fondamenti di prevenzione e riabilitazione geriatrica · definitions of old agedefinitions of old...

Fondamenti di Prevenzione e Riabilitazione geriatrica

Fondamenti di Prevenzione Fondamenti di Prevenzione e Riabilitazione geriatricae Riabilitazione geriatrica

The ElderlyThe ElderlyThe Elderly

First of allFirst First ofof allall

Definitions of Old AgeDefinitions of Old AgeDefinitions of Old AgeMost definitions = having lived a long timeAged: defined as old or advanced in years Aging: process of growing older or more mature

We all age, but not all of us are oldin years, roles, behaviors, health,

or physical limitationsAging is an ongoing developmental processthat begins at conception and ends in death

Most definitions = having lived a long timeAged: defined as old or advanced in years Aging: process of growing older or more mature

We all age, but not all of us are oldin years, roles, behaviors, health,

or physical limitationsAging is an ongoing developmental processAging is an ongoing developmental processthat begins at conception and ends in deaththat begins at conception and ends in death

GerontologyGerontologyGerontology

The study of agingThe study of aging

GeriatricsGeriatricsGeriatricsThe biomedical science of old age

and the application of knowledge related to thebiologic, biomedical, behavioral,

and social aspects of aging to the prevention, diagnosis, treatment, and

care of older persons

The biomedical science of old ageand the application of knowledge related to the

biologic, biomedical, behavioral, and social aspects of aging

to the prevention, diagnosis, treatment, and care of older persons

Modern situation: aged societyModern situation: aged society

Two approaches to agingTwo approaches to aging

passive longevity

anti-aging

passive passive longevitylongevity

antianti--agingaging

Passive longevityPassive Passive longevitylongevityEvidence:

Aging boom or longevity revolution

Due to: Decline in infectious and parasitic diseasesImproved care services

Evidence: Aging boom or longevity revolution

Due to: Decline in infectious and parasitic diseasesImproved care services

Passive longevityPassive Passive longevitylongevityPrognosis

substantial increase of chronically ill bedridden persons with need of home and institutional care

large problems in the conditions of information society

and changed demography situation

Prognosissubstantial increase of chronically ill bedridden persons with need of home and institutional care

large problems in the conditions of information society

and changed demography situation

The main questionThe main question

How to make longevityeffective?How to make longevityeffective?

Anti-aging paradigmAntiAnti--agingaging paradigmparadigm

Goal: slowing the rate of aging and finding the ways of effective aging

Effective aging: conservation of both physical and mental capacities for the whole life extended period

Goal: slowing the rate of aging and finding the ways of effective aging

Effective aging: conservation of both physical and mental capacities for the whole life extended period


Promisesallows people to be effectively involved in work,

diminish the need for home or institutional care, therefore coinciding to the demands of

information society

Promisesallows people to be effectively involved in work,

diminish the need for home or institutional care, therefore coinciding to the demands of

information society


Convergent technologiesnano - bio - info - cognitiveConvergent technologies

nano - bio - info - cognitive

Gerontotechnologies

GerontotechnologiesGerontotechnologies

biotechnologies + nanotechnologiesbiotechnologies + nanotechnologiesstem cell therapy, therapeutic cloning, gene

engineering, investigations related to human genome and proteomics

the optimized care of our organisms and the extended life duration


New information technologies and various strategy are used to create more convenient society and adaptive environment

Intelligent transportation system and barrier free environment for elderly and disabled persons

New information technologies and various strategy are used to create more convenient society and adaptive environment

Intelligent transportation system and barrier free environment for elderly and disabled persons


However, nowadays, such technologies are mostly used

not in the anti-aging context, but otherwise

in the context of adaptation of passive elderly

However, nowadays, such technologies are mostly used

not in the anti-aging context, but otherwise

in the context of adaptation of passive elderly


Is this really enough?Is this really enough?

an active approach to extended longevity

Against the idle brainAgainstAgainst the the idleidle brainbrain

new technologies would be involved in the stimulation of both mental and physical activity

during aging and extended life

new technologies would be involved in the stimulation of both mental and physical activity

during aging and extended life

«against the idle brain»


new technologies makes people too passive in their daily activities and too hopeful on any external effortsmany neurodegenerative disorders seem to be a payoff for the idle brain

new technologies makes people too passive in their daily activities and too hopeful on any external effortsmany neurodegenerative disorders seem to be a payoff for the idle brain

Against the idle brainAgainstAgainst the the idleidle brainbrainBiotechnologies application in the treatment

of neurodegeneration and dementiaBiotechnologies application in the treatment

of neurodegeneration and dementia

complex programs of rehabilitation which rely on active brain

with potential of self-restoration depending on high mental and physical activity


New reasonable ways of brain activity stimulation

and self-restorative capacitiesand/or the search for

mental modulation of immune response

New reasonable ways of brain activity stimulationbrain activity stimulation

and selfself--restorative capacitiesrestorative capacitiesand/or the search for

mental modulationmental modulation of immune responseof immune response

Against the idle brainAgainstAgainst the the idleidle brainbrainThe goal

Brain controlling the process of aging and effective in continuous information processing

in the information societyMeans

the spirit approach of traditional techniques should be converted into modern situation

and be applicable as a part of the whole anti-aging approach,

including prospective bio- and nanotechnologies

The goalBrain controlling the process of aging

and effective in continuous information processing in the information society

Meansthe spirit approach of traditional techniques should be converted into modern situation

and be applicable as a part of the whole anti-aging approach,

including prospective bio- and nanotechnologies

Anti-aging-based health promoting system for longevity

society should include:

NOT only the creation of adaptive environment(with ambient technologies), e.g. social robotics

BUT rather stimulating environmentprovocating application of some aspects of

traditional longevity techniques and mind-body therapy together with new anti-aging therapies

and technological implementations.

AntiAnti--agingaging--based health based health promoting system for longevity promoting system for longevity

society should include:society should include:

NOT only the creation of adaptive environment(with ambient technologies), e.g. social robotics

BUT rather stimulating environmentprovocating application of some aspects of

traditional longevity techniques and mind-body therapy together with new anti-aging therapies

and technological implementations.

Physical Exam Changes with Normal Aging

Physical Exam Changes with Normal AgingEyes - decreased lubrication and visionEars - sensoneural lossOther Senses – taste and smell deficits, neuropathiesHeart - decreased output, dysrhythmiasLungs - increased rigidityMusculoskeletal system - osteoporosis, kyphosisSkin - decreased moisture & turgorDigestive system - decreased motilityGenitourinary system - uroincontinence

Eyes - decreased lubrication and visionEars - sensoneural lossOther Senses – taste and smell deficits, neuropathiesHeart - decreased output, dysrhythmiasLungs - increased rigidityMusculoskeletal system - osteoporosis, kyphosisSkin - decreased moisture & turgorDigestive system - decreased motilityGenitourinary system - uroincontinence

Common Geriatric Problems –The “I”s of Geriatrics

Common Geriatric Problems –The “I”s of Geriatrics

ImmobilityInstabilityIntellectual ImpairmentIsolation (depression)IncontinenceImpotenceImmunodeficiencyInfection

ImmobilityInstabilityIntellectual ImpairmentIsolation (depression)IncontinenceImpotenceImmunodeficiencyInfection

Common Geriatric ProblemsCommon Geriatric Problems

Inanition (malnutrition)Impaction (irritable bowel syndrome)Iatrogenesis (hazards of age)InsomniaImpairment of: vision, hearing, taste, smell, skin integrity, communication and convalescenceImpecunity (impoverishment)

Inanition (malnutrition)Impaction (irritable bowel syndrome)Iatrogenesis (hazards of age)InsomniaImpairment of: vision, hearing, taste, smell, skin integrity, communication and convalescenceImpecunity (impoverishment)

Biologic and Physiologic Factors in Aging

Biologic and Physiologic Factors in Aging

Despite intense interest in longevity by so many cultures, scientists do not agree on precisely why or how humans age Knowledge of the underlying mechanisms of aging is critical to develop a system that considers the special needs and health conditions of an aging population

Despite intense interest in longevity by so many cultures, scientists do not agree on precisely why or how humans age Knowledge of the underlying mechanisms of aging is critical to develop a system that considers the special needs and health conditions of an aging population

Theories of AgingTheories of AgingTheories of Aging

Theories of aging ranged from the concept of purely genetic control of aging to environmental assaults that result in deathMost experts now believe that aging is not explainable by a single theory, but represents many processes working simultaneously

Theories of aging ranged from the concept of purely genetic control of aging to environmental assaults that result in deathMost experts now believe that aging is not explainable by a single theory, but represents many processes working simultaneously

Error TheoriesError TheoriesError Theories

Based on the belief that the rate of aging is directly related to the organism’s rate of living and that external events cause damage to the organism’s cellsThe damage from all causes accumulates over time, resulting in cellular, molecular, and organ malfunction or errors

Based on the belief that the rate of aging is directly related to the organism’s rate of living and that external events cause damage to the organism’s cellsThe damage from all causes accumulates over time, resulting in cellular, molecular, and organ malfunction or errors

Programming TheoriesProgramming TheoriesProgramming Theories

Based on belief that aging is programmed into cells and is internal to the organismThese theories postulate that aging, like prenatal development and menopause, is the natural and expected result of a purposeful sequence of events written internally into gene structure

Based on belief that aging is programmed into cells and is internal to the organismThese theories postulate that aging, like prenatal development and menopause, is the natural and expected result of a purposeful sequence of events written internally into gene structure

Physiologic Changes in Body SystemsPhysiologic Changes in Body Systems

Nervous SystemNervous SystemEssential to know that in the absence of disease, most aged people remain alert, with functional intellectual capability, sound judgment, creativity Only modest impairments in memory and learning after age 70 in most people who are relatively free from major diseaseChanges may result in a progressive slowing of responses, problems with short-term memory, and altered learning

Essential to know that in the absence of disease, most aged people remain alert, with functional intellectual capability, sound judgment, creativity Only modest impairments in memory and learning after age 70 in most people who are relatively free from major diseaseChanges may result in a progressive slowing of responses, problems with short-term memory, and altered learning

Nervous SystemNervous SystemShort-term memory loss frequently a concern of the aged; long-term memory may remain intactMay not remember planned daily events, but easily recall young adulthood experiences Mild cognitive impairment (MCI)

Persistent memory problems with otherwise normal cognitive function40% will develop Alzheimer’s disease within 3 years; others do not progress to more serious impairment

Short-term memory loss frequently a concern of the aged; long-term memory may remain intactMay not remember planned daily events, but easily recall young adulthood experiences Mild cognitive impairment (MCI)

Persistent memory problems with otherwise normal cognitive function40% will develop Alzheimer’s disease within 3 years; others do not progress to more serious impairment

Nervous SystemNervous System

Temperature regulationLow tolerance for extremes in temperature

Pain perception and tactile sensationSome researchers have found dulling of pain and tactile sensation in older persons, but these results are not consistent

Temperature regulationLow tolerance for extremes in temperature

Pain perception and tactile sensationSome researchers have found dulling of pain and tactile sensation in older persons, but these results are not consistent

Respiratory SystemRespiratory System

Forced vital capacity, vital capacity, and maximum breathing capacity thought to decrease progressively with aging

Atrophy/weakening of respiratory muscles Increase in the antero-posterior diameter of the chest as a result of kyphosisVertebral loss of calciumCalcification of costal cartilage

Forced vital capacity, vital capacity, and maximum breathing capacity thought to decrease progressively with aging

Atrophy/weakening of respiratory muscles Increase in the antero-posterior diameter of the chest as a result of kyphosisVertebral loss of calciumCalcification of costal cartilage

Respiratory SystemRespiratory SystemLoss of elastic tissue surrounding alveoli and alterations in pulmonary circulation result in decreased diffusion across the alveolar-capillary membranePulmonary blood flow

Decreases because of a reduction in cardiac outputPulmonary diffusion

Thickened capillary walls, and fewer capillaries surrounding the alveoli, cause impaired gas exchange

Loss of elastic tissue surrounding alveoli and alterations in pulmonary circulation result in decreased diffusion across the alveolar-capillary membranePulmonary blood flow

Decreases because of a reduction in cardiac outputPulmonary diffusion

Thickened capillary walls, and fewer capillaries surrounding the alveoli, cause impaired gas exchange

Respiratory SystemRespiratory SystemExertional dyspnea

Shortness of breath with exertionA frequent complaint with the older adult Ability to perform prolonged strenuous work decreases with aging

Lung disease: acute or chronicPoses a threat to the older adultPulmonary secretions handled less effectively

Exertional dyspneaShortness of breath with exertionA frequent complaint with the older adult Ability to perform prolonged strenuous work decreases with aging

Lung disease: acute or chronicPoses a threat to the older adultPulmonary secretions handled less effectively

Cardiovascular SystemCardiovascular System

Resistance to blood flow in many organs increases as people ageAging results in the development of whitish patches, fibrosis, and sclerosis in the endocardiumThe heart becomes more rigid and myocardial contractility is compromised

Resistance to blood flow in many organs increases as people ageAging results in the development of whitish patches, fibrosis, and sclerosis in the endocardiumThe heart becomes more rigid and myocardial contractility is compromised

Cardiovascular SystemCardiovascular SystemCoronary blood flow may be reduced by as much as 35%, because of changes in the vessels Valvular rigidity and incomplete closure of aortic and pulmonic valves may result in murmurs Heart cells have a decreased capacity to use oxygen, which may help explain the aged person’s reduced tolerance for physical workPulse increases and the pulse pressure widens

Coronary blood flow may be reduced by as much as 35%, because of changes in the vessels Valvular rigidity and incomplete closure of aortic and pulmonic valves may result in murmurs Heart cells have a decreased capacity to use oxygen, which may help explain the aged person’s reduced tolerance for physical workPulse increases and the pulse pressure widens

Cardiovascular SystemCardiovascular SystemDecrease in resting cardiac outputAmount of blood pumped each minute

Between ages 25 and 65, resting cardiac output falls 30% to 40% Reduced cardiac output reflects a decreased heart rate and decreased stroke volumeCerebral blood flow maintained, but other body systems, such as the liver and kidneys, receive a diminished blood supply

Decrease in resting cardiac outputAmount of blood pumped each minute

Between ages 25 and 65, resting cardiac output falls 30% to 40% Reduced cardiac output reflects a decreased heart rate and decreased stroke volumeCerebral blood flow maintained, but other body systems, such as the liver and kidneys, receive a diminished blood supply

Urinary SystemUrinary SystemKidneys decrease in function; decrease in cell mass, and an increase in extracellular fluid Decreased filtration rate, plasma flow rate, and tubular reabsorption and secretion Blood urea nitrogen tends to increaseAbility to concentrate or dilute urine is diminished

Kidneys decrease in function; decrease in cell mass, and an increase in extracellular fluid Decreased filtration rate, plasma flow rate, and tubular reabsorption and secretion Blood urea nitrogen tends to increaseAbility to concentrate or dilute urine is diminished

Urinary SystemUrinary System

The bladder capacity may be reduced by halfResponse to the stretch receptors in the bladder wall that signal the need to void may be delayed until the pressure is high and the bladder almost filled to capacity Lax muscle tone may lead to incomplete emptying of the bladder

Residual volume may cause subsequent urinary tract infections

The bladder capacity may be reduced by halfResponse to the stretch receptors in the bladder wall that signal the need to void may be delayed until the pressure is high and the bladder almost filled to capacity Lax muscle tone may lead to incomplete emptying of the bladder

Residual volume may cause subsequent urinary tract infections

Urinary SystemUrinary SystemIncontinence

May appear as a symptom of upper or lower urinary tract dysfunctionConservative behavioral treatment is recommended as the first level of intervention

Behavioral treatments: scheduled or prompted voiding, environmental adaptation, and pelvic muscle exercises (Kegel exercises)

IncontinenceMay appear as a symptom of upper or lower urinary tract dysfunctionConservative behavioral treatment is recommended as the first level of intervention

Behavioral treatments: scheduled or prompted voiding, environmental adaptation, and pelvic muscle exercises (KegelKegel exercisesexercises)

Integumentary SystemIntegumentary System

Skin changes can be the most distressing to the older person because they are so visibleSkin changes include dryness, loss of elasticity, wrinkles, uneven pigmentation andbrown spots, roughness, looseness, thinness,and the development of various skin lesions

Skin changes can be the most distressing to the older person because they are so visibleSkin changes include dryness, loss of elasticity, wrinkles, uneven pigmentation andbrown spots, roughness, looseness, thinness,and the development of various skin lesions

Integumentary SystemIntegumentary SystemWrinkles

Occur when the deep layer of the skin loses moisture and elasticity Tiny creases and folds are formed Extent and timing determined by genetics and sun exposure Persons in certain ethnic groups with thicker and oilier skin wrinkle at a slower rate, maintaining a youthful, wrinkle-free appearance longer

WrinklesOccur when the deep layer of the skin loses moisture and elasticity Tiny creases and folds are formed Extent and timing determined by genetics and sun exposure Persons in certain ethnic groups with thicker and oilier skin wrinkle at a slower rate, maintaining a youthful, wrinkle-free appearance longer

Integumentary SystemIntegumentary SystemItching

Related to loss of oils in the skin Generalized itching should be reported to the health care provider; may be sign of diabetes, cancer, kidney disease, or liver disease Advice for tepid baths, using moisturizers liberally, avoiding overuse of antiperspirants, soaps, perfumes, and hot baths

ItchingRelated to loss of oils in the skin Generalized itching should be reported to the health care provider; may be sign of diabetes, cancer, kidney disease, or liver disease Advice for tepid baths, using moisturizers liberally, avoiding overuse of antiperspirants, soaps, perfumes, and hot baths

Integumentary SystemIntegumentary SystemHair loss, hair thinning, and color changes

Men tend to grow bald, and women experience thinning of the hair on the head and genitalia The number of facial and nasal hairs may increase Gray hair is caused by a slowing of the pigment production in the hair follicles

Determined by genetics and tends to be irreversible

NailsBecome yellow and thicker

Hair loss, hair thinning, and color changesMen tend to grow bald, and women experience thinning of the hair on the head and genitalia The number of facial and nasal hairs may increase Gray hair is caused by a slowing of the pigment production in the hair follicles

Determined by genetics and tends to be irreversible

NailsBecome yellow and thicker

Gastrointestinal SystemGastrointestinal System

Oral cavity Deterioration in the teeth and a decrease in the functional taste buds Decrease in saliva secretion

Related to medications, inadequate hydration, and illness states rather than normal aging change Saliva tends to become more alkaline as the salivary glands secrete less ptyalin and amylase

Oral cavity Deterioration in the teeth and a decrease in the functional taste buds Decrease in saliva secretion

Related to medications, inadequate hydration, and illness states rather than normal aging change Saliva tends to become more alkaline as the salivary glands secrete less ptyalin and amylase


Muscles associated with chewing weaken, peristalsis is slower, and the risk of formation of intestinal diverticula increasesGastric emptying is slowerGastric glands decrease the volume and concentration of hydrochloric acid, intrinsic factor, and pepsinLess amount of calcium absorbed

Muscles associated with chewing weaken, peristalsis is slower, and the risk of formation of intestinal diverticula increasesGastric emptying is slowerGastric glands decrease the volume and concentration of hydrochloric acid, intrinsic factor, and pepsinLess amount of calcium absorbed


ConstipationFrequent gastrointestinal complaint From decreased intestinal motility, altered bacteria flora, a diet low in bulk and roughage, medications, lack of physical activity

Educate about diet, activity, increased fluid intake, and avoidance of laxative abuse

ConstipationFrequent gastrointestinal complaint From decreased intestinal motility, altered bacteria flora, a diet low in bulk and roughage, medications, lack of physical activity

Educate about diet, activity, increased fluid intake, and avoidance of laxative abuse

Musculoskeletal SystemMusculoskeletal System

OsteoarthritisThe most prevalent chronic disease in menMore severe in womenLeading cause of disabilityCaused by damage to the inside surface of the jointAge, heredity, and obesity contribute to development Large weight-bearing joints (knees, hips, spine) are most affected

OsteoarthritisThe most prevalent chronic disease in menMore severe in womenLeading cause of disabilityCaused by damage to the inside surface of the jointAge, heredity, and obesity contribute to development Large weight-bearing joints (knees, hips, spine) are most affected

Musculoskeletal SystemMusculoskeletal SystemKyphosis

Curvature of the thoracic spine that gives rise to the bent-over appearance of some older adults

Teach benefits of weight-bearing exercisesWalking, bicycling, and stair climbing help maintain bone and muscle massAssistive devices for walking and preventing fallsAvoid too much bed rest because of the detrimental effects of immobility

KyphosisCurvature of the thoracic spine that gives rise to the bent-over appearance of some older adults

Teach benefits of weight-bearing exercisesWalking, bicycling, and stair climbing help maintain bone and muscle massAssistive devices for walking and preventing fallsAvoid too much bed rest because of the detrimental effects of immobility

Sensory SystemSensory SystemPresbyacusis

Hearing loss associated with age 25% of adults older than age 69, and half of adults older than age 85 are hearing impairedConduction deafness

Blockage of the ear canal caused by excessive wax buildup, abnormal structures, or infection

Sensorineural deafnessDamage to nerve tissue as a result of exposure to loud noises, disease, and certain drugs

PresbyacusisHearing loss associated with age 25% of adults older than age 69, and half of adults older than age 85 are hearing impairedConduction deafness

Blockage of the ear canal caused by excessive wax buildup, abnormal structures, or infection

Sensorineural deafnessDamage to nerve tissue as a result of exposure to loud noises, disease, and certain drugs

Sensory SystemSensory System

Macular degenerationAffects the macula, the part of the eye responsible for sharp central vision

CataractClouding or opacity of the normal transparent lens within the eyeSurgical removal of the clouded lens

Macular degenerationAffects the macula, the part of the eye responsible for sharp central vision

CataractClouding or opacity of the normal transparent lens within the eyeSurgical removal of the clouded lens

Sensory SystemSensory SystemPresbyopia

Affects the shape of the lensReading and other close work become difficult

Glaucoma Atrophy of the optic nerve usually associated with elevated pressure of the fluid in the eye

PresbyopiaAffects the shape of the lensReading and other close work become difficult

Glaucoma Atrophy of the optic nerve usually associated with elevated pressure of the fluid in the eye

Sensory SystemSensory SystemChemosensory disorders

Involves taste and smellCauses: nasal obstruction, allergies, certain drugs Some scientists believe that the decline in smell is due to a decrease in olfactory nerve fibersMajor changes in ability to taste most often caused by diseases or side effects of certain drugsDentures, hormonal changes, medications, and changes in chemicals needed to transmit taste are causes of older person’s diminished sense of taste

Chemosensory disordersInvolves taste and smellCauses: nasal obstruction, allergies, certain drugs Some scientists believe that the decline in smell is due to a decrease in olfactory nerve fibersMajor changes in ability to taste most often caused by diseases or side effects of certain drugsDentures, hormonal changes, medications, and changes in chemicals needed to transmit taste are causes of older person’s diminished sense of taste

Aging-Associated Psychosocial FactorsAgingAging--AssociatedAssociated Psychosocial FactorsPsychosocial Factors

Older adults show cumulative developmental effects that produce unique personality styles, coping mechanisms, challenges, and growth

That a person has survived to old age is one marker of successful adaptation

Older adults show cumulative developmental effects that produce unique personality styles, coping mechanisms, challenges, and growth

That a person has survived to old age is one marker of successful adaptation

Aging-Associated Psychosocial FactorsAgingAging--AssociatedAssociated Psychosocial FactorsPsychosocial Factors

Effective adaptation: meeting environmental and functional needs; attaining sense of well-being

Maturity: optimal psychological, social, and biologic adaptation achieved during midlife years, arbitrarily set between 45 and 65 years of age

Effective adaptation: meeting environmental and functional needs; attaining sense of well-being

Maturity: optimal psychological, social, and biologic adaptation achieved during midlife years, arbitrarily set between 45 and 65 years of age

Movement toward Erikson’s ego integrity is facilitated when the older person

Recognizes and accepts changes in physical and mental capabilitiesGives up some roles and develops new ones Develops new activities that can be carried out successfully with aging Develops a different self-concept Revises life goals Adapts to new lifestyles

Movement toward Erikson’s ego integrity is facilitated when the older person

Recognizes and accepts changes in physical and mental capabilitiesGives up some roles and develops new ones Develops new activities that can be carried out successfully with aging Develops a different self-concept Revises life goals Adapts to new lifestyles

Aging-Associated Psychosocial FactorsAgingAging--Associated Psychosocial FactorsAssociated Psychosocial Factors

Coping and AdaptationCoping and AdaptationCoping and AdaptationOld age has been described as the season of losses

Roles, statuses, physical abilities, and deep personal losses through the deaths of friends and the disruption of family networks

Real, threatened, or imaginary lossis a stressor

requires adaptation, flexibility, and resiliencyto cope successfully

Old age has been described as the season of losses

Roles, statuses, physical abilities, and deep personal losses through the deaths of friends and the disruption of family networks

Real, threatened, or imaginary lossis a stressor

requires adaptation, flexibility, and resiliencyto cope successfully

Coping and AdaptationCoping and AdaptationCoping and AdaptationThe older person may cope with these losses with positive or negative adaptation

Positive adaptationInclude rational action, perseverance, positive thinking, intellectual denial, restraint, drawing strength from adversity, and humor

Negative adaptationLose sense of personal identity and fulfillment and suffer from deterioration in self-esteem, an altered self-concept, and a loss of meaningfulness in life

The older person may cope with these losses with positive or negative adaptation

Positive adaptationInclude rational action, perseverance, positive thinking, intellectual denial, restraint, drawing strength from adversity, and humor

Negative adaptationLose sense of personal identity and fulfillment and suffer from deterioration in self-esteem, an altered self-concept, and a loss of meaningfulness in life

Coping and Adaptationthe Family

Coping and AdaptationCoping and Adaptationthe Familythe Family

Most older adults occupy a variety of family roles; come from multigenerational unitsMarital relations and the relationships between parent and child seem to be most importantAlthough family responsibility appears to be an internalized value for most people, it is important to know that State has laws that can require children to provide financial support for needy parents

Most older adults occupy a variety of family roles; come from multigenerational unitsMarital relations and the relationships between parent and child seem to be most importantAlthough family responsibility appears to be an internalized value for most people, it is important to know that State has laws that can require children to provide financial support for needy parents

Coping and Adaptationthe Family

Coping and AdaptationCoping and Adaptationthe Familythe Family

The combination of personal limitations, competing roles, and stresses generated by the care recipient’s behavior and the physical demands created by various levels of emotional, physical, financial, and family strain places enormous stress on informal caregivers Caregivers frequently report symptoms of depression, anxiety, helplessness, low morale, and emotional exhaustion

The combination of personal limitations, competing roles, and stresses generated by the care recipient’s behavior and the physical demands created by various levels of emotional, physical, financial, and family strain places enormous stress on informal caregivers Caregivers frequently report symptoms of depression, anxiety, helplessness, low morale, and emotional exhaustion

Coping and AdaptationFamily

Coping and AdaptationCoping and AdaptationFamilyFamily

In part because of caregiver stress, more than 1 million older adults are abused physically and psychologically or are neglected each year by their caregiversEducation for learning and positive adaptive behaviors can assist caregivers and recipientsFamilies must be part of the holistic approach in the assessment and care of the aged

In part because of caregiver stress, more than 1 million older adults are abused physically and psychologically or are neglected each year by their caregiversEducation for learning and positive adaptive behaviors can assist caregivers and recipientsFamilies must be part of the holistic approach in the assessment and care of the aged

Functional AssessmentFunctional AssessmentFunctional AssessmentActivities of daily living; environmental, financial, family, economic, and community resources Data useful during times of health, at the onset of illness, at the beginning of treatment, and following therapeutic interventionsKnowing what activities an individual performs alone, what activities require assistance, and what activities the person is totally unable to perform or to perform safely is essential to define care needs

Activities of daily living; environmental, financial, family, economic, and community resources Data useful during times of health, at the onset of illness, at the beginning of treatment, and following therapeutic interventionsKnowing what activities an individual performs alone, what activities require assistance, and what activities the person is totally unable to perform or to perform safely is essential to define care needs

Functional AssessmentFunctional AssessmentFunctional Assessment

The older person’s database should describe both basic and instrumental activities of daily living

BasicGrooming, bathing, dressing, eating, elimination, and mobility

InstrumentalPrepare a meal, shop for groceries, use the telephone, negotiate transportation, take medications, housekeeping and laundry tasks

The older person’s database should describe both basic and instrumental activities of daily living

BasicGrooming, bathing, dressing, eating, elimination, and mobility

InstrumentalPrepare a meal, shop for groceries, use the telephone, negotiate transportation, take medications, housekeeping and laundry tasks

Drug TherapyDrug TherapyDrug Therapy

88% of older adults who reside in the community use 1 or more medications In long-term care facilities, more than 75% receive 4 or more medications and 33% receive 7 to 10 medicationsAge- and disease-related changes slow the clearance of drugs, which increases the risk of adverse effects

88% of older adults who reside in the community use 1 or more medications In long-term care facilities, more than 75% receive 4 or more medications and 33% receive 7 to 10 medicationsAge- and disease-related changes slow the clearance of drugs, which increases the risk of adverse effects

Drug TherapyDrug TherapyDrug TherapyReduction in body size, decrease in lean body mass and water content (extracellular volume), and increase in fat Serum albumin concentration is lower; tends to make more free drug available to tissues or to permit more rapid elimination of the drug A gradual decrease in blood flow to the internal organs in the abdomen reduces drug clearance through the liver or kidney

Reduction in body size, decrease in lean body mass and water content (extracellular volume), and increase in fat Serum albumin concentration is lower; tends to make more free drug available to tissues or to permit more rapid elimination of the drug A gradual decrease in blood flow to the internal organs in the abdomen reduces drug clearance through the liver or kidney

Drug TherapyDrug TherapyDrug TherapyThe liver prepares drugs for elimination in the urine or in feces Age-related changes that have an impact on the inactivation of drugs by the liver include decreased liver size, reduced hepatic blood flow, and reduced liver enzyme activity on drugs These changes increase drug concentrations in the blood and possibly increase the amount of time it takes the body to get rid of the drug

The liver prepares drugs for elimination in the urine or in feces Age-related changes that have an impact on the inactivation of drugs by the liver include decreased liver size, reduced hepatic blood flow, and reduced liver enzyme activity on drugs These changes increase drug concentrations in the blood and possibly increase the amount of time it takes the body to get rid of the drug


Older adults tend to respond more vigorously to drugs that act on the central nervous system because of a greater tissue sensitivity and altered physiologic changesAdverse effects: postural imbalance, staggering, uncoordinated movements, respiratory depression, and changes in mental alertness

Older adults tend to respond more vigorously to drugs that act on the central nervous system because of a greater tissue sensitivity and altered physiologic changesAdverse effects: postural imbalance, staggering, uncoordinated movements, respiratory depression, and changes in mental alertness


Risk factors for adverse drug reactions Age, sex, race (more frequent in older white females), number of drugs consumed, dosage, duration of treatment, severity of illness, and patient cooperation

Symptoms and signsRestlessness, falls, depression, confusion, loss of memory, constipation, and urinary incontinence

Risk factors for adverse drug reactions Age, sex, race (more frequent in older white females), number of drugs consumed, dosage, duration of treatment, severity of illness, and patient cooperation

Symptoms and signsRestlessness, falls, depression, confusion, loss of memory, constipation, and urinary incontinence


Baseline and continual assessmentsThe amount, frequency, and purpose of all medications takenAbility and willingness to take recommended medications Potential for drug interactions and adverse drug reactions

Baseline and continual assessmentsThe amount, frequency, and purpose of all medications takenAbility and willingness to take recommended medications Potential for drug interactions and adverse drug reactions


Effectiveness of the medication over time Whether any of the drugs taken can be discontinued or decreased in dose Assessment of drug effects and adverse reactions must be documented

Effectiveness of the medication over time Whether any of the drugs taken can be discontinued or decreased in dose Assessment of drug effects and adverse reactions must be documented

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