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The elderly

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Title: The elderly


1
The elderly
2
Aging
  • Aging- the process by which human behavior alters
    with time
  • Wisdom and judgment become more acute and
    powerful.
  • Fifty is a crucial age in determining the brains
    pattern of aging
  • After this age, brain functioning and mental
    ability are determined by three factors mental
    habits, chronic disease, and minds flexibility.

3
Aging
  • Elderly population is now the fastest growing
    population.
  • It is estimated that by 2030, there will be 50
    million people over 65.
  • More focus is being placed on geriatric health
    issues disabilities, chronic health problems,
    living alone or assisted living, depression,
    loss, pain, Alzheimers and dementia.

4
Growth of Population Sixty-five Years Old and Over
25
25
22.9
20
20
17.7
15
15
12.6
Percent of Population
10
9.2
10
5.4
5
5
4.1
0
0
2050
2020
1990
1960
1930
1900
Year
5
Demographic Revolution
  • We are living currently in the very oldest world
    society that has ever existed.
  • Aging population will be one of the dominant
    trends over the next decades in the
    industrialized world.
  • Over-65 population in the U.S. is 11 times what
    it was in 1900. General population is only 3
    times as many as in 1900.

6
Life Expectancy Selected Data for Men and Women
in Industrialized Nations
Men Women China 68 71 India 59 60 Israel
76 81 Japan 76 83 Turkey 70 74 Canada
76 83 Cuba 75 80 Mexico 70 77 USA 73 79
Poland 68 76 France 74 82 Germany 73 79 G
reece 76 81 Italy 75 81 Spain 74 81 Switz
erland 75 82 Egypt 60 63 Kenya 56 56 Nige
ria 53 56 South Africa 57 62 Zambia 36 36
Australia 76 83 New Zealand 74 80
7
Aging
  • Primary Aging
  • Secondary Aging
  • Physical changes due to aging. Due to maturation
  • Changes due to illness, health habits and are not
    inevitable.

8
Ageism Prejudice Against Older People
  • 1- Negative attitudes about older people
    regarding competence attractiveness
  • 2- Identical behavior by an older person and a
    younger one is interpreted differently.
  • 3- People use baby talk to address older people
    in nursing homes
  • 4- Job discrimination
  • 5- Misinformation

9
The Aging Process
  • Gradual decline, begun decades ago, continues
  • Presbycus (hearing loss)
  • Presbyopia (far-sightedness)
  • Shrinkage of internal organs
  • Shrinkage in height
  • Muscles less flexible
  • Canities (hair becoming gray to white)
  • Wrinkling and mottling skin
  • Neuronal conduction slows
  • Less deep sleep
  • Higher rates of chronic diseases

10
Risk Factors in Late Adulthood
  • Falls (a major cause of death or disability)
  • Misuse of medicines
  • Social isolation
  • Infections
  • Osteoporosis
  • Nutritional deficiencies
  • Depression
  • Cancer
  • Cardiac Disorder/stroke/pneumonia/diabetes/arterio
    sclerosis
  • Dementia
  • The Good News Many older individuals lead
    satisfying lives and maintain their health well
    beyond societys expectations.

11
Prescription Drug Use in Late Adulthood
  • The majority of elderly adults take some
    medications.
  • Some take as many as 7 different drugs.
  • Most common medications are
  • Sleeping pills
  • Laxatives
  • Anti-hypertensives
  • Diuretics
  • Cardiac medications
  • Antacids
  • Antibiotics
  • Cold remedies
  • Analgesics
  • Psychotropics
  • Drugs metabolize more slowly as people age and
    kidney and liver functions decline
  • Hazards include
  • Toxic interactions

12
Major Theories of Aging
1. Wear and Tear Theory (Common Sense) Body is
like a car that wears out after so much mileage.
Looks at buildup of toxins in the body. 2.
Cellular Theories All cells die and are replaced.
Toxins and pollutants affect this cell
reproduction with mutations and imperfection.
Metabolic wastes accumulate. Electrons (free
radicals) break away and destabilize atoms. 3.
Genetic Programming Theories We inherit a
biological blueprint that switches off growth
cells. Cells are unable to continue dividing and
deteriorate. Each time the cells die, the
telomeres grow shorter and eventually dont allow
the cell to replicate.
13
4.- The Peripheral Slowing Hypothesis
  • The overall processing speed declines in the
    peripheral nervous system.
  • It takes longer for information to reach the
    brain.
  • It takes longer for commands from the brain to be
    transmitted to the body muscles

14
5.- The Generalized Slowing Process
  • Processing in all parts of the nervous system is
    less efficient due to loss of neurons
  • They are unable to receive efficiently
    information from the environment to indicate a
    dangerous situation
  • Their decision process may be slower and their
    ability to remove themselves from harm is impaired

15
Living longer
  • 1. Telomeres-working on how to keep them from
    decreasing in size
  • 2. Finding the longevity gene
  • 3. Reducing free radicals with antioxidant drugs
  • 4. Restricting calories
  • 5. Bionic approach replacing worn out genes
  • BUT AT WHAT COST???

16
The Heart
  • The arteries harden
  • The blood vessels shrink
  • Reduction in the capacity of the heart to pump
    blood through out the circulatory system
  • A 75-year-olds heart pumps less than
    three-quarters of the blood it pumped during
    early adulthood

17
The Brain
  • A reduction of the blood flow to the brain
  • The space between the skull and the brain doubles
  • The number of neurons declines in some parts of
    the brain, though not as much as was once thought

18
Vision
  • Lens becomes less transparent and the pupils
    shrink
  • The optic nerve becomes less efficient
  • Distant object becomes less acute
  • More light is needed to see
  • It take longer to adjust to a change from light
    to darkness and vice versa.
  • Driving at night becomes difficult
  • Reading becomes more of a strain

19
Hearing
  • 50 of adults over 75 have hearing loss
  • High frequencies are the hardest to hear
  • Hearing aids would be helpful 75 of the time,
    but only 20 of people wear them
  • Hearing aids amplify all sounds so it is
    difficult to discern conversations
  • Some people withdraw from society because they
    feel left out and lonely

20
Psychological Problems
  • A result of cumulative losses
  • Declining health may contribute to psychological
    problems
  • Anxiety may be caused by inappropriate drug
    dosage
  • Changes in metabolism
  • The effects of drug interaction

21
Dementia
  • Dementia is a disease marked by a gradual loss of
    cognitive functioning which can also incorporate
    losses of motor, emotional, and social
    functioning as well..
  • It is a permanent and progressive disease that
    eventually renders people unable to care for
    themselves.

22
Reversible causes of dementia
  • Alcohol use
  • Depression
  • Medication side effects /
  • Drug interaction
  • Nutritional deficiencies
  • Thyroid imbalance

23
Stages of Progressive Dementia
  • The following may occur over a 5 to 15 year
    period
  • General Forgetfulness losing keys, eyeglasses,
    forgetting names and appointments
  • Forgetfulness More Intense and Prevalent become
    repetitive, confused, unable to concentrate.
    Dysphasic.
  • Dangerous Stage getting lost, dressing
    inappropriately, forgetting to eat, forgetting to
    turn off the stove.
  • Totally Confused and Disoriented doesnt
    recognize spouse or family members. Cannot
    control body functions. Requires full-time care.

24
Dementia
  • Begins with forgetfulness - isolated incidents of
    memory loss do not constitute dementia.
  • Forgetfulness progresses to confusion and
    eventually disorientation.
  • Problem solving
  • Judgment
  • Decision making
  • Orienting to space and time
  • Personality changes - irritable, agitated,
    sadness (depression), manic episodes

25
Dementia - Causes
  • 50 different causes
  • Neurological disorders such as Alzheimers (est.
    50-70 of people with dementia have Alzheimers)
  • Drugs and alcohol
  • Vascular disorders such as multi-infarct disease
    (multiple strokes) Inherited disorders such as
    Huntingtons Infections such as HIV

26
Causes of Dementia
Multi-Infarct Dementia or Vascular Causes (14)
Alzheimers (56)
Brain Injury (4)
Multiple Causes (12)
Other Causes (6)
Parkinsons Disease (8)
Source Trushke, Edward F. (Fall 1998) ADVANCES.
Bulletin of Progress in Alzheimers Disease
Research and Care.
27
Two types of dementia
  • Cortical - Disorder affecting the cortex, the
    outer portion or layers of the brain.
  • Alzheimers and Creutzfeldt-Jakob are two forms
    of cortical dementia
  • Memory and language difficulties (Aphasia) most
    pronounced symptoms.
  • Aphasia is the inability to recall words and
    understand common language.

28
  • Subcortical - Dysfunction in parts of the brain
    that are beneath the cortex.
  • Memory loss language difficulties not present
    or less severe than cortical.
  • Huntingtons disease and AIDS dementia complex.
  • Changes in their personality and attention span.
  • Thinking slows down.

29
Vascular dementia the second leading type of
dementia
Strokes cause between 10 and 20 of dementia
cases.
30
Delirium Definition
  • Disturbance of consciousness
  • i.e., reduced clarity of awareness of the
    environment with reduced ability to focus,
    sustain, or shift attention
  • Change in cognition (memory, orientation,
    language, perception)
  • Development over a short period (hours to days),
    tends to fluctuate
  • Evidence of medical etiology

31
Delirium
  • Tends to occur with
  • the elderly
  • those with medical conditions such as Cancer,
    AIDS or fevers (more prevalent in children)
  • Can also be diagnosed with those who are taking
    drugs

32
  • PREVALENCE
  • Range 20-30 of all patients acutely
  • hospitalized
  • Unrecognized in up to 32-67 of cases
  • Morbidity
  • Skin breakdown
  • Aspiration pneumonia
  • Cardiovascular stress
  • Prolonged hospitalization
  • Mortality 20-30 according to one study

33
Delirium
  • Drugs that may contribute to delirium
  • - Anticonvulsants
  • - Barbiturates
  • Insulin/hypoglycemic agents
  • - Antipsychotics
  • - Benzodiazepines
  • - Narcotics

34
Alzheimers disease the most common type of
dementia
6 out of 10 cases of dementia are Alzheimers
disease.
35
Alzheimers Disease
  • Affects 4 million Americans. 14 million
    predicted to have it by 2050
  • 1 out of 10 people over 65 have Alzheimers. 1
    out of 2 over 85 have it.
  • Costs over 100 billion annually in health care
    and related costs.
  • Definitive diagnosis only on autopsy, with
    findings of plaques and tangles in the brain
    cortex.
  • Possible causes include genetic inheritance, slow
    virus, or environmental toxins.
  • No known cure.

36
Alzheimers Disease
  • Progressive disorder in which neurons deteriorate
    resulting in the loss of cognitive functions
    (memory), judgment and reasoning, movement
    coordination, and pattern recognition.
    Predominantly affects the cerebral cortex and
    hippocampus which atrophy as the disease
    progresses.

37
Alzheimers plaques and tangles
  • Neuritic Plaques
  • Commonly found in brains of elderly people but
    appear in excessive numbers in the cortex of AD
    pt.s
  • Surrounded by deteriorating neurons that produce
    acetylcholine (neurotransmitter essential for
    processing memory and learning.
  • Neurofibrillary Tangles
  • Twisted remains of a protein which is essential
    for maintaining proper cell structure.
  • It is not known whether the plaques and tangles
    are the cause of AD or part of the results of the
    disorder.

38
Areas of the brain that may be affected
  • Frontal lobe
  • thinking, planning, judging, movement
  • Parietal lobe
  • Sensations like pain, temperature, touch
  • Temporal lobe
  • Understanding sounds and speech
  • Occipital lobe
  • Processes visual information

39
Affected area of the brain
  • Hippocampus
  • Plays a crucial role in both the encoding and
    retrieval of information. Damage to the
    hippocampus produces global retrograde amnesia,
    which is the inability to retain newly learned
    information.

40
Symptoms of Alzheimers
  • Aphasia difficulty processing or speaking
    language
  • Apraxia - (decreased ability to perform physical
    tasks such as dressing, eating, etc.)
  • Delusions
  • Easily lost and confused
  • Inability to learn new tasks
  • Loss of judgment and reason
  • Loss of inhibitions and belligerence
  • Social Withdrawal
  • Visual hallucinations

41
Alzheimers early stage
  • Characteristics
  • Begins with forgetfulness
  • Progresses to disorientation and
    confusion Personality changes
  • Symptoms of depression/manic behaviors
  • Interventions
  • Medications - Aricept and Cognex (both are
    commercial names).
  • Both increase acetylcholine (Ach) in the brain by
    inhibiting the enzyme that breaks it down.
  • Therapy (deal with depression that often
    accompanies diagnosis
  • Counseling with family

42
Early Stage
  • Music Therapy
  • Used to relieve depression
  • Coupled with exercise and relaxation techniques
  • Increase or maintain social relationships
    (dancing, improvisation)
  • Maintain positive activities (church choir,
    Senior social dances, etc.)

43
Alzheimers middle stage
  • Characteristics
  • Need assistance with daily skills
  • Unable to remember names
  • Loss of short-term recall
  • May display anxious, agitated, delusional, or
    obsessive behavior
  • May be physically or verbally aggressive
  • Poor personal hygiene
  • Disturbed sleep
  • Inability to carry on a conversation
  • May use word salad (sentence fragments)
  • Posture may be altered
  • Disoriented to time and place
  • May ask questions repeatedly

44
Middle Stage
  • Interventions
  • Validation Therapy
  • Structured Areas for Mobility Positive,
    nurturing, loving environment
  • Music Therapy

45
Alzheimers later stage
  • Characteristics
  • Loss of verbal articulation
  • Loss of ambulation
  • Bowel and bladder incontinence Extended sleep
    patterns
  • Unresponsive to most stimuli
  • Interventions
  • Caring for physical needs Maintain integrity of
    the skin Medical interventions
  • Most activities are inaccessible

46
Cognitive Development Schaies Studies
  • Results show no uniform pattern of adulthood
    age-related changes across all intellectual
    abilities
  • Fluid intelligence decline starting age 25
  • Crystallized intelligence stay steady or increase
  • Training can improve reasoning and spatial skills

47
Memory
  • People are less likely to experience memory loss
    in societies where older people are held in high
    esteem
  • Memory losses occur primarily to episodic memory
  • Semantic memories and implicit memories are
    largely unaffected by age
  • Short-term memory declines gradually until age 70

48
Atchleys Stages of Retirement
  • Phase 1. Preretirement disengage from
    workplace and plan for retirement. May have
    mixed feelings.

49
Atchleys Stages of Retirement
  • Phase 2 - RETIREMENT people do one of three
    things
  • A. Honeymoon initially feel on top of the
    world and do things that they could not when they
    were employed.
  • B. Immediate retirement routine those who
    already had a full and active schedule in
    addition to their employment will become
    individuals who establish comfortable, yet busy
    schedules soon after retirement.
  • C. Rest and relaxation - period of very low
    activity as compared to the "honeymoon" path.
    Persons who have had very busy careers with
    limited time to themselves frequently choose to
    do very little in their early retirement years.
    Frequently, however, activity levels do increase
    after a few years of rest and relaxation.

50
Atchleys Stages of Retirement
  • Phase 3 Disenchantment
  • Following the honeymoon period or a time of
    continued rest and relaxation, there may be a
    period of disappointment or uncertainty. A person
    may miss the feelings of productivity they
    experienced when working. Disenchantment with
    retirement can also occur if there is a
    significant disruption in the retirement
    experience, such as the death of a spouse or an
    undesired move.

51
Atchleys Stages of Retirement
  • Phase 4 Reorientation
  • "take inventory" of their retirement experience
    and find ways that will improve their retirement
    role. Becoming more involved in community
    activities, taking up a new hobby or relocating
    to a more affordable setting may contribute to
    this "second chance" at retirement. A common goal
    of reorientation is to design a retirement
    lifestyle that is satisfying and enjoyable

52
Atchleys Stages of Retirement
  • Phase 5 Retirement Routine
  • Mastering a comfortable and rewarding retirement
    routine is the ultimate goal of retirement. Once
    a fulfilling and comfortable retirement routine
    has been found, this phase of retirement can last
    for many years.

53
Atchleys Stages of Retirement
  • Phase 6 - Termination of Retirement
  • Eventually the retirement role becomes less
    relevant in the lives of older adults. When a
    person can no longer live independently due to
    disability or illness, the role of disabled elder
    becomes the primary focus of his or her life.

54
Top Five Causes of Death
  • 1900
  • Influenza, pneumonia 11.8
  • Tuberculosis 11.3
  • Gastritis, enteritis 8.3
  • Heart Disease 8.0
  • Stroke 6.2
  • 2000
  • Heart Disease 25.7
  • Cancer 20.0
  • Stroke 6.0
  • COPD 4.5
  • Accidents
  • 3.4

55
Where We Die
56
Aging
  • The most common psychological disorder associated
    with aging is depression.
  • Suicide rates among the elderly are increasing at
    startling rates.
  • The highest suicide rates are for white men over
    age 85.
  • The elderly comprise about 13 of the population
    and account for about 20 of all suicides.

57
Older Suicide by Race and Gender, 1992
80
67.6
70
White males
African American males
60
53.0
White females
African American females
50
Percent
40
32.0
30
26.0
18.9
18.5
20
11.8
10.1
7.2
6.6
10
6.3
6.3
2.6
2.0
1.4
0.1
0
85
65-74
55-64
75-84
Age Groupings
58
Risk Factors for Suicide in Late Adulthood
  • Living alone and being socially isolated
  • Experiencing financial difficulty
  • Feeling depressed or useless
  • Being alcohol or drug dependent
  • Having a mental illness that reduces
    communication
  • Suffering from chronic pain, illness, or
    incapacity
  • Being unable to express grief or suffering
  • Losing significant relationships due to the death
    of loved ones

59
Ways in Which Culture Influences Death Concerns
  • Affects the assessment of comfort needs of the
    dying and the kind of care provided
  • Influences selection, perception, and evaluation
    of health care givers and their methods
  • Shapes beliefs about causes of death.
  • Determines the disposition of the body and
    funeral and burial rituals
  • Patterns grief responses and bereavement roles.

60
Dying is Largely Publicly Funded in U.S.A.
  • 70 of people dying are covered by Medicare
  • 13 of Medicare recipients also receive Medicaid
  • Impact on family? 30 of families are
    impoverished by the process of dying

61
Memory
  • Memory deteriorates with age, specifically
    short-term memory as well as the ability to
    perform certain tasks under time constraints.
  • In psychometric psychology, fluid and
    crystallized intelligence are both factors of
    general intelligence.
  • Fluid Intelligence- ability to find meaning in
    confusion and solve new problems.
  • Crystallized Intelligence- ability to utilize
    previously acquired knowledge and experience
  • Brain regions important to memory begin to
    atrophy as we age.

62
(No Transcript)
63
Kubler-Ross Theory
  • Stages of Dying
  • Denial and Isolation Used by almost all patients
    in some form. It is a usually temporary shock
    response to bad news. Isolation arises from
    people avoiding the dying person. People can slip
    back into this stage when new developments emerge
    or they can no longer cope.

64
  • 2. Anger Different ways of expression
  • -Anger at God "Why me?" They feel others are
    more deserving.
  • -Envy of others Other people are enjoying life
    while the dying person experiences pain.
  • -Projected on environment Anger towards doctors,
    nurses, and families.

65
  • 3. Bargaining A brief stage, hard to study
    because it is often between patient and God.
  • -If God didn't respond to anger, maybe being
    "good" will work.
  • -Attempts to postpone "If only I could live to
    see . . ."
  • 4. Depression Mourning for losses
  • -Reactive depression (past losses) loss of job,
    hobbies, mobility.
  • -Preparatory depression (losses yet to come)
    dependence on family, etc.

66
  • 5. Acceptance This is not a "happy" stage, it is
    usually void of feelings. It takes a while to
    reach this stage it consists of basically giving
    up and realizing that death is inevitable.
  • Hope is an important aspect of all stages. A
    person's hope can help them through difficult
    times.

67
Elizabeth Kubler-Rosss Stages of Coping with
Death
Associated Feelings
Stage
Denial Not me. Anger Why
me? Bargaining Yes me, but . .
. Depression Yes me. Begin to
mourn. Acceptance My time is very close now,
and its all right.
68
Erikson
  • Eight Stages of Psychosocial Development
  • Integrity vs. Despair
  • Elderly deal with questions of integrity and
    despair
  • Often reminisce about past, evoking feelings
    of worthlessness or satisfaction
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