Gerontology

1. Gerontology CHAPTER 24

2. Gerontology Overview • Aging (Senescence) • Process of growing old • Gerontology • Study of all aspects of the aging process including: • Clinical, psychological, economical, and sociological issues encountered by older persons and the consequences for both the individual and society

3. Gerontology Overview • Geriatrics • Branch of medicine that deals with the physiological characteristics of aging and the diagnosis and treatment of diseases affecting elderly adults • Geriatrician • Physician who has specialized postgraduate education and experience in the medical care of the older person

4. Gerontology Overview • Geriatric Nurse Practitioner • Registered nurse with additional education obtained through a master’s degree program that prepares the nurse to deliver primary health care to elderly adults

5. Gerontology Overview • Gerontic nursing • Nursing care of the elderly • A compromise between caring for the elderly who are ill and a more holistic view of the nursing care of the elderly • Gerontologist • One who specializes in the study of gerontology

6. Assessing the Elderly • Changes in the elderly • Skin • Decrease in adipose tissue • Skin becomes drier • Decrease in skin turgor • Dryness and flaking of the skin • Thin, transparent skin with increased age • Skin tags and age spots

7. Assessing the Elderly • Changes in the elderly • Hair • Graying of the hair (hypopigmentation) • Decrease in amount of hair on the head • Male pattern baldness may be evident • Men develop thicker eyebrow hair, coarse nasal hair, and hair in the ear canal

8. Assessing the Elderly • Changes in the elderly • Face • Wrinkles and sagging of the skin • Lips may wrinkle due to degeneration of elastin • Receding gum lines, some exposure of root of tooth, some yellowing of teeth • Hyperopia increases (presbyopia) • Myopia decreases

9. Assessing the Elderly • Height and physical shape • Stature (height) of elderly female may decrease by several inches • Due to estrogen depletion • Abdomen may have rounder appearance • Due to redistribution of subcutaneous tissue • Female breasts become more elongated and appear flatter with advanced age

10. PATHOLOGICAL CONDITIONS AND CHANGES Gerontology

11. Integumentary System • Notable changes due to aging • Graying of hair • Wrinkling of skin • Reduced skin turgor • Dry scaly skin • Thinning epidermis • Thicker nails • Age spots

12. Acrochordon • Pronounced • (ak-roh-KOR-don) • Defined • Benign growth that hangs from a short stalk, commonly occurring on the neck, eyelids, axilla, or groin of an older person • Also known as a skin tag

13. Actinic Keratosis • Pronounced • (ak-TIN-ic kair-ah-TOH-sis) • Defined • Premalignant warty lesion, occurring on the sun-exposed skin of the face or hands in aged light-skinned persons • Raised areas appear scaly and may bleed at the edges

14. Carcinoma, Basal Cell • Pronounced • (car-sih-NOH-mah BAY-sal sell) • Defined • Most common malignant tumor of epithelial tissue, occurring most often on areas of skin that are exposed to the sun • Presents as a slightly elevated nodule with a depression or ulceration in the center that becomes more obvious as the tumor grows

15. Carcinoma, Squamous Cell • Pronounced • (car-sih-NOH-mah SKWAY-mus sell) • Defined • Malignancy of the squamous, or scalelike, cells of the epithelial tissue • Much faster growing than basal cell carcinoma and has greater potential for metastasis if not treated

16. Carcinoma, Squamous Cell • Frequent sites on sun-exposed areas • Top of nose • Forehead • Margin of external ear • Back of hands • Lower lip

17. Eczema • Pronounced • (EK-zeh-mah) • Defined • Acute or chronic inflammatory skin condition characterized by erythema, papules, vesicles, pustules, scales, crusts, scabs, and itching

18. Seborrheic Keratosis • Pronounced • (seb-oh-REE-ik kair-ah-TOH-sis) • Defined • Brown or waxy yellow wart-like lesions that are loosely attached to the skin • Senile warts

19. Skeletal System • Notable changes due to aging • Normal age-related changes affect mobility • After age 50, musculoskeletal system gradually loses bone mass • Increase in bone fragility • Decrease in bone strength

20. Fracture of the Hip • Pronounced • (Fracture of the hip) • Defined • Break in continuity of bone involving upper third of femur • Location of most hip fractures is in upper 1/3 of the femur • Occurs most often in the elderly due to diminished sense of equilibrium, coordination and body position

21. Fracture of the Hip • Causes • Falls • Cause of most hip fractures, impactions, or dislocations • Women more susceptible • Due to osteoporosis • Treatment • Surgery • May involve open reduction and internal fixation

22. Fracture of the Hip Internal Fixation Devices

23. Osteomalacia • Pronounced • (oss-tee-oh-mah-LAY-she-ah) • Defined • Abnormal softening of bones due to a deficiency of calcium and phosphorus in blood • Which is necessary for bone mineralization

24. Osteoporosis • Pronounced • (oss-tee-oh-poh-ROW-sis) • Defined • Porous bones • Bones that were once strong become fragile due to loss of bone density • Occurs more frequently in postmenopausal women, in sedentary or immobilized individuals, and in patients on long-term steroid treatment

25. Osteoporosis

26. Paget’s Disease (Osteitis Deformans) • Pronounced • (PAJ-ets disease) • (oss-tee-EYE-tis dee-FOR-manz)

27. Paget’s Disease (Osteitis Deformans) • Defined • Nonmetabolic disease of the bone, characterized by excessive bone destruction and unorganized bone formation by osteoblasts • Bone is weak and prone to fractures • Diseased bone takes on a characteristic mosaic pattern • Detected with X-ray or bone scan

28. Muscles and Joints • Notable changes due to aging • Loss of muscle mass • Decline in muscle strength • Cartilage in joints eventually erodes • Increasing stress on underlying bone • Joint mobility is hampered • Elastic synovial tissue is replaced with collagen fibers • Synovial fluid within joint increases in viscosity

29. Ankylosing Spondylitis • Pronounced • (ang-kih-LOH-sing spon-dil-EYE-tis) • Defined • Type of arthritis that affects the vertebral column • Causes deformities of the spine • Also known as Marie Strümpell disease and as rheumatoid spondylitis

30. Bunion (Hallux Valgus) • Pronounced • (BUN-yun) (HAL-uks VAL-gus) • Defined • Abnormal enlargement of the joint at the base of the great toe • Great toe deviates laterally, causing it to either override or undercut the second toe • Bony prominence enlarges at base of great toe as condition worsens

31. Gout • Pronounced • (GOWT) • Defined • Metabolic disease in which uric acid crystals are deposited in joints or other tissues • Characterized by inflammation of the first metatarsal joint of the great toe • Men 40 to 60 more commonly affected than women • Usually appears in women in postmenopausal period

32. Osteoarthritis • Pronounced • (oss-tee-oh-ar-THRY-tis) • Defined • Most common form of arthritis • Results from wear and tear on the joints, especially weight-bearing joints such as hips and knees • Also known as degenerative joint disease • Universal prevalence in those age 80 and over

33. Osteoarthritis

34. Restless Legs Syndrome • Pronounced • (Restless Legs SIN-drom) • Defined • Condition of legs involving annoying sensations of uneasiness, tiredness, itching, or tingling of the leg muscles while resting • Individual has overwhelming desire to get up and move around, due to jerking sensation and painful twitching of the muscles

35. Nervous System • Notable changes due to aging • Slower nerve transmission • Slower voluntary movements • Stooped forward-flexed posture • Slowed gait • Dry eyes • Impaired ability to hear high-pitched sounds • Decreased ability to maintain balance and correct imbalance

36. Alzheimer’s Disease • Pronounced • (ALTS-high-merz dih-ZEEZ) • Defined • Progressive and extremely debilitating deterioration of a person’s intellectual functioning • Begins with minor memory loss and progresses to complete loss of mental, emotional, and physical functioning frequently occurring in persons over 65 years of age

37. Cerebrovascular Accident (CVA) • Pronounced • (seh-REE-broh-VASS-kyoo-lar AK-sih-dent) • Defined • Death of a specific portion of brain tissue • Results from decreased blood flow to that area of the brain • Also called a stroke

38. Cerebrovascular Accident (CVA) • Causes • Transient ischemic attacks (TIAs) • Also known as mini strokes • Cerebral thrombosis • Occurs largely in individuals older than 50 • Cerebral embolism • Embolus causes an occlusion • Cerebral hemorrhage • Cerebral vessel ruptures

39. Parkinson’s Disease • Pronounced • (PARK-in-sons dih-ZEEZ) • Defined • Degenerative, slowly progressive deterioration of nerves in the brain stem’s motor system, characterized by a gradual onset of symptoms • Classic Symptoms: stooped posture with body flexed forward, bowed head, shuffling gait, pill-rolling gestures, expressionless mask-like facial appearance

40. Shingles (Herpes Zoster) • Pronounced • (SHING-lz) (HER-peez ZOSS-ter) • Defined • Acute viral infection characterized by inflammation of the underlying spinal or cranial nerve pathway producing painful, vesicular eruptions on the skin along these nerve pathways • Seen mainly in adults with highest incidence in adults over 50

41. Shingles Image courtesy of Robert A. Silverman, M.D., Pediatric Dermatology, Georgetown University

42. Blood and Lymphatic Systems • Notable changes due to aging • Percentage of bone marrow space occupied by tissue that produces blood cells declinesprogressively • After age of 70 • Decreased immunity • Specific antibody responses to foreign antigens is impaired

43. Purpura • Pronounced • (PURR-pew-rah) • Defined • Collection of blood beneath the skin in the form of pinpoint hemorrhages appearing as red-purple skin discolorations • Idiopathic thrombocytopenic purpura = antibodies formed by the individual that destroys his/her own platelets

44. Cardiovascular System • Notable changes due to aging • Workload of heart may be compromised due to accumulation of excess fat surrounding the heart • May be due to poor dietary and exercise habits • Risk for cardiovascular disease increases significantly in women after menopause • Risk is about equal in men and women after the age of 65

45. Arteriosclerosis • Pronounced • (ar-tee-ree-oh-skleh-ROH-sis) • Defined • Arterial condition in which there is thickening, hardening and loss of elasticity of the walls of arteries (hardening of the arteries) • Results in decreased blood supply, especially to lower extremities and cerebrum

46. Congestive Heart Failure • Pronounced • (con-JESS-tiv heart failure) • Defined • Condition in which pumping ability of heart is progressively impaired to the point that it no longer meets bodily needs

47. Congestive Heart Failure • Left-sided cardiac failure • Left ventricle unable pump blood that enters it from the lungs • Characteristics: • Dyspnea • Moist sounding cough • Fatigue • Tachycardia • Restlessness • Anxiety

48. Congestive Heart Failure • Right-sided cardiac failure • Right side of heart cannot empty all of blood received from venous circulation • Characteristics • Edema of lower extremities (pitting edema) • Weight gain • Enlargement of liver (hepatomegaly) • Distended neck veins • Ascites • Anorexia • Nocturia • Weakness

49. Coronary Artery Disease • Pronounced • (KOR-oh-nah-ree AR-ter-ee dih-ZEEZ) • Defined • Narrowing of coronary arteries to the extent that adequate blood supply to the myocardium is prevented

50. Coronary Artery Disease • Treatments for occluded coronary arteries • Medications • Percutaneous Transluminal Coronary Angioplasty (PTCA) • Directional Coronary Atherectomy • Coronary Bypass Surgery = Coronary Artery Bypass Graft (CABG)