Chapter 11

Aging Population

13% of U.S. population is 65 years or older By 2030 projected to increase to 19% By 2060, the 65 years and older population will more than double! 2010 - 40 million 2060 - 98 million

Age-Friendly City Domains

8 Domains that influence the health and quality of life of older individuals: social participation respect and social inclusion civic participation and employment housing transportation outdoor spaces and public buildings community support and health services communication and information

Burden of chronic disease

80% of the elderly have a chronic illness prominent chronic diseases of older age - cvd - cancer - type 2 diabetes - osteoporosis - physical disability

American Association of Retired Persons (AARP)

AARP Network of Age-Friendly Communities Membership in the network means that a community's elected leadership has made the commitment to actively work towards making their town, city, or county a great place for people of all ages AARP supports the community as it strives to achieve this goal

The 2030s Marks a Turning Point

According to the U.S. Census Bureau By 2030 all baby boomers will be older than age 65 Every 1 in 5 residents will be retirement age By 2035, for the first time in U.S. history, the elderly will outnumber children ≥ 65 years - 78 million < 18 years - 76.4 million One big issue: Shrinking workforce relative to the size of the growing older population

Major Global Public Health Challenge

According to the United Nations, the number of elderly across the globe will reach 2 billion by 2025! Vast majority live in homes and communities In developed world, 75% live in cities Environments have not been designed with elders' needs and capacities in mind

Biologic Theories of Aging: Facultative aging

Aging that is under our control Attributable to: Life style factors: Diet & exercise Smoking Obesity Social conditions: Poverty Access to healthcare Family support

Cognitive Changes

All humans will develop some degree of decline in cognitive functioning Due to deterioration of the biological framework that allows thinking & reasoning Implications: Short-term memory loss Decreased problem solving capabilities Decreased ability to remain focused Can progress to more serious conditions (E.g. dementia & Alzheimer Disease )

Biologic Theories of Aging: Mandatory aging

Biologic aging that is beyond our control Random environmental events which hinder normal cell activity - Gene mutations - Free-radical damage Aging process is genetically programmed by the cell

Physiologic Changes During Aging

Body Composition Changes endocrine changes cardiovascular changes sensory chages

Body Composition Changes: Bone

Bone is made of collagen (a protein) and calcium (a mineral) which gives the bone strength and flexibility Bone loss can lead to osteoporosis - a disease characterized by low bone mass Osteoporosis increases the risk of fracture adolescence bone mass is being accrued Peak bone mass reached at 25 - 30 years; males have a higher peak mass Both men and women undergo bone loss, but women lose bone more quickly after menopause Bone loss can lead to osteoporosis and bone fracture

Cardiovascular Changes

Changes: - Arterial walls become thick and less elastic - Declines in stroke volume and cardiac output - Declines in maximal aerobic capacity Implications - Increased blood pressure - Diminished peripheral pulses and cold extremities - Decreased exercise tolerance - Increasing fatigue and shortness of breath

Endocrine changes: Growth and insulin

Declines in growth hormones: - Decreases muscle growth and strength - Preferential deposition of fat in the deep (visceral) depot - Fat build up in liver - Increase in inflammatory factors linked to chronic disease Decline in insulin secretion: - Insulin secretion declines due to loss of beta-cell function in the pancreas - Leads to impairments in glucose homeostasis after a meal

Isolation Loop

Diminished sensor and cognitive functions Isolation and decreased contact with community loop where they influence one another and cause stress and anxiety Elders who maintain an active lifestyle and interact with their family and community experience better maintenance of their functioning.

Biologic Theories of Aging

Even among very healthy individuals, physical function declines with age. The degree to which this is attributable to biologic aging versus lifestyle and social factors in not clear.

Economic Burden of Healthcare

For working age (19-64 years) adults, average per capita spending is about 6K For adults 65 years and older, average per capita spending is about 18K Per capita spending increases slowly until the mid-60's, but at that point it balloons considerably. This is a major public health challenge

Endocrine changes: sex hormones

Males: Decline in testosterone Weight gain (mid-section) ↓ Muscle strength ↓ Endurance Depression Memory loss Females: Decline in estrogen and progesterone ↑ Bone loss and osteoporosis ↑ Risk of cardiovascular disease

AARP Age-Friendly Communities Map

Map of various communities (cities, towns, counties) across the U.S. that are considered age-friendly. 276

Body Composition Changes: Muscle

Muscle mass ↓ 3-6% per decade after 65 Sarcopenia - loss of muscle quantity and quality in older age More difficult to maintain strength, balance, reaction time & flexibility

Compression of Morbidity

Refers to the delay of onset of chronic disease and frailty until closer to the end of life Allows for the maintenance of physical functioning, autonomy, and quality of life for a greater proportion of the life span Baseline model - Get sick at 65 and die at 80 Life extension - Get sick at 65 and die at 85 (but that extra 5 years of life you are dealing with chronic illness and poor quality of life) Compression of morbidity - Get sick at 75 and die at 85. This has given the individual 10 more years of life where they are not dealing with chronic illness

85 Years and Older

Since 1930's this demographic subgroup has doubled in number every 30 years Fastest growing sector of the older population

Cardiovascular Vocab

Stroke Volume - amount of blood pumped by the heart with each beat Cardiac Output - amount of blood pumped by the heart per minute Maximal Aerobic Capacity - Body's ability to utilize oxygen in response to physical demand

Neurosensory Changes

Vision - affect many things - reading, cooking, driving Hearing - difficult having a conversation, driving more dangerous Slower reaction time - increase risk of falls, car accidents and other injuries

Global Age-Friendly Cities Project

World Health Organization Project (2006) - has the goal of engaging cities in several countries to make their communities more age friendly More than 1,000 communities are involved

Model of Successful Aging

disease risk physical and cognitive capacity engagement in lifestyle