Camille Fitzpatrick MSN, NPProfessor Nursing Science

August 29, 2018

August 29, 2018

Young-old = 65 to 75 yearsMiddle old = 75 to 85 yearsOld-old = 85+ years85+ grew by 40% between 1980-1990Centenarians 100 yrshas doubled It is estimated that there are between 150 and 600

living people Ethnic diversity 43% of total population

It is estimated that there are between 150 and 600 living people >110

Oldest living person Chiyo Miyako of Japan, died July 22, 2018

Genetics primary factor > life style Secondary factors◦ Female 90%◦ Not getting fat◦ Moderation in everything◦ Keeping physically & mental active◦ Optimistic

By 2035, 20%-25% of US population will be 65+ years Increasing life expectancy:◦ 1930: 59.7 years◦ 1965: 70.2 years◦ Present: 77.8 years

Current Average Age◦ Women = 80.1 years◦ Men = 74.8 years

Advancements in disease control and health technology

Lower infant and child mortality rates

Improved sanitation

Better living conditions

States with the greatest number of older adults: California, Florida, New York, Texas, and Pennsylvania

States with dramatic increases in the past decade: Nevada, Alaska, Hawaii, and Arizona

States with the lowest percentage of total population over age 65: Alaska, Utah, and Georgia

Older women are more likely than men to be married

Most older adults live with a spouse or other family member

More women than men live alone Potential for living alone increased with age Most older adults have family contact

10% of older adults live below the poverty level Older adults dependent on Social Security for

more than half of their income Median net worth is twice the national average

related to home ownership “Asset rich and cash poor” Women and minority groups are poorer than

white men

Increasing levels of education in the older adult population

Advanced degrees and higher income Impact on health care:◦ Older adults will be more informed consumers

The elderly are a very heterogenic group◦ Different life experiences /styles◦ Genetics◦ Chronic diseases & disabilities

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Decrease height Decrease weight Increased fat to lean body mass ratio Decrease total body water

Decreased accommodation Decreased acuity Color sensitivity Depth perception Hyperopia

Cataracts Diabetic retinopathy Macular Degeneration Glaucoma

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Decreased perception of high frequencies Decreased pitch perception

Decreased sense of smell

Altered sense of taste

Reduction in tactile sensation

Slowed intestinal motility Taste

Loss of bone -> Decreased height & kyphosis Weakening of bone Impaired motor capacity Generalized muscle weakness & strength Slower reaction time Poor coordination Impaired balance Increased muscle fatigability Diminished mobility, flexibility & ROM Joint & cartilage erosion (joint pain) Slower, shorter gait

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Skin is less elastic, more dry, and more fragile

Thinning and graying of hair

Reduced sweat gland activity

◦ Trauma = skin tears, leg ulcers◦ Pressure ulcers due to impaired mobility◦ Infections commonly due to inability to

perform ADL’s such as bathing◦ Higher incidence of benign & malignant

growths, infections & other dermatological problems

Decrease cardiac output Decreased heart rate and response to stress Decreased compliance of peripheral blood

vessels Conditioning programs improve aerobic

capacity Maximal HR and early diastolic filling remain

abnormal even in highly trained

Decreased creatinine clearance Decreased renal blood flow Decreased maximum urine osmalality

Decreased FVC and FEV Decreased maximal oxygen uptake Decreased cough reflex TLC unchanged

Increased motor response time Slower psychomotor performance Decreased attention Decreased complex learning Decreased hours of sleep Decreased hours of REM sleep

Increased Diabetes Increased Hypothyroid Decreased sexual functioning

Lower normal body temperatures

Reduced ability to respond to cold temperatures

Differences in response to heat

Depressed immune response:◦ T-cell activity declines◦ Decline in cell-mediated immunity◦ Potential for infection◦ Potential for reactivation of dormant

varicella-zoster and Mycobacteriumtuberculosis

Atypical presentation of infection

◦ Fever not detected related to lower baseline temperatures

Manifestations of infection may include lethargy, weakness, and anorexia

Changes in mental status, incontinence, and falls may be related to infection

Failure to interpret atypical symptoms results in delayed diagnosis of infection

High rate of iatrogenic infections

Influenza Pneumonia Herpes Zoster Urinary tract Infections Tuberculosis Prostatitis

Functional declinee.g., falls, confusion, weight loss

Misleading symptomse.g., pneumonia with low fever & low WBC

count Signs of one disease obscured by another

e.g., COPD worsened by CHF

No presentation at alle.g., silent infarct, painless acute abdomen

Atypical presentation

Maladaptation to environmental change

Adverse drug reactions

Underreporting of symptoms common in the elderly

Many elderly attribute treatable symptoms to “aging” and stated “nothing can be done about it anyway”

1/2-1/3 of symptoms may go unreported to clinicians

Acute Chronic NOT normal part of aging

Believe it is a normal part of aging Are more stoic & reticent than younger

adults to communicate pain Believe using medications daily is a sign

of addiction Refuse treatment because: ◦ They do not understand good pain

management is needed for faster recovery◦ Concerned about $$ ◦ Side effects of medications are unacceptable

THE GERIATRIC “ F” Word

Medical conditions may present first (or only) as functional disturbances

Functional loss highly impacts quality of life Functional losses may lead to further

disability and institutionalization Functional losses impact patient and

caregiver

Use functional status as baseline Use it to guide recommendations for

exercises, PT, adaptive devices for impairments

Consider home evaluation for highly impaired

Potential marker of caregiver stress Useful for evaluating risk of & need for

placement

ADLs◦ Bathing◦ Dressing◦ Toileting◦ Transfers◦ Continence◦ Feeding

IADLs◦ Using telephone◦ Shopping◦ Food preparation◦ Housekeeping◦ Laundry◦ Transportation◦ Medications◦ Managing money

Small changes in function can make a

big difference in

quality of life for patients

and their caregivers

Home Driving

About 2/3 of mild-moderate dementia missed by providers

Content empty speech Loss of IADL function Inability to recall 3 items at 5 minutes Inability to draw clock

Never say “all old people are….” Slow down and speak clearly Write instructions Maintain function Less is better (meds) Treat the older patient the way you would want a

clinician to treat your parent

Thank YouQuestions???????

fitzpatc@uci.edu

� THE OLDER ADULT�Slide Number 2Super-Centenarians > 110 yrsPopulation Growth and �Increasing Life ExpectancyFactors Influencing Increased �Life ExpectancyGeographic DistributionMarital Status and Living ArrangementsIncome of Older AdultsEducationSlide Number 10Slide Number 11Slide Number 12Slide Number 13OverallSlide Number 15EyesSlide Number 17Common Eye DiseasesSlide Number 19Slide Number 20Slide Number 21Slide Number 22HearingChanges in the Body: Sensory OrgansGastrointestinalMusculoskeletalSlide Number 27Slide Number 28Changes in the Body: �Integumentary SystemSlide Number 30Slide Number 31CardiovascularKidneyLungNervous SystemEndocrineChanges in the Body: ThermoregulationChanges in the Body: Immune SystemInfectionsSlide Number 40ATYPICAL PRESENTATIONS �IN OLDER PATIENTSTHE RISK OF MORBIDITY & MORTALITY RISES WITH:Underreporting Common PainCommon Pain Beliefs & BarriersSlide Number 46Why Assess Function?Using Functional InformationSlide Number 49Slide Number 50Slide Number 51 SafetyQuick Clues to DementiaMedicationsTake Home PointsSlide Number 56 Simulation