AT A GLANCEGlossary
|0.1||Welcome to the UCSF AGRC course in Geriatrics and Gerontology|
|0.3||Overall Course Goals|
|0.6||Why Take This Course?|
|0.7||The Multifaceted Face of Aging: 3 Cases|
|0.8||Discussion of the Three Preceding Cases|
|0.9||How To Use This Course|
|0.10||Where To Start?|
|0.12||How to Start--Case 1|
|0.13||How to Start--Case 2|
|0.14||Reflection on Two Cases|
|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|
|2.||Biology and Physiology of Aging|
|2.1||Introduction and Background|
|2.1.1||Table of Contents|
|2.1.2||Module Learning Objectives|
|2.1.5||Historical View of Aging|
|2.1.7||What is the Truth about Aging?|
|2.1.8||When Pathologies are Attributed to Aging|
|2.1.9||Aging or Disease?|
|2.1.10||Understanding Age-Related Changes|
|2.2||Theories of Aging|
|2.3||Physiological Changes with Aging|
|3.||Socio-cultural And Psychologicial…|
|3.2||Social Theories of Aging|
|3.2.2||Modernization Theory (II)|
|3.2.3||Criticisms of Modernization Theory|
|3.2.5||Role Theory (II)|
|3.2.6||Criticisms of Role Theory|
|3.3||Psychological Development In Late Life|
|3.4||Ethno-Cultural Issues And Age-Stratified Societies|
|3.6||Dependent Elders: Special Concerns|
|3.6.1||Adult Guardianship in Euro-American Societies|
|3.6.6||Ageism and Therapeutic Nihilism|
|3.7||Cultural Views of Death|
|4.||Assessment Of The Geriatric…|
|4.2||Domains of Assessment: Functional Assessment|
|4.3||Domains Of Assessment: Psychosocial Health And Functioning|
|4.3.1||Informal Caregiving Support Network|
|4.3.2||Abuse and Neglect|
|4.3.4||Spiritual and Cultural Assessment|
|4.4||Special Considerations In Assessment|
|5.||Health Care Policies|
|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|
|6.||Exploring Age-Related Body…|
|6.1.3||The Cardiovascular System|
|6.1.4||Can These Changes Be Modified?|
|6.1.5||Sodium and Activity|
|6.1.7||What Can We Do About The Process?|
|6.1.8||Links to Theories of Aging|
|6.1.13||Pulse Wave Velocity|
|6.1.14||Additional Functional Changes|
|6.1.16||Response to Stress|
|6.1.17||Congestive Heart Failure|
|6.1.18||Diastolic Versus Systolic Heart Failure|
|6.1.20||Case 3: Points To Consider|
|6.1.22||Review Question 1|
|6.1.23||Review Question 2|
|6.2.1||Case 1: Mr. Jones|
|6.2.3||Hypothalamic-Pituitary and Hypothalamic-Pituitary-Adrenal Axis|
|6.2.5||Why Does Growth Hormone Decrease?|
|6.2.6||Why is Growth Hormone Important to Our Clinical Practice?|
|6.2.7||Is This Good Clinical Practice?|
|6.2.8||Case 2: Discussion|
|6.2.9||CRH, Adrenocorticotropic Hormone/Corticotropin (ACTH), and Cortisol|
|6.2.10||Aging, the Stress Response, Cortisol, and Cognitive Function|
|6.2.13||The Adrenal Medulla|
|6.2.16||Case 3: Clinical|
|6.2.18||What Causes These Changes?|
|6.2.19||Can These Changes Be Prevented?|
|6.2.20||What Do We See Clinically?|
|6.2.22||Should Age-Related Changes in Carbohydrate Metabolism Be Treated?|
|6.2.23||Summary Case and Evaluation Questions|
|6.2.25||Review Question 1|
|6.2.26||Review Question 2|
|6.3.1||Setting the Stage|
|6.3.2||Setting the Stage 2|
|6.3.3||Overview and Background|
|6.3.4||What Happens with Age?|
|6.3.6||The Physical Barriers|
|6.3.7||Acid Contents of the Stomach|
|6.3.10||The "Natural Killer" and the "LAK"|
|6.3.13||What Happens to Specific Immunity With Age?|
|6.3.14||The Immune Response|
|6.4.2||Case 1 Continued|
|6.4.3||The Inter-Relationship of the Muscle and Skeletal System|
|6.4.4||Muscle Changes and Function with Age|
|6.4.5||Changes in Muscle with Age|
|6.4.7||What Are The Physiologic Processes That Cause These Changes?|
|6.4.8||What Is The Impact Of These Changes On Function?|
|6.4.10||Interventions to Minimize Changes|
|6.4.12||Joints, Tendons, and Ligaments|
|6.4.13||Differences in Cartilage Between Aging and Osteoarthritis|
|6.4.14||Skeletal Changes With Age|
|6.4.16||Many Factors Influence Bone Health|
|6.4.18||General Changes in the Bone with Age|
|6.4.19||Factors Influencing Whether a Fracture Will Or Will Not Occur|
Module 3: Socio-cultural And Psychologicial Aspects of Aging
3.1: Module Objectives
Upon completion of this module, participants will be able to:
3.2: Social Theories of Aging
Many theories have been developed to account for the place older people occupy in society. These all attempt to explain, either implicitly or explicitly, the connection between individual experiences and social structures. The following have been major influential theories at one point in time. Modernization theory is comparative and considers large-scale economic and macro-social structures and their impact on the status of the elderly as a distinct sub-group within various populations. Role theory takes as its focus a particular society (Western European society) and discusses how in old age individuals become unhitched from social institutions and cultural norms. The last two theories discussed here, disengagement theory and activity theory, are psycho-social in focus, elaborating on the psychological processes that lead older people to behave in particular ways.
3.3: Psychological Development In Late Life
A Model of Psychological Development
There are many theoretical perspectives on how we age psychologically, but none that covers the entire sphere of psychological aging (e.g., cognition, emotions, personality, coping/self-management, mental health/psychological disorders). However, most psychologists in the field of aging subscribe to a life-span developmental approach. In this view, the multidimensional, multidirectional, and pluralistic processes of human development are seen as continuing throughout the entire life span. The complex phenomenon of aging is considered to be part of a continuous developmental sequence which proceeds through a number of maturational phases during the entire life of the organism (Scheibel, 1996). Thus, in healthy older individuals, learning and behavior-change processes can take place at any point in the life span, including old age.
3.4: Ethno-Cultural Issues And Age-Stratified Societies
Culture And Aging
Different cultural groups organize life with respect to elders in different ways, depending on basic values and world-view, environment, societal circumstances and opportunities. In early studies of the social position of the aged, anthropologists used a macro-cultural approach, comparing the lives of older people in different cultures.
Since Cowgill & Holmes’s (1972) foray into modernization theory (link to screen on Modernization Theory above), cross-cultural understanding of the elderly has shifted emphasis somewhat, from a comparative macro-cultural focus to a more micro-individual or phenomenological focus, resulting in several collections of ethnographic studies depicting aging and the role of the elderly in a wide variety of cultures or societies (Amoss & Harrel, 1981; Keith et al., 1994; Holmes & Holmes, 1995; Sokolovsky, 1997).
Other recent anthropological and sociological studies have investigated culture and its influence within diverse community settings and institutional facilities. Ethnographies have explored a wide range of sites, looking at the impact of culture on the lives of older people in living in nursing homes (Kayser-Jones, 1981; Diamond, 1992; Foner, 1994; Gubrium, 1975; Savishinsky, 1991; Shields, 1988), inner city hotels and apartments (Eckert, 1980; Stephens, 1976; Vesperi, 1985), and age-segregated residential facilities and retirement communities (Johnson, 1971; Hochschild, 1973).
3.5: Late-Life Transitions
Transitions and Ceremonies Marking Age/Stage
In every society, ceremonies mark particular life transitions and age transformations. Naming rituals that welcome and incorporate newborns into the family, initiation ceremonies noting the attainment of sexual maturity, weddings, and funerals are examples. While the move from child to young adult is usually obvious, due to physical growth and psycho-social development, the transition is often elaborately marked by ritual. The shift from mature adult to elder is often much more subtle and not demarcated by ceremony. Sometimes the only markers are increasingly gray hair, a slower pace of activity, or diminished or changed patterns of activity. The transition from healthy elder into frail older person is rarely celebrated. There are no parties when an older person can no longer leave his or her home because the stairs have become a barrier to mobility barrier; no one cheers the entry of a frail older person into a nursing home.
Would it be a good idea to have transitions in old age marked as ceremoniously as those marked at younger ages? Why or why not? Think about this. Discuss it with your friends.
3.6: Dependent Elders: Special Concerns
Competent vs. Decrepit Elders
A pervasive image of decrepitude in old age seems to form our public image of aging and being elderly, and haunts our imagination, telling us what we do not want to become when we get old. Even though this image is based on a small (probably less than 10% of all older persons at any one point in time) and vulnerable segment of the aged population, it is a powerful vision, with real and pervasive consequences.
Frail or decrepit elders are not only different physically, socially and psychologically from intact ones, but they are treated differently, as Barker (1997) showed clearly for a Polynesian group. This is obvious when nursing home populations are compared with elders of the same age living at home in the community. Decrepit elders are more socially isolated, less actively involved in family or community events, less cognitively capable, and more physically impaired. Indeed, it seems that a primary distinction is made in all societies between intact and impaired elders and that the latter are subject to different responses from other (younger) people. In many societies, decrepit or frail elders are treated in a somewhat neglectful or even death-hastening manner (Glascock, 1997).
3.7: Cultural Views of Death
Cultures conceptualize death and perform ceremonials surrounding it in quite distinct ways. In Euro-American society, death is seen as an inevitable. It is an undesired but accepted natural process that arises from the cessation of biological functions and results in a departure from social life, although not necessarily from the collective or individual memory of family. Death is instantaneous and permanent and involves a radical transformation of being that largely precludes any conception of life continuing in any human-like form.
In many other societies, however, death is not a natural or single event but rather the outcome of personal or spiritual agents and deliberate acts, the result of suicide, murder, sorcery or bewitchment, or the action of malevolent spirits. Many Polynesian groups make no linguistic distinction between being unconscious, dying or being dead but rather see death as a long and partly reversible process of transition between living in this world and living in the next. Death is not so much a cessation of animation or being alive as a transformation of the locale in which living occurs.
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