  movement  –   usually  leads  to  falls  and  fear  of  falls   Incontinence   The  involuntary  and  inappropriate  passage  of  urine  and  or  feces   Passage  of  urine  could  be  a  cause  of  bladder  control   (extrinsic  and  intrinsic  factors.  See  online  notes)   Intellectual   -­‐ brain  failure  (malfunction  of  (nearly)  all  of  the  brain)   Impairment   -­‐ delirium  (mental  confusion,  disturbed  consciousness)   -­‐ dementia  (memory  disorders,  personality  change,  etc.)     Incontinence  is  due  to  un-­‐normal  bladder  function     What  is  normal  bladder  function?   -­‐ Avg.  amount  of  urine  secreted  per  hour:  100  ml  per  hour   -­‐ Sensations  of  fullness:   o 300  ml  –  avg  3  hours  (100ml/hr)  –  FULLNESS   § easily  suppressed,  have  to  think  about  it  to  sense  it   o 600  ml  –  after  6  hours  –  DISCOMFORT     § full  bladder,  need  to  find  a  washroom  soon   o 750  ml  +  à  DESPERATION     § find  that  washroom  asap  because  leaking  will  start   So  what  does  it  feel  to  be  incontinent…again?   -­‐ When  we  are  younger  (babies)  we  have  little  to  no  bladder  control   -­‐ Therefore  we  were  wrapped  up  in  diapers   -­‐ The  cycle  of  aging  puts  us  right  back  into  diapers  when  incontinence  strikes   again  at  old  age   -­‐ When  we  are  older  we  try  better  to  control  it  but  sometimes  we  are   restricted  due  to  disabilities     Incontinence:     -­‐ Symptoms:   o Leakage  or  urine  during  exercise,  laughing,  sneezing  or  lifting   o Inability  to  hold  urine  back   o Urine  dribbles  after  urinating   o Smell  of  urine  on  clothes  or  in  house     -­‐ There  may  be  solutions  to  incontinence  but  corporations  are  making  a  lot  of   money  on  these  diapers  and  do  not  want  to  sell  out  their  business   -­‐ Some  products  can  even  lead  to  incontinence     -­‐ Prevalence:     o 25  Million  adult  Americans   o 1/3  of  those  over  60   o 2  x  common  in  women  (might  be  because  of  childbearing)   o frustrating  condition  but  only  25%  seek  help  1  in  4   o when  age  reaches  85  and  over  percentages  almost  double!     Mechanism  –  physical   -­‐ urethra  is  where  the  urine  exits  the  body   -­‐ incontinence  is  due  to  muscle  of  bladder  suddenly  contracting  and  the   sphincter  where  urine  exits  relaxes   o This  it  the  problem  for  women  who  have  given  birth  because  the   muscles  weaken  or  stretch   -­‐ Pelvic  floor  muscles  weaken  due  to  birth  changes     Different  types  of  letting  it  loose?  Apparently…   1. Mixed   2. Stress   3. Overflow   4. Functional   5. Transient   6. Urge         Types  of  Incontinence:     • most  common   Stress   • caused  by  a  stress  such  as  lifting,  sneezing   • overstretched  pelvic  muscles  (childbearing)   • nerves  controlling  bladder  are  overactive   • happens  in  sleep,  drinking  water,  hearing  it   Urge   • more  a  loss  of  neurological  control   • enlarged  prostate  contricts  urethra   Over▯low   • prevents  complete  bladder  emptying   • rare  in  women,  men  prostate  presses  urethra   • conditions  ination  is  due  to  other  medical   Functional   • communicating  (alzheimers)  oving,  thinking  and   • Usually  stress  and  urge  cause  incontinence   Mixed     together   • Temporarily  leakage  occurs  due  to  an  acute   Transient   infection  or  medication   Transient  =  temporary       Treatment  options:   -­‐ Kegel  exercise   -­‐ Electrical  stimulation  to  pelvic  muscles   -­‐ Biofeedback  to  track  bladder  and  urethral  muscle  contractions   -­‐ Absorbent  pads   -­‐ Non-­‐surgical  devices  –  pessaries  –  inserted  in  vagina     -­‐ Surgical  treatments  –  catheterization  –  tube  insertion  into  body     Inevitable  OR  Non-­‐inevitable?     -­‐ Unfortunately  it  is  not  avoidable  with  age   -­‐ It  is  however  treatable  and  curable  at  all  ages   -­‐ Encouragement  to  seek  medical  help       Intellectual  impairment     -­‐ Brain  failure  –  malfunction  in  all  or  nearly  all  brain  due  to  pathological   change  in  the  brain  tissue  or  functional  change  in  brain  nutrition   o Includes:  dementia  and  delirium   o Excludes:  hemorrhage,  infarct,  tumor  or  abscess   -­‐ Intrinsic  vs.  Extrinsic   o Intrinsic:  develops  slow,  runs  long  (infarcts,  Alzheimer,  Parkinson’s,   o Extrinsic  –  develops  rapidly,  runs  a  short  reversible  course  (toxic,   metabolic,  endocrine…)   -­‐ Characteristics:  wandering,  confusion,  disorientation  (time,  place,  person),   incontinence     Intellectual  Impairment   Retained  Features   Lost  Features   •  logical  thought   •  registration   •  intelligence   •  recall   •  personality   •  percept-­‐concept   •  stored  memory   •  cause-­‐effect   •  skills     •  time-­‐space   •  emotion   coordinates     Retained  vs.  lost  à  certain  features  remain  safe  while  others  are  lost   -­‐ Retained  thoughts  make  people  aware       Delirium:   -­‐ Definition:  A  state  in  which  a  person  is  out  of  touch  with  surroundings  and  is   spontaneously  producing  evidence  of  confusion  and  disorientation  by   muttering,  rambling,  shouting,  delusion  hallucination.       -­‐ NOT  a  disease  BUT  a  clinical  syndrome   -­‐ Managed  by  removing  the  underlying  (original)  cause  such  as  fever   -­‐ Motor  activity  that  leads  to  exhaustion   -­‐ 80%  of  ICU  patient  (surgery  patients)  experience  delirium     Who’s  at  risk  of  delirium?  Very  old/young/sick   Scary  à  you  don’t  know  what’s  going  on  around  you  (can  hallucinate)   About  40-­‐60%  of  hospitalized  patients  may  experience  it     The  Nun  Study  (The  school  of  sisters/  Notre  Dame)   -­‐ in  relation  to  dementia   -­‐ asked  sisters  to  donate  brains  after  their  death   -­‐ they  spent  lives  teaching  and  felt  that  they  needed  to  pass  this  on   -­‐ first  time  working  with  brains   -­‐ showed  how  high  developed  brains  like  the  Sisters  in  the  study  will  better   fight  off  diseases  and  age  better   -­‐ lots  showed  Alzheimers  in  brain-­‐  but  did  not  lack  memory     This  is  what  happened:   -­‐ longitudinal  study  of  678  sisters  ages  75-­‐107   -­‐ at  18  years  of  age  went  and  wrote  essays   -­‐ the  level  of  complexity  in  the  essay  which  portrayed  a  higher  level  of  lingual   functioning  in  the  brain   -­‐ the  writing  would  predict  who  would  develop  Alzheimer’s  disease   -­‐ more  complex  sentence  structure  =  better  chances  surviving  (signaling)   -­‐ DATA  looked  at:  middle  life  risk  factors,  annual  cognitive/  physical   evaluations,  postmortem  brain  evaluations  (neuropathogenic)     Major  findings:   -­‐ A  broad  range  of  cognitive  and  physical  functions   -­‐ Manifestation  of  dementia  symptoms  depended  on:   o Degree  of  pathology  in  the  brain  (location,  type  and  amount)   o *Cognitive  reserve  –  capacity  of  the  brain  to  resist  clinical  expression   (symptoms)  of  present  neuropathology           Cognitive  reserve   1. Passive  –  brain  size,  synapse  count,  nutrition,  social  support,  education,   intellectual  stimulation,  maintenance  throughout  middle  age   a. Maintenance  throughout  middle  age  (environmental  protection,   appropriate  medical  care,  good  lifestyle,  early  treatment  of   diseases)   2. Active  –  ability  of  the  brain  to  adapt  and  compensate  for  the  presence  of   the  pathology  by  activating  regions  and  networks  that  are  not  normally   activated     Lessons  learned  from  this  study:   -­‐ Healthy  aging  vs.  dementia  relate  to  the  degree  of  pathology  present  in  the   brain  and  the  level  of  resistance  to  the  clinical  expression  of  the   neuropathology     Special  populations  research:     Advantages   Disadvantages   -­‐ Minimized  confounding   -­‐ Difficult  to  generalize  to   factors   other  populations   -­‐ Homogeneity  of   environments  and  lifestyles   -­‐ Inclusion  of  the  entire   population                                     Week 9 Lecture Notes: Aging Mind   Intelligence  (Crystallized  and  Fluid)     à  from  middle  age  to  late  life     Fluid     Crystallized   • Depends  on  basic   • Skills  that  depend  on:   information  processing   • accumulated  knowledge   skills:   • good  judgment   • detecting  relationsips   • mastery  of  social   among  stimuli   conventions   • working  memory   • Valued  by  person's  culture   • think  logically  and  solve   • ability  to  use  skills,   problems   knowledge  and  experience   • independent  of  acquired   • it  relies  on  memory     knowledge   • it  is  depth  and  breadth  of  a   • inductive/deductive   reasoning   persons  knowledge   • improves  with  age  as  you   • tested  by  IQ  (but  now  IQ   experience  more   tests  both)   • peaks  from  25-­‐54   • Peaks  around  age  20     Age-­‐Related  Slowing  of  Information  Processing:     Neural  Network  View  (Printer/Scanner  Model):     -­‐ Neurons  in  brain  die,  breaking  neural  connections   -­‐ -­‐  Connections  between  neurons  are  broken  (like  taking  photocopy   –  every  copy  after  copy  loses  quality)  –  brain  forms  new   connections  but  not  as  clear  as  before,  we  don’t  create  new   neurons  but  we  can  reconnect  them  –  (broken  or  damaged   neurons  for  example)   -­‐ new  connections  therefore  are  less  efficient     Information-­‐Loss  View:   -­‐ Information  is  lost  as  it  moves  through  cognitive  system   -­‐ Whole  system  slows  to  inspect  and  interpret  information   -­‐ Basically  information  is  lost  and  the  whole  system  eventually   slows  down   -­‐   Individual  and  group  factors  in  high  intelligence  score:     Lifestyle  factors  for  high  intelligence:   -­‐ High  education   -­‐ Complex  job  or  leisure  (eg.  Chess)   -­‐ Lasting  marriage   -­‐ High  SES     Personal  factors  for  high  intelligence:   -­‐ Flexible  personality   -­‐ Healthy  (absence  of  CVD)   -­‐ Gender   -­‐ Perceptual  speed     Attention  in  Middle  Adulthood:     -­‐ Could  be  linked  to  slower  processing   -­‐ Practice,  care  and  training  will  better  performances  (lumosity)     More  difficulties  in  (Mid.  Adulthood+):   -­‐ Multitasking  (no  point  anyway)   -­‐ Switching  attention  à  flashlamp  –  point  it  and  that’s  where   attention  goes   -­‐ Focusing  on  relevant  information  (cognitive  imposition:  brain   chooses  to  overlook  things  it  doesn’t  consider   relevant/important)     Memory  in  middle  adulthood:   -­‐ Working  memory  (fluid)  decreases  from  20s  to  60s   o Ineffective  memory  strategies  (organization,  elaboration   and  linking)  due  to  slower  processi
More Less

Related notes for Health Sciences 2711A/B

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.