Three categories of aging

Young-old: older people who are in generally good health, financially secure, socially integrated; age range usually 75 or younger but can vary.

Old-old: typically over age 75; suffer from at least one debilitating physical, psychological, or social deficit; require supportive health care

Oldest-old: 85+; dependent on other people for almost everything.

Aspects of aging

Biological: age-related changes in appearance, vision, agility, strength

Psychological: adjusting to physical changes that accompany aging, coming to terms with memory loss & reduction in reaction times and information-processing

Social: changes in our self-concepts from growing old, which reflect cultural beliefs and changing social values.

What bothers people about getting old? Main fear—becoming dependent on

other people due to mental decline; increasing isolation and loneliness

Most of us have a need to remain intellectually vigorous and socially connected to others; the threat of losing these things is paralyzing.

Most dread going to a nursing home.

Physical changes in aging

Hair becomes thinner Skin becomes less elastic, more wrinkled and dry;

may have “age spots” Hair turns gray (body loses ability to produce

melanin, the pigment that colors hair. Hair turning gray correlates more accurately

with biological age than any other physical change.

Older adults lose an inch or so in height and several pounds in body weight because of a decline in bone calcium & loss of muscle tissue

Sensory changes

Vision changes—pupil becomes smaller and lens cloudier; presbyopia (become more far-sighted)

Hearing loss—25% of adults between 50 and 80 suffer significant hearing loss; declining ability to hear high-pitched sounds is called presbycusis.

Smell & taste decline with age. Old people lose taste buds.

Physical peak and decline

People reach physical peak around age 30. After that, they’re in a period of senescence—

a gradual decline in physical strength, sensory acuity, reaction time, and cardiovascular strength.

Rate of senescence depends on genetics and health habits. You can slow it down by lifestyle changes.

Signs of senescence

Reduced lung capacity Increased body mass index due to loss of

lean body mass (starting at age 20, you lose 7 lbs of muscle tissue per decade; this rate accelerates after age 45)

Loss of muscle strength Decreased metabolism **Eating well and exercising will prevent or

reverse these declines.

Aging and Disease

80% of people over age 70 have at least one chronic health condition

Biggest killers of older people: heart disease, cancer, stroke

People get sick when they’re old because their immune systems have decreased.

Chronic health conditions from most to least common Arthritis Hypertension Hearing impairment Heart disease Cancer Cataracts Diabetes Stroke, visual impairment, and varicose veins

(equal in frequency)

Memory and intelligence

Neural processing slows with age Memories begin to decay. By age 80, people have lost 5-7% of brain

weight Intelligence doesn’t really decline with age,

but there are wide differences in how you use your intelligence in later years.

Use it or lose it--By remaining intellectually active, you can prevent decline in intellectual or processing abilities.

Dementia and Alzheimer’s Disease Dementia is a dramatic deterioration in

reasoning ability and memory, caused by strokes, tumors, brain infections, alcohol abuse, or Alzheimer’s Disease.

The leading cause of dementia (accounts for 57% of all dementias)

AD strikes 3% of population by age 75 and kills 100,000 Americans each year.

Symptoms of AD

First stage: subtle cognitive changes, especially in short-term memory. Routine tasks become harder.

Second stage: Impairments in a number of higher mental functions (reading, writing, arithmetic)

Third stage: seizures and striking changes in language

Aphasia and apraxia

Aphasia: can’t find the right word to express thoughts

Apraxia: loss of memory for muscular movements, such as brushing teeth; can’t carry out basic “activities of daily living”

These are the two criteria most often used to informally diagnose AD.

Differences of AD brain in autopsy Currently, an autopsy is the only definitive

test for AD. MRI can provide clues, though. Neuritic plaques seen on autopsy: clumps of

degenerative nerve cells. Neurofibrillary tangles are seen as well. Plaques and tangles appear mostly in the part

of the brain that produces acetylcholine, which is found in reduced levels in people with AD.

What causes AD?

Genetic vulnerability is a big factor. No one knows the cause, but the reduction of

acetylcholine seems to be involved. Drugs such as Tacrine, Aricept, and

Namenda slow the rate of decline by increasing neural activity in remaining healthy acetylcholine neurons.

Regular use of ibuprofen and anti-inflammatories may ward off AD by preventing brain inflammation.

Depression in older people

Slightly more common in older people than rest of the population (1 in 6 will suffer clinical depression in the older population)

Generalized anxiety also more common Depression is more likely because of activity

restriction due to chronic illnesses, grief over loss of loved one, financial problems, and lack of social support.

Nursing home residents are especially prone to depression.

Death

Older people die of degenerative diseases—cancer, stroke, heart failure, or just general decline that predisposes them to infectious disease or organ failure.

Actual death in older people is usually easier; the terminal stage is shorter because there’s more than one biological competitor for death.

More likely than other age groups to achieve death with dignity.

Why do some people live into their 90s and 100s? Some people are less likely to have

preexisting or chronic health conditions due to stronger genetic/biological constitutions.

Psychosocial conditions are important—those with close family ties live longer, especially ties between a widowed parent and adult children.

Reduced satisfaction with life and depression predict health declines among elderly.

Women living longer

Women live about 6 years longer than men. Women may be more biologically fit than

men. Could be something protective about the X chromosome or something about estrogen & prolactin.

Male death rates are higher at all ages of life. More likely to take risks.

Women have more social support than men, which offers a protective benefit for them.

Health focus for elderly

No longer on the reduction of mortality Focus is more on improving the quality

of life.

Is there a right to die?

1990: Congress passed Patient Self-Determination Act, requiring that Medicare and Medicaid health care facilities have written policies and procedures concerning patients’ wishes for life-prolonging therapy. (Includes DNR: do not resuscitate)

Derek Humphrey’s book Final Exit, which is a how-to manual for how to commit suicide or assist suicide for the dying. Huge seller.

1975: 41% of Americans believed that someone in pain with a terminal illness had a right to die; in 1999, 61% believed it.

Euthanasia vs. Assisted Suicide Euthanasia: the act of ending someone’s life

who is suffering from a painful terminal illness; illegal in the U.S. but legal in some countries.

Assisted suicide: helping someone commit suicide (“victim” has more control over the situation and actively chooses to die)

Public support for assisted suicide is increasing; for euthanasia, it’s decreasing.

Stages of Dying (Kubler-Ross)

Denial Anger Bargaining Depression Acceptance This is not really a stage-like process;

people can skip stages or omit some. Can go back and forth.