Heathy aging and Health-Related Quality of Life

Question 1

Life Expectancy of gender and age

Answer 1

@ birth = 83 y [85 y (F), 81 y (M)]
1990: 81 F, 77 M
10 y increase from 5 decades ago
Among highest in developed world (#19)
@ age 65: 21.6 y (F), 18.5 y (M) [6y ↑ since 60s]
Current 20 y acceleration period: “Baby-boomers”

Question 2

If you make it to age 65 your life expectancy goes?

Answer 2

down
@ age 65: 21.6 y (F), 18.5 y (M) [6y ↑ since 60s]
Current 20 y acceleration period: “Baby-boomers”

Question 3

ratio of old people to kids

Answer 3

2015: 1st time in Cdn history, ≥ 65 y surpassed 0-14 y
2036: 1/4 (25%) Canadians ≥ 65 y (>10M), vs. 14% in 2009

Question 4

people are likely to live the longest in___

Answer 4

People are likely to live longest in developed countries with state-funded healthcare systems like Japan, Canada, UK, Australia all with average life expectancies > 80 years.

Tiny tax haven of Monaco – notoriously wealthy inhabitants + compulsory state-funded health service – highest life expectancy 89.5 years (93.5 F/85.6 M), 5 years higher than anywhere else on earth. Lowest life expectancies: several African countries 50-55 years.

Question 5

Percentage of canadian semiors health

Answer 5

6% poor
16% fair
38% good
28% very good
12% excellent

Question 6

What is Healthy Aging?

Answer 6

Age @ death = 25% genetics/heredity
Non-genetic factors (e.g. lifestyle behaviours) affect development of age-related diseases
“Successful aging”: Within normal aging, extrinsic lifestyle & psychosocial factors can either have a compounding effect on the aging process, or play a neutral or positive role.

Absence of disease & related disability + high cognitive & physical functional capacity + active engagement in life.

Question 7

“Successful aging”:

Answer 7

implies the inclusion of physical, mental & social health, & the potential for improvement in all of these realms.

Question 8

“Compression of Morbidity”

Answer 8

Previously: Increased life expectancy viewed as pre-cursor to certain pandemic of disability & ill health
Now: Possibility of good health until very end of life
= Dominant paradigm for healthy aging.

Question 9

Average life expectancy continues to rise, but

Answer 9

maximum lifespan has not increased – however, onset of morbidity & disability can be postponed, extending adult vitality further into that fixed lifespan & compressing the period of disability to just a brief time before death.

Question 10

“Compression of Morbidity”
increasing life expectancy, can it be compressed?

Answer 10

With increasing life expectancy, the ideal is that the increase in onset age of morbidity outpaces increases in total life expectancy  this creates compression of morbidity at the end of life.

Morbidity cannot be compressed indefinitely – but the possibility exists for a long healthy life, followed by a relatively rapid terminal decline.

Question 11

Evidence for compressing morbidity

Answer 11

20-year follow-up of Penn University alumni: Among those who were physically active non-smokers with recommended body weight (low risk group), onset of disability was delayed by 10 y, vs. inactive overweight smokers (high risk group)
Age 50+ running club vs. non-running healthy community controls followed for 21 years: Runners developed disability at only 1/4 the rate of non-runners, & onset of disability delayed by 14-16 y in runners group vs. non-runners.
Studies also compared postponement of morbidity (10-16 y) vs. mortality (3-7 y) in these groups  proof-of-concept for “compression of morbidity”.

Question 12

How will you spend your last 10 years? (video)

Answer 12

https://www.youtube.com/watch?v=qNkzVz5Aljk

Question 13

Summary of healthy aging and compression of morbidity

Answer 13

Healthy aging implies maintenance of physical, mental & social health

The compression of morbidity hypothesis suggests that positive lifestyle factors can help delay morbidity to a greater extent than the increases in life expectancy we have witnessed over many decades

Question 14

What Changes Occur with Aging?

Answer 14

Decreases in Fitness (VO2max)
Changes in Body Comp (Increased Fat Mass)
Osteoporosis (Decreased Bone Density)
Sarcopenia (Decreased Muscle Mass)
Changes in Brain

(** Many characteristics associated with aging are not due to aging at all, but rather result from the neglect & abuse of our bodies & minds! **)

Question 15

60 year old Swede commercial (1973):

Answer 15

http://www.youtube.com/watch?v=PMD35tUh-Ek

Question 16

Changes in Maximal Oxygen Uptake over the Lifespan

Answer 16

8% loss per decade 24-56
12% loss per decade 46-68.5
5.8% loss per decade 41-75

Question 17

Changes in Body Composition with Aging

Answer 17

age 67 -> age 79 (fatmass increased, skeleral muscle decreased)

Question 18

Osteoporosis

Answer 18

Abnormal decalcification of bones causing loss of bone density.
Bones are porous & fragile: Break with smaller stress than would occur in healthy (dense) bones.
2 million Canadians: 1 in 4 F, 1 in 8 M > age 50
Common sites of fracture: Hip, vertebrae, wrist

Question 19

Lowering Your Risk of Osteoporosis

Answer 19

Get adequate calcium
Exercise regularly
Drink alcohol only moderately
Don’t smoke
Let the sunshine in

Question 20

Benefits of Regular Physical Activity

Answer 20

Greater ability to live independently
Sustained/increased lung capacity
Maintain strength, flexibility, posture, balance
Reduced blood pressure & healthier blood lipids
Protection against osteoporosis, sarcopenia, arthritis, T2D

Better physical & mental health
Increased immune system effectiveness
Better protection from MI, & greater chance of survival
Fewer symptoms of anxiety, depression, dementia
Lower risk of dying from variety of diseases

Maintenance of mental agility & flexibility, response time, memory, hand-eye coordination ** Fluid intelligence **

Question 21

The Aging Brain

Answer 21

grey matter mass loss

Question 22

Alzheimer’s Disease:

Answer 22

Progressive neurological disease, not normal aging; begins like normal dementia, can die when lose capacity to regulate elementary body functions: malnutrition, dehydration, infection or heart failure. More common in women: 30% by 85 y.

Question 23

Issues in Aging: Nutritional Needs

Answer 23

Nutrients Often Lacking:
Folate Magnesium
Vitamins: D, E, B6, B12, C Zinc
Calcium

Question 24

Issues in Aging: Nutritional Needs reason?

Answer 24

physically not being able to make the food,
not enough momney for supplments

Question 25

Issues in Aging: Substance Misuse & Abuse

Answer 25

Over two thirds of seniors take some medication in a 2-d period, with over 50% taking 2 or more.
Most commonly misused drugs are sleeping pills, tranquilizers, pain medications & laxatives.
Might be innocent (forgetfulness; multiple Rx unknowingly), or just don’t like how they feel without drug.
Older adults take longer to metabolize drugs & alcohol.

Question 26

Issues in Aging: Depression

Answer 26

20% Seniors suffer from mild to severe depression (as high as 40% in long term facilities)
Often seen as a normal part of aging
Challenges Faced by Seniors
Declining health
Social isolation
Physical limitations
Caring for loved ones
Loss of loved ones

Question 27

Issues in Aging: Driving Risks

Answer 27

Common Accidents Involving Seniors

Pulling out / Changing lanes without looking
Careless Backing up
Inaccurate turning
Failure to yield right of way
Difficulty reading traffic signs
Reaction time

Question 28

what age causes the most fatally injured drivers

Answer 28

16-19
75+
20-24

Question 29

Issues in Aging: Grief

Answer 29

Aging associated with “loss”: friends, peers, physical appearance, possessions, health, independence
Can be loneliest most intense period of person’s life
Death of loved one can cause anxiety, guilt, anger & financial concern
Grieving may continue for many years (may accept or avoid), may continue to feel emptiness
Widowed husbands whose wives die suddenly have a greater risk of death than husbands whose wives die slowly
Widowed wives whose husbands die slowly have a greater risk of death than wives whose husbands die suddenly

Question 30

Issues in Aging: Suicide

Answer 30

More common in elderly men than women
Men >80: Highest suicide rates in Canada
Main Factors: Terminal illness, loss of economic status & social power, social isolation, depression

Question 31

Death & Dying: 5 levels of death

Answer 31

Functional death
Cellular death
Cardiac death
Brain death
Spiritual death

Question 32

death and dying: denial

Answer 32

Partially responsible for living empty purposeless lives…postpone what you know you must do… live in prep for tomorrow or in memory of yesterday

Question 33

Kubler-Ross’s 5 Stages of Adjustment to Death

Answer 33

denial - no, not me
anger - why me?
bargaining - yes, me, but…
depression - yes, its me…
acceptance - yes, me; and im ready

Question 34

% of individuals per Self-Rated Health category over time:

Answer 34

health declines 5 years before death