Cognitive and Social Changes of Aging

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Cognitive and Social Changes of Aging
Gerontological Community Based Nursing
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Psychosocial Changes with Aging

• Personality
• Should be consistent with earlier years
• Changes can result from pathology or responses to
  events affecting self-image
• Memory
• Long term memory remains intact
• Short term memory diminished
• Processing affected by stress

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Psychosocial Changes with Aging

• Learning
• Use simple association rather than analysis
• Verbal and abstract abilities are approximately
  equal
• Basic intelligence unchanged
• Creative thought declines
• Factors that affect learning
• Motivation
• Attention span
• Delayed transmission
• Perceptual defecits
• Illness

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Sociological Changes

• Sexual and intimacy
• Sexual patterns persist throughout lifespan
• Maintenance and promotion of sexual functioning
  in is necessary for
• wellness
• sense of normalcy
• Higher quality of life
• Factors that affect individuals ability to
  remain sexually active
• Normal aging variations
• Disabilities
• Medications
• treatments

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Sociological Changes

• Sexual and intimacy contd
• Environmental barriers
• Living with adult children
• Institutionalization
• Assistive devices
• Fears
• Rejection
• Boredom
• Failure
• Hostility

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Relationships

• Close sustaining relationships have a positive
  effect
• ? stress
• ? mental health
• ? life satisfaction
• Married people have better support system
• Married people have better income
• Married people have better nutrition

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Relationships

• Friends
• Shrinking social network
• Organizations neighborhoods
• Promotion of social contacts
• Factors that affect social network
• Family members
• Friends
• Health
• Independence
• Gerontological orphan

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Normal Age-Associated changes of the Neurological
System

• Brain changes
• Neurochemical
• Structural
• Neuropsychological changes
• Small decrease in brain weight
• 7-8 decrease
• Loss of neurons in selective brain structures
• Accumulation of neuritic plaques and
  neurofibrillary tangles
• Neurochemical changes
• Decreased activity of catecholamine synthesis
• Decrease amounts of neurotransmitters
  serotonin, noradrenaline, and dopamine

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Normal Age-relatedMemory Changes

• Memory peaks between the ages of 20-30
• Followed by a subtle decline until age 60
• After 60, memory difficulties become more
  pronounced

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Memory Storage and Retrieval

• Short-term memory lasts 7-10 seconds and can
  only hold 4-7 items at once
• Intermediate memory Lasts 24-48 hours.
• Long-term memory What happened beyond 48 hours
• Successful memory relies on all three

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Normal Age-Related Memory Changes

• Many people assume that as people age their
  memories will fail.
• There are some memory changes that are associated
  with normal aging however, the ability to learn
  new things does not decline.

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Normal Age-Related Memory Changes

• Slower Thinking
• All body systems become less efficient with age,
  including thinking and problem-solving abilities.
• The speed of learning and recall decreases, so it
  may require more time to learn new things or
  retrieve information.
• Difficulty Paying Attention
• Many memory problems are due to problems of
  attention, not retention
• Reduction in the ability to concentrate as a
  person ages makes it harder to remember
• More susceptible to distractions and interruptions

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Normal Age-Related Memory Changes contd

• More memory cues may be required for recall
• Memory cue can be a word, picture, smell, rhyme
  or anything associated with information/events
• Physical Changes of the Brain that may affect
  memory
• Enlargement of the ventricular system
• Ventricles enlarge, possibly because the cells
  surrounding the ventricles are lost.
• Widening of the sulci (the grooves) on the
  surface of the brain
• Reduced brain weight and brain volume
• Probably caused by the loss of neurons

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Normal Age-Related Memory Changes contd

• Other factors that interfere with basis memory
• Visual changes
• Hearing changes
• Sleep
• Pain
• Medications
• Depression and other mood disorders

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Age associated memory changes

• Forgetting specific details and names of people,
  but remembering them later
• Able to learn new material but may have
  difficulty with information retrieval
• General awareness of memory impairment
• Memory impairment does not interfere with daily
  functioning

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Cognitive Impairment

• Currently estimated that over 4 million American
  have some form of dementia
• This number will grow to 14 million by 2050
  unless a cure or prevention is found
• Each year in the US more than a million people
  are newly diagnosed with a chronic brain disease
  or disorder
• Currently 10 of people gt 65 yo and nearly 50 of
  those gt85 yo have dementia

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• gt70 of people with dementia live at home with
  75 of the care and costs provided by family and
  friends with very little training in dementia
  care.
• The cost to society of dementia care giving is
  estimated at 61 billion per year (Alzheimers
  Association, 2002)

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Disorders of the Neurological System

• Alzheimer's
• Non-reversible and progressive form of dementia
  that reduces the ability to think, remember,
  reason, judge and concentrate
• Eventually prevents performance of ADLs
• Personality and language abilities decline
• Accounts for 66 of dementias

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Alzheimers

• Prevalence
• 4 million Americans have been diagnosed with
  Alzheimers type dementia
• 10 of people gt75 y.o. are affected
• 47 of people gt 85 y.o. are affected
• Risk factors
• Advanced age
• Family history of first-degree relatives
  diagnosed with AD

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Alzheimers Disease

• Clinical presentation
• Progression of symptoms and time appearance is
  unique to the individual
• Very early stage
• Usually considered questionable dementia
• Forgets names, events, phone numbers
• Gets lost in familiar surroundings
• Early/Mild stage
• Loss of recent memory
• Forgets bills, misplaces items

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Alzheimers Disease

• Middle/Moderate stage
• Increased memory loss
• Makes up stories to compensate
• Wandering
• Gait changes to small steps
• Late/Severe stage
• Inability to perform ADLs
• Little response to stimuli
• Loss of body weight, bodily functions
• Susceptibility to infection

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10 Warning signs of Alzheimers

• Memory Loss
• Difficulty perfuming familiar tasks
• Problems with language
• Disorientation to time and place
• Poor or decreased judgment
• Problems with abstract thinking
• Misplacing things
• Changes in mood or behavior
• Changes in personality
• Loss of initiative

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Pharmacologic Treatment of Alzheimers

• Medications should be used when all other methods
  of management have failed and the benefits
  outweigh the risks
• Psychotropic medications
• Aricept
• Donepezil is used to treat mild to moderate
  confusion (dementia) related to Alzheimer's
  disease. It does not cure Alzheimer's disease,
  but it may improve memory, awareness, and the
  ability to function. This medication is an enzyme
  blocker that works by restoring the balance of
  natural substances (neurotransmitters) in the
  brain.

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Other Common Problems r/t Alzheimers

• Wandering
• Nutrition/Hydration
• Home Safety

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Non-Alzheimers Dementia

• Development of multiple cognitive impairments,
  including the loss of memory
• Attributable to
• Metabolic disorders
• Thyroid, renal failure, liver failure
• Toxins
• Infections and neoplasms
• s/e of drugs
• Nutritional deficiencies
• Degenerative neurological diseases
• Cerebral vascular injuries, ischemias, or trauma

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Delirium

• AKA acute confusional state, acute brain
  syndrome, toxic psychosis, etc.
• Transient cognitive disorder with a rapid onset
  and brief duration
• Typical clinical presentation
• Reduced ability to maintain attention
• Disorganized thinking
• Difficulty in focusing

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Interacting with Patients with Dementia

• Positive interactions can prevent frustration for
  all parties, and help in understanding and
  meeting the needs of the patient.
• Techniques to enhance interaction and prevent
  problem behaviors
• Approach the pt from the front, establishing eye
  contact, speaking slowly, and using short
  sentences and simple words

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Interacting with Patients with Dementia contd

• Ask yes/no questions. An open-ended question is
  difficult to answer for a cognitively impaired
  patient
• Repeat, restate and paraphrase as needed, to help
  the patient understand
• Speak literally and in concrete terms. Abstract
  thought is difficult for a patient with dementia
  to interpret
• Break down directions or tasks into simple steps
  and the cue the patient s needed at each step
• Refrain from arguing or attempting to use logic
• Reduce environmental stimulus
• Allow the patient the time to do as much as
  he/she can for him/herself

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Stroke

• AKA brain attack, cerebral vascular accident
  (CVA)
• 3rd leading cause of disability in US
• 3 million people live with residual effects of
  stroke
• 75 of stroke patients are gt 65 y.o.

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Stroke

• Intracerebral hemorrhage
• Ischemic stroke
• TIAs
• Acute focal neurological signs than symptoms
  lasting lt24 hours
• Brief stroke-like event resulting in block of
  blood flow to brain
• Precedes stroke in 50 -70 of cases
• 1/3 will have a stroke within 5 years

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Parkinsons Disease

• Degenerative brain disorder of subsantia nigra
  (midbrain), resulting in death of nerve cells
  whose role is motor function reduction of
  neurotransmitter dopamine, which facilitates
  transfer of electrical signals between nerve cells

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Parkinsons Disease

• Early stage PD
• First symptoms mild, slight tremor in had at
  rest.
• Purposeful movements such as brushing teeth
  become slow and difficult
• Medications Symmetrol, Elderpryl, Parlodel,
  Permax
• Mid-stage PD
• Increased symptoms
• Decreasing affect of medications
• Add levodopa (Sinemet)

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Parkinsons Disease

• Late-stage PD
• Decreasing effects of medications
• Increasing difficulty with balance, increased
  muscle contractions, problems initiating
  movement, involuntary abnormal posture,
  nightmares, orthostatic hypotension,
  constipation, rigid face, depression, dementia
• Newer therapies Requip, Mirapex

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Cognitive Assessments

• Instrumental activities of daily living (IADL)
• Bathing
• Dressing
• Toileting
• Transferring
• Continence
• Feeding

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Cognitive Measures

• Mini-Mental State Exam (MMSE)
• 30 item instrument used to screen for cognitive
  deficiencies
• Used in determination of dementia or delirium
• Tests orientation, short-term memory, calculation
  ability, language and construction
• Must be administered exactly as written (copy in
  your syllabus appendix)