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Geriatrics
Psychology of ageing
Courses of Geriatrics
 


 

Fundamental data:

A - SENESCENCE - SENILITY:

The senescence represents normal ageing physiological.

Senility represents a pathological rupture of physiological ageing following accidents which modify normal ageing.

B - EVALUATION OF AGEING:

Ageing is a whole of consequences of the action of time on the alive beings.

It is different according to species' and, in the same species, according to individuals'.

This ageing is biologically arbitrary.

One can make only one analytical approach of it.

C - IN MEDICINE:

Less resistance and less effectiveness.

Involve a reduction in the functional capacities.

The more one ages, the more one has risks to develop medical problems.

Example: less resistance to the infections.

But that does not want to say that the immune system is weakened.

Less effectiveness: reduction in the load-carrying capacity (race, for example).

Reduction in the functional capacities: the maximum is reached around 20 years.

At 80 years, the pulmonary capacity reaches approximately 45% of what it was at 20 years.

The renal function is also maximum at 20 years.

Glomerular filtration is at 100%.

At 80 years, one lost 40% of this capacity.

The creatininemy is 40% higher.

D - MANIFESTATIONS OF AGEING:

a) Morphological aspects

Cutaneous ageing for example.

b) Reduction in the functional capacities

c) Increase in morbidity

The risk to develop certain affections is greater.

The risk of after-effects also increases.

D) Increase in the risk of mortality

Reduction in the capacities of each function.

Currently, average longevity in the industrialized countries is of:

• 82 years for the women

• 78 years for the men

The risk of mortality is primarily due to the heart diseases and cancers.

If they were decreased, one would currently increase the longevity by 18 years.

E - CONCEPT OF AGEING PHYSIOLOGICAL:

1) PRIMARY EDUCATION AGEING:

has) Lifespan:

It is characteristic of each species.

b) Increase in the life expectancy:

Potential possibility to traverse our life such as it is registered according to our species.

c) Deterioration of the functions according to the age:

Two elements:

• Within the same species, all the individuals age on the same mode

• But each individual will age according to his own evolution

Certain factors of the way of life intervene to modify this ageing:

• Food

• Activity

• Occurred of certain affections (lithiasis example: renal function)

For each individual, the functions do not age in the same way.

The major risk of death at an old person is the pulmonary infection, not because the immune system is weakened but because the pulmonary capacity is reduced.

Similar for the renal function: an infection can be enough to cause an acute renal insufficiency requiring dialysis with all the consequences which follow.

2) CHARACTERIZATION Of a DISORDER BINDS TO PRIMARY EDUCATION AGEING:

Four conditions.

It is necessary that this disorder is:

• Noxious: unfavourable

• Endogenous: not caused by an accident

• Progressive: nonbrutal

• Universal: corresponding to the normal ageing of the species

F - BIOLOGICAL CHARACTER OF AGEING:

1) REDUCTION IN THE NUMBER OF CELLS:

a) Present at the level of all the bodies:

Undoubtedly explain largest occurred of cancers.

b) Involve an atrophy of the bodies:

The crystalline lens starts to age as from 12 years.

c) Development of fabric of replacement:

Substitution of fabric of involving support for other fabrics of the consequences on the level of circulation: less vascularized fabric.

2) LOSS OF PROTIDS:

This loss involves a reduction in the thin mass which constitutes primarily the muscles.

3) INCREASE IN THE FATTY MASS:

However it is the thin mass which ensures the performances.

G - THEORIES OF AGEING:

1) THEORY OF AGEING PROGRAMS:

Theory according to which ageing is under the dependence of a regulating gene.

Gene which would start our ageing.

Never to date discovered.

It seems however that our ageing obeys a biological clock.

Of course, this progression the possible biological accidents come to disturb.

The apoptose is synonymous with cellular death.

Each cellular clone has a capacity of 120 divisions.

But a certain number of factors will intervene to decrease the number and to accelerate the rate/rhythm of these divisions.

2) THEORY OF THE FREE RADICALS:

Theory which makes it possible to detect precociously occurred of cancers in particular.

The accumulation of errors in the reproduction of the cells would have a mutagen action.

The cellular renewal would be made in an erroneous way, upon an attack, tissue, cellular, molecular, the reproduction is followed on the basis of genetic inheritance.

One highlighted the presence of genes which represented a pejorative factor on occurred of cancers.

A tumour which develops generally knew 2 to 3 years of evolution before being expressed.

Irrational states:

A - PHYSIOLOGY:

Several manifestations of ageing:

a) Loss of the neuronal cells:

We are born with a definite neuronal stock.

Because of cellular ageing, we regularly lose these cells as of the birth.

b) Cerebral atrophy:

c) ponderal Reduction:

Reduction in the weight of the brain.

The development of an insanity can involve a loss from 40 to 50% of the weight of the brain.

d) Widening of the cortical furrows:

The furrows which represented a virtual space widen, giving place to a real space.

e) Dilation of space interventriculaire:

Space interventriculaire secretes the céphalo-rachidian liquid at a rate of 2 ml/h.

The widening of this space will involve a stagnation of the LCR.

That will cause an increase in the pressure and a phenomenon of dilation.

Visible with the scanner.

B - VARIOUS TYPES:

1) VASCULAR:

Caused by arterial hypertension.

Any HTA must be the subject of a treatment.

2) DEGENERATIVE:

Can lead to an insanity.

The severity of the irrational state is closely dependent on the number of the lesions and their seat.

The demonstrations appear when the lesions reach the peripheral part of the cortex.

• With the lower part of 5% of the lesions: no demonstrations

• Between 5 and 7% beginning of the risk

• Beyond 10%, the irrational state is inescapable

a) Senile plates:

Deterioration of dendrites which puts 5 to 6 years, even 7, to constitute itself without there being demonstration.

When dendrites are reached, the process is inexorable.

b) Neuro-fibrillary degeneration:

Attack of the axon.

c) granulo-vacuolar Degeneration:

Attack of the cellular body.

C - BIOCHEMICAL ASPECTS:

The brain functions by the production of neurotransmitters.

a) Depression:

It is thought for example that the depression is under the dependence of 2 neurotransmitters:

• Serotonin

• Noradrenalin

b) Parkinson's disease:

• Dopamine

c) Disease of Alzheimer or degenerative insanity:

• Acetylcholine: cholinergic system

The symptoms are directly related toits rate: the lower it is, the more the symptoms are violent one.

The modification of the behavior in depressive form can hide the first steps of an insanity.

The fast tracking of the evolution of an irrational problem is determining.

The treatments can operate only existing neurons.

The precocity of the treatment is determining.

Beyond of a year of evolution, the things are generally played.

A neurotransmitter is synthesized and destroyed.

By blocking the enzymes which destroy neurotransmitter one increases its lifespan and thus its action.

d) Disease of Pick:

Irrational degenerative disease.

Duration of evolution from 5 to 6 years.

D - PRIVATE CLINIC:

Irrational syndrome:

• Disorders of the short-term memory and recent.

Conservation of the old memory

• Disorders of the orientation temporo-spaciale

• Disorders of the judgement: absurd acts, loss of self-criticism

• Speech difficulties, but the patient is not aphasic

• Disorders of the motor and gnostic functions

• Disorders of the primitive functions: mood, abulia (food restriction)…

The treatment can only delay the evolution during approximately 5 years.

One considers new molecules which will give 10 years of remission.

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