PSYCHOLOGY 2012: PHYSICAL CHANGES

1. PSYCHOLOGY 2012: PHYSICAL CHANGES BIOLOGICAL PERSPECTIVES ON AGING Biochemical and physiological changes, under genetic influence, interacting with the environment. Causes? Some theorists see aging as a disease that can be cured or prevented!

2. Non-genetic hypotheses: • wear and tear • accumulation of toxins • accumulation of metabolic waste (e.g. lipofuscin) • collagen changes • nutritional deficits • accumulation of free radicals • damaged DNA can’t repair tissues (damage is environmental, e.g. sun) • cross-linking of cellular proteins and collagen (caused by aldehydes)

3. Aldehydes: • by-products of cell metabolism. The more fat, calories and animal protein in the diet, the more aldehydes are produced. Genetic hypotheses: • Hayflick’s limit • genes for aging program changes (e.g. telomeres)

4. Other physiological hypotheses: • aging CV system • endocrine decline (thyroid, pituitary, hypothalamus) • immunological deficits: • less efficient • autoimmune diseases

5. THANATOLOGY: STUDY OF DEATH (Thantos: Greek god of death) CAUSES OF DEATH: Until 20th century: • infections • accidents • epidemics, pandemics • parasites (endemic) • starvation, severe nutritional deficiency

6. CAUSES OF DEATH: Twentieth century: lifestyle diseases (1st World) • hypertension • hypercholesterolemia • cardiovascular problems: heart attacks and strokes • cancer • immune deficits – AIDS • diabetes

7. Causes: • obesity • sedentary life • fatty foods* • excess foods • smoking • pollution (harmful chemicals in the environment) • radiation

8. Individual variables related to longevity: • genetics • personality • accidents • lifestyle Which ones do we have control over?

9. PHYSICAL CHANGES AS WE AGE: First decade of young adulthood: • Growth does not stop in adolescence • Long bones grow to age 25 • Spine grows to age 30 • Skulls grow into old age • Myelinization and differentiation of CNS to age 25 Overall, good health, high energy, quick recovery from illness. No noticeable effects of unhealthy lifestyles. However recently, changes due to childhood obesity and environment toxins. • Past 25-30 a lot depends on lifestyle and heredity

10. Second decade of young adulthood: • face lines • weight harder to keep off • thinning hair (men) • greying hair • “spare tire” (men) • hips (women) • sagging • changes in menstrual cycle (climacteric) • tanning: UV rays interfere with DNA production and protein synthesis (tissue damage) • CV system: past age 20 cardiac output (amount of blood pumped in 60 sec.) decreases 1% a year for sedentary people Significant individual differences.

11. CHANGES IN VISION: • Lens less flexible, doesn’t shed old cells (epithelial) as efficiently. • Therefore, lens becomes thicker, more compact. • This leads to accommodation being slower and harder. • Affects close range focusing: presbyopia • Also becomes yellowish: need more light to see: cataracts • These changes start around 35-45. • Pupil: less flexible – problems for dark/light adaptation. • Some eye muscles less effective. • Visual acuity decreases around 40-50. • Depth perception decreases at about 50. • Field of vision shrinks from 50 on, marked after 75.

12. Retina: after 65 malfunction or destruction • Senile macular degeneration: gradual degeneration of centre of retina, affects both eyes. Leads to blindness. • Disciform macular degeneration: blood leaks to the retina. If caught early, can be treated with laser photocoagulation. If not: blindness. • Glaucoma: intraocular pressure (correlated with hypertension) damages the optic nerve. Beta blockers help. Tonometry diagnostic test after 50. Leads to blindness.

13. DRIVING IN OLD AGE: • Visual acuity – 20/50 • 120° visual field • RT • strength • coordination • range of motion • motor skills – speed • mental ability: • attention: single, multi, switching • memory • problem–solving and decision-making • judgment of distance • depth perception • speed of mental processing

14. Hearing • Declines after age 13 in industrialized countries. • Noise pollution. • Hearing for higher frequency tones goes first. • Presbycusis: loss of hearing for high pitch tones. • How? Damage to receptor: hair cells, inner ear (cochlea) • Also, arthritis of the ossicles possible. • Also processing slower. Loss of hearing can lead to: • social isolation • depression • paranoia

15. Chemical senses: taste and smell • decline too: consequences for nutrition • poor nutrition can be also due to loneliness and isolation, consequences for general health and for CNS functioning. (Vitamin B) Immune system • also declines with age CNS degeneration Reaction time (RT) as measure • loss of neurons (anatomical) • loss of synapses (functional) Use it or lose it!!

16. Sleep: • more interruptions after 35 • disturbances due to illness, medication and pain, not to age • only difference: ½ hr./1 hr. less sleep per night and a few more 3 to 10 minute awakenings

17. Temperature regulation • becomes more difficult: hyper or hypothermia Consequences of temperature regulation decline: • Both the ability to detect temperature correctly and to adjust diminish • Hypo and hyperthermia can lead to death

18. Touch and pain: danger detection, e.g. hot stove Reaction time: decreases if sedentary. RT good if active, e.g. tennis player better at 60 than sedentary 25 year old. Good indicator of nervous system health. Sense of balance impaired after 65: more falls. Coupled with osteoporosis: serious risk. Muscle mass: atrophy if not used Solution: weight lifting, resistance training Endurance better than sheer strength. What would you test for if you had to grant driving licenses to over 75s?

19. SYSTEMS: SKELETAL: • brittle bones, osteoporosis • calcium losses, complex mechanism • add visual impairments and loss of sense of balance: more falls with more serious consequences • osteoarthritis: joints degenerate, not enough cushion • rheumatoid arthritis: progressive tissue destruction – autoimmune?

20. MUSCLE TISSUE: • use it or lose it • importance of exercise • weight training – also benefits for osteoporosis • endurance holds better than fast surges – snow shoveling • RT (reaction time): active 65 year olds better than inactive 25 year olds • Middle Age: repetitive, automatic tasks overall same as young • Older Adults: individual differences

21. HEALTH CHALLENGES AND AGING Young adults: • back problems • hearing • hypertension, hypercholesterolemia • accidents second leading cause of death • by age 35 cancer and heart disease starts to appear as important cause of death • women die more of cancer than of car accidents

22. CHRONIC CONDITIONS BY AGE AND GENDER: Middle age: • asthma • bronchitis • diabetes • mental disorders • arthritis (and rheumatism) • sight and hearing • circulatory, digestive and urinary • for women, menopausal complaints, hysterectomy and sequelae of hysterectomy Deaths: cancer and CV, for women cancer

23. CHRONIC CONDITIONS BY AGE AND GENDER: Old age: • arthritis most common • hypertension • CV • hearing, vision • leading cause of death: MI, cancers and stroke

24. CHRONIC CONDITIONS BY AGE AND GENDER: Old age (cont’d): • In general women more health conscious and knowledgeable than men • Role of marriage. Health gradient from better to worse: married, never married, widowed and divorced. But … effect of marriage much stronger for men • Widowed women healthier than widowed men

25. ILLNESS AND AGING Issues of quality of life: • individual differences (e.g. reading) • having spouse • having children, grandchildren • financial self-sufficiency • being in own home • religious comfort • community

26. ILLNESS AND AGING • Diseases can be acute or chronic • Acute: rapid onset, reversible, short-term (e.g. ‘flu’) • Chronic: slow onset, irreversible, long-term (e.g. CV disease) • As we age, fewer acute illnesses and more chronic ones.

27. Young adults: 20’s not noticeable effects of abuse • 30’s: beginning: more infections, less stamina, sleep disorders, GI troubles • Killers: AIDS, Accidents • 40-60: chronic illness: diabetes, arthritis, rheumatism, sight and hearing, hypertension, GI, all systems may begin to show problems • Killers: heart and cancer lead men more than women

28. 65+: arthritis most common, hypertension, CV disease, cataracts, diabetes. Less acute illness, more chronic killers: cancer and heart lead. • Adult onset diabetes: totally linked to diet

29. ILLNESS AND AGING Arthritis: painful disease of the joints Osteo and Rheumatoid: • Osteo: • wear and tear of the joints (injuries, repetitive motion, obesity) • bones rubbing together, not protected by serous bags or synovial fluid, mostly over 60 • weight loss, no smoking, gentle exercise (water) • use of painkillers • surgical replacement

31. ILLNESS AND AGING • Rheumatoid: • autoimmune disease • can appear at any age • Remicade, research ongoing

32. Arteries: • arteriosclerosis: stiffening of arteries due to less elastin, more collagen and calcium. Appears age related. • atherosclerosis: plaques of fat and other debris coat internal arterial walls. Leads to hypertension. Related to lifestyle. Found in children and young adults too (TV, junk food, sedentary life). Heart attacks in young males.

33. Cardiovascular (CV) System: • Factors: overeating, fatty foods, refined, processed foods, sedentary, stress, smoking +++, high salt (processed foods) • Latest: bacterial (Chlamydia) • Both arterio and athero cause hypertension • Heart Attack: myocardial infarction • Stroke: cerebral artery clogged or bursts: damage to neurons

35. CANCER • leading cause of death • some are eminently preventable: lung (smoking), skin (sun exposure), colorectal (diet), breast (diet and breastfeeding). • only a small percentage of cancers are genetic in origin Possible major causes: • lifestyle • environmental pollution • weakened immune system as we age, together with cumulative exposure to carcinogens

36. Carcinogens are pervasive in modern life: • plastics • synthetic fibers • chemicals to soften or harden susbtances e.g. phthalates • hormones given to cattle • pesticides, herbicides, preservatives • animal flesh that has incorporated those chemicals • radiation (air travel, medical tests, cell phones?) • treated fabrics (e.g. fire retardant in clothes, carpets, drapes) • air pollution (e.g. large cities) • second (and third) hand smoke

37. Despite enormous funds for research, cancer incidence is going up. • Cancer drugs themselves are carcinogenic. • Most funds directed toward detection tests and chemotherapy drugs. • Young men: do testicular self-examination! (imperative if you were born with cryptorchidia). • Young women: do BSE and get a yearly Pap if you are sexually active!

38. Respiratory system: • after age 25 vital capacity (amount of oxygen per breath) decreases if inactive • smoking +++ Other organs: • digestive enzymes decrease after 30 • kidneys shrink after 30, filter more slowly • energy decrement • intestinal problems

39. Supplementary notes on health and lifestyle Until the middle of the 20th century, smoking was mostly a male habit. It was not seemly for a lady to smoke, although some did in secret, and later in some circles as a way to flaunt the status quo. Young women also perceived smoking as sophisticated, since many movie actresses smoked on screen, and as risque and naughty. Because men smoked and women were not supposed to, smoking was perceived as a sign of independence and power by many women. Not surprisingly, men suffered and died from many diseases caused by smoking that hardly touched women. In the 1960s, with the second feminist movement gathering momentum, smoking became acceptable for women. The tobacco companies saw a new, very lucrative market, and started to target women with very slick ads. The Virginia Slims advertising campaign is today considered a classic of the advertising world. The slogan "you've come a long way, baby" became part of the culture. Women were portrayed as daring, strong, professional, competitive and independent - always with the picture of a Virginia Slims package prominently displayed next to the woman. They marketed "feminine" cigarettes: slimmer than the usual cigarette and with soft paisley prints on the cigarette paper and filter. The packages were also slimmer. The campaign used two important themes: competing in a man's world, being more than just a housewife, etc. and losing weight. Millions of women were lured into smoking with the promise of a more exciting life and a slimmer body. The model in the ads was always, of course, slim.

40. Even then, there were segments of the female population that were not responding to these ads. The advertisers did research and discovered several female subpopulations, which they targetted separately, including young adolescents, working class women, rural women, etc. By the 1980s, smoking was as common among women as among men. And now, more young women than young men are smokers. Smoking is highly addictive, at least as addictive as cocaine. Not every brain responds identically, some individuals will become more easily addicted than others, but eventually all regular smokers become addicted. There are receptors in the brain that are very sensitive to nicotine and otherchemicals in cigarette smoke. Smoking is associated with being 'cool' and grown up amongst adolescents, a way to reach adulthood the easy way. So what's so bad about smoking? Let me count the ways. Everyone has heard about lung cancer, and some have heard about emphysema, but these diseases are only the tip of the iceberg. Over 45,000 Canadians die each year from smoking-induced causes. These deaths are completely preventable. Let's take a brief look at the most common effects of smoking: • COPD: chronic obstructive pulmonary disease. The lungs become so filled with "gunk" that they gradually shut down. COPD is one of the leading causes of death and disability.

41. Lung cancer: Although there are some rare lung cancers not caused by smoking, the overwhelming majority are. It takes about 20 years for a cancerous tumour in the lungs to be detectable, so a young person with nosymptoms could already have the cancer growing without being aware of it.Although some strides have been made in treatment, in most cases it's fatal. • Emphysema: now under the umbrella of COPD, it is one of the lung conditions where fluid and scar tissue start to fill the alveoli, the lungphysiological units where the exchange of gases takes place which leads tooxygenation of the circulating blood. Gradually, smaller portions of the lungsare functioning, leading to oxygen deprivation. Many disabilities are due toemphysema and general COPD. Eventually, it's fatal, as it cannot be reversed. • Oral cancers: mouth, tongue and jaws can develop cancer due to smoking. The cancer spreads to the throat, takes de vocal cords and parts of the neck and, eventually, metastasizes to other body parts. • Bladder cancer: because many toxic by products of smoke are processed through the kidneys, they accummulate in the bladder for lengthy periods of time each day, and cause cancer.

42. Circulatory system diseases: The chemicals in cigarette smoke (over 2,000 and counting) promote the formation of plaque through various mechanisms. This plaque, a sticky substance that adheres to the internal walls of the arteries, is like a magnet that attracts particles circulating in the blood, until a blood clot forms. If the clot remains in place and continues to grow, it will eventually prevent blood from getting through. If it becomes free and is carried in the blood circulation, it can end up obstructing an importantvessel, such as a coronary artery (which feeds the heart) leading to a heartattack, or a cerebral artery, leading to a stroke. In both cases, either heartor brain suffer permanent damage due to oxygen deprivation. Even if plaque just sits in the arteries, by decreasing the internal space where blood gets through it leads to hypertension (high blood pressure) one of the most dangerous (and common) diseases of our time. Necrosis of the lower limbs: The feet are the most distal body part from the heart. When circulation is compromised, it is often in the toes. Lack ofcirculation leads to necrosis, or tissue death, which spreads quite rapidlyonce it begins. Many smokers have had their limbs amputated to stop the spread of the gangrene. Other conditions, such as diabetes, can also cause this problem, so a diabetic is at double risk in this regard if they are alsosmokers.

43. Immune system: smoking decreases the capacity of the immune system to fight infections and other foreign invaders. A smoker is at several timeshigher risk of contracting many diseases, including other cancers that are not directly caused by smoking. Ulcers: smokers have a higher incidence of duodenal and gastric ulcers. Cataracts: higher incidence in smokers. Depression and suicide: a recent longitudinal study determined that smoking is associated with higher rates of suicidal thoughts and actual suicide. Although the depression may have preceded the onset of smoking, those who smoked had a higher rate of suicide than those who did not. Thisstudy was done with people ages 21 to 30. Low birth weight babies: women who smoke during pregnancy are much more likely to have babies who are below normal weight, which is associated with many diseases and problems, including learning disabilities. Stillbirths: women who smoke during pregnancy have a higher rate of stillbirths. It appears that smoking, in addition to cutting off the oxygen supply to the fetus, impairs the functioning of the placenta.

44. Second hand smoke: chemically, second hand smoke is even worse than what the smoker initially inhales. People who work in smoking environments are atmuch higher risk for lung cancer and COPD, as well as the other diseases. Ofcourse smokers get both the "fist hand" smoke they inhale and the second hand smoke they exhale and then breathe in, as it stays in the air around them. In addition, wives of smokers have a higher incidence of cervical cancer, although the mechanism is not yet known. In isolated towns where public smoking has been banned, the rates of heart attacks decreased by 58% in only six months. Only 30 minutes of exposure to second hand smoke causes platelets in the blood to become stickier, which is a start for blood clots that block arteries. Although both men and women suffer the consequences of smoking, advertising that targets various subgroups of women very specifically makesmoking a serious issue in women's health. Additionally, we have already seen, in previous weeks, how smoking is dangerous for women on hormonal contraceptives and it contributes to osteoporosis in post-menopausal women.

45. SLEEP DEPRIVATION In our fast-paced society, two thirds of the adult population do not get enough sleep. The consequences are fatigue, irritability, depression, decreased attention span, lack of concentration, lapses in memory, frequent illnesses and loss of productivity. One of the most serious consequences for the individual and society is drowsy driving, which increases the risk for accidents. Sleep-related accidents are most common among young drivers and shift-workers. Both caffeine and alcohol taken in the evening can impair sleep. Alcohol will initially cause drowsiness and lead to sleep, but typically individuals will awake a few hours later and be unable to go back to sleep. Sugar can also have a stimulating effect. Sleeping pills and tranquilizers disrupt the normal sleep cycle, as they impede REM sleep. REM (rapid eye movement) sleep is associated with dreaming and is necessary several times throughout the night, in short periods. When a person misses REM sleep for one night or more, there is arebound effect that results in too many REM periods the first night the sleepaid is not taken, causing restlessness and fatigue the next day.

46. Stress is one of the main reasons for inability to sleep well. There are several methods to deal with stress without resorting to medication. Other causes of sleeplessness are a full stomach (or a really empty one),light, which will prevent the release of the hormone melatonin, necessary forsleep, noise and uncomfortable temperature in the room (too hot or too cold). Although both men and women in modern societies tend to be sleep deprived,women are at higher risk because of the double shift. This is the situationwhere women with a family work 8 hours or more at their paid work, and come home to another few hours of intense homemaking and childcare work. Because so many women have to juggle these responsibilities, they are more likely to also lay awake once they do get to bed and review all the tasks that were left undone and the new ones that need to be done the next day. Women also tend to be prescribed more psychotropic drugs by their doctors, which put them at risk for a vicious cycle of sleeplessness and of addiction

47. Diabetes Metabolic disorder due to problems in either • production of insulin or • utilization of insulin Insulin: pancreatic hormone essential for metabolizing glucose (sugar)

48. Diabetes Two types of diabetes: Type I and Type II Type I (juvenile or early onset): • Either genetic or intrauterine causes • Appears in infancy/childhood • Pancreas does not produce sufficient insulin • Treatment: insulin injections for life, diet

49. Diabetes Type II: adult onset • Although there could be genetic predisposition, it’s overwhelmingly a lifestyle disease • 90-95% of total # of diabetics are type II • 85% are overweight/obese • The other 10% have faulty diets • Used to appear in late middle-age/old age but appearing earlier: • 40’s: 40% increase in last 8 years • 30’s: 70% increase • teens: also on the rise

50. Diabetes Pancreas produces enough insulin initially but diet high in carbohydrates causes strong insulin spikes • eventually tissues do not respond to insulin • a lot of glucose (2-3 times normal) stays in blood • this causes even more insulin production, pancreas overwhelmed, insulin production slows • eventually, insulin shots needed • also insulin spikes cause hunger and cravings