Elderly physical impairments

When an elderly, physically healthy person shows a generalized decline in cognitive functioning that causes significant impairment in social or occupational functioning and represents a significant decline from a previous... 

Vision. Many people experience visual decline as they age (Fig. 3) [135]. Impaired vision may also hinder one s ability to self-administer medication. Listed in Table 10 are some of the effects that are associated with impaired vision in the elderly. Some of the processes of self-administration that are affected by impaired vision are as follows (a) the ability to accurately measure liquids (b) the ability to correctly read instructions and (c) the ability to differentiate between various types of medications (both the labeling of these drugs and their physical characteristics) [137,151-153],... 

Laurin D, Verreault R, Lindsay J, MacPherson K and Rockwood K (2001). Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of Neurology, 58, 498-504. 

Insulin resistance and type 2 diabetes Insulin resistance alone will not lead to type 2 diabetes. Rather, type 2 diabetes develops in insulin-resistant individuals who also show impaired p cell function. Insulin resistance and subsequent development of type 2 diabetes is commonly observed in the elderly, and in individuals who are obese, physically inactive, or in women who are pregnant. These patients are unable to sufficiently compensate for insulin resistance with increased insulin release. Figure 25.8 shows the time course for the develpment of hyperglycemia and the destruction of P cells. 

Benzodiazepine and azapirone derivatives are widely used drugs in this class, and most are metabolized extensively by enzymes of the CYP3A family, except oxazepam, lorazepam, and temazepam, which are mostly glucuronidated (52). Again, several studies have shown that inducers and inhibitors of CYP3A can markedly alter plasma concentrations of many of these drugs, but in only a few cases have toxic effects, such as deep unconsciousness, been reported (19,52,53). Nonetheless, patients on these drugs should probably be monitored carefully, particularly the elderly, who may suffer severe physical injury as a result of falls from impairment of psychomotor function. 

The most frequent adverse effect which occurs in at least one-third of patients is drowsiness, often accompanied by incoordination or ataxia. Problems with driving, operating machinery, or falls can result, particularly in the elderly, and can be an important source of morbidity, loss of physical function, and mortality (47,48). Memory impairment, loss of insight, and transient euphoria are common paradoxical reactions of irritability or aggressive behavior have been well documented (11) and appear to occur more often in individuals with a history of impulsiveness or a personality disorder (40), and in the context of interpersonal stress and frustration (49). Tolerance to the sedative and hypnotic effects generally occurs more rapidly than to the anxiolytic or amnestic effects (1). 

When prescribing medications for the elderly, it is important to consider physical disability, visual impairment, the shape or color of medications (ability to differentiate), and the belief system of the patient. It would be beneficial to have healthcare professionals review the technique of using certain devices and to discuss the use of compliance aids. 

The elderly are more likely to have cognitive impairment or mild dementia, and to be living alone, in poverty or under institutional care. They are also vulnerable to caregiver abuse, often because of indifference, anger or physical abuse triggered by the patients behavior and difficulties derived from their disease. 

Depression in the elderly is a major public health problem. Many elderly depressed patients are often inadequately treated, or depression is missed or mistaken for another disorder, such as dementia. In the elderly, depressed mood, the typical signature symptom of depression, may be less prominent than other depressive symptoms such as loss of appetite, cognitive impairment, sleeplessness, anergia, and loss of interest in and enjoyment of the normal pursuits of life. Somatic (physical) complaints are quite frequently the presenting symptoms in elderly depressed patients. The increased suicidal attempts present in the depressed elderly may be due to access to firearms, diminished cognitive functions, sleep disruptions, poor social interactions, and inattention among primary caregivers. Approximately every 95 minutes an elderly person commits suicide. ... 

Many women experience substantial calcium losses due to rapid bone turnover after the menopause. Hence, intake of calcium that would cause the calcium balance to remain positive should be increased to - 1500 mg per day (Heaney etal. 1978). Apart from the menopause, bone loss in the elderly results probably also from malabsorption of calcium (Ireland and Fordtran 1973, Gallagher etal. 1979). In addition, other factors that are common in the elderly may threaten their nutritional status, including social isolation, impaired cognition, or the physical inability to either obtain or prepare food (Barrett-Connor 1989). 

Impairment of breathing is an early effect of exposure to nerve agent vapor or aerosol. When the exposure is small, the casualty may have mild to severe dyspnea, with corresponding physical findings, and the impairment will be reversed by the administration of atropine. If the distress is severe and the casualty is elderly or has pulmonary or cardiac disease, the antidote may be supplemented by providing oxygen by inhalation. In most other circumstances, supplementation with oxygen is unnecessary. 

By combining clustering with a machine learning process, we could be able to predict the development of physical autonomy loss or mental autonomy loss in elderly people over time. To reach this objective, we use machine learning approach based on grammar inference in order to infer a probabilistic automaton. In the article, we only present the patients profiles evolution regarding to upper body functional disorders (cognitive impairment). 

The engineered devices described so far in this subsection have been concerned with alleviating the effects of physical or cognitive impairment. However, the so-called socially assistive robots are proposed as a means of meeting needs for companionship and emotional support [8, 9]. They have been developed, particularly in Japan, for use in the care of elderly persons who are socially isolated. They often have the form of toy animals and have been suggested as sources of pet-like companionship without the requirement for pet-like physical care. Sophisticated robotics allows them to appear to respond to verbal commands and physical interaction in ways that suggest autonomy. 

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