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 6: Exploring Age-Related Body Systems Changes

6.2: Endocrine System



6.2.24: References

Allolio, B. & Arlt, W. (2002). DHEA treatment: myth or reality? Trends Endocrinology Metab, 13(7), 288-294.

Al-Salman, J. & Pursell, R. (2001), Hyponatremic encephalopathy induced by thiazides. Western Journal of Medicine, 175(2), 87.

Arinzon, A.H. & Lehman, Y.A. (2001), Cilazapril-induced SIADH. Journal of the American Geriatrics Society, 49(12), 1735-1742.

Bartz, B. (2000). Mechanisms of endocrine control. In L-E. C. Copstead & J.L. Banasik (eds). Pathophysiology: Biological and behavioral perspectives (pp. 880-892), Phil: W.B. Saunders Company.

Baulieu, E.E., Thomas, G., Legrain, S., Lahlou, N., Roger, M., Debuire, B. et al. (2000), Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge Study to a sociobiomedical issue. Proceedings of the National Academy of Sciences USA, 97(8), 4279-4284.

Becker, A.J., Uckert, S., et al. (2002). Growth hormone, somatomedins and men’s health. Aging Male 5(4), 258-262.

Carvalhaes-Neto, N., Ramos, L.R. et al., (2002). Urinary free cortisol is similar in older and younger women. Experimental Aging Research, 28(2), 163-168.

De Bruin, V. Am, Vieira, M.C., et al. (2002). Cortisol and dehydroepiandosterone sulfate plasma levels and their relationship to aging, cognitive function, and dementia. Brain Cogn 50(2), 316-323.

Elahi, D. & Muller, D.C. (2000). Carbohydrate metabolism in the elderly. European Journal of Clinical Nutrition, 54 (Suppl 3), S112-S120.

Ferrari, E., Casarotti, D., et al., (2001). Age related changes of the adrenal secretory pattern: Possible role in pathological brain aging. Brain Research Brain Research Rev, 37(1-3), 294-300.

Giordano, R., DiVito, L., et al., (2001). Elderly subjects show severe impairment of dehydroepiandrosterone sulphate and reduced sensitivity of cortisol and aldosterone response to the stimulatory effect of ACTH (1-24). Clinical Endocrinology (Oxf) 55(2), 259-265.

Gruenewald, D.A., & Matsumoto, A.M. (1999), Aging of the endocrine system. In W.R. Hazzard, J.P. Blass, W.H. Ettinger, J.B. Halter, & J.G. Ouslander (eds). Principles of geriatric medicine and gerontology, 4th ed. (pp. 949-966), New York, McGraw-Hill.

Haden, S.T., Glowacki, J., et al. (2000). Effects of age on serum dehydroepiandrosterone sulfate, IGF-I, and IL-6 levels in women. Calcif Tissue Int 66(6), 414-418.

Hassani, S. & Hershman, J.M. (1999). Thyroid Disease, In W.R. Hazzard, J.P. Blass, W.H. Ettinger, J.B. Halter, & J. G. Ouslander (eds). Principles of geriatric medicine and gerontology, 4th ed. (pp. 973-989), New York, McGraw-Hill.

Hennessey, J. V., Chromiak, J. A., et al., (2001). Growth hormone administration and exercise effects on muscle fiber type and diameter in moderately frail older people. Journal of the American Geriatrics Society. 49(7), 852-858.

Hibberd, C., Yau, J. L., et al., (2000). Glucocorticoids and the ageing hippocampus. J. Anat, 197 (Pt 4), 553-562.

Hornsby, P.J. (1997). DHEA: A biologist’s perspective. Journal of the American Geriatrics Society, 45, 1395-1401.

Kahn, A. J. & Halloran, B. (2002). Dehydroepiandrosterone supplementation and bone turnover in middle-aged to elderly men. Journal of Clinical Endocrinology and Metabolism, 87(4), 1544-1549.

Lissett, C. A. & Shalet, S. M. (2003). The insulin-like growth factor-1 generation test: Peripheral responsiveness to growth hormone is not decreased with ageing. Clin Endocrinol (Oxf) 58 (2), 238-245.

Magri, R., Muzzoni, B., et al. (2002). Thyroid function in physiological aging and in centenarians: Possible relationship with some nutritional markers. Metabolism, 51(1), 105-109.

Miller, R. A. (1997). DHEA—Brass ring or red herring? Journal of the American Geriatrics Society, 45, 1402-1403.

Moffat, S.E., Zonderman, A.B. et al., (2000). The relationship between longitudinal declines in dehydroepiandrosterone sulfate concentrations and cognitive performance in older men. Archives of Internal Medicine. 160(14), 2193-2198.

Muller, E. E., Rigamonti, A. E., et al., (2002). GH-related and extra-endocrine actions of GH secretagogues in aging. Neurobiology and Aging, 23(5), 907-919.

Orrego, J. J., Russell-Aulet, M. et al., (2001). Semiquantification of hypothalamic GH-releasing homone output in women: Evidence for sexual dimorphism in the mechanism of the somatopause. Journal of Clinical Endocrinology and Metabolism, 86(11), 5485-5490.

Prinz, P. N., Scanlan, J. M., et al. (1999). Thyroid hormones: Positive relationships with cognition in healthy euthyroid older men. Journal of Gerontology: Medical Science, 54(3), M111-M116.

Ratnakant, S., Ochs, M. E., & Solomon, S. S. (2003). Sounding board: Diabetes in the elderly: A truly heterogeneous entity? Diabetes, Obesity, and Metabolism, 5, 81-92.

Rosen, C. J. (2000). Growth hormone and aging, Endocrine, 12 (2), 197-201.

Rudman, D., Feller, A. G., Nagraj, H. S., Gergans, G. A., Lalitha, P. Y., Goldberg, A. F., Schlenker, R. A., Cohn, L., Rudman, I. W., Mattson, D. E. (1990). Effects of human growth hormone in men over 60 years old. New England Journal of Medicine, 323(1): 1-6.

Russell-Aulet, M. E., Dimaraki, E. V., et al., (2001). Aging-related growth hormone (GH) decrease is selective hypothalamic GH-releasing hormone pulse amplitude mediated phenomenon. Journal of Gerontology A: Medical Science, 56(2), M124-129.

Saseen, J. J. & Carter, B. L. (2001) Essential hypertension. In M. A. Koda-Kimble, L. Y. Young, W. A. Kradjan, & B. J. Guglielmo (eds), Applied therapeutics: The clinical use of drugs (pp. 12-1-12-47), Phil: Lippincott Williams & Wilkins.

Seeman, T. E., Singer, B., et al., (2001). Gender differences in age related changes in HPA axis reactivity. Psychoneuroendocrinology, 26(3), 225-240.

Sharabi, Y., Illan, R., Kamari, Y., Cohen, H., Nadler, M., Messerli, F. H., Grossman, E. (2002). Diuretic induced hyponatraemia in elderly hypertensive women. Journal of Human Hypertension, 16(9), 631-635.

Svec, F. (1997). Ageing and adrenal cortical function. Baillière’s Clinical Endocrinology and Metabolism, 11(2), 271-287.

Tilly-Gentric, A. (1995). Severe hyponatremia associated with Ramipril therapy in an old woman. Journal of the American Geriatrics Society, 43(12), 1448-1449.

Tilvis, R. S., Kähönen, M., & Härkönen, M. (1999). Dehydroepiandrosterone sulfate,disease and mortality in a general aged population. Aging Clinical Experimental Research, 11, 30-34

Timiras, P. S. (2003). The endocrine pancreas, diffuse endocrine glands, and chemical mediators. In P.S. Timiras (ed). Physiological basis of aging and geriatrics, 3rd ed. (pp. 251-264), Boca Raton: CRC Press.

Timiras, P. S. (2003). The thyroid, parathyroid, and pineal gland. In P. S. Timiras (ed). Physiological basis of aging and geriatrics, 3rd ed. (pp. 233-249), Boca Raton: CRC Press.

Van Niekerk, J. K., Huppert, F. A., et al. (2001). Salivary cortisol and DHEA: Association with measures of cognition and well-being in normal older men, and effects of three months of DHEA supplementation. Psychoneuroimmunology, 26(6), 591-612.

Volpato, S., Guralnik, J. M., Fried, L. P., Remaley, A. T., Cappola, A. R., & Launer, L. J. (2002). Serum thyroxine level and cognitive decline in euthyroid older women. Neurology, 58, 1055-1061.

Wilkinson, C. W., Petrie, E. C., et al., (2001). Human glucocorticoid feedback inhibition is reduced in older individuals: evening study. Journal of Clinical Endocrinology and Metabolism. 86(2), 545-550.

Wolf, O. T., Convit, A., et al., (2002). Basal hypothalamic-pituitary activity and corticotropin feedback in young and older men: relationships to magnetic resonance imaging-derived hippocampus and cingulated gyrus volumes. Neuroendocrinology, 75(4), 241-249.

Zietz, B., Hrach, S., et al., (2001). Differential age-related changes of hypothalamus-pituitary-adrenal axis hormones in healthy women and men—role of interleukin 6. Experimental Clinical Endocrinology and Diabetes, 109(2), 93-101.


Module 6: Exploring Age-Related Body Systems Changes
6.2.23 Summary Case and Evaluation…
6.2.25 Review Question 1