Chapter 14: Late Life Physical Challenges

2. Good Aging What is successful aging? Is it aging without physical or mental ailments? Maybe it is making the best of what you have.

3. Good Aging Maybe there is a difference between: Successful Aging - going full steam until the end Aging successfully - being able to thrive on whatever life throws your way The real issue in later life is not so much being ill as it is living as fully as possible in the face of chronic diseases How one lives in later life depends on nature (our biology) and nurture (having the right person-environment fit).

4. Tracing Aging Normal aging changes: are universal, often progressive signs of physical deterioration slide into chronic diseases. Chronic disease is: usually normal aging taken to the extreme any long-term illness that requires ongoing management. Many age-related diseases are not fatal - they simply interfere with the ability to function. They create Activities of Daily living problems.

5. ADL Problems Activities of daily living (ADL) problems occur in two stages: Instrumental ADL problems People have trouble performing independent living functions Independent tasks include cooking, cleaning, driving and walking Basic ADL problems Essential self-care activities

6. ADL Problems

7. The Human Lifespan Biologists believe that the human life has a maximum limit of about 105. Although there are cases of people living a few years past this. More people than ever are living past 100. Some believe our lifespan is genetic. Others believe that it is a case of simple wear and tear. Scientists are trying to �cure� aging. Our average life expectancy has drastically increased and is approaching the maximum value.

8. The Aging Path We do not all age at the same rate. Our gender and SES have influence on how we age.

9. The Aging Path

10. SES, Aging, and Disease Researchers document a SES health gap In every nation, the higher the SES the healthier and longer lived people are By the 30�s and 40�s, people show clear differences in the rate at which they age. Even children show more signs of disease if their mother does not have a high school degree. In countries with large income inequalities and no government health care, the low income crowd dies very young. Could this explain the U.S. death rates? People below the poverty line in the U.S. show statistical similarities to people living in Bangladesh.

11. Low-Income Hurdles People in low-income groups are more likely to: not have health coverage live in �toxic� neighborhoods have chronic stressors in their lives engage in high risk behaviors like smoking eat less expensive, often least healthy, food be unmarried or without any other supportive, nurturing relationship We tend toward the Fundamental Attribution Error when we blame poor health on the person and ignore the conditions.

12. Gender, Aging, and Disease Problems of the cardiovascular system are the main killers of both men and women Men are twice as likely to die from a heart attack Women survive longer, but in old age they are more frail Interestingly, women get sick more often, but live longer Women are the family health providers More attuned to health problems

14. Interventions What you do in your teens effects your health in your 40�s What you do in your 40�s effects your health in your 60�s It is never too late to turn your health around: Start exercising Eat more vegetables, fruits and nuts Give up smoking and alcohol Visit your doctor for regular checkup

15. Vision Changes By age 40. our lens is hardening and clouding glasses or surgeries may eventually be required Presbyopia: trouble seeing close objects a milestone in aging successfully Older people have trouble - Seeing in dim light, judging distance at night, glare, and seeing some colors as vividly, or at all These problems can be successfully overcome, although some mental anguish over �growing older� may ensue.

16. Vision Issues Curable vision problems Cataracts- with surgery Presbyopia - with glasses and some sunglasses Problems that can cause irreversible damage Macular degeneration Glaucoma Diabetic retinopathy Optic nerve damage

17. Hearing Changes Hearing impairments may be worse than vision problems Loss of vision limits our contact with the visual world, but loss of hearing disconnects us from society Hearing problems are very common in later life Effecting about 1 in three people over age 70 Age-related hearing problems have doubled since 1970 Men are more likely than women to loose hearing Men work in noisy occupations without protection Presbycusis Age-related hearing loss especially in the higher pitches Caused by atrophy of hearing receptors in the inner ear Background sounds overpower the sounds we want to hear

18. Hearing Interventions Choosing social activities with care by avoiding: crowded noisy locations eating during peak hours places where sound bounces Install carpeting in the house Replace noisy appliances with quieter ones Talk directly to the person We tend not to think about facing a person when we talk One must project directly toward the person with hearing loss Encourage getting a hearing aid Don�t use elderspeak Similar to infant-directed speech used with little children Particularly degrading to the elderly

19. Motor Performance Older adults move slower, which puts the elderly out of sync with the physical world. It creates negative prejudices against the elderly Slowness is caused by slower reaction time Changes in bone structures: With osteoarthritis joint cartilage wears away With osteoporosis the bones become brittle and easily break Women are most susceptible to osteoporosis Hip fractures are a special danger primary cause for nursing home placement

20. Motor Performance Interventions Be careful in speed oriented situations. Keeping active slows the advance of ADL problems, but don�t overdo it. Guarding against falls: Remodel home to reduce tripping Increase lighting, install low pile carpeting Install grab bars wherever one sits or lays down In Europe, some elderly wear a hip pad to protect against breaks Put shelves within reach and use doors that open easily.

21. Driving in Old Age Some older adults are slow, hard of hearing and have bad vision. Still, they can and want to drive.

22. Driving Interventions Better mass transit access to local needs would reduce the need for the elderly to drive. The elderly may require special driving tests to determine their neural deficits. Any traffic area that requires speed in cognitive decision making should be revamped. Yellow lights may need to have extended times Unprotected left turns may need to have signals Exit ramps need to be extended Larger signs, better lighting, and other simple changes would benefit many older drivers

23. Dementia The general term for any illness that produces serious progressive, usually irreversible, cognitive decline is called dementia. The two main causes of dementia almost always strike in later life Alzheimer's disease Vascular dementia Brain injury or illness, such as AIDS, may also cause dementia.

24. Signs of Dementia Unusual memory loss Forgetting basic semantic info like where they live Impaired abstract reasoning Thinking through options is difficult or impossible Language is compromised Remembering the name of common objects is difficult Judgment becomes impaired Possible to wander aimlessly or endanger their lives Later-stage symptoms may include: The inability to: Feed oneself Dress oneself Make simple movements Loss of speech

25. Dimensions of Dementia Determining the point at which mild cognitive impairment becomes dementia is difficult. Each person�s progress is different. Each disease reacts differently. The time from prognosis to death is usually four to eight years. Typically strikes the very old: One in three centenarians show no signs of dementia. Some very old even outperform young adults in test of crystallized intelligence.

26. Dementia�s Two Main Causes 1. Alzheimer�s disease attacks the neurons. Neurofibrillary tangles and senile plaque build up in the brain destroying brain cells 2. Vascular dementia attacks the blood flow. Impairment of the vascular system to the brain causing multiple small strokes

27. Research into Dementia Research on Alzheimer�s disease concentrates on the plaque and a molecule called amyloid. If scientists can stop its production or find out why it is overproduced in the body, they may be able to stop Alzheimer�s from developing. Some people have a genetic marker that makes them more vulnerable to developing amyloid overproduction.

28. Dealing with Dementia As with other chronic diseases, we can�t cure it and we can�t stop it, but we can slow it down. Physical exercise promotes vascular function which decreases the risk of getting the disease. Anecdotal evidence indicates that a blow to the head will start the disease. Keep your head safe! In dealing with the disease, we must look at both: The patient The caregivers / family and loved ones

29. Dementia and the Patient In the early stages: external aids like note cards are helpful In the advanced stages: Place locks and buzzers on doors Remove toxic substances from reach Protect against injury from knives and dangerous (everyday) appliances At every stage: Protect the patient and keep them functioning as well as a possible, for as long as possible Be caring, loving, and supporting

30. Dementia and the Caregivers Imagine the person you loved: Unable to control their emotions Unable to recognize you Physical and mental abuse may occur There are support groups for family members. Realize that it isn�t the person acting that way, it�s the disease. When total care is impossible in the home, other options are available.

31. Options for the Frail Elderly When you must depend on others for your daily care, what are the options? Roughly 3 out of 4 women in their 80s are widowed and live alone. In multigenerational households, this would never be an issue In traditional collectivist cultures, the children or community members would care for the elderly War, famine, disease, and individualism are breaking those traditions Different cultures have different answers for elderly care.

32. Elder-care in Scandinavia In the Scandinavian countries, government sponsored initiatives help the elderly. Innovative housing alternatives are numerous Cash grants to remodel homes Services available to help with home care Nursing centers with attractive private rooms Multigenerational villages Families take on the responsibility for care, but the government fully funds services The elderly in these countries do not have to worry about what will happen to them when they become frail.

33. Elder-care in the United States Medicare � the U.S. government�s program of health care for the elderly. Only covers cure-oriented services Alternatives to institutionalization Settings and services for older people who don�t require intense 24-hour nursing homes: Continuing care retirement communities Assisted living facilities Day care programs Home health services

34. Elder-care in the United States Continuing care retirement community: Housing option with a series of levels of care moving into more intense care areas as they need it Assisted living facility: Provides care for elderly with instrumental ADL issues Day-care programs: Day-care for elderly who live with relatives Home health services: Nursing-oriented and house keeping services for impaired people living at home

35. Elder-care in the United States Institutionalization is required when a person has basic ADL issues and can no longer be cared for at home. Medicaid pays for long-term-care, most often: Nursing homes and other long-term-care facilities One in four nursing homes is seriously substandard Caregivers in long-term-care locations are CNAs Certified Nursing Assistants are at the bottom of the wage heap and overworked Job can be very generative and rewarding

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