1. Health and the Determinants of Health Gero 300 Chapter 9 Oct 2008

2. Introduction Health during old age-does it decline? Chronic illness is more common in old age-see table 9.1 What we see are rising rates of diabetes, cancer, asthma, hypertension and dementia Perception of sickness is often based on how it affects our lives-functionality and compensation- onset of disability is age related, age is not a predictor of recovery The impact of chronic pain is often associated with many of the chronic diseases

3. Introduction Despite chronic conditions, many seniors perceive their health as good to excellent Mental and physical health must be seen as a combined concept-mens sana in corpore sano Over 75’s have a high degree of sense of coherence in their lives-the concept of generativity. They may be happier and have a better sense of psychological well-being than younger people.

4. Wellness Modern medicine tends to perceive illness in a mechanistic model where disease is viewed as altered functioning of the biological organism Chronic conditions however have a multitude of etiologies with no known cure Wellness is based on the WHO definition of a complete physical, mental and social well-being-a sense of control, coherence, purpose, belonging, satisfaction, mental and social fitness

5. Wellness Health does not mean the same thing to everyone and is often a subjective term, not static but evolving. Most people still determine the state of their health in physical terms and make no reference to their mental health. Quality of life is described in terms of well-being, feeling happy, having a sense of enjoyment, self- esteem. How do we measure these factors?

6. Gender Differences in Health Breast cancer and lung cancer rates in women are increasing Women are more likely to report multiple health problems associated with chronic conditions Women are more likely to take more medication than men, excluding birth control and menopause related drugs Women are more likely to have consulted a Physician about their health problems

7. Gender Differences Social structural factors such as high income, working full-time, caring for a family, and social supports are stronger determinants for women’s health than men Men rate personal health practices, smoking and alcohol use are more important Women are often multi-tasked and have multi roles and therefore are exposed to role conflict and strain more than men It is more socially acceptable for women to adopt a “sick role” than men, in order to deal with health issues

8. Gender Differences For current cohorts therefore old age is more of a gendered experience Many current seniors have lived in traditional societies with paternalistic divisions of labour and current women’s roles are uncharacteristic of previous generations. Frailty-Stats Can 2003-56% of older Canadians have two or more chronic conditions and 33% have three or more-loss of function, loss of support, loss of adaptability, multiple concurrent impairments

9. Determinants of Health See fig 9.1 page 229. This concept embodies the components of biology, lifestyle and environment, influenced by belief, culture, customs, socio-economic and physical environments To this we must add hereditary factors Two determinants-personal and structural Health Beliefs-p 230-235. What we think about health, how we interpret illness, what actions we take when we are ill. Many seniors believe in self-treatment and home remedies and suggest that stress, weather, normal aging, lifestyle, season of the year are important factors.

10. Health Beliefs We must also look at cultural issues such as traditional medicine practices and beliefs Many seniors believe that normal aging is the root cause of many of their health issues-particularly mental and physical decline Two other factors play a part here-what is in your locus of control and what is external-p232. This of course may change with specific onset of diseases or disability

11. Health Beliefs Older adults seem to have increased sense of susceptibility to chronic conditions such as heart disease and HTN. The frequency of health maintenance activities increases with age, because older adults believe they are more vulnerable Lifestyle changes in behaviour may not have impacted the elderly as much as younger people and 74% of seniors described their health as good or fair for their age even though they live with a variety of chronic conditions

12. Personal Health Behaviours Illness behaviour-activities and responses to symptoms and conditions Postive health behaviors-activities to prevent disease and detect it early to promote health. Routine daily activities and avoidance of risk behaviour Health protective behaviour-nutrition, exercise, sleep Self-Care-Lay persons are primary health providers- health protective, symptom evaluation and self- treatment, consultation and self-referral

13. Personal Health Practices Exercise, rest, nutrition vs smoking, alcohol consumption, and risk behaviours. Seniors are less likely to reflect new thinking about how to improve health and environmental practices. Older persons are more exposed to prescribed medications. Review bottom page 237-236 PHP is consistent with the premises of Activity Theory and largely within the control of the individual

14. Social Structures Social structure-pattern of interrelated statuses and roles that lead to a set of stable social relations and interactions with rights and obligations within that interaction. Social structures can vary according to age, socio-economics, social class. Social Class-measured in terms of income, education, occupation, health status. Concept of social gradient-inequality of any number of variables is bad for health and directly impacts mortality rates

15. Summary Economic advantage is clearly related to health status and health practice Social environments affect us psychologically and physiologically-immune system diseases Social status has gender issues and affects morbidity, mortality, and functional ability. Cultural minority groups have high correlations with poor health status. Health promotion and social ecology are interrelated principles at individual, group, community, policy levels.