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80% own home. 75% single unit/detached. 45% live alone. 17% elderly householder had no ... One-Year Prevalence of Mental Disorders in Nursing Homes Estimates from ECA ...
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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