Chapt. 3 - Longevity, Health & Functioning

What is Primary appraisal ?

- Categorizes events into 3 groups based on significance for our well-being. 1. Irrelevant events - Ones that have no bearing on us personally (typhoon in S. Pacific) 2. Benign or positive events - Ones that have good effects (long-anticipated pay raise) 3. Stressful events - Ones that are appraised as harmful, threatening or challenging (upcoming test) - Act as a filter for events - events that are appraised as irrelevant or benign or positive is not stressful. a) Means we can effectively sort out events that may be problems from those that aren't - allows us to concentrate on dealing with difficult situations. b) We could be reading an event wrong initially - a situation that may appear irrelevant, may actually become important or a situation deemed stressful initially may turn out not to be. - such mistakes in primary appraisal could set the stage for real or imagined crisis later on

Arthritis

1 in 6 Canadians over 15yrs 2/3 women Almost all experience some pain - but very variable When it happens later in life -most assume arthritis is part of normal aging, and assume they need to learn to live with it - consequently fail to get appropriate therapy. - structure days around pain levels but reductions in physical activity is a paradoxical problem - Movement stimulates the secretion of synovial fluid - which lubricates the surfaces between and increases blood flow to the joints. - Movement also keeps muscles toned and limber. All is important in keeping joints flexible - refraining from movement ultimately makes joints hurt worse. - Lack of movement over long periods can eventually result in freezing of joints = contracture - Thus people with arthritis must keep moving, the pain is lower than that which results from contracture.

How to increase compliance of medication regime

1. A belief that the disease for which the meds are for is serious 2. Good communication between patient and physician 3. Reminder cardes or organized pill boxes 4. Discussion with patient about importance of compliance Best approach is to keep medications to a minimum and lowest effective dosage used.

Observational and self-report techniques to measure functional health

1. Activities of daily living (ADLs) - everyday competence assessment. - include basic self-care tasks such as eating, bathing, toileting, walking, or dressing - A person is considered frail if he/she needs help with one or more of these tasks. 2. Instrumental activities of daily living (IADLs). - Actions that entail some intellectual competence and planning - Activities vary widely across cultures - Western culture: include shopping for personal items, paying bills, making telephone calls, taking medications appropriately and keeping appointments. (In non-Western cultures may include caring for animal herds, making bread, threshing grain, tending crops) - The number of older adults who need assistant with ADLs and IADLs increases w/ age. ADLs - 65 - 74yrs - less than 5% - over 85yrs - 20% need help - Study - yr before death - 70% & over 85 yrs - all people need some assistance with some ADLs. and 50% with all ADLs IADLs - Some evidence that more recent cohorts have less need for assistance in some areas - esp. because of declining cardiovascular disease rates, but they also may have higher risk for disabilities related to asthma and muscle or skeletal problems.

What is the two types of life expectancy?

1. Average life expectancy - refers to the age at which a particular age cohort can expect to live. 2. Maximum longevity (life span) - refers to the oldest age to which any individual of a species lives.

What three major types of cells is the immune system network made up of?

1. Cell-mediated immunity (thymus-derived or T-lymphocytes) 2. Humoral immunity (B-lymphocytes) 3. Non-specific immunity (monocytes and polymorphonuclear neutrophil leukocytes)

What are some of the factors that affect how well we cope?

1. Healthy, energetic people are better able to cope with an infection than frail, sick people. 2. Psychologically - a positive attitude about oneself and one's abilities is important 3. Good problem-solving skills -puts one at an advantage by creating multiple potential options 4. Social skills and social support - helps one gain suggestions and assistance from others 5. Financial resources - having money to pay to get other to fix situations

What are the implications for the age-related changes seen in the immune system?

1. Older adults become more prone to serious consequences form illnesses that are easily defeated by younger adults 2. Various forms of leukaemia (cancers of the immune cells) increase with age along with other forms of cancer. 3. The immune system can begin to attack the body itself = autoimmunity - Autoimmunity results from an imbalance of B- and T-lymphocytes giving rise to auto antibodies and is responsible for several disorders (e.g. rheumatoid arthritis)

What are the 2 general pain management techniques?

1. Pharmacological a. Non-narcotic (for mild and moderate pain) - - e.g. nonsteroidal anti-inflammatory drugs (NSAIDs) -> ibuprofen, acetaminophen and b. narcotic meds (for severe pain) e.g. - morphine & codeine, (meperidine and pentazocine should be avoided because of age related changes in metabolism). 2. Non-pharmacological pain control a. Therapeutic touch, massage, vibration, heat, cold & ointments - deep and superficial stimulation of skin b. Electrical stimulation of pain site c. Biofeedback - person learns to control and change body processes responsible for pain d. Distraction techniques that draw person's attention away from pain e. Relaxation, meditation and imagery - rid mind of tension and anxiety f. Hypnosis - self-induced or induced by another. - Have advantages and disadvantages - try various techniques to find best one.

What 2 types of psychoneuroimmunological research investigations are usually used?

1. Predicting which healthy older adults are likely to eventually get cancer 2. Predicting those who will live longer after being diagnosed with cancer - So far, findings are mixed. - Some studies show that having a positive attitude and good social support system predict longer life for middle-aged cancer patients but not older ones. - Some evidence suggest that the effects of social support are more important for women than men. Emotional state, like depression has not yet been shown to have a strong effect.

What are the 3 types of appraisals to stress according to Lazarus and Folkman (1984)?

1. Primary Appraisal 2. Secondary Appraisal 3. Reappraisal

What two areas have quality-of-life studies focused on?

1. Quality of life in the context of specific diseases or conditions (ability to handle illness) 2. Quality of life related to end-of-life issues (strengths, optimization of strengths, and compensation for age-related changes (successful use of selection, optimization and compensation to mange one's life resulting in successful aging).

What are the 5 major reasons for urinary incontinence?

1. Stress incontinence - happens when pressure in abdomen exceeds the ability to resist urinary flow may occur when person coughs, sneezes or lifts a heavy object 2. Urge incontinence - usually caused by central nervous system problem after a CVA or urinary tract infection - people feel need to urinate but cannot make it to toilet in time. 3. Overflow incontinence - results from improper contraction of the kidneys causing bladder to become over-distended. Certain drugs, tumours and prostate enlargement are common causes of overflow incontinence. 4. Functional incontinence - occurs when the urinary tract is intact but because of physical disability or cognitive impairment the person is unaware of the need to urinate. 5. Iatrogenic incontinence usually caused by medication side effects changes in dosage often solve the problem.

What are the 4 parts of the model of disability resulting form chronic conditions by Verbrugge & Jette?

1. The main pathway: pathology (diagnosis), impairments (physical dysfunctions), functional limitations (restrictions in basic physical, mental actions), disability (difficulty doing daily activities) 2. Extra-individual factors: medical care & rehabilitation (environmental), medications and other therapeutic regimens, External supports, Built, physical and social environment (e.g. surgery, medication, social support services - meals on wheels, physical supports - wheelchair ramps - may help people maintain their independence for longer. 3. Intra-individual factors: Lifestyle and behaviour (personality) changes, psychological attributes and coping, activity accommodations. (E.g. beginning an exercise program, keeping a positive outlook and taking advantage of transportation programs to increase mobility) 4. Risk factors: Long standing behaviours or conditions that increase one's chances of functional limitation or disability (e.g. low SES, chronic health conditions, and health related behaviours -> smoking) Swedish Study: Most important results were mediating role of psychosocial factors on risk factors for disability. Extra-individual and intra-individual interventions are aimed at reducing restrictions and difficulties from chronic conditions. - Sometime they don't work as intended and may even create problems = Exacerbators - make a situation worse than it was - e.g. prescribed medication may produce side-effects that create a new problem. Social services may have inflexible policies about availability of a program Most important is the fit between the person and the environment - when a person's needs are met by the environment the person's quality of life and adaptation are optimal

What are some of the definitions of stress?

1. To some stress is a property of specific events - e.g. death of a partner - Thus everyone who goes thru the same event experiences the same level of stress. 2. To others stress is the result of a person's evaluation of events in the context of various resources they have. - Thus stress is defined by the person and no two people experience the same even in exactly the same way. 3. The perspective of the allostatic load = Life events, personal styles and resources and individuals genetic makeup and developmental history are considered.

What are some of the reasons why older adults are susceptible to contacting AIDS?

1. some had contracted HIV during middle age and survived to later life 2. Older men (higher risk group) - risk factor = homosexual or bisexual sex. 2. Older women - heterosexual contact with infected partners. Changes to the immune system may make older adults more susceptible to HIV infection. - For women, thinning o f vaginal wall makes it more likely that it will tear and allow HIV to enter blood stream. - Older adults tend to use condoms less frequently Once infected, progression form HIV to AIDS is more rapid - Once diagnosed w/ AIDS, older adults remaining life span = 1 year shorter than newly diagnosed younger adults Older adults are less educated, less likely to raise the issue with a physician less likely to be tested, and less likely to seek support groups if diagnosed.

What are the 3 major approaches to cancer treatment?

1. surgery, 2. chemotherapy 3. radiation Often used in combination Alternative therapies (herbal approaches) are also used. - we may end up with genetically engineered meds that attack cancer cells.

Causes of Functional limitations & disabilities in older adults

2 chronic conditions strong predictors of functional limitations a) cerebrovascular disease b) arthritis Coronary artery disease may also be a predictor (evidence was statistically weaker) Several additional predictive factors found in longitudinal study over 30 yrs. - smoking, heavy drinking, physical inactivity, depression, social isolation and fair or poor perceived health predicted who would become disabled in some way.

Cancer

2nd leading cause of death in Canada behind cardiovascular disease. - 29% in 2002 - 38% of women, 44% of men will develop cancer in their lifetimes - 1 in 4 will die from the disease Many cancer deaths are preventable - lung and colorectal cancer are mostly caused by unhealthy lifestyles. Skin cancer can be prevented by limiting exposure to sun. Lung cancer - smoking. Risk of cancer increases with age - after age 40 and then after age 60 incidence rate increases sharply - Older people having a much higher incidence - may be a cumulative effect of poor health habits (e.g. smoking & poor diet) or of exposure to pollutants and cancer-causing chemicals. - Also Normative age-related changes in immune system resulting in decreased ability to inhibit growth of tumours. Genetic links 1. Two breast cancer susceptibility genes have been id'd - BRCA1 on chromosome 17 and BRCA2 on chromosome 13. These mutations carry a greater risk of breast or ovarian cancer diagnoses. 2. Prostate cancer susceptibility gene: HPCI - on chromosome 1 - may account for about 1 in 500 cases. Age related tissue changes - associated with development of tumours - some of which become cancerous, some may be genetically linked. Telomerase = enzyme that causes cells to grow rapidly without limits on the number of divisions - gives insight in how cancer develops. Interactions with environmental factors (e.g. viruses or pollutants) may explain why there are great differences in when and how cancer develops Screening techniques and preventative lifestyle changes are important. Screening an treatment for prostate cancer controversial - lack of data about causes and the course of disease and disagreement over treatment. Breast cancer treatment controversies - relative merits of radical mastectomy (removal of breast and some surrounding tissue) and lumpectomy (removal of cancerous tumour only) and how chemotherapy, radiation and drugs (e.g. tamoxifen) fit into overall treatment

What is the difference between active life expectancy and dependent (disability-free) life expectancy?

Active life expectancy is living to a healthy old age - Dependent life expectancy is simply living a long time. - The difference between adding years to life and adding life to years. - One's active life expectancy ends at the point when one loses independence or must rely on others for most activities of daily life. The remaining years of one's life constitute living in a dependent state.

What are average ethnic differences in life expectancy?

African Americans = 6.5 yrs lower for men and 5 yrs lower for women than European Americans. - sickle cell anemia and other diseases, hazards like homicide - less access to good health care and less healthy lifestyles - however for those from ethnic minorities that do survive to old age, they may live longer than European Americans - possibly because of a genetic advantage. In Canada - visible minorities (79.7M & 84.3F) have a higher life expectancy than the rest of the population (76.2M & 82.5F) - Accessible health care, ethnic minorities may be younger, and selected immigrants may have good health and higher educational status = "immigrant advantage"

What are the most common chronic conditions experienced by older adults?

Arthritis and various forms of cardiovascular disease first. Then diabetes, cancer, incontinence and stress.

Pharmacology and medication adherence - patterns of medication use

Average number of medications an older adult takes has increased. - until the late 1990s clinical trials for new meds were not required to include older adults - thus was unclear whether they worked to the same degree as they do on younger or middle aged adults. - Many f the new meds are more expensive - 71% increases in out of pocket expenses in purchasing prescription drugs.

Mediation Side Effects and Interactions

Becuase of their high rate of medication use - older adults have highest risk of adverse drug effects. - Result from physiological changes and how drugs are absorbed in body, how long they remain and how well they work. e.g. Changes in stomach may slow down the rate at which drugs enter body, meaning the effective level may take a longer time to achieve Changes in liver and kidney functioning affect how rapidly the drug is removed and excreted from body -> levels of drug may remain high for longer periods of time.

What are acute diseases?

Conditions that develop over a short period of time and cause a rapid change in health (colds, influenza & food poisoning). - usually cured with medications (e.g. antibiotics) or allowed to run their course

What are chronic diseases?

Conditions that last longer (at least 3 months) and may be accompanied by residual functional impairment that necessitates long-term management (e.g. arthritis and diabetes)

How does aging affect the immune system?

Difficult to determine, but most researchers believe that the immune system changes with age. - Older adults are more susceptible to certain infections and have a higher risk of cancer - Research suggests that the total number of T-lymphocytes doesn't change until 90 yrs, although balance in types of T-cells appears to change. E.g. Older adults have fewer immature T-lymphocytes and more mature ones. --- Immature cells 'learn' to fight new invaders which may help explain why older adults immune systems are less effective when exposed to new strains of bacteria or viruses. - The total concentration of indicators of B-cells and NK cells changes little with age.

Functional health and disability -

Disability is the effects of chronic conditions on people's ability to engage in activities that are necessary expected and personally desired in their life. - Disabled people have problems doing daily tasks (chores, personal care and jobs, active recreation, socializing and errands)

How do environmental factors affect aging?

Diseases, toxins, lifestyle, and social class are some of the most important contributing factors. a) Diseases: cardiovascular disease, and Alzheimer's disease. b) Lifestyles issues: smoking & exercise c) Environmental toxins: air & water pollution (e.g. toxins in fish, bacteria & cancer-causing chemicals in drinking water, airborne pollutants) d) Social class: Reduced access to goods & services (esp. medical care) in some minorities. (e.g. Natives on reserves- lower life expectancy, higher chronic disease levels and psychological problems such as substance abuse and depression). Aborignial communities lack adequate healthcare centres or reliable clean drinking water. Elders have high rates of disability, ineligibility for health benefits (vision and dental care) and have to travel far for long-term care.

What is coping?

During secondary appraisal of an event labelled stressful in primary appraisal we may believe there is something we can do to deal with event effectively. - Coping is a complex evolving learned process of dealing with stress. It is dynamic & evolves over time. - This is why we don't cope with stressful situations we are facing for the first time - we need to learn and practice coping. This takes time and effort. - Coping only entails management of the situation , we don't need to overcome it or control it. Many stressful events cannot be fixed or undone, many times the best we can do is learn to live with it. e.g. death of a spouse.

How does time affect environmental factors?

Environmental factors infulence average life expectancy changes over time. AIDS - factor during 1980s Cardiovascular diseases - impact has reduced somewhat as rates decline We are responsible for environmental factors. Denying adequate health care to everyone, continuing to pollute our environment and failing to address underlying causes of poverty

What is secondary appraisal?

Evaluates our perceived ability to cope with harm threat or challenge. a. What can I do? b. How likely is it that I will use one of my options successfully? c. Will this option reduce my stress? - How we answer these questions sets stage for addressing them effectively. - if you believe that there is something you can do in a situation that will make a difference then your perceived stress may be reduced & you may be able to deal with situation effectively. If you believe you can''t do anything to address the situation then you may feel powerless and ineffective - even when others around you believe there are steps you can take. - What matters is what you think is true, not what others think

Drug Metabolism

Getting rid of medications in bloodstream is partly job of liver = metabolism - Process is slower in older adults - meaning drug stays in body longer as people grow older - Slower drug metabolism can also create potential for toxicity if med. schedule does not take this into account.

How is this transactional model of stress affected by age?

Helps explain why people react the way they do over the life span. As our physiological abilities change with increasing age, we may have fewer physical resources to handle particular events, as a result events that were appraised as not stressful become more stressful in later life.

Determining Functional Health Status

How well a person is functioning in daily life. - Essential to differentiate the tasks a person reports he/she can do and the tasks a person can demonstrate in las or clinics that simulates the same tasks at home when making an assessment.

How do genetic factors affect aging?

If your mother lives to at least 80 yrs, you can add roughly 4 yrs to your average longevity. - More than 1.5X likely to live to 100 if you live in Nova Scotia than other provinces, w/ pockets of longevity centred around the south shore and central northern parts of province. Transplanted NS residences bring their longevity with them - suggesting a genetic component. - Genetic factors play a major role in determining how well older people cope with disease - higher thresholds and slower disease progression - Oldest old seem to have a different personality profile - hopeful yet realistic, spiritual, in love with life and involved with others.

What is reappraisal?

Involves making a new primary or secondary appraisal resulting from changes in the situation. - As the situation plays itself out, and event continues to unfold you begin to get an idea as to whether your primary (and secondary if necessary) appraisal was accurate. - Sometimes you learn additional info or experience another situation that indicates that you should reappraise the original event. - E.g. reassessing an accusation that partner is cheating on you (after being shown pics of partner w/ another) - Reappraisal can either increase stress or lower stress

What about the healthy immigrant effect in Canada?

Largely due to gov't policies that lead to the acceptance of healthier individuals into the country. - Middle aged men who had come to Canada within the last 10 yrs had better health than their Canadian-born peers - But those who immigrated more than 10 yrs before and were already old - especially women were in poorer health - Barriers to healthcare use such as language, social class, discrimination - may result in a deterioration of good health of immigrants over time.

Adherence to medication regimes

Likelihood of adverse drug reactions increases with the number of medications taken - Medication adherence becomes less likely the more drugs one takes and more complicated the regimens are. - Sensory, physical and cognitive changes in older adults also add to the problem - Especially the oldest old are at risk - Most common problem - they forget to take meds.

Incontinence

Loss of ability to control the elimination of urine and feces on an occasional or consistent basis. - Often results in social isolation and lower quality of life if not addressed. - Urinary incontinence increases with age - 20% women, 10% men rates are much higher if perosn has dementia and is living in the community (35%) & living in nursing home (70%)

Interventions for incontinence

Many interventions alleviate incontinence. 1. Behavioural interventions - include diet changes, re-learning recognizing the need to go to the toilet, Kegel exercise for improved pelvic muscle control 2. Certain medications and surgical intervention may be needed in some cases 3. Protective undergarments and padding help absorb leaks - All these options help alleviate the psychological and social effects and help improve quality of life.

Cardiovascular disease

Most cardiovascular diseases can be managed effectively thru lifestyle interventions Hypotension (low blood pressure) symptoms include dizziness or light headedness when standing up quickly - often is related to anemia and is very common in older adults - Resulting dizziness can increase likelihood of falls.

Drug Excretion

Occurs mainly in through the kidneys in urine, although some elimination occurs through feces, sweat, and saliva. - Change in kidney function with age related to lower total body water content are common. - Thus drugs are often not excreted as quickly by older adults - risking possible toxic effects.

Diabetes Mellitus

Occurs when the pancreas produces insufficient insulin - Primary characteristic is above-normal glucose (sugar) in blood and urine caused by problems in metabolizing carbohydrates. - Patients can go into coma if level of sugar gets too high and may lapse into unconsciousness if it gets too low - 3 groups of older adults with diabetes - a) Those who developed diabetes as children, adolescents or in late adulthood. b) Those who developed diabetes in late middle age and also usually develop cardiovascular problems c) Those who develop diabetes in later life and usually show mild problems - this last group includes the majority of older adults w/ diabetes mellitus Usually associated with obesity in adults - other symptoms of diabetes seen in younger people (excessive thirst, increased appetite, urination, fatigue, weakness, weight loss and impaired wound healing) are absent in older adults. - thus is often diagnosed in eye exams or hospitalizations for other conditions. - Recent increase in Canada Chronic effects of increased glucose levels may result in - nerve damage, diabetic retinopathy, kidney disorders, CVAs, cognitive dysfunction, damage to coronary arteries, skin problems, and poor circulation in arms and legs which may lead to gangrene. Also increased chance of developing atherosclerosis and coronary heart disease. -> Can be managed effectively through a low-carbohydrate and low-calorie diet, exercise, proper care of skin, gums, teeth, feet and medication (insulin). -> Important to address potential memory difficulties with daily testing and management regimens.

Cerebrovascular accidents

Often create chronic conditions by causing brain damage. Quick intervention is important - but merely limits spread of damage rather (resulting in lower death rates) but doesn't prevent them. - Depending on where damage occurs, people may face months or years of rehabilitation. Despite advances in therapy, approx. 50% of patients who suffered motor impairments still have residual motor difficulties 1 year after their CVA. - thus rehabilitation must address pyschological implications of loss of functioning

What are some of the differences we see in coping strategies between younger and older adults?

Older adults are more likely to use past experience in coping. - Thus use less defensive coping styles - older adults choose coping strategies on basis of whether they feel in control of situation - Shift in management strategies; as people age, they get more proactive -> better at managing their lives in order to avoid stress

What are the major changes in how well lymphocytes work?

Older adults' immune systems take longer to build up defences against specific diseases even after immunization injections. - Probably caused by changing balance in T-lymphocytes and could partially explain why older adults need to be immunized earlier against diseases such as influenza - B-lymphocytes decrease in functioning - Research is examining injecting growth hormone substances to help stimulate lymphocyte functioning back to normal levels.

Drug Distribution

Once in bloodstream, medication is distributed throughout body - how well distribution occurs depends on the cardiovascular systems adequacy. - Maximum effectiveness of a drug depends on the balance between portions of the drug that bind with plasma protein and the portions that remain free. - As we age more portions of drug remain free. This means toxic levels can build up more easily in older adults. - Drugs that are soluble in water or fat tissue can build up more in older adults because of age-related decreases in total body water or increases in fat tissue. - Effective dosage depends on amount of free drug in body - thus age of person, and body type is very important.

Managing pain

One of the most common complaints of older adults. - Is responsible for depression, sleep disorders, decreased social interaction, impaired mobility, increased healthcare costs. - Pain is not a necessary part of growing old, or having a disease or receiving treatment - pain relief is an important part of recovery. - People can control their pain - No one approach is likely to be sufficient - Asking for pain relief is to be expected

What is the primary job of the 2 types of lymphocytes (cell mediated-T-lymphocytes and humoral immunity B-lymphocytes)

Primary job of the 2 types of lymphocytes is to defend against malignant (cancerous) cells, viral infection, fungal infection and some bacteria - Natural killer (NK) cells are a subpopulation of lymphocytes that provide broad surveillance system to prevent tumour growth and our primary defence against cancer. - NK cells also help fight viral infections and parasites and may have a role in multiple sclerosis (disease that typically starts in young adulthood and early middle age)

What are the differences between problem-focused coping and emotion-focused coping?

Problem-focused coping - attempts to tackle problem directly or head-on. (e.g. taking meds for a disease, spending more time studying for an exams Emotion-focused coping involves dealing with one's feelings about the stressful event. E.g. Allowing oneself to express anger or frustration over falling ill or failing an exam. Goal is not to eliminate the problem necessarily (although that might happen), but the purpose is to help oneself deal with situations that are difficult or impossible to tackle head-on.

What is the connection between our immune system functioning an dour psychological state?

Psychological state or attitude can begin a series of neurological, hormonal and behavioural responses that directly change the immune system and make us more likely to become ill.

What happens to incidence of chronic and acute diseases as people age?

Rates of acute diseases go down and rates of chronic diseases increase. - Older adults have fewer colds, but when they do get an acute disease, they tend to get sicker and taker longer to recover - Thus older adults are at greater risk of dying from acute conditions - e.g. rate of respiratory infection is about the same for younger and older adults, but people over 65 yrs account for approx. 90% of the deaths from pneumonia and influenza - this is why the recommendation is that older adults be vaccinated against pneumonia (reduce risk by 2/3) and influenza (reduce risk by 1/2)

What are some other coping behaviours?

Relationship with God and Defence mechanisms - both reduce stress

What does it mean by a person's valuation of life

The degree to which a person is attached to his or her present life. e.g. how much one enjoys life, has hope about future, finds meaning in everyday events has a great impact on how long that person would like to live.

What is psychoneuroimmunology?

The study of relations between psychological, neurological and immunological systems that raise or lower our susceptibility to and ability to recover from disease. - Focus has been on identifying psychological triggers that start the process and result in cancer.

Drug Absorption

The time needed for a medication to enter bloodstream - when taken orally - a key factor is the time it takes for meds to go form stomach to small intestine where maximum absorption occurs - this transfer may take longer in older adults - resulting in too little or too much absorption depending on drug. - Once in small intestine absorption appears similar to middle-aged and younger adults.

What are the 5 types of immunoglobulins, and what do they do?

They are antibodies IgA, IgD, IgE, IgG, and IgM - Each performs a specialized function E.g. IgE mediates allergies and asthma, IgG helps fight hepatitis

Frail Older adults

Those who have physical disabilities, are very ill, may have cognitive or psychological disorder sand need assistance with everyday tasks. - competence is declining but they don't have one specific problem that differentiates them form their active, healthy counterparts. Constitute a minority of older adults but size increases with age.

Developmental changes in how medications work

Understanding how drugs work involves examining developmental changes in absorption, distribution, metabolism and excretion of medications. - THe dosage of a drug needed to achieve desired effect may be differetn for lolder adults than for middle-aged or younger adults. - Often physicians recommend using 1/3 to 1/2 usual adult dosage when difference between effective and toxic dosages are small or there is a high rate of side effects. - Due to age related physiological changes several drugs are not recommended for use with older adults.

Polypharmacy

Use of multiple medications for treating multiple conditions - Potentially dangerous because many drugs do not interact well. - action of some drugs in enhanced when used in combo with others, other drugs may not work at all when used in combo with others. - Drug interactions can produce symptoms that appear to be caused by other diseases e.g. confusion, memory loss that mimic Alzheimer's

What is the stress and the coping paradigm?

Views stress as an interaction of a thinking person and an event (not as an environmental stimulus or as a response) - e.g. how we interpret being stuck in traffic matters, not the even itself - - When the person and environmental being appraised by that person is taxing or exceeding his/her resources it is endangering his/her well-being. - Takes into account personal resources & person's appraisal of situation - unless situation is considered to be threatening, challenging or harmful stress does not result - Resources a person has include the cumulative experience of dealing with similar situations before, knowledge or access to info about the event,ability to get help if necessary, and time necessary to engage in any actions to address situation. - These vary a lot from person to person and reflect the influence of biological (genetics), psychological (personality) sociocultural (ethnicity) and life-cycle (life-stage) - This helps to explain why some people deal with difficult (severe illness) events better, and others have difficulty dealing with seemingly routine events (calming a crying child).

What are the gender differences in average life expectancy

We don't know for sure why women live longer than men. - - Females in Canada have almost 7 years on males. For males: more male babies die in infancy/stillborn, Increased vulnerability to disease continues thru life, between 65-69yrs ratio drops to 81 men for every 100 women, then increases rapidly between 80-84yrs ratio is 53 men for every 100 women, by age 100, ratio is 27 men for every 100 women - Typical for most industrialized countries, but not developing countries and only became apparent in America in early 20th C. because of death in childbirth. - Also infanticide in some countries of baby girls - Some say there are no biological difference in longevity but a greater susceptibility in men contracting fatal diseases - Others say there are potential biological explanations a) women have 2 X chromosomes b) Men have higher metabolic rate c) Women have higher brain to body weight ratio d) Women have lower testosterone levels - However, none of these explanations has sufficient scientific support to explain why women live longer on average. Older men who live past 90 are the hardiest segment of their birth cohort in cognitive test performance. - Between 65-89 women score higher, but beyond 90, men do much better.

Socioeconomic factors in disability predictions

Wealthier, better educated Canadians have lower rates of morbidity and mortality and presumably fewer years of chronic disease and dependency. - This may not be the same in the USA - It is not the affluence of a country that lowers morbidity and mortality rates, it is the smaller overall gap between rich and poor - the national context affects the health of everyone regardless of personal resources.

What are some of the differences we see in sources of stress between younger and older adults?

Younger adults - stress out about finance, work, home maintenance, personal life, family (parenting) and friends. Older adults - more age-related than role-related stress. E.g. Decreased ability to get around more than specific roles. - Some evidence that oldest old report having less stressors - may be be due to narrower focus - may be due to a more philosophical outlook on life - don't let stuff bother them as much.

Gender and Ethnicity in disability predictions

comparison study: US, Jamaica, Malaysia, Bangladesh - - Women's self-reported health was worse in all countries studied - Self-reported health problems were much more prevalent in developing countries than the US Findings indicate that gender makes a difference in health and these differences hold across selected cultures

What is our average life expectancy influenced by?

genetic, environmental, ethnic, and gender factors mostly.