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 brain’s pattern of aging • After this age, brain functioning and mental ability are determined by three factors: mental habits, chronic disease, and mind’s 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, Alzheimer’s 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 10 9.2% 5.4% 5 5 4.1% 0 0 1900 1930 1960 1990 2020 2050 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 Greece 76 81 Italy 75 81 Spain 74 81 Switzerland 75 82 Egypt 60 63 Kenya 56 56 Nigeria 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. AgeismPrejudice 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/arteriosclerosis • Dementia • The Good News: Many older individuals lead satisfying lives and maintain their health well beyond society’s 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 • Improper dosages • Outdated drugs • Storage problems • Confusion

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 don’t 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-old’s 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 – doesn’t 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 Alzheimer’s (est. 50-70% of people with dementia have Alzheimer’s) • Drugs and alcohol • Vascular disorders such as multi-infarct disease (multiple strokes)Inherited disorders such as Huntington’sInfections such as HIV

26. Causes of Dementia Multi-Infarct Dementia or Vascular Causes (14%) Alzheimer’s (56%) Brain Injury (4%) Multiple Causes (12%) Other Causes (6%) Parkinson’s Disease (8%) Source: Trushke, Edward F. (Fall 1998) ADVANCES. Bulletin of Progress in Alzheimer’s Disease Research and Care.

27. Two types of dementia • Cortical - Disorder affecting the cortex, the outer portion or layers of the brain. • Alzheimer’s 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. • Huntington’s 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. Alzheimer’s disease –the most common type of dementia 6 out of 10 cases of dementia are Alzheimer’s disease.

35. Alzheimer’s Disease • Affects 4 million Americans. 14 million predicted to have it by 2050 • 1 out of 10 people over 65 have Alzheimer’s. 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. Alzheimer’s – 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 Alzheimer’s • 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. Alzheimer’s – early stage • Characteristics • Begins with forgetfulness • Progresses to disorientation and confusionPersonality 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. Alzheimer’s – 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 MobilityPositive, nurturing, loving environment • Music Therapy

45. Alzheimer’s – later stage • Characteristics • Loss of verbal articulation • Loss of ambulation • Bowel and bladder incontinenceExtended sleep patterns • Unresponsive to most stimuli • Interventions • Caring for physical needsMaintain integrity of the skinMedical interventions • Most activities are inaccessible

46. Cognitive DevelopmentSchaie’s 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. Atchley’s Stages of Retirement • Phase 1. Preretirement – disengage from workplace and plan for retirement. May have mixed feelings.

49. Atchley’s 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. Atchley’s 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.