The document discusses factors that influence functional health and disability in older adults. It presents a model of the disablement process and examines how chronic conditions, socioeconomic status, gender, and ethnicity can impact functional limitations and the need for assistance with daily activities. Common causes of disability in older adults include cerebrovascular disease, arthritis, smoking, physical inactivity, and depression.

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Mary Jo Ray
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2. Learning Objectives
 What are the average and maximum longevity for
humans?
 What genetic and environmental factors influence
longevity?
 What ethnic factors influence average longevity?
 What factors create gender differences in average
longevity?
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3. Average Longevity 1900-2003
80 yrs
74 yrs
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4. Maximum Longevity
House mouse, 4
Dogs, 29
Cats, 36
Polar bears, 42
Horses, 62
Chimpanzees, 59
Average and Maximum Longevity For Asian elephants, 86
 Average Longevity – age at which half the
individuals born in a particular year will have died.
 Maximum Longevity – the oldest age to which any
individual of a species lives.
 What is the difference between active life
expectancy and dependent life expectancy?
The difference between living to a healthy old age and simply living a long time.
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5. Genetic and Environmental
Factors in Average Longevity
 Genetic Factors
 Family History
Can’t pick your history
 Environmental Factors
 Disease
 Toxins
 Lifestyle
 Social class 121
We can control most Jeanne Calment
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6. Ethnic Differences
 Are ethnic differences associated with genetics? Is
that the only association?
 The differences are complex.
Sociocultural, economic conditions, healthcare disease, etc
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7. Gender Differences in Average Longevity
Women have nearly a seven year edge over men.
Why?
 Men are more vulnerable to disease than women.
 Men are risk-takers.
 Men smoke and use alcohol more than women.
 Men allow stress to enter their lives more than women.
 Anything else?
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8. International Differences
 Dramatic Differences in Longevity Around the
World
 From 38 years in Sierra Leone, West Africa to 80 years in
Japan
 Factors
 Genetic
 Sociocultural
 Economic 111
 Anything else?
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9. International Data on Life Expectancy
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10. Learning Objectives
 What are the key issues in defining health and
illness?
 How is quality of life assessed?
 What normative age-related changes occur in the
immune system?
 What are the developmental trends in chronic and
acute diseases?
 What are the key issues in stress across adulthood?
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11. Defining Health and Illness
 Health – A state of
complete physical, mental,
and social well-being, and
not just the absence of
disease or impairment.
 Illness – Presence of a
physical or mental disease
or impairment.
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12. Quality of Life
 Relating to specific diseases or conditions
 To what extent does distress from illness or side effects
associated with treatment reduce the person’s will to live?
 Valuation of life – value placed on staying alive
 Relating to end-of-life issues
 How much one enjoys life, has hope
for the future, and finds meaning in
every day events, determines how
long a person wants to live.
Quality of life – one’s perception of their
position in life in context of their culture
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13. Changes in the Immune System
 How does the defense system work?
 How does aging affect the immune system?
 Not well understood; more susceptible to infection and cancer
 Aging is related to how well the system works.
 Autoimmunity
 Immune system can attack the body itself.
 Rheumatoid arthritis
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14. Changes in the Immune System – cont.
 Psychoneuroimmunology
 Psychology
 Neurological
 Immunological system changes
(Cohen & Herbert, 1996)
 AIDS and Older Adults
 15,000 people over 65 have AIDS (CDC, 2008)
 Rapid progression from HIV positive to AIDS
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15. Chronic and Acute Diseases
 Acute Diseases
 Conditions that develop over a short period of time and cause a
rapid change in health.
Example: UTI, strep
 Go down in the elderly
 Chronic Diseases
 Conditions that last a long time (min. 3 mo.) and may be
accompanied by residual functional impairment that necessitates
long-term management.
Example: arthritis and diabetes
 Goes up in the elderly
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16. The Role of Stress – bad for your health in the long run
 Stress as a Physiological State
 Sympathetic nervous system
(heart rate, respiration, blood flow, muscle strength, etc)
 Impaired immune system, increase risk of cardiovascular
disease, increase risk of cancer
 Gender differences? Men want to be alone, women want
to be with other people. (fight or flight vs. tend and befriend)
 Stress and Coping Paradigm
 Interaction of a thinking person and an event
(People experience stress differently)
 Two people stuck in traffic – different levels of stress. Why?
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18. The Role of Stress (cont.)
 Appraisal (Lazarus and Folkman, 1984)
 Primary appraisal: categorize the event
 Secondary appraisal: evaluate the event
 Reappraisal: changes in the situation may change the
appraisal
 Coping – dealing with stressful events
 Death of a spouse
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19. The Role of Stress
 Aging, Stress and Coping
 Who has more stress? Older or Younger?
 Management strategies
 Avoid stressful situations
 Change thinking about the situation
 Relaxation techniques --- deep breathing
--- Progressive Muscle Relaxation
--- visualization
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20. Effects of Stress on Health
 Short-term stress vs. long-term stress
 Chronic Stress
 Immune system suppression
 Increased susceptibility to:
 Viral infections
 Risk of atherosclerosis
 Hypertension
 Impaired memory and cognition
 Inhibited menstruation – women
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21. Learning Objectives
 What are the most important issues in chronic
disease?
 What are some common chronic conditions across
adulthood?
 How can people manage chronic conditions?
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22. General Issues in Chronic Conditions
 Common Chronic Conditions
 Arthritis
 Cardiovascular and Cerebrovascular Disease
(leading cause of death in US)
 Diabetes Mellitus
 Cancer
(2nd leading cause of death in US)
Risk increases with age – males at greater risk
 Incontinence
 More embarrassing than dangerous
 15% community dwelling elders
 35% community dwelling elders with dementia
 70% nursing home residents
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23. Cancer Incidence Rates 1973-2000
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24. Leading Sites of New Cancer Cases
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25. Cancer Rates by Race & Ethnicity
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26. Managing Pain
 Myths and Stereotypes
 Part of growing old
 Elders should just accept the pain
 How to manage pain?
 Pharmacological
 More meds than any other age group
 ½ all meds prescribed
 Non-pharmacological
 Therapeutic touch, massage, vibration, heat, cold
 Acupuncture and acupressure
 Biofeedback
 Distraction techniques
 Relaxation, meditation, and imagery
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27. Learning Objectives
 What are the developmental trends in using
medication?
 How does aging affect the way the medications work?
 What are the consequences of medication
interactions?
 What are the important medication adherence issues?
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28. Patterns of Medication Use
 Explosion of new medication available
 People over 60 take nearly 50% of all prescription and over
the counter medication.
 New drugs can be dangerous to older adults.
 New drugs are frequently very expensive.
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29. Developmental Changes and Medication
 Absorption
 Time needed for medications to enter the bloodstream
 Once in the bloodstream the drug is distributed
throughout the body.
 Drug Metabolism
 Drug Excretion
 Drugs not recommended for older adults
 Good strategy: “start low and go slow.”
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30. Medication Side Effects and Interactions
 Polypharmacy
 The use of multiple medications in the same person
 Interactions
 Potentially dangerous
Adherence to Medication Regimens
 Difficult with older patients
 Many older patients go to more than one doctor so
accurate knowledge of drugs taken is important.
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31. Example of a Drug Regimen
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33. Functional Health and Disability
Learning Objectives
 What factors are important to include in a model of
disability in late life?
 What is functional health?
 What causes functional limitations and disability in
older adults?
Britain's Oldest Married Couple
Ralph – 107
Phyllis – 101
Married – 77 years
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34. Functional Health and Disability
Disability in Late Life
 Definition of disability?
Effects of a chronic condition on a person’s ability to engage in activities
that are necessary, expected, or desired in their society
 Compression of morbidity
Becoming disabled later with a shorter period of disability before death
 A model of the disablement process
Interventions strategies:
 Extraindividual factors – environmental & healthcare
(surgery, meds, social support services, physical environment support)
 Intraindividual factors – behavioral & personality
(exercising, positive outlook,etc)
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35. Model of the
Disablement
Process
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36. Functional Health and Disability
Determining Functional Health Status
 Determining Functional Health Status
 Frail older adults
physical disabilities, very ill, cognitive decline or psychological
disorders, and need assistance with everyday tasks
*(minority of older adults; chance increases with age)
*Needs help with more than one ADL
 Activities of daily living: ADL
basic self-care task – eating, dressing, bathing, toileting, walking
 Instrumental activities of daily living: IADL
actions requiring planning & intellectual competence
(shopping, paying bills, taking meds correctly, keeping appointments)
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37. Functional Health and Disability
Limitations and Disability in Older Adults?
 Strong predictors
 Cerebrovascular disease
 Arthritis
 Coronary artery disease (weaker predictor)
 Other predictors
 Smoking
 Heavy drinking
 Physical inactivity
 Depression
 Social isolation and perceived poor health
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38. Percentage of Medicare Enrollees Age 65 and Older
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39. Disability
and the
Need for
Assistance
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40. Functional Health and Disability
What Causes Functional Limitations
and Disability in Older Adults?
 How Important are Socioeconomic Factors?
 Do Gender and Ethnicity Matter?
Britain's Oldest Married Couple
Ralph – 107
Phyllis – 101
Married – 77 years
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