Case Studies In Gerontology
For The Applied Heath Sciences
(evoked) auditory brainstem response
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):
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.
as in pain or having a short, aggressive cause: as in an illness.
age-related deterioration in postural
control and musculo-skeletal system:
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.
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.
ability to walk; occasionally also used to refer to self-propulsion in a wheelchair.
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.
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
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
used to determine the threshold of hearing at various frequencies
augmentative and alternate communication (AAC):
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
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:
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).
or more specifically, not cancerous (malignant).
on both sides.
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.
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’.
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.
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
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..
range of motion in a joint's normal movement pattern, caused by increased
stiffness of the musculo-tendinous unit.
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:
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.
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.
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
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.
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.
or inability to perform normal activities/actions because of an
in sound such that new, unwanted sound is added to the desired sound.
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
and dressing apraxia is closely associated with constructional apraxia.
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.
retention of fluid in interstitial spaces.
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.
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.
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.
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.
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
study of the aging process and the elderly, a sociological perspective.
positioning of the oral musculature and structures during attempts
to produce speech; often observed in individuals who suffer from apraxia
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.
weakness of one side of the body.
Home Care: A
system of health services provided to people in their own homes.
production of thyroid hormone; leads to clinical presentation of lower metabolic
rate, weight gain, and tiredness.
removal of the uterus.
of structure or function that can be anatomical, neurological, etc.
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
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
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).
forward curvature of the spine, usually in the upper segments.
who has undergone a laryngectomy.
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.
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):
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.
or more specifically, cancerous.
one sound inaudible via the presentation of another sound or noise.
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
Ménière’s disease: Disease
of the inner ear which may cause tinnitus, vertigo, and (usually) unilateral
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):
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
so-called "wear and tear" arthritis that is typically seen in weight
bearing joints in older adults.
pathological reduction of bone density, typically seen in post-menopausal
women, which predisposes them to fractures.
otolaryngologist (see ENT)
bone formation in the middle ear that may cause a conductive hearing loss.
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".
of sensory function, usually including tingling, burning, and/or
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
task of basic ADL, this refers to personal hygiene of the perineum and
peripheral neuropathy: Impairment
of peripheral nerve function, usually in the lower extremities.
Symptoms include impaired sensation and increased risk of injury.
peripheral vascular disease:
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.
situation when an individual is taking multiple medications, both prescription
presbycusis (presbyacusis): Hearing
loss associated with the aging process; usually affects high frequency hearing
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.
forecast of the probable course and/or outcome of a disease or condition.
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.
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
reflexes (hearing): Contraction
of the stapedius and tensor tympani muscles of the middle ear in response to an intense sound.
made in expressive language; corrections of errors or starting over again.
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.
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
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.
elevation in baseline muscle tension and resistance to movement.
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,
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
stapedectomy: Surgical removal
of the stapes (i.e., one of the three bones/ossicles of the middle ear).
small opening or artificial opening between cavities or canals; for example,
opening made into the trachea during
stroke (see CVA)
part of the brain that resides below the level of the cerebral cortex.
separation of a joint due to joint lexity and/or injury; often painful.
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.
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
symmetric hearing loss: Hearing
loss that is the same in both ears.
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.
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.
from one surface to another (e.g., wheelchair to bed, to toilet, to bathtub,
to car, etc.).
repetitive, or rhythmic movement of a body part.
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.
A deformity where the fingers are displaced on the ulnar side. Caused by joint
damage at the metacarpal-phalangeal joints.
only one language.
verbal apraxia (see apraxia of
sometimes uncontrolled, production of expressive language.
sensation that the world (or the person) is spinning or twirling.
purposeless ambulation, typically associated with dementia.
weight shift: The
transfer of body support, typically from side to side.
female whose spouse has died.
male whose spouse has died.