GERONTOLOGY

Prepared by:
Dean Cyd F. Eleco, RN-Man
Universal College of Nursing

Human beings - impressive as we are - have a

fatal flaw that prevents us from continuing
along our personal paths of knowledge and
progression.
We age, and as a browning leaf on a tree branch
eventually flutters dry and brittle to the ground,
we perish. There's nothing to stop this
eventual deterioration of our bodies.
Even our minds may dissipate as we age, and
we may become frail and physically incapable.

What is Gerontology? Geriatrics?

Aging is a multidisciplinary field. This
means that the study of aging combines or
integrates information from several
separate areas of study.
Biology, sociology, and psychology are the
"core" or basic areas, along with content
from many other areas of study such as
public policy, humanities, and economics.

Gerontology is the study of the aging processes

and individuals as they grow from middle age
through later life. It includes:
the study of physical, mental, and social
changes in older people as they age
the investigation of the changes in society
resulting from our aging population
the application of this knowledge to policies and
programs. As a result of the multidisciplinary
focus of gerontology, professionals from diverse
fields call themselves"gerontologists"

Geriatrics is:
the study of health and disease in later life
the comprehensive health care of older
persons and the well-being of their
informal caregiver

Why Study Aging and Older Persons?

Populations are aging worldwide. This means that
people are living longer, and the number of older
persons is increasing.
And the age group growing fastest in our society
and in many other countries is the "very old,"
people aged 85 and over. The growth of the elderly
population will continue into the future.
These growth trends will result in a demand for
professionals with knowledge and expertise in
aging. Expanded career opportunities in
gerontology and geriatrics are forecast in many
disciplines and professions.

How Can You Locate Jobs in the Field of Aging?

Field placements, internships, and clinical affiliations, which are required
by many college and university programs in aging
Volunteering at community agencies provides work experience as well as
a network of contacts that is extremely helpful for finding employment in
the field.
Become familiar with the state and local agencies and organizations that
serve older persons. This information can be obtained from your state unit
or area agency on aging. Also contact local hospitals, nursing homes,
senior centers, and retirement communities.
Become involved in one or more professional aging organizations and
attend their annual meetings.
program planner, social worker, nurse, speech therapist, recreation
director, or housing administrator).

Geriatric disease can be classified

(Harrington 1988) as:
diseases proper to old age
diseases that persist into old age
diseases with a changing incidence in old
age.

DISEASES
Alzheimer's Disease
Heart Arrhythmia
Macular Degeneration
Parkinson's Disease
Stroke

Alzheimer's disease
Alzheimer's disease is a progressive disease t hat damages
nerve cells (neurons) in parts of the brain involved in
memory, learning, language, and reasoning.
As the disease progresses, communication among the
neurons breaks down. In early stages, short-term memory
begins to fail.
Over time, functions such as long-term memory, language,
and judgment decline.
Alzheimer's disease is the most common cause of dementia
in older adults.
Dementia is a loss of mental functionssuch as thinking,
memory, and reasoningthat is severe enough to interfere
with a person's daily functioning.

Basic types of Alzheimer's disease:

Early-onset Alzheimer's disease tends to
strike people under age 65 and is more
likely to run in families.
Late-onset Alzheimer's disease, the much
more common type, generally afflicts people
after age 65. The exact cause of Alzheimer's
is unknown, although researchers studying
this puzzling disease are making progress.

Types and stages of Alzheimer's

Early-onset Alzheimer's: This is an uncommon form in which individuals

are diagnosed with the disease before age 65. Fewer than 10 percent of all
Alzheimer's disease patients have this type. Because of their genetic
abnormality, people with Down syndrome are particularly at risk for a form of
early-onset Alzheimer's disease. Adults with Down syndrome often are in
their mid- to late 40s or early 50s when symptoms first appear.

Late-onset dementia: The most common form of Alzheimer's disease, lateonset dementia usually strikes after age 65. It occurs in almost half of all
people over the age of 85 and may or may not be hereditary. Late-onset
dementia is also called sporadic Alzheimer's disease.

Familial Alzheimer's disease (FAD): This form of Alzheimer's disease is

known to be entirely inherited. FAD is extremely rare, accounting for fewer
than 1 percent of all cases of Alzheimer's disease. It has a much earlier
onset (often in the 40s) and follows clear patterns of inheritance.

Causes
Studies show that chemical and structural changes
occur in the brains of people with Alzheimer's
disease. These changes interfere with a person's
ability to process, store, and retrieve information. It is
not known why these changes occur.
Scientists have found two significant abnormalities in
the brains of people with Alzheimer's disease:
twisted nerve cell fibers, known as neurofibrillary tangles,
and a
sticky protein called beta-amyloid, which forms structures
called plaques. Plaques and tangles are associated with
damage to healthy brain cells, causing the brain to atrophy
and shrink.

 Another characteristic of Alzheimer's disease is

the reduced production of certain chemicals in
the brain that are necessary for communication
between nerve cells. These chemicals, called
neurotransmitters, include acetylcholine,
serotonin, and norepinephrine.
In the area of the brain responsible for memory,
the hippocampus, there is a loss of nerve cells,
and decreases occur in the levels of chemicals
needed for carrying messages back and forth
between the nerve cells.

Risk factors
Age: Your risk of developing Alzheimer's
disease increases as you grow older. At 65
years, 1 percent of the population is affected; at
age 85, 30 percent to 50 percent has the
disease. While it has been suggested that
everyone might develop dementia after living
long enough, it should be emphasized that
Alzheimer's is a disease and not simply an
exaggeration of normal aging.

 Family history: If you have relatives who

have Alzheimer's, you are more likely to
develop the disease, although a clear,
inherited pattern of Alzheimer's disease
exists for fewer than 1 percent of all cases.
Alzheimer's disease strikes early and fairly
often in certain families, often enough to
be singled out as a separate form of the
disease and given a label: early-onset
familial Alzheimer's disease, or FAD.

 Sex: Alzheimer's disease is more prevalent

among women than among men.
Head injury: Some studies have shown an
association between Alzheimer's disease and a
history of significant head injury.
Education: Some studies have shown that low
education levels are related to an increased risk
for Alzheimer's disease, although why this might
be the case is not clearly understood.
Down syndrome: People with Down syndrome
often develop Alzheimer's disease in their 40s
and 50s.

Nursing Care for People with

Alzheimer's Disease
Helping someone with Alzheimer's take a bath or
shower can promote anxiety and
embarrassment for previously independent
people.
Sundowning is the term used to describe the
increased confusion and agitation that occurs
later in the day and evening and sometimes into
the night.

 Alzheimer's disease and other types of dementia

can affect people's ability to take a balanced
diet.
Behavior changes such as apathy, agitation,
anxiety, wandering impacts on diet, nutrition and
health. People with Alzheimer's need to keep as
healthy as possible to maximize their feeling of
wellbeing.
Medication can help
footwear

 Keeping warm in cold weather also

becomes more important because as we
get older and our body temperature drop
there is an increased risk of strokes, heart
attacks and breathing difficulties
Fecal incontinence in someone with
dementia is difficult for a person with
dementia, a toilet training program, to treat
fecal incontinence where dementia is
causing the problem.

 Mouth and dental hygiene care is very

important to maintain best physical and
mental health of the individual.
Urinary tract infection in the elderly or in
people with Alzheimer's can profoundly
affect not only their health but can result in
significant behavioral changes.

 Condom Catheters - incontinence often

becomes a major source of stress.
Fungal nail infections may be difficult to
treat and may often recur.
Pressure Sore also known as pressure
ulcers, bed sores, or skin ulcers; pressure
sores are areas of damaged skin and
tissue at the points on the body where
sustained pressure, friction or moisture
leads to the skin being injured.

 Responding to a Seizure
When someone is having a 'fit' their
muscles jerk, they can lose
consciousness, they often fall to the
ground and can make noises- rasping,
shouting out, their faces grimace, they can
become rigid
wandering you can minimize the risks of
someone with Alzheimer's becoming lost.

Arrhythmia
An irregular heartbeat is an arrhythmia also
called dysrhythmia
normal heart rate is 50 to 100 beats per minute.
Arrhythmias and abnormal heart rates don't
necessarily occur together.
Arrhythmias can occur with a normal heart rate,
or with heart rates that are slow (called
bradyarrhythmias -- less than 50 beats per
minute).
Arrhythmias can also occur with rapid heart
rates (called tachyarrhythmias -- faster than 100
beats per minute).

Causes
Coronary artery disease.
Electrolyte imbalances in your blood (such
as sodium or potassium).
Changes in your heart muscle.
Injury from a heart attack.
Healing process after heart surgery.
Irregular heart rhythms can also occur in
"normal, healthy" hearts.

Symptoms
Palpitations (a feeling of skipped heart
beats, fluttering or "flip-flops," or feeling
that your heart is "running away").
Pounding in your chest.
Dizziness or feeling light-headed.
Fainting.
Shortness of breath.
Chest discomfort.
Weakness or fatigue (feeling very tired).

Nursing Care for Cardiac

Arrhythmia
Prevent/treat life-threatening dysrhythmias.
Support patient in dealing with anxiety / fear of
potentially life-threatening situation.
Assist in identification of cause / precipitating
factors.
Review information regarding condition /
prognosis / treatment regimen.

Diagnostic Studies Cardiac

Arrhythmia
ECG: Reveals type/source of dysrhythmia and effects of
electrolyte imbalances and cardiac medications.
Demonstrates patterns of ischemic injury and conduction
aberrance. Note: Exercise ECG can
reveal dysrhythmias occurring only when patient is not at
rest (can be diagnostic for cardiac cause of syncope).
Extended or event monitoring (e.g., Holter
monitor): Extended ECG tracing (24 hr to weeks) may
be desired to determine which dysrhythmias may be
causing specific symptoms when patient is active
(home/work) or at rest. May also be used to evaluate
pacemaker function, antidysrhythmia drug effect, or
effectiveness of cardiac rehabilitation.

 Signal-averaged ECG (SAE): May be used to

screen high-risk patients (especially post-MI or
unexplained syncope) for
ventricular dysrhythmias, presence of delayed
conduction, and late potentials (as occurs with
sustained ventricular tachycardia).
Chest x-ray: May show enlarged cardiac
shadow due to ventricular or valvular
dysfunction.
Myocardial imaging scans: May demonstrate
ischemic/damaged myocardial areas that could
impede normal conduction or impair wall motion
and pumping capabilities.

 Electrophysiological (EP)
studies: Provides cardiac mapping of
entire conduction system to evaluate
normal and abnormal pathways of
electrical conduction. Used to
diagnose dysrhythmias and evaluate
effectiveness of medication or pacemaker
therapies.
Electrolytes: Elevated or decreased
levels of potassium, calcium, and
magnesium can causedysrhythmias.

 Drug screen: May reveal toxicity of

cardiac drugs, presence of street drugs, or
suggest interaction of drugs,
e.g., digitalis and quinidine.
Thyroid studies: Elevated or depressed
serum thyroid levels can
cause/aggravate dysrhythmias.

 ESR: Elevation may indicate acute/active

inflammatory process, e.g., endocarditis,
as a precipitating factor for dysrhythmias.
ABGs/pulse oximetry: Hypoxemia can
cause/exacerbate dysrhythmias

Parkinson's disease
Parkinson's disease is the second most
common neurodegenerative disorder and
the most common movement disorder.
characterized by
progressive loss of muscle control, which
leads to
trembling of the limbs and head while at rest,
stiffness, slowness, and impaired balance.
As symptoms worsen, it may become difficult
to walk, talk, and complete simple tasks.

Causes
Parkinson's disease are caused by a lack
of dopamine due to the loss of dopamineproducing cells in the substantia nigra and
corpus striatum becomes ineffective. and
movement becomes impaired; the greater
the loss of dopamine, the worse the
movement-related symptoms.
Stress

 Parkinson's disease is not understood. In

general, scientists suspect that dopamine
loss is due to a combination of genetic and
environmental factors.

Genes linked to Parkinson's

disease
SNCA (synuclein, alpha non A4
component of amyloid precursor): SNCA
makes the protein alpha-synuclein. In
brain cells of individuals with Parkinson's
disease, this protein aggregates in clumps
called Lewy bodies. Mutations in the
SNCA gene are found in early-onset
Parkinson's disease.

 PARK2 (Parkinson's disease autosomal

recessive, juvenile 2): The PARK2 gene
makes the protein parkin. Mutations of the
PARK2 gene are mostly found in
individuals with juvenile Parkinson's
disease. Parkin normally helps cells break
down and recycle proteins.

 PARK7 (Parkinson's disease autosomal

recessive, early onset 7): PARK7
mutations are found in early-onset
Parkinson's disease. The PARK7 gene
makes the DJ-1 protein, which may
protect cells from oxidative stress.

 PINK1 (PTEN-induced putative kinase 1):

Mutations of this gene are found in earlyonset Parkinson's disease. The exact
function of the protein made by PINK1 is
not known, but it may protect structures
within the cell called mitochondria from
stress.

 LRRK2 (leucine-rich repeat kinase 2):

LRRK2 makes the protein dardarin.
Mutations in the LRRK2 gene have been
linked to late-onset Parkinson's disease.

Risk for Parkinson's disease

Age is the largest risk factor for the development and
progression of Parkinson's disease. Most people who
develop Parkinson's disease are older than 60 years
years of age.
Men are affected about 1.5 to 2 times more often than
women.
A small number of individuals are at increased risk
because of a family history of the disorder.
Head trauma, illness, or exposure to environmental
toxins such as pesticides and herbicides may be a risk
factor.

Symptoms of Parkinson's
disease
The primary symptoms of Parkinson's
disease are all related to voluntary and
involuntary motor function and usually start
on one side of the body.
Symptoms are mild at first and will progress
over time. Some individuals are more
affected than others.

Characteristic motor symptoms

include the following:
Tremors: Trembling in fingers, hands, arms, feet,
legs, jaw, or head. Tremors most often occur while
the individual is resting, but not while involved in a
task. Tremors may worsen when an individual is
excited, tired, or stressed.
Rigidity: Stiffness of the limbs and trunk, which
may increase during movement. Rigidity may
produce muscle aches and pain. Loss of fine
hand movements can lead to cramped
handwriting (micrographia) and may make eating
difficult.

 Bradykinesia: Slowness of voluntary movement. Over

time, it may become difficult to initiate movement and to
complete movement. Bradykinesia together with stiffness
can also affect the facial muscles and result in an
expressionless, "mask-like" appearance.
Postural instability: Impaired or lost reflexes can make it
difficult to adjust posture to maintain balance. Postural
instability may lead to falls.
Parkinsonian gait: Individuals with more progressive
Parkinson's disease develop a distinctive shuffling walk
with a stooped position and a diminished or absent arm
swing. It may become difficult to start walking and to make
turns. Individuals may freeze in mid-stride and appear to
fall forward while walking.

Secondary symptoms of
Parkinson's disease
While the main symptoms of Parkinson's disease
are movement-related, progressive loss of muscle
control and continued damage to the brain can lead
to secondary symptoms.
Secondary symptoms include:
anxiety, insecurity, and stress
confusion, memory loss, and dementia (more
common in elderly individuals)
constipation
depression

 difficulty swallowing and excessive

salivation
diminished sense of smell
increased sweating
male erectile dysfunction
skin problems
slowed, quieter speech, and monotone
voice
urinary frequency/urgency

REFERENCES:
Arenas, E. Towards stem cell replacement therapies for Parkinson's
disease. Biochemical and Biophysical Research Communications, 2010; vol
396: pp 152-156.
Chen, J.C. Parkinson's Disease: Health-Related Quality of Life, Economic
Cost, and Implications of Early TreatmentAmerican Journal of Managing
Care, 2010; vol 16: pp S87-S93.
Fricker-Gates, R.A. and Gates, M.A. Stem cell-derived dopamine neurons for
repair in Parkinson's disease.Regenerative Medicine, March 2010; vol 5(2):
pp267-78.
Hauser, R.A., Early Pharmacologic Treatment in Parkinson's
Disease. American Journal of Managing Care, 2010; vol 16: pp S100-S107.
Pahwa, R. and Lyons, K.E. diagnosis of Parkinson's disease:
recommendations from diagnostic clinical guidelines. American Journal of
Managing Care, 2010; vol 16: pp S194-S99.

Stroke
Brain cell function
requires a constant
delivery of oxygen and
glucose from the
bloodstream.
A stroke, or
cerebrovascular
accident (CVA), occurs
when blood supply to
part of the brain is
disrupted, causing
brain cells to die.

Blockage of an artery
Narrowing of the small arteries within the brain can
cause a lacunar stroke, (lacune means "empty space").
Blockage of a single arteriole can affect a tiny area of
brain causing that tissue to die (infarct).
Hardening of the arteries (atherosclerosis) leading to
the brain. There are four major blood vessels that
supply the brain with blood.
The anterior circulation of the brain that controls most motor
activity, sensation, thought, speech, and emotion is supplied by
the carotid arteries.
The posterior circulation, which supplies the brainstem and
the cerebellum, controlling the automatic parts of brain function
and coordination, is supplied by the vertebrobasilar arteries.

Three Commands
Ask the patient to do the following:
Smile: the face should move
symmetrically
Raise both arms: looking for weakness
on one side of the body
Speak a simple sentence

 If these arteries become narrow as a

result of atherosclerosis, plaque or
cholesterol, debris can break off and float
downstream, clogging the blood supply to
a part of the brain.
Embolism to the brain from the heart. In
some instances blood clots can form
within the heart and the potential exists for
them to break off and travel (embolize) to
the arteries in the brain and cause a
stroke.

Rupture of an artery
(hemorrhage)
Cerebral hemorrhage (bleeding within
the brain substance). The most common
reason to have bleeding within the brain is
uncontrolled high blood pressure.
Other situations include aneurysms that
leak or rupture or arteriovenous
malformations (AVM) in which there is an
abnormal collection of blood vessels that
are fragile and can bleed.

Stroke Symptoms and Signs

A stroke results from impaired oxygen delivery to brain cells via the
bloodstream.

Numbness or weakness of the face, arm or leg, especially on one side

of the body. The loss of voluntary movement and/or sensation may be
complete or partial.

Confusion, trouble speaking or understanding. Sometimes weakness in

the muscles of the face can cause drooling.

Trouble seeing in one or both eyes

Trouble walking, dizziness, loss of balance or coordination

Severe headache with no known cause

Causes of Stroke
The blockage of an artery in the brain by a clot
(thrombosis) is the most common cause of a
stroke. The part of the brain that is supplied by
the clotted blood vessel is then deprived of blood
and oxygen. As a result of the deprived blood
and oxygen, the cells of that part of the brain die
and the part of the body that it controls stops
working.
Typically, a cholesterol plaque in a small blood
vessel within the brain that has gradually caused
blood vessel narrowing ruptures and starts the
process of forming a small blood clot.

Risk Factors
high blood pressure (hypertension),
high cholesterol,
diabetes, and
smoking.

Embolic Stroke
Another type of stroke may occur when a blood clot or a
piece of atherosclerotic plaque (cholesterol and calcium
deposits on the wall of the inside of the heart or artery)
breaks loose, travels through the bloodstream and
lodges in an artery in the brain.
When blood flow stops, brain cells do not receive the
oxygen and glucose they require to function and a stroke
occurs.
This type of stroke is referred to as an embolic stroke.
For example, a blood clot might originally form in the
heart chamber as a result of an irregular heart rhythm,
such as occurs in atrial fibrillation.

Cerebral Hemorrhage
A cerebral hemorrhage occurs when a
blood vessel in the brain ruptures and
bleeds into the surrounding brain tissue.
A cerebral hemorrhage (bleeding in the
brain) causes stroke symptoms by
depriving blood and oxygen to parts of the
brain in a variety of ways. Blood flow is
lost to some cells.

Vasculitis
Another rare cause of stroke is vasculitis,
a condition in which the blood vessels
become inflamed causing decreased
blood flow to brain tissue.

Migraine Headache
There appears to be a very slight
increased occurrence of stroke in people
with migraine headache.
Some migraine headache episodes can
even mimic stroke with loss of function of
one side of the body or vision or speech
problems.

The patient needs to be appropriately

evaluated and stabilized before any clotbusting drugs can be potentially utilized.
Computerized tomography - A CT scan
is used to look for bleeding or masses
within the brain that may cause symptoms
that mimic a stroke
MRI scan: Magnetic resonance imaging MRI images are much more detailed than
those from CT

 Computerized tomography with angiography

Using dye that is injected into a vein in the arm,
images of the blood vessels in the brain can give
information regarding aneurysms or arteriovenous
malformations.
Other abnormalities of brain blood flow may be
evaluated. With faster machines and better
technology, CT angiography may be done at the
same time as the initial CT scan to look for a blood
clot within an artery in the brain.

Heart tests
Certain tests to evaluate heart function are
often performed in stroke patients to
search for the source of an embolism.
Electrocardiograms (EKG or ECG) may be
used to detect abnormal heart rhythms like
atrial fibrillation that are associated with
embolic stroke.

Prevention

High blood pressure

Smoking
Diabetes
High cholesterol
Blood thinner/warfarin: Warfarin
(Coumadin) is a blood "thinner" that
prevents the blood from clotting.

Stroke At A Glance
Stroke is the sudden death of brain cells due to lack of
oxygen.
Stroke is caused by the blockage of blood flow or rupture
of an artery to the brain.
Sudden tingling, weakness, or paralysis on one side of
the body or difficulty with balance, speaking, swallowing,
or vision can be a symptom of a stroke.
Stroke prevention involves minimizing risk factors, such
as controlling high blood pressure, elevated cholesterol,
tobacco abuse, and diabetes.

 REFERENCES:
del Zoppo GJ, et al. Expansion of the Time Window for
Treatment of Acute Ischemic Stroke with Intravenous
Tissue Plasminogen Activator: A Science Advisory from
the American Heart Association/American Stroke
Association. Stroke 2009;40;2945-2948.
Johnston SC. et al. National Stroke Association
guidelines for the management of transient ischemic
attacks. Ann Neurol. 2006 Sep;60(3):301-13.