Three categories of aging

1. Three categories of aging • Young-old: older people who are in generally good health, financially secure, socially integrated; age range usually 75 or younger but can vary. • Old-old: typically over age 75; suffer from at least one debilitating physical, psychological, or social deficit; require supportive health care • Oldest-old: 85+; dependent on other people for almost everything.

2. Aspects of aging • Biological: age-related changes in appearance, vision, agility, strength • Psychological: adjusting to physical changes that accompany aging, coming to terms with memory loss & reduction in reaction times and information-processing • Social: changes in our self-concepts from growing old, which reflect cultural beliefs and changing social values.

3. What bothers people about getting old? • Main fear—becoming dependent on other people due to mental decline; increasing isolation and loneliness • Most of us have a need to remain intellectually vigorous and socially connected to others; the threat of losing these things is paralyzing. • Most dread going to a nursing home.

4. Physical changes in aging • Hair becomes thinner • Skin becomes less elastic, more wrinkled and dry; may have “age spots” • Hair turns gray (body loses ability to produce melanin, the pigment that colors hair. • Hair turning gray correlates more accurately with biological age than any other physical change. • Older adults lose an inch or so in height and several pounds in body weight because of a decline in bone calcium & loss of muscle tissue

5. Sensory changes • Vision changes—pupil becomes smaller and lens cloudier; presbyopia (become more far-sighted) • Hearing loss—25% of adults between 50 and 80 suffer significant hearing loss; declining ability to hear high-pitched sounds is called presbycusis. • Smell & taste decline with age. Old people lose taste buds.

6. Physical peak and decline • People reach physical peak around age 30. • After that, they’re in a period of senescence—a gradual decline in physical strength, sensory acuity, reaction time, and cardiovascular strength. • Rate of senescence depends on genetics and health habits. You can slow it down by lifestyle changes.

7. Signs of senescence • Reduced lung capacity • Increased body mass index due to loss of lean body mass (starting at age 20, you lose 7 lbs of muscle tissue per decade; this rate accelerates after age 45) • Loss of muscle strength • Decreased metabolism • **Eating well and exercising will prevent or reverse these declines.

8. Aging and Disease • 80% of people over age 70 have at least one chronic health condition • Biggest killers of older people: heart disease, cancer, stroke • People get sick when they’re old because their immune systems have decreased.

9. Chronic health conditions from most to least common • Arthritis • Hypertension • Hearing impairment • Heart disease • Cancer • Cataracts • Diabetes • Stroke, visual impairment, and varicose veins (equal in frequency)

10. Memory and intelligence • Neural processing slows with age • Memories begin to decay. • By age 80, people have lost 5-7% of brain weight • Intelligence doesn’t really decline with age, but there are wide differences in how you use your intelligence in later years. • Use it or lose it--By remaining intellectually active, you can prevent decline in intellectual or processing abilities.

11. Dementia and Alzheimer’s Disease • Dementia is a dramatic deterioration in reasoning ability and memory, caused by strokes, tumors, brain infections, alcohol abuse, or Alzheimer’s Disease. • The leading cause of dementia (accounts for 57% of all dementias) • AD strikes 3% of population by age 75 and kills 100,000 Americans each year.

12. Symptoms of AD • First stage: subtle cognitive changes, especially in short-term memory. Routine tasks become harder. • Second stage: Impairments in a number of higher mental functions (reading, writing, arithmetic) • Third stage: seizures and striking changes in language

13. Aphasia and apraxia • Aphasia: can’t find the right word to express thoughts • Apraxia: loss of memory for muscular movements, such as brushing teeth; can’t carry out basic “activities of daily living” • These are the two criteria most often used to informally diagnose AD.

14. Differences of AD brain in autopsy • Currently, an autopsy is the only definitive test for AD. MRI can provide clues, though. • Neuritic plaques seen on autopsy: clumps of degenerative nerve cells. • Neurofibrillary tangles are seen as well. • Plaques and tangles appear mostly in the part of the brain that produces acetylcholine, which is found in reduced levels in people with AD.

15. What causes AD? • Genetic vulnerability is a big factor. • No one knows the cause, but the reduction of acetylcholine seems to be involved. • Drugs such as Tacrine, Aricept, and Namenda slow the rate of decline by increasing neural activity in remaining healthy acetylcholine neurons. • Regular use of ibuprofen and anti-inflammatories may ward off AD by preventing brain inflammation.

16. Depression in older people • Slightly more common in older people than rest of the population (1 in 6 will suffer clinical depression in the older population) • Generalized anxiety also more common • Depression is more likely because of activity restriction due to chronic illnesses, grief over loss of loved one, financial problems, and lack of social support. • Nursing home residents are especially prone to depression.

17. Death • Older people die of degenerative diseases—cancer, stroke, heart failure, or just general decline that predisposes them to infectious disease or organ failure. • Actual death in older people is usually easier; the terminal stage is shorter because there’s more than one biological competitor for death. • More likely than other age groups to achieve death with dignity.

18. Why do some people live into their 90s and 100s? • Some people are less likely to have preexisting or chronic health conditions due to stronger genetic/biological constitutions. • Psychosocial conditions are important—those with close family ties live longer, especially ties between a widowed parent and adult children. • Reduced satisfaction with life and depression predict health declines among elderly.

19. Women living longer • Women live about 6 years longer than men. • Women may be more biologically fit than men. Could be something protective about the X chromosome or something about estrogen & prolactin. • Male death rates are higher at all ages of life. More likely to take risks. • Women have more social support than men, which offers a protective benefit for them.

20. Health focus for elderly • No longer on the reduction of mortality • Focus is more on improving the quality of life.

21. Is there a right to die? • 1990: Congress passed Patient Self-Determination Act, requiring that Medicare and Medicaid health care facilities have written policies and procedures concerning patients’ wishes for life-prolonging therapy. (Includes DNR: do not resuscitate) • Derek Humphrey’s book Final Exit, which is a how-to manual for how to commit suicide or assist suicide for the dying. Huge seller. • 1975: 41% of Americans believed that someone in pain with a terminal illness had a right to die; in 1999, 61% believed it.

22. Euthanasia vs. Assisted Suicide • Euthanasia: the act of ending someone’s life who is suffering from a painful terminal illness; illegal in the U.S. but legal in some countries. • Assisted suicide: helping someone commit suicide (“victim” has more control over the situation and actively chooses to die) • Public support for assisted suicide is increasing; for euthanasia, it’s decreasing.

23. Stages of Dying (Kubler-Ross) • Denial • Anger • Bargaining • Depression • Acceptance • This is not really a stage-like process; people can skip stages or omit some. Can go back and forth.