2 Average Longevity for Men and Women in the US, 1900-2003 Average Longevity – age at which half the individuals born in a particular year will have died.Maximum Longevity – the oldest age to which any individual of a species lives.
3 Genetic and Environmental Factors in Average Longevity Genetic FactorsLiving a long time runs in familiesCentenarians: people over 100Research in Italy showed a connection between genetics and disease vulnerability/progression.
4 Genetic and Environmental Factors in Average Longevity DiseaseToxinsLifestyleSocial class
5 Ethnic Differences in Average Longevity Ethnic/cultural differences are complex and include varied access to resources for healthy livingSocioeconomic status involves where one lives, education level, income level, occupation
7 Gender Differences in Average Longevity Women have nearly a seven year edge over men.Men are more vulnerable to disease than women.Men are risk-takers.Men smoke and use alcohol more than women.Men allow stress to enter their lives more than women.Anything else?
8 International Differences in Average Longevity Dramatic Differences in Longevity Around the WorldFrom 38 years in SierraLeone, West Africa to 80years in JapanFactorsGeneticSocioculturalEconomicAnything else?
9 Defining Health and Illness Health – A state of complete physical, mental, and social well-being, and not just the absence of disease or impairment.Illness – Presence of a physical or mental disease or impairment.Active life expectancy –the age to which one can expect to live independentlyDependent life expectancy – the age to which one can expect to live with assistance
10 Changes in the Immune System Our defense and immune systems help fight off foreign invaders in our body throughout life.Aging is related to how well the system works.AutoimmunityImmune system can attack the body itself.Rheumatoid arthritisHuman Immunodeficiency Virus (HIV) –15,000 people in US over 65 have AIDS
11 Changes in the Immune System PsychoneuroimmunologyThe study of how psychological, neurological and immunological system changes affect a person’s vulnerability to contract or recover from disease.Acute DiseasesConditions that develop over a short period of time and cause a rapid change in health.Usually decrease in frequency with ageMay be harder to recover for older personChronic DiseasesConditions that last a long time (min. 3 mo.) and may be accompanied by residual functional impairment that necessitates long-term management.Usually increase in frequency with age
12 The Role of Stress Stress as a Physiological State Prolonged arousal (chronic stress) associated with:Viral infectionsHypertensionImpaired memory and cognitionInhibited menstruation – womenImpaired immune system functioningIncreased risk of cardiovascular diseaseCancer
13 The Role of Stress Coping – dealing with stressful events Stress and Coping Paradigm (Lazarus and Folkman, 1984)Interaction of a thinking person and an eventTwo people stuck in traffic – different levels of stress?Primary appraisal: categorize the event as irrelevant, benign/positive, or stressfulSecondary appraisal: if stressful, evaluate the event and ones own ability to cope with harm, threat, or challengeReappraisal: changes in the situation may change the primary or secondary appraisal
14 The Role of Stress Aging and the Stress and Coping Paradigm Who has more stress? Older or Younger?Management strategiesReappraise situationAvoid stressful situationsTry to counteract effects of stress with relaxation
15 Common Chronic Conditions Arthritis –Most people over 60 have some formCardiovascular and Cerebrovascular Disease – circulatory problemsDiabetes Mellitus – occurs when pancreas produces insufficient insulinIncontinence – inability to control the elimination of urine and fecesMore embarrassing than dangerousCancer – second leading cause of deathRisk increases with age – males at greater risk
16 Cancer incidence crude rates, nine registries, 1973—2000 Figure 4.5 Cancer incidence crude rates, nine registries, 1973—2000
17 Managing Pain How to manage pain? Pharmacological Non-pharmacological Non-narcotic and narcotic medicationsNon-pharmacologicalTherapeutic touch, massage, vibration, heat, coldElectrical stimulation to spine or pain siteAcupuncture and acupressureBiofeedbackDistraction techniquesRelaxation, meditation, and imageryHypnosis, self-induced or by another person
18 Pharmacology and Medication Adherence How Medications WorkAbsorption - Time needed for medications to enter the bloodstream (can take longer to enter older person’s system)Once in the bloodstream the drug is distributed throughout the body (toxic levels more likely to develop in older person)Drug Metabolism- liver gets rid of medication in bloodstreamDrug Excretion –kidneys create urine; also through sweat, feces, and saliva
19 Medication Side Effects and Interactions PolypharmacyThe use of multiple medications in the same personInteractionsPotentially dangerousGood strategy: “start low and go slow.”
20 Adherence to Medication Regimens Difficult with older patientsMany older patients go to more than one doctor so accurate knowledge of drugs taken is important.Good organization and attention to detail is important with any medication regimen.
21 Functional Health and Disability Disability: the effects of chronic conditions on people’s ability to engage in activities that are necessary, expected, and personally desired in their society. (Verbrugge,1994)Compression of morbidityBecoming disabled later with a shorter period of disability before death
22 A model of the disablement process Extraindividual factors -environmental and health care Intraindividual factors -behavioral and personalityFigure A model of the disablement process
23 Functional Health and Disability Determining Functional Health StatusFrail older adults:have physical disabilitiesare very illmay have cognitive or psychological disordersneed assistance with everyday tasksActivities of daily living (ADL) include basic self-care tasks:EatingBathingToiletingWalkingDressingInstrumental activities of daily living (IADL) are actions that involve some intellectual competence and planning.
24 Functional Health and Disability What Causes Functional Limitationsand Disability in Older Adults?Strong predictorsCerebrovascular diseaseArthritisCoronary artery disease (weaker predictor)Other predictorsSmokingHeavy drinkingPhysical inactivityDepressionSocial isolation and perceived poor health
25 Prevalence of disability and the need for assistance by age Figure Prevalence of disability and the need for assistance by age