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162 Cards in this Set
- Front
- Back
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Work in the early years |
Greeks, Hebrews regarded work as a curse Roman's work was done by slaves (agriculture and business for free men) In industrial age skill and craftsmanship turned to discipline and Anonymity which threatened sense of control and treated work ethic World War 2 had increasing efforts to rewards and make people feel important Invention of world wide web in 1989 lead to greater self expression and self fulfillment |
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What is the protestant work ethic proposed by max weber |
Diligence Punctuality Deferment of gratification Primacy |
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What are the 3 major changes in labour force participation over time |
Rates of participation of women Rates of participation of older adults Rates of participation of older women |
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Rates of participation of women |
From 1953 to 1990 the percentage of women in labour force increased steadily to 76% in 1990
Number of males in labour force stayed about the same during these years |
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What are some reason for more women joining labour force |
New technologies (electrical appliances) reduced the time needed to perform house chores
Fewer children
Increased employment opportunities
Changing of social norms regarding gender roles |
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What has more women in the work place lead to |
Has led to a large rise in median annual wages and salaries for women
-more women working full time on a full year basis -more women employed in wellpaid occupations |
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Rates of participation of older adults |
% of older adults working past the age of 65 has increased significantly over the past decade
Pattern of labour force participation for older men and women has held steady between 2011-2015 |
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Why are more older individuals working past retirement age (65) |
Want to keep work especially professionals with high income and managerial workers
Declines in workplace pension coverage
Inadequate retirement savings
Changing social norms that favor a later exit |
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Employment for older adults |
More than 1/4 (28.8) of older men and more than 1/3 (36.4) of women are employed in consumer services (sales clerks, truck drivers, secretaries)
20.6% of men and 17.7% of women in business services (advertising, accounting)
17.1% of men employed in primary goods (farming)
14.8% in health related industries |
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Part time work in older adults |
39% of workers 65- 69 work part time (12% of works 25-54 work part time)
Most older adults work part time or full time temporary jobs after leaving full time careers (bridge employment) |
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What is the overall dependency ratio |
Used to determine the effects of changes in the labour force by gaugeing the burden that old and young people place on the working age population |
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How is the overall dependency ratio expressed |
The number of dependents (0 to 14 + 65 and older) For every 100 workers (15-64) |
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What does low dependency rate mean |
Indicates that there are proportionally more adults of working age who can support the young and older adult populations |
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Canada dependency ratio |
Has started to increase in 2011 from 45 dependents to 46.5 dependents in 2014 (Small increase)
there is a small increase as the ratio for kids has decreased and ratio of adults 65+ has increased (even out) -lower levels of immigrants of working age -fertility rates below the fertility replacement rate (2.1) |
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Effects of the aging population on the work force |
Lower growth in output and income and increases in lsbour shortages
Increase pressure on public expenditures like age related programs (healthcare) and benifit programs (OAS and GIS)
Could also reduce governmental costs of an older population |
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Differences between old adults today and future older adults |
Future older adults will have higher levels of education, better health, longer life expectancy, and remain more active in retirement (work, volunteering, traveling) |
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Ng and Feldman 6 common negative stereotypes of aging |
Poorer performers
Less motivated
Less willing to participate in training and career development -empirical evidence thar it is true
Less trusting
Less healthy
Experience more work family imbalance
Less qualified for jobs that are fast pasted and require greater energy
(These beliefs are strongest in industries that prefer young individuals like retail, hotel and catering, finance and insurance) |
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Postive stereotypes of older adults in yhe work place |
More reliable
More loyal
Provide more stability than younger workers
Perceived as more qualified for jobs that demand specialized expertise
(These don't translate into postive perceptions of older adults) |
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Some ways organizations can reduce negative stereotypes |
Blinding (not disclosing candidates age when decision making)
Use affirmative action practices
Raising conscientiousness about stereotypes in work place
Encouraging more open discussions
Increasing opportunities for young and old to work alongside each other |
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Challenges of being old and unemployed |
Older workers take longer than younger workers to find work once unemployed due to possible age discrimination
Older adults recive fewer job offers, search for work longer, and are less likely to find re employment after job loss
More inclined to accept wage decrease (10% lower than pervious job) |
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Rates of participation of older women |
Labour force participation rate for Older men is higher than for women across all time periods between 1976-2015 Women work in more part time jobs, more career gaps, lower salaries and fewer opportunities for job advancement -less knowledge on finance |
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What leads to an early or on time retirement (65) (age is negatively correlated with employment) |
Being a women
Poor health
Low socioeconomic status
Fast technical change in job duties/ environment (difficult to adapt)
Financial readiness
High intensity carrgiving is associated with full retirement by 55 to 69 |
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What leads to a later retirement |
Having a spouse who is working
Having high levels of education
Higher socioeconomic status -work is less physically demanding |
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Why do more men retire vs Why more women retire |
Men are more likely to retire due to mandatory reinforcement -20 to 30% of older works see reiterment as forced due to health or organization
Women more likely to retire due to caregiving responsibilities |
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What is bridge employment |
Returning back to work following retirement (part time/full time temporary)
1/4 of retirees engage in it |
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How does active theory of aging explain bridge employment |
The more active and involved older adults are the more satisfying their lives will be.
Return to work to be more active and involved |
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How does continuity theory explain bridge employment |
Maintaining some consistency with one's previous life facilitates the transition to older adulthood |
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Who seeks bridge employment |
Younger (50 to 59) Healthier Male Highly educated Less financial resources Family status (spouse in work force) |
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Canadas 3 pillar pension system (2 private 1 public) |
Canada pension plan/ Quebec pension plan
Old age security (OAS) Program
Personal pension and investments |
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Canada pension plan/ Quebec pension plan |
All working age individuals have to pay into CPP either split with the employer or solely when self employed
Provides pensions and benefits when contributors retire, disabled or die (goes to spouse/ children)
Amount depends on the amount of time and money the person contributed More women rely on CPP |
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Old age security (OAS) Program
-Harper changed age of eligibility from 65 to 67 but Trudeau changed 64 |
The amount depends on how long you have lived in Canada after the age of 18 -lived in Canada for 40 years after 18 get full basic pension Can defer OAS pension for 60 months (5 years) after they become eligible in exchange for high monthly amount (max increase of 36% at 70) GIS provides a further supplement for those with low incomes |
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Gareanteed income suplemnt (GIS) |
Provides monthly non taxable benefit to OAS recipients Amount depends on martial status, receipt of full OAS pension by spouse, receipt of thr GIS by spouse |
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Persinal pension or investments |
Employer-sponsored pension plans 30% of older adults retirement income comes from private income with 59% recive private pension 65 and older are more likely to have investment income |
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2 kinds of employer sponsored pension plans |
Defined contribution pension plans -establishes a set amount that you and your company will contribute to your plan each year (based on how much you earn) Defined benefit pension plans -promises to pay you a set income when you retire -based on income when you were working and number of years worked |
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Older adult poverty in Canada |
OAS and GIS and persinal pensions help ensure that Canadians maintain a basic standard of living in retirement Canada has the 3rd lowest rates of poverty in older adults (Netherlands and france) |
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Stobert, Dosman and Keating two broad types of leisure activities for older adults |
Passive leisure -watching TV, listening to radio, pleasure drive
Active leisure -reading, going to movies, playing cards, socializing and physical recreation (All groups spend more time in active leisure expect men 75 and older as they spend equal amount of time in both) |
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Turoctte and Schellenberg divided active leisure into 3 seperate categories |
Cogntive leisure -reading, educational activities, hobbies, entertainment events, playing cards Social leisure -socializing with friends, talking on phone Physical leisure -exercise, walking, sports and travel |
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Canadian Physcial Acitvity guidelines recommendations for those 65 |
Engage in 150 mins of moderate to vigorous aerobic phyicial activity per week (10 mins at a time) Muscle and bone strengthing activities at least 2 days per week (Phyicial activity increases quality of life and improvements in physical, social, psychological and spiritual well being) |
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What are some barriers in engaging in active leisure activities |
Health issues Fear of falling Financial costs Feeling too old Lack of knowledge Perception that it is inconvenient Living environment not conducive with it |
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What are some enablers to engaging in active leisure acitvies |
Expectatiin of health benefits Social support or companionship Access to physical activity programs |
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World health organization developing programming to remove barriers -work being done by provincial and local government to make public spaces more senior friendly |
Keeping sidewalks in goof repair Adding benches to public areas Implementing exercise displays and equipment for older adults in city parks Redesigning streets for cycling Providing more info on activities |
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Baby boomers vs today's older adults |
Baby boomers more likely to choose aquatics, sports, outdoor programs, self improvement programs Both groups choose leisure programs related to arts, social recreation, health/ wellness, hobbies and travel Young old (55 to 65) are different |
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Life long learning |
More adults engage in self directed informal learning
Some do return to college with a preference for intergenerational learning environment with younger students More women pursue lifelong learning |
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Formal learning vs self directed learning |
Formal learning -used a formal curriculum Self directed informal learning -does not rely on a teacher or organized curriculum Both formal and informal lifelong learning is associated with healthy lifestyles and a higher perceived quality of life |
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Reasons for lifelong learning |
Desire to learn new skills to give back to community (generactivity) Desire to remain independent Keep active and engaged in life Social contact Keep up to date in their current career or learn new skills to branch into new career Contribute value and meaning to older adults life |
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Volunteering |
Is one of the top 5 social activities for men and women over 65 years Volunteering contributes to mental health (symptoms of depression), overall health, fewer functional limitations and greater longevity Greater feelings of productivity, increases in social activity and overall life improvement Postive outcomes (feeling usefulness, boosts in self esteem, social networks) have greater impact on vulnerable older adults -might have limited opportunities to experience postive outcomes in their daily lives compared to non vulnerable |
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Programmed theories of aging |
Argue that again is genetically programmed to occur with time and thi process of deterioration eventually leads to death Aging is dependent on a biological clock |
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Cellular theories of aging |
Propose that human again is the result of cellular aging
Where an increasing production of cells reach senescence, a terminal stage at which cells will cease to divide |
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Hayflick limit theory (cellular theories) |
Argues that the human cell is limited in the number of times it can divide
Human cells divide about 50 times after which they stop and die
Number of dividions a cell is able to make depends on thr age of the cell |
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Why is there a limit placed on cell division |
Limit is due to the shortening of telomeres which are the end tips of chromosomes
Telomere shortening and dysfunction are associated with age related diseases like cardiovascular disease, type 2 diabetes and cancer |
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Error theories of aging |
Argue that aging is due to environmental insults that results in progressive damage to living organisms |
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2 error thoeires of again |
Wear and tear theory -aging is caused by damage done to cells and body systems overtime -wear out due to use and once they are they no longer function correctly
Free radical theory -organisms age from cell accumilation of free radical damage overtime -free radicals form naturally, highly reactive and can cause damage to cells |
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What is a strategy to increase longevity |
Caloric restirction -reducing calories without malnutrition
Lowers risk of developing cancer, diabetes, cardiovascular disease
Aim to eat 25 to 30% fewer calories
Only established anti aging paradigm |
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Okinawans' diet (oldest life expectancy in the world) |
Low in fat and sugar
Had few calories
Rich in antioxidants and seafood
High in legumes and soy |
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What is primary aging |
The Gradual and inevitable process of bodily deterioration that takes place throughout life |
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What is secondary aging |
Aging due to the result of disease and poor health practices such as not exercising, smoking and an unhealthy diet
-preventable through lifestyle choices or modern medicine |
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Layers of the skin (most visible sign of aging is wrinkling) |
Epidermis -made of flat, scale like cells called squamous cells and round basal cells -contains melanocytes which make melanin to give skin its colour Dermis -contains blood/ lymph vessels, hair follicles and glands -glads produce sweat (body temp) and seburm (keeps skin oily) through pores Hypodermis -under the dermis between underlying tissues and organs -mostly adipose tissue and storage site of body fat |
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Intrinsic aging (few wrinkles from this process) |
Is Gradual irreversible changes in structure and function of an organism thar occur due to the passage of time skin becomes pale, thinner, more fragile, dry and less elastic Changes due to reductions of collagen produced, reduction of sweat/ oil glads, less elastin produced and reduction of glycosaminoglycan in the dermis (add mosture) Gender and ethnicity play a role as women and Caucasians show more intrinsic aging of skin |
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External aging |
Due to external factors such as exercise, diet, exposure to sunlight and smoking Two main factors are exposure to solar ultraviolet (UV) (90%) and smoking Show thickening of cornified (top epidermis) layer, freckles, sunspot formation Skin that is skin with deep wrinkles, is rough in appearance, is uneven tone and presence of brown patches |
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What is external aging of skin associated with |
Actinic keratosis And skin cancers such as basal cell carcinoma, squamous cell carcinoma and melanoma Last 2 associated with indoor tanning beds |
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What is collagen |
Fibrous protein that provide strength and elasticity to the skin, bones, cartilage and connective tissue |
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How can some of these external causes of aging to the skin be reversed |
Protection against UVA and UVB rays to reduce risk of cancer Regular use of topical retinoids can rejuvenate premature again of the skin |
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Preoccupation with appearance |
Preoccupation with oned appearance extende across the lifespan but the Onset of middle age is associated with an increase in Preoccupation Baby boomers are the first generation with an increased desire for prevention of youthfulness (more cosmetic surgery since 2000, more products to reverse signs of intrinsic again) |
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Cosmetic surgery |
Concerned with yhe maintenance, restoration or enhancement of physical appearance through surgical and medical techniques Middle and upper class women who are middle and older aged are major consumers -Younger women, and both young and old men becoming more major consumers |
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Presbyphonia |
Age related voice changes -due to lose muscle mass, mucous membranes thin and become drier in larynx and vocal cords Higher pitch in men Lower pitch in women Reduction in volume and projection Tremor or shakiness in voice Reduced vocal endurance |
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Ages in hair |
Graying is due to the reduction of melanocytes (located in hair follicles and produce melanin)
Graying begins in 30s at the temples and extending to the top of the scalp (10 years later for Asian and African)
Body hair also turns grey (later in life) -armpits, chest, public may or may not
Hair becomes thinner with age (hair loss) |
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What is androgenetic alopecia (male pattern baldness) |
Typical pattern of receding hairline and hair thinning on the crown of the head -80% of Caucasian men and 42% of Caucasian women Is polygenentic inheritance (determined by many genes not just on X chromosome) |
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androgenetic alopecia in men |
Due to sensitivity of the hair follicle to androgens as well as genetics
Starts to recced at the temples and starts to thin on top of the head, bald patch develops on top of head which grows till there is a rim of hair around back and sides Treated by oral medication called finasteride and topical solution of minoxidal (rogaine) and hair replacement surgery |
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androgenetic alopecia in women |
Role of androgens is less clear
Affect the top of the head but there also be a more general thinning of hair all over head
More stressful for women than men
Treated by topical minoxidal |
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Vison declines associated with regular aging (20/20 or 6/6) |
Pupil becomes smaller and less responsive
Leans begins to lose elasticity and yellows
Muscles that control pupil size and reaction to light lose strength |
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Pupil becomes smaller and less responsive |
Decrease in diameter in pupil makes seeing in dim light more difficult -loss of dark adaptation (difficult to adapt from darkness to bright light and vice versa)
Changes in dark adaptation can increase sensitivity to glare and making it difficult to drive at night on dark pavement when raining |
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Leans begins to lose elasticity and yellows |
Results in difficulties with accommodation (ability of the lens to change focus from distant to near objects and vice versa)
Presbyopia
Yellowing effects colour perception -dulling of colours, differentiating between colours
Yellowing also affects determining where an object ends and its background begins |
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Presbyopia |
The Gradual loss of the ability to focus on nearby objects (loss of near vison)
-first seen around 40 -can't be prevented -difficultly reading small print, holding objects at arms length, eyestrain and headaches, need for brighter lights |
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Changes in vison due to to disease |
Macular degeneration
Cataracts
Glaucoma |
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Age related macular degeneration (AMD) -leading cause of vison loss |
Chronic eye disease that causes vison loss in the center of an individuals field of vison
Causes damage to photoreceptors in macula (needed for sharp, central vison) resulting in blank spots when the person is looking ahead
Wet AMD -abnormal blood vessels start to grow under macula -thermal laser surgery
Dry -thinning of macula -no treatment |
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Cataracts -leading cause of vison loss and most common cause of reversible blindness in the world |
The clouding of the crystalline lens of the eye which blocks light from reaching the retina
Age, family history, diabetes, sun exposure, tobacco/ alcohol use, previous eye injuries, medications (steroids, diuretics)
Surgery (lens are replaced)
Diet rich in vitamin C and E and carotenoid rich foods help reduce risks |
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Glaucoma |
Normal fluid pressure inside thr eye (intraocular pressure) increases which can result in damage to the optic nerve, leading to blindness
Tonometry (puff of air to measure)
Eye drops or oral medications to promote drainage of fluid and fluid pressure
Laser surgery |
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What are the 2 main types of age realted hearing loss |
Conductive hearing loss -damage to the middle ear (eardrum/ ossicles)
Sensorineural hearing loss (90%) -permanent damage to the inner ear (cochlea) or auditory nerve -a form of which is presbycusis |
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Presbycusis (age related hearing loss) |
Is a progressive and irreversible sensorineural hearing loss resulting from degeneration of the cochlea or inner ear or auditory nerves |
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What is the main risk factor of age related hearing loss |
Long term repeated exposure to noise resulting in Gradual, irreversible damage to the sensory cells and other structures leading to permanent hearing loss
Effects each ear equally
More common in men (25%) to women (14%) |
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Other causes of hearing loss |
Link between GRM7 that produces key protein in the inner ear and impairments in pure tone thresholds and speech perception Links between medical conditions including diabetes, hypertension, renal failure, tobacco use, drug use Leads to depression, isolation, social withdrawal and reduction in overall quality of life (hearing aids can counteract) |
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Commutation and hearing loss |
People with age related hearing loss can here when someone is talking (hear lower frequency vowels) but not able to understand what is said due to loss of consonant information (s, z, t, f, g) -downed out by background noise -can't hear women as voices tend to be higher pitch |
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Relationship between hearing loss and cogntive decline |
Individuals proform worse on cogntvie tests who have hearing loss Individuals with hearing loss showed higher probability of developing dementia |
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Changes in taste |
Research is contradictory as some show no decline and other do show declines but no for all types of taste Changes can be due to disease, radiation therapy, head injury, surgeries to (ear, nose, throat), drugs (antibiotics and antihistamines) Poor oral hygiene and dental problems can also lead to taste disorders |
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Types of taste |
Sweet Salty Bitter Sour Umami Fat |
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Changes in smell |
Anosmia (loss of sense of smell) is an early indicator of overall physiological declines (canary in the coal mind) Loss of smell related to increase in developing dementia Loss of smell and taste can result in loss of food interest and lead to malnutrition Loss of smell and taste can lead to older adults eating food spoiled |
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Changes in touch |
Tactile thresholds increase with age as do thresholds for pain and temperature -reduced ability to detect touch and pressure can lead to pressure ulcers |
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What is the cardiovascular disease |
An umbrella term used to describe many disease of the cardiovascular system -arteriosclerosis -coronary artery disease -heart failure -stroke
Increases with age and effects both physical and cogntive health -more Likely in men Death due to disease and stroke have been decreasing (more than 75%) |
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What is a stroke |
2 kinds
Ischemic stroke (most common) -interupption of blood flow to the brain which kss brain cells
Hemorrhagic stroke -rupture of blood vessels in the brain
Rates of death of stroke increase after 65 |
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Symptoms of strokes |
Sudden numbness, weakness, paralysis in face, arm or legs, slurring of words, trouble seeing, headache, vomiting/ dizziness, difficulty walking |
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What are the 2 parts of the immune system |
Innate immune system -present at birth -white blood cells active in response to infectious and non infections agents (don't need to be trained) (don't need to be trained) Adaptive immune system -develops over time through exposure to certain pathogens -B and T cells that are activated create immunological memory |
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Immune system changes with age |
Both innate and adaptive immune system decline with age Infectious diseased account for roughly 1/3 of all deaths in persons 65 years and older Hosital/ long term care stays increase the risk for exposure to infections (nosocominal infections) Living a healthy lifestyle are recommended as steps towards keeping a healthy and strong immune system |
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digestive system (begins at mouth and ends at anus) |
Two important functions is the digestion and absorption of food Includes organs like liver, gallbladder and pancreas |
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Changes to the digestive system |
Sluggish metabolism (weight gain/ constipation) More susceptible to diverticulitis (small pouches in the lining of colon) -causes pain, fever, discomfort when inflamed Can no longer tolerate coffee, alcohol, spicy foods Heartburn, dyspepsia (indigestion) and intestinal gas |
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What can help with changes in digestion due to age |
Eating low fat, high figure diet with fruits and vegetables Drinking water Regular exercise Practicing moderation by not overindulgjng in food or drinks |
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Changes to metoblic system (Includes pancreas, liver, thyroid, hypothalamus) |
Diabetes is a chronic metabolic disorder that becomes prevalent inlater life
-prevalence increases with age due to inability of the body to produce and use insulin with age
-increase risk of type 2
-75 to 79 have highest proportion of individuals with diabetes |
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Two kinds diabetes |
Type 1 (insulin dependent diabetes) -any age but most often before 30 -body's impaired ability to produce insulin -daily injects needed Type 2 (non insulin dependent diabetes) -over the age of 40 -body's imparted ability to recognize and utilize insulin -managed by diet and oral hypoglycemic agents (lower glucose) Type 2 is associated with age, obesity, physical inactivity |
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Complications of Type 1 and Type 2 diabetes |
Increased risk of cardiovascular disease, kidney disease, damage to eye, nerve damage resulting in tingling, numbness, burning, pain in lower limbs -blood flow to feet can lead to amputations |
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Changes in musculoskeletal system (Bones, muscles, tendons, ligaments, joints, cartilage) |
Age affects muscle mass and strength (Beginning in 4th decade and 50% gone by 8th decade of life) Declines in aerobic capacity Loss of height (1 cm every 10 years after 40, rapidly after 70) (fat is weights less than muscle) -men gain weight till 55 then lose it Weight again (fat is weights less than muscle) -men gain weight till 55 then lose it -women gain weight till 65 then lose it Arthritis -women gain weight till 65 then lose it then lose it Arthritis then lose it Arthritis then lose it Arthritis then lose it Arthritis then lose it Arthritis Arthritis |
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Two most common forms of arthritis |
Osteoarthritis (most common) -when protective cartilage at the ends of bones wear down over time -irreversible damage to joint structures
Rheumatoid arthritis -affects lining of joints, causing painful swelling that leads to bone erosion and joint deformity -common in feet, fingers, shoulders, wrists, ankles |
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What is osteoporosis |
Disease where bones become thin and porous resulting in decreased bon strength and an increase risk of fractures
-29% of women (menopasue) and 6% of men 65 years and older
Silent thief as changes happen without symptoms till fracture
Develop strong bones at young age -calcium and vitamin D |
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nervous system |
Neurons, nerves, tracts, other tissues
Controls and interacts activities and responses to environmental and internal/ external stimulations |
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Changes in nervous system with age |
Reduction in brain size and weight from decrease in volume in cerebral cortex
Reduction in neurons, decrease in number of dendrite branches, changes in synaptic organization, decline in neurotransmitter production
Plaques accumulate in neurons which causes features similar to Alzheimers disease
Have functional consequences (hearing, vision, smell, taste) |
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Changes in reproductive system |
Menopause -mid to late 40s with a reduction in estrogen/ progesterone -Onset of infertility
Andropause -Gradual process involving reduction in sperm and testosterone
Women epxerejcne drying, thining and decreased elasticity in vagina (sex painful) -microorganisms change increasing risk of yeast infections
Men experience enlarged prostate glands (urination) and erectile dysfunction (medical reasons rather than aging) Prostate and bladder cancer more common Libido or sex drive decreases with age partically in women |
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Treatment of menopause |
Hormone replacement theorpay -treating symptoms with estrogen and progesterone Link of estrogen to endometrial cancer so progesterone was added in 1980s Associated with increasing risks of cardiovascular disease and breast cancer No longer used |
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Changes in urinary system (Kidneys, ureters, bladder, urethra) |
Kidneys get smaller and blood flow to Kidneys decreases Kidneys lose the ability to balance the of salt and acid in body Bladder tissue declines in capacity to hold urine Urinary frequency/ urgency increases |
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Health problems due to changes in urinary system |
Urinary incontinence -involuntary leakage of urine -increase with age partically women (pelvic floor weakens) Urinary tract infections -most common bacterial infection in older adults which can cause physical and cogntvie symptoms like delirium |
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Changes in sleep |
Total sleep decreases with age (5-7 hours for 65 and older) Time spend awake at night (more time) Time spent in REM sleep (less time) Individuals agw 60 and older have lower rates of insomnia (other studies suggest otherwise |
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Impact of changes in appearance and stereotypes accosted with aging |
It is hoped that studying this material will bring to light greater awareness of the ways our bodies change with age and highlight the stereotypes we might have about older adults going through those changes
Older adults may have feelings of worthlessness and devaluation because negative views other have about aging (decrease self esteem) |
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How does the DSM-5 define dementia (umbrella term for wide range of symptoms) |
Term dementia has been replaced with neurocogntvie disorders
-due to response to various criticisms of the DSM-4 criteria including the requirement of impairment of memory and it being not a just a disease of old age |
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Neurocogntvie disorders definition |
Has a broader definition in that individual should have s decline in only one area of congtjve functioning in order to recive a diagnosis -memory doesn't need to be impaired to receive a diagnosis
Old criteria required a decline in at least two areas of cogntive functioning such as memory and executive functioning |
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Mild vs major neurocogntvie disorder |
Mild means cogntive impairment more than normal but with little impact on daily functioning
Major means congtive impairment plus functional impairment - more pertaining to dementia
In either case the underlying disease process must be identified |
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Fronto temporal dementia |
Individual may experience language difficulties or symptoms such as apathy or distribution long before there is evidence of impaired memory |
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Non progressive dementia |
Secondary to underlying physical conditions such as infections, reduced oxygen flow to brain, brain tumor
Some medications may cause individuals to behave like they have dementia
Untreated depression may look like dementia in older adults
-it is important fof a through assessment when diagnosisjng dementia as non progressive is reverable |
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Processive dementia |
Most dementia is provessive and involves the destruction of memory, learning, reasoning, communicating, inability to carry out daily activities
Was believed that dementia was inevitable and part of normal aging |
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What is alzheimers disease |
Most common form of dementia (60 to 80% of cases)
Onset is insidious (slowly progressive and don't know when process started)
Early first symptoms include -impaired memory and learning -getting lost in familiar places
Symptoms -progressive decline in all areas of congtvje functioning including attention, reasoning, judgment, problem solving, language abilities, visual perception |
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Alzheimer's progression |
Progressive deline in activities of daily living both complex (driving) and simple (self care and grooming)
Inappropriate social behavior and changes in personality
Life expectancy after diagnosis is 8 to 10 years (can be as short at 3 or as long as 20) |
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Changes to the brain due to Alzheimer's |
Amyloid plaques
Neurofibrillary tangles
Impedes communication between neurons and neuronal functioning to the point of neurons dieing
There is atrophy of normal aging but no where near the amount of shrinkage of the brain caused by death of neurons |
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Amyloid plaques |
Sticky build up of beta-amyloid protein outside neurons
-amyloid precursor protein (APP) is being made inside the cell, part of it remains outside -outside is cut off by alpha-secretases -in Alzheimer's APP is cut off in wrong place and caused beta-amyloid to form -beta-amyloid forms plaques that can't dissolve and they accumulate |
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Neurofibrillary tangles |
Form inside the neuron and are made up of twisted fibers of protein called tau
-each neuron has tranport system that is organized in parallel strands -tau is key component in maintaining the straight strands -in Alzheimer's disease tau collapses into twisted strands called tangles -tracks arnt straight and nutrients can no longer move through neuron and it dies |
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Mental status exams -family physicians first see a person with suspected cognitive decline (use these) -used to screen cogntvie impairment and can be administer quickly in office |
Mini mental status exam (MMSE) -out of 30 low scores less than 24 suggest cogntive impairment
Montreal cognitive assessment (MoCa) -used to screen patients who show cgontvje complaints but who scoure in a normal range on MMSE -less than 26 out of 30
(Can't make diagnosis on screening measures alone and a comprehensive assessment should be done) -may causes go undiagnosed |
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Thorough assessments of Alzheimer's |
Diagnosis is determined through a process of exclusion -all other treatable causes of the changes in cogntvie status or behavior is rules out
Exclusion is used as there is no single test for Alzheimer's -autopsy is the only way to fully know if the neurological disorder is Alzheimer's |
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Alzheimers criteria was developed on the belief that it is a clinical-pathological entity |
Means that individuals who have symptoms will also have the underlying pathology of plaques and tangles Recent research has found that the pathology of plaques and tangles can be present in an individuals brain without the individual ever showing symptoms of Alzheimer's |
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New criteria for making Alzheimer's diagnosis |
Revised NIA-AA criteria includes biomarkers and formal inclusion of the pre-dementia phase and the pre-clinical phase in 2011 |
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Biomarkers |
The measurable substance in an organism whose presence is indicative of some phenomenon such as disease -used to make diagnosis without presence of symptoms Tua (PET scans) and amyloid protein in cerebrospinal fluid and hippocampal atrophy are biomarkers of Alzheimer's -Tua is better predictor of disease |
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Pre-dementia phase and pre-clincial phase |
Pre-dementia phase -mild cogntive impairment Preclinical phase -when diagnosis can be made before the individual exhibits any observable clinical symptoms |
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Early Onset familial Alzheimer's disease |
This type is hereditary Occurs before the age of 65 who have a postive family history of Alzheimer's disease for at least 3 generations 1to 5% of cases 50% of people with this carry mutations in one of 3 genes - presenilin genes PS1 (chromosome 14) -PS2 (chromosome 1) -amyloid precursor protein APP (chrome 21) |
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Sporadic (late onset) Alzheimer's disease |
Occurs after 65 and is due to a complex combination of out genes, environment and lifestyle
-Gene of most importance is apolipoprotein E (ApoE) and is associated with chromosome 19 -exposure to aluminum due to occupation and daily life might be a cause (71% increase in risk) |
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apolipoprotein E (ApoE) |
3 different types -E2, E3, E4
Everyone has 2 copies one from each parent
E2 is the rarest and appears to reduce the risk of Alzheimer's
E4 is present in half of those with sporadic Alzheimer's (affects risk but is not a cause as not everyone with it gets disease) -women with E4 are at greater risk than men with E4 |
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Risk factors of Alzheimer's/ dementia |
Age is biggest risk factor Gender -2/3 of diagnosed people are women (women live longer but loss of estrogen through menopause may be a factor) Education and occupation can be protective factors Phyicial activity, diabetes, obesity, hypertension, eating healthy (Mediterranean diet) |
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Difference between men and women with Alzheimer's |
Men show more aggressive behaviors, more co-morbidities, and have higher mortality rates
Women have more affective symptoms and sidsbility but live longer with disease than men |
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Mild cognvitve impairment |
Deline in thinking abilities more than normal but not sufficient to cause impairment in functional abilities
-previously referred to only memory decline but not includes both memory and non memory
15-20% of persons age 65 or older have it (more common in men)
NIA-AA criteria assume MCI to be an early stage of Alzheimer's but MCI can happen in other other reasons and MCI does not always lead to dementia |
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2 subtypes of Mild cogntive decline |
Amnestic MCI (most common) -memory loss is the main symptom -greater risk of developing Alzheimer's Non-amnestic MCI -memory is not impared but other thinking abilities such as organizing and planning or reasoning and judgement may be affected |
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Vascular dementia causes (loss of brain function) -Second leading cause of dementia (15-20%) |
Can be caused by a large vessel cerebral vascular accident (stroke) -when caused by large vessel stroke it has a sudden Onset anday process stepwise or fluctuating Can also be cause by cerebral small vessel disease -damage to small arteries, capillaries and small veins in brain refered to as white matter lesions (Gradual progression) |
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Risk factors of vascular dementia |
Similar to Alzheimer's disease -hypertension, diabetes, high cholesterol, low physical activity, smoking and depression Occurs with others dementias like Alzheimer's making it mixed dementia |
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Parkinsons disease |
Is a chronic, progressive disorder of the nervous system that affects movment No known cause or cure Not all people with Parkinsons develop dementia but the risk increase with age (may develop dementia) |
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Symptoms of Parkinson disease |
Tremor of hands, arms, legs, jaw, and face Slowness of movment Rigidity or stiffness of limbs and trunk Imparied balance and coordination |
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Fronto-temporal dementia |
Occurs earlier in life before 65 and accounts for 5% of dementia cases
Cluster of syndromes that results from degeneration of the frontal and temporal lobes
Survival after symptom Onset is between 6-11 years |
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2 major forms of fronto-temporal dementia |
Behavioural type -persons mental filter is altered so that social rules are no longer considered when saying or doing somthjng -60% of cases Language type 1) non-fluent aphasia (difficulty communicating orally or written words) 2) primary progressive aphasia (Language capabilities become slowly and progressively impaired |
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2 major forms of fronto-temporal dementia |
Behavioural type -persons mental filter is altered so that social rules are no longer considered when saying or doing somthjng -60% of cases Language type 1) non-fluent aphasia (difficulty communicating orally or written words) 2) primary progressive aphasia (Language capabilities become slowly and progressively impaired |
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Lewy body dementia (prevalence of .1 to 5% in US) |
Involves progressive cogntive impairment which in the early stages of disease appears to affect complex attention and executive functions rather than learning and memory Accompanied by visual hallucinations and sleeping difficulties -may experience falls Expereicne symptoms like parkinsons (rigid muscles, slow movment and tremors) |
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Alcohol related dementia |
Excessive and prolonged use of alcohol can lead to permanent damage to structure and function of the brain
Have co-morbidities like head injury or other drugs which may be causing dementia
If cognitive deficits are recognized early they be reduced or reversed if the individual stops drinking |
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What is delirium |
It is the acute determination of mental status in which individuals exhibit deficits in attention, altered levels of consciousness and psychotic features
Usally associated with some acute medical cause (UTI) and is the most common complication of hospital admission for older persons Temporary and may resolve after a few days |
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Delirium and other dementias |
Strong relationship between delirium and dementia
Challenging to distinguish delirium from lewy body dementia because some features such as hallucinations and fluctuation in symptoms are common in both |
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Risk factors of delirium |
Non modifiable -age, dementia, stroke
Reversible risks -infections, trauma, surgery, constipation and adverse drug effects |
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Wellbeing factors associated with delirium |
Increased morality Greater length of hospital stay Loss of independent living Increased dementia risk |
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Cogntive enhancers |
Acetylcholinedterase inhibitors (ACHEIs) -most commonly used cogntive enhancing medications in the treatment of progressive dementia -Evidence in support of their efficacy on cogntvje function is very limited Vitamin E, estrogen, anti-inflammatory have not been shown to be effective in treatment of dementia (No proven treatments to delay or stop) |
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Memory training |
Growing body of evidence supports the utility of non-pharmacologic interventions -adults with MCI benefited from learning the memory strategies but not to the extent that the healthly adults did |
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What is included in the behavioral and psychological symptoms of dementia (BPSD) |
Includes disinhibition, apathy, psychosis, agitation and aggression
Agitation and aggression are the most common and distressing -occurring in 20 to 30% living in community and 40 to 60% living in care facilities |
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How are agitation and aggression defined |
Agitation -defined as inappropriate verbal, vocal or motored activity that cannot be explained by apparent needs or confusion -pacing, restlessness, repetitive vocalizations (shouting and verbal insults) Aggression -physical aggression seen as biting, hitting and pinching |
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What does BPSD lead to |
Caregiver burnout Early institutionalization Poor quality of life |
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Treatment of BPSD |
Antipsychtoic medication is not safe and is associated with side effects and mortality when treating dementia symptoms Non pharmacologic approaches -music (no long term effects) -reminiscence therapy -muti-sensory stimulation (no long term effects) Training paid caregives in communication and person centered care reduces agitation Removing individual from environment and placing them in a quiet soothing one helps with aggression |
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Incarcerated older adults with dementia |
Older adults represent the fastest growing sector of prison population -1 in 4 in Federal population in Canada is 50 or older -psychological states of inmates are 10 to 15 years beyond their chronological age Mutiple medical co-morbidities and there treatments are not easy to manage in a prison context Not easy to maintain a good diet and exercise which is needed for both physical and congtvie health With accelerated process of aging dementia may be 2 to 3 times more frequent in prison |
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2 types of prisoners with dementia |
Career criminals who develop dementia while in person Individuals incarcerated for a crime they committed while having unrecognized dementia -first time offenders in old age are the manifestation of early dementia (weaken inhibitions) Prisoners with dementia may not recognize rules of Prisoners system and put themselves at risk for more institutional charges |
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Depression and dementia |
Depression and dementia can co-occur frequently (vascular dementia) -50% of people diagnosed with dementia develop depressive symptoms with 20% developing a depressive disorder Relationship Is complex and not well understood due to methodological factors with studies and difficulties in summarizing across studies |
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Driving and dementia |
A variety of factors can render driving unsafe for older adults like sensory impairment (vison) and cogntvie impairment (slow processing) and dementia Can still drive in the early stages of dementia Having conversation about driving cessation can be quite challenging for both older adults and his or her family |
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Negative effects and stigma associated with Alzheimer's disease |
Feelings of shame, loss of independence and identity, humiliation, diminished value, and self worth
These occur in addition to ci-occurring agesim |
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Types of stigma associated with Alzheimer's |
Self stigma -internalizing illness stereotypes and formulating prejudice and discrimination against oneself Structural stigma -quality of Healthcare services and inadequate behavior of professionals Stigma by association -emotions and beliefs of those individuals closest to the stigmatized person |
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What is an informal caregiver |
A family member or friend who provides unpaid care for a loved one who is living with a mental or physical disability or illness Informal care accounts for more than 80% of the care needed by people with long term mental or physical conditions Activities include meal prep, coordinating appointments, providing personal care, transportation, emotional support More women help with medical and personal care while men help with home maintenance or outdoor work |
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Age of caregiving |
45 to 54 (24%) 55 to 65 (20%) Over 65 (20 to 25%) |
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Challenges of caregivjng |
Caregiver burden and are pronounced when care recipient has dementia Reduction of health related quality of life Increase physical health problems (Heart disease) Increased risk of mortality Loss of self (give up hobbies) Anxiety and depression
Dementia anxiety (fear of also developing dementia) |
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Joys of careiging |
Opportunity to give back Personal growth Inner strength discovery Feelings of accomplishment and competence Development of close relationship Postive role model for their own children |
