Geriatric Phase of Life

Age-related Misconceptions

everyone becomes confused or forgetful if he/she lives long enough

the older you get, the less you sleep

most older people are depressed

older people can’t take medication for depression because they take too many other drugs

people begin to lose interest in sex at around age 55

if one of your parents had Alzheimer’s disease, you’re doomed to get it too

as your body changes with age, so does your personality

you can be too old to exercise

suicide is a problem mainly for teenagers

you can’t teach an old dog new tricks

Demographics - in the year 2000, 32 million over age 65

% over age 85: 4% in 1900, 12.4% today

average life expectancy at birth: 45 years in 1900, 75 years today

infants living to age 65: 4 of 10 in 1900, 8 of 10 today
what to expect in the future: number of people over age 65 will increase, but the rate will slow down

Aging

Primary aging - process intrinsic to an organism (due to hereditary mechanisms); natural aging process

Secondary aging - appearance of aging due to life style and environmental factors (i.e. trauma); pathological aging

Stage 1 = development
Stage 2 = senescence - begins at age 25, continually biological process; different parts of body age at different rates

Theories of biological aging

Autoimmune Theory - with age, immune system’s ability to distinguish between own matter and foreign matter ß

with aging, there are more mutations in cell divisions; body responds to these mutant cells as foreign matter

Collagen Theory - collagen in connective tissue becomes rigid with age Þ ß nutrient transmission and waste expulsion

ß elasticity in blood vessels leads to Ý blood pressure and reduced capacity of lungs to expand

Error Theory - problems occur with DNA within cells altering the cell’s identity, function, or rate of reproduction

cells which reproduce propagate the error; over time, more cells in a certain organ are damaged, leading to aging

Free Radical Theory - highly unstable chemical comp interact with nearby molecule, often cell membrane

the interaction damages structure, function and genetic material; damage is small, but cumulative which causes aging

Hormone Theory - aging is the result of a drop in hormone levels (accelerated post-menopause)

premature aging accompanies hypothyroidism; reversed with thyroid injections

Immune System Theory - immune system declines with age

as a result, organisms become more susceptible to various degenerative conditions such as heart disease or cancer

Program Theory - cells have a fixed/finite number of times to divide, then die

as cells age, the time it takes for division increases, so cells are pre-programmed to age and die

Somatic Mutation Theory - with increasing age, there are more mutations due to factors such as radiation produced by the sun

cumulative cell mutations contribute to decreased functioning and normal aging

Wear and Tear Theory - body likened to machine, some parts wear out, others don’t; the body can repair itself

exercise can improve function to some degree

The Baltimore Longitudinal Study of Aging (BLSA)

Changes in appearance - annual height reduction of 1/16^th inch with onset at age 30; reduced forearm diameter at age 60; calf diameter at age 40

Dental changes - changed chewing habits; Ý cavities and periodontal disease; stable saliva flow throughout aging

Weight and metabolic changes - weight increases to age 55 then begins to fall; body consume 12 calories less per day for each year over 30; weight declines between 55 and 75; total body fat remains constant but distribution changes

Cardiovascular changes - blood cholesterol rises to age 50 then falls; risk factors for CAD include smoking, HTN, elevated cholesterol, LDL, low vital capacity, diabetes, and obesity; no evidence that heart function declines with age; thickening of the heart will increase with age

Physiological changes - ability of kidney to clear nitrogenous wastes from blood ß with age; lymphocytes have ß capacity to kill cancer cells starting around age 40; pulmonary function ß ; incidence of CAD ß with age

Changes in the senses - visual acuity ß with age; progressing hearing loss at all frequencies; ability to taste sweet or sour dose not change, salty and bitter tastes decline; ability to correctly identify odors declines

Changes in reaction time - ß ability to notice small changes after age 70; reaction time to noise increases after age 70

Cognitive changes

Changes in sexual activity - sexual activity decreases with age despite maintenance of normal levels of sex hormones

General conclusions from the BLSA:

no single factor or a single clock regulates the rate of aging in all organs
chronological age is a poor predictor of performance
same things, for example resting, heart rate, and personality do not change with age
some slow losses are not caused by aging, but rather by diseases; others are inevitable consequences of aging, unrelated to disease; in general, sudden losses are the result of diseases
some normal changes that occur with age may result from the body’s attempt to compensate for some other normal loss
lifestyle decisions can influence occurrence/progression of diseases, but no evidence for direct effect on aging process
longitudinal changes in function help to distinguish age associated processes from disease

Loss in Multiple Spheres in Life

Health, Physical and Cognitive Abilities

serious illness, injury, disability
menopause
impotence
changing medical care
change in physical dependence

Work Roles

retirement
unemployment

Relationships

worsening health of aging parents
death of a spouse
death of friends
divorce / remarriage
moving in with children

Possessions

sale of childhood home
changing houses to accommodate spouse
financial losses on property

Financial Security

adjusting to changing economic standard of living

adjusting to retirement and ß income

Social Position

loss of status
ageism

Life Itself

increased awareness of mortality

Suicide

older adults are at higher risk by 50% in comparison with the general population

1 in 5 suicides are carried out by older adults, totaling 6,228 in 1989

the highest incidence is among those persons in 75-84 age range

incidence is higher for males across all age groups

incidence for whites peaks in older adulthood; incidence for non-whites peaks by age 35

incidence highest in divorced/widowed, followed by never married and married persons respectively

predominant methods used are firearms, hanging, and gas/poison respectively

Indirect Self-Destructive Behavior - believed to be more common than direct self-destructive behavior, esp. in elderly

involves covert, indirect, and/or unconscious methods
behaviors can include overeating and obesity, smoking, alcoholism and other drug addiction, risk-taking behaviors, and accident proneness
can involve omission of behaviors helpful or essential in sustaining life and health, including neglect in taking meds for illnesses; neglect of routine medical exams; ignoring or denying medical aid when needed; refusal of meds or nourishment; smoking or drinking against medical advice, placing oneself in hazardous situations or environment

Alcohol Abuse Among the Elderly

Prevalence - between 2 and 10% of the general older population; higher rates for males, widowed, and never married; up to 20% of nursing home residents

10% of those receiving treatment for alcoholism are older than 60

Types

early onset alcoholism (develop prior to elderly life)
late onset or "stress induced" alcoholism (attributed to difficulty with adjusting to elderly life)

Triggering Events - bereavement, retirement, or illness

Consequences

(1) physical consequences - physiologic damage, drug interactions, malnutrition, masking symptoms of treatable illness, exacerbation of existing illness

(2) social consequences - loss of family support, economic problems, legal difficulties, work-related problems

Elder Abuse and Neglect

Definition - acts of commission or omission that cause unnecessary suffering to older persons, carried out by individual with whom older persons have a trusting relationship

Types - physical/sexual abuse; psychological abuse; exploitation; medical abuse; neglect

Prevalence - abuse found in 4-10% of individuals aged 65 and older; abuse by spouse more prevalent than by adult children; equal numbers of male vs female victims

Risk Factors

abuser’s dependence upon the victim
abuser’s psychological state
cognitive/physical status of the victim
family social isolation

Consequences - depression, Ý mortality, related sequelae

Special Cases - aggressive Alzheimer’s patients and caregivers; abusive spouse; elder parent and abusive adult child

Interventions - assessment; reporting; supporting caregivers

Pain Management in the Elderly

Prevalence - 80% of persons over 65 have at least one chronic medical issue; 70% of persons over 65 report pain

71-83% of nursing home residents report at least one pain problem significant enough to interfere with ADL’s
7-10% of patients referred for chronic pain management programs are over 65

Factors Related to Undertreatment of Pain

patient factors - beliefs about pain, beliefs about medication, lack of knowledge about therapeutic options
health care provider factors - knowledge deficits about pharm, beliefs about pain, skepticism about patient’s report of pain, failure to recognize pain-related behaviors
system factors - lack of accountability for pain management, legal constraints applied to opioid use, PRN dosages

Solutions - patient and family education about pain management options

dispelling beliefs that pain is inevitable and must be tolerated
education of health care providers; changing attitudes regarding expectations for treatment and outcome
use of pain standards and quality assurance programs
assess availability of pain resources and methods for a variety of pain relief interventions