PH 001 Ch. 29 (FINAL)

The elderly are categorized into three component groups, which have quite different characteristics and needs:

"Young old"; "Aged"; "Oldest old"

Experts on aging agree that the trend of the 20th century has been a

"compression of mortality," meaning that deaths are increasingly concentrated in a relatively short age range at about the biological limit of life span

Baby boomers

(12% live in nursing homes) (this is the fastest growing age group)

Health expectancy vs life expectancy

Health among older adults should no be all about life expectancy but instead be based on: independence, the ability to accomplish one's goals, and the presence of satisfying relationships; Health promotion can help increase health expectancy

Preventing disease and disability in old age

Immunization against pneumonia and influenza; Medications; Osteoporosis ("Porous bones"); Falls

Preventing disease and disability (Impairment of vision and hearing: social isolation)

Impairment of either vision or hearing is likely to lead to social isolation, a risk factor for poor health at any age and an even greater risk factor in the elderly. Sensory loss also is associated with depression and cognitive impairment in the elderly.

Survivorship and end of life care

Pain management and hospice care can be influences by gender and cultural norms; Need to recognize and integrate family values (Educational programs that integrate cultural health beliefs) (Information about the types of care services available) (Resources available for caregivers and patients)

Impairment of vision and hearing (Hearing loss from exposure to noise)

The most common form of hearing loss among the elderly is characterized by reduced sensitivity to higher frequency tones and, therefore, difficulty in comprehending speech. This pattern is similar to that associated with exposure to excessive noise.

Preventing disease and disability in old age (Osteoporosis ["Porous bones"])

The degree of osteoporosis depends on bone density earlier in life, which is determined by a number of factors including genetics, diet, and physical activity.

Many of the elderly, especially women, suffer from

arthritis, diabetes, osteoporosis, and Alzheimer's disease, conditions that limit their independence and may force them into nursing homes.

What is less certain is whether the compression of mortality will be accompanied by a

compression of morbidity—the rates of chronic disease and disability

Alzheimer's is the most common cause of

dementia in the elderly.

Impairment associated with

depression and cognitive impairment

Much of the disease and disability common in later life is linked to unhealthy behavior in

earlier years.

The challenge for public health is twofold:

first, to improve the health of older people by prevention of disease and disability; and second, to confront the issue of how costs can be controlled in an equitable and humane way

The greatest public health concern for Americans over 65 is

long-term chronic illness, disability, and dependency.

Causes of death in elderly are similar to causes of death in

overall population

Dementia among the elderly is a major

public health problem, currently affecting an estimated 5.3 million people in the United States at a cost of an estimated $226 billion per year; much of this cost is for long-term care in nursing home

It is significant that prevalence of smoking drops off with increasing age, in part because many older people have succeeded in

quitting and in part because many smokers die before they reach old age

After the age of 75, most women are

widowed and live alone, while most men are married and live with their wives

Quality of life in later years depends significantly on lifestyle in

youth and middle age.

Women more likely to live longer but also have

chronic, disabling conditions

Percentage of people over 65 living in poverty has declined from

15% in 1974 to 9% in 2010

The median age of the American population—the age at which half the population is younger and half older—increased from

22.9 in 1900 to 37.2 in 2010 and is predicted to reach 39.6 by 2030

"Young old" age"

65 to 74

"Aged" age

75 to 84

"Oldest old" age

85 and older

Hip fractures are the most serious consequence of osteoporosis; there is a significant risk that a hip fracture might lead to substantial disability and death. Of those aged 65 or older who suffer a hip fracture, about 20 percent die within a year.

About 20 percent of the survivors end up in nursing homes because they are unable to walk or care for themselves

Preventing disease and disability in old age (Medications: Side effects)

Although chronic conditions that afflict many of the elderly can be helped by prescription drugs, some of these treatments have unwanted side effects that may seriously impair health and quality of life

Oral health

As people age, they suffer increasingly from diseases and impairments of the mouth, including tooth loss, dental caries, periodontal disease, salivary dysfunction, cancer and precancerous conditions, and chronic pain. May lead to social isolation

These truths have two unhappy consequences: The quality of life of the elderly is, on average, poorer than that for younger people, and their medical costs are higher.

Both issues are of great concern for public health

The leading causes of visual impairment among the elderly are cataracts, glaucoma, macular degeneration, cataracts from exposure to sunlight and diabetic retinopathy.

Cataracts—clouding of the lens—are the most prevalent cause of eye disease; by age 80, more than half of Americans either have a cataract or have had cataract surgery. Exposure to sunlight contributes to the lens damage, so wearing sunglasses and hats with brims can help protect the eyes. Smoking increases the risk of cataracts, as does diabetes. Most cataracts can be effectively corrected by surgery in which the clouded lens is removed and replaced with a synthetic lens

Smoking is always a major risk factor for cardiovascular disease and cancer, still the leading causes of death in those over 65.

Chronic obstructive pulmonary disease (COPD) is caused almost entirely by smoking

Will morbidity lengthen or shorten towards the end of life? (Lengthen argument)

Limited ability to improve physical/mental capacity; Medical advances may increase the life expectancy of individuals with disease

Preventing disease and disability in old age (Falls: Side effects of medications)

Many older people have a high risk of falls because of medical conditions that affect their mobility, such as arthritis, stroke, and Parkinson's disease. Other risk factors include vision impairment, muscular weakness, problems with balance, and the side effects of medications. The use of four or more prescription drugs is considered a risk factor for falls. Psychoactive drugs such as antide- pressants, tranquilizers, and sleeping pills are especially dangerous.

Interestingly, the percentage of the population that is overweight and obese decreases after age 75.

Medical care (Secondary prevention [drugs for high BP, etc.]) (Hormone replacement therapy)

Medical costs of the elderly

Medicare enrollment has more than doubled; Cost per enrollee is rising, even faster than healthcare costs in general; Changes in family structure mean families are less able care for elderly relatives; Only hope is for baby boomers to be healthier and more independent than past generations

Preventing disease and disability in old age (Medications: Risk of drug interactions)

Moreover, older people often take a number of medications for various chronic conditions. This could lead to unexpected interactions between drugs, including over-the-counter drugs, because patients tend not to inform their doctors about these medications

Ethics of care

Moving beyond cultural ideologies (Responsibility) (Change in behavior (e.g., being passive, not attending doctor's appointments; Understanding the illness (Access to knowledge and resources); Familism in ethics of care (Cultural conflict and guilt); Gender roles; Faith & spiritual beliefs

Will morbidity lengthen or shorten towards the end of life? (Shorten argument)

Research advances may prevent or delay the occurrence of disease; The continued potential for reducing risk factors in better health

Alzheimer's and other dementias

Risk increase with increasing age; Tremendous burden is carried by caregivers; Research beginning to give clues on risk factors; No cure, but some medications delay progression

Factors that effect health in old age

Smoking; Diet and physical activity; Medical care - secondary prevention (drugs for high BP, etc.; Hormone replacement therapy

The CDC recommends five measures older people can take to prevent falls:

They should exercise regularly. Muscle strengthening exercises can significantly increase their mobility, strength, and balance. People should have their medications reviewed, as dis- cussed above, to reduce drug interactions and side effects. They should have yearly eye exams. They should improve the lighting in their homes, and they should reduce fall hazards in the home. The environment can be fall-proofed by such means as covering floors with tacked-down carpets, keeping walkways clear of obstacles, equipping bathrooms with grab bars around toilets and tubs, keeping stairways well lit, and using night lights.

Females increasingly outnumber males in older age groups. Among the oldest old, there are more than twice as many women as men.

This is a consequence of the fact that women have a longer life expectancy than men, although the difference is decreasing

The causes of death of older people are pretty much the same as the causes of death in the overall population, with cardiovascular disease and cancer leading the list. Motor vehicle crashes and suicide are also

significant causes of death, among older men far more than older women. Men are likely to die at a younger age, whereas older women are more likely to suffer from chronic, disabling diseases