UCLA Cluster 80a Frontiers of Aging Midterm 1

longevity revolution

Human lifespans grew by 30 years since 1900. It would've taken the previous 5,000 years of human history to achieve that same amount of growth.

Measures of aging

Life span and life expectancy

life span

max number of years a species has been known to survive.

life expectancy

Average number of years a person in a population is expected to live.

Biophyschosiocal Perspective Factors (BPS)

Biological: Physical illness, disability, medication effects

Psychological: Personality, behaviors, memory, coping skills

Sociology: social support, family background, education, social & econ status

Gerontology

The study of how biological, psychological, social, and political factors shapes people's lives.

Geriatrics

clinical study and treatment of older people and the diseases that affect them

• Prevent/manage diseases as people age

• medical study of aging

Chronological age

age measured in years since birth

Psychological age

based on: cognitive abilities, memory, intelligence, maturity

Biological age

based on physical function (ability/disability, organ system)

Social age

based on social roles and relationships (student, parents)

Subjective age

'“you're as young as you feel”

Active aging

The optimization of aging experience and viewing it as a positive continuous growth with family, community, and society, regardless of physical and cognitive decline.

• Optimizing the process of aging; embracing the positive side.

Determinants of active aging

1) Economic Determinants

2) Health & Social Services

3) Behavioral Determinants

4) Personal Determinants

5) Physical Environment

6) Social Determinants

Person-Environment Perspective

Continually changing environment as the older person modifies it and adapts to it

Environment press

load of physical and social environment on the person

Ageism

• Systematic stereotyping and/or discrimination because of age

• Similar experience to racism, sexism, etc

• Can be verbal; name-calling

Stereotyping

Positive or negative beliefs that every person in a group looks, acts, or thinks the exact same way.

Discrimination

Action or behavior based on stereotypes that limits a person's opportunities.

• Often in the workplace

Effect of Ageist Attitudes (Internalize Age Stereotypes)

Older:

• Greater cardiovascular response to stress

• Worse health behavior (higher tobacco use)

• Lower likelihood of recovery from severe disability

Younger:

• Greater likelihood of cardiovascular events compared to those who are exposed to positive stereotypes.

Biology

The study of an organism's origin, growth, reproduction, and behavior.

Psychology

The study of the mind or of mental states and processes

Sociology

The study of human society, social issues, and the consequences of human behavior.

Heterogeneity

Variation in quality

• Everyone ages differently

Diminished Reserve

• Increased frailty

• Harder to recover physically

3 different frameworks

1) Biopsychosocial perspective

• Biological, psychological, sociological

2) Life course perspective

• Individual, Social System, Historical Period

3) Systems perspective

• Hierarchical factors from cell to global

How to study aging

1) Cross-sectional

2) Longitudinal Studies

3) Individual Cells

4) Accidents of Nature

• Genetic diseases that affect aging

Cross sectional

Collection of data on people of different ages all at once.

• Pros: cheaper, no attrition (losing people & disappearing)

• Cons: Showcase immediate and temporary results.

Longitudinal

Study of same person over period of months and years

• Pros: More accurate analysis

• Cons: High cost, selective survival, higher attribution

Individual Cells

• Study aging using cells in laboratory

Accident of Nature

Genetic diseases that affect aging

• Progeriod Syndromes: diseases that mimic physiological aging. (make someone looks older than their age) & caused by genetic mutation:

1) werner's syndrome

2) hutchinson-gilford

3) down syndrome

System Approach

System levels are hierarchal, interactive, and interdependent.

• From cells - gobal world health organization

Process in Living Systems

Boundaries: Divide the larger system into smaller individual components (subsystems)

Feedback: Information that allows the system to self-regulate

Equilibrium: A state of balance between oposite force.

Lifecourse framework

Aging is the intersection of individuals' experiences (biographical), social system (socio - cultural), time period (historical context).

Life Course Perspective Factors

• Sociocultural: sex, race/ethnicity, SES

• Historical: WW1, great depression, Cold War era

• Individual factors: personal characteristics (Life events, opportunities, roles, decisions)

Cohort & Age Cohort

Cohort: Individuals who experience similar event within the same historical time

Age Cohort: People who are born around the same time period

• AKA “generation”

Cohort’s View Shaped By

1) Historical Period:

• Opportunity, event

2) Compositional Characteristics:

• Gender, ethnicity

3) Structural Characteristics

• Education, family

What Make Each Cohort Different?

Age Effect: Change/event that occurs as a result of aging

Period Effect: Impact of an event on the entire society

• (ex: COVID, Economic Recession)

Cohort Effect: Impact on a group in a specific time by a shared life experience.

• (ex: Everyone experiences COVID differently)

Public Health

The art & science of protecting and improving the health of the entire community.

In the Socioecological Model, which level is described as the home of interventions to improve public health?

Community

• interventions to improve the public’s health

• organized effort of community

Public health interventions

Activities to promote public's health and organized efforts of society

3 levels of prevention

Primary: Aims to reduce the risk of diseases before they begin

Secondary: Reducing the risk of current diseases in patients who are already diagnosed

• If illnesses are genetic (cancers, type 1 diabetes), then most people start at secondary prevention.

Tertiary: Focuses on reducing the long-term impact of chronic diseases.

• Surgical intervention

According to the natural history of diseases, when does each level of prevention occur?

Primary: Before onset

Secondary: Early detection

Tertiary: Rehab

Modifiable risk factors

Healthy habits that helps lower the risk of getting a disease.

Non-modifiable risk factors

Health traits that can not be change:

• genetics, age, gender, race, family history

Natural Process of Aging

Down:

• muscle

• bone mineral density

• water content

• wound healing abilities (wrinkle: lack of elasticity/collagen)

• hair loses its pigment (grey hair)

Up:

• body weight

• fat tissues

obesity

Define by body mass index (BMI)

• Height & Weight

• Inaccurate b/c fat & muscles mass can be different even with same height and weight

• Waist circumference and bmi over 30

Diabetes

Impaired ability to produce and respond to insulin

Diagnosis based on glucose level: >100 -125 mg/dL

• Type 1: Body doesn’t produce enough insulin. common in younger people

• Type 2: Body can’t break down glucose properly. Body doesn’t response to insulin. Common in middle age.

Insulin

Help maintain blood glucose → take up excess glucose + stored for later use.

• A hormone that helps move sugar from blood to body cells

Repeated glucose spikes

Leads to:

• heart disease, nerve damage, kidney failure, vision problems, poor circulation, hypertension.

Endocrine system

Produced by cells in the pancreas and secreted into the bloodstream.

Signals cells to metabolize glucose/carbs

• Releases hormones into the bloodstream to regulate bodily functions.

• Level decline with age

• Hormone replacement therapy

Hyperglycemia

Excess levels of glucose from insufficient insulin levels

Anabolic

Processes promote tissue growth

• (ex: lean mass, bone)

Catabolic

Processes break down bone/ lean tissues

Hormonal Shifts with Age - A/C Imbalance

• A < C

• Promote greater visceral adiposity (cardiovascular disease)

Decrease in Anabolic Hormones (growth + sex hormones, etc)

• Poor muscle quality

• Loss of skeletal mass and integrity

• Hypertrophy and adipose tissue

• impaired neurotransmission and neurotropism

Increase in catabolic hormones (cortisol, etc)

• Promotion of visceral adiposity

Ecologic model

Four layers:

• Individual

• Relationship

• Community

• Societal

Successful prevention of disease

Leads to compression of morbidity

Compression Morbidity

Def: living a healthy long life and squeezing all sickness into a short period before dying.

3 factors of disability

lack of exerise, smoking, obesity

Reversal of compression may be caused by

• Increase rate of obesity

• Chronic diseases (e.g. diabetes)

• Increases function impairment

• Low exercise among cohort

3 Issues in life course research

age/period/cohort problem

Life-course fallacy

Comparing younger people to older people, and assume the younger people will eventually become exactly like the older people.

Social determinants of health

Definition: Non-medical factors that influence health outcomes. A system that shapes the conditions of one’s daily life.

5 social determinants of health (SDoH)

-Neighborhood and built environment

-Health and health care

-Social and community context

-Education

-Economic stability

Neighborhood and built environment

• Access to healthy foods

• Crime/violence (more stressors = negative health outcomes)

• Environment (growing up near the freeway can make you shorter)

• Housing (lead paint, mold, bugs)

Health and Health Care

• Access to health care

• Health literacy/management

• Communication with doctors (conversing with doctors in the same lanaguage)

Social and Community context

• Social support

• Discrimination

• Social cohesion

A lack of social support & high discrimination can negatively impact health.

Besides family, most older adults do not have a social circle. Harder to make friends.

Education

Acess/ Quality: Depends on where you live and how accessible it is to certain people

• Ex: California has a more accessible system for higher education

Barriers to Learning: Ability to get to school/ school breakfast program

Economic Stability

• Poverty: hard to get out of, high stress

• Steady Employment: low cortisol level

• Barriers to work: lack of accomodation for disability, transportation, childcare.

How can education affect health?

Edu → health knowledge → income → status

-> smoking, diet, exercise, housing, coping, behavior, resources

Upstream vs Downstream

Upstream: the most impacted intervene

Downstream: last-minute resolution. Not as impactful

Socioeconomic Gradient

Social Economic Status (SES)

• Higher SES = Better Health

Persisting Disparities

Health differences between groups of people based on: race wealth gap, discrimination housing

Most effective interventions for supporting older adults

• Educational

• Employment/volunteer opportunities

• Benefits/retirement policies

• Neighborhood conditions

Swarbrick’s 8 Dimensions of Wellness

1) Physical

• exercise, nutrition, sleep, organ health

2) Emotional

• negative emotions (fear, anger, worry, etc)

• changes in appetite, trouble making decision, worsen chronic diseases

3) Environmental

• Community that promote health, transportation, walkable

• Access to fresh food

• Volunteer opportunity

4) Financial

• Awareness of personal financial situation

• Minimize financial challenges

• Comfortable with sources of money

5) Intellectual

• Open mind to new ideas/ experiences

• Accumulated skills/ knowledge

• Improving cognition: multi tasking can improve cognitive abilities to be 30 years younger

6) Occupational

• Fulfillment from job, schools, volunteering

• Belief of they’re making a positive impact to the world

7) Social

• Connect with others

• Make + maintain positive relationships

• Combats: impaired mental performance & lower risk of illnesses and depression

8) Spiritual

• Living with purpose

• Lived by personal values

• Connected to the world

• Awareness if self + community + environment

5 theories of aging

1) Wear and Tear

2) Antagonistic Pleiotropy

3) Immunological Theory

4) Free Radical/ Oxidative

5) Cellular Senescence Theory

Antagonistic pleiotropy

A single gene/ process can have several different effect with an organism

• Positive effect during youth

• Negative effect during old age

Replicative senescence

Growth arrest of cells

• Stop dividing, don’t die, causing all sorts of malfunction issues

Leads to characteristic changes:

• Resistance to apoptosis, altered gene expression, increased secretions, dysfunction

Hayflick limit

The maximum number of times a cell can divide before dying. 40-60 replications.

• Lung cells could only divide 50

• Cells that reach their growth limit undergo Replicative Senescene

Telomerase

Definition: repetitive DNA sequences (TTAGGG) that exist at the end of chromosomes

• Telomere Shortening causes Replicative Senescence

• Telomeres are important for DNA Replication

Free

Cells in connective tissue that produces collagen and other fibers. Cells w senescent markers increase in frequency in samples from elderly donors. Rate of wound healing decreases with age.

Public health and policy

The art and science of protecting and improving the health of the entire community, rather than one-on-one.

• Interventions to improve the public’s health

• Organized effort of community

Cellular aging can interfere w proper organ function

vasculature- atherosclerosis

lymphocytes- immuno deficiency

Cancer's greatest risk factor

age

Why cancer is related to aging

-6-7 mutations have to accumulate before becoming a tumor

-accumulation of senescent fibroblasts make a favorable environment

-decline in immuno surveilance

Four major cancers in older people

Lung, prostate, breast, colorectal

Non-modifiable risk factors of breast cancer

age, race, sex, family history & genetics, early menarche and late menopause

Modifiable risk factors of breast cancer

older at first pregnancy, nulliparity (never had a baby)

Demographic transition

changes in a population's age structure from "young" to "middle age" to "old"

Demography

study of the characteristics of human populations such as size, growth , density, distribution adn vital statistics

Demographic transitions based on 3 shifts in population

-fertility

-mortality

-migration

Replacement rate

2.1

fertility

average number of children born to a woman over her lifetime

fertility rate

# live births in a year/ # of (15-44 yo) women in the year

Mortality rate

deaths in a population. # deaths in a year/ # ppl in same year

Leading causes of death

overall: heart disease

Depends per group

Migration

establish criteria/boundaries of region. Higher immigration of certain groups add to the changing age structure/pyramid of the US

Stages of demographic transition

1.High fertility rates/ high death rates

2.High fertility rates/ declining death

3. low fertility/low death

Changes that create an aging society

- societal level: better food supply, clean water, sanitation

- public health interventions

Epidemiological transition

changes in a population's age structure due to disease patterns. mortalities, and other factors.

from infectious disease to chronic illnesses