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OBJECTIVES

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  • 1) Distinguish the aging process from pathologic conditions of aging

  • 2) Differentiate the epidemiology and pathophysiology of conditions that produce dementia

  • 3) Identify and discuss optimal treatment options for older adults and those with dementia to maximize function

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Age is a very high price to pay for maturity.

Tom Stoppard

Experience is a wonderful thing – it enables you to recognize a mistake when you make it again.

Source Unknown

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The nervous system, including the autonomic, central, and peripheral components, along with our muscles and special senses experience changes with aging. Combined, these changes lead to declines in executive function and memory, sensory transmission and processing, motor performance such as slowing of movement, and impaired coordination, balance, and gait as compared to young adults.1 Coordination is most impaired in bimanual and multi-joint movements. Balance impairment can be noted in increased postural sway and diminished dynamic balance, and gait is slower and impacted by cognitive, motor, and sensory system changes. Of the special senses, vision is most impacted by aging, yet, we also experience a decline in our ability to smell, taste, and hear as we age.

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CASE A, PART I

Carol Schmidt is a 67-year-old female who has begun to experience some slowing of movement and difficulty with her tennis game. She has noted that she is slower to get to the ball and cannot make some of the trickier shots that she was able to make just a few years ago. Mrs. Schmidt’s mother, Adele Weiss, is 90 years old and moves quite slowly with a stooped posture and is no longer able to run or to safely ambulate in low light conditions. She has fallen twice in the last year and no longer leaves her home other than to shop and go to religious services with her daughter. In addition, both women complain of being forgetful and needing to make shopping lists. Adele recently told Carol that she is having more difficulty bathing and cooking.

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The nervous system experiences declines at a rate of 1% per year, starting at age 30.2 Not all changes in function can be attributed to aging, and it is important for therapists to have an understanding of normal age-related changes versus pathologies, as behaviors that fall outside of what is considered to be the range of normal function should be assessed and treated. An understanding of the aging brain is necessary for successful examination and treatment of individuals with age-related decline in function.

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CASE A, PART II

Mrs. Schmidt (Carol) would be expected to have changes in motor control, as compared to when she was younger, but is expected to continue to be able to function in normal daily activities. She would also be expected to function better than her 90-year-old mother. Adele is in the “old–old” age group and is expected to move slower than ...

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