This seems related to higher rates of Infant mortality, unintentional injuries, life-threatening disease, poverty-linked stress, and higher bevels of violent death in low-SEES minority groups. Quality of life can be predicted by a country health care, housing and social services. O Active lifespan is the number of years of vigorous, healthy life a person born in a particular year can expect. Japan Is first, and the US Is 24th. Japan has a low rate of heart disease due to the low-fat diet, along with good health care and positive polices that benefit the elderly.
In developing nations the life expectancy Is closer to 50 years, and active lifespan is shorter- 44 in Haiti, 38 in Afghanistan, 26 in Sierra Leone. ; Life expectancy in late adulthood- in the US, people age 65+ have grown in numbers- in North America, they have increased from 4% to 13%. The fastest growing group of elders is those 85+. The gender difference expands with age- at 65 there are 1 1 1 women per 100 men. At 85+ there are 160 women for 100 men. O Life expectancy crossover – surviving members of low-SEES ethnic minority groups live longer than members of the white majority.
Perhaps only the sturdiest males and females of low-SEES groups survive into very old age, so they actually can outlive those in more favored groups. After people reach 75 years, heredity is not the same impact that environment is- now lifestyle makes the difference- diet, normal body weight, exercise, little substance use, optimistic outlook. Low stress and social support. Maximum lifespan is the genetic limit to length of life free of external risk factors. 85 seems about average, but the oldest verified age Is 122. Physical changes ; Centenarians’ secrets – centenarians have increased 10 times in the past 40 years.
Women outnumber men by 4/1 . 60-70% have disabilities that prevent independent living, but many lead active lives. What do they do differently? O ivied survival. They also haven’t had many chronic illness. They have efficient immune systems and few brain abnormalities. Most never smoked and were physically active into their late years. O Personality is optimistic, not fear-driven. They score high in independence, hardiness, emotional security and openness to experience. They also cite close family bonds and a long and happy marriage.
Activities include community involvement, work, and leisure activities and continued learning. ; Nervous system impairments show up more after age 60, as the brain tissue declines due to loss of neurons and larger ventricles within the brain. As many as 50% of neurons may die in the visual, auditory, and motor areas of the brain. The cerebellum, which controls motor coordination, loses about 25% of neurons. Even so, aging neurons can establish new synapses in the wake of lost neurons. So parts of the brain compensate for lost ports. Temperature management is poorer as the autonomic nervous system is less efficient.
So elderly are at greater risk during extreme weather. ; Sensory Systems – there is reduced sensitivity with aging. O Vision is reduced in dim light, and in nearby focus, as well as color perception. The ornery becomes more translucent and scatters light which blurs images. The lens yellows which affects color discrimination. ; Cataracts are cloudy areas in the lens which blur vision and can cause blindness if there is no surgery. There is poorer dark adaptation when coming in from the light. Depth perception is also compromised since binocular vision declines, as well as visual acuity.
Muscular degeneration occurs when light-sensitive cells in the Macaulay, the central region of the retina break down, resulting in blurry central vision, and eventual blindness. A diet high in anti-oxidants can delay this condition. Driving may need to be curtailed at a certain point, as the older driver has a harder time discriminating the road distractions and signs. This is a hard thing to give up, since it signals physical dependence on others. Elders also are at higher risk of stumbling and serious falls at this point, as they don’t see changes in the floor and accommodate smoothly. Hearing is impaired with reduced blood supply and death of the sense organs in the ear, the cilia, as well as the auditory cortex in the brain. The eardrum also stiffens, so not as much sensation gets to the inner ear. High requisites are first to go. It is harder to distinguish speech in loud environments, especially after age 70. Hearing loss can affect safety, especially for pedestrians and drivers. Deafness is isolating, as people lose patience trying to communicate with deaf people. It also links to a certain paranoia, as deaf people fear others are talking about them.
Many people learn to read lips as they experience hearing loss, so there are adaptations that can be made, if others will cooperate and help. O Taste and smell declines somewhat, and people may have difficulty recognizing familiar foods by taste alone. It may be due to dentures, smoking, medications or even strokes. If food tastes less, it is also less appealing, so diet may become poorer. Smell is also related to enjoying food, but also protects the person from bad food, gas fumes, or smoke. Smell receptors are lost after age 60, and odor perception often becomes distorted in late adulthood. O Touch perception declines after age 70.
There is a loss of touch receptors as well as a slowing of blood circulation in the extremities. Cardiovascular and respiratory systems are affected by aging as the heart muscle stiffen and accumulate plaque. So the heart pumps with less force, and blood flow slows. So during activity, sufficient oxygen may not be delivered to critical tissues. Lung tissue also loses elasticity, & capacity is reduced by half. The blood absorbs less oxygen and expels less carbon dioxide. People feel more out of breath when exercising. This is more of a problem for people who have smoked, had a high-fat diet, or been exposed to pollutants.
Exercise facilitates respiratory function. Immune system declines as T cells become less effective. O Auto-immune response is a problem when the immune system turns against normal body tissues. This puts elders at risk of infectious diseases, C.V., cancers, rheumatoid arthritis, or diabetes. The more impaired the immune system is, the more at risk the person is to a variety of agents. ; Sleep is essential for healthy functioning all one’s life, but as we age, sleep is harder to come by, as elders sleep less, more lightly, and have more trouble going to sleep.
Men seem to have more sleep problems than women, due to the enlargement of the prostate gland and the need to urinate more often at night. O Sleep apneas is a condition where breathing ceases for 10 sec. Or more, causing the person to awaken with a start to breathe again. This afflicts more men than women, but overweight people have problems with this condition, as more weight is pressing on the lungs, requiring more effort to keep breathing. Legs also move rapidly during the night- “restless legs” and this can disrupt sleep, too.
Unfortunately poor sleep can afflict daytime energy, resulting in a cycle of downward energy, even depression. More prescriptions for sleep aids are given to older adults, but they can have rebound effects later with greater insomnia. ; Physical appearance and mobility involve changes in the skin, hair, facial structure, and body build. The face most often wows the ravages of aging skin. The only structures to continue to grow are the nose and ears, as cartilage continents to grow. Hair thins and loses pigment. Height declines as the spine collapses with bone loss.
Mobility declines as muscle strength declines- 30 – 50% declines after ages 70. Stretching exercises can reduce this decline. Adapting to physical changes of late adulthood – we can do much more to improve physical and cognitive skills than to delay wrinkling or external signs of aging, but many products are hawked because people are more willing to spend money on products than do the hard work of staying active. Coping strategies include both problem-centered and emotion-centered coping. The more people take charge of their lives the greater control they feel about their fates.
People can use compensating techniques to adapt to sensory losses, if they will make the effort. The more passive people are, the more they report negative adjustment to life. Assisted technology is devices that permit people with disabilities to improve their functioning. They include computers, phones that can be dialed by voice command, or print out the speech of the caller allow blind or deaf elders to maintain independence. A computer chip can be placed on medicine bottles to remind elders to take meds on schedule. Smart homes promote safety and mobility.
Stereotypes of aging include the idea that “deterioration is inevitable” and result in younger people talking down to elders, or ignoring them entirely. The more negatively stereotyped elders are, the more negatively their response to stress, producing poorer handwriting, memory, and will to live. The more control seniors are culture views its elders, the better quality of life those elders sustain. ; Cultural differences in aging – in many varieties of culture, elders fare best when they retain social status and opportunities for community participation. The more they are excluded from social roles, aging reduces well-being.
A tribe in Botswana treats aging as a marker of wisdom even making the eldest man and wife the village leaders. And as other elders become frail, children are sent to care for them, but it is considered a role of pride and prestige. In cultures where elders are segregated, they tend to dwell more on their disabilities and exclusion from younger, more powerful members of society. There develops a resentment between the generations, instead of an integration and enhancement of wisdom due to learning from the elders. Health, Fitness, and Disability- health is central to well-being in later life.
Most elders do rate their health positively, & optimism is related to coping abilities in the area of health. There is possibility of overcoming a disability, especially if the elder has a desire to rehabilitate. African-American and Hispanic elderly are at greater risk for certain health problems, especially since they have more people living below the poverty line. Native-Americans are at even higher risk, health-wise, due to such high poverty rates- over 80%. By very old age, women are more impaired than men, since only the hardiest men have survived to this age. Compression of morbidity is the goal of reducing the period of disability in old age. ; Poverty rates and health problems of elderly ethnic minorities o African-American- 23% in poverty- risks of C.V., cancer, diabetes o Hispanic- 20% in poverty- risks of C.V., diabetes o Native-American- 80%+- diabetes, kidney disease, liver disease, TAB, sensory impairments ; Nutrition and exercise – Diet actually needs to be enriched with vitamins and minerals to protect elders’ immune system and bones. But many people eave a poorer diet than in the past. Supplements can help, as well as weight-bearing exercise.
Exercise also improves blood circulation to the brain, which enhances cognitive function and brain tissue. Exercise also contributes to higher sense of physical self-esteem. Unfortunately, those with chronic illnesses tend to think rest and sedentary life style if more healthful. ; Sexuality – there is a decline in sexual desire and frequency of activity in older people, but desire is often still there. Good sex in the past predicts good sex in the future. Availability of a partner is still a powerful determiner of activity. Often when men have more trouble holding an erection they will refrain to act sexual, fearing embarrassment sexually.
Certain illnesses and medications can impact blood flow to the penis- C.V., diabetes, meds for depression or high blood pressure. Unfortunately in our culture, sex among the elderly is viewed with disapproval. ; Physical disabilities do increase toward the end of the lifespan, especially illnesses such as C.V. and cancer. Respiratory diseases also climb in late adulthood- emphysema is caused by loss of elasticity in lung tissue- most result from smoking. As the immune system declines, more people are at risk of ammonia, severe lung inflammation. Stroke is 4th most common killer in the elderly.
There is a blockage of blood flow in the brain which leads to death of neural tissue and accompanying loss of function. Osteoporosis rises in late adulthood, as well as arthritis. Adult-onset diabetes and unintentional injuries also increase in late more often in the aged. The context of good health. O Primary aging – biological aging that occurs even in o Secondary aging – is declines in function due to hereditary defects and negative environmental influences, poor diet, lack of exercise, disease, substance abuse, environmental pollution, and stress. Arthritis is a condition of inflamed, painful, stiff or swollen Joints and muscles.
There are 2 forms: ; Estes-arthritis is the most common type- due to deteriorating cartilage on the ends of bones- “degenerative Joint disease”. Cartilage that cushions the bones in Joints deteriorates, so there is more discomfort with movement. Obesity can place abnormal pressure on Joints and damages cartilage, too. Rheumatoid arthritis is an autoimmune disease that involves the whole body. There is inflammation of connective tissue, there is stiffness, inflammation, and aching. Deformed Joints develop, reducing mobility. Disability due to arthritis affects 45% of American men over 65 & 52% of women.
Water-based exercise can reduce pain and ensure mobility. Meds are prescribed for pain, but they can affect the stomach lining and cause ulcers, if the person is not careful. ; Adult- onset diabetes occurs when the insulin output of the pancreas can’t control blood sugar after a meal. High blood sugar damages the blood vessels, increases risk of stroke, heart attack, circulatory problems in the legs, and injury to the eyes, kidneys, and nerves. If there is severe loss of blood flow, it can result in amputations and blindness. It may require oral insulin or even shots to maintain blood sugar in the healthy range. Unintentional injuries- death rate from injuries increases after age 65- mostly due to car collisions and falls. ; Motor vehicle accidents are responsible for h of injury mortality later in life. But older adults have higher rates of traffic tickets, accidents, and fatalities per mile driven than any other age group, except for teens. Deaths due to injury are greater for men than women in late life. Driving is especially impaired as vision is impaired. They also have a slower reaction time, and don’t always read and interpret road signs effectively.
They are also at risk on foot at intersections when they can’t determine when to walk. ; Falls – 30% of those over 65, and 40% of those over 80 have had a fall within the past year. Serious injury results about 10% of the time- most commonly a hip fracture. This type of break increases XX from 65 to 85. It associates with a 12 – 20% increase in mortality. Half never regain the ability to walk without assistance again. Unfortunately, once someone falls, s/he will tend to avoid activities that may be associated with instability, so they restrict social contact and exercise.
Prevention may entail corrective areaway, improved safety in the home or car, and other family members taking on some of the responsibility for the elder’s ; Mental disabilities are really only shown when there is severe cell transportation. Death and structural or chemical abnormalities in the brain. O Dementia is a set of disorders that occur mostly in old age in which many aspects of thought and behavior are so impaired that everyday activities are disrupted. Usually the person can no longer live alone. 1% of those 65 have dementia, but that rate increases with age- especially after age 75.
It is 50% after 85 years old. There are a variety of causes of dementia, and some are reversible, such as medication interactions. Parkinson disease happens when neurons in the subtropical regions deteriorate, leaving balance, stooped posture. It is very unusual to see it in a person the age of Michael J. Fox. There are cortical dementia- Alchemist’s disease and cardiovascular dementia: o Alchemist’s Disease is the most common form of dementia, in which structural and chemical brain deterioration is associated with loss of thought, behavior, and personality.
Alchemist’s disease is responsible for 60% of all meantime. 5% of deaths of the elderly involve Alchemist’s. ; Symptoms and course of the disease include memory problems- even for repeated behaviors such as dressing, simple cooking, routes to common places. Short-term memory is first affected, but it gradually affects distant memory, and causes the person to be at risk if living alone. They have poor Judgment in the beginning, allowing them to be taken advantage of by con men. As the personality is affected, there is a loss of affect, increased paranoia and fearfulness, aggressiveness, social withdrawal.
Depression is also linked to the illness. Hygiene is unmanageable and the person needs help eating, bathing, dressing and even walking. There may be hallucinations which contribute to the fearfulness. Speech is lost, as well as comprehension of speech. The length of this deterioration can range from 1 year to 15. The average is 6-7 years. Diagnosis is made through excluding other possible causes of the cognitive deficits. ; Brain deterioration- Under imaging techniques, the brains of Alchemist’s victims show shrinking of tissue, due to massive degeneration and death of neurons.
Blood flow and activity in the brain are reduced. There are also chemical changes- lowered bevels of neurotransmitters necessary for communication between neurons. Acetylene’s is especially lost. It is necessary to developing new learning. Serotonin is also lost, and it regulates arousal and mood, relating to sleep disturbances, aggression, impulsively and depression. Autopsies show 2 major structural changes in the cortex of Alchemist’s victims: neurotically tangles and myeloid plaques. ; Neurotically tangles are bundles of twisted threads that occur as neural structures collapse. Myeloid plaques are deposits of a deteriorated protein called myeloid, surrounded by clumps of dead nerve cells. Risk factors – Alchemist’s occurs in 2 types- familial and sporadic, which has no heredity history. Sporadic form occurs later in life and progresses faster. There are genes on certain chromosomes that link to familial Alchemist’s. Another chromosomal abnormality has to do with excess levels of Poe, and is linked to myeloid plaque formation. Head injuries are linked to later development of Alchemist’s. It also seems to attach once there has been stroke damage in the brain.
High-fat diets also seem to relate, since Africans have lower incidence of Alchemist’s than African-Americans tit their high-fat diet. ; Protective factors include Vitamin C and E supplements, as well as anti-inflammatory drugs like aspirin. Education and an active lifestyle seem to be protective, as they increase synaptic connections and allow the brain to compensate for losses more effectively. ; Helping Alchemist’s Victims and Caregivers – there are some new drugs to increase the levels of acetylene’s and reduce the symptoms of Alchemist’s disease. Spouses and family are heavily burdened with caregivers for these sufferers.
It is a tragic disease to watch and stress on caregivers is enormous. There are some community aids- health care workers who come to the house, as well as day care for seniors. The more the Cardiovascular Dementia is a series of strokes that leave the brain dead in different areas, producing degeneration of mental ability in a step-wise format. Heredity influences susceptibility to high blood pressure, C.V., and diabetes, but many environmental influences such as smoking, alcoholism, high salt intake, low protein, obesity, inactivity and stress also heighten stroke risk. More men have cardiovascular dementia by their late ass than women.
Women are at higher risk after 75. Symptoms of stroke are weakness, tingling, numbness in an arm, leg or the face, sudden vision loss or blurring, speech problems, dizziness. Once there has been a stroke, there may be paralysis, loss of speech, vision, coordination, memory, and other mental abilities. O Misdiagnosed and reversible dementia – depression can be missed as a cause of dementia. 3% of those over 65 are moderately or severely depressed. Medication and exercise can overcome the cognitive deficits associated with depression. There are also drugs that can mimic signs of dementia.
Infections can also contribute to dementia. Severe alcoholism will reduce dementia which may not remit if drinking stops. O Interventions for Caregivers of Elders with Dementia (The 36-hour Day) Caregivers for those with Alchemist’s is so demanding, that it cuts short the lives of elders who care for spouses, which includes 15 – 25% of the elderly. ; Knowledge helps in finding assistance, and in knowing the natural progression of the disease. Coping strategies include strategies for managing the ill person’s behavior, techniques for dealing with resentment, support groups, therapy, and educational groups. Caregivers skills have to do with handling everyday tasks, and managing the person’s needs when they can no longer help the caregiver. This includes communication skills, distraction, empathy development and expression of honest feelings. ; Respite can help the caregiver survive- Just a short break during the week or a few days at a time, while the ill person is in a care facility. Eventually other family members may insist that the Alchemist’s patient be put in a nursing home, because the caregivers quality of life may be impaired if they do this too long. Health care is becoming a large issue politically as seniors are becoming so impoverished as they try to pay for their meds and still live independently that the government is being pressured to do something to help. O Cost of health care for the elderly is increasing, as more people are living longer and needing medical care. Medical costs rise with age, as 75 year olds receive 70% more benefits from Medicare than younger seniors. Much of this cost is nursing care and hospital care, as seniors have progressively more chronic ailments.
Even so, Medicare doesn’t cover all medical costs for the elderly- it only covers about half of their costs. So more elders are sinking into poverty as they try to manage their health. O Long-term care is more common the older the person becomes. Only 4. 5% of Americans over 65 will be institutionalized, but the costs of nursing care will bankrupt most seniors. And Medicaid requires that the senior use his/her own funds for nursing care until he gets down to $2000 in assets before Medicaid will pay for nursing home costs. White Americans are more likely to be cared for in extended families.
More people are using assisted living, which is a homelike setting with some help for seniors, but not extreme nursing care. This can allow functional seniors to maintain their independence longer. Some of these places are in conjunction with day cares, allowing seniors to rock babies and play with toddlers during the day. This allows both generations access to the benefits of one another’s life stage. Cognitive development- there is a general loss cognitively as people move closer to the end of life. But there are still techniques of compensation available. Selective optimization with compensation is one means of making best use of their cognitive skills. They narrow their goals, select personally valued activities so as to optimize or examine returns from their energy. They find means to compensate for losses. Memory- older adults are taking in information more slowly, and they use strategies less, can’t inhibit irrelevant information and retrieve important information from long-term memory. So memory failure increases. Slower processing speed means there will be less retained from current activities. They also forget context, which helps us recall information.
Recognition memory does not decline as much as free recall. ; Deliberate vs… Automatic memory o Implicit memory is memory without conscious awareness. This memory is more intact than deliberate memory, trying to recall information. ; Associative memory o Associative memory deficit is a problem creating and retrieving links between pieces of information. This is more common for elders. ; Remote memory is very long-term recall. It is not any clearer than recent recall for seniors, even though the myth is that seniors remember the past better than recent events. Autobiographical memory is memory for your own personally experienced events.
Seniors best recall their adolescent and early adulthood experiences better than later life experiences. There was a lot of novelty in those times, as well as life choices being made- spouses, Jobs, educational choices. These experiences were more emotionally charged, so they are remembered better. They become part of a person’s life story, and are remembered often. ; Prospective memory is remembering to do planned activities in the future. There is more forgetfulness and absentmindedness as people age. They tend to do better on event-based memory tasks than time-based tasks.
Language processing- two aspects of language processing diminish in older age: finding the right words and planning what to say and how to say it. Their speech will have more pronouns, unclear references, they will speak more slowly, pause more often, have trouble finding the right words. There will be more hesitations, false starts, sentence fragments, word repetitions as they age. They tend to simplify their grammatical structures, so they can better retrieve the words they want. Problem solving- problem solving declines in late adulthood so married people tend to collaborate more in problem-solving.
They will be better at solving problems they think are under their control. They will make more rapid decisions in areas of health, s that is an area they feel they have learned a lot about. Wisdom includes practical knowledge, ability to reflect on and apply that knowledge, emotional maturity, It occurs as people deal with more difficulties in life and find various means to adapt to change. Those with wisdom tend to have better education and are physically healthier. It requires insight into the human condition and often follows that people with this ability are found in high positions in business and politics and religion.
Knowledge about fundamental concerns of life: human nature, social relationships, motions ; Effective strategies for applying that knowledge to making life decisions, handling conflict, giving advice ; A view of people that considers multiple demands of their life contexts ; Concern with ultimate human values, the common good, respect for individual differences in values ; Awareness and management of the uncertainties of life- many problems have no perfect solution Factors related to Cognitive change- mentally active people are likely to maintain their cognitive abilities into advanced old age.
Retirement can bring about changes in cognitive abilities depending on how those years are used. Terminal decline is a steady, marked decrease in cognitive functioning prior to death. Cognitive interventions Lifelong learning ; Types of programs include Oldsters, which encourages older adults to live on college campuses and take courses from experts, as well as travel the world.
Many universities offer classes at low or no cost for seniors. ; Benefits of continuing education include learning new information, understanding new ideas, making new friends, and developing a broader perspective on the world. This may serve to shake up their stereotypes and value diversity in a new way.