The Twilight Years

The Twilight Years

1. demography

   • Ahmed (75yrs)
     • his wife
       • Mariam (65yrs)

2. Aging

   • processes as maturity reached & continues until death
   • irreversible stage reached
     • senescence
   • factors
     • genetics
       • defect
         • progeria
           • manifested at early age
         • werner
           • premature aging in adults
     • environment
     • health
   • types
   • theories
     • programmed
       • biological clock
     • error
       • result of internal/external damage
   • changes
     • physiological
       • skin
         • decrease in dermis thickness
         • decrease in keratinocytes & fibroblasts
         • loss of subcutaneous fat
         • decrease in vitD synthesis
       • musculoskeletal
         • reduction in muscle elasticity
         • decrease in bone density
           • osteoporosis
         • cartilage thins out
         • spinal column curves & shortens
           • loss of some fluid separating discs
       • cardiovascular
         • thickening of heart valves
         • increase in b.p
         • increase in plaque formation
         • loss of elasticity
         • hardening of arteries
       • respiratory
         • decrease in aleveolar surface area
         • decrease in elastic recoil of lung
         • decrease in efficiency of gas exchange
         • size/shape of chest cavity
       • gastrointestinal
         • upper GIT
           • decrease in motility
           • decrease in peristaltic response
           • atrophy of fundus & antrum
           • loss of esophageal sphincter control
         • lower GIT
           • decrease in intestinal motility
           • increased storage capacity
           • constipation/bleeding & inflammation
           • defecation disturbance
           • reduction of hormonal secretions
           • less enervation of GIT
             • appetite/ hunger
             • feeding/ satiety centers
             • dysfunction of neural feedback
           • decrease in liver weight
             • hepatic drug metabolism is altered
           • increased in gallstones
       • renal & urinary
         • micturition reflex is affected
         • decrease in bladder capacity
         • decrease in glomerular filtration
         • reduction in kidney function
       • nervous
         • decrease in brain size
         • loss of neurons
         • less synaptic transmission
       • genital
         • women
           • decrease in uterus size
           • decrease in endometrial glands
           • thinner fallopian tubes
           • ovarian abnormalities
           • genitalia vulnerable to infections & trauma
           • stages of menopause
             • pre-menopause
               • period of ovarian failure
               • decreased estrogen level
             • menopause
               • sexual maturity becomes cessation of rep. capability
             • post-menopause
               • estrogen from adipose, liver, & adrenal gland
           • stoppage of estrogen
             • cardiovascular
             • bones
               • bone thinning
               • decrease in bone matrix
               • decrease in calcium & phosphate deposition
         • men
           • gradual decrease in testosterone
           • decrease in blood flow
           • erection is affected
           • decrease in testes size
           • andropause
             • not total gonadal failure
             • mitotic activity of spermatogonia continues
     • physical
       • loss of teeth
       • lungs are less efficient
       • vision decreases
       • hearing loss
       • chronic diseases
         • hypertension
         • diabetes
         • rheumatoid arthritis
         • retinal cataracts
         • alzheimer
     • psychological
       • dementia
       • aggressive
       • lack of interest
       • depression
   • role of elderly
     • active aging
       • engaged with life
         • emotionally
         • physically
         • socially
         • spiritually
         • intellectually
     • holds family together
     • give advices
   • challenges
     • emotional
       • loneliness
       • sadness
       • stages of grief
     • financial
       • pension is insufficient
       • treatment is expensive
     • physical
       • falls
         • risk factors
           • orthostatic hypotension
           • medication
           • insomnia
           • dizziness
         • complications
           • fractures
           • loss of confidence
     • social
       • ageism
         • discrimination based on age
   • nutrition
     • easy to swallow
     • long-life food
     • vitamins & minerals
       • calcium
       • vitamin C
       • fibers
       • iron
       • zinc
   • functional assessment screening
     • standardized mean of obtaining information
     • evaluating
       • level of function
       • cognition
       • safety
     • why is it done?
       • monitor changes
       • enhance independence
       • identify disabilities
       • restore or improve health
   • pharmaceutical problems
     • polypharmacy
     • multiple pathology

3. obesity

   • excess body fat
   • measured by
     • Body Mass Index (BMI)
       • weight/height(2)
     • skin folds
     • waist circumference
     • densitometry
       • under-water measurement
   • health effects
     • diabetes
     • breathing problems
     • heart diseases
     • diabetes

4. Metabolic pathway

   • fed state
   • fasting state

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