Week Topics
1 • Developmental changes
Review Kennedy and Dunphy readings for age related changes
Replicative senescence is theory states that cells can replicate or divide a specific number of times.
This ability tends to decrease with age.
Oxidative damage is the cumulative result of the aerobic metabolism, which generates chemicals
called free radicals. Free radicals may interact with other chemicals in the body and cause damage to
cells.
Telomere shortening is a theory that links aging to a reduction in cell division.
Weakening of the immune response leaves older adults more vulnerable to infection and
debilitating diseases.
Travel
Increased risk for thromboembolic events, altitude sickness with effect on cardiac and cerebral
functioning, effect on pulmonary function from air pollution, dehydration and inability to tolerate
temperature changes, anxiety r/t change of place (central nervous changes), decreased hearing
(sensory changes), increased risk for accidents due to decreased vision, longer reaction times, some
vaccines are less effective for older adults.
Routine immunizations for older adult’s r/t travel, Influenza, pneumococcal, Td/Tdap, zoster, Hep B
for some, and certain vaccines based on destination
Yellow fever not effective until 10 days post administration and if a herpes zoster vaccine has been
given, they must wait 30 days to receive the yellow fever vaccine. If the patient has received a yellow
fever vaccine, they must wait 28 days for a herpes zoster vaccine.
Beer’s Criteria
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called
the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing
medications for older adults. They emphasize deprescribing medications that are unnecessary, which
helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, thereby
improving the risk–benefit ratio of medication regimens in at-risk people.
Exercise in Older Adults
- OA: walking, aquatic, tai chi, resistance exercises, cycling
- Anxiety: walking, biking, weightlifting,
- Fibromyalgia: Aerobic, aquatic, strengthening, tai chi, Pilates
- Sleep: Tai chi, walking, aqua therapy, biking
-Preferred amount of exercise: 30 minutes per day for 5 days a week of moderate exercise; if weight
management is part of this, 60 minutes per day is advised (Can be completed in 10 min. intervals)
,3
Laboratory Changes in Older Adults
• Protein rises slightly renal pathology, UTI, aging kidney changes
• Specific gravity: lower maximum in elderly: 1.016-1.022-decline in nephrons ability to concentrate
urine
• ESR: increases-not sensitive/nor specific in the aging adult
• Iron binding-decreases
• Hgb: decreases-anemia is common in the elderly
• HCT: slight decrease-decline in hematopoiesis
• Leukocytes: drop-drugs/sepsis
• Lymphocytes-T and B cell fall-risk for infection is higher-immunization encouraged
• Platelets: no change in number
• Albumin-decline-smaller liver-and enzymes-protein energy malnutrition
• Globulin: slight increase
• Total serum protein: decreases indicate malnutrition, infection and liver disease
• BUN: increases and decline in GFR-decreased cardiac output
• CR: increases-r/t lean body mass decrease
• CR clearance: decreases-10% per 10 years after 40-careful prescribing drugs that are excreted by
kidneys
• Glucose tolerance: increase of 10 mg/dL/decade after 30-diabetes more prevalent-drugs can cause
glucose intolerance
• Alk phosp: increase-elevations> 2
Geriatric Syndromes
• Sleep Disturbances
• Problems with eating or feeding
• Incontinence
• Confusion
• Evidence of falls
• Skin breakdown
Categories for Aging
• Young – old = 65–74 years
• Old = 75–84
• Oldest-old = 85 and older
, 4
Comprehensive Geriatric Assessment
Physical Health
-Beers Criteria: avoid Polypharmacy & Potentially Inappropriate Medication the elderly/ADR
-STOPP Screening Tool of Older Persons Prescriptions: medications that might likely need to be
stopped for the older adult
-START Screening Tool to Alert Doctors to Right Treatment: includes medications that need to be
added.
-MINI Nutritional Assessment Instrument: identifies older adults who have or at risk of malnutrition
-Nutrition Health Checklist: identifies older adults who have or at risk of malnutrition
Functional Health
- KATZ : Activities of Daily Living Scale
- Lawton and Brody Scale: Instrumentals activities of daily living
- Hendrich II Fall Risk Model: assessment of falls, useful in acute care, ambulatory, assisted
living, and long-term care.
- Timed Get up and Go Test: mobility screen
- Tinetti’s Performance Oriented Mobility Assessment is a task-oriented test that measures gait
and balance abilities
Physiological Health
- DSM-5: describes the characteristics of delirium and mild to moderate neurocognitive mental
disorders
- MMSE Mini Mental Status Examination:
- GDS: SF Geriatric Depression Scale
-Short form: consists of 15 questions requiring yes or no response. Can be completed in any
healthcare setting.
-PHQ-9 Patient Health Questionnaire
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