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PSY313 UofT Midterm 1
PSY313 UofT Midterm 1
414
Psychology
Undergraduate 3
10/18/2012

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Term
Gerontology
Definition
The study of aging from maturity through old age
Term
The life-span perspective
Definition
divides human development into two phases:
1. Early phase: childhood and adolescence
2. Later phase: young adulthood, middle age, and old age
Term
Paul Baltes: 4 key features of the life-span perspective
Definition
Multidirectionality, plasticity, historical context, multiple causation
Term
Multidirectionality
Definition
development involves both growth and decline - ex. vocabulary increases throughout most of life, but reaction time slows down
Term
Plasticity
Definition
One's capacity is not predetermined or set in concrete - many skills can be learned or improved throughout life, though there are limits
Term
Historical context
Definition
each of us develops within a particular set of circumstances determined by historical and cultural context
Term
Multiple causation
Definition
development results from a wide variety of forces --> biological, psychological, sociocultural and life-cycle
Term
For Baltes, life-span development consists of interaction between these three things:
Definition
growth, maintenance, and loss regulation
Term
Baltes, 4 factors of interaction that restrict resources for growth as one ages
Definition
- age related reduction in the amount and quality of biologically based resources
- age related increase in amount and quality of culture needed to generate continuously higher growth
- age related decline in the efficiency with which cultural resources are used
- a lack of 'old-age friendly' support structures
Term
How have age demographics changed over the past century?
Definition
More older adults in industrialized countries than ever before; this is primarily due to better health care and lower birth mortality
Term
What are the "oldest" and "youngest" continents?
Definition
Europe (oldest) and Africa (youngest)
Term
What are the implications of recent population shifts?
Definition
- older adults will become a major economic and political force
- there will be an increased need for pension and health care systems
- there will be fewer workers and consumers because of a shrinking birth rate
Term
Diversity of older adults in Canada
Definition
- Older women outnumber older men in all ethnic groups
- the number of visible minorities are increasing
- education levels are improving contributing to access to better health care and more healthful lifestyles -> longer life
Term
apocalyptic demography
Definition
idea that an aging population will cause social chaos
Term
What five assumptions are implicit in the idea of apocalyptic demography?
Definition
1. Aging is a social problem
2. All old people are the same
3. Older people overuse services and resources
4. Intergenerational inequity and conflict will result from this overuse
5. The welfare state will need to be dismantled and recreated to accommodate the needs of the increasing older population
Term
How can we rebuke the idea of apocalyptic demography?
Definition
Canadian monetary policy has had far more effect on inflation and government debt than demography ever will. Older demographics may cause investments in human capital over physical capital
Term
What are the main 4 forces of development?
Definition
Biological, psychological, sociocultural, and life-cycle
Term
Biological forces of development
Definition
Genetic and health related factors affecting development - ex. menopause, facial wrinkling, organ changes
Term
Psychological forces of development
Definition
Perceptual, cognitive, emotional, and personality factors that affect development - characteristics we notice about people that make them individuals
Term
Sociocultural forces
Definition
Interpersonal, societal, cultural, and ethnic factors that affect development - the overall context in which we develop
Term
Life-cycle forces
Definition
reflect differences in how the other three forces affect people at different points in their lives - ex. becoming pregnant is different at 26 compared to 36
Term
Normative age-graded influences
Definition
experiences caused by biological, psychological, and sociocultural forces that are highly correlated with chronological age
Term
Normative history-graded influences
Definition
events that most people in a specific culture experienced at a specific time
Term
Non-normative influences
Definition
Random or rare events that may be important for a specific individual but are not experienced by most people
Term
Nature-nurture controversy
Definition
Question of the extent to which inborn, hereditary characteristics (nature) and experiential, or environmental, influence (nurture) determines who we are - most theorists today believe that the two interact
Term
Stability-change controversy
Definition
concerns the degree to which people remain the same over time - little controversy over whether children change as they mature to adulthood, more controversy as to whether adults also change
Term
Continuity-discontinuity controversy
Definition
concerns whether a particular developmental phenomenon represents a smooth progression over time (continuity) or a series of abrupt shifts (discontinuity)
continuity -> generally quantitative
discontinuity -> generally qualitative
Term
Universal v. context-specific development controversy
Definition
concerns whether there is just one path of development or several - contextual and cultural differences may greatly affect development
Term
Primary aging
Definition
normal, disease-free development during adulthood
Term
Secondary aging
Definition
developmental changes that are related to disease, lifestyle, and other environmentally induced changes that are not normative
Term
Tertiary aging
Definition
The rapid losses that occur shortly before death - ex. the terminal drop
Term
Chronological age
Definition
Age as the time since our birth
Term
Biological age
Definition
The maximum number of years we could possibly live, based on functioning of vital organ systems
Term
Psychological age
Definition
the functional level of the psychological abilities people use to adapt to changing environmental demands
Term
Sociocultural age
Definition
the specific set of roles individuals adopt in relation to other members of society and culture to which they belong
Term
Reliability
Definition
The extent to which a measure is repeatable across trials
Term
Validity
Definition
The extent to which a measure relates to the researcher's operationalization
Term
Systematic observation
Definition
Watching people and recording what they say and do; includes naturalistic observation and structured observation
Term
Sampling behaviour with tasks
Definition
Giving participants tasks that elicit a behaviour of interest - lower ecological validity
Term
Self reports
Definition
Answers to a question on the topic of interest; can be verbal (interview) or written (questionnaire)
Term
Why don't studies in development often use experimental design?
Definition
Age can not be manipulated, it can only be studied through correlation
Term
What three effects may explain results from a developmental study?
Definition
Age effects: differences caused by underlying age-related processes
cohort effects: differences caused by experiences and circumstances unique to a generation
time-of-measurement effects: differences stemming from sociocultural, environmental, historical, or other events at the time data is obtained
Term
Age change
Definition
how an individual changes behaviour over time
Term
Age difference
Definition
How two individuals of different ages differ
Term
cross-sectional design
Definition
Testing people of different ages at the same time -> can examine age differences, but not age change
- can be confounded by cohort effects
Term
the extreme group design
Definition
comparing two groups with large age differences, a very common design
- problematic because the samples are not generally representative, it clumps age into two large groups, young and old, and it assumes that the measures used are appropriate for both age groups
Term
Longitudinal design
Definition
A sample of individuals are tested repeatedly across an extended period of time. Examines age changes, but can be confounded by time-of-measurement effects
Term
What are three difficulties with longitudinal design?
Definition
1. practice effects: participants may improve on test performance because of repeated measurement
2. participant drop-out: participants may lose interest, or die
3. lack of generalizability outside of the cohort being tested
Term
cross-sequential design
Definition
Two or more cross-sectional designs conducted at two or more times of measurement - include the same age ranges at each test, but use different participants -> can test for cohort effect
Term
longitudinal-sequential
Definition
two or more longitudinal designs that represent two or more cohorts - each longitudinal study examines the same age range and spans the same amount of time - can test for time-of-measurement effects
Term
Requirements for consent
Definition
must:
- obtain informed consent
- tell all participants the purpose of the project
- inform participants of any risks
- inform participants of what they will be asked to do
- inform them of any potential benefits
- inform them of any other relevant info
Term
consent for incapacitated individuals
Definition
consent can be given by family members, or the participant before they are too incapacitated - with advance consent, the researches must ensure that the participant continues to consent after becoming incapacitated
Term
Rate-of-living theories
Definition
theory that people only have so much energy to spend over a lifetime - we should limit our calorie intake and reduce our stress levels
Term
Cellular theories: telomeres
Definition
There is a limit to the number of divisions a cell is capable of - Hayflick limit
- telomeres are reduced on every successive division, the cell dies when the telomere chain becomes too short
- we need this system to stop mutated cells from replicating
Term
Cellular theories: Cross-linking
Definition
collagen proteins interact randomly to produce molecules that are linked in such a way as to make the body stiffer
Term
Cellular theories: free readicals
Definition
highly reactive chemicals which are produced in normal metabolism may cause cellular damage, which could impair organ function or block the effects of important molecules
- antioxidants prevent the development of free radicals (but no evidence that they increase the life-span)
Term
Theories of programmed cell death
Definition
Aging may be programmed into our genetic code - under the correct circumstances cells will self-destruct which may be responsible for the development of mobility problems in old age
Term
Progeria
Definition
accelerated aging which mimics normal aging - people have similar disorders as older adults; but also have characteristics atypical of older adults - bird-like features, small stature
- normal intelligence
- no known cure, not believed to be hereditary
Term
Werner's syndrome
Definition
Accelerated aging which begins in adolescence or early adulthood. Causes appearance of old age by 30-40 years, short stature and development of other features characteristic of older adults
Term
What are three approaches to slowing or reversing the aging process?
Definition
1. Delay the chronic illnesses of old age
2. slow the fundamental processes of aging to increase the life-span
3. Arrest or reverse aging by removing the damage caused by the metabolic process
Term
4 step process of skin wrinkling:
Definition
1. outer layer of skin becomes thinner through cell loss causing it to become more fragile
2. collagen fibres that make up the connective tissue become less flexible, making skin less able to regain it shape
3. elastin fibres in the middle layer of the skin lose their ability to keep skin stretched out, resulting in sagging
4.the underlying fat layer, which provides padding to contours diminishes
Term
What a simple way to prevent skin wrinkling
Definition
Preventing sun exposure, for example, through regular use of sunblock
Term
How does hair change with age?
Definition
Thinning and greying is inevitable; loss is caused by the destruction of germ centres that produce follicles
- greying is caused by cessation of pigment production
Term
How does the voice change with age?
Definition
it becomes thinner and weaker, pitch lowers, there is increased breathlessness and trembling, slower and less precise pronunciation, and decreased volume
Term
How does weight change with age?
Definition
Weight is commonly gained in middle age (between 20s - mid 50s) and lost later in life
Term
How does height change with age?
Definition
remains stable until the mid 50's - then men lose about 1 inch and women lose about 2 inches
- caused by compression of the spine from loss of bone strength, changes in the discs between the vertebrae ad the spine, and changes inposture
Term
What are the reasons for weight change with age?
Definition
Metabolism slows and people don't alter their food intake, resulting in weight gain; later the body loses muscle and bone mass leading to weight loss
Term
What are three causes for mobility changes with age?
Definition
Loss of muscle: generally endurance declines slower than strength - sarcopenia
Bone loss: begins in 30s, accelerates in 50s, and slows in the 70s; women more affected than men
Joint pain: osteoarthritis and rheumatoid arthritis
Term
What causes the gender differences in bone loss?
Definition
1. women begin with less bone mass in young adulthood - less ability to withstand loss
2. the depletion of estrogen speeds up loss
Term
osteoporosis
Definition
disease in which loss in bone mass and increased porosity cause honeycomb shaped bones - the leading cause of broken bones in women
Term
What are some ways of preventing osteoporosis?
Definition
- calcium intake may be helpful - better calcium citrate than calcium carbonate
- estrogen replacement can slow loss, but has potential side effects
- vitamin D has been shown to slow loss, and has few side effects
Term
Osteoarthritis
Definition
gradual onset and progression of pain and disability in the joint with minor signs of inflammation
- caused by damage to bones underneath the cartliage of joints (hands, spine, hips and knees)
- especially common in people who overuse their joints routinely
Term
rheumatoid arthritis
Definition
more destructive and common form of arthritis which develops slowly and affects different joints than osteoarthritis (fingers, wrists and ankles)
- self-induced by diet, habit and job exposure
Term
What are some ways in which adults compensate for age related losses?
Definition
Cosmetics, hair dyes, plastic surgery
Term
What are some gender differences in the psychological effects of aging?
Definition
Women may be regarded as inferior on a number of dimensions; men are often considered more distinguished, experienced, and knowledgeable as they age
Term
What are the psychological effects of losses in strength and endurance?
Definition
Tell the person that they are not as capable of adapting to the environment as they once were
- exercising may become embarrassing and stressful
- in reality, exercise and resistance training remains useful up to age 90-
Term
What are some psychological effects of joint changes?
Definition
Movement becomes limited, reducing independence - joint pain is difficult to ignore or disguise
- additionally, bone fractures may force hospitalization or stay in a nursing home
Term
What are the 2 types of major structural changes in the eye?
Definition
1. decrease in light that passes through the eye
2. changes in the lens
Term
Vision: decrease in light with age
Definition
Causes need for more light to see properly; increased sensitivity to glare; longer time to adapt from light to dark
Term
Vision: lens changes
Definition
become more yellow, reducing colour discrimination; ability to adjust and focus declines as surrounding muscles stiffen - presbyopia: difficulty seeing close objects clearly
- length of time to shift focus increses
Term
Cataracts
Definition
opaque spots which develop on the lens - generally surgically removed
Term
Glaucoma
Definition
fluid in the eye does not drain properly, causing high pressure - generally treated with eye drops
Term
Retinal changes: macular degeneration
Definition
macula: the focal point of vision, where receptors are most dense
degeneration: progressive and irreversible destruction, results in loss of ability to see details
- leading cause of functional blindness in adults
Term
retinal changes: diabetic retinopathy
Definition
blindnes due to diabetes - can involve fluid retention in the macula, detachment of the retina, haemorrhage, and aneurysm
Term
Psychological effects of visual changes
Definition
many common causes of vision loss can be corrected; can be controlled for by changing the environment - brighter lights, larger fonts, high contrast, and low glare
Term
What are some common causes of hearing loss?
Definition
any sound over 70dBA - especially during exercise; a brief, very loud noise can also cause permanent damage - ex. from a concert
Term
Presbycusis
Definition
Reduced sensitivity to high-pitched tones; occurs more severely and earlier than the loss of sensitivity to low-pitched tones - ~50% of adults have presbycusis by their late 70s
Term
What are the 4 changes in the inner ear that result in presbycusis
Definition
1. sensory atrophy and degeneration of receptor cells
2. neural: a loss of neurons in the auditory pathway in the brain
3. metabolic: diminished supply of nutrients to the cells in the receptor
4. mechanical: atrophy and stiffening of the vibrating structures
Term
How does hearing loss affect social adjustment?
Definition
Causes:
- loss of independence, social isolation
- irritation, paranoia, and depression
- hearing loss may be attributed as emotional changes, straining interpersonal relationships
Term
How does hearing loss differ between industrialized and developing nations
Definition
Hearing loss is more drastic in industrialized nations, likely due to higher ambient noise levels
Term
Analogue hearing aids
Definition
most common and least expensive, but provide the lowest sound quality
Term
digital hearing aids
Definition
include microchips tat can be programmed for different situations
Term
cochlear implants
Definition
transmits sound information to a receiver which stimulates auditory nerve fibres directly
Term
Relation of gender and hearing loss
Definition
Men are much more at risk than women - could be due to noisier working conditions
Term
An experiment demonstrated that typists typing speed does not decrease, even as reaction time does decease. What does this tell us about aging?
Definition
Expertise in a skill enables us to adapt to age-related losses, in this case in reaction time
Term
accelerators v decelerators of aging
Definition
accelerators: smoking, alcohol, nutrition, inactivity, hostility... are better understood than decelerators.
Term
Somesthesia
Definition
sensitivity to touch
Term
How does somesthesia change with age?
Definition
decreases on smooth areas (ex. fingertips), but is unchanged in hair covered areas - no clear picture of how pain sensitivity changes
Term
Kinesthesis
Definition
the sense of one's own body position - involves feedback about passive movements and active movements
Term
How does kinesthesis change with age?
Definition
- passive movement sensitivity decreases in the knees and hips
- active movement sensitivity does not change
Term
What sensory organ is responsible for our sense of balance?
Definition
The vestibular system in the inner ear - responds to the forces of gravity and initiates apporpriate movements to maintain balance
Term
What are common age-related changes to the sense of balance?
Definition
Dizziness and vertigo - due to changes in vestibular system, along with loss of visual info, longer time needed to integrate multimodal sensory info, and side effects of medication
Term
What factors increase the likelihood of falling in old age?
Definition
- environmental hazards: loose rugs, slippery floors
- increased body sway
Term
What is one way balance may be improved
Definition
Through Tai Chi
Term
How does taste decline with age?
Definition
Little is know, but decline appears to be gradual, and varies a great deal between people and flavours - not caused by decline in taste buds, could be because of decline in smell
Term
How does smell change with age?
Definition
Does not decline until the 60's - wide variations across people and odour type
Term
What might abnormal changes in ability to smell indicate
Definition
Alzheimer's: has been shown to reduce odour identification ability by 60% -> specifically, ability to detect 'green apple' and 'cinnamon'
Term
What are some negative consequences of inability to smell?
Definition
Safety issues; less enjoyment of food; inability to detect personal odour; loss of scent-based connection to past experiences
Term
What is a possible reason that men have higher rates of cardiovascular disease until old age?
Definition
May be related to protection by estrogen in pre-menopausal women - but mostly explained by the levelling off of death rates in men
Term
Congestive Heart Failure:
Definition
cardiac output and the ability of the heart to contract severly declines, causing the heart to enlarge, pressure in the veins to increase, and the body to swell
Term
Angina Pectoris
Definition
the oxygen supply to the heart muscle becomes insufficient, resulting in chest pain
Term
What are causes and treatments for angina pectoris?
Definition
- usually caused by physical exertion and is relieved within 5-10 minutes of rest
- commonly treated with nitrogen, in some case coronary arteries need to be cleared surgically or replaced through coronary bypass
Term
Myocardial infarction (MI)
Definition
heat attack; blood supply to the heart is reduced or severely cut off
- initial symptoms are identical to angina, but more severe and prolonged
- chest pain more common in older adults and those with diabetes
Term
Atherosclerosis
Definition
age-related build up of fat deposits on, and calcification of, the arterial walls - interferes with blood flow through the arteries
Term
What are some causes of atherosclerosis
Definition
poor nutrition, smoking, and unhealthy lifestyle
Term
Cerebrovascular Accident (CVA)
Definition
when blood flow to a portion of the brain is completely cut off; a stroke
Term
What are 5 warning signs of a stroke?
Definition
1. Sudden weakness, numbness, or paralysis of the face, arm, or leg
2. Sudden dimness or loss of vision
3. Loss of speech, or trouble talking or understanding language
4. Sudden severe headaches with no apparent cause
5. Unexplained dizziness, unsteadiness or sudden falls, with particular concern if they occur with an of the above symptoms
Term
What causes a CVA
Definition
Clots blocking blood flow to, or the breaking of a blood vessel resulting in hemorrhage
Term
What are risk factors for CVAs?
Definition
age, diabetes, smoking and diet - especially amount of salt and fat consumed
Term
What are treatments for CVAs?
Definition
Tissue Plasminogen Activator (TPA), a clot dissolving drug - effective for strokes caused by blood clots, which make up 80%
- must be given promptly
Term
Hypertension
Definition
results from severe blood pressure increases
Term
What are some likely reasons that hypertension is more prevalent among certain minority groups in Canada?
Definition
may be caused by a genetic mutation affecting enzymes that help control blood pressure, or environmental factors related to stress, poor access to health care, and poverty
Term
What is the best way to detect hypertension?
Definition
Frequent blood pressure tests
Term
What are some risk factors for hypertension?
Definition
Stress and high sodium
Term
Chronic Obstructive Pulmonary Disease (COPD)
Definition
the most common incapacitating respiratory disorder; a family of diseases including chronic bronchitis and emphysema
Term
Emphysema
Definition
the destruction of the membranes around the air sacs in the lungs creating holes which reduce oxygen-carbon dioxide exchange
Term
What is by far the largest risk factor for emphysema?
Definition
Smoking, it causes 82% of cases
Term
Chronic bronchitis
Definition
more common with people over age 45, especially those exposed to dust, irritating fumes, or pollution
Term
What are some treatments for chronic bronchitis?
Definition
medication to open up the bronchial passages -> brochodilators , and a change in the work environment
Term
What are common symptoms of menopause?
Definition
hot flashes, night sweats, headaches, vaginal dryness, mood changes, difficulty concentrating, and memory problems
Term
What are some common normative changes to the male reproductive system with age?
Definition
- decline in quantity of sperm
- prostate gland enlarges and becomes stiffer
- gradual reduction in testosterone
Term
What are some psychological implications of normative decline in sexual reproductive systems?
Definition
Desire does not usually diminish, but these barriers along with myths and stereotypes prevent older adults from having an active sex life
Term
Neurofibrillary tangles
Definition
fibres in the neuron's axon become tangles, forming paired helical or spiral filaments - some tangling occurs normally with age
Term
neuritic plaques
Definition
product of damaged/dying neurons collecting around a core protein - large numbers not generally observed until around 90; if earlier, then a sign of Alzheimer's
Term
Parkinson's disease
Definition
results form an extreme decrease in dopamine levels in the brain; characterized by tremors in the hands, arms, and legs and shuffling walking style
Term
Treatment for Parkinson's
Definition
- L-Dopa: drug that is converted into dopamine in the body
- COMPT inhibitor: blocks an enzyme responsible for breaking down L-Dopa
- brain pacemakers: activated via magnet to interrupt tremors
Term
What neurotransmitter is linked to memory problems, Alzheimer's and Huntington's?
Definition
Acetylcholine - low levels may be caused by decrease in choline acetyltransferase, an enzyme involved in acetylcholine synthesis
Term
Computed tomography (CT)
Definition
x-rays are passed through the patient and used to create 3D images
Term
Magnetic Resonance Imaging (MRI)
Definition
magnetically reorienting molecules in the body, then shooting radio waves through the body
Term
Positron Emission Topography (PET)
Definition
creating images by injecting a radioactive isotope and passing positrons through the body, detecting and analysing them
Term
Name some factors that can affect memory
Definition
medical disorders/diseases, medications, diet, exercise, thinking activities, attitude, stress/relaxation, attention
Term
How do older adults differ in their memory strategies used?
Definition
Trick question! They don't actually differ that much
Term
How do older adults differ in their ability to regulate body temperature?
Definition
Difficulty noticing that their core temperature is low, and have a slower vasoconstrictor response - the ability to raise core body temperature
- don't sweat as much, making it difficult for them to respond to high heat
Term
How do circadian rhythms change with age?
Definition
Move from 2-phase - awake during day/asleep during night - to multiphase - daytime napping and shorter night sleep cycles
Term
What causes age-related change in circadian rhythm?
Definition
sleep disturbances caused by: poor temperature regulation, sleep apnoea (stopping breathing for 5-10s), leg jerks, need to urinate, poor physical health, and depression
Term
What is the problem with using sleep medication?
Definition
It may cause insomnia if used in the long term
Term
What are some effective treatments for sleep problems?
Definition
exercise, reduced caffeine intake, avoiding naps, a quiet and dark sleeping environment
Term
Why does long term care place older adults at the highest risk for sleep problems?
Definition
may experience painful medical conditions, medications which interfere with sleep, and a noisy environment
Term
How is dementia different than the public conception of it?
Definition
It is not a part of normal aging - only 6-8% of people over age 65 have it
Term
What phenomenon explains why there is little decline in problem solving ability, reasoning and judgement until late in life?
Definition
Dendritic growth
Term
Average life expectancy
Definition
age at which a particular age cohort can expect to live - largest increase has occurred in the last half of the 20th century
- depends on what is known about the group in question
Term
Maximum longevity
Definition
the oldest age to which any individual of a species lives - expected to be ~120 years for humans
Term
What are the main reasons for the recent increase in average life expectancy in Canada?
Definition
Sanitation, and health sciences - lowered infant mortality is the biggest contributor
Term
What currently limits the maximum longevity in humans?
Definition
key cardiovascular systems have a limit to how long they can last - may chance with ability to create artificial organs
Term
Active life expectancy
Definition
the age to which on e can expect to live an independent, disability free life
Term
Dependent life expectancy
Definition
the age to which one can expect to live beyond the point of independence
Term
What are six factors that might explain how centenarians lived to their age?
Definition
Attitude, genes, good health practices,exercise, investigating new challenges, nutrition, reducing stress
Term
Centenarian lessons for aging: attitude
Definition
centenarians rarely consider their age a limitation. They take advantage of opportunities and new possibilities
Term
Centenarian lessons for aging: genes
Definition
Most people likely have genes that allow them to live to be at least 85; you must take advantage of those genes
Term
Centenarian lessons for aging: good health practices
Definition
Will help make up for genetic differences and maximize the disease-free portion of your life
Term
Centenarian lessons for aging: exercise
Definition
Resistance training becomes increasingly important with age - reduces heart disease risk and enhances sense of well-being
Term
Centenarian lessons for aging: investigate new challenges
Definition
Keep the mind active, exercising different parts of the brain - take advantage of new opportunities, ex. a second career
Term
Centenarian lessons for aging: nutrition
Definition
emphasize fruits and vegetables, and minimize meat, saturated and hydrogenated fats, and sweets, eat moderately, and supplement with vitamins
Term
Centenarian lessons for aging: reduce stress
Definition
Shed psychological stress. Humour, meditation, Tai Chi, exercise, and optimism are some ways to manage stress
Term
Dietary restriction (Japan)
Definition
In the Okinawa region of Japan adults consume fewer calories than the rest of the nation - much lower rates of cerebrovascular disease, heart disease, and cancer
Term
Dietary restriction (Netherlands)
Definition
In the Netherlands, non-obese, middle-aged men who reduced calorie intake by 20% for ten weeks had increased HDL levels, lower BP, and 10% beneficial weight loss
Term
Genetic factors on average life-expectancy
Definition
- Having a mother who has lived to 80 adds ~4 years to average life expectancy
- people who live to older ages tend to have a high threshold for disease and show slower disease progression
Term
Environmental factors on average life-expectancy
Definition
- toxins: mainly air and water pollution
- lifestyle: smoking and exercise
- diseases: Alzheimer's, cardiovascular
- social class: reduced access to medical services
Term
First nations people have a lower average life expectancy than other Canadians. What environmental factors likely explains this?
Definition
Social class: lack of adequate health care, increased substance abuse and depression
toxins: lack of clean drinking water
Term
What is a possible explanation for visible minorities having a higher life expectancy in Canada compared to the rest of the population?
Definition
Immigrants tend to be selected based on their good health and economic status
Term
What is a possible explanation for African Americans having a lower average longevity in the US?
Definition
greater risk for disease and other hazards (homicide), less healthy lifestyles for economic reasons, and less access to health care
Term
Why is it that women have ~7 years more than men in average life expectancy?
Definition
Men are:
- more likely do die in infancy / be stillborn
- more vulnerable to disease
- risk takers, abuse alcohol and smoke more than women
- more likely to be stressed
- affected by their one X chromosome, which carries most disorders, women compensate by having 2
Term
What factors cause women's life expectancy to be lower in developing countries?
Definition
- more women die in childbirth
- infanticide of baby girls
- less access to health care, work, and education
Term
On what are men expected to outperform women on average, beyond the age of 90?
Definition
Cognitive tests
Term
Health
Definition
the absence of chronic physical or mental disease impairments
Term
Illness
Definition
the presence of a physical or mental disease or impairment
Term
Self-ratings of health are predictive of:
Definition
- illness and mortality
- poor ratings may reflect a downward trajectory
- health related behaviours
- internal/external support available
Term
Why is it important to use age-comparative items for self-ratings of health?
Definition
Older adults tend to rate themselves more favourably because they think they're doing well for their age -> can get more realistic ratings by asking them to compare themselves to the general population
Term
Most research on quality of life focuses on what two areas?
Definition
1. Relating to specific diseases
2. Relating to end of life issues
Term
QoL relating to specific diseases
Definition
Must asses the extent that distress from both the illness and side-effects from treatment reduce the person's will to live
Term
QoL relating to end-of-life issues
Definition
Functioning and well being: must make palliative care as comfortable as possible
Alzheimer's and dementia: some people with dementia are very happy; it may be best not to challenge their delusions
Term
Valuation of life
Definition
the degree to which a person is attached to their present life - how much they enjoy life, find meaning, and have hopes about the future
Term
What are the three major cell types that make up the immune system?
Definition
1. Cell mediated immunity: Thymus-derived (T)-lymphocytes
2. Humoral immunity: B-lymphocytes
3. Non-specific immunity: monocytes and polymorphonuclear neutrophilic leukocytes
Term
What is the role of B and T lymphocytes in the immune system?
Definition
Primarily defend against malignant cells, viral infection, fungal infection, and some bacteria
Term
What is the role of the Natural Killer (NK) cells?
Definition
provide broad surveillance to prevent tumour growth; the primary defense against cancer
Term
How does the immune system change with age?
Definition
- older adults are more susceptible to infections and cancer
- older adults take longer to build up defences against diseases - more prone to diseases which are not harmful to young adults
Term
Leukemia
Definition
cancers of the immune cells; increases in likelihood with age
Term
Autoimmunity
Definition
a process by which the immune system begins attack the body itself - results from an imbalance of B and T lympohcytes - rheumatoid arthritis is an autoimmune disease
Term
Psychoneuroimmunology
Definition
The study of relations between psychological, neurological, and immunological systems that raise/lower our susceptiblility to and ability to recover from disease
Term
How might psychological characteristics which may interact with cancer?
Definition
Characteristics, ex. positive attitude and social support, might predict likelihood of getting cancer, and predict life expectancy after after cancer diagnosis
Term
How might psychological factors influence our health?
Definition
Could alter the immune system and hormonal system, increasing or decreasing the likelihood of illness
Term
Medical students' immune responses were assessed in a time of stress and relaxation (exams and vacation). What were the results?
Definition
More stress was reported during exams and there was a decrease in functionality of cellular immune response - decrease in NK activity
Term
Participants were given an innocuous protein and recorded daily events, which were rated as either negative or positive. What were the results?
Definition
Positive events correlated with more antibody production for the protein, and negative events correlated to less antibody production - suggests day-to-day events influence immune regulation
Term
Can stress-reduction techniques prevent immune system change due to stress?
Definition
Findings are inconclusive: Medical students trained in relaxation did not have reduced stress-related decrease in immune function; but older adults in residential care showed increased NK activity and decreased levels of herpes antibody after being trained in relaxation techniques
Term
How might depression affect the immune response?
Definition
May affect behavioural factors which decrease immune system functionality - ex. sleeping less, exercising less, poorer diets, more smoking/alcohol/drug abuse
Term
Social-support interventions for illnesses have had mixed findings describe two successful interventions
Definition
- Six-session group intervention with cancer patients - resulted in decreased distress and increased NK activity
- Sress management prior to HIV diagnosis responded with better immune status (more T-helper and NK cells)
Term
Why do older adults have increased susceptibility to HIV/AIDS?
Definition
- immune system changes
- thinning of vaginal wall increases tears
- lower frequency of condom use
- faster progression from HIV->AIDS
- Greater reduction in life span due to AIDS compared to young adults
- less likely to raise the issue with physician, be tested, or seek support groups
Term
Chronic diseases
Definition
conditions that last a minimum of three months and may be accompanied by residual functional impairment necessitating long-term management
Term
Acute diseses
Definition
conditions that develop over a short period of time and cause a rapid change in health
Term
How does incidence of acute and chronic disease change with age?
Definition
Acute diseases become less common, but chronic diseases become more common; acute diseases take longer to recover from acute diseases and are at greater risk of dying from them
Term
How did the methodology of medical practice change regarding chronic disease in the late 90s?
Definition
Chronic disease was previously viewed as a part of aging; emphasis has since shifted to prevention and wellness
Term
Stress as a physiological state
Definition
Caused by the sympathetic nervous system; potential for gender/genetic differences
Term
Stress as a coping paradigm
Definition
Stress as an interaction between a thinking person and an event
Term
Primary appraisal (stress)
Definition
Categorizing the event as:
1. irrelevant: no bearing on stress level
2. Benign/positive: events with good effects
3. Stressful: harmful, threatening, or challenging
Term
Secondary appraisal (stress)
Definition
evaluating one's perceived ability to cope with the harm, threat, or challenge
Term
Reappraisal
Definition
Making a new primary/secondary appraisal as a result of new information
Term
Coping
Definition
Dealing with a stressful event
Term
problem-focused coping
Definition
attempts to directly deal with a problem
Term
emotion-focused coping
Definition
dealing with one's feelings about a stressful event
Term
What are some factors that affect coping?
Definition
Health, attitude problem solving skills, social skills, resources
Term
What are common sources of stress for young adults?
Definition
Finance, work, home maintenance, family, personal life, and friends - more likely to be parents of small children and employed
Term
What are common sources of stress for older adults?
Definition
More likely to be age-related than role-related - caused by a decrease in independence
Term
How do older adults manage their stress differently than younger adults?
Definition
younger adults: use defensive coping styles, are more likely to deal with illness through interpersonal strategies
older adults: choose coping styles based on whether they feel in control, are better at managing their lives to avoid stress - proactive coping
Term
Short term v. chronic stress
Definition
Short term: has little effect on health
Chronic: suppresses immune system, increasing susceptibility to: viral infection, atherosclerosis, hypertension, impaired memory and cognition, inhibited menstruation
Term
Do stress effects change with age?
Definition
Not clear, hormonal reactions may increase, but variability in hormonal changes across individuals and changes in number of stressors make it hard to determine
Term
What are some common chronic conditions?
Definition
Arthritis, cardiovascular/cerbrovascular disease, diabetes mellitus, cancer
Term
Give examples of biological, psychological, sociocultural, and life-cycle influences on chronic conditions
Definition
biological: genetic predisposition, changes in physical system with age
psychological: coping skills
sociocultural: lack of health-care, ethnic differences
life-cycle factors: different reactions to chronic illness based on age of onset
Term
What type of arthritis is more often age-related?
Definition
osteoarthritis - both genetic and environmental factors have been identified
Term
How does movement interact with arthritis?
Definition

Movement is good for joints - it causes release of synovial fluid, lubricating and increasing blood flow, it also keeps muscles toned and limber

 

Lack of movement can result in contracture - freezing of muscles in place

Term
What are the effects of hypotension (low blood pressure)?
Definition

causes dizziness/lightheadedness from standing up too quickly - not dangerous in itself, but increases risk for falls

Term
What are common effects of cerebrovascular accidents (CVAs)? 
Definition

Can create chronic conditions by causing brain damage -> months - years of rehabilitation, long term motor impairment requiring physiological and psychological rehabilitation

Term
What is the cause of diabetes mellitus and how is it characterized?
Definition

Occurs when the pancreas produces insufficient insulin - causes above normal sugar in the blood and urine due to difficulty metabolizing carbohydrates

- if sugar levels are too high -> coma; if sugar levels are too low -> unconsciousness 

Term
What are the three groups of older adults with diabetes mellitus?
Definition

1. developed in cihldhood/adolescence

2. developed in middle age: typically along with cardiovascular issues

3. developed later in life: the majority of older adults with diabetes; usually show mild problems

Term
What symptoms of diabetes are often seen in younger adults, but not older adults?
Definition
exceessive thirst, increased appetite and urination, fatigue, weakness, wieght loss, and impaired wound healing
Term
What are some ways in which diabetes can be managed?
Definition
low carbohydrate/calorie diet, exercise, proper care of: skin, gums, teeth, and feet, medication
Term
What forms of cancer are preventable?
Definition

Lung and colorectal: caused by unhealthy lifestyles

 

skin cancer: can be prevented through limiting sun exposure

Term
Why does the risk of cancer increase with age?
Definition

1. cumulative effect of unhealthy lifestyle and exposure to pollution

2. result of normative aging changing the immune system - decreased ability to deal with tumours

Term
What are three genes that have been linked to cancer (two breast/ovarian, one prostate)?
Definition

BRCA1 and BRCA2 -> breast/ovarian

HPC1 -> may account for 1/500 cases of prostate cancer

Term
What is the best way to address the problem of cancer?
Definition
By making preventative lifestyle changes
Term
What are the three main approaches to cancer treatment?
Definition
Surgery, chemotherapy and radiation
Term
Incontinence
Definition
the loss of ability to control elimination of urine or feces on an occassional or consistent basis
Term
What is the most common form of incontinence?
Definition
urinary incontinence - risk increases with age
Term
What are the five causes of urinary incontinence?
Definition

1. Stress: pressure on the abdomen exceeds the ability to resist urination - ex. when someone coughs, or lifts heavy objects

2. Urge: CNS issues after a CVA or urinary tract infection - urge to urinnate becomes overpowering

3. Overflow: improper contraction of the kidneys causes the bladder to become over-extended; commonly caused by drugs, tumours, and prostate enlargement

4. Functional: urinary tract is intact, but the person is unaware of the need to urinate

5. Iatrogenic: caused by medication side effects, usually fixed by change in dosage

Term
What are some possible interventions for incontinence?
Definition

- behavioural: dietary changes, re-learning the need to use the toilet, kegel exercises

- medication and surgical intervention

Term
Pharmacological pain managment
Definition
non-narcotic and narcotic pain medications
Term
Narcotic medication
Definition
best for severe pain: morhpine and codeine work well in older adults
Term
non-narcotic medication
Definition
nonsteroidal antiflammatory drugs (NSAID) - ex. ibuprofen and acetaminophen - must be careful of potentially toxic side effects in older adults
Term
Non-pharmacological pain management
Definition

- therapeutic touch, massage, vibration, heat, cold

- electrical stimulation to spine or pain site

- acupuncture and acupressure

- biofeedback - learning to control and change the body processes responsible for pain

- distraction technique

- relaxation, meditation, and imagery

- hypnosis - self induced or by another person

Term
Why about clinical trials fo medications have caused hidden dangers for older adults?
Definition
Until the late 90s, clinical trials were not required to include older adults
Term
What are 4 age related changes that affect how medications  work in adults?
Definition

1. Absorption: the time needed for drugs to enter the blood stream

2. Distribution: movement of a medication throughout the body - in adults, more of a drug will not bind to plasma proteins, allowing for more free drug in the body -> drugs have lower effective dosage

3. Drug metabolism: process by which the liver removes medications from the blood stream - slower in older adults, increasing the risk of toxicity

4. Excretion: elimination of drugs through urine, feces, sweeat, and saliva (primarily urine) - lower body water content means drugs are exreted more slowly in older adults

Term
Polypharmacy
Definition
The use of multiple medications 
Term
What are the dangers of polypharmacy?
Definition

 some drugs don't interact well:

- drug effects may be enhanced, or the drug may not work - secondary effects may arise that need to be treated, or mimic othere diseases 

Term
What are some ways that medical compliance can be increased in older adults?
Definition

- emphasize the seriousness of the disease

- good communication

- issue reminder cards and organized pill boxes

- discussions about the importance of compliance

- keeping medications to a minimum

Term
Disability
Definition

the effects of chronic conditions on people's ability to engage in activities that are necessary, expected, and personally desired in their society

Term
Extraindividual factors affecting disability
Definition
surgical and medical interventions, social supports
Term
Intraindividual factors affecting disability
Definition
beginning and exercise program, positivity, using transportation programs
Term
Exacerbators of disabilites
Definition
things that make disability worse -> negative side effects from medication, inflexibility of support program availability
Term
Frail older adults
Definition
Adults who have physical disabilities, are very ill, may have cognitive or psychological disorders, and need assistance with everyday tasks
Term
Activities of Daily Living (ADL)
Definition
basic self-care tasks, including bathing, toiletting, walking, and dressing
Term
Instrumental Activities of Daily Living (IADL)
Definition
actions that require some competence and planning - ex. shopping, paying bills, making phone calls
Term
In terms of ADL and IADL, when can an adult be considered frail?
Definition
When they need help with 1 or more ADL
Term
What are three likely causes of disability?
Definition

1. Cerebrovasuclar disease

2. arthritis

3. coronary artery disease (weaker predictor)

Term
What are some predictive factors of disability
Definition
Smoking, heavy drinking, physical inactivity, depression, social isolation and perceived poor health
Term
What is the role of socioeconomic factors on disability?
Definition

- wealthier Canadians have lower rates of mortality, and, morbidity and presumably fewer years of chronic disease and dependancy

- but, in the US, residents of a high SES neighbourhood were not shown to have lower prevalence of disease and disability than other areas of the US

-> may be the national context - the gap between the rich and poor - which affects the health of everyone

Term
How does gender and ethnicity affect health?
Definition

- women's self-reported health worse in all countries surveyed

- self-reported health problems are more prevalent in developing countries

 

Term
healthy immigrant effect
Definition
immigrants to Canada are generally healthy because of policies on immigration; but, people who have immigrated more than ten years ago tend to have worse health on average -> barriers to health such as language, social class, and discrimination
Term
Self-perceived mental health
Definition
high ratings in perceived mental health don't change across the lifespan - may be good, but may mean that people don't have insight into their poor health
Term
Self-perceived ability to handle day-to-day demands
Definition
mostly good and excellent - may indicate that peole don't want to admit having problems
Term
Self-perceived ability to handle unexpected problems
Definition
Most people rate themselves very good
Term
How does income affect perceived mental health?
Definition
low SS individuals are much more likely to perceive themselves as having poor mental health
Term
How can stress affect mental health?
Definition
can cause many problems over the long term - cortisol can shrink the hippocampus, leading to memory problems
Term
How does education interact with perceived mental health?
Definition
Positively correlates with good mental health
Term
How does social support affect perceived mental health?
Definition
People who live on their own without social support have much worse perceived mental health
Term
How does age affect perceived work-related stress?
Definition
People in younger age groups (before retirement) have more work stress
Term
mental health
Definition
the ability to strike a balance in all aspects of life
Term
mental illness
Definition
lack of balance; thinking, mood, and behaviour associated with distress and impaired functioning
Term
What characteristics are related to well-being and coping ability?
Definition
optimism, wisdom, generativity, hope, personal integrity
Term
What is the danger of labelling behaviours as 'abnormal' without examining the surrounding context?
Definition
Seemingly abnormal behaviours may actually be adaptive in the situation, and not beindicative of poor mental health
Term
What are some potential protective factors for mental health?
Definition

- Life events and situations: significant other (partner/mentor), avalability of opportunities, economic security

- community and cultural factors: sense of connectedness, attachment to networks, participation in community groups, strong cultural identity, access to support services, norms against violence

Term
What are some predictive factors for poor mental health?
Definition

- Life events and situations: abuse, transitions, loss, physical illness, low SES

 - community and cultural factors: isolation, discrimination, neighbourhood violence, poor living conditions, lack of support services

- individual factors: low intelligence, difficult temperament, chronic illness, poor social skills, low self-esteem

- family/social factors: experiencing rejection or neglect, lack of warmth, parent substance abuse, criminality, or mental disorder, family violence

 

Term
What is the problem with using the DSMIV to diagnose mental disorders
Definition
It does not account for differences of symptoms with age - mental illnesses will have different effects depending on the biological, psychological, and social forces which occur over the life-span
Term
In what ways (in general) might physical and psychological problems interact?
Definition
Physical problems may reflect underlying psychological problems - ex. change in appetite - or psychological problems may be caused by physical problems - ex irritability due to thyroid problems
Term
Principles of multidimensional assessment - 6 principles for assessing older adults
Definition

1. Age and fucntioning are not linearly related in clinical settings

2. It is necessary to recognize the influence of comorbidity in clinical settings

3. A major task in assessment is to distinguish normal from pathological processes

4. Clinical gerontologists should emphasize brief assessment

5. Assessment results should emphasize patient's strenghts, weaknesses and treatment

6. Multiple methods of assessment are optimal

Term
What for dimensions should be assessed when looking at mental health?
Definition

1. physical health: poor health can create mental problems

2. cognitive functioning: must distinguish between normative and abnormal changes

3. functional capacity: identify whether individuals have trouble with ADL or IADL

4. social Factors: the quality of one's social network affects mental health

Term
What are some factors that might bias mental assessment?
Definition

- negative biases about older people: ex. older people are likely to have Alzheimer's

- positive biases: ex. women aren't ever alcoholics

- environmental conditions: assessment may occur in non-ideal conditions - ex. a noisy emergency room

Term
What are the six primary methods of assessment of mental health?
Definition

clinical interview, self-report, report by others, psychophysiological assessment (ex. EEG, heat rate in response to stimulus), direct observation, and performance-based assessment

Term
What are the two general choices for treatment of mental disorders?
Definition
medical treatments and psychotherapy
Term

What is a potential danger of using medical treatment in older age groups?

Definition
Effective dosages change with age, and some medications won't work
Term
What are potential issues with using psychotherapy in older age groups?
Definition
Older adults are likely facing different developmental challenges than younger adults, this must be taken into account
Term
Mood disorder
Definition
when a disturbance in mood affects QoL and ADL - major depressive disorder, dysthymic disorder, bipolar disorder
Term
How does occurence of depression been observed to change over the life-span ?
Definition
Risk declines in middle-adulthood, but increases again in people over 75 -> evidence that it is significantly underdiagnosed in older adults
Term
How might depression interact with other disorders?
Definition
Twice as likely in people with diabetes; increases mortality after heart atttack; risk factor in stroke victims; high rates in people with dementing illness
Term
Why might bipolar disorder be underdiagnosed?
Definition
Many people with bipolar disorder are highly functioning and hide their disorder, even though it reduces their quality of life
Term
Dysphoria
Definition
Feeling 'down, or 'blue'; marked by extreme sadness, apathy, pessimissm, expressionlessness, withdrawl - the most prominent feature of depression
Term
Physical symptoms of depression
Definition
insomnia, changes in appetite, diffused pain, trouble breathing, headaches, fatigue, and sensory loss
Term
To be diagnosed with clinical depression, symptoms must not be transient, meeing...
Definition
Symptoms must last for at least two weeks, ruling out depression due to negative experiences
Term
What causes for depressive symtoms must be ruled out before diagnosis with clinical depression?
Definition
health problems, neurological disorders, medications, metabolic conditions, alcoholism
Term
How does clinical depression affect daily life?
Definition
could affect: ability to interact with others, carrying out domestic responsibilities, work/school
Term
What characteristics are common in older adults with depression?
Definition
female, unmarried, widowed, recently bereaved, experiencing sressful life events, lacking adequate social support
Term
What are high risk factors for depression?
Definition
Chronic illness, nursing home residency, requiring family caregivers
Term
Describe the relationship between gender and depression
Definition
Women are diagnosed as being depressed more than twice as often as men - this could be because women outlive men, making age related depression more likely, or because women are more likely to report depressive symptoms
Term
Depletion syndrome (depression)
Definition
The type of depression often found in older adults; symptoms are similar to classic depression, but dysphoria, guilt, and self-blame are absent - depletion syndrome increases risk with age, whereas risk for classic depression decreases
Term
What is a possible confound of the Beck Depression Inventory?
Definition
It includes assessment of physical symptoms, which may not be relevant when assessing older adults
Term
What scale provides a possible alternative to the Beck Depression Inventory for older adults?
Definition
The Geriatric Depression Scale
Term
Neurochemical factors in depression
Definition
ineffective use of serotonin and norepinephrine are linked to major depression
Term
Psychosocial causes of depression
Definition
Loss is the most common cause - not just bereavement, could be any kind of loss
Term
Behavioural and Cognitive-behavioural explanations for depression
Definition

Behavioural: people engage in fewer pleasant activities and derive less pleasure from them when dperessed

 

CBT: people who experience uncontrollable and unpredictable events may feel helpless, resulting in depression

Term
What are the three families of drugs used to treat depression?
Definition

1. SSRIs: lowest overall side effects, though linked to high levels of agitation - associated with high suicide rates

2. HCAs (heterocylcic antidepressants): most effective with younger and middle-aged people; older adults likely to take other medicaiton that interacts poorly, and they must be taken for about a week before any results, making compliance difficult

3. MAO (monoamine) inhibitors: inhibit MAO, a substance which interferes with transmisison of signals between neurons - less effective, and higher mortality risk, must be used with caution, only if the other two are not an option

Term
Treatments for bipolar disorder
Definition

Lithium: effectively controlls mood swings, but is not well understood - is a salt -> raises blood pressure and is dangerous for people with hypertension

- is linked to slower reaction time and impaired memory

Term
Electroconvulsive therapy (ECT)
Definition

- an effeective treatment for severe depression, especially long term depression

- has immediate effects, with few treatments needed

- side effects: loss of memory for the ECT and recent events, increased risk for heart attack

Term
Psychotherapy for depression: behaviour therapy
Definition

Attempts to alter current behaviour without addressing underlying causes - attempt to increase the amount of rewards/reinforcements people receive from the environment

- assign tasks to patient, ex. meet new people, join clubs

- instruct family members to ignore negative comments and encourage positive comments with rewards and praise

Term
Psychotherapy for depression: cognitive therapy
Definition

Attempts to alter the underlying maladaptive beliefs and cognitionns that cause dperession

- teaches people to recognise these thoughts and evaluate the self and world more realistically

- teaches people to change their basic beliefs about themseles responsible for negative thoughts - ex. belief that one is a failure, or unlovable

- review therapy and reminiscence: use memories of previous events and relationships to confront and resolve conflicts

Term
anxiety disorders
Definition
a group of conditions that are based on fear or uneasiness
Term
Four types of anxiety disorders
Definition

1. generalized: feelings of severe anxiety with no specific trigger

2. phobic: irrational fears of an object or circumstance

3. obsessive-compulsive: thoughts or actions performed repeatedly to lower anxiety

4. PTSD: a traumatic event is relived psychologically, and all stimuli associated with the even are avoided

Term
Common symptoms of anxiety disorders
Definition
dry mouth, sweating, dizziness, upset stomach, diarrhea, headaches, sensation of lump in the throat, insomnia, hyperventilation, chest pain, choking, frequent urination
Term
Why are anxiety disorders difficult to diagnose in older adults?
Definition

- chronic conditions and medications may mimic or coexist with anxiety symptoms

- anxiety may be an apporpriate response: may feel helpless to to actual or potential loss of control/mastery

Term
Drug therapy for anxiety disorders
Definition

benzadiazepines - ex. valium, librium, serax, ativan ; the most comon and widely prescribed medications for anxiety

 

must be careful with older adults -> lower effective dosage, more potential for side effects, side effects can mimic dementia, potential for addiction

Term
Psychotherapy for anxiety
Definition

The treatment of choice for most anxiety disorders:

- relaxation training, substituting rational for irrational thoughts, gradual exposure to images or real situations that generate anxiety

- CBT can succesfully treat generalized anxiety, usually requiring only a few sessions with no long-term side-effects

Term
How do age and anxiety disorders interact?
Definition
More common in people aged 15-64 than in people aged 65+
Term
Schizophrenia
Definition

- Severe impairment of thought process, distorted perceptions, loss of touch with reality, distorted sense of self, abnormal motor behaviour

- create loose associations among conversation topics, lose conversation threads, hear voices, maintain false beliefs

- identity confusion, social withdrawl, difficulty working toward a goal

Term
What is the difference between delusions in paranoid disorders and schizophrenia?
Definition
Hallucinations do not usually occur in paranoid disorders
Term
What is the likley age of onset for schizophrenia
Definition
between 15 and 25
Term
how to schizophrenia symptoms differ by age?
Definition
Older adults have less thought disorders and flattening of emotions
Term
Describe the trajectory of schizophrenia over a lifespan
Definition
Likely to improve with age: first ten years marked by cyclical remission and worsening, later in life symptoms lesson in over 1/2 patients - may be due to rebalancing of neucleotides with age
Term
Treating schizophrenia
Definition

- emphasize medication: use antipsychotics that affect the dopamine system

- do not responde well to psychotherapy: clients often have difficulty trusting therapists - if paranoia is overcome, some evidence that supportive therapy is effective

Term
Gender differences in personality disorders
Definition
women are much more likely to have personality disorders
Term
Common symptoms of personality disorders
Definition

- difficulty getting along with other people, being hostile, manipulative

- behaviour which deviates markedly from society's expectations

- thoguht, emotion, interpersonal relationships and impulse control might be affected

- behaviour patterns which are inflexible and occur over a broad range of situations

- the patter exists over a long duration, beginning in childhood or adolescence

Term
Suicide risk by age and gender
Definition

Risk increases with age (but declines between 55 - 84), especially high risk in very old adults - men are at a higher risk than women throughout life

- more women are hospitalized for attempted suicide: their methods tend to be less voilent, ex. drug overdose

Term
How does substance abuse change with age?
Definition

younger and older adults have issues with different drug types

- younger adults: abuse illegal drugs

- older adults: abuse prescription or over the counter (OTC) drugs

(with the exception of alcohol, which is abused accross age groups)

Term
Four symptoms of alcohol abuse
Definition

1. craving

2. impaired control

3. physical dependence

4. tolerance

Term
why is alcohol abuse more problematic for older adults than younger adults?
Definition
older adults become increasingly sensitive to alcohol - decline in lean boyd mass, decreased water content, decrease in gastric alcohol dehydrogenase enzyme, decline in liver and kidney functions, and potential interaction wiht prescription and over the coutner drugs
Term
Misue of ____ results in 10% of hospitalization of older adults
Definition
Medications
Term
Cohort effects in alcohol use of older adults
Definition
older men are more likely to abuse alcohol, which may be a cultural phenomenon
Term
Dementia
Definition

- characterized by cognitive and behavioural deficits involving some form of permanent damage to the brain

- severe and gradual cognitive decline

- not caused by toxic substances or infection

Term
Prevalence of dementia in older adults
Definition
Overall, 8% of older adults have some form of dementia, it is especially likely in adults 85 and over
Term
Alzheimer's disease
Definition
the most common form of progressive, degenerative, and fatal dementia; accounts for as many as 60% if akk cases of  dementia
Term
Neurological changes in Alzheimer's disease
Definition

- rapid cell death in hippocampus, cortex, basal forebrain

- neurofibrillary tangles

- neuritic plaques -> beta-amyloid protein

Term
Symptoms of Alzheimer's
Definition

- disorientation in time and space

- difficulties in word finding and communication

- declines in hygene and self-care skills

- inapporpriate social behaviour and changes in personality

Term
Sundowning
Definition
phenomenon observed in some Alzheimer's patients in which symptoms are worse in the evening
Term
Early stages of Alzheimer's
Definition

mild cognitive impairment, self-reported significant memory impairment and disability

- before symptoms, plaques and tangles can be detected in areas involved in thinking and planning, and learning and memory

Term
mild-moderate stages of Alzheimer's
Definition

- can spread anywhere, but commonly affects speech and language; sense of body placement may be affected; may have difficulty recognizing people

- develop problems with memory and thinking serious enough to interfere with work or social life

- may get confused, have trouble handling money, expressing or organizing thoughts

- many people are first diagnosed in this stage

Term
severe Alzheimer's
Definition
Loss of all ability to function; most of the cortex is seriously damaged, the brain shrinks dramatically, individuals lose their ability to communicate, recognize faimily and loved ones, and take care of themselves
Term
What 4 genes are predictive of Alzheimer's?
Definition
APP, PS-1, PS-2, ApoE
Term
Autosomal dominant patter (Alzheimer's)
Definition

only one gene in one parent is necessary to produce a disease -> 50% chance that a childof an affeted parent will have the disease

- APP, PS-1, and PS-2 are autosomal dominant for Alzheimer's, but account for only 10% of Alzheimer's cases

Term
ApoE, allele polymorphisms
Definition

ApoE is only a risk factor, it increases the risk of Alzheimer's already present

 

3 different allele polymorphisms for ApoE:  ε2, ε3, & ε4

- one ε4 allele -> three times more risk for Alzheimer's

- 2 ε4 alleles -> nine times more risk

- ApoE exerts the strongest effect on people between the ages of 66 and 75

Term
Changes to the brain associated with Dematia of the Alzheimer's Type (DAT)
Definition

- cortex shrivels -> loss of nueronal tissue, damaging areas involved in thinking, planning and remembering; especially in the hippocampus

- fewer cells and connections

- neuritic plaques and tangles

- ventricles (fluid-filled spaces within the brain) grow larger

 

(DAT because Alzheimer's can only be diagnosed post-mortem)

Term
Progression of Alzheimer's over time
Definition

Earliest Alzheimer's: changes may begin 20 years or more before diagnosis

Mild to moderate: generally lasts between 2 and 10 years

Severe: may last from 1-5 years

Term
What forms of dementia are autosomal dominang?
Definition
Pick's disorder, Huntington's, and Alzheimer's
Term
Pick's disorder
Definition
stems from a link between Alzheimer's and Down syndrome -> almost all people with Down syndrome develop Alzheimer's like symptoms after age 40 -> likely genetic link between the diseases via chromosome 21
Term
At what age do genetic factors cause a increased risk for Alzheimer's
Definition

Not likely to have an effect until around 80

- at 80, first degree relatives of those with Alzheimers have a 25% risk, compared to 6% in the normal popluation 

 

(much lower than the genetic risk for other disorders such as Huntington's)

Term
Can people be screened for genetic predisposition for Alzheimer's
Definition
Yes, but we currently can only identify 5% of individuals with a genetic predisposition
Term
Three areas of possible risk for Alzheimer's
Definition

Family history: hereditary risk

external environment: possible water, soil, or air pollution, could be aluminum

internal environment: could be a slow virus, imbalance of chemicals, or a problem with the immune system

Term
Alzheimer's prevention
Definition
Currently no way to prevent Alzheimer's; may be behaviours that reduce risk - staying socially and mentally active, adopting a healthy lifestyle, protecting the head from injury - uness a cure is found, the number of people with Alzheimer's is set to double within the next generation
Term
Medical treatments for Alzheimer's
Definition

- Alzheimer's believed to be related to choline acetyltransferase deficit, which triggers the synthesis of acetylcholine - medications can counteract this deficit - recommended to patients who score 10-24 on the Mini-Mental Status Examination

- norepinephrine deficits also believed to be involved, but no medication is currently available

- anitpsychotic medications may be effective, but may cause too many negative side-effects

- antiddepressants and sedatives are also used

Term
Caregiving as a 'career path'
Definition

- anticipatory loss of loved one's personality/self

- progressive loss of memory and functioning 

- acknowledged loss of the loved one as he/she was

-> can take a path of coping and acceptance or denial

Term
Key steps to behavioural strategies for taking care of people with Alzheimer's
Definition
- obtain accurate information about the disease; involve the patient as much as possible; identify the primary caregiver; reassess the living situation; set realistic goals
Term
What needs must be addressed as a caregiver for a person with Alzheimer's
Definition

- difficulty dressing, bathing, grooming

- nutritional needs

- correct interpretation of personality and sexual changes

- sleeplesness

- wandering

- incontinence

Term
Alzheimer's: establishing competence in every day activities
Definition

- may have trouble managing money or driving which can cause family conflict -> important for people with Alzheimer's to make their own decisions about transfer of responsibilities

Term
Differential Reinforcement Behaviour (DRI)
Definition
treatment for Alzheimer's in which problem behaviours disrupted by rewarding appropriate behaviours which can't be done at the same time - easily learned, no side effects, as effective or more effective than medication
Term
Respite care and adult day care
Definition

respite care: allows caregivers to get away for a time

- in home: for brief periods - ex. running errands

- residential placement: for longer periods - ex. a weekend

adult day care: placement and programming for frail older adults

- helpful for dealing with adults with behaviour problems -> reduces amount of time needed to deal with behaviour problems and their frequency

-> these systems are generally only used when the family's informal system breaks down

Term
Vascular Dementia
Definition

- CVAs result in disruption of blood flow (an infarct) due to hemorrhage or blockage 

-  a series of small CVAs results in the global decline in cognitive ability

- 2nd leading cause of dementia in Canada

- stepwise rather than gradual decline

- symptom patter is highly variable

- diagnosis: imaging and review of history of CVAs

Term
Lewy Body Dementia
Definition

- caused by abnormal structures in the brain called lewy Bodies - composed of protein alpha synuclein

- progressive loss of language, meory, and higher order reasoning, similar to Alzheimer's, but more rapid

- no cure, but can treat accompanying psychotic symptoms and depression

Term
Parkinson's
Definition

Results in a cluster of characteristic motor problems: slow walking, stiffness, difficulty getting in and out of chairs, slow tremors

- caused by deterioration of neurons in the midbrain that produce dopamine

- symtpoms greatly alleviated with L-Dopa

14-40% will develop dementia -> commonly associated with Lewy Body formation

Term
Huntington's Disease
Definition

- Autosomal disorder that begins between 35 and 50

- involuntary flicking movements of arms and legs, inability to sustain motor acts, prominent psychiatric disturbances - ex. hallucinations paranoia, and depression

- personality changes, swings from apathy to manic behaviour

- cognitive impairments appear late, and onset is very gradual

- associated with GABA and substance P definciency

- antipsychotic medications are used, but are only partially effective

Term
Alcohol Dementia Complex
Definition

Wernicke-Korsakoff's syndrome: major loss of memory and cognitive functioning due to chronic thiamine deficiency

- treatable if vitamine deficiency is detected early, and alcohol consumption ceases

Term
Creutzfeld-Jakob Disease (CJD)
Definition

loss of neurons and degeneration of nerve cell membranes result in small holes in the brain

- rapid decline after onset: memory loss and mood swings

- later: jerky and unstready movements

- unique because it can be both transmitted and inherited: believed to be caused by an abnormal form of prion protein (PrP)

- 'mad cow disease' is a variant of CJC

Term
AIDS dementia complex (ADC)
Definition

- predictable component of AIDS: protein gp 120 - a byproduct of HIV - is responsible for death of neurons

- early symptoms: inability to concentrate, difficulty with complex sequential mental tasks, memory loss in tasks demanding concentration, clumsiness and weakness in arms and legs, apathy, loss of spontaneity, depression, social withdrawl, personality change 

- later symptoms: continued deterioration of motor skills and cognitive performance, incontinence

- terminal phase: bedridden, vacant stare and minimal social and cognitive interaction 

Term
Delirium
Definition

A disturbance of consciousness and change in cognition that develops over a short period of time

- difficulty with attention, memory, orientation, and language

- can affect perception, the sleep-wake cycle, mood, and personality

- rapid onset, and can change rapidly in symptoms/severity over a day

Term
causes of delerium
Definition

medical conditions, medical side effects, intoxiation, withdrawl, toxins

- those with underlying dementia are vulnerable

- rare in normal populations over 55, but occurs in up to 50% of postoperative patients

Term
Assessment and treatment of delirium
Definition

important to distinguis delerium from depression and dementia

- severity is related to the underlying problem

- often accompanied by misinterpretations of the environment and confusion -> best alleviated through reassurance by family and friends

- can be cured in most cases if the cuase is identified, but can be fatal or result in permanent brain damage

Term
B = f(P,E)
Definition
Equation for person environment interactions: behaviour is a function of the interaction between person and environment
Term
Competence
Definition
The theoretical upper limit of a person's capacity to function
Term
5 domains of competence
Definition
biological health, sensory-perceptual functioning, motor skills, cognitive skills, and ego strength
Term
Environmental press
Definition
the demand that an environment places on a person -> physical, interpersonal, or social
Term
Adaptation level
Definition
points at which competence and environmental press are in balance, allowing for normal behaviour and affect
Term
Congruence model
Definition
people with particular needs search for the environments that best suit them 
Term
according to the congruence model, what are three ways environmental options can be limited?
Definition

1. Environmental characteristics are restricted

2. Personal freedom is limited

3. One believes they have limited freedom

Term
Stress and coping framework
Definition

applies Lazarus' stress and coping framework to the understanding of the interaction between older adults and the environment

- One's situation and surroundings are evaluated for potential threats - things can be viewed as harmful, beneficial or irrelevant

- older adults have greater vulnerability to social and physical hazardm making them more likely to view situations as threatening

Term
The loss continuum concept
Definition

View of aging as a progressive series of losses that reduce one's social participation

- children leaving, loss of social role, loss of income, death of spouse, close friends, relatives, loss of sensory acuity, loss of mobility

- as losses are sustained, remaining connections become more important -> the immediate neighbourhood becomes of high value to an older adult without the ability to go beyond a 1 block radius from home

Term
2 important themes in assessing an environment
Definition

1. the focus must be on the interaction between the person and the environment, not one or the other

2. No one environment meets everyone's needs

Term
everyday competence
Definition

a person's potential to perform a wide range of activities considered essential for independent living - not just ADL and IADL

- involves the person's physical, social, and psychological functioning

Term
antecedents, components, mechanisms, and outcomes of everyday competence
Definition

antecedents: individual and sociocultural factors which influence contextual components

contextual components: the particular domains of competence

mechanisms: factors which moderate the way in which competence is expressed

outcomes of everyday competence: psychological and physical well-being

-> health outcomes of one episode of everyday competence become an antecedent for the next

Term
Why are nursing home rates lower in the US than other industrialized countries?
Definition
Residency in nursing homes is not covered by government funded health insurance
Term
Independent or assisted living
Definition

- the 'next step' after independent living

- meant to maintain independence with some level of support - ex. meals, housekeeping, laundry

- cost is based on the amount of services used

- most share the following key characteristics: a home like atmosphere suited to people with mobility and physical problems (barrier free), private lockable rooms, furnished by tenants, regular light housekeeping and laundry

Term
Retirement homes in Ontario
Definition

residential complex with one or more rental units of living accomidation

- occupied by persons 65+

- occupied by at least six people other than the operator

- makes at least 2 care services set out in the Act available directly or indirectly

- residence pay for accomodation and care services -> everyone gets care

- amount of care is determined by cost

Term
The Retirement Homes Act, 2010
Definition

- Creates a regulartory authority with the power to licence homes and conduct inspections and enforce penalties 

- Establishes manditory care and safety standards, and requires emergency plans, infection control and prevention programs, assessment of care needs and care planning, police backround checks and training for staff

- Establishes residents' rights that include the right to know the true cost of care and accommodation, zero tolerance of abuse or neglect

Term
As of 2012 the Retirement Homes Regulatory Authority requires that...
Definition

all retirement homes apply for licence in order to operate in Ontario

- residents' Bill of Rights must be posted in every licensed home

- home operator's duty to protect residents from abuse and neglect

- staff training on abuse, fire prevention and safetty, and whistle blowing protections

- further protections for seniors will come into force in phases up to January 1, 2014

Term
Resident's Bill of Rights includes the right to:
Definition

- participate fully in care decisions

- not be restrained

- privacy and dignity

- raise concerns without fear of reprisal

Term
Long-term care facilities (nursing homes)
Definition

- retirement homes are generally private facilities, nursing homes cannot be run privately

- protective, supervised environments for people who need 24 hour care

- meals, assistance, nursing care/supervision and medical management 24/7

hel with day-to-day living tasks (ex. bathing and dressing)

- social recreation programs

Term
Who is likely to live in long-term care?
Definition
85+, female, recently admitted to the hospital, lives in retirement housing, unmarried/living alone no children or siblings for support, some cognitive impairment, one or more problems with IADL
Term
Long-term care facilities and the congruence approach
Definition

person well-being depends not just on the facilities, but on the congruence of the person's needs and the ability of the facility to meet those needs

- 80% of dependent behaviours of residents are performed because of compliance with staff, not actual dependence

Term
Moo's Approach
Definition

Multiphasic Environmental Assessment Procedure (MEAP) scale evaluates facilities in the following 4 aspects:

1. physical and architectural

2. organizational and administrative staff and policies

3. supportive characteristics of staff

4. social climate

- enables us to measure and examine separate dimensions of the person-environment interation independently

Term
Is the medical model for nursing homes the best?
Definition

- people don't want their home to feel like a hospital

- "nursing home resident" and "patient" have negative connotations

- being overly helpful may actually harm the residents by making the more dependent than they need to be

- strict routine is detrimental to well-being

Term
How can long-term care facilities be made more home-like?
Definition

- include resident in decision making as much as possible

- establish continuity between nursing home and and home -> bring in familiar objects and furniture

- make living in the facility a positive experience

Term
Patronizing and infantalizing speech
Definition

- patronizing: slower, exaggerated intonation, higher pitch, increased volume, closed-end questions, simplified vocabulary and grammar

- infantalization or baby talk: unwarranted use of first names or terms of endearment, simplified expressions, short imperatives, assumption of poor memory, cajoling for compliance

Term
Communication enhancement model
Definition
recognize individual cues, modify communication to suit individual needs and situations, appropriately address health and social problems, empower older adults and health care providers
Term
How might residents respond to patronizing speech?
Definition
Assertively, with humour, or passively 
Term
Patient Self Determination Act (PSDA)
Definition
Law which mandates that all facilities that receive medcare or medicaide  comply with requireements concerning advance care planning (US)
Term
Power of attorney and advance care planning
Definition
family members will often attempt to obtain permanent power of attorney if they don't like a person's decisions or don't think they are cognitively capable of making thejm -> very difficult to obtain
Term
Action research paradigm; three basic principles
Definition

1. Research is done with people rather than on or for people

2. understanding detailed contextual factors is important as understanding the general picture

3. produce knowledge that helps people understand and solve problems

-> goal to generate knowledge that is setting specific and problem focused

Term
The primary goal of action research in environmental gerontology is to...
Definition
improve the quality of life of older adults through collaborative knowledge building that informs design and environmental modification of the social and phsyical living arrangements
Term
Brewster Village, five principles for creatign a non-institutional environment 
Definition

1. regulate sensory and social stimulation - not too much or too little

2. creat clusters of 13-14 residents

3. provide spaces for social interaction

4. facilitate spatial and social orientation

5. creat secure outdoor spaces

Term
Problems identified in Meadowlark Hills
Definition
lack of spatial hierarchy (ex. public areas were close to private areas), lack of sufficient transitional or semi-private spaces between public and private areas
Term
Meadowlark Hills,  two remodelling goals
Definition

1. increase the residents' ability to identify with a family unit by grouping resident rooms into small household clusters

2. enhance resident autonomy and control by establishing the full range of spatial hierarchy within the facility

Term
3 adaptive mechanisms for aging, the SOC model
Definition
Selection, optimization, compensation
Term
What is the difference between successful and usual aging?
Definition
In successful aging one: avoids disease, is engaged with life, maintains high cognitive and physical function - but, highly subjective, involves reaching desired goals with dignity and as independently as possible
Term
Optimal aging, designing interventions
Definition
important to understand the goals of the person - ex. training older adults to use ATMs must adress any fears they have such as difficulties understanding instructions or problems with vision
Term
Core assumptions of the SOC model
Definition

- aging is a complex process

- involves increasing specializatin

- influenced by factors unrelated to age

Term
outcomes of the SOC model that are visible signs of succesful aging:
Definition

- enhanced competence

- quality of life

- future adaptations

Term
Key strategies for optimal aging
Definition
sound health habits; good habits of thought (optimism, staying cognitively active); maintaining a social network and staying engaged with others; maintaining good economic habits to avoid financial dependency
Term
Disease prevention: primary prevention
Definition
preventing a disease from occuring
Term
Secondary prevention
Definition
Early intervention after the disease occurs
Term
Tertiary prevention
Definition
avoiding complications, managing pain, sustaining life through medical procedures including surgery
Term
Quaternary prevention
Definition
improving functional capacity for those with chronic conditions
Term
Lifestyle factors in disease prevention, staying fit
Definition

- people of all ages can benefit from moderate exercise - walking is one of the most succesful and popular ways for older adults to get exercise

-  psychosocial outcomes: improvements in self-efficacy

Term
Suggestions for exercise in older adults
Definition

1. set a time limit and end if you go over

2. exercise large muscles before small ones

3. change your workout plan every 12-14 weeks

4. treat your time in the gym as if it is the most important time of the day

5. make workouts early in the week the hardest, and make workouts at the end the easiest

6. take at least one day off a week

7. change cardiovascular equipment used every time

8. always monitor heart rate

9. plan your workout ahead of time

10. efficiency is more important than length - keep number of reps in mind

Term
Lifestyle factors for disease prevention, eating right
Definition

several modifications for eating habit recommendations for older adults: 

- older adults need fewer calories because of slowed metabolisms

- higher risk for dehydration - should drink more water

- need more protein

Term
BMI
Definition
Ration of body mass to height - related to total body fat
Term
Why is technology important for older adults?
Definition

- government, social agencies, service providers, businesses all shifting to intenet

- allows richer social networks

- valuable for people who are restricted by mobility problems

- not having access may put older adults at a disadvantage in terms of independent living

Term
Ontario, Aging in Place, goals
Definition

- support everyday cognition

- support social connectedness

- respond to crisis if necessary

- provide long term monitoring if necessary

Term
Changes wiht age that affect technology usability
Definition

- distractibility

- vision

- hearing

- dexterity

- memory

Term
Jitterbug cell phone
Definition

designed with older adults in mind, features include:

- soft ear cushion, loud, clear sound, bright screen, large text, yes/no buttons, large backlit buttons, '0' reaches jitterbug operator

Term
Med-eMonitor
Definition

Time and date stamped storage compartments for medication

- indicates which medication and how to take

- alerts family or care provider when medication is missed

- improved independence: family only contacted when medications are missed

- secure health care provider access

Term
Online medicine cabinet
Definition

- uses face-recognition

- reminds you to take medicine

- knows if you take the wrong bottle out

- knows if it's the wrong time

- moitors vital signs

- provides progress charts

- shares information with doctor

- can make appointments

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