Theories & Frameworks

What is Immunity Theory?

• Immune system attacks foreign agents
• Bone marrow, spleen, lymph nodes, and thymus make up the immune system
• Immune response deteriorates in adulthood as thymus decreases resulting in:
• Decreased humural immune respone
• Decrease intensity of delayed hypersensitivity
• Decreased resistance to tumor cells
• Delayed skin allograft rejection
• Bone marrow stem cell efficiency reduced
• Increase in CA, infectiouns, autoimmunity
• Body produced antigens that attack self
• Increased levels of autoantibodies
• Increased amts of lymphocytes & plasma cells in tissue
• Cause:poor nutrition & lack of exercise

• A cross-linking agent attaches to one of the two DNA strands
• Normally the agent is removed and the strand is repaired
• If the agent attaches to both of the strands before our defense mechanism kicks in mitosis occurs and the cell dies
• Chemical cross-linkage occur to molecules in the cell ie: proteins
• Over time the chemical cross-linkage build up and inhibit cell function and intracellular transport
• Collagen is affected by cross-linkage and thought to affect connective tissues

• Free radicals are atoms or molecules with highly chemical reactive electrons which oxidize adjacent molecules quickly
• Lipid molecules are found in mitochondrial and microsomal membranes prone to oxidize by free radicals & change in structure & function
• Free radical oxidation produces more free radicals causing an oxidation chain reaction
• Lipofuscin - lipid protein materal that accumulates in the elderly.
• Lipofuscin disrupts diffusion & cell function

• Age is not chronological but is determined by the amt of stress to the body & the resulting damage
• Each person has an inherit amt of adaptability that is used up trying to deal with stress
• Theory not widely accepted

• Decrease in food intake, rather than decrease in body fate or metabolic rate results in anti-aging process
• Connections made by decreasing consumption between:
• --metabolic change responsible for aging
• --decline in protein synthesis
• --decreased in free radicals

Cell nucleus destroy information causing interference of normal cell function d/t chanes in DNA, increase amts of error in RNA transcription/protein synthesis causing cell mutation d/t radiation exposure

Psychosocial Theories of Aging

Explain Disengagment Theory?

• Elderly and society mutually "disengage"
• Benefit to individual:
• --Reflect & be centered on self
• --Relieved from societal roles
• Value to society:transfer power from young to old
• Theories doesn't account for activity & contributions of elderly
• This theories is not observed by all cultures

• Socially active adapt better to aging
• Social activity needed for role enactment
• Role enactment = positive-image
• Multiple roles = positive self image
• Theory supported by much research
• Replacement of D/C activity encouraged
• Volunter after retirement
• Activites r/t close contacts most beneficial

4 Patterns of Personality & Coping

• Intergrated Personalities: Mature & Happy with diff activity levels
• Defended Personalities: Hold on to middle age, worry about change
• Passive - Dependent Personalities: High dependent/apathetic
• Unitergrated Personalities: Mental illness

Developmental Theories

Erikson's Stages of Psychosocial Development

• Infancy - Trust vs. Mistrust
• Toddler - Autonomy vs. Shame & Doubt
• Early Childhood - Initiative vs. Guilt
• Middle Childhood - Industry vs. Inferiority
• Adolescence - Identity vs. Role Confusion
• Adulthood - Intimacy vs. Isolation
• Middle Age - Generativity vs. Stagnation

Old Age - Ego Identity vs Despair

• 1.Ego Differentiation vs. Role Preoccupation
• -Develop gratificaion in self than job or family
• 2.Body Transcendence Vs. Body Preoccupation
• -Obtain psychological satification, not concerned with health problems or liminations
• 3.Ego Transcendence vs. Ego Preoccupation
• -Satisfaction by reflection, less concerned by # of years left

1. Adjust to physical limitation

2. Develop a sense of satification with life

3. Prepare for death

Socialization & Role Support

Affection & Emotional Support

Caregiving

Martial

Parent-Child

Sibling

Grandparent

slow thinking

physically feeble

non-sexual

does not contribute

grey hair

wrinkles

pessimistic

insecure

meddlesome

lonely

Considerations of Caring for the Elderly

What are the key organs systems that are most vulnerable to illness or disease?

Brain

Lower GU tract

CV

MS

confusion

depression

falling

incontinence

functional decline

syncope

Common drug side effects

1. Mild anticholinergic agents (Dyphenhydramine) causes?

2.Diuretic cause?

3. Digoxind causes?

1. Confusion

2. Urinary Incontinence

3. Anorexia - even with normal ranges

Deconditioning within days

Fluid shifts

Volume Depletion

Decreased cardiac output

Decrased peak O2 uptake/increase resting heart rate

Increase risk for skin breakdown

Mechanical pressure, moisture, friction and shearing forces

Decreased sensitivity of barorecptors

Decreased in HR, stroke volume = decreased CO by 30%

Sclerosis & thickening of valves - systolic murmur common

Loss of elasticity in vessels - HTN

Decrease cardiac condution = increase arryhthmia

Loss of turgor

Loss of fat in face 7 limbs

Hair changes

Decrased elasticity

Increased risk for pressure ulcer

Increased AP diameter

Hyperresonance to percussion

Decreased ability for effective cough

Poor relaxation of the esophageal sphincter

Decreased motility & peristalsis of esophagus

Missed defecation signal

wt loss

malnutrition

failure to thrive

dehydration

Decreased muscle mass

DJD

Concerns: immobility & fall/gait distrubances

• Primary - involves hips, knee, cervical, lumbar spine
•  
• More common in terminal interphalangeal joints (Herberden's nodes)
• Less common in proximal interphaglangeal joints (Bouchard's nodes)
• Metacarpophaglangeal & carpometocarpal joint of the thumb affected
• Metatarsophaglangeal joint of the big toes affected

Any joint after articular injury (acute/overuse/metabolic)

Delayed DTR's

Decreased sence of touch

Increase pain tolerance

• Mental status at each visit:
• --Draw a clock: full credit for #12 at the top (3pts), has 12 #'s (1pt), 2 hands (1pt), time identification (1pt) = <4pts impairment
• --3 item recall after 3 mins
• If fails screening given mini mental exam:
• --Perfect score 30, Mild impairement 18-24, if less than 9 grade completed < or equal to 17 = impairement
• Screen for Depression
• Screen ADL's