1. Implications of the Ageing Process: Opportunities for Prevention Karen E. Peters, DrPH University of Illinois at Chicago School of Public Health IL Prevention Research Center March 6, 2007

2. Objectives To acquire insights into how and why aging occurs
To understand the normal and abnormal physical and mental health changes associated with aging
The farmer community can acquire knowledge about maintenance of workplace safety, preservation of good health, and prevention of chronic diseases that compromise healthy aging

3. Old Age Anne Bradstreet (1612-1672)
Memory is short, and braine is dry.
My Almond-tree (gray haires) doth flourish now,
And back, once straight, begins apace to bow.
My grinders now are few, my sight doth faile
My skin is wrinkled, and my cheeks are pale.
No more rejoyce, at musickes pleasant noyse.
Anne Bradstreet ( )

4. The Aging World Increased longevity has resulted in an ‘Aging World’
Affluent nations/societies most affected by baby boomers reaching > age 60
The older population (> 65 years) was 36.8 million in 2005 in USA
Represented 12.4% of U.S. population- about one in every eight Americans
Expected to be 20% by year about 75 million
Will comprise 1 in 5 Americans by 2030

5. Definition of Ageing
Can be defined as a progressive, generalized impairment of function resulting in a loss of adaptative response to a stress and in a growing risk of age-associated disease (Kirkwood, 1996).

7. 21st Century Phenomenon of Global Ageing
20th century – saw a global phenomenon of longevity – a triumph and a challenge
Average life expectancy at birth- increased by 20 years since 1950 to 66 years
Is expected to increase another 10 years by 2050
By 2050, the population of older people will exceed that of children (0-14 yrs)
Is a social phenomenon without historical precedent
In 2002, number of persons > 60 years was 605 million; expected
By 2050, number is expected to reach almost 2 billion

8. Life Expectancy Rise

11. Population ageing
Refers to a decline in the proportion of children and young people and an increase in the proportion of people age 60 and over.
As populations age, the triangular population pyramid of 2002 will be replaced with a more cylinder-like structure in 2025

13. Older Population in USA
The older population (> 65 years) was 36.8 million in 2005 in USA
Represented 12.4% of U.S. population- about one in every eight Americans
Expected to be 20% by year about 75 million
Will comprise 1 in 5 Americans by 2030
FASTEST GROWING GROUP OF OLDER POPULATION IS OLDEST OLD I.E. > 80YRS

14. Impact on Society
Affect family solidarity and relationships within families
Equity across generations
Lifestyles

15. How Old is ‘Old’? We call ourselves 3 years ‘old’ or 80 years ‘old’
Some say ‘I am running in my 10th year’ or ‘I am running in my 75th year’
So we can be old at 3 and running at 75!
Old is a relative term- I call friends my age ‘girls’, while to ‘youngsters’ we are ‘older’ females or even old!
However, Aging is a Reality- Prepare to Accept Gracefully

16. Definitions Defined as latter part of animate life
Old, elderly, senior citizens- commonly used
Calendar age is not necessarily synonymous with biological age
"Successful aging," "productive aging," and "vital aging" commonly used now
UN – defines 60 +; developed nations 65+
Gerontology- The scientific study of the biological, psychological, and sociological phenomena associated with old age and aging.
Geriatrics- treats the clinical problems of later life

17. Senescence In biology, senescence is the process of ageing
Senescence is the steady deterioration of cell function following the period of development in youth
Cellular senescence- cells lose the ability to divide in response to DNA damage -cells either senesce, or self-destruct (apoptosis) if the damage is irreparable
Organismal senescence is the aging of whole organisms. Aging ↔ Senescence
Species have different "rates of aging"- a mouse is elderly at 3 years; humans at 85 yrs
Apart from species specific genetics, chance events determine the probability of death

18. Organismal ageing Is characterized by:
Declining ability to respond to stress
Increasing homeostatic imbalance
Increased risk of disease
Death is ultimate consequence of ageing

19. Biological definition
Pre-Conception - Ovum, Spermatozoon
Conception Fertilization
Pre-birth Conception - 9 months
Infancy Birth - 2 yrs
Childhood – 12 yrs
Adolescence yrs
Early Adulthood yrs
Middle Adulthood yrs
Late Adulthood yrs
Death – Cessation of vital body (somatic) functions

20. History Desire to live forever is ancient
Zeus(Greek God), granted Tithonus the gift of immortality, but not of perpetual youth, when requested by his wife Eos.Tithonus grew progressively ancient, and begged for death to overcome him
‘Immortalized’ in Tennyson’s poem “Tithonus”:
“Man comes and tills the field and lies beneath, And after many a summer dies the swan. Me only cruel immortality Consumes: I wither slowly in thine arms”
Living longer without youthful vitality is not pleasant

21. THEORIES OF AGING How and Why we age are still not clear
WHY DO WE AGE?
Many theories, none fully explain aging
The rate of living theory of aging –rejected
The oxidative-damage/free-radical hypothesis of aging-topical area
The evolutionary senescence theory of aging-most accepted
The reliability theory of aging
The neuron-endocrine hypothesis of aging

22. The Rate Of Living Theory Of Aging- rejected by modern scientists
Ancient philosophers- Death occurs when a finite amount of “vital substance” consumed
The Oxidative-Damage/Free-Radical Hypothesis of Aging
Mitochondrial ability to repair DNA damage ↓ with age → Decreased cell efficiency
Too much mitochondrial damage → cell death
Oxidative damage →free radicals → DNA damage, cross-linking of proteins, formation of age pigments
Injury caused by free radicals initiates a self-perpetuating cycle in which oxidative damage impairs mitochondrial function, which results in the generation of even greater amounts of oxygen-free radicals.

24. The Evolutionary Senescence Theory of Aging
Most widely accepted overall theory
Species prone to die to predation (e.g. Mice) invest more energy in reproduction than in health maintenance
Humans, less prone, can allocate more resources to repairing physical damage
Humans able to reproduce over a longer period of time
Thomas Kirkwood (1970’s)- disposable soma theory- organisms have to balance the demands of maintaining their body, or soma, cells and reproducing
States that humans have long life spans because we are much better at repairing our bodies than short-lived animals
Steven Austad (early 1990s)-provided evidence that perilous environments support early reproduction and short life spans, whereas safer environments favor the opposite
Most agree that it is currently the best explanation for why we and other organisms age

25. The Reliability Theory Of Aging
Applies mathematical theories of reliability to predict systems failure in machines
Natural selection programs animals to live long enough to reproduce;
Takes variable lengths of time after reproductive failure for animal’s subsystems to fail and make animal vulnerable to death
This theory does not explain why certain species live longer than others
Endorses numerous facets of evolutionary senescence theory of aging

26. The Neuroendocrine Hypothesis Of Aging
The neuron-endocrine system –complex system linking brain, nervous system and hormonal glands
Becomes less functional with age- can lead to HBP, diabetes, and sleep abnormalities
Effects of hormones on different facets of aging studied extensively
Some late-life functional changes linked to reduced levels- e.g. menopause
However, recent evidence reveals the opposite: reduction in some hormones can prolong life

27. Current Areas Of Research To Decrease Aging
Caloric Restriction
Altered dietary intake
Insulin-like growth factor (IGF)
Pharmaceuticals
Most target reactive oxygen species, underscoring substantial role of oxidants in the aging process

28. The Physiology of Aging
Aging is both visible and invisible
Visible changes occur on surface of the body; invisible affect internal organs to impair function
Affects all systems to varying extent; if vital functions involved, cause death
Gerontologists - aging is the cumulative effect of many lifelong influences
Influenced by heredity, environment, culture, diet, exercise, past illnesses, etc
Genetic factors chiefly determine variations in aging/lifespan- we exert no control

29. However, we can control our environmental/lifestyle insults to aging and health
Normal aging in the absence of disease is a remarkably benign process
Biologic and chronologic ages are not the same
Most organs gradually lose some function; noticeable only during exertion/stress
Slower reaction times are common

30. How are Adolescence and Senescence Different?
Changes of adolescence follows predictable norms - can be graphed
Aging affects individuals uniquely; norms not established
Some systems begin aging by age 30 (bones); others much later (mental faculties)
Senescence should not be viewed as a “disease”
Cannot put a ‘Time Clock’ on aging

31. PHYSICAL IMPLICATIONS OF AGING
Skin:
Exhibits most obvious sign of aging
Loss of underlying connective tissue, fat and oil glands → wrinkles, sagging skin
Aging skin appears thinner, paler, and translucent
Increased sensitivity to heat/cold, bruising, and bedsores
Develops "age spots" due to deposits of melanin pigment
Ability to perspire is decreased
Contributing factors: nutrition; exposure to sun, chemicals/toxins; hormones, and heredity

33. Hair:
Shows obvious signs of aging
Hair color is due to pigment ‘melanin’- gradually decreases after age 30-40
Loses pigmentation → turns hair gray/white
Manifests earliest in scalp, followed by facial/body hair
Occurs earlier in Caucasians compared to Asians
Alopecia- baldness/ hair loss is the norm
Coarsening of hair common
Nails:  
Become dull, brittle, ridged, thickened, grow slower
due to reduced blood flow to connective tissues

34. The Cardiovascular System
Overall reduction in blood flow occurs as we age
Heart of a 20-year old can pump 10 times the amount actually needed to preserve life
After age 30, about 1% of reserve is lost/ year
Results in:
Normal atrophy of the heart muscle
Calcification of the heart valves
Arteriosclerosis ("hardening of the arteries")
Atherosclerosis (intra-artery deposits)

36. The reduced blood flow results in less strength due to:
diminished oxygen exchange
reduced kidney and liver function
less cellular nourishment
Other problems:
Intermittent pain in the legs with walking
Varicose veins
Prelediction for Blood clots

37. Changes in Respiratory System
Maximum lung function decreases with age
Diminished elasticity of airways and lung tissue
Reduced ciliary activity→ decreased oxygen uptake/exchange
Muscles of the rib cage atrophy, further reducing the ability to:
breathe deeply
cough
expel carbon dioxide
Aggravating factors: Smoking, Pollution
Results in:
Lower stamina for work; easily fatigued
Shortness of breath
Oxygen lack can increase anxiety
Susceptibility to pneumonia increased

38. Skeletal System Changes
Manifest changes that affect QOL significantly
Osteoporosis is a common condition characterized by:
progressive loss of bone density
Increased vulnerability to fractures
Thinning of vertebrae → loss of height; spontaneous fractures
Reduction in height occurs by1 cm (0.4 inches) every 10 years after age 40
Height loss is even greater after 70 years
The vertebrae calcify increasing rigidity, making bending difficult

40. Joints
Osteoarthritis- degenerative disease, most common chronic condition in elderly
Rheumatoid arthritis- common connective tissue disorder
Both impair mobility and the performance of daily activities of living

41. Gastrointestinal System
A reduction in stomach hydrochloric acid, digestive enzymes, saliva causes:
Bloating and flatulence
Impaired swallowing
Reduced breakdown and absorption of foods
Deficiencies in vitamin B, C, and K ; malnutrition is a real possibility

42. Muscular System
Progressive loss of muscle mass occurs as we age → change in body shape
Accelerated after age 65- causes weight loss
Changes in body shape can affect balance, contributing to falls
Elderly individuals with weak muscles are at greater risk for mortality than age-matched individuals
Increase in amount and rate of loss of muscle increases risk of premature death
Physical inactivity is 3rd leading cause of death; plays role in chronic illnesses of aging

43. Hormones
Sex Hormones
Men may exhibit slightly decreased levels of testosterone
Women have decreased levels of estrogens, progesterone and prolactin after menopause
Insulin
The normal fasting glucose level rises 6-14 mg/dL every 10 years after age 50
Probably due to loss in number of insulin receptor sites in cells
Can lead to diabetes- annual testing recommended
Other Hormones
Not significantly affected

44. Immune System Overall effectiveness decreases, leading to:
Increased infection risk
Decreased ability to fight diseases
Slowed wound healing
Autoimmune disorders
Cancers

45. Female Reproductive System
Menopause is obvious milestone of aging (cessation of periods > 1year)
Loss of Reproductive Capacity occurs
Normal around 50 years; occurs by age 40 in 8% women
Secretion of estrogens, progesterone, and prolactin hormones are reduced
Sex drive is not necessarily diminished
Aging does not impair a woman’s capacity to have or enjoy sexual relationships

46. Physical manifestations in Women
Prolapse- descent of uterus may occur due to lax tissues
Urinary stress incontinence common
Breasts lose tissue and subcutaneous fat→ flatten and sag
Breast cancer risk increases with age
The genital tissue atrophies; more prone to infections

47. Male Reproductive System
Men do not experience a sudden ‘andropause’
Age is not a good predictor of male fertility
Testosterone levels maintained/decrease slightly
Decreases in the sex drive (libido) may occur
Normal for erections to occur less frequently
Aging alone does not impair a man’s capacity to enjoy sexual relationships

48. Physical Manifestations in Men
Prostate grows in size- urinary problems
Cancer of prostrate or bladder is commoner in older men
Erectile dysfunction
Erectile dysfunction may occur
Is frequently related to diseases (diabetes) or medicines
90% of erectile dysfunction- has medical rather than psychological origin
May be amenable to treatment

49. Changes in Kidneys Normally no change
Usually affected by diseases like high BP, diabetes and cancer
Lead to increased risk for acute and chronic kidney failure
Urinary tract infections are common

50. Teeth and Mouth Fall of teeth is an obvious sign of aging
All people eventually lose teeth- rate depends on several factors
Proper hygiene can preserve teeth longer
Increased sensitivity to cold/heat common with attrition
Loss can interfere with healthy eating habits- malnutrition common

51. IMPLICATIONS OF AGING ON MENTAL FACULTIES
The quality, not the longevity, of one's life is what is important. — Martin Luther King Jr. ( )

52. Nervous Tissue and Aging
Aging has profound effects on mental faculties
Brain tissue is irreparable – changes are permanent
Speed of communication between nervous tissues is decreased
Transmission of messages within nerve cells becomes slower
The brain and spinal cord lose nerve cells and weight
Waste products collect in brain, causing plaques and tangles

53. Changes result in:
Lost or reduced reflexes → problems with movement and safety
Slight slowing of thought, memory, and thinking- a normal part of aging
A change in thinking/memory/behavior are important indicators of disease
ALL ELDERLY PEOPLE DO NOT BECOME ‘SENILE’
Disease States
Delirium, dementia, and severe memory loss are NOT normal processes of aging
Caused by degenerative brain disorders such as Alzheimer's disease
Illnesses unrelated to brain can cause changes in thinking/ behavior
Severe infections can lead to confused states
Diabetes- fluctuations in glucose levels can cause thinking/behavioral disorders

54. CHANGES IN SENSES

55. SENSES All senses are controlled totally by the brain
Aging increases minimum amount of stimulation before a sensation is perceived
Any compromise in senses has tremendous impact on lifestyle
Hearing and vision changes- dramatic effect on QOL
Many changes can be improved with glasses, hearing aids, and lifestyle modifications
Communication problems common- lead to social isolation and loneliness

56. HEARING
Ears perform two functions – 1. Hearing 2. Maintaining body balance (equilibrium)
Equilibrium (controlled by the inner ear)
Hearing is ruled by the outer ear– disorders respond better
Aging adversely affects both structures
Acuity of hearing declines slightly after age 50
30% people > 65 have significant hearing impairment
Impacted ear wax commoner with increasing age → deafness, easy to treat
Persistent, abnormal ear noise (tinnitus) - common in older adults

57. VISION Visual acuity may gradually decline- not universal
After age 55, most people need glasses at least part of the time
Driving ability is impaired in 15% to 20% due to bad vision
5% become unable to read
Trouble adapting to darkness or bright light
Significant difficulty with night driving may be the first sign of a cataract

58. Color Perceptions Change
As we age, it is harder to distinguish blues and greens than reds and yellows
Elderly should use yellow, orange, and red contrasts at home- improves ability to locate things
Using a red nightlight is better than a conventional bulb
"Floaters" in vision- harmless; sudden ↑ needs consultation
Reduced peripheral vision occurs- cannot see adjacent people- may cause offense to friends
Blindness- usually caused by diseases like diabetes and high BP

59. Taste and Smell
Taste does not seem to decrease until after age 60, if at all
Sense of smell may diminish, especially after age 70- leads to poor hygiene, and unawareness of gas leaks etc
Touch, Vibration, And Pain
Aging can reduce sensations of pain, vibration, cold, heat, pressure, and touch
Decreased temperature sensitivity increases the risk of frostbite, hypothermia, and burns
After age 50, many people have reduced sensitivity to pain.
Reduced feel of vibrations- loss of stability in motion

60. Social Behavior & Personality Changes with Age
Small changes normal - do not significantly change our sense of who the person is
Personality and social interaction often change due to neurodegenerative diseases
Drastic changes in personality reflect a disease process- difficult for caregivers to cope with/accept
“Senility” or “senile” is an out-dated term- now replaced with “Dementia”
Senility or Dementia should NOT BE EQUATED TO AGING- DEMENTIA IS A DISEASE STATE
Dementia – ‘condition where one has a progressive decline in memory and other cognitive functions that results in a change in the ability to conduct one's usual activities’
Dementia is characterized by multiple cognitive deficits with memory impairments as an early symptom
Diagnosis of dementia- not given in absence of impairment in social functioning/independent living

61. Psychological and Social Impact
With a healthy lifestyle, few changes seen that are deleterious to QOL
In fact, some actions may grow more correct as we age (within limits)
Learning
The ability to learn continues throughout life
Often require more time and effort to absorb new information
Need more effort to organize and understand new information
Tendency to avoid learning new things not perceived as beneficial
Reasons – unknown; may be partly attributed to decline in senses as we age

62. Reaction time
Information processed at a slower pace
Reaction to stressful situations is delayed; uncertainty on how to act may manifest
A + for older people- tend to make fewer mistakes than younger people in decisions taken
Intelligence
Whether intelligence declines as we age is hotly debated- usually maintained
Older people perform lower on many standardized intelligence tests
In formal tests of performance, older people slow down, but make fewer mistakes!
However, most intelligence tests do not address situations in our daily lives
Value correctness as we age- answers are more accurate, though response may be slower
More cautious; less liable to make mistakes in judgment/ action

63. Life skills
As we age, perform most life skills better with experience
As we age, majority are better at managing daily affairs
May fail only in times of stress or loss
Reliable support network maintains QOL longer
Younger people can gain from experiences of elders-meaningful exchanges can occur

64. Stresses
Older adults must often deal with physical, medical or social stressors
Stress can precipitate many diseases like diabetes, high BP, anxiety attacks etc
Common stresses for older people are:
diseases or health conditions, possibly chronic (e.g., heart disease, arthritis, cancer)
perceived loss of social status after retirement
death of a spouse/child/sibling

65. Loss and grief Loss of a spouse is particularly stressful
In 2003, more than 1 million spouses (mostly women) were widowed
This number is estimated to increase to 1.5 million every year by 2030
Loss of sight, hearing, and physical disabilities can induce profound grief and loss
Retirement/job loss with loss of social status is a major cause
Most people grieve intensely for 6-12 months after a major loss- withdraw from others
Takes about 1 year to accept the loss and start normal interaction

66. Substance abuse
A growing problem among older adults, particularly alcohol
Causes physical/mental health problems commonly, especially older men
Exaggerated effects seen in older people
Has negative effects on self-esteem, coping skills, and interpersonal relationships
Warning flags are less obvious in older adults e.g. less likely to be caught on the job, in public

67. Memory Decline in Normal Aging
Definition: Memory refers to the storage, retention and recall of information including past experiences, knowledge and thoughts
Only some types of memory loss are associated with normal aging
Other types are typical of disease states

68. Types of Memory and Loss
Working (intermediate term) – loss occurs with normal aging
Episodic- especially impaired in normal aging e.g. ability to process recent information
Semantic (e.g. vocabulary) – Improves with age; lost in dementias
Procedural (long-term memory of skills) - shows No Decline with age; affected by diseases
Very long-term memory (months to years)- increases upto age 50; maintained until well after 70
Short-term memory- shows little decline; loss associated with diseases
Older adults tend to be worse at remembering the source of their information

69. Abnormal Memory Loss in Aging
Forgetting things much more often than you used to
Forgetting how to do things you've done many times before
Trouble learning new things
Repeating phrases or stories in the same conversation
Trouble making choices or handling money
Not being able to keep track of what happens each day

70. Risk Factors for Cognitive Decline
High blood pressure, diabetes, poor nutrition, and social isolation
Heart disease
Family history of dementia
Psychological factors like stress and depression

71. Normal Cognition Executive Functioning include: Verbal Memory
Organization: attention, decision-making, planning, sequencing, problem solving
Regulation: initiation of action, self-control, self-regulation
Language- coherent, sensible
Working (immediate) Memory
Spatial Memory
Verbal Memory

72. Dementia
The word dementia is used to describe the condition where one has a progressive decline in memory and other cognitive functions that results in a change in the ability to conduct one's usual activities
Dementias are neurodegenerative diseases which cannot be cured
Each type characterized by specific effects on cognitive and motor function
Diagnosis of dementia is not generally given in absence of impairment in social functioning and independent living.
Dementia seriously affects a person’s ability to carry out daily activities
People with dementia lose their abilities at different rates
Eventually, patients may need total care

73. Symptoms of Dementia Dementia symptoms may include:
asking the same questions repeatedly,
becoming lost in familiar places,
being unable to follow directions,
getting disoriented about time, people, and places, and
neglect of personal safety, hygiene, and nutrition.

74. Alzheimer's Disease (AD)
Definition: Is a progressive, neurodegenerative disease characterized in the brain by abnormal clumps (amyloid plaques) and tangled bundles of fibers (neurofibrillary tangles) composed of misplaced proteins
AD is the most common dementia in older adults
Incidence expected to more than double by from 377,000 in 1995 to 959,000
The proportion of new cases >85 will increase from 40% in 1995 to 62% in 2050
The annual incidence expected to shoot up by 2030 (baby boomers [persons born between 1946 and 1964] will be over age 65)
Most of the increase will occur among people age 85 or older
Early symptoms of AD, which include forgetfulness and loss of concentration, are often missed because they resemble natural signs of aging

75. Multi-infarct dementia
Caused by a series of strokes in the brain
Infarcts result in irreversible death of brain tissue
Location/severity of compromised area governs severity of symptoms/loss of function
Symptoms – abrupt onset; progress step-wise as strokes recur
Treatment to prevent further strokes is very important

76. Other Mental Conditions
Anxiety
Anxiety disorders- commoner as we get older as medical, psychological, and social problems build up
One in five older adults suffers anxiety symptoms severe enough to necessitate treatment
Persistent or extreme anxiety can seriously decrease QOL
Can be a sign of other problems like depression, dementia, physical illness
Anxiety is often associated with over-arousal
Specific anxiety disorders include the following:
General Anxiety Disorder –Most Common
Panic Attacks –Previous History Present
Phobias- E.G. Unable To Urinate In Public Bathrooms; Inability To Eat In Public
Obsessive Compulsive Disorder –Usually Present At Younger Age
Post-Traumatic Stress Disorder

77. Delirium
Delirium, or acute confusion, is a sudden change in mental function
Delirium is usually a short-term, temporary problem
May persist for weeks to months in a substantial number of people
Is a common complication of medical illness in elderly
One-third of older adults arrive at hospital emergency departments in delirious state
Is strongly associated with poor outcomes among hospitalized patients
Can be mistaken for dementia or schizophrenia
Delirium common in people with dementia

78. Parkinson's Disease
Parkinson's disease is a slowly progressive degenerative disease of the nervous system
About 50,000 Americans are diagnosed with PD each year
Many more undiagnosed as attribute symptoms to old age
Average age of onset is 60; commoner as we grow older
Caused by loss of nerve cells in brain that produce dopamine
Usually familial
Exposure to high levels of manganese, carbon disulfide or certain pesticides increases risk
An increased risk in people who live in rural areas in advanced countries (unproved)

79. Depression Depression is a serious medical illness characterized by:
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed
1%—2% of older women, and < 1% of older men have major depression
Is a continuation of problem from earlier life in 30%—50% of cases
Major depression may accompany disorders that result in dementia
Many older adults face cancer or grief that promote depression
There is a strong link between major depression and increased risk of dying from heart disease.
Alcohol abuse causes depressed mood

80. Dizziness
Dizziness is lightheadedness, feeling like you might faint, being unsteady, loss of balance, or vertigo (a feeling that you or the room is spinning or moving)
Most causes of dizziness are not serious; quickly resolve on their own or are easily treated
Common complaint of people over age 65, affecting 13%—38% of older Americans
Dizziness increases the risk of falling and decrease QOL
Lightheadedness happens when there is insufficient blood supply to the brain- often seen on sudden change in position
Near-fainting/fainting not uncommon in elderly while straining at stools or coughing
Vertigo is dizziness accompanied by a sensation of spinning – due to ear problems/infections
Benign positional vertigo is commonest; happens on sudden change in position of head
Disturbances in heart rhythm
Dizziness due to drugs not uncommon in elderly

81. Active Ageing (WHO)
Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age
Ageing is a social phenomenon – involves friends, work associates, neighbors, family
Interdependence and intergenerational solidarity are important tenets of active ageing
“Yesterday’s child is today’s adult and tomorrow’s grandmother or grandfather”
Healthy life expectancy is also a synonym for “disability-free life expectancy”
“Disability-free life expectancy” is important to an ageing population

82. Measures of Independent Living
Autonomy is the perceived ability to control, cope with and make personal decisions about how one lives on a day-to-day basis, according to one’s own rules and preferences – difficult to quantify
Independence is commonly understood as the ability to perform functions related to daily living – i.e. the capacity of living independently in the community with no and/or little help from others
ADL’s (Activities related to daily living) - can be measured; e.g. bathing, eating, using the toilet and walking
IADL (Instrumental activities of daily living); measurable; e.g. shopping, housework, making meals

83. Quality of life (QOL)
QOL is “an individual’s perception of his or her position in life in the context of the culture and value system where they live, and in relation to their goals, expectations, standards and concerns
Incorporates a person’s “physical health, psychological state, level of independence, social relationships, personal beliefs and relationship to salient features in the environment.” (WHO, 1994)
As people age, their QOL is determined by their ability to maintain autonomy and independence
ADL and IADL are important measures of QOL

84. Religion, Spirituality and Aging
In USA, > 90% of elderly persons consider themselves religious and spiritual
5% consider themselves spiritual but not religious
Religion is associated with better mental health and a greater ability to cope with stress, illness and disability
Provides relief/support to elderly and their caregivers
Active involvement in a religious community helps to maintain physical functioning/health
Elderly who attend services more likely to stop smoking, exercise more, increase social contacts, stay married, and live longer
Religious activities foster development of community and broad social support networks
Increased networking ↑ likelihood of awareness, early detection of diseases, seeking treatment and adherence
Elderly often have distinct spiritual needs that overlap but are not the same as psychologic needs
Many elderly persons prefer counseling from a clergy member rather than from a mental health care practitioner, as it avoids stigma

86. Farming – an Aging and Hazardous Occupation
Agriculture ranks among the most hazardous industries
More than 3.1 million workers were employed in the agriculture, forestry, and fishing industry in 2001
In USA the average age of civilian laborers was 38, compared to 57 in farmers
Agriculture employs proportionately more workers aged 55 and older (22.9% versus 13.6% for all industries)
Agricultural workers are predominately male (72.4%)
Fatal occupational injury rates in the agricultural sector > 4 times that for private sector (1992–2002)
Were disproportionately high for older workers
Work-related injuries increase as farmers move into their 60’s

87. Facts on Older Farmers
According to the 1997 Agricultural Census, of estimated 500,000 farm workers, 25% farm operators are 65 years or older
The only age category showing a substantial increase in 1992 included farmers age 70 or older
Proportion of farmers age > 55 has risen from 37% in 1954 to 61% in 1997
Share of farmers < 35 years declined from 15 percent in 1954 to 8 percent in 1997
No mandatory retirement age exists for older farmers → continue to perform beyond their safety limits
Full retirement is seldom a choice- farmers live in proximity to workplace/ family enterprises
The average age of farmers within the United States is 54.3 years
Older farmers unwilling to recognize or accept their physical limitations
Older farmers underrepresented in research efforts related to farm health and safety

88. Farmers Are At High Risk
Fatal and nonfatal injuries
Work-related lung diseases
Noise-induced hearing loss
Skin diseases
Certain cancers associated with chemical use
Prolonged sun exposure → skin cancer
Entire families, including children, at similar risk as often share work

89. Fatal Occupational Injury Rates
Rates higher in agriculture, forestry, and fishing in every age group than in the private sector
Rates ranged from 13.7/100,000 for workers aged 16–24 to 62.0 for workers older than 64
These differences increase with age
The greatest differences noted for workers aged 55 or older

92. Adverse Health Effects in Farmers
Are due to:
Chronic as well as acute exposures
Delayed as well as immediate effects
Cumulative and multiple exposures

93. Common Adverse Health Effects
Neurological damage – due to pesticides (organophosphates, OP)
The weight of current evidence suggests that chronic, low-level exposure to OP produces neurotoxicity
Cancers – due to pesticides and sun exposure
Birth Defects – due to pesticides
Respiratory – due to allergens or gases
Developmental, reproductive – mostly due to pesticides
Immune suppression
Eye damage- macular degeneration with fungicide use
Nausea, convulsions, other acute effects due to pesticides

94. Age-Related Changes as Risk Factors
Age-related sensory and physical impairments occur among senior farm operators at various rates
Vision
To see objects as clearly as at age 20, many 45-year-olds need four times as much light
By age 60, the amount of light required is double that needed by 45-year-olds
Decline in visual acuity o detect normal environmental stimuli → impaired reactions
Older farmers routinely work in situations with inadequate lighting → more prone to injury
Hearing
Farm workers of all ages have higher levels of noise-induced hearing loss than the general population
Senior farmers who have difficulty hearing words or sounds may not be able to detect warning signals

95. Sense of Balance
Loss of balance and a feeling of dizziness increase the risk of injury for senior farmers :
May lead to loss of concentration while driving/ performing tasks
Walking across an uneven surface such as hay, or moving in a small fishing boat
Falls around tractors and farm machinery poses a particularly serious safety risk
Muscular capability impairment
Farmers need strength and flexibility in all limbs and joints to work safely
Aging eventually reduces agility and strength - regulate/ delegate heavy work
Compensate by providing invaluable practical experience to younger workers

96. Safety for Senior Farmers
ACCEPTANCE OF IMPAIRMENT IMPORTANT – It is not a sign of weakness- Redesign work schedule
Increase lighting levels in barns and other buildings
Ensure that all steps, stairs, and handrails are of excellent quality and well lighted with switches at both ends of stairs and by all entrances
Put non-slip surfaces on walkways and steps where possible.
Have easily operated or maneuvered fence gates, building doors, and animal handling devices.
Use properly fitted and easily accessible personal protection devices/clothes
Pay special attention to their ability to operate a tractor safely ( for self and others)
Get adequate rest, breaks and eat nutritiously
Know the symptoms of heart attack and stroke
Undergo regular medical check-ups annually for vision, hearing, balance, and muscular range and mobility.
Consult a family physician about physical limitations and work limits.

97. Health Protection Strategies
Hand Protection
Necessary to prevent injuries and exposure to chemicals
Wear rubber or leather gloves, as needed
Hearing Protection
To protect from deafness caused by loud noises (e.g. threshers)
Can use ear inserts/muffs
Respiratory Protection
Helps avoid exposure to allergens and toxic gases
Two types- air supplying and air purifying respirators
Air supplying respirators- use in manure pits, silos, where toxic gases released
Air purifying respirators-commonly used to remove air contaminants

98. 'Prescription for Prevention’
Hippocrates, the Father of Medicine, said nearly 2,400 years ago,"If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health."

100. Healthy Eating Tips for Older Adults
Recommended daily calorie consumption for people over age 50 are:
For women:
1600 calories, if physical activity is low level
1800 calories, for moderate levels of activity
2000 calories, for an active lifestyle
For men:
2000 calories, if physical activity is low level
calories, for moderate levels of activity
calories, for an active lifestyle

101. Daily Dietary Guidelines
US Dietary Guidelines suggest a daily mixture of five food sources for good health:
Grains—5-10 ounces
Choose whole grain breads/pasta
Eat high fiber foods like beans, peas, soya products etc- helps avoid constipation, diverticulosis, and diverticulitis
Vegetables—2 to 31/2 cups with a variety of colors and types of vegetables
Fruits—11/2 to 21/2 cups
Milk, yogurt, and cheese—3 sevings:
1 cup of yogurt equals one cup of milk,
11/2 to 2 ounces of cheese equals one cup of milk,
1 cup of cottage cheese equals 1/2 cup of milk.
Meat, poultry, fish, dry beans, eggs, and nuts—5 to 7 ounces
Choose lean meat, poultry, or fish (without skin)
Fats- limit to 2 teaspoon; use unsaturated vegetable fats

102. Tips for Healthy Eating
Do not skip meals
Use low-fat dairy products and salad dressings
About 2/3 of a teaspoon of table salt
Drink plenty of liquids like water, juice, milk, and soup
Date leftover food, as maybe unable to smell spoilt food
Choose foods fortified with vitamin B12-adults over 50 have
difficulty absorbing adequate amounts of this vitamin
Limit high-fat and high-sugar snacks
Use unsaturated vegetable oils like canola, corn, or olive
Many medications may alter the taste of food
Learn to read food package labels-The first one listed is present in the food in the largest amount.

103. Healthy Weight Healthy BMI is between 20-25(Wt. in lbs/height in feet)
Maintain a healthy weight -reduce risk of many chronic diseases
Health Risks of Being Underweight
Poor Memory
Decreased Immunity
Osteoporosis (Bone Loss) – prone to fractures
Decreased Muscle Strength

104. Health Risks of Overweight
Overweight predisposes to development of:
Type 2 Diabetes
High Blood Pressure/Cholesterol
Coronary Heart Disease/Stroke
Some Types Of Cancer
Osteoarthritis
Gallstones
Slow reaction times and avoidance of activity
May reduce life span

105. Advantages of Physical Activity
The more physically active you are, the less likely to gain weight
Improves your strength, endurance, and flexibility
Regular physical activity helps avoid obesity, diabetes, heart disease/stroke, arthritis, high BP, and mental disorders
Reduces functional declines associated with aging
Lowers stress and boosts your mood and energy
Meet new friends by joining a class or walking group
Reduces risk of bone fractures/other injuries
Improves immunity; recovery from illness is faster
Enhances QOL- keeps one mentally alert and physically independent

106. How Much Physical Activity?
Levels vary from person to person
Consult your healthcare provider for safe limits
A gym is not at all necessary
Most people require 30 minutes of moderate physical activity daily
Exercise intensity is less important than total amount spent exercising
Intermittent exercise is as effective as continuous activity
Spurts of three 10 minute walks are effective

107. Tips for Safe Physical Activity
Take time to warm up, cool down, and stretch.
Start slowly and build up to more intense activity.
Stop the activity if you experience pain, dizziness, or shortness of breath.
Drink plenty of water.
When you are active outdoors, wear lightweight clothes in the summer and layers of clothing in the winter.
Wear sunscreen, sunglasses, and a hat for sun protection.
Wear shoes that fit well and are right for your activity.

108. Can I Take Alcohol Safely?
Yes,
Drinking a small amount (1-2 units per day) protects against heart disease and stroke
Recommended Weekly Limits
Men: maximum 21 units of alcohol per week
Not more than four units in any one day
Women:14 units of alcohol per week
Not > three units in any one day).

109. How Much is One Unit of Alcohol?
One unit of alcohol is 10 ml by volume, or 8 g by weight, of pure alcohol (100%)
One unit of alcohol is about equal to:
Half a pint of ordinary strength beer, lager, or cider (3–4% alcohol by volume), or
A small pub measure (25 ml) of spirits (40% alcohol by volume), or
A standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume).
There are one and a half units of alcohol in:
A small glass (125 ml) of ordinary strength wine (12% alcohol by volume), or
A standard pub measure (35 ml) of spirits (40% alcohol by volume).
Strong beer at 6% has six units/liter. If you drink half a liter or just under a pint - then you have had three units.
Wine at 12% has12 units/liter. If you drink a quarter of a liter (250 ml) or two small glasses, then you have had three units.

110. Smoking is a No!No!
Smoking is the leading preventable cause of death in the United States
Causes about one in five deaths annually
An estimated 38,000 of 438,000 deaths are due to secondhand smoke exposure
On average, smokers die 13 to 14 years earlier than nonsmokers
Among adult smokers, 70% report that they want to quit completely, and more than 40% try to quit each year
The risk of dying from lung cancer is 22 times higher in men and 12 times in women who smoke cigarettes, compared with never smokers
Increases the risk for many cancers, including cancers of the lip, oral cavity, pharynx, esophagus, pancreas, larynx (voice box), lung, uterine cervix, urinary bladder, and kidney

111. Adverse Systemic Effects of Smoking
Heart Disease and Stroke
Smokers 2–4 times more likely to develop coronary heart disease than nonsmokers
Doubles a person’s risk for stroke.
Smokers 10 times likely to develop peripheral vascular disease – limb amputations

112. Respiratory Health
Smoking- tenfold increased risk of dying from chronic obstructive lung diseases like emphysema, bronchitis
About 90% of all deaths from chronic obstructive lung diseases are attributable to cigarette smoking
Cigarette smoking has many adverse reproductive and early childhood effects, including an increased risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS)
Postmenopausal women who smoke have lower bone density than women who never smoked
Women who smoke have an increased risk for hip fracture than never smokers

113. Quit Smoking is Possible
Needs determination and self control
Use free Quitline sources for help
Nicotine replacement drugs are available to make withdrawal easier and feasible
Benefits of quitting far outweigh the expense and agonies of quitting

114. Why Quit Smoking?
Within 20 minutes of quitting: blood pressure and pulse rate drop to normal
Within 24 hours of quitting: risk of sudden heart attack decreases
Within 2 weeks - 9 Months:
Walking is easier, lung function increases 30%
Symptoms like coughing, nasal congestion, fatigue, and shortness of breath decrease
Within 1 year of quitting: excess risk of coronary heart disease is half that of a tobacco user
Within 5 years of quitting:
lung cancer death rate decreases by nearly 50%( for 1 pack smoker)
Risk Of Cancer Of The Mouth Is Half That Of A Tobacco User
Within 10 years of quitting: lung cancer death rate declines to that of a non tobacco user
Risk of stroke is lowered, possibly to that of a non-tobacco user
Within 15 years of quitting: risk of coronary heart disease is same as non-smokers

115. Steps to Healthy Aging MONITORING YOUR OWN HEALTH IS A GOOD ADAGE
Chronic diseases like diabetes, high BP, obesity, etc cause most problems in old age
Most chronic diseases can be delayed or severity reduced
Adopt healthy lifestyle behaviors from childhood
Keep weight at BMI < 26
Be physically active within limitations
Eat nutritious foods
Eat sparingly
Avoid misuse of alcohol/drugs; abstinence best
Avoid smoking
Make a social network
Save for care in old age
Regular screening for cancer/diabetes, high BP etc
Regular medical examinations/dental checks

116. Prevent Chronic Diseases
Practicing a healthy lifestyle
Avoid tobacco use
Use screening for:
Breast, cervical, prostate and colorectal cancers
Diabetes
High Blood Pressure
Cholesterol
Regular physician visits
Adherence to treatment

117. Be Good To Yourself Get adequate sleep
Maintain contacts with family and friends
Join a social group
Surround yourself with people whose company you enjoy
Volunteer or get active with groups in your community.
Try a part-time job at a place you would enjoy working for a few hours a week
Indulge in activities you always yearned to do, but never had the time for when younger!
"The secret of life is enjoying the passage of time.“ James Taylor