chapter 15 lecture outline

15A Lifetime of Health

Lecture OutlineI. Will You Live to Be 50?

A. Overview1. 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 AgingA. 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 Late1. 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.

3. Simply sitting for prolonged periods increases “all-cause mortality,” the risk of dying for any reason, in both sexes and all

Chapter 15 – A Lifetime of Health

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 independentlyb. Reduced risk of falling and fracturing bonesc. Lower risk of dying from coronary heart diseased. Reduced blood pressuree. 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 Obesity1. 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. Memorya. Memory loss and cognitive problems are becoming less

common among older Americans.E. Women at Midlife

1. Reproductive Aginga. 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 monthsc. 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 Therapya. 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 Midlife1. 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 Aging1. 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.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 AgeA. Mild Cognitive Impairment (MCI)

1. Ten to 20 percent of persons 65 and older2. No medications are currently approved to treat3. Coping strategies to slow down impairment

a. Exerciseb. Reduce cardiovascular risk factorsc. Participate in mentally stimulating and socially engaging

activitiesB. 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. Osteoporosis1. 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 LifeWhen 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 Directives1. 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.

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 Proxyi. 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 Wishesi. 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 Orderi. 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 DyingA. 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.

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 Death1. 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 Dying1. Kübler-Ross identified five typical stages of reaction that a

person goes through when facing death:a. Denialb. Angerc. Bargainingd. Depressione. 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. SuicideA. 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.


VII. GriefA. 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-numbnessb. Yearning-searchingc. Disorganization-despaird. Reorganizatione. 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.


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


chapter 15 lecture outline

Education