Cognitive and Social Changes of Aging

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Cognitive and Social Changes of Aging
Gerontological Community Based Nursing
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Psychosocial Changes with Aging

• Personality
• Should be consistent with earlier years
• Changes can result from pathology or responses to
  events affecting self-image
• Memory
• Long term memory remains intact
• Short term memory diminished
• Processing affected by stress

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Psychosocial Changes with Aging

• Learning
• Use simple association rather than analysis
• Verbal and abstract abilities are approximately
  equal
• Basic intelligence unchanged
• Creative thought declines
• Factors that affect learning
• Motivation
• Attention span
• Delayed transmission
• Perceptual defecits
• Illness

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Sociological Changes

• Sexual and intimacy
• Sexual patterns persist throughout lifespan
• Maintenance and promotion of sexual functioning
  in is necessary for
• wellness
• sense of normalcy
• Higher quality of life
• Factors that affect individuals ability to
  remain sexually active
• Normal aging variations
• Disabilities
• Medications
• treatments

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Sociological Changes

• Sexual and intimacy contd
• Environmental barriers
• Living with adult children
• Institutionalization
• Assistive devices
• Fears
• Rejection
• Boredom
• Failure
• Hostility

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Relationships

• Close sustaining relationships have a positive
  effect
• ? stress
• ? mental health
• ? life satisfaction
• Married people have better support system
• Married people have better income
• Married people have better nutrition

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Relationships

• Friends
• Shrinking social network
• Organizations neighborhoods
• Promotion of social contacts
• Factors that affect social network
• Family members
• Friends
• Health
• Independence
• Gerontological orphan

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Normal Age-Associated changes of the Neurological
System

• Brain changes
• Neurochemical
• Structural
• Neuropsychological changes
• Small decrease in brain weight
• 7-8 decrease
• Loss of neurons in selective brain structures
• Accumulation of neuritic plaques and
  neurofibrillary tangles
• Neurochemical changes
• Decreased activity of catecholamine synthesis
• Decrease amounts of neurotransmitters
  serotonin, noradrenaline, and dopamine

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Age associated memory changes

• Forgetting specific details and names of people,
  but remembering them later
• Able to learn new material but may have
  difficulty with information retrieval
• General awareness of memory impairment
• Memory impairment does not interfere with daily
  functioning

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Disorders of the Neurological System

• Alzheimer's
• Non-reversible and progressive form of dementia
  that reduces the ability to think, remember,
  reason, judge and concentrate
• Eventually prevents performance of ADLs
• Personality and language abilities decline
• Accounts for 66 of dementias

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Alzheimers

• Prevalence
• 4 million Americans have been diagnosed with
  Alzheimers type dementia
• 10 of people gt75 y.o. are affected
• 47 of people gt 85 y.o. are affected
• Risk factors
• Advanced age
• Family history of first-degree relatives
  diagnosed with AD

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Alzheimers Disease

• Clinical presentation
• Progression of symptoms and time appearance is
  unique to the individual
• Very early stage
• Usually considered questionable dementia
• Forgets names, events, phone numbers
• Gets lost in familiar surroundings
• Early/Mild stage
• Loss of recent memory
• Forgets bills, misplaces items

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Alzheimers Disease

• Middle/Moderate stage
• Increased memory loss
• Makes up stories to compensate
• Wandering
• Gait changes to small steps
• Late/Severe stage
• Inability to perform ADLs
• Little response to stimuli
• Loss of body weight, bodily functions
• Susceptibility to infection

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Non-Alzheimers Dementia

• Development of multiple cognitive impairments,
  including the loss of memory
• Attributable to
• Metabolic disorders
• Thyroid, renal failure, liver failure
• Toxins
• Infections and neoplasms
• s/e of drugs
• Nutritional deficiencies
• Degenerative neurological diseases
• Cerebral vascular injuries, ischemias, or trauma

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Delirium

• AKA acute confusional state, acute brain
  syndrome, toxic psychosis, etc.
• Transient cognitive disorder with a rapid onset
  and brief duration
• Typical clinical presentation
• Reduced ability to maintain attention
• Disorganized thinking
• Difficulty in focusing

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Stroke

• AKA brain attack, cerebral vascular accident
  (CVA)
• 3rd leading cause of disability in US
• 3 million people live with residual effects of
  stroke
• 75 of stroke patients are gt 65 y.o.

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Stroke

• Intracerebral hemorrhage
• Ischemic stroke
• TIAs
• Acute focal neurological signs than symptoms
  lasting lt24 hours
• Brief stroke-like event resulting in block of
  blood flow to brain
• Precedes stroke in 50 -70 of cases
• 1/3 will have a stroke within 5 years

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Parkinsons Disease

• Degenerative brain disorder of subsantia nigra
  (midbrain), resulting in death of nerve cells
  whose role is motor function reduction of
  neurotransmitter dopamine, which facilitates
  transfer of electrical signals between nerve cells

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Parkinsons Disease

• Early stage PD
• First symptoms mild, slight tremor in had at
  rest.
• Purposeful movements such as brushing teeth
  become slow and difficult
• Medications Symmetrol, Elderpryl, Parlodel,
  Permax
• Mid-stage PD
• Increased symptoms
• Decreasing affect of medications
• Add levodopa (Sinemet)

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Parkinsons Disease

• Late-stage PD
• Decreasing effects of medications
• Increasing difficulty with balance, increased
  muscle contractions, problems initiating
  movement, involuntary abnormal posture,
  nightmares, orthostatic hypotension,
  constipation, rigid face, depression, dementia
• Newer therapies Requip, Mirapex

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Cognitive Assessments

• Instrumental activities of daily living (IADL)
• Bathing
• Dressing
• Toileting
• Transferring
• Continence
• Feeding

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Cognitive Measures

• Mini-Mental State Exam (MMSE)
• 30 item instrument used to screen for cognitive
  deficiencies
• Used in determination of dementia or delirium
• Tests orientation, short-term memory, calculation
  ability, language and construction
• Must be administered exactly as written (copy in
  your syllabus appendix)