Academic Geriatric Resource Center
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AT A GLANCE

Glossary

0. Introduction
1. Demography And Epidemiology
1.1 The Changing Face of Aging: Objectives
1.2 Local and Regional Variations Among Older Adults in the United States
1.3 Implications of an Aging Society for Health Care Needs and Resources
1.4 Common Chronic Conditions Associated with Advanced Age
1.5 Post Test
2. Biology and Physiology of Aging
2.1 Introduction and Background
2.2 Theories of Aging
2.3 Physiological Changes with Aging
2.3.1 Loss of Homeostatic Reserve--Hyperthermia
2.3.2 Loss of Homeostatic Reserve--Hypothermia
2.3.3 Vulnerability of Older Adults to Hypothermia
2.3.4 Clinical Importance of Vulnerability to Hypothermia
2.3.5 Loss of Homeostatic Reserve--Other Examples and Clinical Implications
2.3.6 Clinically Important Age-Related Changes in Organ Systems
2.3.7 Clinically Important Age-Related Changes in the Renal System
2.3.8 Clinical Significance of Age-Related Changes in Renal System
2.3.9 Clinically Important Age-Related Changes in the Cardiovascular System
2.3.10 Clinical Significance of Age-Related Changes in the Cardiovascular System
2.3.11 Clinically Important Age-Related Changes in the Pulmonary System
2.3.12 Clinical Significance of Age-Related Changes in the Pulmonary System
2.3.13 Age-Related Changes in the Neurologic System
2.3.14 Clinical Significance of Age-Related Changes in the Neurologic System (I)
2.3.15 Clinical Significance of Age-Related Changes in the Neurologic System (II)
2.3.16 Clinically Important Age-Related Changes in the Gastrointestinal System
2.3.17 Clinical Significance of Age-Related Changes in the Gastrointestinal System (I)
2.3.18 Clinical Significance of Age-Related Changes in the Gastrointestinal System (II)
2.3.19 Clinically Important Age-Related Changes in the Immune System
2.3.20 Clinical Significance of Age-Related Changes in the Immune System
2.3.21 Clinically Important Age-Related Changes in the Endocrine System (I)
2.3.22 Clinically Important Age-Related Changes in the Endocrine System (II)
2.3.23 Clinical Significance of Age-Related Changes in the Endocrine System
2.3.24 Clinically Important Age-Related Changes in the Musculoskeletal System
2.3.25 Clinical Significance of Age-Related Changes in the Musculoskeletal System (I)
2.3.26 Clinical Significance of Age-Related Changes in the Musculoskeletal System (II)
2.3.27 Clinically Important Age-Related Changes in the Genitourinary System (I)
2.3.28 Clinically Important Age-Related Changes in the Genitourinary System (II)
2.3.29 Clinical Significance of Age-Related Changes in the Genitourinary System
2.3.30 Clinically Important Age-Related Changes in the Sensory Systems
2.3.31 Clinical Significance of Age-Related Changes in the Sensory Systems (I)
2.3.32 Clinical Significance of Age-Related Changes in the Sensory Systems (II)
2.3.33 Clinically Important Age-Related Changes in the Integument
2.3.34 Clinical Significance of Age-Related Changes in the Integument
2.4 Pharmacologic Considerations
2.5 Post Test
3. Socio-cultural And Psychologicial…
3.1 Module Objectives
3.2 Social Theories of Aging
3.3 Psychological Development In Late Life
3.4 Ethno-Cultural Issues And Age-Stratified Societies
3.5 Late-Life Transitions
3.6 Dependent Elders: Special Concerns
3.7 Cultural Views of Death
3.8 References
3.9 Post Test
4. Assessment Of The Geriatric…
4.1 Module Objectives
4.2 Domains of Assessment: Functional Assessment
4.2.1 How to Use Information from a Functional Assessment
4.2.2 Vision Impairment
4.2.3 Hearing Impairment (I)
4.2.4 Hearing Impairment (II)
4.2.5 Oral and Dental Health
4.2.6 Introduction to Oral Health Assessment
4.2.7 Oral Health Assessment
4.2.8 Common Oral Conditions in Older Adults: Tooth Loss (I)
4.2.9 Common Oral Conditions in Older Adults: Tooth Loss (II)
4.2.10 Common Oral Conditions in Older Adults: Care of Dentures
4.2.11 Common Oral Conditions in Older Adults: Dental Decay
4.2.12 Common Oral Conditions in Older Adults: Periodontal Disease
4.2.13 Common Oral Conditions in Older Adults: Candidiasis Infection
4.2.14 Common Oral Conditions in Older Adults: Leukoplakia and the Risk for Oral Cancer
4.2.15 Guidelines for a Dental Referral
4.2.16 Falls and Gait Assessment
4.2.17 Assessing for Falls
4.2.18 Techniques for Gait Assessment
4.2.19 Gait Assessments and Falls Interventions
4.2.20 Risk Factors for Falls and Targeted Interventions
4.2.21 Modification of Risk Factors: Ability to Get Up After a Fall
4.2.22 Modification of Risk Factors: Fracture Risk
4.2.23 Modification of Risk Factors: Anticoagulation
4.2.24 Incontinence
4.2.25 Skin Breakdown: Pressure Ulcers
4.2.26 Cognition/Dementia
4.2.27 Benefits of Early Detection of Dementia
4.2.28 Screening Techniques for Dementia
4.2.29 Decision-Making about Dementia Screening
4.2.30 Nutrition
4.2.31 Alcohol Use and Alcoholism
4.2.32 Medication and Complementary Therapies
4.2.33 Case Example: Mr. Singh
4.2.34 Mr. Singh--Use of Herbal Medicines
4.2.35 Mr. Singh--Possible Interventions
4.2.36 Mr. Singh--Concerns about Marathon Running at 92?
4.2.37 Mr. Singh--Considerations for Patient/Family Well-Being
4.2.38 Assessing for Polypharmacy (I)
4.2.39 Assessing for Polypharmacy (II)
4.3 Domains Of Assessment: Psychosocial Health And Functioning
4.4 Special Considerations In Assessment
4.5 Post Test
5. Health Care Policies
5.1 Module Objectives
5.2 The Policy-Making Process
5.3 Financing Health & Long Term Care
5.4 Quality Of Care Issues In Long Term Care
5.5 Need And Access Across The Spectrum Of Care
5.6 References
5.7 Post Test
6. Exploring Age-Related Body…
6.1 Cardiovascular System
6.2 Endocrine System
6.3 Immune System
6.4 Musculo-Skeletal System
6.5 Neurological System
6.6 Renal System
6.7 Post Test

Module 2: Biology and Physiology of Aging

2.1: Introduction and Background


In Module One, you met Mr. and Mrs. Smith, Mr. Wujing, Mrs. Ramos, and Mrs. Wright. All of these individuals are in their late 70s or early 80s, but their state of health and ability to function vary considerably.

  • Why is there so much heterogeneity with age?
  • Can some of the changes be avoided or minimized?

The goal of the current module is to focus on these issues.

Through an understanding of:

  1. current theories of aging,
  2. changes that appear to occur normally with age, and
  3. factors that modify the changes that occur,

we can better understand how to assist older adults to achieve the best possible quality of life and functional health.

 

2.2: Theories of Aging


The goals of the current section are to discuss the most widely-accepted and well-documented theories of aging and to highlight why an understanding of the changes that occur with age are important to our everyday clinical practices.

2.3: Physiological Changes with Aging


In general, the physiologic changes that occur with aging can be captured within the paradigm, loss of physiologic or homeostatic reserve.

As a result, older patients are more vulnerable to environmental stresses and pressures than their younger counterparts. Although individuals “age” at different rates, vary in their decline from one organ to the next, and can benefit from participating in health-promoting strategies, many of the changes that occur with aging tend to be progressive and, to a certain extent, predictable.

One tendency that has been found in aging organisms is a loss of complexity, a concept derived from the field of nonlinear dynamics or “chaos” theory (Lipsitz and Goldberger, 1992). One example of this loss of complexity that is commonly cited is that heart rate variability tends to decrease with aging. Some researchers theorize that loss of complexity could contribute to loss of homeostatic reserve by decreasing the body’s ability to “fine tune” the response to stressors. The importance of this concept is to aging is currently under investigation.

2.4: Pharmacologic Considerations


Drug Absorption

In the absence of disease, age-related changes in absorption do not appear to be clinically significant. Many early studies may have overestimated the impact of aging on drug absorption by failing to exclude ill elders from analysis. For example, recent studies have shown that gastric acidity is not significantly reduced in older adults, as was once thought (Goldschmidt et al., 1991; Hurwitz et al., 1997). Also, some of the GI motility studies are “suspect”, since they included patients who were diagnosed with conditions that may slow GI motility, such as Parkinson’s disease, and were probably taking drugs that would alter GI motility.

While the rate of absorption is reduced for some drugs, the extent of absorption is similar to that observed in younger adults. However, aging may be associated with a decrease in absorption of some nutrients and minerals, such as calcium and iron (Russell, 2000).

A variety of gastrointestinal diseases, such as Crohn’s disease, ulcerative colitis and celiac disease or surgeries (e.g., gastrectomy, small bowel resection or bypass) may alter the GI absorption of certain drugs (Gubbins & Bertch, 1989). Older adults often take medications, such as antacids, bulk laxatives, iron supplements, or calcium supplements that may impair the absorption of certain drugs. For example, calcium supplementation may interfere with the absorption of levothyroxine.


Module 2: Biology and Physiology of Aging
1.5 Post Test
2.1 Introduction and Background