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Slide 1:Aging

Or: how everything falls apart.

Slide 2:References and Handouts

http://www.brown.edu/Courses/BI_278/

Slide 3:Everything Changes

Psychological issues Socioeconomic Physical health Mental Health

Slide 4:The stats on # elderly

Increased 10-fold in last century Currently 35 million > 65 13% population By 2030 70 million 1/5 Americans > 65 1/11 > 85

Slide 5:More stats

Gender (percentage women) > 65 58% > 85 70% Ethnicity Will be more diverse Currently 85% white By 2050, 64%

Slide 6:Everything Changes

Psychological issues Socioeconomic Physical health Mental Health

Slide 7:Psychological issues

Aging has unique Challenges Life stresses

Slide 8:Ex. Erickson

Slide 9:Stage 8: Maturity

Age: Late Adulthood -- 65 years to death Conflict: Integrity vs. Despair Important Event: Reflection on and acceptance of one's life

Slide 10:Stage 8: Maturity

Elements for a positive outcome:The adult feels a sense of fulfillment about life and accepts death as an unavoidable reality. Elements for a negative outcome:Individuals who are unable to obtain a feeling of fulfillment and completeness will despair and fear death.

Slide 11:Other development approaches

Psychodynamic Formation versus elaboration of psychic processes Levinson1 Structure building and changing Periods of transition 1 Levinson, D. (1986). A conception of adult development. American Psychologist, 41:3-13.

Slide 12:Unique challenges of the elderly

Losses Disablement Driving Health concerns

Slide 13:What do the elderly worry about?

National Council On Aging, 2000

Slide 14:Everything Changes

Psychological issues Socioeconomic Physical health Mental Health

Slide 15:Socioeconomic changes

Retirement Finances Social security Medicare Living situations

Slide 16:Retirement

Median age Men: 62.7 Women: 62.6

Slide 18:Finances

65+: net worth = $92,399 White = $181,000 African American = $13,000 annual household income = $22,812

Slide 19:Percent Living in Poverty

Elderly: 12.1% 3 points below general pop

Slide 20:Living situations

Among 65+ 80% own home 75% single unit/detached 45% live alone 17% elderly householder had no transportation

Slide 21:Nursing Homes

65+ 4% (1.46 million people) 85+ About 192 out of every 1,000

Slide 22:Everything Changes

Psychological issues Socioeconomic Physical health Mental Health

Slide 23:Physical Health

Self perception Survey of Americans age 65 (1996-96) vast majority considered themselves healthy. Whites: 74% AA�s: 59.3 % Hispanics 64.9%

Slide 24:The 3 big killers

Heart disease Cancer Stroke Mortality rates Hrt Dx/Stroke: decr 1/3 since 1980 Cancer: up slightly

Slide 25:Effects of Aging on the Body

Bottom line Most of the news is bad. The question How much is inevitable?

Slide 26:Examples of things we can�t change

Ocular accommodation Cardiac hypertrophy GI: malabsorption/intolerances Loss of immunity/allergies Loss of brain volume

Slide 27:Examples of things we can change somewhat

Loss of skin elasticity Auditory acuity Cardiac loss of elasticity

Slide 28:Examples of things we can change a lot

Muscle Mass, Muscle/Fat Ratio Osteoporosis Functional Cognition

Slide 29:Everything Changes

Psychological issues Socioeconomic Physical health Mental Health

Slide 31:Why Rates in Elderly are Low?

Greater difficulty remembering past symptoms Less psychologically oriented Greater mortality Cohort effect Sampling errors Instrument errors Diagnostic challenges

Slide 32:Elderly Specific Criteria?

Age 65+ Edmonton Canada Newman et al. Psychological Medicine 28; 1998

Slide 35:Some specific diseases

Slide 36:Psychotic Disorders

Slide 37:Schizophrenia

Slide 39:Psychosis in the Elderly

Negative versus positive symptoms Look for alternative causes Esp. if NEW ONSET or no history Most common: MEDS ACUTE problems: infections, metabolic. Tumors, etc. less common

Slide 40:Mood Disorders in the Elderly

Slide 43:Depression in the Elderly

Why so low? (see earlier�) Forme Frustres �Pseudodementia� Diagnosing depression in complex cases How to approach�

Slide 44:Anxiety Disorder in the Elderly

Slide 46:Anxiety Disorders

Primary Versus Secondary Common Secondary Causes Drugs Medical Illness (cardiac, respiratory) Disorders that confuse (dementia, delirium)

Slide 47:Substance Abuse in the Elderly

Slide 49:Substance Abuse

Gender differences and drug choice

Slide 50:Dementia

Slide 51:Problems in Dementia Prevalence Studies

Size of sample Sample composition Age range Proportion of very old Education Method for case identification Content of Interview Supplementary diagnostic information Diagnostic criteria (NINCDS-ADRDA v DSM) Prevalence Estimate

Slide 52:Age Specific Prevalence

Jorms (1987)

Slide 53:Stages of Dementia

Depend on both Cognitive ability Testing Functional Ability Observe, ask.

Slide 55:Special Settings

Slide 56:One-Year Prevalence of Mental Disorders in Nursing Homes Estimates from ECA

Slide 57:Differences in the Psych. Interview in the elderly

Use of multiple sources Respect for confidentiality, but� Relaxing of boundary issues Focus of interview Symptoms versus stories Explanations and honesty The power of genuine interest

Slide 58:Epilogue: the question you are all asking

How can I age well?

Slide 59:To stay healthy

Pick really healthy parents

Slide 60:Other things you can do

Don�t smoke Low-fat, high-fiber diet Exercised vigorously for AT LEAST 30 min ALMOST EVERY day Maintained a healthy weight Consume a moderate amount of alcohol (about one drink per day). All 5 = 80% reduction in heart attack/stroke risk Which then also helps cognition Primary prevention of coronary heart disease in women through diet and lifestyle. M.�Stampfer, �et al., The New England Journal of Medicine, 2000, vol.�343, pp.�16--22