Exam #2 Notes and Exam Review
Exam #2 Notes and Exam Review GERO 1010-
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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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