Aging

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Aging

• Or how everything falls apart.

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References and Handouts

• http//www.brown.edu/Courses/BI_278/

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Everything Changes

• Psychological issues
• Socioeconomic
• Physical health
• Mental Health

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The stats on elderly

• Increased 10-fold in last century
• Currently
• 35 million gt 65
• 13 population
• By 2030
• 70 million
• 1/5 Americans gt 65
• 1/11 gt 85

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More stats

• Gender (percentage women)
• gt 65 58
• gt 85 70
• Ethnicity
• Will be more diverse
• Currently 85 white
• By 2050, 64

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Everything Changes

• Psychological issues
• Socioeconomic
• Physical health
• Mental Health

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Psychological issues

• Aging has unique
• Challenges
• Life stresses

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Ex. Erickson
Stage Age Basic Conflict
Oral-Sensory Birth-12/18mo. Trust v. Mistrust
Muscular-anal 18 mo 3 yrs Autonomy v. shame/doubt
Locomotor 3-6 yrs Initiative vs. guilt
Latency 6-12 yrs Industry vs. inferiority
Adolescence 12-18yrs Identity vs. role confusion
Young Adulthood 19-40 yrs Intimacy vs. isolation
Middle Adulthood 40-65 yrs Generativity vs. stagnation
Maturity 65-death Ego Integrity vs. despair
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Stage 8 Maturity

• Age Late Adulthood -- 65 years to death
• Conflict Integrity vs. Despair
• Important Event Reflection on and acceptance of
  one's life

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Stage 8 Maturity

• Elements for a positive outcomeThe adult feels
  a sense of fulfillment about life and accepts
  death as an unavoidable reality.
• Elements for a negative outcomeIndividuals who
  are unable to obtain a feeling of fulfillment and
  completeness will despair and fear death.

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Other development approaches

• Psychodynamic
• Formation versus elaboration of psychic processes
• Levinson1
• Structure building and changing
• Periods of transition

1 Levinson, D. (1986). A conception of adult
development. American Psychologist, 413-13.
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Unique challenges of the elderly

• Losses
• Disablement
• Driving
• Health concerns

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What do the elderly worry about?
National Council On Aging, 2000
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Everything Changes

• Psychological issues
• Socioeconomic
• Physical health
• Mental Health

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Socioeconomic changes

• Retirement
• Finances
• Social security
• Medicare
• Living situations

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Retirement

• Median age
• Men 62.7
• Women 62.6

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Finances

• 65
• net worth 92,399
• White 181,000
• African American 13,000
• annual household income 22,812

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Percent Living in Poverty

• Elderly 12.1
• 3 points below general pop

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Living situations

• Among 65
• 80 own home
• 75 single unit/detached
• 45 live alone
• 17 elderly householder had no transportation

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Nursing Homes

• 65
• 4 (1.46 million people)
• 85
• About 192 out of every 1,000

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Everything Changes

• Psychological issues
• Socioeconomic
• Physical health
• Mental Health

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Physical Health

• Self perception
• Survey of Americans age 65 (1996-96)
• vast majority considered themselves healthy.
• Whites 74
• AAs 59.3
• Hispanics 64.9

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The 3 big killers

• Heart disease
• Cancer
• Stroke
• Mortality rates
• Hrt Dx/Stroke decr 1/3 since 1980
• Cancer up slightly

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Effects of Aging on the Body

• Bottom line
• Most of the news is bad.
• The question
• How much is inevitable?

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Examples of things we cant change

• Ocular accommodation
• Cardiac hypertrophy
• GI malabsorption/intolerances
• Loss of immunity/allergies
• Loss of brain volume

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Examples of things we can change somewhat

• Loss of skin elasticity
• Auditory acuity
• Cardiac loss of elasticity

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Examples of things we can change a lot

• Muscle Mass, Muscle/Fat Ratio
• Osteoporosis
• Functional Cognition

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Everything Changes

• Psychological issues
• Socioeconomic
• Physical health
• Mental Health

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Why Rates in Elderly are Low?

• Greater difficulty remembering past symptoms
• Less psychologically oriented
• Greater mortality
• Cohort effect
• Sampling errors
• Instrument errors
• Diagnostic challenges

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Elderly Specific Criteria?
Diagnostic Criteria Major Depression Prevalence
AGECAT 11.4
DSM-IV 4.5
Age 65 Edmonton Canada Newman et al.
Psychological Medicine 28 1998
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Some specific diseases
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Psychotic Disorders
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Schizophrenia
Age 1-Month 1-Year Lifetime
All 0.7 1.0 1.5
65 0.1 0.1 0.3
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Psychosis in the Elderly

• Negative versus positive symptoms
• Look for alternative causes
• Esp. if NEW ONSET or no history
• Most common
• MEDS
• ACUTE problems infections, metabolic.
• Tumors, etc. less common

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Mood Disorders in the Elderly
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Depression in the Elderly

• Why so low? (see earlier)
• Forme Frustres
• Pseudodementia
• Diagnosing depression in complex cases
• How to approach

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Anxiety Disorder in the Elderly
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Anxiety Disorders

• Primary Versus Secondary
• Common Secondary Causes
• Drugs
• Medical Illness (cardiac, respiratory)
• Disorders that confuse (dementia, delirium)

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Substance Abuse in the Elderly
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Substance Abuse

• Gender differences and drug choice

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Dementia
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Problems in Dementia Prevalence Studies

• Size of sample
• Sample composition
• Age range
• Proportion of very old
• Education
• Method for case identification
• Content of Interview
• Supplementary diagnostic information
• Diagnostic criteria (NINCDS-ADRDA v DSM)
• Prevalence Estimate

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Age Specific Prevalence
Jorms (1987)
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Stages of Dementia

• Depend on both
• Cognitive ability
• Testing
• Functional Ability
• Observe, ask.

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Special Settings
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One-Year Prevalence of Mental Disorders in
Nursing Homes Estimates from ECA
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Differences in the Psych. Interview in the elderly

• Use of multiple sources
• Respect for confidentiality, but
• Relaxing of boundary issues
• Focus of interview
• Symptoms versus stories
• Explanations and honesty
• The power of genuine interest

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Epilogue the question you are all asking

• How can I age well?

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To stay healthy

• Pick really healthy parents

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Other things you can do

• Dont smoke
• Low-fat, high-fiber diet
• Exercised vigorously for AT LEAST 30 min ALMOST
  EVERY day
• Maintained a healthy weight
• Consume a moderate amount of alcohol (about one
  drink per day).
• All 5 80 reduction in heart attack/stroke risk
  
• Which then also helps cognition

Primary prevention of coronary heart disease in
women through diet and lifestyle. M. Stampfer,
 et al., The New England Journal of Medicine,
2000, vol. 343, pp. 16--22