Week 1 Lecture 1 PDF

Week 1 Lecture 1 Aging is the life long process of growing older,not just later life experiences. Older adults ≥ 65 y.o Successful aging is the ability to age well in the areas of health, social connections and well being. And it is strongly connected to quality of life and satisfaction with life....

Week 1 Lecture 1 Aging is the life long process of growing older,not just later life experiences. Older adults ≥ 65 y.o Successful aging is the ability to age well in the areas of health, social connections and well being. And it is strongly connected to quality of life and satisfaction with life. In traditional view is: Independent living Longevity Good physical health Community living Functional ability Successful aging contemporary view Social life Attainment to goals Self mastery Optimism Personal meaning in life Heterogeneity of aging Heterogeneity of Aging refers to the idea that older adults become increasingly different from one another over time due to various factors. These factors include heredity, lifestyle choices, and experiences with health, illness, and functional disabilities. Essentially, as people age, their individual experiences shape their health and abilities, leading to a diverse range of outcomes among older adults. Gerontology is the study of age and age related issues. Geriatrics: is the medical term for study, diagnosis and treatment of disease in older adults. Centenarian 100 years older Super centenarian : over the age of 110 Frailty: Reduced ability to respond to the challenge AND Inability to respond to the stress. Chronological age : age calendar Or Length of a time a person has been alive. Biopsychosocial: biological, physiological and sociological factors that influence aging process, quality of life and well being. Functional age: a level at which a person can perform. Activity theory;a gerontological theory to examine old age. It posits that older adults are happier and healthier when they remain engaged in daily life and social interactions. Lifespan:maximum lifespan of a species. The maximum lifespan of a species is the characteristic observed age of death for its very oldest individual(s) (e.g., for humans 122+ years) Healthspan: period of your life that you are healthy Longevity: long life Frailty :reduced function; depressed ability to respond to stress life expectancy: average # of years you are expected to live at birth Cohort:A set of people born during a specific time period ; also a set of people born during a historical era that creates different inter- cohort characteristics such as size, composition, experiences, and values. Why are there more women than men> 65 years? Women seek help than men, men tend to engage in more higher riskier occupations, men have higher suicide rates, females may have genetic advantage. Men = higher mortality rates than women across several leading causes of death including cancer, cardiovascular disease, accidents and suicide Science of Ageing Biological clock within genetic makeup Programmed to eventually die DNA replication isn’t perfect so the ends are cut off However telomeres get shorter and shorter and therefore we die because we have a replication limit (cellular senescence (50 times) Ageing: Combination of genetic and environmental factors Gerontology has two goals: Produce accurate knowledge about aging Create a better life for aging clients  Week 3 Lecture 2 Life span vs Life expectancy Life span: theoretical limit on length of life (~122+yr) maximum life span potential (MLP) of an individual if you can avoid accidents/illnesses has not increased over time Life expectancy:average # of years one can expect to live population level: age -specific cohorts average life expectancy: calculated by adding total years of life of all who die in a given year and dividing that by # who died that year increase in life expectancy by decades is due to interventions that extended the lives of young people not older adults Reflects local conditions (environment, location, race, gender, sex Health span :The period of life free of major chronic clinical diseases and disability The period of life free of major chronic clinical diseases and disability As life expectancy increases, goal is to extend the period that is free from disability and disease Optimal longevity:living long but well Physiological dysfunction with age is a major obstacle to optimal Longevity. Including physiology, what also declines as you age? Less response to environmental stress, Increased susceptibility to disease, changes occur from molecular level to organism, and mechanisms may differ in organism, organs, cells Implications of Physical Changes with Aging What are the implications with lessened reserve capacity? Slowness, stress, and homeostatic balance What are the implications with patterns of disease being more complex? Comorbidities (more than one illness at once), symptoms differ, and under-reported What is the importance of accident prevention? More serious implications, increased possibility, and longer recovery What are the skin and accessory organs? Hair, nails, oil (sebaceous glands), sweat glands, sense organs (temp and pain) and pigment (melanin) Emphasis on health promotion and prevention Melanocyte :Produces melanin Integumentary System Composition Skin and accessory organs hair, nails oil (sebaceous) glands sweat glands sense organs (temperature & pressure / pain) pigment (melanin) How does aging affect the dermis layer of skin (connective tissue)? Collagen and elastin decrease,leads to thinning and wrinkling of skin. Less blood flow and sweat glands (wound healing, heat illnesses) When dermis is affected by aging what can happen? Poor functioning leads to vulnerability to heat stroke (other overheating syndromes) How does aging affect the subcutaneous layer (fat tissue)? This layer thins on the face, hands and feet Photoaging:Skin damage due to sunlight not aging How does the rate of aging act when exposed to UV light? UV light leads to mutation of genes. Less turnover in epidermis, less melanin makes UV light more dangerous with age How do hair follicles and melanin react with aging? Graying of hair and hair loss. Growth of finger and toe nails decline with age and nails become brittle How does hearing loss affect those aging? Individuals lose ability to distinguish and discriminate between sounds Conductive hearing loss The external and middle ear causing sounds to not go from the eardrum to the inner ear Sensorineural hearing loss Caused from dysfunction of the inner ear or auditory nerve or a combination of the two Central auditory dysfunction Cause by damage to nerve centers in brain; rare What are other contributors to hearing loss? Can include heredity, disease, injury and occupational preferences Problems in the inner ear pathways can lead to... Progressive loss of high frequency tones making it difficult to understand speech, and tolerate loud noises. Also increases risk of fallings because maintenance of balance is lost Presbycusis:Progressive hearing loss that affect older people. More likely to occur than other diseases What parts of the sensory system are most affected by aging? Hearing and vision. Gradual loss of cones and rods Vision impairment leads to... Loss of basic skills, ease of communication, loss of confidence and a lack of sense of belonging in the community Cornea:Fluid filled bag on the external surface of the eye, most vulnerable Lens:Clear disk behind pupil Iris:Muscular sphincter that creates the pupil (the opening at the center of the iris); coloured Retina:Photosensitive tissue at the back of the eye What happens to the cornea and lens as you age? They thicken and lose elasticity Cataracts Clouding of the lens (cloudy/ opaque) Presbyopia More rigid, less ability to focus on near objects What happens to the retina and lens as you age? Less light reaches specialized cells as lens takes on a yellowish tinge, night vision is impaired, green-blue violet blindness, increased sensitivity to glare, and loss of peripheral vision Cataracts Glaucoma :Too much fluid pressure in the eye Macular degeneration:Macula of the eye required for sharp/ central vision loss effectiveness Diabetic Retinopathy:Blood vessels that supply retina don't work What happens to taste and smell as you age? Smell influences taste, over 75% of older people experience loss in taste and smell sensitivity What other factors beside aging affect taste and smell? Illness, hygiene, medications, smoking The musculoskeletal system can affect what other systems? Visual, respiratory and digestive Sarcopenia Age-associated loss of skeletal muscle mass, strength and quality of contractile function Other effects of sarcopenia include... Heat and cold intolerance, decreased metabolic rate, increase in glucose intolerance and insulin sensitivity, osteoporosis, risk of falls, frailty How does aging affect the bones? Bone material density decreases, more porous, susceptible to fractures, slower healing times, vertebrae are thinned Sarcopenia: the age-associated loss of skeletal muscle mass ,strength and quality of contractile function Secondary effects of sarcopenia include: heat and cold intolerance decreased metabolic rate changes in nutrition and energy requirements decrease in fat free mass and obesity increase in glucose intolerance and insulin sensitivity osteoporosis, risk of falls, frailty, reduced performance Osteoclastic :Breakdown of bones Osteoblastic:Rebuilding of bones Osteopenia:When loss of bone is great enough to be seen radiologically (about 30-50%) Osteoporosis:When loss of bones predisposes to fractures. Reduction of bone mass and bone density How does the heart react to aging? Becomes less efficient and loses strength, cardiac output decreases, leads to more demand. LV wall thickens, increased collagen, less elastin, valves stiffen and calcify, decreased coronary artery blood flow How does aging affect blood vessels? Increased collagen, less elastin, calcification, more difficult to dilate (stiffer) and increased systolic blood pressure Ischemic area and Necrotic/ apoptotic cells are known to be dead cells in the heart How does the respiratory system respond to aging? Decreased lung elasticity, increased stiffness of the chest wall, decreased respiratory muscle strength, calcification of cartilage between ribs and vertebrae How does the brain respond to aging? Loss of nerve cells, structural changes in some glial cells (myelin), decline in cerebrospinal fluid, lipofuscin (lipid residues) are deposited in nerve cells, slows transformation of information, shortens reaction times and weakens reflexes How does the spinal cord react to aging? Number of cells decrease, decrease in nerve conduction are mostly due to changes in the peripheral nerves How do we describe aging? as a life span process or a gradual decrease in physiological reserves, an increased risk of many diseases, a general decline in the intrinsic capacity of the individual Chronological age: length of time you have been alive Functional age:the level at which you can perform Young old:50-64 Old:65-84 Oldest Old:85+ Centenarian:100+ Super Centenarians:110+ What are some ways age is categorized? chronological age, functional age, categories/cohorts, social roles and generations Silent Generation:(1928-1945) Baby Boomers:(1946-1964) Generation X(1965-1980) Millennials(1981-1996) Generation Z(1997-2012) Alpha (2013-2025) Gerontology: the scientific study of aging that examines the biological, psychological and sociological factors associated with old age and aging Geriatrics:a medical term for the study, diagnosis and treatment of diseases/disorders and health problems specific to older adults Lifespan :the maximum lifespan of a species is the characteristic observed age of death for its very oldest individuals Longevity:long life; the condition of having lived a long life Life expectancy: the average number of years remaining for a person at a specified age Cohort: A set of people born during a specific time period; also a set of people born during a historical era that creates different inter-cohort characteristics such as size, composition, experiences and values Aging :the life long process of growing older, not just a later life experience Successful aging (traditional view) free of disease and disability, retaining high cognitive and physical abilities, maintaining meaningful interactional social relationships 3 key factors to successful aging lived free of disease and disability, retained high cognitive and physical abilities, maintained meaningful interactional social relationships Successful aging (contemporary view) satisfaction with social life, feelings of self mastery, optimism, personal meaning in life attainment of goals Quality of life subjective construct that is difficult to measure, influenced by living arrangement, physical and mental health status and health issues, social relationships, sexuality and outlook on life Biological theories of aging programmed and damage or error theory Programmed theories genes switch on and off, age related changes we are locked on, hormones switching on genes, senescence from the gradual accumulation of random mutations in somatic cells of the body, endocrine system focuses on regulation control and biological clocks, the immune system is coded to erode over time thus enhancing the bodys susceptibility to disease and death Damage or error theory/wear and tear theory of aging cells, tissues and organs, much like machines wear out from continuous use, the body's capacity for maintenance and repair is slowly halted, free radical theory, mitochondrial damage Disengagement theory older adults intentionally remove themselves from social roles Activity theory remain active, physically and psychologically fit, as opportunities to be active change, older adults simply replace them with new ones Continuity theory value and personalities, people remain consistent in how they live their life, manage their relationships and exhibit their personalities even though experience changes in their physical, mental and social status Life Course Perspective our past affects who we are, historical situations, considers development, history and importance of relationships over time, highlights potential for growth and adaptation, considers both social factors and individual agency as impacting on health outcomes of the older adults Person environment fit environmental demand, changes that occur in older people when they have less ability to deal with changing situations they encounter, asserts that for each older persons level of competence there is a level of environmental demand, press that is most advantageous for that person, the more impaired an older person is the more vulnerable they are to the demands of the environment Demographics is the study of a population based on factors such as age, race, and sex. Demographic data refers to socio-economic information expressed statistically, also including employment, education, income, marriage rates, birth and death rates and more factors What are demographic changes related to? fertility, longevity and migration What are changes in the population that are predicted to accelerate in Canada the population is predicted to continue to age What does the rectangularization of the population pyramid mean? is defined as a trend toward a more rectangular shape of the survival curve due to increased survival and concentration of deaths around the mean age at death of the population. That is, the variability in the age at death declines and deaths are being compressed into the upper years of life. Compared with previous decades and centuries, an increasing percentage of the population is made up of middle-aged and older adults. In the past, the age structure of the population could be represented by a pyramid, with the largest percentage of the population in the childhood years. Today, the percentages of people at different ages in the life span are more similar, creating what is called the "rectangularization" of the age distribution (a vertical rectangle) (Himes, 2009). The rectangularization has been created by health advances that promote longevity, low fertility rates, and the aging of the baby-boom cohort Health is a state of complete physical, mental and social well being, not merely the absence of disease or infirmity Is demographics impacted by change in life expectancy? Yes, longevity Upstream thinking Means taking wise collective action to ensure better outcomes rather than simply responding to, and being overwhelmed by crises we could have foreseen (macro level, government) Downstream thinking the tendency we have, as individuals, as donors and as decision-makers, to focus on one-off individual lifestyle based, short term solutions rather than long term interventions that address the root causes of well being (micro level, individuals and genetics) Ageism stereotypes, myths, language, negative images of older adults Ageist stereotypes set roles or categories into which older adults are placed by ageist comments Myths about aging making blanket assumptions and generalization about older adults perpetuates myths Health promotion activities aimed at improving or enhancing health, the process of enabling people to increase control over and to improve their health What are key action areas in health promotion building healthy public policy, creative supportive environments for health, strengthening community action for health, reorienting health services, developing personal skills What is health promotion for the older adult? A fundamental goal of health promotion is to facilitate well being for older adults on a daily basis. This includes activities that help individuals gain skills to maintain and improve their health, as well as community programs and policies to improve their environment and encourage healthy habits What is the focus of health promotion activity for the older adult? Health promotion strategies for the elderly generally have three basic aims: maintaining and increasing functional capacity, maintaining or improving self-care , and stimulating one's social network What is healthy aging? the process of developing and maintaining the functional ability that enable wellness in older age, life course will determine the path or trajectory of each individual,the older adult can optimize their existing abilities through practice and new technologies and compensate for the losses of some abilities by finding other ways to accomplish tasks What is prevention? Disease prevention, understood as specific, population based and individual based interventions for primary and secondary prevention aiming to minimize the burden of diseases and associated risk factors. Prevention includes any activity that reduces the occurrence, severity and consequence of disease Primary Prevention Directed towards preventing the initial occurrence of a disease; to prevent it from happening in the first place. Identifying those social determinants of health that increase risk of mental health challenges Secondary Prevention It aims to reduce the impact of disease or injury that has already occurred. Early detection and appropriate treatment of a disease to halt or slow the disease process Tertiary prevention Directed toward individuals with a disease in order to reduce the consequences of the disease. This is done by helping people to manage long term health problems and injuries to improve function What is compression of morbidity Ideal situation in which we envision people living as long as possible having the least amount of personal and systematic burden to the system How do we understand health status chronic health conditions, functional limitations , vaccinations and self rated health Health inequities: are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries Poor oral health is related to: respiratory disease, heart disease and stroke, diabetes, osteoporosis Oral biofilm 300+ species of microorganisms, continual growth everywhere in the mouth, grows even in those who are tube fed, needs to be removed daily to maintain health, hardens to form tartar which cannot be brushed off. Causes tooth decay and gum disease Aspiration pneumonia reservoir of potential lung pathogens, aspiration of dental plaque, significant cause of morbidity, hospitalization and mortality in nursing home population Dental Caries and Diabetes Saliva flow is less which results in less cleansing action, less buffering action so dental plaque grows rapidly and there is a change in microflora. Diabetes and oral disease it is a cycle, salivary flow rate is reduced, decrease in buffering capacity, blood supply to teeth surface-blood vessels become smaller and therefore there is not a good blood supply. There are already challenges with diabetes so it results in complications with the teeth Periodontal disease preventable, an infection, destroys bone, can cause tooth loss Signs of periodontal disease bleeding, pus, loose teeth, bad breath, bad taste, itchy gyms Dry mouth: high risk for decay, gum disease, infections Oral disease of older adults in personal care homes oral disease is rampant for these people, oral disease is preventable; however it requires the ability to remove dental plaque from the toothurface, which is not easy to do without cooperation or the proper tools Why are residents at increased risk of developing dental caries and periodontal disease More seniors are living longer with complex physical and mental challenges, still have their natural teeth, place more value on medical care of dental care, take mouth drying medications, depend on others for mouth care Monthly oral screening: helps with catching problems early, systematic look around the mouth and look out for lumps, sores, white, red or dark patches, bleeding, swollen gums, broken teeth, dry mouth, trouble swallowing, plaque or food debris The world report on ageing and health summarizes the best available evidence, outlines a framework for action around a new concept of functional ability Health Ageing :The process of developing and maintaining the functional ability that enable well being in older age Functional ability comprises the health related attributes that enable people it be and to do what they have reason to value Intrinsic capacity the composite of all the physical and mental capacities of an individual Environment: comprise all the factors in the extrinsic world that form the context of an individual's life What influences health in older age? individual behaviour, age related changes, genetics, disease, and the environment they live in-housing, assistive technologies, transport and social facilities Figure 2.4 so we look at the blue line and what we are trying to do is maximize functional ability, and then we look at the red line which represents our intrinsic capacity and shows how it declines with age, how can we do things in a health services environment, a long term care environment and more broader environments to have an influence on intrinsic capacity and functional ability. So when we have a high functional capacity we need to make sure we are doing things to prevent future problems. Our environments should promote capacity enhancing behaviour and the remove barriers to participation to compensate for loss of capacity High and Stable Capacity prevent chronic conditions, ensure early detection and control, promote capacity enhancing behaviors Declining capacity reverse or slow declines in capacity, support capacity enhancing behaviours, ensure a dignified late life, promote capacity enhancing behaviour and remove barriers to participation Significant loss of capacity: manage advanced chronic conditions, support capacity enhancing behaviors, ensure a dignified late life, promote capacity enhancing behaviors What are barriers to healthy aging? outdated and ageist stereotypes, inadequate policies, lack of accessibility, inadequate or absent services, lack of consultation and involvement What does investing in Health Aging mean? Means creating a future that gives older people the freedom to live lives that previous generations could never have imagined What are the benefits and returns for investments? Investments in the health systems, long term care systems, lifelong learning, age friendly environments, social protection. Benefits: health, skills and knowledge, mobility, social connectivity, financial security, personal dignity, safety and security. Return: individual well being, workforce participation, consumption, entrepreneurship and investment, innovation, social and cultural contribution, social cohesion What are some global strategies and action plans for putting priorities to action? May 2016 GSAP endorsed by World Health Assembly of United Nations, Country/stakeholder action plans developed between 2016-2020, Decade of Healthy Ageing 2020-2030 Align Health Systems Place older people at the centre of health care, Shift the care focus from managing disease to optimizing what people can do, Develop the health workforce Develop long term care systems Establish the foundation for a functioning system, Develop the long term care work force, Ensure the quality of long term care What are the features of an age-friendly environment? Combat ageism, Enable autonomy, Support healthy ageing in policies Physiological dysfunction: with age is a major obstacle to optimal longevity The Nathan Shock Model aging process as decline in physiological parameters, as you age your physiological parameters decrease (cognitive status, nerve conduction, velocity, muscle strength, visual acuity, vascular stiffening, insulin sensitivity) Implications of physical changes with aging lessened reserve capacity( slowness, stress, homeostatic balance and pacing) patterns of disease are more complex (comorbidities, symptoms differ, under reported), importance of accident prevention (increased possibility, longer recovery, more serious implications), emphasis on health promotion Compression of morbidity delaying the age of onset of chronic diseases and disability longer than any associated increase in lifespan of the overall morbidity incurred in a lifetime and healthspan is a period of healthy ageing with a modestly increasing chronic disease burden followed by a period of age related clinical disease. To achieve optimal longevity in the future the healthspan must be significantly extended Conductive hearing loss: in the external and middle ear, sounds don't go from eardrum to inner ear Sensorineural hearing loss: due to dysfunction of the inner ear or auditory nerve or a combination of the two Central auditory dysfunction:due to damage to nerve centers in the brain; rare Causes of hearing loss:heredity, disease, injury and occupational preferences Vision impairment:loss of basic skills, ease of communication, loss of confidence and a lack of sense of belonging in the community Cornea:Fluid filled bag on the external surface of the eye, most vulnerable Lens:Clear disk behind the pupil Iris:Muscular sphincter that creates the pupil opening at the center of the eye Retina:Photosensitive tissue at the back of the eye Cataracts:clouding of the lens Presbyopia: more rigid, less ability to focus on near objects Changes in the retina and the lens less light reaches cells as lens takes on a yellowish tinge, night vision is impaired, decreased ability to discriminate between colours in the green blue violet range, increased sensitivity to glare and loss of peripheral vision Glaucoma:too much fluid pressure in the eye Macular degeneration:macular required for sharp/central vision loses effectiveness Diabetic retinopathy: blood vessels that supply retina don't work Sarcopenia :the age associated loss of skeletal muscle mass, strength and quality of contractile function Secondary effects of sarcopenia :heat and cold intolerance, decreased metabolic rate, changes in nutrition and energy requirements, decrease in fat free mass and obesity, increase in glucose intolerance and insulin sensitivity, osteoporosis, risk of falls, frailty, reduced performance Age related changes in bone bone mineral density decreases, bones become more poroys, more susceptible to fractures, slower healing fractures, vertebrae thinned Age related changes in the heart left ventricular wall thickens, increased collagen, less elastin, valves stiffen, calcify, decreased pacemaker cells, decreased coronary artery blood flow and oxygen delivery Age related changes in the blood vessels increased collagen, less elastin, calcification, stiffer, more difficult to dilate, increased systolic blood pressure Age related changes in the lungs decrease in lung elasticity, increased stiffness of the chest wall, decreased respiratory muscle strength, decreased gas exchange impacts maximum capacity not resting capacity Age related changes in the brain loss of nerve cells in some areas, structural changes in some glial cells (myelin), 10% decrease in nerve conduction velocity, decline in cerebrospinal fluid, lipofuscin is deposited in nerve cells, free radical accumulate, changes in neurotransmitter balance Age related changes in the spinal cord the number of cells decrease, decreases in nerve conduction are mostly due to changes in the peripheral nerves Older adults are more/less responsive to environmental stress less Older adults have increased or decreased susceptibility to disease increased Disability physical, mental, cognitive or developmental condition that impairs interferes with or limits a person's ability to engaged in certain tasks or actions or participate in typical daily activities and interactions. Disability as an umbrella term covers impairments, activity limitations and participation restrictions. General guidelines for talking to someone with a disability use the term disability, just because someone is disabled that does not make them special, ask people what term they prefer, its okay to say " people without disabilities." Or just call them by their name Disability Tax Credit available to Canadians with a severe or significant disability. It can be difficult to qualify for and the application process is complex Who administers the disability tax credit? Canada Revenue Department What organization filed a report describing what they found about how the tax credit was being applied? The Disability Advisory Committee What does the Disability Advisory Committee recommend? Making it easier for more Canadians to qualify for the disability tax credit, making the disability tax credit application process fairer, making it easier to keep RDSPs and get other disability benefits, making helping Canadians with disabilities a priority International Classification of functioning, disability and health organizes and provides a framework for documenting function and disability What are the inter relating factors that influence function, disability and health? body function, body structure, impairment, activity and activity limitations, participation and participation restrictions, environmental factors Function dynamic interaction between a person's health condition, environmental factors and personal factors How do you measure the difference made by an intervention by a health professional: Achieved by assessing the same individual before and after the intervention What are the domains of assessment? Cognition, Mobility, Self care, getting along, life activities, participation Cognition (Domain of assessment) Understanding and Communicating Mobility (Domain of assessment) Moving and Getting around Self care (Domain of assessment) Attending to one's hygiene, dressing, eating and staying alone Getting Along (Domain of assessment) Interacting with other people Life activities (Domain of assessment) Domestic responsibilities, leisure, work and school Participation (Domain of assessment) joining in community activities, participating in society Who are the members of the rehabilitation team? Audiologist, dietician, diagnostic technologists, nurses, OT, pharmacist, PT, physicians, respiratory therapist, speech language pathologist and social workers What does an occupational therapist do? holistic, patient centre, occupation based approach to life skill development, this health profession helps people whose lives have been altered by a physical or menta disease, injury or other health problems. People of any age can benefit from OT to prevent injury and improve skills needed to perform everyday tasks or occupations at home, work or school. What are ADL's? Eating, personal hygiene, dressing, toileting, transferring, continence, mobility What are IADL's telephone, shopping, food preparation, laundry, housekeeping, transportation, medication and finances Why are they important and how do they relate to the domains of assessment? ADL is one's ability to do self care and IADL is the ability to live independently What do physical therapists do? Prevent, assess and treat the impact of injury, disease and or disorders in movement and function. Improve, restore and maintain functional independence and physical performance, prevent and manage pain, physical impairments, disabilities and limits participation and promote fitness health and wellness. What are the new syndromes associated with aging? frailty, sarcopenia, anorexia of aging and cognitive impairment Why is it important to prevent falls in the older adult? falls result in hospitalization as a result of head injuries and hip fractures, people who fall sustain injuries such as lacerations, hip fractures or head trauma. Falling once increases the risk of falling again. What are strategies used to prevent falls? improve postural control and exercise, rehabilitation therapist How does the prevalence ( number of total number of cases reports) of mobility problems change as we age according to a graph describing Manitobans in 2014 of the age of 65 and over Mobility problems worsen as you get older, seems like women have more problems than men but overall the 75+ population has the most mobility issues. What are the physical activity guidelines for the older adult and how are they different from young adults? 150 moderate to vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more, at least 2 days a week of muscle and bone strengthening activity What situations support opportunities for the older adult to meet the minimum requirement of the physical health guidelines? planned exercise session, recreation and sports, in the course of daily living; transportation, occupational demands in the context of family, work, volunteer and community activities What are the benefits of improving overall fitness? improved physical health, cardiovascular capacity, muscle strength and balance, improved sense of well being, decreased anxiety and depressive symptoms, improved self esteem, minimizes physical declines that lead to restrictions in completing ADL's and IADL's Following the guidelines for physical activity can reduce risk of chronic disease and premature death, maintain functional independence and mobility, improve fitness, body composition, bone health, cognitive function and indicators of mental health What percent of seniors were prescribed 10+ drug classes in 2016? : ¼ or 25% What are the most common drugs? 37% for pain,anxiety or depression, 44% cardiac and blood pressure and then 23% for ulcer and constipation or diabetes For a drug to work: it must be absorbed, distributed, metabolized and then there must be a response Pharmacological changes with aging and absorption possibly delayed absorption because of reduced gastric acidity, reduced motility and reduced but sufficient surface area of the small intestine Pharmacological changes with aging and distribution drugs that are preferentially stored in fat are affected by changes in body composition, so the same dose is more potent in an 80 year old than a 50 year old, certain drugs bind to protein in the blood, the same dose more potent if there is a disease affecting the amount of protein in the blood Pharmacological changes with aging and hepatic metabolism liver tests do not predict capacity to metabolize drugs, considerable variability between individuals, 2 different enzymes that metabolize drugs, each can be affected by age, disease, other medication Pharmacological changes with aging response receptors can be normal in aged individuals or exhibit reduced sensitivity to drugs, drug effects may be diminished or unpredictably exaggerated due to homeostatic instability Pharmacological changes with aging-excretion medications and metabolites eliminated by urine or feces, kidney function deteriorates with age, if kidneys impaired, often takes longer to eliminate the drug, need to adjust frequency medication is taken Markers of frailty low BMI, low cholesterol, postural hypotension, cognitive impairment, immobility, incontinence, functional dependence, social isolation. If one is frail drug response is less predictable Polypharmacy: 4 or more drugs Adverse drug reactions harmful or unpleasant reaction from taking a medication, dose related, time related, withdrawal, failure of therapy Prevalence of adverse drug reactions 7 times more frequent in your 70s than those in their 20s, 10-20% of acute hospital admissions are believed to be drug related High blood pressure pill causes asthma to be worse Water pill causes: gout Arthritis pill causes: kidney failure Adherence problems not understanding reason for the pills, side effects, struggling with the mechanics of staying organized, memory issues, not being able to afford medications Difficulty managing medications keeping track, pharmacare, re-ordering, staying organized Factors associated with non-adherence in elderly patients cognitive function is a key factor, poor knowledge of the drug regimen, complexity of drug regimen, occurrence of adverse drug effects, living alone, low income,low education, personal and cultural beliefs about medication, depressive symptoms and depression, current smoking or problem drinking and race Measures for helping patients take their meds more instruction, counseling about the patients disease, assisted patient monitoring, involving patients more in their care through self monitoring of their blood pressure or respiratory function, comprehensive pharmaceutical care services, simplified dosing, different med formulations, tailoring the regimen to daily habits, the dose, appointment and prescription refill reminders, direct observations of treatments by health workers or family Things we consider with medication is the medication effective, is there duplication, dosage, interactions, duration, goals Medstopper: CIHR funded KT project, for an individual medication will rate on symptom benefit, disease prevention benefit and harm