AGING· The human lifespan seems to be limited to 80 -100 year.docx

AGING:
· The human lifespan seems to be limited to 80 -100 years
(cross-cultural, multi-ethnic) with some exceptions (to 115+
years)
· Life expectancy among genders and races (& socio-economic
groups) varies due to standard of living, cultural behaviors
(diet, risk taking behaviors, etc)
· In general, women have higher life expectancy than men
(possibly due to cardiovascular disease developing later in
life).
· Multiple theories of aging:
· Somatic mutation theory: cells are "programmed" to mutate
& die after a limited number of divisions (ceiling to possible
number of cell divisions of all human cells); possibly due to
accumulated defects in mitochondria over time (cells can no
longer extract energy from foodstuffs).
· The molecular clock and the Hayflick Limit: after each cell
division, the chromosome becomes shortened at the telomere
(the tip of the chromosome). Eventually, the shortening is so
great that the replicating enzymes can't "read" the chromosome
to replicate it, and the cell can no longer divide – this is
sometimes called the “Hayflick limit” … this prevents cells
from indefinite reproduction, otherwise called the "molecular
clock”
· Catastrophic theory: also called the "complexity theory
(really a "chaos" theory) of accumulated mistakes in DNA
transcription & translation & the inability of the cells and
organs to function together in response to the normal stresses of
the environment. This results in adaptive dysfunction and organ
derangements leading to organism disease as well as the
"normal" process of aging & death. Helps explain associated
neurological changes with advanced age.
· Neuroendocrine theory: the brain is "programmed" to stop

producing needed supportive hormonal factors.
· Extracellular degenerative theory: accumulation of disease
over time due to environmental factors.
· Modifiable factors? Can we turn back the hands of time (or at
least slow them down)?
· Pay attention to diet
· Fruit and vegetable consumption and mortality (Wang, et al.,
2014, BMJ):
http://www.bmj.com/content/349/bmj.g4490 (Links to an
external site.)Links to an external site.
· Dietary protein sources and cancer (Farvid, et al., 2014,
BMJ): http://www.bmj.com/content/348/bmj.g3437 (Links to an
external site.)Links to an external site.
· The “Mediterranean” diet and telomere length (Crous-Bou, et
al., 2014): http://www.bmj.com/content/349/bmj.g6674 (Links
to an external site.)Links to an external site.
· Increase physical activity
· Reduce exposure to environmental pollutants
View this video:2012 AMMG lecture: Telomeres and a new
theory of aging (Links to an external site.)Links to an external
site.
Park, E. (2012, June, 9). 2012 AMMG lecture: Telomeres and a
new theory of aging [Video file]. Retrieved from
https://www.youtube.com/watch?v=m0DZ1-
WVtao&feature=youtu.be
Definitions of health:
Definitions and perspectives on the concepts of health,
wellness, and illness/disease, psychology topics in
health/wellness/illness/disease. Note that health is NOT simply
an absence of disease. See the World Health Organization
(WHO) definition, adopted in
1948:http://www.who.int/about/definition/en/print.html (Links
to an external site.)Links to an external site..
Research concepts:

Correlational Research: what is the difference between
causality & association? People often insist that experts tell us
what “causes” an event or condition to occur. To determine
“association” between variables, correlational research is done.
However, this type of research can only indicate that there is (or
isn’t) a relationship between the variables – not causality. One
story that helped me: “When you see a fire, firefighters are
always there – does this mean that firefighters cause fires?” (of
course they do NOT cause them – but firefighters are associated
with fires)(see link at end of guidance)
Clinical Research: we are trying to come closer to the answer
of “causality.” This usually takes years of painstaking, well
designed research trials by many investigators. Today, most
practitioners in the healthcare fields will require such research
to make clinical decisions; this is called Evidence Based
Practice (EBP). We are expected to know how to “grade” the
clinical research (strength of taxonomy) and interpret data from
randomized clinical trials (RCTs)(see links at end of guidance).
Regarding RCTs:
· Used to test an intervention (drug, lifestyle, surgery, etc.) and
determine how an outcome is matched to the intervention
· Used to determine risk factors associated with the
development of disease
· Requires matched cohorts of patients – matched as closely as
possible by age, sex, clinical condition, lifestyle, possibly
race/ethnicity, etc.
· Requires the use of placebo to test on one cohort and active
drug (or other intervention) on the other cohort
· Usually it is “double-blind” (neither the investigator nor the
subject knows if they are receiving a placebo or an active
drug/intervention)
· Usually it is “double-dummy” (midway through the
experiment, the placebo and active cohorts are switched)
· Clinicians expect that results obtained by properly “powered”
(enough subjects to be able to perform statistical analysis on the
results)

The biopsychosocial approach to health and healthcare:
The biopsychosocial model had two main authors – Roy Grinker
(1954) and George Engel (1977). Probably, Engel is more
recognized in the USA as the “father” of this theory and
approach to psychology. In this paradigm (a paradigm is a way
of thinking about something) we give equal importance to three
aspects of health care: the biological, psychological, and social.
This paradigm probably opened the door to evidence-based
practice in psychology and psychiatry, as well as emphasizing
the integration of psychopharmacology into care for
neuropsychiatric conditions. In addition, patient preferences
and beliefs are also incorporated into management choices.
Thus, when thinking of medical topics, it is not just the
diagnosis and management or cure of illness, but also how the
patient views its value and the impact on desired functional
capacity.
This approach has been used to discuss many topics –
everything from pain management, irritable bowel syndrome,
and emergency department care. For instance, in managing
pain, it is not just the biological aspects (cause, location,
intensity of pain) but also psychological (emotional distress,
health beliefs) and social (functional impact).
Health Behaviors and Behavior Change:
Health behaviors are choices made by the individual or
communities, and the study of motivations and beliefs that
underlie these choices is part of health psychology. We can
focus on health behavior change using the biopsychosocial
model; various theories are used to explain behavior change.
Two commonly-used “models” of behavior change are the
Health Belief Model(HBM) and the Transtheoretical Model
(TTM). Using these models, we can analyze individual health
choices in preventive care as well as management of illness and
disease states. See more about these two different “models”
below.
In Week 1, we look at factors affecting life expectancy and in
many cases individual and community choices regarding health

behaviors can greatly impact individual life expectancy. For
instance, deciding to quit smoking can have enormous positive
effects on overall health, function in later years, and life
expectancy.
Health Belief Model (HBM):
The HBM contains three main concepts – readiness to act, cues
to action, and self-efficacy. Within readiness to act, four
components are included: perceived threat or benefit,
describing them as susceptibility, severity, benefits and
barriers. Cues to action describe strategies that activate
readiness. Self-efficacy involves one’s confidence in being able
to be successful in an action or endeavor. This model can be
applied to both acute and chronic illness as well as health
promotion (preventive care). There are limitations to this
model, but it is very widely used.
Concept
Definition
Application
Perceived Susceptibility
One's opinion of chances of getting a condition
Define population(s) at risk, risk levels; personalize risk based
on a person's features or behavior; heighten perceived
susceptibility if too low.
Perceived Severity
One's opinion of how serious a condition and its consequences
are
Specify consequences of the risk and the condition
Perceived Benefits
One's belief in the efficacy of the advised action to reduce risk
or seriousness of impact
Define action to take; how, where, when; clarify the positive
effects to be expected.
Perceived Barriers
One's opinion of the tangible and psychological costs of the
advised action
Identify and reduce barriers through reassurance, incentives,

assistance.
Cues to Action
Strategies to activate "readiness"
Provide how-to information, promote awareness, reminders.
Self-Efficacy
Confidence in one's ability to take action
Provide training, guidance in performing action.
Modified from: National Institutes of Health. (2005) “Theory at
a Glance: A Guide for Health Promotion Practice” NIH number
05-3896. Retrieved
from http://www.sneb.org/2014/Theory%20at%20a%20Glance.p
df (Links to an external site.)Links to an external site.
Transtheoretical Model (TTM) of Behavior Change (Stages of
Change Model):
The TTM is also called the “Stages of Change” model – since it
describes individuals moving through specific stages of
change: precontemplation, contemplation, preparation, action,
and maintenance. Some descriptions of this model also include
an additional final stage called termination, but this is not
usually included in health-related behaviors. One focus of the
TTM is to describe interventional strategies that can influence
the movement from one stage to the next. The goal is to
achieve maintenance. Much research has been done regarding
this model, and was originally applied by Prochaska to smoking
cessation interventions.
For instance, in smoking cessation, research has identified the
amount of time typically spent in the different stages. The
information below is taken from one of your instructor’s
publications on this topic (see reference list at end of this
guidance):
· Precontemplation: currently smoking, will not consider
quitting within the next six months
· Contemplation: currently smoking, will consider quitting with
in the next six months
· Preparation: currently smoking, change is imminent, may
even start some action (e.g., “cutting down” on cigarettes)

· Action: not smoking, high rate of relapse in this stage (needs
more support)
· Maintenance: not smoking, greater confidence, less relapse
risk, may help others to make the same change (quitting
smoking)
Life Expectancy & Longevity:
Data for the United States is published annually by the Centers
for Disease Control (CDC) on their website, National Center for
Health Statistics (NCHS). A publication is available for
download that provides details of life expectancy data by type
of illness, risk factors, healthcare services utilization, access to
care & resources, and healthcare expenditures. Comparisons are
provided for the U.S.A. vs. other countries, as well as
comparing subpopulations to determine if there are ethnic/racial
disparities for various health outcomes. Risk factors for
illnesses are also compared, and data for each state is also
included.
To access the CDC website: https://www.cdc.gov/nchs/ (Links
to an external site.)Links to an external site.
For instance, the reduction in life expectancy for black males as
compared to white males is explained by the following factors:
heart disease, homicide, cancer, stroke and even perinatal
conditions (surrounding birth). On the other hand, certain
conditions were lower in black males vs. white males (suicide,
unintentional injuries, chronic liver disease, chronic lower
respiratory diseases, Parkinson’s disease).
Why is it important for us to “track” this information? If we are
aware of healthcare disparities, we can write public policy to
direct funds and initiatives to correct some issues. Typically,
overall, risk factors affecting longevity include the quality of
medical care, behavioral risk factors (obesity, smoking, AIDS
incidence), and other variables (education, income, health
insurance coverage, medical expenditures). We are of course
thinking about this from the biopsychosocial perspective.
Positive psychological factors include personality traits such as
resilience and conscientiousness. Social factors include social

connectedness and the availability of social support. There is
evidence that social isolation can actually cause deleterious
changes in physiology that are associated with worsening
health. Biological factors include genetics, and much research
has been done on heritable factors in longevity – yes, if you
come from a family with long-lived persons, your longevity will
probably be good. Please see the references section for more
information.
Additional Resources:
1. American Academy of Family Practice. (2007). SORT: The
strength-of-recommendation taxonomy (Links to an external
site.)Links to an external site.. Retrieved from:
http://www.aafp.org/dam/AAFP/documents/journals/afp/sortdef
07.pdf
2. Bogg, T., & Roberts, B. W. (2013). The case for
conscientiousness: Evidence and implications for a personality
trait marker of health and longevity (Links to an external
site.)Links to an external site.. Annals of Behavioral Medicine,
45(3), 278-288. doi:10.1007/s12160-012-9454-6
3. Brooks-Wilson, A. R. (2013). Genetics of healthy aging and
longevity (Links to an external site.)Links to an external site..
Human Genetics, 132(12), 1323-1338. doi:10.1007/s00439-013-
1342-z
4. Cherry, K. (2016, May 11). Correlational studies: A closer
look at correlational research (Links to an external site.)Links
to an external site.. Very Well. Retrieved from:
http://psychology.about.com/od/researchmethods/a/correlational
.htm
5. If you would like to see the original 1977 article by George
Engel mentioned above, see (you can download the full PDF of
the article):
a. Engel, G. L. (1977). The need for a new medical model: A
challenge for biomedicine (Links to an external site.)Links to an
external site.. Science, 196(4286), 129-136.
doi:10.1126/science.847460

6. Ghaemi, S. N. (2009). The rise and fall of the
biopsychosocial model (Links to an external site.)Links to an
external site.. British Journal of Psychiatry, 195(1), 3-4.
doi:10.1192/bjp.bp.109.063859
7. Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Main
constructs (Links to an external site.)Links to an external site..
In Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.), Health
behavior and health education: Theory, research, and practice.
Retrieved from http://www.med.upenn.edu/hbhe4/part2-ch3-
main-constructs.shtml
8. Virginia Tech Continuing and Professional Education. (n.d.).
The transtheoretical model (Stages of change) (Links to an
external site.)Links to an external site.. In Behavioral Change
Models. Retrieved from:
http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf
9. Woody, D., DeCristofaro, C., Carlton, B. G. (2008, August).
Smoking cessation readiness: Are your patients ready to
quit? (Links to an external site.)Links to an external site.Journal
of the American Academy of Nurse Practitioners, 20(8), 407-
414. doi:10.1111/j.1745-7599.2008.00344.x
10. World health organization – WHO definition of
health (Links to an external site.)Links to an external site..
(2003). Retrieved from
http://www.who.int/about/definition/en/print.html
11. Yang, C. Y., McClintock, M. K., Kozloski, M., & Li, T.
(2013). Social isolation and adult mortality: The role of chronic
inflammation and sex differences (Links to an external
site.)Links to an external site.. Journal of Health and Social
Behavior, 54(2), 183-203. doi:10.1177/0022146513485244
Course Text:
Ferrini, A. & Ferrini, R. (2013). Health in the later years (5th
ed.). New York, NY. McGraw-Hill.
AGING:

·
The human lifespan seems to be limited to 80
-
100 years (cross
-
cultural, multi
-
ethnic)
with some exceptions (to 1
15+ years)
·
Life expectancy among genders and races (& socio
-
economic groups) varies due to
standard of living, cultural behaviors (diet, risk taking
behaviors, etc)
·
In general, women have higher life expectancy than men
(possibly due to cardiovascular
dise
ase developing later in life).
·
Multiple theories of aging:
o

Somatic mutation theory:
cells are "programmed" to mutate & die after a
limited number of divisions (ceiling to
possible number of cell divisions of all
human cells); possibly due to accumulated defects in
mitochondria over time
(cells can no longer extract energy from foodstuffs).
o
The molecular clock and the Hayflick Limit:
after each cell division, the
chromoso
me becomes shortened at the
telomere
(the tip of the
chromosome).
Eventually, the shortening is so great that the replicating
enzymes
can't "read" the chromosome to replicate
it, and the cell can no longer divide
–
this is sometimes called the
“Hayflick limit” …
this prevents cells from
indefinite reproduction, otherwise called the "molecular clock”

o
Catastrophic theory:
also called the "complexity theory (really a "chaos"
the
ory) of accumulated mistakes in DNA transcription &
translation & the
inability of the cells and organs to function together in response
to the normal
stresses of the environment.
This results in adaptive dysfunction and organ
derangements leading to orga
nism disease as well as the "normal" process of
aging & death.
Helps explain associated neurological changes with advanced
age.
o
Neuroendocrine theory:
the brain is "programmed" to stop producing needed
supportive hormonal factors.
o
Extracellular degenerat
ive theory:

accumulation of disease over time due to
environmental factors.
·
Modifiable factors? Can we turn back the hands of time (or at
o
Pay attention to diet
§
Fruit and vegetable consumption and mortality (Wang, et al.,
2014,
BMJ
):
http://www.bmj.com/content/349/bmj.g4490
(Links to an external
site.)Links to an external site.
§
Dietary protein sources and cancer (Farvid, et al., 2014,
BMJ
):

§
The “Mediterranean” diet and telomere length (Crous
-
Bou, et al.,
2014):
o
Increase physical activity
o
Reduce exposure to environmental pollutants
AGING:
-100 years
(cross-cultural, multi-ethnic)
with some exceptions (to 115+ years)
-economic
groups) varies due to

standard of living, cultural behaviors (diet, risk taking
behaviors, etc)
(possibly due to cardiovascular
disease developing later in life).
o Somatic mutation theory: cells are "programmed" to mutate
& die after a
limited number of divisions (ceiling to possible number of cell
divisions of all
human cells); possibly due to accumulated defects in
mitochondria over time
(cells can no longer extract energy from foodstuffs).
o The molecular clock and the Hayflick Limit: after each cell
division, the
chromosome becomes shortened at the telomere (the tip of the
chromosome). Eventually, the shortening is so great that the
replicating enzymes
can't "read" the chromosome to replicate it, and the cell can no
longer divide –
this is sometimes called the “Hayflick limit” … this prevents
cells from
indefinite reproduction, otherwise called the "molecular clock”
o Catastrophic theory: also called the "complexity theory
(really a "chaos"
theory) of accumulated mistakes in DNA transcription &
translation & the
inability of the cells and organs to function together in response
to the normal
stresses of the environment. This results in adaptive
dysfunction and organ
derangements leading to organism disease as well as the
"normal" process of
aging & death. Helps explain associated neurological changes
with advanced age.
o Neuroendocrine theory: the brain is "programmed" to stop

producing needed
supportive hormonal factors.
o Extracellular degenerative theory: accumulation of disease
over time due to
environmental factors.
o Pay attention to diet
tality (Wang, et al.,
2014,
external
external
-Bou, et
al.,
2014): http://www.bmj.com/content/349/bmj.g6674 (Links to
an external
o Increase physical activity
o Reduce exposure to environmental pollutants

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