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What Does it Mean to Age Successfully?
Many scientists would label this man as aging successfully, because he is relatively healthy at age 95.
However, nursing home residents can also be models of ideal aging, if they live fully in the face of disease.
But successful aging depends ON MORE THAN THE PERSON. The wider world must offer people support to function at their best.
The person- environment fit is essential.
3 Basic Aging Principles/Definitions

Normal aging changes: Progressive signs of physical deterioration that occur with age
We all experience these changes but at different rates.
Age-related chronic diseases: chronic illnesses at the endpoint of normal aging changes
Ex.: Bone density loss, when extreme, is called osteoporosis.
Many are not fatal but cause problems handling daily life.
ADL (activities of daily living) impairments: difficulties in performing everyday tasks necessary for independent living
Instrumental (household) vs. basic (self-care) activities
Become far more frequent among the old-old as the number of chronic diseases accumulates

Two Types of ADL Problems

Instrumental ADL’s
Trouble performing tasks such as cooking and cleaning, but can still get around
Common in advanced old age
Basic ADL’s
Problems caring for the self, such as dressing, sitting, or getting to the toilet
Relatively rare until the old-old years
Require full-time help or nursing home care
Age Risk of IADLS and Basic ADLS
Final Aging Fact: We all must die
Maximum human lifespan= the absolute limit of human life (roughly 105); has not changed much over the centuries
Possibly programmed into our human genetic code.
Or maybe wear and tear on our bodies simply makes death inevitable beyond this age.
A few people live even longer, into the 120’s.

But average life expectancy has increased dramatically, into the late 70s in the developed world.
Especially for well-off women in affluent countries



SES, Aging, and Death
In every nation, there is an SES-health gap– with affluent people living longer and enjoying better health.
Although the relationship between SES, aging, and disease shows up in middle age, its roots go back to health practices earlier in life.
Poor people are vulnerable to a host of life-shortening influences (poor health habits, lack of education about health, inadequate access to health care, etc.).
Don’t blame the person—Many of these forces are due to the “toxic” environment of being poor.

BOTTOM LINE : There are many interacting reasons why poor people tend to die sooner and develop age related diseases at a younger age.


Gender, Aging, and Disease
Basic principle: Women survive longer but are more frail.
Men are twice as likely to die from a heart attack earlier in life because estrogen protects against heart disease.
Women are more prone to illnesses that cause ADL problems but don’t kill.
But women rank higher on sickness indicators, such as seeing a doctor, throughout adult life.
Bottom line: Both nature (biology) and nurture (health sensitivity) explain why women outlive men in every developed world nation by at least 4 years.
The Aging Pathway and How it Varies by SES and Gender
Normal Vision Changes
Presbyopia=impaired near vision
universal change that happens in midlife
classic tip-off of being older

Poorer dark vision=cannot see as well in dimly lit places

More troubles with glare= being blinded by bright light shining in the eye

The Main Cause: The Lens
Lens gets cloudier

Less light gets to the retina= special probs. seeing in the dark
Light hits the more opaque lens= rays scatter, glare sensitivity


Interventions for “Older Eyes”
Use strong indirect lighting and avoid florescent lighting—especially on bare floors (produces glare).

Use adjustable lighting and larger numerals on appliances, and provide non-reflective surfaces.

Look into low-vision aids such as magnifiers.

Cataract surgery—for the end point of lens clouding—is an easy outpatient procedure.

Three top-ranking vision conditions currently have no cure.
Macular degeneration
Glaucoma
Diabetic retinopathy


Hearing Issues, Fact Sheet

Very common in later life, especially for men (1 in 3)

Most have an environmental cause - exposure to noise.

Hearing impairments may be worse than vision problems because they limit the ability to connect with the human world through language.

Presbycusis
The Classic Age-Related Hearing Loss:
Selective problems hearing higher pitched tones

Caused by atrophy of hearing receptors in the inner ear

Background noise (typically of lower pitch) overpowers the sounds people want to hear.

Traditional hearing aids--which magnify all sounds--don’t help much.

Hearing Interventions

Avoid noisy environments, such as crowded restaurants.

Install carpeting in the house (it absorbs noise) and replace noisy air-conditioners or fans.

Face people when you talk and speak more loudly
(reading lips can help).

Avoid elderspeak
Similar to infant-directed speech used with little children
Makes it sound like you are treating the person like a baby

For younger people:
Prevention is key. AVOID EXCESSIVE NOISE.
Motor Slowness: Fact Sheet
Characteristic of old age— a main reason why we have such prejudices against the old
(Think of the last time you were behind a slow older person at the supermarket.)

Caused mainly by slowed reaction time
Symptom of overall information processing speed change
Begins in late 20s or thirties, and gradually gets more pronounced (see also the discussion of fluid IQ)

Amplified by skeletal system disorders:
Osteoarthritis—wearing away of joint cartilage
Osteoporosis= bones porous and break easily
(Note: Hip fractures are a major risk factor for nursing home admissions.)

Interventions for Motor Problems
Be careful in speed-oriented situations.

Keep active but don’t overdo it (exercise can prevent osteoporosis; and even improve joint problems).

Modify person’s home to guard against falls:
Increase lighting, install low pile carpeting.
Install grab bars in dangerous places like bath.
Put shelves within reaching distance, and use doors that open easily.
IN GENERAL, make streets, sidewalks etc. more age friendly for older walkers and anyone prone to falls.

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Driving in Old Age
Vision, hearing and reaction- time problems converge to make driving more dangerous esp. in the old- old years.

The Issue and Some Solutions
The problem:
Driving is essential in our car-oriented society; giving up may mean having to enter a nursing home.
Not driving infantilizes people, forcing them to depend on others.
Solutions:
To weed out incompetent drivers, use tests that go beyond simple vision measures.

BUT MAINLY CHANGE THE ENVIRONMENT
Larger signs, better lighting on exit ramps, etc.
Build communities with stores within walking distance of homes.
Invest in transportation systems that don’t involve cars.

Dementia: Fact Sheet

General term for any illness that produces serious, progressive, usually irreversible cognitive decline

Prevalence low in the 60’s and 70’s, jumps in the old-old
(but some centenarians are still very cognitively sharp)

A long-term illness (the time from diagnosis to death is 4 to 8 years) in which every function gets progressively worse

Two main causes in later life are Alzheimer’s disease and vascular dementia
Symptoms
Early stages
Forget basic semantic information like address
Often a fuzzy in-between period where diagnosis is unclear
Person is aware of problems with thinking

Middle stages
Serious impairments in memory, language, and judgment
Inappropriate actions such as wandering and reckless behavior

Later stages
Bedridden, may be unable to talk, eat, or swallow

The course is variable from person to person.

More About the Two Types of Dementia
Alzheimer’s disease: neurons are lost.
Replaced by neurofibrillary tangles and senile plaques

Vascular dementia: small strokes
Impaired blood flow causes neural death

Difficult to distinguish
Two forms cause similar
symptoms
very old people with dementia
may have both forms
Research Findings: Alzheimer’s Disease
Exercise may be helpful in prevention because it reduces the risk of cardiovascular disease.
Major focus is on why amyloid, a core component of the senile plaques, develops.
There is a genetic predisposition: People with a special APOE marker are much more likely to develop the disease.
We are not yet close finding a cure or targeting the causes of this devastating disease.

Therefore the key lies in modifying the environment to provide the right person-environment fit.
Interventions: For the Patient
Early stages
Use external aids like note cards.
Consider enrolling in an early Alzheimer’s support group.
Consider medications.

Middle stages
Lock and put buzzers on doors—to prevent wandering.
Remove toxic substances and deactivate dangerous appliances (such as stove).
Consider admission to a NH Alzheimer’s unit.

Every stage
Be caring, loving, and supportive.

Interventions: For Caregivers
Issue: The person you love is now an unpredictable stranger.
Enroll in a caregiver support group to problem solve and get emotional support.

Look into nursing homes and other options.

Don’t take insulting comments personally. Realize it’s the disease talking, not the person.

Respect the person’s humanity.

Use this trauma as a redemption sequence– a chance to say “I don’t care what the world thinks, let me just show my love.”


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Options for the Frail Elderly: Some Facts
In collectivist cultures (and in the past) family members took on all the elder care, but this network is not in place like before.

Nations vary in whether they provide innovative quality elder care—with Scandinavia leading the way.

A big issue is whether society pays for “chronic care services.” In the US we don’t unless the person is in a nursing home and poor enough to qualify for Medicaid.

It’s a myth that families abandon their elderly. Children in every nation take responsibility for caring for parents, or for monitoring their care, when they are old and ill.

Alternatives to Institutionalization
Options for frail older people who don’t require nursing home care:
Continuing care retirement
communities
Assisted living facilities
Day care programs
Home health services

Basic fact: Medicare only
pays for cure oriented services,
so most of the options
are only available to the
relatively wealthy.


Exploring the 3 Elder Care Options
Continuing care retirement community:
Person enters relatively healthy then gets care at different levels when needed.
Offers peace of mind: “I don’t have to burden my children and I know where I am going if I need a nursing home.”
Assisted living:
Specifically for elderly with instrumental ADL problems
Fastest growing option– offering care in a more homey, humane environment than a nursing home
Day-care programs:
For older adults who live with relatives
Gives family a place to take the person during the day, when they are afraid to leave loved one at home
Nursing Homes, the Last Stop

Designed for people with Basic ADL impairments

Residents are mainly very old and female

Entry often occurs after trauma such as breaking a hip, or—in many cases– when the person has dementia

People without families (or the money for assisted living facilities) are most at risk of entry

Vary dramatically in quality, but in general leave a good deal to be desired

The primary caregiver, the CNA, is terribly underpaid, but some people find this a very fulfilling job.