Transcript PHYSICAL CHANGES WITH OLD AGE & THEIR IMPACT

PHYSICAL CHANGES WITH OLD AGE
& THEIR IMPACT
Mary C. Sengstock. Ph.D.
Sociology, Wayne State University
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BIOLOGICAL THEORIES:
Will Not Discuss in Detail
Will Consider Major Biological Issues …
As They Impact on the Sociological Perspective
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VARIATION IN FUNCTIONAL LEVELS
• Variability Between Individuals of Same Age
• Variability Between Different Functions of
Same Individual
– Heart Rate vs. Brain Function
– Breathing Rate vs. Renal Flow … Etc.
• Greater Variability Among the Aged Than
Among Younger Persons?
– Experts Disagree About This Issue
FUNCTIONAL AGE
• Defining a Person’s Age in Terms of Their
Ability to Function
• Great Variability Among Individuals
• “She Doesn’t Look That Old!”
• “Oh! Only 65? I Thought He Was Older!”
• EX: 2 Patients Sharing Hospital Room:
– 65 Yr Old – 95 Yr Old
SENSORY DECLINE
• All Senses Decline in Acuity AS We Age
– Sight – Hearing – Touch – Taste – Smell
• All Result in Changes in Ability to Perceive &
React to Environment
• Sight: Stronger Glasses, Bifocals, Cataracts
• Smell & Taste: Affects Appetite; Eating Habits
• Touch: Peripheral Neuropathy
– Difficult to Feel Pain, Recognize Problems
– Diabetic Foot Problems
MOST SERIOUS DECLINE?
• Which Would You Think Would be the Most
Serious Type of Sensory Decline?
Sight
Touch
Hearing
Smell
Taste
MOST SERIOUS DECLINE:
HEARING
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Severe Impact on Social Interaction
Hard to Hear What Others Say
Make Odd or Inappropriate Responses
Makes It Difficult to Interact With Others
Lose Ability to Participate in Social Relations
Lose Contact; Decrease Social Stimulation
EX 1: ELDERLY WOMAN & FAMILY
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There’s Mike Shay. “What Did Mike Say?”
There’s John Hagan. “Door’s Shaking? Fix it!”
Write the Senate. “Call Sheriff? What For?”
Where My Pants? “Pen? We’re Going Out!”
Phone: We’ll Be Late. “They’re Not Home.
Call Back Later.”
• “I’m Not Hard of Hearing! You Don’t Talk Loud
Enough! Even My Friends Don’t Talk Loud
Enough Anymore!”
EX 2: PRES. REAGAN & AIDES
• Conversation: John Poindexter & Oliver North
• Told Reagan of Plans to Sell Arms to Iran & Use
the Funds to Support Diversionary Actions in
Nicaragua
• Reagan Didn’t Understand – Like Most Hard of
Hearing People, Was Embarrassed to Admit It
• So He Nodded Absent-Mindedly
• They Took This As a Sign of Consent
PHYSICAL HEALTH IN OLD AGE
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Health Status Declines As We Age
What Are Some of These Changes?
Definition of “HEALTH” Is a Critical Issue
4 Definitions:
– WHO (World Health Organization)
– Functional Definition
– Alternate Functional Definition
– Coping Definition
“HEALTH” DEFINED BY “WHO”
(World Health Organization)
• “Complete Physical, Mental, Social Well-Being,
Not Just the Absence of Disease or Infirmity”
• Is This Realistic?
• May Cause “Medicalization” of the Social …
• I.e., Use of Medication or Therapy for …
– Disruptive Behavior
– Opposition to Social Structure
HEALTH: FUNCTIONAL DEFINITION
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Talcott Parsons
State of Optimal Capacity of the Individual
For Effective Performance of Roles
Typical for a Structural-Functionalist!
Only the Social Structure is Important!
Emphasizes a Market Economy
Health Care Useful to Get People Back to Work
Elderly Not Useful – Why Provide Health Care?
ALTERNATE FUNCTIONAL
DEFINITION OF HEALTH
• James O’Brien, M.D.
• Maintaining Highest Possible Functional
Capacity of Individual …
• For As Long as Possible
• The Approach of Most Geriatric Physicians
“COPING” DEFINITION OF HEALTH
• Dubos:
• Achieving A Rewarding & Not Too Painful
Existence
• In Coping With an Imperfect World
• Question: Which One(s) Do You Think Are
Most Useful or Appropriate?
MORBIDITY (DISEASES) OF OLD AGE
Major Causes of Death in Old Age:
• Heart Disease – Atherosclerosis
• Hypertension – Cancer – Diabetes Mellitus
• Cerebrovascular Accidents (Strokes)
• Oral & Dental Problems – Cirrhosis of Liver
• Suicide – Pneumonia – Accidents
• Multiple Pathologies
HEART DISEASE
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Heart Attacks
“Coronary Infarction” (Tissue Death)
Highest for Older Men
Increases for Post-Menopausal Women
Higher for Non-Whites
ATHEROSCLEROSIS
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Hardening of Arteries
Fatty Deposits Inside Arteries
Leads to Narrowing (Thrombosis)
Followed By Occlusion (Complete Closing &
Tissue Death)
• Can Cause Death & Impairment
HYPERTENSION
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High Blood Pressure
“Sneaky Disease”
Very Difficult to Diagnose
Causes Organ Damage Due to Increased
Pressure on Organs
• Higher Rates for Non-Whites
MALIGNANCY (CANCER)
• Cancer Rates Are High Throughout Life
• Types of Cancer Vary By Age
• Young Patients:
– Lung – Breast – Cervix
• Aged Patients:
– Stomach – Intestine – Prostate
– Skin – Kidney – Leukemia
DIABETES MELLITIS
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Inability of Body to Metabolize Sucrose (Sugar)
Due to Non (Low) Production of Insulin
Approx 4% of Population 65+
Slightly More Frequent with Women
More Frequent With Obese
More Frequent for Patients in Their 60s & 70s
Severe Effects on Heart, Kidneys, Arteries
CEREBROVASCULAR ACCIDENTS
(STROKES)
• Embolisms (Blood Clots) That Cut Off Blood
Supply to Brain
• Loss of Blood Flow Causes Brain Damage
• Results in Body Damage – Depending on the
Portion of the Brain Affected:
– Speech Aphasia
– Memory Loss
– Paralysis
ORAL & DENTAL PROBLEMS
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Lost Teeth
Gum Problems
90% of Population 65+
Can Cause Inability to Eat
Improper Nutrition
Many Elderly Do Not Go to Dentists
CIRRHOSIS OF LIVER
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Normal Liver Tissue is Replaced
By Scar Tissue or Fibrous Tissue
Decreases Liver Function
Major Causes Are Alcoholism & Hepatitis
Much More Frequent in Men Than Women
PNEUMONIA
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Inflammation of Lungs & Lung Tissue
Symptoms Are Coughing, Breathing Problems
Common Side Effect of Other Chronic Illnesses
Often the Actual Cause of Death Listed
Especially True for the Elderly
ACCIDENTS & SUICIDE
ACCIDENTS:
• Primarily Home Accidents For the Aged
• Less Likely to Be Car Accidents
SUICIDE:
• Very Much More Common Among Elderly
Men Than Women
MULTIPLE PATHOLOGIES
IN THE ELDERLY
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Many Chronic Conditions Occur Together
Diagnosis Is Complicated
Specialty of Geriatric Physicians
Many Physicians Are Not Trained to Diagnose
& Treat These Simultaneously Occurring
Conditions
• Results in Missed Conditions, Over-Medication
ILLNESSES IN OLD AGE
VS. YOUNGER PATIENTS
YOUNGER PATIENTS:
• Acute Illneses:
• Often From Exogenous Causes:
– Bacterial or Viral Infections
– Trauma
• Definite Onset  Crisis  Self Limiting End
ILLNESSES IN OLDER ADULTS
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Chronic Illnesses – Not Acute
85% of Aged (65+) – At Least 1 Chronic Illness
Persons <50 – Only 10% Have a Chronic Illness
Elderly Often Have Several at One Time
Complex Symptomology – Many Drs Not Used
to Diagnosing & Treating
• Medications Often Interact or Conflict
EXAMPLE OF CHRONIC ILLNESS:
ATHEROSCLEROSIS
• Multiple Causes: Intrinsic Aging + Genetic
Propensity + Environment (Diet)
• Men > Women
• Leads to Thrombosis (Build Up in Arteries)
• Breaks Loose (Embolism)
• Cuts Off Blood Flow – Cannot Be Regenerated
• Leads to Death of Tissue in Area (Infarction)
• Treated By Bypass/Scrape/Balloon
ACUTE ILLNESSES IN ELDERLY
• Persons 65+ Who Have Acute Illnesses or
Accidents:
• Tend to Have Longer Periods of Disability
• Greater Restriction of Activity
• Suffer From Decreased Social Contact
• Illness Makes Elderly “Miss Out” on More
Than Is True of Younger Persons
LIMITATIONS DUE TO ILLNESS
• 1/2 of Persons 65+ Suffer Some Limitation in
Lifestyle Due to Chronic or Acute Illnesses
• NOTE: Disease Incidence is Based on % of
Persons Affected – Not On Degree of Difficulty
• I.e., 50% of Persons 65+ Suffer Limitation
• It Does NOT Mean That Affected Persons
Suffer 50% Limitation
LIFE STYLE & HEALTH
• Many Aspects of Lifestyle Lead to Health
Problems in Old Age:
• Tobacco  Cancer; Heart Disease;
Osteoporosis
• Alcohol  Cirrhosis of Liver; Gastric Problems;
Some Cancers; Mental Problems; Falls
• Environmental Threats (Air,
Industrial/Occupational Pollutants)  Black
Lung Disease, Cancers, Etc.
NUTRITIONAL PROBLEMS
IN OLD AGE
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Malnutrition for the Poor
Obesity for Middle & Upper Class
Nutrition Affected By Several Factors:
Social Isolation – Eating Is Social
Problems With Dentures; Poor Taste & Smell
Inability to Shop, Prepare Food
CONTROLLING LIFE & HEALTH
• Goal: Prolong VIGOROUS Life (Not Just LIFE)
• 1/3 to 1/2 Aged Health Problems: Nutritional
• Need Nutritional Improvements for Elderly
– More Adequate Diet for Poor Aged
– Control of Obesity; Less Fat, Sugar for Others
– Repair Dentures; Improve Taste, Smell
– Increase Calcium Intake
– Decrease Cholesterol
LIFESTYLE & HEALTH
Recognize the Health Significance of Lifestyle
• Social Isolation: Why Many Elderly Do Not Eat
– Difficult to Cook for 1; Depression
• Exercise – Lack of Exercise:
– Contributes to Heart Problems, Obesity,
Osteoporosis, Etc.
– Only 40% of Elderly Exercise Regularly
• Smoking: Diminishes Lung Capacity
LIFE SATISFACTION &
SUBJECTIVE PERCEPTIONS
OF HEALTH
• Subjective Health May Be More Important
Than Objective Health
• To Both Well-Being & Longevity
• Common Measure: “How Do You Feel?”
• “Pretty Good, Considering My Age!”
• VS. “At My Age, You’re Sick Most of the Time.”
• EX: Elderly Patient Eating Dinner In Hospital
IMPACT OF LIFE SATISFACTION
“Feeling Healthy” Associated With:
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Intact Marriages (+)
Adequate Finances (+)
Stress Free (+)
Cohesive Personality (+)
Comparison to Previous Health (+)
Comparison to Other Aged (+)
Retirement (-)
Death of Lived One (-)
SOCIAL CONSEQUENCES OF
PHYSIOLOGICAL AGING
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Decreases Capacity for Social Interaction
Limits Resources for “Social Exchange”
Increases Dependence – Impacts Family
Increases Health Needs:
– Health Care Cost; Time for Medical Care
– Decreases Resources (Time, Money) for Alternates
• Biological Aging Masks Other Needs:
– Abuse; Ailments Attributed to Aging: “You’re Old!”
CULTURAL IMPACT ON HEALTH
• Decreased Animal Meat/Increased Vegetables
 Decreased Cholesterol/Cardiovascular-Japan
• Increased Fish & Salt Intake
 Increased Hypertension – Japan
• Lower Fat  Lower Hypertension
– Rural African Blacks vs. African Americans
• Ethnic Cultures Which Discourage Members
From Caring for Health (Mammograms)