Movement is good for joints - it causes release of synovial fluid, lubricating and increasing blood flow, it also keeps muscles toned and limber

Lack of movement can result in contracture - freezing of muscles in place

causes dizziness/lightheadedness from standing up too quickly - not dangerous in itself, but increases risk for falls

Can create chronic conditions by causing brain damage -> months - years of rehabilitation, long term motor impairment requiring physiological and psychological rehabilitation

Occurs when the pancreas produces insufficient insulin - causes above normal sugar in the blood and urine due to difficulty metabolizing carbohydrates

- if sugar levels are too high -> coma; if sugar levels are too low -> unconsciousness 

1. developed in cihldhood/adolescence

2. developed in middle age: typically along with cardiovascular issues

3. developed later in life: the majority of older adults with diabetes; usually show mild problems

Lung and colorectal: caused by unhealthy lifestyles

skin cancer: can be prevented through limiting sun exposure

1. cumulative effect of unhealthy lifestyle and exposure to pollution

2. result of normative aging changing the immune system - decreased ability to deal with tumours

BRCA1 and BRCA2 -> breast/ovarian

HPC1 -> may account for 1/500 cases of prostate cancer

1. Stress: pressure on the abdomen exceeds the ability to resist urination - ex. when someone coughs, or lifts heavy objects

2. Urge: CNS issues after a CVA or urinary tract infection - urge to urinnate becomes overpowering

3. Overflow: improper contraction of the kidneys causes the bladder to become over-extended; commonly caused by drugs, tumours, and prostate enlargement

4. Functional: urinary tract is intact, but the person is unaware of the need to urinate

5. Iatrogenic: caused by medication side effects, usually fixed by change in dosage

- behavioural: dietary changes, re-learning the need to use the toilet, kegel exercises

- medication and surgical intervention

- therapeutic touch, massage, vibration, heat, cold

- electrical stimulation to spine or pain site

- acupuncture and acupressure

- biofeedback - learning to control and change the body processes responsible for pain

- distraction technique

- relaxation, meditation, and imagery

- hypnosis - self induced or by another person

1. Absorption: the time needed for drugs to enter the blood stream

2. Distribution: movement of a medication throughout the body - in adults, more of a drug will not bind to plasma proteins, allowing for more free drug in the body -> drugs have lower effective dosage

3. Drug metabolism: process by which the liver removes medications from the blood stream - slower in older adults, increasing the risk of toxicity

4. Excretion: elimination of drugs through urine, feces, sweeat, and saliva (primarily urine) - lower body water content means drugs are exreted more slowly in older adults

 some drugs don't interact well:

- drug effects may be enhanced, or the drug may not work - secondary effects may arise that need to be treated, or mimic othere diseases 

- emphasize the seriousness of the disease

- good communication

- issue reminder cards and organized pill boxes

- discussions about the importance of compliance

- keeping medications to a minimum

the effects of chronic conditions on people's ability to engage in activities that are necessary, expected, and personally desired in their society

1. Cerebrovasuclar disease

2. arthritis

3. coronary artery disease (weaker predictor)

- wealthier Canadians have lower rates of mortality, and, morbidity and presumably fewer years of chronic disease and dependancy

- but, in the US, residents of a high SES neighbourhood were not shown to have lower prevalence of disease and disability than other areas of the US

-> may be the national context - the gap between the rich and poor - which affects the health of everyone

- women's self-reported health worse in all countries surveyed

- self-reported health problems are more prevalent in developing countries

- Life events and situations: significant other (partner/mentor), avalability of opportunities, economic security

- community and cultural factors: sense of connectedness, attachment to networks, participation in community groups, strong cultural identity, access to support services, norms against violence

- Life events and situations: abuse, transitions, loss, physical illness, low SES

 - community and cultural factors: isolation, discrimination, neighbourhood violence, poor living conditions, lack of support services

- individual factors: low intelligence, difficult temperament, chronic illness, poor social skills, low self-esteem

- family/social factors: experiencing rejection or neglect, lack of warmth, parent substance abuse, criminality, or mental disorder, family violence

1. Age and fucntioning are not linearly related in clinical settings

2. It is necessary to recognize the influence of comorbidity in clinical settings

3. A major task in assessment is to distinguish normal from pathological processes

4. Clinical gerontologists should emphasize brief assessment

5. Assessment results should emphasize patient's strenghts, weaknesses and treatment

6. Multiple methods of assessment are optimal

1. physical health: poor health can create mental problems

2. cognitive functioning: must distinguish between normative and abnormal changes

3. functional capacity: identify whether individuals have trouble with ADL or IADL

4. social Factors: the quality of one's social network affects mental health

- negative biases about older people: ex. older people are likely to have Alzheimer's

- positive biases: ex. women aren't ever alcoholics

- environmental conditions: assessment may occur in non-ideal conditions - ex. a noisy emergency room

clinical interview, self-report, report by others, psychophysiological assessment (ex. EEG, heat rate in response to stimulus), direct observation, and performance-based assessment

What is a potential danger of using medical treatment in older age groups?

Behavioural: people engage in fewer pleasant activities and derive less pleasure from them when dperessed

CBT: people who experience uncontrollable and unpredictable events may feel helpless, resulting in depression

1. SSRIs: lowest overall side effects, though linked to high levels of agitation - associated with high suicide rates

2. HCAs (heterocylcic antidepressants): most effective with younger and middle-aged people; older adults likely to take other medicaiton that interacts poorly, and they must be taken for about a week before any results, making compliance difficult

3. MAO (monoamine) inhibitors: inhibit MAO, a substance which interferes with transmisison of signals between neurons - less effective, and higher mortality risk, must be used with caution, only if the other two are not an option

Lithium: effectively controlls mood swings, but is not well understood - is a salt -> raises blood pressure and is dangerous for people with hypertension

- is linked to slower reaction time and impaired memory

- an effeective treatment for severe depression, especially long term depression

- has immediate effects, with few treatments needed

- side effects: loss of memory for the ECT and recent events, increased risk for heart attack

Attempts to alter current behaviour without addressing underlying causes - attempt to increase the amount of rewards/reinforcements people receive from the environment

- assign tasks to patient, ex. meet new people, join clubs

- instruct family members to ignore negative comments and encourage positive comments with rewards and praise

Attempts to alter the underlying maladaptive beliefs and cognitionns that cause dperession

- teaches people to recognise these thoughts and evaluate the self and world more realistically

- teaches people to change their basic beliefs about themseles responsible for negative thoughts - ex. belief that one is a failure, or unlovable

- review therapy and reminiscence: use memories of previous events and relationships to confront and resolve conflicts

1. generalized: feelings of severe anxiety with no specific trigger

2. phobic: irrational fears of an object or circumstance

3. obsessive-compulsive: thoughts or actions performed repeatedly to lower anxiety

4. PTSD: a traumatic event is relived psychologically, and all stimuli associated with the even are avoided

- chronic conditions and medications may mimic or coexist with anxiety symptoms

- anxiety may be an apporpriate response: may feel helpless to to actual or potential loss of control/mastery

benzadiazepines - ex. valium, librium, serax, ativan ; the most comon and widely prescribed medications for anxiety

must be careful with older adults -> lower effective dosage, more potential for side effects, side effects can mimic dementia, potential for addiction

The treatment of choice for most anxiety disorders:

- relaxation training, substituting rational for irrational thoughts, gradual exposure to images or real situations that generate anxiety

- CBT can succesfully treat generalized anxiety, usually requiring only a few sessions with no long-term side-effects

- Severe impairment of thought process, distorted perceptions, loss of touch with reality, distorted sense of self, abnormal motor behaviour

- create loose associations among conversation topics, lose conversation threads, hear voices, maintain false beliefs

- identity confusion, social withdrawl, difficulty working toward a goal

- emphasize medication: use antipsychotics that affect the dopamine system

- do not responde well to psychotherapy: clients often have difficulty trusting therapists - if paranoia is overcome, some evidence that supportive therapy is effective

- difficulty getting along with other people, being hostile, manipulative

- behaviour which deviates markedly from society's expectations

- thoguht, emotion, interpersonal relationships and impulse control might be affected

- behaviour patterns which are inflexible and occur over a broad range of situations

- the patter exists over a long duration, beginning in childhood or adolescence

Risk increases with age (but declines between 55 - 84), especially high risk in very old adults - men are at a higher risk than women throughout life

- more women are hospitalized for attempted suicide: their methods tend to be less voilent, ex. drug overdose

younger and older adults have issues with different drug types

- younger adults: abuse illegal drugs

- older adults: abuse prescription or over the counter (OTC) drugs

(with the exception of alcohol, which is abused accross age groups)

1. craving

2. impaired control

3. physical dependence

4. tolerance

- characterized by cognitive and behavioural deficits involving some form of permanent damage to the brain

- severe and gradual cognitive decline

- not caused by toxic substances or infection

- rapid cell death in hippocampus, cortex, basal forebrain

- neurofibrillary tangles

- neuritic plaques -> beta-amyloid protein

- disorientation in time and space

- difficulties in word finding and communication

- declines in hygene and self-care skills

- inapporpriate social behaviour and changes in personality

mild cognitive impairment, self-reported significant memory impairment and disability

- before symptoms, plaques and tangles can be detected in areas involved in thinking and planning, and learning and memory

- can spread anywhere, but commonly affects speech and language; sense of body placement may be affected; may have difficulty recognizing people

- develop problems with memory and thinking serious enough to interfere with work or social life

- may get confused, have trouble handling money, expressing or organizing thoughts

- many people are first diagnosed in this stage

only one gene in one parent is necessary to produce a disease -> 50% chance that a childof an affeted parent will have the disease

- APP, PS-1, and PS-2 are autosomal dominant for Alzheimer's, but account for only 10% of Alzheimer's cases

ApoE is only a risk factor, it increases the risk of Alzheimer's already present

3 different allele polymorphisms for ApoE:  ε2, ε3, & ε4

- one ε4 allele -> three times more risk for Alzheimer's

- 2 ε4 alleles -> nine times more risk

- ApoE exerts the strongest effect on people between the ages of 66 and 75

- cortex shrivels -> loss of nueronal tissue, damaging areas involved in thinking, planning and remembering; especially in the hippocampus

- fewer cells and connections

- neuritic plaques and tangles

- ventricles (fluid-filled spaces within the brain) grow larger

(DAT because Alzheimer's can only be diagnosed post-mortem)

Earliest Alzheimer's: changes may begin 20 years or more before diagnosis

Mild to moderate: generally lasts between 2 and 10 years

Severe: may last from 1-5 years

Not likely to have an effect until around 80

- at 80, first degree relatives of those with Alzheimers have a 25% risk, compared to 6% in the normal popluation 

(much lower than the genetic risk for other disorders such as Huntington's)

Family history: hereditary risk

external environment: possible water, soil, or air pollution, could be aluminum

internal environment: could be a slow virus, imbalance of chemicals, or a problem with the immune system

- Alzheimer's believed to be related to choline acetyltransferase deficit, which triggers the synthesis of acetylcholine - medications can counteract this deficit - recommended to patients who score 10-24 on the Mini-Mental Status Examination

- norepinephrine deficits also believed to be involved, but no medication is currently available

- anitpsychotic medications may be effective, but may cause too many negative side-effects

- antiddepressants and sedatives are also used

- anticipatory loss of loved one's personality/self

- progressive loss of memory and functioning 

- acknowledged loss of the loved one as he/she was

-> can take a path of coping and acceptance or denial

- difficulty dressing, bathing, grooming

- nutritional needs

- correct interpretation of personality and sexual changes

- sleeplesness

- wandering

- incontinence

- may have trouble managing money or driving which can cause family conflict -> important for people with Alzheimer's to make their own decisions about transfer of responsibilities

respite care: allows caregivers to get away for a time

- in home: for brief periods - ex. running errands

- residential placement: for longer periods - ex. a weekend

adult day care: placement and programming for frail older adults

- helpful for dealing with adults with behaviour problems -> reduces amount of time needed to deal with behaviour problems and their frequency

-> these systems are generally only used when the family's informal system breaks down

- CVAs result in disruption of blood flow (an infarct) due to hemorrhage or blockage 

-  a series of small CVAs results in the global decline in cognitive ability

- 2nd leading cause of dementia in Canada

- stepwise rather than gradual decline

- symptom patter is highly variable

- diagnosis: imaging and review of history of CVAs

- caused by abnormal structures in the brain called lewy Bodies - composed of protein alpha synuclein

- progressive loss of language, meory, and higher order reasoning, similar to Alzheimer's, but more rapid

- no cure, but can treat accompanying psychotic symptoms and depression

Results in a cluster of characteristic motor problems: slow walking, stiffness, difficulty getting in and out of chairs, slow tremors

- caused by deterioration of neurons in the midbrain that produce dopamine

- symtpoms greatly alleviated with L-Dopa

14-40% will develop dementia -> commonly associated with Lewy Body formation

- Autosomal disorder that begins between 35 and 50

- involuntary flicking movements of arms and legs, inability to sustain motor acts, prominent psychiatric disturbances - ex. hallucinations paranoia, and depression

- personality changes, swings from apathy to manic behaviour

- cognitive impairments appear late, and onset is very gradual

- associated with GABA and substance P definciency

- antipsychotic medications are used, but are only partially effective

Wernicke-Korsakoff's syndrome: major loss of memory and cognitive functioning due to chronic thiamine deficiency

- treatable if vitamine deficiency is detected early, and alcohol consumption ceases

loss of neurons and degeneration of nerve cell membranes result in small holes in the brain

- rapid decline after onset: memory loss and mood swings

- later: jerky and unstready movements

- unique because it can be both transmitted and inherited: believed to be caused by an abnormal form of prion protein (PrP)

- 'mad cow disease' is a variant of CJC

- predictable component of AIDS: protein gp 120 - a byproduct of HIV - is responsible for death of neurons

- early symptoms: inability to concentrate, difficulty with complex sequential mental tasks, memory loss in tasks demanding concentration, clumsiness and weakness in arms and legs, apathy, loss of spontaneity, depression, social withdrawl, personality change 

- later symptoms: continued deterioration of motor skills and cognitive performance, incontinence

- terminal phase: bedridden, vacant stare and minimal social and cognitive interaction 

A disturbance of consciousness and change in cognition that develops over a short period of time

- difficulty with attention, memory, orientation, and language

- can affect perception, the sleep-wake cycle, mood, and personality

- rapid onset, and can change rapidly in symptoms/severity over a day

medical conditions, medical side effects, intoxiation, withdrawl, toxins

- those with underlying dementia are vulnerable

- rare in normal populations over 55, but occurs in up to 50% of postoperative patients

important to distinguis delerium from depression and dementia

- severity is related to the underlying problem

- often accompanied by misinterpretations of the environment and confusion -> best alleviated through reassurance by family and friends

- can be cured in most cases if the cuase is identified, but can be fatal or result in permanent brain damage

1. Environmental characteristics are restricted

2. Personal freedom is limited

3. One believes they have limited freedom

applies Lazarus' stress and coping framework to the understanding of the interaction between older adults and the environment

- One's situation and surroundings are evaluated for potential threats - things can be viewed as harmful, beneficial or irrelevant

- older adults have greater vulnerability to social and physical hazardm making them more likely to view situations as threatening

View of aging as a progressive series of losses that reduce one's social participation

- children leaving, loss of social role, loss of income, death of spouse, close friends, relatives, loss of sensory acuity, loss of mobility

- as losses are sustained, remaining connections become more important -> the immediate neighbourhood becomes of high value to an older adult without the ability to go beyond a 1 block radius from home

1. the focus must be on the interaction between the person and the environment, not one or the other

2. No one environment meets everyone's needs

a person's potential to perform a wide range of activities considered essential for independent living - not just ADL and IADL

- involves the person's physical, social, and psychological functioning

antecedents: individual and sociocultural factors which influence contextual components

contextual components: the particular domains of competence

mechanisms: factors which moderate the way in which competence is expressed

outcomes of everyday competence: psychological and physical well-being

-> health outcomes of one episode of everyday competence become an antecedent for the next

- the 'next step' after independent living

- meant to maintain independence with some level of support - ex. meals, housekeeping, laundry

- cost is based on the amount of services used

- most share the following key characteristics: a home like atmosphere suited to people with mobility and physical problems (barrier free), private lockable rooms, furnished by tenants, regular light housekeeping and laundry

residential complex with one or more rental units of living accomidation

- occupied by persons 65+

- occupied by at least six people other than the operator

- makes at least 2 care services set out in the Act available directly or indirectly

- residence pay for accomodation and care services -> everyone gets care

- amount of care is determined by cost

- Creates a regulartory authority with the power to licence homes and conduct inspections and enforce penalties 

- Establishes manditory care and safety standards, and requires emergency plans, infection control and prevention programs, assessment of care needs and care planning, police backround checks and training for staff

- Establishes residents' rights that include the right to know the true cost of care and accommodation, zero tolerance of abuse or neglect

all retirement homes apply for licence in order to operate in Ontario

- residents' Bill of Rights must be posted in every licensed home

- home operator's duty to protect residents from abuse and neglect

- staff training on abuse, fire prevention and safetty, and whistle blowing protections

- further protections for seniors will come into force in phases up to January 1, 2014

- participate fully in care decisions

- not be restrained

- privacy and dignity

- raise concerns without fear of reprisal

- retirement homes are generally private facilities, nursing homes cannot be run privately

- protective, supervised environments for people who need 24 hour care

- meals, assistance, nursing care/supervision and medical management 24/7

hel with day-to-day living tasks (ex. bathing and dressing)

- social recreation programs

person well-being depends not just on the facilities, but on the congruence of the person's needs and the ability of the facility to meet those needs

- 80% of dependent behaviours of residents are performed because of compliance with staff, not actual dependence

Multiphasic Environmental Assessment Procedure (MEAP) scale evaluates facilities in the following 4 aspects:

1. physical and architectural

2. organizational and administrative staff and policies

3. supportive characteristics of staff

4. social climate

- enables us to measure and examine separate dimensions of the person-environment interation independently

- people don't want their home to feel like a hospital

- "nursing home resident" and "patient" have negative connotations

- being overly helpful may actually harm the residents by making the more dependent than they need to be

- strict routine is detrimental to well-being

- include resident in decision making as much as possible

- establish continuity between nursing home and and home -> bring in familiar objects and furniture

- make living in the facility a positive experience

- patronizing: slower, exaggerated intonation, higher pitch, increased volume, closed-end questions, simplified vocabulary and grammar

- infantalization or baby talk: unwarranted use of first names or terms of endearment, simplified expressions, short imperatives, assumption of poor memory, cajoling for compliance

1. Research is done with people rather than on or for people

2. understanding detailed contextual factors is important as understanding the general picture

3. produce knowledge that helps people understand and solve problems

-> goal to generate knowledge that is setting specific and problem focused

1. regulate sensory and social stimulation - not too much or too little

2. creat clusters of 13-14 residents

3. provide spaces for social interaction

4. facilitate spatial and social orientation

5. creat secure outdoor spaces

1. increase the residents' ability to identify with a family unit by grouping resident rooms into small household clusters

2. enhance resident autonomy and control by establishing the full range of spatial hierarchy within the facility