1. CHAPTER FOUR CHAPTER FOUR Longevity, Health, and Functioning

2. 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. Average Longevity for Men and Women in the US, 1900-2003

3. Genetic Factors –Living a long time runs in families –Centenarians: people over 100 –Research in Italy showed a connection between genetics and disease vulnerability/progression. Genetic and Environmental Factors in Average Longevity

4. Environmental Factors –Disease –Toxins –Lifestyle –Social class Genetic and Environmental Factors in Average Longevity

5. Ethnic/cultural differences are complex and include varied access to resources for healthy living Socioeconomic status involves where one lives, education level, income level, occupation Ethnic Differences in Average Longevity

6. Why do women outlive men by 7 years on average? 6 of 40

7. 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? Gender Differences in Average Longevity

8. Dramatic Differences in Longevity Around the World –From 38 years in Sierra Leone, West Africa to 80 years in Japan –Factors Genetic Sociocultural Economic Anything else? International Differences in Average Longevity

9. 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 independently Dependent life expectancy – the age to which one can expect to live with assistance Defining Health and Illness

10. Our defense and immune systems help fight off foreign invaders in our body throughout life. Aging is related to how well the system works. Autoimmunity –Immune system can attack the body itself. Rheumatoid arthritis Human Immunodeficiency Virus (HIV) – –15,000 people in US over 65 have AIDS Changes in the Immune System

11. Psychoneuroimmunology –The study of how psychological, neurological and immunological system changes affect a person’s vulnerability to contract or recover from disease. Acute Diseases –Conditions that develop over a short period of time and cause a rapid change in health. Usually decrease in frequency with age May be harder to recover for older person Chronic Diseases –Conditions 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 Changes in the Immune System

12. –Arthritis –Most people over 60 have some form –Cardiovascular and Cerebrovascular Disease – circulatory problems –Diabetes Mellitus – occurs when pancreas produces insufficient insulin –Incontinence – inability to control the elimination of urine and feces More embarrassing than dangerous –Cancer – second leading cause of death Risk increases with age – males at greater risk Common Chronic Conditions

13. Cancer incidence crude rates, nine registries, 1973—2000

14. Stress as a Physiological State –Prolonged arousal (chronic stress) associated with: Viral infections Hypertension Impaired memory and cognition Inhibited menstruation – women Impaired immune system functioning Increased risk of cardiovascular disease Cancer The Role of Stress

15. Coping – dealing with stressful events Stress and Coping Paradigm (Lazarus and Folkman, 1984) –Interaction of a thinking person and an event Two people stuck in traffic – different levels of stress? –Primary appraisal : categorize the event as irrelevant, benign/positive, or stressful –Secondary appraisal: if stressful, evaluate the event and ones own ability to cope with harm, threat, or challenge –Reappraisal: changes in the situation may change the primary or secondary appraisal The Role of Stress

16. Aging and the Stress and Coping Paradigm –Who has more stress? Older or Younger? Management strategies –Reappraise situation –Avoid stressful situations –Try to counteract effects of stress with relaxation The Role of Stress

17. How to manage pain? –Pharmacological Non-narcotic and narcotic medications –Non-pharmacological Therapeutic touch, massage, vibration, heat, cold Electrical stimulation to spine or pain site Acupuncture and acupressure Biofeedback Distraction techniques Relaxation, meditation, and imagery Hypnosis, self-induced or by another person Managing Pain

18. How Medications Work Absorption - 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 bloodstream –Drug Excretion –kidneys create urine; also through sweat, feces, and saliva Pharmacology and Medication Adherence

19. Polypharmacy –The use of multiple medications in the same person –Interactions –Potentially dangerous –Good strategy: “start low and go slow.” Medication Side Effects and Interactions

20. –Difficult with older patients –Many 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. Adherence to Medication Regimens

21. 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 morbidity –Becoming disabled later with a shorter period of disability before death Functional Health and Disability

22. Verbrugge’s model of the disablement process Extraindividual factors -environmental and health care Intraindividual factors -behavioral and personality

23. Determining Functional Health Status –Frail older adults: have physical disabilities are very ill may have cognitive or psychological disorders need assistance with everyday tasks –Activities of daily living (ADL) include basic self-care tasks: Eating Bathing Toileting Walking Dressing –Instrumental activities of daily living (IADL) are actions that involve some intellectual competence and planning. Functional Health and Disability

24. What Causes Functional Limitations and Disability in Older Adults? Strong predictors –Cerebrovascular disease –Arthritis –Coronary artery disease (weaker predictor) Other predictors –Smoking –Heavy drinking –Physical inactivity –Depression –Social isolation and perceived poor health Functional Health and Disability

25. Prevalence of disability and the need for assistance by age