What Is Optimal Physical Aging

1
What Is Optimal Physical Aging?

• Optimal physical aging is continuing to function
  at the highest possible level in the context of
  the inevitable limitations that growing older
  places upon us
• It is being aware, as opposed to being unaware,
  of the beneficial effects of certain physical,
  cognitive, psychosocial activities on HRQOL

PSYC S-1293, 2004
2
What Is Optimal Physical Aging? (Cont)

• Optimal physical aging is also doing, as opposed
  to not doing, things that are known to maintain
  and enhance HRQOL
• It is being proactive about medical checkups
  screenings when not symptomatic, and regularly
  appraising cognitive and psychosocial status,
  making adjustments as needed
• Optimal aging is getting the best out of what is
  possible for as long as possible

PSYC S-1293, 2004
3
Can We Be an APAger at 85?Which Standards Shall
We Use?

• Are there physical standards by which a 65, 75 or
  85 year old can judge whether they are aging
  optimally?
• Subjective or objective standards
• Gold standard or relative standards
• Other?
• Is there an age when OPA is impossible?

PSYC S-1293, 2006
4
What Is Optimal Physical Aging?Data from
Interviews

• Lots of variety
• Hi HRQOL, but not perfect health
• Modern medicine minimizing effects of physical
  decline
• Health awareness regular med checkups
• Rates present HRQOL good/better than same age
  peers
• No significant decline in past 5 years

PSYC S-1293
5
What Is Optimal Physical Aging?Data from
Interviews (Cont)

• Much higher energy/activity level than peers
• Engage in regular exercise/other activity
• Their living has a meaning and purpose
• Positive attitude about their activities
• Active social networks
• Quality of life more important than longevity

PSYC S-1293
6
Standards for OPA at 85 Preliminary Thoughts

• An important Q is Do I think I am an optimal
  ager?
• Standards must involve HRQOL
• Standards are likely to be subjective, so involve
  self- assessment
• In relation to others in age group, and self (5
  years ago?)
• Evidence of adjustment to changing physical
  realities
• Recognizing age imposed limitations, and getting
  most out of what is possible
• Stephen Hawking

PSYCH S-1293, 2006
7
Gain in Life Expectancy If Certain Diseases Were
Eliminated
Hayflick, 1994
8
Suppose There Were a Pill..

• That would
• Protect against CVD
• Moderate effects of obesity
• Protect against Type 2 diabetes
• Lower blood pressure
• Quicken healing
• Improve balance
• Enhance mental ability
• Make you feel better

PSYC S-1293, 2006
9
There Is a such a PillExcept It Is Called
Exercise

• Protects against CVD
• Moderates effects of obesity
• Protects against Type 2 diabetes
• Lowers blood pressure
• Quickens healing
• Improves balance

PSYC S-1293, 2006
10
Exercise and Protection Against Heart Attacks

• Exercise may lengthen/improve quality of life
  because balances cholesterol readings, lowering
  probability of heart attacks (AKA, MI)
• Elevates HDL (hi density lipoprotein), AKA good
  cholesterol
• Lowers LDL (low density lipoprotein), AKA bad
  cholesterol

11
Effect of Age, Gender, and Fitness on
Cardiovascular Response to Exercise
Uncontrolled for Weight/Fat Free Mass
Ogawa et al., 1992
12
BMI and Demonstrated Health Risks

• Several research studies confirm relationship
• Lowest risk is among those with BMIs below 25
• (thats 54 140 or 6 180)
• Follow-up of 115,000 nurses (Nurses Study) found
  risk of CVD and death doubled with BMIs of
  27-29, and was five times greater beyond 30

Wickelgren, 1998
13
Overweight in America Obesity, Fitness and
Mortality

• Cooper Institute in Dallas examined and followed
  25,000 men for 8 years.
• Weight and fitness assessed at start
• Obese Ss had highest death rate
• But fitness level more strongly associated with
  mortality than weight

14
Physical Fitness and BMI Percent Reporting
Adverse Medical Events by Categories of Obesity
Fitness

Wessel, et al., 2004
15
Diabetes

• Diabetes is a metabolic disorder that leads to
  excess sugar in the blood
• 90 of diabetes is the type 2, or "adult- onset"
  
• Cause cells that normally take in sugar in
  response to the body's secretion of insulin
  become "insulin resistant," causing blood-sugar
  levels to spike

Firdus, Mathew Wright, 2006
16
Exercise and type 2 Diabetes

• Exercise reduces insulin resistance of the cells,
  allowing sugar intake, lowering blood sugar
• Independent of its effect on weight
• Large scale studies of older adults found
  physical activity (30 min/day, 5 days/week),
  along with low calorie/fat diet, reduced the
  probability of developing type 2 diabetes by
  58
• Even walking for 30 to 45 minutes per day lowered
  the risk of developing type 2 diabetes by 30 to
  40 percent in older nurses

17
Exercise as Protection Against type 2 Diabetes
ComplicationsFinnish Study

• During the 18 year period of follow-up the
  percentage of death due to CVD and other causes
  by exercise level was as follows
• Exercise level Low Med High
• CVD 2.5 1.4 0.9
• Other causes 1.2 0.8 0.6
• Total 3.7 2.2 1.5

Hu, Qing, Jousilhahti, Lakka, et al., 2005
18
Major Threat to Optimal AgingHypertension/High
Blood Pressure

• High blood pressure associated with
  cardiovascular disease (CVD) and is a cause of
  stroke, heart attacks, heart failure and kidney
  disease
• Called silent killer because so few symptoms
• Affects 1/3 U.S. adults
• Systolic BP (top ) when heart is pumping
• Diastolic BP (bottom ) when heart at rest
• HBP standards vary, but usually as over 140/90

19
Lifestyle Modification andBlood Pressure Control

• Objective was to determine whether lifestyle
  changes would lower Stage 1 hypertension (HBP)
• Stage 1 HBP SBP between 140-159, DBP between
  90-95 during 3 screening visits
• 810 Ss Age 50, 62 female, 63 white, 50 some
  college, 50 income 60,000, average BMI 33,
  81 sedentary, not on BP meds
• 478 Ss did not have HBP (SBP120-139/DBP80-89)

PREMIER Research Group, 2003
20
Lifestyle Modification andBlood Pressure Control

• Interventions (All Ss randomly assigned to one)
• Advice only from dietitian
• Behavioral interventions (1) Exercise 180/week
  (2) low intake of sodium/alcohol (3)lose 15 lbs
  in 6 months
• Behavioral interventions DASH diet Same as
  above with DASH, which includes increased
  fruits/veggies low fat dairy, decreased
  saturated unsaturated fat, avoiding high
  fat/calorie foods

PREMIER Research Group, 2003
21
Lifestyle Modification andBlood Pressure Control
PREMIER Research Group, 2003
22
Exercise and Healing

• Older adults wounds heal more slowly
• When healing is delayed, the risk of infection
  increases
• Stress retards the healing process among young
  adults
• Exercise lowers stress level
• Ohio State University researchers wondered
  whether exercise would result in speedier wound
  healing
• Conducted 3-month study

Emery, et al., 2005
23
Exercise and Healing

• Results 3 months later
• Fitness of the exercise group increased
  VO2max-07 treadmill endurance-26
• No difference in stress ratings
• But lower cortisol readings, suggesting more
  effective immune system operations
• And faster wound healing

Emery, et al., 2005
24
Exercise and Healing
Emery, et al., 2005
25
Optimal Physical AgingHow Long Can We Keep It
Up?

• 10 frail 90 year olds were given 8 weeks of
  quadriceps strength training (3x weekly)
• Average chronic diseases 4.5
• Average meds taken regularly 4.4
• 9 Ss completed study

Fiatarone, et al., 1990
26
Optimal Physical AgingHow Long Can We Keep It
Up?

• Gains in weight lifted by legs
• Right leg from 17.6 lbs to 45.3lbs (257)
• Left leg from 16.7 to 42.5 lbs (254)
• Gait speed increased 48
• Clinically
• 2 Ss no longer used canes
• 1 S could rise from chair without using arms

Fiatarone, et al., 1990
27
Optimal Physical AgingHow Long Can We Keep It
Up?

• Detraining effects
• All Ss returned to sedentary lifestyle
• 4 weeks after training ended their quadriceps
  strength declined 32
• from maximum during training
• What might they have done to maintain their
  fitness??

Fiatarone, et al., 1990
28
Social Relationships and Health

• Scientists long noted association between social
  relationships(soc rels) and health
• of people in social networks associated with
  better health
• All cause morbidity/mortality more among
  socially isolated
• Ditto for accidents and mental disorders
• Suicide more frequent among isolated

29
Social Relationships and Age-Adjusted Mortality
For Females Males Four Prospective Studies
House et al., 1988
30
How Much Does Exercise Actually Contribute?
Little Differences

• Many of the statistics used for data analysis are
  correlations
• Correlations range from .00 to 1.00
• Meaningassociation not cause
• Correlations between exercise and health are
  modest (around.30)
• Means that exercise gives you 10 edge

31
Class 4Normal Cognitive Aging

• Normal cognitive aging
• Average changes in cognition
• Aptitudes spared and impaired with age
• What explains decline in cognitive abilities
• Role of experience
• Gender similarities/differences

32
What Is Normal Cognitive Aging? A Provisional
Definition

• Normal cognitive aging is continuing to function
  at a level characteristic of our age group as
  influenced by relevant demographic factors
• Memory within normal limits
• Overall cognitive functioning is no lower than
  the bottom 10 (- 1.25 SD) of age group, with no
  more than one aptitude below than that level
• (such as attention, spatial, calculation
  skills)

PSYC S-1293, 2004
33
What Is Normal Cognitive Aging? A Provisional
Definition (Contd)

• Normal cognitive aging is also being inattentive
  to potential problems associated with normal
  age-related cognitive decline
• Assuming that one functions as well cognitively
  in the Third Age (60-80) as in the prime of
  life, ignoring evidence to the contrary
• Being unaware, as opposed to being aware, of
  activities that are associated with optimal
  cognitive aging

PSYC S-1293, 2004
34
Average WAIS Full Scale IQ Scores for Age Groups
25-34 to 75Normal Subjects
Kaufman, 1990
35
Age-Associated Decline in MicroCog Total Scores
Among MDs and Normals
lt30
65-74
75
35-44
45-54
55-64
Powell, 1994
36
Decline in MicroCog Total Scores Among MDs
30-75
75
30
50
60
40
70
Powell, 1994
37
Difference in Decline Rate With
AgingCrystallized Fluid Abilities

• Crystallized slower
• Less time pressure
• More education related
• Single task attention
• Vocabulary
• Information
• Calculation

• Fluid faster decline
• More time pressure
• Less education related
• Dual task attention
• Working memory
• Spatial abilities
• Reasoning
• Memory after delay

38
Change in WAIS-R Verbal IQs Across the 20- to
74-year Range
Kaufman, 1990
39
Fluid Aptitudes Decline the Most MicroCog
Subtest Scores By Decade Compared With Total
Powell, 1994
40
Fluid Aptitudes Decline the Most MicroCog
Subtest Scores By Decade Compared With Total
Powell, 1994
41
Crystallized Aptitudes Decline the Least
MicroCog Subtest Scores By Decade Compared With
Total
Powell, 1994
42
Crystallized Aptitudes Decline the Least
MicroCog Subtest Scores By Decade Compared With
Total
Powell, 1994
43
What Explains Age-Related Decline Rate in
Abilities?

• Slowing of processing speed
• Shrinking of working memory
• Task complexity
• Growing cognitive disinhibition

44
Response Time and Aging Research Studies
Salthouse, 1991
45
SpeedResponse Time (RT) and Aging

• Generally, measures of simple RT(response time)
  are not greatly affected by aging
• RT can be divided into
• Motor speed
• Processing speed or complex RT
• Processing speed, or complex RT slows greatly
  with age

Salthouse,1992
46
Working Memory

• Working Memory The ability to retain
  information in memory while simultaneously
  using this and other information to solve a
  problem
• Analogous to your desktop when writing term
  paper
• Or, working back and forth between two or more
  documents

47
Working Memory Measures

• Backwards digit span
• Alphabet span (repeating a series of words after
  first putting them in alphabetical order)
• Reading/listening span (read/listen to several
  sentences and repeat last word of each sentence
• Missing item (from a list of words repeat those
  not mentioned twice)

Salthouse, 1990
48
Working MemoryBackwards Digit Span

• 3-1-8-4

49
Working MemoryBackwards Digit Span???
50
Working MemoryBackwards Digit Span

• 7-2-5-4-9

51
Working MemoryBackwards Digit Span???
52
Working MemoryBackwards Digit Span

• 8-3-5-9-1-6

53
Working MemoryBackwards Digit Span???
54
Working Memory and Age Research Studies

• Studies by Salthouse at Georgia Tech examined
  age effects on working memory for simple and
  complex problems
• Tested 451 adults on simple and complex problems
  and compared scores by age

Salthouse, 1992
55
Working Memory and Age Performance on Analogies
Salthouse, 1992
56
Task Complexity and Decision Making in Older
Adults

• Investigated Q of whether decision making
  competence (DMC) declines with age
• Compared older and younger Ss DMC on simple and
  complex problems about health, finance and
  nutrition
• Older Ss recruited from Eugene, Oregon Average
  age 75, 62 female, 53 some college, 85 with
  household income lt40K
• Younger Ss Average age 35, 54 female, 71 some
  college, 80 with household income lt40K

Finucane, Mertz, Slovic, Schmidt, 2005
57
Task Complexity and Decision Making in Older
Adults

• Defining DMC the Person-Task fit
• Degree of congruence between the characteristics
  of the decision maker and the demands of the task
  and of the context
• Qualities of the individual education, skills,
  experience, need for emotional regulation
• Qualities of the task complexity, how it is
  framed, time pressure
• Context cultural values, social norms

Finucane, Mertz, Slovic, Schmidt, 2005
58
Task Complexity and Decision Making in Older
Adults Sample Complex Task

• HMO A B C D
• Monthly premium 50 75 48 63
• Prescription co-pay 3 10 10 5
• Med tests co-pay 10 15 10 5
• Doctor co-pay 10 5 15 10
• very satisfied 38 34 28
  38
• very dissatisfied 12 14 10
  10

Finucane, Mertz, Slovic, Schmidt, 2005
59
Task Complexity and Decision Making in Older
Adults Sample Complex Task

• Simple question of DMC What is the lowest
  co-payment for a doctors visit?
• Complex question of DMC Which HMO provides the
  best treatment quality according the members
  ratings?

Finucane, Mertz, Slovic, Schmidt, 2005
60
Task Complexity and Decision Making in Older
Adults Results

• Younger Ss made many fewer errors on both simple
  and complex tasks
• Younger Ss were more consistent in their
  responses
• Younger Ss worked faster and had better short
  term memory

Finucane, Mertz, Slovic, Schmidt, 2005
61
Task Complexity and Decision Making in Older
Adults Results

• Unexpectedly, however, age was not the only
  factor that explained how people performed on
  these tasks
• Other factors included education/income,
  physical/emotional health, cognitive abilities
  and willingness to delegate

Finucane, Mertz, Slovic, Schmidt, 2005
62
Growing Age Related Cognitive Disinhibition

• Cognitive inhibition allows to attend to a task
  by preventing the allocation of attention to
  irrelevant or distracting stimuli in the
  internal or external environment
• Essential to most cognitive tasks, including
  attention working memory

Persad, et al., 2002
63
Growing Age Related Cognitive Disinhibition

• Q Does cognitive inhibition decline with age?
• Cognitive inhibition blocks irrelevant stimuli
  from interfering with concentration on a task
• Also, as tasks change, suppresses
  thoughts/feelings that are associated with
  previous task(s)
• Without cognitive inhibition irrelevant thoughts
  disrupt concentration, lowering performance
• Interferes with both encoding and retrieval

Persad, et al., 2002
64
Growing Age Related Cognitive Disinhibition
Subjects

• Ss were independently dwelling from Lansing, MI
• Recruited from local churches foster GPs Assn
• Mean age72.74
• Clustered in ½ decade groups(?)60-65, 66-70
• Years of education (YoE)13.65
• Exclusionary criteriadementia and depression

Persad, et al., 2002
65
Growing Age Related Cognitive Disinhibition Tests

• Trails-B Task is to connect with lines
  sequential numbers and letters, alternating
  between the two
• PASAT (Paced Auditory Serial Addition Test)
• Memory for 16 word shopping list
• Verbal Fluency (Name as many words in one minute
  as possible beginning with C, F, L
• Reading speed speed of reading 125 word story
• Vocabulary

Persad, et al., 2002
66
Growing Age Related Cognitive Disinhibition
Trails BConnect the numbers and letters in
alternating sequence
3
D
1
A
C
E
5
2
4
B
Score is combination of speed to completion and
errors
Persad, et al., 2002
67
Growing Age Related Cognitive Disinhibition
Trails BConnect the numbers and letters in
alternating sequence
C
4
A
1
3
5
E
B
D
2
Score is combination of speed to completion and
errors
Persad, et al., 2002
68
PASAT (Paced Auditory Serial Addition Test)

• A string of 61 randomized numbers is read 4
  times, each time a little faster
• The task is add each number to the one before it
  and say the sum aloud, and then adding it to the
  next number to the previous one
• For example 85 (13!), 52 (7!), 24 (9!)
• Score is total correct

Persad, et al., 2002
69
Verbal Fluency Write Down All Words Beginning
With C, F, or L

• Average in one minute
• 60-65 13.80
• 71-75 12.25 11 decline from 60-65
• 81-85 10.16 26 decline from 60-65

Persad, et al., 2002
70
Growing Age Related Cognitive DisinhibitionResult
s

• Major impact of age-related cognitive
  disinhibition is upon tasks requiring
  concentration and working memory
• Cognitive dishibition grows with age, especially
  in the tendency to have past methods of problem
  solving persist in new settings
• Processing speed also declines with age
• But cognitive disinhibition had greater negative
  impact
• Vocabulary doesnt decline with age
• Gender differences Men read faster, but women
  remember verbal content better

Persad, et al., 2002
71
Use It or Lose ItHow Much Does Experience Count?
72
Use It or Lose It

• Salthouse quotes numerous experts about the
  validity of the Use-It-or Lose It theory
• Poorer test performance by elders caused by
  disuse
• Abilities used regularly are maintained
• People continuing to work in their areas of
  expertise retain their skills until late in
  life
• Then he goes about to test these theories

Salthouse Mitchell, 1990
73
Use It or Lose It

• Method
• Q Does experience with spatial tasks cause
  someone to retain that skill as (s)he ages?
• 383 Ss, 20-83, were asked about experience with
  spatial tasks
• Then given several tests of spatial ability
• Compared spatial experience test scores

Salthouse Mitchell, 1990
74
Use It or Lose It

• Results
• Strong negative correlation between age spatial
  skills
• Age was associated with lower scores on spatial
  tests for all levels of experience
• Ss with the most spatial ability at 30 retained
  their edge over their agemates at 80, but not
  compared to those at mid-life
• Concludes that age-related cognitive decline is
  independent of experience

Salthouse Mitchell, 1990
75
Performance of Older and Younger Faculty on 8
Cognitive Tests
Sward,1945
76
The Immeasurable Dimensions of Experience

• Self Knowledge
• Store of accumulated information
• Discriminating important from unimportant
• Knowing how to proceed with complex tasks
• Understanding the rhythm of things
• Considering possible problem solving scenarios
• Accessing resources

Salthouse Mitchell, 1990
77
Do Men and Women Differ in Aptitudes?
78
Gender Differences on Cognitive Tests

• With high aptitude groups (Terman, Project
  Talent) males are more numerous among the high
  scorers
• Not unusual to have more males among the
  graduating Summas in sciences and math
• But more at bottom of class, too
• May have to do with variability

79
The Bell Curve of Normal Distribution of Test
Scores
Lots
Few
IQ
80
Hypothetical Distribution of Group As Scores on
a Cognitive Test
81
Hypothetical Distribution of Group Bs Scores on
a Cognitive Test
82
Hypothetical Differences in the Distribution of
Scores of Groups A B on a Cognitive Test
83
Gender Differences on Cognitive Tests

• A consistent finding has been that M W do not
  differ much on cognitive test averages
• Especially when the testing is of large numbers
  of diverse Ss
• Elite groups show greater gender differences in
  spatial/math scores

84
Gender Differences in Reading Test Scores100
Studies
Hyde, et al., 1990
85
Gender Differences

• Bottom line is that few differences in aptitude
  have emerged, and those were small
• Most differences at extremes or tails of bell
  curve
• For instance, older men were often stronger on
  tests of number memory and spatial tasks
• Older women stronger on verbal memory tasks
• Gender differences on tests are much smaller than
  the impact of energy, diligence, social skills,
  etc.
• Could the differences between the sexes be more a
  function of generation than gender?