exam notes on chapter 1-3

Exam Notes:
Chapter 1:
Gerontology: study of aging form maturity through old age

Agism: a form of discrimination against older adults based on their age

Life-span perspective:
Divides human development into two stages-
Early phase: (childhood and adolescence) rapid age-related increases in peoples size and abilities
Later phase: (young adulthood, middle age, and old age) change are slow, but abilities to continue to develop as people continue adapting to the environment.

4 key features:
1) multidirectionality: development involves both growth and decline, as people grow in one area, they may lose in another and at different rates.
2) Plasticity: ones capacity is not predetermined or set in concrete. Skills can be learned later in life
3) Historical context: each of us develops within a particular set of circumstances determined by historical time in which we are born and the culture in which we grow up
4) Multiple causation: how we develop results from a wide variety of forces. Development is shaped by biological, psychological, sociocultural, and life-cycle forces.

Takes a human lifetime to completely develop

Bates believes life-span development consists of the dynamic interaction between growth, maintenance, and loss regulation
-age-related reduction in amount of quality of biologically based resources as people get older age related increase in amount and quality of culture needed to generate continuously higher growth. Net slowing of growth as age increases age related decline in efficiency which cultural resources are used lack of cultural “old-age friendly” support structures

These 4 factors create need to shift more and more resources to maintain function and deal with biologically related losses as we get older. Less resources devoted to continuous growth

Developmentalists place special emphasis on 4 forces: biological, psychological, sociocultural and life cycle

The forces of development:
Biological forces: genetic and health related factors that affect development, examples of biological forces include menopause, facial wrinkling, and changes in the major organ system
Psychological forces: all internal perceptual, cognitive, emotional, and personality factors that affect development, phsycological forces provide the characteristics we notice about people that make them individuals
Sociocultural forces: interpersonal, societal, cultural, ethnic factors that affect development, provide overall context in which we develop.
Life-cycle forces:
Reflect differences in how the same event or combination of biological, psychological and sociocultural forces affect people at different points in their lives. Context is important.

Interrelations between the forces: developmental influences
3 set of influences that interact to produce developmental change over the life span normative age-graded influences: experiences caused by biological, psychological, and sociocultural forces that are highly correlated with chronological age. Like puberty, menarche, and menopause, are biological. These normative events usually indicate a major change in a perons life. Focus on certain concerns at different points in adulthood. Others like sociocultural forces, such as time when first marriage occurs, and the age at which one retires corresponds to major time marker in someone’s life, like turning 18.

Normative history-graded influences: most people in specific culture experience at the same time, may be biological( epidemics), psychological (particular stereotypes, or sociocultural (changing attitudes toward sexuality). Give generation its unique identity. Attack on world trade tower is an example, changed views of safety of Americans.

Non-normative influences:random or rare events that may be important for a specific individual and not experienced by most people. Could be winning lottery, or an election, or bad ones like a divorce or layoff

Controversies in development:
Nature vs nurture controversy- the extent to which inborn, hereditary characteristics (nature) and experiential, or environmental influences (nature) determine who we are make up the controversy.
Idea is now they interact, such as an environmental trigger can cuase something to occur.

Stability-change controversy:
Concerns the degree to which people remain the same over time. Stability is important focus to recognize that the same individual at times goes on.

Continuity-discontinuity controversy:
Derivity of the stability change controversy. This concerns whether a particular developmental phenomenon represents a smooth progression over time, or a series of abrupt shift. Focus on the amount of characteristic a person has, whereas discontinuity approaches usually focus on the KIND of characteristics a person has
Example of continuity reaction time. As people grow older, the speed which they can respond slows down.

Universal vs context-specific development controversy: whether there is 1 path or many. Some argue that contextual differences do not greatly affect development, one basic process for everyone. Differences in development are simply variations of a fundamental developmental process. Opposing view is that adult development and aging are inextricably intertwined with the context in which they occur. Develop is product of complex interactions with the environment, and these interactions are not fundamentally the same in all environments.
View of book is that development and aging must be undetstood within the context in which they occur.

The meaning of age:

Aging consists of 3 proceses:
-primary aging: is normal, disease-free development during adulthood, changes in biology psychology, sociocultural, and life cycle processes in priary aging are inevitable party of the development. Like menopause

secondary aging: is developmental changes that are related to disease, lifestyle, and other environmentally induced changes that are not inevitable (pollution)

tertiary aging: rapid losses that occur shortly before death, such as terminal drop, which intellectual abilities show a marked decline in last few years before death. Everyone does not grow old in same way.
Some people don’t get illness as they get older maybe due to combination of genetics, optimal environment, optimal environment, flexibility in dealing with life situations, and a strong sense of personal control.

Chronological age: organize time and events and date by using a calendar time

Perceived age: age you think you are

Biological age: max number of years we can possibly live. Function of the various vital, and life limiting, organ systems, such as cardiovascular system

Psychological age: functional level of psychological abilities people use to adapt to changing environmental demands. Such as memory, intelligence, feelings, motivation and other skills that foster and maintain self-esteem.

Sociocultural age: specific set of roles individuals adopt in relation to other members of the society and culture to which they belong. Based on many behaviors and habits such as style of dress, customs, language, and interpersonal style. Important in understanding many of the family and work roles we adopt.
Most damaging stereotypes about aging are based on faulty assumptions about sociocultural age.

Measurement in adult development and aging research:
Use 1 of 3 approaches: observing systematically, using tasks to sample behavior, and asking people for self-reports

Must choose most reliable and valid. Reliability of measure is extent to which it provides a consistent index of behavior which it provides a consistent index of behavior of topic of interest.

validity measures what researcher think it measures

systematic observation; watching people and recording what they say and do. Naturalistic: as people behave spontaneously structured: create a setting

sampling beahviour with tasks: create task to sample behavior of interest. Main problem is validity, if the task is irrelevant to their life, they wont do well.

Self reports: people answer questionnaire, when posed verbally, it is an interview

Representative sampling: research you use a population, and only a smaple of people, which is a subset of population
Unpreresantative sample can result in invalid generalizations

General design of research:
Experimental design: manipulating a key factor that research believes is responsible for a particular behavior and randomly assigning participants to the experimental and control groups.
Important distinction is made between independent variables, which are variables manipulated by experimenter, and indpendent variables, which are behaviors or outcomes that are measured.

Age, cohort, and time of measurement: all studys for adult development and agingis built on the combination of three building blocks: age cohort and time of measurement

Age effect relect differences caused by underlying processes, such as biological, psych, or sociocultural changes

Chort effect: differences caused by experiences and circumstances unique to a generation to which one belongs, corresponds to normative history-grade influence.

Time of measuremet effect: reflect differences stemming from sociocultural, environmental, and historical, or other events at the time the date are obtained from the participants. Clearly if study is conductd during a recession or a boom affects what is learned about pay changes

Cross sectional study: developmental differences are identified by tesing people at different ages at the same time.

Longitudinal desings: same individuals are observed or tested repeatedly at different points in their lives

Sequential designs: different combinations of cross-sectional or longitudinal studies. Consists of two or more cross-secotional studies conducted at tow or more times of measurement.

Chapter 2: physical changes

Rate of living theories: idea that people only have so much energy in one lifetime. Metabolism of other animals correlates to this dea
Reducing caloric intake lowers the risk of remature death, slows down a wide range of normative age-related changes, and in some caes, results in longer life span than do normal diets

A third variation of rate of living theory is hormonal regulatory systems adaptation to stress. Stress does not cause aging, but bodys ability to deal with it undergoes significant decline with gae

Cellular theory:
Point to cuase of aging at cellular level
Cells only can go under a certain amount of division before dying, dropping depending on the age of the donor organism, this is called hayflik limit.
Evidence suggests that the tip of the choromosomes, called telomeres, play a major role. An enzyme called telomerase is needed in dna replication to fully replicate the telomeres. Each reproduction, the telomere gets smaller and smaller. Cancel cells proliferate so quicly in some cases because they can activate telomerase, meaning cancer cells may become fnctioanlly immortal and take over organ system.

Second cellular theory is based on process called cross-linking, which certain proteins in human cells interact randomly and produce molecules that are linked in such a way as to make the bod stiffer.

Third type of cellular theory proposes that aging is caused by unstable molecules called free radicals, which are highly reactive chemicals produced randomly in normal metabolism. May cause cell damage, important evidence that free raicals may be involved in aging comes from research with substances that prevent initial development of free radicals, such as antioxidants, prevent oxygen from combing with susceptible molecules to fomr free radicals. Such as vitamin A, C, E and coenzyme Q.

Theories of programmed cell death:
Programmed cell death appears to be a function of physiological processes, the innate ability of cells to self-destuct, and the ability of dying cells to trigger key processes in other cells.

Ability and mobility:
Changes in skin, hair, and voice

Skin: wrinkling is a complex 4 step process, first, outer layer of skin becomes thinner through cell loss, second, collagen fibers that make up connective tissue lose much of their flexibility, making the skin less able to regain shape, 3rd, elastin fibers in the middle layer of skin lose ability to keep skin stretched out resulting in sagging, and finally, the underlying layer of fat, which helps provide padding to smooth out the contours, diminishes.
Some of the blood vessels in the skin may become dilated and create small, irregular red lines, varicose veins may appear as knotty, bluish irregularities in blood vessels, especially on legs.

changes in hair: hair loss is cuased by destruction of the germ centres that produce hair follicles, where greying results from cessation of pigment production. Hair growth is related to hormonal changes of the climacteric.

Changes in voice: change due to larynx, and respiratory system as the cuase of these changes

Changes in body build: a crease in height and fluctuations in weight. Height remains fairly stable until 50;s but between 50s and 70s men lose 1 inch, and women 2 inches. Caused by compression of the spine from loss of bone strength, changes in the discs between the vertebrae in the spine, and changes in posture.

Weight gain in middle age, by weight loss in later life, caused by change in metabolism, which tends to slow down, and reduce level of exercise, which reduces the number of calories needed a day.
More recent cohorts of old women are showing les body fat, compared with older men who show more. Cuased by changes in lifestyle and dietary habits.

Changes in mobility:
Muscles: at age 70, no more than 20% loss, how ever rate change increases. By 80 40%, and severe in legs than in arms and hands

Bones: bone loss begins in 30s, accelerates in the 50s, and slows by 70s. women lose it twice as fast as me, because of depletion of estrogen after menopause speeds up bone loss. Women susceptible to severe bone degenation, a disease called osteoporosis, increased porosity create bones that resemble laced honeycombs. Leading cause of broken bones in old women. Casued by low bone mass at skeletal maturity, deficiencies of calcium and vitamin D< estrogen depletion, and lack of weight-bearing exercise.

Sensory sytems:
Vision: first noticieable sign of aging, along with wrinkles and grey hair.
Changes in the structure of the eye at 40s, and changes in the retina in 50s

Structural changes in eye:
Decreased amount of light that pases through the eye, resulting in the need for more light to do tasks such as reading. Changes to ability to adjust to changes in illumination, called adaptation declines.
The other key structural changes involve the lens. Lens becomes more yellow, causing poorer color discrimination in green blue violet end of the spectru,. Lens ability to adjust and focus declines as muscles around it stiffens. This is called presbyopia. Difficulty in seeing close objects, necessitation either longer arms of corrective lenses

Opaque spots called cataracts maybe develop on lens, which limits the amount of light ransmitted, treated by surgical removal or corrective lenses. And fluid in eye may not drain properly, causing very high pressure, this is called glaucoma, can caus interal damage and loss of vision.

Retinal changes: retina lines 2/3 of interior eye. Rods and cones densly packed toward rear and focus point of vision called macula. Centre of macula is forvea, where incoming light is focused from maximum acuity. Increased age means degeneration of macula increases. Involves progressive and irreversible destruction of receptors form any of number of causes. Loss of ability to see detail.
2nd age related retinal disease is by product of diabetes. Accekereated aging of arteries, with blindness being one of serious side effects. Diabetic retinopathy can involve fluid rretnetion in macula, detachment from retina and hemmorage and aneurysms.

Hearing: experiencing hearng loss is normative changes with age. Reduced sensitivity to high pitched tones, called presbycusis, offurs earlier and more severely than the loss of sensitiovty to low pitched tones. Half older adults have it. Men more than women. Loss is gradual but accelerates during 40s.
Presbycusis results from 4 types of changes in inner ear, sensory, consisting of atrophy and degeneration of receptor cells, neural, consisting of loss of neurons in the auditory path way in the brain, and metabpoloc, consisting of diminished supply of nutrients to the cells in the receptor area, and mechanical, consisting of atrophy and stiffening of vibrating structures in the receptor area .
Sensory presbycusis little effect on other hearing
Neural pre seriosulyy affects ability to understand speech
Metabolic pre produces severe loss of sensitivity to all pitches. Finally mechanical presbycusis produces loss acorss all pitches, but loss is higher for high pitches.
Cochlear implants do not amplfy sound, father, a microphone transmits sound to a receiver which stimulates auditory nereve fibers directly.

Somesthesia and balance:
Somestheisa- touch receptors, greatest concentration in lips, tongue, and fingertips, takes more pressure with age to feel a touch on smooth skin, on the hands such as the fingertips, touch sensitivity in the fingertips-covered part of the body in maintained into later life. Research that pain is not well assessed, diagnosed or managed in older adults

Kinesthesis: involves sensory feedback about two kinds of movements: passive movements and active movements, passive movements are instigated by something else, when someone picks up your hand, active omenment is voluntary as in walking.
Age related changes to passive movements dpends on the part of body in question, example judgments of muslc eor tendon strain produced by picking up different weights do not differ with age.

Balance: we get info about blancae from vestibular system, house deep in inner ear, designed to respond to foce of gravity as they act on the head and then to provide this information to the parts of the brain that initiate the appropriate movements so that we can maintain balance

Dizziness and vertigo are common experiences for older adults

Taste and smell:
Smell: ability to detec odours remains failrly intact until 60s when it begins to decline, and there are wide variations across people and types of odurs
Alzheimers disease are able to identify only 60% of odours identified by age matched control participants, this was deduced to only 40% compared with controls.

Vital functions: two essential system sot life are cardiovascular system and our respiratory system that’s why they are called vital functions.

Cadivascular system: with age 2 things change in heart accumulation of fat deposits and stiffening of heart muscle caused by tissue changes. Reduce the amount of musle tissue available to contract heart, must work marker, and amount of blood heart can pump declines from 5 liters per min at 20 to 3.5 at 70.
Most important change is stiffening of the walls of arteries. Caused by calcification of the arterial walls and by replacement of elastic fibres with less elastic ones. Means less abiiity to deal with physical activities. By 65 average adult experienced 60-70% decline in aeriobic capacity since young adulthood. , but if stay I shape only 20-25% .

Cardiovascular disease:
Menopause associated with lower levels of HDL good cholesterol and higher levels of LDL bad cholesterol.
Several types of cardiovascular disease
Congestive heart failure: when cardiac output and the ability of the heart to contract severely decline, making the heart enlarge, pressuring the velins increase, and the body swell. Most common cuase of hopsitalisation for people over 65.

Angina pectoris: when oxygen supply to heart muscle becomes insufficient, resulting in chest pain. Angina feels like chest pressure, burning pain, or squeezing that radiates from chest to the back neck and arm.

Hear attack, Myocardial infraction(MI) when blood supply to hear is severely reduced or cut off

Atherosclerosis: age related disease casued by buildup of fat deposits on and the calcification of the arterial walls. Fat deposits interfere with blood flow through the arteries. When it severly occurs in blood vesels the supply to brain, neurons may not receive proper nourishment, causing them to alfucntion or die, condition called cerebrovascular disease.

Cerebrovascular accident: when blood flow to a portion of the brain is completely cut off, resulting in a stroke. 4th leading cause of death in Canada, more common in women. Treatment for CVA is using clotdissolving drug tissue plasminogen activator (TPA) to treat CVA’s.

When blood pressure tends to rise, defined as 140 mm hg or more systolic pressure or 90 mm hd or more diastolic pressure, the disease hypertension results. 25% of population from 24-75 have it.

Respiratory system:
Maximum amount of air w can take inot lungs in a single breath cedline 20s, dereasig 40% by 85. Rate to exchange oxygen for cardon dioxide drops significantly as air sacs in lungs deteriorate

Respiratory diseases: the most common incapacitating respiratory disorder in older adults is chronic obstructive pulmonary disease (COPD) like chornic bronchitis and emphasema.

Emphysema: serious type of COPD, most. Characterzed by destruction of the membranes around the air acs in lungs. Creates hole in lung, drastically reducing the ability to exchange oxygen for carbon dioxide.

The reproductive system:
Menopause also called climacteric, bio process women cannot reproduce, overies stop releasing eggs.

Female reproduction system: end of monthly period accompanied by decreases in estrogen and progesterone levels, as well changes in working memory function. Variety of phsycial and psych symptoms may accompany perimenopause and menopause with decreases in hormonal levels. Hot flashes, night sweats, headaches, vaginal dryness, nood changes, difficulty concentrating, memory problems.

Nervous system:
Central nervous system:
Structural changes in neurons:
Neurofibrillary tangles- where fibers in axon become twisted together to form paired hecal, or spiral filaments. Associated with alzheimers.
Damaged and dying neurons sometimes collect around a core of protein and produce a neuritic plaques, also indicators of alzheimers.

Parkinsons: declime is extreme, creates parkinsons, treat with L-dopa and if that works, use catechol-o-methyltransferase(COMT) inhibitor (tasmar) with l-dopa, bacuse it blocks akey enzyme responsimble for breaking down l-dopa before reaching brain. Also can use a brain pacemaker.
Much research for drug alleviate the smptoms of alzheimers focuses on this an d other enzymes related to acetylcholine.

Autonomic nervous system: not many changes, just little in body temp control and sleep. Adults troulb eresponding to high heat because they don’t sweat. Can get hypothermia. Most hospitalization occur bacuase of cold injry, and most death with heat occur im women.

Chapter 3: longevity, health, and functioning
Average life expectancy and maximum life span: years one lives, as jointly determined by genetic environmental factors, is called longevity.
Two types of longevity
Average life expectancy: age at while a particular age cohort can epect to live. Affected by both genetic and environmental factors
Maximum longevity: oldest age to which any individual of a species lives. If eliminate all disease, we can live to 120.
Active life expectancy vs dependent or disability free life expectancy:
Difference is between living to a healthy old age, and simply living a long time. Active life exp ends at point when one loses independence or ust rely on others for most activities of daily living.

Genetic and environmental factors in average life expectancy:
Genetic factors- 1.5x more times to become centurian if live in Halifax, perhaps genetic component to long life.

Environmental factors: heredity is major determinant of longevity, but environ factor also affect the life span. Some factors are more obvious, like diseases, toxins, lifestyles and social class.

Ethnic differences in average life expectancy:
Immigrant advantage: selsecting heathy immigrants on health and education, correlates to lower morbidity and mortality.

Gender: men rate of dying form the top 15 diseases was significantly higher than women’s at nearly everyage, these differenced mean perhaps no bio difference in longevity but rather greater susceptibility in men of contracting fatal disease.

Health and illness:
Defining heath and illness- health is the absence of acute and chronic physical mental disease and impairments. Illness is the presence of a physical or mental disease or impairment.

Quality of life: multidimensional concept encompassing biological, psychological, and sociocultural domains oat any point in the life cycle. can be subjective judgement, understood in context of broader models of adult development and aging. One way is way people select domains of relative strength, optimize their use of strentghs to compensate for age related changes.
Quality of life is successful use of selection, optimization, and compensation to manage ones life, resulting in successful aging.
Apply this to health, then quality of life is ability to manage illness
Albert argues that quality of life includes both physical and mental health.
Valuation of life: how attached one is to their life

Changes in the immune system:
Immune system can tell it self from invaiders, researchers think it involves recognizing certain substances, called antigens, on the surface of invading bacteria and cells that have been taken over by viruses.

Immune system composed of 3 major tyupes of cells that for anetwork of interacting parts:
Cell-mediated immunity: consisting of thymus derived, or t-lymphocytes
Hymoral immunity: b lymphocytes
Non-specific immunity: monocytes and polymorphonuclear neutrophil leukocytles

Job of two types of lymphocytes is defend against malignant (cancerous) cells, viral infection, fungal infection, and some bacteria

Natural Killer NK cells are subpopulation of lymphoctys that provide a borad surveillance system to prevent tumour growth and our primary defence against cancer
They fight viral infection and parasites, have a role in multiple sclerosis, a disease that manifests itself inyoung childhood and early middle age.

5 major type sof antibodies: immunoglobulin (IgA, IgD, IgE, IgG, and IgM) each performs a specialized function, example, IgE mediates allergies and asthma, and IgG helps fuck hepatitis.

Lvel of t-lymphocytes does not change until atleast 90, but balance of them change. Older adults have fewere immature T and more mature ones. Immature ones that learn to fight new ivaders, this balance shift may explain why old adults immune system are less effective when exposed to new strains of bacteria and viruses.
B-lymph change little, so does NK.

Autoimmunity: body attacks itself. Results from inbalance of b and t lymph giving rise to autoantibodies and is responsible for several disorders, such as rheumatoid arthritis.
Immune system and psycholigcal state have a connection.
Out psych state can be a serious of neuro, hormonal and beahv responses that directly change the immune system, and make us more likely to become ill.

Psychoneuroimmunology: study of relation between psych, neuro and immunological system that raise or lower or susceptibility to and abilituy to recover from disease.

Positive attitude and good social support predict longer life for middle age patients with cancer, but not for old ones.

AIDS and older adults:
Many older patients not tested because old people supposedly don’t have sex.

Chronic and acute disease: Acute diease: conditions that develop over a short period of time and cause a rapid change in health. Like colds, flu, and food poisioning. Most cured with medication

Chronic diseases: last longer period of time (3 months) and may be accompanied by residual function impairment that necessitates long-term management. Such as arthritis and diabetes.

Role of stress: stress is property of specific events, like death of partner. Stress is defined by the person and that no two people experience the same event exactly the same way.

Stress and coping paradigm:
Views stress not as environmental stimulus or as a response but as the interaction of a thinking person and an event.. particular relation between person and event.
Resources a person has include things as cumulative experience of ealing with a sutiaotn that’s similar, knowing or access to imformation about event, help, and engage in actions necessary to address the situation. . reflect the influence of bio, psych, and sociocultural and life cycle forces.

Appraisal:
Three types of appraisal of stress
Primary: categorize events into three groups based on significantce, irrelevant, bening or positive, and stressful

Irrelevant: no bearing on us personally. Like hearing about typhoon in Indonesia.
Benign: good effect, such as longanticipation increase.
Stressful: like upcoming operation or test, appraised as harmful, threatening or challenging

Secondary appraisal: evaluates our perceived ability to come with harm, trheat or challenge. . matters what you think is true, not others.

Reappraisal: making new primary and secondary appraisal resulting from changes in the situation

Coping: during secondary appraisal, we believe that there is something we can do to deal with event effecitvly, attempts to deal with stressful events are called coping. Evolving process of dealing with stress that is learned.
Problem focused coping: attempts to tackle problems head on. Taking medication, spending time studying

Emotion focused coping: dealing with feelings. Express anger or frustration. Used to deal with problem focused issues you cannot deal with head on. . believing In god is a coping mechanism.

Aging and the stress of cping paradigm: young adults experience stress in areas of finance, work, home maintenance, personal life, family, and friends than do older people.

Older adults use past experience in coping guide. Creating difference in coping mechanism.
Young adults use defensive coping styles, where adults choose coping strategies on the basis of whether they feel in control of the situation

Effects on stress on health:
Chronic stress- immune system suppression leading to increased susceptibility to viral infection, increased risk of atherosclerosis and hypertension, and impaired memory and cognition. Women who have chronic stress inhibit menstration. Hormonal reaction increases with age.

General issues in chronic conditions:
Common chronic conditions
Arthritis and various forms of cardiovascular disease are the most prevalent.
Four others quite important: diabetes, cancer, incontinence, and stress

Arthritis: P arthritis is not age ralted, osteoarthritis is. Not beginning intil late in life. Genetic and environ factors have been identified.
Less phsycial activity has bad effect on arthritis. Don’t use it and lose it applies. Ffreezing of joints in place called contracture.

Cardiovascular and cerebrovascular disease:
Hypotension, or low blood pressure. Symptoms include dizziness or light headedness when you stand up. Related to anemia and is common older adults.
Cerebrovascular accidents (CVA) create chronic conditions by causing brain damage.

Diabetes mellitus:
When pancreas produces insufficient insulin. Above normal sugar in blood and urine causined by problems in metabolizing carboohydrates. People can go into coma if level of sugar is too high and can lapse into unconsciousness
In adults associated with obesity. Symptoms in younger adults (excessive thirst, increased appetite and urination, fatigue, weakness, weight loss, and impaired wound healing.

Chronic effect of inceased glucose level may be result in complcations. Long term effect nerve damage, diabetic retinopathy, kindney disorder, CVA, cognitive dysnfunction, damage to coronary arteries, skin problems, and ppor circulation in the arms and legs, whihch may lead to gangrene. Can lead to developing atherosclerosis and coronary heart disease.

Cancer:
Two breast cancer susceptibility genes have been identified as BRCA1 on chromosome 17 and BRCA2 chromosome 13.

When a women carriest mutation in either, greater risk with breast or ovarian cancer. Similarly potential susceptibity locus for prostate cancer has been identified with chromosome 1, calls HPC1.

Incontinence: loss of abiity to control elimination of urine and feces on an occasial or consistent basis called incontinence. Uniary incontinence is most common form.

Urinary incontinence occurs for 5 major reasons.

Stress incontinence: when pressure in abdomen exceeds ability to resisit peeing. When cough, sneese, or lift a heavy object

Urge incontinence: by central nervous sytem probem after CA or urinary tract infection.

Overflow incontinence: improper contraction of the kidneys, causing bladder to become over distended. Drugs tumours and prostate englargment are common causes

Functional incontinence: when unrinary tract is intact but because of phsytical disability or cognitive impairment person unaway or need to unirnate

Iatrogenic incontinence: medication side effects. Change in dosage solves issue.

All can be allievated with intervention. Most effective is behavior intervention, like diet change, learning to recognize the need to toilet and Kegal excercises for improved pelvic muscle control.

Managing pain:
Non narcotic medication is best for mild to moderate paint, whereas narcotic medication are best for severe pain. Non narcotic medication includes nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen.

Narcotics that work well in older adults is morphoine and codeine, and other commonly used drugs such as meperidine and pentazocine should be avioided because of age related changes in metabolism.

Non-pharmacological pain control includes a variety of approaches
-deep and superficial stimulation of skin through therapeutic touch, massage, vibration, heat, cold and various ointments.
-electrical stimulation over the pain site or to the spine
-acupuncture and acupressure
-boifeedback, in which a person learns to control and change the body processes responsible for pain
-distraction techniques that draw a person’s attention away from pain
-relaxation, meditation, and imagery approaches that rid the mind of tension and anxiety hypnosis, either self induced or induced by another person

pharmacology and medication adherence: developmental changes in how medication works: absorption is time needed for a medication to enter bloodstream. Orally is time it takes for medication to go from the stomach to the small intestine, where maximum obsorption occurs. May take loer than expected in older adults. Resulting in too little or too much absorption depending on drug. Once in bloodstream medication is distributed through the body. Maxiumal effectiveness of a drug depends on the balance between the portions of the drug that bind with plasma protein and the portion that remain free. As we grow older, more free drugs remain free.

Getting rid of drugs in system is part of the liver called metabolism. Drug excretion occurs through the kidneys in urine, although some elimination through feces, sweat and saliva occur.

Polypharmacy: treatment with multiple medications. Potentially dangerous because many drugs do not interact well

Activities of daily living: basic self care, eating, bathing, toileting, walking, or dressing

Instrumental activities of daily living. Actions that entail some intellectual competence and planning. Vary across culture, for westerners, IADLs would be shopping, paying bills, calls, taking medication