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

6.6: Renal System



6.6.15: References

Anderson, S. & Brenner, B. M. (1988) The aging kidney: Structure, function, mechanisms, and therapeutic implications. JAGS, 35, 590-593.

Ash, S. L. & Goldin, B. B. (1988). Effects of age and estrogen on renal vitamin D metabolism in the female rat. American Journal of Clinical Nutrition, April, 47(4), 694-699. (Abstract).

Beck, L. H. & Burkart, J. M. (1990). Aging changes in renal function. In W. R. Hazzard, R. Andres, E. L. Bierman, and J. P. Blass (Eds). Principles of geriatric medicine and gerontology 2nd Ed (pp. 555-564) NY: McGraw-Hill Information Services Co.

Beck, L. H. (1998). Changes in renal function with aging. Clinics in Geriatric Medicine, 14(2), 199-209.

Beck, L. H. (1999). Aging changes in renal function. In W. R. Hazzard, J. P. Blass, W. H. Ettinger, J. B. Halter, and J. G. Ouslander (Eds). Principles of geriatric medicine and gerontology 4th Ed (pp.767-776) NY: McGraw-Hill Health Professions Division.

Brenner, B. M., Meyer, T. W., Hostetter, T. H. (1989). Dietary protein intake and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular sclerosis in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. NEJM, 307: 652-659 (get)

Clark, B. (2000). Biology of renal aging in humans. Advances in Renal Replacement Therapy, 7(1), 11-21.

Cogan, M. G. (1991). Fluid and electrolytes: Physiology and Pathophysiology, Norwalk, CT: Appleton & Lange.

Corman, B. & Michel, J. B. (1987). Glomerular filtration, renal blood flow, and solute excretion in conscious aging rats. American Journal of Physiology, Oct, 253(4 pt 2), R555-560.

Danziger, R. S., Tobin, J. D., Becker, L. C., Lakatta, E. E., & Fleg, J. L. (1990). The age-associated decline in glomerular filtration in healthy normotensive volunteers: Lack of relationship to cardiovascular performance. JAGS, 38, 1127-1132.

Drusano, G. L., Muncie, H. L., Hoopes, J. M., Damron, D. J. and Warren, J. W. (1988). Commonly used methods of estimating creatinine clearance are inadequate for elderly debilitated nursing home patients. JAGS, 36, 437-441.

Feinstein, E. I. (1986) Renal disease in the elderly. In I. Rossman, (Ed). Clinical geriatrics, 3rd Ed, (pp. 215-229) Phil: J. B. Lippincott Company.

Frassetto, L. and Sebastian, A. (1996). Age and systemic acid-base equilibrium: Analysis of published data. Journal of Gerontology: Biological Sciences, 51A(1), B91-B99.

Friedman, J. R., Norman, D. C., & Yoshikawa, T. T. (1989). Correlation of estimated renal function parameters versus 24-hour creatinine clearance in ambulatory elderly. JAGS, 37, 145-149.

Gerich, J. E., Meyer, C. Woerle, H. J., & Stumvoll, M. (2001). “Renal gluconeogenesis: its importance in human glucose homeostasis.” Diabetes Care 24(2): 382-91.

Haviv, Y. S., Sharkia, M., Safadi, R.(2000). “Hypoglycemia in patients with renal failure.” Renal Failure 22(2): 219-23.

Hollenberg, N. K., Rivera, A., Meinking, T., Martinez, G., McCullough, M., Passan, D., Preston, M., Taplin, D., Vicaria-Clement, M. (1999). Age, renal perfusion and function in island-dwelling indigenous Kuna Amerinds of Panama. Nephron, 82: 131-138.

Ishidam, M., Bulos , B., Takamoto, S., and Sacktor, B. (1987) Hydroxylation of 25-hydroxyvitamin D3 by renal mitochondria from rats of different ages. Endocrinology, 121(2), 443-448. (Abstract)

Krepinsky, J., Ingram, A. J., & Clase, C. M. (2000). “Prolonged sulfonylurea-induced hypoglycemia in diabetic patients with end-stage renal disease.” American Journal of Kidney Diseases 35(3): 500-5.

Li, Y. M., Steffes, M., Donnelly, T., Liu, C., Fuh, H., Basgen, J., Bucala, R., & Vlassara, H. (1996). Prevention of cardiovascular and renal pathology of aging by the advanced glycation inhibitor aminoguanidine. Proceedings of the National Academy of Sciences of the United States of America, 93(9), 3902-7.

Lindeman, R. D. et al (1985). Longitudinal studies on the rate of decline in renal function with age. JAGS, 33, 278-285.

Lindeman, R. D., Romero, L. J., Liang, H. C., Baumgartner, R. N., Koehler, K. M., & Garry, P. J. (2000). “Do elderly persons need to be encouraged to drink more fluids?” Journal of Gerontolontology A Biolological Sciences Med Sciences 55(7): M361-5.

Lindeman, R. D. & Goldman, R. (1986). Anatomic and physiologic age changes in the kidney. Experimental Gerontology, 21(4-5), 379-406. (Abstract)

Lindeman, R. D. (1993). Renal physiology and pathophysiology of aging. In A. Sessa, M. Meroni, G. Battini (eds). Glomerulonephritis in the elderly. Contributions in Nephrology(?). Basel, Karger, Vol 105, 1-12.

Lindeman, R. D. (1998). Is the decline in renal function with normal aging inevitable? Geriatric Nephrology and Urology, 8: 7-9.

McKenna, K., Thompson, C. (1998). Osmoregulation in clinical disorders of thirst appreciation. Clinical Endocrinology, 49, 139-152.

Melk, A., Ramassar, V., Helms, L. M. H., Moore, R., Rayner, D., Solez, K., Halloran, P. F. (2000). Telomere shortening in kidneys with age. J Am Soc Nephrol, 11: 444-453.

Meyer, C., J. M. Dostou, J. M. & Gerich, J. E. (1999). “Role of the human kidney in glucose counterregulation.” Diabetes 48(5): 943-8.

Meyer, C., M. Stumvoll, M., Nadkarni, V., Dostou, J., Mitrakou, A., & Gerich, J. (1998). “Abnormal renal and hepatic glucose metabolism in type 2 diabetes mellitus.” J Clin Invest 102(3): 619-24.

Meyer, C., M. Stumvoll, M., Dostou, J., Welle, S., Haymond, M., & Gerich, J. (2002). “Renal substrate exchange and gluconeogenesis in normal postabsorptive humans.” Am J Physiol Endocrinol Metab 282(2): E428-34.

Meyer, C., M. Stumvoll, M., Welle, S., Woerle, H. J., Haymond, M., & Gerich, J. (2003). “Relative importance of liver, kidney, and substrates in epinephrine-induced increased gluconeogenesis in humans.” Am J Physiol Endocrinol Metab 285(4): E819-26.

Nunez, J. F., Roman, A. B., & Commes, J. L. R. (1987) Physiology and disorders of water balance and electrolytes in the elderly. In J. F. M. Nunez and J. S. Cameron (eds) Renal function and disease in the elderly (pp.67-93). London: Butterworths.

Rowe, J. W. (1988). Renal system. In J. W. Rowe and R. W. Besdine (Eds) Geriatric medicine, 2nd Ed (pp. 231-245) Boston: Little, Brown and Company.

Sebastian, A., Harris, S. T., Ottaway, J. H., Todd, K. M., & Morris, R. C., Jr. (1994). Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate, New England Journal of Medicine, 330(25), 1776-81.

Silver, A. J. & Morley, J. E. (1992). Role of the opiod system in the hypodipsia associated with aging. Journal of the American Geriatrics Society, 40(6), 556-560

Silver, A. J., Flood, J. F., & Morley, J. E. (1991). Effect of aging on fluid ingestion in mice. Journal of Gerontology: Biological Science, 46, B117-B121.

Stout, N. R., Kenny, R. A., & Baylis, P. H. (1999) A review of water balance in ageing in health and disease. Gerontology, 45, 61-66.

Stumvoll, M. (1998). “Glucose production by the human kidney—its importance has been underestimated.” Nephrol Dial Transplant 13(12): 2996-9.

Stumvoll, M., Meyer, C., Mitrakou, A., Nadkarni, V., & Gerich, J. E. (1997). “Renal glucose production and utilization: new aspects in humans.” Diabetologia 40(7): 749-57.

Stumvoll, M., Meyer, C., Perriello, G., Kreider, M., Welle, S., & Gerich, J. (1998). “Human kidney and liver gluconeogenesis: evidence for organ substrate selectivity.” Am J Physiol 274(5 Pt 1): E817-26.

Stumvoll, M., Meyer, C., Mitrakou, A., & Gerich, J. E. (1999). “Important role of the kidney in human carbohydrate metabolism.” Med Hypotheses 52(5): 363-6.

Stumvoll, M., Perriello, G., Meyer, C., & Gerich, J. (1999). “Role of glutamine in human carbohydrate metabolism in Kidney and other tissues.” Kidney International 55(3): 778-92.

Timiras, P. S. & Leary, J. (2003) The Kidney, the lower urinary tract, body fluids, and the prostate. In P. S. Timiras (Ed) Physiological basis of aging and geriatrics (pp.337-358). New York: MacMillan Book Company.

Tracy, R. E., Malcom, G. T., Oalmann, M. C., Qureshi, U., Ishii, T., Velez-Duran, M. (1992) Renal microvascular features of hypertension in Japan, Guatemala, and the United States. Arch Pathol Lab Med, 116: 50-55.

Wilson, P. D., Dillingham, M. A., & Anderson, R. J. (1990) Age-associated decline in renal response to vasopressin: Diminished adenylate cyclase activation in collecting ducts. In A. L. Goldstein, Biomedical advances in aging (pp. 291-296), New York: Plenum Press.


Module 6: Exploring Age-Related Body Systems Changes
6.6.14 Putting It All Together:…
6.7 Post Test