Case Studies In Gerontology

For The Applied Heath Sciences




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(evoked) auditory brainstem response (ABR):  Auditory brainstem response. Electrical activity evoked from the brainstem by presentation of an auditory signal. Occurs within 10 ms of the signal.

activities of daily living (ADL): Refers to basic self care activities including   feeding, washing, dressing, transfers, and mobility. Occasionally this may  be used   more broadly to refer to self care, productivity and leisure activities.

acute: Sharp, as in pain or having a short, aggressive cause: as in an illness.

age-related deterioration in postural control and musculo-skeletal system:

The ability to maintain balance in the upright standing posture of humans is reduced with aging. This reduction includes both an increase in unsteadiness while  attempting to stand still, and a reduced control of balance during movements. Deficits in neural, muscular and skeletal systems all contribute.

Alzheimer’s disease:  A mid-to-late life acquired, progressive, persistent degeneration in several spheres of mental activity including memory, language and communication, personality, visuospatial skills, and orientation; most common type of dementia.

ambulation: The ability to walk; occasionally also used to refer to self-propulsion in a wheelchair.

amputation: The surgical removal of a part or all of a limb or body part.

ankle-foot orthosis (AFO): A splint providing support for the ankle and foot.

anterior: Toward the front.

aphasia: A language disorder syndrome caused by focal cortical and/or subcortical lesions (most frequently a stroke or CVA) to the language dominant cerebral hemisphere; characterized by impairments in verbal and written expression and listening and reading comprehension; excludes motor speech disorders such as   dysarthria and apraxia of speech, and cognitive-communication disorders resulting from dementia and traumatic brain injury.

applied health sciences: Refers collectively to audiology, occupational therapy, physical therapy and speech-language pathology. Sometimes referred to as rehabilitation sciences,

apraxia of speech: A neuro-motor planning/co-ordination problem in speech  production related to impaired capacity to programme the position of speech musculature and the sequencing of muscle movements for the volitional       production of sounds; is not based on cognitive-impairments, listening comprehension difficulties, inattention, abnormal reflexes, impaired visual or        tactile perception, or muscle paralysis or paresis; characterized by inconsistent speech production errors, sound groping especially at the beginnings of words, better   involuntary versus voluntary production, and errors of complication predominate;  often co-occurs with Broca’s aphasia.

audiogram: A graphic representation of the minimum detectable level of a sound (threshold) as a function of sound frequency. Usually expressed in decibel (dB) hearing level (HL,) where 0-20 dB HL is considered as the  “normal” range of   hearing thresholds.

audiometer: Device used to determine the threshold of hearing at various frequencies of sounds.

augmentative and alternate communication (AAC): Approaches designed

to support, enhance, supplement (i.e., augment) (e.g., gestures or pantomime) or replace (i.e., alternate) (e.g., word or picture boards, computer-based   communication systems, sign language) existing modes of communication for individuals who are not independent spoken communicators.

aural rehabilitation: Treatment for a hearing-impaired person, such as counselling, speech reading, strategies for improving communication, hearing aid orientation, environmental changes, and positive assertiveness training.





behind-the-ear (BTE) hearing aid: A two part hearing aid that consists of an individually fit earmold which is inserted in the ear canal, and the hearing aid itself, that is attached to the earmold by a length of flexible tubing and rests above and behind the pinna (i.e., cartilaginous outer ear).

benign: Harmless, or more specifically, not cancerous (malignant).

bilateral: Occurring on both sides.

bilingualism: The ability to speak two languages fluently.

Bobath stages: A system of describing motor recovery after CVA, particularly of the upper extremity, based on the work of Berta Bobath.

brittle diabetic: Someone whose diabetes is difficult to control.

Broca’s aphasia: Anterior, non-fluent, or motor aphasia resulting from damage to the anterior portion of the language dominant cerebral hemisphere: specifically the  posterior-inferior portions of the frontal lobe (inferior frontal gyrus); spoken output labelled “telegraphic” and characterized primarily by content words (e.g., nouns, adjectives) and few connector words (e.g., pronouns, articles “the” and “a”, and auxiliary verbs, etc.); listening and reading comprehension better preserved; motor programming problems (apraxia of speech) and limb motor strength difficulties (paralysis or paresis) frequently co-occur.

Brunnstrom stages: This is a system of classifying the stage/degree of motor recovery following CVA. based on the work of Signe Brunnstrom.





caregiver burden: The subjective experience of stress associated with the caregiving role.

caregiver burnout: The stage of extreme fatigue of a caregiver, where continuation of  care becomes risky or impossible. The risk may be to caregiver health or the care          recipient’s (e.g., abuse).

case manager: Case management is a model of health care service delivery wherein one individual on the team is assigned the responsibility of coordinating the care of a particular client. The case manager may offer direct care but, more usually, broker’s care, accessing the necessary resources from the community.

cataracts: The lens of the eye becomes discoloured and opaque to such a degree that it interferes with functional vision.

cerebral vascular accident (CVA): An interruption of blood flow within the brain, commonly called a ‘stroke’.

chronic: Persisting over a long time.

chronic care hospital: A hospital providing care of an indefinite length to patients with high care needs; may also imply a specific level of government funding.

communication: The process of encoding, transmitting, and decoding signals to exchange information or ideas between participants.

communication enhancement: The advantageous use of communication strategies and opportunities to optimize independent interactions, well-being, self-esteem, and personal control.

communication predicament: Actions or conditions which limit interactions,   restrict independence, and reduce self-esteem; communication predicament of aging model first described by Ryan and colleagues in 1986.

communication strategies: Actions, opportunities, or environments that are used,  made available, or put into place to support independent communication and to minimize communication barriers.

completely-in-the-canal (CIC) hearing aid: An  extremely small hearing aid that fits entirely inside the ear canal. Usually has a small handle to assist removal.

conductive hearing loss: Hearing loss caused by faulty sound transmission through the outer and middle ear systems; often remediable by medical intervention.

congestive heart failure: Potentially fatal condition where fluid build up around the heart compresses its ability to beat and circulate blood effectively.

constructional apraxia: Inability to reproduce designs (i.e., drawing or block patterns) in 2 or 3 dimensions or assemble things..

contractures: Reduced range of motion in a joint's normal movement pattern, caused by increased stiffness of the musculo-tendinous unit.

cortical: Relating to the cortex; the outer portion of an organ, such as the brain or kidney.

Computerized axial tomography (CT) scan: Anatomical information gathered from a series of cross-sectional plane X-rays of the body; images are created by computer synthesis of the multiple plane X-rays. Also referred to as a CAT scan.

cuing (cueing): The provision of reminders, usually verbal, to enhance function despite language, memory, or other cognitive deficits.

cycle of falls: A cyclic pattern where a fall may lead to a fear of falling, with subsequent reduction in exercise, which in turn leads to weakness, which in turn predisposes the individual to a greater risk of falling.





“daughter from California” syndrome: First described in the literature by Molloy  and colleagues (1991); refers to children of older adults who live at great distance from their parents or in-laws and who attempt to make contributions to decisions of care that are not based on a comprehensive understanding of the day-to-day functioning, skills, or needs of their relations(s), who are often assessed as not having the capacity (i.e., not competent) to make decisions about financial, health, legal, or other matters.

day program: A supervised, structured environment with social stimulation and activity for clients living in the community. A meal may be provided at mid-day.  Clients usually only attend 1-3 times per week.

deaf (adj.): Unable to hear; usually used only to refer to a person with hearing loss who communicates using modalities other than aural/oral (cf. hard-of-hearing).

decibel hearing level (dB HL): A unit of sound level referring to 0 decibel (dB) hearing level (HL), or the average normal young adult’s hearing threshold.

dementia:An organic syndrome of acquired, persistent impairment in memory,  language, perceptual, cognitive, and ultimately motor function.

dementia syndrome of depression (pseudodementia): Sometimes referred to as  pseudodementia; a condition resembling a dementia but is due to a depressive   disorder rather than a true dementia.

depression:  A treatable/reversible illness characterized by feelings of sadness,   hopelessness and helplessness. and often a change in sleeping, eating, and   elimination patterns and energy level/fatiguibility. Often expressed as somatic   complaints in older adults (e.g., pain, constipation). Can co-occur with dementia.

diabetes mellitus: (can be IDDM or NIDDM): A condition characterized by reduced insulin levels, resulting in faulty metabolism of sugar. Its symptoms include elevated sugar levels in blood and urine, increased urine production, and increased thirst and hunger.

diabetic retinopathy: Disease of the retina due to diabetes, resulting in impaired visual acuity and/or visual field reduction.

diagnosis: The determination of the nature (cause) of a disease or disorder.

Diogenes’ syndrome (Senile Squalor syndrome): A syndrome of marked self-neglect in the elderly, characterized by little interest in cleanliness or social activity, in the absence of marked psychiatric illness to account for the behaviours noted.

disability: Difficulty or inability to perform normal activities/actions because of an impairment.

distortion: Change in sound such that new, unwanted sound is added to the desired sound.

diuretic: An agent that increases the excretion of urine (e.g., a class of antihypertensive medications); sometimes referred to by lay-people as their “water or pee pill”.

dressing apraxia: The inability to dress oneself due to perceptual, rather than motor, impairment.  The perceptual impairment is usually in body scheme and/or spatial        relations, and dressing apraxia is closely associated with constructional apraxia.

dysarthria: A motor speech production problem due to central or peripheral nervous system involvement; impairment in one or more of respiration, phonation (vocal fold vibration), resonance, articulation, and prosody (i.e., speaking rate, pitch, intonation, sound/syllable stress, sound duration); Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis produce different types of dysarthria.

dysphagia: Problems swallowing.





edema: Swelling, retention of fluid in interstitial spaces.

edentulous: Loss of one’s natural teeth.

elder abuse: Deliberately causing physical, psychological, or financial harm to an elderly person.  Neglect (the failure to provide the necessities of life and basic health care) also is a form of abuse.

embolism: Obstruction or blockage of a vessel (e.g., artery) by an embolus (i.e., a plug,  wedge or mass that obstructs blood vessels).

endolymphatic hydrops: Disorder of the inner ear, also called Ménière’s disease.

ENT: A physician in specialized practise for ear, nose, and throat disorders; also called an otolaryngologist or otorhinolaryngologist.

errors of complication: Speech production problems in which sounds are added,  substituted, distorted, prolonged, or repeated in words; often observed in individuals with apraxia of speech.

etiology: Science and study of the cause(s) of disease.

expressive language: Use of speaking, writing, gestures, pantomime, sign language, or AAC assistive device to communicate one’s perceptions, ideas, or feelings.





festinations: A gait pattern frequently seen in Parkinson’s disease; short vigorously rapid steps accompanied by a forward flexed body posture.  

flaccid flexed knee posture: A half-sitting posture caused by an inability of the quadriceps muscles to extend the knees (i.e., straighten up the legs against the body's weight when trying to stand fully erect).

foot drop: A condition in which the ankle plantar flexor muscles shorten excessively causing the foot to rotate ("drop") into excessive extension.

formal support system: The system of government or privately-sponsored programs and resources available to assist people in the community.





geriatrics: Domain of medicine concerned with the medical problems of older adults.

geriatric assessment team: Group of medical, nursing, applied health science, psychological, nutritional, and social professionals who often work on a Geriatric Assessment Unit; can function on models of inter-disciplinary, multi-disciplinary,  or trans-disciplinary team work.

geriatric assessment unit (GAU): Programme where the medical, nursing, health, communicative, cognitive, nutritional, and social needs of older adults are evaluated by geriatric assessment team members.

gerontology: The study of the aging process and the elderly, a sociological perspective.

groping: Repeated positioning of the oral musculature and structures during attempts   to produce speech; often observed in individuals who suffer from apraxia of speech.





handicap: Societal barriers to assuming normal activities, due to impairment or disability.

hard-of-hearing (adj.): Reference to a person who has a hearing impairment but communicates primarily through aural/oral means (cf. deaf).

hearing impaired (adj.): Reference to a condition in which hearing thresholds exceed 20 decibel (dB) hearing level (HL) or significant difficulties in hearing.

hemiparesis: Muscle weakness of one side of the body.

Home Care: A system of health services provided to people in their own homes.

hypertension: Elevated blood pressure.

hypothyroidism: Reduced production of thyroid hormone; leads to clinical presentation of lower metabolic rate, weight gain, and tiredness.

hysterectomy: Surgical removal of the uterus.





impairment: Abnormality of structure or function that can be anatomical, neurological, etc.

incontinence: Loss of voluntary control, usually of the bladder, occasionally the bowel as well.

informal support system: A system of assistance provided by family and/or friends, which may help someone in remaining in the community.

instrumental activities of daily living (IADL): This usually refers to self care activities that are required to maintain oneself in the community, such as telephone use, shopping, food preparation, housekeeping, laundry, self-medication, handling finances, and accessing health care.

in-the-canal (ITC) hearing aid: A small hearing aid that fits in the ear canal and does not project into the outer ear.

in-the-ear (ITE) hearing aid: A hearing aid that fits into the ear canal and fills much or all of the outer ear.

internal fixation of a fracture: Surgical repair of a fracture site, using steel reinforcement, such as pins, nails, or a plate.

interphalangeal (IP) joints: The two distal joints of the fingers or one of the thumb;  similarly, the two distal joints of the fingers of one of the great toes.





Korsakoff’s syndrome: A memory (i.e., amnestic) based psychosis induced by alcohol abuse; characterized by confusion and severe impairment of recent memory and        confabulation (i.e., making-up events to compensate for memory loss).

kyphosis: A forward curvature of the spine, usually in the upper segments.





laryngectomee: One who has undergone a laryngectomy.

laryngectomy: Surgical removal of all or part of the larynx and supporting tissues.

“la belle indifference”: A very mild form of twisted insight and/or euphoria, a lack of reasonable concern.

language: An accepted system of symbols, represented as conventionally agreed upon codes that are rule governed, which is used to represent and to communicate ideas.

language impaired: Disturbance(s) to the rule systems which govern language use or language understanding.

long-term care facility: Any facility providing care on an indefinite basis, may include homes for the aged. nursing homes or chronic care hospitals.





magnetic resonance imaging (MRI): A non-invasive neuroradio imaging system in which a person’s body is placed in a strong magnetic field;  radio frequency signals given off by hydrogen ions as they move through changes in the magnetic field are computer analyzed to produce detailed images of organs and tissues.

malignant: Harmful, or more specifically, cancerous.

masking: Making one sound inaudible via the presentation of another sound or noise.

melanoma: A malignant form of cancer that is derived from cells capable of forming melanin (i.e., the dark colour skin, hair, and retina).

Medivac Air Ambulance: Fixed wing (i.e., airplane) or rotary wing (i.e., helicopter) aircraft transportation of patients.

Ménière’s disease: Disease of the inner ear which may cause tinnitus, vertigo, and (usually) unilateral hearing loss.

motor relearning program (MRP): A specific approach to treating motor impairment after CVA developed by Janet Carr and Roberta Shepherd.

motor-speech assessment: Examination of neuromotor processes (i.e., muscle strength, and rate, range, duration, speed, and strength of motion) involved in respiration, phonation (i.e., voicing), resonance, articulation, and prosody (i.e., rate of speech, duration of sound, pitch changes, etc.).

multi-skilled worker: A health care worker who has very basic training from several  health disciplines, typically nursing, physical therapy, and occupational therapy, which allows them to provide basic daily care for frail individuals under the supervision of a professional.





neurodevelopmental treatment (NDT): A specific approach used in treating motor impairment of neurological origin developed by Berta Bobath.

noise-induced hearing loss: Hearing impairment produced by exposure to high intensity sound, usually as a result of  long term exposure.





old age security: Federal government old age pension system.

oral apraxia (non-verbal): Disruption in the ability to programme the neuromotor movements for non-speech tasks (e.g., opening-closing mouth; tongue, cheek and lip        movements, etc.) (see Apraxia of speech).

oral-peripheral examination: Examination of the oral cavity to determine the  integrity of oral structures and the adequacy of their function in the support of speech production.

osteoarthritis: The so-called "wear and tear" arthritis that is typically seen in weight bearing joints in older adults.

osteoporosis: A pathological reduction of bone density, typically seen in post-menopausal women, which predisposes them to fractures.

otolaryngologist (see ENT)

otosclerosis: Abnormal bone formation in the middle ear that may cause a conductive hearing loss.





paraphasia:  Spoken or written errors in language in which sound(s), syllable(s), word(s), or phrases(s) are substituted for the intended word; for example, using "cap" instead   of "cat" or using "walking" instead of "driving".

paresthesia: Impairment of sensory function, usually including tingling, burning, and/or numbness.

Parkinson’s disease: A neurological, chronic, progressive, degenerative disease resulting from deficiency of the neurotransmitter dopamine in the basal ganglia; characterized by rhythmical resting tremor, rigidity of movement, festination of gait, droopy posture, and mask-like faces; end stages can involve dementia.

passive flexion: Movement of the joint by an external force, such as the therapist, the client’s other arm, etc.

pericare: One task of basic ADL, this refers to personal hygiene of the perineum and external genitalia.

peripheral neuropathy: Impairment of peripheral nerve function, usually in the lower extremities.  Symptoms include impaired sensation and increased risk of injury.

peripheral vascular disease: Impairment in peripheral circulation, usually due to artherosclerosis in the leg vessels. Symptoms include intermittent claudication, which causes leg cramps, and impaired wound healing in affected areas.

physical prompting: The provision of physical hints to enhance function despite cognitive, perceptual, or motor deficits.

polypharmacy: The situation when an individual is taking multiple medications, both prescription and over-the-counter.

presbycusis (presbyacusis): Hearing loss associated with the aging process; usually affects high frequency hearing initially.

primary health care: Direct care of an individual with some illness or disability, aimed at curing or alleviating the consequences of that illness or disability.

primary care worker: That individual, a health care worker, who is most immediately responsible for the care of a sick or disabled patient. (NB - This term is not used to identify an unpaid care giver, but a paid one.  The term care-giver is used to indicate a friend or family member who provided care on a voluntary basis.).

primary language (L1): The language which a person first learned and spoke as a child and the language in which he/she continues to be fluent.

private hospital: Usually refers to non-governmental, profit-oriented ownership.

prognosis: A forecast of the probable course and/or outcome of a disease or condition.

prosody:  Measurable characteristics of speech production including pitch and pitch changes of sounds (e.g., high versus low frequency of sounds), rate of speaking (e.g., fast, medium, slow), stress on sound(s) or syllable(s), length of time sound(s) spoken, and loudness of sound(s).

prosthetic devices: Artificial limb, usually. Technically it is any device added externally to replace lost body part or functions, including communication.

psychosocial: Pertaining to both psychological and social realms of an individual and his/her environment.  It may include internal elements, such as affect (mood) and cognition, as well as external elements, such as friend and family relationships or interpersonal skills.

pure tone average (PTA): The average of a person’s thresholds (in dB HL)  at 500, 1000, and 2000 Hz (i.e., Hertz, a unit of sound). Often used to classify the severity of a hearing loss from mild to profound.





receptive language: Listening and reading understanding, and comprehension of nonverbal behaviours.

reflexive inhibiting posture (or position) (RIP): A position used in therapy which is known to reduce the influence of abnormal reflex activity.

reflexes (hearing): Contraction of the stapedius and tensor tympani muscles of the middle ear in response to an intense sound.

reformulation: Revisions made in expressive language; corrections of errors or starting over again.

rehabilitation: The process of restoring health and function after an injury or illness.

respite care: A program of care designed to give temporary relief to family caregivers: may be offered in the home or in an institution.

response mode: Manner of responding to questions or request: may be written, oral, gestural, etc.

retirement community/complex: A community, building, or group of buildings which is specifically designed to attract the elderly and to accommodate any anticipated special needs.

retrocochlear hearing loss: Hearing loss caused by damage at a level beyond the cochlea (e.g., auditory nerve, brainstem, etc.).

rheumatoid arthritis: A systemic, inflammatory disease characterized by painful and swollen joints, as well as generalized malaise.





sandwich generation: Those persons in mid-adulthood who find themselves responsible for the care of older and younger family members, usually their parents and children.

schizophrenia: A psychiatric illness characterized by hallucinations, delusions, and disturbed though processes, mood, and behaviour.

seating assessment: An assessment of the posture, stability, balance and support needs of a client in a wheelchair. Often includes assessment of skin condition as well.

secondary language (L2): A language, other than the primary language (L1), spoken and understood by a person.

sensorineural hearing loss (SNHL): Hearing loss caused by damage to the cochlea or neural pathways. Not usually remediable by medical intervention.

social support team: Assistance accessing services related to housing, funding,  community programs, and so forth, or assistance dealing with some of the emotional reactions to health problems and other situations (grief, anger,    alienation, etc.).  This support is often, but not exclusively, provided by social  workers.

spastic contraction: Excessive muscle contraction which causes it to shorten and  hold the joint tightly in one position.

spasticity: Abnormal elevation in baseline muscle tension and resistance to movement.

speech: Comprised of A) 1. speech perception and 2. production; B) 1. Identification, interpretation, and organization of auditory sensory data; 2. the complex, neurodynamic aspects of sound generation involving respiration, phonation (i.e., voicing), resonance, articulation, and prosody.

speech-motor control: Neuromotor processes involved in modulation of speech production.

spontaneous language: Language produced (spoken, written, non-verbal) in non-prompting conditions.

speech reception threshold (SRT): The minimum level of speech at which a person can accurately repeat 50% of the words.

stapedectomy: Surgical removal of the stapes (i.e., one of the three bones/ossicles of the middle ear).

stoma: The small opening or artificial opening between cavities or canals; for example,  opening made into the trachea during a laryngectomy.

stroke (see CVA)

subcortical: Any part of the brain that resides below the level of the cerebral cortex.

subluxation: A separation of a joint due to joint lexity and/or injury; often painful.

substitution: The replacement of sounds, syllables, words, clauses, phrases, etc. by related or closely-related forms; see reformulation.

sundowning effect: A behavioral disturbance, seen in those with dementia, whereby they become agitated during the twilight or early evening hours. It is thought to be associated with a lack of environmental stimulation during this typically quiet part of the day.

Swan neck: A deformity with extensors/hyperextensors of the proximal interphalangeal joints (IP) and flexion at the distal IP joints.  Usually accompanied by extension/hyperextension of the metacarpal-phalangeal joints.

symmetric hearing loss: Hearing loss that is the same in both ears.





tangential: Unrelated; peripheral to main topic or theme.

telegraphic utterances: Short, condensed language in which only the most essential (i.e., mostly nouns and verbs) words are used to convey high levels of information; few connector words appear (i.e., prepositions, conjunctions, articles, and auxiliary verbs); observed often in individuals with Broca’s aphasia; likened to language used in transmissions by telegraph.

tinnitus: Ringing, rushing, hissing, or roaring sounds heard in absence of any sound.  May be a temporary or permanent condition. Caused by various factors such as ototoxic drugs (i.e., toxic to hearing), excessive noise exposure, endolymphatic hydrops (i.e., Ménière’s disease), or sensorineural hearing loss.

tone: The level of tension across joints, generated by the combination of connective tissue properties and muscle contraction.

tranfers: Movements from one surface to another (e.g., wheelchair to bed, to toilet, to bathtub, to car, etc.).

tremor: Involuntary, repetitive, or rhythmic movement of a body part.

tympanometry: Measurement of the tympanic membrane (ear drum) movement in response to changes in air pressure applied to it.  Test is used to examine middle ear function.




ulnar drift: A deformity where the fingers are displaced on the ulnar side.  Caused by   joint damage at the metacarpal-phalangeal joints.

unilingual: Speaking only one language.





verbal apraxia (see apraxia of speech)

verbose: Copious, sometimes uncontrolled, production of expressive language.

vertigo: The sensation that the world (or the person) is spinning or twirling.





wandering: Increased purposeless ambulation, typically associated with dementia.

weight shift: The transfer of body support, typically from side to side.

widow: A female whose spouse has died.

widower: A male whose spouse has died.


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