The document discusses aging and health over the lifetime. It covers how lifestyle factors like physical activity, nutrition, and avoiding chronic illnesses can help people live long and healthy lives well into older age. As people age, they may experience various health challenges like mild cognitive impairment, Alzheimer's disease, osteoporosis, and grief following loss of loved ones. The document provides guidance on advance care planning and end of life preferences through legal documents like living wills and health care proxies.

1. Chapter 15 – A Lifetime of Health
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A Lifetime of Health
LectureOutline
I. Will You Live to Be 50?
A. Overview
1. Aging - the characteristic pattern of normal life changes that occurs as
living things grow older.
2. People age 65 and older make up 12 percent of the U.S. population.
3. Older Americans are as diverse as other segments of our population.
4. About three in four older Americans describe their health as good or
better.
B. How Long Can You Expect to Live?
1. Life expectancy has been increasing steadily over the last century, and is
now 78.2 years. Life expectancy for women now stands at 80.6 years; for
men, it is a record high of 75.7 years.
2. The difference in life expectancy each of these health hazards can make is:
a. High blood pressure: 1.5 for men, 1.6 for women.
b. Obesity: 1.3 years for men, 1.3 years for women.
c. High blood sugar: .5 years for men, .3 years for women.
d. Smoking: 10 years for both men and women.
II. Successful Aging
A. Overview
1. According to a recent survey, physical disabilities that limit mobility are
increasing among middle-aged Americans.
2. The key factors to living long and well are maintaining a healthy lifestyle
and avoiding or delaying chronic illnesses.
B. Physical Activity: It’s Never Too Late
1. The effects of ongoing activity are so profound that gerontologists
sometimes refer to exercise as “the closest thing to an anti-aging pill.”
2. Exercise slows many of the changes that occur with advancing age, such
as loss of lean muscle tissue, increase in body fat, and decreased work
capacity.

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3. Simply sitting for prolonged periods increases “all-cause mortality,” the
risk of dying for any reason, in both sexes and all age groups regardless of
general health, body mass index, and physical activity levels.
4. No one is ever too old to get in shape.
5. According to the U.S. surgeon general, physical activity offers older
Americans the following benefits:
a. Greater ability to live independently
b. Reduced risk of falling and fracturing bones
c. Lower risk of dying from coronary heart disease
d. Reduced blood pressure
e. Fewer symptoms of anxiety and depression.
f. Improvements in mood and feelings of well-being
6. The basis of a fitness plan should include:
a. Do moderately intense aerobic exercise 30 minutes a day, 5 days a
week OR do vigorously intense aerobic exercise 20 minutes a day, 3
days a week.
b. Do 8 to 10 strength-training exercises, 10–15 repetitions of each
exercise twice to three times per week along with balance exercises.
C. Nutrition and Obesity
1. Obesity is the most common nutritional disorder in older persons.
2. Over 65 persons face diabetes, heart disease, stroke, and arthritis, all
exacerbated by obesity.
D. The Aging Brain
1. The brain does and can repair itself.
2. Cognitive Aging
a. Mental ability does not decline along with physical vigor.
b. Older people who remain mentally healthy think just as quickly and
sharply as college students.
c. The brain, like the body, may begin to show signs of aging in middle
age.
d. Watching your weight also can help keep your brain sharp.
3. Memory
a. Memory loss and cognitive problems are becoming less common
among older Americans.
E. Women at Midlife
1. Reproductive Aging
a. Medical specialists have identified several stages that characterize the
aging of the female reproductive system.
b. Menopause – the complete cessation of ovulation and menstruation for
12 consecutive months

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c. Perimenopause - For many women, perimenopause—the four-to-ten
year span before a woman’s last period—is more baffling and
bothersome than the years after
d. Hormonal shifts can trigger an array of symptoms.
i. Night sweats and hot flashes are the most common symptoms.
e. A woman’s habits and health history also have an impact.
2. Menopause
a. Race and ethnicity profoundly affect women’s experiences.
b. Dwindling levels of estrogen subtly affect many aspects of a woman’s
health, from her mouth (where dryness, unusual tastes, burning, and
gum problems can develop) to her skin (which may become drier,
itchier, and overly sensitive to touch).
c. A woman’s clitoris, vulva, and vaginal lining begin to shrivel,
sometimes resulting in pain or bleeding during intercourse.
d. In the United States, the average woman who reaches menopause has
a life expectancy of about 30 more years.
3. Hormone Therapy
a. HT is no longer recommended for reasons other than short-term relief
of symptoms, such as hot flashes and night sweats.
b. Combination therapy slightly increased the risk of breast cancer, heart
disease, blood clots, and stroke.
c. Black cohosh, the most popular herbal treatment, either alone or with
other herbs, proved no more effective than a placebo in relieving hot
flashes and other menopausal symptoms.
F. Men at Midlife
1. Men experience a decline by as much as 30 to 40 percent in their primary
sex hormone, testosterone, between the ages of 48 and 70.
2. This change, sometimes called andropause, may cause a range of
symptoms, including decreased muscle mass, greater body fat, loss of
bone density, flagging energy, lowered fertility, and impaired virility.
3. After age 40, the prostate gland, which surrounds the urethra at the base
of the bladder, enlarges.
4. This condition called benign prostatic hypertrophy occurs in every man.
5. Medical treatments for benign prostatic hypertrophy include drugs, and
possible surgical treatment.
G. Sexuality and Aging
1. The fittest men and women report more frequent sexual activity.
2. Aging does cause some changes in sexual response:
a. Women produce less vaginal lubrication.

4. Chapter 15 – A Lifetime of Health
b. An older man needs more time to achieve an erection or orgasm and to
attain another erection after ejaculating.
c. Both men and women experience fewer contractions during orgasm.
d. None of these changes reduces sexual pleasure or desire.
III. The Challenges of Age
A. Mild Cognitive Impairment (MCI)
1. Ten to 20 percent of persons 65 and older
2. No medications are currently approved to treat
3. Coping strategies to slow down impairment
a. Exercise
b. Reduce cardiovascular risk factors
c. Participate in mentally stimulating and socially engaging activities
B. Alzheimer’s Disease
1. About 15 percent of older Americans lose previous mental capabilities, a
brain disorder called dementia.
2. Sixty percent of these suffer from the type of dementia called Alzheimer’s
disease, a progressive deterioration of brain cells and mental capacity.
3. A person with the disease typically lives eight years after the onset of
symptoms.
4. Women are more likely to develop Alzheimer’s than men.
5. The early signs of dementia—insomnia, irritability, increased sensitivity to
alcohol and other drugs, and decreased energy and tolerance of
frustration—are usually subtle and insidious.
6. Medications can control difficult behavioral symptoms and enhance or
partially restore cognitive ability.
C. Osteoporosis
1. Osteoporosis, a condition in which losses in bone density become so
severe that a bone will break after even slight trauma or injury.
a. One in every two women and one in every four men over 50 will have
an osteoporosis-related fracture in their lifetimes.
IV. Preparing for Medical Crisis and the End of Life
When facing a serious, potentially life-threatening illness, people typically have
practical, realistic goals, such as maintaining their quality of life, remaining
independent, being comfortable, and providing for their families.
A. Advance Directives
1. Every state and the District of Columbia has laws authorizing the use of
advance directives to specify the kind of medical treatment individuals
want in case of a medical crisis.

5. Chapter 15 – A Lifetime of Health
2. These documents are important because, without clear indications of a
person’s preferences, hospitals and other institutions often make decisions
on an individual’s behalf.
3. The two most common advance directives are health-care proxy, and
living wills.
a. Health-Care Proxy
i. A health-care proxy is an advance directive that gives someone else
the power to make decisions on your behalf.
b. Living Will
i. These indicate whether they want or do not want all possible
medical treatments and technology used to prolong their lives.
ii. Most states recognize living wills as legally binding, and a growing
number of health-care professionals and facilities offer patients
help in drafting living wills.
c. The Five Wishes
i. Helps the aged, the seriously ill, their loved ones, and caregivers
prepare for medical crisis.
ii. Persons using this document can specify:
(a) Which kinds of medical treatments they do or do not want
(b) How comfortable they want to be made
(c) How they want people to treat them
(d) What they want loved ones to know
d. DNR Order
i. You can also sign an advance directive specifying that you want to
be allowed to die naturally—you do not want to be resuscitated in
case your heart stops beating.
V. Death and Dying
A. Defining Death
1. Death has been broken down into the following categories:
a. Functional death: the end of all vital functions, such as heartbeat and
respiration.
b. Cellular death: the gradual death of body cells after the heart stops
beating.
c. Death: the moment when the heart stops beating.
d. Brain death: the end of all brain activity, indicated by an absence of
electrical activity (confirmed by an electroencephalogram, or EEG) and
a lack of reflexes.
e. Spiritual death: the moment when the soul, as defined by many
religions, leaves the body.

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2. Most states have declared that an individual is considered dead only
when the brain, including the brain stem, completely stops functioning.
3. Brain-death law prohibits a medical staff from “pulling the plug” if there
is any hope of sustaining life.
B. Denying Death
1. One important factor in denial is the nature of the threat.
2. The late Elisabeth Kübler-Ross, a psychiatrist who extensively studied the
process of dying, described the downside of denying death in Death: The
Final Stage of Growth.
a. It is the denial of death that is partially responsible for people living
empty, purposeless lives; for when you live as if you will live forever,
it becomes too easy to postpone the things you know that you must do.
C. Emotional Responses to Dying
1. Kübler-Ross identified five typical stages of reaction that a person goes
through when facing death:
a. Denial
b. Anger
c. Bargaining
d. Depression
e. Acceptance
2. Several stages may occur at the same time, and some may happen out of
sequence.
3. An individual’s will to live can postpone death for a while.
4. The family of a dying person experiences a spectrum of often wrenching
emotions.
5. As patients confront reality, they eventually can “let go and be.”
VI. Suicide
A. Suicide increases with age and is most common in persons aged 65 years and
older.
B. One of the main factors leading to suicide is illness, especially terminal
illness.
C. Advocates of the right to “self-deliverance” argue that individuals in great
pain or faced with the prospect of debilitating, hopeless battle against and
incurable disease can and should be able to decide to end their lives.
D. As legislatures and the legal system tackle the thorny questions of an
individual’s right to die, mental health professionals worry that, even in those
with fatal diseases, suicidal wishes often stem from undiagnosed depression.

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VII. Grief
A. Introduction
1. An estimated 8 million Americans lose a member of their immediate
family each year.
2. Death of a loved one produces a wide range of reactions, including
anxiety, guilt, anger, and financial concern.
3. According to the stage theory of grief, individuals respond to the loss of a
loved one by progressing through several steps, just like people facing
death.
a. Shock-numbness
b. Yearning-searching
c. Disorganization-despair
d. Reorganization
e. All of these reactions can occur simultaneously, although most peak
within six months.
4. Bereavement is not a rare occurrence on college campuses, but is largely
an ignored problem.
B. Grief’s Effects on Health
1. Men and women who lose partners, parents, or children endure so much
stress that they’re at increased risk of serious physical and mental illness,
and even of premature death.
2. Studies of the health effects of grief have found the following:
a. Grief produces changes in the respiratory, hormonal, and central
nervous systems, and may affect functions of the heart, blood, and
immune systems.
b. Grieving adults may experience mood swings between sadness and
anger, guilt and anxiety.
c. They may feel physically sick, lose their appetite, sleep poorly, or fear
that they’re going crazy because they “see” the deceased person in
different places.
d. Friendships and remarriage offer the greatest protection against health
problems.
e. Some widows may have increased rates of depression, suicide, and
death from cirrhosis of the liver.
f. Grieving parents, partners, and adult children are at increased risk of
serious physical and mental illness, suicide, and premature death.
3. Sometimes grief progresses from an emotionally painful but normal
experience to a more persistent problem called complicated grief.

8. Chapter 15 – A Lifetime of Health
Key Terms
advance directives
aging
Alzheimer’s disease
black cohosh
dementia
do-not-resuscitate (DNR) order
hormone therapy (HT)
living will
menopause
mild cognitive impairment (MCI)
perimenopause