Social determinants of health & ageing Flashcards
Define Allostasis
- A dynamic regulatory process
- How the body maintains stability through change in various physiological systems(eg autonomic nervous system, HPA) in response to internal& external demands ( eg noise, hunger). These systems are designed to operate within broad ranges, by constantly modifying “set points”
Define homeostasis
- Different from allostasis
- Maintaining constant internal state
What is allostatic load
- “The wear and tear on the body” that accumulates as an individual is exposed to repeated or chronic stress
- The cost of chronic exposure to elevated or fluctuating endocrine or neural responses resulting from chronic or repeated challenges that the individual experiences as stressful.
- The more/ more frequent the stress put on an individual is, the greater the ‘wear& tear’
Outline the ‘protection-vs-damage paradox’ using cortisol and epinephrine as an eg
PROTECTIVE: cortisol& epinephrine help mobilize energy in acute stress, help immune cells move to sites in the body to combat infection
-DAMAGING: but if their secretion isn’t turned off, they can promote fat deposition, insulin resistance, hypertension & immunesuppression ( the opposite of the effect above), damage to nerve cells
Outline the health effects of high cortisol
- Increased lipid (LDL cholesterol) in the blood
- Decalcification of bone
- Deposition of abdominal fat
- Damage to the hippocampus
- Muscle wasting
- Impaired reproductive function
- Suppression of immune function
What is the role of early life programming
- A way of the social environment ‘getting under the skin’
- In utero& early life exposures during critical or sensitive periods of development can modify developing physiological systems and have long-term effects on behaviour and health
What are epigenetics
- One mechanism by which the genome adapts to the environment
- the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.
- Eg adding methyl groups or histone modification
- As a result the genes have different patterns of expression or silencing depending on the environment
- EPIGENOME= PHENOTYPE
What is APOE-4 a genetic risk factor of?
Alzheimer’s disease
Outline the cumulative advantage/disadvantage ( CAD) theory
- Process where early structural advantage/disadvantage results in systematic divergence of life course processes( health) over time
- A ‘favorable relative position becomes a resource that produces further relative gains’
- Evidence of CAD in income and wealth inequalities in health
State the theories of ageing & old age
- Inequalities in ageing
- Disengagement
- Structured dependency
- Third & fourth age
What is the third and fourth age theory ?
- Some elders are healthy and thus third agers
- Others are frail and thus fourth agers
- No fixed age cut-offs; move through at different rates= long third age 50+
- Freedom from pressure of family & work
- Rejection of being ‘old’ until 4th age
- Short 4th age of illness & incapacity
- May move in and out of 4th age if temporarily incapacitated
What is the disengagement theory?
- Progressive loss of roles ( retirement, widowhood)
- Loss of social relationships
- Social& psychological withdrawal from society
- Function of industrial society( compare to pre-industrial societies, where the elderly retain skills& roles
- Challenge for the individual of adjusting to loss of roles
What is the structured dependency theory?
- Compulsory retirement
- Economic dependency due to low pension/poverty; disincentives to work
- Social dependency: state provision of long-term care- creates ‘grateful/passive recipients’
- Explains exclusion of older people from society ( disengagement); ageism
