Implications of the Ageing Process: Opportunities for Prevention

Karen E. Peters, DrPHUniversity of Illinois at ChicagoSchool of Public HealthIL Prevention Research Center

March 6, 2007

Objectives

To acquire insights into how and why aging occurs

To understand the normal and abnormal physical and mental health changes associated with aging

The farmer community can acquire knowledge about maintenance of workplace safety, preservation of good health, and prevention of chronic diseases that compromise healthy aging

Old Age

Memory is short, and braine is dry. My Almond-tree (gray haires) doth flourish now, And back, once straight, begins apace to bow. My grinders now are few, my sight doth faile My skin is wrinkled, and my cheeks are pale. No more rejoyce, at musickes pleasant noyse.

Anne Bradstreet (1612-1672)

The Aging World

Increased longevity has resulted in an ‘Aging World’ Affluent nations/societies most affected by baby

boomers reaching > age 60 The older population (> 65 years) was 36.8 million in

2005 in USA Represented 12.4% of U.S. population- about one in

every eight Americans Expected to be 20% by year 2030- about 75 million Will comprise 1 in 5 Americans by 2030

Definition of Ageing Can be defined as a progressive, generalized

impairment of function resulting in a loss of adaptative response to a stress and in a growing risk of age-associated disease (Kirkwood, 1996).

21st Century Phenomenon of Global Ageing 20th century – saw a global phenomenon of longevity – a

triumph and a challenge Average life expectancy at birth- increased by 20 years since

1950 to 66 years Is expected to increase another 10 years by 2050 By 2050, the population of older people will exceed that of

children (0-14 yrs) Is a social phenomenon without historical precedent In 2002, number of persons > 60 years was 605 million;

expected By 2050, number is expected to reach almost 2 billion

Life Expectancy Rise

Population ageing

Refers to a decline in the proportion of children and young people and an increase in the proportion of people age 60 and over.

As populations age, the triangular population pyramid of 2002 will be replaced with a more cylinder-like structure in 2025

Older Population in USA

The older population (> 65 years) was 36.8 million in 2005 in USA

Represented 12.4% of U.S. population- about one in every eight Americans

Expected to be 20% by year 2030- about 75 million Will comprise 1 in 5 Americans by 2030 FASTEST GROWING GROUP OF OLDER

POPULATION IS OLDEST OLD I.E. > 80YRS

Impact on Society

Affect family solidarity and relationships within families

Equity across generations Lifestyles

How Old is ‘Old’? We call ourselves 3 years ‘old’ or 80 years ‘old’ Some say ‘I am running in my 10th year’ or ‘I am

running in my 75th year’ So we can be old at 3 and running at 75! Old is a relative term- I call friends my age ‘girls’,

while to ‘youngsters’ we are ‘older’ females or even old!

However, Aging is a Reality- Prepare to Accept Gracefully

Definitions

Defined as latter part of animate life Old, elderly, senior citizens- commonly used Calendar age is not necessarily synonymous with

biological age "Successful aging," "productive aging," and "vital

aging" commonly used now UN – defines 60 +; developed nations 65+ Gerontology- The scientific study of the biological,

psychological, and sociological phenomena associated with old age and aging.

Geriatrics- treats the clinical problems of later life

Senescence

In biology, senescence is the process of ageing Senescence is the steady deterioration of cell function following

the period of development in youth Cellular senescence- cells lose the ability to divide in response to

DNA damage -cells either senesce, or self-destruct (apoptosis) if the damage is irreparable

Organismal senescence is the aging of whole organisms. Aging ↔ Senescence

Species have different "rates of aging"- a mouse is elderly at 3 years; humans at 85 yrs

Apart from species specific genetics, chance events determine the probability of death

Organismal ageing

Is characterized by: Declining ability to respond to stress Increasing homeostatic imbalance Increased risk of disease Death is ultimate consequence of ageing

Biological definition

Pre-Conception - Ovum, Spermatozoon Conception - Fertilization Pre-birth Conception - 9 months Infancy Birth - 2 yrs Childhood 3 – 12 yrs Adolescence 13 - 19 yrs Early Adulthood 20 - 39 yrs Middle Adulthood 40 - 64 yrs Late Adulthood 65+ yrs Death – Cessation of vital body (somatic) functions

History

Desire to live forever is ancient Zeus(Greek God), granted Tithonus the gift of immortality, but

not of perpetual youth, when requested by his wife Eos.Tithonus grew progressively ancient, and begged for death to overcome him

‘Immortalized’ in Tennyson’s poem “Tithonus”: “Man comes and tills the field and lies beneath,

And after many a summer dies the swan.Me only cruel immortalityConsumes: I wither slowly in thine arms”

Living longer without youthful vitality is not pleasant

THEORIES OF AGING

How and Why we age are still not clearWHY DO WE AGE? Many theories, none fully explain aging The rate of living theory of aging –rejected The oxidative-damage/free-radical hypothesis of

aging-topical area The evolutionary senescence theory of aging-

most accepted The reliability theory of aging The neuron-endocrine hypothesis of aging

The Rate Of Living Theory Of Aging- rejected by modern scientists

Ancient philosophers- Death occurs when a finite amount of “vital substance” consumed

The Oxidative-Damage/Free-Radical Hypothesis of Aging Mitochondrial ability to repair DNA damage ↓ with age →

Decreased cell efficiency Too much mitochondrial damage → cell death Oxidative damage →free radicals → DNA damage, cross-linking

of proteins, formation of age pigments Injury caused by free radicals initiates a self-perpetuating cycle in

which oxidative damage impairs mitochondrial function, which results in the generation of even greater amounts of oxygen-free radicals.

The Oxidative-Damage/Free-Radical Hypothesis Of Aging

Oxidative cell damage

↓Mitochondrial

Damage

Oxygen-free radicals release

-DNA Damage-Cross-linking

proteins-Mitochondria

Damage-Form age

pigments

Self–perpetuating Cycle of Impaired

Function↓

Increased Oxygen -free radicals

The Evolutionary Senescence Theory of Aging Most widely accepted overall theory Species prone to die to predation (e.g. Mice) invest more energy in

reproduction than in health maintenance Humans, less prone, can allocate more resources to repairing

physical damage Humans able to reproduce over a longer period of time Thomas Kirkwood (1970’s)- disposable soma theory- organisms

have to balance the demands of maintaining their body, or soma, cells and reproducing

States that humans have long life spans because we are much better at repairing our bodies than short-lived animals

Steven Austad (early 1990s)-provided evidence that perilous environments support early reproduction and short life spans, whereas safer environments favor the opposite

Most agree that it is currently the best explanation for why we and other organisms age

The Reliability Theory Of Aging Applies mathematical theories of reliability to predict

systems failure in machines Natural selection programs animals to live long

enough to reproduce; Takes variable lengths of time after reproductive

failure for animal’s subsystems to fail and make animal vulnerable to death

This theory does not explain why certain species live longer than others

Endorses numerous facets of evolutionary senescence theory of aging

The Neuroendocrine Hypothesis Of Aging The neuron-endocrine system –complex system

linking brain, nervous system and hormonal glands Becomes less functional with age- can lead to HBP,

diabetes, and sleep abnormalities Effects of hormones on different facets of aging

studied extensively Some late-life functional changes linked to reduced

levels- e.g. menopause However, recent evidence reveals the opposite:

reduction in some hormones can prolong life

Current Areas Of Research To Decrease Aging Caloric Restriction Altered dietary intake Insulin-like growth factor (IGF) Pharmaceuticals Most target reactive oxygen species,

underscoring substantial role of oxidants in the aging process

The Physiology of Aging

Aging is both visible and invisible Visible changes occur on surface of the body;

invisible affect internal organs to impair function Affects all systems to varying extent; if vital

functions involved, cause death Gerontologists - aging is the cumulative effect of

many lifelong influences Influenced by heredity, environment, culture, diet,

exercise, past illnesses, etc Genetic factors chiefly determine variations in

aging/lifespan- we exert no control

However, we can control our environmental/lifestyle insults to aging and health

Normal aging in the absence of disease is a remarkably benign process

Biologic and chronologic ages are not the same

Most organs gradually lose some function; noticeable only during exertion/stress

Slower reaction times are common

How are Adolescence and Senescence Different? Changes of adolescence follows predictable norms -

can be graphed Aging affects individuals uniquely; norms not

established Some systems begin aging by age 30 (bones);

others much later (mental faculties) Senescence should not be viewed as a “disease” Cannot put a ‘Time Clock’ on aging

PHYSICAL IMPLICATIONS OF AGING Skin: Exhibits most obvious sign of aging Loss of underlying connective tissue, fat and oil

glands → wrinkles, sagging skin Aging skin appears thinner, paler, and translucent Increased sensitivity to heat/cold, bruising, and

bedsores Develops "age spots" due to deposits of melanin

pigment Ability to perspire is decreased Contributing factors: nutrition; exposure to sun,

chemicals/toxins; hormones, and heredity

Hair: Shows obvious signs of aging Hair color is due to pigment ‘melanin’- gradually decreases after

age 30-40 Loses pigmentation → turns hair gray/white Manifests earliest in scalp, followed by facial/body hair Occurs earlier in Caucasians compared to Asians Alopecia- baldness/ hair loss is the norm Coarsening of hair common

Nails: 

Become dull, brittle, ridged, thickened, grow slower due to reduced blood flow to connective tissues

The Cardiovascular System Overall reduction in blood flow occurs as we age Heart of a 20-year old can pump 10 times the

amount actually needed to preserve life After age 30, about 1% of reserve is lost/ yearResults in: Normal atrophy of the heart muscle Calcification of the heart valves Arteriosclerosis ("hardening of the arteries") Atherosclerosis (intra-artery deposits)

Reduced Brain, Liver and Kidney

Function

Vulnerable to Drug Toxicity

↑ Risk of HBP, Heart Attack, Stroke, Heart Failure

Poor Response to Stress

Slower Healing rate

CVD Changes↓

Poorer Cell Oxygen

The reduced blood flow results in less strength due to:

diminished oxygen exchange reduced kidney and liver function less cellular nourishment

Other problems: Intermittent pain in the legs with walking Varicose veins Prelediction for Blood clots

Changes in Respiratory System Maximum lung function decreases with age Diminished elasticity of airways and lung tissue Reduced ciliary activity→ decreased oxygen uptake/exchange Muscles of the rib cage atrophy, further reducing the ability to:

breathe deeply cough expel carbon dioxide

Aggravating factors: Smoking, Pollution Results in:

Lower stamina for work; easily fatigued Shortness of breath Oxygen lack can increase anxiety Susceptibility to pneumonia increased

Skeletal System Changes

Manifest changes that affect QOL significantlyOsteoporosis is a common condition characterized by: progressive loss of bone density Increased vulnerability to fractures Thinning of vertebrae → loss of height; spontaneous fractures Reduction in height occurs by1 cm (0.4 inches) every 10 years

after age 40 Height loss is even greater after 70 years The vertebrae calcify increasing rigidity, making bending difficult

Joints

Osteoarthritis- degenerative disease, most common chronic condition in elderly

Rheumatoid arthritis- common connective tissue disorder

Both impair mobility and the performance of daily activities of living

Gastrointestinal System

A reduction in stomach hydrochloric acid, digestive enzymes, saliva causes:

Bloating and flatulence Impaired swallowing Reduced breakdown and absorption of foods Deficiencies in vitamin B, C, and K ;

malnutrition is a real possibility

Muscular System

Progressive loss of muscle mass occurs as we age → change in body shape

Accelerated after age 65- causes weight loss Changes in body shape can affect balance, contributing to falls Elderly individuals with weak muscles are at greater risk for

mortality than age-matched individuals Increase in amount and rate of loss of muscle increases risk of

premature death Physical inactivity is 3rd leading cause of death; plays role in

chronic illnesses of aging

Hormones

Sex Hormones Men may exhibit slightly decreased levels of testosterone Women have decreased levels of estrogens, progesterone and

prolactin after menopauseInsulin The normal fasting glucose level rises 6-14 mg/dL every 10

years after age 50 Probably due to loss in number of insulin receptor sites in cells Can lead to diabetes- annual testing recommendedOther Hormones Not significantly affected

Immune System

Overall effectiveness decreases, leading to: Increased infection risk Decreased ability to fight diseases Slowed wound healing Autoimmune disorders Cancers

Female Reproductive System Menopause is obvious milestone of aging (cessation

of periods > 1year) Loss of Reproductive Capacity occurs Normal around 50 years; occurs by age 40 in 8%

women Secretion of estrogens, progesterone, and prolactin

hormones are reduced Sex drive is not necessarily diminished Aging does not impair a woman’s capacity to have

or enjoy sexual relationships

Physical manifestationsin Women Prolapse- descent of uterus may occur due to

lax tissues Urinary stress incontinence common Breasts lose tissue and subcutaneous fat→

flatten and sag Breast cancer risk increases with age The genital tissue atrophies; more prone to

infections

Male Reproductive System

Men do not experience a sudden ‘andropause’ Age is not a good predictor of male fertility Testosterone levels maintained/decrease slightly Decreases in the sex drive (libido) may occur Normal for erections to occur less frequently Aging alone does not impair a man’s capacity to

enjoy sexual relationships

Physical Manifestationsin Men

Prostate grows in size- urinary problems Cancer of prostrate or bladder is commoner in older

menErectile dysfunction Erectile dysfunction may occur Is frequently related to diseases (diabetes) or

medicines 90% of erectile dysfunction- has medical rather than

psychological origin May be amenable to treatment

Changes in Kidneys

Normally no change Usually affected by diseases like high BP,

diabetes and cancer Lead to increased risk for acute and chronic

kidney failure Urinary tract infections are common

Teeth and Mouth

Fall of teeth is an obvious sign of aging All people eventually lose teeth- rate depends

on several factors Proper hygiene can preserve teeth longer Increased sensitivity to cold/heat common

with attrition Loss can interfere with healthy eating habits-

malnutrition common

IMPLICATIONS OF AGING ON MENTAL FACULTIES

The quality, not the longevity, of one's life is what is important. — Martin Luther King Jr. (1929-1968)

Nervous Tissue and Aging

Aging has profound effects on mental faculties Brain tissue is irreparable – changes are permanent Speed of communication between nervous tissues is decreased Transmission of messages within nerve cells becomes slower The brain and spinal cord lose nerve cells and weight Waste products collect in brain, causing plaques and tangles

Changes result in: Lost or reduced reflexes → problems with movement and safety Slight slowing of thought, memory, and thinking- a normal part of aging A change in thinking/memory/behavior are important indicators of

disease ALL ELDERLY PEOPLE DO NOT BECOME ‘SENILE’

Disease States Delirium, dementia, and severe memory loss are NOT normal

processes of aging Caused by degenerative brain disorders such as Alzheimer's disease Illnesses unrelated to brain can cause changes in thinking/ behavior Severe infections can lead to confused states Diabetes- fluctuations in glucose levels can cause thinking/behavioral

disorders

CHANGES IN SENSES

TOUCH-Gradual reduction after 50- injuries,

hypothermia

SMELL- Decreases after

70 yrs- may affect hygiene

TASTE- Minimal changes

VISION-Usually need glasses by 55-Only 15-20% have ↓ driving

ability

HEARING30% people over

age 65 have impairment

SENSES

Normal acuity ↓ with age

SENSES

All senses are controlled totally by the brain Aging increases minimum amount of stimulation

before a sensation is perceived Any compromise in senses has tremendous impact

on lifestyle Hearing and vision changes- dramatic effect on

QOL Many changes can be improved with glasses,

hearing aids, and lifestyle modifications Communication problems common- lead to social

isolation and loneliness

HEARING

Ears perform two functions – 1. Hearing 2. Maintaining body balance (equilibrium)

Equilibrium (controlled by the inner ear) Hearing is ruled by the outer ear– disorders respond better Aging adversely affects both structures Acuity of hearing declines slightly after age 50 30% people > 65 have significant hearing impairment Impacted ear wax commoner with increasing age → deafness,

easy to treat Persistent, abnormal ear noise (tinnitus) - common in older

adults

VISION

Visual acuity may gradually decline- not universal After age 55, most people need glasses at least part

of the time Driving ability is impaired in 15% to 20% due to bad

vision 5% become unable to read Trouble adapting to darkness or bright light Significant difficulty with night driving may be the

first sign of a cataract

Color Perceptions Change As we age, it is harder to distinguish blues and greens

than reds and yellows Elderly should use yellow, orange, and red contrasts at

home- improves ability to locate things Using a red nightlight is better than a conventional bulb

"Floaters" in vision- harmless; sudden ↑ needs consultation

Reduced peripheral vision occurs- cannot see adjacent people- may cause offense to friends

Blindness- usually caused by diseases like diabetes and high BP

Taste and Smell Taste does not seem to decrease until after age 60,

if at all Sense of smell may diminish, especially after age

70- leads to poor hygiene, and unawareness of gas leaks etc

Touch, Vibration, And Pain Aging can reduce sensations of pain, vibration, cold,

heat, pressure, and touch Decreased temperature sensitivity increases the risk

of frostbite, hypothermia, and burns After age 50, many people have reduced sensitivity

to pain. Reduced feel of vibrations- loss of stability in motion

Social Behavior & Personality Changes with Age Small changes normal - do not significantly change our sense of who the person

is Personality and social interaction often change due to neurodegenerative

diseases Drastic changes in personality reflect a disease process- difficult for caregivers

to cope with/accept “Senility” or “senile” is an out-dated term- now replaced with “Dementia” Senility or Dementia should NOT BE EQUATED TO AGING- DEMENTIA IS A

DISEASE STATE Dementia – ‘condition where one has a progressive decline in memory and other

cognitive functions that results in a change in the ability to conduct one's usual activities’

Dementia is characterized by multiple cognitive deficits with memory impairments as an early symptom

Diagnosis of dementia- not given in absence of impairment in social functioning/independent living

Psychological and Social Impact With a healthy lifestyle, few changes seen that are deleterious to QOL In fact, some actions may grow more correct as we age (within limits)

Learning

The ability to learn continues throughout life Often require more time and effort to absorb new information Need more effort to organize and understand new information Tendency to avoid learning new things not perceived as beneficial Reasons – unknown; may be partly attributed to decline in senses

as we age

Reaction time Information processed at a slower pace Reaction to stressful situations is delayed; uncertainty on how to

act may manifest A + for older people- tend to make fewer mistakes than younger

people in decisions takenIntelligence Whether intelligence declines as we age is hotly debated- usually

maintained Older people perform lower on many standardized intelligence

tests In formal tests of performance, older people slow down, but

make fewer mistakes! However, most intelligence tests do not address situations in our

daily lives Value correctness as we age- answers are more accurate,

though response may be slower More cautious; less liable to make mistakes in judgment/ action

Life skills As we age, perform most life skills better with

experience As we age, majority are better at managing

daily affairs May fail only in times of stress or loss Reliable support network maintains QOL

longer Younger people can gain from experiences of

elders-meaningful exchanges can occur

Stresses

Older adults must often deal with physical, medical or social stressors

Stress can precipitate many diseases like diabetes, high BP, anxiety attacks etc

Common stresses for older people are: diseases or health conditions, possibly chronic (e.g.,

heart disease, arthritis, cancer) perceived loss of social status after retirement death of a spouse/child/sibling

Loss and grief

Loss of a spouse is particularly stressful In 2003, more than 1 million spouses (mostly women) were

widowed This number is estimated to increase to 1.5 million every year by

2030 Loss of sight, hearing, and physical disabilities can induce

profound grief and loss Retirement/job loss with loss of social status is a major cause Most people grieve intensely for 6-12 months after a major loss-

withdraw from others Takes about 1 year to accept the loss and start normal

interaction

Substance abuse

A growing problem among older adults, particularly alcohol

Causes physical/mental health problems commonly, especially older men

Exaggerated effects seen in older people Has negative effects on self-esteem, coping skills,

and interpersonal relationships Warning flags are less obvious in older adults e.g.

less likely to be caught on the job, in public

Memory Decline in Normal AgingDefinition: Memory refers to the storage,

retention and recall of information including past experiences, knowledge and thoughts

Only some types of memory loss are associated with normal aging

Other types are typical of disease states

Types of Memory and Loss

Working (intermediate term) – loss occurs with normal aging Episodic- especially impaired in normal aging e.g. ability to

process recent information Semantic (e.g. vocabulary) – Improves with age; lost in

dementias Procedural (long-term memory of skills) - shows No Decline with

age; affected by diseases Very long-term memory (months to years)- increases upto age

50; maintained until well after 70 Short-term memory- shows little decline; loss associated with

diseases Older adults tend to be worse at remembering the source of their

information

Abnormal Memory Loss in Aging Forgetting things much more often than you used to Forgetting how to do things you've done many times

before Trouble learning new things Repeating phrases or stories in the same

conversation Trouble making choices or handling money Not being able to keep track of what happens each

day

Risk Factors for Cognitive Decline High blood pressure, diabetes, poor nutrition,

and social isolation Heart disease Family history of dementia Psychological factors like stress and

depression

Normal Cognition

Executive Functioning include: Organization: attention, decision-making,

planning, sequencing, problem solving Regulation: initiation of action, self-control, self-

regulation Language- coherent, sensible Working (immediate) Memory Spatial Memory

Verbal Memory

Dementia The word dementia is used to describe the condition where one

has a progressive decline in memory and other cognitive functions that results in a change in the ability to conduct one's usual activities

Dementias are neurodegenerative diseases which cannot be cured

Each type characterized by specific effects on cognitive and motor function

Diagnosis of dementia is not generally given in absence of impairment in social functioning and independent living.

Dementia seriously affects a person’s ability to carry out daily activities

People with dementia lose their abilities at different rates Eventually, patients may need total care

Symptoms of Dementia

Dementia symptoms may include: asking the same questions repeatedly, becoming lost in familiar places, being unable to follow directions, getting disoriented about time, people, and

places, and neglect of personal safety, hygiene, and

nutrition.

Alzheimer's Disease (AD)

Definition: Is a progressive, neurodegenerative disease characterized in the brain by abnormal clumps (amyloid plaques) and tangled bundles of fibers (neurofibrillary tangles) composed of misplaced proteins

AD is the most common dementia in older adults Incidence expected to more than double by 2050- from 377,000 in 1995

to 959,000 The proportion of new cases >85 will increase from 40% in 1995 to 62%

in 2050 The annual incidence expected to shoot up by 2030 (baby boomers

[persons born between 1946 and 1964] will be over age 65) Most of the increase will occur among people age 85 or older Early symptoms of AD, which include forgetfulness and loss of

concentration, are often missed because they resemble natural signs of aging

Multi-infarct dementia

Caused by a series of strokes in the brain Infarcts result in irreversible death of brain tissue Location/severity of compromised area governs

severity of symptoms/loss of function Symptoms – abrupt onset; progress step-wise as

strokes recur Treatment to prevent further strokes is very

important

Other Mental Conditions

Anxiety Anxiety disorders- commoner as we get older as medical, psychological,

and social problems build up One in five older adults suffers anxiety symptoms severe enough to

necessitate treatment Persistent or extreme anxiety can seriously decrease QOL Can be a sign of other problems like depression, dementia, physical

illness Anxiety is often associated with over-arousal Specific anxiety disorders include the following:

General Anxiety Disorder –Most Common Panic Attacks –Previous History Present Phobias- E.G. Unable To Urinate In Public Bathrooms; Inability To Eat In

Public Obsessive Compulsive Disorder –Usually Present At Younger Age Post-Traumatic Stress Disorder

Delirium

Delirium, or acute confusion, is a sudden change in mental function

Delirium is usually a short-term, temporary problem May persist for weeks to months in a substantial number of

people Is a common complication of medical illness in elderly One-third of older adults arrive at hospital emergency

departments in delirious state Is strongly associated with poor outcomes among hospitalized

patients Can be mistaken for dementia or schizophrenia Delirium common in people with dementia

Parkinson's Disease

Parkinson's disease is a slowly progressive degenerative disease of the nervous system

About 50,000 Americans are diagnosed with PD each year Many more undiagnosed as attribute symptoms to old age Average age of onset is 60; commoner as we grow older Caused by loss of nerve cells in brain that produce dopamine Usually familial Exposure to high levels of manganese, carbon disulfide or certain

pesticides increases risk An increased risk in people who live in rural areas in advanced

countries (unproved)

Depression

Depression is a serious medical illness characterized by: Persistent sad, anxious, or "empty" mood Feelings of hopelessness, pessimism Feelings of guilt, worthlessness, helplessness Loss of interest or pleasure in hobbies and activities that were

once enjoyed 1%—2% of older women, and < 1% of older men have major

depression Is a continuation of problem from earlier life in 30%—50% of cases Major depression may accompany disorders that result in dementia Many older adults face cancer or grief that promote depression There is a strong link between major depression and increased risk of

dying from heart disease. Alcohol abuse causes depressed mood

Dizziness Dizziness is lightheadedness, feeling like you might faint, being

unsteady, loss of balance, or vertigo (a feeling that you or the room is spinning or moving)

Most causes of dizziness are not serious; quickly resolve on their own or are easily treated

Common complaint of people over age 65, affecting 13%—38% of older Americans

Dizziness increases the risk of falling and decrease QOL Lightheadedness happens when there is insufficient blood supply to the

brain- often seen on sudden change in position Near-fainting/fainting not uncommon in elderly while straining at stools

or coughing Vertigo is dizziness accompanied by a sensation of spinning – due to

ear problems/infections Benign positional vertigo is commonest; happens on sudden change in

position of head Disturbances in heart rhythm Dizziness due to drugs not uncommon in elderly

Active Ageing (WHO)

Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age

Ageing is a social phenomenon – involves friends, work associates, neighbors, family

Interdependence and intergenerational solidarity are important tenets of active ageing

“Yesterday’s child is today’s adult and tomorrow’s grandmother or grandfather”

Healthy life expectancy is also a synonym for “disability-free life expectancy”

“Disability-free life expectancy” is important to an ageing population

Measures of Independent Living Autonomy is the perceived ability to control, cope with and

make personal decisions about how one lives on a day-to-day basis, according to one’s own rules and preferences – difficult to quantify

Independence is commonly understood as the ability to perform functions related to daily living – i.e. the capacity of living independently in the community with no and/or little help from others

ADL’s (Activities related to daily living) - can be measured; e.g. bathing, eating, using the toilet and walking

IADL (Instrumental activities of daily living); measurable; e.g. shopping, housework, making meals

Quality of life (QOL)

QOL is “an individual’s perception of his or her position in life in the context of the culture and value system where they live, and in relation to their goals, expectations, standards and concerns

Incorporates a person’s “physical health, psychological state, level of independence, social relationships, personal beliefs and relationship to salient features in the environment.” (WHO, 1994)

As people age, their QOL is determined by their ability to maintain autonomy and independence

ADL and IADL are important measures of QOL

Religion, Spirituality and Aging In USA, > 90% of elderly persons consider themselves religious and spiritual 5% consider themselves spiritual but not religious Religion is associated with better mental health and a greater ability to cope with

stress, illness and disability Provides relief/support to elderly and their caregivers Active involvement in a religious community helps to maintain physical

functioning/health Elderly who attend services more likely to stop smoking, exercise more, increase

social contacts, stay married, and live longer Religious activities foster development of community and broad social support

networks Increased networking ↑ likelihood of awareness, early detection of diseases, seeking

treatment and adherence Elderly often have distinct spiritual needs that overlap but are not the same as

psychologic needs Many elderly persons prefer counseling from a clergy member rather than from a

mental health care practitioner, as it avoids stigma

Farming – an Aging and Hazardous Occupation Agriculture ranks among the most hazardous industries More than 3.1 million workers were employed in the agriculture,

forestry, and fishing industry in 2001 In USA the average age of civilian laborers was 38, compared to

57 in farmers Agriculture employs proportionately more workers aged 55 and

older (22.9% versus 13.6% for all industries) Agricultural workers are predominately male (72.4%) Fatal occupational injury rates in the agricultural sector > 4 times

that for private sector (1992–2002) Were disproportionately high for older workers Work-related injuries increase as farmers move into their 60’s

Facts on Older Farmers According to the 1997 Agricultural Census, of estimated 500,000 farm

workers, 25% farm operators are 65 years or older The only age category showing a substantial increase in 1992 included

farmers age 70 or older Proportion of farmers age > 55 has risen from 37% in 1954 to 61% in

1997 Share of farmers < 35 years declined from 15 percent in 1954 to 8

percent in 1997 No mandatory retirement age exists for older farmers → continue to

perform beyond their safety limits Full retirement is seldom a choice- farmers live in proximity to

workplace/ family enterprises The average age of farmers within the United States is 54.3 years Older farmers unwilling to recognize or accept their physical limitations Older farmers underrepresented in research efforts related to farm

health and safety

Farmers Are At High Risk

Fatal and nonfatal injuries Work-related lung diseases Noise-induced hearing loss Skin diseases Certain cancers associated with chemical use Prolonged sun exposure → skin cancer Entire families, including children, at similar risk as

often share work

Fatal Occupational Injury Rates Rates higher in agriculture, forestry, and

fishing in every age group than in the private sector

Rates ranged from 13.7/100,000 for workers aged 16–24 to 62.0 for workers older than 64

These differences increase with age The greatest differences noted for workers

aged 55 or older

Adverse Health Effects in FarmersAre due to: Chronic as well as acute exposures Delayed as well as immediate effects Cumulative and multiple exposures

Common Adverse Health Effects Neurological damage – due to pesticides (organophosphates,

OP) The weight of current evidence suggests that chronic, low-level

exposure to OP produces neurotoxicity Cancers – due to pesticides and sun exposure Birth Defects – due to pesticides Respiratory – due to allergens or gases Developmental, reproductive – mostly due to pesticides Immune suppression Eye damage- macular degeneration with fungicide use Nausea, convulsions, other acute effects due to pesticides

Age-Related Changes as Risk Factors

Age-related sensory and physical impairments occur among senior farm operators at various rates

Vision To see objects as clearly as at age 20, many 45-year-olds need four times as

much light By age 60, the amount of light required is double that needed by 45-year-olds Decline in visual acuity o detect normal environmental stimuli → impaired

reactions Older farmers routinely work in situations with inadequate lighting → more prone

to injury

Hearing

Farm workers of all ages have higher levels of noise-induced hearing loss than the general population

Senior farmers who have difficulty hearing words or sounds may not be able to detect warning signals

Sense of Balance Loss of balance and a feeling of dizziness increase the risk of injury for

senior farmers : May lead to loss of concentration while driving/ performing tasks Walking across an uneven surface such as hay, or moving in a small

fishing boat Falls around tractors and farm machinery poses a particularly serious

safety risk Muscular capability impairment Farmers need strength and flexibility in all limbs and joints to work

safely Aging eventually reduces agility and strength - regulate/ delegate heavy

work Compensate by providing invaluable practical experience to younger

workers

Safety for Senior Farmers

ACCEPTANCE OF IMPAIRMENT IMPORTANT – It is not a sign of weakness- Redesign work schedule

Increase lighting levels in barns and other buildings Ensure that all steps, stairs, and handrails are of excellent quality and well

lighted with switches at both ends of stairs and by all entrances Put non-slip surfaces on walkways and steps where possible. Have easily operated or maneuvered fence gates, building doors, and animal

handling devices. Use properly fitted and easily accessible personal protection devices/clothes Pay special attention to their ability to operate a tractor safely ( for self and

others) Get adequate rest, breaks and eat nutritiously Know the symptoms of heart attack and stroke Undergo regular medical check-ups annually for vision, hearing, balance, and

muscular range and mobility. Consult a family physician about physical limitations and work limits.

Health Protection StrategiesHand Protection Necessary to prevent injuries and exposure to chemicals Wear rubber or leather gloves, as needed

Hearing Protection To protect from deafness caused by loud noises (e.g. threshers) Can use ear inserts/muffs

Respiratory Protection Helps avoid exposure to allergens and toxic gases Two types- air supplying and air purifying respirators Air supplying respirators- use in manure pits, silos, where toxic gases

released Air purifying respirators-commonly used to remove air contaminants

'Prescription for Prevention’

Hippocrates, the Father of Medicine, said nearly 2,400 years ago,"If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health."

Healthy Eating

Tips for Older Adults Recommended daily calorie consumption for people over age 50

are:For women: 1600 calories, if physical activity is low level 1800 calories, for moderate levels of activity 2000 calories, for an active lifestyleFor men: 2000 calories, if physical activity is low level 2200-2400 calories, for moderate levels of activity 2400-2800 calories, for an active lifestyle

Daily Dietary Guidelines

US Dietary Guidelines suggest a daily mixture of five food sources for good health: Grains—5-10 ounces Choose whole grain breads/pasta Eat high fiber foods like beans, peas, soya products etc- helps avoid

constipation, diverticulosis, and diverticulitis Vegetables—2 to 31/2 cups with a variety of colors and types of vegetables Fruits—11/2 to 21/2 cups Milk, yogurt, and cheese—3 sevings: 1 cup of yogurt equals one cup of milk, 11/2 to 2 ounces of cheese equals one cup of milk, 1 cup of cottage cheese equals 1/2 cup of milk. Meat, poultry, fish, dry beans, eggs, and nuts—5 to 7 ounces Choose lean meat, poultry, or fish (without skin) Fats- limit to 2 teaspoon; use unsaturated vegetable fats

Tips for Healthy Eating Do not skip meals Use low-fat dairy products and salad dressings About 2/3 of a teaspoon of table salt Drink plenty of liquids like water, juice, milk, and soup Date leftover food, as maybe unable to smell spoilt food Choose foods fortified with vitamin B12-adults over 50 have difficulty absorbing adequate amounts of this vitamin Limit high-fat and high-sugar snacks Use unsaturated vegetable oils like canola, corn, or olive Many medications may alter the taste of food Learn to read food package labels-The first one listed is present in the

food in the largest amount.

Healthy Weight

Healthy BMI is between 20-25(Wt. in lbs/height in feet)

Maintain a healthy weight -reduce risk of many chronic diseases

Health Risks of Being Underweight Poor Memory Decreased Immunity Osteoporosis (Bone Loss) – prone to fractures Decreased Muscle Strength

Health Risks of Overweight

Overweight predisposes to development of: Type 2 Diabetes High Blood Pressure/Cholesterol Coronary Heart Disease/Stroke Some Types Of Cancer Osteoarthritis Gallstones Slow reaction times and avoidance of activity May reduce life span

Advantages of Physical Activity The more physically active you are, the less likely to gain weight Improves your strength, endurance, and flexibility Regular physical activity helps avoid obesity, diabetes, heart

disease/stroke, arthritis, high BP, and mental disorders Reduces functional declines associated with aging Lowers stress and boosts your mood and energy Meet new friends by joining a class or walking group Reduces risk of bone fractures/other injuries Improves immunity; recovery from illness is faster Enhances QOL- keeps one mentally alert and physically

independent

How Much Physical Activity?

Levels vary from person to person Consult your healthcare provider for safe limits A gym is not at all necessary Most people require 30 minutes of moderate

physical activity daily Exercise intensity is less important than total

amount spent exercising Intermittent exercise is as effective as continuous

activity Spurts of three 10 minute walks are effective

Tips for Safe Physical Activity Take time to warm up, cool down, and stretch. Start slowly and build up to more intense activity. Stop the activity if you experience pain, dizziness, or shortness

of breath. Drink plenty of water. When you are active outdoors, wear lightweight clothes in the

summer and layers of clothing in the winter. Wear sunscreen, sunglasses, and a hat for sun protection. Wear shoes that fit well and are right for your activity.

Can I Take Alcohol Safely?

Yes, Drinking a small amount (1-2 units per day) protects

against heart disease and stroke

Recommended Weekly Limits Men: maximum 21 units of alcohol per week Not more than four units in any one day Women:14 units of alcohol per week Not > three units in any one day).

How Much is One Unit of Alcohol? One unit of alcohol is 10 ml by volume, or 8 g by weight, of pure alcohol

(100%) One unit of alcohol is about equal to:

Half a pint of ordinary strength beer, lager, or cider (3–4% alcohol by volume), or

A small pub measure (25 ml) of spirits (40% alcohol by volume), or A standard pub measure (50 ml) of fortified wine such as sherry or port (20%

alcohol by volume). There are one and a half units of alcohol in:

A small glass (125 ml) of ordinary strength wine (12% alcohol by volume), or A standard pub measure (35 ml) of spirits (40% alcohol by volume).

Strong beer at 6% has six units/liter. If you drink half a liter or just under a pint - then you have had three units.

Wine at 12% has12 units/liter. If you drink a quarter of a liter (250 ml) or two small glasses, then you have had three units.

Smoking is a No!No!

Smoking is the leading preventable cause of death in the United States Causes about one in five deaths annually An estimated 38,000 of 438,000 deaths are due to secondhand smoke

exposure On average, smokers die 13 to 14 years earlier than nonsmokers Among adult smokers, 70% report that they want to quit completely, and

more than 40% try to quit each year The risk of dying from lung cancer is 22 times higher in men and 12

times in women who smoke cigarettes, compared with never smokers Increases the risk for many cancers, including cancers of the lip, oral

cavity, pharynx, esophagus, pancreas, larynx (voice box), lung, uterine cervix, urinary bladder, and kidney

Adverse Systemic Effects of SmokingHeart Disease and Stroke Smokers 2–4 times more likely to develop

coronary heart disease than nonsmokers Doubles a person’s risk for stroke. Smokers 10 times likely to develop

peripheral vascular disease – limb amputations

Respiratory Health

Smoking- tenfold increased risk of dying from chronic obstructive lung diseases like emphysema, bronchitis

About 90% of all deaths from chronic obstructive lung diseases are attributable to cigarette smoking

Cigarette smoking has many adverse reproductive and early childhood effects, including an increased risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS)

Postmenopausal women who smoke have lower bone density than women who never smoked

Women who smoke have an increased risk for hip fracture than never smokers

Quit Smoking is Possible

Needs determination and self control Use free Quitline sources for help Nicotine replacement drugs are available to

make withdrawal easier and feasible Benefits of quitting far outweigh the expense

and agonies of quitting

Why Quit Smoking?

Within 20 minutes of quitting: blood pressure and pulse rate drop to normal Within 24 hours of quitting: risk of sudden heart attack decreases Within 2 weeks - 9 Months: Walking is easier, lung function increases 30% Symptoms like coughing, nasal congestion, fatigue, and shortness of breath

decrease Within 1 year of quitting: excess risk of coronary heart disease is half that of a

tobacco user Within 5 years of quitting: lung cancer death rate decreases by nearly 50%( for 1 pack smoker) Risk Of Cancer Of The Mouth Is Half That Of A Tobacco User Within 10 years of quitting: lung cancer death rate declines to that of a non

tobacco user Risk of stroke is lowered, possibly to that of a non-tobacco user

Within 15 years of quitting: risk of coronary heart disease is same as non-

smokers

Steps to Healthy Aging

MONITORING YOUR OWN HEALTH IS A GOOD ADAGE Chronic diseases like diabetes, high BP, obesity, etc cause most problems in old

age Most chronic diseases can be delayed or severity reduced Adopt healthy lifestyle behaviors from childhood Keep weight at BMI < 26 Be physically active within limitations Eat nutritious foods Eat sparingly Avoid misuse of alcohol/drugs; abstinence best Avoid smoking Make a social network Save for care in old age Regular screening for cancer/diabetes, high BP etc Regular medical examinations/dental checks

Prevent Chronic Diseases

Practicing a healthy lifestyle Avoid tobacco use Use screening for:

Breast, cervical, prostate and colorectal cancers Diabetes High Blood Pressure Cholesterol

Regular physician visits Adherence to treatment

Be Good To Yourself

Get adequate sleep Maintain contacts with family and friends Join a social group Surround yourself with people whose company you enjoy Volunteer or get active with groups in your community. Try a part-time job at a place you would enjoy working for a few hours a

week Indulge in activities you always yearned to do, but never had the time

for when younger!

"The secret of life is enjoying the passage of time.“ James Taylor