TRAINING PROGRAM Introduction Gerontology is the study of the social, psychological and biological aspects of aging.

It is distinguished from geriatrics, which is the branch of medicine that studies the diseases of older adults. The seminar workshop will focus in the field of gerontology and discuss the physiological and psychological changes of aging, mental health, wellness and know health care methods that may benefit the older adult. And also to inform the participants the knowledge about the situation of older adults regarding their hospitalization. Objective General Objective This seminar workshop focuses on developing the skills, knowledge and attitudes (SKA) aspect of the nurses in assisting and caring for the older adults. It is also important to distinguish changes involved with normal aging from changes attributable to pathophysiology. Alterations in the structure and function of multiple body system may affect an older person appearance, mobility and ability to fight off infections so nurses can be efficient in giving out care to geriatrics patients.. Learning Objectives Upon completion of this module, participants will be able to: 1. Differentiate among various terms and concepts related to aging, such as chronological vs. functional age, life course perspectives, and the differences among longevity, life span, and life expectancy. 2. Discuss the demographic imperative for increased care of the elderly. 3. Differentiate between normal aging and diseases. The physiological changes which occur during the normal aging process. 4. Discuss myths and stereotypes about aging. Operating Details A. Participants B. Duration C. Venue D. Methodology E. Evaluation

30 nurses 5 days; 8:00 AM- 5:00 PM Hospital Conference Room Lecture, Discussion, Workshop Workshop Output

Section 1: Defining Terms Section 2 Leading Causes of Death Patterns vs. Disease Section 3: Normal Aging Patterns vs. Disease Normal Physiologic Changes Associated with Aging Specific Changes to Organ Systems Section 4: Summary Levels of Functioning Section 5: Health Disparities among the Elderly Section 6: Myths about Aging

Section 1 - Defining Terms Chronological age Functional determinants Life course perspectives Longevity Life span Life expectancy Cross-over effect Stereotypes in aging Transitions Defining old age: 1) Chronological age - retirement; 65 years of age - service eligibility - 60 years of age

The need to define old age by chronological age has been adopted more by western cultures compared to non-western cultures. 2) Functional determinants - Age may be accessed by examining and measuring the ability of individuals to perform basic activities of daily living (ADL) such as eating, dressing, bathing, grooming and toileting without assistance. This concept has been adopted more by non-western cultures. This method conflicts with those who are disabled and unable to perform ADLs without assistance and are obviously of younger age. Life course perspectives: (Matilda Riley, 1979) 1) Aging is a life-long process of growing up and growing old. All phases of aging work together and cannot be considered separate. 2) Aging consists of three major processes - biological psychological, and social. All interact with each other over the life course. 3) The life-course pattern of any individual is affected by social and environmental changes or factors. 4) New patterns of aging can cause social change. Longevity - the length of life of one or a few individual organisms of the same species; the highest recorded age at death & maximal life span estimated for entire species. Life span - the generic attribution used to define a biological limit of life; intrinsic factors, such as genetics, which may predetermine life span; refers to a group or entire species. e.g. maximum life span for humans=115 years; average life span for humans =75 years Life expectancy - refers to the individual; epidemiological extrinsic factors we can use to modify and help our aging process along. How many years is a person with this particular demographic make-up - current age, gender, race, economic status, geographic location - expected to live. e.g. males=72 years, females= 78 years Cross-over effect - the changing of trends in aging for a particular group based on specific demographic indicators. e.g. White Americans tend to outlive non-white Americans up to age 75 years.

Between the ages of 75-85 there is a cross-over where non-whites outlive Whites. After age 85 this effect disappears and no difference in life expectancy is seen. I. Stereotypes in aging Stereotyping implies a prejudicial, usually negative, response to a perceived group. Much of the stereotyping of old age is perceived on ideas concerning loss of independence or autonomy, loss of wealth, and power and external beauty. Loss of friends & family; this leads to a double jeopardy effect where older people who are at greatest risk of declining health also are given the opportunities to continue to gain from society what they hope to either obtain or maintain. 1) isolation and loneliness - most elderly people have frequent contact with their children or other relatives and friends. 2) elderly as grandparents - closeness and informality 3) retirement causes unhappiness & idleness 4) 4 main myths & fallacies on aging - most old people are not destitute, dependent or residing in nursing homes. - most are not seriously diseased. Disability and disease are more prevalent in old age but not persistent. - work productivity does not invariable decline in old age - most old people do feel adequate II. Transitions: 1. Functional - inability to do as much as before; increase # chronic illnesses functioning - role of adaptation 2. Social - retirement; changes in social network - loss of friends/family Effects of race and SES (socioeconomic status) on social transition - Double jeopardy 3. Psychological - decreased short-term memory; minor decline in intelligence - changes in perceived Intelligence level may be due to progress (sociocultural change). - need to become more structured with age; take less risks (1) General Demographics A. The older age group is growing rapidly and there is an increased need for practitioners with geriatric training.

may restrict

B. Important Facts 1. The overall numbers of adults age 65+ has increased by 10 million between 1990 and 2000. The projected number is expected to increased to over 70 million by 2050 (Figure 1). 2. From 1970-2000, the percentage of people age 65+ has grown from 10% to 13%. By the year 2050, it is projected to be 20% 3. The worlds annual growth rate for the geriatric population is 1.5% compared to the annual growth rate for adults 65+, which is 2.7%. 4. Minority populations are projected to represent 25.4% of the elderly population in 2030, up from 16.4% in 2000 5. Life expectancy - Since 1900, the life expectancy for males and females at birth has increased dramatically from approximately 50 years to close to 80 among women and 73 among men. Those alive at age 65 can expect to live another 20 years among women and 16 years among men. C. What About the Old-Old? The population age 85+ is fastest growing segment of the older population U.S. Census Bureau projects population age 85+ could grow from about 4 million in 2000 to 19 million by 2050 Module 1: Introduction to Geriatrics There were about 65,000 people age 100 or older in 2000; could be as many as 381,000 by 2030 D. Other demographics: 1. Year under age 18 over age 65 1900 40% 4% 1980 28% 11% 2030 21% 22% 2. Most common chronic health conditions: arthritis - 47% hypertension - 37% hearing impairments - 32% heart disease - 29% cataracts - 15% sinusitis - 15% 3. Physician visits - increased 22% between 1990-2000; 115% by 2030 4. Medications - older adults=12% of population but consumed 25% of prescription drugs and 40% of over-the-counter drugs 5. Health habits - older people less likely to smoke, drink, to be obese, or report high stress compared to younger adults. 6. Perceptions of health - 75% elderly tend to view their health as either excellent, very good, or good

Leading Causes of Death Among Elderly The #1 cause of death among persons age 65+ is heart disease (1,832 deaths per 100,000 persons) #2 cancer (1,133 per 100,000) #3 stroke (426 per 100,000) #4 COPDs (281 per 100,000) #5 pneumonia and influenza (237 per 100,000) #6 diabetes (141 per 100,000) #7 Alzheimers disease (floating rank among killers) Relative Importance of Ranked Causes of Death Death rates across causes are higher for older men than for older women 65+ until age 95 when they equalize Death rates vary by ethnicity and race across all 65+ age groups and gender differences EIGHTY YEAR OLDS DO NOT AGE ANY FASTER THAN THIRTY YEAR OLDS ANSWER: The physiologic functions that change with age do so in a linear fashion beginning at about age 30 and continue at about the same rate through the 9th decade Normal Aging Patterns versus Disease Normal aging involves universal changes inherent in the aging process. These changes are the results of both intrinsic (developmental and genetic) and extrinsic causes. (1) Normal Physiologic Changes Associated with Aging Integumentary System Musculoskeletal System Decreased vascularity of the dermis Decreased bone calcium Decreased melanin production Decreased blood supply to muscle Decreased sebaceous and sweat gland function Decreased muscle mass Decreased collagen and subcutaneous fat Decreased muscle mass Decreased thickness of epidermis Decreased tissue elasticity Increased capillary fragility Thinning of hair Nervous System Decreased rate of nail growth Decreased number of brain cells Thickening of connective tissue Decreased reflexes Decreased balance and coordination Respiratory System Decreased motor responses Decreased number of cilia Decreased sensory perception Decreased gas exchange Decreased lung capacity Thickening of alveoli

Cardiovascular System Sensory Changes Decreased heart size Visual: Decreased cardiac output Decreased color perception Increased arteriosclerosis Decreased peripheral vision Thickening and fibrosis of mitral and aortic valves Decreased night vision Decreased elasticity of heart muscle and blood vessels Thickening of the lens, presbyopia Decreased tear production Increased sensitivity to glare Hearing Decreased ability to distinguish highfrequency sounds Decreased number of hair cells in inner ear Thickening of eardrum - decreased ability to hear Taste and Smell Decreased number of taste buds Decreased production of thyroid stimulating hormone - decreased basal metabolic rate Decreased production of parathyroid hormone Urinary System Decreased urinary filtration rate Increased concentration of urine Decreased bladder capacity Increased volume of residual urine Changes Affecting All Body Systems Decreased body fluid Decreased tissue elasticity Decreased blood supply

Hematopoietic and Lymph System Increased plasma viscosity Decreased red blood cell production Decreased immune response

Gastrointestinal System Decreased gag reflex Decreased salivary production Decreased gastric secretions Decreased esophageal and gastrointestinal peristalsis Decreased sphincter tone Reproductive System Female Decreased estrogen levels Decreased vaginal secretions Decreased size of uterus and ovaries Decreased vaginal length and width Increased vaginal alkalinity Male Decreased testosterone levels Decreased rate and force of ejaculation Decreased speed gaining erection Decreased circulation Decreased muscle tone

Normal Changes Associated with Aging Basic Premise The physiologic state for any organ in any individual is a function of the rate of change that organ has been experiencing multiplied by the number of years that change has occurred The Goals of a Health Promotion and Functional Abilities Approach to the Care of Older Adults maximize the positive aspects of aging

 add life to years, not just more years to life delay the onset of chronic illness facilitate function, avoid disability support independence with dignity (2) Specific changes to organ system which occur with normal aging A. Cardiovascular There is no obligatory decline in CV function at rest; but a decreased c.o. may occur during exercise The change in the hemodynamic profile during exercise is explained by a diminished cardiovascular response to beta-adrenergic stimulation Changes in elastin and collagen properties during aging result in aortic stiffness, loss of diastolic recoil, and increased peripheral resistance Slowing of the electrical activity of the intrinsic cardiac pacemakers of the heart make the older person more susceptible to arrythmias and extrasystoles B. Respiratory Pulmonary changes with aging are subtle but slowly progressive increased rigidity of chest wall lowered diaphragm during tidal breathing decreased vital capacity increased residual volume losses in internal alveolar surface progressive decrease in arterial oxygenation C. Gastrointestinal Gastrointestinal complaints are frequent in the elderly however, the G-I tract basically retains physiologic function with aging because of the large surface area and redundancy involved Decline in gastric acid secretion by 5 meq/h per decade over the age of 30 Clearance of antipyrine, a measurement of microsomal oxidation, has been found to be slowed with aging An increased frequency of gallstones, however, is seen clinically D. Renal With aging there is both loss in the number of functioning nephrons and decrease in renal plasma flow The total number of glomeruli falls by 30 to 40% by age 80 The glomerular filtration rate (GFR) decreases by 50% over the time one ages from age 30 to The age-dependent decline in active renin concentration is responsible for a blunted renin response to postural changes, and is one of the mechanisms postulated for the frequency of postural hypotension in the elderly

 There is a water conservation defect in the elderly which predisposes them to dehydration due to a decreased responsiveness to vasopressin and a resting decrease in total body water with age that is more pronounced in women than in men E. Genitourinary Benign prostatic hypertrophy (BPH) is rarely seen before age 40, then progresses in frequency until it affects almost 90% of those age 80 or greater Menopause, the clinical syndrome associated with hormonal changes is associated not only with the symptoms of hot flashes, agitation, and sleep disturbance, but also is associated with increased risk for osteoporosis and atherosclerotic cardiovascular disease(ASCVD) F. Musculoskeletal Osteoporosis Degenerative arthritis evidence that this is due to unmodifiable aging related changes in articular structure and function is still debated Thinning of skin Fewer new hair growths G. Neurological Decreased ability of the autonomic nervous system to respond to stress Impaired body temperature regulation Changes in peripheral sensation and deep tendon reflexes Alteration in utilization of glucose by the brain Long term memory, especially the ability to retain large amounts of information over long periods of time, may demonstrate considerable loss beginning in the 4th decade Slight slowing is exhibited on some sensorimotor tasks and tasks involving mental transformations beginning in the 40s and 50s Until age 74, decrements in specific abilities affect less than a third of all aging adults H. Endocrine Hyperglycemia in the elderly has been related to resistance of peripheral tissues to the effect of insulin and the exercise and dietary changes among the elderly Some elderly may be subjected to altered nutritional states with deficiencies of isolated nutrients, generalized malnutrition, and obesity associated with protein calorie malnutrition I. Hearing Degeneration of the organ of Corti can result in sensory presbycusis Asymmetric, bilateral, high frequency hearing loss is characteristic of advancing age As hearing loss is 2X as common in the institutionalized elderly, part of the hearing loss reported may be related to illness and trauma J. Oral Cavity Taste sensations change as the number of lingual taste buds decline with age

K. Vision Visual acuity declines with age Corrections with contact lenses or glasses improve visual losses not related to disease Chronic Diseases Linked to Uncompensated NCsAA, Lifestyles, Trauma, and Neglect Most older persons have at least one chronic condition and many have multiple conditions The most frequently occurring conditions per 100 elderly in 1996 were: arthritis (49) hypertension (36) hearing impairments (30) heart disease (27) cataracts (17) orthopedic impairments (18) sinusitis (12) diabetes (10) Section 4. Summary Levels of Functioning In 1997, more than half of the older population (54.5%) reported having at least one disability Over a third (37.7%) reported at least one severe disability Over 4.5 million (14.2%) had difficulty in carrying out activities of daily living (ADLs) 6.9 million (21.6%) reported difficulties with instrumental activities of daily living (IADLs) Functional Disabilities Section 5: Health Disparities Among the Elderly While we celebrate our nations rich diversity, we recognize that minority Americans often are at greater risk of poor health, social isolation, and poverty Ethnogeriatrics - health care for elders from diverse ethnic populations Ageism: What and Why A bias, prejudice A major barrier to positive views about aging Makes some people view the elderly as valueless According to Western cultures, the association between old age and death and the desire to shun death may be major factors contributing to the negativism surrounding aging Section 6: Myths about Aging Myth 1: The majority of older persons are senile or demented Fact: Less than 20% have measurable memory impairment Myth 2: The majority of older persons feel miserable most of the time Fact: Happiness and life satisfaction studies show that the majority of elderly are just as happy as when they were younger Myth 3: Most older people cannot work as effectively as younger people Fact: Older workers are more consistent, have fewer accidents, and less absenteeism than younger workers Myth 4: Most old persons are unhealthy and need assistance with daily activities

Fact: Less than 20% are unable to perform activities of daily living, less than 5% are institutionalized for debilitating health problems Myth 5: The majority of old persons are socially isolated and lonely Fact: Although loneliness is a severe problem in one third of elderly, most elderly have close relatives, friends, organizations, and church activities that are considered significant

The Breaking Down of Old Myths Myth #1: To be old is to be sick. Only 5% of elderly population lives in nursing homes. Elderly may have chronic diseases but they still function quite well. Only 23% of elderly claim to have a disability. Module 1: Introduction to Geriatrics Myth #2: You cant teach an old dog new tricks. The less people are challenged, the less they perform-elders need to stay mentally active and stimulated. Conditions of successful learning are different for older people than for the young. Learning institutions are not flexible particularly concerning the elderly. Myth #3: The horse is out of the barn. Bad habits do not always produce irreparable damage. It is never too late to start good lifestyle habits of diet and exercise. Myth #4: The secret to successful aging is to choose your parents wisely. Heredity is a factor but environment and behavior choices strongly influence how well an elderly person functions. Myth #5: The lights may be on, but the voltage is low. Sexuality does decrease with age but there are tremendous individual differences among the elderly. The definition of sexuality and intimacy needs to be redefined and broadened. Myth #6: The elderly dont pull their own weight. The belief that the elderly are unproductive is false. The measures for productivity are wrong; paid employment should not be the only measure. There is job discrimination against the elderly