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KINE 3350 Class Notes After Mid-term #1.doc

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Kinesiology & Health Science
KINE 3350
Kathy Broderick

Feb 10 th The nervous system Age related changes 1) Loss of neurons; after age 25 2) Atrophy of the brain; can't replace the brain, becomes smaller 3) Increase of plaques and tangles 4) Changes in transmission; less efficient 5) Changes in brainwaves; slowing down of brain functions 6) Sleep patterns; hard to go to sleep and wake up early; baby boomers are spending lots of money on beds to get a good sleep 7) Changes in the autonomic nervous system Age related disorders 1) Tremors; hand twitching 2) Tardive dyskinesia; smacking lips, rocking back and forth, sticking tongue out 3) The terrible triad; Lou Gehrig’s disease, Parkinson’s disease and Alzheimer’s disease Lou Gehrig’s disease (ALS) - Don’t know the cause of it and no cure; progressively paralyses the person; more in men than women; kills muscles in swallowing, breathing and talking; die in a matter of 5 years or less; quadriplegic, some need a communication board to communicate Parkinson’s disease - No cure; death of brain cells, dopamine; both men and women get it equally; around 60-65 you get it; genetic predisposition; environment plays a role; more educated have gotten it - Tremors, start when in their lap; pin rolling hand movements, muscles are ridged; shuffling motion; movements become slow, difficultly in swallowing, speech affected, show no expression; suffer from depression - Physical therapy helps them a bit; drugs help with tremors and don’t prevent anything else; surgery, killing brain cells, doesn’t really work, deep brain surgery Alzheimer’s disease - Affects more women (2/3’s); # of cases are doubling every year - Brain is smaller; affects learning, judgment; very difficult disease to diagnosis, due to social issues and also people what want to have the disease - Symptoms; stage 1, people are forgetful; stage 2, they become very repetitive, severe memory loss, aggressive and violent; stage 3, can barely walk, can't swallow, - It's not the same person that you know; they aren’t in pain, disorientation of place and time, poor or decreased judgment, have rapid mood swings, changes in personality, become very passive, affects family members more than the individual - Genetic predisposition; internal (head traumas, diabetes, hypertension) and external (toxins) environment; diet; if you speak 2 or more languages you have less chance of getting Alzheimer’s; if you keep your brain active with crosswords, etc.; keeping physical activity up; memory books of past, taking care of them is a big issue, then is prevention and then cure - Have you read 15 words and then recall them all; Tell them to draw 2:43 on a clock and see how accurate they are (75% accurate), drugs only help with behavior - Getting diagnosis is difficult; how to communicate with them; treatment at early stages; how do you get genetic testing; when to quit driving; it's like caring for a child, they get energy at night; a lot of nursing homes don’t take them in; monitoring patients, have transmitters on them - Have programs “forget me not”; once a week, adult daycares are pretty good; usually outlive caregivers Sleep disorders - Sleep apnea: sleeping but no airflow; stop breathing 5-10 times in an hour; they wake up not slept well; could be cause of night heart attack or stroke; can affect heart function; can have high blood pressure; sleep disorder clinics - Restless legs: people have to move their legs every 20 seconds during the night; tooth ache of the leg - Excessive sleeping: sleep for like 5 hours in the afternoon - Disrupted sleep/wake cycle: people that take pills at night; within the hospital Learning - Brain shrinks; as long as older people get the material slowly they will still respond, but will be slowly, they do as well as anyone though Memory - Will have minimal changes in memory; especially short term memory; Gastrointestinal System The Mouth Age related changes - Brittle teeth; can get cankers; many have to get dentures; fewer teeth; wear and tear Age related disorders - Xerostoma: can be from radiation; keep mouth moist - Dysphagia: ability to swallow; due to strokes or Parkinson’s disease; have to be fed or don’t eat; have to think about swallowing - Periodontal disease: root of tooth, and get bleeding gums; Esophagus Age related changes Age related disorders - Acid reflex disease: heart burn; can wear away at it; if you have it more than twice a week, should see a doctor, because you can get esophagus cancer - Peptic ulcer: if you’re on drugs, alcohol The intestines Age related disorders - Diarrhea; can become dehydrated; electrolyte balance goes out of whack; can get malnutrition because intestines don’t reabsorb properly - Constipation: shitting a brick Gall bladder Age related disorders - Gall stones: yo-yo diets; have more trouble with gall stones The liver Age related disorders - Cirrhosis: drinking to early; more men than women - Food poisoning: disrupts homeostatic ability; best before date they don’t check and it's expired Feb 15 th Endocrine system Age related changes Age related disorders 1) Diabetes: can't be cured but can be prevented, not diagnosed right away, live with it more than any other disease o The disease: type 1, pancreas doesn’t produce insulin; and type 2, because of lifestyle o Diabetic epidemic; occurs more so later in life, ¼ Canadians have it; family history, poor diet, lack of exercise o The cost: billions of dollars o Health complications: when blood sugar dips, blackouts, hypoglycemia; cataracts more prevalent, adult blindness, kidney disease, complication of limbs o Life expectancy is cut by 15 years for type 1 and 5-10 years for type 2 o DICE study: “diabetes in Canada evaluation”  Prediabetes: elevated blood glucose levels but not at diabetes level, peripheral neuropathy; put on Avandia for medication  Diabetes: give lifestyle changes 2 months, if not under control, go on medication; final option is insulin  Diabetes and heart disease; 80% of people with diabetes will die of heart disease or stroke; look at cholesterol and blood pressure  Family doctors: not up to speed with diabetes and heart disease, with counseling, were they doing the tests  Seniors and diabetes; seniors weren’t looked after properly, o Research 2) Obesity o facts: overwhelming the world; more obese people than malnutrition people; rising in people between 60-75, bigger portions, junk foods, bad template for children, boomers are growing because of fast food places o problems: orthopedic problems; if fall tend to have more fractures, fat affects their breathing, miss tumors, longer needles 3) malnutrition o causes: poverty; medical conditions; medications; stroke; eating disorders 4) cancers o lung cancer: #1 form of cancer; women in 60 developing now and are more susceptible o prostate cancer: 1/7 men get it; early detection o skin cancer: prevalent amongst older people o colon cancer: most curable cancer when detected beforehand, 2 nd cause of cancer death o breast cancer: increases after age of 50 Reproductive system Age related changes - menopause: in 1980s, it was considered a disease back then, seen as a positive now; reproductive capacity ceases; usually 50s but can be later Age related disorders - osteoporosis - heart disease - cancer Male Age related changes - andropause: increase in testosterone; men are underdiagnosed; suffer same things as women Age related disorders - prostate cancer - heart disease - osteoporosis Sexuality - women it's painful, Viagra has many side effects though; medications affect sexual drives; lack of a partner for women; sex plays an important role; socially acceptable with older people Ageism - think old people are a burden; think old is bad Ageism and health care - family doctors: 2053 family doctors and 171 geriatric doctors; not enough family doctors - examples of ageism: older people don’t get mammograms; many can't wait for specialized tests; don’t get treated for arthritis - heart disease: a lot of cardiologists are reluctant to older people; many not put on medications - joint replacement: surgeons say they need to have home care and rehab in place first - gender bias: older women aren’t admitted to ICU as readily as men; angiogram more for men; 9 times more likely to get knee and hip surgery - gay men: discriminated against too - family doctors and ageism: don’t do house calls these days March 1 st For ageism in the workplace - proficiency: older people can't work efficiently - create jobs: older people should make jobs available for younger people/unemployed - Costs money: at high salary level, use health plan, got life insurance Against ageism in the workplace - Retirement fund: rather have them pay taxes and provide for government funds instead of sitting back and taking the funds - Labour force: Canada needs them to maintain work force - Can't afford to retire: need to maintain job - Negative effects on workforce Ageism and driving - Losing a license: I sign of independence, and if in the suburb it's a necessity - Decline in driving ability after 50: less ability to react, cognition, physical decline, - Medical conditions: if they have different disease, people with hearing lose or poor vision - Doctors - gate keepers: they have to report if someone is not able to drive anymore; men drive more when their abilities are impaired/can't drive anymore - Warning signs: get police warnings, get lost in familiar areas, confused/frustrated behind the wheel, get distracted, don’t obey rules, go slower, don’t know size of the car - Seniors are good drivers: avoid high crash areas, avoid bad weather, wont drive at night - Ministry of transportation: doctors job to report, after 80 have to have a medical, a visual and a written test and may have to have the road test, every 2 years after that - Drivable: goes straight to the ministry of transportation rd - Research: by 2020 it’ll be the 3 leading cause of death Ageism and treatment - Can't tell them to do something, tend to treat them like children, In the economy - That they are birds Retirement - Make them seem invisible, old people what to seem to be busy Media - Positive ageism (golden girl TV show), in terms of their medications, negative ageism, medical alert Attitudes - People have attitudes that are formed in childhood, think they are sickly, wrinkled , all sort of negative, older people contribute to their own ageism How to prevent ageism: have to get rid of the myths about old people - Teach children about old people - Bring old people into schools to talk about their life - Combine day care and retirement homes - “Students supporting senior programs” - Convince old people that it's never too late to change lifestyle - Age stimulation workshop - University of Toronto students and seniors - Look at diversity of seniors Personality types: Kansas City study, Neugarten - Mature integrated: the ones satisfied with their lives, accept aging and death - Armour defense: very aggressive, using all the anti-aging products, keep working, very independent, stubborn, not successful in accepting old age - Angry: blame everyone for everything, jealous, find fault, - Passive dependent-rocking chair: don’t do anything for themselves, very sweet, could be attention seeking, some of it is very learned - Self-hater: depressed people, no friends, doesn’t get along with family - Disorganized: people with dementia, poor coping skills, very disorganized with how they deal with people - Middle age you have physical changes: have to wear glasses, getting gray hair; can be changed today with physical activity and cosmetic surgery, people are dealing with it; coping becomes psychological, some cope well, are well adjusted; some aren’t, examine themselves and aren’t satisfied and have the midlife crisis in a negative way - If not resolved, they will be unhappy when they get older; it has to be resolved or else there are many consequences as they age March 3 rd Retirement - 58 for those who are financially well off; 62 for doctors and lawyers; 65+ for those who are self-employed; average is 61 - Workaholics are scared of retiring; those who can't retire financially - Blue collar workers don’t mind retiring - Professional people, work gives meaning to their life, don’t want to retire - Personality will affect If and when you will retire - 2 ndchapter, are those that times after retirement that they can bring back; old band, open restaurant Successful retirement 1) Finances: men took care of the family; women want to be able to provide for their kids if single 2) Health: can buy health with money; if you have no money you have no control over health 3) Time management: balance your time between being busy and resting 4) Interests: have to have hobbies, must be meaningful 5) Spouse partner: not lonely and isolated; women become more aggressive; when men do adjust to retirement, they feel very relaxed Atchley’s theory of retirement adjustment 1) Pre-retirement: getting ready for retirement; a lot of it is financial 2) Honeymoon: go on a trip; thinks all very exciting 3) Retirement routine: fill their calendar, want to seem like they are busy 4) Rest and relaxation: busy but like their free time 5) Disenchantment: may become somewhat disenchanted; tired of having lunch with everyone 6) Re- orientation: 1 activity a day that they really what to do 7) Routine or stability: they were contempt 8) Termination: death Row and Kahn: the gerontologist - Three components of successful aging 1) Low probability of disease and disability 2) High cognitive and physical functional capacity 3) Active engagement with life in the form of interpersonal relationships and productive activity Effects of medication - Research: on 25-45 year olds, don’t want to find complications, mostly on men; 125lb - Physiology and medications: body functions are slower; medications are in body longer and not absorbed efficiently o Interaction with drugs: drugs can have cardiac and hypertension in older people o Interaction with food: grapefruits are bad for absorption for beta- blockers and cancer medications o Drugs and gender: not as effective on women because studies are on men o Prescribing cascade: drugs will cause side effects and they think that it's another disease - Physician and medications: may prescribe drugs that are suitable for young people; tend to over prescribe; can't read writing; many don’t do follow ups - The patient and medication: have to communicate clearly; do they know what the medications are for; take a number of pills; does the family doctor know what drugs you are taking; they forget to take their pills and overdose, take more because they think it's better; don’t allow drugs to take effect; don’t read the labels properly; all the pill containers look the same; think over the counter drugs are harmless - Dangers with medication: people get adverse effects; prescription is wrong - Rules: people should go to the same pharmacists and talk over their medications with their doctors; see if expirer dates are th March 8 Drugs - Big drug companies; $40 billion; bribe doctors to use their drugs; hire ghost writers - Drugs in Canada; 3 years of trail to be approved and after the USA, brand name drugs vs. generic drugs, both the same thing - Ontario drug benefit plan: spend $580 per person per year, elderly have to pay $100 a year deductible; a lot of people don’t have a drug plan now - Pharmacies: huge business; they want more power; they want to be able to alter peoples prescriptions, give meds for minor things; would reduce the load off the doctors; doctors say that they don’t have the knowledge and that they will over/under prescribe patients - Drug advertising: in Canada, they can state the disease and not the drug or the state the drug and not the disease, or they can , in USA, they can do both ; - Organs; 2000 people waiting for organ transplant; Complementary alternative medicine - CAM; a lot of people are turning to the alternative meds, natural defenses; they think it's safe, can complicate things - Health Canada/natural products: don’t have to go through any trials; put NPN or DIN on bottle to tell that government has look at it, no quality control - Health nutrition stores: just because it's natural, doesn’t mean it's safe - Chinese medicine: no restrictions on who can practice it; no regulating body - Marijuana: over 1800 people are licensed; Pain - 1 in 5 people in Canada suffer from pain; women have more pain than men; everyone has different pain - Faces of pain: mental pain; emotional pain; physical pain; if you’re in pain all the time It gets exhausting; self-esteem is affected, stress; socially, you can attend social functions, feel isolated - Treatment: shamefully neglected; ultimate thing that brings people to the hospital; still isn’t perfected to control pain - Specialty: multidisciplinary approach to deal with it; looking at the whole person, physical or emotional - Pain clinics: where people can go and they look at the whole person - Communicating pain: what kind of pain is it; piercing, hurting; express pain by pointing to images of faces of pain/scales, by facial expression; seniors have felt pain, are afraid of it Depression - Cause: both mental and physical; more people depressed in nursing homes; 1 in 4 women and 1 in 8 men - Myth: that elderly people are depressed; not necessarily so - Symptoms: feel hopeless, sad, excessive worrying, physical complaints - Reasons: health, many chronic diseases are linked to depression; some medications; loneness; their personality; SAD: Seasonal Affective Disorder, don’t get enough sunshine, like the winter blues; - Diagnosis: grossly underdiagnosed and undertreated; with seniors, often times they don’t want to speak about it, don’t like to talk about emotion, feel ashamed, sign of weakness, very important that family members know if they are depressed - Treatment: it's a challenge; they are on other pills; seniors on phone treatment had less dropout rates than those that went face-face to see the doctor - Depression and Alzheimer’s is very closely linked; properly deal with depression as a first case Delirium - Symptoms: hallucinations, agitation, disorientation - Causes: new medication; infection; dehydration; serious problem in hospital, no visitors - H.E.L.P: volunteers that go and see those people who do not get visitors to make sure that they are eating, drinking properly How seniors influence society - The older you get, the more willing you are to pay for services - Grand parenting: those who don’t live near grandchildren; those who are involved with grandchildren, they are always there; those who live/grow up with grandchildren; those who look over grandchildren fulltime; those who have full custody of grandchildren, financial point of view; Grandparents Right Association, if parents get divorced or if the parent s are unfit to kids - Volunteering: we couldn’t pay for the amount of unpaid workers; will baby boomers contribute like older seniors now - Political clout: American Association of Retired People (AARP), Canadian Association of Retired People (CARP), 35 million members; very important group; look at things like transportation, elder abuse; raging grannies, go to political rallies, are global peace, attack political parties - Transportation: have to have transportation; affecting taxis, busses because they have walkers and wheelchairs; have more pedestrians that are elderly and have more fast/bad drivers - Recreation/leisure time activities: seniors love to do things like golf, walking, bird watching, gardening, wine making, sports March 10 th - Marketing: senior discounts, seniors will travel for good deals - Moses Znaimer; CARP, combined it with ZOOMER (boomers with zip); changed the magazine to ZOOMER, which is much more positive now - Recreation/leisure time activates - Travel: have bus tours, go on vacation, cruises, spas, more active seniors are going on active tours; problem with health care in other countries - Business entrepreneurship: catering to older people with many different things; senior proofing house; elevated toilets, wider doors for wheelchairs - Fraud: convince people to believe them to buy things and then say something’s wrong with it and then never come back with it - Health care industry: can buy people devices for many different things, they don’t want them to look bad; geriatric doctors, dentists - Yee Hong Centre, centers for geriatric care, baycrest is the best for geriatric care; started by Joseph Wong; included the recreation centers in it; longer life expectancy - Specific physical activity needs will vary as a function of the individuals position along a health fitness gradient o Group 3: physically fit; healthy; independent; need self-discipline; won’t stay in group 3 if they have an illness or injury o Group 2: physically unfit, unhealthy, independent; obese, hypertensive; eating government health care dollars o Group 1: physically unfit/frail; unhealthy; dependent; o How can you move group 2 to group 3 Benefits of physical activity for society - Reduces health and social care costs - Enhances the productivity of older adults - Promotes a positive and active image of older persons-society; see them as a productive people - Health insurance: liberty health sets there rates, older they are, the more diseases they have, the more medication they take will increase the costs, should decrease with PA but doesn’t, Alberta only province that gives tax break for PA, GO FIT program, How to achieve a healthy public policy; Sectors - Family support - Peer support groups - Community and social providers - The media - Non-governmental organizations - Health care providers - Primary care providers - Nursing homes - Universities/colleges - Rehabilitation centers - Residential and housing facilities - Private sector - Sports/fitness/social clubs/community centers March 15 th - In a 30 year span; 1980-2010; heavier, bigger belly, less fit and weaker; men 50+ are 20 pounds heavier, women 50+ are 12 pounds heavier than they were 30 years ago Older adult exercise programs - Pre-exercise screening; use on older people; don’t know if they have a silent disease or not, can find out what they can and cannot do o Medical history; want to know if they have any chronic diseases and what type of drugs they are taking; find out if they wear a hearing aid; disclose the side effects of PA; do a PAR-Q to assess them; use easy screening tool, it's more specific, especially to the musculoskeletal system and also gives them safety tips when designing a program o Interview; gather information in a comfortable setting; ask them about a typical week; people over estimate their PA levels; have them describe their house - Physical assessment protocol o Blood pressure; want to find out their blood pressure, if they have high/low BP; what medications they are taking; o Body composition; fat increases and muscle decreases; BMI is obsolete, doesn’t show percentage of fat and muscle, doesn’t show where it is located too, not a good measurement for over 65 people; should us the waist-to-hip measurement, pinch and itch - Heart rate o Target heart rate zone; level of intensity that is high enough for benefits but low enough to not be damaging o Karvonen method; age 65; resting HR 70 BPM; intensity 50-70%; max HR 220-65=155; heart rate reserve 155-70=85; heart rate range (50%)x85-43 & (75%)x85=64; target heart rate zone HR(70)+50%(43)=113 & HR(70)+75%(64)=134 ;THRZ = 113-134 - Rate of perceived exertion (RPE); used people with Beta-blockers because their max HR can only go to 80-85; Borg’s RPE; people should be in between light and hard, it's a 10 point scale; from very, very light to extremely hard; - rate of perceived breathlessness (RPB); should be in between slight and somewhat severe breathlessness - rate of perceived pain (RPP): should in between slight to moderate pain - degree of difficulty; should be in between easy and somewhat difficult - talk test; if you can talk properly you are in the proper aerobic zone, if you can't complete a sentence you are in the anaerobic zone, if you are gasping then you are working too hard; if you can sing you aren’t working hard enough; JAB, Just Audible Breath, if you can just hear your breathing while you are walking you are in a good zone - walk test; have them set the pace and the distance; can do the talk test at the same time - strength: how do they perform their ADL’s; can they raise their arms, their legs; do it without weights; use weights fi they are fit to lift weights - assessment of flexibility; after 18 flexibility decreases - function; assess their ability; can they take care of them self, can they drive; function declines with age; Mary tinetti; looks at evaluation of gait, and at balance - 30 second chair stand; see how many times someone can stand up from the sitting position in 30 second period; lower body strength - Arm curls; 6 pounds for women, 8 for men - two minute step in place; look at aerobic endurance; see how many times right leg comes up - sit and reach; sitting on a chair and reaching, plus or minus scores - back scratch; reaching hand at behind the back March 17 th - PA Senior Test Manual has norms for ages 60-94 Post Physical Assessment Report - Movement need of the elderly: women need more work on strength and men need more work on flexibility, dexterity and balance - Leaders have to give motivation and feedback, give modifications - More classes of appropriate ability What You Know - Fitness level; if they are active or frail - Health status; if they have diseases - Level of mobility; if they have arthritis, osteoporosis; know limitations - Source of motivation; whether they do it on their own or if it's a group thing - Degree of motivation; if they are the people in the front, very active; or if they are in the back, just going through the motions - time commitment; if they exercise 3 times a week or daily - Interests; whatever they want to do; tai chi, aerobics - Can't have a program too varied because they will get confused Design of Exercise Program - Warm up and cool down; have to have a proper warm up and cool down - Walking program; o Walking protocol; shouldn’t walk about 25 Celsius or above 60% humidity or high pollution days or not when -10 Celsius; have proper running shoes; yack trap walkers, go on bottom of shoes; should have water bottles; walk in familiar places o Walking intensity; unfit elderly should walk for 2 mins and then slowly get up to 5 mins to 10 mins, increase walking mins by 5 mins every 2 weeks; the time spent walking is better than the intensity o Walking Reebok Program  Health walking; 20 mins per day up to 40 mins a day  Fitness walking; focus on arm swing and on heel toe movement  Speed walking; do about 12 mins to walk a km; stride frequency picked up  Running; 2 mins of walking and 30 seconds of running; do it 12 times o Walking promotions; walking tapes; apartment walking  Marathons; - Aerobic program; some have mats, chairs, warm ups, music; set up of room - Aquafit program; non-weight bearing, cushioning effect, resistance in all directions, 12 times resistance of air; can train every muscle group; can do more in water; prevents falls - Strength training program; for the frail; use own body as resistance; don’t know much about weight training; don’t know how strong they are, how strong they can be - Flexibility program; should be daily; some people do yoga March 22 nd - Balance program; stand on one leg, a lot of stability ball balance, fencing, tai chi - Chair exercise program; do it with some standing component to it, resistance
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