Chapter 22 Understanding Aging and Dying

Aging Refers to the normal changes in body functions that occur after sexual maturity and continue until death. Maximum life span is the theoretical (idealized) maximum number of years that individuals of a species can live; for humans, this is about 110 to 115 years.

Aging Average life span is defined as the age at which half of the members of a population have died. Life expectancy is the average length of time that members of a population can expect to live. Average life expectancy in the United States is about 77 years.

Life Span

Life Span Some gerontologists believe that people in many countries are approaching the current maximum average life span of 85 to 90 years. If all cancers could be cured or prevented, only about 3 years of life would be added to the life span of the average baby born today. If all heart disease were eliminated, average life expectancy at birth would increase by about 14 years.

Life Span

Theories of Aging Biological and genetic mechanisms. Environmental factors. Evidence of the “biological clock” that determines maximum life span comes from measuring the amount of energy per gram of body weight consumed per day by mammals of different species.

Environmental Factors Affect Aging The longer we live, the longer we are exposed to radiation and chemicals that can damage DNA in cells and that, over time, may cause death of essential cells in the body. An effect of exposure to radiation and chemicals is the production of very reactive molecules in cells called free radicals. The aging process is complicated and is more than likely brought on by a combination of genetic and environmental factors.

Alzheimer’s Disease and Senile Dementia Many people over age 85 have some loss of normal cognitive functions; this is readily determined by asking a few simple questions. Senile dementia is the medical term for impairment or loss of mental functions in elderly people.

Symptoms of Alzheimer’s Disease Loss of memory that increases over time Feeling confused Loss of problem-solving skills Agitated behavior Becoming lost in familiar settings

Alzheimer’s Disease More than 4 million Americans have Alzheimer’s disease now, and the number is expected to rise as the population ages. Alzheimer’s disease is characterized by: Brain tissue that appears to have presence of bundles of tangled nerve fibrils in certain areas Presence of a specific protein, called amyloid protein, which is localized in certain areas of blood vessels in the brain

Alzheimer’s Disease Researchers have found four genes that contribute to the development of Alzheimer’s disease. Three of these genes (APP, PS1, PS2) occur only in about 100 families worldwide. Chemical tests are being developed that can tell whether a person has Alzheimer’s disease still in the early stages, although nothing can be done at that point to stop the progression of the disease.

Alzheimer’s Disease There are two forms of Alzheimer’s disease: Familial Alzheimer’s disease Sporadic Alzheimer’s disease Slowing the onset of Alzheimer’s symptoms would benefit society and reduce the expenditure of health dollars. People with higher levels of education are less likely to develop Alzheimer’s disease.

Parkinson’s Disease (PD) Second most common cause of neurodegenerative disease (after Alzheimer’s disease) among older persons Four defining symptoms of PD: Tremor Rigidity Bradykinesia: The slowing down and loss of spontaneous movement Postural instability: Impaired balance and coordination of movements

Osteoporosis Osteoporosis is a condition in older persons, particularly women, that results from loss of bone material, causing bones to become thin, porous, and brittle. Brittleness of bones makes older people susceptible to hip fractures. Osteoporosis affects 25 million women in the United States and is responsible for 300,000 hip fractures each year.

Osteoporosis

Osteoporosis Osteoporosis occurs because the rate of bone breakdown exceeds the rate of bone renewal. Estrogen loss resulting from menopause contributes to reduction of bone mass. The risk in women can be reduced by replacing the lost estrogen with hormone replacement therapy (ERT). Prevention is to build up as much bone mass as possible when young through calcium consumption and exercise.

Age-Related Vision Loss Macular degeneration is the dying of the cells in the central portion of the retina. 1.75 million Americans have macular degeneration.

Age-Related Hearing Loss Hearing loss is the third most common chronic condition among older adults. Approximately 4 million adults over the age of 65 suffer from hearing loss.

Thinking About Aging The choices you make today affect your lifetime. Think about: Physical health Mental health Emotional health Spiritual health

Thinking About Aging Some fears include: Illness Poverty Being attacked or victimized Falling and being injured while alone Loss of responsibility for one’s life Memory loss Sexual inadequacy

Death and Dying Death is the greatest of human fears. Suggestions to overcome fears associated with death include: Become a volunteer and spend time with patients who are dying and willing to share their thoughts. Write down feelings about death and dying. Humor helps deal with fears.

Stages of Dying Not all people experience all of the following stages, but most experience some: Denial and isolation Anger Bargaining Depression Acceptance

Advance Directives Advance directives consist of two documents: A living will, which explicitly states your desires for or rejection of specific treatments Health care power of attorney, which designates a person responsible for health decisions for you

Physician-Assisted Suicide Some people suffering from a severe, disabling, painful illness that cannot be relieved by medical care elect euthanasia, the act of helping a person experience a peaceful, painless death. In recent years, physician-assisted suicide has become a controversial form of euthanasia.

Palliative Care The World Health Organization (WHO) defines palliative care as: Neither hastening nor postponing death Providing relief from pain and other distressing symptoms Integrating the psychological and spiritual aspects of patient care Offering a support system to help patients live life as actively as possible until death Offering a support system to help families cope with the patient’s illness and death

Palliative Care Newly recognized branch of medicine that focuses on noncurative treatments for the dying Emphasis of treatment shifts from prolonging life to: Enhancing the quality of life that remains Preserving a person’s dignity Relieving suffering

Hospice Goal is to meet the total health needs of patients who have weeks or months to live. Medications are given to ease pain, but no heroic measures are taken to prolong life. Philosophy is that dying is part of living and should not be resisted with every weapon in the modern medical arsenal. Counseling and social services are available at hospices.

Healthy Aging Depends on a Healthy Lifestyle Increased attention is being paid to the role of nutrition in healthy aging. Consumption of fresh fruits and vegetables are thought to slow the aging process. Foods containing antioxidants are regarded as potent anti-aging foods. Supplements containing antioxidants are also recommended.