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Midterm

Aging Lecture Notes for midterm 2.docx

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Department
Kinesiology & Health Science
Course
KINE 3350
Professor
Kathy Broderick
Semester
Winter

Description
Aging Lecture Notes 2 Holland Orthopedic and Arthritic Center  Model for hip and knee surgery  Assessment o A PT does the assessment  Pain plan o Take Tylenol, ice, etc o 2 weeks before surgery a kine will give you a pain plan; get a nerve block so you aren’t in as much pain  less pain, quicker recovery  Rheumatoid Arthritis  body attacks cartilage, ligaments, bones  it is symmetrical  no cure; progressive disease  more common in women  Symptoms: o Stiffness and pain that can last all day o Hard time doing ADLs o Have to remodel houses o Affects their jobs  Treatment o Have identified a gene that detects the severity of the disease o Many don’t see a specialist soon enough and so joint damage occurs o Treating early is key o Drugs called Biologics (Remicaide) can get back their activities (ADLs) o Exercise is also very important  Gout  Buildup of uric acid (generally in the big toe)  Rapid sudden onset  More common in men  Can become chronic  Medications are prescribed  Lupus  More common in women  Affects joints and eventually the heart, lungs, kidneys  Phases of flare ups and then goes down   Fibromyalgia  No inflammation  Very hard to diagnose  Many believe that their pain is just in their head  Pain and tenderness to touch  11 joints are testes Muscle System – age related changes  Muscle wasting  Elders have about 15% muscle; other have 30%  Being bed ridden can cause this  Age related Disorders:  Sarcopenia o Extreme muscle wasting o Cant perform ADLs  Muscle cramps o Can be caused by dehydration, lack of potassium  Bursitis o Fluid build up and becomes inflamed; in joints like knees, shoulders o Has psych impact on patient as they may not be able to do things they use to  Nervous System – age related changes  Loss of neurons  Atrophy of the brain  Increase in plaques and tangles in the brain  Changes in transmission (slower)  Changes in brainwaves  Sleep patterns affected o Day time napping generally causes it o Pain, need to go to the bathroom o Meds can also affect it o Sleeping pills are prescribed but they can be addictive and are not solving the problem; risk is greater than benefit o Baby boomers are most concerned with their sleep; they spend more on beds; more health concerns and awareness about the importance of sleep in the media  Changes in the autonomic nervous system  Age related disorders:  Tremors  Tardive dyskinesia o Movement disorder o Smack their lips, stick their tongue out, rocking body back and forth o Caused by use of long term meds  The terrible triad o Lou Gehrig’s Disease/ALS  Cause unknown, no cure  Diagnosis occurs around 60 and most die within 2-5 years  Become progressively paralyzed  Disease kills the nerve  The nerves in the muscles start dying then starts affecting their breathing and etc  Generally die of a respiratory complication o Parkinson’s Disease  Chronic disease, slow progressing  No cure  Cells in the brain don’t produce dopamine (controls movement)  Non-fatal  More common in men  Genetic component  Environmental component: chemicals, pesticides  A study found that more medical professionals have it  They have pronounced tremors, pin rolling fingers, muscles become rigid, difficulty initiating movement  Generally become confined to a wheel chair  Have difficulty swallowing, speaking  Treatment: PT, OT, drugs  Mirapex drug: drug mimics dopamine  Dopamine is also involved in pleasure and arousal so it can affect those aspects of someone’s life  Michael J Fox, Mohammed Ali, last Pope all had it o Alzheimer’s Disease  In Canada every 5 mins someone is diagnosed  Generally diagnosed after 65  Need a lot of care  There are 40 mil people who have it in the world  Cause not known, no cure  People with Alzheimer’s have more plaques and tangles; brain also shrinks with age and those with the disease have smaller brains  Cant reason, cant make decision, forgets things  Early detection is key  Diagnosis is not easy; many are in denial and so will not reveal their symptoms  Don’t know if symptoms are part of normal aging or part of the disease  Symptoms can develop slowly or quickly  Stage 1: Starts with headaches, irritability, memory problems  At stage 2: become confused, agitated, can become aggressive  Stage 3: cannot speak, walk, breathe  Usually lasts for 6 years; generally spend 2 years in each stage  10 warning signs were developed by Alzheimer’s society (handout)  4. they like to wander and get lost  5. Don’t know how to dress  8. Mood swings  9. Become very passive, can sit all day and not move  many love to sing  Alzheimer’s and love: forget they are married and start new relationships  Research: lots more research now, family history, external enviroments like toxins are linked, ppl with heart contitions, strokes and diabetetes are also linked  Nun story research: perfect study, same living conditions, same healthcare  They had each written an autobiography  Results: those who could write with expressive language did not get alzheimers  They are not pain but care is they most important part  Trying to develop blood tests to diagnose  Concussions and head injuries are linked  People who speak 2 more languages delay the onset  We have lazy brains with today’s technology; use it or lose it  Tests: memory tests, other basic tasks  Not many drugs that are beneficial  Tough issues: getting the diagnosis  Do you tell the patient or their family?  Depression can also accompany it  Law stating that unless the employee with Alzheimer’s is harming the company they cannot fire them  Should families get the genetic testing done?  Often people who are close (families) are in denial  They wander at night (sun downers)  Caring for them is very tiring and hard  Programs:  Forget Me Not: group meeting for people going through the similar situations, allows caregivers to have a break  Sleep disorders  Sleep apnea o Affects heart because of the disruption of sleep o Can result in high BP, stroke, HA o Can wear a retainer that keeps mouth open so you can breathe  Restless legs o Urge to move their legs  Excessive sleeping  Disrupted sleep/wake cycle o When they have to get up to go to the bathroom, take meds   Learning  Material should be pced slowly  Can still learn new skills but just slower  Memory  Minimal changes in long term memory  Changes in short term memory; must use it to maintain it  Book: neurotic exercises – series of activities done with non dominant hands, change places you store things etc; keeps brain thinking and active Reproductive System  Female:  Age related changes:  Menopause – cant have children o Oldest mother was 67 o In a book published 33 years ago menopause was considered a psychological disorder; treatment was to put them through shock or LSD o Hormone replacement therapy research showed that they had higher cases of heart disease and etc o Now it is only used for severe cases  Age relatd disorders:  Osteoporosis  Heart disease  Cancer  Male:  Age related changes:  Andropause o Often ignored and not treated since men don’t go to the doctors often o In Europe it is better treated o Men can be put on hormone replacement therapy as well  Age related disorders:  Prostate cnacer  Heart disease  Osteoporosis  Sexuality:  As people get older it take longer for them to get aroused  Might not achieve orgasm  Women may have pain during intercourse  1 out of 7 take Viagara  viagara has several side affects  health issues or medications affects their sex drive  older man tend to have more sex than older women  family doctors should ask about sexual concerns as it is part of their lives  nursing homes have a lack of privacy and so it is difficult  some nursing homes have special rooms designated for sex  Aids and HIV is a cause of concern for the elderly  Women are rarely tested and it has become prevalent in retirement destinations like Florida  Sex education and condoms are important  Sensory system:  Vision  Goes down at around 40  Presbyopia: loss of vision as part of the aging process  Age related changes: o Lens – becomes stiff, focus becomes distorted; becomes yellow o Cornea – becomes thicker; distorts vision o Iris – begins to fade o Pupils – decreases in size; less light comes in  How changes in vision affect behaviour: o Decreased visual acuity  Need more lighting  More sensitive to glare  Shiny floors, sunshine o Slower light & dark adaptation o Identification of colour  Have offsetting colours o Decrease in depth perception  Regular eye exams are key, OHIP covers them if over 65  Age related disorders:  Cataracts o Develop slowly can’t remove it until it is progressed o Lens becomes cloudy and it has to be replaced o Before the surgery existed people would go blind  Macular Degeneration (AMD – age related macular degeneration) o Eyesight deteriorates: can’t read, see the tv, recognize faces o Not curable but can slow the progression o Two types of AMD: dry & wet o Dry is slower o Wet has much more deterioration  Glaucoma o Silent disease o Pressure on the optic nerve o If untreated can have irreversible blindness o Treatment: eye drops to relieve pressure  Low vision  Hearing:  Presbyacusis: loss of the ability to perceive sounds as part of the aging process  Only 50% lose their hearing  Studies showed that older women would choose vision loss over hearing loss; older man would rather be deaf  Age related changes:  Sounds o We live in a noisy world o People use to not wear protective equipment o Hearing loss is occurring now at 40 o We confuse loud sounds with excitement  Behaviour o Have to keep asking people to repeat themselves o Many don’t admit to being hard of hearing o Become isolated cause they cant hear  Communication o Speak slowly and be patient o They think they are yelling and end up whispering o Invisible handicap  Hearing Aids o Many were proud and didn’t want to wear them; didn’t want to be incompetent o Now hearing aids are much smaller and discrete o Hearing aids don’t cure the problem but it does improve their lives o It amplifies the sound o Batteries don’t last long and are expensive o Longer they go without a hearing aid, the harder it is to get fitted and get used to a hearing aid o Some studies showed that it can even be a precursor to alzheimers  Age related disorders:  Tinnitus o Buzzing, roaring, ringing o Can be constant or intermittent o No cure o Can be mild or extremely loud  Taste  Age related changes:  Smell  Age related changes  Touch  No real treatments for these changes  Balance  Age related changes:  Receptors in inner ear is affected  Age related disorders:  Dizziness  Imbalance  Faintness  Vertigo  Sensory System and Sementia  Snozelen: relaxation therapy for seniors with dementia; therapy focuses on experiencing different sensory stimuli (colourful lamps, fish tanks)  Falls  Prevalence : 1/3 of seniors fall  Most common cause of accidental death  Most break their wrists and or hips  Falls generally result in more falls  Many fall from slippery sidewalks, in bath tubs  Seniors should have medical alerts  Fall Prevention  Shoes  Walker and canes  Glasses  Night light  Trip hazards  Lower beds  Home modifications  Medications and their side effects  Pain – if suffering from pain they are disctracted  Diet  Exercise  Buddy system  Community fall prevention program Gastrointestinal System  Many older people have problems with digestion  75% of the immune system is in the GI tract so the health of it is very important  Age related changes:  they lose taste buds  teeth health deteriorates  saliva production goes down; harder to chew and swallow  older people might have a harder time taking care of their oral health  dental treatments are expensive and many cannot afford it  Age related disorders  Xerostoma: dry mouth; can be caused by aging, radiation treatment  Dysphagia: difficulty swallowing; must think every time they swallow  Periodontal Disease: bacteria gets into the root and causes problems  Esophagus  Age related disorders:  Acid reflex disease: acid coming back up from the stomach o Can be mistaken as a heart attack o Taking tums regularly can have negative affects o Can cause esophageal cancer o Avoid spicy foods o Often occurs at night when laying down  Stomach:  Gastritis – inflammation of the stomach  Peptic ulcer  Food poisoning – more serious for elders o Can affect their heart o Disrupts their homeostasis o If they are taking medications it might not be digested o Elders might be more susceptible to food poisoning due to certain habits they may possess  Intestines  Diarrhea o Losing fluids and can cause dehydration o Can be caused by infections o Elders are susceptible to diarrhea  Dehydration o Inability to sense thirst o Can lead to confusion  Constipation o Very common and painful o Can be caused by many pain meds o Fluids, fiber, prune juice are key  Diverticulosis o Causes cramps and diarrhea o If it gets inflamed or infected can be serious  Gall stones o Can lead to removal of gallbladders  The liver  Cirrhosis  Alcoholism  Skin, Hair, Nails  Skin changes mostly due to the sun  Can’t perspire as well  Hair loss and thinning  Nails become yellow and thick  Ingrown tow nails are also a big problem  Disorders: o Xerosis – dry skin o Pruritus – itching caused by severe dry skin o Dandruff – more common in men o Shingles  Develops from a virus that causes chicken pox  Can be contagious to people who haven’t had chicken pox o Pressure ulcers  Bed sores  Generally occurs near the tail bone  Starts with res skin then becomes a wound  Changing body positions helps, keep skin moist  Good indicator of care in hospitals and nursing homes o Malignant melanoma  If detected early 98% survival  If caught late only 15% chance  Tanning beds is a major issue o Hypothermia  Elderly are more sensitive to cold because they have slower metabolism, aren’t as active, don’t eat as much, etc o Hyperthermia  Don’t sweat as much and so it is hard to dissipate heat  Can cause muscle cramps, headaches  Urinary System  Age related changes  Kidneys – lose ability to move drugs from the body and so they stay in the body longer  Bladder – loses capacity  Age related disorders:  UTI – more common in older women  Incontinence- over active bladder and no control; more common in women  Kidney failure – need dialysis or if complete failure a transplant  Respiratory  Age related changes  coughing mechanism is less effective – can lead to pneumonia  gag reflex is less effective – can lead to choking  pitch in voice – men’s get lower, women’s decrease  shortness of breath  lungs become smaller and flabby  residual volume increases  decreased O2/CO2 exchange – fatigue easily  Age related disorders:  Chronic bronchitis – mucus produced and difficulty getting air into lungs; causes a lot of coughing  Emphesyma – difficulty getting air out of lungs; lungs fill with stale air  Chronis obstructive pulmonary disease (COPD) cannot get air in or out; is insidious ; 4 leading cause of death o More common because of long time smokers o Many do not get diagnosed as it develops slowly o More women are effected because their lungs are smaller o Is preventable and treatable o 85% is caused by smoking o pollution and smog also cause COPD o Ontario has high smog values  Chronic Asthma o Older people don’t have proper management  Tuberculosis o Lung disease o Very contagious o Virus lays dormant and starts to resurface in elders  Pneumonia o Infectious inflammation of the lungs o Common in nursing homes and hospitals o Can be prevented by flu shot and drinking water o Flu shot is controversial o Ontario is trying to make it mandatory for staff of nursing homes to get the flu shot o Also known as “old people’s friend”  Age related disorders:  Diabetes o Type 1 and type two (90%) o Diabetes epidemic o Very expensive on the health care system o Health complications: blood sugar drops, hypoglycemia (may lead to black out or coma); kidney disease, may lead to amputations o Dice Study  Prediabetes – should be diagnosed first before it become full diabetes  Anyone with a large waist should have a blood test done  Signs are numbness in feet and toes  Healthy diet, exercise, lose weight is a great treatment for prediabetes (lifestyle changes)  Lifestyle changes is also key in diabetes  Give a patient 2 months for lifestyle change if they don’t change then put them on meds  Diabetes and heart disease – heart disease was the most important thing from DICE study; started a campaign called Diabetes Get Serious o Many doctors put diabetics on statins for their heart (high cholesterol) o Family doctors should know the links between diabetes and heart disease and do proper management o Seniors and diabetes – many go untreated or don’t get treated properly o Routine test by doctor should include blood test, urine test, foot check o Research is higher now; better management, knowledge, medications, etc o More methods of insulin injections; easier to use o Some medications even help them lose weight  Obesity o More overweight people in the world than under o UK is the most obese country followed by US, Mexico, Canada o Weight accumulates in the abdomen as one ages o Diet and exercise is key o Low income people gain weight because it is expensive to gain weight o In some cultures being overweight is a positive thing o Seniors that have some reserve fat they may live longer because they have that reserve but they might be living in disease o Twice as likely to do in car accidents and fires o Paramedics have back problems from lifting obese people o Some airlines charge if you need two seats o  Malnutrition o Causes: lose interest due to loss of taste buds, Alzheimer’s-cant remember if they ate, loneliness, isolation o Eating disorders o Sheena’s place – looks after people with eating disorders o Older women diet excessively and exercise excessively o Can lead to osteoporosis, heart conditions, etc  Cancer o Decline in death rate from cancer but it is still the number 1 cause of mortality o Number of cases of cancer has increased o in Canada every 3 mintues someone is diagnosed o more men die of cancer o lung cancer is number 1 followed by colon and prostate/breast cancer o increased cases of lung cancer in women because more women started smoking in 60s o women don’t get the warning signs like men do o second hand smoke causes 25% of lung cancer cases o Barb Tarbocks: died of lung cancer but went a round the country educating children on lung cancer o Prostate cancer  Movember has increased donations o Colon Cancer – screening should begin at 50; if detected early is 90% curable  Slow growing and many don’t know and so can go undiagnosed  Screening is fecal blood test or colonoscopy o Breast cancer  Mammograms should be done every 1-2 years  Older women are most likely to die of breast cancer  Effects of Medications  Research – not done on the elderly but the elderly are the ones that are actually taking the drugs  Physiology and medications o Interactions with drugs  Can have adverse reactions o Interactions with food o Drugs and gender – women react differently from men o Prescribing cascade – side effect from one drug makes it look like they have another condition so it can be misinterpreted  Physician and medications  The patient and medications  Physician and medications  The patient and Medications  Dangers with medications - people should keep a list of their list of medications and dosages  Rules  Internet and Drugs - they may start questioning a doctors diagnosis because of what they've read on the internet. Look at the website, who runs it? is is someone random? is it controlled by health canada? Buying drugs online? it's risky  Pain - everybody has a different pain threshold, each person cannot understand anther persons pain. Interferes with daily activities, can't concentrate because of pain, results in poor quality of life, chronic pain every day, social pain - can't go to social functions, family members don't understand pain so don't go to family functions.  Faces of Pain - they can point to a picture describing how they feel n  Treatment - do they inquire about pain at the doctors office? Doctors are undertrained in pain management. They usually assume its a short term pain and don't really look at concept of pain or have time to deal with it. Doctors may be afraid to prescribe because they're worried patient will get addicted. Allowing people to control their morphine for pain  Speciality- chronic pain is a disease. Pain management is not just drugs, it's dealing with the whole person.  Pain clinics  Communicating Pain - doctors recognize pain depending on how their describe it  Seniors and Pain - many seniors are better at understanding pain  New Pain Treatment - danish company has come out with a foam matrix they put on pressure ulcers so it doesn't have to go through bloodstream. Painkillers are addicting, in some areas they are being sold on the streets Research -  the Brain - how does the brain overriding pain?  Pain Perception - placebo tests, fake surgery. Brain releases endorphins which relieves pain. Pain was more elevated with expensive pills Michael DeGroote, Multimillionaire who had a stroke and had excruciating pain to try to figure out how to deal with pain Depression -  Causes - genetic, social, biological, chemical. Minor depression can lead to major depression. It strikes any time but can be treated  Myths - people think old people are depressed. It common in older people, more common in women. 50% in nursing homes are on anti-depressants  Symptoms - sad, hopeless, worry a lot, thoughts of suicide, poor sleep, lack of appetite  Reasons - poor health, many of health conditions diabetes, heart disease are linked with depression, side effects of medications, health/death of loved ones.lonely, may be personality. SAD - seasonal affective disorder.  Diagnosis - misconception that aging is depression and oder people can't recover - all incorrect. Usually misdiagnosed and are not treated. Hard to diagnosis since many are unaware they have depression and do not articulate their feelings, may be ashamed - stigma. Usually talk about physical pain since they're not used to talking about how they feel  Treatment - can be treated regardless of age but is challenging. Doctors should ask if they've felt hopeless in last 2 weeks  someone deeply depressed have symptoms to Alzheimer  Delerium -  Changes severe confusion, agitated, hallucinations, happens very suddenly  Causes - pneumonia  Hospitals - they are agitated and are restrained, makes it even worse, delirium can be cured, if not cured can lead to death or morbidity  Treatment - medications to stop agitation, making sure they're hydrated and visited. Can be chronic if not treated. if treated can be cured  H-E-L-P - volunteers visit people in homes who are high risk and don't have visitors, talks and feeds them, exercise program.  Personality Types - Cheerful people live longer. Neusarten did a landmark study of adaptation of aging and personality types. Men do become more nurturing as they age and women become more aggressive.   Mature -Integrated- person who is very happy with their life, realistic good self- esteem and happy personality  Armored Defensive - ambitious, aggressive, independent, stubborn, don't want to stop working, don't have successful adaptation to old age. baby boomers may fall into category  Angry - blames other, resentful, jealous, find fault with things and blame the government.  Passive Dependent - Rocking chair type - not resentful, very dependent  Self Hater - low self esteem, depressed, isolated  Disorganized - may have dementia and living with it, poor coping skills, not satisfied with life but they keep living  Middle age aging people are who accept middle age - may have had death of a parent and realize health is deteriorating and time goes faster. Both men and women suffer and fear it. Midlife crisis and may be depressed when they become older. May be positive, may realize they don't want to be like the same person they are and change diet, leave bad marriage and start exercise.  Retirement  Retirement Age - used to retire at 58, private sectors reared at 60-62, self employed people retire a bit later. Now average age for retirement is 68.  Reasons for Retirement - it gives them meaning, may be remove form job because of bad health, have enough money, they don't want to retire  What to do - people need to figure out what to do to fill their time, take up a sport, volunteer. People need structure  Where to live - do they stay in their house? may need to renovate it (bathroom on main floor), do they downside? It is traumatic. If you live in the city it will prolong you life - walking places,  Negative experience - nothing to do, many drink after retirement, go to funeral all the time,  Positive experience  rebirth -people reinvent themselves, take courses  Successful Retirement  1. Finances - older people do not want to be dependent and borrow money  2. Health - health is your wealth - worrying about finances can bring on poor health  3. Time management - busy and rest, pacing is important  4. Interests - need to cultivate interests but need to be meaningful  5. Spouse/Partner - if you have a good relationship with spouse, doing activities together. Atchley’s Theory of Retirement Adjustment  Pre-Retirement  Honeymoon  First phase of retirement  Go on vacation and relax  Retirement routine  Exercise classes, lunch with friends  Fill their calendar to keep busy  Rest and relaxation  Input rest time in their schedule  Disenchantment  Not going to the gym  Expenses from lunches are adding up and they might realize they don’t enjoy people’s company  Don’t enjoy going on holidays  Pre-Orientation  Developing health problems; have to go see doctors  Stop rushing around  Routine of stability  Figure out what they want and are content  Termination Ageism  2/3 of older people have experienced it  Treatment: examples of ageism is how we treat people  Talk down to them, tell them they can’t do certain things  Economics: blame them for being a burden to society  Retirement: they are retired and so are useless  Media  Attitudes: we learn certain attitudes towards elders from when we are young Ageism and driving  Transportation is the number one concern for seniors  It gives them a social life and independence  400,000 drivers over 75  10,000 small collisions in that population  18,000 for 19-22; yet elders receive the negative stereotype  losing license is devastating for seniors  decline in driving ability after 50  reaction time is slower  their depth perception is off  ability to focus takes longer  narrower field of vision  mental decline  Medical conditions  Poor vision from catarax, etc  Poor hearing  Stiff necks from osteoporosis  Dementia  Doctors – gate keepers  Doctors must report someone who should not be driving  Doctors might not realize that they are driving or might not want to interfere  Women tend to stop driving earlier  Generally the worst drivers are the ones most stubborn to stop  Warning Signs  Missing stop signs  Think driving slowly is better  Seniors are good drivers  Have experience  Most are good drivers  Ministry of transportation  Use to have a drive test for elders but took it away due to ageism  If over 80 must have medical exams, eye exams and written exam o Must be renewed every 2 years o No road test  Drivable  Cognitive screen that look at people with memory  Research  20 year olds with cellphone drive like 70 year olds  people do many things in the car, eat, dress, shave Ageism and Healthcare  Family doctors  Many don’t want to work with elders  Its time consuming  Some family doctors don’t want to see elderly patients  Healthcare  Research done on young people but should be done also on elders  Procedures  Treatment – many doctors say certain conditions are age related and brush it off  Medical errors – occur more due to the complex procedures they get done  Medications should be monitored better  Heart Disease o Story about cardiologist that did not want to do surgery on a senior o They should not be denied heart health care o Their concern is harder recovery  Joint replacement o Must make sure they have proper rehab and homecare before they can do surgery o Elders rehab takes longer and have harder time finding homecare o Because elders have a harder time getting those 2 criteria their surgeries get pushed back  Gender Bias o Study in Ontario: 1 male and 1 female patient went to several doct
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