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108 Cards in this Set
- Front
- Back
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What should a health care provider do?
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-Schedule longer appointments
-Give the older adult time to talk -Give patients written information |
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What does the older patient think about health care providers?
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-The Provider is the expert
-Too Fast! -It is normal to be this sick -Overwhelmed -Do not disclose all of their problems -Feel comfortable with same gender |
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What are companions and why are they important?
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-40% of visits involve a companion
-Usually adult daughters or spouse -Can be positive if they are providing more information or collaborate -Can be negative if they are forming an alliance or coalition with the doctor to work against the patient -Most negative outcomes occur when the patient is excluded from the process…not part of the decision process |
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What are the 3 roles of medical companions? Define each.
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1. Watchdog - verifies information for patient and physician
2. Significant other - provides feedback about feasibility of health management 3. Surrogate parent - answers questions directed to the patient |
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How do we make the interactions between elderly and health care providers better?
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-Provide written information
-Avoid ageist attitudes...treat everyone as an individual -Treat the person as a person not as a disease -Encourage the patient to ask questions -Being responsive to issues raised by the patient -Attending to the patients agenda -Check that there is nothing else they want to talk about…in a positive way -Address them in a manner that they deem appropriate |
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How can older patients better contribute to their doctors appointment?
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-Prepare for the visits
-Identify an agenda -Prioritize a list of questions…possibly type a list -Patient needs to negotiate the role of the companion prior to the appointment -Let the doctor know about any sensory impairment -Patient need to ask for classification -Need to be aware that they have the option of changing healthcare providers if they are not happy with the level of service |
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What does patient satisfaction result in?
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-Directly linked to compliance and positive health comes
-Reduced anxiety -Keeping of future appointments -Reduced malpractice lawsuits |
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How do you increase older patient satisfaction?
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-Increase the time for appointment
-Involve more humor and shared laughter -Involve more questions from the healthcare provider -High levels of information from healthcare provider -Healthcare provider does not dominate the encounter -Healthcare provider provides more orienting statements |
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What is geriatrics? What is the goal of geriatrics?
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-Sub-specialty of internal medicine
-Aims to promote health by preventing and treating diseases and disabilities in older people |
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What is polypharmacy? Why is this happening?
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-Use of one or more medications concurrently
-Includes prescription, OTC and herbal products -Often taking them incorrectly because they cost too much or did not think they need them |
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What happens during adverse side effects? Why?
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-Increases as body fat and mass decrease, liver size decrease and blood flow decrease
-Responsible for at least 30,000 deaths and 1.5 million admissions to hospitals annually -Drug dosage is developed for 150 lb. males who are 22-26 years old -Most elders are excluded from drug trials |
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Why does non-compliance happen?
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-Complex medication schedules
-Lack of doctor-patient discussion -Memory impairment -Sensory deficit (hearing, vision, dexterity) -Lack of information about the drug -Uncomfortable side-effects of medications -Lack of literacy skills -Inability to organize drug regimen and clearly understand how the drugs are to be taken |
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What is pharmacokinetics?
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The study of the time it takes for drugs to be liberated, absorbed, distributed, metabolized and excreted (LADME) from the body and the correlation between where they are distributed I the body and the duration of the intensity of therapeutic effects
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What does LADME stand for?
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1. Liberated-how is the medication taken
2. Absorption-amount of time medication is absorbed into the blood 3. Distributed-how long it takes for medication to be used by body part 4. Metabolized-how long does it take kidners and liver to filter out of system 5. Excretion-amount of time body takes to break down medication |
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What factors affect pharmacokinetics?
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Age, disease, presence of other medications, food in the body, smoking, alcohol ingestion, cody weight and compostition, genetics, evironmental influence
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How does metabolism affect medications?
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-Done by the liver for most drugs
-The point where the medication is breaking into parts and pieces so it can be absorbed by the blood and sent through the system -Liver function is compromised by decreased blood flow and enzyme production -Causes an increase in the half-life of the medication and increase in the concentration of the medication in the blood and tissue of the body |
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What is half-life?
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Amount of time body takes to break down medication until it’s 50% effective
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Are tissues sensitive to medications?
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-As we age the effective dosage may increase or decreased as result of change in tissue sensitivity
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What are over the counter drugs?
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-Dosage is usually lower than prescription
-Elders use these to treat minor ailments 69-85% of the time -Need to make the physician and/ or pharmacist aware of what they are taking as well as prescriptions medications -Can cause negative side effects: nausea, confusion, depression |
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What are OTC durgs used?
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-More cost effective
-Lack of personal physician -Desire to self-medicate -Presence of a chronic healthcare problem |
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What are generic medications?
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-Supposed to be bioequivical to name brand
-Within a 20-25% absorption range -Same active ingredients but may have different fillers -Comes onto the market 17 years after the name brand is first marketed |
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What are adverse drug interactions? What causes this?
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-Unexpected and undesirable pharmacological response to drugs
-Causes: Ingestion of wrong dosage at wrong time, Stopping drug too early, Prescribing the drug inappropriately -35% of older adults who live in non-institutional settings experience adverse drug reactions yearly with 29% needing medical attention -If recognized as a disease it would be the 5th leading cause of death in the US |
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What are the recommendations to prevent food and drug interactions?
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-Drugs and alcohol should not be taken together
-Medications should be ingested with sufficient amounts of water for a complete swallowing -Medications should not be taken with juices, tea, coffee, or soft drinks -The cautions about food and drug interactions on OTC should be headed -Talk to you healthcare provider when getting new meds |
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What are the psychological factors of drug misuse?
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Cognitive impairments, depression, multiple meds, fear of addiction, lack of knowledge
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What are the physiological factors of drug misuse?
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Poor vision, hearing impairment, problmes opening bottles, sedation, allergic reaction to mediction, too weak/frail to take at right time
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What are the sociological factors of drug misuse?
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Reduced financial stability, religious/cultural beliefs, so not want to be the "sick" person
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What are other factors of drug misuse?
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Not getting it refilled, skipping doese, taking it at wrong time, swapping meds with friends, stopping meds prematurely, overdosing, under dosing, using old meds, getting meds at different pharmacies or from different physicians, lack of follow up with doctors
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What are the categories of drugs most elders are taking?
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-Cardiovascular
-Coagulation -Joint disorders -Osteoporosis -Parkinson’s -Psychotherapeutic -Antibiotics -Anti-diabetic -Laxatives |
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How do we prevent problems with medications?
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-Communication
-Written instruction -Follow up frequently -Memory aids -Support from family/caregivers |
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What is the Stress Process Model?
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-Perlinet, 1981
-Focuses on classes of factors as they develop over time. |
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What are the 3 categories of the Stress Process Model?
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1. Stressors
2. Resources 3. Health outcomes |
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What are stressors?
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Conditions that challenge or threaten individual’s capacities to respond in ways that preserve and protect personal well being
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What are the 2 categories of stressors?
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1. acture stress
2. chronic stress |
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What is acute stress?
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-Short period of time
-Life events; discrete changes in life patterns ...Divorce, entering work force -Onset is identifiable -Duration varies -Length of exposure and impact are time-limited |
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What is chronic stress?
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-Long period of time
-Long-term conditions that threaten well being -Minimal research re: duration of extent of effect of duration -As we get older we seem to experience more chronic stress -Older adults are more likely to experience stress related to loss of resources, roles, and relationships -If events are more difficult to come with, older adults are higher risk of compromised health and well being -Distribution of chronic stressor differ by age ...Marriage conflict, Work stress, Financial strain, Chronic illness, Loss of significant other |
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What are 3 types of resources?
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1. Social support
2. Psychological resources (self-esteem) 3. Coping efforts |
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Describe social support?
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-Tangible and intangible rewards and assistance provided by significant others
-Structural components: size of network available, proportion of family vs. non-family -Functional components: Receipt of help [e.g. for housework and meals], Receipt of emotional support, Perceptions of social support adequacy -Social support plays an intervening role ...Stressor causes support network to be mobilized ...Assistance provided by the network reduces the probability of negative health consequences -Possible negative consequences: Long-term receipt of help can lower self-esteem or create resentment, may slow recovery -Social network shrinks in older age -Widowhood -Adulthood -Older age |
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Describe psycholoigcal resources.
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-Self-esteem
-Self-efficacy |
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What is self efficacy?
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-Perceptions of self to competently handle life challenges
-Related to mastery and sense of control -Persons who view self as competent and worthy will respond better to stress -May require less social support -Resources expected to mediate the relationship between stress and illness |
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Describe coping efforts.
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-Those who effectively cope with stress are less likely to have negative health consequences
-Not all responses to stress are coping responses -Coping strategies for one stressor may not be effective for others -Active/problem-focused coping: try to alter the stressor or its consequences; better for avoiding negative stress outcomes -Emotion-focused coping: try to make self feel better, despite the stressor; may not avoid negative health outcomes; positive comparisons; avoidance coping -As we age we engage in more anticipatory coping strategies -Use of these coping efforts are the best predictor of emotional well being we have -As we age we do not employ as many coping mechanisms |
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What are the links between stress and health in later life?
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-Some stressors occur more frequently in older age and contribute to declining health
-Studies have shown links between negative coping strategies and higher HDL’s and positive coping strategies and higher LDL’s -Immune system suppression |
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What are the most negative effects from stress?
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Depression, psycholoigcal distress, physical health, disability, mortality
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Why should we care about hearing loss in older adults?
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-Hearing loss potentially has a significant negative impact on communication and well-being
-We, therefore, need to be familiar with the prevalence, nature, and consequences of age-related hearing loss |
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What is the primary complaint of older adults and hearing loss?
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-Difficulty understanding speech, especially when in noise
-Wide variations in changes in hearing sensitivity, reactions to hearing loss, and speech understanding problems among the elderly, in general, and genders |
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What are the characteristics and causes of hearing loss?
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-Typically gradually progressive
-May be accompanied by tinnitus -Men tend to have greater loss in the high frequencies -Women tend to have lesser degrees of HF loss and more LF loss |
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What are are related changes of the outer ear?
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-Cerumen tends to increase
-hair growth at opening to canal -Cartilage starts to breakdown |
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What are age related changes of the pinna?
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-Loss of elasticity
-Decreases in collagen -Increase in size of ear and lobes and presence of creases -Pigmentation spots -Ulcerations/ carcinomas primarily from sun exposure |
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What is chondrodermatitis?
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-Tender pink ulceration on the helix or antihelix
-Occurs as a result of degeneration o the skin or cartilage from chronic sun exposure, pressure, or trauma |
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What is squamous cell carcinoma?
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-Appears as red-brown nodule
-90+% occur on fair-skinned people on face or ears -Primarily in elderly |
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What is basal cell carcinoma?
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-2nd most common malignant
-Tumor of pinna occurring more often in males -Secondary to sun exposure |
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What are age related changes of the ear canal?
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-Skin atrophies and is more susceptible to cracking and bleeding with manipulation
-Reduction in cerumen production=dryness, less protection -Excessive amounts of cerumen may be produced and/or epithelial migration may be inadequate leading to impaction -EAM may narow due to sagging of skin -Use extreme care when doing cerumen management |
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What are age related changes of the middle ear?
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-TM stiffens, thins, and becomes less vascular
-ME muscles and ossicular ligaments atrophy and fiber degeneration -Thinning and calcification of ossicular joints related to arthritis -Calcification of ET cartilage and muscle atrophy -Loss of ossicular and TM flexibility may result in air-bone gap often seen in elderly at 4K Hz -Acoustic reflex amplitude and growth may be diminished (especially uncrossed – motor component) |
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What are age related changes of temporal processing?
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-Elder listeners have some limitations in temporal resolutions independent of peripheral hearing loss
-The extent is highly influenced by the listening task -Greater difficulty with discrimination of duration, especially for speech (complex stimuli) -Frequency and intensity discrimination -Aging effect on both suggests a common mechanism underlying the age-related deficit |
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What is gap detection?
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Ability to detect a brief silent interval in the stimulus waveform
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What are age related changes of speech perception?
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-Change in speech noise most likely to occur in 80+ population
-Temporally distored speech -Longer reverberation times result in greater detrimental effects on speech recognition -Poorer performance in recognizing rapid speech |
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What are age related changes of cognitive factors and speech?
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-When linguistic and semantic cues in speech are reduced or enhanced, the age-effects or correspondingly enhances or reduced
-Contextual cues enhance understanding -Reduced availability of short-term memory functions under adverse listening conditions |
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What is phonemic regression?
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-Unusually poor word identification in comparison with hearing thresholds
-May exhibit rollover in performance-intensity functions -Occurs more among 80+ |
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What is presbycusis?
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-Hearing loss attributed to aging effects
-Impossible to distinguish it from associates issues with heredity, noise exposure, disease, ototoxicity, etc. |
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What are the attitudes about hearing loss?
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Older women are more likely to:
-Admit it to communication partners -Assign more importance to effective communication -Use nonverbal strategies to circumvent communication problems |
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What is a handicap? How does this related to hearing?
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-The disadvantage resulting from impairment
-Communication and personal adjustment problems related to hearing loss may not be eliminated by use of a hearing aid |
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Hearing Handicap Inventory for the Elderly is what age group?
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65 and over
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Hearing Handicap Inventory for Adults is what age group?
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65 and under
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What does SAC/ SOAC stand for?
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Self Assessment of Communication
Significant Other Assessment of Communication |
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What are the general goals of hearing aids?
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-To make sounds audible
-Provide the widest frequency response possible -Keep souns from becoming uncomfortably loud |
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What are the implications of hearing aids?
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-Stigma: you're old, you can't hear well, people will talk slow to you
-Cost/benefit: $1000-$5000/ piece, only lasts 5-7 years, takes up to 2 years to get used to hearing aids |
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What is motivation?
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-Having the impetus to seek out opportunities
-Important cognitive factor that affects adaptation to chronic disease and resultant disability -State of being that produces a tendency toward some type of action |
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What are 4 variables of motivation?
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1. Wants
2. Expectations/ Belief 3. Reinforcement 4. Cost of Behavior |
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What are beliefs?
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-What a person acts upon
-Situation and/or task the person is facing, the future as the person sees it, and the person himself/ herself -A person must be optimistic about their capability to succeed at a task to actually succeed -Belief is one’s capabilities will initiate behavior |
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What happens to motivation as we age?
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-May require more and different reinforcement
-Older adults respond to more concrete goals that re immediate and affect daily function -Older adult need to be given reason to believe that improvement or success is possible prior to attempting a new technique or intervention -Regular corrective feedback present in a nonthreatening supportive manner will help reduce anxiety about a task, sustaining continued involvement, motivation and sense of success |
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What are the 2 outer layers of the eye?
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1. Sclera
2. Cornea |
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Describe the Sclera.
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-Dense, white, opaque outer layer that is continuous with the cornea
-Tough fibrous protective tissue -Prevents scattered light from entering the eye -Protects the eye |
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Describe the Cornea.
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-Primarily function is to regract light onto the focal point on the retina
-Highly transparent avascular protective membrane that allows light to pass through to the retina |
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What are the 4 middle layers of the eye?
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1. Uveal tract
2. Lens 3. Iris 4. Vitreous humor |
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Describe the uveal tract.
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-Highly vascular middle layer of the eye that provides the blood supply and nutrition to the other 2 portions of the eye
-Control light absorption -Secrete the aqueous humour |
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Describe the lens.
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-Focuses light on the retina by relaxing and contracting muscles
-Avascular -Colorless -Transparent -Suspended behind the iris -Over time it thickens |
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Describe the iris.
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-Contrast sensitivity
-Pigmented portion of the eye -Purpose is to regulate the amount of light entering the eye through dilation and constriction of the pupil -Circular membrane suspended behind the cornea and immediately in front of the lens |
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Describe the vitreous humor.
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-Clear, avascular gelatin making up 2/3 of the volume and weight of the eye
-Helps maintain shape and transparencies of the eye -Build up of the contributes to intraocular pressure |
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What is the inner most layer of the eye?
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Retina
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Descibe the retina.
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-Semitransparent
-Continuous with the optic nerve -Photo-receptors that are “antennae” for the visual system -Receives visual images -Houses rods and cones |
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What are cones?
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-Color sensitive
-Visual acuity -Color vision in bright light |
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What are rods?
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-Peripheral vision, especially in dim room
-Black-white vision |
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What is the optic disc?
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-Region where retina meets the optic nerve
-Contains no light receptors therefore is known as a “natural blind spot |
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What is the macula?
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-Oval, yellowish spot to the side of the optic disc
-Contains the fovea largely composed of cones and is the areas of sharpest vision -Key to focusing an area of the retina and its responsible for central vision |
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What are age related changes of the lens?
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-Thickens and becomes less elastic, limiting ability to change shape
-Changes interfere with ability to shift focus from distant to near objects [age-related far-sightedness] -Yellows and becomes opaque causing cooler colors to be difficult to see -Pin-point opacities develop that produce dazzle from sources of bright light -Better able to distinguish between bright colors |
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What is presbyopia?
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-Dimished ability to focus clearly on objects at a normal distance
-Results in most adults needing reading glasses at age 40-50 |
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What are age related changes of the iris?
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-Eye color fades
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What are age related changes of the vitreous humor?
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-Becomes less transparent
-Allows light to scatter instead of highly focused -Floaters: Loss cells and tissues casting shadows on the retina -Higher Visual threshold: Takes more light to be able to obtain info from the environment |
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What are age related changes of the pupil?
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-Pupil diameter decreases
-Directed pupil reaction to light to decrease resulting in much less light reaching the retina -Results in: ...Older people need more light for readings and getting around safely indoors ...Decreased ability to adjust to abrupt changes in lighting ...Both light and dark adaptation takes more time |
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What are cataracts?
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-Opacities on the lens as a result of protein build-up (surgical treatment)
-Most common eye disorder related to aging -May see halos around objects, experience blurred vision, decreased light and color perception |
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What are risk factors for cataracts?
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-HBP
-Diabetes -Use of corticosteroids -Excessive exposure to sunlight -Excessive consumption of alcohol -Family history of cataracts |
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What is glaucoma?
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Increased pressure in eye and leads to degeneration of the optic nerve and blindness, if not treated
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What is primary glaucoma?
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-PACG (Primary angle closure)
...Results from thickening of the lends causing closure of the duct that allows fluid to drain out ...Result in eye pain, clouded vision, nausea and vomiting -PADG ...Most predominant ...Degenerative changes in the eye results in increased pressure slowly over time ...Medications and topic cream prescribed to inhibit vitreous humor production |
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What is secondary glaucoma?
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-A pathological process blocks the flow of vitreous humor from the eye
-Older women are most at risk -Can result in loss of peripheral vision -Occurs slowly over time -Causes: Inflammation, Diabetes, Tumors |
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What is diabetic retinopathy?
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-Leading cause of adult blindness
-Nearly every diabetic has some form of this after the 20 year mark of having Diabetes -Small retinal blood vessels develop small aneurysms which cause hemorrhages -Symptoms: cloudy vision, seeing shower spots -Treatment is later photocoagulation |
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What is macular degeneration?
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-Severe loss of central vision
-Dry = no bleeding, no treatment -Wet = bleeding -The need for increasingly bright light when reading or doing close work -Causes: genetics, smoking, cardiovascular disease, long term sunlight exposure |
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What are age related changes in speech production?
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-Resistant to aging
-Manner of production may be somewhat different -Atrophy of the jaw, tongue and facial muscles -Severity and length of significant hearing loss -Notable differences between young and old considered normal variations rather than pathological |
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What are age related changes in phonemic production?
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-Centralize vowels
-Decrease in formant frequency of vowels -Acoustic changes related changes in the vocal tract -Lowering of larynx -Muscle atrophy that decreases muscle mass in pharynx and tongue |
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What is Voice Onset Time (VOT)?
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Distinguished voiced and voiceless cognate stop phonemes
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What are age related changes in artiuclatory timing?
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-Increased variability with age related to diminished coordination/neuromuscular control
-Elders normally produce vowel and consonant segments that are longer -For longer utterances |
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What are age related changes in fluency?
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-Generally increases from preschool to early adult years
-Disfluencies may increase later in life -Elders tend to use slower speech rates -Speak 20-25% slower and 55% more variable than younger adults -Longer and more frequent pauses -Reduced velocity of articulatory movements -Longer speech sound durations -Produce fewer syllables per second -The majority of elderly errors are: Interjections & Revisions/incomplete phrases -More likely to be dysfluent when under stress -May need more time to organize and/or execute articulation to maintain fluency |
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What are age related changes in speech and voice production?
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-Result of complex coordination of sensory and motor processes that depends on effective and efficient neural transmission between the central and peripheral nervous system
-Secondary changes include: ...those caused by physical or emotional abnormalties ...pharmocoloigcal or medical treatment ...idiopathic causes |
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What are age related changes of the respiration?
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-Decreased rib movement
-Increased thorax stiffness -Increased residual lung volume -Decreased lung recoil and diaphragmatic strength |
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What are stuctural changes of the oral-pharyngeal mechanism?
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-Tooth loss and/or compromised dentition
-Amount of bony structures decrease because of bone resportion -Epithelium of tongue, pharynx, and soft palate atrophies along with other connective tissue -Oral mucosa becomes thinner and drier -Decteased salivary flow |
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What are age related changes in sensory ability?
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-Reduced lingual sensation
-Reduced abilty to perceive pressure on tongue |
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What are age related changes of the larynx?
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-Ossification of thyroid, cricoid, and arytenoid cartilages
-Erosion and calcification of laryngeal cartilage joints -Changes in the mucosa of the vocal folds -Muscular atrophy -Incomplete vocal fold approximation -Glottal gaps or reduced glottal resistance |
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What happens to the larynx and phonation when structurally aging?
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-Laryngeal glads
...lubricate the vocal fold mucosa ...changes could result in dehydration of epithelial lining of the vocal folds ...May be responsible for excessive throat clearing -Vocal folds |
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What happens to the larynx and phonation when functionally aging?
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-Voice quality
...Great variability due to highly variable rate in onset and progression of physioloigical aging ...Voice amplifier can be used with weak voice if it interferes with communication ...Changes in vocal fold tissue may introduce vibratory irregularities that contribute to voice quality deviations -Vocal intensity ...o Depends on subglottal pressure which is determined by efficiency of the respiratory power supply -Vocal pitch ... Changes in laryngeal anatomy and physiology as well as the respiratory/ supra-glottal systems causes gradual decrease in pitch from infancy to early adulthood, where it becomes stable -Fundamental frequency ...Contradictory findings in the aging population ...Trend to increase slightly in males and decrease in females as function of normal aging |
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What is the difference between jitter and shimmer of the voice?
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-Jitter: small cycle to cycle vaiations in vibratory frequency
-Shimmer: cycle to cycle amplitude perturbations |
