Chapter 4: Longevity, Health, and functioning

Coping

+ Attempts to deal with stressful events + Lazarus and Folkman view coping more as a complex, evolving process of dealing with stress that is learned + Coping is learned not automatic - Our first attempt might fail, but if we try again in a different way we may succeed - Why we don't cope well with stressful situations that are new + Takes time and effort + Entails only managing the situation; we need not overcome or control it

Changes in the Immune System

+ Defense system is based on only 3 MAJOR TYPES OF CELLS which form a network of integrating parts - Cell Mediated Immunity (consisting of thymus-derived or Y-lymphocytes) - Humoral Immunity (B-lymphocytes) - Nonspecific Immunity (monocytes and polymorphonuclear neutrophil leukocytes) + Primary job of T- and B-lymphocytes is to defend against malignant (cancerous) cells, viral infection, fungal infection and some bacteria + Natural killer (NK) cells are another lymphocyte that monitor our bodies to prevent tumor growth + There are 5 TYPES OF SPECIALIZED ANTIBODIES called Immunoglobulins + Immune system is sensitive to lifestyle and environmental factors + Older adults are MORE susceptible to certain infections and have a much HIGHER RISK or cancer - So most research believe that the immune system changes with age - Several aspects of the immune system do DECREASE in effectiveness with age + Older adults immune systems take longer to build up defences against specific diseases - Probably caused by changes in the balance in T-lymphocytes + B- lymphocytes also DECREASE in functioning +Older adults become MORE prone to serious consequences from illnesses, and benefit less from immunizations

A Model of Disability in Late Life

+ Disability: the effects of chronic conditions on peoples ability to engage in activities that are necessary, expected and personally desired in their society + Compression of Morbidity: - refers to the situation in which the average age when one becomes disabled for the first time is postponed, causing the time between the onset of disability and death to be compressed into a shorter period of time - older adults are becoming disabled later in life than previously, and are disabled for a shorter period of time before dying + Verbrugge and Jette proposed a comprehensive model of disability resulting from chronic conditions + Model consists of 4 pain parts - The main pathway emphasizes: (1) the relations between pathology (the chronic conditions a person has), (2) impairments of organ systems, (3) functional limitations in ability to perform activities, and (4) disability - Also consists of risk factors and two type of intervention strategies: environmental and health care (extraindividual factors) and behavioral and personality (intraindividual factors) + Risk Factors: are long standing behaviors or conditions that increase ones changes of functional limitation or disability (ex: low SES) + Extraindividual factors include interventions such as surgery, medication, social support services, physical environmental supports - Help people maintain their independence and may make the difference between living at home and in a long-term care facility + Intraindividual factors include such things as beginning an exercise program, keeping positive outlook + Exacerbators: things that make the situation worse than It was originally

Effects of Stress on Health

+ Effects from chronic stress can last for decades; severe stress in childhood can last well into adulthood + Different types of appraisals that are interpreted as stressful create different psychological outcomes - May mean that how the body reacts depends on appraisal process - Implies that changing peoples appraisal may also be a way to lower the impacts of stress on the body

How Important are Socioeconomic Factors? (SES)

+ Fairly strong and consistent relationship between SES and health related quality of life + Across all racial and ethnic groups, more affluent older adults have LOWER levels of disability and HIGHER health related quality of life

HIV/AIDS and Older Adults

+ For MEN, the most common risk factor is HOMOSEXUAL or BISEXUAL BEHAVIOR + In OLDER WOMEN, it is HETEROSEXUAL CONTACT + Thinning of vaginal wall makes it easier for HIV to enter blood stream + May believe that condom use is no longer necessary + Progression from HIV positive status to AIDS is MORE RAPID due to changes in immune system + Once diagnosed with AIDS, lifespan is significantly SHORTER than for newly diagnosed younger adults, and mortality rates are HIGHER + LESS LIKELY to tell physician, to be tested and seek support + Ageism by professionals, misconception about sexual activity among older adults, lack of knowledge are all barriers + Older men are at HIGHER risk for aids, older women also are at significant risk + aging estimate is that 1.2 million people in the United States have HIV. + By 2015 about half of United States with HIV will be over 50

Determining Functional Health Status

+ Functional Health Status: how well the person is functioning in daily life + Done to identify older adults who need help + Frail Older Adults: those who have physical disabilities, are very ill, and may have cognitive or psychological disorders and need assistance with everyday tasks - People who's competence is declining, but don't have one specific problem that differentiates them from active healthy counterparts - Constitutes minority of older adults - More prone to depression and anxiety + Everyday competence assessment consists of examining how well people can complete activities of daily living and instrumental activities of daily living + Activities of Daily Living (ADLs): include basic self care task such as eating, bathing, toileting, walking or dressing + Instrumental Activities of Daily Living (IADLs): are actions that entail some intellectual competence and planning + About 26% of older enrolled in Medicare need assistance with atleast one ADL +About 12% need help with at least one IADL +About 4% are sufficiently impaired that they live in an assisted living or nursing home facility

Medication Side Effects and Interactions

+ Have the highest rate of aversive drug effects + Polypharmacy: the use of multiple medications - Potentially dangerous because many drugs do not interact well, and may create secondary medical problems - May produce symptoms that appear to be caused by other diseases

Developmental Changes in How Medications Work

+ Knowing the developmental changes in absorption, distribution, metabolism and excretion of medication + Absorption - The time needed for medications to enter the bloodstream - For oral medication, it is the time it takes to go from stomach to small intestine - Transfer may take longer in older adults resulting in too little or too much absorption - Once in the small intestine, absorption does not appear to be different than with younger adults + How well it is distributed in the blood stream depends on adequacy of cardiovascular system - As we grow older more portion of the drug remain free, than the portion that bind with plasma protein, this means that toxic levels can build up more easily - Drugs that are soluble in water or fat tissue can build up more easily + Drug Metabolism: - getting rid of medications in the bloodstream is partly the job of the liver - Evidence that this is slower in older adults, meaning drugs stay longer + Drug Excretion - Occurs mainly through the kidneys in the urine, although some elimination occurs though feces, sweat and saliva - Changes in kidney function with age result in lower total body water content - means drugs are not excreted as quickly + Dosage of a drug for older adults may be different + Most cases, recommend using 1/3 or ½ usual adult dosage + Also higher rate of side effects + Dosage strategy: "start low and go slow"

Adherence to Medication Regimes

+ Likelihood of adverse drug reactions INCREASES as the number of medications INCREASES + Medication adherence: taking medication correctly - becomes less likely the more drugs a person takes and the more complicated regimes are + The oldest old are at most risk + Best to keep amount of medications low, and the lowest effective dosage should be used

Common Chronic Conditions

+ Nearly ½ of adults in US have a chronic health condition + Diabetes Mellitus - Occurs when the pancreas produces insufficient insulin - Type 1: usually develops earlier in life and requires the use of insulin, "insulin dependent diabetes" - Type 2: develops in adulthood and is often effectively managed through diet - More common among older adults and minority groups - May result in serious complications (nerve damage, kidney disorders) - Increase change of stroke or atherosclerosis, and coronary heart disease - Cannot be cured but can be managed + Cancer - Second leading cause of death in US - Risk increases with age - Death rates have been decreasing since 1990s - Some forms are caused by unhealthy lifestyles (lung, colorectal) - Smoking causes more preventable health conditions than any other lifestyle issue - Prostate is most common form for men, breast cancer for women - But lung cancer kills more men than prostate, and more women than breast - 5 year survival rates for these cancers also differ dramatically; 15% of patients with lung cancer are still living 5 years after their diagnosis - Part of the reason older people are at increased risk is the cumulative effect of poor health habits over a long period of time - Normative age related changes in immune system may also inhibit growth of tumors - Found genetic links - Treatment usually involves several major approaches used in combination: surgery, chemotherapy, radiation etc. + Incontinence - The loss of the ability to control the elimination of urine and feces on an occasional or consistent basis, is a source of great concern and embarrassment - Increases with age, and varies in ethnic groups and gender - In older adults, 20% women and 10% men - Much higher is a person have dementia, or living in nursing home - Europeans American women report higher rates than African or Latina - Rates for men do not vary across ethnic groups - Occurs most often for 4 reasons Urinary Inconsistency: the most common form Increases with age and varies across ethnic groups as a function of gender - among community dwelling older adults, roughly 20% of women and 10% of men have urinary incontinence -rates are HIGHER if the person has dementia and is lving in a nursing community (about 35%) or living in a nursing home (70%) * Stress incontinence: happens when pressure in the abdomen exceeds the ability to resist urinary flow * Urge incontinence: caused by a central nervous system problem after a stroke or UTI * Overflow incontinence: from improper contraction of the kidneys, causing the bladder to become over distended * Functional incontinence: when the urinary tract is intact but because of physical disability or cognitive impairment the person is unaware of the need to urinate - Can be treated with interventions, most effective being behavioral interventions

Managing Pain

+ Pain is one of the most common complaints of older adults + Different than in younger adults; it can indicate that something is wrong but also be responsible for depression, sleep disorders, impaired mobility etc. + 2 general pain management techniques: pharmacological and nonpharmacological + Pharmacological approached include nonnarcotic and narcotic medications - nonnarcotic are best for mild pain(ibuprofen), while narcotic are for sever pain (morphine) + Nonpharmacoligical pain control involves a variety of approaches - Deep and superficial stimulation of the skin through therapeutic touch, massage, vibration, heat - Electronic stimulation where pain is - Acupuncture, distraction techniques, relaxation, meditation, hypnosis + Important to understand pain is not a necessary part of growing older

Lazarus and Folkman describe 3 types of appraisals of stress

+ Primary appraisal + Secondary Appraisal + Reappraisal

Stress as a Physiological State

+ Prolonged exposure to stress results in damaging influences from the sympathetic nervous system (controls heart rate, blood flow, perspiration, respiration) and a weakening of the immune system + These effects have a direct causative effect on susceptibility to a wide range of diseases + Gender differences in stress responses have also been documented - When stressed, men opt for a fight or flight response where women go for a tend and befriend approach - Difference may be due to hormone Oxycontin - In MEN, performance improves only for competition recognition, where WOMEN it improves for kinship recognition

How Does Disability in Older Adults Differ Globally

+ Rates of disabilities are higher in low income countries, and among women + Early detection and treatment of chronic disease can LOWER these rates + Important different is access to health care

What Causes Functional Limitations and Disability in Older Adults

+ Smoking, heavy drinking, inactivity, depression, isolation and poor perceived health somewhat predictive of who would become disabled in some way + Lack of physical activity is a powerful predictor of later disability and with HIGHER rates of cancer, cardiovascular disease, diabetes, and obesity, all of which result in HIGHER rates of disability and premature death

Aging and the Stress and Coping Paradigm

+ Two important age related differences in stress and coping: the sources of stress and coping strategy + Younger adults and those with lower levels of education and income report HIGHER stress than older adults with higher education and income + Age differences in coping strategies across life span are consistent - Older adults are less likely to use active coping strategies, and more likely to use past experience, emotion focused and religious strategies

Patterns of Medication Use

+ Until 1990s, clinical trails of medications were not required to include older adults, thus for most medication we do not know whether they are as effective for older adults + Because of normative changes in metabolism with age, the effective dosage of medication may change as people get older (may be at greater risk of overdose) + Medication is also very expensive + Figuring out which option is best is often a complex process

The Stress and Coping Paradigm

+ Views stress not as an environmental stimulus or as a response, but as the interaction of a thinking person + How we interpret the event is what matters, not the event itself + Stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding their resources and endangering their well being

Defining Health and Illness

+ WHO (World of Health) defines health as: a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity + Illness: the presence of a physical or mental disease or impairment + Self ratings of health are very predictive of future health outcomes, and tend to be fairly stable over time - Men rated their health worse than women - In the oldest old, self rated health is a powerful predictor across cultures - Self rating does not reflect differences in SES background

Gender Differences in Average Longevity

+ Women's is about 5 years more than men's at birth, narrowing to roughly 1 year by age 85 - Typical of industrialized countries but not of developing + Death in childbirth still partially explains the lack of a female advantage in developing countries today + Another different in some countries results from the infanticide of baby girls + Difference in men and women may be also because of lifestyle, improved health care, greater susceptibility in men of contracting certain fatal diseases + Others argue that it is due to biological explanations - Women have two X chromosomes, men have higher metabolic rate, women have higher brain to body weight ratio, women have lower testosterone levels + men's rates of dying from the top 15 causes of death are significantly higher than women's at nearly every age, and men are also more susceptible to infectious diseases + older men who survive beyond age 90 are the hardiest segment of their birth cohort in terms of performance on cognitive tests + between ages 65 and 89, women score higher on cognitive tests; beyond age 90 men do much better

Autoimmunity

+ the immune system begins to attack the body itself - Results from an imbalance of B and T lymphocytes, giving rise to autoantibodies and is responsible for several disorders, such as rheumatoid arthritis + Connection between immune system and psychological state have growing support -

Average Longevity

- "Average life expectancy" and refers to the age at which half of the individuals who are born in a particular year will have died - Effected by genetics and environment - Currently about 79 for US - Computed on all the people who are alive at that age, people who died earlier are not included - Has been increasing since 1900, with biggest increase in first half, because of declines in infant mortality rates from eliminating diseases like smallpox and polio, as well as decrease in mothers who died giving birth

Acute Disease

- Are conditions that develop over a short period of time and cause a rapid change in health - Most cured with medications, or allowed to run its course + Older adults have fewer colds + When they do get acute diseases, they tend to get sicker, recovery takes longer, and death occurs more often

Primary appraisal

- Categorizes events into 3 groups based on the significance they have for our well being: irrelevant, benign, or positive, and stressful - Filter the events we experience - Anything that is irrelevant or benign is not stressful - Means we sort out events and concentrate on dealing with them effectively - But also means we can be wrong about our reading of an event

Chronic Disease

- Conditions that last longer period of time, and may be accompanied by residual functional impairment that necessitates long-term management

Environmental Factors in Average Longevity

- Disease, toxins, lifestyle and social class are among the most important - Impact of SES results from the access one has to goods and services, especially medical care and died - How environmental factors influence average life expectancy changes over time - For the most part, we are responsible for them

Secondary Appraisal

- Evaluated our perceived ability to cope with harm, threat, or challenge - "What can I do", "how likely is it that I can use one of my options successfully", and "will this option reduce my stress"

Genetic Factors in Average Longevity

- Having long or short lived parents is a good predictor of your life expectancy - Human Genome Project has mapped all of our genes - Attempts are being made to treat diseases by improving the way that medications work and even by implanting 'correct' genes into people in the hope that the good genes will reproduce and wipe out defective genes

Problem Focused Coping

- Involves attempts to tackle the problem head on - Ex: taking medication for disease, studying for an exam

Emption Focused Coping

- Involves dealing with ones feelings about the stressful event - Ex: allowing oneself to express anger over being ill, or failing an exam - Purpose may be to help oneself deal with a situation + A positive attitude about ones self and ones abilities Is important + Good problem solving skills, social skills, and social support help + Financial resources are also important

Reappraisal

- Involves making a new primary or secondary appraisal resulting from change in the situation - Can either increase stress or lower stress

Ethnic Differences in Average Longevity

- People in different ethnic group do not have the same average longevity at birth - Differences result primarily from differences in nutrition, health care, stress, and SES - In late life, people in some ethnic minority groups live longer than European Americans

Maximum Longevity

- The oldest age to which any individual of species lives - Estimated to be somewhere around 120 years, because key body systems have limits on how long they last

Quality of Life

- refers to peoples perceptions of their position in life in context of their culture and in relation to their goals, expectations, values, and concerns - Tend to look at health related quality of life and non health related quality - Most research focuses on two areas: (1) quality of life in the context specific diseases or conditions (2) quality of life relating to end of life issues - In many respects it is subjective judgement - Selection, optimization, and compensation model (SOC) - quality of life is a successful use of SOC, and refers to peoples perceptions of their position in life in context of their culture and in relation to their goals, expectations, values and concerns - More difficult to assess in people with dementia and chronic diseases

Active Life Expectancy

Living to a healthy old age - ends at the point when one loses independence or must rely on others for most activities of daily living

The Role of Stress

Over long term, stress is very bad for your health + Most widely applied approach to stress involve: (a) focusing on the psychological responses the body makes through the nervous and endocrine systems (b) the idea that stress is what people define as stressful

Dependent Life Expectancy

simply living a long time

Psychoneuroimmunology

the study of relations between psychological, neurological and immunological systems that raise or lower our susceptibility to and ability to recover from disease