Ch.5: Longevity, Health, & Functioning Flashcards
Average longevity (life expectancy)
the age at which half of the individuals born in a given year will have died
2 factors that affect longevity
Environment and Genetics (25-30%)
Between 1921 and 2011, the gain in overall life expectancy for Canadians was nearly 25 years, largely due to reductions in ________________
infant mortality
In Canada, is life expectancy increasing or decreasing?
Increasing
Canadian life expectancy at birth in 202o for women and men
Women: 85.9 years
Men: 81.1 years
According to WHO, women in all countries outlive men.
What is the reason for this?
- men are more likely to smoke, drink, do violent acts
- heart disease come early in men
- men are more susceptible to infectious diseases
The gender gap in men and women life expectancy at birth is closing. Why is that?
- women are starting to work more
- 80% of all suicide deaths are men
- 97% of workplace accidents are men
- men are taking better care of themselves
WHO definition of health
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Another way to measure health is counting how many chronic conditions they have. What is one finding in this study?
There’s variability. Some people don’t have diseases at 80
Self-rated health
- a person’s subjective evaluation of his/her general health
- if somebody asks you how healthy you are
- has excellent predictive value for illness & mortality
- It’s a more valid & powerful predictor of morbidity & mortality than any other combination of objective or self-report measure
People with more positive self perceptions of aging live 7 1/2 years longer than people with negative perceptions of aging. Why is that?
People with more self perceptions of aging practice more preventative health behaviors.
Why do older adults’ beliefs about aging matter?
- Older adults who believe pain, fatigue, depressed mood, dependency upon others, and decreased libido are a normal part of aging. They are less likely to seek healthcare, and therefore are at risk for being undertreated.
- Older adults with low expectations about aging are less likely to engage in physical activity and other preventive behaviors like having regular physical examinations, eating a balanced diet, using a seatbelt, exercising, and limiting alcohol and tobacco use.
Leading causes of death for younger people
Accidents, Suicide
Leading causes of death for older people
Chronic conditions such as cancer, heart disease
Disability
- often arises with chronic conditions
- “any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being” - WHO
Activities of Daily Living (ADL)
- basic self-care activities
- fundamental functioning
- eating, bathing, dressing, transferring, toileting, walking or moving around
As chronic condition _____________ (increase/decrease), that’s where we’re seeing more disability
increase
Instrumental Activities of Daily Living (IADL)
- complex everyday tasks
- these are the things that you need to do to live independently
- housework, grocery shopping, money management, medicine, getting around outside, telephone use, laundry, preparing meals, going places outside of walking distance
There is a worldwide obesity epidemic, where:
the BMI has more than doubled since 1980
Obesity in older adults contributes to increased risk of _____________, ___________, and ______________
Type 2 diabetes, hypertension, and heart disease
Comorbidity
- if you got one or more thing going on at the time
- co-occurrence of multiple chronic or acute diseases and medical conditions within an individual
- with increased age, the risk of having more than one chronic condition increases
Polypharmacy
- the use of five or more medications
- According to Canadian surveys, prescription drug use increases with age, increasing from 12% among 6-to-14-year-olds to 83% among 65-to-79-year-olds
Polypharmacy in the older adult population comes with risks due to age-related differences in ______________ and ________________
Pharmacokinetics and Pharmacodynamics
Pharmacokinetics
- what the body does to the drug
- dose of drug -> drug concentration in target organ over time
- Absorption of drug reduced with age due to loss of mucosal intestinal surface (you need that surface to absorb the drug), decrease in gastrointestinal blood flow and reduced gastric acidity. You’re not absorbing the drug as well with age.
- Drug distribution impacted by the changes in body composition (Sarcopenia=muscle loss, we also lose total body water and because of these two there’s relative increase in body fat
- Reduction in total liver size and in liver blood flow leads to a decrease in the levels of drug metabolizing enzymes. Not gonna metabolize drug quickly.
- Decreased kidney size and decreased renal blood flow with increasing age reduces rate of renal excretion. Water soluble drugs are gonna accumulate in your body if your kidneys are not excreting it quickly enough.
Pharmacodynamics
- what the drugs do to the body
- drug concentration in target organ over time -> mechanism and magnitude of drug effect
- Receptor binding and signal transduction
=Response to benzodiazepines is increased
=Response to warfarin is increased
=b1 and b2 receptor responsiveness is decreased (e.g. response to salbutamol and terbutaline)
=a2 receptors responsiveness is decreased (e.g. response to clonidine and methyldopa)
=Response to Opioid analgesics increased - Physiological effect
In older people it is often found that there is an impairment in aspects of homeostasis:
=Temperature regulation, blood pressure regulation, bladder function, blood sugar levels, fluid and electrolyte balance
=Due to the impaired homeostatic mechanisms older people have an increased susceptibility to drug induces side effects such as urinary incontinence, urine retention, confusional states, hypothermia and postural hypotension
Older Adult’s use of the healthcare system
Older adults are frequent users of healthcare
- but the per capita spending on older adult healthcare has actually decreased between 1998 and 2009
- the belief that older adults are “to blame” for increases in health expenditures is likely to reflect ageism
- Older adults’ healthcare use is strongly related to comorbidity
Healthcare Rationing
- denying patients the potentially beneficial health care services
- ex: COVID issue- ventilators
What are 3 components of Rowe & Kahn’s model of successful aging?
- active engagement with life
- no disease and disability
- maintain cognitive and physical function
Criticisms of the Rowe & Kahn’s model of successful aging
- an unrealistic focus on the complete absence of disease
- a neglect of structural forces that may limit resources to support successful aging (e.g., financial resources)
- existing criteria may inadvertently promote ageism
- a lack of criteria that are generated by older adults themselves
Baltes & Baltes’ SOC model of successful aging
- Selection: choose areas of focus
- Optimization: maximize performance in those areas of focus
- Compensation: make up for losses in one area with gains in another
The idea is when you age, you’re more likely to encounter losses
Criticism of Baltes & Baltes’ SOC model of successful aging
Compensation and optimization strategies become harder to use as resources decrease with age
