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

6.5: Neurological System



6.5.5: Changes with Age

A number of changes have already been alluded to in relation to the neuron, several of which we will discuss in more detail further on in the module. First, however, it’s helpful to get an overall idea of the changes that occur in the brain with age that need to be considered when caring for an older adult.

The brain gets smaller as we age (atrophy) and experiences a decrease in weight, changes that are generally attributed to loss of neurons. Note that it is important to differentiate between neurons and neuroglia (definitions). Neurons are differentiated and generally non-replaceable, although some recent data have called this latter belief into question. In contrast, neuroglia can undergo cell division and proliferate, a point we’ll come back to.

While loss of neurons occurs, it is localized to specific layers and regions of the brain and shows considerable individual variability (Timeras, 1994). Thus data are often conflicting, a problem that is exacerbated by the difficulties inherent in studying changes in humans rather than animals.

Losses in the locus ceruleus, a major source of catacholaminergic neurons, and the substantia nigra, which is part of the basal ganglia and a major source of dopaminergic neurons, have been reported and may be a factor in age changes in stability, gait, homeostasis, and sleep as well as cognitive functioning (Reeves, et al., 2002; Timeras, 1994). On the other hand, loses in the nucleus basalis of Meynert (an area of the Amygdala), which is a major source of cholinergic neurons, occur mainly in persons with Alzheimer’s type dementia, with relatively minor changes occurring in non-demented elders (Timeras, 1994).

In general, changes tend to affect the white matter (myelinated neurons) to a greater extent than the gray matter (Mrak, et al., 1997). This may be consistent with the the idea that retrogenesis occurs with age and may underpin a number of neurodegenerative conditions (Braak, et al., 1999; Reisberg, et al., 1999). Retrogenesis is defined as “the process by which degenerative mechanisms reverse the order of acquisition in normal development” (Reisberg, et al., 1999). According to this hypothesis, the parts of the brain that undergo late myelination are first to undergo demyelination and the development of pathologic intra- and extra- cellular changes. While more data are needed to support this process, it has been linked to the stages of development of Alzheimer’s disease and related clinical findings (Braak, et al., 1999; Reisberg, et al., 1999).


Module 6: Exploring Age-Related Body Systems Changes
6.5.4 The Neuron
6.5.6 Case Study Two: Brain…