University of California, San Francisco

About UCSF

Search UCSF

UCSF Medical Center

Curricular Contents

About The Curriculum

CE Credit

Increase Font Size

AT A GLANCE

Glossary

0.	Introduction

0.1	Welcome to the UCSF AGRC course in Geriatrics and Gerontology

0.2	Course Topics

0.3	Overall Course Goals

0.4	Philosophy

0.5

Faculty

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?

0.11	Then What?

0.12	How to Start--Case 1

0.13	How to Start--Case 2

0.14	Reflection on Two Cases

0.15

Post Test

1.	Demography And Epidemiology

1.1	The Changing Face of Aging: Objectives

1.1.1	Historical Issues and Cohort Effects
1.1.2	Historical Issues and Cohort Effects (II)
1.1.3	The Greying of American Society: Changes in Age Composition within the Past Century
1.1.4	Why We Become Old At 65
1.1.5	Why We Become Old At 65 (II)
1.1.6	Projections for Growth in the Older Population Aging of the Baby Boomers
1.1.7	Projections for Growth in the Older Population More on the Aging of the Baby Boomers
1.1.8	Projections for Growth in the Older Population More on the Aging of the Baby Boomers (II)
1.1.9	Projections for Growth in the Older Population Aging of the Baby Boomers: Reflection of the Issues
1.1.10	The Fastest Growing Population Segment: The Old-Old
1.1.11	The Reasons for Changes in the Aging Patterns in the Past Century
1.1.12	The Reasons for Changes in the Aging Patterns in the Past Century (II)
1.1.13	Aging Is Not A New Phenomenon
1.1.14	Why Are We Living Longer?
1.1.15	Why Are We Living Longer? (II)

1.2	Local and Regional Variations Among Older Adults in the United States

1.2.1	Factors Affecting the Proportion of Older Adults in the Population
1.2.2	Projections Regarding Regional Variations in the Older Population
1.2.3	Projections Regarding Regional Variations in the Oldest-Old
1.2.4	Ethnic Variations Among Older Adults in the United States
1.2.5	Regional Distribution of Ethnic Elders in the United States
1.2.6	Population Diversity: An Urban Phenomenon
1.2.7	Effects of Immigration
1.2.8	Implications of Increasing Diversity for Health Care
1.2.9	Gender Differences in Life Expectancy
1.2.10	Life Span vs. Life Expectancy
1.2.11	Life Expectancy among Other Racial Groups
1.2.12	The Crossover Phenomenon
1.2.13	Gender Differences in Longevity
1.2.14	Impact of Gender Differences in Longevity on Health Care
1.2.15	Implications of Longevity for the Lives of Women
1.2.16	Implications of Longevity for the Lives of Women (II)
1.2.17	Implications of Longevity for the Lives of Women (III)
1.2.18	Implications for You

1.3	Implications of an Aging Society for Health Care Needs and Resources

1.3.1	Health Care Expenditures
1.3.2	Health Care Expenditures (II)
1.3.3	Health Care Utilization--Increases Associated with Advancing Age
1.3.4	Out-of-Pocket Health Care Expenditures for Older Adults
1.3.5	Special Considerations Regarding Health Care Expenditures Among Older Adults
1.3.6	Functional Changes with Age
1.3.7	Active Life Expectancy for Well-Active Life Expectancy for Well-Elders
1.3.8	Active Life Expectancy for Well-Elders (II)
1.3.9	Consider Mrs. Wright!
1.3.10	Risk of Dependency for Mr. Smith and Mrs. Wright
1.3.11	Importance of Wellness, Disease Prevention, and Rehabilitation
1.3.12	Caregiving for Dependent Elders
1.3.13	Costs of Caregiving
1.3.14	Nursing Homes
1.3.15	Gender: A Risk Factor in Nursing Home Placement
1.3.16	Projections for Informal Caregiving
1.3.17	Alternatives to Nursing Home Placement

1.4	Common Chronic Conditions Associated with Advanced Age

1.4.1	The Situation of Mr. Smith and Mrs. Wright
1.4.2	Three Most Common Chronic Conditions
1.4.3	Clinical Concerns Related to Chronic Conditions
1.4.4	Leading Causes of Death in Older Adults
1.4.5	The Patient's Point of View (I)
1.4.6	The Patient's Point of View (II)
1.4.7	Other Significant Causes of Death and Disability: Suicide Rates
1.4.8	Other Significant Causes of Death and Disability: Suicide and Alcoholism
1.4.9	Other Significant Causes of Death and Disability: AIDS in Older Adults
1.4.10	Other Significant Causes of Death and Disability: Prevalence of Memory Disorder
1.4.11	More on Memory Impairments
1.4.12	Other Significant Causes of Death and Disability: Sensory Declines
1.4.13	Other Significant Causes of Death and Disability: Oral Health in Later Life
1.4.14	Where do we go from here? Changing demographics have forced a discussion at all levels--individual, community, state, and nation--of how we allocate scarce resources, particularly as related to health care. Increasing knowledge of the impact of life style

1.5

Post Test

2.	Biology and Physiology of Aging

2.1	Introduction and Background

2.1.1	Table of Contents
2.1.2	Module Learning Objectives
2.1.3	Personal Exercise
2.1.4	Case Background
2.1.5	Historical View of Aging
2.1.6	Successful 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

2.2.1	What causes aging?
2.2.2	Categories of Biological Theories of Aging
2.2.3	Theories of Aging as Random Events
2.2.4	Theories of Aging as Programmed Event (I)
2.2.5	Theories of Aging as Programmed Event (II)
2.2.6	Theories of Aging as Evolutionary (I)
2.2.7	Theories of Aging as Evolutionary (II)
2.2.8	Disposable Soma Theory
2.2.9	Theories of Biological Aging
2.2.10	The Free Radical Theory of Aging
2.2.11	What Effect Do Free Radicals Have in the Body?
2.2.12	Defenses Against Oxidative Attack
2.2.13	Clinical Implications of the Free Radical Theory and Antioxidants
2.2.14	The Maillard Theory Of Aging
2.2.15	Clinical Implications of the Maillard Theory
2.2.16	Telomere Theory of Aging
2.2.17	Clinical Implications of the Telomere Theory
2.2.18	Caloric Restriction
2.2.19	Gene Manipulation
2.2.20	Longevity Gene Theory of Aging
2.2.21	Section Summary

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

2.4.1	Gastrointestinal Motility
2.4.2	Drug Administration as a Factor in Absorption: Oral
2.4.3	Drug Administration as a Factor in Absorption: Intramuscular and Subcutaneous
2.4.4	Transdermal and Topical Administration of Medications
2.4.5	Fentanyl Transdermal Patch: An Example
2.4.6	Other Modalities of Drug Administration
2.4.7	Clinical Tips Related to Absorption
2.4.8	Distribution of Drugs throughout the Body
2.4.9	Drug Metabolism
2.4.10	Drug Excretion: Impaired Renal Function
2.4.11	Drugs Which are Eliminated via the Kidneys
2.4.12	Pathways of Drug Clearance
2.4.13	Dosing for Drugs Which are Renally Cleared (I)
2.4.14	Dosing for Drugs Which are Renally Cleared (II)
2.4.15	Profile of the Elder at Risk for Adverse Drug Reactions
2.4.16	References

2.5

Post Test

3.	Socio-cultural And Psychologicial…

3.1	Module Objectives

3.1.1	Introduction: Underlying Assumptions
3.1.2	What to Expect
3.1.3	Temporal Dimensions of Life: Age
3.1.4	Temporal Dimensions of Life: Aging
3.1.5	Temporal Dimensions of Life: Cohort Effects I
3.1.6	Temporal Dimensions of Life: Cohort Effects II
3.1.7	Temporal Dimensions of Life: The Aged
3.1.8	Temporal Dimensions of Life: The Aged (II)
3.1.9	History vs. Cohort vs. Time
3.1.10	Reflection (I)
3.1.11	Reflections (II)

3.2	Social Theories of Aging

3.2.1	Modernization Theory
3.2.2	Modernization Theory (II)
3.2.3	Criticisms of Modernization Theory
3.2.4	Role Theory
3.2.5	Role Theory (II)
3.2.6	Criticisms of Role Theory
3.2.7	Disengagement Theory
3.2.8	Activity Theory
3.2.9	Reflections (III)

3.3	Psychological Development In Late Life

3.3.1	An Explanation of Development
3.3.2	Nonnormative Influences: On-time vs. Off-time
3.3.3	Age-related Changes in Overall Cognitive Functioning
3.3.4	Age-related Changes in Intellectual Functioning (Cont'd)
3.3.5	Aging and Memory
3.3.6	Benign Senescent Forgetting
3.3.7	More on Aging and Memory
3.3.8	Old Dogs and New Tricks
3.3.9	Personality in Late Life
3.3.10	Mental Health in Late Life
3.3.11	Coping In Late Life
3.3.12	Successful Aging

3.4	Ethno-Cultural Issues And Age-Stratified Societies

3.4.1	Age as an Organizing Principle in Society
3.4.2	Gerontocracy
3.4.3	Reflections (IV)
3.4.4	Other Stratifying Principles: Gender
3.4.5	Other Stratifying Principles: Ethnicity, Race, and Minority Status
3.4.6	More on Race
3.4.7	The Concept of Ethnicity
3.4.8	Importance of Distinguishing Race and Ethnicity
3.4.9	Minority Status as a Stratifying Principle: Sexual Orientation
3.4.10	Minority Status as a Stratifying Principle: National Origin
3.4.11	The Special Plight of Older Migrants
3.4.12	Social Class as Stratifying Principle
3.4.13	Reflections (V)
3.4.14	Multiple Jeopardy?
3.4.15	Formal Age-Graded Social Organization
3.4.16	Intergenerational Relations
3.4.17	Intergenerational Relations (II)
3.4.18	Case: Mr. Wujing Xian
3.4.19	Case: Mr. Wujing Xian (II)
3.4.20	Case: Mr. Wujing Xian (III)
3.4.21	Case: Mr. Wujing Xian (IV)
3.4.22	Case: Mr. Wujing Xian (V)
3.4.23	Case: Mr. Wujing Xian (VI)
3.4.24	Language Problems of Older Immigrants
3.4.25	Intergenerational Conflict in Immigrant Households
3.4.26	Intergenerational Equity
3.4.27	Achieving Social Control Over Adolescence
3.4.28	Achieving Control of Late Adulthood?
3.4.29	Reflections (VI)

3.5	Late-Life Transitions

3.5.1	Normative Transitions in Later Life
3.5.2	"Off Time" Transitions
3.5.3	Reflections (VII)

3.6	Dependent Elders: Special Concerns

3.6.1	Adult Guardianship in Euro-American Societies
3.6.2	Elder Abuse
3.6.3	Caregiving: Informal
3.6.4	Caregiving: Formal
3.6.5	Residential Care
3.6.6	Ageism and Therapeutic Nihilism

3.7	Cultural Views of Death

3.7.1	Funeral Rites
3.7.2	The "Good Death"
3.7.3	End of Life Care

3.8	References

3.9

Post Test

4.	Assessment Of The Geriatric…

4.1	Module Objectives

4.1.1	Introduction
4.1.2	Overview
4.1.3	Importance of Appropriate Geriatric Assessment
4.1.4	Approach to the Patient
4.1.5	Weighing Priorities
4.1.6	An Example of Age-Related Priorities
4.1.7	Using Life Expectancy in Setting Priorities
4.1.8	The Geriatric Physical Examination
4.1.9	Common Age-related Nonpathologic Changes and Common Age-related Pathologies

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

4.3.1	Informal Caregiving Support Network
4.3.2	Abuse and Neglect
4.3.3	Social Support
4.3.4	Spiritual and Cultural Assessment
4.3.5	Home Assessment

4.4	Special Considerations In Assessment

4.4.1	Assessing for Decline in Function in High-Functioning Elders
4.4.2	Usefulness of a Combined Screening Instrument
4.4.3	Teams and Resources
4.4.4	Health Care Teams: Multidisciplinary or Interdisciplinary?
4.4.5	Health Care Teams: Differences in Roles and Function
4.4.6	Potential Geriatric Team Members: Roles and Functions
4.4.7	Characteristics of Effective Team Behavior
4.4.8	Interdisciplinary Team Meeting: The Case of Ms. R.
4.4.9	Modeling Effective Team Behaviors
4.4.10	Utilizing Time Efficiently
4.4.11	Summary
4.4.12	References

4.5

Post Test

5.	Health Care Policies

5.1	Module Objectives

5.1.1	Definition of Public Policies
5.1.2	Domestic Policies
5.1.3	Definition of Health Care Policies
5.1.4	Impact of Health Care Policies
5.1.5	Definition of Long Term Health Care
5.1.6	Activities of Daily Living I
5.1.7	Activities of Daily Living II
5.1.8	Instrumental Activities of Daily Living
5.1.9	Groups Targeted for Long Term Care
5.1.10	Definition of Long Term Care Policies
5.1.11	Utilization of Long Term Care Services by Older Adults

5.2	The Policy-Making Process

5.2.1	Major Policy-Making Processes: Administrative Policies
5.2.2	Major Policy-Making Processes: Budgetary Policies I
5.2.3	Major Policy-Making Processes: Budgetary Policies II
5.2.4	Federal Expenditures: National Defense vs. Health Care
5.2.5	Major Policy-Making Processes: Judicial Policies
5.2.6	Components of the Policy-Making Process
5.2.7	Steps in the Policy-Making Process
5.2.8	Interest Groups in Health Care Policy-Making
5.2.9	Health Economics in the Policy-Making Process
5.2.10	Basic Assumptions in Health Economics

5.3	Financing Health & Long Term Care

5.3.1	Sources for Financing Long Term Care II
5.3.2	Spending for Nursing Home Care as a Percentage of LTC
5.3.3	Medicare
5.3.4	Medicare Coverage (Part A)
5.3.5	Medicare Coverage (Part B)
5.3.6	Medicare Coverage (Part D)
5.3.7	What Medicare Does Not Cover
5.3.8	Issue 1: Cost Containment
5.3.9	Issue 2: High Out-Of-Pocket Costs
5.3.10	Issue 3: Lack of Long Term Coverage I
5.3.11	Issue 3: Lack of Long Term Coverage II
5.3.12	Issue 4: Outpatient Prescription Drug Costs I
5.3.13	Issue 4: Outpatient Prescription Drug Costs II
5.3.14	Social Security I
5.3.15	Social Security II
5.3.16	Who are Social Security Beneficiaries?
5.3.17	Medicaid
5.3.18	Medicaid Coverage
5.3.19	Medicaid: Primary Payer for Long Term Care
5.3.20	Issue 1: Cost Containment I
5.3.21	Issue 1: Cost Containment II
5.3.22	Issue 2: Expanding Home & Community-Based Services

5.4	Quality Of Care Issues In Long Term Care

5.4.1	Residents of Nursing Facilities
5.4.2	Regulatory Requirements for Nursing Facilities: OBRA '87
5.4.3	Quality of Care in Nursing Facilities I
5.4.4	Quality of Care in Nursing Facilities II
5.4.5	Quality of Care in Nursing Facilities III: Relation to Inadequate Staffing
5.4.6	Quality of Care in Nursing Facilities IV
5.4.7	Quality of Care in Nursing Facilities V: Policy Recommendations
5.4.8	Are Staffing Levels at Nursing Facilities Adequate?
5.4.9	Resource Guide to Quality in Nursing Facilities, Home Health, & Hospice
5.4.10	Medicare Reimbursement Issues for Nursing Facilities
5.4.11	Medicaid Reimbursement Issues for Nursing Facilities

5.5	Need And Access Across The Spectrum Of Care

5.5.1	Payment for Residential Care Facilities
5.5.2	Quality Issues in Residential Care
5.5.3	Demand for Home Health & Hospice Care I
5.5.4	Demand for Home Health & Hospice Care II
5.5.5	Payment for Home Health Care
5.5.6	Payment Issues for Home Health and Hospice Care I
5.5.7	Payment Issues for Home Health and Hospice Care II
5.5.8	Access Issues for Personal Assistance Services (PAS)
5.5.9	Expanding Optional Personal Assistance Services (PAS)
5.5.10	Home and Community-Based Service (HCBS) Waiver Programs I
5.5.11	Home and Community-Based Service (HCBS) Waiver Programs II
5.5.12	Waivers Under Medicaid Home and Community-Based Service (HCBS) Program
5.5.13	Personal Assistance Services by Informal Caregivers I
5.5.14	Personal Assistance Services by Informal Caregivers II
5.5.15	Lack of Access to Appropriate Care: Legal Considerations
5.5.16	The Labor Market in Long Term Care I
5.5.17	The Labor Market in Long Term Care II
5.5.18	Percentages of Long Term Care Workers
5.5.19	Labor Market Problems in Long Term Care
5.5.20	Labor Market Policy Issues in Long Term Care
5.5.21	What Can Be Done to Address LTC Policy Issues?

5.6	References

5.7

Post Test

6.	Exploring Age-Related Body…

6.1	Cardiovascular System

6.1.1	Case 1
6.1.2	Case 2
6.1.3	The Cardiovascular System
6.1.4	Can These Changes Be Modified?
6.1.5	Sodium and Activity
6.1.6	Atherosclerosis
6.1.7	What Can We Do About The Process?
6.1.8	Links to Theories of Aging
6.1.9	Myocardium
6.1.10	Clinical Implications
6.1.11	Cellular Calcium
6.1.12	Functional Changes
6.1.13	Pulse Wave Velocity
6.1.14	Additional Functional Changes
6.1.15	Clinical Significance
6.1.16	Response to Stress
6.1.17	Congestive Heart Failure
6.1.18	Diastolic Versus Systolic Heart Failure
6.1.19	Case 3
6.1.20	Case 3: Points To Consider
6.1.21	References
6.1.22	Review Question 1
6.1.23	Review Question 2

6.2	Endocrine System

6.2.1	Case 1: Mr. Jones
6.2.2	Circadian Rhythms
6.2.3	Hypothalamic-Pituitary and Hypothalamic-Pituitary-Adrenal Axis
6.2.4	Growth Hormone
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
6.2.11	Aldosterone
6.2.12	Dehydroepiandrosterone (DHEA)
6.2.13	The Adrenal Medulla
6.2.14	Hypothalamic-Pituitary-Thyroid Axis
6.2.15	Posterior Pituitary
6.2.16	Case 3: Clinical
6.2.17	Endocrine Pancreas
6.2.18	What Causes These Changes?
6.2.19	Can These Changes Be Prevented?
6.2.20	What Do We See Clinically?
6.2.21	Discussion Point
6.2.22	Should Age-Related Changes in Carbohydrate Metabolism Be Treated?
6.2.23	Summary Case and Evaluation Questions
6.2.24	References
6.2.25	Review Question 1
6.2.26	Review Question 2

6.3	Immune System

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?
6.3.5	Non-Specific Immunity
6.3.6	The Physical Barriers
6.3.7	Acid Contents of the Stomach
6.3.8	Phagocytosis
6.3.9	The Macrophage
6.3.10	The "Natural Killer" and the "LAK"
6.3.11	Non-Specific Summary
6.3.12	Specific Immunity
6.3.13	What Happens to Specific Immunity With Age?
6.3.14	The Immune Response
6.3.15	References

6.4	Musculo-Skeletal System

6.4.1	Case 1
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
6.4.6	Muscle Fibers
6.4.7	What Are The Physiologic Processes That Cause These Changes?
6.4.8	What Is The Impact Of These Changes On Function?
6.4.9	Mobility Changes
6.4.10	Interventions to Minimize Changes
6.4.11	Discussion Point
6.4.12	Joints, Tendons, and Ligaments
6.4.13	Differences in Cartilage Between Aging and Osteoarthritis
6.4.14	Skeletal Changes With Age
6.4.15	Bone Components
6.4.16	Many Factors Influence Bone Health
6.4.17	Bone Loss
6.4.18	General Changes in the Bone with Age
6.4.19	Factors Influencing Whether a Fracture Will Or Will Not Occur
6.4.20	Summary Case
6.4.21	References

6.5	Neurological System

6.5.1	Case Study One
6.5.2	The Nervous System
6.5.3	Components of the Nervous System
6.5.4	The Neuron
6.5.5	Changes with Age
6.5.6	Case Study Two: Brain Atrophy--Does It Matter?
6.5.7	Changes in Dendritic Processes
6.5.8	Cerebral Blood Flow and Cerebral Metabolism
6.5.9	Central Neurotransmitters and Aging
6.5.10	Neurotrophic Growth Factors
6.5.11	Case Study Four: Evidence of Signs of Dementia
6.5.12	Cognitive Changes with Age
6.5.13	Memory and Aging
6.5.14	Storage and Retrieval
6.5.15	Clinical Implications of Cognitive Change
6.5.16	Incidence of Cognitive Impairment
6.5.17	Why Changes in Structure, Metabolism, and Function Occur
6.5.18	What is Brain Damaging?
6.5.19	Cognitive Impairment--Differential Diagnosis
6.5.20	Dementia vs Delirium
6.5.21	Sleep and Aging
6.5.22	Sleep Changes with Aging
6.5.23	The Peripheral Nervous System
6.5.24	Clinical Vignette
6.5.25	Other Consequences of Diminished B-adrenergic Receptor Responsiveness
6.5.26	Why Does This Decreased Responsivity Occur?
6.5.27	What Are The Clinical Implications Of These Changes?
6.5.28	Summary
6.5.29	References

6.6	Renal System

6.6.1	Anatomy of the Kidney
6.6.2	Review of the Renal Function
6.6.3	Body Composition and Fluid Balance
6.6.4	Body Composition and Fluid Balance 2
6.6.5	Renal Changes with Age
6.6.6	Changes in Renal Homeostatic Controls
6.6.7	Changes in Renal Homeostatic Controls 2
6.6.8	Concentrating and Diluting Functions; Water Homeostasis
6.6.9	Maintenance of pH Balance: Acid Excretion
6.6.10	Endocrine Functions of the Kidney
6.6.11	Evaluation of Renal Function
6.6.12	What are the Clinical Implications?
6.6.13	Effects of Drugs on the Kidneys
6.6.14	Putting It All Together: A Case Study/Quiz
6.6.15	References

6.7

Post Test

Module 6: Exploring Age-Related Body Systems Changes

6.1: Cardiovascular System

6.1.18: Diastolic Versus Systolic Heart Failure

About 1/3 of patients with symptomatic CHF have a “normal” Ejection Fraction (EF at least >40%) and experience symptoms that are entirely or predominantly the result of diastolic dysfunction. However, about 50-60% of elderly persons with heart failure have adequate ventricular contractile function and are thus experiencing mainly diastolic dysfunction (Kitzman, 2002).

age changes

CHF secondary to systolic dysfunction is the result of an impaired inotropic state; this is failure of the heart’s actual pumping capacity—it can’t get blood out. Causes include idiopathic dilated cardiomyopathy, or myocardial infarctions that damage the muscle.

CHF secondary to diastolic dysfunction is the result of an impairment in heart’s ability to relax. There is an increase in the ventricular diastolic pressure at any given diastolic volume. The heart doesn’t let blood in well. Causes include restrictive and hypertrophic cardiomyopathies, ischemic states, hypertension, and senile cardiac amyloid.

Why is it important?

We currently know much more about systolic dysfunction than diastolic dysfunction in terms of treatment, but drugs may differ. Unfortunately, there are currently no data from prospective, randomized, blinded drug trials to guide treatment (Kitzman, 2002). Control of hypertension and minimizing ischemia are important goals. ACE inhibitors and Angiotensin Receptor Blocking agents appear to be indicated for both. While digoxin might be considered in systolic dysfunction, mainly now when there is atrial fibrillation, it may not be as effective in diastolic dysfunction because it increases contractility rather than relaxation. However, some data suggest that it may improve symptoms (Kitzman, 2002). Beta blockers also may be indicated in diastolic dysfunction. Thus in general, much more research is needed in this area to identify the best pharmacotherapeutic approach. However, it is also important to keep in mind that with diastolic dysfunction, venous return and adequate ventricular filling are very important to maintaining cardiac output. Thus there is a fine balance between giving diuretics to minimize symptoms and over-dehydrating the patient which can cause further cardiac dysfunction.

Module 6: Exploring Age-Related Body Systems Changes

6.1.17 Congestive Heart Failure

6.1.19 Case 3