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Exam #2 Notes and Exam Review

by: Harper Smith

Exam #2 Notes and Exam Review GERO 1010-

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Harper Smith


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In-class notes from immediately after exam #1 through the exam review for exam #2
Intro to Gerontology
Cynthia Spitler
gero, Gerontology, spitler, BGSU, gero 1010
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This 23 page Bundle was uploaded by Harper Smith on Tuesday February 2, 2016. The Bundle belongs to GERO 1010- at a university taught by Cynthia Spitler in Fall 2015. Since its upload, it has received 73 views.

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Date Created: 02/02/16
Demography of Aging 09/14/2015 INCLUDES TEST REVIEW EXAM 2 Sources of Population Data  Demographic analysis is based on census counts taken by public and/or private agencies o Bureau of the Census is the central clearinghouse for all national US population data  National census is taken every 10 years  Births, deaths, country of origin, health, living arrangements, and income are tracked ▯ Measures of Individual Aging  Life Span: longest number of years any member of a species has been known to survive  Life Expectancy: the average number of years people in a given population can expect to live o The average age at death o Life expectancy worldwide is higher for females  Sex Ratio: number of males for every 100 females o Every 106 males born, only 100 females are born  Declines progressively over the life course ▯ Processes of Population Aging  A population’s age structure can change through 3 processes o Fertility rates o Mortality rates o Migration Demographic Transition  As countries industrialize, accompanying changes in fertility and mortality produce changes in population structure o At the end, a country’s population is older and larger  3 stage shift from high to low mortality and fertility o 1. Economy is agricultural, young marriage and childbearing  Few reach adulthood, even fewer make it to old age  Population pyramid is a perfect triangle o 2. Public Health advancing  Control of diseases reduces mortality in young kids  Age structure expands at the bottom of the pyramid  Once these kids make it to childbearing age, significant population growth occurs  Public health advances increases life expectancy o 3. Modernization/Industrialization  Fertility rates decline  When birth and death rates reach low at the same time, the demographic transition is complete ▯ International Variations in Population Aging  Elderly percentage of populations differ by country  Oldest nations are in Western Europe and North America o USA 36-39 median age  Africa/Asia/Latin America are still in the first stage of demographic transition o Young population profiles ▯ Dependency Ratios p. 87  Elderly Dependency Ratio o Number of persons 65+ per 100 people of working age (18- 64) o Child Dependency Ratio  Number of persons under 18 relative to those of working age o Total Dependency Ratio  Combined ratio of children and older people to workers ▯ Changing Age Structure in the US  1900 – 4.1% over 65  2000 – 12.8% over 65  2030 – 20% over 65 projected  2060 – 25% over 65 projected  85+ population is the fastest growing sector ▯ Changing Patterns of Fertility  Climbed in 1946 and peaked by 1958 with 3.17 children per woman  Between 1971-1980 dropped dramatically o Birth Control and abortion o Women’s labor movement ▯ Changing Patterns of Mortality  Declined greatly in o 1940s due to major gains against infant, child, and maternal mortality o 1970s due to heart disease treatment  Heart disease remains leading cause  Cancer deaths have increased among the elderly most likely because they are living longer ▯ Changing Immigration Patterns in the US  Most immigrants are relatively young o 1970-1980 75% of Hispanic immigrants were under 35  8% of total growth in the elderly population in the US from 1992- 2000 due to international migration  Due to higher immigration/birth rates, Hispanic, AF. Am, and Asian populations are increasing more rapidly than white populations Consequences of an Aging Population  Fewer workers will be paying into Social Security taxes o More people will retire later o Increased demand for elderly housing options o Who will be paying for healthcare? How will we meet the demand ▯ Life Expectancy in the US  1900-1996 went from 47 – 76 o male 76 o female 86 ▯ Environmental Theories of Aging  Wear and Tear Theory o Looks at the body like a machine that simply wears out o Difficult to test because we don’t know what normal wear is o In theory, the more active the quicker the wearing out but in reality it’s the other way  Somatic Mutation Theory o With exposure to external things like air pollution, chemicals, and radiation, mutation is caused to somatic cells  Proposes that harmful or deleterious mutations accumulate with age  Will lead to an increase in pathological changes in the body Developmental/Genetic Theories  Immune Function Theory o Body’s protective immune reactions decline with age o An aging immune system loses its ability to distinguish between self and foreign  Starts to attack proteins of the body like they’re foreign  Cross-Linkage Theory o Common protein, collagen which holds cells together by cross- links  These cross-links accumulate and cause wrinkles, hardening arteries (higher blood pressure), and stiff joints  Free Radical Theory o Free radicals are unstable molecules that are produced when the body transforms food into energy  When free molecules unite with other molecules, they can damage the cell and cause mutation  Most changes associated with aging result from free radical damage o Not in itself a general theory of biological aging  Genetic Control Theory o Views life span as programmed into the genes  Genes don’t determine whether an individual gets a specific disease or how long someone lives  Many people have genetic susceptibility to a disease never get it ▯ The Aging Body  Active Life Expectancy p. 126 o Measure of the number of years a person can expect to live without a disability o Men’s is 60 years, 84% of their life o Women’s is 58, 82% of their life  Fewer years because their total life expectancy is longer than men  The end years, their risk increases rapidly  Skin Changes o Wrinkles and sagging skin  Subcutaneous fat redistributes  Lentigo – the discoloration or spotting on the face, back of hands, and forearms of older people. Buildup of melanin  Senile pupura – sites where fragile blood vessels have ruptured  Not necessarily harmful o Skin cancers  UV ray exposure over life  Basal cell carcinoma  Squamous cell carcinoma  Melanoma (most dangerous)  Males are 2x as likely to develop o Males play more outdoor sports  Caucasians are 10x more likely  Hair Changes o Hair turns gray because fewer active pigment producing cells (melanocytes) o Balding is more common in males because of testosterone decline  Nervous System o Neurons in the brain die and aren’t replaced  Brain loses 20% of it’s peak weight o Cerebellum is in charge of the body’s movements and balance  When damaged, can cause falls  Strength and balance training can help prevent them o Sleep patterns  Need less sleep, don’t always sleep through the night  2/3rds of adults have sleep issues o Parkinson’s Disease  Develops slowly over the years beginning as early as 30  Caused by slow death of nerve cells in the central portion of the brain  Symptoms  Trembling  Slow movement/rigidity  Temporary inability to move  Chronic constipation  Drooling  Spasms  Tremors  Hallucinations  Sensory System Changes o Vision  Presbyopia – inability to focus on near objects  Changes in various parts of the eye reduce ability to receive visual stimulation  Older people need more light to perceive depth and see clearly  Cataracts  Lens of the eye becomes cloudy and light cannot penetrate  Laser surgery  Lens may be replaced by an artificial lens  Glaucoma  Caused by buildup of fluid in the anterior cavity of the eye  Gradually destroys vision  Laser surgery, diuretics or eyedrops o Hearing  Declines through middle years  Normal hearing loss is presbycusis  Harder to hear high-pitched sounds  Worse in males because they are exposed to louder stuff in jobs and in life o Smell and Taste  Degeneration of the taste buds or change in the way the brain perceives the information  Can cause poor nutrition o Touch and Temperature  Older people lose some ability to regulate heating and cooling  Have problems staying warm because subcutaneous fatty tissue beneath the skin goes away  Skeletal System o Calcium is taken from the bones when needed and then calcium replaces the bone  Older bone is broken down faster than it is replaced resulting in bone loss in old age (Osteopenia) o Osteoporosis occurs when outside walls of the bone become thinner and inner part becomes spongy  Women 4x more likely to have it  Symptoms: loss of height, back pain, curving of upper back or spine o Arthritis  1/3 of men, ½ of women over 65  Joint inflammation and pain, swelling, deformity  Muscle Changes o 30-80% of muscle mass loss by 80 years o Sarcopenia – muscle loss o 25% body fat by age 25. 40% by old age  Reproductive System o Female  Menopause – climacteric change  End of period, ovaries shrink and stop ovulating, vaginal walls become thinner, decline in production of estrogen and progesterone o Male  No menopause  Testosterone production slows  Erectile Dysfunction  Benign Prostate Hyperplasia  Enlarged prostate  Nocturia  Having to pee often at night  Cardiovascular System o Muscle atrophy in the heart  Reduction in the amount of blood pumped with each contraction  Chest pain = angina o Blood vessel changes  Loss of elasticity of the blood vessels arteriosclerosis  Blood pressure increases  Hypertension  Arteries are clogged and not elastic  Leading to a heart attack is called hypertensive cardiovascular disease  Symptomless  Cognitive psychology is the study of mental processes  Social gerontologists are concerned with identifying and understanding patterns of change in mental processes as we age  Creativity  People of any age can make creative contributions in science, the arts, and literature o Many artists produce their best work in their older adulthood  People nearing the end of a creative career typically produce ½ as much as they did in their late 30s and early 40s  Measuring creativity is difficult  Wisdom  We look at older people are wise  Wisdom is the ability to reason, to learn from experience, to use good judgment, and use information o With age, we learn how to make better decisions from trial & error Intelligence  Fluid intelligence o Reasoning, memory, and information processing skills o Ability to deal with novel situations o Testing  Verbal  Vocab, arithmetic, learned knowledge, and comprehension  Performance  Puzzle solving ability involving blocks and pictures o Research  Schaie  Measured intelligence using  Verbal meaning  Spatial orientation  Inductive reasoning  Number  Word fluency  Subjects intelligence peaked in late 30s-early 40s  Modest decline in early 60s  Dropped around age 70  None declined in all 5 areas, just onsie twosies  Healthier people maintained higher levels of intellectual functioning than ill  Crystallized Intelligence o Information, skills, and strategies learned through experience  Reflects accumulated past experience and socialization  Refers to acquisition of practical expertise  Learning and Memory  Process of acquiring knowledge and skills  Memory is the retention or storage of knowledge o Encoding  Short Term o Limited capacity system that keeps memory and consciousness o Interruption during learning the information makes it not repeatable  Short term memory is affected more than long term o Slows down in older adults o Older adults remain capable of retrieving the information needed, but it takes longer  Dementia o Mental disorders caused by deterioration of the brain o Can affect memory, personality, social functioning, cognitive functioning, and normal activities o Symptoms  Impairment of memory, intellect, judgment, orientation, and excessive/shallow emotions  May have depression, anxiety, delusions, and aggressive behavior o Alzheimer’s Disease  Slow onset and involves subtle changes  Loss of short-term memory early on  Repetition and confusion  Dramatic personality changes  Can be withdrawn, physically aggressive  Alzheimer’s patients lose memory permanently  Causes  Hereditary, can be an effect of poor nutrition or stress o Vascular Dementia  Result of multiple small strokes  Brain damage over time is irreversible  Aphasia  Clinical Depression o Symptoms  Depressed mood  Loss of interest in pleasurable activities  Loss of appetite  Sleep disturbance  Fatigue  Feelings of worthlessness and guild  Difficulties thinking and concentrating  Psychomotor disturbances  Suicidal notions for at least two weeks o In elderly  Depression level peak at 30, then rises again at 60  80+ group has the highest depression level  80+ males are the most likely to commit suicide  Women are more susceptible to depression  Depression is associated with poor health, lower SES and minimal interaction with others  Personality and Adaptation o Personality traits are enduring dispositions toward thoughts, feelings, and behavior, both inherited and learned  5 major factors are neuroticism, extraversion, openness, agreeableness, conscientiousness o Self-concept  Self-esteem, self-image, beliefs, and personality traits  Who am I? o Adaptation – behaviors used to meet demands such as confronting problems and managing frustration and anxiety o Coping – state of compatibility between the individual and the environment that allows him/her to maintain a sense of well- being satisfaction with life  Erikson’s Theory of Identity Development  Basic trust vs. Mistrust Birth - 12 months Autonomy vs. Shame 18 months - 2 years Initiative vs. Guilt 3 yrs – 6 yrs Industry vs. Inferiority 6 yrs – Puberty Identity vs. Identity Confusion Puberty – Early Adulthood Intimacy vs. Isolation Young adulthood Generavity vs. Stagnation Middle adulthood Integrity vs. Despair Old age o Person’s feels their life has been appropriate and meaningful when they achieve integrity  Levinson Men’s Transition through Adulthood o Men and women go through adulthood through stages, but at different times o Beginning at 30 men have a chance to fix things in their life  Those satisfied with their life have smooth transition  Others who were not would find conflict and try to rediscover who they were o Early 40s men go through midlife transition, asking what they’ve accomplished anything o Some who spent more time on career would shift priorities and focus more on families  Apter’s Women in the Midlife Transition o Traditional – typical housewife who fulfilled social expectations; in midlife became tired of meeting needs of others o Innovative – Pioneers in the man’s world, modeled careers as men do; in midlife, looked back ito see if career success was worth taking time away from family o Expansive – Late starter, limited in training and education; seek radical change in their lives o Protestors – Forced to mature more quickly than social norm; try to find a way to gain back early adulthood o  Stages of epidemiologic transition  A change in the leading causes of death from infectious diseases to chronic diseases  Stages o 1. Age of pestilence and famine characterized by high death rates from chronic malnutrition and periods of epidemics of infectious disease o 2. Decline in deaths from epidemics and famine while infectious diseases become the major cause of death o 3. Shift in the leading causes of death from infectious disease to chronic disease  Chronic diseases  Diseases for which there is no cure  The increase of chronic illness means that poor health becomes associated with old age  The risk of suffering from multiple chronic ailments increases with age  Functional status  Functional status refers to the degree of difficulty an individual experiences in performing activities of daily life o Personal activities of daily living such as bathing, eating, dressing, and toileting o Instrumental activities of daily living such as shopping, preparing meals, managing money, and getting outside  Compression of Morbidity Thesis  Coined by James Fries in 1980  Two premises of the theory o Human life span is fixed and finite o Improvements in health care and prevention will compress years of disability and improve quality of life for an indicidual  Results o Demand for health care resources will decline o Quality of life will improve and increased life expectancy will not bring about increased illness and disability o Evidence increases the compression of morbidity thesis Health Lifestyles  Defined as a pattern of… o Smoking  Top 3 causes of death (heart attack, cancer, and stroke) are linked to smoking  Smoking is the major cause of COPD  Smoking is associated with disability  The number of older people who smoke has been steadily declining since 1980s o Exercise  People who exercise are able to keep their weight under control, have fewer aches and pains related to joints and back  Improved cardiovascular function, better memory, and less disability o Alcohol consumption  Heavy drinkers are more likely to suffer from cirrhosis of the liver, certain cancers, and hypertension  People who drink an occasional glass of wine have a lower risk of mortality than nondrinkers o Diet  Being overweight increases the risk of diability, heart disease, diabetes, and joint problems  Obese elderly have less physical strength  Sitting up for 2+ hours  Getting up from sitting  Pushing heavy objects  Upper body mobility  Socioeconomic status and health  High SES maintain relatively good health and low levels of disability until quite late in life o Health insurance for low SES  SES is measured using income, occupation, and education  Cumulative disadvantage theory vs. convergence theory o Cumulative disadvantage  People who begin life with greater resources continue to accumulate more  Those who are born with less fall further behind o Convergence  Old age is a great leveler  Inequality is reduced later in life o Research supports cumulative disadvantage  Gender difference  Why do women live longer than men but have a greater risk of disability o Women are more likely to go to the doctor. Engage in help- seeking behavior more than men o Women generally know more about their health and take better care of themselves o More frequent contact with health providers because of OBGYN o Higher levels of disability among women are due to the fact that they live longer and experience more years when they’re vulnerable to illness  Race and ethnicity  African Americans, Hispanics, and Native Americans have poorer health  With age they are more likely to develop serious illness  Gap can be explained by social factors including lifestyle, employment history, and access to healthcare  Health care providers and the elderly  Many physicians are biased against the aged and don’t want to work with them o Elderly patients have more complex issues and risk of rapid decline o Medical education is geared towards curing disease, not treating chronic illness o Can be more difficult to communicate with elderly patients o Medicare regulations are a pain  Illness in older people are sometimes undertreated o The standard treatments for cancer are pursued less aggressively o Older patients are undertreated in rehab, preventative services, mental health services, and primary care  Organization of the health care system o Fee-for-service  Physicians set the fees, people or their insurance company pay  Grant doctors lots of autonomy  Contain financial incentives to perform many services and procedures o Health maintenance organization(HMO), or managed care  Health insurance plans run by financial officers  Control costs through capitation where reimbursements to health care providers are set in advance  Prospective Payment System (PPS) o Introduced in 1983 in Medicare o Estimates cost of an average patient with a specific diagnosis  Groups illnesses into diagnostic-related groupings (DRGs)  Contains cost by setting reimbursement rates in advance  Patient Protection and Affordable Care Act of 2010 o AKA Obamacare o Increases regulations on insurance companies o Allows older children to remain on parent policies until 26 yo o Includes provisions to help judge quality of nursing home care o Includes an individual mandate specifying that everyone must have health insurance  Why have employers stopped paying retiree health benefits? o These policies have become increasingly expensive as health care costs have increased o The aging of the workforce has increased ratio of retired to active workers o Government now requires all firms to report the costs and liabilities associated with retiree health plans o  1. Senescence is increased vulnerability to stress and increased probability of death  2. Most obvious sign of aging  Wrinkling of the skin  3. Senile purpura is purple colored spots or bruises  4. Wear and tear theory equates the body to a machine that deteriorates over time  5. Blood pressure increases with age due to decreased elasticity of the blood vessels  6. Older adults can reduce the risk of driving by…  Stop driving at night  Stop driving in heavy traffic  Give up their license voluntarily  7. Cataracts are not part of normal aging  8. When does peak bone mass occur?  30  9. Osteoporosis is Severe bone depletion  10. 40% of dementia is vascular dementia  11. Loss of appetite, fatigue, and difficulty concentrating are symptoms of depression  12. Patient Protection and Affordable Care Act of 2010 does not pay for assisted living care  13. Ethnic group with the highest risk of diabetes, high blood pressure, and stroke is African Americans  14. Physicians caring for older adults are concerned about  Their complex health problems  Risk of rapid decline  Frustration of chronic diseases  15. Primary way of reimbursing physicians in the 1950s was fee for service  16. One reason why women tend to have higher depression rates in later life is due to…  Men are more likely to remarry and therefore have more social support  17. Nursing home residents have especially high depression rates  True  18. What is the premise of cumulative disadvantage theory  Those who start with greater resources have more opportunities to acquire more resources  Those with less continue to get less  19. What is a stroke?  Rupture or obstruction of a blood vessel  20. There are no advantages to drinking alcohol in later life  False  Advantages include the fact that it is a blood thinner, wine can be an antioxidant  21. The main purpose of health maintenance organizations is to achieve efficiency and control cost  22. What displays the age structure of a population?  Population pyramid  23. The average life expectancy in Africa was only 46 years in 2000 because of HIV/AIDS  24. What is the greatest number of years any member of a species can live?  Life span  25. Why do employers see retirees’ health insurance plans as a liability  Policies are expensive  Number of retirees has increased  Government requires firms to report all costs and liabilities associated with retirees’ health plans  26. What is layering?  When older adults with dementia put their clothes on in an irregular order  27. Fastest growing segment of the population is Oldest Old  28. What refers to the mortality rates of oldest old African Americans who fall below that of whites?  Race crossover  29. The Caucasian population as a proportion of the overall population will decline by the year 2050  30. Most recent immigrants come from Latin America and Asia


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