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Fondamenti di Prevenzione e Riabilitazione geriatrica
Fondamenti di Prevenzione Fondamenti di Prevenzione e Riabilitazione geriatricae Riabilitazione geriatrica
The ElderlyThe ElderlyThe Elderly
First of allFirst First ofof allall
Definitions of Old AgeDefinitions of Old AgeDefinitions of Old AgeMost definitions = having lived a long timeAged: defined as old or advanced in years Aging: process of growing older or more mature
We all age, but not all of us are oldin years, roles, behaviors, health,
or physical limitationsAging is an ongoing developmental processthat begins at conception and ends in death
Most definitions = having lived a long timeAged: defined as old or advanced in years Aging: process of growing older or more mature
We all age, but not all of us are oldin years, roles, behaviors, health,
or physical limitationsAging is an ongoing developmental processAging is an ongoing developmental processthat begins at conception and ends in deaththat begins at conception and ends in death
GerontologyGerontologyGerontology
The study of agingThe study of aging
GeriatricsGeriatricsGeriatricsThe biomedical science of old age
and the application of knowledge related to thebiologic, biomedical, behavioral,
and social aspects of aging to the prevention, diagnosis, treatment, and
care of older persons
The biomedical science of old ageand the application of knowledge related to the
biologic, biomedical, behavioral, and social aspects of aging
to the prevention, diagnosis, treatment, and care of older persons
Modern situation: aged societyModern situation: aged society
Two approaches to agingTwo approaches to aging
passive longevity
anti-aging
passive passive longevitylongevity
antianti--agingaging
Passive longevityPassive Passive longevitylongevityEvidence:
Aging boom or longevity revolution
Due to: Decline in infectious and parasitic diseasesImproved care services
Evidence: Aging boom or longevity revolution
Due to: Decline in infectious and parasitic diseasesImproved care services
Passive longevityPassive Passive longevitylongevityPrognosis
substantial increase of chronically ill bedridden persons with need of home and institutional care
large problems in the conditions of information society
and changed demography situation
Prognosissubstantial increase of chronically ill bedridden persons with need of home and institutional care
large problems in the conditions of information society
and changed demography situation
The main questionThe main question
How to make longevityeffective?How to make longevityeffective?
Anti-aging paradigmAntiAnti--agingaging paradigmparadigm
Goal: slowing the rate of aging and finding the ways of effective aging
Effective aging: conservation of both physical and mental capacities for the whole life extended period
Goal: slowing the rate of aging and finding the ways of effective aging
Effective aging: conservation of both physical and mental capacities for the whole life extended period
Anti-aging paradigmAntiAnti--agingaging paradigmparadigm
Promisesallows people to be effectively involved in work,
diminish the need for home or institutional care, therefore coinciding to the demands of
information society
Promisesallows people to be effectively involved in work,
diminish the need for home or institutional care, therefore coinciding to the demands of
information society
Anti-aging paradigmAntiAnti--agingaging paradigmparadigm
Convergent technologiesnano - bio - info - cognitiveConvergent technologies
nano - bio - info - cognitive
Gerontotechnologies
GerontotechnologiesGerontotechnologies
biotechnologies + nanotechnologiesbiotechnologies + nanotechnologiesstem cell therapy, therapeutic cloning, gene
engineering, investigations related to human genome and proteomics
the optimized care of our organisms and the extended life duration
GerontotechnologiesGerontotechnologies
New information technologies and various strategy are used to create more convenient society and adaptive environment
Intelligent transportation system and barrier free environment for elderly and disabled persons
New information technologies and various strategy are used to create more convenient society and adaptive environment
Intelligent transportation system and barrier free environment for elderly and disabled persons
GerontotechnologiesGerontotechnologies
However, nowadays, such technologies are mostly used
not in the anti-aging context, but otherwise
in the context of adaptation of passive elderly
However, nowadays, such technologies are mostly used
not in the anti-aging context, but otherwise
in the context of adaptation of passive elderly
GerontotechnologiesGerontotechnologies
Is this really enough?Is this really enough?
an active approach to extended longevity
Against the idle brainAgainstAgainst the the idleidle brainbrain
new technologies would be involved in the stimulation of both mental and physical activity
during aging and extended life
new technologies would be involved in the stimulation of both mental and physical activity
during aging and extended life
«against the idle brain»
Against the idle brainAgainstAgainst the the idleidle brainbrain
new technologies makes people too passive in their daily activities and too hopeful on any external effortsmany neurodegenerative disorders seem to be a payoff for the idle brain
new technologies makes people too passive in their daily activities and too hopeful on any external effortsmany neurodegenerative disorders seem to be a payoff for the idle brain
Against the idle brainAgainstAgainst the the idleidle brainbrainBiotechnologies application in the treatment
of neurodegeneration and dementiaBiotechnologies application in the treatment
of neurodegeneration and dementia
complex programs of rehabilitation which rely on active brain
with potential of self-restoration depending on high mental and physical activity
Against the idle brainAgainstAgainst the the idleidle brainbrain
New reasonable ways of brain activity stimulation
and self-restorative capacitiesand/or the search for
mental modulation of immune response
New reasonable ways of brain activity stimulationbrain activity stimulation
and selfself--restorative capacitiesrestorative capacitiesand/or the search for
mental modulationmental modulation of immune responseof immune response
Against the idle brainAgainstAgainst the the idleidle brainbrainThe goal
Brain controlling the process of aging and effective in continuous information processing
in the information societyMeans
the spirit approach of traditional techniques should be converted into modern situation
and be applicable as a part of the whole anti-aging approach,
including prospective bio- and nanotechnologies
The goalBrain controlling the process of aging
and effective in continuous information processing in the information society
Meansthe spirit approach of traditional techniques should be converted into modern situation
and be applicable as a part of the whole anti-aging approach,
including prospective bio- and nanotechnologies
Anti-aging-based health promoting system for longevity
society should include:
NOT only the creation of adaptive environment(with ambient technologies), e.g. social robotics
BUT rather stimulating environmentprovocating application of some aspects of
traditional longevity techniques and mind-body therapy together with new anti-aging therapies
and technological implementations.
AntiAnti--agingaging--based health based health promoting system for longevity promoting system for longevity
society should include:society should include:
NOT only the creation of adaptive environment(with ambient technologies), e.g. social robotics
BUT rather stimulating environmentprovocating application of some aspects of
traditional longevity techniques and mind-body therapy together with new anti-aging therapies
and technological implementations.
Physical Exam Changes with Normal Aging
Physical Exam Changes with Normal AgingEyes - decreased lubrication and visionEars - sensoneural lossOther Senses – taste and smell deficits, neuropathiesHeart - decreased output, dysrhythmiasLungs - increased rigidityMusculoskeletal system - osteoporosis, kyphosisSkin - decreased moisture & turgorDigestive system - decreased motilityGenitourinary system - uroincontinence
Eyes - decreased lubrication and visionEars - sensoneural lossOther Senses – taste and smell deficits, neuropathiesHeart - decreased output, dysrhythmiasLungs - increased rigidityMusculoskeletal system - osteoporosis, kyphosisSkin - decreased moisture & turgorDigestive system - decreased motilityGenitourinary system - uroincontinence
Common Geriatric Problems –The “I”s of Geriatrics
Common Geriatric Problems –The “I”s of Geriatrics
ImmobilityInstabilityIntellectual ImpairmentIsolation (depression)IncontinenceImpotenceImmunodeficiencyInfection
ImmobilityInstabilityIntellectual ImpairmentIsolation (depression)IncontinenceImpotenceImmunodeficiencyInfection
Common Geriatric ProblemsCommon Geriatric Problems
Inanition (malnutrition)Impaction (irritable bowel syndrome)Iatrogenesis (hazards of age)InsomniaImpairment of: vision, hearing, taste, smell, skin integrity, communication and convalescenceImpecunity (impoverishment)
Inanition (malnutrition)Impaction (irritable bowel syndrome)Iatrogenesis (hazards of age)InsomniaImpairment of: vision, hearing, taste, smell, skin integrity, communication and convalescenceImpecunity (impoverishment)
Biologic and Physiologic Factors in Aging
Biologic and Physiologic Factors in Aging
Despite intense interest in longevity by so many cultures, scientists do not agree on precisely why or how humans age Knowledge of the underlying mechanisms of aging is critical to develop a system that considers the special needs and health conditions of an aging population
Despite intense interest in longevity by so many cultures, scientists do not agree on precisely why or how humans age Knowledge of the underlying mechanisms of aging is critical to develop a system that considers the special needs and health conditions of an aging population
Theories of AgingTheories of AgingTheories of Aging
Theories of aging ranged from the concept of purely genetic control of aging to environmental assaults that result in deathMost experts now believe that aging is not explainable by a single theory, but represents many processes working simultaneously
Theories of aging ranged from the concept of purely genetic control of aging to environmental assaults that result in deathMost experts now believe that aging is not explainable by a single theory, but represents many processes working simultaneously
Error TheoriesError TheoriesError Theories
Based on the belief that the rate of aging is directly related to the organism’s rate of living and that external events cause damage to the organism’s cellsThe damage from all causes accumulates over time, resulting in cellular, molecular, and organ malfunction or errors
Based on the belief that the rate of aging is directly related to the organism’s rate of living and that external events cause damage to the organism’s cellsThe damage from all causes accumulates over time, resulting in cellular, molecular, and organ malfunction or errors
Programming TheoriesProgramming TheoriesProgramming Theories
Based on belief that aging is programmed into cells and is internal to the organismThese theories postulate that aging, like prenatal development and menopause, is the natural and expected result of a purposeful sequence of events written internally into gene structure
Based on belief that aging is programmed into cells and is internal to the organismThese theories postulate that aging, like prenatal development and menopause, is the natural and expected result of a purposeful sequence of events written internally into gene structure
Physiologic Changes in Body SystemsPhysiologic Changes in Body Systems
Nervous SystemNervous SystemEssential to know that in the absence of disease, most aged people remain alert, with functional intellectual capability, sound judgment, creativity Only modest impairments in memory and learning after age 70 in most people who are relatively free from major diseaseChanges may result in a progressive slowing of responses, problems with short-term memory, and altered learning
Essential to know that in the absence of disease, most aged people remain alert, with functional intellectual capability, sound judgment, creativity Only modest impairments in memory and learning after age 70 in most people who are relatively free from major diseaseChanges may result in a progressive slowing of responses, problems with short-term memory, and altered learning
Nervous SystemNervous SystemShort-term memory loss frequently a concern of the aged; long-term memory may remain intactMay not remember planned daily events, but easily recall young adulthood experiences Mild cognitive impairment (MCI)
Persistent memory problems with otherwise normal cognitive function40% will develop Alzheimer’s disease within 3 years; others do not progress to more serious impairment
Short-term memory loss frequently a concern of the aged; long-term memory may remain intactMay not remember planned daily events, but easily recall young adulthood experiences Mild cognitive impairment (MCI)
Persistent memory problems with otherwise normal cognitive function40% will develop Alzheimer’s disease within 3 years; others do not progress to more serious impairment
Nervous SystemNervous System
Temperature regulationLow tolerance for extremes in temperature
Pain perception and tactile sensationSome researchers have found dulling of pain and tactile sensation in older persons, but these results are not consistent
Temperature regulationLow tolerance for extremes in temperature
Pain perception and tactile sensationSome researchers have found dulling of pain and tactile sensation in older persons, but these results are not consistent
Respiratory SystemRespiratory System
Forced vital capacity, vital capacity, and maximum breathing capacity thought to decrease progressively with aging
Atrophy/weakening of respiratory muscles Increase in the antero-posterior diameter of the chest as a result of kyphosisVertebral loss of calciumCalcification of costal cartilage
Forced vital capacity, vital capacity, and maximum breathing capacity thought to decrease progressively with aging
Atrophy/weakening of respiratory muscles Increase in the antero-posterior diameter of the chest as a result of kyphosisVertebral loss of calciumCalcification of costal cartilage
Respiratory SystemRespiratory SystemLoss of elastic tissue surrounding alveoli and alterations in pulmonary circulation result in decreased diffusion across the alveolar-capillary membranePulmonary blood flow
Decreases because of a reduction in cardiac outputPulmonary diffusion
Thickened capillary walls, and fewer capillaries surrounding the alveoli, cause impaired gas exchange
Loss of elastic tissue surrounding alveoli and alterations in pulmonary circulation result in decreased diffusion across the alveolar-capillary membranePulmonary blood flow
Decreases because of a reduction in cardiac outputPulmonary diffusion
Thickened capillary walls, and fewer capillaries surrounding the alveoli, cause impaired gas exchange
Respiratory SystemRespiratory SystemExertional dyspnea
Shortness of breath with exertionA frequent complaint with the older adult Ability to perform prolonged strenuous work decreases with aging
Lung disease: acute or chronicPoses a threat to the older adultPulmonary secretions handled less effectively
Exertional dyspneaShortness of breath with exertionA frequent complaint with the older adult Ability to perform prolonged strenuous work decreases with aging
Lung disease: acute or chronicPoses a threat to the older adultPulmonary secretions handled less effectively
Cardiovascular SystemCardiovascular System
Resistance to blood flow in many organs increases as people ageAging results in the development of whitish patches, fibrosis, and sclerosis in the endocardiumThe heart becomes more rigid and myocardial contractility is compromised
Resistance to blood flow in many organs increases as people ageAging results in the development of whitish patches, fibrosis, and sclerosis in the endocardiumThe heart becomes more rigid and myocardial contractility is compromised
Cardiovascular SystemCardiovascular SystemCoronary blood flow may be reduced by as much as 35%, because of changes in the vessels Valvular rigidity and incomplete closure of aortic and pulmonic valves may result in murmurs Heart cells have a decreased capacity to use oxygen, which may help explain the aged person’s reduced tolerance for physical workPulse increases and the pulse pressure widens
Coronary blood flow may be reduced by as much as 35%, because of changes in the vessels Valvular rigidity and incomplete closure of aortic and pulmonic valves may result in murmurs Heart cells have a decreased capacity to use oxygen, which may help explain the aged person’s reduced tolerance for physical workPulse increases and the pulse pressure widens
Cardiovascular SystemCardiovascular SystemDecrease in resting cardiac outputAmount of blood pumped each minute
Between ages 25 and 65, resting cardiac output falls 30% to 40% Reduced cardiac output reflects a decreased heart rate and decreased stroke volumeCerebral blood flow maintained, but other body systems, such as the liver and kidneys, receive a diminished blood supply
Decrease in resting cardiac outputAmount of blood pumped each minute
Between ages 25 and 65, resting cardiac output falls 30% to 40% Reduced cardiac output reflects a decreased heart rate and decreased stroke volumeCerebral blood flow maintained, but other body systems, such as the liver and kidneys, receive a diminished blood supply
Urinary SystemUrinary SystemKidneys decrease in function; decrease in cell mass, and an increase in extracellular fluid Decreased filtration rate, plasma flow rate, and tubular reabsorption and secretion Blood urea nitrogen tends to increaseAbility to concentrate or dilute urine is diminished
Kidneys decrease in function; decrease in cell mass, and an increase in extracellular fluid Decreased filtration rate, plasma flow rate, and tubular reabsorption and secretion Blood urea nitrogen tends to increaseAbility to concentrate or dilute urine is diminished
Urinary SystemUrinary System
The bladder capacity may be reduced by halfResponse to the stretch receptors in the bladder wall that signal the need to void may be delayed until the pressure is high and the bladder almost filled to capacity Lax muscle tone may lead to incomplete emptying of the bladder
Residual volume may cause subsequent urinary tract infections
The bladder capacity may be reduced by halfResponse to the stretch receptors in the bladder wall that signal the need to void may be delayed until the pressure is high and the bladder almost filled to capacity Lax muscle tone may lead to incomplete emptying of the bladder
Residual volume may cause subsequent urinary tract infections
Urinary SystemUrinary SystemIncontinence
May appear as a symptom of upper or lower urinary tract dysfunctionConservative behavioral treatment is recommended as the first level of intervention
Behavioral treatments: scheduled or prompted voiding, environmental adaptation, and pelvic muscle exercises (Kegel exercises)
IncontinenceMay appear as a symptom of upper or lower urinary tract dysfunctionConservative behavioral treatment is recommended as the first level of intervention
Behavioral treatments: scheduled or prompted voiding, environmental adaptation, and pelvic muscle exercises (KegelKegel exercisesexercises)
Integumentary SystemIntegumentary System
Skin changes can be the most distressing to the older person because they are so visibleSkin changes include dryness, loss of elasticity, wrinkles, uneven pigmentation andbrown spots, roughness, looseness, thinness,and the development of various skin lesions
Skin changes can be the most distressing to the older person because they are so visibleSkin changes include dryness, loss of elasticity, wrinkles, uneven pigmentation andbrown spots, roughness, looseness, thinness,and the development of various skin lesions
Integumentary SystemIntegumentary SystemWrinkles
Occur when the deep layer of the skin loses moisture and elasticity Tiny creases and folds are formed Extent and timing determined by genetics and sun exposure Persons in certain ethnic groups with thicker and oilier skin wrinkle at a slower rate, maintaining a youthful, wrinkle-free appearance longer
WrinklesOccur when the deep layer of the skin loses moisture and elasticity Tiny creases and folds are formed Extent and timing determined by genetics and sun exposure Persons in certain ethnic groups with thicker and oilier skin wrinkle at a slower rate, maintaining a youthful, wrinkle-free appearance longer
Integumentary SystemIntegumentary SystemItching
Related to loss of oils in the skin Generalized itching should be reported to the health care provider; may be sign of diabetes, cancer, kidney disease, or liver disease Advice for tepid baths, using moisturizers liberally, avoiding overuse of antiperspirants, soaps, perfumes, and hot baths
ItchingRelated to loss of oils in the skin Generalized itching should be reported to the health care provider; may be sign of diabetes, cancer, kidney disease, or liver disease Advice for tepid baths, using moisturizers liberally, avoiding overuse of antiperspirants, soaps, perfumes, and hot baths
Integumentary SystemIntegumentary SystemHair loss, hair thinning, and color changes
Men tend to grow bald, and women experience thinning of the hair on the head and genitalia The number of facial and nasal hairs may increase Gray hair is caused by a slowing of the pigment production in the hair follicles
Determined by genetics and tends to be irreversible
NailsBecome yellow and thicker
Hair loss, hair thinning, and color changesMen tend to grow bald, and women experience thinning of the hair on the head and genitalia The number of facial and nasal hairs may increase Gray hair is caused by a slowing of the pigment production in the hair follicles
Determined by genetics and tends to be irreversible
NailsBecome yellow and thicker
Gastrointestinal SystemGastrointestinal System
Oral cavity Deterioration in the teeth and a decrease in the functional taste buds Decrease in saliva secretion
Related to medications, inadequate hydration, and illness states rather than normal aging change Saliva tends to become more alkaline as the salivary glands secrete less ptyalin and amylase
Oral cavity Deterioration in the teeth and a decrease in the functional taste buds Decrease in saliva secretion
Related to medications, inadequate hydration, and illness states rather than normal aging change Saliva tends to become more alkaline as the salivary glands secrete less ptyalin and amylase
Gastrointestinal SystemGastrointestinal System
Muscles associated with chewing weaken, peristalsis is slower, and the risk of formation of intestinal diverticula increasesGastric emptying is slowerGastric glands decrease the volume and concentration of hydrochloric acid, intrinsic factor, and pepsinLess amount of calcium absorbed
Muscles associated with chewing weaken, peristalsis is slower, and the risk of formation of intestinal diverticula increasesGastric emptying is slowerGastric glands decrease the volume and concentration of hydrochloric acid, intrinsic factor, and pepsinLess amount of calcium absorbed
Gastrointestinal SystemGastrointestinal System
ConstipationFrequent gastrointestinal complaint From decreased intestinal motility, altered bacteria flora, a diet low in bulk and roughage, medications, lack of physical activity
Educate about diet, activity, increased fluid intake, and avoidance of laxative abuse
ConstipationFrequent gastrointestinal complaint From decreased intestinal motility, altered bacteria flora, a diet low in bulk and roughage, medications, lack of physical activity
Educate about diet, activity, increased fluid intake, and avoidance of laxative abuse
Musculoskeletal SystemMusculoskeletal System
OsteoarthritisThe most prevalent chronic disease in menMore severe in womenLeading cause of disabilityCaused by damage to the inside surface of the jointAge, heredity, and obesity contribute to development Large weight-bearing joints (knees, hips, spine) are most affected
OsteoarthritisThe most prevalent chronic disease in menMore severe in womenLeading cause of disabilityCaused by damage to the inside surface of the jointAge, heredity, and obesity contribute to development Large weight-bearing joints (knees, hips, spine) are most affected
Musculoskeletal SystemMusculoskeletal SystemKyphosis
Curvature of the thoracic spine that gives rise to the bent-over appearance of some older adults
Teach benefits of weight-bearing exercisesWalking, bicycling, and stair climbing help maintain bone and muscle massAssistive devices for walking and preventing fallsAvoid too much bed rest because of the detrimental effects of immobility
KyphosisCurvature of the thoracic spine that gives rise to the bent-over appearance of some older adults
Teach benefits of weight-bearing exercisesWalking, bicycling, and stair climbing help maintain bone and muscle massAssistive devices for walking and preventing fallsAvoid too much bed rest because of the detrimental effects of immobility
Sensory SystemSensory SystemPresbyacusis
Hearing loss associated with age 25% of adults older than age 69, and half of adults older than age 85 are hearing impairedConduction deafness
Blockage of the ear canal caused by excessive wax buildup, abnormal structures, or infection
Sensorineural deafnessDamage to nerve tissue as a result of exposure to loud noises, disease, and certain drugs
PresbyacusisHearing loss associated with age 25% of adults older than age 69, and half of adults older than age 85 are hearing impairedConduction deafness
Blockage of the ear canal caused by excessive wax buildup, abnormal structures, or infection
Sensorineural deafnessDamage to nerve tissue as a result of exposure to loud noises, disease, and certain drugs
Sensory SystemSensory System
Macular degenerationAffects the macula, the part of the eye responsible for sharp central vision
CataractClouding or opacity of the normal transparent lens within the eyeSurgical removal of the clouded lens
Macular degenerationAffects the macula, the part of the eye responsible for sharp central vision
CataractClouding or opacity of the normal transparent lens within the eyeSurgical removal of the clouded lens
Sensory SystemSensory SystemPresbyopia
Affects the shape of the lensReading and other close work become difficult
Glaucoma Atrophy of the optic nerve usually associated with elevated pressure of the fluid in the eye
PresbyopiaAffects the shape of the lensReading and other close work become difficult
Glaucoma Atrophy of the optic nerve usually associated with elevated pressure of the fluid in the eye
Sensory SystemSensory SystemChemosensory disorders
Involves taste and smellCauses: nasal obstruction, allergies, certain drugs Some scientists believe that the decline in smell is due to a decrease in olfactory nerve fibersMajor changes in ability to taste most often caused by diseases or side effects of certain drugsDentures, hormonal changes, medications, and changes in chemicals needed to transmit taste are causes of older person’s diminished sense of taste
Chemosensory disordersInvolves taste and smellCauses: nasal obstruction, allergies, certain drugs Some scientists believe that the decline in smell is due to a decrease in olfactory nerve fibersMajor changes in ability to taste most often caused by diseases or side effects of certain drugsDentures, hormonal changes, medications, and changes in chemicals needed to transmit taste are causes of older person’s diminished sense of taste
Aging-Associated Psychosocial FactorsAgingAging--AssociatedAssociated Psychosocial FactorsPsychosocial Factors
Older adults show cumulative developmental effects that produce unique personality styles, coping mechanisms, challenges, and growth
That a person has survived to old age is one marker of successful adaptation
Older adults show cumulative developmental effects that produce unique personality styles, coping mechanisms, challenges, and growth
That a person has survived to old age is one marker of successful adaptation
Aging-Associated Psychosocial FactorsAgingAging--AssociatedAssociated Psychosocial FactorsPsychosocial Factors
Effective adaptation: meeting environmental and functional needs; attaining sense of well-being
Maturity: optimal psychological, social, and biologic adaptation achieved during midlife years, arbitrarily set between 45 and 65 years of age
Effective adaptation: meeting environmental and functional needs; attaining sense of well-being
Maturity: optimal psychological, social, and biologic adaptation achieved during midlife years, arbitrarily set between 45 and 65 years of age
Movement toward Erikson’s ego integrity is facilitated when the older person
Recognizes and accepts changes in physical and mental capabilitiesGives up some roles and develops new ones Develops new activities that can be carried out successfully with aging Develops a different self-concept Revises life goals Adapts to new lifestyles
Movement toward Erikson’s ego integrity is facilitated when the older person
Recognizes and accepts changes in physical and mental capabilitiesGives up some roles and develops new ones Develops new activities that can be carried out successfully with aging Develops a different self-concept Revises life goals Adapts to new lifestyles
Aging-Associated Psychosocial FactorsAgingAging--Associated Psychosocial FactorsAssociated Psychosocial Factors
Coping and AdaptationCoping and AdaptationCoping and AdaptationOld age has been described as the season of losses
Roles, statuses, physical abilities, and deep personal losses through the deaths of friends and the disruption of family networks
Real, threatened, or imaginary lossis a stressor
requires adaptation, flexibility, and resiliencyto cope successfully
Old age has been described as the season of losses
Roles, statuses, physical abilities, and deep personal losses through the deaths of friends and the disruption of family networks
Real, threatened, or imaginary lossis a stressor
requires adaptation, flexibility, and resiliencyto cope successfully
Coping and AdaptationCoping and AdaptationCoping and AdaptationThe older person may cope with these losses with positive or negative adaptation
Positive adaptationInclude rational action, perseverance, positive thinking, intellectual denial, restraint, drawing strength from adversity, and humor
Negative adaptationLose sense of personal identity and fulfillment and suffer from deterioration in self-esteem, an altered self-concept, and a loss of meaningfulness in life
The older person may cope with these losses with positive or negative adaptation
Positive adaptationInclude rational action, perseverance, positive thinking, intellectual denial, restraint, drawing strength from adversity, and humor
Negative adaptationLose sense of personal identity and fulfillment and suffer from deterioration in self-esteem, an altered self-concept, and a loss of meaningfulness in life
Coping and Adaptationthe Family
Coping and AdaptationCoping and Adaptationthe Familythe Family
Most older adults occupy a variety of family roles; come from multigenerational unitsMarital relations and the relationships between parent and child seem to be most importantAlthough family responsibility appears to be an internalized value for most people, it is important to know that State has laws that can require children to provide financial support for needy parents
Most older adults occupy a variety of family roles; come from multigenerational unitsMarital relations and the relationships between parent and child seem to be most importantAlthough family responsibility appears to be an internalized value for most people, it is important to know that State has laws that can require children to provide financial support for needy parents
Coping and Adaptationthe Family
Coping and AdaptationCoping and Adaptationthe Familythe Family
The combination of personal limitations, competing roles, and stresses generated by the care recipient’s behavior and the physical demands created by various levels of emotional, physical, financial, and family strain places enormous stress on informal caregivers Caregivers frequently report symptoms of depression, anxiety, helplessness, low morale, and emotional exhaustion
The combination of personal limitations, competing roles, and stresses generated by the care recipient’s behavior and the physical demands created by various levels of emotional, physical, financial, and family strain places enormous stress on informal caregivers Caregivers frequently report symptoms of depression, anxiety, helplessness, low morale, and emotional exhaustion
Coping and AdaptationFamily
Coping and AdaptationCoping and AdaptationFamilyFamily
In part because of caregiver stress, more than 1 million older adults are abused physically and psychologically or are neglected each year by their caregiversEducation for learning and positive adaptive behaviors can assist caregivers and recipientsFamilies must be part of the holistic approach in the assessment and care of the aged
In part because of caregiver stress, more than 1 million older adults are abused physically and psychologically or are neglected each year by their caregiversEducation for learning and positive adaptive behaviors can assist caregivers and recipientsFamilies must be part of the holistic approach in the assessment and care of the aged
Functional AssessmentFunctional AssessmentFunctional AssessmentActivities of daily living; environmental, financial, family, economic, and community resources Data useful during times of health, at the onset of illness, at the beginning of treatment, and following therapeutic interventionsKnowing what activities an individual performs alone, what activities require assistance, and what activities the person is totally unable to perform or to perform safely is essential to define care needs
Activities of daily living; environmental, financial, family, economic, and community resources Data useful during times of health, at the onset of illness, at the beginning of treatment, and following therapeutic interventionsKnowing what activities an individual performs alone, what activities require assistance, and what activities the person is totally unable to perform or to perform safely is essential to define care needs
Functional AssessmentFunctional AssessmentFunctional Assessment
The older person’s database should describe both basic and instrumental activities of daily living
BasicGrooming, bathing, dressing, eating, elimination, and mobility
InstrumentalPrepare a meal, shop for groceries, use the telephone, negotiate transportation, take medications, housekeeping and laundry tasks
The older person’s database should describe both basic and instrumental activities of daily living
BasicGrooming, bathing, dressing, eating, elimination, and mobility
InstrumentalPrepare a meal, shop for groceries, use the telephone, negotiate transportation, take medications, housekeeping and laundry tasks
Drug TherapyDrug TherapyDrug Therapy
88% of older adults who reside in the community use 1 or more medications In long-term care facilities, more than 75% receive 4 or more medications and 33% receive 7 to 10 medicationsAge- and disease-related changes slow the clearance of drugs, which increases the risk of adverse effects
88% of older adults who reside in the community use 1 or more medications In long-term care facilities, more than 75% receive 4 or more medications and 33% receive 7 to 10 medicationsAge- and disease-related changes slow the clearance of drugs, which increases the risk of adverse effects
Drug TherapyDrug TherapyDrug TherapyReduction in body size, decrease in lean body mass and water content (extracellular volume), and increase in fat Serum albumin concentration is lower; tends to make more free drug available to tissues or to permit more rapid elimination of the drug A gradual decrease in blood flow to the internal organs in the abdomen reduces drug clearance through the liver or kidney
Reduction in body size, decrease in lean body mass and water content (extracellular volume), and increase in fat Serum albumin concentration is lower; tends to make more free drug available to tissues or to permit more rapid elimination of the drug A gradual decrease in blood flow to the internal organs in the abdomen reduces drug clearance through the liver or kidney
Drug TherapyDrug TherapyDrug TherapyThe liver prepares drugs for elimination in the urine or in feces Age-related changes that have an impact on the inactivation of drugs by the liver include decreased liver size, reduced hepatic blood flow, and reduced liver enzyme activity on drugs These changes increase drug concentrations in the blood and possibly increase the amount of time it takes the body to get rid of the drug
The liver prepares drugs for elimination in the urine or in feces Age-related changes that have an impact on the inactivation of drugs by the liver include decreased liver size, reduced hepatic blood flow, and reduced liver enzyme activity on drugs These changes increase drug concentrations in the blood and possibly increase the amount of time it takes the body to get rid of the drug
Drug TherapyDrug TherapyDrug Therapy
Older adults tend to respond more vigorously to drugs that act on the central nervous system because of a greater tissue sensitivity and altered physiologic changesAdverse effects: postural imbalance, staggering, uncoordinated movements, respiratory depression, and changes in mental alertness
Older adults tend to respond more vigorously to drugs that act on the central nervous system because of a greater tissue sensitivity and altered physiologic changesAdverse effects: postural imbalance, staggering, uncoordinated movements, respiratory depression, and changes in mental alertness
Drug TherapyDrug TherapyDrug Therapy
Risk factors for adverse drug reactions Age, sex, race (more frequent in older white females), number of drugs consumed, dosage, duration of treatment, severity of illness, and patient cooperation
Symptoms and signsRestlessness, falls, depression, confusion, loss of memory, constipation, and urinary incontinence
Risk factors for adverse drug reactions Age, sex, race (more frequent in older white females), number of drugs consumed, dosage, duration of treatment, severity of illness, and patient cooperation
Symptoms and signsRestlessness, falls, depression, confusion, loss of memory, constipation, and urinary incontinence
Drug TherapyDrug TherapyDrug Therapy
Baseline and continual assessmentsThe amount, frequency, and purpose of all medications takenAbility and willingness to take recommended medications Potential for drug interactions and adverse drug reactions
Baseline and continual assessmentsThe amount, frequency, and purpose of all medications takenAbility and willingness to take recommended medications Potential for drug interactions and adverse drug reactions
Drug TherapyDrug TherapyDrug Therapy
Effectiveness of the medication over time Whether any of the drugs taken can be discontinued or decreased in dose Assessment of drug effects and adverse reactions must be documented
Effectiveness of the medication over time Whether any of the drugs taken can be discontinued or decreased in dose Assessment of drug effects and adverse reactions must be documented