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| A) | young-old. | ||
| B) | middle-old. | ||
| C) | oldest-old. | ||
| D) | fragile-old. |
The age at which one is considered "older" or "senior" is always evolving and is influenced by culture and societal life expectancy. In England in 1875, old age was defined as 50 years or older, as stated in the Friendly Societies Act [88]. Today, most developed countries in the world use the chronologic marker of 65 years as a definition of old age; in some cases, the age of 62 years is used as a chronologic marker because, in the United States, one could receive social security benefits starting at this age [87]. However, Mohanty notes that using the criterion of age at retirement or when one becomes eligible to receive retirement benefits is not universal, given the fact that there are so many in the world who live in areas in which there are no formal definitions of retirement [88]. Using these chronologic markers to define old age is arbitrary, but they can be useful when studying the group as a whole [2]. Older adults can be further divided into various segments: the young-old, defined as 65 to 74 years of age; middle-old, defined as 75 to 84 years of age; and the oldest-old, defined as those who are 85 years of age and older [3]. In 2021, 32.5 million Americans were 65 to 74 years of age, 16.5 million were 75 to 84 years of age, and 6.7 million were 85 years of age and older [31]. In 2010, there were 53,364 persons 100 years of age and older in the United States [94]. By 2020, there were 92,000 U.S. centenarians [32]. Worldwide, in 2015, there were more than 500,000 centenarians, and it is estimated by 2050, there will be 3.7 million, with the greatest growth in China [90]. In the United States, it is projected that there will be 9.7 centenarians per 10,000 people by 2050 [90].
| A) | replication of cells slows with aging. | ||
| B) | each species has a genetically determined maximum life span. | ||
| C) | the body's proteins undergo changes, decreasing elasticity of skin. | ||
| D) | the body loses its ability to discern foreign bacteria and viruses as it ages. |
Biologic and physiologic changes are part of aging. Although it is not known why these changes occur, biologic theories of physiologic aging include [3,7,86,95,121,140,143,91,105]:
Wear and tear: Aging is genetically determined, and as a result, the tissues and muscles eventually deteriorate. However, one of the critiques of this theory is that cells repair themselves, and it is possible to get stronger as one ages.
Cross-linkage: The body's proteins attach to other structural substances, thus decreasing elasticity in the skin and causing other physical changes in the organs and slowing of physiologic processes. This is an example of an error theory, which focuses on aging as a series of "accidents" rather than something that is programmed to occur.
Autoimmune: As the body ages, it is unable to recognize the difference between healthy and diseased cells, causing it to react against itself.
Cellular aging: The replication of cells slows as a result of aging.
Apoptosis theory: Aging is due to inevitable pre-programmed cell death in our bodies. Apoptosis is a normal process in the body, but it is speculated that if dysregulated apoptosis could lead to Alzheimer disease, Parkinson disease, or cancer.
Free radical: This is another example of an error theory. As free radical exposure increases in older organisms, the antioxidant system is not able to counteract the free radicals that have been generated and accumulated during the life of the cell, resulting in cellular death. Experimental findings have not conclusively supported this theory.
Evolutionary: Humans' developmental life cycles are affected by mutation and selection. In other words, all biologic dimensions are affected by mutation, and there will be variations among human beings. This will lead to a natural selection of those who are more fit to survive in an environment. Aging leads to vulnerability.
| A) | Stroke | ||
| B) | Hip fractures | ||
| C) | Hypertension | ||
| D) | All of the above |
The losses in the physical arena for older adults can be numerous, which may then compound and/or have implications in social and psychological arenas. Studies have shown that brain tissues atrophy due to natural cell degeneration, with the volume of the brain decreasing by 15% or more between adolescence and old age [122]. Crews notes that the health status of older persons with vision and hearing loss is poorer compared with those without vision or hearing loss [10].
| A) | Prevalence is extremely low. | ||
| B) | Older adults harbor the misconception that they are not at risk. | ||
| C) | Symptoms of HIV infection mimic age-related illnesses, such as dementia. | ||
| D) | None of the above |
In industrialized countries, it is estimated that 10% to 15% of human immunodeficiency virus (HIV) infections occur in adults 50 years of age and older, and approximately one of every nine new HIV diagnoses in the United States occur in those 50 years of age or older [17,18,126]. In 2019, there were 3,100 new cases of HIV among adults 55 years of age and older [225]. Between 2015 and 2019, the rate of new HIV diagnoses remained stable among those 55 years of age and older [226]. This prevalence may be higher in developing countries [18]. In 2016, there were an estimated 6,812 newly diagnosed cases of HIV among adults 50 years of age and older, accounting for 17% of total diagnoses in the United States. Of these, 841 diagnoses occurred in persons 65 years of age and older. In 2015, approximately 47% of all individuals with living with HIV were 50 years of age and older, and 2,749 people 55 years of age and older died from HIV disease [97]. However, older adults are not generally considered an at-risk group. This has led to a lack of targeted education and screening among older adults. For example, only 32% of state departments of public health websites contained information about HIV/AIDS in older adults [167].
| A) | trust versus mistrust. | ||
| B) | initiative versus guilt. | ||
| C) | integrity versus despair. | ||
| D) | generativity versus stagnation. |
Erik Erikson, a prominent developmental theorist, had a more optimistic view of aging, focusing on the positive ways of overcoming the various crises one encounters throughout life [25,26]. Erikson postulated eight stages of psychosocial development. Each stage provides the individual with a choice of two alternatives to consider and accept; one is an opportunity for growth, while the other results in unhappiness. In late adulthood, individuals confront the challenge of integrity versus despair. During this stage, individuals reflect on their lives, and determine if they have lived a life of purpose. If so, the individual will feel contentment, having attained integrity [26].
| A) | Mode of death | ||
| B) | Nature of attachment | ||
| C) | Changes and concurrent stressors | ||
| D) | Occurrence of holidays or significant days |
In cases of terminal illness, grief counseling should begin before death occurs, with a focus on life meaning and contributions [37]. Awareness and understanding of the mediators of grief responses can assist in recognizing individuals who may be at increased risk for adapting poorly to the loss. These mediators are [38]:
Nature of attachment (how close and/or dependent the individual was with regard to the deceased)
Mode of death (the suddenness of the death)
Historical antecedents (how the individual has handled loss in the past)
Personality variables (factors related to age, gender, ability to express feelings)
Social factors (availability of social support; involvement in ethnic and religious groups)
Changes and concurrent stressors (number of other stressors in the individual's life, as well as coping styles)
| A) | Acute disease(s) | ||
| B) | Non-White race | ||
| C) | Higher income bracket | ||
| D) | Cognitive impairments or a history of falls |
In 2018 in the United States, 56% of those 65 years and older required long-term services [213]. Institutions providing long-term care to older individuals often provide a variety of services, including personal, social, and medical services. Key factors that predict older adults entering a nursing home include [111]:
Non-Hispanic White race
Lower income bracket
Restricted activities of daily living
Cognitive impairments or a history of falls
Chronic diseases (e.g., diabetes, cardiac conditions, stroke)
Limited social supports (e.g., widowed, divorced, few or no children)
| A) | social and binge drinking. | ||
| B) | loss of consciousness or memory as a result of drinking. | ||
| C) | effects of drinking on occupation and family relationships. | ||
| D) | drinking in response to grief and changes in drinking patterns over time. |
There are several screening tools available for assessing older adults with problem drinking. The Drug Abuse Screening Test (DAST) is a 28-item questionnaire consisting of yes or no responses. The Short Michigan Alcohol Screening Test (SMAST) is a 13-item questionnaire with a similar response format. These instruments are commonly used but may not be appropriate for the older adult population. However, a longer version of the SMAST, the Michigan Alcohol Screening Test-Geriatric (MAST-G) was specifically developed in order to accurately assess alcohol abuse and dependence in older adults [46]. The MAST-G consists of 24 items, which may limit its incorporation into regular screening procedures. As opposed to the standard MAST, this version focuses more on drinking in response to grief and changes in drinking patterns over time.
| A) | Individual therapy with a specialist | ||
| B) | Group activities that provide support | ||
| C) | Activities emphasizing elders' control | ||
| D) | Activities targeted at a specific subgroup, such as widowers |
Increasing or intensifying social networks can involve various approaches. Cattan and White identified three key aspects of interventions for older adults that support active engagement: group activities that provide support (e.g., support for bereavement), interventions targeted to a specific subgroup (e.g., widowers), and activities or interventions emphasizing older adults' control [70]. Several interventions for older adults that focus on decreasing social isolation have been identified and may be classified into four general categories [71]. The first type of intervention to address isolation is one-on-one telephone support services, whereby a counselor checks in with older adults periodically. Second, teleconferencing, whereby a group of older individuals are brought together via a phone conference, has been found to be a cost-effective and useful intervention. Third, face-to-face support groups were found to be beneficial in reducing social isolation, particular groups that last for at least five months [71]. Lastly, with increasing Internet accessibility, e-mails and Internet support groups can also be beneficial for older individuals. Older adults who have access to and use computers have more social support and are less likely to experience loneliness [217]. A study exploring the use of videoconferencing with frail older adults in Australia found that the patients preferred videoconferencing with a pain specialist over a face-to-face consultation [116]. A systematic review found that social connectedness and support were increased in older adults who used Internet technologies, although the effects were short term [187]. As discussed, loneliness is often intertwined with other variables, such as shyness or limited resources. Therefore, interventions should not simply focus on providing venues for older adults to meet; interventions and programs that focus on people's expectations about friendships and relationships are equally important [157].
| A) | Call an attorney | ||
| B) | Disregard informed consent | ||
| C) | Consult with family members to determine the best course of action | ||
| D) | Have a surrogate caregiver provide informed consent and the elder provide assent |
The issues of an older adult's mental capacity and self-determination come into play with informed consent, particularly if cognitive impairments are present. Informed consent involves three dimensions: the communication of the information, the opportunity to ask questions, and the process of making a decision [162]. As stated, an older adult's self-determination should be promoted. It must involve not only the communication of the information but also giving older adults the opportunity to ask questions about their care, the intervention, and/or services provided to them and empowering them to make the decision. However, there may be times when an older adult cannot give informed consent. One way to assess if the older adult understands the intervention is to have him/her reiterate what the intervention entails [6]. However, there are a few options when an older adult's capacity is compromised. First, a surrogate caregiver could provide consent. Second, double informed consent could occur, whereby the surrogate caregiver gives informed consent and the older adult gives assent. Finally, it is possible to obtain early informed consent from the older person via legally binding documentation of wishes prior to any cognitive impairment [6]. Practitioners may consider the following questions when assessing capacity [266]:
Is the patient able to provide consent for the treatment or intervention?
Is the patient capable of refusing treatment?
Is it safe for the patient to live alone?
Is the patient at risk of abuse?
Can the patient continue to drive safely?