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Department
Kinesiology & Health Science
Course
KINE 3350
Professor
Kathy Broderick
Semester
Fall

Description
Sexuality Ø Longer time for men and women to get aroused Ø Less stamina Ø Women find intercourse painful Ø Viagra helped the situation for both men and women Women – no spouse Men – poor health Ø Doctors should ask if there’s any sexual concern Ø Old people feel they are too old to be affected by aids Ø In nursing homes – lack of privacy – you usually have a roommate but most nursing homes have a special room Ø Is sex socially acceptable in old people? Ø They did a study in Denmark nursing homes and they did porn movies on Saturday and even bringing in a prostitute and found that attitude and outlook improved The Nervous System Age Related Changes 1. Loss of Neurons 2. Atrophy of the brain – brain shrinks 3. Increase in plaques and tangles 4. Changes in transmission – less efficient in sending and receiving messages 5. Changes in the brain waves 6. Sleep patterns – older people might have trouble getting to sleep, or get to sleep and wake up short after, and in most old people their biological clock changes – also due to pain, medications, chronic diseases, disorders Age related disorders 1. Tremors – body twitches, also when they hold things etc 2. Tardive Dyskinesia – movement disorder – stick tongue out, or constantly in rocking motion, or lips smack – usually a result of long term medications 3. The Terrible Triad (Lou Gehrig’s, Alzheimer’s, Parkinson’s) The Terrible Triad 1. Lou Gehrig’s Disease (ALS) Ø Diagnosis occurs at about 60 Ø About 80% die from it in 5 years from diagnosis Ø No cure for it   1   Ø Cant move arms or legs Ø It kills the muscles involved in breathing and talking but their minds alert Ø You eventually die of some respiratory disease Ø Little money spent on research Ø Most of money is spent on buying equipment for people with ALS (i.e. wheelchairs that cost 30k with breathing mechanisms etc) 2. Parkinson’s Disease Ø The disease – cells the control movement in the brain fail (Dopamine controls movement – these cells are killed) Ø Does not kill you Ø Affects men and women equally Ø There is a family history of it, and the environment has an effect (pesticides) Ø The Symptoms o Very difficult to identify o Some of the symptoms as it progressive are pronounced shaking all the time o Muscles become rigid o Initiating and stopping movement is difficult o Eventually get confined to a wheel chair o Slow movement to eat o There face is a mask – with no expression Ø Treatment – no cure, but physio helps with the movement and they do have drugs that diminish the tremors (Mirapex-mimics dopamine), but the drugs do cause impulse control disorder – i.e. what ever they like they will do it 10x more 3. Alzheimer’s Disease Ø Prevalence – in Canada every 5 minutes someone is diagnosed with it (affects memory and learning) Ø Very costly too look after Ø The disease – no cause, and no cure, and it eventually ends in death o They know the brain is smaller than normal o Increase in plaques and tangles in the brain Ø Symptoms – often time they are ignored o 10 warning signs (developed by the Alzheimer’s society – about 85% accurate in terms of diagnosing the disease) Ø People with Alzheimer’s Ø Research (US spending 1 billion, Canada – 30M) o 3 areas § Family history (genetic predisposition, § External environment - pesticides § Internal environment – high blood pressure, stroke etc make you more prone o Very difficult to diagnose until you die o Cost 40k a year for each person with this disease   2   Ø Findings to date o Most prevalent research has been done on nuns and started in 1986 – research on 700 nuns all with the same living conditions since they all live together – controlled condition § They all had to write an autobiography and found that the people who were positive and highly articulated language did not develop Alzheimer’s while those with poor grammar skills did develop it § So they have this as a predictor o A doctor at UFT has found a gene that slows down the decline of the brain – trying to develop drug that mimics it o Mild cognitive impairment could be a precursor to it – Sunnybrook has 2 tests to test for this – 1) give you 15 words and then ask you to repeat them (if 70% accurate you don’t have it 2) give you clock and tell you to set it at 2:43 o Aricept – most popular drug – slow down memory loss and control behavior – but some say it does nothing Ø Tough Issues o Very difficult to diagnose o Communicating the diagnose (doctors don’t want to say you have it and misdiagnose since its very similar to depression) o When to quit driving o People with early stages of it can completely function properly o Family dynamics – family denial o Many nursing homes wont take them o In Toronto they have a wandering registry – since they tend to wander o Use of restraints for the safety of the patient Ø Care givers o Nursing home care o But its so stressful for the caregiver that it shortens their life from 4-8 years Ø Programs o “Forget me not program” – in TO for people in the early stages of Alzheimer’s and they go to this club once a week and talk to people in the same situation o They have adult day cares where you can drop them off 10 Warning Signs (handout) – 85% accurate in diagnosing (since you can only diagnose once you’re dead) 1. Memory loss that affects day to day function 2. Difficulty performing familiar tasks 3. Problems with language 4. Disorientation of time and place 5. Poor or decreased judgment   3   6. Problems with abstract thinking – numbers, spelling words, what is a birthday 7. Misplacing things – putting iron in the fridge 8. Changes in mood and behavior – one minute sad and the other happy 9. Changes in personality 10. Loss of initiative - they become passive 4. Sleep Disorders Ø Sleep Apnea o Stops breathing 20 times per hour during sleep o This significantly affects the heart function o A lot of night strokes are caused by sleep apnea o Men more than women develop it o Sleep disorder clinics are opening all over the city to determine if you have sleep disorders Ø Restless legs – disorder where they have to move their legs during the night every Ø Excessive Sleeping 5. Learning Ø Older people become slower but they can learn Ø Material has to be presented slower but they can learn 6. Memory Ø Short term memory tend to start being lost at around 40 Ø Long term memory remains intact usually October 27th The Endocrine System Age Related Disorders 1. Diabetes Ø Is a result of elevated blood sugar in the blood Ø It’s a chronic disease that cant be cured Ø It can be prevented and managed Ø Only condition that does affect every part of your body The Disease: Ø Type one o Pancreas cant produce insulin therefore you depend on insulin intake o More prevalent in younger people Ø Type two o 90 % are in this category o Its either the body does not produce insulin or you don’t use the insulin effectively o Older people are more to developing it o Many people are over weight   4   Diabetic Epidemic Ø In Canada 3 million are diagnosed, 1 million don’t even know they have it, and 6 million have pre diabetes The Cost: Ø Very serious Ø Costs Canada 16 billion a year, and Ontario 5 billion a year to deal with it so its costly of the health care system Ø Its also costly for the individual – it can go from 8-15,000 a year to deal with it Health Complications: Ø Blood sugar dip radically (hyperglycemia) and people become confused, adult blindness, have blackouts, comas and this is very dangerous for drivers Ø Kidney disease – can be cause if diabetes is not treated Ø Feet ulcers due to poor blood circulation Ø Shorten the lifespan by 12 years Dice Study: started in 2004 (Diabetes in Canada evaluation) Ø They major findings Ø A) Medical treatment was not progressive enough Ø B) 50% did not have their diabetes under control Ø Prediabetes o Identifying these people so that they can be dealt with and hopefully don’t develop it o People with it have a elevated blood sugar level but not as much as a diabetic o Awareness was the key to prevention via exercise, healthy diet, loose weight (three things) o If this did not work (2 months) they were put on medication to prevent it o If no results from drugs after 6 months they were put on insulin Ø Diabetes o They felt that those with diabetes Ø Diabetes and heart disease o Major focus of the dice study – they came up with a campaign called “diabetes get serious” and they said that diabetes goes straight to the heart o People with diabetes should see themselves as have a cardiovascular disease o 80% of people with diabetes will die of either a heart attack or stroke so the 2 have to be linked Ø Family doctors o The study was found that the doctors were good at treating the sugar for diabetes but did not deal with the cholesterol and high blood pressure o Also found the doctors are not good at lifestyle counseling   5   o Family doctors should do a following test on every physical, blood test, urine test, feet examination, and eye examination and that this should we standard for a person when they have a physical Ø Seniors and diabetes o Seniors can prevent it Ø Treatment o Blood sugar and cholesterol should be looked at as well as high blood pressure o The guidelines that they use is that they should be put on medication if they have high cholesterol Research: Ø For type 1 diabetes they have done a lot of research for developing better insulin than 10 years ago Ø The methods of getting the insulin (the pumps) and monitoring device have improved and they feel that in 10 years from they will have an artificial pancreas Ø For type 2 diabetes, they have better methods of detecting it, and better medications, and they are using it more aggressively Ø So from the dice study they have done a good job in tackling diabetes in terms of education and prevention but now its up to the people to deal with it 2. Obesity Facts: Ø More over weight people than under nourished people Ø An epidemic all over the world Ø 62% of Canadians are over weight or obese Ø Its very easy for older people to gain weight with out them recognizing it, due to diet and lack of exercise Ø More costly to eat healthy Ø Lack of activity Ø They are more likely to develop diabetes, hypertension, hip replacement Ø With older people its not a bad thing to be slightly overweight because when they are very frail they cant fight off illnesses as well Ø Osteoarthritis of knees and hips Ø More susceptible to breaking bones Ø 75% of paramedic calls are due to obesity Ø Parametric stretchers have significantly increased in size Ø Hospital had to get reinforced beds and toilets Ø A lot of obese people cant get through MRI machine so they get shipped off to Guelph where the animals get it in vet school Ø Tumors are missed in medical field Problems: 3. Malnutrition   6   Causes: Ø Poverty Ø No stove or fridge Ø Cant purchase food Ø Cognitive impairment Ø Medication make you loose appetite so you are not eating Ø Eating disorders in younger people Ø Older people tend to exercise impulsively and diet 4. Cancer Causes: Ø 500 diagnoses per day Ø 200 die per day in Canada Ø Cancer grows much slower in older people but they have had it for longer Ø Lung cancer – number 1 cause of death (older people get the diagnosis because they are long term smokers, and unfortunately with lung cancer, it does not get as much awareness and funding as other cancers) o 25% of lung cancer diagnosed are from second hand smoke Ø Prostate cancer o Routine check ups for men over 50 o Movember – grew mustaches to make people aware – it started in Australia Ø Skin cancer o Older people are more susceptible to it because they have had more exposure to sun Ø Colon cancer – 90% treatable if detected early o 4 cause of cancer deaths o 90% treatable if detected early o Easy simple tests but older people are embarrassed of talking about those things Ø Breast cancer o On the increase for women o And women need to be doing mammogram tests Respiratory System Age Related Changes Ø Coughing mechanisms o Less effective as you age o can become serious since coughing gets rid of bacteria and infection Ø Gag mechanism o Less effective o A lot of older people start chocking when they are eating   7   Ø Pitch of voice o Male voice gets louder o Female voice decreases Ø Shortness of breath o Ø Lungs o Diminish in size so they become less effective Ø Vital capacity o Air we expel decreases Ø Residual volume o The stale air that’s left in the lung increases because you cant expel it Ø Decreased O2/CO2 exchange o Decreases, therefore they are more tired- less energy Age Related Disorders Ø Chronic bronchitis o Bronchial tubes get inflamed and there is a mucus build up and you cant get the air in so you cough o Prevalent in smoker – “smokers cough” Ø Emphysema o Condition where you cant get the air out so they have stale air in lungs and its hard to breath in fresh air Ø Chronic obstructive pulmonary disease (COPD) o The combination of the two above so those people cant get the air in or out th o 4 leading cause of death after cancer (1), heart disease, stroke o The main cause is smoking (90%) and 10% pollution Ø Chronic asthma o Irritation of airways causing shortness of breath o In older people they don’t manage it properly Ø Tuberculosis (Tb) o Contagious lung disease o Bacteria destroys the tissues of the lungs and people cough up blood Ø Pneumonia o Inflammation of the lungs o Very common in older people o Flu shot is good for prevention because the flu triggers pneumonia o Considered the “old peoples friend” by the medical community because old people (around 80-90) because people come to a hospital with a broken hip, and they end up dying from catching Pneumonia, so instead of them dying in 2 years bed ridden, pneumonia will kill them Gastrointestinal System The Mouth:   8   Age related Changes Ø Loose teeth or they become discolored Ø Salvia decreases Ø Saliva keeps bacteria under control so with a decrease you will have more bacteria Ø A lot don’t take care of it because its so expensive Age related Disorder Xerostoma: Ø Dry mouth due to lack of saliva, or chemo or radiation Dysphagia Ø Difficulty in swallowing due to lack in saliva or also people with strokes, or Parkinson’s Periodontal disease Ø Both a bone and gum disease Ø They will loose their teeth and have bleeding gums Esophagus Age related disorder: Acid reflux disease Ø When the acid starts moving up from stomach into the esophagus and you get heart burn Stomach Age related disorders: Gastritis: Peptic Ulcer: Ø Both are caused by inflammation of stomach Ø Causes burning sensation Ø Caused by stress in older people Food poisoning: Ø Very serious in older people Ø It affects their homeostatic equilibrium Ø Their absorption of medications are not as good Intestines   9   Age related disorders: Diarrhea Ø Warning sign for older people that they are not absorbing their nutrients and medication Ø Can get it from medications, or food poisoning Dehydration Ø Older people tend not to sense thirst so they get dehydrated Ø Older people get disoriented with dehydration and it looks like the person has dementia Constipation Ø Can get it from medication or not enough fluid Diverticulosis Ø Colon gets bulges and if it become inflamed it can be life threatening The Gall Bladder Age related disorders: Gall stones Ø More common in older people, particularly in women Ø Can be day surgery The Liver Age related disorders: Cirrosis: Ø Caused by either alcohol or nutrition deficiencies Ø With older people alcoholism can be a problem due to combination of it with drugs particularly in men Urinary System 2 Age Related Changes to urinary system 1. Kidneys - Decrease in size and their abilities to function i.e. remove drugs from body 2. Bladder - Also declines in capacity so it does not hold as much so they have to frequently go to the bathroom   10   - Therefore its embarrassing leading to social isolation, also can result in more falls Age Related Disorders 1. Urinary Tract Infection - It a bacterial infection and it can become chronic and painful 2. Incontinence - Biggest/most common disorder = “an over active bladder” - More women than men are affected because they have had children, weaken muscles and also when they go through metapouse (lack of estrogen) - Men develop it if they had prostate surgery - Also diabetics/ obsessed people are more likely to get it - Difficulty as a behavioral problem because it hurts to laughs, talk, go up the stairs etc - Can affect self esteem if you are wearing diapers and social isolation - 2/3 of women don’t seek treatment - People stop drinking and than they become dehydrated - It is often time why people put them in nursing homes - Bladder can be retrained, through surgery, drugs etc 3. Kidney failure (WHATS THE TREATMENT THAT’S SO EXPENSIVE AND WHY SO EXPENSIVE? - Kidney problems b/c they have old kidneys and are living longer - Answer: People with kidney have to do dialysis, for 4 hours a day, 3 days a week – very costly Ageism and Driving - “Growing old is like being repeatedly penalized for a crime you did not commit” - Ageism can be discriminative just as racism, sexism - Seniors today probably have experience Ageism and they are probably more forgiving but the boomers wont be just as they got rid of racism, sexism, the baby boomers will not put up with it - We see ageism the most in driving - Transportation is extremely important to older people, it is their transportation, provides social life, doc appt’s - In 2010 75 years of age + were involved in 10,000 collision in Ontario and 18,000 19 year olds were involved yet the add in the paper say “license to kill” with a picture of an old lady - We also make fun of elderly women driving 1. Loosing a license - Its devastating, they have to shop, go to medical appts etc - And for an older man it was a symbol of power (many women didn’t drive and had to wait for him) - It gave them freedom   11   - For women is showed a sign of independence because they did not have to rely on husband - “ if you take a way my license away I will die” 2. Decline in driving ability after 50 - Eye sight, focus declines - Cognitively slower - Reaction time is slower - Muscles are weaker for putting on break and wheels and turning the head - Other medical conditions, arthritis, Alzheimer’s, hearing loss, fatigue, medication causes drowsiness - Less peripheral vision - Poor depth perception - BUT they do have experience 3. Medical conditions - People with dementia is the scariest - In Ontario 45,000+ are driving with dementia or early stages of Alzheimer’s and are 8 times more likely to get into a collision whereas a drunk driver is 5 times more likely 4. Doctors – gate keepers - They detect the problem whether its physical or mental problems - But doctors may not detect the problem or may not want to interfere - Patients don’t listen to them 5. Warning signs - Police stop them - Get lost in familiar areas (i.e. forgot where parked car) - Get confused/angry when they drive - Change lanes with out looking with only putting on signal - Driving much slower than speed limit - Being honked at all the time but don’t hear, get fingered but cant see 6. Seniors are good drivers - Avoid 401 - Don’t go in bad weather or at night - They go down small streets - So they look after themselves - Old people like speed bumps 7. Ministry of transportation - They have to put their foot down, and recognize that someone has a medical condition or cognitive impairment - Up to doctors as well - In Ontario you have to take a medical after 80, a vision test, a written test, and they have to do this every 2 years after 80 and also a road test in some place i.e. BC 8. Drivable - A cognitive test where they can analyze your judgment and so on - Cost 500$ and a lot of families will spend the money because they know they can get the license away from the elderly   12   - Doctors will send patients to this if they refuse to give up license 9. Research - Lot of money spent, because they said by 2020 it will be the 3 leading cause of death - The know that the baby boomers will not want to give up their license so they have to try and find ways to make them safe drivers - Scooters – no laws against driving scooter at any age, which makes it dangerous, and more and more old people are going to be getting scooter so it’s a problem they will have to deal with Ageism and Health Care – 2examples Family Doctors Ø We have a shortage of family doctors Ø 2053 pediatricians and 171 Geriatric doctors and so it certainly a problem Ø Many students in medical school don’t want to be family doctors Ø Only 30% of graduates go into family medicine Ø They turn down those who are ill/old Health Care Ø Research o Is not generally done on old people because they complicate their studies with all there medical problem o So research is done mostly on younger people and preferably men Ø Procedures o Many procedures have been cut off o I.e. procedures of drugs, physiotherapy, hearing aids, walkers, are not covered o Only 5% of men over 70 with prostate cancer get surgery o After age 75 mammograms are not paid for by government and that is ageism since those women need it o Depression and arthritis are under treated because doctors just assume you have it because you are old Ø Treatment Ø Medical errors o More common amongst older people o Medication errors Ø Medication Ø Heart disease o Many cardiologists are reluctant to do surgery on people over 80-85 o It was ageism that individual who was healthy was just looked at (who fell from skiing) and the doctor refused doing surgery just because of his physical appearance rather than looking into his actual problems Ø Joint replacement o Older people are discriminated against in this way   13   o With older people a lot of orthopedic surgeons will not do hip or knee replacements unless the person has adequate care after surgery and good rehab o Obviously people have a waiting list, however if a person does not have good home care will be moved down the line, and those that are younger that can care for themselves get moved up the line Ø Gender bias o Found that women were not admitted to ICU as readily as men were o For joint replacement they did a study – sent a male and a female to 29 joint replacements clinics, both exhibiting same symptoms and the men were recommended 9 times more for surgery than women Ø Gay men o Discriminated against in health care especially in the 50’s and 60’s by doctors because they would actually report them and give them shock treatment to get over this Ø Family doctors and ageism o Family doctors wont do house calls o Often times its just impossible for an older person who’s ill to come to the hours Dr. Mark Nowaczynski Ø Showed the usefulness of house calls and elderly Ø He used to ride around his bike giving house calls to people with out getting paid Ø They did a documentary on him, and now OHIP covers house calls in elderly people before it was out of their own heart Ø 1/3 people live the hospital with higher levels of illness because they get infections etc which is why house calls are so important The Elderly and Health Care: Ø Elderly are not demanding like the baby boomers Ø They respect the man in the white suit and they take order – they don’t ask Ø So its very important that younger people take them to the doctor For Ageism in the Workplace Retirement is not mandatory in some provinces such as Ontario Bismark determined that the age of 65 is considered old age and in Canada 65 is the that you got mandatory retirement and the ON government stopped mandatory retirement because they knew it was Ageism (people are capable of working at 65) and they needed people working for the work force. Ø Proficiency o People that support mandatory retirement (i.e. those who support ageism in the workplace) claim that older workers are not as proficient so we have to get rid of them at 65 Ø Create jobs   14   o They feel that if we get rid of older people at the age of 65 we will create jobs for the younger people (ageism) Ø Costs money o Also people like mandatory retirement because older people cost money because they are at the highest salary level with all these benefits that they have to give them (therefore showing ageism) Against Ageism in the Workplace – against it, mandatory retirement (ageism) because older workers contribute to the retirement fund because if they are working they are paying taxes which helps the CPP and they are not taking CPP Ø Retirement fund Ø Labor force o They are skilled, experienced and we need man power in this country Ø Cant afford to retire o So they don’t want to have ageism in the workplace (mandatory retirement) because of recession etc they need money Ø Negative affect on worker o It can affect people negative if they get fired since in ON (there is no mandatory retirement) and it can affect them mentally and physically to get fired Note: retirement is mandatory in airline pilots and firefighter at age 60, judges have mandatory retirement at 75 Ø There is also ageism in terms of getting a job Ø And the employer resist high ring older people Ø Old people actually leave they’re age off the resume Urinary System Age Related Changes Ø Kidneys Ø Bladder Age Related Disorders 4. Urinary Tract Infection 5. Incontinence 6. Kidney failure Ageism and Driving Ø Loosing a license Ø Decline in driving ability after 50 Ø Medical conditions   15   Ø Doctors – gate keepers Ø Warning signs Ø Seniors are good drivers Ø Ministry of transportation Ø Drivable Ø Research Ageism and Health Care Family Doctors Health Care Ø Research Ø Procedures Ø Treatment Ø Medical errors Ø Medication Ø Heart disease Ø Joint replacement Ø Gender bias Ø Gay men Ø Family doctors and ageism Dr. Mark Nowaczynski The Elderly and Health Care For Ageism in the Workplace Ø Proficiency Ø Create jobs Ø Costs money Against Ageism in the Workplace Ø Retirement fund Ø Labor force Ø Cant afford to retire Ø Negative affect on worker November 3 2011 Examples of Ageism:   16   Ø Driving Ø In the workplace Ø Getting a job Ø Health care Ø Treatment o People start treating them like children especially in nursing homes o You begin to behave the way you are treated Ø Economics o We blame the elderly for using up the pension and health care Ø Retirement o People say you are retired as if you do nothing Ø Media o Can be positive – Soap Opras o Ads for pampers – negative o Stair lift - negative and contribute to ageism Ø Attitudes o Little kids think old people are sick because they grew up going to visit grandparents in hospital o Young people see them as invisible, old, slow Myths Re. Aging Ø Myths that old people are all the same – old and frail Ø That they are victim of crime Ø Are older people sexy? How to prevent ageism: (baby boomers wont put up with it) Ø Teach children about old people Ø Bring old people into schools to talk about their life – war etc Ø Combine day care and retirement homes – so kids connect with old people, get homework help etc Ø Students supporting senior programs – community service Ø Convince old people that it is never too late to change lifestyle – become more fit, eat healthier, stop smoking can help them in terms of self esteem Ø Alter vision of old age – change stereotypes Ø Minimize disability in old age – i.e. scooters, and walker so they can go out Ø Age simulation workshop Ø University of Toronto students and seniors – old age home near students Ø Look at diversity of seniors – don’t treat them as all being the same Personality Types Ø They have found the personality types are pretty stable Ø A person whose cheerful at age 30 will be cheerful at age 70   17   Ø A person whose a bitch at age 30 will be a bitch at age 70 Ø Neugarten – Kansas City Study o Neugarten was a lady who did personality study called the Kansas city study and it is still used today in psychology books as looking to how people adapt to their aging and their personality o They found men to be more nurturing and women to be more aggressive as they got older o She came up with 6 types of personality 1. Mature – integrated o Very satisfied with their lives o Realistic about life and death o Don’t mind retiring 2. Armored defensive o Very ambitious and stubborn o They are independent and want to continue to be o They fight aging (they don’t like birthdays) o Don’t want to retire 3. Angry o They blame others/jealous o They think health care system is pathetic in Canada o Complain about the youth of today 4. Passive dependent – rocking chair o The sweet old lady that sits in her rocking chair and lets everyone do everything for her o She does not want to be independent o These are the clever ones who make you do everything 5. Self hater o Blame themselves o Are isolated 6. Disorganized o Older people that have dementia o They have poor coping skills o They are confused o They can live like this for a long time Retirement Ø Retirement age o The public sector retired at about 58 o The private sector retired at about 62 o Self employed – 65 o Than we had the recession and retirement got affected o Now the average retirement is 68 now so it went up o And they say the baby boomers will increase this Ø Reason for retirement   18   o Mandatory retirement (i.e. firefighter or pilots or company contracts that require you too o Some retire because they have the money o Some retire because they lost their job o Work aholics are very scared to o Some cant retire because of the recession o Freedom 55 and freedom 75 – those with money can retire at 55 and those that don’t will have to continue to work till 75 o Find the blue collar worker don’t mind to retire because their job did not give them meaning whereas a doctor would not want to retire Ø What to do! o Travel? o Take up sports or join the gym o Get a pet Ø Where to live! o Stay in your house or sell it o Downsize o Do they move to smaller cheaper towns o Do they go into retirement communities o Do they move to Florida o Move in with children Ø Negative experience o Poverty – cant live the retired life they want o Depression – have nothing to do all day Ø Positive experience o Rebirth o Third chapter – 2 mistakes (regrouping the old band and starting a restaurants) o Encore career o Regeneration Successful Retirement: (this is the order of importance) 1. Finances Ø Very devastating to borrow money from children so they want to have money Ø Most important thing Ø Single women fear poverty and being dependent 2. Health Ø If you have poor finances you will worry about your health Ø With money you could buy health Ø You have some control over your health with money 3. Time management Ø Being able to balance their days by being busy and resting since it is a long day 4. Interests Ø You have to develop new interests / reinvent yourself 5. Spouse/partner   19   Ø Have a playmate with something to do Ø A lot of divorces occur after retirement called “grey divorces” since they spent their life running errands and being preoccupied and now they get to know each other and decide to divorce Athcley’s Theory of Retirement Adjustment (steps) 1. Pre – Retirement Ø People should plan to retire Ø Companies that set up how you should retire with your health and finance requirements 2. Honeymoon Ø Retirement party or travel 3. Retirement routine Ø Develop this so they become busy 4. Rest and relaxation 5. Disenchantment Ø They might decide they don’t like their routine Ø They become tired of their routine 6. Re-orientation Ø Than they re-orient themselves to maybe 1 activity a day that they like Ø They are probably getting health problem 7. Routine or stability Ø As they are in their 80’s their routine becomes more stable Ø They accept retirement and old age 8. Termination Ø They die Depression in older people and relative to retirement Cause: Ø Can be genetic Ø Some are biological – i.e. brain chemical imbalance, metapouse Ø Environmental triggers Myth: Ø Myths the old people are depressed but certainly not true Ø But its definitely a problem in older people Ø ¼ women are depressed Ø 1/8 men are depressed Ø About 70% of people in nursing home are depressed Symptoms: Ø Sadness Ø Worry to much Ø Physical complaints   20   Reasons: Ø Sad Disorder o Seasonal affective disorder o Prevalent in Canada and is called the winter blues o They get reduced sunlight and they don’t feel well o Its gets dark earlier o The treatment is a light that you sit and mimics natural sunlight o Can result in clinical depression Ø Chronic diseases that relate to depression (i.e. Parkinson’s, Diabetes, Alzheimer’s, and cardiac surgery in men – because they tend to go straight into depression) Ø Poor health of a loved one Ø Loneliness Ø Their personality type Diagnosis: Ø Very difficult to diagnose Ø They don’t speak of it Ø They don’t like to speak of their emotions Ø Doctors have trouble diagnosing depression Ø Very difficult since it overlaps with Alzheimer’s Treatment: Ø Drugs Ø In England they threw out all the drugs and now use self help books Pain Faces of pain: Ø Physical Pain – people cant get dressed, cant do ADL’s, interferes with sleep and eating Ø Psychological pain – become depressed, low self esteem, Ø Social Pain – stay home, become isolated, and lonely Ø Chronic Pain Treatment: Ø Very poor treatment of pain Ø It is very neglected in the health care system Specialty: Ø In medical school they don’t do a lot of work on it Pain clinic:   21   November 8th Pain Faces of pain: Treatment: Ø Pain is not emphasized in medical school, all doctors do is tell you take Tylenol Specialty: Ø Cancer pain probably started this concept that pain an important thing to be looked at Ø And now they have pain management specialists – they finish their medical degree and specialize in pain Pain clinics: Communicating pain: Ø Cannot see pain so its very important that people communicate it to doctors Seniors and Pain: Ø They have experienced pain Ø Mothers went to through the pain of child birth when they didn’t have all these pain killer drugs Ø Men with the War – they did not have pain killers New pain and treatment: Ø They are always coming up with something new Research: Ø The Brain o Pain is how you protect your body i.e. so you don’t move that area as much so it can heal but chronic pain is when that alarm system is broken and they are looking at the brain to see if it can override pain Ø Pain perception o Looking at peoples pain perception (i.e. placebo vs. the actual drug helps) Ø Pain and surgery o Putting pain plans before people even have surgery to deal with the pain after the surgery o De Grout – multi millionaire who had a stroke and suffered tremendous pain and gave McMaster 20 million dollars to deal with pain research Delirium Symptoms: Ø Sudden and acute symptoms   22   Ø Hallucinate, cognitive impairment, agitation Causes: Ø Change in environment i.e. taken to nursing home or hospital Ø New medications might cause it Ø Dehydration Ø Pneumonia and infection can cause it Ø All systems can be reversed if treated early Ø If not it can end in death if not treated H.E.L.P Ø Volunteer organization that goes to the hospital and talks to people with delirium Effects of Medication Ø Research o Research is done on 25-45 and the majority are done on males o 12,000 deaths in older people o Inappropriate dosage since they do it on that cohort Ø Physiology and medications o Interaction with drugs § Older people are on many drugs § All of these drugs together can be dangerous o Interaction with foods § I.e. people on cumadin should not have salad because it thickens their blood § Grape fruit juice is very bad since they block drug absorption o Drugs and gender § Research is done mainly one men and women react very differently o Prescribing cascade § Some drug side effects makes its look like you have another condition – so they than give you more drugs or less drugs because of all theses side effects Physicians and Medications: Ø Many doctors are not trained to deal with elderly Ø They write poorly Ø Celebrex – arthritic pain Ø Celexa – antidepressant Ø With bad writing which one are you getting? Ø They often over prescribe Ø We need more physicians dealing with geriatric conditions The Patient and Medications: Ø Old people don’t communicate clearly   23   Ø They cant hear Ø They don’t know why they are taking them Ø Do specialists know all the drugs you are taking Danger with medications: Ø They forget to take them Ø More is better – and they take more Ø Vioxx – worked and people started taking more Ø People stop taking medications because they feel better Ø Pill containers are difficult to read and distinguish and open Ø They have to chop up some pills to take less Ø Old people borrow pills Ø 3 Main Dangers: 1. Adverse effects/side effects 2. Improperly prescribed by physician 3. Non – compliance Rules: Ø List of drugs and dosages Ø Discuss medication with doctors and pharmacy Ø Should use the same pharmacy so they know which drugs they are taking Ø Take medications as directed by doctor Ø Throw away expired medications Ø Store medication in cool place (not bathroom) Internet and drugs: Ø A lot of people use internet to learn about drugs and often self medicate themselves Drugs Ø Big Drug Companies o Always busy developing new drugs o 40 billion/year for research o 10 years to develop a drug o For every drug you take it costs them 600 million dollar to produce it o So they have to make a lot of money selling the drugs o Drug companies make researchers publish only positive results even if she gets negative results o The only truthful medical journal is the New England journal of medicine since they research the publication on drugs o Sales rep get doctors to prescribe their heart medications and give them 5 star treatment Ø Drugs in Canada o Strict drug policy   24   o You can get cancer drugs 3 years earlier than we do here o Pros – can be good because they make sure drugs are reliable Ø Generic drugs o Copy cat drugs o After a drug company makes a drug they can copy it after 10 year patents o And these drugs are cheaper and OHIP wants people to start using these drugs because they are cheaper and are the same exact thing Ø Drug benefit plan o 600/person a year o Could be lowered if they prescribed generic drugs o Seniors 65+ have entire drug coverage and all they have to pay is 100$ a year a dispensing fee in Canada Ø Pharmacies o They are very caring o Spend more time than doctors o They do free delivery o Some even go into the home o Tremendous shortage in pharmacists Ø Drugs and advertising o 18 billion on sales of drugs o Drug companies 2.5 billion on advertising o In Canada you can say the name of drug but not what its for o U.S. thinks our rules are better Ø Selling drugs to USA o Our drugs are far cheaper so they buy them from Canada Ø Drug issues o Politics and media are deciding who gets drugs – people complain to media and than they get very expensive treatment and we just can afford to give everyone treatment for expensive rare cancers Ø Organ transplant o 16,000 Canadians are on waiting lists o We have poor registry systems o People are skipping the lists by buying them in the US etc o People are buying organs from third world countries who are selling their organs because they need the money o Old people can take older vintage organs so they are more available for old people How Seniors Influence Society: Ø As people get older they will pay for service Ø Eventually old people will be working for us and the more we know about them the better we will be in dealing with them Grandparenting Role of Grandparents: Scenario 1:   25   Ø Grandparents that you don’t see because they don’t live in Toronto or they might live in a retirement community down the road but just are not interested in grandchildren Scenario 2: Ø Grandparents that want to be involved Ø Grandmothers never loose their role as a mother Ø Fathers who did not have time with their own kids love spending time with grandchildren Scenario 3: Ø Grandparents that live in multi generational homes where they live with their families Ø They are there as a support system Scenario 4: Ø Grandparents looking after grandchildren full time Ø The family needs them Ø Is this fair? They have done their parenting and its hard for a senior and it does deny their senior years Scenario 5: Ø Grandparents who are expected to step in and take over the custody of their grandchildren Children’s Aid: Ø They never looked at the grandparents to look after grandchildren so they don’t get put into a foster home Ø Children’s Aid now changed their policies Guardianship: Ø Some grandparents take over looking after children when they think they need to Ø The government will give them 250/month if they say its temporary (this is stupid) Grandparents right association: Ø Deals with legal matters Ø Family divorces – cant see grandparent so this organization steps in Other rules November 10 th Volunteerism:   26   Ø Challenge of volunteer centre o Canada is the second largest volunteer section in the world o Senior want to volunteer because they have time and want to give back to society o They find that these seniors remain healthy and happy o 2 Kinds of Volunteers: § Seniors that have been volunteering for a while § New volunteers (baby boomers) want to volunteer but they want to get something out of its more for self interest (paid for lunch, parking etc) § So it’s a challenge for the volunteer centre’s to deal with these people § As well a lot of the older volunteers have not been replaced when there are those that can do more Political Clout: - 2 0rganizations that have it Do they have it? YES Ø AARP o American association of retired people o They have 35 million members o Therefore any politician knows they need there votes o Therefore they have a huge influence in terms of American politics Ø CARP o Canada association of retired people o 0.5 million people o They still have political power o Changed road test law that you don’t have to do it every time after 80 o OHIP tried to cut back on drugs for old people and physiotherapy and CARP moved in and stopped that o They also have the first gay and lesbian and apartment in TO for seniors Ø One voice o Group in Canada o It even deals more on political matters o Deals with condition of seniors – fraud, elder abuse, affordable housing and transportation Raging Granny’s – has political clout Ø A group in Canada Ø 70+ Ø They do protests in political events Sue Ellen Cooper – has political clout Ø She realized that she was invisible   27   Ø One day she wore a read hat and people really liked it Ø And from that she started the “Red Hat Society” Ø 58k chapters all around the world Ø And they address political issues Transportation: Ø Number 1 concern of seniors Modes: Ø Wheel Tran o Designed for old people o Unfortunately wheel tran is reducing drastically Ø Taxi o Now have bigger vans so they can deal with wheel chairs and walkers Ø Buses o They say by 2012 all busses will be elderly accessible o Wheel chair accessible etc o Soon bus shelter will be bigger Ø Subway o By 2030 they will be elderly friendly Pedestrians: Ø Crossing the road o 1/3 of pedestrians killed are seniors o We need longer lights for older people Ø Media o In 9 days there were 10 fatalities last year 6 of which were seniors o Media is helping the situation Ø Making Toronto more friendly o More handicap parking spaces Ø Scooters/strollers o Liability, since they can go very fast, and they take over the sidewalk and bike lanes o Strollers are also a liability since the stroller seat is much larger than the baby, and they run down people Marketing: Ø Read your audience – know what the seniors want Ø Senior discounts – old people love to say Ø Newspapers/magazines – more senior magazines Ø Moses Znaimer – Zoomers o Coined the phrase Zoomers o He owned much music, city tv, chum – he was the guy who marketed that whole area of life o He recognizes that the next market you have to target is the baby boomer market   28   o He is now the head of Zoomer media – which is plays a lot of tv program old people watch and Zoomer radio – which plays 70’s music Ø Advertising o Retirement homes are selling what they try to make a happy lifestyle o Elliot lake – mining town that completely shut down in 80’s and all they had was all the homes that company owned and no people so the mayor of the town started renting out these homes for cheap – to seniors and marketed all these outdoor sports o 2 years ago dove got a 55 year old women advertis
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