Theories of Ageing

Theories of Ageing

1. Theories of ageing and assessment of elderly

2. DEFINITION AGEING Ageing the normal process of time related change begins with birth and continues throught life. Ageing in living organism usually refers to a series of time dependent anatomical and physiological changes that reduce physiological reserve and functional capacity, although occasionally the term refers to the positive, process of maturation or acquiring a desirable quality. GERIATRICS The branch of medicine dealing with the physiological, psychological aspects of ageing and with diagnosis and treatment of diseases affecting older adult

3. THEORIES OF AGING: attempt to explain the phenomenon of aging as it occurs over the lifespan aging is viewed as a total process that begins at conception senescence: a change in the behavior of an organism with age leading to a decreased power of survival and adjustment Theories of Aging: Types o Biologic o Sociologic o Psychologic o Moral/Spiritual

4. BIOLOGIC THEORIES : o Concerned with answering basic questions regarding the physiological processes that occur in all living organisms as they chronologically age Foci of Biologic Theories o Explanations of: 1) deleterious effects leading to decreasing function of the organism 2) gradually occurring age-related changes that are progressive over time 3) intrinsic changes that can affect all member of a species because of chronologic age 4)all organs in any one organism do not age at the same rate 5) any single organ does not necessarily age at the same rate in difference individuals of the same species

5. BIOLOGIC THEORIES: DIVISIONS Stochastic : Explain aging as events that occur randomly and accumulate over time Nonstochastic : View aging as certain predetermined, timed phenomena STOCHASTIC THEORIES Error Theory Free Radical Theory Cross-Linkage Theory Wear & Tear Theory

6. ERROR THEORY Originally proposed in 1963 Basis: 1)errors can occur in the transcription in any step of the protein synthesis of DNA 2) error causes the reproduction of an enzyme or protein that is not an exact copy More recently the theory has not been supported by research,not all aged cells contain altered or misspecified proteins nor is aging automatically or necessarily accelerated if misspecified proteins or enzymes are introduced into a cell

7. FREE RADICAL THEORY o Free radicals are byproducts of metabolism--can increase as a result of environmental pollutants o When they accumulate, they damage cell membrane, decreasing its efficiency o The body produces antioxidants that scavenge the free radicals o In animal studies, administration of antioxidants postpones the appearance of diseases such as cardiovascular disease and CA o Free radicals are also implicated in the development of plaques associated with Alzheimer’s

8. CROSS-LINKAGE THEORY Some proteins in the body become cross-linked, thereby not allowing for normal metabolic activities o Waste products accumulate o Result: tissues do not function at optimal efficiency o Some research supports a combination of exercise and dietary restrictions in helping to inhibit the cross-linkage process

9. WEAR & TEAR THEORY o Proposed first in 1882 o Cells simply wear out over time because of continued use--rather like a machine o Would seem to be refuted by the fact that exercise in OA’s actually makes them MORE functional, not less

10. NONSTOCHASTIC THEORIES o Programmed Theory Immunity Theory PROGRAMMED (HAYFLICK LIMIT) THEORY Based on lab experiments on fetal fibroblastic cells and their reproductive capabilities in 1961 o Cells can only reproduce themselves a limited number of times. o Life expectancies are seen as preprogrammed within a species-specific range

11. IMMUNITY THEORY o Immunosenescence : Age-related functional diminution of the immune system o Lower rate of T-lymphocyte (“killer cells”) proliferation in response to a stimulus& therefore a decrease in the body’s defense against foreign pathogens o Change include a decrease in humoral immune response, often predisposing older adults to: 1)decreased resistance to a tumor cell challenge and the development of cancer 2) decreased ability to initiate the immune process and mobilize defenses in aggressively attaching pathogens 3) increased susceptibility to auto-immune diseases

12. EMERGING THEORIES OF AGING o Neuroendocrine Control (Pacemaker) Theory o Metabolic Theory/Caloric Restriction o DNA-Related Research

13. NEUROENDOCRINE CONTROL Examines the interrelated role of the neurologic and endocrine systems over the life-span of an individual”. there is a decline, or even cessation, in many of the components of the neuroendocrine system over the lifespan Research has shown 1) the female reproductive system is controlled by the hypothalamus. What are the mechanisms that trigger changes? 2) adrenal glands’ DHEA hormone 3) melatonin (from pineal gland)--a regulator of biologic rhythms and a powerful antioxidant. Declines sharply from just after puberty

14. METOBOLIC THEORY OF AGING (CALORIC RESTRICTION proposes that all organisms have a finite amount of metabolic lifetime and that organisms with a higher metabolic rate have a shorter lifespan”. Rodent-based research has demonstrated that caloric restriction increases the lifespan and delays the onset of age-dependent diseases

15. DNA-RELATED RESEARCH Major Developments: o Mapping the human genome (“…there may be as many as 200 genes responsible for contolling aging in humans”) o Discovery of telomeres

16. SOCIOLOGIC THEORIES OF AGING o Disengagement Theory o Activity/Developmental Task Theory o Continuity Theory o Age Stratification Theory o Person-Environment Fit Theory

17. DISENGAGEMENT THEORY o Cumming & Henry- -1961 o Aging seen as a developmental task in and of itself, with its own norms & appropriate patterns of behavior o “appropriate” behavior patterns involved a mutual agreement between OA’s and society on a reciprocal withdrawal. o No longer supported

18. ACTIVITY THEORY (DEVELOPMENTAL TASK THEORY) o Havighurst , Neugarten , Tobin ~1963 o “Activity is viewed by this theory as necessary to maintain a person’s life satisfaction and a positive self-concept”. o Theory based on assumptions: 1) it’s better to be active than inactive 2) it is better to be happy than unhappy 3) an older individual is the best judge of his or her own success in achieving the first two assumptions

19. CONTINUITY THEORY o How a person has been throughout life is how that person will continue through the remainder of life o Old age is not a separate phase of life, but rather a continuation and thus an integral component AGE STRATIFICATION THEORY o Riley--1985 o Society consists of groups of cohorts that age collectively o The people & Roles in these cohorts change & influence each other, as does society at large o Thus, there is a high degree of interdependence between older adults & society

20. PERSON-ENVIRONMENT FIT THEORY o Lawton, 1982 o Individuals have personal competencies that assist in dealing with the environment: o ego strength o level of motor skills o individual biologic health o cognitive & sensory-perceptual capacities o As a person ages, there may be changes in competencies & these changes alter the ability to interrelate with the environment o Significant implications in a society that is characterized by constantly changing technology

21. PSYCHOLOGIC THEORIES OF AGING o Maslow’s Hierarchy of Human Needs o Jung’s Theory of Individualism o Erikson’s Eight Stages of Life

22. MASLOW’S HIERARCHY OF HUMAN NEEDS o Maslow--1954 o each individual has an innate internal hierarchy of needs that motivates all human behaviors ”. o depicted as a pyramid; the ideal is to achieve self-actualization, having met all the “lower” level needs successful o Maslow’s fully developed, self-actualized person displays high levels of all of the following characteristics: perception of reality; acceptance of self, others, and nature; spontaneity; problem-solving ability; self-direction; detachment and the desire for primacy; freshness of peak experiences; identification with other human beings satisfying and changing relationships with other people; a democratic character structure; creativity; and a sense of values. o Only about 1% of us are truly ideal self-actualized persons

23. JUNG’S THEORY OF INDIVIDUALISM o Carl Jung--1960 o origins are Freudian o Self-realization is the goal of personality development o as individual ages, each is capable of transforming into a more spiritual being

24. ERIKSON’S EIGHT STAGES OF LIFE o 1993 o Stages throughout the life course. Each represents a crisis to be resolved. o For OA’s: o 40 to 65 (middle adulthood): generativity versus self-absorption or stagnation o 65 to death (older adulthood): ego integrity versus despair o Self-absorbed adults will be preoccupied with their personal well-being and material gains. Preoccupation with self leads to stagnation of life” o “Unsuccessful resolution of the last crisis may result in a sense of despair in which individuals view life as a series of misfortunes, disappointments, and failures ”.

25. HISTORY COLLECTION AND PHYSICAL ASSESSMENT THE HISTORY Demographic data • Full name • Age, sex and birth date • Marital status • Source of history

26. CHIEF COMPLAINTS • Primary reason for visit, ideally in patient on words • Duration of presenting symptoms PRESENT ILLNESS • Chronological narrative of patient visit • Persistence, change, severity, character and disabling effect of initial symptoms • Presence of new symptoms and associated symptoms • History of similar symptoms in the past • Aggravating and mitigating factors

27. PAST HISTORY • Previous medical history • General state of health • Childhood disease and immunization • History of adult medical diseases, injuries and operations • History of hospitalization • Medication including dosage, duration and indication • Allergies • Dietary habits

28. SOCIAL HISTORY • Birth place and residence • Level of education • Ethnicity and race MARITAL STATUS • Quality of significant relationship and health of partner Vocation included type of industry, past and present industrial exposure, duration of employment and retirement Avocations , including hobbies and interests Habits including quality of sleep, exercise and recreation, consumtion of alcohol and other drugs Significant life experiences FAMILY HISTORY Presence of disease with recognized familial importance in first degree relatives – type II diabetes, tuberculosis, cancer, hypertension, allergy, heart disease, neurological and psychiatric disease and arthritis Similar presenting symptoms in family members.

29. PHYSICAL EXAMINATION General Observation and Vital Signs Check: a. Signs of ADL deficits, poor hygiene, dishevelled appearance. b. Rectal temperature if patient is seriously ill because of blunted immune response . c. Orthostatic changes in blood pressure (BP) and pulse. d. Osler's maneuver if systolic BP is greater than 160 to screen for "pseudo hypertension"-positive if radial artery is palpable with cuff inflated above systolic BP level. e. Weight (at each visit to identify losses early and to establish a pattern). f. Signs of malnutrition or trauma (elder abuse and neglect or falls).

30. SKIN • Assess the skin for Neoplasm (especially in sun exposed areas), nipple retraction, peau d'orange . • Observe skin for signs of excessive dryness or impairment. Note presence, location, and amount of exudates. • Observe hair for excessive loss, dryness or oiliness. • Observe nails for excessive length, sharp edges and brittleness . SPECIAL SENSES ..EYE • Inspect the fundus for colloid bodies causing alteration in pigmentation called druses. • Assess for visual acuity. HEARING • Test hearing by occluding one ear and using the technique for whispered voice or an audioscope • Be sure to inspect the ear canals for cerumen because of removal can quickly improve hearing.

31. SMELL AND TASTE •Check these sensation with different type of substances NECK a . Dix- Hallpike positional test maneuver for benign positional vertigo (see Dizziness). b. Jugular venous pulse is better observed on the right side since compression of the left innominate vein by an elongated aortic arch may cause false distension on the left. CARDIOVASCULAR •Assess for signs of pallor, rubor or cyanosis •Assess apical and peripheral pulses. Compare both extremities while assessing the characteristics of peripheral pulses. •Assess capillary filling time •Assess for presence of vertigo or syncope •Assess blood pressure in lying, sitting and standing position. •Assess for edema , note the location and severity

32. LUNGS- - Age-related changes in pulmonary physiology and age-associated pulmonary pathology often result in rales that may not indicate pneumonia or pulmonary edema . For this reason, it is important to document a baseline exam at a time when the patient is not ill. Localized wheezes may indicate an obstructing bronchial lesion (carcinoma). • Assess depth, rhythm and rate of respiration at rest and with activity • Assess the amount of activity the individual is able to tolerate. • Note the activities that result in excess respiratory effort • Assess the presence of cough. Note whether productive or non productive. BREAST EXAM- - Tumors may be easier to palpate because of atrophy and less fibrocystic disease. Remember, men may have gynecomastia or malignancy

33. ORAL CAVITY AND GASTRO INTESTINAL SYSTEM • Examine the oral cavity for odour, appearance of the gingival mucosa, any caries, mobility of the teeth, quality of saliva. • Inspect closely for lesions on any of the mucosal surface. • Ask the patient to remove dentures so you can check the gum for denture sores. • Assess for complaints of pyrosis ( heart burn) and intestinal cramping • Assess dietary intake, especially of high fiber food, fat and sodium • Note the amount of food and fluid intake. Monitor weight • Assess for signs of abdominal distension • Assess frequency, amount and consistency of bowel elimination • Assess bowel elimination routines and use of laxatives

34. EXTREMITIES: Arthritis (rheumatoid, degenerative and crystalline), deformities, contractures, injuries, podiatric care, poor hygiene all increase the risk of pain, infection and gait disturbances GENITOR URINARY SYSTEM • Assess frequency, amount, odor , colour and consistency of urine • Assess individual’s ability to control urination R ECTAL - -Assess for diseases of the prostate, fecal impaction, integrity of sacral reflexes in persons with impotence, spinal stenosis or posterior column findings, hemoccult . Pelvic examination--Assess for pelvic prolapse, uterine, adnexal or vaginal neoplasm, infections, estrogen deficit.

35. FEMALE GENITALIA • Inspect the vulva for changes related to menopause such as thinning of the skin, loss of pubic hair and decreased ability to introitus . • Identify any labial masses. Note the bluish swelling that may be varicosities. • Bulging of the anterior vaginal wall below the urethra may indicate urethrocele or urethra diverticulum • Look for valvular erythma . Note the enlargement of clitoris MALE GENITALIA AND PROSTATE Examine the penis, retracting the foreskin if present. Examine the scrotum, testes and epididymis. Proceed with rectal examination, paying special attention to any rectal masses and any nodularity or masses of the prostate.

36. NEUROLOGICAL • Mental status examination should be performed in all patients to establish a baseline in the event of future dysfunction). This need not occur in the first session. • Asses alertness level • Assess appropriateness of behaviour and responses • Assess change in memory • Assess sleep patterns. Note onset, duration and quality of sleep as well as of any day time napping