PHYSICAL CHANGES WITH OLD AGE & THEIR IMPACT Mary C. Sengstock. Ph.D. Sociology, Wayne State University

1. PHYSICAL CHANGES WITH OLD AGE& THEIR IMPACTMary C. Sengstock. Ph.D.Sociology, Wayne State University • BIOLOGICAL THEORIES: • Will Not Discuss in Detail • Will Consider Major Biological Issues … • As They Impact on the Sociological Perspective

2. VARIATION IN FUNCTIONAL LEVELS • Variability Between Individuals of Same Age • Variability Between Different Functions of Same Individual • Heart Rate vs. Brain Function • Breathing Rate vs. Renal Flow … Etc. • Greater Variability Among the Aged Than Among Younger Persons? • Experts Disagree About This Issue

3. FUNCTIONAL AGE • Defining a Person’s Age in Terms of Their Ability to Function • Great Variability Among Individuals • “She Doesn’t Look That Old!” • “Oh! Only 65? I Thought He Was Older!” • EX: 2 Patients Sharing Hospital Room: • 65 Yr Old – 95 Yr Old

4. SENSORY DECLINE • All Senses Decline in Acuity AS We Age • Sight – Hearing – Touch – Taste – Smell • All Result in Changes in Ability to Perceive & React to Environment • Sight: Stronger Glasses, Bifocals, Cataracts • Smell & Taste: Affects Appetite; Eating Habits • Touch: Peripheral Neuropathy • Difficult to Feel Pain, Recognize Problems • Diabetic Foot Problems

5. MOST SERIOUS DECLINE? • Which Would You Think Would be the Most Serious Type of Sensory Decline? Sight Touch Hearing Smell Taste

6. MOST SERIOUS DECLINE:HEARING • Severe Impact on Social Interaction • Hard to Hear What Others Say • Make Odd or Inappropriate Responses • Makes It Difficult to Interact With Others • Lose Ability to Participate in Social Relations • Lose Contact; Decrease Social Stimulation

7. EX 1: ELDERLY WOMAN & FAMILY • There’s Mike Shay. “What Did Mike Say?” • There’s John Hagan. “Door’s Shaking? Fix it!” • Write the Senate. “Call Sheriff? What For?” • Where My Pants? “Pen? We’re Going Out!” • Phone: We’ll Be Late. “They’re Not Home. Call Back Later.” • “I’m Not Hard of Hearing! You Don’t Talk Loud Enough! Even My Friends Don’t Talk Loud Enough Anymore!”

8. EX 2: PRES. REAGAN & AIDES • Conversation: John Poindexter & Oliver North • Told Reagan of Plans to Sell Arms to Iran & Use the Funds to Support Diversionary Actions in Nicaragua • Reagan Didn’t Understand – Like Most Hard of Hearing People, Was Embarrassed to Admit It • So He Nodded Absent-Mindedly • They Took This As a Sign of Consent

9. PHYSICAL HEALTH IN OLD AGE • Health Status Declines As We Age • What Are Some of These Changes? • Definition of “HEALTH” Is a Critical Issue • 4 Definitions: • WHO (World Health Organization) • Functional Definition • Alternate Functional Definition • Coping Definition

10. “HEALTH” DEFINED BY “WHO” (World Health Organization) • “Complete Physical, Mental, Social Well-Being, Not Just the Absence of Disease or Infirmity” • Is This Realistic? • May Cause “Medicalization” of the Social … • I.e., Use of Medication or Therapy for … • Disruptive Behavior • Opposition to Social Structure

11. HEALTH: FUNCTIONAL DEFINITION • Talcott Parsons • State of Optimal Capacity of the Individual • For Effective Performance of Roles • Typical for a Structural-Functionalist! • Only the Social Structure is Important! • Emphasizes a Market Economy • Health Care Useful to Get People Back to Work • Elderly Not Useful – Why Provide Health Care?

12. ALTERNATE FUNCTIONAL DEFINITION OF HEALTH • James O’Brien, M.D. • Maintaining Highest Possible Functional Capacity of Individual … • For As Long as Possible • The Approach of Most Geriatric Physicians

13. “COPING” DEFINITION OF HEALTH • Dubos: • Achieving A Rewarding & Not Too Painful Existence • In Coping With an Imperfect World • Question: Which One(s) Do You Think Are Most Useful or Appropriate?

14. MORBIDITY (DISEASES) OF OLD AGE Major Causes of Death in Old Age: • Heart Disease – Atherosclerosis • Hypertension – Cancer – Diabetes Mellitus • Cerebrovascular Accidents (Strokes) • Oral & Dental Problems – Cirrhosis of Liver • Suicide – Pneumonia – Accidents • Multiple Pathologies

15. HEART DISEASE • Heart Attacks • “Coronary Infarction” (Tissue Death) • Highest for Older Men • Increases for Post-Menopausal Women • Higher for Non-Whites

16. ATHEROSCLEROSIS • Hardening of Arteries • Fatty Deposits Inside Arteries • Leads to Narrowing (Thrombosis) • Followed By Occlusion (Complete Closing & Tissue Death) • Can Cause Death & Impairment

17. HYPERTENSION • High Blood Pressure • “Sneaky Disease” • Very Difficult to Diagnose • Causes Organ Damage Due to Increased Pressure on Organs • Higher Rates for Non-Whites

18. MALIGNANCY (CANCER) • Cancer Rates Are High Throughout Life • Types of Cancer Vary By Age • Young Patients: • Lung – Breast – Cervix • Aged Patients: • Stomach – Intestine – Prostate • Skin – Kidney – Leukemia

19. DIABETES MELLITIS • Inability of Body to Metabolize Sucrose (Sugar) • Due to Non (Low) Production of Insulin • Approx 4% of Population 65+ • Slightly More Frequent with Women • More Frequent With Obese • More Frequent for Patients in Their 60s & 70s • Severe Effects on Heart, Kidneys, Arteries

20. CEREBROVASCULAR ACCIDENTS(STROKES) • Embolisms (Blood Clots) That Cut Off Blood Supply to Brain • Loss of Blood Flow Causes Brain Damage • Results in Body Damage – Depending on the Portion of the Brain Affected: • Speech Aphasia • Memory Loss • Paralysis

21. ORAL & DENTAL PROBLEMS • Lost Teeth • Gum Problems • 90% of Population 65+ • Can Cause Inability to Eat • Improper Nutrition • Many Elderly Do Not Go to Dentists

22. CIRRHOSIS OF LIVER • Normal Liver Tissue is Replaced • By Scar Tissue or Fibrous Tissue • Decreases Liver Function • Major Causes Are Alcoholism & Hepatitis • Much More Frequent in Men Than Women

23. PNEUMONIA • Inflammation of Lungs & Lung Tissue • Symptoms Are Coughing, Breathing Problems • Common Side Effect of Other Chronic Illnesses • Often the Actual Cause of Death Listed • Especially True for the Elderly

24. ACCIDENTS & SUICIDE ACCIDENTS: • Primarily Home Accidents For the Aged • Less Likely to Be Car Accidents SUICIDE: • Very Much More Common Among Elderly Men Than Women

25. MULTIPLE PATHOLOGIESIN THE ELDERLY • Many Chronic Conditions Occur Together • Diagnosis Is Complicated • Specialty of Geriatric Physicians • Many Physicians Are Not Trained to Diagnose & Treat These Simultaneously Occurring Conditions • Results in Missed Conditions, Over-Medication

26. ILLNESSES IN OLD AGE VS. YOUNGER PATIENTS YOUNGER PATIENTS: • Acute Illneses: • Often From Exogenous Causes: • Bacterial or Viral Infections • Trauma • Definite Onset  Crisis  Self Limiting End

27. ILLNESSES IN OLDER ADULTS • Chronic Illnesses – Not Acute • 85% of Aged (65+) – At Least 1 Chronic Illness • Persons <50 – Only 10% Have a Chronic Illness • Elderly Often Have Several at One Time • Complex Symptomology – Many Drs Not Used to Diagnosing & Treating • Medications Often Interact or Conflict

28. EXAMPLE OF CHRONIC ILLNESS:ATHEROSCLEROSIS • Multiple Causes: Intrinsic Aging + Genetic Propensity + Environment (Diet) • Men > Women • Leads to Thrombosis (Build Up in Arteries) • Breaks Loose (Embolism) • Cuts Off Blood Flow – Cannot Be Regenerated • Leads to Death of Tissue in Area (Infarction) • Treated By Bypass/Scrape/Balloon

29. ACUTE ILLNESSES IN ELDERLY • Persons 65+ Who Have Acute Illnesses or Accidents: • Tend to Have Longer Periods of Disability • Greater Restriction of Activity • Suffer From Decreased Social Contact • Illness Makes Elderly “Miss Out” on More Than Is True of Younger Persons

30. LIMITATIONS DUE TO ILLNESS • 1/2 of Persons 65+ Suffer Some Limitation in Lifestyle Due to Chronic or Acute Illnesses • NOTE: Disease Incidence is Based on % of Persons Affected – Not On Degree of Difficulty • I.e., 50% of Persons 65+ Suffer Limitation • It Does NOT Mean That Affected Persons Suffer 50% Limitation

31. LIFE STYLE & HEALTH • Many Aspects of Lifestyle Lead to Health Problems in Old Age: • Tobacco  Cancer; Heart Disease; Osteoporosis • Alcohol  Cirrhosis of Liver; Gastric Problems; Some Cancers; Mental Problems; Falls • Environmental Threats (Air, Industrial/Occupational Pollutants)  Black Lung Disease, Cancers, Etc.

32. NUTRITIONAL PROBLEMS IN OLD AGE • Malnutrition for the Poor • Obesity for Middle & Upper Class • Nutrition Affected By Several Factors: • Social Isolation – Eating Is Social • Problems With Dentures; Poor Taste & Smell • Inability to Shop, Prepare Food

33. CONTROLLING LIFE & HEALTH • Goal: Prolong VIGOROUS Life (Not Just LIFE) • 1/3 to 1/2 Aged Health Problems: Nutritional • Need Nutritional Improvements for Elderly • More Adequate Diet for Poor Aged • Control of Obesity; Less Fat, Sugar for Others • Repair Dentures; Improve Taste, Smell • Increase Calcium Intake • Decrease Cholesterol

34. LIFESTYLE & HEALTH Recognize the Health Significance of Lifestyle • Social Isolation: Why Many Elderly Do Not Eat • Difficult to Cook for 1; Depression • Exercise – Lack of Exercise: • Contributes to Heart Problems, Obesity, Osteoporosis, Etc. • Only 40% of Elderly Exercise Regularly • Smoking: Diminishes Lung Capacity

35. LIFE SATISFACTION &SUBJECTIVE PERCEPTIONS OF HEALTH • Subjective Health May Be More Important Than Objective Health • To Both Well-Being & Longevity • Common Measure: “How Do You Feel?” • “Pretty Good, Considering My Age!” • VS. “At My Age, You’re Sick Most of the Time.” • EX: Elderly Patient Eating Dinner In Hospital

36. IMPACT OF LIFE SATISFACTION “Feeling Healthy” Associated With: • Intact Marriages (+) • Adequate Finances (+) • Stress Free (+) • Cohesive Personality (+) • Comparison to Previous Health (+) • Comparison to Other Aged (+) • Retirement (-) • Death of Lived One (-)

37. SOCIAL CONSEQUENCES OF PHYSIOLOGICAL AGING • Decreases Capacity for Social Interaction • Limits Resources for “Social Exchange” • Increases Dependence – Impacts Family • Increases Health Needs: • Health Care Cost; Time for Medical Care • Decreases Resources (Time, Money) for Alternates • Biological Aging Masks Other Needs: • Abuse; Ailments Attributed to Aging: “You’re Old!”

38. CULTURAL IMPACT ON HEALTH • Decreased Animal Meat/Increased Vegetables  Decreased Cholesterol/Cardiovascular-Japan • Increased Fish & Salt Intake  Increased Hypertension – Japan • Lower Fat  Lower Hypertension • Rural African Blacks vs. African Americans • Ethnic Cultures Which Discourage Members From Caring for Health (Mammograms)