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Chapter 1,12,3,5.doc

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Health Studies
Anna Walsh

Chapter 1- Introduction and Basic Concepts in Aging  Main focus of the book is optimal aging  Aging processes are plastic- how we age and the rate at which we age are balanced between resources to which we have access and our exposure to various toxins, both of which are, in part, reflections of the choices we make.  Psychosocial gerontologist focus more on describing what happens cognitively, emotionally, and socially as we age, w/ a view toward identifying factors that promote positive aging or increase the risk of negative aging  Biogerontologists focus on describing what happens at the molecular, cellular, and organ system levels, models emphasize factors that affect the rate of aging. Eg free radicals can accelerate deterioration, but antioxidants may decelerate it  Health psychology and behavioural medicine provide clear documentation that psychosocial factors can affect physical health  Psychosocial risk factors can be protective factors as well  All 3 studies are in consensus about ^  Cholesterol-lowering agents and Viagra are among the most commonly prescribed meds in this country.  Birren, Bulter, Greenhourse and Yarrow (1963) first differentiated between aging per se and disease they found that nearly all of the deficits generally associated with aging were found in the older men with subclinical disease, but not in the optimally healthy men. One exception was neuronal slowing, which even the healthiest older men manifested. Study showed that older adults can enjoy good health  The recognition that optimal aging is possible led to longititudinal studies such as the Normative Aging Study and the MacArthur Study of Successful Aging w/ the goal of understanding healthy aging  Gerontology- since its inception, it has recognized that interdisciplinary endeavors are required for understanding the aging process  Biogerontology has increased our understanding of the genetic and cellular mechanisms of aging  Psychology, sociology, and anthropology are also essential to understand aging  Many of the cognitive and physiological declines associated with normal aging can be reversed  Not only are we fragmented within fields, but we are also becoming fragmented across them. Less communication between the fields  Journal of Gerontology; Biological Sciences and Medical Sciences & Psychological Sciences and Social Sciences  Although the biological process underlying the aging process were universal, the rate at which we age is largely a function of culture  How we live and the resources we can use profoundly affect the way we age as much, if not more than our genetic endowment Basic Definitions  It is most common to define young-old persons as those between the ages of 65 and 79, old-old individuals as those between 80 and 99 and the oldest-old, or centenarians, as those who are age 100 or older  Young-old individuals are typically relatively healthy and quite functional  Old-old are more likely to be physically and cognitive frail and in need of support  Centenarians are a class unto themselves, and it is more difficult to make generalization about them  Age- the number of years a person has been alive  Cohort- a group of people who share the same birth year or sometimes those who shared historical events  Period- the time at which the measurement or assessment occurred  If a particular phenomenon always changes with age, regardless of cohort or period, then it is an age effect. If the change is specific to a particular cohort but does not occur in any other group, then it is a cohort effect. If all cohorts or ages change at a particular point in time, then it is a period effect  Period effects- sometimes general shifts in the whole culture, or even temporary shifts in the whole culture, or even temporary shifts, may be confused w/ aging effects  Life Span- the absolute length of time a member of a give species may live (humans 120yrs)  Life Expectancy – the length of time an average member of a particular cohort can expect to live- the age at which half of a cohort will have died  Age- specific life expectancy- the avg number of years that members of a given cohort who have reached a specific age can expect to live  In nearly every country women enjoy higher life expectancies than men  Calculating life expectancies does not take into account unforeseen historical circumstances n difficult to project for immigrant groups  Mortality- refers to death  Morbidity refers to illness  All cause mortality ( the total number of deaths in a population)  Morbidity rate refers to the prevalence or total number of cases of a specific disease in a population, whereas the incidence of illness refers to the number of new cases in a year  Acute illnesses are often self limiting and/or can be successfully treated with medicines  Chronic diseases are often incurable, and treatment focus is on the management and the delay of disability rather than cure  Nearly 80% of ppl over the age of 65 have atleast one chronic disease  In late life the acute versus chronic distinction can become blurred  The presence of a chronic illness may also reduce the ability to recover from an acute incident, n acute illness can give rise to a chronic illness  Functional health- the ability to perform daily tasks, such as shopping, paying bills, preparing meals, or getting around, called instrumental activities of daily living (IADLs), and caring for oneself, such as bathing, dressing, and eating, which are called activities of daily life (ADLs)  Optimal Aging-allows for the recognition that there may be different ways of aging well, that people begin with different configurations of vulnerabilities and resources that afftect how they age, and that this is a process that continually unfolds  Optimal Aging- is a multidimensional construct that involves avoiding the accelerating agents that promote premature illness and disability, as well as developing protective factors that delay or decelerate the aging and disease processes to maintain good physical, cognitive, and mental health. At the heart of optimal aging is the concept of wisdom  The development of wisdom in adulthood allows individuals to help other to optimize capacities despite illness and disability, to find meaning and purpose in life,, and to face disability and even death with relative equanimity Chapter 12 What is Optimal Aging?  Optimal aging is more than just good health; it must include notions of adult development as well Models of Optimal Aging  Optimal Aging- allows for the recognition that there may be different ways of aging well, that people start with different configurations of vulnerabilities and resources that affect how they age, and that this is a process that continually unfolds, depending in part on choices that individuals make  Most models are multidimensional  Models of optimal aging are also teleological, in that they specify a desirable outcome or telos (goal). A telos reflects the assumptions of the dominant paradigm, as well as cultural values Rowe and Kahn’s Model of Successful Aging  Rowe and Kahn identified three components of successful aging avoidance of disease, maintenance of high cognitive and physical function, and an active engagement with life  The model is hierarchical: good health is thought to enable the other two. Avoiding disease is defined not only as the absence of overt disease but includes other risk factors as well. Absence of disease allows for the maintenance of good cognitive and physical function. In turn, good cognitive and physical function is necessary (but not sufficient) for active engagement with life. Active engagement is the relationships with other people and productive behaviour Avoidance of Disease  There are three critical elements in the prevention of chronic illnesses in late life, all of which are related to health behaviour habits: avoidance of toxins, good nutrition, and exercise  Genetic defects play a role primarily in premature death. Once individuals have survived into later life, their own behaviour plays a much greater role infuture longevity  Bad nutrition- diets too high in fats, simple sugars, and protein, without fresh fruits or vegetables, and with too many calories promote cardiovascular disease, diabetes, and cancer  Supersizing of portions, combined with increasing inactivity,a re considered to be factors in the obesity epidemic we are currently experience  What constitutes good nutrion for any particular individual depends on a variety of factors, including age, gender, family history of illness, body type, and a host of other factors  Caloric restriction clearly decelerates the aging process in lab animals (especially those that are cancer prone) and obesity equally clearly accelerates aging in humans  An avg weight seems to be most protective of god health in later years and losing weight in late life has been associated with heightened risk of mortality  The need for supplements may also depend on age, genetic endowment, and health behaiour habits (heart disease- folic acid, osteoporosis- Ca and Vit D, smokers and asthmatics- Vit C n antioxidants, alcohol drinkers- Vit B)  Moderate exercise aging decelerator  Aerobic exercise maintains or improves cardiovascular function and regulates weight. Weight bearing exercise maintains muscle and skeletal mass, preventing (or delaying) osteoporosis. Exercise may also regulate endocrine and immune function. Older adults with a regular exercise program have fewer respiratory illnesses  Daily exertion as part of normal routines is more beneficial than occasional strenuous exercise Maintenance of High Cognitive and Physical Function  The same factors that maintain good cardiovascular function in late life also maintain good cognitive function- that is , good diet, exercise, and avoiding toxins  Exercise is cognitive activity too  Older adults recovering from even serious illnesses can regain high levels of physical functioning (ie through physical, speech, and occupational therapy) Active Engagement with Life  Rowe and Kahn define active engagement with life as a high level of social support as well as productive work. The benefits of social support include helping to maintain good mental and physical health, both directly and indirectly. Marital satisfaction tends to increase in late life. Marriage tends to promote longevity, especially for men. Caregiving and family and friends are also good  An older couple, especially an older married couple, working together on a memory task can perform as well as a younger person. By collaborating, they can compensate for faulty memories  Social support is not always beneficial- negative interactions, bad advice,  Dysfunctional autonomy- one member of an old-old couple is released from the hospital and the spouse becomes a primary caregiver, although the spouse is also disabled (they pretend they don’t have any problems) because they are scared of being split up and one being institutionalized. As a result they do not seek help from medical professionals  Cargiving is one form of productive work engaged in by elders. Another example is volunteer work  In rural areas elders often are the lifeblood of the community  Inner development ( to be discussed later) Vaillant’s Model of Aging Well  Vaillant proposed a model that has six criteria. Three of the criteria involve physical health: 1) No physical disability at age 75 2) good subjective physical health (no problems with instrumental activities of daily living 3) length of undisabled life The other three concern social engagemtn and productive activity: 4) good mental health 5) objective of social support 6) self rated life satisfaction in eight domains: marriage, income-producing work, children, friendships and social contacts, hobbies, community service activities, religion, and recreation/sports  He drew on three longitudinal studies: Grant study of Harvard men, a study of inner city men at risk for delinquency and women from the Terman study of gifted children  These studies followed their participants from childhood or adolescence to the present  Premature death was predicted by genetic endowment but once having achieved late life, individual health behaviour habits were more important  The variable that predict morbidity and motality in midlife may not remain predictors in later life  Predictors of successful aging- no heavy smoking or alcohol abuse before 50,s ome exercise and no obesity n stable marriage  Other potential predictors include education, and depression  The Harvard men in Vaillant’s study, most of whom were upper class, and the iner city- men, most of whom were from lower social classes. Health in the latter group was much poorer overall, in larger part due to poor health beaviour habits. The inner city men who graduated from collge enjoyed the same level of good health in later life as the Harvard men  The use of mature defenses, including altruism, humor, suppression, and sublimation, was an important component of successful aging  Vaillant described mature defenses not only as coping strategies but also as virtues: ---. Doing as one would be done by (altruism); artistic creation to resolve conflict and spinning straw into gold (sublimation); a stiff upper lip, patience, seeing the bright side (suppression); and the ability not to take oneself too seriously (humor)  Aldwin transformational coping: the ability to perceive benefit in stressful situations and to resolve them in a manner that maximizes whatever gain can be derived from the problem and that facilitates the growth of positive characteristics such as empathy, altruism, and an increase in mastery  Vaillant’s model is similar to Rowe and Kahn’s model in its emphasis on physical health, social integration, and productivity  Vaillant concluded that wisdom could be equated with the use of mature defense. Aldwin also linked transformational coping with wisdom but argue that this is just one path toward wisdom Wisdom an Optimal Aging  The most common definition focuses on the cognitive aspects  “fundamental life pragmatics”- which include a rich factual-knowledge base and the ability to think contextually and relativistically  Mckee and Barber focus on perspicacity ( the ability to see through illusions) whereas Sternberg equates wisdom with reasoning ability and perspicacity  Labouvie-Vief defined wisdom as encompassing both cognitive and emotional complexity  Birren and Fisher identify three aspects: cognitive, affective and conative, which refers to motivation  A personological approach that encompasses the integration of cognition with affect, affiliation, and social concerns. Wisdom thus reflects an advanced development of personality  Wisdom is a multidimensional construct that includes three domains: cognition, personality, and interpersonal processes  Cognitive component can be loosely defined as perspicacity or insightfulness, which is based on oth knowledge and higher order cognitive processes, such as the ability to comprehend complex constructs and to use dialectical and relavistic modes of thinking.  The personality aspect of wisdom  ego processes, including emotional balance, detachment and integrity, which are all based on self knowledge.  The interpersonal modes justice, generosity, and compassion, which some of cultures refer to as “character’  It is an integration of the three domains  Can be contextual or culture specific  Aspects of wisdom transcend cultural bounds  Wise action is that which is focused on long term goals rather than immediate gain or gratification  Tornstam theory of “gerotranscendence’ – aging can be associated with a metatheorectical shift toward a picture of the world that a Zen Buddhist would probably have. He notes that geronologists misinter[ret older person’ lack of interest in social busyness as a sign of patholocial disengagement rather than an increase propensity for comtemplation  Gerotranscendence involves a forward looking redefinition of reality that treats one’s development as a work still progress. Implies a certain level of detachment  :Levenson arguesd that transcendence of self is the sine qua non of adult development. Most theories characterize development in terms of gain-the ego becomes more cognitively and emotionally complex, one achieves integrity or develops the self through goals . The problemw/ this prespective is that in late life there are more loses than gains. Loss can also be an intergral part of development  Valliant noted that wisdom is the opposite of narcissism Religiosity, spirituality, and optimal aging  Participation in religios practives especially group practices is negatively related to mental illness  Listening to or watching religious radio or t.v programs was positively related to depression  People who are higher in intrinsic religiosity recover from depressionmroe quickly  Religious preference was also differentially associated with depressice symptoms  Increased prayer better health  Social support in a religious context  Confouders- if their healthy enough to go out to church  Strong religious belief was a predictor of positive affect among caregivers under chronic stress  There is a difference between religiosity and spirituality with the former more closely associated with organized religion. In contrast spirituality is more intrinsic and tied to being centered, as well as to the experience of the numinous Ars Moriendi- The art of Dying  Death is a physioloical process but it is a psychological and spiritual process as well. Ars moriendi is a term dating from the Middle Ages, when it was understood that how a patient dies will in any case, reflect at least in part how that patient has lived a life and what kind of character is brought to the dying  The primary cause of death in late lide is heart disease, 2 cancer, stroke 3 rd Chapter 3- Theories of Aging  There are three different aspects of age on which theories can focus: characteristics of the aging population, the developmental or aging process, and the way in which age is incorporated into the social structure. Gerontology has been a bottom up discipline  Rowe and Kahn’s theory of successful aging- successful aging consiss of good physical and mental health, as well as good social functioning  There is no genetic program that specifies senescence-only one that maximizes life span  Maruyama’s deviation amplification model  most systems have deviation-countering mechanisms to maintain homeostatis, early precursor to chaos theory, way of specifying nondeterminate processes. Nondeterminate processes occur when systems have a large number of interacting variables  Chaos theory sows how initially small changes can result in very large differences between systems or individuals (cascade effects)  Aldwin and Stokols the effects of environmental stress.  Maruyama’s model can be applied to positive and negative changes. Biological processes relevant to ging fall into two categoried- those that promote homeostatsis and decelerate the aging process( eg DNA repair mechanisms and heat shock proteins) and those that amplify t
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